Prameha is described as a santarpanajanya vyādhi characterized by prabhuta-mutratā (excessive urination) and madhurya of urine. It involves kapha-meda dushti and ojakṣaya. Classical Ayurveda identifies 20 types — 10 Kaphaja, 6 Pittaja, and 4 Vātaja — with Madhumeha considered the incurable or chronic form, correlating with Diabetes Mellitus.

"प्रमेहास्तु त्रयो विंशतिरुक्ताः पूर्वोक्तलक्षणाः । कफजा पित्तजा वातजाश्चान्यान् प्रयोजयेत् ॥"
(चरक चिकित्सा ६/४)

Prameha is primarily a Kapha-Meda disorder. Excessive intake of guru-snigdha-madhura āhāra, avyayāma, and divasvapna lead to meda vriddhi and kapha prakopa, causing prameha. Chronicity leads to dhatukṣaya and Madhumeha (Vāta-pradhāna stage). Suśruta and Charaka both emphasize the link between obesity (Sthaulya) and Prameha, while Mādhava Nidāna details lakṣaṇa and upadrava. Later texts like Bhaishajya Ratnāvali and Bhāvaprakāśa list extensive formulations for Prameha.

Dietary causes:

• Ati-madhura, guru, snigdha āhāra — excessive sweets, milk, curd, rice, oily foods.

  "मधुरं गुरु स्निग्धं च भोजनं प्रमेहकरं"
  (चरक सूत्रस्थान १७)

• Ati-annapāna (overeating, excess food and drink)

  "अतिसम्पूर्णं ह्यन्नं प्रमेहं जनयत्यपि"
  (सुश्रुत निदान ६)

• Madyapāna (alcohol), navānna (new grains), payaḥ preparations

  "नवान्नपानीयमध्यमां प्रमेहे दोषकारणम्"
  (माधवनिदान ३३)

• Viruddhāhāra — incompatible combinations produce āma and meda vriddhi.

Lifestyle causes:

• Avyayāma (lack of exercise) → Kapha-Meda vriddhi.

  "अव्यायामः प्रमेहेषु दोषाणां संप्रवर्धकः"
  (चरक सूत्रस्थान २१)

• Diwasvapna (day sleep) → Kapha increase.

  "दिवास्वप्नः प्रमेहकरः"
  (अष्टाङ्गहृदय सूत्रस्थान ७)

• Ati-vyayāma, ratrijagarana → later cause dhatukṣaya, leading to Madhumeha.
• Manasika hetu — stress, anger, grief worsen Vāta and Ojas depletion.

Pathogenesis: Kapha-predominant hetus → Meda dhātu vriddhi and Kapha prakopa → obstruction of Mutravaha srotas → Prameha. Prolonged disease leads to dhatukṣaya (mamsa, meda, majja, shukra), Vāta prakopa, and transformation into Madhumeha. Charaka: Santarpana → Kapha-Meda vriddhi; Suśruta: medovaha srotodushti; Mādhava: rakta involvement in chronicity.

"मेहेषु प्रथमं दोषः कफ एव प्रकुप्यति । ततोऽन्येऽपि प्रकोपं लभन्ते"
(चरक चिकित्सा ६)

Diagnosis: Classical — prabhuta mutratā, madhurya of urine, daurbalya. Examination of urine for sweetness/oiliness described. Modern — fasting blood sugar, PPBS, HbA1c, urine sugar, lipid profile, renal function.

• Atimatra pipāsā (excessive thirst)
• Ati-mutratā (polyuria)
• Guruta (heaviness)
• Swedadhikya (excessive sweating)
• Kandu (itching, especially in genital region)

• Prabhuta Mutrata (Excessive urination)
• Madhurya of Mutra (Sweetness of urine)
• Ati-pipasa (Excessive thirst)
• Daurbalya (Weakness, fatigue)
• Sharira Gaurava (Heaviness of body)
• Swedadhikya (Excessive sweating)
• Prameha Pidaka (Boils/carbuncles on skin)

• Prabhuta-mutrata (polyuria)
• Madhurya of urine (sweet taste)
• Oily/unctuous urine
• Daurbalya (weakness)
• Sharira-gaurava (heaviness of body)
• Prameha-pidaka (boils, carbuncles)

"प्रभूतं मधुरं तैलं मूत्रं प्रमेहिनो भवेत्"
(माधवनिदान ३३)

Classical types:

• 10 Kaphaja Prameha — bahu-mūtratā with kleda, snigdha-mūtra
• 6 Pittaja Prameha — yellowish/bloody urine, dāha
• 4 Vātaja Prameha — madhumeha, kṣaya-lakṣaṇa, incurable

• Prameha-pidaka (skin infections, boils)
• Hṛdroga
• Pakshaghāta
• Renal disease
• Netra roga (retinopathy)

Kaphaja prameha — sadhya; Pittaja — yapya; Vātaja/Madhumeha — asadhya.

• Principles: Langhana, Lekhana, Kapha-Meda hara, Vāta-pittānusārī chikitsa in chronic stage.
• Panchakarma: Vamana for Kapha type, Virechana for Pitta, Basti (Niruha & Anuvasana) in Vāta/Madhumeha; Raktamokṣaṇa in complications.

  "वमनं कफजे श्रेष्ठं विरेचनं तु पित्तजे । बस्तिर्वातजमेहेषु चिकित्सारत्नमुच्यते ॥"
  (भैषज्य रत्नावली प्रमेह चिकी.

• Herbal medicines:
  • Nisha-katuki yoga
  • Triphala + Turmeric
  • Shilajatu
  • Guggulu (Chandraprabha Vati, Shilajitvadi Vati)
  • Arjuna, Jambu, Bilva, Gudmar, Meshashringi
• Rasāushadhi: Arogyavardhini Vati, Vasant Kusumakar Ras, Prabhakar Vati (for complications)
• Pathya: Yava (barley), Kulattha, Mudga, Tikta-śaka, Triphala, Honey water.
• Apathya: Milk, curd, sugarcane products, sweets, day-sleep, alcohol.
• Yoga & Lifestyle:
  • Āsana: Ardha Matsyendrasana, Dhanurasana, Trikonasana
  • Prānāyāma: Kapalabhati, Anuloma-Viloma, Bhastrika
  • Mudra: Apāna Mudrā, Prāṇa Mudrā
  • Mantra: Recitation of "Maha Mrityunjaya Mantra" for mental steadiness
  • Daily Vyāyāma and Dinacharya regulation

• Barley, green gram, bitter vegetables
• Honey (in moderation)
• Warm water
• Regular exercise, yoga

• Sweets, milk, curd, new rice
• Alcohol
• Day sleep
• Sedentary habits

Diabetes Mellitus is a metabolic disorder characterized by chronic hyperglycemia. Ayurveda correlates it with Prameha/Madhumeha. Management combines Ayurvedic Shodhana, Shamana, Rasayana, diet and lifestyle correction, alongside modern glucose monitoring and pharmacotherapy when needed.

• Urine sugar testing (classical taste/texture, modern dipstick)
• Blood glucose: FBS, PPBS, HbA1c
• Lipid profile
• Renal function tests