Prameha

Mythological origin of Prameha

During the destruction of Dakshaas sacrifice due to Havih Praas`hana, Prameha manifested itself after Gulma, so it has been described after Gulma. Ch. Ni. 8.11
Havih is the sacred offering meant for the deity and the Agni, if a person consumes it then his Jaat`haraagni is affected adversely and manifests as various diseases of low gastric fire activity (Mandaagni) Prameha being one of them.

Svaroopa

Prameha is the Sanskrit word formed from the verb root Mih Sechane or Migh. It means to void or pass urine, make water upon, to cause to make water.
Increase in amount (Prabhoota Mootra) and turbidity of urine (Aavila Mootra) are the characteristic symptoms of Prameha.
All the three Doshas are responsible for 20 types of Prameha and all other related diseases.

General Aetiologyof disease

Manifestation of disease and pacification of disease, are dependent on Nidaana (Causative Factors), Dosha (Vaata, Pitta and Kapha), Dooshya (Dhaatu).
Due to the permutations and combinations, four conditions are possible, when Dosha, Nidaana and Dooshya are not favorable to each other
- A disease may not manifest (Vikaara Ajananam)
- A disease will manifest after a long period (Chiren`a Jananam)
- A disease will manifest but in a mild form (An`uvikaarajananam)
- A disease will not manifest its all the symptoms (Asarvlingavikaarajananam)
If causative factors are favorable to the respective Dosha, they will aggravate; but if these causative factors are not favorable to Dosha, they will not aggravate the Dosha. Dosha will affect that Dooshya which is similar in the attributes.
Depending upon the strength of the vitiated Dosha and their association with specific Dooshya the clinical picture will differ.
The following stages are essential in the manifestation of any diseases
- Causative factors being similar to the Dosha aggravate them
- Thus aggravated Dosha then manifests diseases as per the causative factors.

General Sampraapti

In occurrence of any disease, following steps necessarily happen

As causative factors (Nidaana) are similar to the Dosha by their attributes they will aggravate the Dosha (Dosha Janana)
These aggravated Dosha are responsible for occurrence of disease in accordance with causative factors.

Unless and until the qualities of causative factors are analogous to respective Dosha the pathogenesis will not go on. This is the reason that these factors are called as causative factors. Therefore the causative factors; will always exhibit properties that are analogous to the Dosha.
It is essential that the attributes of the Dosha and the Dooshya be compatible otherwise the diseases may not manifest as they the opposing attributes nullify the effect of each other. Doshas being more powerful and vitiating in nature always overpower the Dooshya; hence the causative factors are generally described in respect to the Dosha attributes.
Weak Dosha remain dormant in various Dooshya like a seed waiting for favourable time and to germinate. When the time is ripe and the causative factor to precipitate it they manifest as disease. Some times after expending their strength in generating the disease they tend to pacify and cease their pathological activity, again to resurface at proper time and condition in the internal environment. This will lead to various possibilities as under
- the disease will manifest

the diseases will manifest immediately
the diseases will be strong and
the disease will manifest with all its symptoms
the disease may not manifest at all
the disease may manifest slowly or after prolonged period
the disease may manifest with mild form
the disease may manifest with out all the symptoms

When they get favourable conditions to grow up they manifest themselves after a specific time period. This is the late manifestation of disease. Another situation may take place that with due course of time Dosha may lose their strength and get pacified, thus they do not produce any disease after long time period also. In case if at all a disease gets manifested it will develop slowly or in a hidden form or its all the symptoms may not manifest.
Whereas, when causative factors (Nidaana), Dosha, Dooshya are favourable to each other, Dosha will vitiate due to the causative factors and will blend up with Dooshya, then

The disease will simply get manifested.
The disease will manifest immediately.
The disease will be strong in nature.
The disease will manifest with all the symptoms.

This phenomenon is applicable to all the diseases. It is specifically mentioned in the chapter of Prameha as manifestation of different types of Prameha is also determined by these factors. Ch. Ni. 4.4 Chakrapaan`i
In Prameha, causative factors, Dosha and Dooshyaa all are favorable to increase the S`hleshmaa in body. Hence S`hleshmaa is the most important contributor in pathogenesis of Prameha.
Other factors responsible for increase and vitiation of Meda as well as Mootra should also be considered while assessing the pathogenesis.

Dosha

S`hleshmaa (having liquidity in excess /devoid of its natural density)
Pitta
Vaayu

Dooshya

Medas in excess (Bahu) and with liquidity (Abaddha Aghana / lost consistency / unformed / devoid of unctuousness)
Maamsa (Pis`hita) – in abundance (Bahu) and with liquidity (Abaddha Aghana / devoid of density, firmness)
Vasaa (S`huddha Maamsa Sneha) – in abundance (Bahu) and with liquidity /density (Abaddha Aghana)
Majjaa – in abundance (Bahu) and with liquidity (Abaddha Aghana) / devoid of unctuousness and granular structure,
S`hareeraja Kleda (Ambu) Excess Kleda
S`hukra in excess (Bahu) / devoid of density, unctuousness, heaviness,
S`hon`it a (Asra) – in excess (Bahu) / increased fluidity
Laseekaa (Maamsa Tvag Antare Udakabhaagah) – in abundance (Bahu)

Rasa (which is like Oja) – in excess (Bahu)

Oja C.Chi.6/8
A person said to be having Prameha when all the premonitory symptoms are seen with the excessive urination. S.Ni.6/22
When some of the Poorvaroopaa are manifested with Polyuria, then it can be diagnosed as Prameha. S.Ni.6/23
When Polyuriais associated with history of some of the Prodromal symptoms of Prameha, it is diagnosed as Prameha.

A person suffering with Prameha feels to sit if he is walking. He wishes to have relaxed position when he sits. He prefers to sleep when he is relaxing. S.Ni.6/25

Vis`hesha Sampraapti S`hleshmaja Prameha

To have a disease like Prameha it is the most important fact the S`hleshmaa should be in excess in the body (Praag Ati Bhooyastvaat)
For a disease like Prameha t manifest it is a prerequisite that the S`hleshmaa be aggravated due to the causes.
In this condition, due to the combination of causative factors, Dosha and Dooshya S`hleshmaa get aggravated immediately.
Due to the aggravation and depending upon the specific causative factor it reaches various Dooshaya.
As the body has become flaccid (S`haithilya) already, this aggravated S`hleshmaa spreads all over the body.
The fluid predominant Shleshmaa, the lax constituents spread all over the internal environment.
While spreading in the body, first of all this S`hleshmaa gets mixed with Medas Dhaatu, as the qualities of Medas Dhaatu are closely similar (Samaana Gun`a Bhooyisht`ha) to S`hleshmaa. Qualities of Medas like Madhura, Snigddha, Guru, S`heeta are also the qualities of S`hleshmaa. This happens according to Saamaanya Vis`hesha Siddhaanta that due to similarity similar thing gets increased. (Samaanam Hi Samaanena Milati Iti Bhaavah)
Being comparable with Shleshmaa in all respects the vitiated liquid Shleshmaa reaches the Meda first and Harbours itself there.
The spread of S`hleshmaa is enhanced by liquidity (Abaddhatva) and excessive amount (Bahutva) of Medas Dhaatu.
As S`hleshmaa is already vitiated, it vitiates Medas after getting mixed with it (S`hleshmaa).
The powerful Dosha vitiated Shleshmaa vitiates the Meda
This vitiated S`hleshmaa collectively with vitiated Medas gets mixed up with body fluid (S`hareera Kleda) and Maamsa Dhaatu as these two factors Viz., body fluid and Maamsa have already exceeded their quantity. Thus, Maamsa Dhaatu also gets vitiated.
The combination of Shleshmaa and Meda further mixes with other body constituents like Maamsa, the Kleda increasing them substantially.
Ultimately, putrefied carbuncles (Pooti Maamsa Pid`akaa) are formed in Maamsa Dhaatu; they are named as S`haraavikaa, Kachchhapikaa etc. These carbuncles are formed due to the vitiation of Maamsa Dhaatu (Aprakritibhootatvaat)
The fluid predominant combination when reaches the skin layers the Pitta, Vaata and Rasa, Laseeka get putrefied and manifest as eruptions which are known as Prameha Pid`akaa / carbuncles.
Further, body fluid gets vitiated and transformed in to urine.
This collectively increased fluid on reaching the Basti / urinary bladder is expelled with increased frequency and turbidity.
Vankshan`a (Groin Region) and Basti (Urinary Bladder) are the two roots (controlling organs) of the channel carrying urine (Mootravaha Srotas). Medas and Kleda (Body fluid) clogs the channel carrying urine (Pratirudhyaat)
Thus, S`hleshmaa get vitiated by its all the attributes and as it remains already aggravated this vitiation becomes stable and this excessive vitiation leads to incurability of disease. (Prakritivikritibhootatvaat)
When this S`hleshmaa merges in Vasaa or Medas due to their analogous attributes, the disease is at its severe stage. (Balitva)
Whereas when S`hleshmaa merges in S`hon`ita etc. I.e. Dooshya different in attributes to S`hleshmaa, the disease like Prameha becomes difficult to treat. (Viruddhopakrama). Then the disease stables and further gets the incurable status.
Viruddhopakrama is a situation that when Vaidya tries to pacify S`hleshmaa by means of hot drugs, simultaneously it vitiates S`hon`ita as it is hot in nature. This mutual contradiction leads to the incurability of disease.
Body fluids mixed with S`hleshmaa and Medas enter into the Basti and gets transformed into urine. During this process this urine acquire the 10 morbid qualities of S`hleshmaa Viz., S`hveta, S`heeta, Moorta, Pichchhila, Achchha, Snigdha, Guru, Madhura, Saandraprasaada, Manda.
The name of the type of Prameha is allotted on the basis of the attribute of the S`hleshmaa which gets manifested on urine (Gaun`am Naamasamaakhyam). The attribute of S`hleshmaa manifests on urine as it is excessively increased.
The 10 types of S`hleshmaja Prameha are manifested in accordance with the permutation and combination of attributes of S`hleshmaa. (Ekena Anekena Vaa Bhooyastaram Upasrijyate)
The 10 types of S`hleshmaja Prameha are

Udaka Meha watery urination.
Ikshuvaalikaarasa Meha urine resembles to sugarcane juice.
Saandra Meha viscid urination.
Saadraprasaada Meha urine coagulates and renders to clear little bit.
S`hukla Meha urine turns to white Colour and resembles to flour.
S`hukra Meha urines like semen or it mixes with semen.
S`heeta Meha urine tastes highly sweet and cold to touch.
Sikataa Meha urine with gravel.
S`hanaih Meha slow and sluggish urination.
Aalaala Meha lubricous, fibrous, filamentous and saliva like urination

It is only about S`hleshmaja Meha that 10 qualities of S`hleshmaa produce 10 types of Prameha by permutation and combination. This thing cannot happen with other Dosha. It is true that the fact that is seen with eyes can be discussed.

Vis`hesha Sampraapti Pittaja Prameha

As explained in the S`hlaishmika Prameha, there is a prerequisite that S`hleshmaa should have been aggravated.
Due to the indulgence in causative factors of Pitta, it gets aggravated immediately.
As explained for S`hlaishmika Prameha, the same pathogenesis happens to manifest 6 types of Prameha due to Pitta, immediately.
With respect to S`hlaishmika Prameha, Pittaja Prameha manifest quickly as Pitta is sharp in nature.
The types of Pittaja Prameha are named according to the qualities of Pitta. They are

Kshaara Meha alkaline urine similar in aspect of smell, Colour, taste and touch
Kaala Meha unobstructed black Coloured urine
Neela Meha acidic and dark blue Coloured urine
Lohita Meha bloody, raw meat smelling like and salty urine
Maanjisht`ha Meha dark red / blackish red Coloured urine like decoction of Rubia Cordifolia (Manjisht`Haa)
Haaridra Meha Yellow Coloured urine like decoction of curcuma Longa (Turmeric Haridraa)
The attributes of Pitta responsible for Pittaja Prameha are Kshaara (alkaline), Amla (sour), Lavan`a (Salty), Kat`uka (pungent), Visra (smelling of raw meat), Ushn`a (hot).

All the types of Pittaja Prameha are palliative (Yaapya).

These types of Pittaja Prameha cannot be completely cured, as there is mutual contradiction in treating them. In Pittaja Prameha, Pitta harboursin Medas. The site of Prameha is Medas that vitiates in pathogenesis of this disease. To pacify Pitta cold potency drugs and sweet foodstuffs are to be used but they are favourable to Medas and to pacify Medas pungent drugs are to be used but they are favourable to increase Pitta, so it becomes complicated to treat Pittaja Prameha. This is called as Viruddhopakrama.

Chakrapaan`i said that due to Vyaadhi Prabhaava Pittaja Prameha can not be treated easily.

Vis`hesha Sampraapti Vaataja Prameha

S`hleshmaa should have been aggravated.
Vaata gets immediately aggravated in a person who indulges in Vaata aggravating factors.
When this aggravated Vaayu, while spreading through the body takes Vasaa with it and reaches to channels of urine (Mootravaha Srotas), it manifests Vasaa Meha.
When Vaayu forces Majjaa to bladder, then Meha manifested is Majja Meha.
When Laseekaa (Yat Maamsa Tvag Antare Udakam, tat Laseekaa S`habdam Labhate | Ch. S`haa. 7) (Lymph), due to its excess amount and dissipation quality of Vaayu, enters in to urinary bladder, person urines profusely and continuously (Ajasram) but with Sanga (stagnation) (Sa Avas`hesha Mootra Ati Ksharan`a Gangaadhara) like an elephant, this is Hasti Meha.
Oja is Madhura in nature. When due to dryness (Raukshya) Vaayu converts Maadhurya of Oja into Kashaaya (astringent) taste and takes it into the urinary bladder, Madhu Meha gets manifested.
These 4 types of Vaataja Prameha are incurable as they are very serious and also because of contraindication involved in their treatment.
It is very serious as it passes the essence of Dhaatus through urine out of the body.
This is incurable due to Viruddhopakrama. It means that unctuous things useful to pacify Vaayu aggravate Medas and dry things useful to lower down Medas increase Vaayu.
These 4 types of Vaataja Prameha are named after the attributes involved in the pathogenesis. These are

Vasaa Meha oily and repeated urination
Majja Meha urine mixed with Majja and repeated urination
Hasti Meha large quantity of urine passing continuously like a passionate elephant.
Madhu Meha urine turns to sweet and astringent in taste, pale in Colour and dry in nature.

One who is very passionate to eat and envies to bath and walk (reluctant to exercise) could be captured by Prameha like a bird that reaches to its nest very quickly.

Prameha is seen in those people who are lazy, less enthusiastic, obese, over unctuous and eat excessively, gluttonous (Audarika).

Actually, a person who takes wholesome diet and resorts, which bring about the normal state of the Dhaatu in the body leads to happy life.

Prameha Types: Comparative Study

*Vaataja Prameha*	*Pittaja Prameha*	*Kaphaja Prameha*
Charaka	Sushruta	Vaagbhat`a	Charaka	Sushruta	Vaagbhat`a	Charaka	Sushruta	Vaagbhat`a
Vasaa	Vasaa	Vasaa	Kshaara	Kshaara	Kshaara	Udaka (Jala)	Udaka	Udaka
Majja	Sarpi *	Majja	Kaala	Amla *	Kaala	Ikshuvaalikaa (Ikshu)	Ikshuvaalikaa	Ikshu
Hasti (Laseekaa)	Hasti	Hasti	Neela	Neela	Neela	Saandra	Saandra	Saandra
Madhu (Ojomeha)	Kshaudra *	Madhu	Lohita (Rakta)	S`hon`ita	Rakta	Saandraprasaada	Suraa	Suraa
			Maanjisht`ha	Maanjisht`ha	Maanjisht`ha	S`hukla	Pisht`a *	Pisht`a *
			Haaridra	Haaridra	Haaridra	S`hukra	S`hukra	S`hukra
						S`heeta	Phena *	S`heeta
						Sikataa (Vaalukaa)	Sikataa	Sikataa
						S`hanaih	S`hanaih	S`hanaih
						Aalaala (Laalaa)	Lavan`a *	Laalaa

( ) = names as given in Ch.Chi. 6
* = as per Madhukosha T`eekaa M.N. 33.7-12

Kaphaja Mehaa (10 types) are curable (Saadhya)
Pittaja Mehaa (6 types) are palliative (Yaapya)
Vaataja Mehaa (4 types) are incurable (Asaadhya) C.Chi.6/7
As per the combinations of Dosha, Dooshya Prameha gets manifested. These types of Prameha are Categorised on the basis of Colour (Varn`a), smell (Gandha), taste (Rasa), touch (SparS`ha) of urine. A.H.Ni.10/7, 8

Sampraapti 1 – Prameha (C.Chi.6/ 5, 6)
Kapha aggravates due to its causative factors, like Aasyaa etc.
Kapha vitiates Medas, Maamsa and Kleda (body fluid) which are located in Basti. This is the basic cause of Meha. (Kaphaja Meha)
Similarly, Pitta aggravated due to hot things vitiates Medas, Maamsa, Kleda situated in the Basti causes Meha. (Pittaja Meha)
When other two Dosha (Pitta and Kapha) are relatively diminished, the aggravated Vaayu takes away the Dhaatu (Majja, Oja and Laseekaa Chakrapaan`i C.Chi.6/6) to Basti (urinary bladder) causing Meha. (Vaataja Meha)

Sampraapti 2 – Prameha (A.H.Ni.10/4)
Vitiated Kapha Harbouring in bladder (Basti) and vitiating body fluid (Kleda), sweat (Sveda), Medas (Adipose tissue), Rasa and Maamsa, lead to Prameha.
When Kapha and all other cold natured factors are diminished (Kaphaadau Ksheen`e sati) then Pitta and Rakta both Harbouring in urinary bladder give rise to Prameha.
Vaayu takes the (Dhaatu) towards bladder. On the other way due to the depletion of Dhaatu, Vaayu lead to Prameha.

Saamaanya Sampraapti 3- Prameha}
In general, respective Dosha traverse through the body to Basti (urinary bladder) vitiating urine (Mootra) generate respective types of Meha. C.Chi.6/6
Different types of Prameha as mentioned above are characterized by Varn`a (Colour), Rasa (Taste), Spars`ha (Touch) and Gandha (Smell) of urine. C.Chi.6/12
It means that the type of Prameha should be diagnosed on the basis of urine examination looking at Varn`a, Rasa, SparS`ha, Gandha of urine.
When urine turns to dark brown (S`hyaava) and reddish brown (Arun`a Varn`a), when urine resembles to the attributes of Majja etc., Dhaatu, also a person experiencing pain, then these are symptoms that Vaataja Prameha has turned to incurable status (Asaadhya) C.Chi.6/12
If the Colour of urine is yellow or when Hematurea is there, without the Poorvaroopa (premonitory symptoms) of Prameha, this condition should be diagnosed as Raktapitta instead of Prameha. C.Chi.6/54
The patients who are Pramehee or Madhumehee (diabetic) right from the birth (Jaata Pramehee congenital) and those who are borne of Pramehee or Madhumehee (diabetic) parents (Kulaja – hereditary) are not curable (Asaadhya). Not only Prameha or Madhumeha but all other Kulaja (hereditary) diseases are also incurable. C.Chi.6/57
Beeja Dosha (genetic cause) is the major factor in this aspect. Beeja (S`hukra or S`hon`ita) itself is affected by the factors that are responsible for manifestation of Prameha or Madhumeha.
The word Meha is generally applied to all types of Prameha; on the other hand the word Madhumeha is applied to Madhumeha and also to all types of Prameha.(Chakrapaan`i)
Prameha is Anushangee Vikaara. C.Su.25 There is a possibility to happen Prameha in the progeny. Anushangee is Punarbhaavee as explained by Chakrapaan`i.
Aachaarya Charaka has explained pathogenesis in Sootrasthaanas 17^th chapter (Kiyantahshiraseeya) C.Su.17.78-89
The pathogenesis happens in a person, who is eating heavy, unctuous, sour (Amla), salty (Lavan`a), in excess amount, newly arrived grains, who enjoys sleep (sedentary life) and remain at a place for longer time without moving here and there, who does not exercise, who does not have any stress and enjoys life completely, who never carry out cleansing processes (Panchakarma therapies); a person with these hobbits is more prone to have Prameha. This is a prerequisite for Prameha.
In such person, S`hlshmaa, Pitta, Medas and Maamsa aggravate vigorously.
The path of Vaayu gets obstructed (Aavrita Gati) and so Vaayu together with Ojas traverse to Basti (urinary bladder) causing the obstinate type of disease called Madhumeha.
In this disease, the signs and symptoms of Madhumeha are seen according to the Dosha. Vaata, Pitta and Kapha manifest their signs and symptoms repeatedly. They vanish at times and reoccur again.
If this disease is not treated properly or neglected, it causes more serious seven types of carbuncles. These carbuncles are named as Prameha Pid`akaa. These appear at Marma, joints (Sandhi) of the body, muscular areas, porous areas (AvakaaS`ha).

These Prameha Pid`akaa are

S`haraavikaa
Kachchhapikaa
Jaalinee
Sarshapee
Alajee
Vinataa
Vidradhee

Sampraapti 4 – Prameha
A person can be diseased who has sedentary habits, reluctant to exercise, lazy, consuming a food that is cold, unctuous, sweet, fatty, excess liquid. This is a prerequisite that in a person with such Habbits only a disease like Prameha will manifest.
In above-mentioned person, Aakva Aama (Unripe(raw)) Dosha are the major factor.
These all three Dosha, when combine with Medas, travel in the body in downward direction towards Mootravaha Storas.
They Harbour in to Basti Mukha and are urinated. S.Ni.6/4
Prameha Pid`Kaa also are caused due to all the three Dosha. S.Ni.6/7

Types
Kaphaja Prameha – 10 types S.Ni.6/8

Udaka Meha
Ikshuvaalikaa Meha
Suraa Meha
Sikataa Meha
Shanaih Meha
Lavan`a Meha
Pisht`a Meha
Saandra Meha
S`hukra Meha
Phena Meha

Pittaja Prameha – 10 types S.Ni.6/8

Neela Meha
Haridraa Meha
Amla Meha
Kshaara Meha
Manjisht`ha Meha
S`hon`ita Meha

Vaataja Prameha – 10 types S.Ni.6/11

Sarpi Meha
Vasaa Meha
Kshaudra Meha
Hasti Meha

Although, 20 types of Prameha are explained on the basis of Dosha, there may be many permutations and combinations to have more and more types. For example, if we permute and combine 5 Colours then depending upon the combination we will have many types of Colours. The same situation happens here regarding types of Prameha. S.Ni.6/ 26

Sushruta has classified Prameha in to S.Chi.11/3

Sahaja (right from the birth) due to genetic reason
Apathya Nimittaja (due to unwholesome practices)

Vagbhat`a has classified Prameha in to A.H.Ni.10/18

When Vaayu aggravates due to depletion of Dhaatu and generates Prameha
When Vaayu becomes stagnant due to covering by Dosha

When Vaayu gets covered by Dosha etc. the symptoms are suddenly manifested as Vaayu is of Chala (moving) attribute. Suddenly, urinary bladder gets filled by urine or remain empty. So when Prameha happens due to Aavaran`a of Vaayu by other entities it turns to Krichchhrasaadhya (difficultly curable) state, while when Prameha happens due to depletion of Dhaatu it remains Asaadhya (incurable). A.H.Ni.10/19

When Prameha is Dhaatukshayaja (Kevala Vaataja), symptoms related to Vaayu only manifest. In this type there is no Aavaran`a.

Where as, Gadaadhara says that Madhumeha happens due to only Aavaran`a. He quotes reference of Charaka as C.Su.17/78-89

All types of Prameha turns to Madhumeha when neglected or not treated. Generally, in all types of Prameha, urine turns to sweet taste and it resembles to honey (Madhu) by means of Colour, touch, taste, and smell. A.H.Ni.10/21 In other words, in a patient with Prameha, the body is completely enriched by sweetness. A.H.Ni.10/21 (Maadhuryaat Cha Tanoratah)

Last updated on February 11th, 2021 at 11:39 am