The sixth chapter of Nidanasthana of Sushruta Samhita is called as Prameha Nidanam Adhyaya. This chapter offers with Diabetes.
अथातः प्रमेहनिदानं व्याख्यास्यामः ।। १ ।।
यथोवाच भगवान् धन्वन्तरिः ।।२ ।।
We are going to now expound Prameha Nidanam- prognosis of Diabetes (Polyuria) as revealed by the venerable Dhanvantari.
Nidana Causes
दिवास्वप्नाव्यायामालस्यप्रसक्तं शीतस्निग्धमधुरमेद्यद्रवान्नपानसेविनं पुरुषं जानियात् प्रमेही भविष्यतीति ||३||
The one that indulges within the beneath talked about causative components ought to be thought-about because the one who would grow to be a affected person of prameha in future –
– Always sleeping through the day time
– Not indulging in bodily actions and being lazy
– Extreme and common consumption of meals and drinks that are chilly, unctuous, candy, fatty and liquid
Samprapti: Pathogenesis
तस्य चैवम्प्रवृत्तस्यापरिपक्वा एव वातपित्तश्लेष्माणो यदा मेदसा सहैकत्वमुपेत्य मूत्रवाहिस्रोतांस्यनुसृत्याधो गत्वा बस्तेर्मुखमाश्रित्य निर्भिद्यन्ते तदा प्रमेहाञ्जनयन्ति ||४||
In individuals who’re indulged within the above stated etiological components
↓
immature vata, pitta and kapha get blended with medas – fats tissues
↓
the doshas together with medas now journey downward alongside the mutravaha srotas i.e. channels which convey urine
↓
these doshas now get localized on the bastimukha i.e. orifice / opening of the urinary bladder and
↓
start to move out, blended with urine and
↓
offers rise to a illness known as as Prameha
Purvarupa: Premonitory signs
तेषां तु पूर्वरूपाणि- हस्तपादतलदाहः स्निग्धपिच्छिलगुरुता गात्राणां मधुरशुक्लमूत्रता तन्द्रा सादः पिपासा दुर्गन्धश्च श्वासस्तालुगलजिह्वादन्तेषु मलोत्पत्तिर्जटिलीभावः केशानां वृद्धिश्च नखानाम् ||५||
Their premonitory signs are –
- Burning sensation within the fingers and toes (palms and soles)
- Unctuousness, sliminess and heaviness of the physique / pores and skin
- Elimination of white coloured urine which is good in style and smells dangerous
- Stupor
- Debility
- Extreme thirst
- Problem in respiration
- Extreme accumulation / deposition of dust in palate, throat, tongue and tooth
- Matting of hairs on the top
- Extreme development of hairs and nails
Rupa: Indicators and Signs
तत्राविलप्रभूतमूत्रलक्षणाः सर्व एव प्रमेहा भवन्ति ||६||
The generalized signs of all types of Prameha are –
– Avila mutrata – turbidity of urine and
– Prabhuta mutrata – elevated amount of urine
सर्व एव सर्वदोषसमुत्थाः सह पिडकाभिः ||७||
All types of prameha and prameha pidakas i.e. eruptions born out of prameha are ‘sarva dosha samuttha’ i.e. brought on by all three doshas aggravated collectively.
Bheda: Sorts
तत्र, कफादुदकेक्षुवालिकासुरासिकताशनैर्लवणपिष्टसान्द्रशुक्रफेनमेहा दश साध्याः, दोषदूष्याणां समक्रियत्वात्; पित्तान्नीलहरिद्राम्लक्षारमञ्जिष्ठाशोणितमेहाः षड् याप्याः, दोषदूष्याणां विषमक्तियत्वात्; वातात् सर्पिर्वसाक्षौद्रहस्तिमेहाश्चत्वारोऽसाध्यतमाः, महात्ययिकत्वात् ||८||
10 sorts of prameha come up from kapha –
- Udakameha,
- Iksuvalikameha,
- Surameha,
- Sikatameha,
- Shanairmeha,
- Lavanameha,
- Pistameha,
- Sandrameha,
- Sukrameha and
- Phenameha
These ten varieties of prameha brought on by kapha are curable. It’s because the remedy for each the doshas and dushyas i.e. tissues concerned within the pathogenesis of kaphaja prameha are frequent.
Six varieties of Prameha come up from Pitta. They’re –
- Nilameha,
- Haridrameha,
- Amlameha,
- Ksarameha,
- Manjisthameha and
- Sonitameha (Raktameha)
These six varieties of prameha brought on by pitta may be managed however can’t be handled fully. The reason being that the remedies for doshas and dushyas concerned within the pathogenesis are completely different from one another.
4 sorts of prameha come up from Vata. They’re –
- Sarpimeha,
- Vasameha,
- Ksaudrameha and
- Hastimeha
The above talked about 4 varieties of prameha brought on by vata are tremendously incurable. It’s because it produces nice hazard of shedding tissues and in addition life.
Manifestation (Pathogenesis) of Kaphaja, Pittaja and Vataja Pramehas
तत्र वातपित्तमेदोभिरन्वितः श्लेष्मा श्लेष्मप्रमेहाञ्जनयति, वातकफशोणितमेदोभिरन्वितं पित्तं पित्तप्रमेहान्, कफपित्तवसामज्जमेदोभिरन्वितो वायुर्वातप्रमेहान् ||९||
Kaphaja Prameha – is produced by aggravated kapha getting related to vata, pitta and medas – fats.
Pittaja Prameha – is produced by aggravated pitta getting related to vata, kapha, rakta and medas.
Vataja Prameha – is produced by aggravated vata getting related to kapha, pitta, vasa – muscle fats, majja – bone marrow and medas – fats.
Kaphaja Pramehas: Diabetes of Kapha Origin
तत्र, श्वेतमवेदनमुदकसदृशमुदकमेही मेहति; इक्षुरसतुल्यमिक्षुवालिकामेही; सुरातुल्यं सुरामेही; सरुजं सिकतानुविद्धं सिकतामेही; शनैः सकफं मृत्स्नं शनैर्मेही; विशदं लवणतुल्यं लवणमेही; हृष्टरोमा पिष्टरसतुल्यं पिष्टमेही; आविलं सान्द्रं सान्द्रमेही; शुक्रतुल्यं शुक्रमेही; स्तोकं स्तोकं सफेनमच्छं फेनमेही मेहति ||१०||
| Title of Kaphaja Prameha | Signs |
| Udaka Meha | Urine – white coloured urine, resembles water,Devoid of ache and discomfort |
| Iksuvalisa Meha | Urine resembles sugarcane juice |
| Sura Meha | Urine resembles sura – beer |
| Sikata Meha | Urine is eradicated with ache and has sand / gravel in it |
| Sanair Meha | Urine is blended with kapha and is slimyUrine is eradicated slowly |
| Lavana Meha | Urine is non-slimyIs salty in style |
| Pista Meha | Urine resembles resolution of flourUrination is related to horripilation |
| Sandra Meha | Urine is turbid and thick |
| Sukra Meha | Urine resembles semen |
| Phena Meha | Urine is frothy and clearUrine is eradicated in small portions, little by little |
Pittaja Prameha: Diabetes of Pitta Origin
अत ऊर्ध्वं पित्तनिमित्तान् वक्ष्यामः- सफेनमच्छं नीलं नीलमेही मेहति; सदाहं हरिद्राभं हरिद्रामेही; अम्लरसगन्धमम्लमेही; स्रुतक्षारप्रतिमं क्षारमेही; मञ्जिष्ठोदकप्रकाशं मञ्जिष्ठामेही; शोणितप्रकाशं शोणितमेही मेहति ||११||
After this, we’ll describe six varieties of pittaja prameha
| Title of Pittaja Prameha | Signs |
| Nila Meha | Urine is frothy, clear and blue in colour |
| Haridra Meha | Urine resembles turmeric in colorBurning sensation whereas urinating |
| Amla Meha | Urine has bitter style and odor |
| Ksara Meha | Urine resembles alkali resolution |
| Manjistha Meha | Urine resembles resolution / decoction of Manjistha – Rubia cordifolia (mild crimson in colour) |
| Sonita Meha | Urine resembles blood (darkish crimson) |
Vataja Prameha: Diabetes of Vata Origin
अत ऊर्ध्वं वातनिमित्तान् वक्ष्यामः- सर्पिःप्रकाशं सर्पिर्मेही मेहति; वसाप्रकाशं वसामेही; क्षौद्ररसवर्णं क्षौद्रमेही; मत्तमातङ्गवदनुप्रबन्धं [१] हस्तिमेही मेहति ||१२||
Additional, we’ll describe Prameha produced by Vata:-
| Title of Vataja Prameha | Signs |
| Sarpi Meha | Urine resembles ghee |
| Vasa Meha | Urine resembles muscle fats |
| Ksaudra Meha / Madhu Meha | Urine resembles honey in colour and style |
| Hasti Meha | Urine is repeatedly voided like an elephant in rut |
Upadrava: Issues / Secondary Ailments
मक्षिकोपसर्पणमालस्यं मांसोपचयः प्रतिश्यायः शैथिल्यारोचकाविपाकाः कफप्रसेकच्छर्दिनिद्राकासश्वासाश्चेति श्लेष्मजानामुपद्रवाः; वृषणयोरवदरणं बस्तिभेदो मेढ्रतोदो हृदि शूलमम्लीकाज्वरातीसारारोचका वमथुः परिधूपनं दाहो मूर्च्छा पिपासा निद्रानाशः पाण्डुरोगः पीतविण्मूत्रनेत्रत्वं चेति पैत्तिकानां; हृद्ग्रहो लौल्यमनिद्रा स्तम्भः कम्पः शूलं बद्धपुरीषत्वं चेति वातजानाम् |
एवमेते विंशति प्रमेहाः सोपद्रवा व्याख्याताः ||१३||
| Sort of Prameha | Upadrava: Issues |
| Kaphaja Prameha | Swarming of flies in direction of the bodyLassitudeGrowth of musclesNasal catarrhLooseness of physique partsLoss of tasteImproper digestionExcessive elimination of fluids from the mouth and so forth.VomitingExcessive sleepCoughDyspnea |
| Pittaja Prameha | Cracks or fissures happen over the scrotal skinCutting ache within the bladderPricking ache within the penisPain within the area of heartSour belchingFeverDiarrheaLoss of tasteVomitingFeeling of smoking coming outBurning sensationFaintingSevere thirstLoss of sleepAnemiaYellow colour of the feces, urinen and eyes |
| Vataja Prameha | Catching or gripping ache within the area of the heartLiking in direction of all types of tastesLoss of sleepRigidity of physique partsTremorsPain in physique partsConstipation |
Thus, the twenty types of diabetes and their problems have been described.
Prameha Pidaka: Diabetic Eruption
तत्र वसामेदोभ्यामभिपन्नशरीरस्य त्रिभिर्दोषैश्चानुगतधातोः प्रमेहिणो दश पिडका जायन्ते |
तद्यथा- शराविका, सर्षपिका, कच्छपिका, जालिनी, विनता, पुत्रिणी, मसूरिका, अलजी, विदारिका, विद्रधिका चेति ||१४||
Ten sorts of Prameha Pidaka i.e. eruptions or carbuncles come up in sufferers affected by prameha having abundance of vasa – muscle fats and medas – fats of their physique. In these individuals, the three doshas collectively invade the tissues giving rise to prameha pidaka. The ten sorts of prameha pidaka are –
i. Saravika,
ii. Sarsapika,
iii. Kacchapika,
iv. Jalini,
v. Vinata,
vi. Putrini,
vii. Masurika,
viii. Alaji,
ix. Vidarika and
x. Vidhradika
शरावमात्रा तद्रूपा निम्नमध्या शराविका |
गौरसर्षपसंस्थाना तत्प्रमाणा च सार्षपी ||१५||
सदाहा कूर्मसंस्थाना ज्ञेया कच्छपिका बुधैः |
जालिनी तीव्रदाहा तु मांसजालसमावृता [१] ||१६||
महती पिडका नीला पिडका विनता स्मृता [२] |
महत्यल्पाचिता ज्ञेया पिडका सा तु पुत्रिणी ||१७||
मसूरसमसंस्थाना ज्ञेया सा तु मसूरिका |
रक्ता सिता स्फोटवती दारुणा त्वलजी भवेत् ||१८||
विदारीकन्दवद्वृत्ता कठिना च विदारिका |
विद्रधेर्लक्षणैर्युक्ता ज्ञेया विद्रधिका बुधैः ||१९||
| Title of the Prameha Pidaka | Options |
| Saravika | Resembles saucer form, is depressed on the heart |
| Sarsapi | Just like white mustard in dimension |
| Kacchapika | Resembles tortoise shell in shapeHas burning sensation |
| Jalini | Community of muscle fibersSevere burning sensation |
| Vinata | Large eruption, blue in colour |
| Putrini | Large eruption surrounded by many small eruptions |
| Masurika | The eruption resembles masura – lentil in dimension and form |
| Alaji | Pink or white coloured vesicle / bleb which might burst openDreadful |
| Vidarika | Spherical in form like Vidarikanda – tuber of Pueraria tuberosaHard in consistency |
| Vidradhika | Has the options of Vidradhi – abscess |
‘These pidakas are produced by the identical types of prameha which have been described by me’ says the grasp.
Sadhyasadhyata: Prognosis
ये यन्मयाः स्मृता मेहास्तेषामेतास्तु तत्कृताः |२०|
गुदे हृदि शिरस्यंसे पृष्ठे मर्मणि चोत्थिताः |
सोपद्रवा दुर्बलाग्नेः पिडकाः परिवर्जयेत् ||२०||
The affected person of prameha ought to be rejected and never handled when –
– The pidakas have developed within the rectum or anus, area of coronary heart, head, shoulders, again and marmas – very important organs / spots
– There’s presence of problems
– The individual has durbala agni i.e. weak digestive capability
Incurability of Vataja Prameha
कृत्स्नं शरीरं निष्पीड्य मेदोमज्जवसायुतः |
अधः प्रक्रमते वायुस्तेनासाध्यास्तु वातजाः ||२१||
Prameha brought on by vata is alleged to be incurable as a result of on this situation, the aggravated vata on getting related to fats, bone marrow and muscle fats, squeezes your entire physique, strikes downwards and expels the urine blended with fats, marrow and muscle fats.
Standards of diagnosing an individual as diabetic
प्रमेहपूर्वरूपाणामाकृतिर्यत्र दृश्यते |
किञ्चिच्चाप्यधिकं मूत्रं तं प्रमेहिणमादिशेत् ||२२||
कृत्स्नान्यर्धानि वा यस्मिन् पूर्वरूपाणि मानवे |
प्रवृत्तमूत्रमत्यर्थं तं प्रमेहिणमादिरोत् ||२३||
An individual may be thought-about to have prameha when he has premonitory signs of prameha together with slight enhance in amount of urine.
The individual must also be thought-about to be a pramehi i.e. one affected by prameha if he has all and even half of premonitory signs and has nice enhance within the amount of urine.
पिडकापीडितं गाढमुपसृष्टमुपद्रवैः |
मधुमेहिनमाचष्टे स चासाध्यः प्रकीर्तितः ||२४||
स चापि गमनात् स्थानं स्थानादासनमिच्छति |
आसनादृणुते शय्यां शयनात् स्वप्नमिच्छति ||२५||
One ought to be designated as a affected person of Madhumeha if –
– He’s tremendously affected by prameha pidakas
– Has extreme problems of the illness
This situation is incurable.
The affected person affected by Madhumeha will want –
- To face, as a substitute of strolling
- To take a seat, as a substitute of standing
- To take a seat on a snug chair, as a substitute of sitting on the bottom
- To lie down on a mattress, as a substitute of sitting in a chair
- To sleep, as a substitute of merely mendacity down
Analogy to elucidate formation of various sorts of Prameha
यथा हि वर्णानां पञ्चानामुत्कर्षापकर्षकृतेन संयोगविशेषेण शबलबभ्रुकपिलकपोतमेचकादीनां वर्णानामनेकेषामुत्पत्तिर्भवति, एवमेव दोषधातुमलाहारविशेषेणोत्कर्षापकर्षकृतेन संयोगविशेषेण प्रमेहाणां नानाकरणं भवति ||२६||
Colours reminiscent of Sabala (variegated colour, noticed), Babhru (deep brown), Kapila (brown, tawny), Kapota (gray), Mecaka (darkish blue), and so forth. are manifested simply by enhance or lower of amount taken whereas combining the 5 varieties of colours. Equally, completely different sorts of prameha are brought about as a consequence of enhance or lower of proportions within the mixture of doshas, dhatus, mala and ahara – meals.
Transformation of Pramehas into Madhumeha
भवति चात्र-
सर्व एव प्रमेहास्तु कालेनाप्रतिकुर्वतः [१] |
मधुमेहत्वमायान्ति तदाऽसाध्या भवन्ति हि ||२७||
As soon as verse right here: –
If not handled at correct time, all types of prameha will remodel into Madhumeha and therefore grow to be incurable.
इति सुश्रुतसंहितायां निदानस्थाने प्रमेहनिदानं नाम षष्ठोऽध्यायः ||६||
Thus ends the Sixth chapter by title Prameha Nidana- in Nidana Sthana of Susrutha Samhita.
