^?1 PG Scholar, Department of Gunapadam, Government Siddha Medical College, (The Tamilnadu Dr. M.G.R Medical university Chennai, Tamilnadu, India), Palayamkottai, Tirunelveli (627002),Tamilnadu, India. njqtharshan@gmail.com ² Medical Officer, District Siddha Hospital, Mannar, Srilanka. prohini165@gmail.com

ABSTRACT

Siddhars viewed every disease under the roof of diagnostic techniques, finding the root causes, clinical features and treatment methodologies. In Siddha system Sage Theraiyar who lived 350 years ago has worked out a detailed procedure of urine examination, which includes study of its Niram (color), Nirai (density), Naatram (odor), Nurai (froth) and Enjal (volume decrease) and oil drop spreading pattern em of medicine, diagnosis of the disease is based on Ennvagaithervukal (Eight-fold examination), in which NeerkkuriNeikkuri (Urine examination) is one among them. This study aims to validate the Neerkuri on the Neerilivunoi mentioned in Siddha texts.Neerilivu is one of the Kapha diseases propounded by Siddhars. It affects all the Keelnokkukaal (Vatham) and Sapthathaathukal. In Pararaasaseharam (Fifth Part) diabetes is called as losing water, water related disease and sweet urine in Siddha medicine and it is characterized by frequently passing hot urine, passing foamy urine like a pearl (drop) of fresh honey in the water, and this is an incurable disease. From the parallel analysis, the scriptures of Sage Theraiyar about the signs in a urinary examination closely correlate with diabetes mentioned in the modern medical literature.

Key words: Sage Theraiyar, Neerkuri, Neerilivunoi

 INTRODUCTION

Siddha system is a way of life morally and ethically founded upon and instituted by Siddhars to attain ultimate aim of reaching bliss. Siddhars viewed every disease under the roof of diagnostic techniques, finding the root causes, clinical features and treatment methodologies.A good diagnosis can make a good treatment protocol in any disease ⁽¹⁾. In Siddha system of medicine, diagnosis of the disease is based on Ennvagai thervukal (Eight-fold examination), in which NeerkkuriNeikkuri (Urine examination) is one among them. It is an effective and sensitive measure for the diagnosis and prognosis of diseases ⁽²⁾. Siddhars out of their supernatural wisdom have bestowed in this world, many wonderful remedies for myriad type of ailments. But then, they did not stop with that, they have also devised and propounded the diagnostic procedures with the sources of technology and tools at their disposal.

The methodology of diagnosing is based on eight fold examinations which involve the examination of pulse, tactile perception, tongue, color and complexion, speech, eyes, stools, urine. Of all these parameters, Urine examination has gained paramount importance next only to Pulse examination. Sage Theraiyar who lived 350 years ago has worked out a detailed procedure of urine examination, which includes study of its color, smell, density, quantity and oil drop spreading pattern ⁽³⁾. This study aims to validate the Neerkuri on the Neerilivunoi mentioned in Siddha texts. A Siddha literature TheraiyarNeerkuri and Neikuri, illustrated the method to collect the urine sample from the patients to perform the Neerkuri test.

Urine shall be collected in the early morning in the Padigapaathiram (Crystal vessel) and examined within 90 minutes. On the day before collection of urine, the patients shall have the diet containing balanced six tastes and consume up to his appetite level at the regular time. In more severely ill patients, above criteria is not to be applied during the collection of urine and could be done instantly. The collected urine sample would be examined for five parameters such as Niram (color), Nirai (Density), Naatram (odor), Nurai (Froth) and Enjal (Volume decrease) ⁽⁴⁾.

Characteristics of diabetes in Siddha medicine

The disease Neerilivu is called by different names, Mathumeham, Salarogam, Mihuneer, Vehumooththiram, Inippuneer, Mehaneer, Theanneerand diabetes. Neerilivu is one of the Kapha diseases propounded by Siddhars. It affects all the Keelnokkukaal (Vatham) and Sapthathaathukal. On the international basis this had affected many people. At the beginning only the rich became victims to this disease but now it affects both the rich and the poor ⁽¹³⁾. In the following causes and signs which are seen to the Siddha correspondence of diabetes are described. The description is based on Siddha texts and as such follows the principles of Siddha medical theory. In Pararaasaseharam (Fifth Part) diabetes is called as losing water, water related disease and sweet urine in Siddha medicine and it is characterized by frequently passing hot urine, passing foamy urine like a pearl (drop) of fresh honey in the water, and this is an incurable disease ⁽⁵⁾. It is grouped within the polyuria related conditions of which there are 20 types. These are categorized into three groups: fire (6 types), wind (4 types), and water related polyuria conditions (10 types).  Moreover, diabetes is considered as one of the wind related polyuria related condition ^{(13), (14)}.

Causes of diabetes

                Consumption of ghee (semifluid butter), curd, and milk (which increase the coolness of the body), consumption of meat, not applying oil on the body, excessively walking in the sun, and excessive sexual intercourse with woman are considered to be causes of diabetes. Consuming excess or dearth food (eating disorder), having meals at irregular times (irregular eating), excess consumption of ghee and milk and excessive consumption of sour foods. Also having excessive sexual intercourse with a woman and excessively walking in the sun during summer may cause diabetes⁽⁶⁾. In books; “Siddha Maruthuvam, Yuki vaidya Sinthamani, and Pararajasekaram the following symptoms are cited for this disease, excessive excretion of urine, collection of ants and flies in places where a person passes urine, loss of physical strength exhaustion of body, dry mouth etc.  Further in the same books the following have been quoted as the causes of this disease ⁽¹³⁾.

Signs of diabetes

The signs of diabetes include feeling laziness, excessive sweating, body odour, always wanting to sleep, dry tongue, grease formation on tongue, sweet taste in mouth, desiring to consume cold drinks and foods, dry chest and throat, rapid growth of hair and nail, and ants and flies gather around the urine ⁽⁵⁾. The signs mentioned in Segarasasegaram text are somewhat different and include burning sensation in the stomach, paleness of body skin, weight loss, consciousness loss, dry tongue, feeling thirsty, excessive urination during the night (nocturia), difficulty in walking, blurred vision on humid, foggy, and rainy days, excessive urination, and feeling depressed.  Another set of signs is described including burning sensation in the stomach, sweating, difficulty in walking, blurred vision, wanting to quench thirst by drinking buttermilk and coconut water, loss of appetite, dry tongue, body ache, passing clear and foamless urine during day and night, extreme pain, ear congestion, and unable to fall asleep (insomnia) .urine with properties of coconut water during the night, dry tongue, feeling thirsty, body weakness, laziness are seen as signs and may cause death ⁽⁶⁾. Types of diabetes in Siddha medicine 24 types of neerilivu (what according to the textbook is considered to be diabetes are distinguished and further divided into seven categories. These categories are based on the impact the basic elements have on the human body and the types are identified based on the taste and odour of the urine. The seven categories are:

1. Wind associated diabetes – Vaathaneerilivu including three types. The urine can be characterized by:

An odour of Mangiferaindica L. (Anacardiaceae) flower and sour taste, or an odour of Crocus sativus L. (Iridaceae) flower and sour-bitter taste.

2. Wind-fire associated diabetes – Vaathapiththaneerilivu including four types. The urine can be characterized by:

An odour of Curcuma longa L. rhizome (Zingiberaceae) and sour-bitter taste, an odour of Nerium oleander L. (Apocynaceae) flower and sweet-pungent bitter-sour-astringent taste, An odour of milk and buttery taste, and   An odour of brain odour and bitter taste.

3. Fire associated diabetes – Piththaneerilivu including three types. The urine can be characterized by:

 An odour of fruit juice and bitter taste, a salty odour and taste, and an odour of Jasminumsambac (L.) Aiton(Oleaceae) flower and producing a burning sensation when urinating

 4. Fire-wind associated diabetes – piththavaathaneerilivuincluding two types. The urine can be characterized by:  An odour of cow urine and astringent taste and  Anodour of Santalum album L. (Santalaceae) wood and peppery taste. 

5. Water associated diabetes – Siletpananeerilivuincluding four types. The urine can be characterised by:  An odour of Pandanusodorifer (Forssk.) Kuntze (Pandanaceae) flower- cow manure-lemon-blood and sweet taste.

6. Water-fire associated diabetes – Siletpanapiththaneerilivu including four types. The urine can be characterized by: 

An odour of Magnolia champaca (L.) Baill.ex Pierre (Magnoliaceae) flower, a taste like Syzygiumcumini(L.) Skeels (Myrtaceae) fruit, a bad odour and a bitter-sour taste as well as ants gathering around the urine, and   An odour of slaked lime (calcium hydroxide) and producing a burning sensation (similar to the one caused by lime (calcium oxide) when urinating.   

7. Water-wind associated diabetes – Siletpanavaathaneerilivu. The urine can be characterized by:  A strong odour and sour taste. ⁽⁷⁾.

Diabetes complications like in Medical biology

Diabetes complications have been reported in Siddha medicine. Some of the complications include lower abdominal pain, tiredness after urinating, flatulence, increased deficiency in sperm secretion, sperm in urine, general body weakness, loss of appetite, abscess formation, diarrhea, unconsciousness, and death ⁽⁷⁾.

 
DISCUSSION  

Colour (Niram) of urine

Whitish changes in urine, Crystal clear white urine is suggestive of extreme kabam, Sage Theran. Pale white and clear urine due to reduction of warmth in body indicates incurable nature of illness. Urine with mucous discharge and whitish in colour denotes the kaphadosha due to excess heat. Milky white (shayaneer)-destruction of marrow and possibility of wasting disease. Semen like urine – highly depleted kaphadosha and disturbance of all doshas.Urine with no sediment – incurable disease.Urine like milk or butter milk – incurable disease.Urine resembling washings of spoiled meat – bad functioning of kidneys and depletion of blood and kapha. The dense urine with the consistency like melted ghee indicates Neerilivu⁽⁸⁾. The patient may not survive; if at all they survive, it is like a person drowned in sea coming back alive. “Diabetes is a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, caused by a deficiency of the anti-diuretic hormone ⁽⁹⁾.

Density (Nirai) of urine

 If the voided urine is denseless and clear it is due to excessive Kabam or due to melting of the Kabam, Sage Theran⁽⁸⁾. “Diabetes is a condition characterized by excessive thirst and excretion of large amount of severely diluted urine, caused by an insensitivity of the kidneys to ADH. Urine analysis demonstrates dilute urine with a low specific gravity” ⁽¹⁰⁾.

 Odour(Naatram) of urine               

Gee smell, Cow urine smell, Raw meat washed water smell and toddy smell indicates possibility of diabetes. disease of muscle or adipose tissue ⁽⁸⁾. Sweet or fruity smelling urine may be due to ketones. Ketones are formed when the body burns fat for fuel, and this can occur when there is not enough insulin to move glucose in to cells for energy ⁽¹²⁾.

 CONCLUSION

Neerilivu is one of the Kapha diseases propounded by Siddhars. It affects all the Keelnokkukaal (Vatham) and Sapthathaathukal, this disease could be easily diagnosed by eight-fold examination. Neerkuri is a tool to elicit the disease Diabetes. Based on the Neerkuri examination observed as finding, this showed the involvement of Kapha and Vatha in the pathogenesis of Neerilivu. From the above parallel analysis, it is clear that the scriptures of Sage Theraiyar about the signs in a urinary examination closely correlate with that of the urinary manifestation of signs in diabetes mentioned in the modern medical literature. The urinary signs and symptoms of the medical conditions mentioned in modern literature have already been scientifically validated. Therefore, the Sage Theraiyar’s signs and symptoms of urinary examination following the close lines of modern medical literature automatically stands validated. So it is the need of the hour to focus on this precious urinary diagnostic tool Neerkuri. Further researches are yet to be done in the field of Siddha diagnostic methods, particularly Neerkuri which will help us in better understanding of disease conditions.

REFERENCES

1.       Shanmughavelu M(2003), NoiNaadalNoimudhalNaadalpartI.thirdedition.Chennai: Kanan press pvt ltd.

2.       FasilaBanu S et al (2017), A Study on Siddha Urinary Diagnostic Methodology Neerkkuri and Neikkuri in AdhirathaAzhutham (Hypertension), Int J Pharmacol and Clin Sci.2017;6(1):6-14.

3.      Shanmugavelan R (2005), TheranAruliseithaSiruNeerkuriSodhanai 3rd Edition Thanjavur: SarasvatiMahal Library.

4.      Janani L et al (2016), Neerkuri by sage theraiyar - a review on siddha way of urine examination in the light of contemporary clinical methods, International Journal of Ayurveda and Pharma Research, 4(4):80-82.

5.      Anonymous (2003),Pararasaseharam (Fifth Part) - Pararaasaseharam (AinthaamPaaham)). Niyanthree Publication, Nallur, Jaffna, Sri Lanka.

6.      Anonymous (2000),Seharaasasehara Treatment - SeharaasaseharaVaiththiyam). Provincial Department of Indigenous Medicine, Ministry of Health north and east Provinces.

7.      Sithamparthanuppillai, S., 1982. Disorder Explanation ( NoiVilakkam). Chennai: Siddha Medicine Book Research Centre. [In Tamil].

8.      RamachandiranS.P ,(2000), theraiyarneerkurivaithyam (chennai: thamarainoolagam

9.      G.s. gerber, c.b. brendler(2007) evaluation of urologic patient; history, physical examination and the urinalysis -walsh urology. 9th ed. (philadelphia: saunderselsevier;).

10.    S. Baldasseroni, c. Opasich, m.  Gorini, d. Lucci et al (2002), left bundle branch block is associated with increased first year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the italian network on congestive heart failure, american heart journal 143(3): 398-405.

11.     Shanmugarubini s et al(2017), analysis of disease by neerkuri and neikuri, siddha research , independence day special issue

12.    Melissa Conrad Stoppler( 2018)Urine odor: symptoms and signs, Medicine net.

13.   Kumuthaeranjan T (2013), The Assessment of the Curing effect of MathumehaChooranam on those Affected by Mathumeka Disease, International Journal of Scientific and Research Publications, Volume 3, Issue 1, ISSN 2250-315

14.   KuppusamyMuthaliyar K N (2004), PothuMaruthuvam ,6^th edition Published Indian medicine and Department of Homoeopathy,Chennai 106 ,Pages 509-513

^?1 PG Scholar, Department of Gunapadam, Government Siddha Medical College, (The Tamilnadu Dr. M.G.R Medical university Chennai, Tamilnadu, India), Palayamkottai, Tirunelveli (627002),Tamilnadu, India. njqtharshan@gmail.com ² Medical Officer, District Siddha Hospital, Mannar, Srilanka. prohini165@gmail.com

ABSTRACT

Siddhars viewed every disease under the roof of diagnostic techniques, finding the root causes, clinical features and treatment methodologies. In Siddha system Sage Theraiyar who lived 350 years ago has worked out a detailed procedure of urine examination, which includes study of its Niram (color), Nirai (density), Naatram (odor), Nurai (froth) and Enjal (volume decrease) and oil drop spreading pattern em of medicine, diagnosis of the disease is based on Ennvagaithervukal (Eight-fold examination), in which NeerkkuriNeikkuri (Urine examination) is one among them. This study aims to validate the Neerkuri on the Neerilivunoi mentioned in Siddha texts.Neerilivu is one of the Kapha diseases propounded by Siddhars. It affects all the Keelnokkukaal (Vatham) and Sapthathaathukal. In Pararaasaseharam (Fifth Part) diabetes is called as losing water, water related disease and sweet urine in Siddha medicine and it is characterized by frequently passing hot urine, passing foamy urine like a pearl (drop) of fresh honey in the water, and this is an incurable disease. From the parallel analysis, the scriptures of Sage Theraiyar about the signs in a urinary examination closely correlate with diabetes mentioned in the modern medical literature.

Key words: Sage Theraiyar, Neerkuri, Neerilivunoi

 INTRODUCTION

Siddha system is a way of life morally and ethically founded upon and instituted by Siddhars to attain ultimate aim of reaching bliss. Siddhars viewed every disease under the roof of diagnostic techniques, finding the root causes, clinical features and treatment methodologies.A good diagnosis can make a good treatment protocol in any disease ⁽¹⁾. In Siddha system of medicine, diagnosis of the disease is based on Ennvagai thervukal (Eight-fold examination), in which NeerkkuriNeikkuri (Urine examination) is one among them. It is an effective and sensitive measure for the diagnosis and prognosis of diseases ⁽²⁾. Siddhars out of their supernatural wisdom have bestowed in this world, many wonderful remedies for myriad type of ailments. But then, they did not stop with that, they have also devised and propounded the diagnostic procedures with the sources of technology and tools at their disposal.

The methodology of diagnosing is based on eight fold examinations which involve the examination of pulse, tactile perception, tongue, color and complexion, speech, eyes, stools, urine. Of all these parameters, Urine examination has gained paramount importance next only to Pulse examination. Sage Theraiyar who lived 350 years ago has worked out a detailed procedure of urine examination, which includes study of its color, smell, density, quantity and oil drop spreading pattern ⁽³⁾. This study aims to validate the Neerkuri on the Neerilivunoi mentioned in Siddha texts. A Siddha literature TheraiyarNeerkuri and Neikuri, illustrated the method to collect the urine sample from the patients to perform the Neerkuri test.

Urine shall be collected in the early morning in the Padigapaathiram (Crystal vessel) and examined within 90 minutes. On the day before collection of urine, the patients shall have the diet containing balanced six tastes and consume up to his appetite level at the regular time. In more severely ill patients, above criteria is not to be applied during the collection of urine and could be done instantly. The collected urine sample would be examined for five parameters such as Niram (color), Nirai (Density), Naatram (odor), Nurai (Froth) and Enjal (Volume decrease) ⁽⁴⁾.

Characteristics of diabetes in Siddha medicine

The disease Neerilivu is called by different names, Mathumeham, Salarogam, Mihuneer, Vehumooththiram, Inippuneer, Mehaneer, Theanneerand diabetes. Neerilivu is one of the Kapha diseases propounded by Siddhars. It affects all the Keelnokkukaal (Vatham) and Sapthathaathukal. On the international basis this had affected many people. At the beginning only the rich became victims to this disease but now it affects both the rich and the poor ⁽¹³⁾. In the following causes and signs which are seen to the Siddha correspondence of diabetes are described. The description is based on Siddha texts and as such follows the principles of Siddha medical theory. In Pararaasaseharam (Fifth Part) diabetes is called as losing water, water related disease and sweet urine in Siddha medicine and it is characterized by frequently passing hot urine, passing foamy urine like a pearl (drop) of fresh honey in the water, and this is an incurable disease ⁽⁵⁾. It is grouped within the polyuria related conditions of which there are 20 types. These are categorized into three groups: fire (6 types), wind (4 types), and water related polyuria conditions (10 types).  Moreover, diabetes is considered as one of the wind related polyuria related condition ^{(13), (14)}.

Causes of diabetes

                Consumption of ghee (semifluid butter), curd, and milk (which increase the coolness of the body), consumption of meat, not applying oil on the body, excessively walking in the sun, and excessive sexual intercourse with woman are considered to be causes of diabetes. Consuming excess or dearth food (eating disorder), having meals at irregular times (irregular eating), excess consumption of ghee and milk and excessive consumption of sour foods. Also having excessive sexual intercourse with a woman and excessively walking in the sun during summer may cause diabetes⁽⁶⁾. In books; “Siddha Maruthuvam, Yuki vaidya Sinthamani, and Pararajasekaram the following symptoms are cited for this disease, excessive excretion of urine, collection of ants and flies in places where a person passes urine, loss of physical strength exhaustion of body, dry mouth etc.  Further in the same books the following have been quoted as the causes of this disease ⁽¹³⁾.

Signs of diabetes

The signs of diabetes include feeling laziness, excessive sweating, body odour, always wanting to sleep, dry tongue, grease formation on tongue, sweet taste in mouth, desiring to consume cold drinks and foods, dry chest and throat, rapid growth of hair and nail, and ants and flies gather around the urine ⁽⁵⁾. The signs mentioned in Segarasasegaram text are somewhat different and include burning sensation in the stomach, paleness of body skin, weight loss, consciousness loss, dry tongue, feeling thirsty, excessive urination during the night (nocturia), difficulty in walking, blurred vision on humid, foggy, and rainy days, excessive urination, and feeling depressed.  Another set of signs is described including burning sensation in the stomach, sweating, difficulty in walking, blurred vision, wanting to quench thirst by drinking buttermilk and coconut water, loss of appetite, dry tongue, body ache, passing clear and foamless urine during day and night, extreme pain, ear congestion, and unable to fall asleep (insomnia) .urine with properties of coconut water during the night, dry tongue, feeling thirsty, body weakness, laziness are seen as signs and may cause death ⁽⁶⁾. Types of diabetes in Siddha medicine 24 types of neerilivu (what according to the textbook is considered to be diabetes are distinguished and further divided into seven categories. These categories are based on the impact the basic elements have on the human body and the types are identified based on the taste and odour of the urine. The seven categories are:

1. Wind associated diabetes – Vaathaneerilivu including three types. The urine can be characterized by:

An odour of Mangiferaindica L. (Anacardiaceae) flower and sour taste, or an odour of Crocus sativus L. (Iridaceae) flower and sour-bitter taste.

2. Wind-fire associated diabetes – Vaathapiththaneerilivu including four types. The urine can be characterized by:

An odour of Curcuma longa L. rhizome (Zingiberaceae) and sour-bitter taste, an odour of Nerium oleander L. (Apocynaceae) flower and sweet-pungent bitter-sour-astringent taste, An odour of milk and buttery taste, and   An odour of brain odour and bitter taste.

3. Fire associated diabetes – Piththaneerilivu including three types. The urine can be characterized by:

 An odour of fruit juice and bitter taste, a salty odour and taste, and an odour of Jasminumsambac (L.) Aiton(Oleaceae) flower and producing a burning sensation when urinating

 4. Fire-wind associated diabetes – piththavaathaneerilivuincluding two types. The urine can be characterized by:  An odour of cow urine and astringent taste and  Anodour of Santalum album L. (Santalaceae) wood and peppery taste. 

5. Water associated diabetes – Siletpananeerilivuincluding four types. The urine can be characterised by:  An odour of Pandanusodorifer (Forssk.) Kuntze (Pandanaceae) flower- cow manure-lemon-blood and sweet taste.

6. Water-fire associated diabetes – Siletpanapiththaneerilivu including four types. The urine can be characterized by: 

An odour of Magnolia champaca (L.) Baill.ex Pierre (Magnoliaceae) flower, a taste like Syzygiumcumini(L.) Skeels (Myrtaceae) fruit, a bad odour and a bitter-sour taste as well as ants gathering around the urine, and   An odour of slaked lime (calcium hydroxide) and producing a burning sensation (similar to the one caused by lime (calcium oxide) when urinating.   

7. Water-wind associated diabetes – Siletpanavaathaneerilivu. The urine can be characterized by:  A strong odour and sour taste. ⁽⁷⁾.

Diabetes complications like in Medical biology

Diabetes complications have been reported in Siddha medicine. Some of the complications include lower abdominal pain, tiredness after urinating, flatulence, increased deficiency in sperm secretion, sperm in urine, general body weakness, loss of appetite, abscess formation, diarrhea, unconsciousness, and death ⁽⁷⁾.

 
DISCUSSION  

Colour (Niram) of urine

Whitish changes in urine, Crystal clear white urine is suggestive of extreme kabam, Sage Theran. Pale white and clear urine due to reduction of warmth in body indicates incurable nature of illness. Urine with mucous discharge and whitish in colour denotes the kaphadosha due to excess heat. Milky white (shayaneer)-destruction of marrow and possibility of wasting disease. Semen like urine – highly depleted kaphadosha and disturbance of all doshas.Urine with no sediment – incurable disease.Urine like milk or butter milk – incurable disease.Urine resembling washings of spoiled meat – bad functioning of kidneys and depletion of blood and kapha. The dense urine with the consistency like melted ghee indicates Neerilivu⁽⁸⁾. The patient may not survive; if at all they survive, it is like a person drowned in sea coming back alive. “Diabetes is a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, caused by a deficiency of the anti-diuretic hormone ⁽⁹⁾.

Density (Nirai) of urine

 If the voided urine is denseless and clear it is due to excessive Kabam or due to melting of the Kabam, Sage Theran⁽⁸⁾. “Diabetes is a condition characterized by excessive thirst and excretion of large amount of severely diluted urine, caused by an insensitivity of the kidneys to ADH. Urine analysis demonstrates dilute urine with a low specific gravity” ⁽¹⁰⁾.

 Odour(Naatram) of urine               

Gee smell, Cow urine smell, Raw meat washed water smell and toddy smell indicates possibility of diabetes. disease of muscle or adipose tissue ⁽⁸⁾. Sweet or fruity smelling urine may be due to ketones. Ketones are formed when the body burns fat for fuel, and this can occur when there is not enough insulin to move glucose in to cells for energy ⁽¹²⁾.

 CONCLUSION

Neerilivu is one of the Kapha diseases propounded by Siddhars. It affects all the Keelnokkukaal (Vatham) and Sapthathaathukal, this disease could be easily diagnosed by eight-fold examination. Neerkuri is a tool to elicit the disease Diabetes. Based on the Neerkuri examination observed as finding, this showed the involvement of Kapha and Vatha in the pathogenesis of Neerilivu. From the above parallel analysis, it is clear that the scriptures of Sage Theraiyar about the signs in a urinary examination closely correlate with that of the urinary manifestation of signs in diabetes mentioned in the modern medical literature. The urinary signs and symptoms of the medical conditions mentioned in modern literature have already been scientifically validated. Therefore, the Sage Theraiyar’s signs and symptoms of urinary examination following the close lines of modern medical literature automatically stands validated. So it is the need of the hour to focus on this precious urinary diagnostic tool Neerkuri. Further researches are yet to be done in the field of Siddha diagnostic methods, particularly Neerkuri which will help us in better understanding of disease conditions.

REFERENCES

1.       Shanmughavelu M(2003), NoiNaadalNoimudhalNaadalpartI.thirdedition.Chennai: Kanan press pvt ltd.

2.       FasilaBanu S et al (2017), A Study on Siddha Urinary Diagnostic Methodology Neerkkuri and Neikkuri in AdhirathaAzhutham (Hypertension), Int J Pharmacol and Clin Sci.2017;6(1):6-14.

3.      Shanmugavelan R (2005), TheranAruliseithaSiruNeerkuriSodhanai 3rd Edition Thanjavur: SarasvatiMahal Library.

4.      Janani L et al (2016), Neerkuri by sage theraiyar - a review on siddha way of urine examination in the light of contemporary clinical methods, International Journal of Ayurveda and Pharma Research, 4(4):80-82.

5.      Anonymous (2003),Pararasaseharam (Fifth Part) - Pararaasaseharam (AinthaamPaaham)). Niyanthree Publication, Nallur, Jaffna, Sri Lanka.

6.      Anonymous (2000),Seharaasasehara Treatment - SeharaasaseharaVaiththiyam). Provincial Department of Indigenous Medicine, Ministry of Health north and east Provinces.

7.      Sithamparthanuppillai, S., 1982. Disorder Explanation ( NoiVilakkam). Chennai: Siddha Medicine Book Research Centre. [In Tamil].

8.      RamachandiranS.P ,(2000), theraiyarneerkurivaithyam (chennai: thamarainoolagam

9.      G.s. gerber, c.b. brendler(2007) evaluation of urologic patient; history, physical examination and the urinalysis -walsh urology. 9th ed. (philadelphia: saunderselsevier;).

10.    S. Baldasseroni, c. Opasich, m.  Gorini, d. Lucci et al (2002), left bundle branch block is associated with increased first year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the italian network on congestive heart failure, american heart journal 143(3): 398-405.

11.     Shanmugarubini s et al(2017), analysis of disease by neerkuri and neikuri, siddha research , independence day special issue

12.    Melissa Conrad Stoppler( 2018)Urine odor: symptoms and signs, Medicine net.

13.   Kumuthaeranjan T (2013), The Assessment of the Curing effect of MathumehaChooranam on those Affected by Mathumeka Disease, International Journal of Scientific and Research Publications, Volume 3, Issue 1, ISSN 2250-315

14.   KuppusamyMuthaliyar K N (2004), PothuMaruthuvam ,6^th edition Published Indian medicine and Department of Homoeopathy,Chennai 106 ,Pages 509-513