अथातो प्रमेहनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Prameha nidana diagnosis of diabetes/polyuria; thus said Atreya and other great sages.
Prameha Sankhya – types of diabetes
प्रमेहा विंशतिस्तत्र श्लेष्मतो दश, पित्ततः । षट, चत्वारोऽनिलात्
Prameha (polyuria diabetes) are twenty, out of which ten are born from slesma (kapha), six from pitta and four from anila (vata).
Nidana – causes of diabetes
तेषां मेदोमूत्रकफावहम् ॥ १ ॥
अन्नपानक्रियाजातं
यत्प्रायस्तत्प्रवर्तकम् । ॥२॥
स्वाद्वम्ललवणस्निग्धगुरुपिच्छिलशीतलम् नवधान्यसुरानूपामांसेक्षुगुडगोरसम् एकस्थानासनरतिः शयनं विधिवर्जितम् ॥ ३ ॥ ।
Foods, drinks and activities which produce an increase of medas (fat), mutra (urine) and kapha are generally the chief causes, such as; foods which are sweet, sour, salt, fatty, not easily digestible, slimy and cold; fresh grains, beer, meat of animals of marshy regions, sugarcane juice, molasses and milk; (habit of) always sitting at a place and sleeping without adopting its proper procedure. 1b-3.
Prameha Samprapti – pathogenesis of diabetes
बस्तिमाश्रित्य कुरुते प्रमेहान् दूषितः कफः । दूषयित्वा वपुः क्लेदस्वेदमेदोरसामिषम् ॥ ४ ॥
पित्तं रक्तमपि क्षीणे कफादौ मूत्रसंश्रयम् । धातून् बस्तिमुपानीय तत्क्षयेऽपि च मारुतः ॥ ५॥
Kapha which gets vitiated (increased) and localised in the urinary bladder, produces prameha by vitiating the body water, sweat, pitta, fat, plasma and muscle (all these are watery tissues,); even pitta and rakta (blood) also produce it, by vitiating the residence of urine (urinary bladder) when they (watery tissues) are decreased (depleted); even maruta (vata) also causes it, by dragging the dhatus (watery tissues) into the bladder when they are depleted. 4-5.
साध्ययाप्यपरित्याज्या मेहास्तेनैव तद्भवाः । समासमक्रियतया महात्ययतयाऽपि च ॥६॥
Meha is classified as curable, controllable and rejectable, is done so on their basis, (of the dosas) and (the quality of) samakriyata (identical therapy), asama (visama kriyata non-identical therapy) and mahatyayata (great danger involved). 6.
Notes The above breif statement is explained as follows; the ten kinds of prameha produced by kapha are curable because in them, the causative dosa and dusyas (tissues and wastes) are identical (of the same qualities) and so drugs and therapies are the same for both (identical therapy). The six kinds produced by pitta, are controllable but persist till death because in these the causative dosa (pitta) and the dusyas (tissues and wastes) are of different qualities and so drugs and therapies have to be different (non-identical therapy). The four kinds produced by vata are incurable because of the risk of grave complication/secondary diseases arising due to loss of all the tissues.
Rupa – clinical features of diabetes
Samanya laksana (common symptoms)
सामान्यं लक्षणं तेषां प्रभूताविलमूत्रता । The common symptoms in all of them are-increased quantity and turbidity of the urine. 7a.
दोषदृष्याविशेषेऽपि
तत्संयोगविशेषतः ॥७॥
मूत्रवर्णादिभेदेन भेदो मेहेषु कल्प्यते ।
Though the dosas and dusyas are similar, their combination (types of combination) being different; there occurs differences in the colour etc. (other properties) of urine; based on these (properties) they (kinds of diabetes) are described further. 7b-8a.
Kaphaja meha – diabetes caused by kapha
अच्छं बहु सितं शीतं निर्गन्धमुदकोपमम् ॥ ८ ॥
मेहत्युदकमेहेन किञ्चिच्चाविलपिच्छिलम् । इक्षो रसमिवात्यर्थं मधुरं चेक्षुमेहतः ॥ ९ ॥
सान्द्रीभवेत्पर्युषितं सान्द्रमेहेन मेहति । सुरामेही सुरातुल्यमुपर्यच्छमधो घनम् ॥ १०॥
संहृष्टरोमा पिष्टेन पिष्टवद्वहलं शुक्राभं शुक्रमिश्रं वा शुक्रमेही प्रमेहति ॥ ११ ॥
मूर्ताणून सिकतामेही सिकतारूपिणो मलान् । शीतमेही सुबहुशो मधुरं भृशशीतलम् ॥ १२ ॥
शनैः शनैः शनैर्मेही मन्दमन्दं प्रमेहति । सितम् । लालातन्तुयुतं मूत्रं लालामेहेन पिच्छिलम् ॥ १३ ॥
In Udaka meha the person passes urine which is clear (not turbid) lar in quantity, white, cold, odourless, resembling water, sometimes with slight turbidity and slimyness. In Iksumeha the urine is like the juice of sugarcane and very sweet. In Sandra meha the urine become thick when kept over night. In Sura meha the urine resembles sura ( beer ) with clear top ( portion) and thick bottom (portion ). In Pista meha the person has horripilations, voids urine which is thick like a solution of corn flour and is white. In Sukra meha the urine is like semen or mixed with semen. In Sikata meha the person passes urine containing dirty particles resembling sand. In Sita meha the urine is sweet and very cold. In Sanairmeha the person passes urine very slowly and with very little force. In Lalameha the urine contains threads like that of saliva and slimy. 8b-13.
Pittaja meha – diabetes caused by pitta
गन्धवर्णरसस्पर्शैः क्षारेण क्षारतोयवत् । नीलमेहेन नीलाभं कालमेही मषीनिभम् ॥ १४ ॥
हरिद्रासन्निभं दहत् । मञ्जिष्ठासलिलोपमम् ॥ १५ ॥ हारिद्रमेही कटुकं विस्त्रं माञ्जिष्ठमेहेन वित्रमुष्णं सलवणं रक्ताभं रक्तमेहतः ।
In ksara meha the urine is like a solution of alkali in smell, colour, taste and touch, In Nila meha it (urine) is blue.
In Kala meha it resembles ink (black). In Haridra meha the urine is pungent (or bitter) resembles haridra ( termuric) (yellow in colour) passed associated with burning sensation. In Manjista meha the urine is foul smelling and resembles solution of manjista (slight red in colour). In Rakta meha the urine is foul smelling, hot, slight salty and resembles blood (red in colour). 14-16a.
Vataja meha – diabetes caused by vata
वसामेही वसामिश्रं वसां वा मूत्रयेन्मुहुः ॥ १६ ॥
मज्जानं मज्जमिश्रं वा मज्जमेही मुहुर्मुहुः । हस्ती मत्त इवाजस्त्रं मूत्रं वेगविवर्जितम् ॥ १७ ॥
सलसीकं विबद्धं च हस्तिमेही प्रमेहति । मधुमेही मधुसमम्
In Vasa meha the urine is mixed with muscle fat, or only muscle fat may be passed frequently, In Majja meha the person passes only marrow or urine mixed with marrow frequently. In Hasti meha the person passes urine like an elephant in rut, continuously and without force, mixed with lasika (lymph) and with obstruction (difficulty), In Madhumeha the person passes urine resembling honey ( in taste). 16-18a.
जायते स किल द्विधा ॥ १८ ॥ दोषावृतपथेऽथवा । क्रुद्धे धातुक्षयाद्वायौ आवृतो दोषलिङ्गानि सोऽनिमित्तं प्रदर्शयेत् ॥ १९ ॥
क्षीणः क्षणात्क्षणात् पूर्णो भजते कृच्छ्रसाध्यताम् । कालेनोपेक्षिताः सर्व यद्यान्ति मधुमेहताम् ॥ २० ॥
मधुरं यच्च सर्वेषु प्रायो मध्विव मेहति । सर्वेऽपि मधुमेहाख्या माधुर्याच्च तनोरतः ॥ २१ ॥
This (madhumeha) arises in two ways, by the aggravation of vata caused by a) dhatuksaya-depletion/loss of tissues and b) obstruction of its path ( movement) by the dosas covering it.
In the obstructed kind, it (vata) exhibits the symptoms of the dosa covering it, without any other reason, occassionally, hence the bladder is found sometimes empty and sometimes full, and the diseases becomes difficult to cure. All varieties (of prameha) if neglected will, in course of time, become madhumeha. All those in which the urine is sweet resembling honey and the body also becoming sweet, are called madhumeha. 18b-21.
Prameha upadrava – complications / secondary diseases of diabetes
अविपाकोऽरुचिश्च्छर्दिर्निद्रा कासः सपीनसः । उपद्रवाः प्रजायन्ते मेहानां कफजन्मनाम् ॥ २२ ॥
बस्तिमेहनयोस्तोदो मुष्कावदरणं ज्वरः । दाहस्तृष्णाऽम्लको मूर्च्छा विड्भेदः पित्तजन्मनाम् ॥ २३ ॥
वातिकानामुदावर्तकम्पहृद्ग्रहलोलताः शूलमुन्निद्रता शोष: कासः श्वासश्च जायते ॥ २४ ॥
Poor digestion, anorexia, vomitting, more of sleepcough and nasal catarrh-are the complications/secondary, diseases of diabetes arising from kapha.
Pricking pain in the bladder and penis, exudation from the scrotum, fever, burning sensation, thirst, sourness (increased acidity), fainting and loose bowels are the upadrava of those (diabetes) arising from pitta. Udavarta (upward movement of vata), tremors, catching pain in the region of the heart, different kinds of desires, pain in the abdomen, loss of sleep, dryness (of the mouth, throat etc.); cough and dyspnoea are the upadrava of those (diabetes) arising from vata. 22-24.
Prameha pidika – diabetec ulcer/corbuncles
शराविका कच्छपिका जालिनी विनताऽलजी । मसूरिका सर्षपिका पुत्रिणी सविदारिका ॥ २५ ॥
विद्रधिश्चेति पिटिकाः प्रमेहोपेक्षया दश । सन्धिमर्मसु जायन्ते मांसलेषु च धामसु ॥ २६ ॥
Saravika kacchapika jalini, vinata, alaji, masurikasarsapika, putrini, vidarika and vidhradhi-are the ten eruptions/ulcers appearing on the joints, vital spots and muscular parts during the course of diabetes. 25-26
अन्तोन्नता मध्यनिम्म्रा श्यावा क्लेदरुजान्विता ।
शरावमानसंस्थाना पिटिका स्याच्छराविका ॥ २७ ॥
महावस्तुपरिग्रहा। अवगाढार्तिनिस्तोदा श्लक्ष्णा कच्छपपृष्ठाभा पिटिका कच्छपी मता ॥ २८ ॥
स्तब्धा सिराजालवती स्निग्धस्त्रावा महाशया । रुजानिस्तोदबहुला सूक्ष्मच्छिद्रा च जालिनी ॥ २९ ॥
अवगाढरुजाक्लेदा पृष्ठे वा जठरेऽपि वा। महती पिटिका नीला विनता विनता स्मृता ॥ ३० ॥
दहति त्वचमुत्थाने भृशं कष्टा विसर्पिणी | रक्तकृष्णाऽतितृट्स्फोटदाहमोहज्वराऽलजी ॥ ३१ ॥
मानसंस्थानयोस्तुल्या मसूरेण मसूरिका | सर्षपामानसंस्थाना क्षिप्रपाका महारुजा ॥ ३२ ॥
सर्षपी सर्षपातुल्यपिटिकापरिवारिता । पुत्रिणी महती भूरिसुसूक्ष्मपिटिकाचिता ॥ ३३ ॥
विदारीकन्दवद्धृत्ता कठिना च विदारिका । विद्रधिर्वक्ष्यतेऽन्यत्र
Saravika is pitaka ( eruptions / ulcers ) having elevated edges and depressed centre, black in colour, associated with
exudation and pain, resembling a saucer is size and shape. Kacchapika is pitaka having severe ( deep) pain, either continuous or intermittent, extends over a large area, smooth and resembles the shell of a tortoise.
Jalini is stable, has veneous net-work, greasy (unctuous) exudate, and big cavity inside, with severe pain, intermittent pain and has minute openings.
Vinata is big sized eruption, developing either on the back or abdomen, blue in colour having severe ( deep) pain and exudation and bent downwards.
Alaji has burning sensation and elevation of the skin, very difficult to bear, spreads to other places, reddish-black in colour and accompanied with severe thirst, boils (appearing in different places of the body), burning sensation all over the body, delusion and fever.
Masurika resembles masura ( lentil) in size and shape. Sarsapika is like sarsapa (mustard seed) in size and shape, ulcerates soon, has severe pain and surrounded by eruptions resembling mustard seeds.
Putrini is a big eruption, surrounded by many small eruptions.
Vidarika is round like the tuber of vidari and hard. Vidradhi will be described elsewhere (in the next chapter 27-34b.
तत्राद्यं पिटिकात्रयम् ॥ ३४ ॥ पुत्रिणी च विदारी च दुःसहा बहुमेदसः। सह्याः पित्तोल्बणास्त्वन्याः सम्भवन्त्यल्पमेदसः ॥ ३५ ॥
तासु मेहवशाच्च स्याद्दोषोद्रेको यथायथम् । प्रमेहेण विनाऽप्येता जायन्ते दुष्टमेदसः । नोपलक्ष्यन्ते यावद्वस्तुपरिग्रहः ॥ ३६॥
Out of these, the first three (saravika, kacchapika and jalini), putrini and vidarika are difficult to bear (and also to treat), these arise from predominance of fat tissue, the remaning and those having predominance of pitta and those arising from less of fat are bearable (and easy to treat). In these (e) s) the recogni of aggravation of dosas is similar to that of (the kinds of) diabetes.
These eruptions occur even without diabetes, due to vitiation of fat tissue but are not taken note of (treated) till they get localised (permanantly at any place). 34b-36.
Sapeksya nidana – differential diagnosis
हारिद्रवर्ण रक्तं वा मेहपाग्रूपवर्जितम् ।
यो मूत्रयेन्न तं मेहं रक्तपित्तं तु तद्विदुः ॥ ३७॥ If a person passes urine having the colour either of termuric (deep yellow) or of blood (red) without the appearance of premonitory symptoms of diabetes, he should not be understood as having prameha (diabetes) but be taken as having raktapitta (bleeding diseases). 37.
Prediabetes symptoms – Prameha purvarupa
स्वेदोऽङ्गगन्धः शिथिलत्वमङ्गे शय्यासनस्वप्नसुखाभिषङ्गः ।
हृन्नेत्रजिह्वाश्रवणोपदेहो घनाङ्गता केशनखातिवृद्धिः ॥ ३८ ॥
शीतप्रियत्वं गलतालुशोषो माधुर्यमास्ये करपाददाहः । भविष्यतो मेहगणस्य रूपं मूत्रेऽभिधावन्ति पिपीलिकाश्च ॥ ३९ ॥
More of perspiration, bad smell of the body, looseness/ flacidity of the body parts, desire for the comfort fo the bed,
seat and sleep; thickening of the heart, eyes tongue and ears; stoutness of the body, greater increase of (growth rate) the hairs and nails, desire for cold, dryness of the throat and palate, sweet taste in the mouth (always) burning sensation of the palms and soles; and swarming of ants towards his urine (place of urination or urine pots) are the premonitory 38-39. symptoms of the groups of diabetes.
Prameha sadhyasadhyata – prognosis of diabetes
दृष्ट्वा प्रमेहं मधुरं सपिच्छं मधूपमं स्याद्दिवविधो विचारः । सम्पूरणाद्वा कफसम्भवः स्यात् क्षीणेषु दोषेष्वनिलात्मको वा ॥ ४० ॥
Finding diabetes, with urine being sweet, slimy and resembling honey, the (unintellegent) physician gets doubt on two points; whether it is born from kapha caused by over nutrition or whether it is born from anila (vata) caused by decrease of the dosas (under-nutrition). 40.
सपूर्वरूपाः कफपित्तमेहाः क्रमेण ये वातकृताश्च मेहाः । साध्या न ते, पित्तकृतास्तु याप्याः साध्यास्तु मेदो यदि नातिदुष्टम् ॥ ४१ ॥
Prameha caused by kapha and pitta (all varieties) having all the premonitory symptoms and those caused by vata, after lapse of time are incurable; those caused by vata, after lapse of time are incurable; those caused by pitta persist for long time and are controllable; and those are curable in which the fat tissue is not greatly vitiated (increased). 41.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने प्रमेहनिदानं नाम
दशमोऽध्यायः ॥ १०॥
Thus ends the chapter-prameha nidana-the tenth in of Astangahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
