Changes

The fourth chapter in the [[Nidana Sthana]], dealing with the diagnosis of ''prameha'', follows the diagnosis of ''gulma'' disease associated with the ''mamsa dhatu''. Twenty known types of ''prameha'', including diabetes mellitus (''madhumeha''), have been described here. However, there could be innumerable variations of a disease based on the presence or absence of disease (provoking or mitigating) factors in the body. The manifestation of the disease depends upon the interaction between causative factors, ''dosha, dushya'' and the defense mechanism of the body. Some of these factors can also help determine if there could be a delayed or an early onset of the disease, the severity of the disease, etc. Various etiological factors of ''prameha'' are described here that lead to vitiation of ''kapha, meda,'' and ''mutra''. A vitiated ''kapha'' affects ten fluid-predominant body tissues, resulting in the production of excessive ''kleda'' (moisture/excess discharge of body fluids) that, when intermixed with ''meda'' (lipid)and ''mamsa'' (muscle protein), further vitiates ''mutra'' (urine) and results in ''prameha''. A patient afflicted with diabetes mellitus, on an initial visit to the physician, may complain of numbness, tingling, burning sensation in feet, fatigue, dryness of mouth, drowsiness, etc. It is highlighted these signs and symptoms for an early diagnosis and management of ''prameha''. Ten types of curable ''kaphaja prameha'', six variants of ''yaapya'' (palliative) and four variants of incurable ''vataja prameha'', totaling twenty types of ''prameha'' have been described here in this text. Prodromal symptoms, complications, treatment procedures (enumerated briefly), and some rules (do’s and don’ts) have been included in the course of this chapter.

The fourth chapter in the [[Nidana Sthana]], dealing with the diagnosis of ''prameha'', follows the diagnosis of ''gulma'' disease associated with the ''mamsa dhatu''. Twenty known types of ''prameha'', including diabetes mellitus (''madhumeha''), have been described here. However, there could be innumerable variations of a disease based on the presence or absence of disease (provoking or mitigating) factors in the body. The manifestation of the disease depends upon the interaction between causative factors, ''dosha, dushya'' and the defense mechanism of the body. Some of these factors can also help determine if there could be a delayed or an early onset of the disease, the severity of the disease, etc. Various etiological factors of ''prameha'' are described here that lead to vitiation of ''kapha, meda,'' and ''mutra''. A vitiated ''kapha'' affects ten fluid-predominant body tissues, resulting in the production of excessive ''kleda'' (moisture/excess discharge of body fluids) that, when intermixed with ''meda'' (lipid)and ''mamsa'' (muscle protein), further vitiates ''mutra'' (urine) and results in ''prameha''. A patient afflicted with diabetes mellitus, on an initial visit to the physician, may complain of numbness, tingling, burning sensation in feet, fatigue, dryness of mouth, drowsiness, etc. It is highlighted these signs and symptoms for an early diagnosis and management of ''prameha''. Ten types of curable ''kaphaja prameha'', six variants of ''yaapya'' (palliative) and four variants of incurable ''vataja prameha'', totaling twenty types of ''prameha'' have been described here in this text. Prodromal symptoms, complications, treatment procedures (enumerated briefly), and some rules (do’s and don’ts) have been included in the course of this chapter.

===Sanskrit text, transliteration and english translation===

===Sanskrit Text, Transliteration and English Translation===

अथातःप्रमेहनिदानंव्याख्यास्यामः||१||

अथातःप्रमेहनिदानंव्याख्यास्यामः||१||

इतिहस्माहभगवानात्रेयः||२|

इतिहस्माहभगवानात्रेयः||२|

athātaḥ pramēhanidānaṁ vyākhyāsyāmaḥ||1||  

athātaḥ pramēhanidānaṁ vyākhyāsyāmaḥ||1||  

iti ha smāha bhagavānātrēyaḥ||2||  

iti ha smāha bhagavānātrēyaḥ||2||  

Now we shall expound the chapter on the diagnosis of prameha. Thus, said Lord Atreya. [1-2]

 

 

Now we shall expound the chapter on the diagnosis of ''prameha''. Thus, said Lord Atreya. [1-2]

==== Types of prameha ====

==== Types of prameha ====

tatra yathA tridoShaprakopaH  pramehAnabhinirvartayati tathA~anuvyAkhyAsyAmaH||3||

tatra yathA tridoShaprakopaH  pramehAnabhinirvartayati tathA~anuvyAkhyAsyAmaH||3||

Due to vitiation of three doshas, (any of) twenty types of prameha could occur. However, there may be innumerable other variations of the disease. We shall now explain the ways in which vitiation of the three doshas leads to the manifestation of the various types of prameha. [3]

Due to vitiation of three ''doshas'', (any of) twenty types of ''prameha'' could occur. However, there may be innumerable other variations of the disease. We shall now explain the ways in which vitiation of the three ''doshas'' leads to the manifestation of the various types of ''prameha''. [3]

==== Process of onset of disease ====

==== Process of onset of disease ====

sarvavikAravighAtabhAvAbhAvaprativisheShAbhinirvRuttiheturbhavatyuktaH||4||

sarvavikAravighAtabhAvAbhAvaprativisheShAbhinirvRuttiheturbhavatyuktaH||4||

Here, the specific interaction of etiological factors with doshas and dushyas, as well as the presence or absence of disease-resisting factors (individual’s immunity or ability to resist the disease), influence the outcome regarding the manifestation of a disease (including prameha). Temporal factors (e.g. season) also play a role here. For example, if the interaction of etiological factors, doshas and dushyas are weak and these are antagonistic to each other, and if the influence of temporal factors (time or seasonal influence) are also weak, then either the disease does not manifest, or there is a delay in manifestation of the disease. In such cases, even if there is an onset of the disease, its severity could be low, or all of its signs and symptoms may not manifest.  

Here, the specific interaction of etiological factors with ''doshas'' and ''dushyas'', as well as the presence or absence of disease-resisting factors (individual’s immunity or ability to resist the disease), influence the outcome regarding the manifestation of a disease (including ''prameha''). Temporal factors (e.g. season) also play a role here. For example, if the interaction of etiological factors, ''doshas'' and ''dushyas'' are weak and these are antagonistic to each other, and if the influence of temporal factors (time or seasonal influence) are also weak, then either the disease does not manifest, or there is a delay in manifestation of the disease. In such cases, even if there is an onset of the disease, its severity could be low, or all of its signs and symptoms may not manifest.  

Thus, the presence or absence of specific factors determine the ability or otherwise of the body to resist all types of diseases. [4]

Thus, the presence or absence of specific factors determine the ability or otherwise of the body to resist all types of diseases. [4]

==== Etiology of kaphajaprameha ====

==== Etiology of ''kaphaja prameha'' ====

तत्रेमेत्रयोनिदानादिविशेषाःश्लेष्मनिमित्तानांप्रमेहाणामाश्वभिर्निर्वृत्तिकराभवन्ति; तद्यथा-  

तत्रेमेत्रयोनिदानादिविशेषाःश्लेष्मनिमित्तानांप्रमेहाणामाश्वभिर्निर्वृत्तिकराभवन्ति; तद्यथा-  

lasIkA rasashcaujaHsa~gkhyAta iti dUShyavisheShAH ||7||

lasIkA rasashcaujaHsa~gkhyAta iti dUShyavisheShAH ||7||

An excessive intake of kapha-vitiating food articles or lifestyle activities contributes to severe manifestations of kaphaja prameha. The following are some of the specific etiological factors for the kaphaja variant of this disease:

An excessive intake of ''kapha''-vitiating food articles or lifestyle activities contributes to severe manifestations of ''kaphaja prameha''. The following are some of the specific etiological factors for the ''kaphaja'' variant of this disease:

 

• Frequent and excessive intake of:

• Frequent and excessive intake of:

o newly harvested grains like hayanaka, yavaka (a variety of Hordeum vulgare Linn), cinaka, uddalaka,naishadha,itkata, mukundaka, mahavrihi, promodaka, and sugandhaka;

o newly harvested grains like hayanaka, yavaka (a variety of Hordeum vulgare Linn), cinaka, uddalaka,naishadha,itkata, mukundaka, mahavrihi, promodaka, and sugandhaka;