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A classic description of diabetes is contained in the Nei Ching Su Wen, a famous book of internal medicine attributed to Huang Ti, the Yellow Emperor (ca. 2696 BC), although historians now believe the book is more recent, going back to circa 1000 BC. In later years, on the basis of the Yin-Yang paradigm, Chinese medicine still recommended that a physician should concern himself with urine, an expression of spilling of the Yin. Since about 200 AD, mention is made of “sweet urine that attracts dogs” among the symptoms of “Xiao-Ke,” or “thirst effusing into urine” [1, 2]. Indeed, the Chinese name for diabetes, táng niăo bìng (糖尿病), means “sugar urine disease.” In the 7th century AD, Li Hsuan noted that patients with diabetes were prone to boils and lung infections and prescribed avoidance of sex and wine as treatment.

Sanskrit medical tradition, extending from 2500 to 600 BC, with the Charaka Sahmita and Susruta Sahmita (Charaka’s and Susruta’s textbooks of Hindu medicine) [3, 4] included “sweet urines” among the twenty disorders of urination, collectively described as “prameha” (literally, “to micturate abnormally” or simply “polyuria”). Of the 20 varieties of “prameha,” 10 derived from phlegma and were curable, 6 from the bile and could be eliminated, whereas 4 derived from the air and were incurable. The latter affected “individuals with flaccidity of the flesh, sweet taste in the mouth, dryness of the throat, burning of the palms in the hands and feet and flux of urine as sweet as cane sugar [iksumeha] or honey [madhumeha].” Urine tasting was recommended practice, with the annotation that the urines, and sometimes the patient’s body itself, had the property of attracting large black ants and flies, insects that another medical text – the Canidana – confirmed as being extraordinarily inclined towards sweetness. Such variety of “prameha” was associated with “astimeha,” or excess of clear urine (as seen in elephants in heat) and thirst. The presence of major drowsiness and breath scenting of rotten fruit or fermented fluid (“surameha”) was also mentioned in association, suggesting that the syndrome we know today as diabetes mellitus had been identified. If these symptoms appeared in an overweight individual, fasting was recommended.

Such reports from oriental medicine do not appear to have spilled over westwards. There is no mention of them in Sumerian or Babylonian sources, such as Hammurabi’s code or what remains of the Treatise on Diagnosis and Prognosis from the 18th century BC.