Sushruta Samhita Nidan Sthana 7- Prameha Nidana
Diwaswapnavyayamalasyaprasaktam shitsnigdhamadhurmedyadravannapanasevinam purusham janiyat pramehi bhavishyatiti. (sushruta Samhita/ nidan sthana/ 7/3)
The person who indulges constantly in day sleep, absence of physical activities and laziness, consumes foods and drinks which are cold, unctuous, sweet, fatty and liquid – should be understood as going to become a patient of diabetes.
Tasya chaivampravruttasyaparipaktva eva vatapittashleshmano yada medasa sahaikatvamupetya mutravahistrotratasyanusrutyadho gatva bastermukhamashritya nirbhidyante tada pramehanjanayati. (sushruta Samhita/ nidan sthana/ 7/4)
In such a person, vata, pitta and kapha which are not properly cooked (processed by heat), when get mixed with meda (fat tissue) travel downward along the channels of urine, getting localized in the orifice of the urinary bladder, begin to flow out (mixed with urine) and gives rise to prameha.
Tesham tu purvarupani- hastapadataladahah snigdhapichhilguruta gatranam madhurshuklamutrata tandra sadah pipasa durgandhascha shwasastalugalajivhadanteshu malotpattirjatilibhavah keshanam vruddhischa nakhanam. (sushruta Samhita/ nidan sthana/ 7/5)
Their premonitory symptoms are- feeling of burning in the palms and soles, body (skin) becoming unctuous and slimy and feel heavy, urine is sweet, bad in smell and white in colour; stupor, debility, profound thirst, dyspnea, more accumulation of dirt in the palate, throat, tongue and teeth; hairs of the head adhering to one another and more growth of the hairs and nails.
Tatravilaprabhutamutralakshanah sarva eva prameha bhavanti. (sushruta Samhita/ nidan sthana/ 7/6)
All varieties of prameha, will have turbidity and increased quantity of urine.
Sarva eva sarvadoshasamuthah saha pidakabhihi. (sushruta Samhita/ nidan sthana/ 7/7)
All varieties of prameha and also their eruptions are born from all the doshas aggravated together.
Tatra, kaphadudakekshuvalikasurasikatashanairlavanapishtasandrashukraphenameha dasha sadhya, doshadushyanam samakriyatvata; pittanilaharidramlaksharamanjishthashonitamehah shad yapyah, doshadushyanam vishamakriyatvata; vatat sarpirvasakshaudrahastimehaschatvaroasadhyatamah, mahatyayikaatvata. (sushruta Samhita/ nidan sthana/ 7/8)
From kapha arise udakameha, ikshuvalika, sura, sikata, lavana, pishta, sandra, shukra and phena- these ten kinds are curable because of common treatment for both the doshas and dushyas (tissues) involved.
From pitta arise nilameha, haridra, amla, kshara, manjishtha and shonita- these six kinds are controllable (but persistent) because the treatments for the doshas and dushyas are different, to each other.
From vata arise sarpimeha, vasa, kshudra, and hasti- these four kinds are greatly incurable, because of producing great danger (loss of tissues, and even of life).
Tatra vatapittamedobhiranvitah shleshma shleshmapramehanjanayati, vatakaphashonitamedobhirananvitam pittampittapramehan, kaphapittanmajjamedobhiranvito vayurvatapramehan. (sushruta Samhita/ nidan sthana/ 7/9)
Kapha getting aggravated and associating with vata, pitta and medas produces kaphaja pramehas; pitta (getting aggravated and associating with vata, and shonita and medas produces) pittaj pramehas; vata getting aggravated and associating with kapha, pitta vasa, majja and medas produces vataja pramehas.
Tatra, shwetamavedanamudakasadrushamudakamehi mehati; ikshurasatulyamikshuvalikamehi; suratulyam suramehi, sarujam sikatanuvidham sikatamehi; shanaihi sakapham mrutsnamshanairmehi; vishadam lavanatulyam lavanamehi; hrushtaroma pishtarasatulyam pishtamehi; avilam sandram sandramehi; shukratulyam shukramehi; stokam stokam saphenamachham phenamehi mehati. (sushruta Samhita/ nidan sthana/ 7/10)
Udaka meha- the person eliminates urine which is white in colour and resembling water, without any pain.
Ikshuvalika meha- the person eliminates urine resembling juice of sugar cane.
Sura meha- the person eliminates urine resembling sura (beer)
Sikata meha- the person eliminates urine with pain and having sand.
Shanair meha- the person eliminates urine slowly, mixed with kapha and is slimy.
Lavana meha- the person eliminates urine which is non slimy and resembling salt in taste.
Pishta meha- the person eliminates urine resembling solution of flour and accompanied with horripilation’s.
Sandra meha- the person eliminates urine which is turbid and thick.
Shukra meha- the person eliminates urine resembling semen.
Phena meha- the person eliminates urine, little by little, being frothy and clear.
Ata urdhwa pittanimittan vakshyamah- saphenamachham nilam nilamehi mehati; sadaham haridrabham haridramehi; amlarasagandhi ksharamehi; strutaksharapratimam ksharamehi; manjishthodakprakasham manjishthamehi; shonitaprakasham shonitamehi mehati. (sushruta Samhita/ nidan sthana/ 7/11)
Further on, we will describe pittaja prameha –
Nila meha- the person eliminates urine which is frothy, clear and blue in colour.
Haridra meha- the person eliminates urine resembling turmeric accompanied with burning sensation.
Amla meha- the person eliminates urine which has sour taste and smell.
Ksharameha- the person eliminates urine resembling solution of alkali.
Manjishtha meha- the person eliminates urine resembling solution of manjishtha.
Shonitameha- the person eliminates urine resembling blood.
Ata urdhwa vatanimittan vakshyamah- sarpih prakasham sarpimehi mehati; vasaprakasham vasamehi; kshaudrasavarnam kshaudramehi; mattamatangavadanuprabandha hastimehi mehati. (sushruta Samhita/ nidan sthana/ 7/12)
Further on, we will describe vataj prameha –
Sarpi meha- the person eliminates urine resembling ghee.
Vasa meha- the person eliminates urine resembling muscle- fat.
Kshaudra meha- the person eliminates urine resembling honey in taste and colour.
Hasti meha- the person eliminates urine resembling elephant in rut.
Makshikopasarpanamalasyam mamsopachayah pratishyayah shaithilyarochakavipakah kaphaprasekachhardinidrakasashwasacheti shleshmajanamupadravah; vrushanayoravadaranam bastibhedo medratodo hrudi sshulamamlikajvaratisararochaka vamathu paridhupanam daho murchha pipasa nidranashah pandurogah pitavinmutranetratvam cheti paittikanam; hrudgraho laulyamanidra stambhah kampah shulam badhapurishatvam cheti vatajanam. Evamete vinshati pramehah sopadrava vyakhyatah. (sushruta Samhita/ nidan sthana/ 7/13)
Swarming of flies (to the body), lassitude, (slight) growth of muscles, nasal catarrh, looseness of the body, loss of taste, improper digestion, more elimination of fluid from the mouth etc. vomiting, more of sleep, cough and dyspnea- are the complication/ secondary diseases of diabetes of kapha origin.
Cracks in the skin of the scrotum, cutting pain in the bladder, pricking pain in the penis, pain in the heart, sour belching, fever, diarrhea, loss of taste, vomiting, feeling of smoke coming out, burning sensation, fainting, severe thirst, loss of sleep, anemia, yellow colour of the faeces, urine and eyes- are the secondary diseases of diabetes of pitta origin.
Catching pain in the region of the heart, greediness, loss of sleep, rigidity, tremors and pain of the body parts and constipation are the complications/ secondary diseases of the diabetes of vata origin.
Thus, were described the 20 varieties of diabetes, along with their secondary diseases.
Tatra vasamedobhyamabhipannasharirasya tribhirdoshaschanugatadhatoho pramehino dasha pidaka jayante. (sushruta Samhita/ nidan sthana/ 7/14)
In patients of diabetes, whose body is filled with vasa (muscles fat) and medas the dhatus getting invaded by the three doshas together give rise to ten kinds of pidaka such as sharavika, kachhapika, jalini, vinata, putrini, masurika, alaji, vidarika and vidradhika.
Sharavamatra tadrupa nimnamadhya sharavika.
Gaursarshapasansthana tatpramana cha sarshapi. (15)
Sadaha kurmasansthana gyeya kachhapika budhaihi.
Jalini tivradaha tu mamsajalasamavruta. (16)
Mahati pidaka nila pidaka vinata smruta.
Mahatyalpachita gyeya pidaka sa putrini. (17)
Masurasamasansthanana gyeya sa tu masurika.
Rakta sita sphotavati daruna tvalaji bhavet. (18)
Vidarikandavrudhhata kathina cha vidarika.
Vidradherlakshanairyukta gyeya vidarika budhaihi. (sushruta Samhita/ nidan sthana/ 7/19)
Ye yanmayah smruta mehasteshametastu tatkrutah.
Sharavika- is similar to a saucer in shape, with depression in its centre.
Sarshapi- is similar to gaura sarshapa (white mustard) in size.
Kachhapika- is understood by the wise, as having burning sensation and like the tortoise shell in shape.
Jalini- has severe burning sensation and covered with network of muscle fibre.
Vinata- is a big eruption, of blue colour.
Putrini- is a big eruption surrounded by many small eruptions.
Masurika- is eruption resembling masura (lentil) in size and shape.
Alaji- is red or white coloured vesicle (bleb) which bursts and is dreadful.
Vidarika- is round like vidarikanda and hard.
Vidradhika- is to be understood by the wise as that having the features of an abscess.
Gude hrudi shirasyanse prushte marmani chothithah.
Sopadrava durbalagnehe pidaka parivarjayet. (sushruta Samhita/ nidan sthana/ 7/20)
The person in whom these eruptions have developed in the anus/ rectum, (region of) the heart, head, shoulders, back and vital organs; which are accompanied with complications or secondary diseases and the person having weak digestive power- should be rejected.
Krtsnam shariram nishpidya medomajjavasayutah.
Adhah prakramate vayustenasadhyastu vatajah. (sushruta Samhita/ nidan sthana/ 7/21)
Aggravated vata, associating with fat, marrow and muscle fat, squeezes the entire body and then moves downward (expelling these mixed with urine) hence diabetes produced by vata are incurable.
Pramehapurvarupanamakrutiryatra drushyate.
Kinchichapyadhikam mutram tam pramehinamadishet. (22)
Krutsnanyardhani va yasmin purvarupani manave.
Pravruttamutramatyartham tam pramehinamadishet. (sushruta Samhita/ nidan sthana/ 7/23)
He, in whom premonitory symptoms of diabetes appear along with slight increase in quantity of urine, such a person should be called a diabetic; the person in whom all or half of the premonitory symptoms are manifest, accompanied with great quantity of urine should also be called a diabetic.
Pidakapiditam gadamupasrushtamupadravaihi.
Madhumehinamachaste sa chasadhyah prakirtitah. (24)
Sa chapi gamanat sthanam sthanadasanamichati.
Asanadvrunute shayyam shayanat swapnamichhati. (sushruta Samhita/ nidan sthana/ 7/25)
He, who is greatly suffering from eruptions accompanied with secondary diabetes should be called as a patient of madhumeha (Diabetes Mellitus) which is incurable).
Such a patient desires to stand instead of walking, to sit instead of standing, to sit in a chair instead of sitting (on the ground), to lie on a bed instead of sitting in a chair, and to get into sleep instead of lying simply.
Yatha hi varnanam panchanamutkarshapakarshakrutena sanyogavisheshena shabalababhrukapila kapotamechakadinam varnanamanekamutpattirbhavati, evameva doshashatumalaharavisheshenotkarshapakarshakrutena sanyogavisheshena pramehanam nanakaranam bhavati. (sushruta Samhita/ nidan sthana/ 7/26)
Just as increase or decrease of proportion in the combination of the five kinds of colours give rise to many different colours such as shabal (verigated colour, spotted), babhru (deep brown), Kapila (brown, tawny), kapota (grey), mechaka (dark blue) etc, similarly by the increase or decrease of proportion in the combination of doshas, dhatu, mala and ahara, different varieties of diabetes are produced.
Sarva eva pramehastu kalenapratikurvatah.
Madhumehatvamayanti tada asadhya bhavanti hi. (sushruta Samhita/ nidan sthana/ 7/27)
All varieties of diabetes, if not treated at the appropriate time, become changed to madhumeha and then become incurable.
