Critical review on Sushruta contribution of the urology

D.SASHIKUMARANG.SAHAYAPRAGASH

E.P.C.PRIYADARSHANIL.A.A.C.SUBHASHINI

KAVIDU KARUNARATHNA

INTRODUCTION• Urology  is the branch of medicine that focuses on

the surgical and medical diseases of the male and female urinary tract  system and the male reproductive organs.

• The organs under the domain of urology include The Kidney

Ureters

Urinary bladder

Urethra and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis).

 

• Benign prostatic hyperplasia• Bladder stones• Kidney stone• Urolithiasis• Prostitis(prostate gland infection)• Prostate cancer• Bladder cancer• Cystitis• Epididymitis• Kidney cancer• Retrograde urethra• Testicular cancer

Urology-associated issues

ANATOMY OF URINARY SYSTEM ACCORDING TO SUSHRUTHA SAMHITHA

KIDNEYS (jDlal&jDlafl! udxi msKaä oajhx tafld jdu md¾Yj ia:s;# oaù;’fhd olaIsK md¾Yj ia:s;# - iq$ks 9$7 v,ayk -

rla; fïo# m%idod;aufl! jDlafl! - iq$Yd 4$31Kidneys are originated from prasada bhaga of raktha and meda.

Bladder ( jia;sh)

1. Originated from raktha and kapha and it boil from pitta. (Su.Sha.4/26)

2' kdNs mDIag lG’ uqIal .=o jxlaIKfYAMidx taloajdria;kq;ajDlafl! ufOH jia;srfOdauqL# basthi is situated in the midst of umbilicus, back, waist, scrotum, rectum, groins and penis and it has one orifice and place with its face downwards.  

3' w,íjd bj rEfmk isrd iakdhq mrs.%y# uq;%dYfhdau,dOdr# m%dKdh;kuq;a;ï iq$ks 3$18-24   the shape of the bladder is looks like alabu(pitcher gourd) and supported by sira and snayu.

PHYSIOLOGY OF THE URINARY SYSTEM Overview of kidney functions:

• Regulating blood ionic composition: The kidneys help regular the blood levels of several ions, most importantly sodium ions (Na+) potassium ions (K+) calcium ions(Ca2+) chloride ions (CI-) and phosphate ions (HPO42)

• Regulating blood Ph: The kidneys excrete a variable amount of hydrogen ions (H+) into the urine and conserve bicarbonate ions (HCO3) which are an important buffer of H+ in the blood. Both of these activities help regulate blood pH

• Regulating blood volume: The kidneys adjust blood volume by conversing or eliminating water in the urine. Also, an increase in blood volume increase blood pressure whereas a decrease in blood volume decrease blood pressure.

• Regulating blood pressure: Beside adjusting blood volume, the kidneys help

regulate blood pressure by secreting the enzyme renin, which activates the renin angiotensin - aldosterone pathway Increased renin causes an increase in blood pressure.

• Maintaining blood osmolality: By separately regulating loss of water and loss of solutes in the urine, the kidneys maintain a relatively constant blood osmolality close to 290 milliosmoles per liter.

• Producing hormones: The kidneys produce two hormones. Calcitol the active form of vitamin D, helps regulate calcium homeostasis and erythropoietin stimulates production of red blood cells.

• Regulating blood glucose level : Like the liver, the kidneys can use the amino acid glutamine in gluconeogenesis, the synthesis of new glucose molecules. They can then release glucose into the blood to help maintain a normal blood glucose level.

• Excreting wastes and foreign substances: By forming urine the kidneys help excrete wastes substances that have no useful function in the body. Some wastes excreted in urine result from metabolic reactions in the body.

• These include ammonia and urea from the deamination of amino acids; bilirubin from the catabolism of hemoglobin; creatine from the breakdown of creatine phosphate in muscle fibers; and uric acid from the catabolism of nucleic acids. Other wastes excreted in urine are foreign substances from the diet, such as drugs and environmental toxins.

Overview of renal physiology according to Sushruta Samhitha

Su.Ni.3/18-24• Mutravaha nadi, fill the bladder by bringing

urine continuously just like the rivers satisfying the ocean.

• The urine, fill the bladder by oozing through it’s wall, both during waking and sleeping status, just as a fresh earthen pot kept immersed in water up to its mouth gets filled with water through its sides.

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REVIEW ON MUTRA ROGA

• The disease pertaining to Mutravaha srotas are considered as Mutraroga. The “Vasti“- urinary bladder is considered as main seat of the mutraroga.

(S.S.Ni.3/28) • Variation of Tridosha leads to the pathology of the

urinary system and produce various mutravikara.

• Normal physiology of the urinary system is maintained by the Apana vayu one among the five types of Vayu.

(S.S.NI. 3/27)

• According to Sushruta, derangement of vayu itself is the chief causes for the pathological conditions of the Mutrapravrathi .

• Act of urination of voiding vitiation of vata dosha and sthana-samshraya in basti leads to various urinary diseases.

Eg: Prameha 20

Ashmari 04

Mutraghata 13

Mutrakriccha 08

(Su.Su. 21/33)

NIDANA AND SAMPRAPTHI

i. Basic cause for mutraroga are mutravega dharana (suppression of urge of micturition) and mithyahara vihara ( Unadvisable food and activities).

ii. Vata dosha is the main dosha responsible for the functions like nishkarmana of (expulsion or execration of ) shukra (semen), arthava (menstrual flow) shakrit (stool/feces) and mutra (voiding).

The Pathology attains at different stages like sanchaya,prakopa, prasasa, sthanasamshraya, vyakta and bheda. When vitiated dosha takes seat in Basti produces obstructive uropathy etc, urinary diseases.

Mithyahara Vihara / Abhighataja

Vata vaishamya

Basti desha sthana samshraya

Mutravikara or Mutraroga

Pathology

1.  General Classification:      A. Diseases of Urinary tract.

i.   Mutraghata ii. Mutrakricchraiii. Ashmari iv. Prameha

       B. Systemic diseases presenting urinary symptoms:

i.   Rakta pitta ii.  Atisaraiii. Kamala iv. Jwara

  iii. Miscellaneous :

i. Mutrashukraii. Bastishulaiii. Mutraudavartaiv. Mutraktav. Niruddha prakasha

 

CLASSIFICATION

2. According to Cardinal features: i.  With Obstruction: In this group of disorders, obstruction to the free passage of urine.  There will be mechanical cause leads to obstruction:Eg. Ashmari(urolithiasis), Ashtila (BPH), Niruddha prakasha (pinhole meatus)  (Su.Ni. 13/52,53,5).

ii. Disease with Dysuria  : Painful micturition is the dominant symptoms in this group. ( Su.Ut.59)

iii.  Diseases with Urinary abnormalities  :    Change  in  the characteristics of urine Eg. Prameharoga ( Su.Ni. 6/4)

3. According to Urinary Flow (Mutra Pravritthi)i.  Atipravrittaja: Prameha roga

Kapaja Pittaja Vataja

Udakameha Ksharameda Vasameha

Ikshumeha Neelameha Sarpimeha

Sandrameha Shonitameha Hastimeha

Surameha Manjistameha Kshoudrameha

Pishtameha Haridrameha Madhumeha

Shukrameha Amlameha

Sikatameha Kalameha

Shanairmeha

Lavanameha

Phenameha

Shitameha

Alalameha

ii Apravrittaja Mutra RogaMutraghata Mutrakricchra Miscellaneous

1. Vatakundalika 1. Vataja 1. Tuni

2. Vatashtila 2. Pittaja 2. Pratituni

3. Vatabasti 3. Kapaja 3. Mutravruta – vata

4. Mutratita 4. Sannipataja 4. Pratyastila

5. Murajatara 5. Abhighataja 5. Basti shula

6. Murtasanga 6. Shakritjanya 6. Mutraviddha

7. Mutrakshaya 7. Ashmari- janya 7. Parivartika

8. Mutragranthi 8. Sharkarajanya 8. Vitiation of mutravaha srotus

9. Mutrashukra 9. Niruddha Prakasha

10. Mutroutasada - Pittaja 10. Complication of pittaja premeha

11. Mutroutasada - Kaphaja

12. Vitvighata - Caraka

13. Bastikundala

Sushruta Samhita mentioned

        12 Mutraghata +8 Mutra kruchra -4 Ashmari = 24•  Mutraghata : Sushruta Samhita Uttaratantra – 58 (Mutraghata pratisheda adhyaya)

• Mutrakruchra: Sushruta Samhita Uttara Tantra – 59 (Mutrakruchra Pratisheda adyaya)

• Ashmari : Sushruta Samhita Nidana stana – 3 (Ashmari Nidana adhyaya) Sushruta Samhita Chikitsa sthana – 7 (Ashmari Chikitsa adhyaya)

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According to Treatment (Chikitsa) :

A Medical • Ashmari – All varieties in early stage• Mutrakricchra – Vataja, pittaja, kapaja,

sannipatana, abhighataya• Mutraghata – all variety of Mutraghata

B Surgical• Ashmari all varieties – except Shukra Ashmari in

later stage• Mutrakricchra – Ashmari and sharkara janya

MUTRAKRUCHCHA (uq;% lDÉP)

REVIEW ON MUTRARICCHANIDANADietary Causes :

Tikshna oushadha sevana (Taking powerful/strong drugs)Ruksha anna (Dry meal)Atimadyapana (Excess intake of alcohol)Anupa mamsa sevana (meat of marshy place animals)Atimatsya sevana (Excess fish intake)Adyashana (Over indulgence or intake of food)Ajirna (Indigestion)

Physical strains:

Ativyayama (Excess Exercise)Atimaithuna ( over indulgence in coitus)Ati nritya karma ( Dancing)Atidrita ( Fast riding)Prishtayana ( riding vehicles, animals etc...)

SAMPRAPTI

• The various mala (doshas) of the body vitiates due to their own vitiating causes.  This vitiated dosha singly or in combination vitiates vasti, three by peedana (functional derangement) of mutramarga, leads to difficulty in micturition.

BHEDA• Vata• Pitta• Kapha• Sannipata• Ashmari• Shakrit•  Sharkara• Abhighataja

VISHISTA LAKSHANA (SPECIAL SYMPTOMS):

VATAJA MUTRAKRICCHRA(Su.U.59/4,PN.529)

• Alpam alpam ( less quantity)• Vedana is mushka mehana and  vasti (pain in scrotum,

penis and suprapublic region)• Phalat bhiriva kricchrena ( difficulty micturition)• Vataghanena mehati (all types of vata vedana

manifests).

PITTAJA MUTRAKRICHRA(Su.U.59/5,PN 579)

• Haridra mutra ( Yellowish urine)• Ushna mutra ( feeling hot during urination)• Rakta mutrata ( blood in urine)• Agni dahayamana iva daha in mushka, mehana and vasti (severe burning sensation in scrotum, penis and bladder area)

KAPHAJA MUTRAKRICCHRA (Su.U.59/6,PN.580)

• Snigdha (oil like/consistency of urine)• Shukla (whitish urine)• Mushka, mehana, basti gurutva, (heaviness in

scrotum, penis and suprapublic area)

SHALYAJA MUTRAKRICCHRA(Su.U. 59/7, PN 580)

• Due  to  injury  to mutravaha srotas  (urinary system)  it produces symptoms similar to mutraghata.

• Injury to the uinary tract produces symptom similar to vataja  variety  where  severe pain, frequency micturition, difficulty micturition, pain in groin and scrotal area  are  common.    Above  said  symptoms appears    in  trauma  of  the  urinary  system.    But  the manifestation  of  classically  said  symptoms  depends on the type of injury, site of injury.

SHARKARAJANYA MUTRAKRICCHA(Su.U. 59/12 -14, PN 580)

• Hrupida (chest pain)• Vepathu ( tremors)• Kukshishula ( pain in pelvic region)• Vahnidurbalala ( vitiation of agni)• Murcha ( fainting)• Mutraghata ( difficulty micturition)• If sharkara flushed out them vedanashanti. (Subsidence of symptoms)

• During passage of fresh sharkara, vedana utpatti. (Appearance of symptoms).

TREATMENT OF MUTRAKRICHHRA

• Swedana• Avagaha• Abhyanga•  grita avapidana•  trividha vasti karma (anuvasana, asthanpana and uttara vasti) are common procedures used for urinary disorders (Su.Su.7/7)

MUTRAGHATHA (uq;%d>d;)

MUTRAGHATA

NIDANA SAMPRAPTI (ETIOPATHOGENESIS)• Nidana :(i) Vega avrodha ( suppression of natural urge for micturition)(ii) Vata vriddhikara ahara and vihara ( alteration of diet and activities which vitiates vata dosha).

• Dosha :    Tridosha, pridomineatly vata dosha• Dushya :    Mutra• Adhistana vasti

Samprapti

Vega avarodha

Vitiation of vata

Vitiation of mutra 

Mutraghata

Classification

• Vatashtila • Ushnavata • Vatabasti  • Mutrouksada - Pittaja• Mutratita  • Mutroukasada – Kaphaja • Murajatara  • Mutratita• Murtasanga • Mutrakshaya • Mutragranthi• Mutrashukra

1. Types of mutraghata according to sustrutha

2. ACCORDING TO FLOW OF URINE 

3. ACCORDING TO DOSHA : Vataja Pittaja kaphaja Vatakaphaja Vatapittaja

01.Vatakundalika

02.Vatastila

03.Vatabasthi

04. Mutratia

05. Mutrajatara

06. Mutrasanga

07. Mutrashukra

08. Vitighata

09. Bastikundala

Pittaja

Mutrouksada

Kaphaja

Mutsouksada

Raktagranthi

Mutrakshaya

Ushnavata

4. ACCORDING TO CAUSENIJA ( Intrinsic) AGANTUJA (Extrinsic)

1.Vatakundalika

2. Vatastila

3. Vatabasti

4. Mutratia

5. Mutrajatara

6. Mutrakshaya

7. Mutrashukra

8. Mutrouksada

9.Mutrouksanda pittaja

10.Mutrokasada kaphaja

11. Vitvighata

1. Ushnavata

2. Mutrasanga

3. Bastikundala

4. Vitvighata

5. ACCORDING TO ETIOPATHOGENESISInflammatory Metabolic Traumatic Neoplastic Neurogenic

1. Ushanavata

2. Mutrasanga

1. Mutagranthi

2. Mutrakshaya

3. Pittaja

Mutrouksada

4. Kaphaja Mutroukasada

1. Mutrasanga

2. Vivighata

3. Bastikundala

1.Vatashtila

2. Mutragranthi

1.Bastikundalika

2. Vastabasti

3. Mutrajatara

4. Mutratita

6. ACCORDING TO LESION

Functional Organic

i. Vatakundalika

ii. Vatabasti

iii. Mutratita

iv. Mutrajatara

v. Mutrakshaya

vi. Mutrouksada pittaja

vii. Mutrouksada kaphaja

i. Mutragranthi

ii. Mutrashukra

iii. Vitvighata

iv. Vitastila

v. Mutrasanga

vi. Mutragranthi

vii.Ushnavata

viii Bastikundal

7.ACCORDING TO SPECIAL SYMPTOMSMutraghata Obstruction Pain Frequency Burning Haematuria

Vatakundalika + + + - -

Vatashtila + + - - -

Vatabasti

+ + - - -

Mutratita + + + - -

Murajatara + + - - -

Murtasanga + + + - -

Mutrakshaya - + - + -

Mutragranthi + + + - +

Mutrashukra - - - - -

Ushnavata - + + + +

Mutrouksada - Pittaja - - - + -

Mutroukasada – Kaphaja - + - - -

Bastikundala + + - - -

VATASHTILA

• The  vitiated  apanavayu  when  takes  seat  in  the space  between  rectum  (  guda)  and  urinary bladder  (basti)    produces,  firm  (sthira)  elevated (unnata),  stone  like  (astilavatgranthi)  growth  .   This  growth  in  turn  produces  obstruction  to passage  of  faces,  urine  and  flatus  (Mala,  Muta and  Anila  Sanga)  andAdhmana.    it  leads  to intense pain (vedana) in suprapubic region.

(Su.U.59/7-9)

CHIKITSA (TREATMENT)

• Abhyanga•  swedana•  vasti etc,•  to be adopted along with these measures, dashamula kashaya, shilajitu along with sharkara to be given orally ( for pana).

VATA KUNDALIKA

 • Etiology    :  Dryness  and  suppression  of  urge  of urination

• Pathology  :  Aggravated  vata  begins  to  move  inside the  urinary  bladder  along  with  urine    accumulates and moves in a circular manner.

• Symptoms: Patient eliminates urine in small quantity often,  accompanied with pain.

• Prognosis: It was considered as grave disease.                 (Su.U.58/5-6 )

VATAVASTI

• Etiology  : Suppressing the urge of urination• Pathology  :  Vata  residing    in  the  bladder  gets aggravated, blocks the mouth of the bladder

• Symptoms: Retention of urine inside the bladder and causing pain in the bladder and abdomen

• Prognosis :Difficult cure                     (Su.U.58/9 – 10)

MUTRATITA

• Etiology  :Suppressing  the urge of  urine  (  for  a  long time) and then desires to  eliminate it.

• Pathology: Vitiation of vata• Symptoms: The urine does not  come out or  comes out  in  little quantity after     training, with mild pain, less quantity, increased frequency.

(Su.U.58/3 – 4)  

MUTRAJATARA

• Etiology  : Suppression of urge of urination• Pathology :  Apana  vata  getting  aggravated  and moving  in  upward  directions  and  accumulates  in great amount inside the abdomen 

• Symptoms  :Distention  below  the  umbilicus,  severe pain, and obstruction of lower passages ( urethra and rectum)

  (Su.U.58/13-14)  

MUTRASANGA

• Etiology : Aggravation of  vata• Pathology:  Obstruction  of  flow  of  urine  at  the level of bladder, urethral  canal  or Glans penis

• Symptoms  :  Urine  flows  out mixed  with  blood after  straining  or  in  little  quantities  again  and again, either with pain or without pain.

(Su.U.58/15 – 16) 

MUTRAKSHAYA

• Etiology  :Persons who are dry and fatigued• Pathology:  Aggravation  of  pitta  and  Vata located in the urinary bladder

• Symptoms:  Burning  sensation,  pain  in  the bladder and difficulty for urination

    (Su.U. 58/17)

MUTRAGRANTHI AND RAKTAGRANTHI (Acute Prostitis) 

• Aetiopathogenesis  :  A  small  ,  round  and immovable  tumor  developing  quickly  at  the level of bladder neck.

• Symptoms: Severe pain, obstruction of urinary passage and other 

• symptoms of Ashmari ( urinary calculus).(Su.U. 58/18 – 19)

MUTRASHUKRA

• Etiology :  Indulging  in  copulation  when  the urge of urination pronounced

• Pathology: The semen mixed with urine• Symptoms: Semen mixed urine comes out either before or some times after  urination and urine resembles solution of ash. 

• Semen  mixed  urine  may  be  compared  to retrograde ejaculation.  

USHNAVATA

• Etiology  :  Indulging  in  physical  activities, walking for long time or exposure   to sunlight. 

• Pathology:  Pitta  gets  aggravates  and  obstructs  by vata.

• Symptoms:  Burning  sensation  in  the  bladder,  penis and  rectum during flow of urine.       Urine  is yellow, mixed  with  blood  or  blood  itself  comes  out  with difficulty.

(Su.U. 58/22-23) 

PITTAJA MUTRAUKASADA

• Aetiopathology: Vitiation of pitta• Symptoms: Urine becoming non-slimy, yellow, thick  and  dry  flows  out  accompanied  with burning  sensation  and  resembling  powder  of ox gall in color ( Yellow)

(Su.U.58/25)

KAPHAJA MUTRAUKASADA

• Aetiopathogenesis : Vitiation of kapha.• Symptoms:  Urine  being  dry,  thick,  white  in color, eliminated with    difficulty. becomes dry resembling powder or conch or very white.

(Su.U. 58/25)

VITVIGHATA

• Vitvighata  was  explained  in  Caraka  Samhita  was not mentioned in Sushruta Samhita.

• Etiology: Vitiation  of  vayu  in  dry,  debilitated person.

• Pathology:  Leading  to  abnormal  upward movement of faecess. 

• This  is  nothing  but  colo-vesical  or  recto-vesical fistula of various etiologies

TREATMENT OF MUTRAGHATA

• Kashaya,  Kalka,  Sarpi  (Ghritha),  Bakhshya,  Leha,  Payasa, Kshara,  Mastu,  Swedana,  Basti  and  Uttar  Basti  to  be administered in mutraghata.

       (SU. 58/27 – 28)• Baladi  ghrita  and  Mahabaladi  ghrita  are  some  of  the compound  drugs  used  for  mutraghata.    Most  of  the  drugs used in mutraghata are diuretic.

• Some of the yoga mentioned in Sushruta Samhita :• Ervaruka bhija kalka + Saindhava – Kanji• Souvarchala + Sura• Mamsa bhakshana + guda = Madya – Madya• Kunkuma + Madhudaka• Dadima + Jiraka + Nagara + Ela + Saindhava = Sura

• Vidarigandhadi & Gokshuramula siddha kshirapaka + Madhu• Ashvagardabha vasa• Musta + Abhaya + Devadaru + Murva Madhuka Kalka.• Draksha kalka• Nidighika svarasa• Amalaki svarasa +  Madhu• Dhatripphala svarasa + Sukshma ela• Tala taruna mula + Shali tandula vari + Sweta karkata + Trapusha Swarasa for pana.

• Kakolyadi Madhura gandaravya siddha siddha kshira.• Bala+Gokshura + Krounchakasthi + Kokilaksha +Tandula + Shataparvakamula + Devadaru + Chitraka + Akshaaka siddha Kalka.

AHMARI (wYaur’)

ASMARI / UROLITHIASIS

 • The  word  “Asmari”  means  “stone”.  In Ayurveda  the word Asmari  is mainly used  for Urinary  calculi  and  can  be  considered  as “Mutrasmari”(Urolithiasis).

     Ashma means Stones Ari means An enemy

Symptoms of Mutrasmari

• Excruciating  pain  over  nabhi,  vasti,  or  at sevani, medra during micturition.

• Sudden stoppage of urine flow• Blood stained urine • Twisting and slitting of urine• Aggravation of pain during running ,jolting etc.

MUTRASMARI NIDANA

• Teekshna Oushada sevana• Ruksha Madhya sevana• Anupa  matsya  sevana  –Sea  Food-  Fish,  Herring,  Fish rhoe, Lobster, Crab, Prawns, Shrimps, Sardines etc. 

• Ajeerna bhojana also alter the absorption at the  level of  intestines  ex:-  Hyperuricosuric  calcium,  secondary to dietary excess. 

• Athivyayama• Apathya  sevana,  diet  having  more  oxalates  (e.g., Cabbage,  rhubarb,  spinach,  coca,  black  tea),  uric  acid and calcium containing foods )

VATAJA ASHMARI• Patient’s complains- severe pain in umbilical region or rubs his penis or fingers his rectum and loudly screams.- urination,  belching  and  daefecation  become  difficult  and 

painful.

• Ashmari- Dusky colour- Rough- Uneven in shape- Hard- Facetted and nodular like a Kadambha flower.- (Oxalate calculi/Staghorn calculi)

PITTAJA ASHMARI• Patient’s complains- Sucking, drawing, and severe burning pain- Symptoms which characterise of Ushnavatha.- Fever 

• Ashmari- yellowish, black colour- Like a Ballathaka fruit- Coloured like honey- (Uric acid stones)

KAPHAJA ASHMARI• Patient’s complains- Heaviness in bladder area- Pain comes when walking or jumping- Pain reduced when rest

• Ashmari- White colour- Large size- Like a Hen’s egg- Colour of the Madhuka flower- (Phosphate stones)

SHUKRASHMARI

• Usually formed in adults.• A sudden or abrupt stoppage of a sexual act or 

excessive  coitus  tends  to  dislodge  the  semen from its natural receptacle.

Treatment of Mutrashmari• wYaur’ odrefKd jHdërka;l m%;sfuday;# ;refK fNIcx m:Hx m%jDoafO fPo u¾y;s - Early stage – medicinal treatments     -  Later stages -  chedana/surgeryMainly • Shalya • Bhedana• Pathana 

Treatments • Bhedana Polpala, akkapana, shilajathu, kuppameniyaChandraprabha vatiDecoction – akkapana+polpala+lunuwarana• Pathana Murunga, lunuwarana, kakiri, ranawaraDecoction – murunga, lunuwarana• MutrakarakaSarana, gokatu, truna panchamulayaPunarnawasawa, gokshura guggulu  

PRAMEHA (m%fïy)

PRAMEHA

• Prameha  is  a  syndrome  which  includes  all  the clinical conditions which are characterized by with more  quantity  and  increased  frequency  of abnormal micturition along with other symptoms.

•   Prameha  can  correlate  in  many  ways  with Metabolic Syndrome and Diabetes mellitus.

•  Inclusion of Prameha among Maha Gada group in Caraka  Nidana  Sthana  shows  the  significance  of this disease.

• The word Prameha consist two words.     Pra + Meha    ‘Pra‘             excessive quantity and frequency.    ‘Meha’       passing of large quantity of urine. Mehati means to excrete. 

The main characteristic features of Prameha said to be• prabhuta mutrata (More urination) • Avila mutrata (Frequent urination)

Nidana  

• Aahara (Dietary) factors: Sheeta  (cold), snigdha (unctuous),Madhura (sweet), medhya(fatty), drava arma  (liquid  food),  paana  (drinks),  Excessive  intake  of  Dadhi  (yogurt), meat  of    aquatic  animals,  milk,  new  (not  aged)  grains, foodsfdrinkscontaining  sugar  and  jaggery  (an  un  refined  form  of  cane sugar),foods that are heavy to digest.

• Vihara (Lifestyle) factors: Excessive  sleeping, Diva Swapna,  (daytime sleeping), Avyayama    (Lack of exercise),  Aprasaktum  (Idealness,  laziness,  excessive  sitting),  Sedemary lifestyle

 • Manasika (Psychological) factors: 

Disturbance  in  mental  health  caused  by  extreme  level  of  thinking, Vishaada(depression), Manasika chinta

 

Classification of Prameha

• Classification can be done based on :i.  Hetu (EtiologY)ii.  Deha Prakruti iii.  Dosha 

 According to Sushruta:• Hetu Bedhas (Biological Classification) of Prameha     prameha is of 2 types

i.  Sahaja Pramehaa ii.  Apathyaja prameha

.

• Sahaja Prameha  - due to defect in beeja. Means it arises due to genetic defect, inherited from parents due to some abnormality in sperm or ovum.

• Apathya Nimittaja PramehaApathyaja  nimittaja  prameha  is  caused  by improper dietetic habits.

Sahaja PramehaRoopa (Signs & Symptoms)• Prabhuta mutrata (More urination)• Avila mutrata (Frequent turbid urination - Polyuria)

• Krusha (emaciation)• Rooksha (Dryness of mouth & throat)• Alpashi (Loss of appetite)• Pipasa (afflicted with excessive thirst (Polydipsia)

Types of Prameha• Vataja prameha   -  04• Pittaja prameha   - 06• Kaphaja prameha- 10

Vataja prameha1. Vasameha2. Hasthimeha3. Sarpimeha4. Kshaudrameha  

• Pittaja meha

1. Ksharameha2. Nilameha3. Manjishtameha4. Haridrameha5. Shonithameha6. Amlameha

• Kaphaja meha1. Udakameha2. Ikshuwalikameha3. Sandrameha4. Surameha5. Pishtameha6. Shukrameha7. Sikathameha8. Kshanairrmeha9. Lavanameha10.Phenameha  

Thank you…….