Department of Ayurveda Samhita & Sidddanta

1. 1

2. A COMPARATIVE INSIGHT
INTO THE SAMANYA
SAMPRAPTI OF PRAMEHA
VYADHI.
2

3. Presenter –
Dr Rohit Gavali
Final year PG scholar,
Dept. of Ayurveda Samhita and
Siddhanta;
Govt. Ayurveda Medical College,
Mysore.
Under the Guidance of –
Dr Shreevathsa
Head and professor,
Dept. of Ayurveda Samhita and
Siddhanta;
Govt. Ayurveda Medical College,
Mysore.
3

4. CONTENT –
1. Upodghata (Introduction and General Consideration)
2. Vyadhita avastha (Clinical presentation)
2.1 Poorvaroopa
2.2 Roopa
2.3 Arishta
3. Other considerations
3.1 Risk factor
3.2 Family history
4

5. Cont..
4. Vyadhi vinischaya (Consideration of Diagnosis)
4.1 Nidana (Aetiology)
4.2 Samprapti
4.3 Sadhya - asadhyata (Prognosis)
5. Chikitsa Vivecana (Probable treatment plan)
6. Upasamhara (Conclusion)
5

6. 1. UPODGHATA
(Introduction and General Consideration) –
Health and disease being two faces of a single coin are equally
addressed in Ayurveda Shastra with the prime purpose being providing
relief to the sufferings of diseased people i.e., “vyādhyupasr
̥ ṣṭānāṁ
vyādhiparimōkṣaḥ”.
To achieve this goal, the physician should not only possess the in
depth knowledge of pathological process underlying a disease but also
the physiological considerations of human body.
6

7. As it is well said by Acharya Charaka, “rōgamādau
parīkṣēta tatō'nantaramauṣadham| tataḥ karma bhiṣak
paścājjñānapūrvaṁ samācarēt||;” highlighting the importance
of prior examination of patient before commencement of a
treatment.
Atura pariksha has been discussed under various
headings in Ayurveda Shastra viz., Dashavidha pariksha,
Ashta Sthana pariksha and so on.
Every known curable disease has been provided with
nidanadi pancaka for its diagnosis under the heading of Roga
pariksha and appropriate treatment protocols have been
defined for the same. 7

8. The very word nidana is a jati suchaka pada, which
stands for determination or diagnosis as, “ni niścaya
niṣēdhayōḥ” iti | lōkē'pi ‘adya tē nidānaṁ kariṣyāmi’ ityuktē
niścayaṁ kariṣyāmītyavagamyatē |.
Among the five; Nidana, Poorva roopa, Roopa,
Upashaya (-Anupashaya) can be elicited by the physician
either by darshana, sparshana and prashna or any of the three
i.e., by Pratyaksha pramana and anumana pramana. But
determining the samprapti by examining nidanadi four
components is a tedious job unless it is narrated in Arsha
granthas.
8

9. As the diseases are innumerable and the variables
involved in the disease process like doshadi factors are more in
number, so innumerable types of sampeapti can occur. So
eliciting a definitive samprapti for a set of given nidana,
dosha, dushya requires considerations of many concepts
mentioned in shatstras and decoding them with the help of
logical reasoning is always desirable.
9

10. Understanding of a disease process could be mainly by two
different methods viz., starting from consideration of aetiology,
pathogenesis, symptomatology, treatment and so on, for a particular
disease or by starting from the clinical presentation of a disease, tracing
back its aetiology, prodromal symptoms etc., correlating them to elicit
the pathogenesis and there by arriving at a proper clinical diagnosis. In
the initial phase of learning, the formal method would be more ideal and
in later stages the latter.
When it comes to treatment of a disease, the latter approach is
more suitable at it reveals the minute details of various factors involved
in a disease. Considering these factors, the latter method has been
implemented in this presentation.
10

11. 2. VYADHITA AVASTHA
(Clinical presentation) –
The presenting complaints of the patients constitute the
clinical picture.
The patients may approach to the physician seeking
medical care with any of the following complaints, a wise
physician should try to elicit in which stage of what disease the
patient is presenting to.
11

12. So to consider the presenting complaints of
the prameha patients would be –
2.1 Roopa –
स चापि गमनात् स्थानं स्थानादासनपमच्छपत |
आसनादृणुते शय्ां शयनात् स्वप्नपमच्छपत ||२५|| Su Nid 06
The patient may present with lethargy, lack of enthusiasm,
leading to reduced daily activities.
12

13. • आपिल प्रभूत मूत्रता …
• मधुरं सपिच्छं मधूिमं …
• मूत्रे पििीपलका अपभसरणं ….
i.e., the patient may present with increased frequency of
micturition associated with turbidity of urine.
13

14. 2.2 Poorvaroopa –
स्वेदोऽङ्गगन्धः पशपथलाङ्गता च शय्ासनस्वप्नसु े रपतच |
हृन्नेत्रपिह्वाश्रिणोिदेहो घनाङ्गता क
े शन ापतिद्धः ||१३||
शीतपप्रयत्वं गलतालुशोषो माधुययमास्ये करिाददाहः |
भपिष्यतो मेहगदस्य रूिं मूत्रेऽपभधाि्ि पििीपलकाच ||१४||
Ca. Chi 06
14

15. 15
TABLE 1 Enlisting the Poorva roopa of Prameha
Poorva roopa CS SS AH
svēda   
aṅga gandhaḥ / durgandha   
śithilāṅgatā   
śayyā – āsana – svapna – sukhē ratiḥ   
hr
̥ t – nētra – jihvā – śravaṇa upadēha / tālu – gala – jihvā – dantēṣu malōtpatti   
ghanāṅgatā (sthūlāṅgatā)   
kēśa – nakha ativr
̥ ddhiḥ / kēśānāṁ - nakhānām vr
̥ ddhi   
śīta priyatvaṁ   
gala – tālu śōṣa / pipāsā   
mādhuryam āsyē   
kara – pāda dāhaḥ / hasta – pāda tala dāhaḥ   
mūtrē'bhidhāvanti pipīlikāśca / madhura – śukla mūtratā   
snigdha – picchila – gurutā gātrāṇāṁ   
tandrā – sādaḥ   
Śvāsa   
Poorva roopa in prameha are important as there are no other sārvadaihika lakṣaṇa mentioned for this
disease. The interpretation in relation to the manifestation of porva roopas and their relevance in prognosis will
be done in due course of the discussion.

16. 2.3 Arishta –
िातव्यापधरिस्मारी क
ु ष्ठी शोफी तथोदरी |
गुल्मी च मधुमेही च राियक्ष्मी च यो नरः ||८||
अपचपकत्स्या भिन्त्येते बलमांसक्षये सपत |
अन्येष्वपि पिकारेषु तान् पभषक
् िररििययेत् ||९||
Ca. Ind 09
16

17. Here the general consideration into the prognosis of
eight multi-factorial diseases has been given (as an
example) by keeping the patient’s physical strength in the
centre.
Here the word madhumeha should be considered as
indicative of prameha itself, as by nature madhumeha is
asadhya so there is no need of considering other criteria to
determine its prognosis.
So, if the patients present with prameha lakshanas
associated with bala mamsa kshaya, then the physician
should understand the disease as acikitsya and should not
assure of fruitfulness of treatment to the patients.
17

18. Other arishta,
स्नातानुपलप्तगात्रेऽपि य्स्मन् गदध्न्ि मपक्षकाः |
स प्रमेहेण संस्पशं प्राप्य तेनैि हन्यते ||१६|| Ca. Ind 05
And,
स्नेहं बहुपिधं स्वप्ने चण्डालैः सह यः पिबेत् |
बध्यते स प्रमेहेण स्पदश्यतेऽिाय मानिः ||१७|| Ca. Ind 05
18

19. Though the patient may not present with these
complaints, but as a part of negative history the physician
should enquire into these aspects to understand about the
prognosis of the disease.
The treatment aspect of such incurable prameha will be
summarized at the later part of discussion.
19

20. 3. OTHER FACTORS –
3.1 Risk Factors –
गदध्नुमभ्यिहायेषु स्नानचङ्क् रमणपिषम् |
प्रमेहः पक्षप्रमभ्येपत नीडद्रुमपमिाण्डिः ||५०||
and,
मन्दोत्साहमपतस्थूलमपतपस्नग्धं महाशनम् |
मदत्ुः प्रमेहरूिेण पक्षप्रमादाय गच्छपत ||५१|| Ca Ni 04
20

21. Prameha manifests in people who are –
• Greedy for food articles.
• Not taking bath regularly.
• Not involving into physical activities like regular
walking etc.,
• Lack enthusiasm.
• Obese.
• Consume excess of unctuous food.
• Consume excess quantity of food.
21

22. All these habits are indicative of santarpanotha prameha.
Eliciting these components makes it relatively easy for the
physician to consider other relevant etiological factors. This also
provides an insight into the underlying common pathogenesis of
Santarpanotha vyadhis.
The interrelation between santarpanotha vyadhis, sthaulya
and prameha will be discussed further in detail.
22

23. 3.2 Family history –
Considering sahaja prameha.
A positive family history may indicate the yapya avastha or
asadhya avastha of prameha.
The aetiology being bījadōṣa (i.e., genetic predisposition); as it is
said,
“तत्र सहिो मातदपितदबीिदोषक
द तः”
23

24. 24

25. • The child born to a couple suffering from prameha will also suffer
prameha and such condition is manageable (yapya).
• The child born to a couple suffering from madhumeha will also suffer
madhumeha and this condition cannot be treated (asadhhya).
And the phenotypic presentation would be –
“क
द शो रूक्षोऽल्पाशी पििासुभदयशं िररसरणशीलच भिपत”
25

26. 4. VYADHI VINISCHAYA
(Consideration of Diagnosis) –
Considering apathy nimittaja prameha.
Pratyātmika lakṣaṇa of a vyadhi itself is sufficient for the
diagnosis of a disease; however, pratyātmika lakṣaṇa has not
been mentioned for every disease discussed in the shastra. So
nidanadi pancake has been mentioned for each disease which
either individually or collectively helps in diagnosing a
disease, even in case of anukta vyādhi.
26

27. Treatment of any disease can be broadly classified under two
headings viz.
1. Hētupratyanīka cikitsā and
2. vyādhi pratyanīka.
So knowledge of individual components of nidanadi pancaka is
essential.
27

28. 4.1 Nidana –
In the context of prameha nidana, a special concept
called “vikāra vighāta bhava ābhāva” has been discussed
which throws light on the association of nidana with dosha and
nidana with dushya. It also speaks about the time duration of
these associations and the quantum of nidana consumed both
in terms of frequency and duration.
If the association of the nidana with the dosha and the
dushya is for a brief time and amount, then it would lead to
mild vitiation of the doshas and the dushyas.
28

29. This determines the degree of vitiation of doshas and in turn the
severity of the manifesting disease.
As it is said, “dōṣa pramāṇa viśēṣam apacāra viśēṣēṇa” i.e.,
apacāraviśēṣēṇēti mahatā'pacārēṇa bhūridōṣō bhavati, svalpēṇa svalpa iti |
and also “saṅkṣēpataḥ kriyāyōgō nidānaparivarjanam |”, so the detailed
analysis of the nidanas becomes important for a physician.
Looking into the prameha nidana –
Table 2.
29

30. 30
TABLE 2 Showing prameha nidana and their effect on the body
Ca Nid 04 / Su Ni 06 Ca Chi 06 Effects on the body
हायनक / यिक / चीनक / उद्दालक
/ नैषध / इत्कट / मुक
ु न्दक /
महाव्रीपह / प्रमोदक / सुगन्धकानां
निानाम् अपतिेलम् अपतप्रमाणेन
चोियोगः
नवान्न शूकधान्यवर्गः – प्रायेणाभिनवं र्ुरु | 27/309
तक्रान्तो नवधान्याभियोऽयं वर्ग उिाहृतः |
िोषसञ्जननो ह्येष भवज्ञेयः पूयवधगनः || Su Su 19/17
(नवधान्य माष भतल कलाय क
ु लत्थ भनष्पाव हरितकशाक अम्ल लवण कटुक र्ुड
भपष्टभवक
ृ भत वल्लूि शुष्कशाक अज अभवक आनूप औिक- मांस वसा शीतोिक क
ृ शिा
पायस िभध िुग्ध तक्र प्रिृतीभन परिहिेत् ||१६||)
आनूि मांस / औदक मांस आनूप िसाः /
औिक िसाः
क्षीर द्रि पयांभस
मन्दकदपध िधीभन भििोषं मन्दक
ं … Ca Su 27/228
िधी – मेिःशुक्रबलश्लेष्मभपत्तिक्ताभिशोफक
ृ त् As H Su 5/30
ग्राम्य मांस ग्राम्य िसाः कफभपत्तभववधगनाः Ca Su 27/57
निहरेणु / निसूप्यानां पूयवधगनः र्ण्
शाक / पतलिलल भपण्याकभतलकल्कस्थूभणकाशुष्कशाकाभन सवगिोषप्रकोपणाभन | Su Su 46/294
कफभपत्तकिाभण च | Su Su 46/382

31. 31
पिष्टान्न पिष्टान्नं नैि भुञ्जीत … Su Su 46/494
िायस / क
द शरा / पिलेपि पूयवधगनः र्ण्
निमाष
सपियष्मतां !
प्रिूतान्तमगलो माषसूपः Ca Su 27/4
माष बहुमलः Ca Su 27/25
ईक्षुपिकार ईक्षुभवकाि - फाभणतं र्ुवगभिष्यन्दन्द चयक
ृ न्मूिशोधनम् |
As Hr Su 05/47 and ईक्षु – मूिक
ृ त् As Hr Su
05/42
र्ुडवैक
ृ तं र्ुड नवः श्लेष्माभिसािक
ृ त् |
निमद्य नव पानं प्रायशोऽभिनवं मद्यं र्ुरुिोषसमीिणम् | Ca Su 27/ 193
मधुर तरुणप्रायाणां च उियोगः
गुरूष्णपस्नग्धमधुरा
यच कपचपिपधर अन्यो अपि श्लेष्म मेद मूत्र सञ्जननः
शीत पस्नग्ध मधुर मेद्य द्रि अन्न िान सेपिनं
कफक
ृ च्च
सवगम् |
स्वप्न शयन आसन प्रसङ्गः
आलस्य प्रसक्तं
पदिास्वप्न
आस्यासुखं
स्वप्नसुखं
मेिन्दस्वनः स्नेहभनत्ाः श्लेष्मलाः श्लेष्मिोभर्णः|
िू षीभवषातागश्च भिवा न शयीिन् किाचन||४५|| Ca Su 21
श्लेष्मभपत्त प्रकोप / सवगिोष प्रकोपण
मदिा व्यायाम िियनं
अव्यायाम प्रसक्तं

32. As an overview, all these Ahara-vihara are benefiting the
body in a way by providing nourishment and developing strength,
as most of these ahara dravyas (except shukadhanya) can be seen
in rasayana adhikarana but when consumed in excessive
quantities for a comparatively prolonged period (अपतिेलम्
अपतप्रमाणेन चोियोगः), they can also cause vitiation of doshas
(predominantly kapha dosha) and also medovaha srotodusti.
32

33. Now considering these nidanas, one shall see how they are
causing various srotodusti as mentioned in the below table.
33
TABLE 3 showing an overview on nidana and srotodusti.
Nidana Srotodusti
अपतमात्रस्य चाकाले चापहतस्य च भोिनात् | अन्नवाह
गुरुशीतमपतपस्नग्धमपतमात्रं… िसवाह
पस्नग्धोष्णापन द्रिापण च… भितां चातिानलौ | (pittaja prameha) िक्तवाह
अपभष्यन्दीपन भोज्यापन… भुक्त्वा च स्वितां पदिा | मांसवाह
अव्यायामापद्दिास्वप्नान्मेद्यानां चापतभक्षणात् |.. िारुण्याचापतसेिनात् | (Su
Nid)
मेिोवाह
अत्पभष्यन्दात्… मज्जवाह
क्षीणस्या… (Vataja prameha) मूिवाह
अत्शनादिीणायध्यशनात्तथा | वचोवाह

34. 34
As the prameha nidanas are causing dusti of almost all srotasas and are leading
to the formation of abadda dhatus.
So there is an interaction of the nidana with the dosha and the dushya;
nidana is vitiating the doshas and the dushyas simultaneously (since
kiñciddōṣapraśamanaṁ kiñciddhātupradūṣaṇam |… trividhaṁ dravyamucyatē|).

35. Thus vitiated doshas further vitiate the dhatus depending
upon the type of nidana the patient indulges in.
One can also notice the similarities in santarpanotha
vyadhi nidana (Ca Su 23/3-5) with that of prameha nidana and
also the similar things have been mentioned as risk factors for
the manifestation of prameha as discussed earlier.
Consequently, there is co - existence of other
santarpanotha vikaras as comorbid conditions with prameha
and similarities with the sthaulya aṣṭa dōṣāḥ and the best
example is co- existence of prameha and prameha pdaka.
35

36. 36
TABLE 4 depicting Clinical manifestation of nidana sevana mentioned in prameha vyadhi
Santarpana janya vikaras Ca Su 23 Sthaulya Ca Su 21 Bahu dosha linga Ca Su 16
अिोचकः / आमप्रिोषाः - अरुभचः / अभवपाक
अभतस्थौल्यम् अभतस्थूल स्थौल्यं
-
िौर्गन्ध्यं
(मेिोिोषात् मेिसः स्विावात् स्वेिनत्वाच्च)
िौर्गन्ध्यम्
र्ुरुर्ािता
स्वेिाबाधः
(मेिसः श्लेष्मसंसर्ागत् भवष्यन्दन्दत्वात् बहुत्वात् र्ुरुत्वात् व्यायाम
असहत्वाच्च)
र्ौिवं
- (शैभथल्यात् सौक
ु मायागत् र्ुरुत्वाच्च मेिसो जवोपिोधः) -
- भपपासाभतयोर् (तीक्ष्णाभित्वात् प्रिूतकोष्ठवायुत्वाच्च) -
-
िौबगल्यं
(असमत्वाद्धातूनां)
िौबगल्यं
आलस्यं
सौक
ु मायागन्मेिसः सवगभक्रयास्वसमथगः –
clinical presentation
आलस्य / क्लमः (अनायासक
ृ तः श्रमः क्लमः) /
श्रम (स्वल्पेनायासेन ज्ञेयः)
- अवसािकः (अवसािको मनोऽवसािः)
तन्द्रा तन्द्रा / अभतभनद्रता / भनद्रानाश
प्रमेहभपडका प्रमेहभपडका ज्वि …. वातभवकािाणामन्यतमं प्राप्य पञ्चत्वमुपयाभत भपडका
इन्दन्द्रय - स्रोतसां लेपः - -
एवंभवधाश्च अन्ये शीघ्रं अप्रभतक
ु वगतः - श्लेष्मभपत्तसमुत्क्क्लेश
To understand and look into this santarpanotha shareera one shall consider other relevant references as –

37. This explains the manifestation of most of the poorva roopas of
prameha which were mentioned previously.
The remaining, हस्तिादतलदाहः – हस्ततलापददाहः प्रभािात्| (Nya.
Cha)
Thus manifested santarpanotha shareera is liable to many
diseases, further among which one shall see the pathogenesis of
prameha.
37

38. 4.2 Samprapti –
Prerequisites for manifestation of prameha –
• शरीरशैपथल्य
• बह्वबध मेदसत्व
• शरीरक्लेद - मांस अप्रक
द पतभूतत्व
• प्रक
द पतपिक
द पतभूतत्वात् (प्रक
ृ भतिूतैः र्ुणैः सववः एव भवक
ृ तत्वात्)
These things are manifested as a result to consumption of
santarpanakara ahara vihara for a sufficiently prolonged time period and
in larger quantities than usual, leading to a condition called, santarpanotha
shareera as discussed earlier.
38

39. Image representing the phenotype
susceptible for the manifestation of
prameha vyadhi.
Now as this phenotype is
conducive for further nidanas to
vitiate doshas and dushyas,
leading to the manifestation of
different types of prameha,
which will be discussed in
detail.
39

40. 4.2.1 Kaphaja Prammeha –
..ियो भनिानाभिभवशेषाः श्लेष्मपनपमत्तानां प्रमेहाणामाश्वपभपनयिदयपत्तकरा
िवन्दन्त;
The nidana - dosha - dushya trio, when conducive to one
another, initially the kapha dosha gets vitiated easily due to
similar gunas of kapha dosha and nidanas along with dushyas
like Shareeraja kleda, mamsa and meda.
40

41. 41
Figure 1

42. 42

43. 4.2.2 Pittaja Prameha –
Nidana –
उष्ण अम्ल लिण क्षार कटुक अिीणयभोिन उिसेपिनः तथा
अपततीक्ष्ण आति अपिसिाि श्रम रोध पिषमाहारोिसेपिनच
तथापिधशरीरस्यैि पक्षप्रं पित्तं प्रकोिमािद्यते |
• Figure 2.
• Pittaja prameha samprapti
43

44. 44
Figure 2

45. 45

46. This is summarized by Acharya Charaka as –
मेदच मांसं च शरीरिं च क्लेदं कफो ब्स्तगतं प्रदू ष्य |
करोपत मेहान् समुदीणयमुष्णैस्तानेि पित्तं िररदू ष्य चापि ||५||
Ca Chi 06
46

47. Further,
There could be involvement of pitta in the kaphaja samprapti in
the santarpanotha shareera, this could lead to the manifestation of
avarana saprapti of prameha
As mentioned,
श्लेष्मा पित्तं च मेदच मांसं चापतप्रिधयते ||७९||
तैरािदतगपतिाययुरोि आदाय गच्छपत |
यदा ब्स्तं तदा क
द च्छ
र ो मधुमेहः प्रितयते ||८०||
स मारुतस्य पित्तस्य कफस्य च मुहुमुयहुः |
दशययत्ाक
द पतं गत्वा क्षयमाप्यायते िुनः ||८१||
उिेक्षयाऽस्य िायिे पिडकाः सप्त दारुणाः | Ca Su 17
47

48. i.e..
vrudha kapha-pitta doshas and upachita mamsa and meda
cause avarana of vata dosha, leading to vitiation of vata dosha
leading to the manifestation of prameha and the symptomatology is uncertain
depending on avarana
i.e., there could be symptoms of kapha or pitta or vata dosha
because of this uncertainty in symptoms, it is usually neglected and thus it
becomes chronic and leads to the manifestation of prameha pidakas and also
the involvement of ojas there by the pathogenesis of madhumeha is set in.
48

49. 4.2.3 Vataja prameha
The patient may approach in kaphaja or pittaja prameha avastha or in
santarpanotha bahu dosha avastha and the physician by evaluating santarpanotha
nidana considers shodhana and apatarpana to be the line of treatment and manages
the condition with aggressive shodhana karmas or kashayadi yogas.
• In shamana, the prolonged use of kashayas may cause rukshata in shareera
• In shodhana, the atiyoga may cause dhatukshaya
So in the pathogenesis of kaphaja prameha or pittaja prameha or kapha
pittaja prameha, there could be involvement of vata dosha due to excessive
removal of shareeraja kleda (or sneha bhava) leading into manifestation of vataja
prameha.
49

50. Now considering the Nidana -
कषाय कटु भतक्त रूक्ष लघु शीत व्यवाय व्यायाम वमन भविेचन आस्थापन- भशिोभविेचन अभतयोर्
सन्धािण अनशन अभिघात आतप उद्वेर् शोक शोभणत अभतषेक जार्िण भवषमशिीिन्यासान्
उपसेवमानस्थ तथाभवधशिीिस्यैव भक्षप्रं वातः प्रकोपमापद्यते ।।
i.e.,
because of indulging in vatakara ahara vihara, or due to vamanadi karma
atiyoga,
vata prakopa due to rukshata and kashayata
when this vitiated vata spreads all over the body and does the dushana of -
vasa, causes vasa meha / majja, causes majja meha / lasika, causes hasti meha
/ oja, causes madhumeha. 50

51. This has been beautifully explained by Acharya Sushruta as –
क
ृ त्स्नं शिीिं भनष्पीड्य मेिोमज्जवसायुतः । अधः प्रक्रमते वायुस्तेनासाध्याास्तु वातजाः ||२१|| Su Nid 04
i.e..
the vitiated vata dosha spreads all over the body and literally meda, majja, vasa
etc., dhatus are squeezed out and brought down to the basti and causes asadhya
prameha
This is summarized by Acharya Charaka as -
क्षीणेषु िोषेष्ववक
ृ ष्य बस्तौ धातून प्रमेहानभनलः किोभत । Ca. Chi 06/06
51

52. Here the term ksheeneshu dosheshu is relative, which indicates the
relative increase of vata dosha compared to pitta and kapha dosha due to the
excess of removal of ama doshas and dushyas.
This santarpanotha prameha landing up into vata samsrushta prameha
initially and later may get converted into kevala vataja prameha due to
excess loss of shariraja snehamsha and becomes asadhya madhumeha.
वायुभहग मेहेष्वभतकभशगतानां क
ु प्यत्साध्याान् प्रभत नान्दस्त भचन्ता ||५२|| Ca Chi 06
And as mentioned earlier, kevala vatja prameha could occur in familial cases
where the patient is lean and occurring due to bijadosha.
52

53. Samprapti Ghataka -
• Dosha :
भििोषकोपभनभमत्ता भवंशभतः प्रमेहा िवन्दन्त । Ca. Nid 04/03
अपरिपक्वा (आमाः) वातभपत्तश्लेष्माणः .... Su. Nid 06/04
बहुद्रवः श्लेष्मा िोषभवशेषः | Ca Nid 04/06
शुक्रिोषप्रमेहास्तु व्यानापानप्रकोपजाः ||२०|| Su Nid 01
 शुक्रस्य सवागङ्गर्तत्वात् प्रमेहस्य सवगिेहर्तिसाभिदृष्यप्रिवत्वाद्ध्यानक
ृ तत्वं, मेद्वािसंभश्रतत्वािपानक
ृ तत्वं च ||२०||
• Dushya:
बहबद्ध मेिो मांस शिीिजक्लेिः शुक्र
ं शोभणतं वसा मज्जा लसीका िसश्चौजः सङ्ख् यात इभत दृष्यभवशेषाः ||७||
Ca. Nid 04
i.e., bahutvam, aghanatvam of Meda - Mamsa - Vasa – Majja
bahutvam of Shareeraja kleda - Rasa Rakta - Lasika- Shukra - Oja
मेिस Su. Nid 06/04
 मेिसेभत अिाभपशब्दो लुप्तो द्रष्टव्यः तेन वसाियो ग्राह्या
53

54. • Agni – जाठिाभि, धात्वाभि
• Ama – कोष्ठर्त आम धातुर्त आम
• Srotodusti – अभतप्रवृभत्तः सङ्ग भवमार्गर्मन
• Udbhava Sthana – आमाशयसमुत्थ
• Sancara sthana – सवग शिीि
• Vyakta Sthana – बन्दस्त मुख
• Roga marga – बाह्य िोर्मार्ग
• Vyadhi Swabhava – याप्य (since प्रमेहोऽनुषभङ्गणा)
54

55. 4.3 Sadhya - Asadhyata
As mentioned earlier the poorvaroopas of prameha -
• If all the poorvaroopas are present, then the prameha is asadhya irrespective of
which type of prameha the patient is suffering from.
• In kaphaja pramehi, if few poorva roopas are present then the sadhya prameha
becomes yapya
• In pittaja prameha, if any of the poorva roopas present, then the yapya prameha turns
asadhya.
And,
साध्यााः कफोत्था िश, भपत्तजाः षट् याप्या, न साध्याः पवनाच्चतुष्कः।
समभक्रयत्वाभद्वषमभक्रयत्वान्महात्यत्वाच्च यथाक्रमं ते ||७|| Ca Chi 06
Kaphaja ten pramehas are sadhya due to sama kriya, pittaja six pramehas are yapya
due to requirement of vishama kriya for pitta dosha and medadi dushyas and the vataja
four pramehas are asadhya as they make the person to land up into mahatyaya avastha
(due to loss of oja).
55

56. 5. Chikitsa Vivecana (Probable treatment plan)
By looking into the samprapti, one shall know that in chikitsa one has to
address the following issues -
• To prevent further utpatti of ama doshas and abadda dhatus i.e., by
nidana parivarjan (Cha. Chi 06/53)
• Measures to remove the dushta doshas and dushta dhatus from the
body (Cha Chi 06/49) i.e., by shodhana.
• Measures to re-establish prakruta dhatu utpatti (Cha Chi 06/16)
56

57. 6. Upasamhara (Conclusion) -
So understanding of the pathogenesis of a disease not only
provides an insight into the various factors involved in the manifestation
of the disease process but also it also unveils the diverse range of
available treatment modalities which can be implemented at various
stages of a disease.
"न एवं शब्दमभपऽन्यिार्मात्”
57

58. Discussion
58

59. Thank you
59