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=== Abstract ===

=== Abstract ===

 

[[Prameha Nidana]] describes the disease ''prameha'' (chronic urinary disorders including diabetes) as well as its etiopathogenesis, types, clinical features, prognosis, prodromal symptoms, complications, and a line of treatment. Though it is predominantly a ''kapha dosha'' disorder, there are variants involving all three ''doshas'' and ten ''dushya'' (body tissues and other elements).''Prameha'' is a very broad term that includes the signs of obstinate urinary disorders such as diabetes. ''Prabhuta'' (excessive) and ''avila'' (turbid) ''mutrata'' (urination) are the cardinal signs of all ''prameha''. All those urinary and systemic diseases that cause copious quantities, as well as the abnormal (including turbid) quality of urination, come under the umbrella of ''prameha''. This chapter briefly explains the importance of exogenous, endogenous and tissue response in the manifestation of the disease. The concept of genetic susceptibility to disease and effect of chronic disease on genes is also incorporated in this chapter.

[[Prameha Nidana]] describes the disease ''prameha'' (chronic urinary disorders including diabetes) as well as its etiopathogenesis, types, clinical features, prognosis, prodromal symptoms, complications, and a line of treatment. Though it is predominantly a ''kapha dosha'' disorder, there are variants involving all three ''doshas'' and ten ''dushya'' (body tissues and other elements).''Prameha'' is a very broad term that includes the signs of obstinate urinary disorders such as diabetes. ''Prabhuta'' (excessive) and ''avila'' (turbid) ''mutrata'' (urination) are the cardinal signs of all ''prameha''. All those urinary and systemic diseases that cause copious quantities, as well as the abnormal (including turbid) quality of urination, come under the umbrella of ''prameha''. This chapter briefly explains the importance of exogenous, endogenous and tissue response in the manifestation of the disease. The concept of genetic susceptibility to disease and effect of chronic disease on genes is also incorporated in this chapter.

'''Keywords''':  ''Prameha'', diabetes, genetic susceptibility, ''prabhuta mutrata'', polyuria, ''avila mutrata'', turbid urine, ''vikarabhighata''.

'''Keywords''':  ''Prameha'', diabetes, genetic susceptibility, ''prabhuta mutrata'', polyuria, ''avila mutrata'', turbid urine, ''vikarabhighata''.

 

=== Introduction ===

=== Introduction ===

 

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===

TridoShakopanimittA viMshatiH pramehA bhavanti vikArAshcApare~aparisa~gkhyeyAH |

TridoShakopanimittA viMshatiH pramehA bhavanti vikArAshcApare~aparisa~gkhyeyAH |

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 ====

Iha khalu nidAna doShadUShyavisheShebhyo vikAravighAtabhAvAbhAvaprativisheShA bhavanti|  yadA hyete trayo nidAnAdivisheShAH  parasparaM nAnubadhnantyathavA kAlaprakarShAdabalIyAMso~athavA~anubadhnantina tadA vikArAbhinirvRuttiH, cirAdvA~apyabhinirvartante, tanavovA bhavantyayathoktasarvali~ggAvA;viparyaye viparItAH; iti

Iha khalu nidAna doShadUShyavisheShebhyo vikAravighAtabhAvAbhAvaprativisheShA bhavanti|  yadA hyete trayo nidAnAdivisheShAH  parasparaM nAnubadhnantyathavA kAlaprakarShAdabalIyAMso~athavA~anubadhnantina tadA vikArAbhinirvRuttiH, cirAdvA~apyabhinirvartante, tanavovA bhavantyayathoktasarvali~ggAvA;viparyaye viparItAH; iti

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 ''Kaphaja Prameha'' ====

==== Etiology of ''Kaphaja Prameha'' ====

Bahvabaddham medo mAMsaM sharIrajakledaH shukraM shoNitaM vasA majjA

Bahvabaddham medo mAMsaM sharIrajakledaH shukraM shoNitaM vasA majjA

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:

The ''kapha'' with excessive fluid component is specific vitiation in ''prameha''.

The ''kapha'' with excessive fluid component is specific vitiation in ''prameha''.

Specific ''dushyas'' of ''prameha'' include excess ''abaddha meda'' (loose fat), ''mamsa'' (muscle tissues), ''vasa'' (muscle fat), ''majja'' (marrow), ''kleda''(body fluids), ''shukra'' (semen and reproductive tissues), ''rakta'' (blood), ''lasika'' (lymph) and ''rasa'' (plasma) and ''ojas'' (the purest of all ''dhatus'').  [5-7]

Specific ''dushyas'' of ''prameha'' include excess ''abaddha meda'' (loose fat), ''mamsa'' (muscle tissues), ''vasa'' (muscle fat), ''majja'' (marrow), ''kleda''(body fluids), ''shukra'' (semen and reproductive tissues), ''rakta'' (blood), ''lasika'' (lymph) and ''rasa'' (plasma) and ''ojas'' (the purest of all ''dhatus'').  [5-7]

 

==== Pathogenesis ====

==== Pathogenesis ====

TrayAnAmesaM nidAnAdivisheShANAM sannipAte kShipraM shleShmA prakopamApadyate, prAgatibhUyastvAt; sa prakupitaH kShiprameva sharIre visRuptiM labhate, sharIrashaithilyAt;sa visarpa~j sharIre medasaivAdito mishrIbhAvaM gacchati, medasashcaiva bahvabaddhatvAnmedasashca guNaiH samAnaguNabhUyiShThatvAt;sa medasA mishrIbhavan dUShayatyenat, vikRutatvAt; sa vikRuto duShTena medasopahitaH sharIrakledamAMsAbhyAM saMsargaM gacchati, kledamAMsayoratipramANAbhivRuddhatvAt;  sa mAMse Ma MsapradoShAt pUtimA MsapiDakAH sharAvikAkacchapikAdyAH sa~jjanayati, aprakRutibhUtatvAt; sharIrakledaM punardUShayanmUtratvena pariNamayati,mUtravahAnAM ca srotasAM va~gkShaNabastiprabhavANAM medaHkledopahitAni gurUNi mukhAnyAsAdya pratirudhyate; tataH pramehAMsteShAM sthairyamasAdhyatAM vA janayati, prakRutivikRutibhUtatvAt ||8||

TrayAnAmesaM nidAnAdivisheShANAM sannipAte kShipraM shleShmA prakopamApadyate, prAgatibhUyastvAt; sa prakupitaH kShiprameva sharIre visRuptiM labhate, sharIrashaithilyAt;sa visarpa~j sharIre medasaivAdito mishrIbhAvaM gacchati, medasashcaiva bahvabaddhatvAnmedasashca guNaiH samAnaguNabhUyiShThatvAt;sa medasA mishrIbhavan dUShayatyenat, vikRutatvAt; sa vikRuto duShTena medasopahitaH sharIrakledamAMsAbhyAM saMsargaM gacchati, kledamAMsayoratipramANAbhivRuddhatvAt;  sa mAMse Ma MsapradoShAt pUtimA MsapiDakAH sharAvikAkacchapikAdyAH sa~jjanayati, aprakRutibhUtatvAt; sharIrakledaM punardUShayanmUtratvena pariNamayati,mUtravahAnAM ca srotasAM va~gkShaNabastiprabhavANAM medaHkledopahitAni gurUNi mukhAnyAsAdya pratirudhyate; tataH pramehAMsteShAM sthairyamasAdhyatAM vA janayati, prakRutivikRutibhUtatvAt ||8||

 

Etiological factors (especially ''kapha''-dominant ones), ''doshas'', and ''dushyas'' mentioned in the preceding verses can trigger the manifestation of ''kaphaja prameha''. The aggravated ''kapha'' spreads all over the body quickly because of flaccid muscles and fatty tissues. The ''kapha'' blends quickly with the ''medas'' (fat) – primarily because the fats typically are excessive in quantity and viscous and soft in "favorable" body conditions but also because ''kapha'' and ''medas'' share identical qualities. As ''kapha'' itself is vitiated, it vitiates ''medas'' in the process. The vitiated ''kapha - meda'' then mixes with ''mamsa'' (muscle tissues) and ''kleda'' (moisture/body fluid), in as much as these two are supposed to have already exceeded their quantity. Vitiation of the muscle tissues provides a congenial atmosphere for the manifestation of putrified carbuncles (''pidika'') like ''sharavika'' and ''kacchapika'' in the muscle. The liquid ''dhatus'' in the body get further vitiated and transformed into ''mutra'' (urine). ''Vrikka'' (kidney) and ''basti'' (urinary bladder) are at the two ends of the channels carrying urine; the openings of these channels get affected by ''meda'' (fat) and ''kleda''. The vitiated ''kapha'' obstructs the openings of these channels. This results in the manifestation of ''prameha'' which becomes chronic or incurable due to the affection of all qualities of ''kapha'' and simultaneous vitiation of homogenous and heterogenous ''dhatus''. [8]

Etiological factors (especially ''kapha''-dominant ones), ''doshas'', and ''dushyas'' mentioned in the preceding verses can trigger the manifestation of ''kaphaja prameha''. The aggravated ''kapha'' spreads all over the body quickly because of flaccid muscles and fatty tissues. The ''kapha'' blends quickly with the ''medas'' (fat) – primarily because the fats typically are excessive in quantity and viscous and soft in "favorable" body conditions but also because ''kapha'' and ''medas'' share identical qualities. As ''kapha'' itself is vitiated, it vitiates ''medas'' in the process. The vitiated ''kapha - meda'' then mixes with ''mamsa'' (muscle tissues) and ''kleda'' (moisture/body fluid), in as much as these two are supposed to have already exceeded their quantity. Vitiation of the muscle tissues provides a congenial atmosphere for the manifestation of putrified carbuncles (''pidika'') like ''sharavika'' and ''kacchapika'' in the muscle. The liquid ''dhatus'' in the body get further vitiated and transformed into ''mutra'' (urine). ''Vrikka'' (kidney) and ''basti'' (urinary bladder) are at the two ends of the channels carrying urine; the openings of these channels get affected by ''meda'' (fat) and ''kleda''. The vitiated ''kapha'' obstructs the openings of these channels. This results in the manifestation of ''prameha'' which becomes chronic or incurable due to the affection of all qualities of ''kapha'' and simultaneous vitiation of homogenous and heterogenous ''dhatus''. [8]

 

==== Signs, Types, and Prognosis of ''Kaphaja Prameha'' ====

==== Signs, Types, and Prognosis of ''Kaphaja Prameha'' ====

te dasha pramehAH sAdhyAH; samAnaguNamedaHsthAnakatvAt,

te dasha pramehAH sAdhyAH; samAnaguNamedaHsthAnakatvAt,

kaphasya prAdhAnyAt, samakriyatvAcca||11||

kaphasya prAdhAnyAt, samakriyatvAcca||11||

 

Fluids of the body (''kleda'') along with ''kapha'' and ''medas'' (fat) enter the ''vrikka'' (kidney) and ''basti'' (urinary bladder), transforming into ''mutra'' (urine). During this process, they acquire the morbid qualities of ''kapha'', viz, white, cold, particulate, slimy, transparent, unctuous, heavy, sweet, dense, clear and slow. The morbid conditions are named after these qualities, one or many of which may dominate the process of pathogenesis.

Fluids of the body (''kleda'') along with ''kapha'' and ''medas'' (fat) enter the ''vrikka'' (kidney) and ''basti'' (urinary bladder), transforming into ''mutra'' (urine). During this process, they acquire the morbid qualities of ''kapha'', viz, white, cold, particulate, slimy, transparent, unctuous, heavy, sweet, dense, clear and slow. The morbid conditions are named after these qualities, one or many of which may dominate the process of pathogenesis.

 

The ten ''kaphaja prameha'' variants are as follows:

The ten ''kaphaja prameha'' variants are as follows:

#''Udakameha''

#''Udakameha''

#Exposure to excessively hot sun, heat of the fire, physical exertion and anger; and

#Exposure to excessively hot sun, heat of the fire, physical exertion and anger; and

#Intake of mutually contradictory food articles.

#Intake of mutually contradictory food articles.

 

The aggravated ''pitta'' following the same pathogenic process (as mentioned for ''kaphaja prameha'') and manifests into one of six types of ''pittaja prameha''. The process of manifestation is quicker than that of ''kaphaja meha''. According to the characteristics of ''pitta'', they are named as follows:

The aggravated ''pitta'' following the same pathogenic process (as mentioned for ''kaphaja prameha'') and manifests into one of six types of ''pittaja prameha''. The process of manifestation is quicker than that of ''kaphaja meha''. According to the characteristics of ''pitta'', they are named as follows:

 

#''Kharameha''

#''Kharameha''

#''Kalameha''

#''Kalameha''

ityete ShaT pramehAH pittaprakopanimittA vyAkhyAtA bhavanti||35||

ityete ShaT pramehAH pittaprakopanimittA vyAkhyAtA bhavanti||35||

 

All these types of ''prameha'' are palliable (but not fully curable) because the loci of vitiated ''medas'' in the pathogenesis of this disease are closer to those of the affected ''doshas'' and the treatment of ''pitta'' and ''medas'' is in mutual contradiction. The specific features of different types of ''prameha'' caused by ''pitta'' are given below:

All these types of ''prameha'' are palliable (but not fully curable) because the loci of vitiated ''medas'' in the pathogenesis of this disease are closer to those of the affected ''doshas'' and the treatment of ''pitta'' and ''medas'' is in mutual contradiction. The specific features of different types of ''prameha'' caused by ''pitta'' are given below:

#In ''manjisthameha'' the patient passes urine frequently, and the urine smells like raw flesh and looks like the juice of ''manjistha'' (Rubia cordifolia Linn.).

#In ''manjisthameha'' the patient passes urine frequently, and the urine smells like raw flesh and looks like the juice of ''manjistha'' (Rubia cordifolia Linn.).

#In ''haridrameha'' the patient passes urine having pungent taste and color like that of the juice of ''haridra'' (Curcuma longa Linn.).

#In ''haridrameha'' the patient passes urine having pungent taste and color like that of the juice of ''haridra'' (Curcuma longa Linn.).

 

Thus, six varieties of ''prameha'' due to vitiation of ''pitta'' are explained. [27-35]

Thus, six varieties of ''prameha'' due to vitiation of ''pitta'' are explained. [27-35]

sa prakupitastathAvidhe sharIre visarpan yadA vasAmAdAya mUtravahAni srotAMsi pratipadyate tadA vasAmehamabhinirvartayati; yadA punarmajjAnaM mUtrabastAvAkarShati tadA majjamehamabhinirvartayati; yadA tu lasIkAM mUtrAshaye~abhivahanmUtramanubandhaM cyotayati lasIkAtibahutvAdvikShepaNAcca  vAyoH khalvasyAtimUtrapravRuttisa~ggaM karoti, tadA sa matta iva gajaH kSharatyajasraM mUtramavegaM, taM hastimehinamAcakShate; ojaH punarmadhurasvabhAvaM, tad yadA raukShyAdvAyuH kaShAyatvenAbhisaMsRujya mUtrAshaye~abhivahati tadA madhumehaM karoti||37||

sa prakupitastathAvidhe sharIre visarpan yadA vasAmAdAya mUtravahAni srotAMsi pratipadyate tadA vasAmehamabhinirvartayati; yadA punarmajjAnaM mUtrabastAvAkarShati tadA majjamehamabhinirvartayati; yadA tu lasIkAM mUtrAshaye~abhivahanmUtramanubandhaM cyotayati lasIkAtibahutvAdvikShepaNAcca  vAyoH khalvasyAtimUtrapravRuttisa~ggaM karoti, tadA sa matta iva gajaH kSharatyajasraM mUtramavegaM, taM hastimehinamAcakShate; ojaH punarmadhurasvabhAvaM, tad yadA raukShyAdvAyuH kaShAyatvenAbhisaMsRujya mUtrAshaye~abhivahati tadA madhumehaM karoti||37||

 

''Vata'' gets immediately aggravated in an individual whose body is pre-conditioned by above mentioned (verse 5) factors and exposed to the following factors:  

''Vata'' gets immediately aggravated in an individual whose body is pre-conditioned by above mentioned (verse 5) factors and exposed to the following factors:  

Due to the large quantity of ''lasika'' (lymphs) in the body and also due to the property of ''vata'' to dissipate things, ''lasika'' entering the urinary bladder produces large quantity of urine, causing a continuous urge for micturition and, thus, passing copious amounts of urine continuously (even) without any pressure, like an elephant (''hasti'') gone amuck. Thus, this is also known as ''hastimeha''.  

Due to the large quantity of ''lasika'' (lymphs) in the body and also due to the property of ''vata'' to dissipate things, ''lasika'' entering the urinary bladder produces large quantity of urine, causing a continuous urge for micturition and, thus, passing copious amounts of urine continuously (even) without any pressure, like an elephant (''hasti'') gone amuck. Thus, this is also known as ''hastimeha''.  

''Ojas'' is, by nature, of sweet taste. However, its roughness causes ''vata'' to convert it into an astringent tasting element. This ''vata''-afflicted ''ojas'', when gets into the urinary bladder, causes ''madhumeha''. [36-37]

''Ojas'' is, by nature, of sweet taste. However, its roughness causes ''vata'' to convert it into an astringent tasting element. This ''vata''-afflicted ''ojas'', when gets into the urinary bladder, causes ''madhumeha''. [36-37]

 

==== Incurability of ''Vataja Prameha'' and its Other Characteristics ====

==== Incurability of ''Vataja Prameha'' and its Other Characteristics ====

evaM tridoShaprakopanimittA viMshatiH pramehA vyAkhyAtA bhavanti||46||  

evaM tridoShaprakopanimittA viMshatiH pramehA vyAkhyAtA bhavanti||46||  

 

These four types of ''prameha'' (''vasameha, majjameha, hastimeha,'' and ''madhumeha'') due to the vitiation of ''vata'' are known to be serious conditions and are incurable because of the contradictions involved in their treatment.

These four types of ''prameha'' (''vasameha, majjameha, hastimeha,'' and ''madhumeha'') due to the vitiation of ''vata'' are known to be serious conditions and are incurable because of the contradictions involved in their treatment.

Thus explained are the four variants of ''vataja prameha'' and twenty types of ''prameha'' (due to vitiation of the three ''doshas'').[38-46]

Thus explained are the four variants of ''vataja prameha'' and twenty types of ''prameha'' (due to vitiation of the three ''doshas'').[38-46]

 

==== General Prodromal Features of ''Prameha'' ====

==== General Prodromal Features of ''Prameha'' ====

yastvAhAraM sharIrasya dhAtusAmyakaraM naraH|

yastvAhAraM sharIrasya dhAtusAmyakaraM naraH|

sevate vividhAshcAnyAshceShTAHsa sukhamashnute||52||

sevate vividhAshcAnyAshceShTAHsa sukhamashnute||52||

 

Thus, it can be said: As the birds are attracted towards the trees where their nests are situated, similarly ''prameha'' is attracted to people who are gluttonous, who have an aversion to bathing, or who have an aversion to physical exercises. Death immediately comes in the form of ''prameha'' to those who are very lethargic and morbidly obese.  

Thus, it can be said: As the birds are attracted towards the trees where their nests are situated, similarly ''prameha'' is attracted to people who are gluttonous, who have an aversion to bathing, or who have an aversion to physical exercises. Death immediately comes in the form of ''prameha'' to those who are very lethargic and morbidly obese.  

The individual who follows a dietary regimen or lifestyle that brings his ''doshas'' and ''dhatus'' to a state of equilibrium is said to be leading a healthy life. [50-52]

The individual who follows a dietary regimen or lifestyle that brings his ''doshas'' and ''dhatus'' to a state of equilibrium is said to be leading a healthy life. [50-52]

 

==== Summary ====

==== Summary ====

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

 

#''Nidana'' (etiological factors), ''dosha'', and ''dushya'' are three major factors that cause any disease. Besides these, there are temporal influences, pre-existing conditions, genetic predispositions, as well as the presence or absence of resisting factors in the host body that decide the propensity of the affliction of a disease, including ''prameha''.

#''Nidana'' (etiological factors), ''dosha'', and ''dushya'' are three major factors that cause any disease. Besides these, there are temporal influences, pre-existing conditions, genetic predispositions, as well as the presence or absence of resisting factors in the host body that decide the propensity of the affliction of a disease, including ''prameha''.

#The onset of disease pathology, its severity and progress depend upon the cumulative effect of interaction between above-mentioned factors. If the disease resisting factors in the host body are stronger than the disease provoking factors, then the disease doesn't occur or occurs with less severity or with fewer symptoms. On the contrary, the disease is severe, acute, and fully manifested in the case of stronger disease provoking factors.   

#The onset of disease pathology, its severity and progress depend upon the cumulative effect of interaction between above-mentioned factors. If the disease resisting factors in the host body are stronger than the disease provoking factors, then the disease doesn't occur or occurs with less severity or with fewer symptoms. On the contrary, the disease is severe, acute, and fully manifested in the case of stronger disease provoking factors.   

On the basis of prognosis, patients of ''prameha'' have been classified into three groups: ''Sadhya'' (curable), ''Yapya'' (controllable), and ''Asadhya'' (difficult to manage).

On the basis of prognosis, patients of ''prameha'' have been classified into three groups: ''Sadhya'' (curable), ''Yapya'' (controllable), and ''Asadhya'' (difficult to manage).

 

===== Features of ''Prameha'' Classified on the Basis of Prognosis =====

===== Features of ''Prameha'' Classified on the Basis of Prognosis =====

=== Future Scope for Research ===

=== Future Scope for Research ===

 

#Assessment criteria for the classification of various types of Prameha based on both physical as well as laboratory parameters.

#Assessment criteria for the classification of various types of Prameha based on both physical as well as laboratory parameters.

#Scaling the Prameha on the basis of modern investing tools so that the management can be done on the basis of classification.

#Scaling the Prameha on the basis of modern investing tools so that the management can be done on the basis of classification.

#Collecting data to search the most prevalent type of dyslipidemia in diabetes.

#Collecting data to search the most prevalent type of dyslipidemia in diabetes.

#Retroprospective clinical study to establish the fact that dyslipidemia is the cause of diabetes and not the consequence of diabetes.

#Retroprospective clinical study to establish the fact that dyslipidemia is the cause of diabetes and not the consequence of diabetes.

 

=== Glossary of Tecchnical Terms ===

=== Glossary of Tecchnical Terms ===