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In Sanskrit, the word ''mih'' (from which ''meha'' is derived) denotes water, to wet, and to emit semen. Regarding the above explanation, we can easily postulate that the disease ''prameha'' resulted because of an excessive excretion of something (''ati-pravrittija''). ''Prameha'' comprises of all those diseases that cause clinical abnormalities in urine due to derangement of metabolism at the level of tissues (''dhatvagnimandya'').  

In Sanskrit, the word ''mih'' (from which ''meha'' is derived) denotes water, to wet, and to emit semen. Regarding the above explanation, we can easily postulate that the disease ''prameha'' resulted because of an excessive excretion of something (''ati-pravrittija''). ''Prameha'' comprises of all those diseases that cause clinical abnormalities in urine due to derangement of metabolism at the level of tissues (''dhatvagnimandya'').  

==== The scope of prameha ====

==== The scope of ''prameha'' ====

Prameha is a complex syndrome encompassing obesity, metabolic syndrome, diabetes insipidus, alkaptonuria, hemoglobinuria, lipiduria, diabetes mellitus and more. At the gross level, prameha is considered an endocrinal and metabolic disorder. Classification of prameha as sahaja (hereditary) and apathyanimittaja (acquired) favors the correlation of madhumeha as diabetes mellitus. The pathological foci of the disease lie in the kidney (vrikka) causing the destruction of nephrons (srotomukh pratirudhyante).  

''Prameha'' is a complex syndrome encompassing obesity, metabolic syndrome, diabetes insipidus, alkaptonuria, hemoglobinuria, lipiduria, diabetes mellitus and more. At the gross level, ''prameha'' is considered an endocrinal and metabolic disorder. Classification of ''prameha'' as ''sahaja'' (hereditary) and ''apathyanimittaja'' (acquired) favors the correlation of ''madhumeha'' as diabetes mellitus. The pathological foci of the disease lie in the kidney (''vrikka'') causing the destruction of nephrons (''srotomukh pratirudhyante'').  

The classification of prameha on the basis of onset as sahaja/jataja pramehi madhumehi (hereditary) and apathyanimittaja pramehi (acquired) could be considered analogous to the classification of diabetes conditions as congenital/ Type-I, insulin dependent diabetes mellitus (IDDM) and acquired/ Type-II, non insulin-dependent diabetes mellitus (NIDDM) respectively.  

The classification of ''prameha'' on the basis of onset as ''sahaja/jataja pramehi madhumehi'' (hereditary) and ''apathyanimittaja pramehi'' (acquired) could be considered analogous to the classification of diabetes conditions as congenital/ Type-I, insulin dependent diabetes mellitus (IDDM) and acquired/ Type-II, non insulin-dependent diabetes mellitus (NIDDM) respectively.  

Considering the pathogenesis, two types of prameha patients are as given below:  

Considering the pathogenesis, two types of prameha patients are as given below:  

1. A certain defect in the sperm and ovum (referred to as bija dosha) results in a genetic disorder or genetic predisposition to disease. Regarding prameha, Charaka Samhita mentions that excessive indulgence in madhura rasa (foods/ drinks with a sweet taste) by the parents is the chief cause of this chromosomal damage to the sperm and ovum.

===== ''Sahaja prameha''/ ''jatah pramehi'' (hereditary) =====

The diet, lifestyle, and adverse psychologic state of the mother during lactation (and only during the stage of pregnancy)may also play a decisive role in precipitating prameha in the infants. In addition, excessive intake of madhura rasa during childhood can contribute to the onset of prameha in children who are genetically predisposed. Thus, hereditary predisposition and unwholesome dietary and lifestyle choices, especially excessive intake of madhura rasa, can play a combined role to cause hereditary prameha. The description of sahaja prameha in Sushruta Samhita and jatah prameha  in Charaka Samhita are quite similar to that of type-I diabetes (also known as insulin- dependent diabetes mellitus or juvenile- onset diabetes). Jatah pramehi madhumehino, as defined in Charaka Samhita, correlates with type-I diabetes beginning in early childhood.

In [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], the words ''sahaja'' and ''jatah'' indicate genetic predisposition to the disease.  

Broadly, in hereditary diseases there may be two contributing factors:

The acquired form of prameha (apathyanimittaja pramehi), in contrast, is a lifestyle condition caused due to sedentary, or inactive living, and psychologic factors include depression and stress.

The description of apathyanimittaja prameha in Sushruta Samhita is very similar to that of type-II diabetes.  The types of food and drink likely to precipitate this disease have been enumerated in all the classical Ayurvedic texts.  , . These are briefly listed below, along with lifestyle factors and psychological factors that lead to the onset of prameha:

1. Dietary factors: Excessive intake of yogurt, meat of aquatic animals, milk, new grains, food/drinks containing sugar and jaggery (an unrefined form of cane sugar), cold foods, sweet foods, liquid foods, foods that are heavy to digest, and slimy foods.

All types of prameha ultimately morph into madhumeha which is incurable. From the standpoint of its pathology and clinical manifestation, madhumeha can be correlated with diabetes mellitus. Certain forms of kaphaja prameha could be considered to be very similar (if not identical) to maturity onset diabetes (MODY) or type -II diabetes or NIDDM. Udakameha is analogous to diabetes insipidus, while certain pittaja prameha relate to urinary tract infection and glomerulonephritis relates to diabetes and its complications (diabetic patients are more prone to developing UTI due to deranged immunity).  

#A certain defect in the sperm and ovum (referred to as ''bija dosha'') results in a genetic disorder or genetic predisposition to disease. Regarding ''prameha'', [[Charaka Samhita]] mentions that excessive indulgence in ''madhura rasa'' (foods/ drinks with a sweet taste) by the parents is the chief cause of this chromosomal damage to the sperm and ovum.

#An intrauterine environment that negatively affects the development of the fetus due to the mother’s diet, lifestyle, or adverse psychological state during pregnancy. This congenital aspect can trigger the disease process for which there is a genetic predisposition. Regarding ''prameha'', the overindulgence of ''madhura rasa'' by the mother during pregnancy is likely to trigger ''prameha''.

All the twenty types of prameha should be considered as distinct disorders. For example, kalameha can be considered as an alkaptonuria-a disease of tyrosine and phenylalanine metabolism. Vasameha can be considered as lipiduria (as in nephrotic syndrome).   

Causative factors of prameha/diabetes mellitus: Type I Diabetes

 

Type-I diabetes is a multi-genomic disease and heredity plays an important role in determining an individual’s predisposition to it. Secondly, type-I diabetes is an autoimmune disease in which insulin itself could trigger an attack on beta cells by white blood cells (T-cells) . Finally, there are environmental factors such as foods, viruses and toxins that could trigger an early onset of the disease.  

 

 

 

 

 

All the twenty types of ''prameha'' should be considered as distinct disorders. For example, ''kalameha'' can be considered as an alkaptonuria-a disease of tyrosine and phenylalanine metabolism. ''Vasameha'' can be considered as ''lipiduria'' (as in nephrotic syndrome).   

 

===== Causative factors of ''prameha''/diabetes mellitus =====

 

====== Type I Diabetes ======

 

Type-I diabetes is a multi-genomic disease and heredity plays an important role in determining an individual’s predisposition to it. Secondly, type-I diabetes is an autoimmune disease in which insulin itself could trigger an attack on beta cells by white blood cells (T-cells). Finally, there are environmental factors such as foods, viruses and toxins that could trigger an early onset of the disease.

 

 

Food articles that are high in saturated fats, including dairy products (especially whole-milk products like cream and full-fat yogurt), red meat and meat juice (''mamsarasa'') are known to increase the probability of contracting type II diabetes. High saturated fats lead to increase in adipose tissue secretory factors (ATSF), or resistine, that cause insulin resistance.  

Another important causative factor for type-II diabetes is an inactive/sedentary lifestyle. According to a World Bank report, almost 10% of all deaths reported worldwide in 2008 could be attribute to inactivity, due largely to four major diseases, including type II diabetes.  ,

Another important causative factor for type-II diabetes is an inactive/sedentary lifestyle. According to a World Bank report, almost 10% of all deaths reported worldwide in 2008 could be attribute to inactivity, due largely to four major diseases, including type II diabetes.  ,

Jaggery & jaggery products including sugar (gudavaikritum)

==== Jaggery and jaggery products including sugar (''gudavaikritum'') ====

 

A study published in the International Journal of Diabetes in Developing Countries showed that jaggery and sugar have nearly the same glycemic values.  This means that when consumed, both raise blood glucose levels by approximately equal values. The only difference is that the release of glucose from jaggery is comparatively slower than sugar as it is a complex sucrose which takes longer to break down.

A study published in the International Journal of Diabetes in Developing Countries showed that jaggery and sugar have nearly the same glycemic values.  This means that when consumed, both raise blood glucose levels by approximately equal values. The only difference is that the release of glucose from jaggery is comparatively slower than sugar as it is a complex sucrose which takes longer to break down.

(Note: Glycemic Index is a unit which measures the amount of glucose released into the blood by a food source. Foods which release more glucose into the blood will have a high glycemic Index value and vice versa.)

(Note: Glycemic Index is a unit which measures the amount of glucose released into the blood by a food source. Foods which release more glucose into the blood will have a high Glycemic Index value and vice versa.)

==== The classification of prameha ====

==== The classification of prameha ====