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The commentary says that if prameha is not treated quickly it later takes the form of madhumeha; the patient is then called madhumehi and has prameha boils, as the verse also says of the…

For prameha boils, leeches are first applied over the boils to let blood, and then strong purgation is given; the text warns that the madhumeha patient is hard to purge.

When, with the prodromes present, a person begins to pass much urine, it is to be called prameha, and the patient is called pramidha. The commentary adds that if prameha is not treated…

First, bloodletting by applying leeches over the boils is beneficial, and after that strong purgation should be given; the madhumeha patient, however, is hard to purge.

It turns in time into madhumeha; the patient is then called madhumehi and develops prameha boils.