Diabetes is the most common metabolic disorder affecting millions of people worldwide. Many of them consume anti-diabetic medication to bring their blood glucose level to normal. Following strict diet and taking medication in time and yet failing to control blood sugar levels is a common complaint of many.

In Ayurveda Prameha roga refers to a set of urinary disorders. Prameha is considered as one amongst 8 grave diseases according to Acharya Sushruta, which is also an indication that Prameha existed even during the Vedic period. The word, Prameha is derived from the root ‘mih sechane’ meaning ‘watering’. Pra means excess of urine in both frequency and volume. Prameha, thus, becomes self-explanatory and holds the twin meanings of “Prabhutha-mutratha” or excessive urination and “Avil-mutratha” or turbid urine. A Diabetic person passes urine in large quantities and urinates frequently during day and night resulting in dehydration and increase in thirst levels. Frequent increase in the blood sugar levels increases the sugar levels in urine too.

Unlike the modern classification of Diabetes which is of 2 types Ayurveda classifies Prameha into 20 types depending on the dosha and urine abnormality.

Types and features of the 20 types of Prameha:

Kaphaja Prameha – is manifested due to the contamination and morbidity caused by excess Kapha. It is further classified into 10 types:

• Udaka meha- The urine is transparent, excess, white, cold to touch, odourless, similar to water, turbid and slimy.
• Ikshu meha- The urine is very sweet similar to sugar cane juice. It is slimy and turbid in nature.
• Sandra meha- The urine is dense and it precipitates when allowed to settle down when kept overnight.
• Sura meha- In this condition, urine appears similar to arrack (A distilled alcoholic drink). The supernatant part appears clear and the lower part is dense and thick.
• Pishta meha- In this condition, the person feels horripilation on urination and the urine is white like the paste of the fine grain flour.
• Ihukra meha- The urine appears like semen or mixed with semen.
• Sikatra meha- In this condition, the urinary gravels appearing like sand particles are expelled out.
• Sheeta meha- Excessive urination which is sweet and cold in nature is found in this condition.
• Shanai meha- Frequent, repeated little by little, slow urination appears in this disease.
• Lala meha- In lala meha, the urine appears similar to saliva and is slimy in nature.

Pittaja Prameha – When there is Pitta predominance, the body goes through inflammatory changes in various tissues and sees more systemic symptoms. It is classified into 6 types:

• Kshara meha – Urine has odour, colour, taste and texture of alkaline solution.
• Kala meha – Large quantity of black coloured urine, just like the burnt coal is found in Kalameha.
• Neela meha – The urine is blue in colour similar to the feather of Blue jay bird.
• Rakta meha – Here, urine will have the colour and smell of blood and is salty in taste.
• Manjishta meha – Here, the urine will have very foul odour and the urine appears similar to the decoction of Manjishta (Rubia cordifolia).
• Haridra meha-In this particular kind of prameha, urine will be pungent and has dark yellow colour similar to turmeric and associated with burning sensation.

Vataja Prameha – predominance of Vata indicates complicated stages, where there is tissue destruction or depletion, deteriorating immunity and multiple organ failure. It is further classified into 4 types:

• Vasa Meha – The person passes urine recurrently which is mixed with fatty oil and often appears turbid and sticky similar to fat.
• Majja meha – Here, urine will have the appearance similar to bone marrow and it is frequently excreted.
• Hasti meha – In this condition, urine is often excreted like an intoxicated elephant without force. In few cases lymph with clots are also found.
• Madhu meha – Acharya Charaka explained that the roughness of aggravated vatadosha transforms the sweet taste of ojas (Body essence) into astringent taste and expels out along with urine. This causes Madhumeha. Urine with astringent mixed sweet taste, pale color and unctuousness are the features of this condition.

Any form of Prameha if not treated in its early stage or if neglected, reaches the stage of Madhumeha. The 20 classifications of Prameha will help in an accurate diagnosis and treatment of the disease.

Doshas which are involved in pathogenesis of the disease if not treated appropriately may further complicate the problem and must be considered in the management of the original disease. Complication of Prameha is known as Upadravas. Individual suffering from Prameha usually seeks doctor’s help when the complications have developed.

Fatigue, excessive thirst and excessive urination are some of the symptoms for which the diseased person approaches physician. Susrutha has described Prameha complications according to dosha predominance. Briha Thrayees have described prameha pidaka (Diabetic carbuncles) as a major complication of Prameha. Susrutha has mentioned “Malabandhata” (constipation) as a commonly observed complication as the body of the diseased person has excessive fat deposition hence they do not respond to common purgatives in usual doses. Modern Physiological theories attribute this complication to the involvement of autonomous nervous system.

The following symptoms mentioned under each category of Kaphaja, Pithaja and Vathaja Prameha describes the dominant element in each diabetic patient.

Kaphaja Prameha complications are indigestion, Loss of appetite, vomiting tendency, excessive sleep, cough, cold with running nose.

Pittaja Prameha complications includes pain in bladder & urinary path, pain in testes, fever, burning sensation, thirst, acidity, giddiness, loose motion, pain in heart region and loss of sleep.

Vataja Prameha complications are upward movement of vatha, tremor, gripping pain in chest region, pain, insomnia, wasting, cough, difficulty to breathe and constipation.

The beauty of Ayurveda lies in the treatment aspect where every person is treated as an individual and the same applies to Prameha too. Modern medicine focuses on bringing back the raised sugar level to normalcy but doesn’t treat the root of the disease. Though urinary system is involved directly in the formation of disease Gastro intestinal, lymphatic, endocrine, and circulatory system are also involved. Treatment in Prameha depends on the nature of the patient. If he is obese then Panchakarma treatment is given and if he is lean then palliative treatment is given.

Some of the herbs used in Prameha treatment are 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), Vata (Ficus bengalensis Linn), Asana (Saraca indica Linn), Guggulu (Commiphora mukul), Guduchi (Tinospora cordifolia), Nimba (Neem – Azadirachta indica), Ashwattha (Ficus religiosa), Gokshura (Tibulus terrestris Linn) and Manjishta (Rubia cordifolia Linn).