Dhanvantari, the divine physician, addressed Suśruta with deep compassion and clarity. “Listen, Suśruta,” he began, “I shall now explain the causes and varieties of prameha, the set of diseases arising from disorders of urine. There are twenty distinct types of prameha, each with its own roots and manifestations. Of these, ten have their origin in phlegm, while others stem from bile and wind. Specifically, four types arise from disturbances of wind, and six more from imbalances involving fat, marrow, and phlegm. Let me describe their forms to you. In the condition known as haridramehī, the urine takes on a pungent quality, resembling turmeric, and even the feces appear similar. Then there is mañjiṣṭhameha, where the urine is as clear as water, while vistrameha presents with urine that is hot, salty, and tinged red. In raktameha, the urine bears the hue of blood. Some pass urine mixed with fat, thick and unctuous, a condition called vasāmeha, which recurs again and again. Others, afflicted by majjāmeha, expel urine that is mingled with marrow, resembling marrow itself. There is a form likened to an elephant, hasti-meha, where the urine flows slowly, thick and sticky, lacking force. Of particular note is madhumeha, in which the urine is sweet like honey. This condition arises from the disturbance of the elements, depletion of bodily tissues, or when wind obstructs the body’s channels. When these channels are blocked, the signs of the doṣas—vāta, pitta, and kapha—manifest without obvious cause; sometimes the body is depleted, sometimes overfilled, making the disease slow and difficult to cure. If prameha is neglected over time, all forms eventually become madhumeha, where the urine is generally sweet, like honey. This is why all these forms are ultimately called madhumeha, for the body becomes pervaded by sweetness. With it come indigestion, loss of taste, vomiting, sleeplessness, cough, and nasal congestion. Complications arise according to the dominant doṣa. When prameha is born of phlegm, there is pain in the bladder and penis, swelling of the scrotum, and fever. If bile predominates, burning sensations, thirst, sourness, fainting, and diarrhea occur. When wind is at fault, one experiences reversals, trembling, pain in the heart, and restlessness. As the trident of pain (śūla) rises, dryness, breathlessness, and coughing follow. Various eruptions can manifest: śarāvikā, kacchapikā, jvālinī, and vinatālajī. Other types include masūrikā, sarṣapikā, putriṇī, and savidārikā, along with vidradhi—making ten types of eruptions that arise when prameha is neglected. These conditions generally begin when kapha-tainted foods are consumed—especially those that are sweet, sour, salty, unctuous, heavy, slimy, and cold. Foods such as new grains, wine, rich soups, meat, sugarcane, jaggery, and milk products, as well as habits like sitting or lying down for long periods, should be avoided. When prameha corrupts kapha, it settles in the bladder, then spreads to disturb the body’s moisture, sweat, fat, marrow, and flesh. If pitta and blood are greatly diminished, kapha first takes refuge in the urine; then, as the tissue in the bladder is depleted, vāta arises. Thus, the types of prameha are determined by whether they are curable or incurable. Even when all doṣas are involved, their predominance creates differences. The general symptom is urine that is excessive and turbid, though the specific combinations of doṣas and affected tissues produce variations. The types of prameha are distinguished by the color and qualities of the urine: sometimes clear, very white, cold, odorless, and like water. In udakameha, the urine is watery, slightly turbid, and slimy. In ikṣumeha, it is exceedingly sweet, like sugarcane juice. In sāndrameha, the urine is thick and stale. Surāmeha presents with urine like wine—clear on top and dense below. In śukrameha, the person feels hair standing on end, and the urine is thick and white like flour, resembling semen or mixed with it. In sikatāmeha, the urine contains sandy particles. In śītameha, the urine is abundant, sweet, and very cold. In śanairmeha, urination is slow and gradual. Lālāmeha is marked by slimy urine mixed with threads of saliva. Kṣārameha is characterized by urine that resembles alkaline water in smell, color, taste, and touch. In nīlameha, the urine is blue; in kālameha, it is black like ink. Those afflicted may develop eruptions at the joints, vital spots, and muscular channels—raised at the edges, sunken in the middle, dry, and painless. Śarāvikā is shaped like a shallow dish; kacchapikā always burns and, as the wise say, resembles a tortoise. Vinatā is a large, blue eruption; jvālinī appears on the skin with burning and causes severe pain. Masūrikā is red or white, with bursting blisters, severe, and shaped like a lentil. Putriṇī resembles mustard seeds, brings severe pain, ulcerates the tongue, and can be large, small, or very minute. Vidradhikā is round like the root of vidārī, hard, and has the features of an abscess. Putriṇī and vidārī are most difficult to endure and occur in those with much fat, while the others, dominated by pitta, arise in the lean. These pustules manifest according to the aggravation of the doṣas; even without diabetes, they can arise from corrupted fat. So long as there is no change in color, these eruptions go unnoticed; yellow or red coloration, or absence of the early signs of diabetes, should be taken as warning. One who passes such urine is said to have raktapitta. The symptoms include sweating, body odor, looseness of the limbs, drowsiness, cravings for food and sleep, burning in the heart, eyes, tongue, and ears, heaviness, and excessive growth of hair and nails. There is a fondness for cold, dryness of the throat and palate, sweetness in the mouth, burning in the hands and feet—these are signs of impending diabetes. Sometimes, ants are seen attracted to the urine. In diabetes, there is thirst, sweetness, and stickiness in the mouth, and many disorders arise. When the body is full, it comes from kapha; when the doṣas are depleted, vāta dominates. Cases of diabetes caused by kapha and pitta manifest gradually and fully; those arising from sexual activity are chronic if caused by pitta. Yet, know this: diabetes is curable, unless it is ordained by fate. Thus, O Suśruta, have I described the causes, forms, and signs of prameha, so that you may recognize and address them with wisdom and care.