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 colour is the main feature of this illness.

Components of Prameha

Prameha is caused by vitiation of all the doshas and many other components of the body, many of which are the important tissues of the body. They are –

• Excessively increased free fat
• Lymph
• Blood
• Muscle
• Fat
• Bone marrow
• Semen
• Water ingredients of the body / fluid compartment
• Muscle fat
• Serum
• Essence of all the tissues

Clinical features

Features of Kaphaja prameha

1. Udaka meha – The urine is transparent (accha), excess (bahu), white (sita), cold (sheeta), odourless (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. Sikata 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. Shanair meha – Little by little, repeated, slow urination is complained of in this disease.
10. 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 odour, colour, taste and texture of alkaline solution (ksharatoyavat).
2. Kala meha – Large quantity of black coloured urine, just like burnt coal (masinibha) is found in Kalameha.
3. Neela meha – The urine which is blue in colour similar to the feather of Blue jay bird (chashapakshanibha) is complained of in this condition.
4. Rakta meha – Here, urine will have the colour and smell of blood and is salty in taste.
5. Manjishta meha – Manjishta (Rubia cordifolia) is a drug which gives dark red coloured 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 Vataja prameha

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 with the urine, thus causing Madhumeha. Urine with astringent mixed sweet taste, pale colour 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

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

Symptoms

Signs and Symptoms of Prameha vis-à-vis Diabetes Mellitus – Ayurveda

1. General symptoms

1. Prabhuta mutrata – excessive urination
2. Avila mutrata – turbid / unclear / muddy / polluted / mixed with

Here turbidity is closely applicable to avilata. But I would like to take the meaning ‘mixed with’ in this instance. Why is urine turbid or unclear in prameha? This is because of

• elimination of many tissues and important components of the body in the urine
• strange, diverse and abnormal admixture of doshas and tissues
  Read – Prameha: Ayurvedic Approach To Urinary Disorders

2. Specific symptoms according to the appearance of urine depending on the predominant dosha involved

a. Kaphaja Prameha symptoms

b. Pittaja Prameha symptoms

c. Vataja Prameha symptoms

Read – Diabetic carbuncle – Ayurvedic Understanding And Treatment Modalities

Premonitory symptoms

3. Premonitory symptoms of prameha taking the form of symptoms

Ayurveda treatises have mentioned many premonitory symptoms of prameha in comparison to the symptoms. Most premonitory symptoms if not all would get matured and transformed into the symptoms of diabetes in the progressive stages.

Below mentioned are those premonitory symptoms which could shape into symptoms –

• matting of hairs
• sweetness in the mouth
• numbness and burning sensation in the hands and feet
• dryness of mouth, palate and throat
• increased thirst
• laziness and lethargy
• excessive accumulation of wastes in the body
• deposits of wastes in the orifices of the body / accumulation of dirt in teeth, palate, throat, tongue etc
• burning sensation and numbness in various parts of the body
• flies and insects / ants are attracted towards the body and urine of the person
• the contaminants of the urine are seen in the urine
• foul smell or smell of raw meat eliminated from the body
• always feeling drowsy and always sleeping
• increased unctuousness / smoothness of the body
  Read – How To Differentiate Laziness, Tiredness And Fatigue? – From Ayurveda Point of View

Management

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.

Herbs for Urinary Disorders – Why You Should Not Decide Herbs Before Analyzing the Disease?

Single drugs in Prameha

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 benghalensis 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.

Ayurvedic formulations

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

Yogas from Sahasra Yoga Text book

1. Pramehahara kashaya
2. Panchatiktaka guggulu ghrita
3. Vastyamayantaka ghrita
4. Tikantaka ghrita
5. Akulyadi ghrita
6. Dhanvantari Ghrita
7. Mahakusmanda Ghrita
8. Nisosiradi Taila
9. Amrutottara Taila
10. Khandasama Choorna
11. Pridhu Nimba panchaka choorna
12. Lavangadi Choorna
13. Nimbadi choorna
14. Vyoshadi choorna
15. Dasamoolarishta
16. Devadarvyarishta
17. Satavari guda
18. Madhusnuhi Rasayana
19. Agastya Rasayana
20. Kaisora guggulu
21. Amruta guggulu
22. Mandoora vataka
23. Niruryadi gutika
24. Suchimukha rasa
25. Bahumutrantaka rasa
26. Nishakatakadi kashaya
27. Tecchiveradi kashaya
28. Vidanga Rajanyadi kashaya
29. Palasa pushpa kashaya
30. Mudgadikkanji 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.

According to Yogaratnakara –

Indian barnyard millet, Kodo millet, Glue berry, Wheat, Bengal gram, Pigeonpea, Rice, Green gram, Horse gram, Bitter vegetables, Pointed gourd, Soup of meat of animals of desert-like land, Rock salt, Black pepper,

Unwholesome diet

1. Kanda moola (root-rhizome)
2. Ikshu (sugar cane juice)
3. Taila (oil)
4. Ghrita (ghee)
5. Guda (jaggery)
6. Kanjika/shukta (sour gruel)
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.

According to Yogaratnakara –

Prolonged sitting, Day sleeping, intake of freshly harvesetd rice, curd, suppressing the urge of urine, inhalation of smoke, sudation, blood letting, sour gruel, alcohol, oil, alkali, ghee, jaggery, sour substances, sugarcane juice, food prepared from flour, meat of animals living in marshy lands etc.

Last drop:
Dear easy Ayurveda readers, I am very sure that you have got a 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.

Turmeric Amla Honey Remedy For Urinary Disorders

Contribution by Dr Raghuram:

Classification of Prameha

Prameha is grossly divided into 3 types:
Kaphaja Prameha – Prameha manifested due to the contamination and morbidity caused by morbid Kapha. This is of 10 types. These Prameha’s are curable. Most of the symptoms of Kaphaja Prameha are limited to contamination of urine by kapha, change in consistency, quality and quantity of urine.

Pittaja Prameha – When morbid Pitta gets involved in the pathogenesis, the disease becomes difficult to handle as inflammatory changes in various tissues set in with more systemic symptoms getting manifested. Pittaja Pramehas are said to be 6 in number.

Vataja Prameha – Finally all the Prameha’s are said to be ending up with Vata predominance when not attended or treated properly. Involvement of Vata in pathogenesis of Prameha indicates complicated stages. Vataja Prameha’s are manifested with predominance of tissue destruction or depletion, deteriorating immunity and multiple organ failure.

All Vataja Prameha’s ultimately end up manifesting as Madhumeha (the end stages of Diabetes Mellitus). This sets up a bad prognosis to the disease, putting it out of context of getting it cured. The disease has now become impossible to handle.

Vataja Prameha’s are 4 in number.Thus total number of Prameha’s sums up to 20 types.

It is not a rule that all Prameha’s undergo these sequential changes leading from Kapha to Vataja Prameha’s. The explanation shows that things get complicated in due course of time. The Kaphaja Prameha’s can be handled effectively not allowing them to progress to difficult conditions.

Same is the case with Pittaja Prameha’s. Early diagnosis and prompt treatment with suitable disease modifying medicines, treatments, diet changes and life-style changes is the key.

All Kaphaja, Pittaja and Vataja Prameha’s can manifest individually without passing through the sequence. In such cases they have to be handled as such not allowing the impending complications.

But the bottom-line is – Whichever is the type of Prameha, Kapha is the primary and initiating element which is mandatorily involved in the pathogenesis of the disease.

Kaphaja Prameha’s are easy to treat. Pittaja Prameha’s are difficult to handle and Vataja Prameha’s are impossible to treat.

How is Prameha manifested? (Ayurveda view)

According to Ayurvedic explanation of pathogenesis of Prameha, the steps and chronology in which the disease is formed is the same in all types of Prameha but the dosha involved differs.
There is predominance of morbid Kapha in Kaphaja Prameha’s, Pitta in Pittaja Prameha’s and Vata in Vataja Prameha’s. But the initiating element in all the 3 types of Prameha’s and their subtypes is Kapha.

Kaphaja Prameha’s:
The vitiated Kapha contaminates the fat, flesh and the body fluids accumulated in the urinary bladder and causes 10 types of Prameha’s,
Pittaja Prameha’s:
Similarly Pitta aggravated by consumption of hot foods and other etiological factors contaminates the fat, flesh and body fluids causing 6 types of Pittaja Prameha’s.
Vataja Prameha’s:
When Pitta and Kapha get deteriorated in quality and quantity in comparison to Vata, the Vata Dosha gets aggravated and pulls the Dhatus (tissues) i.e. Vasa (oily part of flesh), majja (bone marrow), oja (essence of all the tissues) and lasika (lymph) into the urinary bladder causing 4 types of Vataja Prameha’s.

Prameha Doshas and Dushyas

The contaminants and contaminated elements in Prameha:
Dosha’s (contaminants):
In the manifestation of Prameha, all the 3 Dosha’s Vata, Pitta and Kapha are essentially morbid in various proportions. The disturbance of either Kapha or Pitta or Vata triggers the onset of pathogenesis of Diabetes Mellitus or chronic urinary disorders (Prameha or Madhumeha).

The vitiated Doshas, either singly or in combination will attack the tissues, get localised (or destroy the tissues – as is caused mainly by the morbid Vata) and initiate a disease process. The vitiation of Dosha’s is a must for the onset of the disease to take place.

Dushya’s (contaminated):
Meda (fat), Asra (Blood), Shukra (Semen), Ambu (fluids of the body), Vasa (oily part of flesh), Lasika (lymph), Majja (bone marrow), Rasa (Digestive juice, plasma), Oja (essence of all the tissues) and Pishita (flesh).
When the 3 Dosha’s contaminate the 10 Dushya’s, 20 Prameha’s are manifested due to various permutations and combinations of contamination.