Prameha

Definition of Prameha
The term Prameha is derived from the root of Sanskrit language Mih
Ksharane [Radhakantadeva 1813] which means passing of urine.
The prefix Pra stands for excessiveness.
Therefore, the term Prameha literally stands for excessive passing of urine.
the term Meha is defined as Mehati Sincati Mutraretansi. (Halayudhakosha)
Excessive passing of urine Prabhtamutrat and the Turbidity of urine vilamutrat are main characteristic features of Prameha.
Therefore, the condition Prameha can be basically defined as a group of
diseases of any cause, which manifests excessive passing of urine with or without
turbidity of urine.

Prameha

Diseases of the Urinary System in Ayurveda

Prameha
Mutraghata
Ashmari

Mutrakricchra

Prameha and Chronic Kidney Disease

Prameha
is a group of disorders characterized by
abnormalities of urine
Polyuria and Turbidity of urine are common in
Prameha
Each type of prameha is named according to the
characteristics of abnormal urine
Each type represents particular stage of renal
diseases.

Prameha

Classification of Prameha
Kaphajaprameha:
Udakameha, Ikshublikrasameha (Ikshumeha), Sndrameha,
Sndraprasdameha, Suklameha, Sukrameha, Stameha, Sanirmeha,
Sikatameha, and Llmeha - Ca. Su. 19.12; Ca.Ni.6.5
Susruta refers to the terms Pishtameha, Surmeha, Lavanameha and
Phenameha - Su. Ni, 6.10 instead of Sndraprasdameha, Suklameha,
Stameha, llameha of Carakasamhit
Ashtngahrida-yasamhit refers to Udakameha, Ikshumeha, Sndrameha,
Sukrameha, Stameha, Sanirmeha, Sikatameha, Pishtameha, Surmeha
and Llmeha [AHS Ni 10.7]

Classification of Prameha
Pittajaprameha:
Kshrameha, Klameha, Nlameha, Lhitameha, Mnjishtameha and
Hridrameha Ca. Su. 19.12, Ca.Ni.6.7 299
Susruta refers to the terms Amlameha and Snitameha - Su. Ni, 6.10
instead of Klameha and Lhitameha of Carakasamhit
Ashtngahridayasamhit has followed the Carakasamhit but
Lhitameha has been replaced by Snitameha of Susrtasamhit AHS Ni 10.7

Classification of Prameha
Vtaja Prameha:
Vasmeha, Majjmeha, Hastimeha and Madhumeha - Ca. Su.
19.12, Ca.Ni.4.9, Ca.Ni.6.7
Susruta refers to the terms Sarpirmeha and Kshaudrameha Su.Ni.6.10 instead of Majjmeha and Madhumeha of
Carakasamhit
Ashtngahridayasamhit has followed Carakasamhit - AHS
Ni 10.7

Classification of Prameha
Kaphaja Prameha

Dialute Urine,
Glycosuria, Protienuria,
Phosphaturia, Oxaluria
Mild to Severe Alkalinuria, Haematuria,
Haemoglobinuria, Proteinuria

Pittaja Prameha
Chyluria, Lipiduria, Gross
Haematuria

Vataja Prameha

Kapha Prameha - Udakameha

Udakameha :

passes clear, colourless, odorless, slightly turbid, cold, and viscous urine that is
similar to water in excessive volume without pain.

Occurs in Diabetes insipidus , Impaired glucose tolerance, Renal tubular damage,

Pyelonephritis and in Intestitial nephritis

They cause predominantly tubular dysfunction with polyuria early in the disease.

Kapha Prameha - Ikshumeha

Ikshumeha:
Patient passes urine that is similar to characteristcs of juice of sugar cane
(glycosuria).

In early stages of all types of diabetes mellitus, renal tubular transport diseases,
renal tubular dysfunctions and inherited metabolic disorders show glycosuria
leading to CKD

Diabetes mellitus has been identified as the most common cause of CKD.

Kapha Prameha - Sandrameha

Sndrameha:

In this condition condensation of Urine, at keeping stand for some time, occur in addition to
the turbidity of urine - Su. Ni, 6.10: Ca. Ni, 4.6:

Precipitations may occur due to the presence of organic and inorganic matters such as cells,
proteins, phosphates and urates etc.

show different degree of proteinuria, proteinuria is found in nephrotic syndrome or second

and third stage of CKD.

Sandraprasdameha:
Sample of urine separates into two phases: Condensed and Clear - Ca. Ni, 4.6

Kapha Prameha
Surmeha:
Passing of urine similar to wine; the top layer of urine is clear while the bottom
layer is condensed on standing for some time - Su.Ni.6.10; A.H.Ni.10.10.
Carakasamhit does not refer to this condition

Kapha Prameha
Pishtameha:
Carakasamhit does not refer to this condition,
shows an erection of hair at the moment of passing of urine that is similar to flour
dissolved in water [Su.Ni.6.10; A.H.Ni.10.11].
The appearance of urine may be due to the presence of Phosphate and Carbonate
in alkaline urine. Leukocytes and Phosphates in urine may also produce white
clouds.
Suklameha:
Suklameha, shows increase of frequency of urine and urine is in white colour
consisting a matter of similar to flour [Ca. Ni, 4.6].
Sukrameha:

Sukrameha increases the frequency of urine consisted of Sukra or urine similar to Sukra
Su. Ni, 6.10; Ca.Ci.6.6

Kapha Prameha
Sikatameha:
Painful passing of urine that consists of minute particles similar to sand [Su. Ni,
6.10; Ca. Ni, 4.6].
Crystals of calcium oxalate, calcium phosphate, urates and uric acid are the
responsible agents in pathogenesis of urinary calculi.
Stameha:
Shows passing of excessive volume of sweet and cold urine [Ca. Ni, 4.6: AH.Ni.10.12
Stameha is not mentioned in Susrutasamhit.

Kapha Prameha
Sanirmeha:
In this condition, patients pass urine in small volumes frequently with difficulty
in low velocity.
Urine consists of Kapha and is viscous [Su. Ni, 6.10; Ca. Ni, 4.6; A.H.Ni.10.11].
Llmeha (llameha):

Patient passes viscous urine similar to the phlegm bounded by a thread.

llameha is mentioned in Carakasamhit.
The same pathological condition is known as Allmeha [Ca.Ci.6.8 ;A.H.Ni.10.13].
In Susrutasamhit, no reference is found for Llmeha or llameha.

Kapha Prameha
Lavanameha: Patient passes clear urine
similar to saline [Su. Ni, 6.10]. This condition
is referred in Susrutasamhit only.

Phenameha: Patient passes urine frequently,

which consists of form [Su. Ni, 6.10]. This
condition is referred in Susrutasamhit only.

Kaphaja Prameha
Sandrameha, Sandraprasadameha,
Shukrameha, Shanirmeha and Alalameha
show different degree of proteinuria
Proteinuria is found in Nephrotic syndrome or
second and third stage of CKD.

Pitta Prameha
Kshrameha: urine is similar to an alkaline solution in colour, smell, taste and tactile [Su. Ni,
6.10; Ca.Ci.6.6].
Alkaline urine - some fruits and vegetables, Sodium bicarbonate, Potassium citrate, and
Acetazolamide
In respiratory alkalosis, Metabolic alkalosis - increased excreation of bicarbonate, ammonia
production is decreased. pH >7.8.
Renal tubular acidosis - glomerular filtration is normal , defective distal tubular ability to form
ammonia, defective exchange hydrogen ion for cations , results systemic acidosis.Fanconis
syndrome - Proximal renal tubular acidosis, bicarbonate wasting occurs.

Pitta Prameha
Nlameha: Passing of clear, formed [Su. Ni, 6.10: (RB)
295] sour tasted urine in bluish colour [Ca.Ci.6.6 ] of
bird Csha [Ca.Ni.4.8; A.H.Ni.10.14].

Blue green coloured urine may be due to the presence

of Indicans, Chlorophyll and can be observed in small
intestinal infections such as pseudomonal infections.

Pitta Prameha
Klameha: Excessive volume of black or dark brown coloured
warm urine [Ca.Ci.6.6; Ca. Ni, 4.8; A.H.Ni.10.14].
Dark Brown or Black urine may be due to the presence of
haemoglobin in acid urine, which forms methemoglobin.
In the presence of unstable haemoglobin such as Haemoglobin
Koln, the urine becomes red brown.
Yellobrown or greenbown urine is most often associated with bile
pigments, chiefly bilirubin.
Dark brown urine can be seen in Alkaptonuria (Homogentisic Acid)
and Melanin. Colourless melanogens are converted into Melanin in
acid urine.

Pitta Prameha
Haridrameha:
Urine is similar to Haridrodaka in colour, Katuka (pungent) in taste and patients feel
burning sensation on passing urine [Su. Ni, 6.11; Ca. Ni, 4.8; A.H.Ni.10.15].

In severe obstructive jaundice, the urine may be dark green, orange red or orange
brown due to presence of large amount of urobilin in urine.
Yellow colour of the urine is due largely to the urochrom and to small amount of
urobilins and uroerythrin.
Urochorme excretion is thought to be propotional to the metabolic rate and
excreation is increased during fever, thyrotoxicosis, and starvation.
Darker urine may be seen when fluids are withheld.

Pitta Prameha
Manjishthmeha:
Passing of urine similar to raw flesh in odour and in the colour of Manjishthodaka
(Juice of Manjishtha) [Su. Ni, 6.11; Ca.Ci.6.6 A.H.Ni.10.11].
Haematuria may appear as cloudy, smoky, pink, red, or brown in colour.

Urine in the Haemoglobinuria is clear red clear red brown or dark brown.

Pitta Prameha
Raktameha:

Passing of salt tasted warm urine similar to raw flesh in odour similar to Rakta or
Shonita in appearance [Su. Ni, 6.10; Ca.Ci.6.6; A.H.Ni.10.15].

Occur due to the presence of blood in urine or haematuria. Haematuria may appear
cloudy, smoky, pink, red, or brown. Urine in the Haemoglobinuria is clear and red
brown or dark brown in colour.

Red brown colour of urine is due to the presence of erythrocytes in urine due to
haematuria, myoglobin in urine due to muscle injury and Bilifuscin (dipyrrole) in urine
as a result of unstable haemoglobin.
Snitameha: Passing of urine that is similar to Snita in colour

Pitta Prameha
Amlameha:
Passing of urine in sour taste and is similar to acid [Su. Ni, 6.10: (RB) 295].

Metabolic activity of the body produces non-volatile acids that cannot be extracted by
lungs principally sulphuric acid, phosporic acid, and hydrochloric acid but small amount
of pyruvic acid, lactic acid, citric acid and some ketonebodies.

When protein intake is high, more phosphates and sulfates are produced, resulting in
more acid urine.

In respiratory acidosis acid urine is formed and the amount of ammonium excreted is
increased.

In Diabeteic Ketoacidosis a very large amount of hydrogen irons are excreted, much of it
as ammonium ion.

Pittaja Prameha
Ksharameha - Alkalineuria
Occurs in Metabolic Alkalosis, Proximal Renal
Tubular Diseases due to Bicarbonate loss with
urine.
Amlameha Aciduria
Shonitameha/Raktameha/Kalameha - Haematuria
Manjistameha- Haematuria

Pittaja Prameha and Metabolic Acidosis

Metabolic acidosis is a common complication of CKD.
It gives deleterious effects on protein balance, Increase
protein degradation and essential amino acid
oxidation,
Reduce albumin synthesis.
It is associated with protein-energy malnutrition, loss
of body mass, and muscle weakness.
Metabolic acidosis is a factor in the development of
renal osteodystrophy (Osteomalacia)and interfere with
vitamin D metabolism,

Vata Prameha
Vasmeha:
Urine similar to Vas (Lymph) or mixed with Vas (Lymph) [Su. Ni, 6.10; Ca.Ci. 6.7,
A.H.Ni.10.16].

Chyluria, which shows milky appearance and it is resulted from lymphatic

obstruction.
Associated with the obstruction to lymph flow and rupture of lymphatic vessels
into the renal pelvis, ureters, bladder or urethra.
Filariasis (Late in the disease) abdominal lymph node enlargement, and tumors
have been associated with Chyluria.

Vata Prameha
Majjmeha:

Shows frequent passing of urine mixed with Majj (Marrow) [Ca.Ci.6.7;

A.H.Ni.10.17].

This is closely related to Sarpirmeha. The difference of the names is due to

the appearance of the particles in urine.

Vata Prameha
Hastimeha:

Patient passes slowly a large volume of urine that is mixed with Lasik and
is similar to that of elephant gone amok [Ca.Ci. 6.7; Su. Ni, 6.11;
A.H.Ni.10.18].

Vata Prameha
Kshaudrameha:
Urine is similar to Kshaudra in taste and colour [Su. Ni, 6.11: (RB) 295].
The urine is Madhura, and Kashya in taste and Rksha (Rough) in quality.

Vata Prameha - Madhumeha

Vata Prameha - Madhumeha

Madhumeha:
Madhumeha belongs to the category of Medodshaja rga, which includes the
conditions caused by defective functions of Meda [Su. Su, 24.9]
It is a Mahrga [Su. Ci, 14.11].
The characteristics of urine is sweet and Kashya in taste and is similar to that of
Madhu, a variety of bees honey, and the term "Madhumeha" is given because of
colour, smell and taste of urine, which are similar to those of bees honey [Su. Ni,
6.10; A.H.Ni.10.19].
The colour of urine is Pndu and is Ruksha (Rough) in the quality.
In this condition ja is mixed with urine [Ca.Ci. 6.7 RB 514]. ja, which is the
essence, includes the vital constituent that maintains life.
The Madhumeha, which is the fatal stage of all type of Prameha, is characterized
by abscess, and other complications of Prameha - It is incurable and Patient suffer
with restlessness [Su. Ni, 6.24 - 25].
Diagnosis of Madhumeha is confirmed at the occasion of patient, who is affected
with Prameha Pidak showing the Characteristics of complications [Su. Ni, 6.24].

Vataja Prameha
Vasameha (Chyluria) Opening of lymph channel
to the kidney hylum cause chyluria
Majjameha/Sarpirmeha (Lipiduria) occurs in late
stage of Nephrotic syndrome
Kshaudrameha/Madumeha (Gross Haematuria)
Madumeha is the end stage of Prameha

Correlation of Prameha and Renal

Diseases
Kaphaja Prameha

Diabetes Insipidus, Early stage of DM, Nephrotic syndrome,

Renal Tubular Diseases

Pittaja Prameha

Inflammatory Diseases of the Kidney (Glomerular Nephritis,

Renal tubular Diseases)
Metabolic alkalosis, Metabolic acidosis, Renal tubular acidosis,
Diabetic ketoacidosis

Vataja Prameha

Renal Diseases with Lymphatic obstruction or rupture

Severe form of Nephrotic syndrome (Heavy Lipiduria)
End Stage Renal Disease of any cause

Chronic Kidney Disease

Stage

Description

GFR
(ml/min/1.73m2)

Stage of Prameha

Kidney damage with normal GFR or

GFR

90

Kaphaja Prameha

Kidney damage with mild GFR

60-89

Kaphaja Prameha

Moderate GFR

30-59

Kaphaja Prameha

Sever GFR

15-29

Pittaja Prameha

Renal Failure (Dialysis or Renal

Transplant)

15

Vataja Prameha

Aetiology of Prameha and CKD

Dietary Factors
Behavioral Factors
Genetic Factors

Other Diseases and Drugs

Diabetes
Hypertension

Diseases of the Urinary System

(Mutrakricchra, Mutraghata,
Ashmari)

Prameha
CKD

Environmental Factors
Toxins , Heavy Metals

Pathogenesis of CKD in term of

Ayurveda

Concept of Tridosa
Concept of Shrotodushti
Concept of Datukshaya and Dathu Saitilya
Concept of Oja kshaya

Pathogenesis of Prameha

Osteomalasia
(Astisaitilya)

Diabetes
Hypertension

Plasma Ca
Glomerular Injury
(Srotodushti)

Vit D3

Infections
Immune mediated
Aldos
Na

ECFV (Shota)

Proteinuria
(Dhatukshaya)

1 Hydro
GFR

Angiotensin II
Anaemia
(Pandu)

PTH

PO4 Excreation

Uremia

Fibrosis
NMS, CVS, RS
Erythropoitin

Prameha - Upadrava

Prameha - Asadyatha

Madhumeha
End Stage of Prameha
Loss vital body constituents (Blood and Oja) with
urine
Represent Stage 5 of CKD
Incurable with Medical Management
All types of Prameha will lead to Madhumeha in
the absence of proper management at proper
time.

Prameha Pidaka

Prameha Pidaka
Sarvik: Abscess with elevated peripheral margin and central depression .
Sarshapik: Abscess similar to white mustard seed in appearance and size.

Kacchapik: Abscess with burning pain and is similar to the appearance of turtles
Jlani:

Abscess with severe burning pain and covered with a reticulum of flesh

Prameha Pidaka
Vinat: Large blue coloured abscess with severe pain occurring in back and abdomen

Putrani: Wide and thin abscess.

Masurik: Abscess similar to red dhal in appearance and size.

Prameha Pidaka

Alaji: Skin covered with red or black coloured vesicles, which are serious.

Vidarika: Hard and round abscesses in global shape, similar to the tuber of Ipomea
digitata.
Vidradhika: Small abscesses, similar to Vidradhi

Prameha Pidaka

Prameha Pidaka