The Nidanam of diseases of the Urinary organs (Pramehas) ||159||

1-2Dhanvantari said: -Now hear, me O Susruta, discourse on the causes and symptoms of Pramehas. Twenty different forms of Prameha are recognized in practice. Of these, ten are due to the action of the deranged Kapham, six are caused through the agency of the deranged Pittam, and four have their origin in the aggravated condition of the bodily Vayu. The semen, fat, and urine, surcharged with Kapham, should be looked upon as the immediate exciting factors of the several types of Prameha. A patient suffering from Haridra-Meha passes hot stool and urine, having the colour of turmeric.
3-4aA person attacked with Manjishtha-Meha passes urine like the solution of Manjishtha (yellowish red). The urine in a case of Rakta-Meha is either pure blood, or hot, bloody and saline, while that in Vasa-Meha is either a jet of fat or is found to be coloured like lard.
4b-5A person suffering from Majja-Meha passes urine, which resembles, or is charged with, marrow. A patient in this disease, Uke a wild and infuriated elephant, does not constantly pass urine, but passes a copious flow whenever urinating. The urine in Hasti-Meha is copious and found to be largely charged with slimy mucous.
6-7A Madhu-Meha patient passes urine which resembles honey. The obstruction of the channels of the bodily Vayu (nerves) by the deranged Pittam and Kapham in an organism, which as suffered a considerable loss in its fundamental, vital principles, may be likewise set down as the exciting factor of Madhu-Meha. The morbic principles, which usher in the disease in a given case, soon exhibit their specific symptoms. A case of Prameha spontaneously exhibits symptoms of amelioration or aggravation without any apparent reason, and soon runs into one of the most difficult and obstinate type.
8All types of Prameha, neglected at the outset, may run into Madu-Meha in course of time. The urine in Madhu-Meha becomes sweet like honey.
9-10aAll cases of Prameha in which the bodily excretions of the patient acquire a sweetish taste, should be regarded as cases of Madhu-meha. Indigestion, with a non-relish for food, vomiting, somnolence, cough, and catarrh are the distressing symptoms, which are found to supervene in a case of Meha due to the action of the deranged Kapham.
10b-11A pricking pain in the urinary bladder and urethra, bursting of the scrotum, fever with a burning sensation of the body, epilepsy, thirst, sour risings, and loose motions of the bowels are the distressing symptoms, which supervene in a case of Meha due to the action of the deranged Pittam. Suppression of stool, flatus, and urine, shivering, a catching pain about the heart, with a desire for (pungent,- bitter or astringent) food, colic, insomnia, cough, dyspnea, and wasting are the distressing symptoms, which mark a Vitaja-type of Prameha.
12-13The ten kinds of carbuncles, or abscesses, which mark the sequel of Prameha are caµed Saravika, Kacchapika, Jvalini, Vinati, Alaji, Masurika, Surshapika, Purtrini and Vidirika.
14-15The ingested food in combination with the deranged Kapham of the system usually ushers in an attack of Prameha, and the deranged Kapha, in most cases, may be set down as the primary and exciting factor of the disease. The urine in every type of Prameha becomes slimy, acid, sweet or saline, heavy (in respect of its specific gravity) oily and cold.
16-17Use of newly harvested rice, new wine, meat-soup, meat, sugarcane, treacle and milk in excessive quantities, and sharing the same bed or cushion with a Prameha patient may be set down as the exciting factors of this disease. The deranged Kapha located in the urinary bladder liquefies the fat and myosin of the body like excrementitious discharge. The aggravated Vayu, on the subsidence of the action of the deranged Kapham, augments the action of the Pittam, and brings on congestion of blood in the urinary blader, thus producing the disease, which is called Prameha.
18-19The prognosis in a case of Prameha should be determined in consideration of the nature of the morbific diatheses undenying the attack. A continuance of the Vayu, Pittam, and Kapham in their normal state (in the patient’s body) points to a happy prognosis, while the reverse is indicated when their natural equilibrium is in any way disturbed. The patient, in each type of Prameha, passes a copious, turbid urine, which should be regarded as one of the general characteristics of the disease.
20As a variety of colours may be produced through a combination of those that are white, yellow, black or red, so the deranged Vayu, Pittam and Kapham, is combination with the different organic principles of fat, flesh, etc., tray serve to give a variety of colours to the urine in this disease.
21In the type known as Udaka-Meha (poluria), the patient passes a copious, transparent, water-like or slightly turbid, slimy, cold, and odourless urine. In a case of Ikshu-Meha, the patient passes a sweet, vinegar-like urine.
22-23In Sandra-Meha (Chyluria), the patient passes a thick urine, which resembles stale rice boiling. In Pishta-Meha, the patient passes urine like a solution of pasted rice attended with horripilation. In Sura-Meha, the patient passes urine like wine, which is transparent in its surface but leaves a sediment at its bottom. In Sukra (Spermatorrhoea), the patient passes urine highly charged with semen, or resembling semen in colour.
24-25aIn Sikata-Meha, the urine becomes turbid, and is found to leave a sediment resembling hard grains of sand. The urine becomes cold, sweet, and copious in Vata-Meha, while it dribbles out or is emitted in successive and broken jets in Sanair-Meha.
25b-26aIn Lala-Meha, the urine becomes slimy and shreddy like saliva, while in Kshara-Meha, it assumes an alkaline character, or resembles an alkaline solution in taste, touch, smell and appearance.
26bIn Nila-Meha, the patient passes a bluish urine, while in Kala Meha, the urine becomes black as ink.
27-28A case of Prameha, neglected at the outset, may be followed by the appearance of one of the ten aforesaid types of abscess at a fleshy part of the patient’s body, or about any of his bone joints, or about any anastomosis of veins, arteries, etc., (Marmasthanam). Of these, the type of abscess known as Saravika, is raised or elevated at its margin and dipped in it centre, characterized by the absence of any pain or discharge, and resembles a saucer in shape. An abscess appearing about the seat of the body, and characterized by an intolerable, burning sensation in its inside, and resembling a tortoise in shape, is called Kacchapika.
29An abscess, which is of a considerably large size and assumes a bluish colour, is called Vinata. An abscess, which develops a kind of intolerable burning sensation ·in the skin during ist stage of incubation, is called Jvalini.
30-31An abscess of the present type becomes extremely painful. An abscess, which is tinged either red or white, is studded with blebs or blisters, and is characterized by a sort of burning sensation, is called Alaji. Postules to the size of lentil seeds are called Masarika, while those that crop up like small mustard seeds on the tongue in the latter stage if Prameha, attended with an extreme pain and local suppuration, are called Sarshaapika. Abscesses, that crop up. covering a considerable extensive area, marked by a comparatively smaller elevation, are called Putrini.
32An abscess, which is hard and round like the root of a Vidariki, is called Vidarika. An abscess, which is marked by features peculiar tc;, erysipelas, is called Vidradhika.
33Of these, the types known as Putrini and Vidari are characterized by an excessive deposit of fat, and a kind of intolerable pain.
34Other kinds of abscesses may mark the sequel of a case of Prameha, marked by an extremely aggravated condition of the deranged Pittam.
35-37The deranged Vayu, Pittam and Kapham in connection with a case of Prameha give rise to abscesses peculiar to their respective aggravated conditions in the body of a person of vitiated fat, even without an attack of Prameha, but their specific natures cannot be ascertained till their characteristic colours are developed. A case in which a person passes an extremely high-coloured urine, like washings of turmeric. or blood, without the specific features of urine in Prameha as described before, should be diagnosed as a case of Raktapittam (urethral hemorrhage) Perspiration, with a bad smell in the body, lassitude of the body with a kind of gone feeling in the limbs, inclination to sleep, eating, and repose, a burning sensation in the heart, eyes, tongue and ears, growth, and thickness, of the ends of finger-nails and hairs, fondness for cool things and cooling measures, and dryness of the palate, with a sweet taste in the mouth and burning sensation in the extremities are the symptoms, which mark the premonitory stage of Prameha.
38-39Ants are found to infest the urine of a patient during this stage of Prameha, and thirst, and sweetness of the urine, etc., are the symptoms, which are developed with the progress of the disease. The body having been permeated with deranged Kapha, the bodily Vayu gets the upper hand of the other morbific diathesis in the body, and produces the Vataja type of Prameha. Types of Prameha, due to the action of the deranged Pittam of Kapham, fully exhibit their characteristic symptoms, while those, which are due to any impure contact, take time to develop all their specific features, and are contaminated from one person to another. Types of Prameha, due the action of the deranged Pittam, may be checked, if not cured. A case of Prameha may be expected to be cured only before the specific symptoms are fully developed.