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HomeHealthAshtanga Hridayam Nidanasthanam Chapter 10:  Prameha Nidanam Adhyaya (Analysis of diabetes, polyuria)

Ashtanga Hridayam Nidanasthanam Chapter 10:  Prameha Nidanam Adhyaya (Analysis of diabetes, polyuria)


The tenth chapter of Nidanasthanam of Ashtanga Hridayam is known as as Prameha Nidanam Adhyayah. This chapter offers with the reason of ‘analysis of diabetes, polyuria’.

The subjects lined on this chapter embrace –

–       Prameha Sankhya (sorts of diabetes)
–       Nidana (causes), Samprapti (pathogenesis), Sadhyasadhyata (prognosis), Rupa (medical options) of prameha
–       Causes for manifestation of many sorts of prameha (diabetes)
–       Kaphaja, Pittaja and Vataja Meha (diabetes) sorts and signs
–       Dhatukshayajanya and Avaranajanya Meha
–       Prameha Upadrava (problems of diabetes)
–       Prameha Pitaka (diabetes ulcers / carbuncles)
–       Sapekshya Nidana (differential analysis)
–       Prameha Purvarupa (premonitory signs of diabetes)
–       Prameha Sadhyasadhyata (prognosis of diabetes)

Pledge by the writer(s)

अथातो प्रमेहनिदानं व्याख्यास्याम ।
इति ह स्माहुरात्रेयादयो महर्षय: ।

After having provided prayers to the God, henceforth we’re going to clarify the chapter pertaining to the reason of ‘analysis of diabetes, polyuria’. Thus say (pledge) atreya and different sages.

Prameha Sankhya (sorts of diabetes)

प्रमेहा विंशतिस्तत्र श्लेष्मतो दश पित्ततः ।
षट् चत्वारोऽनिलात्तेषां
Prameha (polyuria, diabetes) are twenty, out of which ten are born from Slesma (Kapha), six sorts are as a result of Pitta and 4 from Anila (Vata).

Nidana (causes)

मेदोमूत्रकफावहम् ॥ १ ॥
अन्नपानक्रियाजातं यत्प्रायस्तत्प्रवर्तकम् ।
स्वाद्वम्ललवणस्निग्धगुरुपिच्छिलशीतलम् ॥ २ ॥
नवधान्यसुरानूपमांसेक्षुगुडगोरसम् ।
एकस्थानासनरतिः शयनं विधिवर्जितम् ॥ ३ ॥
Meals, drinks and actions which usually produce improve of Medas (fats), Mutra(urine) and Kapha are the chief causes, corresponding to, meals that are candy, bitter, salt, unctuous troublesome to digest, sticky and chilly; contemporary grains, wine, meat of animals of marshy areas, sugarcane juice, molasses and milk; (behavior of) at all times sitting at a spot sleeping with out adopting its correct process.

Kaphaja Prameha Samprapti (pathogenesis)

बस्तिमाश्रित्य कुरुते प्रमेहान् दूषितः कफः ।
दूषयित्वा वपुःक्लेदस्वेदमेदोरसामिषम् ॥ ४ ॥
Vitiated Kapha will get localized in urinary bladder vitiates the water ingredient within the physique (vitiates) sweat, fats, plasma and muscle to provide Kaphaja Prameha.

Pittaja and Vataja Prameha Samprapti (pathogenesis)

पित्तं रक्तमपि क्षीणे कफादौ मूत्रसंश्रयम् ।
धातून् बस्तिमुपानीय तत्क्षयेऽपि च मारुतः ॥ ५ ॥
Kapha and its associated Dhatus are decreased Imbalanced Pitta vitiates Rakta Dhatu and Kleda (moisture half) of the physique, sweat, fats, plasma and musclegets lodged in residence of urine (urinary bladder) to trigger Prameha of Pitta origin. Even Vata additionally causes Prameha,even Vata additionally causes Prameha, by dragging the Dhatus (watery tissues) into the bladder when they’re depleted.

Sadhya Asadhyata (prognosis)

साध्ययाप्यपरित्याज्या मेहास्तेनैव तद्भवाः ।
समासमक्रियतया महात्ययतयाऽपि च ॥ ६ ॥
Prameha is assessed as curable, controllable and rejectable, on the premise of their root reason for origin – Doshas. Primarily based on equivalent remedy (Sama Kriya) for each Kapha Dosha and Prameha, in case of Kaphaja Prameha, unidentical, reverse therapies for Pitta and Prameha, in case of Pittaja Prameha and larger hazard concerned as a result of excessively aggravated Vata Dosha, in case of Vataja Prameha.

Notes: The above transient assertion is defined as follows; the ten sorts of Prameha produced by Kapha are curable as a result of in them, the causative Dosha and Dusyas (tissues and wastes) are equivalent (of the identical qualities) and so medicine and therapies are the identical for each (equivalent remedy). The six varieties produced by Pitta, are controllable however persist until loss of life as a result of in these the causative Dosha (Pitta) and the Dushyas (tissues and wastes) are of various qualities and so medicine therapies need to be totally different (non-identical remedy). The 4 varieties produced by Vata are incurable due to the danger of grave complication/ secondary ailments arising as a result of lack of all tissues.

Rupa (medical options)

Samanya Lakshana (frequent signs)

सामान्यं लक्षणं तेषां प्रभूताविलमूत्रता ।
The frequent signs in all of them areincreased amount and Turbidity of the urine.

Causes for a lot of manifestations of prameha

दोषदूष्याविशेषेऽपि तत्संयोगविशेषतः ॥ ७ ॥
मूत्रवर्णादिभेदेन भेदो मेहेषु कल्प्यते ।
Although the doshas and Dusyas are comparable, because of the peculiarities of their mixture, there happens variations in Prameha sorts, in coloration and many others. (different properties) of urine in prameha, the sorts of Prameha are described additional.

Kaphaja Meha (diabetes attributable to Kapha)

1. Udaka Meha

    अच्छं बहु सितं शीतं निर्गन्धमुदकोपमम् ॥ ८ ॥
    मेहत्युदकमेहेन किञ्चिच्चाविलपिच्छिलम् ।
    In Udaka Meha the individual passes urine which is,clear (not turbid) giant in amount, white, chilly,odorless, resembling water,typically with slight turbidity and sliminess.

    2. Ikshu Meha

    इक्षो रसमिवात्यर्थं मधुरं चेक्षुमेहतः ॥ ९ ॥
    In Iksumeha, the urine is just like the juice of sugarcane and really candy.

    3. Sandra Meha

    सान्द्रीभवेत्पर्युषितं सान्द्रमेहेन मेहति ।
    In Sandra Meha urine turns into thick, when stored over-night.

    4. Sura Meha

    सुरामेही सुरातुल्यमुपर्यच्छमधो घनम् ॥ १० ॥
    In Sura Meha the urine resembles Sura (alcohol) with clear liquid within the high portion and thick and dense backside portion.

    5. Pishta Meha

    संहृष्टरोमा पिष्टेन पिष्टवद्बहलं सितम् ।
    In Pista Meha, the individual has horripilations, voids urine which is thick like an answer of corn flour and is white in color.

    6. Shukra Meha

    शुक्राभं शुक्रमिश्रं वा शुक्रमेही प्रमेहति ॥ ११ ॥
    In Sukra Meha the urine is, like semen or combined with semen.

    7. Sikata Meha

    मूर्ताणून् सिकतामेही सिकतारूपिणो मलान् ।
    Affected person of Sikata meha passes urine containing soiled particles resembling sand.

    8. Sheetameha

    शीतमेही सुबहुशो मधुरं भृशशीतलम् ॥ १२ ॥
    Affected person of Sheetameha passes giant portions of urine, which is good and really chilly.

    9. Shanairmeha

    शनैः शनैः शनैर्मेही मन्दं मन्दं प्रमेहति ।
    The affected person of Shanairmeha passes extreme amount of urine, very continuously, very slowly.

    10. Lala Meha

    लालातन्तुयुतं मूत्रं लालामेहेन पिच्छिलम् ॥ १३ ॥
    As a result of Lalameha, the urine seems threaded, like saliva and is slimy.

    Pittaja Meha (Urinary problems attributable to Pitta)

    1. Kshara Meha

    गन्धवर्णरसस्पर्शैः क्षारेण क्षारतोयवत् ।
    In Ksara Meha –the urine resembles resolution of Alkali has odor, color, style and contact of alkali water.

    2, 3 – Neela Meha, Kala Meha

    नीलमेहेन नीलाभं कालमेही मषीनिभम् ॥ १४ ॥
    In Nila Meha it (urine) is blue. In Kala Meha, urine resembles ink (black).

    4. Haridra Meha

    हारिद्रमेही कटुकं हरिद्रासन्निभं दहत् ।
    The affected person of Haridra Meha passes urine which is Pungent, resembles turmeric (yellow in coloration), related to burning sensation.

    5. Manjishta Meha

    विस्रं माञ्जिष्ठमेहेन मञ्जिष्ठासलिलोपमम् ॥ १५ ॥
    As a result of Manjishta Meha, urine is foul smelling, resembles resolution of Manjista (slight crimson in coloration).

    6. Rakta Meha

    विस्रमुष्णं सलवणं रक्ताभं रक्तमेहतः ।
    As a result of Raktameha, urine is foul smelling, scorching slight salty and resembles blood (crimson in coloration).

    Vataja Meha (diabetes attributable to Vata)

    1. Vasameha

    वसामेही वसामिश्रं वसां वा मूत्रयेन्मुहुः ॥ १६ ॥
    In Vasameha the urine is combined with muscle fats. The affected person urinates solely the fats or urine combined with fats, repeatedly

    2. Majjameha

    मज्जानं मज्जमिश्रं वा मज्जमेही मुहुर्मुहुः ।
    In Majja Meha – the individual passes solely marrow or urine combined marrow continuously.

    3. Hastimeha

    हस्ती मत्त इवाजस्रं मूत्रं वेगविवर्जितम् ॥ १७ ॥
    सलसीकं विबद्धं च हस्तिमेही प्रमेहति ।
    In Hasti Meha, the individual passes urine in giant portions, urination occurs like an elephant in rut, constantly with out drive, combined Lasika (lymph) and with obstruction (issue).

    4. Madhumeha

    मधुमेही मधुसमं
    In Madhumeha the individual passes urine resembling honey (in style).

    Two sorts of Madhumeha – Dhatukshayajanya and Avaranajanya Meha (diabetes precipitated as a result of destruction of tissues and as a result of obstruction of passages)

    Two sorts of Madhumeha

    जायते स किल द्विधा ॥ १८ ॥
    क्रुद्धे धातुक्षयाद्वायौ दोषावृतपथेऽथवा ।
    This (Madhumeha) arises in two methods, by the aggravation of Vata attributable to a Dhatuksaya- depletion/lack of tissues or by obstruction of Vata’s path by the Doshas masking it.

    Severity of Dosha Avruta kind of Madhumeha

    आवृतो दोषलिङ्गानि सोऽनिमित्तं प्रदर्शयेत् ॥ १९ ॥
    क्षीणः क्षणात्क्षणात् पूर्णो भजते कृच्छ्रसाध्यताम् ।
    Within the obstructed form, it (Vata) reveals the signs of the Dosha masking it, with out another purpose. Therefore the bladder is discovered typically empty and typically full, and the illness turns into troublesome to treatment.

    All Kinds of Prameha flip Madhumeha over time

    कालेनोपेक्षिताः सर्वे यद्यान्ति मधुमेहताम् ॥ २० ॥
    मधुरं यच्च सर्वेषु प्रायो मध्विव मेहति ।
    सर्वेऽपि मधुमेहाख्या माधुर्याच्च तनोरतः ॥ २१ ॥
    All varieties (of Prameha) if uncared for will, over a time frame, grow to be Madhumeha. All these by which the urine is good resembling honey and the physique additionally turns into candy, therefore all power Pramehas are referred to as Madhumeha.

    Prameha Upadrava (problems / secondary ailments)

    1. Upadravas of Kaphaja Pramehas –

    अविपाकोऽरुचिश्छर्दिर्निद्रा कासः सपीनसः ।
    उपद्रवाः प्रजायन्ते मेहानां कफजन्मनाम् ॥ २२ ॥
    Poor digestion, anorexia, vomiting, extreme sleep, cough and nasal catarrh are the problems / secondary ailments of Prameha arising from Kapha.

    2. Upadravas of Pittaja prameha

    बस्तिमेहनयोस्तोदो मुष्कावदरणं ज्वरः ।
    दाहस्तृष्णाम्लको मूर्छा विड्भेदः पित्तजन्मनाम् ॥ २३ ॥
    Ache within the bladder and penis, exudations from the scrotum, fever, burning sensation, extreme thirst, sourness (elevated acidity), fainting unfastened bowels are the Upadrava of Prameha arising from Pitta.

    3. Problems of Vataja Prameha

    वातिकानामुदावर्तकम्पहृद्ग्रहलोलताः ।
    शूलमुन्निद्रता शोषः कासः श्वासश्च जायते ॥ २४ ॥
    Bloating of stomach (upward motion of Vata), tremors, catching ache within the area of the center, extra want for meals and drinks, ache within the stomach, lack of sleep, dryness (of the mouth, throat and many others); cough and dyspnoea. These compilications come up as a result of Vataja Pramehas.

    Prameha Pitaka (diabetes ulcer / carbuncles)

    शराविका कच्छपिका जालिनी विनतालजी ।
    मसूरिका सर्षपिका पुत्रिणी सविदारिका ॥ २५ ॥
    विद्रधिश्चेति पिटिकाः प्रमेहोपेक्षया दश ।
    सन्धिमर्मसु जायन्ते मांसलेषु च धामसु ॥ २६ ॥
    Saravika, Kacchapika, Jalini, Vinata, Alaji, Masurika, Sarasapika, Putrini, Vidrarika and Vidhradhi – are the ten eruptions / ulcers precipitated as a result of negligence of prameha showing on the joints, important spots and muscular components through the course of diabetes.

    Prameha Pitaka (diabetes ulcer / carbuncles)

    1. Sharavika Prameha Pidaka

    अन्तोन्नता मध्यनिम्ना श्यावा क्लेदरुजान्विता ।
    शरावमानसंस्थाना पिटिका स्याच्छराविका ॥ २७ ॥
    Saravika is Pitaka (carbuncles /ulcers), having elevated edges and depressed middle, black in coloration, related to exudation and ache, resembling a saucer in measurement and form.

    2. Kacchapika Prameha Pidaka

    अवगाढार्तिनिस्तोदा महावस्तुपरिग्रहा ।
    श्लक्ष्णा कच्छपपृष्ठाभा पिटिका कच्छपी मता ॥ २८ ॥
    Kacchapika is Pitaka having extreme (deep) ache, pricking ache, steady or intermittent, extends over a big space, clean and resembles the shell of a tortoise.

    3. Jalini Prameha Pidaka

    स्तब्धा सिराजालवती स्निग्धस्रावा महाशया ।
    रुजानिस्तोदबहुला सूक्ष्मच्छिद्रा च जालिनी ॥ २९ ॥
    Jalini is steady, stiff, has venous community, greasy (unctuous) exudates, has large cavity inside, with extreme ache, extreme pricking ache, has minute openings.

    4. Vinata Prameha Pidaka

    अवगाढरुजाक्लेदा पृष्ठे वा जठरेऽपि वा ।
    महती पिटिका नीला विनता विनता स्मृता ॥ ३० ॥
    Vinata is large sized eruption, creating both on the again or on the stomach, blue in coloration having extreme (deep) ache exudation and pointed downwards.

    5. Alaji Prameha Pidaka

    दहति त्वचमुत्थाने भृशं कष्टा विसर्पिणी ।
    रक्तकृष्णातितृट्स्फोटदाहमोहज्वरालजी ॥ ३१ ॥
    Alaji has burning sensation with elevation of the pores and skin, very troublesome to bear, spreads to different locations, reddish-black in coloration accompanied with extreme thirst, boils (showing elsewhere of the physique), and burning sensation everywhere in the physique, delusion and fever.

    6. Masurika Prameha Pidaka

    मानसंस्थानयोस्तुल्या मसूरेण मसूरिका ।
    Masurika resembles Masura (lentil) in measurement and form.

    7. Sarshapi Prameha Pidaka

    सर्षपामानसंस्थाना क्षिप्रपाका महारुजा ॥ ३२ ॥
    सर्षपी सर्षपातुल्यपिटिकापरिवारिता ।
    Sarsapika is like Sarsapa (mustard seed) in measurement and form, ulcerates quickly, has extreme ache surrounded by eruptions, resembling mustard seeds.

    8. Putrini, Vidarika Prameha Pidaka

    पुत्रिणी महती भूरिसुसूक्ष्मपिटिकाचिता ॥ ३३ ॥
    विदारीकन्दवद्वृत्ता कठिना च विदारिका ।
    Putrini is an enormous eruption, surrounded by many small eruptions. Vidarika is spherical just like the tuber of Vidani and onerous.

    Prameha Pitaka (diabetes ulcer / carbuncles)

    विद्रधिर्वक्ष्यतेऽन्यत्र तत्राद्यं पिटिकात्रयम् ॥ ३४ ॥
    पुत्रिणी च विदारी च दुःसहा बहुमेदसः ।
    सह्याः पित्तोल्बणास्त्वन्याः सम्भवन्त्यल्पमेदसः ॥ ३५ ॥
    तासु मेहवशाच्च स्याद्दोषोद्रेको यथायथम् |
    प्रमेहेण विनाप्येता जायन्ते दुष्टमेदसः |
    तावच्च नोपलक्ष्यन्ते यावद्वस्तुपरिग्रहः ॥ ३६ ॥
    Vidhradi shall be described elsewhere (within the subsequent chapter). Out of those, the primary three (Saravika, Kacchapika and Jalini), Putrini and Vidarika are troublesome to bear (and likewise to risk), these come up from predominance of fats tissue, the remaining and people having predominance of Pitta and come up from much less fats are bearable (and straightforward to deal with). In these (eruptions) the popularity of aggravation of Doshas is just like that of (the sorts of) diabetes. These eruptions happen even with out Prameha, as a result of vitiation of fats tissue however should not taken observe of (handled) until they get localized (completely at one place).

    Sapekshya Nidana (differential analysis)

    हारिद्रवर्णं रक्तं वा मेहप्राग्रूपवर्जितम् ।
    यो मूत्रयेन्न तं मेहं रक्तपित्तं तु तद्विदुः ॥ ३७ ॥
    If an individual passes urine having the colour both or turmeric, deep yellow) or of blood (crimson) with out the looks of premonitory signs of diabetes, he shouldn’t be understood as having Prameha (diabetes) however be taken as having Raktapitta (bleeding ailments).

    Prameha Purvarupa (premonitory signs of diabetes)

    स्वेदोऽङ्गगन्धः शिथिलत्वमङ्गे शय्यासनस्वप्नसुखाभिषङ्गः ।
    हृन्नेत्रजिह्वाश्रवणोपदेहो घनाङ्गता केशनखातिवृद्धिः ॥ ३८ ॥
    शीतप्रियत्वं गलतालुशोषो माधुर्यमास्ये करपाददाहः ।
    भविष्यतो मेहगणस्य रूपं मूत्रेऽभिधावन्ति पिपीलिकाश्च ॥ ३९ ॥
    Extreme sweating, unhealthy odor of the physique, looseness / flaccidity of the physique components, want for the consolation of the mattress, seat and sleep: thickening of the center, eyes, tongue and ears; stoutness of physique, larger improve of (progress charge) hairs and nails, want for chilly, dryness of the throat and palate, candy style within the mouth burning sensation of the palms and soles; swarming of ants in direction of his urine are the premonitory signs of the teams of diabetes.

    Prameha Sadhyasadhyata (prognosis of diabetes)

    दृष्ट्वा प्रमेहं मधुरं सपिच्छं मधूपमं स्याद्विविधो विचारः ।
    सम्पूरणाद्वा कफसम्भवः स्यात् क्षीणेषु दोषेष्वनिलात्मको वा ॥ ४० ॥
    Discovering diabetes, which urine being candy, sticky, and resembling honey, the doctor will get doubt on two factors; whether or not it’s born from Kapha attributable to over vitamin or whether or not it’s born from Anila (Vata) attributable to lower of the Doshas(under-nutrition).

    Prameha Sadhya asadhyata (prognosis of diabetes)

    सपूर्वरूपाः कफपित्तमेहाः क्रमेण ये वातकृताश्च मेहाः ।
    साध्या न ते पित्तकृतास्तु याप्याः साध्यास्तु मेदो यदि नातिदुष्टम् ॥ ४१ ॥
    Prameha attributable to Kapha and Pitta (all varieties),having all of the premonitory symptomsand these attributable to Vata,should not curable after lengthy timethose attributable to pitta are controllable;and by which the fats tissue will not be significantly vitiated (elevated) are curable.

    इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थाने प्रमेहनिदानं नाम दशमोऽध्याय: ।।१०॥
    Thus ends the chapter- Prameha – diabetes, urinary tract problems Nidana – the tenth in Nidanasathana of Astangahrdaya Samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.



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