Prameha- The Ultimate Diabetes Guide

In today’s fast-paced world, the prevalence of Prameha (urinary disorders) is rising, largely due to lifestyle changes. You or someone you know might already be dealing with this condition or showing early signs. In this post, I’ve gathered essential information on Prameha to help you understand it better. If you find this helpful, please share it with others. I’d also love to hear your feedback on how I can improve and what other diseases you’d like me to cover in future posts.

This post focuses on providing a broad overview of Prameha, excluding specific topics like Prameha Pidika (skin complications), detailed complications, hereditary factors, and treatments. Don’t worry—these topics will be covered in upcoming posts.

Exciting news: We’re soon launching an app called Aaharvaidya, designed to offer personalized dietary recommendations, including what to eat and what to avoid. Visit aaharvaidya.com to learn more.

Stay tuned for more insights and take care of your health!

Nirukti –

• Meha:
  The word “meha” originates from the root “miha,” which is used in the context of “sinchana” (sprinkling) and “ksharana” (flowing). In Ayurvedic terminology, “meha” is also employed to denote “prasava,” meaning excessive excretion, particularly in relation to Prameha, a specific type of disorder characterized by abnormal urination.
• Prameha: The term “Prameha” is composed of two parts: “Pra” and “meha.” The word “meha” is derived from the root “mih sechane,” with the addition of the “Lue” pratyaya, resulting in the phrase “mehati, sinchati, mutraretansi,” which signifies the act of excretion. The root “Mih” is thus associated with actions like making water, wetting, or emitting fluids.
  • By adding the prefix “pra” to this root, the word “Prameha” is formed. The prefix “Pra” intensifies the meaning, indicating severity—hence, “Prakarshena mehati ksharati iti,” which translates to “excessive or severe urination.” Prameha is therefore defined as a disease characterized by the excessive excretion of urine.
  • In another interpretation, “Pra” signifies “large” or “turbid,” while “meha” refers to “urination,” together describing the nature of the disease as involving copious or cloudy urination.

Other References-

• Prameha, according to the Apte Sanskrit Dictionary, is a general term used for urinary diseases.
• It encompasses a wide range of conditions where there is a noticeable change in the color, quantity, or consistency of urine. This broad classification includes various types of urinary infections and disorders, with a total of twenty-one varieties being identified. Among these are conditions such as diabetes and gonorrhea, as noted in the Shabda-Sagara dictionary.
• प्रकर्षेण मेहति क्षरति वीर्य्यादिरने- नेति । प्र + मिह क्षरणे + करणे घञ् । रोगविशेषः । तत्पर्य्यायः । मेहः (Kalpadruma)
  • मूत्रदोषः
  • इति राजनिर्घण्टः ॥ बहुमूत्रता

Utpati/ Etiology –

Charak Samhita Nidan 4/1-3 Chakrapani commentary :

During the destruction of the Daksha Yagya, after the manifestation of Gulma, Prameha was believed to have emerged due to the consumption of Hawi (sacrificial offerings). This is considered one of the earliest references to Prameha, connecting its origin to this significant event in Hindu mythology.

History-

• APEDHAMARI, VIDMA SHARASVATl PRAMEHANAM BEHNANI ( Kaushik Sutra of Atharva Veda [K.Su.26/6-10]
  • Atharvaveda there is mentioning of a disease condition called ‘Asrava’ along with its management. Sayanacharya, the commentator described Asrava as ‘Mutraatisara’ or excessive urination.
  • Aasrava & Prameha told in Atharva Veda
• KRIVLASG.RIHGOUJKAMDHY AHIKADHOMOU
  SA EVA CITRAMEKANTRAMADHUYUKTAH
  PRAMEHA MAP ADAYTI (Kuatilya artha shastra)
• Agni Purana: Prameha is categorized into two types, Kshaudra Meha and Akshaudra Meha, emphasizing different characteristics of the disease.
• Ramayana: There are accounts of monkeys experiencing excessive urination after consuming large quantities of sweet juices, which align with the symptoms of Prameha.
• Lord Ganesha: It is said that Lord Ganesha, known for his fondness for sweets and a sedentary lifestyle, consumed kapitta and jambu. Additionally, Shiva Gutika, a medicinal preparation, was mentioned as being prepared by Lord Shiva specifically for Ganesha, possibly to manage symptoms related to Prameha.
• Garuda Purana: Prameha is described as an illness where sweetness pervades the entire body, indicating the systemic nature of the disorder.
• Yagnavalka Smriti: Madhumeha, a severe form of Prameha, is depicted as a chronic and painful disease, referred to as Badhyaruk.
• Brahma Samhita: Prameha is indicated by terms such as “Prasrava” and “Asrava,” which denote excessive discharge or flow, highlighting the characteristic symptoms of excessive urination in this condition.

Normal urine –

मूत्रं स्वभावात् तन्वच्छमापीतं लवणाम्लकम्। प्रायश्च षोड़शपलं पुंसां प्रत्यहमिष्यते । स्त्रीणां तु किञ्चिदूनं तद् बालानां तु यथावयः । न्यूनं ज्वरातिसारादौ घनं ताम्र सति ज्वरे ॥ Siddhnata nidana 9/1-2

Urine is typically clear, thin (tanu), and slightly yellow in color, with a salty and sour taste. The daily excretion amount is generally around 16 pala in males, slightly less in females, and varies in children according to their age. The quantity of urine tends to decrease during conditions like fever and diarrhea.

Doshas involved in Prameha –

सर्व एव सर्वदोषसमुत्थाः सह पिडकाभिः ॥ Sushruta Samhita Nidana 6/7

All prameha and the carbuncles are caused by all three doshas.

Mahamaya,Mahatyayika and Mahagada-

वातव्याधिरपस्मारी कुष्ठी शोफी तथोदरी|
गुल्मी च मधुमेही च राजयक्ष्मी च यो नरः||८||
अचिकित्स्या भवन्त्येते बलमांसक्षये सति|
अन्येष्वपि विकारेषु तान् भिषक् परिवर्जयेत्||९|| Charak Samhita Indriya sthana 9/8-9

वातव्याधिः प्रमेहश्च कुष्ठमर्शो भगन्दरम् |
अश्मरी मूढगर्भश्च तथैवोदरमष्टमम् ||४||
अष्टावेते प्रकृत्यैव दुश्चिकित्स्या महागदाः |५| Sushruta Samhita 33/4-5

वातव्याधिरपस्मारी कुष्ठी रक्त्युदरी क्षयी|
गुल्मी मेही च तान्क्षीणान्विकारेऽल्पेऽपि वर्जयेत्|२| Ashtanga sangraha sharir 11/35

महामया इत्यखिलाभयाधिकाः प्रमेहकुष्ठोदरदुष्टवातजः ।समूढगर्भ गुदजाङ्कराश्मरी भगन्दरं चाहुरशेषवेदिनः ।।Kalyanakarkam 11/4

Prameha, kushta, udara roga, vata vyadhi, mudha garbha, Ashamari, Bhagandara, arsha are known as Mahamaya or Maharoga, mahatyayika

Why disease is called mahatyayika

Charak samhita nidana 4/38 commentary in vataj prameha

“Diseases are termed Mahatayika, meaning very severe or serious, when there is a loss of essential dhatus like Majja (bone marrow) and others, which are crucial for the body. This severity is compounded by the challenge of contradictory treatment approaches.”

Sushrut samhita 6/8 dalhana

“Mahatayajatvat refers to the severe acuteness of a disease, characterized by the discharge or depletion of essential tissues.”

Chakrapani dutta charak samhita sutra 25/40

Anusangi refers to a condition that is persistent and does not easily resolve or leave the patient. It implies that the disease remains constant or chronic, often requiring ongoing management and treatment.

Previous janam karma as Prameha –

• चंडाली गमनात्सर्वः प्रमेहव्याधिमान्धवेत् । श्रुत्पिासातुरश्चैव जायते तस्य निष्कृतिः।। Vaidya chintamani 20/1
• Same is mentioned in Brihat nighantu ratnakar.

A person who does intercourse with a chandala lady gets diseased with Prameha.

• तिर्यग्गामी सशूलेन प्रमेहेन युतो भवेत् ।। Vaidya chintamani 20/3

Anyone who does intercourse with a horse suffers from Shoolameha.

• पर्वव्यवायी मनुजः कन्यागामी तथैव च ।। Vaidya chintamani 20/4
• Also mentioned in brihat nighantu ratnakar

A person who does intercourse on the Amavasya or Purnima with his wife or with a small aged girl suffers with Vataja prameha.

• मधुमेही मातृगामी सततं जायते नरः ।। Vaidya chintamani 20/5,  brihat nighantu ratnakar

A man who does intercourse with mother gets suffering in the form of Madhumeha.

• यो गच्छेद्भगिनीं नित्यमिक्षुमेही भवेन्नरः ।। Vaidya chintamani 20/6, brihat nighantu ratnakar

Anybody who had sex with his own sister gets Ikshu meha

तिर्यग्गामी सशूलेन प्रमेहेन युतो भवेत् । Brihat nighantu ratnakar

A person who has sex with except human gets painful prameha

Nidana / Etiology –

• आस्थासुखं स्वप्नसुखं दधीनि ग्राम्यौदकानूपरसाः पयांसि । नवान्नपानं गुडवैकृतं च प्रमेहहेतुः कफकृच्च सर्वम् ॥ Charak Samhita Chikitsa 6/4, Gada nigraha 30/1, Madhava nidana 33/1Brihat nighantu ratnakar, yoga ratnakar prameha 1, basavarajeevam 9/3, vaidya vinoda samhita 21/27, vangasena samhita 38/1, Anjan nidana 144, Vaidya chintamani 20/7, Bhavaprakasha samhita 38/1, Rasa kamadhenu 29/16-17

1. Prolonged and idle Sitting on a soft seat (आराम से गुदगुदे बिस्तर पर बैठे रहना)
2. Excessive sleep and daytime sleeping (सुखपूर्वक अधिक सोना)
3. Frequently eating curd in large quantities (अधिक दही सेवन)
4. Meat of Gramaya mansa (ग्राम्य मांस) (like goat), Sea food (जल जंतु ), Anupa mansa (आनूप मांस)
5. Milk (दूध)
6. Recently harvested cereals (नया अन्न)
7. Newly prepared drinks
8. Consumption of Rain water (नवीन अथवा वर्षा जल)
9. Food items made from Jaggery/ sugar (गुड विकार)
10. Kapha vardhak aahar (कफ वर्धक आहार)

• तेषां च यत्किञ्चिदाहारविहारजातं श्लेष्ममेटो- मूत्रजननं स हेतुः॥ Ashtanga Sangraha nidana 10/4

All the food and lifestyle choices that lead to an increase in Kapha (phlegm), Meda (fat), and Mutra (urine) contribute significantly to the development of Prameha

• गृध्नुमभ्यवहार्येषु स्नानचङ्क्रमणद्विषम् । प्रमेहः क्षिप्रमभ्येति नीडद्रुममिवाण्डजः ॥ मन्दोत्साहमतिस्थूलमतिस्निग्धं महाशनम् । मृत्युः प्रमेहरूपेण क्षिप्रमादाय गच्छति ॥ Charaka nidana 4/50-51

Just as birds instinctively return to their nests to lay eggs, Prameha similarly approaches individuals who are greedy for food, neglect bathing, and avoid walking. Prameha, as a harbinger of death, targets those who are lethargic, obese, overly indulgent in unctuous foods, and prone to overeating.

• दिवास्वप्नाव्यायामालस्यप्रसक्तं शीतस्त्रिग्धमधुरमेद्यद्रवान्नपानसेविनं पुरुषं जानीयात् प्रमेही भविष्यतीति॥ Sushrut samhita nidana 6/3

Daytime sleep, lack of exercise, laziness, and the consumption of cold, oily, sweet, fatty, and liquid foods are indicators of someone who is likely to become a future patient of Prameha.

• तेषां मेदोमूत्रकफावहम्॥ अन्नपानक्रियाजातं यत्प्रायस्तत्प्रवर्तकम्। स्वाद्वम्ललवणस्निग्धगुरुपिच्छिलशीतलम् ।। नवधान्यसुरानूपमांसेक्षुगुडगोरसम् । एकस्थानासनरतिः शयनं विधिवर्जितम् ।। Ashtanga Hridayam nidana 10/1-3

Food and daily activities that contribute to an increase in Meda (fat), Mutra (urine), and Kapha include consuming Madhura (sweet), Amla (sour), Snigdha (unctuous), Guru (heavy), Picchila (sticky), and Sheeta (cold) foods. Additionally, newly harvested grains, new alcohol, Anupa (local) and Gramya (village) mansa (meat), sugarcane, and milk products exacerbate these conditions. Prolonged sitting, excessive sex, and daytime sleeping also contribute Prameha

अनूपजानां सुस्निग्धैर्विविधैश्चापि वारिजैः ।गव्याजौरभ्रमांसैश्च सद्यौ दध्ना घृतेन वा।गुडप्रकारैः पयसा पललेनौदकैः खगैः। अव्यायामाद्दिवास्वप्नात्सुखशय्यासनात्तथा ।।  इत्येभिरीदृशैश्चान्यैर्मेदः स्निग्धैः प्रवर्धते। मेदः प्रवृद्धं देहं च बस्ति च क्लेदयत्यपि ॥ Bhela samhita 6 /4-6

Anupa mansa , marine meat, oiled and unctuous meats from cow, sheep, and ram, freshly prepared curd, ghee, various preparations of jaggery products with milk, and meat of aquatic animals prepared with tila taila (sesame oil) contribute to an increase in Kapha, Meda (fat), and Kleda (moisture) in the body. Additionally, a lack of physical exercise, daytime sleeping, sitting on comfortable seats and beds, and Meda-vardhaka (fat-increasing) treatments such as Basti (enema)

गुरुद्रवस्निग्धहिमातिभोजनं दिवातिनिद्रालुतया श्रमालसं।नरं प्रमेहो हि भविष्यतीरितं विनिर्दिशेदासु विशेषलक्षणैः ।। Kalyanakarkam11/6

Heavy, liquid, oily, and cold foods, excessive sleep, lack of physical exercise, and laziness are contributing factors to Prameha.

श्रमाद्व्यवायाच्च तथैव घर्मविरूद्धतीक्ष्णोष्णविभोजनेन । मद्येन वा क्षीरकटुप्रसेवनान्मेहप्रसूतिः कथिता मुनीन्द्रैः ॥ Harita samhita 28/2

Resting, consuming sharp and incompatible foods (teekshan and virudha bhojana), alcohol, milk, and pungent foods (katu bhojana) are contributing factors to Prameha.

नवान्नदधिमद्यांबुगुडधूमनिषेवणात् ।। Basavarajeevam 9/3

New cereals, curd, alcohol, excessive water intake, jaggery products, and exposure to fumes are contributing factors to Prameha.

कफोत्थानां हि मेहानां निदानं श्लेष्मवर्धनम् । विशेषान्मधुरं दुग्धं भक्तं व्यायामवर्जनम् । पित्तोल्वणानां मेहानां निदानं पित्तवर्धनम् । विशेषात् कटु-तीब्राऽम्ल-रौद्र-वहिनिषेवणम् ॥वातोल्वणानां मेहानांहेतुर्वातलसेवनम् । विशेषात् क्षय-विक्षोभ-शोक-चिन्ता-प्रजागराः ॥ Sidhanta nidana 6/555-557

Kapha-vardhak aahara, sweets, milk, rice, and lack of physical activity are causative factors for Kaphaja Prameha. Factors that increase Pitta, such as katu, amla, ushna, and strong sunlight, contribute to Pittaja Prameha. For Vataja Prameha, causative factors include things that increase Vata, as well as kshaya, vishobha, shoka, chinta, and loss of sleep.

दधिमधुघृतदुग्धं मद्यपानं नवान्न फलरसमतिमिष्टं तक्रमिक्षो- विकारम् ॥ रविकृतपरितापः सुन्दरीस्त्रीकटाक्षैर्भवति विषम- चतो मेहहेतुनितांतम् ॥ Hansa raj nidana prameha 1

Curd, honey, ghee, milk, alcohol, new fruits, cereals, sugarcane products, buttermilk, and walking in sunlight are all factors that can contribute to the development or aggravation of Prameha.

All disease nidana same –

मूत्राघाताः प्रमेहाश्च शुक्रदोषास्तथैव च ।मूत्रदोषाश्च ये वाऽपि वस्तौ चैव भवन्ति हि ।। Yoga ratnakar prameha 2

The causative factors (Nidana) for diseases such as Mutraghata (urinary obstruction), Prameha (a group of urinary disorders), Shukradosha (disorders related to semen), Mutradosha (disorders related to urine), and other diseases affecting the bladder share similar origins. These conditions often arise from factors that disturb the normal function of the urinary system.

Does prameha occur in females –

रजः प्रवर्त्तते यस्मान्मासि मासि विशोधयेत् । सर्वाञ्छरीरदोषांश्च न प्रमेहन्त्यतः स्त्रियः ।। Bhavaprakasha samhita 38/23

It is stated that during menstruation, females naturally expel doshas, which may contribute to a lower incidence of Prameha in women compared to men.

Dalhana commentry nidana 6/3, Sushruta samhita chikitsa 11/3

Male is more prominent to disease, Women can be carrier?

Nidan of kafaja prameha –

हायनकयवकचीनकोद्दालकनैषधेत्कटमुकुन्दकमहाव्रीहिप्रमोदकसुगन्धकानां नवानामतिवेलमतिप्रमाणेन चोपयोगः, तथा सर्पिष्मतां नवहरेणुमाषसूप्यानां, ग्राम्यानूपौदकानां च मांसानां, शाकतिलपललपिष्टान्त्र- पायसकृशराविलेपीक्षुविकाराणां, क्षीरनवमद्यमन्दकदधिद्रवमधुरतरुणप्रायाणां चोपयोगः, मृजाव्यायामवर्जनं, स्वप्नशयनासनप्रसङ्गः, यश्च कश्चिद्विधिरन्योऽपि श्लेष्ममेदोमूत्रसंजननः स सर्वो निदानविशेषः ॥ Charak samhita nidana 4/5

Excessive consumption of newly harvested cereals such as hayanama, yawaka, cinaka, uddalaka, naisadha, itkata, krasara, and those prepared with tila, rice, masa, mukundaka, mahavrihi, pramodaka, and sugandhaka; yush made from harenu and masa with ghee; meat from gramya, anupa, and jaliya pashu pakshi; vegetables like shaak, tila, palala, krsara, vilepi; sugarcane juice, milk, madya, mandaka, curd, buttermilk; along with insufficient body cleaning, lack of exercise, excessive sleeping or sitting, and consuming food with high liquid content can all contribute to an increase in kapha, meda, and urine, exacerbating the risk of Prameha.

Pittaj prameha nidana –

उष्णाम्ललवणक्षारकटुकाजीर्णभोजनोपसेविनस्तथाऽतितीक्ष्णातपाग्निसंतापश्रमक्रोधविषमाहारोपसेविनश्च charak samhita nidana 4/24

Hot, sour, salty, kshar (alkaline), and katu (pungent) foods, eating during ajeerna (indigestion), excessive exposure to heat or fire, physical exertion and anger, irregular diet or virudha ahara (incompatible food combinations), and a pitta prakriti (predominance of pitta dosha).

Vataja prameha nidana –

कषायकटुतिक्तरूक्षलघुशीतव्यवायव्यायामवमनविरेचनास्थापनशिरोविरेचनातियोगसंधारणानशनाभिघातातपोद्वेगशोकशोणितातिषेकजागरणविषमशरीरन्यासानुपसेवमानस्य तथाविधशरीरस्यैव क्षिप्रं वातः प्रकोपमापद्यते ।। Charak samhita nidana 4/36

Kashaya (astringent), katu (pungent), tikta (bitter), ruksha (dry), laghu (light), and sheeta (cold) foods; excessive sex and exercise; ati vamana (excessive emesis), virechana (purgation), aasthapana basti (retention enemas), and shiro virechana (head purgation); vega dharana (suppression of natural urges), fasting, trauma, exposure to harsh sunlight (aataap), anxiety, sholay (excessive bleeding), ati rakta mokshan (excessive bloodletting); constant use of abnormal body postures, and vataj prakriti (predominance of vata dosha).

Samprapti :-

मेदश्च मांसं च शरीरजं च क्लेदं कफो बस्तिगतं प्रदूष्य । करोति मेहान् समुदीर्णमुष्णैस्तानेव पित्तं परिदूष्य चापि ॥क्षीणेषु दोषेष्ववकृष्य बस्तौ धातून् प्रमेहाननिलः करोति । दोषो हि बस्ति समुपेत्य मूत्रं संदूष्य मेहाञ्जनयेद्यथास्वम् ॥charak samhita chikitsa 6/5-6, Bhava prakasha samhita 38/2

Kapha manifests prameha by vitiating medas (fat), muscles, and kleda (bodily secretions) present in the urinary bladder. Pitta, when aggravated by hot substances, can similarly lead to prameha. Vayu, when the other two doshas are diminished, pulls dhatus (tissues) into the urinary bladder and produces prameha. When these doshas reach the bladder, they influence the urine, leading to the condition of prameha.

Samprapti of kafaja prameha –

Charak samhita nidana 4/8

The combination of nidana (causative factors), dosha, and dusya results in the aggravation of kapha, which spreads throughout the body due to laxity. Before spreading, it mixes with meda (fat) and further aggravates it. This aggravated kapha and meda then come into contact with the kleda and mansa (muscles), which have also increased. The kapha in vitiated muscles produces conditions like sarawika and kacchapika peedikas (types of boils). This further affects the kleda, transforming it into urine and blocking the mutravaha srotas (urinary channels). Which originates from the vrkka (kidneys) and basti (bladder), which are also affected by meda and kleda.

Prameha, resulting from the interaction of homogeneous and heterogeneous dhatus (tissues), becomes settled and, in some cases, incurable. The kleda in the body, when mixed with slesma (kapha) and meda enters the urinary bladder. It is then transformed into urine, taking on the properties of kapha. This leads to the manifestation of 10 types of kaphaja prameha, each named accordingly.

तत्त्र वातपित्तमेदोभिरन्वितः श्लेष्मा श्लेष्मप्रमेहाञ्जनयति, वातकफशोणितमेदोभिरन्वितं पित्तं पित्तप्रमेहान्, कफपित्तवसामज्जामेदोभिरन्वितो वायुर्वातप्रमेहान् ॥ Sushruta samhita nidana 6/9

Kapha, when associated with vata, pitta, and meda, leads to the manifestation of kaphaja (or sleshma) prameha. Pitta, when combined with vata, kapha, sonita (blood), and meda, results in pittaja prameha. Vata, in association with kapha, pitta, vasa (muscle fat), majja (bone marrow), and meda, causes vataja prameha.

तत्र वातपित्तमेदः क्लेदमांसशुक्ररसैरन्वितो व- स्तिगतः श्लेष्मा प्रमेहान् जनयति ।   ashtanga sangraha nidana 10/5

When vata, pitta, meda, kleda, mamsa (muscle tissue), shukra (reproductive tissue), and rasa (nutrient fluid) reach the bladder and mix with kapha, they produce kaphaja prameha.

मेदश्च मांसं च शरीरजं च वस्नेदं कफो वस्तिगतः प्रदूष्य। करोति मेहान् समुदीर्णमुष्णैस्तानेव पित्तं परिदूष्य चापि।।७।। क्षीणेषु दोषेष्ववकृष्य धातून् संदूष्य मेहान् कुरुतेऽनिलश्च। Basavarajeevam 9/9, Gada nigraha 30/2

Vitiated kapha dosha vitates meda, mansa, kaleda, all get accumulated in the bladder. With the association of ushnata of pitta dhatus get squeezed and comes out in the form of the urine. This leads to reduction in the strength of dushya as well as the body strength. This will lead to  vitation of vata.

Pittaj prameha samprapti –

पित्तं रक्तमपि क्षीणे कफादौ मूत्रसंश्रयम् । ( Ashtanga hridya nidana 10/5

When kapha decreases, pitta increases, and along with rakta (blood), it leads to the manifestation of pittaja prameha.

तैः कफशोणि- ताभ्यां च युक्तं पित्तम् । Ashtanga sangraha nidana 10/5

When vata, pitta, meda, kleda, mamsa, shukra, rasa, and rakta accumulate in the bladder and combine with pitta, it leads to the manifestation of pittaja prameha.

करोति मेहान् समुदीर्णमुष्णस्तान्येव पित्तं परिदूष्य चापि ॥ Gada nigraha 30/2

Due to the consumption of hot food, pitta situated in the bladder (basti) combines with meda, mamsa, and kleda, leading to the development of pittaja prameha.

Vataja prameha samprapti –

धातून् बस्तिमुपानीय तत्क्षयेऽपि च मारुतः ॥ Ashtanga hridya nidana 4/5

When vata becomes vitiated and carries vasa, majja, and other dhatus to the bladder (basti pradesha), it leads to vataja prameha, where these dhatus are excreted in the form of urine, resulting in the deterioration of the body’s strength and health.

तैर्वसालसीकामज्जौजोभिश्च वायुः ॥ Ashtanga sangraha nidana 10/5

When vata, combined with pitta, meda, kleda, mamsa, shukra, rasa, rakta, vasa, lasika, majja, and ojas, reaches the bladder and merges with vayu, it results in the onset of vataja prameha.

क्षीणेषु मांसेष्ववकृष्य धातून् संदूष्य मेहान् कुरुतेऽनिलश्च । Gada nigraha 30/3

When pitta and kapha diminish, vata seizes the dhatus, carrying them to the bladder, leading to the manifestation of vataja prameha.

Chronical order samprapti –

त्रयाणामपि दोषाणां श्लेष्मा प्रमेहेषु प्रायः प्राकृ ॥ प्रकोपमापद्यते श्लेष्माधिष्ठानत्वान्मूत्रस्य तदृद्धेश्च मेद एव तेन प्रथमं दूष्यतेऽत्यन्तसहागत्वात् । तदनन्तरं क्लेदादयः । ततः श्लेष्मादिक्षये पित्तं प्रब लीभवच्छोणितमप्रि दूषयति। तत्क्षयेऽपि वायूरसा- मोदीन्धातून् शरीरस्खे परस्परं सारभूतान् वस्तिमा- कृष्य मूत्रेण सह विसृजति ॥ Ashtanga sangraha nidana 10/6

Out of the three doshas, kapha is vitiated first. This is because the site of kapha is associated with urine. This vitiated kapha then aggravates meda, as kapha and meda share similar properties. Following this, kaleda becomes vitiated. When kapha diminishes, pitta gains strength and vitiates rakta. If there is a depletion of pitta, it leads to vata carrying vasa and other dhatus to the urine, which are then expelled out from the body. Thus, kapha vitiation leads to pitta imbalance, which in turn results in vataja prameha.

10 stages of Prameha –

प्रथमा वस्तिभेदश्च द्वितीया मूत्रपीडनम् । तृतीया मरुतः कोपश्चतुर्था सन्निपातिकी । पंचमी धातुनाशः स्यात् षष्ठी दाहः समोहकः । सप्तम्यरोचको जाड्यमष्टमी ग्रन्थिसंभवः नवमी स्यादतीसारः संज्ञाया दशमी क्षयः । उपेक्षितानामित्येवमवस्थाः स्युः शरीरिणाम् Vaidya sara sangraha 5/101-105

In the progression of Prameha, the 10 stages are as follows:

1. Stage 1-Pain in the Hypochondric Region: Initial discomfort in the upper abdomen or sides.
2. Stage 2- Difficulty in Micturition: Trouble or pain during urination.
3. Stage 3- Vitiation of Vata: Imbalance or disturbance in the Vata dosha.
4. Stage 4- Vitiation of Tridosha: Imbalance affecting all three doshas (Vata, Pitta, Kapha).
5. Stage 5- Destruction of Dhatus: Degradation or loss of the body’s essential tissues.
6. Stage 6- Burning Sensation and Bewilderment: Experiencing a burning sensation and confusion.
7. Stage 7- Tastelessness and Apathy: Loss of taste and a general sense of indifference or lack of interest.
8. Stage 8 –Formation of Granthis: Development of abnormal growths or nodules.
9. Stage 9- Diarrhea: Frequent, loose bowel movements.
10. Stage 10- Murcha: Fainting or loss of consciousness.

Curebility :-

साध्याः कफोत्था दश, पित्तजाः षट् याप्या, न साध्यः पवनाच्चतुष्कः । समक्रियत्वाद्विषमक्रियत्वान्महात्ययत्वाच्च यथाक्रमं ते ॥ Charak samhita chikitsa 6/7

Kaphaja prameha consists of ten types and is considered curable due to the similarity between the treatments for kapha and prameha. Pittaja prameha includes six types and is classified as yapya (manageable but not completely curable) because of the differences in the treatments for pitta and prameha. Vataja prameha, comprising four types, is deemed incurable due to the similarities and dissimilarities in treatment approaches, the severity of the disease, and the presence of severe complications.

Sushrut samhita nidana 6/8 dalhana

Kapha prameha is considered curable as long as fat (meda) is not excessively vitiated.

पिडकापीडितं गाढमुपसृष्टमुपद्रवैः । मधुमेहिनमाचष्टे स चासाध्यः प्रकीर्तितः ।। sushruta samhita nidana 6/24

A patient with Madhumeha who has Pidika (skin lesions) and severe complications (upadravas) is considered to be incurable.

आवृतो दोषलिङ्गानि सोऽनिमित्तं प्रदर्शयेत् ।। क्षीणः क्षणात्क्षणात् पूर्णो भजते कृच्छ्रसाध्यताम् । Ashtanga hridya nidana 10/19

Vata manifests symptoms by affecting the doshas it surrounds, leading to irregular bladder function where it may sometimes be full and at other times empty. These unpredictable fluctuations contribute to Madhumeha being classified as kricha sadhya (difficult to cure).

अत्र शुक्राभमिति सर्वमेव मूत्रं शुक्रतुल्यं, शुक्रमिश्र बेति शुक्राभशुक्रमिश्र; वास्तवशुक्रमिश्रत्वे तु कफजस्याप्यसाध्यत्वं स्यादिति; वाप्यचन्द्रस्तु madhava nidana madhukosha tikka

According to Vapyachandra, if sukra (semen) is mixed with urine, then kaphaja prameha is considered ashadhya (incurable).

Why is prameha kashta sadhaya –

सर्वजत्वान्महामर्म संश्रयादनुषङ्गतः । सुबहूपद्रवत्वाच्च प्रमेहो दारुणो गदः ।। Ashtanga sangraha chikitsa 14/27

Prameha, being caused by the tridosha, is linked to the maha marma (vital organs) and is characterized by its long duration and numerous complications. These factors contribute to its kricha sadhya (difficult to cure) nature.

10 dushaya of prameha –

कफः सपित्तः पवनश्च दोषा मेदोऽस्त्रशुक्राम्बुवसालसीकाः । मज्जा रसौजः पिशितं च दूष्याः प्रमेहिणां, विंशतिरेव मेहाः ॥ Charak samhita chikitsa 6/8

In the 20 types of Prameha, the dushya (pathological factors) involved are diverse. These include the three doshas—Kapha, Pitta, and Vata—which are central to the disease’s manifestation. Additionally, Meda (fat), Asra (blood), Shukra (semen), Ambu (water), Vasa (tissue fat), Lasika (lymphatic fluid), Majja (bone marrow), Rasa (nutritional fluid), Ojas (vital energy or immunity), and Mamsa (muscle tissue) are also implicated. Each of these factors plays a role in the pathogenesis and progression of Prameha, contributing to its complexity and varied presentation.

Vishesh dushya –

बह्नबद्धं मेदो मांसं शरीरजक्लेदः शुक्रं शोणितं वसा मज्जा लसीका रसश्चौजः संख्यात इति दूष्यविशेषाः ।। Charak samhita nidana 4/7

Abundant and over-accumulated Meda (fat), Mamsa (muscle tissue), Kaleda (dysfunctional body fluid), Shukra (semen), Rakta (blood), Vasa (tissue fat), Rasa (nutritional fluid), Lasika (lymphatic fluid), and Oja (vital energy or immunity) are considered specific dushya vishesha (particular pathological factors) in Prameha

पूर्वरूप :-

स्वेदोऽङ्गगन्धः शिथिलाङ्गता च शय्यासनस्वप्नसुखे रतिश्च । हृन्नेत्रजिह्वाश्रवणोपदेहो घनाङ्गता केशनखातिवृद्धिः ॥ शीतप्रियत्वं गलतालुशोषो माधुर्यमास्ये करपाददाहः । भविष्यतो मेहगदस्य रूपं मूत्रेऽभिधावन्ति पिपीलिकाश्च ॥ Charak samhita chikitsa 6/13-14, Ashtanga hridya nidana 10/38-39

The preliminary symptoms (purvarupa) of prameha include excessive sweating and a foul body odor, accompanied by flaccid or slack body parts. Individuals may exhibit a strong preference for comfortable positions, such as lying down or sitting, and may feel a sense of covering or heaviness around the cardiac region, eyes, tongue, and ears. Other symptoms include an increase in hair and nail growth, a liking for cold environments, dryness in the throat and palate, and a sweet taste in the mouth. Additionally, patients may experience a burning sensation in the palms and feet, and ants may be attracted to their urine.

त्रयस्तु खलु दोषाः प्रकुपिताः प्रमेहानभिनिर्वर्तयिष्यन्त इमानि पूर्वरूपाणि दर्शयन्ति; तद्यथा-जटिलीभावं केशेषु, माधुर्यमास्यस्य, करपादयोः सुप्ततादाहौ, मुखतालुकण्ठशोषं, पिपासाम्, आलस्यं, मलं काये, कायच्छिद्रेषूपदेहं, परिदाहं सुप्ततां चाङ्गेषु, षट्पदपिपीलिकौभिश्च शरीरमूत्राभिसरणं, मूत्रे च मूत्रदोषान्, विस्त्रं शरीरगन्धं, निद्रां, तन्द्रां च सर्वकालमिति ॥ Charak samhita nidana 4/47

The preliminary symptoms (purvarupa) of prameha include matting of the hair, a persistent sweetness in the mouth, and numbness along with a burning sensation in the hands and legs. Additional signs are dryness of the face, palate, and throat, intense thirst (trishna), and general laziness. There may also be a noticeable dirtiness of the body, closure of body pores and orifices, and a pervasive smell of raw flesh emanating from the body. These symptoms are often accompanied by drowsiness and a feeling of discomfort in the vicinity of the body and urine.

तेषां तु पूर्वरूपाणि-हस्तपादतलदाहः स्त्रिग्ध पिच्छिलगुरुता गात्त्राणां मधुरशुक्लमूत्रता तन्द्रा सादः पिपासा दुर्गन्धश्च श्वासस्तालुगलजिह्वादन्तेषु मलोत्पत्तिर्जटिलीभावः केशानां वृद्धिश्च नखानाम् ॥ Sushruta nidana 6/5

The preliminary symptoms of prameha include a burning sensation in the palms and soles, a feeling of oiliness (snighdta), and heaviness in the limbs. The urine is typically sweet and white. Additional signs are dizziness, depression, intense thirst (trishna), and a bad smell emanating from the body. There may be dryness and dirtiness in the palate, throat, and teeth, along with rigidity and excessive growth of hair and nails.

प्रमेहपूर्वरूपाणामाकृतिर्यत्र दृश्यते ॥ किञ्चिच्चाप्यधिकं मूत्रं तं प्रमेहिणमादिशेत् ॥कृत्स्त्रान्यर्धानि वा यस्मिन् पूर्वरूपाणि मानव ॥ प्रवृत्तमूत्त्रमत्यर्थं तं प्रमेहिणमादिशेत् ॥ Sushruta samhita nidana 6/22-23

When there is an increase in the frequency and quantity of urine, the patient should be considered at risk of developing prameha. If some or all of the preliminary symptoms (poorvaroopa) of prameha are observed, then the person should be diagnosed with prameha.

तेषां पूर्वरूपाण्यतिवृद्धिर्नखानां जटिलीभावश्च केशानां माधुर्यमास्यस्य तालुकण्ठशोषः पिपासा मलाधिक्यं बहिःकाये कायछिद्रेषु च शीतेच्छा स्नेहः स्वेदः सुप्तता चाङ्गेषु पाणिपाददाहोऽतिमाधुर्यात्पि- पीलिकोपसर्पणं विस्त्रगन्धता च मूत्रशरीरयोः शुक्लता च मूत्रे श्वासो निद्रा तन्द्रालस्याप्रहर्षाश्च ashtanga sangraha nidana 10/10

An increase in the size of nails, hair resembling matted locks (jata), a sweet taste in the mouth, dryness in the throat, persistent thirst, excess dirt on the body, a preference for cold things, oiliness of the body, ants being attracted to the urine, a smell of ama (undigested food) from the urine and body, whiteness in the urine, excessive sleep, laziness, and breathlessness (shvasa) are indicative of prameha.

दन्तादीनां मलाढ्यत्वं प्राग्रूपं पाणिपादयोः ।दाहश्चिक्कणतादेहे तृट्स्वाद्वास्यं च जायते ।। Rasakamadhenu 29/18, yoga ratnakar 10, Bhava prakāśh samhita 38/5, vangasena a 38/5, vaidya chintamani 20/13, Sidha sara samhita 11/2, Gada nigraha 30/5, Madhava nidana 33/5, Brihat nighantu ratnakar

Preliminary Signs of prameha include dirtiness of the teeth, throat, mouth, and tongue; burning sensations in the hands and legs; oiliness of the body; persistent thirst (trishna); and a sweet taste in the mouth.

स्वपाणिपादाङ्गविदाहता तृषा शरीरसुस्निग्धतयातिचिक्कणम्। मुखातिमाधुर्यमिहातिभोजनम् प्रमेहरूपाणि भवन्ति पूर्वतः ।। Kalyanakarkam11/7

Preliminary Symptoms of prameha include burning sensations in the hands and soles, persistent thirst (trishna), oiliness (snighdta) in the body, a sweet taste in the mouth, and excessive hunger.

लक्षण

तत्राविलप्रभूतमूत्रलक्षणाः सर्व एव प्रमेहा भवन्ति ॥ Sushrut samhita nidana 6/6

सामान्यं लक्षणं तेषां प्रभूताविलमूत्रता ।  Ashtang hridya nidana 10/6, Bhava prakasha samhita 38/6, Gada nigraha 30/6, yoga ratnakar10, Madhava nidana 33/6, brihat nighantu ratnakar

All types of prameha are characterized by excessive and turbid urination.

दुष्टमूत्रार्त्तिवृत्तिं च प्रमेहं मुनयो जगुः ।। Sidha sara samhita 11/1

In prameha, dushita (impure) and painful urination is a symptom, which was described by ancient sages.

सूत्रमिश्र केवलं वा शुक्रं मेद्दति चेन्मुहुः । स प्रमेहोऽत्र भेदस्तु मूत्रवर्णविभेदतः ॥ Anjana nidana 145

If urine is mixed with shukra or if only shukra continuously excretes, it is known as prameha. Due to variations in urine color, prameha is classified into several types.

Kashyapa Samhita (Vedanadhyaya, Chapter 10, 22/55)

Vedanadhyaya. Gaurava, Baddhata, Jadya, Akasmat Mutra Nirgama Makshikakrant

शोषस्तापोऽङ्गकार्थं च बहुमूत्रत्वमेव च । अस्वास्थ्यं सर्वगात्रेषु मूत्रमेहस्य लक्षणम् ।। Rasa ratna samuchya 17/27

Symptoms of prameha include mouth dryness, burning sensation, weight loss, frequent urination, and debility.

स्वेदोंऽ गगंधंः शिथिलत्वमंगे शय्यासनस्वप्नसुखाभिलाषः । हृन्नेत्रजिह्वाश्रवणोपदाहो घनांगता केशनखातिवृद्धिः ।। शीतप्रियत्वं गलतालुशोषो माधुर्यमास्ये करपाददाहः। भविष्यतो मेहगणस्य लिंगं मूत्रेऽभिधावंति पिपीलिकाश्च।। तृष्णा प्रमेहो मधुरः सपिच्छो मधूपमस्स्याद्विविधो विकारः ।। Basavarajeevam 9/27-28

Symptoms of prameha include sweating, bad body odor, heaviness in the body, a desire to lie down or sleep, burning sensations in the chest, eyes, tongue, ears, hands, and legs, excessive growth of nails and hair, a preference for coldness, mouth dryness, sweetness in the mouth, and thirst. The urine may be similar to honey and attract ants.

All urinary diseases under prameha –

मधुरं यच्च सर्वेषु प्रायो मध्विव मेहति। सर्वेऽपि मधुमेहाख्या माधुर्याच्च तनोरतः ।। Bhavaprakasha samhita 38/28

All diseases of the urinary tract in which the urine resembles honey are classified as Madhumeha. In this condition, the entire body becomes sweet, reflecting the sweetness of the urine.

Reason for above symptoms –

धातुसंपर्कात्पुनः सर्वमेहेषु मूत्रमाविलं भूरि च भवति ॥ Ashtanga sangraha nidana 10/8

As their aee dhatus related in prameha that’s why their is excess urine and turbid urine

Reason for different types of prameha –

दोषदृष्यविशेषेऽपि तत्संयोगविशेषतः । मूत्रवर्णादिभेदेन भेदो मेहेषु कल्प्यते । ashtanga hridya nidana 10/7

Even though Kapha, Meda, and other dushya (pathological factors) in Prameha are similar, the variations in their degrees of vitiation result in differences in the color, taste, and characteristics of the urine. This variation leads to the classification of different types of Prameha based on these distinctive features.

Types –

2 types

द्वौ प्रमेहौ भवतः – सहजोऽपथ्यनिमित्तश्च । तत्र सहजो मातृपितृबीजदोषकृतः, अहिताहारजोऽपथ्यनिमित्तः । तयोः पूर्वेणोपद्रुतः कृशो रूक्षोऽल्पाशी पिपासुभृशं परिसरणशीलश्च भवति; उत्तरेण स्थूलो बह्वाशी स्त्रिग्धः शय्यासनस्वप्नशीलः प्रायेणेति ।। Sushruta samhita chikitsa 11/3

दृष्ट्वा प्रमेहं मधुरं सपिच्छं मधूपमं स्याद्विविधो विचारः । सम्पूरणाद्वा कफसम्भवः स्यात् क्षीणेषु दोषेष्वनिलात्मको वा ॥ Ashtanga hridya nidana 10/40

प्रकृतिप्रभवश्चैव नरस्य स्वकृतस्तथा।ज्ञेयः प्रमेहो द्विविधस्तस्य वक्ष्यामि लक्षणम् ।। Bhela samhita 6/1

There are two types of Prameha: hereditary and acquired.

Hereditary Prameha is caused by defects in the sperm or ovum and is characterized by a person who is lean, dry, has a poor appetite, is constantly thirsty, and remains active. Acquired Prameha, on the other hand, results from unwholesome food and behaviors. Individuals with this type are typically obese, overeat, consume oily foods, and prefer to lie down, sit, and sleep frequently.

20 types –

जलोपमं चेक्षुरसोपमं वा घनं घनं चोपरि विप्रसन्नम् । शुक्लं सशुक्रं शिशिरं शनैर्वा लालेव वा वालुकया युतं वा ॥
विद्यात् प्रमेहान् कफजान् दशैतान् क्षारोपमं कालमथापि नीलम् । हारिद्रमञ्जिष्ठमथापि रक्तमेतान् प्रमेहान् षडुशन्ति पित्तात् ॥
मज्जौजसा वा वसयाऽन्वितं वा लसीकया वा सततं विबद्धम् । चतुर्विधं मूत्रयतीह वाताच्छेषेषु धातुष्वपकर्षितेषु ॥ Charak samhita chikitsa 6/9-11

विंशतिः प्रमेहा भवन्ति । कफादुदकेक्षुसान्द्रसु- रापिष्टशुक्र सिकताशीतशनैर्लालाप्रमेहा दश । पि- त्तात्क्षारकालनीलहारिद्र‌माञ्जिष्ठशोणितमेहाः षट्। वाताद्वसामज्जहस्तिमधुमेहाश्चत्वार इति ॥ Ashtanga sangraha nidana 10/3

जलप्रमेहो रुधिरप्रमेहः लवणप्रमेहः । पूयप्रमेहो तक्रप्रमेहः खटिकाप्रमेहः शुक्रप्रमेहः कथितः पुरस्तात् ॥३॥स्याच्छर्करामेहो वसाप्रमेहो रसप्रमेहोऽन्यघृतप्रमेहः । पित्तप्रमेही कफमेहिनश्च मधुप्रमेहीति विभावयेच्च ॥४॥यथा च नामानि तथैव लक्षणं बलक्षयं वापि नरस्य देहे । Harita samhita 28/3-5 ( 14 types mentioned)

मेहाश्च विंशति ।।इक्षुमेहः सुरामेहः पिष्टमेहश्च सान्द्रकः। शुक्रमेहोदकाख्यौ च लालामेहश्च शीतकः । सिकताख्यः शनैर्मेहो दशैते कफसंभवाः।मञ्जिष्ठाख्यो हरिद्रा नीलमेहश्च रक्तकः ।।कृष्णमेहः क्षारमेहः षडेते पित्त्संभवाः हस्तिमेहो वसामेहो मज्जामेहो मधुप्रभः ।। चत्वारो वातजा मेहा इति मेहाश्च विंशतिः Sharangara samhita 7/59- 62

जलेतु सान्द्रास व शुक्रपिष्टलालाशनैः सैकतशीततस्ते ।माञ्जिष्ठद्दारिद्रक नीलका लक्षारास्रतो मज्जवसेभपौष्पात् ॥ Anjana nidana 146 slightly different name

उदके क्षुसांद्रसुरासिकताशुक्लशीतलम् । पिष्टलालातिमूत्रं च क्षारहारिद्ररक्तकम् ।। मंजिष्ठां नीलकालाश्च वसामज्जामधूत्थितम्। हस्तिमेहो विंशतिः स्युर्ज्ञात्वा वर्णेन लक्षयेत् ।। Basavarajeevam 9/10-11 

चत्वारो वातजा मज्जावसाक्षौद्रेभसंज्ञकाः ।। क्षारहारिद्रमंजिष्ठा नीलकालाश्च रक्तजम्। तोयेक्षुसिकतापिष्ट शुक्लसांद्रसुराशनैः ।।
शीतलं बहुसूत्रत्वं दशमेहाः कफोद्भवाः । Basavarajeevam 9/31-32

वसामज्जगजक्षौद्रसंज्ञा वातेन पित्ततः । रक्तहारिद्रमंजिष्ठा क्षारनीलाख्यकालकाः ।। जलेक्षु सिकतापिष्ट सुरासान्द्रसिताभिदाः । शुक्ललालाशनैराख्याः श्लेष्मतो लक्षयोद्भिषक् ।।Vaidya sara sangraha 6/72-73

उदकेक्षुसान्द्रसुरासिकताशुक्रशीतकम् पिष्टलालाशिमूत्रं च क्षारहारिद्ररक्तकम् ।।  मंजिष्ठानीलकालं च वसामज्जामधूत्थितम् । हस्तिमेहं विंशतीमं जातं वर्णेन लक्षयेत् ।। शोषस्तापोङ्गकार्थं च बहुमूत्रं तृषा भ्रमः । अस्वास्थ्यं सर्वगात्रेषु मेहोऽयं बहुमूत्रकः ।।Nityanatha name different

Kafaja Prameha-

Charak samhita samhita 6/12 commentry

In kaphaja prameha, the urine is typically white, sweet, and cold to the touch, with a smell reminiscent of ama (a toxic substance resulting from improper digestion).

शोषस्तापोंऽ गकाय च बहुमूत्रं तृवा भ्रमः ।। अस्वास्थ्यं सर्वगात्रेषु मेहोऽयं बहुमूत्रकः basavarajeevam 9/17

In kaphaja prameha, common symptoms include bahumutratra (excessive urination), krishta (weakness), jwara (fever), trishna (thirst), bhrama (dizziness), and general discomfort throughout the body.

अच्छे बहु सितं शीतं निर्गन्धमुदकोपमम् । श्लेष्मकोपान्नरो मूत्रमुदमेही प्रमेहति ॥ अत्यर्थमधुरं शीतमीषत्पिच्छिलमाविलम् । काण्डेक्षुरससङ्काशं श्लेष्मकोपात् प्रमेहति ।। यस्य पर्युषितं मूत्रं सान्द्रीभवति भाजने । पुरुषं कफकोपेन तमाहुः सान्द्रमेहिनम् ॥ यस्य संहन्यते मूत्रं किंचित् किंचित् प्रसीदति । सान्द्रप्रसादमेहीति तमाहुः श्लेष्मकोपतः ॥ शुक्लं पिष्टनिभं मूत्रमभीक्ष्णं यः प्रमेहति । पुरुषं कफकोपेन तमाहुः शुक्लमेहिनम् ।। शुक्राभं शुक्रमिश्र वा मुहुर्मेहति यो नरः । शुक्रमेहिनमाहुस्तं पुरुषं श्लेष्मकोपतः ॥ अत्यर्थमधुरं शीतं मूत्रं मेहति यो भृशम् । शीतमेहिनमाहुस्तं पुरुषं श्लेष्मकोपतः ॥मूर्तान्सूत्रगतान् दोषानणून्मेहति यो नरः । सिकतामेहिनं विद्यात्तं नरं श्लेष्मकोपतः ॥ मन्दं मन्दमवेगं तु कृच्छ्रं यो मूत्रयेच्छनैः । शनैर्मेहिनमाहुस्तं पुरुषं श्लेष्मकोपतः । तन्तुबद्धमिवालालं पिच्छिलं यः प्रमेहति । आलालमेहिनं विद्यात्तं नरं श्लेष्मकोपतः ॥ Charak samhita nidana 4/12-22

अच्छं बहु सितं शीतं निर्गन्धमुदकोपमम् ॥ मेहत्युदकमेहेन किञ्चिच्चाविलपिच्छिलम् ।इक्षो रसमिवात्यर्थ मधुरं चेक्षुमेहतः ॥ सान्द्रीभवेत्पर्युषितं सान्द्रमेहेन मेहति ।सुरामेही सुरातुल्यमुपर्यच्छमधो घनम् ॥ संहृष्टरोमा पिष्टेन पिष्टवद्वहलं सितम् ।शुक्राभं शुक्रमिश्र वा शुक्रमेही प्रमेहति ॥ मूर्ताणून् सिकतामेही सिकतारूपिणो मलान् ।शीतमेही सुबहुशो मधुरं भृशशीतलम् ॥शनैः शनैः शनैर्मेही मन्दं मन्दं प्रमेहति।लालातन्तुयुतं मूत्रं लालामेहेन पिच्छिलम् ॥ Ashtanga hridya nidana 10/8-17, Bhava prakasha samhita 38/ 8-12, Madhava nidana 33/7-12, Gada nigraha 30/7-12,Madhava Nidana, Brihat Nighantu Ratnakar

स्वच्छं बहुसितं शीतं निर्गंधमुदकोपमं । मेहत्युदकमेहेन किंचिदाविल पिच्छिलम् ।।इक्षो रसमिवात्यर्थ मधुरं चेक्षु मेहतः । सांद्री भत्रेत्पर्युषितं सांद्रमेहं तदुच्यते ।।सुरामेही सुरातुल्य मुपर्यच्छमधोधनम् । मूत्राणून्सिकतामेही सिकता रूपिणोमलान् ।।शुक्लाभः शुक्रमिश्र वा शुक्रमेही प्रमेहति शीतमेही सुबहुशो मधुरं चाति शीलतम् ।।संहृष्ट रोमा पिष्टेन पिष्टवद्वहलं सितम् शनैश्शनैश्शनैर्मेही मंद मंदं प्रमेहति । ।लाला तंतु युतं मूत्रं लालामेहेन पिच्छिलम् Vaidya chintamani 20/16-20

तत्त्र, श्वेतमवेदनमुदकसदृशमुदकमेही मेहति; इक्षुरसतुल्यमिक्षुवालिकामेही; सुरातुल्यं सुरामेही; सरुजं सिकतानुविद्धं सिकतामेही; शनैः सकफं मृत्स्त्रं शनैर्मेही; विशदं लवणतुल्यं लवणमेही; हृष्टरोमा पिष्टरसतुल्यं पिष्टमेही; आविलं सान्द्रं सान्द्रमेही; शुक्रतुल्यं शुक्रमेही; स्तोकं स्तोकं सफेनमच्छं फेनमेही मेहति ॥ sushrut samhita nidana 6/10

तत्र शीतं श्वेतमगन्धमच्छमुदकमिवोदकमेही मेहति । इक्षुरसमिवातिमधुरं शीतमीषत्पिच्छिला- विलमिधुमेही । पर्युषितं सान्द्रीभवत्सान्द्रमेही । सुरातुल्यमुपरिप्रसन्नमधः सान्द्रं सुरामेही । हृष्टरोमा पिष्टमिव सान्द्रसितं च पिष्टमेही। शुक्राभं शुक्रमिश्र वा शुक्रमेही । सरुजं ससिकतमिव सिकतामेही । मधुरमतिशीतं शीतमेही । मन्दं शनैः शनैः शनै- मेंही । पिच्छिलं तन्तुबद्धमिव लालावल्लालामेही ashtanga sangraha nidana 10/11

यस्सदा मेदसा क्लिन्नः श्लेष्मलं भजतेऽशनम्। तस्य प्रकुपितः श्लेष्मा प्रमेहान् कुरुते दश॥तद्यथोदकमेहं च पिष्टमेह तथैव च । एवमादींस्तथान्यांश्च तेषां वक्ष्यामि लक्षणम् ॥ स्फटिकाम्बुनिभं मूत्रमुदमेही प्रमेहति। शुक्लपिष्टनिभं चापि पिष्टमेही प्रमेहति ॥ काण्डेक्षुरसमेही च मेहतीक्षुरसोपमम्।मूत्रं शुक्लोपमं चापि शुक्लमेही तु मेहति ॥ इत्येतांश्चतुरो मेहाञ्जानीयात्केवलात्कफात्। श्लेष्मण्यनुबले पित्ते ये मेहन्ति तु ताञ्छृणु ॥ लवणाम्बुनिभं मूत्रं विद्याल्लवणमेहिनः । प्रमेहति तथा जन्तुस्सुरामेही सुराकृति॥  मूत्रं सान्द्रं प्रसन्नं तु दृश्यते सान्द्रमेहिनः । Bhela samhita 6/7-12

प्रमेहो बहुमूत्रत्वं मेहः स्यान्सूत्रदूषणम् ।तद्विंशतिप्रकारं स्यात्कफपित्तानिलैः पुनः । rasakamadhenu 29/19

पिष्टमिश्रोदकनिभं तले सान्द्रञ्च रक्षितम्। मूत्रं यत्र भवेत् प्रायः पिष्टमेहः स उच्यते ॥प्रायेण शुक्रमिश्र हि शुक्रमेही प्रमेहति। स प्रायः कामजो यूनां विबन्दौ तु सोऽधिकः ॥लालातन्तुयुतं मूत्रं लालां वा यस्तु मेहति। तं लालामेहिनं विद्यात् स प्रायः स्वप्नदोषयुक् ॥ स चापि कामजो रोगो यूनां प्रायेण दृश्यते।पौरुषग्रन्थिजा लाला ह्यत्र स्त्रवति भूरिशः ॥  Sidhanta nidana 6/564

• Like water but contains little impurities and Singda (ashtanga hridya), transparent, excessive, white, cold, odourless, slightly turbid (bhavaprakasha)- udaka meha
  • अच्छं बहु मुहुर्गन्ध वर्णहीनं जलोपमम्। मेहत्युदकमेहेन सूत्रं माधुर्यवर्जितम् ॥ स चापि द्विविधो ज्ञेयः कफजो वातजस्तथा। कफजो मधुमेहाग्रयोऽपरो भूम्ना तु योषिताम् ॥ sidhanta nidana 6/562-63
  • Clear, bahu, muhuh, odurless, colourless, sweetness and similar to water. It’s of 2 types of kaphaja that occur during early stages of madhumeha and second one being vataja commonly seen in females
• Like Sugarcane, excessive sweet, cold, slight snighda, turbid- iksu meha
• Thick or viscous when kept in pot overnight it precipitates- sandra meha
• Having precipitation downward and  upper layer totally clear- sandra prashada meha
• White coloured – sukla meha
• Mixed with semen, due to kama, in young people with constipation ( sidhanta nidana) – sukra meha
• Urine cold in touch, frequent urination, sweet ( astanga hridya)- sita meha/ sisira meha
• Slow urine, sticky( sushruta), again again urine (ashtanga hridya)- sanair meha
• Saliva like urine,  contains thread like saliva, due to savapanadosha, kama, in young people , lala is secreation from purusha granthi ( sidhanta nidana ) – lala meha
• Gravels containing, painful urination with sand like particles (sushruta) – sikata meha
  • मूर्जाणून् सिकतामेही सह मूत्रेण मेहति। अल्पाम्बुपानात् स प्रायो विदग्धाजीर्णतस्तथा ॥ Sidhanta nidana 6/570
  • It’s due to drinking less water and vidagajeerna
• Like alcohol, clean on top and ghana in bottom(ashtanga hridya )- surameha ( sushruta)
  • उत्सिक्तशीधुवदगन्धं मूत्रं स्यात् शीधुमेहिनः ।मधुमेहे पुराणे स क्वचिद् घोरप्रमोहयुक् ॥ Sidhanta nidana 6/584
  • Sidhu meha – urine smells like sidhu, seen in chronic madhumeha and produces profound delusion.
• Like salt – lavanamehi (sushruta)
• Like pisti, hairs raising, white, remains thick when put in water (sidhanta nidana )- pistamehi ( sushruta)
• Froathy – phenamehi ( sushruta)
• Turbid and dense urine – sundramehi ( sushruta)
• Krishta, jwar, weakness, excessive urination, thirst, dizziness, heaviness in- bahumutratra (nityanatha)
  • Bahu mutra meha –
    • कार्यं स्वेदोऽङ्गगन्धः करपदरसनानेत्रकर्णोपदेहः कासः शैथिल्यभङ्गेऽरुचिरपि पिटिकाः कण्ठताल्वोष्ठशोषः ।दाहः शीतप्रियत्वं धवलिमतनुता श्रान्तता पीतमूत्रं मूत्रस्था मक्षिकाद्याश्चिरमपि बहुमूत्राख्यरोगे प्रवृद्धे ।। yoga ratnakar Bahumutrameha 1
    • In chronic polyuria, symptoms may include an unpleasant body odor, dirtiness on the hands, legs, tongue, eyes, and ears, coughing (kasa), body stiffness (anga shilta), loss of appetite (aruchi), skin lesions (peedika), dryness of mouth, a burning sensation, preference for cold environments, fatigue, yellowish urine, and the presence of flies on the urine.
• वृक्काभ्यां निःस्रुतं मूत्रं लसीकावर्जितं स्वतः ।वृक्करोगेषु सा मूत्रे मिश्रितैव प्रवत्र्त्तते ॥ लसीकामेहसंज्ञोऽयं, द्विविधः स च दृश्यते । बहुमूत्रोऽल्पमूत्रशश्च, भूम्ना शोथसखः परः ॥Siddhnata nidana 6/567-568
  • Urine coming out of vrikka normally doesn’t conatin lasika, in vrikka vikara lasika comes out with urine it is of two types – bahumutra and alapmutra with shithaLasika meha

Pittaja Prameha

गन्धवर्णरसस्पर्शेर्यथा क्षारस्तथाविधम् । पित्तकोपान्नरो मूत्रं क्षारमेही प्रमेहति । मसीवर्णमजस्त्रं यो मूत्रमुष्णं प्रमेहति । पित्तस्य परिकोपेण तं विद्यात् कालमेहिनम् ॥ चाषपक्षनिभं मूत्रमम्लं मेहति यो नरः । पित्तस्य परिकोपेण तं विद्यान्नीलमेहिनम् ॥ विस्त्रं लवणमुष्णं च रक्तं मेहति यो नरः । पित्तस्य परिकोपेण तं विद्याद्रक्तमेहिनम् ।। मञ्जिष्ठोदकसंकाशं भृशं विस्त्रं प्रमेहति । पित्तस्य परिकोपात्तं विद्यान्माञ्जिष्ठमेहिनम् ॥हरिद्रोदकसङ्काशं कटुकं यःप्रमेहति । पित्तस्य परिकोपात्तं विद्याद्धारिद्रमेहिनम् ॥ Charak samhita nidana 4/33-34

अत ऊर्ध्वं पित्तनिमित्तान् वक्ष्यामः – सफेनमच्छं नीलं नीलमेही मेहति; सदाहं हरिद्राभं हरिदामेही अम्लरसगन्धमम्लमेही; स्स्रुतक्षारप्रतिमं क्षारमेही; मञ्जिष्ठोदकप्रकाशं मञ्जिष्ठामेही; शोणितप्रकाशं शोणितमेही मेहति ॥sushruta samhita nidana 6/11

गन्धवर्णरसस्पर्शेः क्षारेण क्षारतोयवत् ।नीलमेहेन नीलाभं कालमेही मषीनिभम् ।।हारिद्रमेही कटुकं हरिद्रासन्निभं दहत् । विस्रं माञ्जिष्ठमेहेन मञ्जिष्ठासलिलोपमम् ।। विस्रमुष्णं सलवणं रक्ताभं रक्तमेहतः । Ashtanga hridya nidana 10/13-16, Bhava prakasha 38/13-15, Vaidya chintamani 20/21-23, Gada nigraha 30/13-14, Madhava Nidana, Brihat Nighantu Ratnakar

वर्णगन्धरसस्पर्शेस्तु क्षारोपमं क्षारमेही । उष्णं मषीकालं कालमेही। सफेनमच्छमम्लं चाषपत्रनीलं नीलमेही । कटुकं सदाहं हरिद्राप्नुतमिव हारिद्र‌मेही । विस्त्रं मञ्जिष्ठोदकवर्ण माञ्जिष्ठमेही । विस्त्रमुष्णं लवणं शोणितसङ्काशं शोणितमेही ॥ Astanga sangraha nidana 10/12

• Like alkali, smell, colour, taste, touch same as alkali, similar to kshara washed with water(ashtanga hridya), – ksara meha
• Black coloured urine, hot – kala meha
• Like the feathers of bird casa, Blue coloured urine, froath (sushruta), clear and amla rasa( ashtanga sangrha) – nila meha
  • शकृतः सञ्चयाद् भूयो नीलमेहः प्रजायते।विस्त्रं नीलञ्च तन्मूत्रमुदावर्त्तादिषु क्वचित् ॥ Sidhanta nidana 6/577
  • Due to the mixing of faeces, it can be seen in udavarta, 
• Like haridra, Yellow coloured, burning sensation (sushruta), katu rasa (ashtanga sangraha)- haridra meha
  • घोरहारिद्रवर्णं तु मूत्रं हारिद्रमेहिनः । स भवेत् पित्तदोषेण कामलादौ यकृद्गदे ॥ Siddhanta nidana 6/572
  • It is commonly seen in kamla and diseases of liver
• Like manjistha, Deep red coloured urine,  abundant, smell like raw flesh- manistha meha
• Urine mixed with blood, hot, red, smell of raw flesh, salty taste( ashtanga hridya)- rakta meha
  • रक्तवर्णं विवर्ण वा रक्तमेही प्रमेहीति ।माञ्जिष्ठमसणं वापि मसीवर्णमथापि वा ॥बस्तौ वा मेहनान्तर्वा रक्तस्त्रावाद् भृशारुणम् ॥ श्लीपदादीक्रिर्वापि कदाचिद् रक्तामूत्रता।अतिमैथुनतो वाऽपि रक्तं मूत्रे प्रवर्त्तते। पूयमेहे तथाश्मर्यां कदाचिद् रक्तमूत्रता।विषमज्वरतः क्वापि कालमेहस्य सम्भवः ॥ Sidhanta nidana 6/573-576
  • It is commonly seen in shalipada, excess copulation, similar to puyameha, ashamari, vishma jwar, kala jwar
• Puyameha – urine mixed with puya, turbid, solid particles, caused by paka in vrikka, it can also be agantuj in which blood comes before urine, with or without pain
  • पूयमिश्र यदा मूत्रमाविलं तले घनम् ।विस्त्रञ्च पूयमेहोऽसौ वृक्क बस्त्यादिपाकतः । आगन्तुः पूयमेहोऽन्यो विषजो यत्र मूत्रणात् ।
    पुरः पूयं सरुग्रक्तं तनु वाऽरुक् प्रवर्त्तते ॥ Sidhanta nidana 6/578
• Taste and smell like amla – amlameha ( sushruta)

Vataja Prameha-

श्यावारुणो वातकृतः सशूलो मज्जादिसाद्‌गुण्यमुपैत्यसाध्यः ॥ Charak Samhita chikitsa 6/12

Characterized by a swarthy or red-colored urine, is often associated with pain and exhibits attributes similar to majja (bone marrow). This type of prameha is considered incurable due to its severity and the deep-seated nature of the symptoms.

Types –

वसामिश्र वसाभं वा मुहुर्मेहति यो नरः । वसामेहिनमाहुस्तमसाध्यं वातकोपतः ॥ मज्जानं सह मूत्रेण मुहुर्मेहति यो नरः । मज्जमेहिनमाहुस्तमसाध्यं वातकोपतः ॥ हस्ती मत्त इवाजस्त्रं मूत्रं क्षरति यो भृशम् । हस्तिमेहिनमाहुस्तमसाध्यं वातकोपतः ॥ कषायमधुरं पाण्डु रूक्षं मेहति यो नरः । वातकोपादसाध्यं तं प्रतीयान्मधुमेहिनम् ॥ Charak samhita nidan 4/41-44

अत ऊर्ध्वं वातनिमित्तान् वक्ष्यामः – सर्पिः प्रकाशं सर्पिर्मेही मेहति; वसाप्रकाशं वसामेही; क्षौदरसवर्ण क्षौद्रमेही; मत्तमातङ्गवदनुप्रबन्धं हस्तिमेही मेहति ॥ Sushruta samhita nidana 6/12

वसामेही वसामिश्र वसां वा मूत्रयेन्मुहुः ।।मज्जानं मज्जमिश्र वा मज्जमेही मुहुर्मुहुः । हस्ती मत्त इवाजस्रं मूत्रं वेगविवर्जितम् ।। सलसीकं विबद्धं च हस्तिमेही प्रमेहति ।मधुमेही मधुसमं | ashtanga hridya nidana 10/16-18, Bhavaprakasha samhita 38/16-17, gada nigraha 30/15- 17,Vaidya chintamani 20/23-25, Madhava Nidana, Brihat Nighantu Ratnakar

वसामिश्र वसां वा वसामेही । मजमिश्र मजानं प्रमे वा मज्जमेही । सलसीकं मधुरमवेगं लसीकयैव च पु विबद्धमनुबद्धमजस्त्रं मत्त इव हस्ती स्रवति हस्ति- है मेही । सफेनमच्छमोजः स्निग्धमधुरं तद्रौक्ष्याद्वायुः कषायत्वेनोपसृजति तेन कषायमधुरोपेतं मध्विव मेहति मधुमेही । सतु द्विधा कैश्चिदिष्यते । धातु- क्षयेणानिलप्रकोपाद्दोषावरणेन वा ॥ Ashtang sangraha nidana 10/13

• Bone marrow mixed, pure bone marrow as urine(ashtanga hridya)- Majja meha
• Ojas mixed, kashaya, madhur, pale, ruksha like honey ( ashtanga hridya), doesn’t contain any fat (bhavaprakasha)- oja meha, madhu meha
• Vasa mixed or similar to vasa – vasa meha
  • दुग्धाभं वा वसाभं वा मूत्रं सान्द्रीभवेद् यदि। वसाणुकणिकाधिक्यात् स वसामेह उच्यते ॥ सर्पिर्मेहस्तु तद्भदो वसाभूयिष्ठताकृतः । स प्रायः श्लीपदे दृष्टः शूक्ष्मक्रिमिसमाकुलः । असृग्लेशयुतं तत्र मूत्रं प्रायेण दृश्यते ॥कदाचिन्मधुमेहेऽपि तनुस्नेहं प्रमेहति ॥ Sidhanta meha 6/581-83
  • Urine resembles milk or vasa, becomes thick as it contains vasa it has one type known as sarpimeha that has more vasa in it, its commonly seen in shalipada, krimi, it has less blood, it is sometimes seen in madhumeha.
• Like elephant, Lymph mixed or passes urine with broken stream or with obstruction, without urge, sweet(ashtanga sangraha )-hastimeha
• Urine like ghee – sarpimeha ( sushruta)
• Like honey, smell also like honey – ksaudramehi
  • मधुवन्मधुरं मूत्रं यः प्रायो भूरि मेहति। मधुमेहीति तं विद्यात् तृष्णा-दाह-क्लमान्वितम् ॥ sidhanta nidana 6/595
  • Urine sweet, large quantity, with thirst, burning sensation and exhaustion is called madhumeha

Dvandaja prameha-

यथा हि वर्णानां पञ्चानामुत्कर्षापकर्षकृते न संयोगविशेषेण शबलबभ्रुकपिलकपोतमेचकादीना वर्णानामनेकेषामुत्पत्तिर्भवति, एवमेव दोषधातुमलाहारविशेषेणोत्कर्षापकर्षकृतेन संयोगविशेषेण प्रमेहाणां नानाकरणं भवति ॥ Sushruta nidana 6/26

The five basic colors of urine, influenced by the permutations and combinations of doshas (biological energies), dhatus (tissues), malas (waste products), and ahara (diet), give rise to a variety of urine colors, such as Sabala (spotted or variegated), Babhru (brownish), Kapila (tawny or reddish-brown), Kapota (dove-colored or grayish), and Mecaka (blackish or dark).

Aagantuja prameha –

आगन्तुहेतुकाश्चापि सन्ति मेहाः पृथग्विधाः । यथा हि वक्ष्यमाणाः स्युः सूक्ष्मजन्त्वादिसम्भवाः ॥ Sidhanta nidana 6/558

This type of Prameha, caused by subtle microorganisms (Sushma Jantus), differs from other types of Prameha caused by stationary (Sthavara) and mobile (Jangama) entities. The subtle microorganisms are often linked to specific, more refined disturbances in the body’s doshas and dhatus, leading to distinct manifestations and challenges in treatment compared to those caused by the stationary and mobile pathogens.

Bhesaja meha –

विविधैर्नील-रक्तादिभेषजैरुपसेवितैःतत्तत्सवर्णता मूत्रे स मेहो भेषजोद्भवः ॥ Sidhanta nidana 6/585

Sometimes, medications can cause changes in urine color. For instance, certain drugs might turn the urine blue or red. These color changes are often due to the presence of pigments or metabolites in the drugs that are excreted through urine. It’s important to differentiate these drug-induced color changes from pathological conditions to avoid misdiagnosis.

Mutra Pariksha in prameha –

वात पित्त कफमेह समुत्थं मूत्रमग्नि निहितं परिपाकात् । पंच सप्त नव भागवशिष्टं कल्कमुद्भवति चेत् दसाध्यम् ।।vaidya chintamani 20/50, basavarajeevam 9/39, nityanatha

When urine is heated at a mild temperature, the extent to which it concentrates can help in diagnosing the type and severity of Prameha. If one-fifth of the urine evaporates, it suggests the condition is Vataja Prameha, one-seventh of the urine evaporates, it indicates Pittaja Prameha. And one-ninth of the urine evaporates, signifies Kaphaja Prameha. These varying levels of concentration imply the seriousness of the condition, with greater concentrations generally indicating a more difficult or incurable state of Prameha.

Diagnosis of madhumeha –

स चापि गमनात् स्थानं स्थानादासनमिच्छति । आसनाद्वृणुते शय्यां शयनात् स्वप्नमिच्छति ।। Sushruta samhita nidana 6/25

Madhumeha patients typically prefer standing over walking, lying down over sitting, and sleeping while lying down rather than sitting.

Types of madhu meha –

2 types of Madhumeha

जायते स किल द्विधा ॥ क्रुद्धे धातुक्षयाद्वायौ दोषावृतपथेऽथवा । Ashtanga hridya nidana 10/18

मधुमेहे मधुसमं जायते स किल द्विधा ।। कृध्दे धातुक्षयाद्वायौ दोषावृतपथेथवा । Vaidya chintamani 20/33-34

• Path Blockage Type: This type occurs due to the obstruction in the pathways of Vata, which prevents its proper flow and function.
  • आवृतो दोषलिंगैस्तु सोऽनिमित्तं प्रदर्शयन् ।क्षीणः क्षणात्पुनः पूर्णो भजते कृच्छ्रसाध्यताम् ॥ Brihat nighantu ratnakar
  • When Vayu is obstructed by any dosha and its signs frequently flare up, the condition becomes incurable.
• Vata Vitiation Type: This type arises due to the vitiation of Vata caused by the depletion (Kshaya) of bodily tissues (Dhatus).
  • तृष्णा तीव्रा त्वचो रौक्ष्यं क्लमो दौर्बल्यमेव च। विड्बन्ध कृशता वृद्धिर्मधुरप्राज्यमूत्रता । जिह्वादिषु मलाधिक्यं दाहश्च करपादयोः । मधुमेहस्य लिङ्गानि भस्मकाग्निश्च कुत्रचित् ॥ मेदस्विनस्तु तान्यादौ सन्ति गूढ़ानि भूयसा । तस्य व्यायामहीनत्वे प्रदुःषन्ति शनैः शनैः । पिपासा कृशतावृद्धौ पिड़काद्युद्गमेऽथवा । विज्ञाते मूत्रमाधुर्ये स प्रायः प्रतिबुध्यते ॥कृशस्य मधुमेहे तु प्रचुर-स्वादुमूत्रता । तृष्णा-दौर्वल्य-कार्थ्यानाम वृद्धिरत्यग्निता तथा ॥ Siddhant nidana 6/613-27
  • The signs of Dhantu Kshaya Janaka include thirst, dryness, debility, constipation, weakness, sweetness in the urine, increased urine volume, accumulation of dirt on the tongue, burning sensations in the hands and palms, and sometimes the presence of ash-like substances.

4 types of Madhumeha –

नवीनश्च पुराणश्च मधुमेहो द्विधा मतः । भूयश्च द्विविधः प्रोक्तः स्थूलस्य च कृशस्य च। स्थूलस्य मधुमेहस्तु प्रौढ़स्य बलिनो भवेत्। त्रिंशदूर्ध्ववयस्कस्य चिरकारी स दृश्यते ॥ कृशस्य तु ततः पूर्वं बालस्य तरुणस्य च। दृश्यते दुर्बलस्यैव शीघ्रकारी स कष्टदः ॥ Siddhnat nidana 6/610-12

Madhumeha can be categorized into:

1. Navena: A recent onset of the condition, characterized by a relatively new development.
2. Purana: A long-standing or chronic form of Madhumeha that has persisted for a long time.
3. Sthula: This type occurs in middle age, is typically strong, and tends to be more persistent (Chirkari).
4. Krisha: This type occurs in childhood, is associated with weakness, has a more troublesome nature (Kastda), and progresses rapidly (Shigrakari).

Samprapti of Madhumeha –

भूयिष्ठमधुरं भुक्तं रसं संजनयेत् विपाकान्मधुरोत्तरम् सोऽसौ रक्तमाश्रित्य सञ्चरन्। परिणामं न लभते सम्यग् धात्वग्निवैकृतात् । माधुर्यं तेन रक्तादेस्ततो मधुरमूत्रता ॥अथ धात्वग्निविकृतिर्यथा स्यात् तत् प्रवर्ण्यते । अग्ग्र्याशयोद्गतः सूक्ष्मो रसोऽन्तःस्रवणस्तु यः ।रसस्य परिणामाय मधुरस्य प्रभाववान् । स रक्ते सञ्चरन् नित्यं धात्वग्नेर्बलमावहेत् ॥ यदा त्वग्न्याशयांशस्य विकृतेः स प्रहीयतेतदा स्याद् रक्तमाधुर्य मूत्रमाधुर्यमेव च ॥अथ स्वभावाद् यकृतो या शक्तिः परिणामकृत्। मधुराणां विशेषेण सञ्चयाय व्ययाय च। साऽप्यत्र हीयते कालेऽव्यायामाद् भूरिभोजनात्। तेनापि रक्तमाधुर्यं विशेषाद् भवति ध्रुवम् ॥ इति नव्यमतं प्रोक्तं प्रत्यक्षज्ञानमूलकम् । परीक्षाशतसिद्धं च, प्राञ्चस्त्वेवं प्रचक्षते ॥ Siddhanta nidana 6/599-605

When excessive sweets are consumed, the resulting digestion also becomes sweet, leading to a sweetened rasa. This sweetened rasa then mixes with rakta and circulates throughout the body. Due to abnormalities in dhatvagni, this sweetness does not transform properly.

How Dhatvagni Vikriti Occurs:

Antarsrava from the agnashaya is required to convert the sweetness of rakta. This process travels with the rakta and enhances the strength of dhatvagni. However, if there are abnormalities or alterations in the agnashaya, it impairs the capacity of the liver to store, utilize, or transform sweetness effectively. Over time, with continued intake of nidana (such as lack of physical exercise), there is increased storage of sweetness. This phenomenon is discussed in various texts and corroborated by numerous experiments and direct observations.

Signs explanation –

शोषंस्तापोंग कार्यं च बहुमूत्रं तृषा भ्रम ।। अस्वास्थ्यं सर्व गात्रेषु मेहोयं बहुमूत्रकः। कार्यं स्वोदोंग गंधः करपदरसना नेत्र कर्णोप दाहः ।। कासश्शैथिल्यमंगेरुचिर पिपिटका कंठताल्वोष्ठ शोषः । दाहशीत प्रियत्वं धवव्ठिम्नतनुताश्रांतता पीतमूत्रं ।।  मूत्रस्थां मक्षिकाद्याश्चिरमपि बहुमूत्राख्य रोगे प्रवृध्दे । Vaidya chintamani 20/34-36

Madhumeha is predominantly characterized by bahumutratra (excessive urination) and manifests with symptoms such as dhatu shosha (tissue wasting), daha (burning sensation), sharir kshaya (general weakness), trishna (thirst), bhrama (dizziness), and satvika hanita (diminished vitality). As bahumutratra intensifies, it leads to additional issues including krishta (weakness), sweda (excessive sweating), sharir dorgandayta (body weakness and frailty), and a burning sensation over the hands, legs, and other body parts. The condition can also cause kasa (cough), sthalyata (obesity), aruchi (loss of appetite), pidika (blisters), and dryness of the kanta (throat), talu (palate), and oshta (lips). Patients may develop an increased desire for cold foods, experience a white coloration of the body, and notice weakness along with a yellowish hue in the urine. Additionally, the urine may attract ants and flies, reflecting the severity and extensive impact of the condition on overall health.

End point of every prameha –

सर्व एव प्रमेहास्तु कालेनाप्रतिकारिणः । मधुमेहत्वमायान्ति तदाऽसाध्या भवन्ति हि ( sushrut samhita nidan 6/27)

If prameha is not treated properly and in a timely manner, it can progress to madhumeha and become incurable.

कालेनोपेक्षिताः सर्वे यद्यान्ति मधुमेहताम् ।। मधुरं यच्च सर्वेषु प्रायो मध्विव मेहति । सर्वेऽपि मधुमेहाख्या माधुर्याच्च तनोरतः ॥ Astanga hridya nidana 10/20-21

When prameha is not treated effectively, it can progress to madhumeha. In cases where the urine becomes sweet, resembling honey, due to the consumption of sweet food products, all such types of prameha are classified as madhumeha.

Chikitsa sutra –

स्थूलः प्रमेही बलवानिहैकः कृशस्तथैकः परिदुर्बलश्च । सबृंहणं तत्र कृशस्य कार्यं संशोधनं दोषबलाधिकस्य ॥ऊर्ध्वं तथाऽधश्च मलेऽपनीते मेहेषु संतर्पणमेव कार्यम् ॥गुल्मः क्षयो मेहनबस्तिशूलं मूत्रग्रहश्चाप्यपतर्पणेन । प्रमेहिणः स्युः, परितर्पणानि कार्याणि तस्य प्रसमीक्ष्य वह्निम् ॥ Charak samhita chikitsa 6/15-17, Bhaisjya ratnavali 37/1

प्रायेण हि प्रमेहिणोऽभिष्यण्णदेहत्वादुपहताग्नेर्भक्ष्यादि- पञ्चविधमप्यन्नमुपयुक्तं सूत्राय मेवसे च विपरिणमते । तस्मादस्य तेजोधातुवृद्धये क्लेदमेदः प्रशमनाय च बलिनः बलिनः तु संशमनानि । सर्वस्य संशोधनानि प्रयुञ्जीत । दुर्बलस्य तु संशमनानि । सर्वस्य च बद्धमुत्राण्यमेदस्कराण्यबृंहणान्यग्निदीपनानि बलजननानि चान्नपानानि । बलं हि विधिनोपचितमशेषामय संप्रवर्तते ।। Ashtanga sangraha chikitsa 14/2

There are two types of prameha patients: those who are obese and strong, and those who are lean and weak. For the emaciated and weak patient, sambhramana (nourishing treatment) should be administered. For those with good strength or an abundance of dosha, sansodhana (purification therapy) is appropriate. After snehan (oleation) and shodhana (cleansing), santarpana (nourishment) should be performed. If santarpana is not done, the patient may suffer from complications such as gulma (abdominal masses), kshaya (wasting), pain in the bladder or penis, and urine retention. Santarpana should be carried out with consideration of the patient’s agni (digestive fire).

तत्त्र कृशमन्नपानप्रतिसंस्कृताभिः क्रियाभिश्चिकित्सेत, स्थूलमपतर्पणयुक्ताभिः ।। Sushruta samhita chikitsa 11/4

Krisha pramehi (a patient with emaciated and weak prameha) is treated with processed foods and nourishing drinks to build strength and vitality. In contrast, an obese pramehi (a patient with excess body weight due to prameha) is managed with apatarpan chikitsa (reduction therapy) to decrease excess weight and balance doshas.

बृहयेदौषधाहारैरमेदोमूत्रलैः कृशम् । Ashtanga hridya chikitsa 12/38

Krisha pramehi (emaciated patient) should be given medicines and foods that promote sharir pushti (body nourishment) without increasing meda (fat) and mutra (urine). This involves choosing nutrient-dense foods that support overall health and vitality without exacerbating urinary issues or contributing to further fat accumulation.

Early treatment required –

मेही गुल्मी वातरोगी च कुष्ठी रक्ती चापस्माररोगी क्षयी च। वर्ज्याः क्षीणा अल्पमात्रेऽपि रोगे प्रोक्ता एते यस्तथैवोदरार्तः ॥ Yoga chandrika 14/25

Diseases like Meha, Gulma, Vataroga, Kushta, Rakta Pitta, Kashaya, and Apasmara, especially when accompanied by Udara Roga or when in a debilitated state, should not be treated lightly, even if they appear mild. The underlying severity and complexity of these conditions necessitate careful and thorough management.

Pathya

• Charaka Chikitsa (6/18-24)
  • Recommended Diet: Includes mantha, kashaya, yava churna, leha, laghu aahar, non-unctuous foods like boiled barley, vatya, saktu, meats from anupa and wild animals, vatya madya, old sali rice, mudga daal, bitter vegetables mixed with oils like danti, ingudi, atasi, sarshapa, and sastika rice. Barley (yava), saktu, apupa, and dhana with jaggery are particularly beneficial. For animals, feed vaya, godhuma, and venu yava, then use their dung for cooking. Haridra (turmeric) is also recommended.
  • Kapha Prameha: Yava with honey is beneficial. For santarpana, use vaya soaked overnight with triphala and honey, or yava with sidhu daily.
• Charaka Chikitsa (6/46-48, 49-50)
  • Therapies and Diets: Includes sarodska, kusidaka, madhudaka, triphala rasa, sidhu, madhvika, and dry, ruksha (without added ghee) foods. Emphasizes amla, exercise, bath, udavartana, sprinkling water, and kaphaj kushta treatment. The diet for obesity should be applied to prameha.
• Sushruta Samhita (11/6)
  • Recommended Foods: Sali, sastika, yava, godhuma, old kodrava, uddalaka, canaka, adhaki, kuluttha, mudga, tikhta, kashaya, leafy vegetables processed in oils like nikumbha, ingudi, sarsapa, and atasi. Wild animal meats (e.g., deer) are advised without amla or ghee. Include banana tree twigs, patola, and prapunnata.
• Ashtanga Hridaya (12/5, 12/10-14, 33)
  • Diet and Therapies: Haridra with madhu (honey), amla swaras with honey or haridra, and foods processed (gehu and jo) with kaphaja and pittaja shamak dravya kwatha. Include jo ke aate ka maalpua (apoop), sattu, bati, daliya, trina dhanya, moonga, purane shali chawal, tila and sarsa ki khali, shrikukuta, kaitha, tinduk, jamuna, tikhta rasa shaak, madhu, sukhe bhakshya, and shool par banaya gaya mansa. Shilajeet with mansa rasa or shali chawal is recommended. Regular exercise and night vigilance are crucial.
• Sushruta Samhita (11/10)
  • Diet for Rich or Disinclined Patients: Include more patha, abhaya, chitraka, and honey. Meat should be served with madhvika. Use foods and drinks with more honey, kapitha, and maricha. Add powders of camel, horse, and donkey dung. Include hing and saindhava. Syamaka and nivara with fruits of amla, kapittha, tinduka, and ashmantaka are beneficial. Obese patients should engage in physical activities like walking and riding.
• Bhela Samhita (7/3)
  • Dietary Recommendations: Frequent bathing for kapahaja prameha. For pittaja prameha, consume tikhta and kashaya rasas.
• Bhaisjya Ratnavali (37/3-5)
  • Beneficial Foods and Therapies: Meat soups from viškira, pratuda, vihanga, and jangala animals; mantha, powders of kashaya, rasa dravyas, mudga, masora. Include syamaka, kodrava, uddalaka, godhima, cana, adhaki, kuluttha, jangala mamsa (wild animal meat), tikta saka (bitter leafy vegetables), yavanna (barley diet), and honey. Recommended therapies include deep dry massage (udvartana), night awakening, and slesma and pitta alleviating treatments. Various exercises, amla juice with haldi, guduchi with haldi, and therapies like langhana, vamana, and virechana are beneficial.
• Yoga Ratnakar (Prameha)
  • Diet: Includes sanva, kodo, vana kodo, wheat, chana, arahar, shali dhanya, moonga, kulathi, and yava (best). Also recommended are tikta shaka, parval, jangal mansa, saindhava, and maricha.
• Basavarajeevam (9/169-171)
  • Diet and Therapies: Purana shali, wheat, shashtika shali, jangala mansa, tila pinayaka, buttermilk, butter, palak, rice, dhatura, jeevanti, shigru, moonga, guduchi, amla, patola, vasa, honey, udambara phala, unriped banana, banana flowers, changeri, zharasi, shyonaka, kaputa, mesha shringa, maushaka, kataka, karela, akhuparni, tikta dravya. Includes exercise, bathing, and massage.
• Ras Ratnakar (34/2-3)
  • Diet: Includes old vana kodo, wheat, chana, arahar, kulathi, ruksha ubatan, and kapha-pitta reducing diet and vihar.
• Ottamoolikalum Ayurvedavum (Malayalam Book)
  • Dietary Recommendations: Avoid spicy foods, overeating, and undereating. Focus on fiber-rich vegetables, leafy greens, and reduce salt intake.
• Vrinda Vaidak (38/1-2)
  • Diet: Shyamak, vana kodo, kodo, gehu, chana, arahar, purani kulathi.
• Vrinda Vaidak (38/3-4)
  • Diet for Shukrameha: Includes katu shaak, jangal mansa, yava vikara, moong, shali dhanya, santhi chawal, doodh, pootikaranj, kaseru, nagakesara, and kevatimotha.
• Harita Samhita (28)
  • Diet: Rakta shali, santhi chawal, arahar, kulthi, and ghrita.
• Vrinda Madha (35)
  • Diet: Old syamaka, jangli kodav rice, wheat, chana, arahar, kulathi, chakaramard, parval, tikta rasa shaak, yava, sattu, moonga, shali and shashitik dhanya, and laja.
• Sidha Sara Samhita (11)
  • Diet: Includes tikta shaka (e.g., karela), jangal mansa, yava products, moonga, shali and shastik dhanya, sidhu, madhvik, sarodak, madhudhak (honey with water), kusha jala, and triphala jala.
• Chakradutta (Prameha 61)
  • Lifestyle: Living like a monk, engaging in exercise, walking without an umbrella and slippers, living in a jungle, and eating amla.
• Brihat Nighantu Ratnakar
  • Therapies and Diets: Includes langhan, vamana, virechana, ubtan, deepan. Use foods like purane trina dhanya, kangni, joh, bansa ke chawal, jovo, samkhiya, nagarmotha, moth, wheat, shali chawal, kamli chawal, purane kulathi, moong, arahar, chana, tila, khila, old alcohol, honey, buttermilk, buffalo and sheep urine, jangal mansa rasa, parval, karela, kakoda, tilak, kateri, goolar, lahsuna, naveen banana, gokshura, moshakarni, pattura, karnika saga, arka, giloy, triphala, kaitha, jamun, kaseru, kamal, bhasida, kamal seeds, khajur, kliyari, taal ohala, trikatu, teendy, khair, indrajoh, tikhata- kashaya food, traveling on animals, and engaging in exercise.

Diet for poor people –

• Sushruta Samhita Chikitsa 11/12-14
  • Lifestyle:
    • Walk without footwear and umbrella.
    • Roam for begging food.
    • Stay in one village for one night.
    • Live like a monk and walk more than 100 yojana.
    • Engage in physical exercise.
    • Live with animals and consume their urine and dung.
  • Therapeutic Applications:
    • Usira (Vetiver), Twak (Cinnamon), Ela (Cardamom), Agaru (Agarwood), Chandana (Sandalwood), etc.
• Ashtanga Hridaya Chikitsa 12/36-37
  • Lifestyle:
    • Walk without umbrella and shoes.
    • Live like a monk, walk long distances, or make ponds.
    • Consume food processed from animal dung or gomutra (cow urine).
  • Diet:
    • Food prepared from Gehu (wheat) and Jo (barley) along with dung of animals.
• Vaidya Chintamani 20/215-217
  • Diet:
    • Old Shali rice, Gehu (wheat), Shashti rice, Jangal mansa (meat of wild animals), Tila (sesame seeds), Pinayaka (a type of grain), Takra (buttermilk), Upodaki (a type of pulse), Tanduliyoka (rice), Chaulayi (another variety of rice), Yusha (soup), Mudga (green gram), Guduchi (Tinospora), Amalaki (Indian gooseberry), Patola (pointed gourd), Indrayava (a type of fruit), Madhu (honey), Apakva Udumbara (unripe fig), Apakva Kadli (unripe banana), Kadli Pushpa (banana flower), Changeri (a type of fruit), Jharsi (a type of fruit), Dhunduka (a type of fruit), Kapitha (wood apple), Mesasringi (a type of fruit), Muskaka (musk melon), Kataka (a type of fruit), Karela (bitter gourd), Musakarni (a type of fruit), Tikta Varga (bitter vegetables).
  • Lifestyle:
    • Exercise, bath, and massage.

Apathya –

• Sushruta Samhita Chikitsa 11/5
  • Sauviraka (fermented beverage), Tusodaka, Sukta (fermented preparations), Maireya, Sura (alcoholic beverages), Asava.
  • Milk, oil, ghee, sugarcane products.
  • Curd, pasty food, sour Yavagu (gruel).
  • Gramya (domesticated) and Anupa (wetland) meat.
• Bhela Samhita 7/1
  • Women should avoid day sleep.
• Bhavaprakasha Samhita 38/43
  • Sauviraka, Surā (alcohol made from starch and various plants).
  • Buttermilk, oil, milk, ghee, jaggery.
  • Sour substances, sugarcane juice.
  • Concentrated starches, aquatic meat.
• Kalyanakarkam 11/30
  • Madya, Asava, Arishta (alcoholic beverages).
  • Milk, ghee, curd.
  • Sweets, sour foods like Imli (tamarind), sugarcane.
  • Physical exercise, walking barefoot to pilgrimage sites.
  • One-time meal, living like a monk.
• Vrinda Vaidya 34/4
  • Jaggery products, heavy (Guru) food, unwholesome substances.
  • Kanji, alcohol, Taila (oil), milk, ghee.
  • Sour food, sugarcane juice.
  • Jangala Mansa (wild animal meat).
• Harita Samhita 28/35-39
  • Sour and bitter food.
  • Day sleep, viewing women, sexual activity, overeating.
  • Walking or running, suppressing natural urges (Mutra Vega Dharana).
  • Exposure to strong winds, wearing clothes, singing alone, wearing ornaments, chewing Paan (betel leaf), anger.
• Vrinda Madhava 35
  • Kanji, alcohol, vinegar, Taila (oil).
  • Milk, ghee, jaggery, sour food, sugarcane juice.
  • Urad (black gram) preparations, Anupa Mansa Rasa (meat of wetland animals like buffalo).
• Vaidya Chintamani 20/218-19
  • Curd, alcohol, Sura (beer), jaggery.
  • Ghee, milk, sour substances (Amla Dravya), Hingu (asafoetida), salt, garlic.
  • Sleep, sex, fish, Tila (sesame), Sarso (mustard), Shunthi (dry ginger), coconut water.
  • Pishti (pasty food), Brinjal (eggplant), Jackfruit, Kanda Dravya (tuberous foods).
• Chakrapani Prameha 64
  • Kanji, Sharab (alcohol), vinegar.
  • Taila (oil), milk, ghee, jaggery.
  • Amla Rasa products (sour substances), sugarcane.
  • Pisti Anna (pasty food), Anupa Mansa (wetland animal meat).
• Brihat Nighantu Ratnakar
  • Suppressing natural urges (Vega Dharana), smoking (Dhoompana), bloodletting (Raktamokshan), fomentation (Swedana).
  • Day sleep, frequent meals, new cereals.
  • Curd, Pisti (pasty food), Anupa Mansa Rasa (meat of wetland animals).
  • Sex, alcohol, vinegar, Taila (oil), milk, jaggery, ghee.
  • Paan (betel leaf), Tala Majja (palm marrow), incompatible food combinations (Viruddha Aahar).
  • New pumpkin, sugarcane, polluted water, sweet and sour foods (Abhisyandi Bhojana).
• Yoga Ratnakar Prameha
  • Sitting, day sleep, new cereals.
  • Suppressing natural urges (Mutra Vega Dharana), smoking (Dhoompana), fomentation (Swedana), bloodletting (Raktamokshan).
  • Sivira, Sura (beer), Sukta (fermented preparations), Taila (oil), alkaline substances (Kshara).
  • Ghee, jaggery, sour food, sugarcane juice, Pisti (pasty food).
  • Anupa Mansa (wetland animal meat).
• Basavarajeevam 9/172
  • Curd, honey, jaggery, ghee, milk.
  • Sour products, Hingu (asafoetida), salt, garlic.
  • Sleep, sex, fish, Tila (sesame), mustard, Shunthi (dry ginger), coconut water.
  • Pishti (pasty food), Brinjal (eggplant), Jackfruit, Kanda Dravya (tuberous foods).
• Yoga Tarangini 34/3
  • Ber (fruit), alcohol, vinegar.
  • Oil, milk, jaggery, ghee.
  • Sour food, sugarcane juice, sweet food.

Importance of pathya in prameha –

यैर्हेतुभिर्ये प्रभवन्ति मेहास्तेषु प्रमेहेषु न ते निषेव्याः । हेतोरसेवा विहिता यथैव जातस्य रोगस्य भवेच्चिकित्सा ॥ Charak samhita chikitsa 6/53

“Prameha, regardless of its causative factors, should be managed by completely eliminating these factors even after the disease manifests. The removal of the causative factors is in itself a crucial aspect of the treatment, as addressing the root cause directly influences the disease’s progression and aids in its resolution.”

दृष्ट्वा प्रमेहं मधुरं सपिच्छं मधूपमं स्याद्विविधो विचारः । क्षीणेषु दोषेष्वनिलात्मकः स्यात् संतर्पणाद्वा कफसंभवः स्यात् ॥ Charak samhita chikitsa 6/55

“If the urine in Prameha is sweet, unctuous, and honey-like, the diagnosis can be made based on the individual’s condition. If these symptoms manifest in a person with diminished dhatus (tissues), it indicates Vataja Prameha. On the other hand, if it occurs in an over-satiated person, it is indicative of Kaphaja Prameha.”

यै हेतुभिः ये प्रभवन्तिमेहाः तेषु प्रमेहेषु नते निषेव्याः। हेतोरसेवा विहिता यथैव जातस्य रोगस्य भवेच्चिकित्सा ।। Ras ratnakar 34/1

“A person should abandon all the causative factors (nidana) of Prameha, as the very act of avoiding these causes constitutes the treatment itself.”

Prognosis –

सपूर्वरूपाः कफपित्तमेहाः क्रमेण ये वातकृताश्च मेहाः । साध्या न ते, पित्तकृतास्तु याप्याः, साध्यास्तु मेदो यदि न प्रदुष्टम् ॥ Charak samhita chikitsa 6/56

“If Kaphaja and Pittaja Prameha manifest with poorvaroopa (premonitory symptoms), they become incurable. Vatika Prameha is also incurable. However, Pittaja Prameha is manageable (Yapya), and if Meda (fat tissue) is not vitiated, it can be cured.”

Updravas of Prameha-

उपद्रवास्तु खलु प्रमेहिणां तृष्णातीसारज्वरदाहदौर्बल्यारोचकाविपाकाः पूतिमांसपिडकालजीविद्रध्यादयश्च तत्प्रसङ्गाद्भवन्ति ।। Charak samhita nidana 4/49

Trishna (excessive thirst), atisara (diarrhea), fever, burning sensation, dorbalay (weakness), aruchi (loss of appetite), ajeerna (indigestion), peedika (boils), alaji (small pustules), and vidradhi (abscess) are recognized as upadravas (complications) of Prameha.”

अरुचिश्चाङ्गमर्दश्च तृष्णाकासौ भ्रमस्तमः॥ शूलानि पिटका कण्डूः प्रमेहाणामुपद्रवाः bhela samhita 7/3, (चिकित्सासारसंग्रह), basavarajeevam 9/36

Complications of Prameha include loss of appetite (Aruchi), pain throughout the body, excessive thirst (Trishna), coughing (Kasa), dizziness (Bhrama), episodes of darkness before the eyes (Tama Praveha), generalized pain, pustules, and itching.

Kaphaja –

मक्षिकोपसर्पणमालस्यं मांसोपचयः प्रतिश्यायः शैथिल्यारोचकाविपाकाः कफप्रसेकच्छर्दि- निद्राकासश्वासाश्चेति श्लेष्मजानामुपद्रवाः; वृषणयोरवदरणं बस्तिभेदो मेढ्रतोदो हृदि शूलमम्लीका- ज्वरातीसारारोचका वमथुः परिधूपनं दाहो मूर्च्छा पिपासा निद्रानाशः पाण्डुरोगः पीतविण्मूत्रनेत्रत्वं चेति पैत्तिकानां; हृग्रहो लौल्यमनिद्रा स्तम्भः कम्पः शूलं बद्धपुरीषत्वं चेति वातजानाम्। एवमेते विंशति प्रमेहाः सोपदवा व्याख्याताः ॥sushruta samhita nidana 6/13

Complications of Kaphaja Prameha include several notable symptoms. The condition may cause flies to be attracted to both the urine and body of the affected individual. There is often an increase in musculature, accompanied by a cold and lethargic body. Other symptoms include nasal discharge (Pratishya), excessive secretion of Kapha, and episodes of vomiting. Additionally, individuals may experience excessive sleep, cough, and difficulty in breathing (dyspnea).

अविपाको ऽरुचिश्च्छर्दिर्निद्रा कासः सपीनसः । उपद्रवाः प्रजायन्ते मेहानां कफजन्मनाम् ।। Ashtanga hridya nidana 10/22 bhavaprakasha samhita 38/18, Vaidya chintamani 20/26, Gada nigraha 30/18, basavarajeevam 9

Complications of Kaphaja Prameha according to the Ashtanga Hridya include indigestion (Ajeerna), loss of appetite (Aruchi), vomiting (Vamana), excessive sleep (Nidra), cough (Kasa), and nasal congestion (Peenasa).

तत्र प्रतिश्यायः शरीरशैथिल्यमरोचकाविपाकौ प्रसेकश्छर्दिर्निद्रा कासश्च श्लेष्मजानामुपद्रवा भ- वन्ति ॥ Ashtang sangraha nidana 10/16

Complications of Kaphaja Prameha include a runny nose (Pratishya), heaviness and stiffness in the body (Sthilata), loss of appetite (Arochaka), indigestion (Avipaka), excessive salivation (Lalastrava), vomiting (Vamana), excessive sleep (Nidra Adhikya), and cough (Kasa).

अरोचकाजीर्णकफप्रसेकताप्रपीनसालस्यमथातिनिद्राःसमक्षिकासर्पणमास्यपिच्छिलं कफप्रमेहेषु भवन्त्युपद्रवाः।। Kalyanakarkam11/22

The complications (Upadravas) of Kaphaja Prameha include loss of appetite (Aruchi), indigestion (Ajeerna), excessive secretion of mucus (Kafa Praseka), chronic cold (Peenasa), lethargy (Aalasya), excessive sleep (Atinidra), flies gathering around the body, and a feeling of something in mouth.

Pittaja –

बस्तिमेहनयोस्तोदो मुष्कावदरणं ज्वरः । दाहस्तृष्णाऽम्लको मूर्च्छा विड्भेदः पित्तजन्मनाम् । Ashtanga hridya nidana 10/23, bhavaprakasha samhita 38/19, Vaidya chintamani 20/27-28, Gada nigraha 30/19,basavarajeevam 9, Madhava Nidana, Brihat Nighantu Ratnakar

Complications of Pittaja Prameha encompass a range of symptoms that impact various systems in the body. These include breaking of the testicular skin, pain in the bladder, pinning pain in the penis, and heart pain. Patients may experience sour belching, fever, diarrhea (Atisara), loss of appetite (Aruchi), and vomiting. There can be a sensation of smoke (Dhoopa) emanating from the body, accompanied by a burning sensation, syncope (Murcha), and thirst (Trishna). Additionally, there might be issues with sleep, anemia, and yellowing of the stool, urine, and eyes.

वृषणावदणं बस्तिमेण्ट्रतोदोऽम्लिका पिपासा ज्वरो दाहो मूर्च्छाऽतीसारः पाण्डुरोगश्च पित्तजा- नाम् ॥ Ashtanga sangraha nidana 10/17

Complications of Pittaja Prameha include cracking of the skin of the testis, pain in the bladder and penis, sour taste in the mouth (Amla Rasa), excessive thirst (Trishna), fever (Jwara), burning sensation (Daha), fainting (Murcha), diarrhea (Atisara), and anemia (Pandu).

समेढ्रमुष्कक्षतबस्तितोदनं विदाहकृच्छूलपिपासिकाम्लिकम् ज्वरातिमूर्च्छामदपाण्डुरोगताः सपित्तमेहेषु भवन्त्युपद्रवाः।। kalyanakarkam11/23

Vataja –

धातिकानामुदावर्तकम्पहृद्ग्रहलोलताः । शूलमुन्निद्रता शोषः कासः श्वासश्च जायते ॥  Ashtanga hridya nidana 10/24, Bhavaprakasha samhita 38/20, vaidya chintamani 20/28-29, Gada nigraha 30/20, Yoga ratnakar prameha 28, basavarajeevam 9, Madhava Nidana, Brihat Nighantu Ratnakar

Complications of Vataja Prameha include a gripping sensation in the heart (Hridya Graha), lack of sleep (Nidranasha), rigidity, a strong desire to eat food, trembling, pain, and constipation of stool. Additionally, there may be symptoms such as upward movement of wind (Udavarta), choking sensation in the throat (Kantha Sanga), an insatiable feeling of wanting to eat everything, along with pain, emaciation (Shosha), cough (Kasa), and even the risk of death (Shavas).

हृङ्ग्रहो लौल्यमनिद्रता कम्पः शूलं बद्धपुरीषत्वं शोषः कासः श्वासश्च वातजानाम् ॥ Ashtanga sangraha nidana 10/18

Complications of Vataja Prameha include pain in the heart, a desire to eat every taste (Rasa), sleeplessness, trembling (Kampan), pain, constipation, emaciation (Shosha), coughing (Kasa), and difficulty in breathing (Shavasa).

सहृद्ग्रहं लौल्यमनिद्रया सह प्रकम्पशूलातिपुरीषबन्धनम्।प्रकासहिक्का श्वसनास्यशोषणं संघातमेहेषु भवन्त्युपद्रवाः ।। kalyanakarkam11/24

The complications (Upadravas) of Vataja Prameha include a gripping sensation in the heart (Hridya Graha), intense craving for sensory objects, sleeplessness, severe pain (Ati Shoola), tremors (Kampan), cough (Kasa), breathlessness (Shvasa), hiccups, and dryness of the mouth.

मधुमेहोपक्षया च काले काले भवन्त्यमी। उपद्रवाः कृच्चूसाध्याः केचित् प्राणान्तका अपि ॥ कासः श्वासो ज्वरो मन्दः शीघ्रकारी क्षयस्तथा। पिडका मांसकोथश्च प्रमोहो वा कदाचन ॥ शाखागताशु नाड़ीषु क्वचित्तीव्ररुजोद्गमः । क्लैव्यं च प्रायशः काले तस्य धातुक्षयाद् भवेत् ॥ दृष्टिनाड़ीवितानस्य प्रशोथाच्छोषतोऽथवा । तदन्तर्वाऽसृजः स्त्रवाद् दृष्टिदोषोऽन्धताऽपि च  अथास्य वृक्करोगश्च यकृद्रोगश्च कुत्रचित् । हृत्पेशीदुर्बलत्वं च तीव्र शोथोदरादिकृत् ॥रक्तेऽतिमधुरीभूते त्वङ्-मेदो-मांसदूषणात् । महत्यः पिडकास्तस्य काले काले भवन्ति च ॥ siddhant nidana 6/618-623

Complications of Prameha that are difficult to treat and may lead to death over time include cough (Kasa), breathlessness (Shvasa), fever (Jwara), and severe emaciation (Kshaya), which can cause instant death. Additionally, ulcers (Peedika), muscle wasting (Mamsakotha), delirium (Pramoha), and nerve pain are also severe and life-threatening complications.

Prameha arishta –

स्नेहं बहुविधं स्वप्ने चण्डालैः सह यः पिबेत बध्यते स प्रमेहेण स्पृश्यतेऽन्ताय मानवः ॥ (C.S., 2005.pp.362)

A person who, in their dreams, consumes various kinds of oils, ghee, or other unctuous preparations along with Chandala (a person of low social status in ancient times) may face the risk of dying from Prameha in the future.

गुल्मी च मधुमेही च राजयक्ष्मी च यो नरः ॥अचिकित्स्या भवन्त्येते बलमांसङ्क्षये सति। (C.S., 2005.pp.368)

Patients suffering from Madhumeha (a type of prameha characterized by sweet-smelling urine) who lose their muscle mass (mamsa) and strength (bala) are at a high risk of dying soon.

प्राणमांसक्षयः शोषस्तृष्णा च्छर्दिज्वरस्तथा ॥अतीसारश्च मूर्च्छा च हिक्‌काश्वासस्तथैव च । एतैरुप्द्रवैर्जुष्टान् सर्वानव विवर्जयेत् 

A patient suffering from prameha who is also afflicted with complications such as dyspepsia (indigestion), anorexia (loss of appetite), and severe peedika (painful skin lesions) with profuse discharge of urine will certainly face a high risk of death due to this disorder.

यथोक्तोपद्रवाविष्टमतिप्रस्रुतमेव च । पिडिकापीडितं गाढं प्रमेहो हन्ति मानवम् ।। मूर्च्छाच्छर्दिज्वरश्वासकासवीसर्पगौरवैः । उपद्रवैरुपेतो यः प्रमेही दुष्प्रतिक्रियः ।। Bhavaprakasha samhita 38/21-22

An increasing effect of upadrava (complications), excessive urination, and peedika (painful skin conditions) can lead to death in cases of prameha. Additionally, if murcha (fainting), vomiting, fever, shavas (debilitating conditions), kasa (cough), visarpa (erysipelas), and gorva (severe weakness) manifest, the prameha becomes difficult to cure.

यस्य मूत्रं स्त्रवेत्तैलं मधुमद्यं स्त्रवैत्तदा। यमेन नीयते शीघ्रं कारितः पशुपालकः ।।(सिद्धरसार्णवे), basavarajeevam 9/41

If a person’s urine appears oily, honey-like, or resembles alcohol, it is considered a fatal sign, indicating that the patient will likely not survive. According to certain beliefs, such individuals are destined to become animal caretakers (pashu palaka) in their next life.

Prameha vimukta lakshana –

यदा प्रमेही विशदातितिक्तर्क सरूक्षसक्षारकदृष्णमूत्रकम्।कदाचिदल्पं विसृजेदनाविलं तदा भवेन्मेहविहीनलक्षणम्।। Kalyanakarkam11/56

In Madhumeha, the urine is described as vishad (pure or clear), ati tikta (excessively bitter), ruksha (dry), kshaar (alkaline), manda (slow or weak), and ushna (hot). It is clear without turbidity, and only small amounts of urine are passed occasionally.

प्रमेहितस्य यन्मूत्रमनाविलमपिच्छिलम् ।विशदं तिक्तकटुकं स्यादारोग्यं प्रचक्षते ॥vrinda vaidya38/57

Signs of Prameha being cured include urine that is clear, white, and free from complications. Additionally, the urine may be tikta (bitter) and katu (pungent), indicating improvement in the condition.

Differential diagnosis of Pittaja Prameha with Rakta – Pitta

If urine exhibits a yellow color or if blood is passed in the urine without any preceding signs or symptoms of Prameha, the individual should not be diagnosed with Prameha. Instead, such symptoms are indicative of Raktapitta, a condition characterized by bleeding disorders and not Prameha.

Importance of Mansa in prameha –

गुल्मी च मधुमेही च राजयक्ष्मी च यो नरः । अचिकित्स्या भवन्येते बलमांसपरिक्षयात् ।। Yoga ratnakar prameha 35

If there is a significant reduction in muscle tissue (mansa) and strength (bala) in conditions such as Gulma, Madhumeha, and Rajayakshama, these diseases become incurable. The depletion of these vital aspects undermines the body’s ability to manage and recover from these disorders, leading to a poor prognosis.

No. of times mentioned

• चरकसंहिता – 37
  सुश्रुतसंहिता – 33
  अष्टाङ्गहृदयसंहिता – 21
  राजनिघण्टु – 21
  भावप्रकाश – 14
  योगरत्नाकर – 13
  मदनपालनिघण्टु – 8
  आनन्दकन्द – 7
  गरुडपुराण – 7
  धन्वन्तरिनिघण्टु – 6
  रसरत्नसमुच्चय – 6
  रसेन्द्रचूडामणि – 6
  रसमञ्जरी – 5
  रसप्रकाशसुधाकर – 5
  गूढार्थदीपिका – 3
  रसेन्द्रचिन्तामणि – 3
  अष्टाङ्गनिघण्टु – 2
  अष्टाङ्गसंग्रह – 2
  आयुर्वेददीपिका – 2
  अर्थशास्त्र – 1
  घेरण्डसंहिता – 1
  कैयदेवनिघण्टु – 1
  मुग्धावबोधिनी – 1
  नाडीपरीक्षा – 1
  रसरत्नाकर – 1
  रससंकेतकलिका – 1
  सर्वाङ्गसुन्दरा – 1