159 - Diseases

Dhanvantari said: 

1. I shall now explain the pathology of Pramehas (Diabetes), please listen O Sushruta. Diabetes consists of twenty varieties. Ten are caused by Kapha, six are caused by Pitta and four are caused by Vayu. Fat, urine and phlegm are the seats of disorders. 

2. A patient of Haridrameha passes hot faeces and urine having the colour of turmeric and smelling like saw flesh. A patient of Manjishthameha passes urine like the water with which Indian madder is washed (yellowish red). 

3. A patient of Raktameha discharges flesh smelling hot saline red urine. A patient of Vasameha frequently discharges urine mixed with fat and having the colour of fat. 

4-5. "A patient of Majjameha passess urine charged with marrow and resembling marrow. A patient of Hastimeha discharges a continuous copious flow of urine containing slimy mucous matter. 

6. A patient of Madhumeha discharges urine like honey. It is of two types. 

7-9. When the Vayu gets aggravated due to deficiency of dhatus and its path is obstructed by the doshas the patient begins to exhibit the symptoms and without any apparent reason he shows signs of amelioration and aggravation by turns. It then becomes incurable. All pramehas, neglected at the outset, turn into Madhumeha in course of time. 

All those cases of Prameha where the excretions are sweet like honey can be classified under Madhumeha. 

10. The common disorders in the Pramehas caused by Kapha are indigestion, nonrelish for food, vomiting, somnolence, cough and chatarrh. 

11. The characteristic symptoms in Meha caused by deranged Pitta are: -Pricking pain in the bladder and urethra, bursting of the scrotum, fever, burning sensation in the body, thirst, sour eructations, epilepsy and loose bowels. 

12. The Vayu afflicted person exhibits the following symptoms: --Udavarta (Prolapsus of the anus), shivering, pain in the heart, morbid longing (for bitter and astringent food-stuffs), Colic, sleeplessness withering up, dyspnea and cough. 

13. Ten types of abscesses caused by the neglect of Prameha are: --(1) Sharavika (2) Kacchapika (3) Jvalini (4) Vinata (5) Alaji (6) Masurika (7) Sarshapika (8) Putrini (9) Vidarika and (10) Vidradhi. 

14. The main cause is food stuff, sweat, sour, saline, oily, heavy, lubricious and cold in combination with Kapha. 

15. Newly harvested grains, wine, dal soup, gravy, jaggery and milk products in excess cause sharing the bed or seat as a patient may also cause the same. 

16. The defiled Kapha located in the urinary bladder first defiles the body, secretions like sweat, and the fat and flesh. Then it produces Pramehas. 

17. The Kapha makes the blood mixed with urine when Kapha etc. are exhausted. When Kapha subsides, Vayu brings the dhatus to the bladder. 

18. The curability or otherwise and the necessity to wait in the case of Pramehas shall be decided by understanding the underlying cause. If the doshas are eliminated the disease can be cured, if they are aggravated the sickness persists. 

19. The general characteristic of all Pramehas is copiousurination turbid in nature, By the combination of doshas different disorders are observed. The different types of Prameha are classified according to the colour of the urine, 

20. The patient of Udakameha (Polyuria) passes clear copiouscool odourless urine like water. It is slightly lubricious and turbid. 

21-22. The patient of Ikshumeha discharges excessively sweet wine, like sugar-cane juice. The patient of Sandrameha (Chyluria) passes thick urine resembling state rice gruel. 

23. The patient of Surameha passes urine like wine transparent at the surface but leaving a sediment at the bottom. The patient of Pishtameha passes copious urine white-like pasted rice. He has horripilation at the time of urination. 

24. The patient of Shukrameha (Spermatorrhoea) passes une highly charged with semen resembling it in colour. The patient of Sikatameha passes urine with sediments like grains of sand. 

25. The patient of Shitameha passes copious urine cold and sweet. The patient of Shanairmeha passes urine slowly in broken jets. The patient of Lalameha passes slimy, shreddy urine like saliva. 

26. The patient of Ksharameha passes urine alkaline in character in smell, colour, taste and touch. The patient of Nilameha passes bluish urine and the patient of Kalameha passes urine black like ink. 

27. Abscesses usually occur in vulnerable joints and fleshy portions in the body. An abscess elevated at the extremities and dipped in the centre, producing no discharges nor giving any pain is called Sharavika since it resembles a saucer in shape. 

28. An abscess giving a burning sensation and resembling the back of a tortoise shall be known Kacchapika by scholars. The abscess large in size and blue in colour is called Vinata. 

29. At the time of its incubation the abscess Jvalini gives excruciating pain and a burning sensation. The abscess Alaji is terrible. It is either red or white and is surrounded by blisters. 

30. An abscess resembling a Masura dala (lentil seed) is called Masurika. Small clusters of abscesses resembling mustard seeds in the tongue are called Sarshapika. They are very painful. They suppurate too. 

31. The abscess Putrini is of various sizes. Some are large, some small and some very minute. The abscess Vidarika is hard and round like the bulbous root of Vidari (an esculent tuber). 

32. An abscess with the characteristics of Vidradhi (Erysipelas) is called Vidradhika. The abscesses Putrini and Vidarika give intolerable pain and are fatty. 

33. Many other abscesses occurring suddenly due to the deranged Pitta are less fatty. Their virulence is in accordance with the aggravation of the doshas. 

34. In a patient of defiled fat these abscesses occur even without Prameha, They are not recognized as long as the colour is not clearly developed. 

35. Without the characteristic symptoms of Prameha if a patient passes urine red in colour or resembling the washings of turmeric he is a victim of Raktapitta (urethral haemorrhage). 

36-37. Perspiration, foul smell in the limbs, lassitude and looseness in the limbs, inclination to lie down, sleep, or take food, burning sensation in the chest, eyes, tongue and ears, thickness of the tips hair and nails and their profuse growth, fondness for cool things, parchedness in the throat and palate, taste of sweetness in the mouth, burning sensation in hands and feet, all these are the symptoms indicating the onset of Prameha. Ants move about in the urine of the patient. 

38. Thirst and sweetness of urine and similar disorders of various forms occur when the illness progresses. When the symptoms are full the type occurs. When the other doshas subside the Vataja type may occur. 

39. Prameha caused by Pitta and Kapha exhibits the entire symptoms simultaneously and that caused by sexual indulgence exhibits them gradually. Pittaja Prameha can be checked or alleviated. If the Prameha is not fully developed it can be cured.