Chapter CLIX - The Nidanam of diseases of the Urinary organs (Pramehas)

Dhanvantari said:—Now hear me, O Sushruta, discourse on the causes and symptoms of Pramehas.

Twenty different forms of Prameha are recognised in practice. Of these, ten are due to the action of the deranged Kapham, six are caused through the agency of the deranged Pittam, and four have their origin in the aggravated condition of the bodily Vayu. The semen, fat, and urine, surcharged with Kapham, should be looked upon as the immediate exciting factors of the several types of Prameha.

A patient suffering from Haridra-Meha passes hot stool and urine, having the colour of turmeric. A person attacked with Manjishtha-Meha passes urine like the solution of Mangishtha (yellowish red). The urine in a case of Rakta-Meha is either pure blood, or hot, bloody and saline, while that in Vasa-Meha is either a jet of fat, or is found to be coloured like lard. A person suffering from Majja-Meha passes urine, which resembles, or is charged with, marrow, A patient in this disease, like a wild and infuriated elephant, does not constantly pass urine, but passes a copious flow Whenever urinating. The urine in Hasti-Meha is copious and found to be largely charged with slimy mucous. A Madhu-Meha patient passes urine which resembles honey. The obstruction of the channels of the bodily Vayu (nerves) by the deranged Pittam and Kapham in an organism, which has suffered a considerable loss in its fundamental, vital principles, may be likewise set down as the exciting factor of Madhu meha. The morbic principles, which usher in the disease in a given case, soon exhibit their specific symptoms.

A case of Prameha spontaneously exhibits symptoms of amelioration or aggravation without any apparent reason, and soon runs into one of the most difficult and obstinate type. All types of Prameha, neglected at the outset, may run into Madhu-Meha in course of time. The urine in Madhu-Meha becomes sweet like honey. All cases of Prameha in which the bodily excretions of the patient acquire a sweetish taste, should be regarded as cases of Madhumeha.

Indigestion, with a non-relish for food, vomiting, somnolence, cough, and catarrh are the distessing symptoms, which are found to supervene in a case of Meha due to the action of the deranged Kapham. A pricking pain in the urinary bladder and urethra, bursting of the scortum, fever with a burning sensation of the body, epilepsy, thirst, sour risings, and loose motions of the bowels are the distressing symptoms, which supervene in a case of Maha due to the action of the deranged Pittam. Suppression of stool, flatus, and urine, shivering, a catching pain about the heart, with a desire for (pungent, bitter or astringent) food, colic, insomnia, cough, dyspnœa, and wasting are the distressing symptoms, which mark a Vataja type of Prameha.

The ten kinds of carbuncles, or abscesses, which mark the sequel of Prameha are called Saravika, Kachchhapika, Jvalini, Vinata, Alaji, Masurika, Sarshapika, Putrini, and Vidarika. The ingested food in combination with the deranged Kapham of the system usually ushers in an attack of Prameha, and the deranged Kaphah, in most cases, may be set down as the primary and exciting factor of the disease. The urine in every type of Prameha becomes slimy, acid, sweet or saline, heavy (in respect of its specific gravity), oily and cold. Use of newly harvested rice, new wine, meat-soup, meat, sugarcane, treacle and milk in excessive quantities, and sharing the same bed or cushion with a Prameha-patient may be set down as the exciting factors of this disease. The deranged Kaphah located in the urinary bladder liquefies the fat and myosin of the body like excrementitious discharge. The aggravated Vayu, on the subsidence of the action of the deranged Kapham, augments the action of the Pittam, and brings on congestion of blood in the urinary bladder, thus producing the disease, which is called Prameha.

The prognosis in a case of Prameha should be determined in consideration of the nature of the morbific diatheses underlying the attack. A continuance of the Vayu, Pittam, and Kapham in their normal state (in the patient's body) points to a happy prognosis, while the reverse is indicated when their natural equilibrium is in any way disturbed. The patient, in each type of Prameha, passes a copious, turbid urine, which should be regarded as one of the general characteristics of the disease. As a variety of colours may be produced through a combination of those that are white, yellow, black or red, so the deranged Vayu, Pittam and Kapham, in combination with the different organic principles of fat, flesh, etc., may serve to give a variety of colours to the urine in this disease.

In the type known as Udaka-Meha (poluria), the patient passes a copious, transparent, water-like or slightly turbid, slimy, cold, and odourless urine. In a case of Ikshu-Meha, the patient passes a sweet, vinegar-like urine.

In Sandra-Meha (Chyluria), the patient passes a thick urine, which resembles stale rice-boilings. In Pishta-Meha, the patient passes urine like a solution of pasted rice attended with horripilation. In Sura-Meha, the patient passes urine like wine, which is transparent in its surface but leaves a sediment at its bottom. In Sukra-Meha (Spermatorrhœa), the patient passes urine highly charged with semen, or resembling semen in colour. In Sikata-Meha, the urine becomes turbid, and is found to leave a sediment resembling hard grains of sand. The urine becomes cold, sweet, and copious in shita-Meha, while it dribbles out or is emitted in successive and broken jets in shanair Meha. In Lala-Meha, the urine becomes slimy and shreddy like saliva, while in Kshara-Meha, it assumes an alkaline character, or resembles an alkaline solution in taste, touch, smell and appearance. In Nilameha, the patient passes a bluish urine, while in Kala Meha, the urine becomes black as ink.

A case of Prameha, neglected at the outset, may be followed by the appearance of one of the ten aforesaid types of abscess at a fleshy part of the patient’s body, or about any of his bone-joints, or about any anastomosis of veins, arteries, etc., (Marmasthanam). Of these, the type of abscess known as shara’vika, is raised or elevated at its margin and dipped in its centre, characterised by the absence of any pain or discharge, and resembles a saucer in shape. An abscess appearing about the seat of the body, and characterised By an intolerable, burning sensation in its inside, and resembling a tortoise in shape, is called Kachchhapika. An abscess, which is of a considerably large size and assumes a bluish colour, is called Vinata. An abscess, which develops a kind of intolerable, burning sensation in the skin during its stage of incubation, is called Jvalini. An abscess of the present type becomes extremely painful. An abscess, which is tinged either red or white, is studded with belbs or blisters, and is characterised by a sort of burning sensation, is called Alaji. Postules to the size of lentil seeds are called Masurika, while those that crop up like small mustard seeds-on the tongue in the latter stage of Prameha, attended with an extreme pain and local suppuration, are called Sarshapika. Abscesses, that crop up covering a considerably extensive area, marked by a comparatively smaller elevation, are called Putrini. An abscess, which is hard and round like the root of a Vidarika, is called Vidarika. An abscess, which is marked by features peculiar to erysipelas, is called Vidradhika. Of these, the types known as Putrini and Vidari are characterised by an excessive deposit of fat, and a kind of intolerable pain. Other kinds of abscesses may mark the sequel of a case of Prameha, marked by an extremely aggravated condition of the deranged Pittam. The deranged Vayu, Pittam and Kapham in connection with a case of Prameha give rise to abscesses peculiar to their respective aggravated conditions in the body of a person of vitiated fat, even without an attack of Prameha, but their specific natures can not be ascertained till their characterestic colours are developed. A ease in which a person passes an extremely high-coloured urine, like washings of turmeric or blood, without the specific features of urine in Prameha as described before, should be diagnosed as a case of Raktapittam (urethral hæmorrhage) Perspiration, with a bad smell in the body, lassitude of the body with a kind of gone feeling in the limbs, inclination to sleep, eating, and repose, a burning sensation in the heart, eyes, tongue and ears, growth, and thickness, of the ends of finger-nails and hairs, fondness for cool things and cooling measures, and dryness of the palate, with a sweet taste in the mouth and burning sensation in the extremities are the symptoms, which mark the premonitory stage of Prameha. Ants are found to infest the urine of a patient during this stage of Prameha, and thirst, and sweetness of the urine, etc., are the symptoms, which are developed with the progress of the disease. The body having been permeated with deranged Kaphah, the bodily Vayu gets the upper hand of the other morbific diathesis in the body, and produces the Vataja type of Prameha. Types of Prameha, due to the action of the deranged Pittam or Kapham, fully exhibit their charateristic symptoms, while those, which are due to any impure contact, take time to develop all their specific features, and are contaminated from one person to another. Types of Prameha, due to the action of the deranged Pittam, may be checked, if not cured. A case of Prameha may be expected to be cured only before the specific symptoms are fully developed.