The Compendium of Caraka 2.4: caturtho 'adhyāyaḥ/

Now we shall explain the etiology of prameha [urinary disorders].

Thus spoke the venerable Ātreya.

Due to provocation of all three doshas, there are twenty varieties of prameha, and countless other disorders.

Here, we shall expound how provocation of the three doshas brings about the pramehas.

In this world, indeed, from the particular variations in etiology, doshas, and dūṣyas [vitiable tissues], there arise the specific variations in the existence or non-existence of prevention of disease.

For when these three particular factors—etiology and so forth—do not combine with one another, or are weaker due to the lapse of time, or do not combine [completely], then manifestation of disease does not occur; or they manifest after a long time, or are slight, or lack all the stated symptoms; in the opposite case, it is the reverse. Thus the cause of the particular variation in the existence or non-existence of prevention of all diseases has been stated.

Here, these three particular factors, beginning with etiology, bring about the rapid manifestation of pramehas caused by phlegm; namely: excessive and excessively large intake of newly harvested hāyanaka, yavaka, cīnaka, uddālaka, naiṣadha, itkaṭa, mukundaka, mahāvrīhi, pramodaka, and sugandhaka rice; likewise, the intake of newly harvested hareśu and māṣa pulses prepared with ghee, meats of domestic, wetland, and aquatic animals, greens, sesame, sesame paste, flour preparations, milk pudding, kṛśarā, vilepikā, and sugarcane products; intake mostly of milk, fresh wine, mandaka yogurt, and liquid, sweet, and fresh substances; avoidance of bodily cleansing and physical exercise; indulgence in sleep, lying down, and sitting; and whatever other regimen engenders phlegm, fat, and urine—all that is the particular etiology.

Abundant, liquid phlegm is the particular dosha.

Abundant, uncompacted fat, flesh, bodily moisture, semen, blood, muscle fat, bone marrow, lymph, and nutrient fluid, designated as ojas—these are the particular dūṣyas.

Upon the combination of these three particular factors, beginning with etiology, phlegm is quickly provoked on account of its prior excessive abundance; being provoked, it quickly spreads in the body because of the body's looseness; spreading in the body, it enters into mixture with fat from the very start, because fat is abundant and uncompacted, and because it largely shares identical qualities with fat; mixing with fat, it corrupts it because it is [itself] abnormal; becoming abnormal and conjoined with corrupted fat, it enters into contact with the body's moisture and flesh, because the moisture and flesh are excessively increased; in the flesh, through corruption of the flesh, it produces putrid flesh carbuncles such as śarāvikā and kacchapikā, because it has become unnatural; corrupting further the bodily moisture, it transforms it into urine, and reaching the openings of the urine-carrying channels that arise from the groins and bladder, which have become heavy when laden with fat and moisture, it is obstructed; then it produces the pramehas, or their chronicity or incurability, because it has become of an abnormal nature.

The bodily moisture, mixed with phlegm and fat, entering the urinary bladder and turning into urine, is affected by these ten qualities of phlegm associated with morbid increase; namely: white, cold, solid, slimy, clear, unctuous, heavy, sweet, dense, bright, and sluggish; there, by whichever single quality or multiple qualities it is more affected, it acquires a secondary specific name according to that designation.

These ten pramehas, indeed, are distinguished by specific names; namely: udakameha, ikṣuvālikārasameha, sāndrameha, sāndraprasādameha, śuklameha, śukrameha, śītameha, sikatāmeha, śanairmeha, and ālālameha.

These ten pramehas are curable, because the prameha and its site share similar qualities, because phlegm is predominant, and because the treatments are concordant.

Here are verses for the purpose of distinguishing the varieties of phlegm prameha:

Clear, copious, white, cold, odorless, and resembling water:
from provocation of phlegm, a man suffering from udakameha urinates [such] urine.

Extremely sweet, cold, slightly slimy, turbid,
and resembling sugarcane stalk juice, he urinates from provocation of phlegm.

One whose urine, having stayed overnight in a vessel, becomes dense:
that man they call a sāndramehin, from provocation of phlegm.

One whose urine solidifies [at the bottom] and becomes somewhat clear [above]:
they call him a sāndraprasādamehin, from provocation of phlegm.

One who repeatedly urinates white urine resembling flour paste:
that man they call a śuklamehin, from provocation of phlegm.

The man who frequently passes urine resembling semen or mixed with semen:
that man they call a śukramehin, from provocation of phlegm.

The man who passes excessively sweet and cold urine in great quantity:
that man they call a śītamehin, from provocation of phlegm.

The man who passes solid, minute impurities present in the urine:
one should recognize that man as a sikatāmehin, from provocation of phlegm.

One who urinates slowly, sluggishly, without urge, and with difficulty:
that man they call a śanairmehin, from provocation of phlegm.

One who passes slimy urine full of saliva-like threads, as if bound by fibers:
one should recognize that man as an ālālamehin, from provocation of phlegm.

Thus, these ten pramehas caused by the provocation of phlegm have been explained.

In a person who indulges in hot, sour, salty, alkaline, pungent, and undigested food, and who likewise indulges in excessively intense sunshine, heat from fire, exertion, anger, and irregular diet, in just such a body pitta is swiftly provoked; and provoked, in that very sequence, it produces these six pramehas even more swiftly.

Their distinct names also arise entirely from the particular qualities of pitta; namely: kṣārameha, kālameha, nīlameha, lohitameha, māñjiṣṭhameha, and hāridrameha.

They are endowed, as before, with the six qualities of pitta: alkaline, sour, salty, pungent, foul-smelling, and hot.

All of them are only manageable, because their seat involves mingled doshas and fat, and because the treatments are mutually contradictory.

Here are the verses for understanding the distinctions among the pitta pramehas:

In smell, color, taste, and touch, just as an alkali is, such urine
a man passes from provocation of pitta as a kṣāramehin.

One who continuously passes hot urine the color of ink:
one should recognize him as a kālamehin, from provocation of pitta.

The man who passes sour urine resembling the wing of a blue jay:
one should recognize him as a nīlamehin, from provocation of pitta.

The man who passes foul-smelling, salty, hot, and red urine:
one should recognize him as a raktamehin, from provocation of pitta.

One who passes urine resembling madder water, very foul-smelling:
one should recognize him as a māñjiṣṭhamehin, from provocation of pitta.

One who passes pungent urine resembling turmeric water:
one should recognize him as a hāridramehin, from provocation of pitta.

Thus, these six pramehas caused by the provocation of pitta have been explained.

In one who indulges in astringent, pungent, bitter, dry, light, and cold foods, sexual intercourse, physical exercise, excess of emesis, purgation, non-unctuous enema, and errhines, suppression [of natural urges], fasting, physical trauma, sunshine, anxiety, grief, excessive loss of blood, staying awake at night, and awkward bodily postures, in just such a body vāta is swiftly provoked.

Provoked and spreading throughout such a body, when it takes hold of the muscle fat and enters the urine-carrying channels, it produces vasāmeha; when it draws bone marrow into the urinary bladder, it produces majjameha; but when, carrying lymph to the urinary bladder, it causes continuous dripping of urine, and because of the excessive abundance of lymph and the dispersiveness of vāta, it causes an obstruction to excessive discharge of urine, then like an elephant in rut he continuously discharges urine without urge; they call him a hastimehin. Ojas, moreover, is sweet by nature; when vāta, through its dryness, combines with it as astringent and carries it to the urinary bladder, then it produces madhumeha.

These four pramehas born of vāta physicians declare to be incurable, because of their extreme danger and because the treatments are mutually contradictory.

Their distinct names also arise, as before, from specific qualities; namely: vasāmeha, majjameha, hastimeha, and madhumeha.

Here are the verses for understanding the distinctions among the vāta pramehas:

The man who frequently passes urine mixed with muscle fat or resembling muscle fat:
they call him an incurable vasāmehin, from provocation of vāta.

The man who frequently passes bone marrow together with urine:
they call him an incurable majjamehin, from provocation of vāta.

One who, like an elephant in rut, continuously and copiously discharges urine:
they call him an incurable hastimehin, from provocation of vāta.

The man who passes astringent, sweet, pale, and un-unctuous urine:
one should recognize him as an incurable madhumehin, from provocation of vāta.

Thus, these four pramehas caused by the provocation of vāta have been explained.

Thus, the twenty pramehas caused by the provocation of the three doshas have been explained.

The three doshas, indeed, when provoked and about to produce pramehas, manifest these premonitory symptoms; namely: matting of the hair, sweetness in the mouth, numbness and burning sensation in the hands and feet, dryness of the mouth, palate, and throat, thirst, laziness, accumulation of filth on the body, coating in the bodily orifices, burning sensation and numbness in the limbs, bees and ants flocking to the body and urine, impurities in the urine, foul body odor, somnolence, and drowsiness at all times.

The complications of those with prameha arising from its chronicity are thirst, diarrhea, fever, burning sensation, debility, anorexia, indigestion, and putrid fleshy boils such as alajī and vidradhi.

Among them, one should treat the curable pramehas by administering purifying and pacifying therapies according to what is appropriate.

And on this there are [verses]:
Upon one greedy for food, who hates bathing and walking,

prameha swiftly descends, like a bird upon a tree with its nest.

One lacking zeal, excessively obese, excessively unctuous, an excessive eater—

death, in the form of prameha, swiftly takes away and departs.

But the man who partakes of food that brings equilibrium to the bodily tissues,

and engages in various other [healthy] activities, attains happiness.

Here are the summary verses:

The cause of the disease varieties and the etiology of the pramehas,
the combination of doshas and tissues, and their varied symptoms;

the reason why ten pramehas are caused by phlegm and six born of pitta,
and how powerful vāta produces four pramehas;

the distinctions between curable and incurable, the premonitory symptoms, the complications,
and the guidelines of treatment have been spoken in this etiology of pramehas.

Thus ends the fourth chapter, entitled "The Specification of Prameha", in the Section on Etiology in the treatise composed by Agniveśa and redacted by Caraka. //4