Chapter VI - Diagnosis of diabetes

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

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.

Pathology:—

The bodily principles of Vayu, Pitta and Kaphah 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^[2], causing diseases, known by the (generic) name of Prameha. 3

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.

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 Doshas (Vayu, Pitta and Kaphah). 5.

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, Sikata-meha, Shanai-meha, Lavana-meha, Pishta-meha, Sandra-meha, Shukra-meha and Phena-meha. The ten aforesaid types are curable, inasmuch as the medicines which tend to remedy the deranged Kapha (Dosha), the cause of the disease, prove also remedial to the other principles of the body (flesh, marrow, blood, semen etc.) deranged (Dushya) from the same causes. 6.

The Pittaja Types:—

The types, which are brought about through an exuberance of the deranged Pitta, are named as Nila-meha, Haridra-meha, Amla- meha, Kshara-meha, Manjishtha-meha, and Shonita-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 (Dushyas) deranged by it. 7.

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, Kshaudra-meha and Hasti-meha. These should be regarded as most incurable inasmuch as no kind of medicine can restore the fleet-coursing, deep diving (ie. 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.

The deranged Kaphah, in conjunction with 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 ones; while the deranged Vayu, in unison with the deranged Kapha, Pitta, fat, marrow and Vasa (myosin), engenders the types of Vataja Prameha. 9.

Symptoms of Kaphaja-Mehas:—

The urine^[3] 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 Ikshumeha the urine resembles the expressed juice of sugarcane. It has the colour of wine in a case of Surameha. 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 (Sikatas). In a case of Sanaimeka the urine gushes out at intervals in jets and is charged with a slimy mucous (kaphah). 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 Pishtameha (Chyluria), the urine resembling a stream of water, charged with a solution of pasted rice (Pishta).

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

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 Amlameka acquires an acid taste and smell. The urine in a case of Ksharameha^[4] 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.

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

Supervening symptoms:—

The fact of the urine being assailed by a swarm of flies, lassitude, growth of flesh (obesity), catarrh, looseness of the limbs, a  non-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 (veda) pain in the bladder, a shooting pain (Tuda) in the penis, a griping pain at the heart, acid eructations, fever, dysentery, a non-relish for food, vomiting, a sensation as if the entire body is emitting 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 (Hridgraha), 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. 13-16.

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 Sharavika, Sarshapika, Kaccapika, Jalini, Vinata, Putrini, Masurika, Alaji, Vidarika and Vidradhika. 17.

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 Sarshapika. An abscess, resembling (the back of) a tortoise in shape and attended with a burning sensation, is called Kaccapika 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 withslender 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 or exuding vesicles is called Alaji. A hard and round abscess as large as a (full-grown) 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 (Dosha) as that which has produced the disease (Prameha) 18-28.

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. 29-30.

A person in whom the premonitory symptoms (Purvarupam 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. 31—32.

A Prameha patient afflicted with deep-seated abscesses 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. 33—34.

As five mixed colours such as grey, brown, Kapila (bluish yellow), Kapota (blackish grey), Mechaka (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 Doshas, root principles (Dhatu) and excretions of the body (Mala), may be attributed to the origin of Prameha. 35.

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. 36

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, Hemoglobinuria, Hematuria, Peptonuria, Pyuria, Spermatorrhoea and Diabetes, Proteuria and Polyuria.

 

Thus ends the sixth Chapter of the Nidana Sthana in the Sushruta Samhita, which treats of the Nidana of Prameha.

Footnotes and references:

[1]:

The particle “ca” in the text denotes other virus or morbific matter. Dallana.

[2]:

Remain incarcerated therein according to others.

[3]:

The Sanskrit term Meha literally means to micturate. The verbal noun Mehana 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.—Ed.

[4]:

The urine acquires a distinct alkaline taste, smell, colour and touch. (Madhaba Nidana).

[5]:

Charaka has included it within Kshaudra Meha and Madhu Meha.