Prameha – Ayurvedic concept of urinary disorders

 

Prameha in ayurveda   is  syndrome which includes the condition which refer to alter the urine matabolism in terms of frequency of micturition, quality, color and quantity  of urine. It also associated with obesity, prediabetes, diabetes mellitus, and   metabolic disorders.

Overview

The very first reference  of “Prameha” is found in the Vedas of India. The word Prameh means “to flow” which is derived from the Sanskrit dhatu ‘mih-sarane’. The Atharva Veda is considered to be first to describe this topic, and is mentioned in Kausika-Sutra.

According Ayurveda , the word Prameh is derived from ‘mih- ksharne dhatu’ with ‘pra’ pratya & ‘ghaj’ upsarg.

प्र + मिह + घञ् = प्रमेह

The word Prameha means excessive micturition of malformed urine. There is excessive urination.

The normal range of urine passed per day ranges from 800ml to 2l and in Prameh Rog the range may be as high as 15litres per day. Ayurveda fixed the normal quantity of urine as 4 Anjalis (1600 ml) and puts frequency 6.

Ayurvedic Samhitas (classical texts) found abundant clinical descriptions on this disase.

Prameh and diabetes history

By study of these samhita it is clear that physician of ancient India were aware of presence of sugar in urine and blood.

And now after Thomas wills (1621-1675) demonstrated it more scientifically and then like the Prameha-Madhumeha concept of Ayurveda,William Cullen (1712-1794) has affixed word “Mellitus” to diabetes. After that as time passes many other study observed by Johann Peter Frank (1745-1821), Cawley (1778),Fehling (1848), they classified the disease into mellitus and insipidus; linked with pancreas; prove the presence of sugar in urine of diabetes patient, respectively.

But after all these recent study we also know that ayurveda has mentioned many such disease which are not fully known to modern science.

Prameh Rog not only includes diabetes but also many more urinary tract related disorders within it.

There are some similarities in  Prameh and Diabetes as far as causing factors, clinical presentation and to some extent therapeutic aspects are concerned. Which we will discuss here further.

Definition of Prameh

“Prakarsena Prabhutam Pracuram Varam Varam Va MehatiMutratvagam Karoti Iti Pramehah”   ।। Ma. Ni. 33/1 ।।

Prameha is a syndrome i.e. group of symptoms, includes all clinical conditions which are characterized by increase in quantity of urine  with or without the increased frequency of urination. Turbidity in the urine & poly urea are the two essential features of this disease

Diabetes Mellitus  is disease which is associated with Hyperglycaemia with or without glycosuria  which due to defective insulin process , characterized by poly phagia or poly urea & poly dypsia.

Prameha is the repeated (Prakarsha) excessive (Prabhoota) and turbid urination, in terms of  quantity, frequency and clarity.

Meaning of term “Prameha” and diabetes

The term ‘Pra’ means abundant, and ‘Meha’ means ‘passing of large quantity of Urine’.“

Diabetes” term has been derived from the Greek term ‘Diabainein’. Which meaning ‘to cross through a siphon’ means continuous free flow of water and it is applied to means of elimination of large quantity of Urine.

Relation between prameh and diabetes / madhumeha

Therefore we can say the words  ‘Prameha’ and ‘Diabetes’ carry comparable meaning.
Also the terms madhumeha and diabetes mellitus are similar to madhu and mellitus means honey and hence, madhumeha & diabetes mellitus meaning is to passing of large quantity of sweet urine.

Diabetes Mellitus is characterized by
hyperglycaemia may be due to the deficiency  of Insulin or not effective use if insulin by cells. The disease is kept among the endocrinal and metabolic disorders with endocrinal involvement leading to metabolic derangement.

Causing factors for Prameh / Prameh k Nidaan :

According to charak samhita:

Causes may include- idle siting ,oversleep, excessive use of curd,meat soup of domestic animal aquatic & marshy animals; new cereals & drinks, products of jaggery and all other kapha promoting regiment are etiological Factor of Prameha.

Primary factors:

Kapha vardhak Ahara Vihar (kapha promoting food & activities) are the prime factors causing the disease process and all Kapha vardhak Bhava are Prameha karak Bhava (prameh causing factor) also.

1. Overeating of fast food
2. Over intake of sugars
3. Excessive intake of fluids such as milk, alcohol etc.
4. Excessive intake of rice , rice flour , urad Dal , meat , yogurt , kheer etc. Kapha vardhak aahar
5. Excessive intake of ghee and sweet dishes
6. Lack of physical exercise
7. Excessive sleeping
8. Lack of body movement
9. Excessive rest
10. Excessive intake of soup of  meat of animals of domestic, aquatic, and marshy regions
11. Freshly prepared wines & freshly harvested grains.

“Mithyaharavihara” (Improper dietary habits and physical activities).

• The food stuff which has properties of Brumhana (diet more rich in carbohydrate and fat than proteins.
• Sithaveerya (Cold in nature and
  action.
• Snigdh guna (Which increases
  Kapha dosha, Meda dhatu & Mutra
  mala
• Amla rasa (Food with more acidic
  properties.
• Habit of over eating and smoking.

Factors which predispose diabetes.

• Habit of consuming food with
  madhura rasa (Sweet taste).
• Habit of indulgence in excessive
  sleep, especially during day time.
• Excessive indulgence in sexual and other sedentary habits etc.
• these vitiate the Kapha dosa which leads to diabetes.

Apart from all these,

1. Excessive mental strain,
2. emotion and
3. constant worry are also main causes of diabetes.

By the study of Ayurveda principles closely can lead to the conclusion that people who lives in Anup desha (Wet land) has more chance of occurrence of diabetes.

 

Types of Prameh :

With an intuitive foresight Aacharya Susruta, the ancient Indian surgeon broadly divided diabetes into two groups

(i) Hereditary and

(ii) diabetes due to an imprudent way of life.

According to him hereditary prameh is occuring due to the defect in genes of parents. Caraka also expresses the
same theory.

According to the dominance of dosa and their relation with dushyas, the Ayurveda has classified the disease into 20 different types. It can again be sub-classified  into:

(a) Vataj prameh

(b) pittaj prameh

(c) Kaphaj prameh

1. Kaphaj prameh

It is of 10 types –

1. Udak meh (Diabetes insipidus) Watery Urine
2. Ikshu meh (Alimentary Glycosuria) Like sugarcane juice
3. Sandra meh (Phosphaturia) Means Viscosity
4. Sandraprasad meh (Phosphaturia) Means having precipitates
5. Shukla meh (Chyluria) Means White
6. Shukra meh (Spermaturia) Means semen
7. Sheeta meh (Renal Glycosuria) Means cold
8. Sikta meh -means with slow impulse
9. Sanair meh- means saliva like
10. Aalal meh /lala meh (Albuminuria). Means with gravels

2. Pittaj Prameh

It is of 6 types –

1. Kshar meh (Alkalinuria)
2. Kaal meh (Indicanuria)
3. Neel meh (Indicanuria)
4. Lohit meh ( rakt meh ) (Hematuria)
5. Manjistha meh (Urobilinuria/Haemoglobinuria)
6. Haridra meh (Bilirubinuria/Haemoglobinuria)

3. Vataj Prameh

It is of 4 types –

1. Vasa meh (Gonorrhea)
2. Majja meh ( sarpi meh )
3. Hasti meh ( Lashika meh ) (prostate gland enlargement)
4. Madhu meh ( Ojjo meh, Kshodra meh ) (Diabetes mellitus).

Dosha avam Dushya

Dosha:

The chiefly responsible for production of Prameha are 3- Vat , pitta and Kapha.

Dushya:

The dushyas are  vitaited tissues of body affected by dosha,  are 10 in number-

1. Rasa ( plasma)
2. Rakta ( blood )
3. Mansa ( muscles )
4. Medas ( fat tissue )
5. Majja ( bone marrow )
6. Shukra ( semen )
7. Ojjas ( Essence of tissue )
8. Vasa ( muscle fat )
9. Ambu ( body fluids/ water )
10. Lassika ( lymph )

20 types of Prameha

Kaphaj prameh :

1. Udakameh – The patient eliminates urine which is clear, large in quantity, white colour, cold to touch, having no smell, it resembles water, or has slight turbidity or sliminess.
2. Ikshuvalika meh – The urine excreted is sweet , cold somewhat slimy & turbid & resembles sugarcane juice.
3. Sandrameh – The urine on standing untouched for few hours becomes thick in consistency.
4. Sandraprasad meh – The urine when kept in a container for some time , the urine is separated into two parts – lower part of urine becomes thick in consistency & the upper part becomes clear.
5. Shukla meh – The urine passed is as white as rice flour & the frequency of urine is increased.
6. Shukra meh – The patient eliminates urine resembling semen or mixed with it.
7. Shita meh – The patient eliminates urine in large quantity very frequently , urine being very sweet & cold.
8. Sikta meh – The patient eliminates minute particles of waste resembling sand with urine.
9. Sanair meh – The patient eliminates urine very slowly without urge to urination with pain.
10. Aalala meh – The urine eliminated resembles the threads like saliva & is slimy.

Pittaj Prameh :

1. Kshara meh – The urine resembles solution of kshara (alkalies/ash) in its smell, taste , colour and touch.
2. Nilameh – Colour of urine is blue.
3. Kala meh – Colour of urine resembles that of black ink.
4. Haridra meh – The urine resembles haridra (turmeric /deep yellow) in colour & is pungent in taste and causes burning sensation during elimination.
5. Manjistha meh – The urine is having bad smell and resembles the colour of decoction of manjistha.
6. Rakta meh – The urine is bad smelling , hot , slightly salty and resembles that of blood in colour.

Vataj Prameh :

1. Vasa meh – The patient eliminates urine mixed with Vasa ( muscle fat) resembling Vasa in colour and passes urine frequently.
2. Majja meh – The urine resembles bone marrow or is mixed with it & passed out frequently.
3. Hasti meh / Lashika meh – The patient of hasti meha eliminates urine continuously , slowly, over a long time, without any force, just like an elephat in rut’ mixed with lasika (lymph) and thick in consistency.
4. Madhu meh /Kshodra meh – If the urine is astringent , sweet in tastc and dry (visid) then the wise call that condition as Kshodra meh.

Purvaroopa / Premonitory symptoms of Prameha

• Accumulation of more of dirt/waste materials on the teeth etc (Palate, gums, tongue, throat, skin),
• Dryness in throat and palate
• Feeling of mild burning sensation in the hands (palms)
  and feet (soles).
• Stickyness all over the body,
• Thirst and sweet taste in the mouth.
• Sweating
• Foul smell in body
• Slackness in body
• Liking for comfort in lying , sitting and sleeping
• Smearing in heart , eyes , tongue and ears
• Heaviness in body parts (overweight)
• Excessive growth of hair and nails.
• Liking for cold
• Ants run towards the urine of the person.

Lakshan of Prameh / Symptoms :

• Increased quantity of urine
• Increased turbidity of urine.
• Differences in the colour of the urine.

They occur because of  different combinations of doshas and dushyas (dhatus and mala – tissue & wastes)and on the basis of colour of urine etc. varieties of Prameh are recognised.

Prameha chikitsa in ayurveda / treatment :

Prameha chikitsa in ayurveda include different type of treatment according to (bala) strength of patient along with strength of disease or dosha.

Kaphaj Prameha is easy to cure, but Pittaj Prameha is difficult to cure and vataj Prameha is not curable only treatment can help to some extent.

The patients of Prameh can be categorised into two :-

1. Obese and strong
2. Lean and weak

The patient of prameha (diabetes) should be given mild oleation therapy  in the beginning itself and then administered medicated oil prepared with drugs of priyangvadi gana to produce more bouts of both vomitting and purgations called Vamana and virechana.

After purgation, decoction basti (medicated enemas) should be administered using decoction of drugs of surasadi gana, added with paste of mahausadha, bhadradaru, musta, honey and saindhava; if this produces burning sensation, the decoction of drugs
of nyagrodhadi gana should be used without adding oil.

In diabetes which have predominance of vata – oil drinking is to be done especially.

Decoction of following eight drugs added with honey and consumed, cures the following kinds of diabetes respectivcly.

1. Parijata cures udaka meha
2. Jaya cures iksumeha
3. Nimba cures surameha
4. Vahni (citraka) cures siktameha
5. Gayatri (khadira) cures Sanairmeha
6. Patha cures ksarameha
7. Aguru cures pistameha
8. Two haridra and Sarada (sweta kamala) cures sandrameha.

The ten decoctions prepared from drugs mentioned in quarter part of the following verses, added with honey and consumed cure prameha of kapha origin.

1. Haritaki, katphala, musta and lodhra
2. Patha, vidanga, arjuna, and dhanvana
3. The two haridra, tagara and vidanga
4. Visala, kanda, arjuna and dipyaka(ajwain)
5. Darvi, vidanga, khadira and dhava
6. Surahva, kustha, aguru, and chandan
7. Darvi, agnimantha, triphala and vaca
8. Patha, murva and Svadamstra(gokhru )
9. Vaca, usira, abhaya and guduchi
10. Vrsa, Siva, citraka and saptaparna.

The following ten decoction prepared from drugs mentioned in quarter
parts of the following verses, added with honey and consumed cures prameha of pitta origin.

1. Ushira, lodhra, arjuna and chandan
2. Ushira, musta, amalaka and abhaya
3. Patola, nimba, amalaka and amrta
4. Musta, abhaya, mustaka and vrksaka
5. Lodhra, amra, kasisa and dhataki
6. Visva, arjuna, ela, Sirisa and utpala
7. Sirisa, dhanyaka, arjuna and kesara
8. Priyangu, padma, utpala and kimsuka
9. Asvattha, patha, asana and vetasa
10. Katankateri, utpala and musta.

The following five decoctions added with honey and consumed cures the following kinds of diabetes.

1. Asvattha cures neela meha
2. Caturangula cures haridrameha.
3. Drugs of nyagrodhadigana cures phenameha
4. Phalatraya cures ksara meha
5. Raktasara and manjistha cures manjistha meha.

Samanya Prameha  nashak Yog / (General formulations):

1. Daruharidra + Devdaru +Triphala + Nagarmotha make kwatha
2. Aamlaki fresh fruit juice + turmeric powder+ honey
3. Trikantakadhya Sneha
4. Phalatrikaadi kwatha
5. Lodhrasava ya Madhavasava
6. Dantyasava
7. Bhallatakasava

Drinks for Prameh rogi :

1. Saarodak
2. Kushaodak
3. Madhu Ka sharbat
4. Triphala Ka kwath ya sawaras
5. Sidhu
6. Madhya (Draksharishta) made with old munakka

Preventive measures :

Benefits of exercise :

• Doing exercise
• Avgahan and parishek snan with Vijayasar or khadirsar
• Lep with Khas, dalcheeni, choti ilayachi, agara, Chandan

Nidan parivarjan/ (to be avoided):

In Prameh, the respective etiological factors should not be used. The treatment of a disease starts with abstenance from etiological factors.

Pathya-Apathya/ (beneficial-harmful)

Pathya / beneficial– kodrava, uddalka, godhuma, canaka, adhaka and kulattha which are old are suitable to be used as foods by patients of prameha (diabetes).

Vegetables of bitter taste, meat of animals and eggs of birds of desert like regions, boiled yava and its preparations, mudga, sali and sastika are all suitable as foods.

Apathya – Sauviraka (fermented gruel), sura (beer) buttermilk, oils, milk, ghee, jaggery, foods processed wilh sours, sugarcane -juice, food prepared from flour, meat of animals of marshy regions should be avoided from use.

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