The Diagnosis of Prameha (Urinary and Metabolic Disorders)

Verse 1 (garuda.1.159.1)

धन्वन्वरिरुवाच । प्रमेहाणां निदानन्ते वक्ष्येऽहं शृणु सुश्रुत ! । प्रमेहा विंशतिस्तत्र श्लेष्मणो दश पित्ततः

dhanvanvariruvāca pramehāṇāṁ nidānante vakṣye'haṁ śṛṇu suśruta ! pramehā viṁśatistatra śleṣmaṇo daśa pittataḥ

Dhanvantari said: Now I shall declare the diagnosis of Prameha, urinary and metabolic disorders; listen, O Sushruta. There are twenty types of Prameha: ten from Kapha, six from Pitta —

Verse 2 (garuda.1.159.2)

षट्चत्वारोऽनिलात्तेच मेदोमत्रकफावहाः । हारिद्रमेही कटुकं हरिद्रासन्निभं शकृत्

ṣaṭcatvāro'nilātteca medomatrakaphāvahāḥ hāridramehī kaṭukaṁ haridrāsannibhaṁ śakṛt

and four from Vata; these affect fat, urine, and phlegm. The Haridra-meha patient passes pungent, turmeric-colored, stool-thick urine —

Verse 3 (garuda.1.159.3)

विस्त्रं माञ्जिष्ठमेहेच मञ्जिष्ठा सलिलोपमम् । विस्त्रमुष्णं सलवणं रक्ताभ रक्तमेहतः

vistraṁ māñjiṣṭhameheca mañjiṣṭhā salilopamam vistramuṣṇaṁ salavaṇaṁ raktābha raktamehataḥ

in Manjishtha-meha, the urine is foul-smelling and colored like manjishtha-dye water. In Rakta-meha, the urine is foul-smelling, hot, salty, and blood-colored —

Verse 4 (garuda.1.159.4)

वसामेही वसामिश्रं वसाभं मूत्रयेन्मुहुः । मज्जाभं मज्जमिश्रं वा मज्जमेही मुहुर्मुहुः

vasāmehī vasāmiśraṁ vasābhaṁ mūtrayenmuhuḥ majjābhaṁ majjamiśraṁ vā majjamehī muhurmuhuḥ

the Vasa-meha patient repeatedly passes urine mixed with, or resembling, fatty tissue. The Majja-meha patient repeatedly passes urine mixed with, or resembling, bone-marrow —

Verse 5 (garuda.1.159.5)

हस्ती मत्त इवाजस्त्रं मूत्रं वेगविवर्जितम् । सलसीकं विवद्धं च हस्तिमेही प्रमेहति

hastī matta ivājastraṁ mūtraṁ vegavivarjitam salasīkaṁ vivaddhaṁ ca hastimehī pramehati

the Hasti-meha patient urinates continuously like a rutting elephant, without any controlled urge, mixed with mucus, thick and turbid.

Verse 6 (garuda.1.159.6)

मधुमेही मधुसमं जायते स किल द्विधा । क्रुद्धे धातुक्षयाद्वायौ दोषावृतपथे यदा

madhumehī madhusamaṁ jāyate sa kila dvidhā kruddhe dhātukṣayādvāyau doṣāvṛtapathe yadā

the Madhu-meha patient passes urine like honey; this is in fact of two kinds. When Vata, aggravated through depletion of the bodily tissues, has its path obstructed by the other humors —

Verse 7 (garuda.1.159.7)

आवृतो दोषलिङ्गानि सोऽनिमित्तं प्रदर्शयेत् । क्षणात्क्षीणः क्षणात्पूर्णो भजते कृच्छ्रसाघ्यताम्

āvṛto doṣaliṅgāni so'nimittaṁ pradarśayet kṣaṇātkṣīṇaḥ kṣaṇātpūrṇo bhajate kṛcchrasāghyatām

then this obstructed Vata may display the signs of other humors without apparent cause; the patient appears emaciated one moment and robust the next, and the disease becomes curable only with difficulty.

Verse 8 (garuda.1.159.8)

कालेनोपेक्षितः सर्वोह्यायाति मधुमेहताम् । मधुरं यच्च मेहेषु प्रायो मध्विव मेहति

kālenopekṣitaḥ sarvohyāyāti madhumehatām madhuraṁ yacca meheṣu prāyo madhviva mehati

if neglected over time, every type of Prameha tends to progress into Madhumeha; and whatever is sweet among the Prameha types is passed, for the most part, as if it were honey itself —

Verse 9 (garuda.1.159.9)

सर्वे ते मधुमेहाख्या माधुर्याच्च तनोर्यतः । अविपाकोऽरुचिश्छर्दिर्निद्रा कासः सपीनसः

sarve te madhumehākhyā mādhuryācca tanoryataḥ avipāko'ruciśchardirnidrā kāsaḥ sapīnasaḥ

all these are called Madhumeha, because of the sweetness pervading the body. Indigestion, loss of appetite, vomiting, drowsiness, cough, and catarrh —

Verse 10 (garuda.1.159.10)

उपद्रवाः प्रजायन्ते मेहानां कफजन्मनाम् । बस्तिमेहनयोस्तोदोमुष्कावदरणं ज्वरः

upadravāḥ prajāyante mehānāṁ kaphajanmanām bastimehanayostodomuṣkāvadaraṇaṁ jvaraḥ

these are complications of the Kapha-caused types of Prameha. Pricking pain in the bladder and urethra, splitting pain in the testicles, and fever —

Verse 11 (garuda.1.159.11)

दाहस्तृष्णाम्लिका मूर्छा विड्भेदः पित्तजन्मनाम् । वातजानामुदावर्तः कम्पहृद्गहलोलताः

dāhastṛṣṇāmlikā mūrchā viḍbhedaḥ pittajanmanām vātajānāmudāvartaḥ kampahṛdgahalolatāḥ

burning, thirst, acidity, fainting, and diarrhea — these are complications of the Pitta-caused types. In Vata-caused types: Udavarta, trembling, heaviness and unsteadiness of the heart —

Verse 12 (garuda.1.159.12)

शूलमुन्निद्राता शोषः श्वासः कासञ्च जायते । शराविका कच्छपिका ज्वालिनी विनतालजी

śūlamunnidrātā śoṣaḥ śvāsaḥ kāsañca jāyate śarāvikā kacchapikā jvālinī vinatālajī

cramping pain, sleeplessness, wasting, breathlessness, and cough also arise. Sharavika, Kacchapika, Jvalini, Vinata, Alaji —

Verse 13 (garuda.1.159.13)

मसूरिका सर्षपिका पुत्रिणी सविदारिका । विद्रधिश्चेति पिडिकाः प्रमेहोपेक्षया दश

masūrikā sarṣapikā putriṇī savidārikā vidradhiśceti piḍikāḥ pramehopekṣayā daśa

Masurika, Sarshapika, Putrini, Vidarika, and Vidradhi — these are the ten boils arising from neglect of Prameha.

Verse 14 (garuda.1.159.14)

अन्नस्य कफसंश्लेषात्प्रायस्तत्र प्रवर्तनम् । स्वाद्वम्ललवणस्निग्धगुरुपिच्छिलशीतम्

annasya kaphasaṁśleṣātprāyastatra pravartanam svādvamlalavaṇasnigdhagurupicchilaśītam

Their onset generally occurs from food adhering to kapha. Sweet, sour, salty, unctuous, heavy, slimy, and cold foods —

Verse 15 (garuda.1.159.15)

नवं धान्यं सुरासूपमांसेक्षुगुडगोरसम् । एकस्थानासनवति शयनं विनिवर्तनम्

navaṁ dhānyaṁ surāsūpamāṁsekṣuguḍagorasam ekasthānāsanavati śayanaṁ vinivartanam

from fresh grain, liquor, lentil-soup, meat, sugarcane, jaggery, and dairy products; and from sitting in one place, sleeping, and avoiding activity —

Verse 16 (garuda.1.159.16)

बस्तिमाश्रित्य कुरुते प्रमेहाद्दूषितः कफः । दूषयित्वा वपुः क्लेदं स्वेदमेदोवसामिषम्

bastimāśritya kurute pramehāddūṣitaḥ kaphaḥ dūṣayitvā vapuḥ kledaṁ svedamedovasāmiṣam

vitiated kapha, lodging in the bladder, produces Prameha; corrupting the body's moisture, sweat, fat, marrow-fat, and flesh —

Verse 17 (garuda.1.159.17)

पित्तं रक्तमतिक्षीणे कफादौ मूत्रसंश्रयम् । धातुं बस्तिमुपानीय तत्क्षयेच्चैव मारुतः

pittaṁ raktamatikṣīṇe kaphādau mūtrasaṁśrayam dhātuṁ bastimupānīya tatkṣayeccaiva mārutaḥ

when Kapha and the rest become greatly diminished, Pitta and blood come to be lodged in the urine; the tissue reaches the bladder, and Vata too plays a role in its wasting —

Verse 18 (garuda.1.159.18)

साध्यासाध्यप्रतीत्याद्याः मेहास्तेनैव तद्भवाः । समे समकृता दोषे परमत्वात्तथापि च

sādhyāsādhyapratītyādyāḥ mehāstenaiva tadbhavāḥ same samakṛtā doṣe paramatvāttathāpi ca

in this way, the curable and incurable Prameha types arise from these very humors. When the humors are equal, treatment too is equal; yet, according to their differing predominance, distinctions remain —

Verse 19 (garuda.1.159.19)

सामान्य लक्षणन्तेषां प्रभूताविलमूत्रता । दोषदूष्या विशेषेऽपि तत्संयोगविशेषतः

sāmānya lakṣaṇanteṣāṁ prabhūtāvilamūtratā doṣadūṣyā viśeṣe'pi tatsaṁyogaviśeṣataḥ

their common sign is copious, turbid urination. Even in the specific types, according to the particular combination of humor and tissue —

Verse 20 (garuda.1.159.20)

मूत्रवर्णादिभेदेन भेदो मेहेषु कल्प्यते । अच्छं बहुसितं शीतं निर्गन्धमुदकोपमम्

mūtravarṇādibhedena bhedo meheṣu kalpyate acchaṁ bahusitaṁ śītaṁ nirgandhamudakopamam

the distinction among Prameha types is determined by the difference in the urine's color and the like. Clear, very white, cold, odorless, resembling water —

Verse 21 (garuda.1.159.21)

मेहत्युदकमेहेन किञ्चिदाविलपिच्छिलम् । इक्षो रसमिवात्यर्थं मधुरं चेक्षुमेहतः

mehatyudakamehena kiñcidāvilapicchilam ikṣo rasamivātyarthaṁ madhuraṁ cekṣumehataḥ

such is the urine in Udakameha, water-urine, which is also somewhat turbid and slimy; extremely sweet urine like sugarcane juice occurs in Ikshumeha, sugarcane-urine —

Verse 22 (garuda.1.159.22)

सान्द्री भवेत्पर्युषितं सान्द्रमेहेन मेहति । सुरामेही सुरातुल्यमुपर्यच्छमधोघनम्

sāndrī bhavetparyuṣitaṁ sāndramehena mehati surāmehī surātulyamuparyacchamadhoghanam

in Sandrameha, thick urine with a stale odor is passed; the Suramehi passes urine resembling liquor, clear above and dense below —

Verse 23 (garuda.1.159.23)

सहृष्टरोमा पिष्टेन पिष्टबद्बहुलं सितम् । शुक्राभं शुक्रमिश्रं वा शुक्रमेही प्रमेहति

sahṛṣṭaromā piṣṭena piṣṭabadbahulaṁ sitam śukrābhaṁ śukramiśraṁ vā śukramehī pramehati

with horripilation, the urine has a flour-like sediment, is copious and white. The Shukra-mehi passes urine resembling, or mixed with, semen —

Verse 24 (garuda.1.159.24)

मूत्रयेत्सिकतामेही सिकतारूपिणो मलान् । शीतमेही सुबहुशो मधुरं भृशशीतलम्

mūtrayetsikatāmehī sikatārūpiṇo malān śītamehī subahuśo madhuraṁ bhṛśaśītalam

the Sikata-mehi passes urine with sand-like sediment. The Shita-mehi passes very abundant, sweet, and extremely cold urine —

Verse 25 (garuda.1.159.25)

शनैः शनैः शनैर्मेही मन्दं मन्दंप्रमेहति । लालातन्तुयुतं मूत्रं लालामेहेन पिच्छिलम्

śanaiḥ śanaiḥ śanairmehī mandaṁ mandaṁpramehati lālātantuyutaṁ mūtraṁ lālāmehena picchilam

the slow-flowing type passes urine drop by drop, slowly. In Lalameha, saliva-urine, thread-like mucus mixes with slimy urine —

Verse 26 (garuda.1.159.26)

गन्धवर्णरसस्पर्शेः क्षारेण क्षारतोयवत् । नीलमेहन नीलाभं कालमेही मसीनिभम्

gandhavarṇarasasparśeḥ kṣāreṇa kṣāratoyavat nīlamehana nīlābhaṁ kālamehī masīnibham

resembling alkaline water in smell, color, taste, and texture is Kshaarameha; Nilameha has bluish urine, Kalameha has urine resembling ink —

Verse 27 (garuda.1.159.27)

सन्धिमर्मसु जायन्ते मांसलेषु च धामसु । अन्तोन्नता मध्यनिन्मा अक्लेदसुरुजान्विता

sandhimarmasu jāyante māṁsaleṣu ca dhāmasu antonnatā madhyaninmā akledasurujānvitā

the boils of Prameha arise at the joints, vital points, and fleshy regions; raised at the edges and depressed in the middle, without discharge, and with intense pain —

Verse 28 (garuda.1.159.28)

शरावमानसंस्थाना पिडिका स्याच्छराविका । सदाहा कूर्मसंस्थाना ज्ञेया कच्छपिका बुधैः

śarāvamānasaṁsthānā piḍikā syāccharāvikā sadāhā kūrmasaṁsthānā jñeyā kacchapikā budhaiḥ

a saucer-shaped boil is called Sharavika; the one shaped like a tortoise, accompanied by burning, the wise know as Kacchapika —

Verse 29 (garuda.1.159.29)

महती पिडिका नीला विनता नाम सा स्मृता । दहति त्वचमुत्थाने ज्वालिनी कष्टदायिनी

mahatī piḍikā nīlā vinatā nāma sā smṛtā dahati tvacamutthāne jvālinī kaṣṭadāyinī

a large, bluish boil is remembered by the name Vinata; the one that burns the skin upon arising, causing great distress, is called Jvalini —

Verse 30 (garuda.1.159.30)

रक्ता सिता स्फोटचिता दारुणा त्वलजी भवेत् । मसूराकृति संस्थाना विज्ञेया तु मसूरिका

raktā sitā sphoṭacitā dāruṇā tvalajī bhavet masūrākṛti saṁsthānā vijñeyā tu masūrikā

a red-and-white boil studded with small blisters, terrible in nature, is called Alaji; the one shaped like a lentil should be known as Masurika —

Verse 31 (garuda.1.159.31)

सर्षपोपमसंस्थाना जिह्वापाकमहारुजा । पुत्रिणी महती चाल्पा सुसूक्ष्मा पिडिका स्मृता

sarṣapopamasaṁsthānā jihvāpākamahārujā putriṇī mahatī cālpā susūkṣmā piḍikā smṛtā

the one shaped like a mustard seed, causing intense pain like a ripened sore on the tongue, is called Sarshapika; the very small, subtle boil, whether large or small, is called Putrini —

Verse 32 (garuda.1.159.32)

विदारीकन्दवद्वृत्ता कठिना च विदारिका । विद्रधेर्लक्षणैर्युक्ता ज्ञेया विद्रधिका तु सा

vidārīkandavadvṛttā kaṭhinā ca vidārikā vidradherlakṣaṇairyuktā jñeyā vidradhikā tu sā

the one round and hard like the tuber of the vidari plant is called Vidarika; that which shows the signs of Vidradhi, a deep abscess, should be known as Vidradhika.

Verse 33 (garuda.1.159.33)

पुत्रिणी च विदारी च दुः सहा बहुमेदसः । सद्यः पित्तोल्बणास्त्वन्याः सम्भवन्त्यल्पमेदसः

putriṇī ca vidārī ca duḥ sahā bahumedasaḥ sadyaḥ pittolbaṇāstvanyāḥ sambhavantyalpamedasaḥ

Putrini and Vidarika are extremely unbearable and arise in those with much fat; the other, Pitta-predominant boils arise suddenly in those with little fat.

Verse 34 (garuda.1.159.34)

पिडिकास्ता भवेयुः स्याद्दोषोद्रेको यथायथम् । प्रमेहेण विनाप्येता जायन्ते दुष्टमेदसः

piḍikāstā bhaveyuḥ syāddoṣodreko yathāyatham prameheṇa vināpyetā jāyante duṣṭamedasaḥ

These boils arise according to the predominance of each humor in each case. They can arise even without Prameha, in those whose fat tissue is vitiated.

Verse 35 (garuda.1.159.35)

तावच्च नोपलक्ष्यन्ते यावद्वर्णञ्च वर्जितम् । हारिद्रं रक्तवर्णं वा मेहप्राग्रूपवर्जितम्

tāvacca nopalakṣyante yāvadvarṇañca varjitam hāridraṁ raktavarṇaṁ vā mehaprāgrūpavarjitam

As long as the yellowish or blood-red discoloration associated with Prameha's premonitory signs is absent, these should not be recognized as Prameha-related —

Verse 36 (garuda.1.159.36)

यो मूत्रयेत तन्महें रक्तपित्तन्तु तद्विदुः । स्वेदोऽङ्गगान्धः शिथिलत्वमङ्गे श्य्याशनस्वप्नसुखाभिषङ्गः । हृन्नेत्रजिह्वाश्रवणोपदाहा घनोग्रता केशनखाभिवृद्धिः

yo mūtrayeta tanmaheṁ raktapittantu tadviduḥ svedo'ṅgagāndhaḥ śithilatvamaṅge śyyāśanasvapnasukhābhiṣaṅgaḥ hṛnnetrajihvāśravaṇopadāhā ghanogratā keśanakhābhivṛddhiḥ

one who passes such urine, colored but without Prameha's other signs, should be understood to have Raktapitta, not Prameha. Sweating, foul odor, looseness of the limbs, excessive attachment to bed, food, sleep, and comfort; burning in the heart, eyes, tongue, and ears; thick, coarse hair, and excessive growth of hair and nails —

Verse 37 (garuda.1.159.37)

शीतप्रियत्वं गलतालुशोषो माधुर्य मास्ये करपाददाहः । भविष्यतो मेहगणस्य रूपं मूत्रेऽपि धावन्ति पिपीलिकाश्च

śītapriyatvaṁ galatāluśoṣo mādhurya māsye karapādadāhaḥ bhaviṣyato mehagaṇasya rūpaṁ mūtre'pi dhāvanti pipīlikāśca

a fondness for cold things, dryness of the throat and palate, sweetness in the mouth, and burning of the hands and feet — these are the signs of the coming group of Prameha diseases; and even ants run toward the urine.

Verse 38 (garuda.1.159.38)

तृष्णा प्रमेहे मधुरं प्रपिच्छं मध्वामये स्याद्विविधोविकारः । सम्पूरणाद्वा कफसम्भवः स्यात्क्षीणेषु दोषेष्वनिलात्मको वा

tṛṣṇā pramehe madhuraṁ prapicchaṁ madhvāmaye syādvividhovikāraḥ sampūraṇādvā kaphasambhavaḥ syātkṣīṇeṣu doṣeṣvanilātmako vā

In Prameha there is thirst; the urine is sweet and slimy. In Madhumeha various disorders occur — it may arise from Kapha through over-nourishment, or, when the other humors are depleted, it may be predominantly of Vata.

Verse 39 (garuda.1.159.39)

सम्पूर्णरूपाः कफपित्तमेहाः क्रमेण ये वै रतिसम्भवाश्च । सक्रामते पित्तकृतास्तु याप्याः साध्योऽस्ति मेहो यदि नास्ति दिष्टम्

sampūrṇarūpāḥ kaphapittamehāḥ krameṇa ye vai ratisambhavāśca sakrāmate pittakṛtāstu yāpyāḥ sādhyo'sti meho yadi nāsti diṣṭam

The Kapha- and Pitta-caused types of Prameha manifest fully in due course, and also arise from excessive indulgence in sexual pleasure. The Pitta-caused types spread progressively and are only manageable, not curable; Prameha is curable only when it has not yet become fixed by fate.