The text says a person strongly habituated to daytime sleep, lack of exercise, inactivity, and frequent intake of cold, oily, sweet, medas-promoting, liquid foods and drinks may be expected to develop prameha.
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ಪ್ರಮೇಹಹೇತುಮಾಹ- ದಿವಾಸ್ವಪ್ನೇತ್ಯಾದಿ| ಪ್ರಸಕ್ತಂ ಪ್ರಕರ್ಷೇಣ ಸಕ್ತಮತಿಶಯೇನಾನುಷಙ್ಗಿಣಮ್| ಮೇದ್ಯಂ ಮೇದುರಂ ಮೇದೋಜನಕಮಿತ್ಯರ್ಥಃ| ಪುರುಷಂ ಜಾನೀಯಾತ್ ಪ್ರಮೇಹೀ ಭವಿಷ್ಯತಿ; ತತ್ರಾಹುರೇಕೇ- ಸ್ತ್ರೀಣಾಂ ಪ್ರಮೇಹಾ ನ ಭವನ್ತಿ, ತಥಾ ಚ ತನ್ತ್ರಾನ್ತರೇ- “ರಜಃಪ್ರಸೇಕಾನ್ನಾರೀಣಾಂ ಮಾಸಿ ಮಾಸಿ ವಿಶುಧ್ಯತಿ| ಸರ್ವಂ ಶರೀರಂ ದೋಷಾಶ್ಚ ನ ಪ್ರಮೇಹನ್ತ್ಯತಃ ಸ್ತ್ರಿಯಃ” ಇತಿ; ಏತತ್ತು ನ ಯುಕ್ತಂ, ಸರ್ವತನ್ತ್ರಾಪ್ರಸಿದ್ಧೇಃ ಪ್ರತ್ಯಕ್ಷವಿರೋಧಾಚ್ಚ||೩||
Meaning of the commentary
The commentary presents these as causes of prameha. Prasakta means intensely attached or habitually engaged, and medya means rich or promoting medas. Some authorities claimed that women do not develop prameha because monthly menstrual flow purifies the body and doṣas. The commentator rejects that claim because it is not accepted across the authoritative texts and directly contradicts observation.
Key terms
divAsvapna (divāsvapna)
Sleeping during the daytime.
avyAyAma (avyāyāma)
Lack of physical exercise.
medya
Considered to promote or increase medas in the classical framework.
As the described process continues, vāta, pitta, and kapha in an unprocessed state are said to unite with medas, follow the urine-carrying channels downward, reach the bladder outlet, and emerge there, thereby producing the prameha disorders.
The commentary glosses aparipakva as āma or unprocessed. It understands an omitted 'and' after medas to include vasā and other affected materials. Others read 'medas too is unprocessed,' using the conjunction to include vasā and further unmentioned materials. Upetya means reaching the site. One explanation takes nirbhidyante as flowing or passing out. Another reads vinirbhidyante and explains it as becoming established there, while a third explains the word as becoming excessively fluid.
Key terms
aparipakva
Unprocessed or improperly transformed; glossed as āma.
medas
The classical adipose or fatty tissue category.
mUtravaha srotas (mūtravaha srotas)
The urine-carrying channels in classical anatomy.
bastimukha (basti-mukha)
The outlet or mouth of the urinary bladder.
nirbhidyante
Interpreted variously as passing out, becoming established, or becoming excessively fluid.
Prodromal features of prameha include burning of the palms and soles; an oily, sticky, or heavy feeling in the body; urine described as sweet and pale; drowsiness, weakness, thirst, foul-smelling breath, deposits on the palate, throat, tongue, and teeth; matting of the hair; and increased nail growth.
Ten kapha-predominant forms—udakameha, ikṣuvālikāmeha, surāmeha, sikatāmeha, śanair-meha, lavaṇameha, piṣṭameha, sāndrameha, śukrameha, and phenameha—are described as treatable because the doṣa and affected tissues respond to similar therapeutic actions. Six pitta-predominant forms—nīla, haridrā, amla, kṣāra, mañjiṣṭhā, and śoṇitameha—are described as manageable but persistent because treatment suitable for the doṣa and tissues differs. Four vāta-predominant forms—sarpir, vasā, kṣaudra, and hastimeha—are described as the most incurable because of their grave course.
The commentary says one doṣa is named by predominance even though all forms involve all doṣas. The ten kapha forms are considered treatable only when medas is not severely affected. Here kapha is the doṣa, while rasa, muscle, medas, marrow, śukra, lasīkā, and ojas are affected materials; pungent, bitter, astringent, and similar measures are understood to act compatibly upon them. The six pitta forms are likewise only manageable when the affected materials are not severely disrupted. Their treatment is considered conflicting because what calms pitta may promote rasa and the other affected tissues. The vāta forms are said to destroy rapidly because they cause discharge of progressively more essential tissues; the conflicting-treatment problem also applies to them.
Key terms
sAdhya (sādhya)
Considered treatable within the classical prognosis.
yApya (yāpya)
Considered controllable or manageable but persistent.
asAdhyatama (asādhyatama)
Considered the most incurable in the historical prognosis.
doShadUShya (doṣa-dūṣya)
The causative doṣa and the bodily material it affects.
Kapha joined with vāta, pitta, and medas is said to generate the kapha-predominant pramehas. Pitta joined with vāta, kapha, blood, and medas generates the pitta-predominant forms. Vāyu joined with kapha, pitta, vasā, marrow, and medas generates the vāta-predominant forms.
The commentary says this verse makes explicit that each category arises through multiple factors, even though a particular doṣa gives the group its name by predominance.
Key terms
shleShmaprameha (śleṣma-prameha)
The prameha group named for predominance of kapha.
pittaprameha (pitta-prameha)
The prameha group named for predominance of pitta.
vAtaprameha (vāta-prameha)
The prameha group named for predominance of vāta.
vasA (vasā)
A classical fatty tissue or fat substance included among affected materials.
Ten kapha-related prameha types are distinguished by the appearance and manner of urination: udakameha has pale, painless urine like water; ikṣuvālikāmeha resembles sugarcane juice; surāmeha resembles alcoholic liquor; sikatāmeha is painful and mixed with sand-like particles; śanairmeha is passed slowly and is slimy with kapha; lavaṇameha is clear and resembles salt water; piṣṭameha, accompanied by horripilation, resembles water mixed with flour; sāndrameha is very turbid and dense; śukrameha resembles semen; and phenameha is passed little by little, frothy, and clear.
The commentary lists the signs of the kapha-origin types in order. Sikatānuviddha means mixed with sand-like material, mṛtsna means slimy, and ‘like salt’ means like salt water. Hṛṣṭaroman means having horripilation. Piṣṭa-rasa means resembling water mixed with flour. Āvila is repeated to emphasize extreme turbidity. Mehati means urinates.
Key terms
udakameha
A prameha type with pale, painless, water-like urine.
sikatAmeha (sikatāmeha)
A painful type with sand-like material in urine.
piShTameha (piṣṭameha)
A type whose urine resembles flour mixed with water.
sAndrameha (sāndrameha)
A type with markedly turbid, dense urine.
phenameha
A type with small, repeated quantities of frothy, clear urine.
Six pitta-related prameha types are then described: nīlameha has frothy, clear, blue-dark urine; haridrāmeha has burning and turmeric-coloured urine; amlameha has sour taste and smell; kṣārameha resembles filtered alkaline liquid; mañjiṣṭhāmeha resembles water coloured with mañjiṣṭhā; and śoṇitameha resembles blood.
The commentary glosses sruta-kṣāra as liquid obtained by filtering alkali. Urine resembling mañjiṣṭhā-water or blood can also occur in raktapitta, so it asks how this is distinguished as prameha. Its answer is that raktapitta lacks the prodromal signs of prameha, whereas mañjiṣṭhāmeha and śoṇitameha are preceded by those signs.
Key terms
haridrAmeha (haridrāmeha)
A pitta-related type with burning and turmeric-coloured urine.
kShArameha (kṣārameha)
A type whose urine resembles filtered alkaline liquid.
ma~jjiShThAmeha (mañjiṣṭhāmeha)
A type whose urine resembles water coloured with mañjiṣṭhā.
shoNitameha (śoṇitameha)
A type whose urine has a blood-like appearance.
pramehapUrvarUpa (prameha-pūrvarūpa)
Prodromal signs used by the commentary to distinguish these types from raktapitta.
Four vāta-related prameha types are described: sarpirmeha has urine resembling ghee; vasāmeha resembles fat; kṣaudrameha resembles honey in taste and colour; and hastimeha involves a continuous stream like that of an intoxicated elephant.
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ಅತ ಇತ್ಯಾದಿ| ಅನುಪ್ರಬನ್ಧಂ ಸತತಮ್||೧೨||
Meaning of the commentary
The commentary explains anuprabandha as continuous or uninterrupted and otherwise adds no detail to the four comparisons.
Key terms
sarpirmeha
A vāta-related type whose urine is compared with ghee.
vasAmeha (vasāmeha)
A type whose urine is compared with animal fat.
kShaudrameha (kṣaudrameha)
A type whose urine is compared with honey in colour and taste.
hastimeha
A type marked by a continuous urinary stream, compared with an elephant’s urination.
Complications listed for kapha-related prameha include flies gathering, lethargy, increase of flesh, rhinitis, laxity, poor appetite, indigestion, excessive kapha or salivation, vomiting, sleepiness, cough, and difficult breathing. For pitta-related types they include splitting pain in the testicles, bladder pain, penile pricking, heart-region pain, sour belching, fever, diarrhea, poor appetite, vomiting, diffuse heat, burning, fainting, thirst, insomnia, pāṇḍu, and yellow stool, urine, and eyes. For vāta-related types they include constriction in the heart region, craving for all tastes, insomnia, stiffness, tremor, pain, and constipation. Thus the twenty forms of prameha and their complications are described.
The commentary organizes complications by doṣa. Avadaraṇa means splitting pain. Amlīkā is sour eructation; vamathu means vomiting; paridhūpana is heat felt all around; and burning is compared with fire injury. Laulya means desire for every taste, likened to the vāta type of grahaṇī disease.
Key terms
upadrava
A complication or secondary disorder associated with the main condition.
avadaraNa (avadaraṇa)
Splitting or tearing pain, here affecting the testicles.
In a person with prameha whose body is described as permeated by vasā and medas and whose dhātus are affected by all three doṣas, ten kinds of piḍakā may arise: śarāvikā, sarṣapikā, kacchapikā, jālinī, vinatā, putriṇī, masūrikā, alajī, vidārikā, and vidradhikā.
The commentary gives the pathogenesis of these eruptive complications. Vasā is glossed as fat of muscle, though others interpret it as the unctuous component of the whole body. Abhipanna-śarīra means that the body is pervaded, and anugata-dhātu means that the dhātus are pervaded. These piḍakās occur mainly on the lower body. The remainder of the passage lists their names.
Key terms
pramehapiDakA (prameha-piḍakā)
An eruptive or swelling complication described in association with prameha.
vasA (vasā)
Muscle fat, or according to another view the body’s entire unctuous component.
medas
The classical adipose or fatty tissue constituent.
anugatadhAtu (anugata-dhātu)
Having dhātus pervaded or affected in the stated pathogenesis.
Śarāvikā is dish-sized and dish-shaped with a depressed centre. Sarṣapikā has the size and form of pale mustard seed. Kacchapikā causes burning and resembles a tortoise. Jālinī has intense burning and is covered with a network of fleshy strands. Vinatā is a large, dark-blue swelling. Putriṇī is large and surrounded by many small eruptions. Masūrikā resembles a lentil. Alajī is red and white, blistered, and severe. Vidārikā is round and hard like a vidārī tuber. Vidradhikā has the signs of vidradhi.
The commentary defines the visual comparisons. Sarṣapikā resembles pale mustard. Although a later line says each lesion is produced by the doṣa responsible for its corresponding prameha, jālinī should be understood as predominantly pitta-related because the descriptions most often state it that way. Vinatā is large or thick, and putriṇī is encircled by minute eruptions.
Key terms
sharAvikA (śarāvikā)
A broad, dish-shaped lesion with a depressed centre.
kacchapikA (kacchapikā)
A burning lesion shaped like a tortoise.
jAlinI (jālinī)
An intensely burning lesion covered by a network-like arrangement of flesh.
putriNI (putriṇī)
A large lesion surrounded by many minute eruptions.
vidradhikA (vidradhikā)
A lesion displaying features of the classical vidradhi category.
Piḍakās arising at the anus, heart region, head, shoulder, back, or a vital point, accompanied by complications and occurring in a person with weak digestive fire, are said to be unsuitable for treatment.
The commentary presents signs of historical incurability. Aṃsa means the upper shoulder. The listed complications are thirst, cough, decomposition of flesh, confusion or loss of awareness, hiccup, intoxication-like disturbance, fever, spreading inflammation, and obstruction of a vital point. Some read ‘piḍakās should be avoided in a person with complications, a small body, and weak digestive fire’; in that reading, sopadrava qualifies the person rather than the lesions.
Key terms
marma
A vital or vulnerable bodily point in classical anatomy.
sopadrava
Accompanied by complications; in a variant, qualifying the affected person.
durbalAgni (durbalāgni)
Weak digestive fire in classical assessment.
parivarjayet
Should avoid treating, expressing a grave historical prognosis.
Vayu, associated with medas, majja, and vasa, is described as pressing the whole body and moving downward with its constituents; for this reason, vataja pramehas are classed as incurable in the historical prognosis.
The commentary explains 'pressing the whole body' as draining it and carrying all the dhatus through the urinary passage. Vasa stands representatively for additional substances, including ojas and lasika. Moving downward means becoming accumulated or powerful below. Gayadasa reads the three verses beginning before the apatanika passage differently. The word tu also links this incurability with two causes stated earlier.
Key terms
vAtaja prameha (vataja prameha)
Prameha classified by predominant vata involvement.
niShpIDya (nishpidya)
Pressing or, in the commentary, draining the whole body.
vasA (vasa)
Fatty tissue, also used representatively for ojas and lasika here.
adhaH prakramate (adhah prakramate)
Moves downward and becomes powerful or accumulated below.
A person in whom the prodromal pattern of prameha is observed together with a somewhat increased quantity of urine is to be identified, in this classical framework, as having prameha.
The commentary presents this as the general diagnostic form in a person who has the causal factors associated with prameha. It adds no further explanation of the individual prodromal signs.
Key terms
pramehapUrvarUpa (prameha purvarupa)
The prodromal pattern described for prameha.
AkRuti (akriti)
The overall appearance or pattern of signs.
adhika mUtra (adhika mutra)
Urine described as somewhat greater in quantity.
pramehin
A person classified in the text as having prameha.
The main commentary treats this as completing the general description of prameha. Gayadasa gives a different arrangement: he understands the preceding verse as identifying stages of prodrome, swelling, and pidaka that guide the fivefold therapeutic sequence later taught for prameha-pidaka. The prodromal stage indicates that prameha may develop; he mentions reducing measures and drinks made from plant decoctions at that stage. Very excessive urination marks manifest disease and a distinct treatment stage. The cited treatment passage then describes a progression in which, if earlier measures are not undertaken, urine, sweat, and shleshma become sweet and prameha becomes manifest; it mentions purification in both directions. If still unaddressed, aggravated doshas affect flesh and blood, producing swelling and complications, for which countermeasures and siramoksha are mentioned. Further progression is said to produce pidakas and ultimately death if their treatment is also omitted.
Key terms
pUrvarUpa (purvarupa)
Prodromal signs preceding manifest disease.
pravRuttamUtra atyartha (pravrittamutra atyartha)
Very excessive passage of urine.
pramehapiDakA (prameha pidaka)
A lesion or boil described as a later complication of prameha.
apatarpaNa (apatarpana)
A reducing therapeutic approach mentioned in the historical commentary.
sirAmokSha (siramoksha)
A historical blood-release procedure mentioned for a later complication stage.
Adhikarana ೨೦ (೨೪) · Śloka ೨೪
ಪಿಡಕಾಪೀಡಿತಂ ಗಾಢಮುಪಸೃಷ್ಟಮುಪದ್ರವೈಃ |
ಮಧುಮೇಹಿನಮಾಚಷ್ಟೇ ಸ ಚಾಸಾಧ್ಯಃ ಪ್ರಕೀರ್ತಿತಃ ||೨೪||
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पिडकापीडितं गाढमुपसृष्टमुपद्रवैः |
मधुमेहिनमाचष्टे स चासाध्यः प्रकीर्तितः ||२४||
Meaning of the śloka
A person with prameha who is severely affected by pidakas and heavily burdened by complications is termed a madhumehin in this passage and is described as incurable in the historical prognosis.
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ಸರ್ವಪ್ರಮೇಹಾಣಾಮವಸ್ಥಾನ್ತರಪ್ರಾಪ್ತಾನಾಂ ಸಜ್ಞಾನ್ತರಮಸಧ್ಯಿತ್ವಂ ಚ ದರ್ಶಯನ್ನಾಹ- ಪಿಡಕಾಪೀಡಿತಮಿತ್ಯಾದಿ| ಸ ಚೇತಿ ಚಕಾರ ಉತ್ಪತ್ತೌ ವಾತಜಾನಾಮಸಾಧ್ಯತ್ವಂ ಸಮುಚ್ಚಿನೋತಿ| ಅತ್ಪತ್ತೌ ಚ ಸಹಜೋ ಯಾಪ್ಯತ್ವಾದಸಾಧ್ಯಃ, ಪಿತ್ತಜಃ ಪುನರಸಾಧ್ಯತರಃ, ವಾತಜಃ ಪುನರುತ್ಪತ್ತಿಕ್ರಮೇಣಾಸಾಧ್ಯತಮಃ||೨೪||
Meaning of the commentary
The commentary describes a later state of any prameha that receives another designation and prognosis. The conjunction also includes the view that vataja forms are incurable from their onset. It then gives a graded historical prognosis: sahaja is classed as yapya yet treated here as incurable, pittaja as still more incurable, and vataja as most incurable according to the sequence of development.
Key terms
madhumehin
A later or complicated prameha state in this passage.
piDakA (pidaka)
A boil, lesion, or inflammatory swelling associated with complicated prameha.
upadrava
A complication.
sahaja
Present from birth or constitutionally arising in the classical classification.
yApya (yapya)
Manageable or controllable, though not readily curable in the historical prognosis.
The commentary presents this sequence of five activity states as a behavioral sign of madhumeha. Sthana means remaining upright or standing, vrinute means desires or chooses, and shayana here refers to being on the bed.
Just as many colors such as mottled, brown, tawny, dove-colored, and dark arise from differing proportions and combinations of five basic colors, the many forms of prameha arise from differing degrees and combinations of doshas, dhatus, malas, and dietary factors.
The commentary uses the color analogy to explain how three doshas can yield twenty kinds of prameha. The five basic colors are white, green, black, yellow, and red. Utkarsha and apakarsha mean increase and decrease in their relative strength. Babhru is tawny-brown, kapota resembles a dove, and mecaka is dark. Mala is used broadly to include the subsidiary tissues vasa and lasika and also water.
Key terms
utkarShApakarSha (utkarshapakarsha)
Relative increase and decrease in predominance.
saMyogavisheSha (samyogavishesha)
A particular combination or proportion.
shabala
Mottled or variegated color.
kapota
Dove-colored or grayish.
mecaka
Dark or blackish coloration.
lasIkA (lasika)
A fluid or subsidiary tissue included under mala by the commentary.
भवति चात्र- सर्व एव प्रमेहास्तु कालेनाप्रतिकुर्वतः |
मधुमेहत्वमायान्ति तदाऽसाध्या भवन्ति हि ||२७||
Meaning of the śloka
The text states that every form of prameha, if not addressed in its appropriate stage over time, progresses to the state called madhumeha and is then considered incurable in the historical prognosis.
The commentary describes the harmful consequence of leaving the prodromal and later stages of prameha unaddressed. Kala refers to the successive opportunities for the first and later therapeutic actions, while apratikurvatah means when no countermeasure is undertaken.
Key terms
madhumehatva
Progression to the state designated madhumeha in this classical account.
kAla (kala)
The appropriate stage or opportunity for successive therapeutic action.
apratikurvataH (apratikurvatah)
When the condition is not being addressed or counteracted.
The commentary colophon states that the sixth chapter of the Nidanasthana is complete in Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.
Key terms
pramehanidAna (Pramehanidana)
The chapter on causes and diagnostic description of prameha.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.