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===== Classification by ''Dosha''/Stage of Progression =====

===== Classification by ''Dosha''/Stage of Progression =====

As for all other disease systems described in Ayurvedic texts, ''prameha'' has been classified according to the predominant ''dosha'' in the disease process. [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] describes three distinct categories of ''prameha'' by ''dosha'', i.e., ''kaphaja, pittaja,'' and ''vataja prameha''. However, it is important to note here that the dominance of a ''dosha'' varies as the disease progresses. In the initial stage, ''kapha'' is in excess, which vitiates ''meda'' and ''kleda'' causing ''kaphaja prameha''.  

As for all other disease systems described in Ayurvedic texts, ''prameha'' has been classified according to the predominant ''dosha'' in the disease process. [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] describes three distinct categories of ''prameha'' by ''dosha'', i.e., ''kaphaja, pittaja,'' and ''vataja prameha''<ref> Shastri KN, Chaturvedi GN. Agnivesha, Charaka Samhita, Vidyotini Commentary. Varanasi, India : Chaukhamba Bharti Academy, 2004. </ref> <ref> Shukla VD, Tripathi RD. Agnivesha, Charaka Samhita, Vaidyamanorama Hindi Commentary. Delhi, India; Chaukhamba Sanskrit Pratisthana, 2002. </ref>. However, it is important to note here that the dominance of a ''dosha'' varies as the disease progresses. In the initial stage, ''kapha'' is in excess, which vitiates ''meda'' and ''kleda'' causing ''kaphaja prameha''.  

Further progression results in the loss (or ''kshaya'') of ''kapha''. ''Pitta'' then predominates, which vitiates the blood (''rakta''), precipitating ''pittaja prameha''. Further progression results in loss of ''pitta''. This leads to vitiation of ''vata'', which weans the body of vital substances/vital essence through urine, precipitating ''vataja prameha''. Charaka says that any of these three types of ''prameha'' can be precipitated directly, depending upon genetic predisposition and improper diet and lifestyle.  

Further progression results in the loss (or ''kshaya'') of ''kapha''. ''Pitta'' then predominates, which vitiates the blood (''rakta''), precipitating ''pittaja prameha''. Further progression results in loss of ''pitta''. This leads to vitiation of ''vata'', which weans the body of vital substances/vital essence through urine, precipitating ''vataja prameha''<ref> Chandola HM, Bhatia S. Concept of Diabetes mellitus in Ayurveda and its treatment with certain indigenous drugs. AYU Int 2001;1:84-87. </ref>. Charaka says that any of these three types of ''prameha'' can be precipitated directly, depending upon genetic predisposition and improper diet and lifestyle.  

Correlating the ''doshic'' classification of ''prameha'' with the etiology, ''kaphaja'' and ''pittaja prameha'' are always ''apathyanimittaja'' ''prameha'' (acquired), while ''vataja prameha'' can be hereditary or acquired. If ''kaphaja'' and ''pittaja'' ''prameha'' are not managed properly, in due course of time they lead to ''madhumeha'' (a subtype of ''vataja prameha''), which is a terminal stage of the disease and is said to be incurable. This disease can be equated with the terminal stage of type 2 diabetes, which progresses to insulin- dependent diabetes. It has been observed that in the ''pittaja'' stage of ''prameha'', there is a tendency toward moderate hyperglycemia, which may be due to increased adrenal medullary and cortical activities. In ''vataja prameha'', there may be severe hyperglycemia with hypoinsulinemia.   

Correlating the ''doshic'' classification of ''prameha'' with the etiology, ''kaphaja'' and ''pittaja prameha'' are always ''apathyanimittaja'' ''prameha'' (acquired), while ''vataja prameha'' can be hereditary or acquired. If ''kaphaja'' and ''pittaja'' ''prameha'' are not managed properly, in due course of time they lead to ''madhumeha'' (a subtype of ''vataja prameha''), which is a terminal stage of the disease and is said to be incurable<ref> Tripathi SN,  Chandola HM.Study on variations in diabetes mellitus (Prameha) with special reference to plasma insulin, cortisol and catecholamines. In Bajaj JS,ed. Diabetes mellitus in Developing Countries. New Delhi, India: Interprint, 1984:125-128. </ref>. This disease can be equated with the terminal stage of type 2 diabetes, which progresses to insulin- dependent diabetes. It has been observed that in the ''pittaja'' stage of ''prameha'', there is a tendency toward moderate hyperglycemia, which may be due to increased adrenal medullary and cortical activities. In ''vataja prameha'', there may be severe hyperglycemia with hypoinsulinemia.<ref> Sharma H, Chandola HM..Prameha in Ayurveda: Correlation with Obesity, Metabolic Syndrome, and Diabetes Mellitus.Part 1-Etiology, Classification, and Pathogenesis. The Journal of Alternative and Complementary Medicine.2011. 17(6):491-496. </ref>    

As mentioned earlier, ''prameha'' can be correlated with obesity, metabolic syndrome, and diabetes mellitus. The early manifestation of the disease process in these conditions is characterized by lipid, carbohydrate, and protein metabolism disturbances accompanied by glycosuria, proteinuria, etc., which can be equates with a ''kaphaja'' condition (i.e., which can be easily controlled and cured.  ''Pittaja prameha'' can be correlated with the inflammatory conditions accompanied with diabetes like urinary tract infection and diabetic ketoacidosis. The advanced stage of disease, with metabolic disturbances associated with loss of immunity, correlates with type 2 diabetes that has progressed to insulin dependent diabetes, and correlates with the hereditary form of type 1 diabetes, which both correlate with ''vataja prameha''. Both of these forms are incurable as described by Charaka.

As mentioned earlier, ''prameha'' can be correlated with obesity, metabolic syndrome, and diabetes mellitus. The early manifestation of the disease process in these conditions is characterized by lipid, carbohydrate, and protein metabolism disturbances accompanied by glycosuria, proteinuria, etc., which can be equates with a ''kaphaja'' condition (i.e., which can be easily controlled and cured.  ''Pittaja prameha'' can be correlated with the inflammatory conditions accompanied with diabetes like urinary tract infection and diabetic ketoacidosis. The advanced stage of disease, with metabolic disturbances associated with loss of immunity, correlates with type 2 diabetes that has progressed to insulin dependent diabetes, and correlates with the hereditary form of type 1 diabetes, which both correlate with ''vataja prameha''. Both of these forms are incurable as described by Charaka.