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Sushruta SamhitaNidana SthanaPrameha Nidana - Diabetes and diseases of the urinary tracts - Sushrutasamhita...

Prameha Nidana – Diabetes and diseases of the urinary tracts – Sushrutasamhita Nidanasthana Chapter 6

षष्ठोऽध्यायः । अथातः प्रमेहनिदानं व्याख्यास्यामः यथोवाच भगवान् धन्वन्तरिः ।। १ ।।

Now we shall discourse on the Nidana of Prameha (diseases of the urinary tracts). 1

दिवास्वप्नाव्यायामालस्यप्रसक्तं शीतस्निग्धमधुरमेद्यद्रवान्नपानसेविनं पुरुषं जानीयात् प्रमेही भविष्यतीति ।। २॥

It may be prognosticated that an idle man, who indulges in day sleep, or follows sedentary pursuits or is in the habit of taking sweet liquids, or cold and fat-making or emollient food, will ere long fall an easy victim to this disease. 2

तस्य चैवंप्रवृत्तस्यापरिपक्वा एव वातपित्तश्लेष्माणो यदा मेदसा सह्रैकत्वमुपेत्य मूत्रवाहिस्रोतांस्यनुसृत्याधो गत्वा बस्तेर्मुखमाश्रित्य निर्भिद्यन्ते तदा प्रमेहान् जनयन्ति । ॥ ३॥

Pathology: The bodily principles of Vayu, Pitta and Kapha of such a person get mixed with improperly formed chyle of the organism. Thus deranged, they carry down through the urinary ducts the deranged fat, etc.1 of the body and find lodgment at the mouth ( neck) of the bladder, whence they are emitted through the urethra, causing diseases, known by the (generic) name of Prameha. 3

तेशान्तु पूर्वरूपाणि-हस्तपादतलदाहः स्निग्धपिच्छिलगुरुता गात्राणां

1. The particle cha’ in the text denotes other virus or morbific matter. Dalhana 2. Remain incarcerated therein according to others.

मधुरशुक्लमूत्रता तन्द्रा सादः पिपासा दुर्गन्धश्च श्वासस्तालुगलजिह्वादन्तेषु मलोत्पत्तिर्जटिलीभावः केशानां वृद्धिश्च नखानाम्।। ४।।

Premonitory Symptoms : A burning sensation in the palms of the hands and of the soles of the feet, a heaviness of the body, coldness or sliminess of the skin and limbs, sweetness and whiteness of the urine, somnolence, lassitude, thirst, a bad-smelling breath, a shortness of breath, slimy mucous deposit on the tongue, palate, pharyx and teeth, clotted hair and an inordinate growth of the finger and toe nails are the indications which mark the advent of the disease. 4

तत्राविलप्रभूतमूत्रलक्षणाः सर्व एव प्रमेहा भवन्ति; सर्व एव सर्वदोषसमुत्थाः सह पिडकाभिः ॥ ५ ॥

General Characteristics : A copious flow of cloudy or turbid urine characterises all the types of the disease. which, together with the abscesses and eruptions (Pidaka) which mark its sequel, should be regarded as involving the concerted action of the deranged Dosas (Vayu, Pitta and Kapha). 5

कफादुदकेक्षुवालिकासुरासिकताशनैर्लवणपिष्टसान्द्रशुक्रफेनमेहा दश साध्याः, दोषदूष्याणां समक्रियत्वात् ।। ६ ।। तत्र,

The Kaphaja Types : Cases of Prameha, which are caused by an exuberance of the deranged Kapha, may be grouped under ten subheads such as, Udaka-meha, Ikshu-meha, Sura-meha, Sikatameha, Sanai-meha. Lavana meha, Pista-meha, Sandra-meha, Sukrameha and Phena-meha. The ten aforesaid types are curable, inasmuch as the medicines which tend to remedy the deranged Kapha (Dosa), the cause of the disease, prove also remedial to the other principles of the body (flesh, marrow, blood, semen etc.) deranged (Dusya) from the same causes. 6

पित्तान्नीलहरिद्राम्लक्षारमञ्जिष्ठाशोणितमेहाः षड् याप्या; दोषदृष्याणां विषमक्रियत्वात् ॥ ७॥

The Pittaja Types: The types, which are brought about through an exuberance of the deranged Pitta, are named as Nila-meha, Haridrameha, Amla-meha, Ksara-meha, Manjistha-meha, and Sonita-meha, Palliation is all that can be effected in these types, inasmuch as the medicines which tend to correct the deranged Pitta, which has brought on the disease, fail to exert similar virtues on the organic principles (Dusyas) deranged by it. 7

वातात् सर्पिवसाक्षौद्रहस्तिमेहाश्चत्वारोऽसाध्यतमाः, महात्ययिकत्वात् ।। ८ ।।

The Vataja Types : The types of Prameha which are produced by an aggravated condition of the bodily Vayu are divided into four subgroups such as Sarpi-meha, Vasa-meha, Ksaudra-meha and Hasti-meha. These should be regarded as most incurable inasmuch as no kind of medicine can restore the fleet-coursing, deap diving (i.e. invading the bones and the marrow) Vayu, which at the same time also augments the Pitta to its normal state and thus advances (unchecked) in its work of disintegration. 8

तत्र वातपित्तमेदोभिरन्वितः श्लेष्मा श्लेष्मप्रमेहान् जनयति, वातकफशोणितमेदोभिरन्वितं पित्तं पित्तप्रमेहान, कफपित्तवसामज्जमेदोभिरन्वितो वायुर्वातप्रमेहान्।। ९ ।।

The deranged Kapha, in conjunction witth the (morbid) Pitta, Vayu and fat, gives rise to all Kaphaja types of Prameha. The deranged Pitta, in conjunction with the deranged Vayu, blood, fat and Kapha, produces the Pittaja one; while the deranged Vayu, in unison with the deranged Kapha, Pitta, fat, marrow and Vasa (myosin), engenders the types of Vataja Prameha. 9

तत्र, श्वेतमवेदनमुदकसदृशमुदकमेही मेहति; इक्षुरसतुल्यमिक्षुवालिकामेही, सुरातुल्यं सुरामेही, सरुजं सिकतानुविद्धं सिकतामेही, शनैः सकफं मृत्स्नं शनैर्मेही, विशदं लवणतुल्यं लवणमेही, हृष्टरोमः पिष्टरसतुल्यं पिष्टमेही, अविलं सान्द्रं सान्द्रमेही, शुक्रतुल्यं शुक्रमेही, स्तोकं स्तोकं सफेनमच्छं फेनमेही मेहति ।। १० ।।

Symptoms of Kaphaja-Mehas : The urine of a person suffering from an attack of Udaka-meha becomes white and water-like and is passed without the least pain. In a case of Iksumeha the urine resembles the expressed juice of sugarcane. It has the colour of wine in a case of

1. The Sanskrit term Meha literally means to micturate. The verbal noun Mehanam signifies urination as well as the act of passing any morbid urethral secretion. Hence the urine in most of these cases denotes the fact of its being charged with pus or any other morbid secretion of the urinary organs such as Ojah (albumen), marrow, etc., which imparts their characteristic colours to the fluid,-a fact which determines the nomenclature of the disease and forms the keynote of its diagnosis in the Ayurveda.

Sura-meha. The urine in a case of Sikatameha is passed with pain and is found to leave a sediment of extremely fine and sand-like concretions (Sikata’s). In a case of Sanarimeha the urine gushes out at intervals in jets and is charged with a slimy mucous (Kapha). The urine in a case of Lavanameha becomes limpid (non-viscid) and acquires a saline taste. There is horripilation at the time of micturition in a case of Pistameha (Chyluria), the urine resembling a stream of water, charged with a solution of pasted rice (Pistam).

In a case Sandrameha, the urine becomes thick and turbid, while in a case of Sukrameha the urine resembles semen (or the urine is found to be charged with semen: Madhava). In a case of Phenameha the patient passes frothy urine in broken jets. 10

अत ऊर्ध्वं पित्तनिमित्तान् वक्ष्यामःसफेनमच्छं नीलं नीलमेही मेहति; सदाहं हरिद्राभं हरिद्रामेही, अम्लरसगन्धमम्लमेही; स्रुतक्षारप्रतिमं क्षारमेही, मञ्जिष्ठोदकप्रकाशं मञ्जिष्ठामेही, शेणितप्रकाशं शोणितमेही मेहति ।। ११ ।।

Symptoms of Pittaja Mehas: Now we shall describe the characteristic features of the types of Prameha, which are due to the action of the deranged Pitta. The urine in a case of Nilameha becomes frothy, transparent and bluish. The urine in a case of Haridrameha becomes deep yellow like turmeric (Haridra) and is passed with a burning pain. The urine in a case of Amlameha acquires an acid taste and smell. The urine in a case of Ksarameha¹ resembles an alkaline solution filtered (through a piece of linen). The urine in a case of Manjisthameha resembles the washing of the Manjistha, while in a case of Raktameha, the urine is found to be of blood-colour (or charged with blood-Madhava). 11

अत ऊर्ध्वं वातनिमित्तान् वक्ष्यामः-सर्पिः प्रकाशं सर्पिर्मेही मेहति; वसाप्रकाशं वसामेही, क्षौद्ररसवर्णं क्षौद्रमेही, मत्तमातङ्गवदनुप्रवृद्धं हस्तिमेही मेहति ।। १२ ।

Symptoms of Vataja-Mehas: Now we shall describe the characteristics of the different types of Prameha, which are due to an exuberance of the deranged Vayu. In a case of Sarpimeha, the urine looks like a stream of clarified butter, while in one of Vasameha it 1. The unrine acquires a distinct alkaline taste, smell, colour and touch. (Madhava Nidana).

resembles the washings of Vasa. In a case of Ksaudrameha, the urine looks like honey and acquires a sweet taste. In Hastimeha, the patient passes a copious quantity of urine, like an excited elephant, at a time, and in unbroken stream, (the organ becoming steady immediately after the act of micturition). 12

मक्षिकोपसर्पणमालस्यं मांसोपचयः प्रतिश्यायः शैथिल्यारोचकाविपाकाः कफप्रसेकच्छर्दिनिद्राकासश्वासाश्चेति श्लेष्मजानामुपद्रवाः । वृषणयोरवदरणं बस्तिभेदो मेढ्रतोदो हृदि शूलमम्लीकाज्वरातीसारारोचका वमथुः परिधूपनं दाहो मूर्च्छा पिपासा निद्रानाशः पाण्डुरोगः पीतविण्मूत्रत्वञ्चेति पैत्तिकानाम् | हृद्ग्रहो लौल्यमनिद्रा स्तम्भः कम्पः शूलं बद्धपुरीषत्वञ्चेति वातजानाम् । एवमेते विंशति प्रमेहाः सोपद्रवा व्याख्याताः ।। १३ ।।

Supervening Symptoms : The fact of the urine being assailed by a swarm of flies, lassitude, growth of flesh (obesity), catarrh, looseness of the limbs, anon-relish for food, indigestion, expectoration of mucous, vomiting, excessive sleep, cough and laboured breathing (svasa) are the supervening traits (Upadrava) of the Kaphaja Prameha. A piercing pain in the testes, a pricking (Vedana) pain in the bladder, a shooting pain (Tuda ) in the penis, a griping pain at the heart, acid eructations, fever, diarrohea, a non-relish for food, vomiting, a sensation as if the entire body is emiting fumes, a burning sensation in the skin, thirst, epileptic fits, insomnia, jaundice (Pandu) and a yellow colour of the stool and urine are the supervening symptoms which mark the Pittaja types of Prameha. An oppressive feeling at the heart (Hrdgraha), eager longings for foods of all tastes, insomnia, numbness of the body, fits of shivering, colic pain and constipation of the bowels are the supervening symptoms, which specifically mark the Vataja types. Thus we have described the nature of the twenty different types of Meha with their supervening evils as well. 13

तत्र वसामेदोभ्यामभिपन्नशरीरस्य त्रिभिर्दोषैश्चानुगतधातोः प्रमेहिणो दश पिडका जायन्ते । तद्यथा-शराविका, सर्षपिका, कच्छपिका, जालिनी, विनता, पुत्रिणी, मसूरिका, अलजी, विदारिका, विद्रधिका, चेति ।।१४।।

1. Charaka has included it within Ksaudra Meha and Madhu Meha.

The ten different types of Pidaka (abscess, carbuncles, pimples, pustules etc.) are found to crop up on the bodies of patients, suffering from Prameha, and abounding in fat and Vasa, and whose fundamental principles have been affected by the simultaneous derangement of the Vayu, Pitta and Kapha. They are named as Saravika, Sarsapika, Kacchapika, Jalini, Vinata, Putrini, Masurika, Alaji, Vidarika and Vidradhika. 14

शरावमात्रा तद्रूपा निम्नमध्या शराविका । गौरसर्षपसंस्थाना तत्प्रमाणा च सार्षपी ।। १५ ।।

सदाहा कूर्मसंस्थाना ज्ञेया कच्छपिका बुधैः । जालिनी तीव्रदाहा तु मांसजालसमावृता ।। १६ ।।

वगाढरुजाक्लेदा पृष्ठे वाप्युदरेऽपि वा । महती पिडका नीला पिडका विनता स्मृता ।

महत्यल्पाचिता ज्ञेया पिडका सा तु पुत्रिणी । । १७ । ।

मसूरसमसंस्थानां ज्ञेया सा तु मसूरिका । रक्ता सिता स्फोटवती दारुणा त्वलजी भवेत् ।। १८ ।।

विदारीकन्दवद् वृत्ता कठिना च विदारिका । विद्रधेर्लक्षणैर्युक्ता ज्ञेया विद्रधिका बुधैः ।। १९ । ।

ये यन्मयाः स्मृता मेहास्तेषामेतास्तु तत्कृताः

Metrical Texts: An abscess which is raised at the margin and dipped in its centre, so as to resemble an Indian saucer in its shape is called Saravika. Pimples or pustules of the shape and size of white mustard seeds are called Sarspika. An abscess resembling (the back of) a tortoise in shape and attended with a burning sensation, is called Kacchapika by the wise. An abscess studded with slender vegetations of flesh and attended with an intolerable burning sensation is called Jalini. A large blue-coloured abscess (carbuncle) appearing on the back or the abdomen and exuding a slimy secretion and attended with a deep-seated pain is called Vinata. A thin and extensive abscess (studded with slender pustules–D.R.) is called Putrini. Pimples to the size of lentil seeds are called Masurika. A dreadful abscess which is of a red and white colour, studded over with blisters of exuding vesicles is called Alaji. A hard and round abscess as large as a (fullgrown) gourd is called Vidarika. An abscess of the Vidradhi type is called Vidradhika (carbuncle) by the wise. An incidental abscess in a case of Prameha should be regarded as having its origin in the same morbific principle (Dosa) as that which has produced the disease (Prameha). 15-19

गुदे हृदि शिरस्यंसे पृष्ठे मर्मणि चोत्थिताः। सोपद्रवा दुर्बलस्य पिडका: परिवर्जयेत् ॥ २० ॥

कृत्स्नं शरीरं निष्पीड्य मेदोमज्जवसायुतः। अधः प्रक्रमते वायुस्तेनासाध्यास्तु वातजाः ।। २१ ।।

Prognosis: A Pidaka or an abscess, appearing about the region of the heart, anus, head, shoulder, back or at any of the vital joints (Marma) of the body, and attended with other supervening symptoms producing extreme prostration [impaired digestion–D. R. ] in the patient should be abandoned as incurable. In a case of Vataja meha, the deranged Vayu presses all the fundamental principles out of the body through the urethra and rages rampant in the lower part of the body united with the deranged fat, marrow and Vasa. Hence a case of Vataja meha (or its accompanying abscess ) , is held as incurable. 20-21

प्रमेहपूर्वरूपाणामाकृतिर्यत्र दृश्यते । किञ्चिच्चाप्यधिकं मूत्रं तं प्रमेहिणमादिशेत् ।। २२ ।।

कृत्स्नान्यर्धानि वा यस्मिन् पूर्वरूपाणि मानवे । प्रवृद्ध (त्त) मूत्रमत्यर्थं तं प्रमेहिणमादिशेत् ।। २३ ।।

A person in whom the premonitory symptoms (Purvarupa of Prameha ) have appeared and who passes a little larger quantity of urine than usual, should be considered as already afflicted with it. A person afflicted with all or half of the premonitory symptoms of the disease and passing a copious quantity of urine should be considered as one suffering from an attack of Prameha. 22-23

पिडकापीडितं गाढमुपसृष्टमुपद्रवैः । मधुमेहिनमाचष्टे स चासाध्यः प्रकीर्त्तितः ।। २४ ।।

स चापि गमनात् स्थानं स्थानादासनमिच्छति। आसनाद् वृणुते शय्यां शयनात् स्वप्नमिच्छति ।। २५ ।।

A Prameha patient afflicted with deep-seated abscess and other distressing symptoms, which are usually found to supervene in the disease, should be pronounced as suffering from Madhumeha and adjudged incurable. A Madhumeha patient seeks a halting place while walking, wants a place to sit on while halting, lies down if he finds a sitting place, and sleeps if he lies down. 24-25

यथा हि वर्णानां पञ्चानामुत्कर्षापकर्षकृतेन संयोगविशेषेण शबलबभ्रुकपिलकपोतमेचकादीनां वर्णानामनेकेषामुत्पत्तिर्भवति, एवमेव दोषधातुमलाहारविशेषेणोत्कर्षापकर्षकृतेन संयोगविशेषेण प्रमेहाणां नानाकरणं भवति ।। २६ । ।

As five mixed colours such as grey, brown, Kapila (bluish yellow), Kapota (blackish grey), mecaka (light-green) may be produced by combination of the five primary colours in definite proportions ( such as white, green, black, yellow and red), so a diversity of causes, through the relative preponderance of the particular kinds of food, and of the deranged Dosas, root principles (Dhatu) and excretions of the body (Mala), may be attributed to the origin of Prameha. 26

भवति चात्र ।

सर्व एव प्रमेहास्तु कालेनाप्रतिकारिणः । मधुमेहत्वमायान्ति तदाऽसाध्या भवन्ति हि ।। २७ ।।

Memorial Verses: All types of Prameha, not properly treated and attended to at the outset, may ultimately develop into those of Madhumeha types, which are incurable. 27

इति सुश्रुतसंहितायां निदानस्थाने प्रमेहनिदानं नाम षष्ठोऽध्यायः ।। ६ ।।

Thus ends the Sixth Chapter of the Nidana Sthana in the Susruta Samhita, which treats of the Nidana of Prameha.

For English equivalents of the different types of Prameha compare : Cystitis (Acute Infective ) — Frequent, painful micturition, small quantity of urine voided with pain and urgency. Urine–slightly acid or alkaline in reaction, cloudy, containing blood corpuscles. Cystitis (Chronic Infective)–Great and frequent pain, in the lumbar region, rigor, Urine–thick, offensive and alkaline, containing ropy mucous and blood. Cystitis (Non-Infective)–Symptoms like those of acute inflammatory type. Urine–acid and cloudy with mucous. Blood is generally present in considerable quantity. Neuralgia of the bladder, compare Albuminuria, Albumosuria, Hoemoglobinuria, Hoematuria, Peptonuria, Pyuria, Spermatorrhoea and Diabetes, Proteuria and Polyuria.


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