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Perplexities of Prameha and Parallel.pdf

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Perplexities of Prameha and Parallel.pdf

  1. 1. PERPLEXITIES OF PRAMEHA AND PARALLEL PERSPECTIVE DR PRASANNA. N MOGASALE MD(AYU) SDM COLLEGE OF AYURVEDA UDUPI
  2. 2. सामा यं ल णतया तेषां भूतािवलमू ता | DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  3. 3. त आिवल भूतमू ल णाः सव एव मेहा भवि त || सु.िन.६/६ आिवलं समलम् | त ािवल वं मू य मेहदू याणां मेदोर मांसम जाशु ोदकवसालसीकौजसां विचदेव मेहे क यिचदेव दू य य अवयव िम ीभावात् | तेषामेव च दू याणां वैरेक भूत वात् मू भूत वम् | सामा यं ल णतया तेषां भूतािवलमू ता | अ. .िन.१०/७ मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  4. 4. सामा यं ल णतया तेषां भूतािवलमू ता | ( भूत आिवल) ( भूतमू ता) ( भूतािवलमू ता) DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  5. 5. ... मेदःसं यां तु च महे | िनि दतािन मेहाणां पूव पािण यािन च || च,िच.२८/१५ ि थवृि गलग डाबुदमेदोजौ कोप मधुमेहाित थौ याित वेद भृतयो मेदोदोषजाः; सु.सू.२४/९ त मा मधुमेहश दः सव मेहे मधुमेहिवशेषे च वतते; यथा तृणश दः सवतृणे तृणिवशेषे च वतते| च पािण च.िच.६/५७ Prameha is Meda pradoshaja vikara मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  6. 6. मेदोवहानां ोतसां वृ कौ मूलं वपावहनं च | च.िव.५/८ Prameha is Meda pradoshaja vikara Vrikka - Adrenal gland Adrenal glands produce hormones that help regulate metabolism, immune system, blood pressure, response to stress and other essential functions. मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  7. 7. मेदोवहानां ोतसां वृ कौ मूलं वपावहनं च | च.िव.५/८ वपावहनं वपा उदर था ि न धवितका यामाहजना तैलवितक े ित| Prameha is Meda pradoshaja vikara Vapavahana - Pancreas The pancreas is a heterocrine gland. Functioning as an exocrine gland, the pancreas excretes enzymes to break down the proteins, lipids, carbohydrates, and nucleic acids in food. Functioning as an endocrine gland, the pancreas secretes the hormones insulin and glucagon to control blood sugar levels throughout the day. मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  8. 8. अधोमुखोऽिप बि तिह मू वािहिसरामुखैः | पा यः पूयते सू मैः य दमानैरनारतम् || यै तैरेव िव यैनं दोषाः क ु वि त िवंशितम् | मू ाघातान् मेहां क ृ ा ममसमा यान् || अ. .िन.९/२-३ मेहा - मू रोग Mootraroga are of two types: § Prabhoota mootrata: 20 Prameha. § Alpa mootrata: 20 mootraghata. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  9. 9. थूलः मेही बलवािनहैकः क ृ श तथैकः प रदुबल | च.िच.६/१५ मेह भेद Prameha bheda: § Sthula prameha: § Krusha prameha: DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  10. 10. ौ मेहौ भवतः- सहजोऽप यिनिम | त सहजो मातृिपतृबीजदोषक ृ तः, अिहताहारजोऽप यिनिम ः | तयोः पूवणोप ुतः क ृ शो ोऽ पाशी िपपासुभृशं प रसरणशील भवित; उ रेण थूलो ब ाशी ि न धः श यासन व नशीलः ायेणेित || सु.िच.११/३ कृ शं का यािदल णयु ं सहजिम यथः| थूलं थौ यािदधमयु मिहताहारिवहारजिम यथः| मेह भेद Prameha bheda: § Sahaja prameha: § Apathya nimittaja prameha: DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  11. 11. ौ मेहौ भवतः- सहजोऽप यिनिम | सु.िच.११/३ क ृ शं का यािदल णयु ं सहजिम यथः| थूलं थौ यािदधमयु मिहताहारिवहारजिम यथः| मेह भेद Prameha bheda: § Sahaja prameha = Krusha pramehi § Apathya nimittaja prameha = Sthoola pramehi थूलः मेही बलवािनहैकः क ृ श तथैकः प रदुबल | च.िच.६/१५ DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  12. 12. सपूव पाः कफिप मेहाः मेण ये वातकृ ता मेहाः | सा या न ते, िप कृ ता तु या याः, सा या तु मेदो यिद न दु म् || च.िच.६/५६ त कफमेहाः सा या उ ा ते पूव पेण सह वतमाना असा या भवि त, िप मेहा या या उ ा ते या येया भवि त| तथा मेण च ये वातक ृ ता ते पूव परिहता अ यसा याः| मेह भेद Prameha bheda: § Sa poorvaroopa prameha: § A poorvaroopa prameha: DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  13. 13. उ ं च यथा- “अ य यािप च रोग य पूव पािण यं नरम् | िवश यनेन क पेन त यािप मरणं ुवम्” (इ.अ.५) इित; त सवपूव पानुब धे सवरोगाणामसा य वमु म्, इह तु असम तपूव पानुब धेऽ यसा य वं भवतीित िवशेषवचना ल यते | च पािण - च.िच.६/५६ मेह भेद Prameha bheda: § Sa poorvaroopa prameha: § A poorvaroopa prameha: DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  14. 14. पूव परिह येन िप कृ ते मेहे कदािचत् सा य वमिप भवतीित अपवादिविधं दशियतुम् उ सग ा ां पैि कया यताम् अनुवदित- िप कृ ता तु या या इित | अव थासा यान् पैि कानाह- सा याि व यािद | च पािण - च.िच.६/५६ मेह भेद Prameha bheda: § Sa poorvaroopa prameha: § A poorvaroopa prameha: DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  15. 15. सपूव पाः कफिप मेहाः मेण ये वातकृ ता मेहाः | सा या न ते, िप कृ ता तु या याः, सा या तु मेदो यिद न दु म् || च.िच.६/५६ अदु मेदसः पैि काः सा या भव ती यथः| िक ं वा दु ाः कफिप मेहा तावद् असा याः, तथा सपूव पाः स तोऽसा या भवि त |- च पािण मेह भेद Prameha bheda: § Adusta meda prameha: § Pradusta meda prameha: DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  16. 16. सपूव पाः कफिप मेहाः मेण ये वातकृ ता मेहाः | सा या न ते, िप कृ ता तु या याः, सा या तु मेदो यिद न दु म् || च.िच.६/५६ अदु मेदसः पैि काः सा या भव ती यथः| िक ं वा दु ाः कफिप मेहा तावद् असा याः, तथा सपूव पाः स तोऽसा या भवि त |- च पािण Prameha bheda: § Adusta meda prameha = A poorvaroopa prameha. § Pradusta meda prameha = Sa poorvaroopa prameha मेह भेद DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  17. 17. य तु खलु दोषाः क ु िपताः मेहानिभिनवतिय य त इमािन पूव पािण दशयि त; त था- जिटलीभावं क े शेषु, माधुयमा य य, करपादयोः सु तादाहौ, मुखतालुक ठशोषं, िपपासाम्, आल यं, मलं काये, कायि छ ेषूपदेहं, प रदाहं सु तां चाङ ् गेषु, षट्पदिपपीिलकािभ शरीरमू ािभसरणं, मू े च मू दोषान्, िव ं शरीरग धं, िन ां, त ां च सवकालिमित || च.िन.४/४७ मेह भेद Adusta meda prameha = Pradusta meda prameha DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  18. 18. ADUSTA MEDA PRAMEHA = A POORVAROOPA PRAMEHA In the early stages of the illness, when the glomerular filtration rate (GFR) is reduced but not to levels below 35-50 per cent of normal, the patient is either asymptomatic or complains only of generalized weakness. The clinical examination or investigations do not reveal any significant abnormality. The patient is prescribed some tonics and his symptoms are often dubbed as functional. On direct interrogation at this time many patients will come out with the history of nocturia, which is one of the earliest manifestations of CRF and often ignored by the patient as well as the physician. Nocturia and polyuria are more likely to be early features of renal disease that predominantly affect the medulla and in such conditions may be accompanied by hyposthenuria rather than isosthenuria. Hyposthenuria when carefully looked for is a common feature of CRF irrespective of the underlying disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5531136/ मेह भेद DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  19. 19. ADUSTA MEDA PRAMEHA = A POORVAROOPA PRAMEHA अधोमुखोऽिप बि तिह मू वािहिसरामुखैः | पा यः पूयते सू मैः य दमानैरनारतम् || यै तैरेव िव यैनं दोषाः क ु वि त िवंशितम् | मू ाघातान् मेहां कृ ा ममसमा यान् || अ. .िन.९/२-३ सामा यं ल णतया तेषां भूतािवलमू ता | अ. .िन.१०/७ मेह भेद DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  20. 20. PRADUSTA MEDA PRAMEHA = SA POORVAROOPA PRAMEHA मेह भेद ौ मेहौ भवतः- सहजोऽप यिनिम | त सहजो मातृिपतृबीजदोषक ृ तः, अिहताहारजोऽप यिनिम ः | सु.िच.११/३ क ृ शं का यािदल णयु ं सहजिम यथः| थूलं थौ यािदधमयु मिहताहारिवहारजिम यथः| § Sahaja prameha = Krusha pramehi § Apathya nimittaja prameha = Sthoola pramehi DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  21. 21. SAHAJA PRAMEHA = KRUSHA PRAMEHI मेह ौ मेहौ भवतः- सहजोऽप यिनिम | त सहजो मातृिपतृबीजदोषक ृ तः, अिहताहारजोऽप यिनिम ः | तयोः पूवणोप ुतः क ृ शो ोऽ पाशी िपपासुभृशं प रसरणशील भवित; सु.िच.११/३ क ृ शं का यािदल णयु ं सहजिम यथः| § Beeja dosha is responsible for Sahaja prameha. § Generally emaciated/ Dhatu kshaya /not food craving/active. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  22. 22. स िह बीजदोषािदित; मेहार भकदोषदु बीजजात मेिह वात् | च.िच.६/ ५७-च पािण त सहजाः शु ातवदोषा वयाःI क ु ाश मेहादयः | िपतृजा मातृजा - अ.सं.सु.२२/१,२ क ु लजा इित िपतृिपतामहािदकारणो ूताः| च पािण – च.िच६/५७ SAHAJA PRAMEHA = KRUSHA PRAMEHI § Beeja dusti by Prameharambhaka dosha in the parents/grand parents. मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  23. 23. सा यज ायं गभः| ........... यािन ख व य गभ य सा यजािन, यािन चा य सा यतः स भवतः स भवि त, ता यनु या या यामः; त था- आरो यमनाल यमलोलुप विमि य सादः वरवणबीजस पत् हषभूय वं चेित (सा यजािन)|| च.शा.३/११ असा यसेवां च गभ पघाितन दशयन् सा यसेवाया गभ ित कारण वं ढयित| SAHAJA PRAMEHA = KRUSHA PRAMEHI मेह Saatmyaja bhava transforms information to the progeny. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  24. 24. त ो यते- य य य य ङ ् गावयव य बीजे बीज भाग उपत ो भवित, त य त याङ ् गावयव य िवकृ ित पजायते, नोपजायते चानुपतापात्; त मादुभयोपपि र य | च.शा.३/१७ बीज इित शु शोिणते | बीज याङ ् ग यङ ् गिनवतको भागो बीजभागः | मनु यबीजं िह यङ ् गबीजभागसमुदाया मक ं वस श यङ ् गसमुदाय पपु षजनकम्, च पािण § Shukra shonita is Beeja which holds beeja bhaga. § Beeja bhaga - The factor which is responsible for different anga pratyanga. § Hence, Beeja is responsible for it’s replicate/ offspring. § Normalcy and abnormalcy of an Avayava depends on Beeja bhaga i.,e Beeja. मेह SAHAJA PRAMEHA = KRUSHA PRAMEHI DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  25. 25. त ि िवधो बीजोपत ौ हेतुः- मातािप ोरपचारः, पूवक ृ तं च कम; तथाऽ येषामिप सहजानां िवकाराणाम् | च.िच.१४/५ अपचार इित अनुिचताहारिवहार पः शु शोिणतभागिवशेषदूषकः| पूवकृ तं च कमित जायमान य सहजाश ऽिभिनवतक ं ज मा तरीयं कम | त च कम दुबलं स मातािप पचारसिहतं बीजदूषक ं भवित, बलव ु िवनाऽपचारजनकमेव भवतीित ेयम् | मेह SAHAJA PRAMEHA = KRUSHA PRAMEHI § Karma decides Bheejopaghata § Karma results in v Genetic disorders v Mutation DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  26. 26. त सहजाः शु ातवदोषा वयाःI क ु ाश मेहादयः | िपतृजा मातृजा अ.सं.सु.२२/१,२ स िह बीजदोषािदित; मेहार भकदोषदु बीजजात मेिह वात् | च.िच.६/ ५७-च पािण क ु लजा इित िपतृिपतामहािदकारणो ूताः| च पािण – च.िच६/५७ मेह SAHAJA PRAMEHA = KRUSHA PRAMEHI § Family history - Beeja dusti by Prameharambhaka dosha from the parents/grand parents. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  27. 27. मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI ि दोष कोपिनिम ा इित सवमेहे वेव ि दोषाः कारणम्, अिधक वा च ैि मकािद यपदेश इित दशयित | सु ुतेऽ यु ं - “सव एव मेहाः सवदोषजाः” (िन.अ.६) इित | ि दोषकोपिनिम ा िवंशितः मेहा भवि त िवकारा ापरेऽप रसङ ् येयाः | त यथा ि दोष कोपः मेहानिभिनवतयित तथाऽनु या या यामः || च.िन.४/३ § Tridosha are responsible for all types of Prameha. § Vataja, Pittaja, Kaphaja prameha are based on Doshadhikyata. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  28. 28. य मपीनसमेहादीन् कफजान् कफसङ ् गतम् | च.िच.१५/४८ आ यासुखं व नसुखं दधीिन ा यौदकानूपरसाः पयांिस | नवा नपानं गुडवैक ृ तं च मेहहेतुः कफक ृ च सवम् || च.िच.६/४ APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI § Kapha dosha leads Prameha. मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  29. 29. बह वः े मा दोषिवशेषः || च.िन.४/६ बह वः े मा दोषिवशेष इित बह व एव कफो मेहजनको ना प व इित | त था- ै यशै यक डू थैयगौरव नेहसुि लेदोपदेहब धमाधुयिचरका र वािन े मणः कमािण; च.सू.२०/१८ उदकादयो िह लेदनािदषु अ याः े ा इ यथः|| च.सू.२७/३५१-३५२-च पािणद APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI § Kledadikyata of Prameha is because of Kapha dosha. मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  30. 30. पुरीषमुप त भं वा वि नधारणं च, बि तपूरणिव लेदक ृ मू ं, वेदः लेद व सौक ु मायक ृ त्; | सु.सू.१५/५-२ बि तमू ाशयः, त य पूरणं, िव लेदमा वं च, मू ं करोती यथः| ड हण क ृ त िनब धसङ ् ह या या अव भः पुरीष य, मू य लेदवाहनम् | वेद य लेदिवधृितः अ. .सू.११/५ मू य सा यं ल यित-मू येित| लेदवाहनं- लेद य बिहिनगमनम्| ीमद णद कृ तसवाङ ् गसु दरी या या Basti - Avayava where § Mootram karoti – Formation of Urine § Kledasya bahir nirgamana – Elimination of Kleda/Mootra BASTHI मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  31. 31. ... मेदःसं यां तु च महे | िनि दतािन मेहाणां पूव पािण यािन च || च.सू.२८/१५ मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI § Medho dusti results in Sthoulya and Prameha. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  32. 32. कफः सिप ः पवन दोषा मेदोऽ शु ा बुवसालसीकाः | म जा रसौजः िपिशतं च दू याः मेिहणां, िवंशितरेव मेहाः || च.िच.६/८ APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI § Dasha dooshya observed in Prameha. मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  33. 33. य िप मेदः भृतयो दू या इह उ य ते, तथाऽिप मेदोमांसशरीर लेदानामव य भािवतया प र हः | म जादय सवमेहे न पुनरव यं दू य ते, तोक ं वा दु ा भवि त; च पािण- च.िच.६/८ APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI § Among the dooshya - Meda, Mamsa and Shareeraja kleda are invariably involved in all types of Prameha. § Involvement of other dooshya are not mandatory for all varieties of Prameha. मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  34. 34. § Kapha Prameha = Kapha pradhana dosha + Vata, Pitta, Meda (Mamsa, Kleda). § Pitta Prameha = Pitta pradhana dosha + Vata, Kapha, Shonita, Meda (Mamsa, Kleda). § Vata Prameha = Vata pradhana dosha + Kapha, Pitta,Vasa, Majja, Meda (Mamsa, Kleda). त वातिप मेदोिभरि वतः े मा े म मेहा जनयित, वातकफशोिणतमेदोिभरि वतं िप ं िप मेहान्, कफिप वसाम जमेदोिभरि वतो वायुवात मेहान् || सु.िन.६/९ मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  35. 35. ब ब ं मेदो मांसं शरीरज लेदः शु ं शोिणतं वसा म जा लसीका रस ौजःसङ ् यात इित दू यिवशेषाः || च.िन.४/७ अब िमित असंहतम् | अ तु बह वमघन वं च यथायो यतया बो यम् | बि त तु थूलगुदमु कसेवनीशु मू वािहनीनां नाडी(ली)नां म ये मू धारोऽ बुवहानां सव ोतसामुदिध रवापगानां ित ा, च.सी.९/४ अ बुवहानां ोतसां ित ेित थानिम यथः, उदिधयथाऽऽपगानां पूरणीय थानं, तथा बि तर य बुवह ोतसां िव ाम थानम् | च पािणद मेह § An excess of Abaddha Medha, Mamsa, Shukra, Shonita, Vasaa, Majja, Laseeka, Rasa, Ojas mixes with Shareeraja Kleda resulting excess of Shareeraja kleda. § Hence, Prabhoota Avila Mootrata. APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  36. 36. त य च एवं वृ य अप रप वा एव वातिप े माणो यदा मेदसा सहैक वमुपे य मू वािह ोतां यनुसृ याधो ग वा ब तेमुखमाि य िनिभ ते तदा मेहा जनयि त || सु.िन.६/४ अप रप वा आमाः | मेदसेित अ ािपश दो लु ो यः, तेन वसादयो ा ाः; अ ये ित ‘मेद ाप रप वं’ इित पठि त, चकारेणानु ानिप वसादीन् समुि च वि त | उपे य ग वा| िनिभ ते िनःसर ती यथः | मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI § Ahara and Achara Vitiates Kapha pradhana dosha acts as external milieu for the disease Prameha. § Derangement in the Metabolism of Meda dhatu ( Medasca Aparipakwa) acts as internal milieu for the disease Prameha. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  37. 37. रसिनिम मेव थौ यं का य च | त े मलाहारसेिवनोऽ यशनशील य अ यायािमनो िदवा व नरत य चाम एव अ नरसो मधुरतर शरीरमनु ाम नित नेहान् मेदो जनयित, तदित थौ यमापादयित; ...... सु.सू.१५/३२ मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI िदवा व ना यायामाल य स ं शीति न धमधुरमे वा नपानसेिवनं पु षं जािनयात् मेही भिव यतीित || त य च एवं वृ य अप रप वा एव (अप रप वा आमाः/ मेद ाप रप वं) वातिप े माणो यदा मेदसा सहैक वमुपे य मू वािह ोतां यनुसृ याधो ग वा ब तेमुखमाि य िनिभ ते तदा मेहा जनयि त || सु.िन.६/3,४ आ यासुखं व नसुखं दधीिन ा यौदकानूपरसाः पयांिस | नवा नपानं गुडवैक ृ तं च मेहहेतुः कफक ृ च सवम् || च.िच.६/४ ... मेदःसं यां तु च महे | िनि दतािन मेहाणां पूव पािण यािन च || च.सू.२८/१५ DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  38. 38. ‘आम एवेित इवाथ ऽयमेवश दः, र ािद पेणाप रणततया अप व इवे यथः | न तु ‘आमाशय थः काया नेद ब यादिवपािचतः’ इ यािदनो ः, त य रोगहेतुतयाऽऽमाशय थ वेन च मेदोजनक वायोगात्’ इित | च पािण स यं, जाठरेणाि नना रसः क ावेन क ृ त एव, िक तु धा वि निभरपाकादाम इ यु यते | ड हण § चाम एव/ अप रप वा एव / ‘मेद ाप रप वं = Metabolic error – Not digestive error मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  39. 39. िवंशित मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  40. 40. ि दोषकोपिनिम ा िवंशितः मेहा भवि त िवकारा ापरेऽप रसङ ् येयाः | त यथा ि दोष कोपः मेहानिभिनवतयित तथाऽनु या या यामः || च.िन.४/३ दोषदू यािवशेषेऽिप त संयोगिवशेषतः || मू वणािदभेदेन भेदो मेहेषु क यते | अ. .िन.१०/७,८ दोषदू यािवशेषेऽिप-समान वेऽिप सित, तयोः-दोषदू ययोः, संयोगः-सं ेषः, त संयोगः, त य िवशेषः- ा क ृ तकमवशा ेदो, दोषदू ययोः संयोगानेक विम यथः| त मा मू य यो वणािदभेदो-वणग धरस पशािदिवशेषः, तेन भेदेन भेदो मेहेषु क यते-िन यते| मेह DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  41. 41. उदकमेह - DIABETES INSIPIDUS अ छं बह िसतं शीतं िनग धमुदकोपमम् | े मकोपा नरो मू मुदमेही मेहित || च.िन.४/१३ उदकोपमिमित उदकवणािदतु यम्| त शीतं तेमग धम छमुदकिमवोदकमेही मेहित | अ.सं.िन१०/९ Urine excreted in large quantity which is transparent, white, cold and odourless DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  42. 42. Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine. Urinary specific gravity is between 1 to 1.005. It has 2 major forms: Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP]) Nephrogenic DI, characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney. Etiology DI is usually an acquired disorder, with central DI having different causes than does nephrogenic DI. In rare cases, central or nephrogenic DI may be an inherited disorder. https://emedicine.medscape.com/article/117648-overview उदकमेह - DIABETES INSIPIDUS DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  43. 43. अ यथमधुरं शीतमीषि पि छलमािवलम् | का डे ुरसमङ ् काशं े मकोपात् मेहित || च.िन.४/१४ इ ुवािलकारसमेह - KETOACIDOSIS Moderately turbid urine which is cold, little slimy, extremely sweet like sugarcane juice. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  44. 44. इ ुवािलकारसमेह - KETOACIDOSIS Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source. The overproduction of ketones ensues, causing them to accumulate in the blood and urine and turn the blood acidic. DKA occurs mainly in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. https://emedicine.medscape.com/article/118361-overview DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  45. 45. शीतमेह- KETOACIDOSIS अ यथमधुरं शीतं मू ं मेहित यो भृशम् | शीतमेिहनमाह तं पु षं े मकोपतः || च. िन.४/१९ शीतमेही सुबहशो मधुरं भृशशीतलम् || अ. .िन.१०/१२ शीतमेही सु बहशो मधुरमितशीतलं च मेहित| Turbid urine passed frequently which is cold and extremely sweet. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  46. 46. शीतमेह- KETOACIDOSIS Hypothermia is reduction in core temperature below 95°F (35°C), with the most accurate reading taken by rectally. (Med Sci Law 1969;9[4]:231.) Hypothermia can be caused by starvation, malnutrition, immobility, myocardial infarction, pulmonary embolism, and endocrine disorders such as hypopituitarism and hypothyroidism. A British study determined that DKA-induced hypothermia (11.8% of all cases of hypothermia admissions) is more common than hypothyroidism-induced hypothermia (8% of all cases of hypothermia admissions). (Br Med J 1978;2[6149]:1387.) DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  47. 47. य य पयुिषतं मू ं सा ीभवित भाजने | पु षं कफकोपेन तमाहः सा मेिहनम् || च.िन.४/१३,१४, १५ आिवलं सा ं सा मेही; सु.िन.६/१० आिवलम यथ कलुषं, सा ीभवे पयुिषतं सा मेहेन मेहित| अ. .िन.१०/१० सा मेहेन य मेहित त पयुिषतं-राि ि थतं, घनीभवेत्| सा मेह - PROTEINURIA Turbid urine which gets condensed over time/over night. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  48. 48. सा मेह - PROTEINURIA Proteinuria identifies patients with renal damage and those at risk for worsening renal disease and increased cardiovascular morbidity. An individual with proteinuria in the setting of a normal glomerular filtration rate (GFR) is at high risk of progressive loss of renal function. The normal mean albumin excretion rate (AER) is 5-10 mg/day, with an AER of >30 mg/day considered abnormal. AER between 30 to 300 mg/day is called moderately increased albuminuria. Levels greater than 300 mg/day are called severely increased albuminuria. Albuminuria that persists for 3 months is considered CKD. Nephrotic-range proteinuria is defined as greater than 3.5 g of protein excreted in the urine over 24 hours. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  49. 49. सा मेह - PROTEINURIA Proteinuria can be differentiated on the basis of any of the following: Amount of protein (nephrotic or non-nephrotic) Type of protein (albuminuria or low molecular weight proteinuria) Underlying pathological damage (glomerular vs non-glomerular). Pathophysiologically, most cases of proteinuria are classified into one or more of the following categories: Tubular Overflow Glomerular DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  50. 50. सा सादमेह - PROTEINURIA य य संह यते मू ं िकि चत् िकि चत् सीदित | सा सादमेहीित तमाहः े मकोपतः || च. िन.४/१६ संह यते यानीभवित | घनं चोप र िव स निम यनेन सा सादमेहमाह | Urine becomes partly viscous and partly clear when kept overtime. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  51. 51. सुरामेह - PROTEINURIA सुरामेही सुरातु यमुपय छमधो घनम् || अ. .िन.१०/१० सुरामेही सुरातु यं मेहित| त च मू ं पयुिषतमेवोप रभागेऽ छमधः-अध तात्, घनं भवेत्| सुरामेही सुरातु यमुपय छमधो घनम् || मा.िन.३३/९ चरक े सुरामेह थाने सा सादमेहः पिठतः Looks like a spirituous liquor that is transparent above and dense below. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  52. 52. फ े नमेह - PROTEINURIA तोक ं तोक ं सफ े नम छं फ े नमेही मेहित || सु.िन.६/१० Eliminates urine little by little, being frothy and clear. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  53. 53. Polyuria/ Nocturia is observed in CKD even at grade three and four. In early stage it is the osmotic diuresis. But, it is suggested that at later stage of chronic renal failure the mechanism of a diuresis increase is not due to osmotic diuresis but rather to secretion of prostaglandin E2 which inhibits cation reabsorption and stimulates diuresis. https://pubmed.ncbi.nlm.nih.gov/10900642/ सा मेह/ सा सादमेह / सुरामेह/ फ े नमेह - PROTEINURIA DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  54. 54. शु मेह - SPERMATURIA शु ाभं शु िम ं वा मुहमहित यो नरः | शु मेिहनमाह तं पु षं े मकोपतः || च. िन.४/१८ Turbid urine as a consequence of Spermaturia. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  55. 55. शु मेह - SPERMATURIA Etiology: Retrograde ejaculation Enlarged prostate Alcohol Diabetes mellitus https://www.lybrate.com/topic/spermaturia-causes-prevention-of-it/8659428dcf044c2483ff33f263959916 DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  56. 56. त तुब िमवालालं िपि छलं यः मेहित | आलालमेिहनं िव ा ं नरं े मकोपतः || च. िन.४/२२ त तुब ं त तुव ीघिम यथः| लालािमवालालं, सम ता लाला पिम यथः| आलालमेह - CHYLURIA Turbid urine appears thready and contains slimy object. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  57. 57. म दं म दमवेगं तु क ृ ं यो मू ये छनैः | शनैमिहनमाह तं पु षं े मकोपतः | च. िन.४/२१ शनैः सकफ ं मृ नं शनैमही; सु.िन.६/१० मृ नं िपि छलम्| शनैमह– CHYLURIA Turbid urine passed frequently with difficulty. Mostly urine contains Kapha/slimy content. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  58. 58. आलालमेह/शनैमह– CHYLURIA Chyluria denotes the urinary excretion of chyle, which is a lymphatic fluid rich in chylomicrons. Chyle flows from the intestinal lacteals to the left subclavian vein through the thoracic duct. When an abnormal connection between these structures and the urinary tract develops, chyluria appears. Chyluria is classified as parasitic or nonparasitic, the former being induced by lymphatic filariasis, whereas the latter is caused by medical, traumatic or inherited diseases. The patient usually reports excretion of milky urines, monolateral flank pain, malnutrition, weight loss and weakness. Urinalysis demonstrates nephrotic-range proteinuria, lymphocyturia associated with chylomicrons and triglycerides in the supernatant. https://www.karger.com/article/fulltext/329154 DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  59. 59. िसकतामेह- CYSTINURIA मूता मू गतान् दोषानणू मेहित यो नरः | िसकतामेिहनं िव ा ं नरं े मकोपतः || च. िन.४/२० मूतािनित किठनान् | दोषािनित जातौ बहवचनं, येन दोषोऽ ैक एव भूतः कफः| स जं िसकतानुिव ं िसकतामेही; सु.िन.६/१० िसकतानुिव ं वालुकािम म् | Turbid urine is passed along with small gravels. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  60. 60. िसकतामेह- CYSTINURIA Cystinuria is an autosomal-recessive defect in re-absorptive transport of cystine and the dibasic amino acids ornithine, arginine, and lysine from the luminal fluid of the renal proximal tubule and small intestine. The only phenotypic manifestation of cystinuria is cystine urolithiasis, which often recurs throughout an affected individual’s lifetime. Worldwide, the overall prevalence is 1 person per 7000 population but varies significantly by population. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  61. 61. िसकतामेह- CYSTINURIA The presentation in patients with cystinuria is similar to that of patients with other types of renal calculi and includes the following: Renal colic, Chronic urinary tract infections in a young person with a family history of kidney stones, Passage of stones or gravel, Hematuria & Dysuria. Cystine is one of the sulfur-containing amino acids; therefore, the urine may have the characteristic odor of rotten eggs. Urinalysis may show typical hexagonal or benzene crystals, which are essentially pathognomonic of cystinuria. Microscopic crystalluria is present in 26%-83% of patients. Disappearance of cystine crystals in the first morning urine is a good index of treatment efficacy. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  62. 62. िप मेह - PHOSPHATURIA रोमा िप रसतु यं िप मेही; सु.िन.६/१० रोमा ा रोम चः| िप रसतु यं िप िम ोदकतु यम् | सं रोमा िप ेन िप व हलं िसतम् | अ. .िन.१०/११ िप ेन-िप मेहेन, सं रोमा सन् िप वत्-िप स शं, बहलं शु लं च मेहित | Turbid urine resembling flour solution and accompanied with horripilation. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  63. 63. शु लमेह- PHOSPHATURIA शु लं िप िनभं मू मभी णं यः मेहित | पु षं कफकोपेन तमाहः शु लमेिहनम् || च. िन.४/१७ Turbid urine having the opaque, white color like that of pasted flour. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  64. 64. िप मेह/शु लमेह - PHOSPHATURIA Phosphaturia is caused due to excess of excretion of phosphate in urine. Presence of too much of phosphate makes the urine appear milky or cloudy in appearance. Any cause of primary hyperparathyroidism will cause phosphaturia and tend to cause hypophosphatemia. Hyperparathyroidism caused by hypocalcemia or vitamin D deficiency or resistance is similarly associated with hypophosphatemia. Extracellular volume expansion increases the filtered phosphorus load and dilutes the luminal concentration of phosphorus, resulting in phosphaturia. Ethanol and glycosuria both decrease proximal tubule phosphate reabsorption. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  65. 65. िप मेह/शु लमेह - PHOSPHATURIA Fanconi syndrome is a syndrome of inadequate reabsorption in the proximal renal tubules of the kidney. The syndrome can be caused by various underlying congenital or acquired diseases, by toxicity (for example, from toxic heavy metals), or by adverse drug reactions. It results in various small molecules of metabolism being passed into the urine instead of being reabsorbed from the tubular fluid such as glucose, amino acids, uric acid, phosphate, and bicarbonate. Different forms of Fanconi syndrome can affect different functions of the proximal tubule, and result in different complications. The loss of phosphate results in the bone diseases rickets and osteomalacia (even with adequate vitamin D and calcium levels), because phosphate is necessary for bone development in children and even for ongoing bone metabolism in adults. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  66. 66. ग धवणरस पशयथा ार तथािवधम् | िप कोपा नरो मू ं ारमेही मेहित || च.िन.४/२९ ारमेह - ALKALINURIA Urine has the smell, color, taste and touch similar to those of alkali. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  67. 67. ारमेह - ALKALINURIA Alkaline urine has traditionally been associated with Proteus urinary tract infections. In the absence of an infection, clinical findings might suggest other diagnoses. The following are some of the traditional causes of alkaline urine: (1) Urinary tract infection (Proteus and others) (2) Metabolic alkalosis (pyloric stenosis and others) (3) Failure of acidification (renal tubular acidosis, chronic renal failure, or aldosterone abnormalities) (4) Ingestion (salicylate, sodium bicarbonate, acetazolamide, etc); and (5) Respiratory alkalosis (hyperventilation). https://jamanetwork.com/journals/jamapediatrics/article-abstract/515482 DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  68. 68. कालमेह -ALKAPTONURIA (BLACK URINE DISEASE) मसीवणमज ं यो मू मु णं मेहित | िप य प रकोपेण तं िव ात् कालमेिहनम् || च.िन.४/३० Turbid urine passed in large quantity of black or dark urine DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  69. 69. कालमेह -ALKAPTONURIA (BLACK URINE DISEASE) Alkaptonuria is a rare inherited disorder. It occurs when body can’t produce enough of an enzyme called homogentisic dioxygenase (HGD). This enzyme is used to break down a toxic substance called homogentisic acid. The buildup of homogentisic acid causes bones and cartilage to become discolored and brittle. This typically leads to osteoarthritis, especially in spine and large joints. People with alkaptonuria also have urine that turns dark brown or black when it’s exposed to air. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  70. 70. चाषप िनभं मू म लं मेहित यो नरः| िप य प रकोपेण तं िव ा नीलमेिहनम् || च.िन.४/३१ सफ े नम छं नीलं नीलमेही मेहित | सु.िन.६/११ नीलमेह - INDICANURIA Turbid urine with sour taste and color like that of the feather of the blue jay. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  71. 71. नीलमेह - INDICANURIA Blue diaper syndrome is a rare, autosomal or X-linked recessive trait metabolic disorder characterized in infants by bluish urine-stained diapers. It is also known as Drummond's syndrome, and Hypercalcemia, Familial, with Nephrocalcinosis and Indicanuria. Indican (potassium indoxyl sulphate) is a normal constituent of urine in amounts up to 30 mg per day. It is formed from indole derived from the action of intestinal bacteria on tryptophan. It is usually invisible, but urines containing a large excess of indican may darken on exposure to air and very occasionally oxidation to indigo in alkaline urine may produce a bluish tinge to the phosphate deposit. In such cases, typical blue rectangular or needlelike crystals may be seen in the deposit.
  72. 72. िव ं लवणमु णं च र ं मेहित यो नरः| िप य प रकोपेण तं िव ा मेिहनम् || च.िन.४/३२ र मेह - HAEMATURIA Turbid urine having red color, saline taste and smell like that of raw meat. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  73. 73. र मेह - HAEMATURIA POLYCYSTIC KIDNEY DISEASE It is a genetic disorder in which the renal tubules become structurally abnormal, resulting in the development and growth of multiple cysts within the kidney. These cysts may begin to develop in utero, in infancy, in childhood, or in adulthood. Cysts are non- functioning tubules filled with fluid pumped into them, which range in size from microscopic to enormous, crushing adjacent normal tubules and eventually rendering them non-functional as well. PKD is a general term for two types, each having their own pathology and genetic cause: autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD). Signs and symptoms include high blood pressure, headaches, abdominal pain, blood in the urine, and excessive urination. Other symptoms include pain in the back, and cyst formation (renal and other organs). DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  74. 74. र मेह - HAEMATURIA ALPORT SYNDROME The term Alport syndrome encompasses a group of inherited, heterogeneous disorders involving the basement membranes of the kidney and frequently affecting the cochlea and eye as well. There are various forms of the disease which includes Autosomal recessive Alport syndrome (ARAS), X-linked Alport syndrome (XLAS), Autosomal dominant Alport syndrome (ADAS). DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  75. 75. र मेह - HAEMATURIA ALPORT SYNDROME Kidney-related manifestations Hematuria - Most common and earliest manifestation of Alport syndrome Proteinuria - Develops in males with XLAS and in males and females with ARAS and ADAS Hypertension - Usually present in males with XLAS and in males and females with ARAS and ADAS. Edema and nephrotic syndrome are present in 30-40% of young adults with Alport syndrome; they are not common in early childhood, but their incidence progressively increases with age. With onset of kidney insufficiency, symptoms of chronic anemia and osteodystrophy may become evident. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  76. 76. र मेह - HAEMATURIA FAMILIAL GLOMERULAR HEMATURIA – TBM Thin basement membrane nephropathy (TBM) disease also known as benign familial hematuria along with IgA nephropathy, the most common cause of blood in the urine without any other symptoms. The only abnormal finding in this disease is a thinning of the basement membrane of the glomeruli (filters) in the kidneys. Most patients with TBM disease maintain normal kidney function throughout their lives. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  77. 77. माि ज मेह - HEMOGLOBINURIA मि ज ोदकसङ ् काशं भृशं िव ं मेहित | िप य प रकोपा ं िव ा माि ज मेिहनम् || च.िन.४/३३ Turbid urine passed frequently, which smells like raw flesh and looks like the decoction of Manjistha. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  78. 78. माि ज मेह - HEMOGLOBINURIA Hemoglobinuria is a condition in which the oxygen transport protein hemoglobin is found in abnormally high concentrations in the urine. The condition is caused by excessive intravascular hemolysis, in which large numbers of red blood cells (RBCs) are destroyed, thereby releasing free hemoglobin into the plasma. Excess hemoglobin is filtered by the kidneys, which excrete it into the urine, giving urine a purple color. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  79. 79. माि ज मेह - HEMOGLOBINURIA § Acute glomerulonephritis § Burns § Renal cancer § Malaria § Paroxysmal nocturnal hemoglobinuria § Microangiopathies, e.g. hemolytic-uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP) leading to microangiopathic hemolytic anemia § Transfusion reactions § IgM autoimmune hemolytic anemia § Glucose-6-phosphate dehydrogenase deficiency § Pyelonephritis § Sickle cell anemia § Tuberculosis of the urinary tract § March hemoglobinuria secondary to repetitive impacts on the body, usually the feet § Athletic nephritis secondary to strenuous exercise § Acute lead poisoning DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  80. 80. हा र मेह - UROBILINOGENURIA ह र ोदकसङ ् काशं कटुक ं यः मेहित | िप य प रकोपा ं िव ा ा र मेिहनम् || च.िन.४/३४ कटुक ं सदाहं ह र ायु िमव हा र मेही | अ.सं.िन.१०/१३ Turbid urine having pungent taste and color like that of the juice of Haridra DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  81. 81. हा र मेह - UROBILINOGENURIA Excess of urobilinogen may be due to excessive formation of bilirubin by cells of the reticulo-endothelial system on account of (1)Excessive red cell destruction, as in acute malaria. (2)Excessive hemolysis, as in pernicious anemia or poisoning by drugs, etc. (3)Excessive absorption of the products of blood disintegration, as in internal hemorrhage anywhere, or in lobar pneumonia. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  82. 82. वसामेह - LIPIDURIA वसािम ं वसाभं वा मुहमहित यो नरः| वसामेिहनमाह तमसा यं वातकोपतः|| च.िन.४/४१ Turbid urine mixed with Vasaa (serum of flesh) or having the appearance of Vasaa. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  83. 83. वसामेह - LIPIDURIA Lipiduria or lipuria is the presence of lipids in the urine. Lipiduria is most frequently observed in nephrotic syndrome where it is passed as lipoproteins along with other proteins. Congenital nephrotic syndrome is a rare kidney disease which manifests in infants during the first 3 months of life, and is characterized by high levels of protein in the urine (proteinuria), low levels of protein in the blood, and swelling. This disease is primarily caused by genetic mutations which result in damage to components of the glomerular filtration barrier and allow for leakage of plasma proteins into the urinary space DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  84. 84. म जानं सह मू ेण मुहमहित यो नरः| म जमेिहनमाह तमसा यं वातकोपतः|| च.िन.४/४२ सिपः काशं सिपमही मेहित | सु.िन.६/१२ वातजे सिपमह रक े म जमेहः म जमेह / सिपमह – LIPIDURIA/CHYLURIA Turbid urine mixed with Majja (marrow of bones) DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  85. 85. म जमेह / सिपमह - LIPIDURIA/CHYLURIA Nephrotic syndrome is the combination of nephrotic-range proteinuria with a low serum albumin level and edema. Nephrotic-range proteinuria is the loss of 3 grams or more per day of protein into the urine or, on a single spot urine collection, the presence of 2 g of protein per gram of urine creatinine. Nephrotic syndrome has many causes, including primary kidney diseases such as minimal-change disease, focal segmental glomerulosclerosis, and membranous glomerulonephritis. Nephrotic syndrome can also result from systemic diseases that affect other organs in addition to the kidneys, such as diabetes, amyloidosis, and lupus erythematosus. Nephrotic syndrome may affect adults and children of both sexes and of any race. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  86. 86. हि तमेह - AMINOACIDURIA ह ती म इवाज ं मू ं रित यो भृशम् | हि तमेिहनमाह तमसा यं वातकोपतः|| च.िन.४/४३ ह ती म इवाज ं मू ं वेगिवविजतम् | सलसीक ं िवब ं च हि तमेही मेहित || अ. .िन.१०/ १७-१८; मा.िन.३३/१७ हि तमेहमाह– ह ती यािद| अज मनवरतं, वेगिवविजतं वेगरिहतं, सलसीक ं लसीकया सह, िवब ं िप डीभूतिमव | लसीका िवलीनमेदः ायम्| Large quantities of turbid urine frequently like an elephant gone amuck. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  87. 87. हि तमेह - AMINOACIDURIA The term aminoaciduria is applied when more than 5% of the filtered load is detected in the urine. It may result from an inherited metabolic abnormality, in which case the aminoaciduria is a permanent finding, or it may be an acquired abnormality which may either be transient or become permanent. Only negligible amounts of amino acids and glucose are normally present in the final urine, reflecting very efficient reabsorption mechanisms for these organic solutes in the proximal tubule. Renal tubular transport defects or specific metabolic abnormalities result in excretion of significant quantities of amino acids & glucose in the urine. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  88. 88. हि तमेह - AMINOACIDURIA Fanconi's syndrome is the most frequently studied inherited aminoaciduria. The syndrome is characterized by a generalized aminoaciduria and by other renal tubular defects affecting reabsorption of phosphate and glucose. Hartnup disease is a rare autosomal recessive metabolic disorder where renal tubular transport is defective and causes gross aminoaciduria. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  89. 89. मधुमेह / ौ मेह – DIABETES MELLITUS कषायमधुरं पा डु ं मेहित यो नरः | वातकोपादसा यं तं तीया मधुमेिहनम् || च.िन.४/४४ मधुमेही मधुसमम्--------- | अ. .िन.१०/१८ ौ रसवण ौ मेही; …..| सु.िन.६/१२ ौ मेहो मधुमेहः| Diabetes comes from a Greek word that means to siphon. The most obvious sign of diabetes is excessive urination. Water passes through the body of a person with diabetes as if it were being siphoned from the mouth through the urinary system and out of the body. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  90. 90. मधुमेह / ौ मेह – DIABETES MELLITUS कषायमधुरं पा डु ं मेहित यो नरः | वातकोपादसा यं तं तीया मधुमेिहनम् || च.िन.४/४४ मधुमेही मधुसमम्--------- | अ. .िन.१०/१८ ौ रसवण ौ मेही; …..| सु.िन.६/१२ ौ मेहो मधुमेहः| Mellitus comes from a Latin word that means sweet like honey. The urine of a person with diabetes contains extra sugar (glucose). In 1679,the physician Thomas Willis, tasted the urine of a person with diabetes and described as ‘wonderfully sweet’ like honey. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  91. 91. मधुमेही मधुसमम् जायते स िकल ि धा || ु े धातु या ायौ दोषावृतपथेऽथवा | अ. .िन.१०/१८,१९ आवृतो दोषिलङ ् गािन सोऽिनिम ं दशयेत् || ीणः णा णात् पूण भजते क ृ सा यताम् | अ. .िन.१०/१९,२० अिनिम ं-अक मात्, मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI Modes of manifestation of Madhumeha: 1. Dhatu kshaya: Progressive manifestation - ीणः णा णात् पूण भजते 2. Margaavarana: Sudden onset - सोऽिनिम ं (अक मात्) दशयेत् DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  92. 92. गु ि न धा ललवणा यितमा ं सम ताम् | नवम नं च पानं च िन ामा यासुखािन च || य यायामिच तानां संशोधनमक ु वताम् | च.सू.१७/७८, ७९ े मा िप ं च मेद मांसं चाित वधते || तैरावृतगितवायुरोज आदाय ग छित | यदा बि तं तदा क ृ ो मधुमेहः वतते || स मा त य िप य कफ य च मुहमुहः | दशय याकृ ितं ग वा यमा यायते पुनः || च.सू.१७/७९ -८१ मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI Modes of manifestation of Madhumeha: Kapha Pitta Margavarana to Vata dosha. Results in Madhumeha. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  93. 93. य तु मागावरणेन वायुः क ु यित, स आवरकधिमतया ायेण सामो भवित, त च लङ ् घनं मा या कत यमेव | च.िच.३/१३९ – च पािण आमम नरसं क े िचत्, क े िच ु मलस चयम् | थमां दोषदुि ं च क े िचदामं च ते || मधुकोश या या मा.िन.२५/१-५ मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI § Margaavarana: Sudden onset - सोऽिनिम ं (अक मात्) दशयेत् . § Saama dosha itself is considered as Margavarana. § Dosha dusti janya Ama is responsible for Prameha. But, onset must be sudden. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  94. 94. मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI िव ैरिप न वेते गुणै नि त पर परम् | दोषाः सहजसा य वाि षं घोरमहीिनव || च.िच.२६/२९३ पर परगुणोपघात तु य िप दोषाणां ायो ना येव, तथाऽ य वशात् विच वतीित ेयं; च.िव.१/१०-च पािण § Dosha are having opposite guna. § Dosha guna does not fight each other in an individual as they are Satmya to self. § Sometime, dosha guna may fight each other and hence disease. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  95. 95. मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI अ ये दोषे य एवाितदु े योऽ यो यमू छनात् | को वे यो िवष येव वद याम य स भवम् || अ. .सू.१३/२६ य धातु देशे वि म दो भवित त ैवामस भवाि पिडका ु पि ः यात् | मा.िन.६/२२ - आतङ ् कदपण या या § Anyonya moorchana of dusta dosha or fight between dosha guna results in disease. § This causes dhatu dusti / dhatwagni dusti. § Hence, Prameha. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  96. 96. य तु मागावरणेन वायुः क ु यित, स आवरकधिमतया ायेण सामो भवित, | च.िच.३/१३९ – च पािण अ ये दोषे य एवाितदु े योऽ यो यमू छनात् | को वे यो िवष येव वद याम य स भवम् || अ. .सू.१३/२६ Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults. Currently, autoimmunity is considered the major factor in the pathophysiology of type 1 DM. In a genetically susceptible individual, viral infection may stimulate the production of antibodies against a viral protein that trigger an autoimmune response against antigenically similar beta cell molecules. https://emedicine.medscape.com/article/117739-overview मेह APATHYA NIMITTAJA PRAMEHA = STHOOLA PRAMEHI DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  97. 97. उप व & पूव प DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  98. 98. उप वा तु खलु मेिहणां तृ णातीसार वरदाहदौब यारोचकािवपाकाः पूितमांसिपडकालजीिव यादय त सङ ् गा वि त || च.िन.४/४८ मेह उप व • Thirst, diarrhea, fever, burning sensation, weakness, anorexia, and indigestion. • Carbuncles that putrefy muscle tissues, alaji and vidradhi, appear during the chronic stage of the disease. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  99. 99. मि कोपसपणमाल यं मांसोपचयः ित यायः शैिथ यारोचकािवपाकाः कफ सेक छिदिन ाकास ासा ेित े मजानामुप वाः; वृषणयोरवदरणं बि तभेदो मे तोदो िद शूलम लीका वरातीसारारोचका वमथुः प रधूपनं दाहो मू छा िपपासा िन ानाशः पा डु रोगः पीतिव मू ने वं चेित पैि कानां; द् हो लौ यमिन ा त भः क पः शूलं ब पुरीष वं चेित वातजानाम् | एवमेते िवंशित मेहाः सोप वा या याताः || सु.िन.६/१३ ‘शोषः कासः ास ेित वातजानामुप वा भवि त’ इित ता.| मेह उप व Sushruta briefed the complication under doshic classification. Kaphaja – Mostly GIT & Cardio-respiratory symptoms. Pittaja - Mostly GIT, Circulatory, Urinary, CNS, Haemopoietic system Vataja – Cardio-respiratory, CNS, Locomotor and Anorectal symptoms. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  100. 100. वेदोऽङ ् गग धः िशिथलाङ ् गता च श यासन व नसुखे रित | ने िज ा वणोपदेहो घनाङ ् गता क े शनखाितवृि ः|| शीति य वं गलतालुशोषो माधुयमा ये करपाददाहः| भिव यतो मेहगद य पं मू ेऽिभधावि त िपपीिलका || च.िच.६/१३,१४ य तु खलु दोषाः क ु िपताः मेहानिभिनवतिय य त इमािन पूव पािण दशयि त; त था- जिटलीभावं क े शेषु, माधुयमा य य, करपादयोः सु तादाहौ, मुखतालुक ठशोषं, िपपासाम्, आल यं, मलं काये, कायि छ ेषूपदेहं, प रदाहं सु तां चाङ ् गेषु, षट्पदिपपीिलकािभ शरीरमू ािभसरणं, मू े च मू दोषान्, िव ं शरीरग धं, िन ां, त ां च सवकालिमित || च.िन.४/४७ मेह पूव प LOOKS LIKE COMPLICATIONS: § करपादयोः सु तादाहौ/प रदाहं सु तां चाङ ् गेषु, § मलं काये, कायि छ ेषूपदेह § मू े च मू दोषान्, DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  101. 101. मेह पूव प DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  102. 102. मेह पूव प DR PRASANNA. N MOGASALE pnmogasale73@gmail.com
  103. 103. तेषां यि कि चदाहारिवहारजातं े ममेदोमू जननं स हेतुः|| अ.सं.िन.१०/३ तेषां मेदोमू कफावहम् || अ नपानि याजातं य ाय त वतकम् | वा ललवणि न धगु िपि छलशीतलम् || नवधा यसुरानूपमांसे ुगुडगोरसम् | एक थानासनरितः शयनं िविधविजतम् || अ. .िन.१०/१-३ मेह िनदान – मू जनक आहार End product of fat digestion is not water soluble. End product of Protein is mostly water soluble. End product of carbohydrates are definitely water soluble. DR PRASANNA. N MOGASALE pnmogasale73@gmail.com

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