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Introduction: Prameha, described extensively in Ayurvedic Samhitas, is a complex metabolic disorder characterized by derangements in Dosha, Dhatu, and Mala, often correlating with diabetes mellitus in contemporary medicine. The condition encompasses 20 subtypes with unique pathophysiological explanations rooted in Dosha imbalance and impaired Medo-dhatu metabolism. Methods: A narrative review was conducted by analyzing primary Ayurvedic texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya) alongside secondary sources from PubMed, Scopus, and Web of Science. Inclusion criteria comprised classical interpretations of Prameha, therapeutic principles in Samhitas, and modern studies on Ayurvedic interventions for diabetes. Results: The Samhitas emphasize Nidana (etiology), Samprapti (pathogenesis), and Chikitsa (treatment), with focus on dietary regulations, lifestyle modifications, Panchakarma, and the use of herbal formulations such as Nishakatakadi Kashaya, Triphala, and Shilajatu. Modern research supports anti-hyperglycemic and insulin-sensitizing properties of several Ayurvedic herbs including Gymnema sylvestre, Tinospora cordifolia, and Momordica charantia. Panchakarma, particularly Vamana, Virechana, and Basti, has been shown to enhance glucose metabolism and prevent complications. Discussion: A critical comparison reveals significant overlaps between Ayurvedic approaches and modern diabetes management, particularly in dietary discipline, exercise, detoxification, and phytotherapy. However, challenges remain in integrating evidence-based clinical validation, standardization of formulations, and mechanistic understanding. Conclusion:  The Samhita-based approach to Prameha provides holistic strategies that are relevant even today, offering preventive, promotive, and therapeutic dimensions. Bridging classical wisdom with modern evidence holds promise for developing integrative, patient-centered diabetes management protocols.

KEYWORDS: Ayurveda, Diabetes, Herbal formulations, Prameha, Samhitas