Prameha – Ayurvedic Approach To Urinary Disorders

This guest article is by Dr MS Krishnamurthy.
In Ayurveda system of medicine, Prameha roga refers to a set of urinary disorders. Even though urinary system is directly involved in this disease, it is also closely related to other systems like Gastro intestinal, Lymphatic, Endocrinal, Circulatory system etc. 

Acharya Sushruta considered it under one among the eight grave diseases.

Word derivation of Prameha:
The word, Prameha is derived from the root ‘mih sechane’    meaning ‘watering’. In reference to disease of human beings, it many have a meaning of passing urine, qualified by prefix ‘Pra’ meaning excess in both frequency and quantity.
Prameha is derived form Pra+Miha. A condition characterized by excessive outflow of urine (shabda kalpadruma)

Characteristic feature: Frequent urge to pass urine (which may be excessive or scanty) is the cardinal feature of Prameha.

Types of Prameha –Two main types of Prameha are described – sahaja and doshaja.
Sahaja refers to natural, which are originated due to the precipitating factors from the inherited or congenital factors.
Doshaja are the results of dosha vitiation.

Based on the clinical importance, two types are specified as –

• Sthoola prameha (urinary disorders of stouts)
• Krisha prameha (urinary disorders of lean)

General causes for urinary disorders: 

1. Asyasukha (excessive food intake)
2. Swapnasukha (excessive sleep)
3. Dadhi (curd)
4. Gramya mamsa (meat of domestic animals)
5. Oudaka mamsa (aquatic animals)
6. Anupa mamsa (marshy animals)
7. Payamsi (milk and milk products)
8. Navanna (new grains)
9. Gudavikriti (jaggery and its products)
10. Kaphakara ahara (food and beverages increasing kapha dosha)
11. Avyayama (sedentary life)
12. Alasya (laziness)
13. Sheeta-snigdha-madhura ahara (old, unctuous and sweet substances)
14. Dravanna (excess liquid diet) etc

Origin of the disease:Due to the above said factors, Kapha dosha is dominantly aggravated (in association with other doshas) and they affect medas (fat), mamsa (flesh), udaka (lymphatic channel/endocrinal secretions) etc. Due to the abnormal digestion, the afflicted dhatus (tissues and their derivatives) are driven towards urinary system and the disease prameha is resulted. Based upon the dosha involvement their degree of affliction and gradation of the illness, various signs and symptoms are resulted. According to the features, different names are given.

Predominant clinical features:Excretion of large amount of vitiated urine (turbid or unctuous) with deranged color is the main feature of this illness.

Clinical features:Features of Kaphaja prameha:

1. Udaka meha- The urine is transparent (accha), excess(bahu), white(sita), cold (sheeta), odorless(nirgandha), similar to water (udakopama), turbid (avila) and slimy (picchila).
2. Ikshu meha- The urine is very sweet and similar to sugar cane juice (ikshurasavat madhura). It is slimy and turbid in nature.
3. Sandra meha- The urine is dense (sandra) and it precipitates when allowed to settle down when kept overnight (paryushita sandra).
4. Sura meha- In this condition, the urine appears similar to arrack (sura). The supernatant part appears clear and the lower part will be dense and thick.
5. Pishta meha- In this condition, the person feels horripilation on urination and the urine is white (sita) like the paste of the fine grain flour (pishtavat).
6. Shukra meha- The urine appears like semen (shukrabha) or mixed with semen (shukramishra).
7. Sikatra meha- In this condition, the urinary gravels appearing like sand particles are expelled out.
8. Sheeta meha- Excess amount of urination which is sweet (madhura) and cold(sheeta) in nature is found in this condition.
9. Shanai meha- Little by little, repeated, slow urination is complained in this disease.
10. Lala meha- In lala meha, the urine appears similar to saliva (lalatantrayuta) and is slimy (picchila) in nature.

Features of Pittaja prameha:

1. Kshara meha- Here, the urine has the odor, color, taste and texture of alkaline solution (ksharatoyavat).
2. Kala meha- Large quantity of black colored urine, just like the burnt coal (masinibha) is found in Kalameha.
3. Neela meha- The urine which is blue in color similar to the feather if Blue jay bird (chashapakshanibha) is complained in this condition.
4. Rakta meha- Here, urine will have the color and smell of blood and is salty in taste.
5. Manjishta meha- Manjishta (Rubia cordifolia) is a drug which gives dark red colored decoction or fresh juice. Here, the urine will have bad smell (visra gandha) and the urine appears similar to the decoction of manjishta.
6. Haridra meha-In this particular kind of prameha, the urine will be pungent (katu), has dark yellow color similar to turmeric (haridranibha) and associated with burning sensation.

Features of Vatajaprameha:

1. Vasa meha- In vasa meha, the person passes the urine repeatedly which is mixed with fatty oil and often appears turbid and sticky similar to fat.
2. Majja meha- Here, urine will have the appearance similar to marrow and it is excreted frequently.
3. Hasti meha- In this condition of Hastimeha, urine is often excreted like an intoxicated elephant (mattahastiriva ajasrammutra) without force. In few of the cases lymph with clots are also found.
4. Madhu meha- Acharya Charaka explained that the roughness of aggravated vatadosha transforms the sweet taste (of ojas) into astringent taste and expels out along the urine. Thus, casuses Madhumeha. Urine with astringent mixed sweet taste, pale color and unctuousness are the features of this condition.

Acharya Vagbhata opines that all pramehas if neglected or not treated properly, ultimately they reach the terminal stage -madhumeha.

Complications of prameha:

1. Thrishna (thirst)
2. Atisara (diarrhea)
3. Jwara (fever)
4. Daha (burning)
5. Dourbalya (debility)
6. Aruchi (anorexia)
7. Avipaka (indigestion)
8. Pootimamsa (bad odor)
9. Pramehapidaka (diabetic carbuncles)
10. Alaji (cellulitis)
11. Vidradhi (abscess)
12. Hrit shola (cardiac pain)
13. Makshikopasarpana (neuritis) etc

Management of prameha:Treatment is based upon the nature of the individuals in obese (sthoola) and lean (krisha). In obese patients, purification (samshodana) is carried first and later santarpana (tissue rejuvenation) is followed. The disease is controlled by wholesome diet and habits. In case of lean, brimhana (tissue nourishment/rejuvenation) is carried by selective medicines and diet. Other than this, all the pramehas are treated based upon Dosha dominance.

Single drugs referred in Urinary disorders (prameha):
Haridra – Turmeric – Curcuma longa
Amalaki – Amla – Indian Gooseberry
Jambu – Jamun seed – Syzygium cumini (Linn.) Skeels.
Udumbara – Ficus glomerata Roxb.
Haritaki – Terminalia chebula Retz.
Meshashringi – Gymnema sylvestre R. Br.
Lodhra – Symplocos racemosa Roxb.
Asana – Saraca indica Linn.
Vata – Ficus bengalensis Linn
Guggulu – Commiphora mukul (Hook. Ex. Stocks.) Engl.
Guduchi – Tinospora cordifolia (Willd.) Miers.
Nimba – Neem – Azadirachta indica A. Juss.
Pata – Cissampelos pareira Linn.
Ashwattha – Ficus religiosa Linn.
Durva – Cynodon dactylon (Linn.) Pers.
Gokshura – Tibulus terrestris Linn.
Manjishta – Rubia cordifolia Linn.
Khadira – Acacia catechu Willd.
Devadaru – Cedrus deodara (Roxb.) Loud.
Aragwadha – Cassia fistula Linn.

Formulations referred in Prameha (in general):

1. Asanadi kashaya
2. Nishakhadiradi kashaya
3. Kathakakhadhiradi kashaya
4. Triphala kashaya
5. Chandraprabhavati
6. Lodhrasava
7. Jambwasava
8. Shilajaturasayana
9. Vasantakusumakara rasa
10. Mahamanjishtadi kashaya

Wholesome diet habits:

1. Shigru-drum stick
2. Haridra-turmeric
3. Amalaki-goose berry
4. Shyamaka- Setaria italica (L.) Beauv.
5. Kodrava- Echinochloa frumentacea Linn.
6. Yava-barley
7. Godhuma-wheat
8. Mudga-green gram
9. Kulattha-horse gram
10. Patola-snake gourd
11. Karavellaka-bitter gourd
12. Maricha-pepper
13. Lashuna-garlic
14. Jambu-blue berry
15. Vyayama-exercise etc

Unwholesome diet:

1. Kanda moola (root-rhizome)
2. Ikshu (sugar cane juice)
3. Taila(oil)
4. Ghrita(ghee)
5. Guda(jiggery)
6. Kanjika/shukta(sour gruels)
7. Madya(alcohol)
8. Pishtanna(carbohydrate rich food)
9. Anupamamsa(animals of marshy land)
10. Dadhi (curd)
11. Navanna (new grains)
12. Divaswapna (day sleep) etc

Last drop:
Dear easy Ayurveda readers, I am very sure that you have got brief idea about the disease and its severity. It is very important to regulate the disease with food and habits in case of all kinds of prameha, especially madhumeha. Madhumeha (diabetes) is a disease which is becoming a burning problem worldwide. Along with the medicine, care and caution regarding food and habits will help in control of the disease.