Diagnosis of diabetes (Prameha Nidanam) in Ayurveda

Diagnosis of diabetes (Prameha Nidanam) in Ayurveda

This chapter delves into the causes, types, and pathogenesis of Prameha, highlighting its systemic nature and impact on various bodily tissues and systems. Prameha is described as a systemic disease with urinary manifestations, where the urine may be increased in quantity, frequency, or both. The chapter emphasizes the significance of identifying and avoiding the causative factors to prevent and manage Prameha. It provides a comprehensive overview of the causes, types, and pathogenesis of Prameha, emphasizing the importance of lifestyle and dietary modifications in its management. 

Prameha Sankhya (types of diabetes)

Prameha (polyuria diabetes) are twenty, out of which ten are born from slesma (kapha), six from pitta and four from anila (vata). 1a. 

Nidana (causes of diabetes)

Foods, drinks and activities which produce an increase of medas (fat), mutra (urine) and kapha are generally the chief causes, such as; foods which are sweet, sour, salt, fatty, not easily digestible, slimy and cold; fresh grains, beer, meat of animals of marshy regions, sugarcane juice, molasses and milk; (habit of) always sitting at a place and sleeping without adopting its proper procedure. 1b-3. 

Prameha Samprapti (Pathogenesis of diabetes)

Kapha which gets vitiated (increased) and localised in the urinary bladder, produces prameha by vitiating the body water, sweat, pitta, fat, plasma and muscle (all these are watery tissues,); even pitta and rakta (blood) also produce it, by vitiating the residence of urine (urinary bladder) when they (watery tissues) are decreased (depleted); even maruta (vata) also causes it, by dragging the dhatus (watery tissues) into the bladder when they are depleted. 4-5. 

Meha is classified as curable, controllable and rejectable, is done so on their basis, (of the dosas) and (the quality of) samakriyata (identical therapy), asama (visama kriyata non-identical therapy) and mahatyayata (great danger involved). 6. 

Notes: The above breif statement is explained as follows; the ten kinds of prameha produced by kapha are curable because in them, the causative dosa and dusyas (tissues and wastes) are identical (of the same qualities) and so drugs and therapies are the same for both (identical therapy). The six kinds produced by pitta, are controllable but persist till death because in these the causative dosa (pitta) and the dusyas (tissues and wastes) are of different qualities and so drugs and therapies have to be different (non-identical therapy). The four kinds produced by vata are incurable because of the risk of grave complication/secondary diseases arising due to loss of all the tissues. 

Rupa (Clinical features of diabetes) 

Samanya laksana (common symptoms) 

The common symptoms in all of them are-increased quantity and turbidity of the urine. 7a.

Though the dosas and dusyas are similar, their combination (types of combination) being different; there occurs differences in the colour etc. (other properties) of urine; based on these (properties) they (kinds of diabetes) are described further. 7b-8a. 

Kaphaja meha (Diabetes caused by kapha): In Udaka meha the person passes urine which is clear (not turbid) lar in quantity, white, cold, odourless, resembling water, sometimes with slight turbidity and slimyness. In Iksu meha the urine is like the juice of sugarcane and very sweet. In Sandra meha the urine become thick when kept over night. In Sura meha the urine resembles sura (beer) with clear top (portion) and thick bottom (portion). In Pista meha the person has horripilations, voids urine which is thick like a solution of corn flour and is white. In Sukra meha the urine is like semen or mixed with semen. In Sikata meha the person passes urine containing dirty particles resembling sand. In Sita meha the urine is sweet and very cold. In Sanair meha the person passes urine very slowly and with very little force. In Lala meha the urine contains threads like that of saliva and slimy. 8b-13. 

Pittaja meha (Diabetes caused by pitta): In ksara meha the urine is like a solution of alkali in smell, colour, taste and touch, In Nila meha it (urine) is blue. In Kala meha it resembles ink (black). In Haridra meha the urine is pungent (or bitter) resembles haridra (termuric) (yellow in colour) passed associated with burning sensation. In Manjista meha the urine is foul smelling and resembles solution of manjista (slight red in colour). In Rakta meha the urine is foul smelling, hot, slight salty and resembles blood (red in colour). 14-16a. 

Vataja meha (Diabetes caused by vata): In Vasa meha the urine is mixed with muscle fat, or only muscle fat may be passed frequently, In Majja meha the person passes only marrow or urine mixed with marrow frequently. In Hasti meha the person passes urine like an elephant in rut, continuously and without force, mixed with lasika (lymph) and with obstruction (difficulty), In Madhumeha the person passes urine resembling honey (in taste). 16-18a. 

This (madhumeha) arises in two ways, by the aggravation of vata caused by a) dhatuksaya-depletion/loss of tissues and b) obstruction of its path (movement) by the dosas covering it. In the obstructed kind, it (vata) exhibits the symptoms of the dosa covering it, without any other reason, occassionally, hence the bladder is found sometimes empty and sometimes full, and the diseases becomes difficult to cure. All varieties (of prameha) if neglected will, in course of time, become madhumeha. All those in which the urine is sweet resembling honey and the body also becoming sweet, are called madhumeha. 18b-21. 

Prameha upadrava (complications/ secondary diseases of diabetes)

Poor digestion, anorexia, vomitting, more of sleep cough and nasal catarrh-are the complications/secondary, diseases of diabetes arising from kapha. Pricking pain in the bladder and penis, exudation from the scrotum, fever, burning sensation, thirst, sourness (increased acidity), fainting and loose bowels are the upadrava of those (diabetes) arising from pitta. Udavarta (upward movement of vata), tremors, catching pain in the region of the heart, different kinds of desires, pain in the abdomen, loss of sleep, dryness (of the mouth, throat etc.); cough and dyspnoea are the upadrava of those (diabetes) arising from vata. 22-24. 

Prameha pidika  (diabetec ulcer/corbuncles)

Saravika kacchapika jalini, vinata, alaji, masurikasarsapika, putrini, vidarika and vidhradhi– are the ten eruptions/ulcers appearing on the joints, vital spots and muscular parts during the course of diabetes. 25-26. 

Saravika is pitaka (eruptions/ ulcers) having elevated edges and depressed centre, black in colour, associated with exudation and pain, resembling a saucer is size and shape. Kacchapika is pitaka having severe (deep) pain, either continuous or intermittent, extends over a large area, smooth and resembles the shell of a tortoise. Jalini is stable, has veneous net-work, greasy (unctuous) exudate, and big cavity inside, with severe pain, intermittent pain and has minute openings. Vinata is big sized eruption, developing either on the back or abdomen, blue in colour having severe (deep) pain and exudation and bent downwards. Alaji has burning sensation and elevation of the skin, very difficult to bear, spreads to other places, reddish-black in colour and accompanied with severe thirst, boils (appearing in different places of the body), burning sensation all over the body, delusion and fever. Masurika resembles masura (lentil) in size and shape. Sarsapika is like sarsapa (mustard seed) in size and shape, ulcerates soon, has severe pain and surrounded by eruptions resembling mustard seeds. Putrini is a big eruption, surrounded by many small eruptions. Vidarika is round like the tuber of vidari and hard. Vidradhi will be described elsewhere (in the next chapter 27-34b. 

Out of these, the first three (saravika, kacchapika and jalini), putrini and vidarika are difficult to bear (and also to treat), these arise from predominance of fat tissue, the remaning and those having predominance of pitta and those arising from less of fat are bearable (and easy to treat). In these (e) (s) the recogni of aggravation of dosas is similar to that of (the kinds of) diabetes. These eruptions occur even without diabetes, due to vitiation of fat tissue but are not taken note of (treated) till they get localised (permanantly at any place). 34b-36. 

Sapeksya nidana (differential diagnosis)

If a person passes urine having the colour either of termuric (deep yellow) or of blood (red) without the appearance of premonitory symptoms of diabetes, he should not be understood as having prameha (diabetes) but be taken as having raktapitta (bleeding diseases). 37. 

Prameha purvarupa (Prediabetes symptoms) 

More of perspiration, bad smell of the body, looseness/ flacidity of the body parts, desire for the comfort on the bed, seat and sleep; thickening of the heart, eyes tongue and ears; stoutness of the body, greater increase of (growth rate) the hairs and nails, desire for cold, dryness of the throat and palate, sweet taste in the mouth (always) burning sensation of the palms and soles; and swarming of ants towards his urine (place of urination or urine pots) are the premonitory symptoms of the groups of diabetes. 38-39. 

Prameha sadhyasadhyata (Prognosis of diabetes) 

Finding diabetes, with urine being sweet, slimy and resembling honey, the (unintellegent) physician gets doubt on two points; whether it is born from kapha caused by over nutrition or whether it is born from anila (vata) caused by decrease of the dosas (under-nutrition). 40. 

Prameha caused by kapha and pitta (all varieties) having all the premonitory symptoms and those caused by vata, after lapse of time are incurable; those caused by vata, after lapse of time are incurable; those caused by pitta persist for long time and are controllable; and those are curable in which the fat tissue is not greatly vitiated (increased). 41.