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Prameha Nidana (view source)

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{{#seo:

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|title=Prameha Nidana

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|titlemode=append

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|keywords=Factors affecting disease pathology, Prameha, diabetes, genetic susceptibility, prabhuta mutrata, polyuria, avila mutrata, turbid urine, vikarabhighata, urinary disorders

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|description=Nidana Sthana Chapter 4. Diagnosis and etiopatheogenesis of Obstinate Urinary Disorders including diabetes

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}}

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<big>'''Nidana Sthana Chapter 4. Diagnosis and etiopatheogenesis of Obstinate Urinary Disorders including diabetes '''</big>

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</div>

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

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अथातःप्रमेहनिदानंव्याख्यास्यामः||१||

इतिहस्माहभगवानात्रेयः||२|

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athātaḥ pramēhanidānaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAn AtreyaH ||2||

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</div></div>

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

==== Types of ''Prameha'' ====

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त्रिदोषकोपनिमित्ताविंशतिःप्रमेहाभवन्तिविकाराश्चापरेऽपरिसङ्ख्येयाः|

तत्रयथात्रिदोषप्रकोपःप्रमेहानभिनिर्वर्तयतितथाऽनुव्याख्यास्यामः||३||

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tridōṣakōpanimittā viṁśatiḥ pramēhā bhavanti vikārāścāparē'parisaṅkhyēyāḥ|

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TridoShakopanimittA viMshatiH pramehA bhavanti vikArAshcApare~aparisa~gkhyeyAH |

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

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</div></div>

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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]

</div>

==== Process of Onset of Disease ====

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इहखलुनिदानदोषदूष्यविशेषेभ्योविकारविघातभावाभावप्रतिविशेषाभवन्ति|

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चिराद्वाऽप्यभिनिर्वर्तन्ते, तनवोवाभवन्त्ययथोक्तसर्वलिङ्गावा;

विपर्ययेविपरीताः;इतिसर्वविकारविघातभावाभावप्रतिविशेषाभिनिर्वृत्तिहेतुर्भवत्युक्तः||४||

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iha khalu nidānadōṣadūṣyaviśēṣēbhyō vikāravighātabhāvābhāvaprativiśēṣā bhavanti|

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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||

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</div></div>

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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.

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</div>

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

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तत्रेमेत्रयोनिदानादिविशेषाःश्लेष्मनिमित्तानांप्रमेहाणामाश्वभिर्निर्वृत्तिकराभवन्ति; तद्यथा-

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बह्वबद्धं[१]मेदोमांसंशरीरजक्लेदःशुक्रंशोणितंवसामज्जालसीका

रसश्चौजःसङ्ख्यातइतिदूष्यविशेषाः||७||

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tatrēmē trayō nidānādiviśēṣāḥ ślēṣmanimittānāṁ pramēhāṇāmāśvabhirnirvr̥ttikarā bhavanti; tadyathā-hāyanakayavakacīnakōddālakanaiṣadhētkaṭamukundakamahāvrīhipramōdakasugandhakānāṁ navānāmativēlamatipramāṇēna cōpayōgaḥ, tathā sarpiṣmatāṁnavaharēṇumāṣasūpyānāṁ, grāmyānūpaudakānāṁ ca māṁsānāṁ, śākatilapalalapiṣṭānnapāyasakr̥śarāvilēpīkṣuvikārāṇāṁ,kṣīranavamadyamandakadadhidravamadhurataruṇaprāyāṇāṁ cōpayōgaḥ, mr̥jāvyāyāmavarjanaṁ, svapnaśayanāsanaprasaṅgaḥ, yaśca kaścidvidhiranyō'piślēṣmamēdōmūtrasañjananaḥ, sa sarvō nidānaviśēṣaḥ||5||

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Bahvabaddham medo mAMsaM sharIrajakledaH shukraM shoNitaM vasA majjA

lasIkA rasashcaujaHsa~gkhyAta iti dUShyavisheShAH ||7||

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</div></div>

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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:

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==== Pathogenesis ====

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त्रयाणामेषांनिदानादिविशेषाणांसन्निपातेक्षिप्रंश्लेष्माप्रकोपमापद्यते,

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अप्रकृतिभूतत्वात्; शरीरक्लेदंपुनर्दूषयन्मूत्रत्वेनपरिणमयति, मूत्रवहानांचस्रोतसांवङ्क्षणबस्तिप्रभवाणां[१]मेदःक्लेदोपहितानिगुरूणिमुखान्यासाद्यप्रतिरुध्यते;ततःप्रमेहांस्तेषांस्थैर्यमसाध्यतांवाजनयति, प्रकृतिविकृतिभूतत्वात्||८||

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trayāṇāmēṣāṁ nidānādiviśēṣāṇāṁ sannipātē kṣipraṁ ślēṣmā prakōpamāpadyatē, prāgatibhūyastvāt; sa prakupitaḥ kṣipramēva śarīrē visr̥ptiṁ labhatē,śarīraśaithilyāt; sa visarpañ śarīrē mēdasaivāditō miśrībhāvaṁ gacchati, mēdasaścaiva bahvabaddhatvānmēdasaśca guṇaiḥ samānaguṇabhūyiṣṭhatvāt; sa mēdasāmiśrībhavan dūṣayatyēnat, vikr̥tatvāt; sa vikr̥tō duṣṭēna mēdasōpahitaḥ śarīraklēdamāṁsābhyāṁ saṁsargaṁ gacchati, klēdamāṁsayōratipramāṇābhivr̥ddhatvāt; samāṁsē māṁsapradōṣāt pūtimāṁsapiḍakāḥ śarāvikākacchapikādyāḥ sañjanayati, aprakr̥tibhūtatvāt; śarīraklēdaṁ punardūṣayan mūtratvēna pariṇamayati,mūtravahānāṁ ca srōtasāṁ vaṅkṣaṇabastiprabhavāṇāṁ mēdaḥklēdōpahitāni gurūṇi mukhānyāsādya pratirudhyatē; tataḥ pramēhāṁstēṣāṁsthairyamasādhyatāṁ vā janayati, prakr̥tivikr̥tibhūtatvāt||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||

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</div></div>

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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]

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

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शरीरक्लेदस्तुश्लेष्ममेदोमिश्रःप्रविशन्मूत्राशयंमूत्रत्वमापद्यमानःश्लैष्मिकैरेभिर्दशभिर्गुणैरुपसृज्यतेवैषम्ययुक्तैः; तद्यथा- श्वेतशीतमूर्तपिच्छिलाच्छस्निग्धगुरुमधुरसान्द्रप्रसादमन्दैः,तत्रयेनगुणेनैकेनानेकेनवाभूयस्तरमुपसृज्यतेतत्समाख्यंगौणंनामविशेषंप्राप्नोति||९||

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तेदशप्रमेहाःसाध्याः;समानगुणमेदःस्थानकत्वात्, कफस्यप्राधान्यात्, समक्रियत्वाच्च||११||

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śarīraklēdastu ślēṣmamēdōmiśraḥ praviśan mūtrāśayaṁ mūtratvamāpadyamānaḥ ślaiṣmikairēbhirdaśabhirguṇairupasr̥jyatē vaiṣamyayuktaiḥ; tadyathā-śvētaśītamūrtapicchilācchasnigdhagurumadhurasāndraprasādamandaiḥ, tatra yēna guṇēnaikēnānēkēna vā bhūyastaramupasr̥jyatē tatsamākhyaṁ gauṇaṁnāmaviśēṣaṁ prāpnōti||9||

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te dasha pramehAH sAdhyAH; samAnaguNamedaHsthAnakatvAt,

kaphasya prAdhAnyAt, samakriyatvAcca||11||

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</div></div>

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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.

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==== Specific Features of Types of ''Kaphaja Prameha'' ====

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तत्रश्लोकाः

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इत्येतेदशप्रमेहाःश्लेष्मप्रकोपनिमित्ताव्याख्याताभवन्ति||२३||

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tatra ślōkāḥ ślēṣmapramēhaviśēṣavijñānārthā bhavanti-||12||

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ityete dasha pramehAH shleShmaprakopanimittA vyAkhyAtA bhavanti||23||

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</div></div>

The specific features of different types of ''kaphaja prameha'' are as follows (in verses):

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==== Etiology and Types of ''Pittaja Prameha'' ====

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उष्णाम्ललवणक्षारकटुकाजीर्णभोजनोपसेविनस्तथाऽतितीक्ष्णातपाग्निसन्तापश्रमक्रोधविषमाहारोपसेविनश्चतथाविधशरीरस्यैवक्षिप्रंपित्तंप्रकोपमापद्यते, तत्तुप्रकुपितंतयैवानुपूर्व्याप्रमेहानिमान्षट्क्षिप्रतरमभिनिर्वर्तयति||२४||

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तेषड्भिरेवक्षाराम्ललवणकटुकविस्रोष्णैःपित्तगुणैःपूर्ववद्युक्ताभवन्ति||२६||

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uṣṇāmlalavaṇakṣārakaṭukājīrṇabhōjanōpasēvinastathā'titīkṣṇātapāgnisantāpaśrama krōdhaviṣamāhārōpasēvinaśca tathāvidhaśarīrasyaiva kṣipraṁ pittaṁprakōpamāpadyatē, tattu prakupitaṁ tayaivānupūrvyā pramēhānimān ṣaṭ kṣiprataramabhinirvartayati||24||

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te ShaDbhireva kShArAmlalavaNakaTukavisroShNaiH pittaguNaiH pUrvavadyuktA bhavanti||26||

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</div></div>

''Pitta'' gets immediately aggravated in an individual whose body is pre-conditioned by abovementioned (verse 5) factors and exposed to factors such as the following:

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==== Specific Features of Types of ''Pittaja Prameha'' ====

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सर्वएवतेयाप्याःसंसृष्टदोषमेदःस्थानत्वाद्विरुद्धोपक्रमत्वाच्चेति||२७||

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इत्येतेषट्प्रमेहाःपित्तप्रकोपनिमित्ताव्याख्याताभवन्ति||३५||

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sarva ēva tē yāpyāḥ saṁsr̥ṣṭadōṣamēdaḥsthānatvādviruddhōpakramatvāccēti||27||

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ityete ShaT pramehAH pittaprakopanimittA vyAkhyAtA bhavanti||35||

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</div></div>

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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:

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==== Etio-pathogenesis of ''Vataja Prameha'' ====

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कषायकटुतिक्तरूक्षलघुशीतव्यवायव्यायामवमनविरेचनास्थापन-शिरोविरेचनातियोगसन्धारणानशनाभिघातातपोद्वेगशोकशोणितातिषेक-

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सप्रकुपितस्तथाविधेशरीरेविसर्पन्यदावसामादायमूत्रवहानिस्रोतांसिप्रतिपद्यतेतदावसामेहमभिनिर्वर्तयति; यदापुनर्मज्जानंमूत्रबस्तावाकर्षतितदामज्जमेहमभिनिर्वर्तयति; यदातुलसीकांमूत्राशयेऽभिवहन्मूत्रमनुबन्धंच्योतयतिलसीकातिबहुत्वाद्विक्षेपणाच्चवायोःखल्वस्यातिमूत्रप्रवृत्तिसङ्गं[१]करोति, तदासमत्तइवगजःक्षरत्यजस्रंमूत्रमवेगं, तंहस्तिमेहिनमाचक्षते; ओजःपुनर्मधुरस्वभावं, तद्यदारौक्ष्याद्वायुःकषायत्वेनाभिसंसृज्यमूत्राशयेऽभिवहतितदामधुमेहंकरोति||३७||

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kaṣāyakaṭutiktarūkṣalaghuśītavyavāyavyāyāmavamanavirēcanāsthāpana-śirōvirēcanātiyōgasandhāraṇānaśanābhighātātapōdvēgaśōkaśōṇitātiṣēka-jāgaraṇaviṣamaśarīranyāsānupasēvamānasya tathāvidhaśarīrasyaiva kṣipraṁ vātaḥ prakōpamāpadyatē||36||

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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||

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</div></div>

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

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</div>

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

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इमांश्चतुरः प्रमेहान् वातजानसाध्यानाचक्षते भिषजः, महात्ययिकत्वाद्विरुद्धोपक्रमत्वाच्चेति||३८||

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एवं त्रिदोषप्रकोपनिमित्ता विंशतिः प्रमेहा व्याख्याता भवन्ति||४६||

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imāṁścaturaḥ pramēhān vātajānasādhyānācakṣatē bhiṣajaḥ, mahātyayikatvādviruddhōpakramatvāccēti||38||

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evaM tridoShaprakopanimittA viMshatiH pramehA vyAkhyAtA bhavanti||46||

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</div></div>

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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.

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</div>

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

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त्रयस्तुखलुदोषाःप्रकुपिताःप्रमेहानभिनिर्वर्तयिष्यन्तइमानि

पूर्वरूपाणिदर्शयन्ति; तद्यथा- जटिलीभावंकेशेषु, माधुर्यमास्यस्य, करपादयोःसुप्ततादाहौ, मुखतालुकण्ठशोषं, पिपासाम्, आलस्यं, मलंकाये,कायच्छिद्रेषूपदेहं, परिदाहंसुप्ततांचाङ्गेषु, षट्पदपिपीलिकाभिश्चशरीरमूत्राभिसरणं, मूत्रेचमूत्रदोषान्, विस्रंशरीरगन्धं, निद्रां, तन्द्रांचसर्वकालमिति||४७||

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trayastu khalu dōṣāḥ prakupitāḥ pramēhānabhinirvartayiṣyanta imāni pūrvarūpāṇi darśayanti; tadyathā- jaṭilībhāvaṁ kēśēṣu, mādhuryamāsyasya, karapādayōḥsuptatādāhau, mukhatālukaṇṭhaśōṣaṁ, pipāsām, ālasyaṁ, malaṁ kāyē, kāyacchidrēṣūpadēhaṁ, paridāhaṁ suptatāṁ cāṅgēṣu, ṣaṭpadapipīlikābhiścaśarīramūtrābhisaraṇaṁ, mūtrē ca mūtradōṣān, visraṁ śarīragandhaṁ, nidrāṁ, tandrāṁ ca sarvakālamiti||47||

Trayastu khalu doShAH prakupitAH pramehAnabhinirvartayiShyanta imAni pUrvarUpANi darshayanti; tadyathA- jaTilIbhAvaM kesheShu, mAdhuryamAsyasya, karapAdayoH suptatAdAhau, mukhatAlukaNThashoShaM, pipAsAm, AlasyaM, malaM kAye, kAyacchidreShUpadehaM, paridAhaM suptatAM cA~ggeShu, ShaTpadapipIlikAbhishca sharIramUtrAbhisaraNaM, mUtre ca mUtradoShAn, visraM sharIragandhaM, nidrAM, tandrAM ca sarvakAlamiti||47||

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</div></div>

The three vitiated ''doshas'', while causing ''prameha'', produce the following prodromal symptoms:

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==== General Complications and Principles of Treatment ====

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उपद्रवास्तुखलुप्रमेहिणांतृष्णातीसारज्वरदाहदौर्बल्यारोचकाविपाकाः

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तत्रसाध्यान्प्रमेहान्संशोधनोपशमनैर्यथार्हमुपपादयंश्चिकित्सेदिति||४९||

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upadravāstu khalu pramēhiṇāṁ tr̥ṣṇātīsārajvaradāhadaurbalyārōcakāvipākāḥ pūtimāṁsapiḍakālajīvidradhyādayaśca tatprasaṅgādbhavanti||48||

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tatra sAdhyAn pramehAn

saMshodhanopashamanairyathArhamupapAdayaMshcikitsediti||49||

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</div></div>

Complications associated with ''prameha'' are thirst, diarrhea, fever, burning sensation, weakness, anorexia, and indigestion. Carbuncles that putrify muscle tissues, like ''alaji'' and ''vidradhi'', appear during the chronic stage of the disease.

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==== Consequences of ''Prameha'' ====

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भवन्तिचात्र-

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यस्त्वाहारंशरीरस्यधातुसाम्यकरंनरः|

सेवतेविविधाश्चान्याश्चेष्टाःससुखमश्नुते||५२||

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bhavanti cātra- gr̥dhnumabhyavahāryēṣu snānacaṅkramaṇadviṣam|

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yastvAhAraM sharIrasya dhAtusAmyakaraM naraH|

sevate vividhAshcAnyAshceShTAHsa sukhamashnute||52||

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</div></div>

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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.

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</div>

==== Summary ====

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तत्रश्लोकाः-

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साध्यासाध्यविशेषाश्चपूर्वरूपाण्युपद्रवाः|

प्रमेहाणांनिदानेऽस्मिन्क्रियासूत्रंचभाषितम्||५५||

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tatra ślōkāḥ- hēturvyādhiviśēṣāṇāṁ pramēhāṇāṁ ca kāraṇam|

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sAdhyAsAdhyavisheShAshca pUrvarUpANyupadravAH| pramehANAM nidAne~asmin kriyAsUtraM ca bhAShitam||55||

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</div></div>

To sum up:

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#Prognosis, premonitory symptoms and complications; and

#Their line of treatment. [53-55]

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इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेनिदानस्थानेप्रमेहनिदानंनाम

चतुर्थोऽध्यायः||४||

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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē pramēhanidānaṁ nāma caturthō'dhyāyaḥ||4||

ityagniveshakRute tantre CharakapratisaMskRute nidAnasthAne pramehanidAnaM nAma caturtho~adhyAyaH||4||

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</div></div>

Thus, ends the fourth chapter on the diagnosis of ''prameha''.

Agnivesha

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Prameha Nidana (view source)

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