When the wind within the body becomes disturbed at the mouth of the bladder, it can cause the urine to be expelled together with the natural flow, or, if it moves contrary to its course, the urine is digested within. But when this wind is agitated, it leads to the retention of urine. As a result, a person experiences not only difficulty in passing urine but also pain, itching, and sometimes swelling. The wind, covering the bladder, may rise up, becoming large and displaced, even reaching the region near the anus. In that place, the afflicted one suffers pain, burning sensations, throbbing, and a twisting feeling. When pressure is applied to the bladder, urine is expelled only drop by drop. This obstruction of the urinary stream is known as "wind in the bladder." Overcoming it is difficult, and when a second, stronger wind arises, it is even more challenging. When the wind occupies the space between the rectum and the bladder, it forms a hard, knotty, and elevated mass, resembling a pestle. This condition is called "wind-pestle," produced by the wind flowing through Vishnu’s channel. When this wind is defective, coiled, and intense, it causes severe pain in the bladder, binding up the urine and moving about, bringing stiffness, twisting, and heaviness. The urine is then passed only a little at a time, or very infrequently. This is known as "wind-coil." Sometimes, when urine is retained for a short period, it becomes obstructed and does not come out, or only a small amount is passed, followed by mild pain. If the wind is further obstructed and begins to whirl about due to retention, the lower abdomen, especially below the navel, fills with urine. This leads to intense pain, distension, inability to pass urine, and an accumulation of waste. Such a condition may arise from a defect in the opening of the stomach or from the action of wind. When only a little urine is forcibly retained in the bladder or at the navel, it remains there, floating with a desire to be passed, and eventually is expelled, sometimes with pain and sometimes without. The passage of urine is interrupted, though this is less severe in those with larger genitals. At the mouth of the inner bladder, thirst arises, and the flow, though steady, is scanty and sudden. A knot that causes pain like a stone is called a "urinary knot." In someone who has just urinated or engaged in intercourse, the wind may draw up the semen. When, after urination, the semen is displaced from its place, it may come out either before or after urination. This semen, mixed with urine, is described as resembling water in which ash has been dissolved. When the wind acts upon the rough and weak, reversing the movement of feces and obstructing the urinary channel, the feces may become mixed with the urine. One should recognize obstruction when the urine drop shares a similar odor, a condition caused by bile, exertion, sharp and sour foods, bloating, and similar factors. If the wind increases further, it produces burning sensations in the bladder and urine, and sometimes the urine appears bloody or entirely blood-colored. Repeatedly, the urine is hot and difficult to pass. This is called "hot wind," and it occurs when bile and wind reside in the bladder of a body that is exhausted and rough. These conditions cause depletion of urine and severe burning, and are thus named accordingly. Whether the cause is bile, phlegm, or both, they are ultimately dominated by wind. The urine, then, is passed with difficulty, appearing yellow, red, white, or thick, always accompanied by burning. Its color may resemble rocanā, conch, or powder. When the urine is dry or of all colors, the condition is called "urinary weakness." Thus, the diseases arising from urine have been described in detail. At this point, Dhanvantari spoke, saying, “Now, O Suśruta, I will explain the causes of prameha. Listen well! There are twenty types of prameha: ten arise from phlegm, and the rest from bile and wind. Of these, four are from bile, and six from wind, with additional types caused by the disturbance of fat, marrow, and phlegm. The type called Haridramehī is pungent, with urine and feces resembling turmeric. Mañjiṣṭhameha produces urine like water, while vistra is hot, salty, and reddish. Raktameha is characterized by urine with a blood-like hue. Vasāmehi is marked by urine mixed with fat, passed repeatedly and resembling fat, whereas majjāmehī involves urine mixed with marrow, again passed repeatedly and resembling marrow. There is a type, likened to an elephant, where the urine flows without force, thick and sticky; this is known as the elephant-like prameha. Madhumehī is when the urine becomes like honey. It is of two kinds, arising from the anger of the elements, the depletion of tissues, or when wind obstructs the channels. When the channels are obstructed, the signs of the doṣas may appear without clear cause, sometimes showing depletion, sometimes fullness, and the condition becomes difficult and slow to cure. If neglected over time, all types can become madhumeha, in which the urine is generally sweet, like honey. All these are called madhumeha because of the sweetness in the body. With this condition come indigestion, loss of taste, vomiting, insomnia, cough, and nasal congestion. Complications arise in pramehas born of phlegm, such as pain in the bladder and penis, swelling of the scrotum, and fever. Those born of bile bring burning, thirst, sourness, fainting, and diarrhea. When wind is the cause, there is reversal, trembling, heart pain, and restlessness. As the trident (śūla) rises, there appear dryness, breathlessness, and coughing. Other conditions such as śarāvikā, kacchapikā, jvālinī, and vinatālajī manifest as well. Masūrikā, sarṣapikā, putriṇī, savidārikā, and vidradhi—these ten types of eruptions or boils—arise as a result of neglected prameha. Generally, these conditions begin with the admixture of kapha in food, especially with sweet, sour, salty, unctuous, heavy, slimy, and cold foods. New grains, wine, soups, meat, sugarcane, jaggery, milk products, as well as habits such as sitting in one place and lying down, should be avoided. Kapha, corrupted by prameha, settles in the bladder. After corrupting the body, it affects the moisture, sweat, fat, marrow, and flesh. When pitta and blood are greatly diminished, kapha first takes refuge in the urine. Then, having reached the tissue in the bladder, when that is depleted, vāta arises. Thus, the types of prameha are determined by whether they are curable or incurable. Even when the doṣas are equally involved, distinctions remain due to their predominance. The general symptom in all is excessive and turbid urine. Though the doṣas and the affected tissues may differ, the specific combinations produce various forms of the condition.