Listen now to the detailed account of the disorders of urine and the conditions known as prameha, as expounded by the great sage Dhanvantari to Suśruta. It begins with the observation that when a small quantity of urine is forcibly held back within the bladder or at the navel, it lingers there, yearning to be expelled. Eventually, it is released, sometimes with pain, sometimes without. In such cases, the flow of urine is interrupted and incomplete. This interruption is less troublesome in those with large genitals, but at the opening of the inner bladder, there arises a sensation of thirst, and the urine, though steady, emerges in scanty and sudden spurts. There are times when a painful knot forms, hard as a stone, known as a urinary knot. This can occur in one who has urinated or engaged in intercourse; then, the wind within the body draws up the semen. If, after urination, the semen is displaced, it may flow out before or after the urine, mingling with it and giving it the appearance of water mixed with ashes. When the wind within acts upon the rough and weak parts of the body, it may reverse the course of the feces, and if the urinary channel is blocked, the feces and urine may mix together. Obstruction is recognized when a drop of urine carries a particular odor, a result of bile, overexertion, sharp and sour foods, bloating, and similar causes. When the wind increases further, it brings a burning sensation to the bladder and urine, and the urine itself may first appear tinged with blood or entirely blood-colored. The passage of urine becomes repeatedly hot and difficult, a condition known as hot wind, which arises when both bile and wind dwell in the bladder of a body that is exhausted and rough. This leads to depletion of urine and intense burning, and whether the cause is bile, phlegm, or both, ultimately, wind prevails. In such states, the urine is passed with great difficulty, sometimes yellow, red, white, or thick, always accompanied by burning. Its color may resemble substances like rocanā, conch, or powder. When the urine is dry or displays all colors, this is called urinary weakness. Thus, the diseases arising from urine have been described in detail. Then Dhanvantari spoke: “Now, Suśruta, listen as I explain the causes of prameha. There are twenty types of prameha: ten arise from phlegm, while the rest arise from bile and wind. Of these, four are due to wind and six are due to a combination of fat, marrow, and phlegm. One type, haridramehī, is pungent and yellow like turmeric, and even the feces resemble turmeric. In vistramehī and mañjiṣṭhamehī, the urine takes on the qualities of hot, salty, and reddish water, or the hue of blood. Vasāmehī is marked by urine mixed with fat, passed repeatedly and resembling fat itself, while majjāmehī is characterized by urine mixed with marrow, passed again and again. There is also a type known as hastimeha, or 'elephant-like' prameha, where the urine flows thick and sticky, without force, much like an elephant’s. In madhumehī, the urine becomes sweet like honey. This condition is of two kinds, arising from the disturbance of the bodily elements, depletion of tissues, or when wind obstructs the channels. When these channels are blocked, the signs of the doshas appear without obvious cause; sometimes the body is depleted, sometimes full, and the condition becomes difficult and slow to cure. If neglected over time, all pramehas tend to become madhumeha, in which the urine is generally sweet, like honey. All these are called madhumeha because of the sweetness pervading the body; from this, indigestion, loss of taste, vomiting, insomnia, cough, and nasal congestion can arise. Complications of prameha that arise from phlegm include pain in the bladder and penis, swelling of the scrotum, and fever. When bile is the cause, there is burning, thirst, sourness, fainting, and diarrhea. Those caused by wind bring about reversal of normal functions, trembling, pain in the heart, and restlessness. When the trident of pain (śūla) arises, it brings dryness, breathlessness, and coughing. Other conditions such as śarāvikā, kacchapikā, jvālinī, and vinatālajī can also manifest. Further, eruptions known as masūrikā, sarṣapikā, putriṇī, savidārikā, and vidradhi may appear—ten kinds of eruptions that result from neglecting prameha. These conditions generally arise from an excess of kapha in the diet, especially when one consumes foods that are sweet, sour, salty, unctuous, heavy, slimy, and cold. New grains, wine, soups, meat, sugarcane, jaggery, milk products, prolonged sitting, and lying down should be avoided. Kapha, corrupted by prameha, settles in the bladder. It first corrupts the body, affecting moisture, sweat, fat, marrow, and flesh. When pitta and blood are greatly diminished, kapha first takes refuge in the urine. Once it reaches the tissue in the bladder and that is also depleted, wind (vāta) arises. Thus, the types of prameha are determined by whether they are curable or incurable; even when all the doṣas are involved, their predominance determines the distinction. The general sign of all pramehas is the excessive and turbid nature of the urine. Though the doṣas and affected tissues may differ, their specific combinations produce variations. The types of prameha are further distinguished by the color and other qualities of the urine: it may be clear, very white, cold, odorless, and water-like. In udakameha, the urine is watery, slightly turbid, and slimy. In ikṣumeha, it is exceedingly sweet, like the juice of sugarcane. In sāndrameha, the urine is thick and stale; in surāmeha, it is like wine—clear on top and dense below. In śukrameha, the person experiences hair standing on end; the urine is thick and white like flour, resembling semen or mixed with semen. In sikatāmeha, the urine contains sandy particles. In śītameha, the urine is abundant, sweet, and very cold. In śanairmeha, urination happens slowly and gradually, while in lālāmeha, the urine is slimy and mixed with threads of saliva. In kṣārameha, the urine resembles alkaline water in smell, color, taste, and touch. In nīlameha, it is blue, and in kālameha, it is black like ink. Eruptions may appear at the joints, vital spots, and muscular channels. These are raised at the edges, sunken in the middle, dry, and painless. The eruption called śarāvikā is shaped like a shallow dish; kacchapikā always burns and, as the wise say, resembles a tortoise. A large, blue eruption is known as vinatā, and jvālinī arises on the skin with burning and causes severe pain. Thus, in detail, are the disorders of urine and the many forms of prameha, their causes, symptoms, and complications, as described by the wise for the benefit of all.