अथातो मूत्राघातचिकित्सितं व्याख्यास्यामः । इतिहस्माहुरात्रेयादयो महर्षयः । ॥ १ ॥
We will now expound Mutraghata-treatment of retention of urine; thus said Atreya and other great sages. (1)
Mutrakriccha chikitsa – treatment of dysuria
वातान्मूत्रकृच्छ्रे वातहरतैलाभ्यक्तगात्रस्याधोनाभेः सर्वमङ्गं पिण्डेन सेकावगाहैश्च वातघ्नैः कुम्भीस्वेदेनचस्वेदयेत् ॥ २ ॥
In mutrakriccha (difficulty in urination) of vata origin, the parts of the body below the umbilicus should be anointed with medicated oil which subdues vata and then fomentation done by pindasveda (balls of drugs made hot), seka (pouring warm liquids) avagaha (immersing the part) and kumbhisveda-sudation by exposure to hot steam from pots containing boiling liquids. (2)
दशमूलबलैरण्डमूलपुनर्नवाशतावरीवृश्चीवपत्तूरपाषाणभेदककोलकुलत्थयवक्वाथेन तत्कल्केन च तैलं सर्पिः सूकरर्क्षवसालवणपञ्चकोपेतं सिद्धं पानाय दद्यात् । एतान्येव चौषधान्यन्नपाने पिण्डोपनाहस्वेदयोश्चतैलफलस्त्रेहाम्लयुक्तानि कल्पयेत् । प्रसन्नांच सौवर्चलाढ्यांपिबेत् ||३||
Medicated oil or ghee prepared with decoction of dashamoola, bala, erandamula, punarnava, satavari. vrsciva, pattura, pashanabheda, kola, kulattha and yava, the paste also of the same drugs, muscle-fat of boar and bear, and lavana panchaka; it should be used for drinking (internal oleation therapy). The same drugs should be made use of for processing the food and drink, for preparing balls and poultices for fomentation, for processing juices from fruits which are unctous and sour for use as drinks; the patient can drink also prasanna (scum of varuni- a kind of liquor) added with more of souvarchala. (3)
पित्तजे शीतसेकावगाहप्रदेहान् प्रयुञ्जीत। तृणपञ्चमूलश्वदंष्ट्राभीरुविदारीकशेरुकक्वाथं शीतं समधुशर्करं पिबेत् । तद्वच्च काण्डेक्षुरकमूलम् । कमलोत्पलविदारीशृङ्गाटकानि । द्राक्षारसेन वा त्रपुसकुसुम्भोर्वारुबीजवृषककुङ्कुमकल्कंसर्वमूत्राघातघ्नम्। मधुकदार्ब्युर्वारुबीजानिवातण्डुल-धावनेन । समाक्षिकां वा दार्वीमामलकरसेन । मृद्वीकाकल्कं वापर्युषिताम्भसा ॥४॥
In that of pitta origin, water for pouring over and immersion of body parts and poultices should be cold. Decoction of trnapanacamula, svadamstra, abhiru, vidari and kaseruka mixed with honey and sugar should be cooled and given for drinking; similarly that of roots of kandeksuraka; or of kamala, utpala, vidari and Srngataka; or paste of trapusa, kusurnbha, urvarubija, vrsaka, kunkuma, along with juice of draksa. All these cure mutraghata (retention of urine). Madhuka, daru and urvarubija, mixed with ricewash or juice of darvi and amalaka, mixed with honey; or paste of mrdvika with boiled water kept overnight (cure retention of urine). (4)
कफजे यथास्वं स्वेदो वमनं कटुतीक्ष्णोष्णक्षारमन्नपानं यवान्नं तक्रं च | पिबेच्च मद्येन सूक्ष्मैलामामलकरसेन वा मधुयुतां वा कदलीरसेन कैडर्यकरसेन वा शितिवारकबीजं वा तक्रेण । प्रवालचूर्णवातण्डुलाम्बुना। धवकुटजकरञ्जामृताकेबुकैलारग्वधसप्तच्छदक्वाथं वा शीतं सक्षौद्रम् । तत्सिद्धां वा यवागूम् । कण्टकारिकास्वरसं वा समाक्षिकम् । व्योषैलागोक्षुरकसारसास्थीनि वा मधुमूत्रयुक्तानि । पाटलीक्षारं वा बहुकृत्वः परिस्त्रुतं तैलयुक्तम् । तिलपाटलीपारिभद्रयावशूकक्षारोदकानुविद्धां वा त्वगेलोषकचूर्णयुक्तां प्रसन्नाम् । तिलादीनां वा पृथक् क्षारं गुडोपदंशमनीयात् । तीक्ष्णोष्णद्रव्यसिद्धं च तैलंपानाभ्यङ्गार्थे ॥५॥
In that of kapha origin, suitable type of sudation and emesis therapies, foods and drinks which possess pungent, penetrating, heat producing and alkaline properties; yava (barley), and takra (buttermilk) should be partaken, powder of suksmaela along with wine, or juice of amalaka or honey should be consumed; or powder of suksmaela mixed with honey along with juice of kadali or of kaidarya should be taken. Or powder of pravala (coral) with rice-wash, or decoction of dhava, kutaja, karanja, amrita, kebuka, ela, aragvadha and saptachada, cooled and mixed with honey; or yavagu (gruel) processed with these drugs; or fresh juice of kantakari with honey; or decoction of vyosa, ela, goksuraka and bones of animals living in ponds (or hard tubers of acquatic plants) mixed with honey and cowsurine; or alkali (ash) of patali prepared by washing many times, and mixed with oil; or drink prasanna (scum of varuni liquor) mixed with solution of alkalies of tila, patali, paraibhadra and yavasuka, to which is added the powder of tvak, ela, usaka. He should eat condiments made of tila etc, alkalies and jaggery; medicated oil prepared from drugs possessing penetrating property and hot potency should be used for drinking (oleation therapy) and for external massage. (5)
सन्निपातात्मके वातादीनां स्थानानुपूर्व्या यथासन्नं प्रतिकुर्वीत । यथोल्बणं वा सर्वेषु समस्थितेषु वा समसितं यवक्षारं भक्षयेत् | अपिच ॥ ६ ॥
In that (mutraghata) caused by the increase of all the three doshas together, the treatment of vata etc (doshas) should commence with that dosha which is localised in greater measure in the urinary bladder and next to others appropriately; or first to that which has undergone profound increase; when all the doshas are of equal strength, the patient should eat yavakshara mixed with equal quantity of sugar. (6)
एलाश्मभेदकशिलाजतुपिप्पलीनां चूर्णानि तण्डुलजलालुलितानि पीत्वा ।
तद्वद्गुडेन सहितान्युपयुज्य मासमासन्नमृत्युरपिजीवति मूत्रकृच्छ्री ॥७॥
Further, powder of ela, asmabhedaka, silajatu, and pippali mixed with rice-wash used as a drink and the same powder mixed with guda (jaggery) used as lictuary, for a period of one month, cures the patient of mutrakricha (difficult urination) though he is at the verge of death. (7)
एलोपकुल्यामधुकाश्मभेदकौन्तीश्वदंष्ट्रावृषकोरुपूगैः ।
क्काथं पिबेच्छर्करयावगाढं कृच्छ्रे सदाहे सरुजे बिबन्धे ।।८।।
Decoction of ela, upakulya, madhuka, asmabheda, kaunti, svadamstra, vrsaka and urupuga made thick by addition of sugar and used cures difficult urination accompanied with burning sensation, pain and obstruction. (8)
हरीतकीगोक्षुरराजवृक्षपाषाणभिद्धन्वयवासकानाम् । क्वथंपिबेदश्मजतुप्रधानं सशर्करेसाश्मरिमूत्रकृच्छ्रे ।। ९ ।।
Decoction to haritaki, goksura, rajavriksha, pashanabheda and dhanva-yavasaka, mixed with more quantity of silajatu and also sugar, cures both asmari (urinary calculi) and difficulty of urination. ( 9 )
Ashmari chikitsa – treatment of renal calculii
अश्मर्यामचिरोत्थितायांवातबस्त्यादिषु च यथादोषमिदमेवाचरेत् ।।१०।।
The following shall be the method of treatment for asmari (renal calculii) of recent origin and vatabasti and other ( disorders). (10)
पाषाणभेदकवसुकवसिराश्मन्तकशतावरीश्वदंष्ट्राबृहतीद्वयकपोतवङ्काबलातिबलाकच्छुरोशीरगुन्धुवृक्षादनीभल्लूकवरणयवकोलकुलत्थशाकफलकतकफलक्वाथेसर्पिरूषकादिप्रतीवापं विपाच्य पीतमाशु वाताश्मरीं भिनत्ति। एभिरेव चद्रव्यैः कषायक्षारान्नपानानि कल्पयेत् ।।११ ॥
Medicated ghee should be prepared from the decoction of pashanabheda, vasuka, vasira, asmantaka, satavari. svadamstra, the two brihati kapotavanka, bala, atibala, kacchura, usira, gundhu (a variety of grass), vrikshadani, bhalluka, (sallaka), varana, yava, kola, kulattha sakaphala (Sakhota) and katakaphala; ghrta ( ghee) and paste of drugs of usakadi gana (chapter 16 of sutrasthana). This ghee consumed (daily) breaks the stone caused by aggravated vata. Decoction, alkali, foods and drinks should be prepared from these drugs only. (11)
सिंहीव्याघ्रीगोक्षुरकेक्षुरकोरुबूकमूलकल्कोऽमधुरेण दध्ना पीत: सप्ताहादश्मरीं भिनत्ति । शिग्रुमूलकल्केन दधिलवणयमकसिद्धोयूषः ॥ १२ ॥
Paste of simhi, vyaghri, goksuraka, iksuraka and urubukamula mixed with dadhi (curds) which is not sweet (which is sour), used as drink splits the stone in seven days.
So also the soup prepared from paste of sigrumula, dadhi (curds), salt and yamaka (mixture of two fats- oil and ghee). (12)
वीरतरादिगुन्द्रेत्कटपत्तूरवाराहीपाठापाटलीशिरीषशालिमूलविदारीद्विपुनर्नवक्वाथे त्रपुसकुसुम्भैर्वारुकर्कारुबीजमधुकशिलाजतुप्रतीवापं सर्पिर्विपाच्य पीतमाशु पित्ताश्मरीं भिनत्ति । पूर्ववच्च कषायादीनेभिः कल्पयेत् ।। १३ ।।
Medicated ghee is prepared with the decoction of drugs of Virataradi gana (chapter 16of sutrasthana) gundra, itkata, pattura, varahi, patha, patali, Sirisa, salimula, vidari, and the two punarnava and the paste of trapusa, kusumbha, ervaru, karkarubija, madhuka, and silajatu. This ghee, used as a drink, breaks the stone quickly caused by pitta. Decoction etc (food and drinks) should be prepared from these drugs only as stated earlier. (13)
वरणादिभद्रदार्वादिगुग्गुल्वेलाद्वयकुष्ठमरिचचित्रकमुस्तासुरसाह्वयैः कल्कीकृतैः साधितमूषकादिप्रतीवापं सर्पिः श्रेष्माश्मरीं भिनत्ति । इति समानं पूर्वेण ||१४||
Medicated ghee prepared from the decoction of drugs of varanadi gana, bhadradarvadi gana (chapter 16 of sutrasthana), guggulu, the two ela, kustha, maricha, chitraka, musta and surasa, and the paste of drugs of uskadi gana (chapter 16 of sutrasthana), breaks the stone caused by slesma (kapha); it is similar to the earlier. (14)
मस्तुना बहुशः पाटलीभस्मं गालयित्वा भस्मं विसर्जयेत् । ततस्तन्मस्तु गृहीत्वा कुलत्थैः सह क्वाथयेत् । तं क्वाथं गोक्षुरकमूलैलात्रपुसकुरण्टकबीजपाषाणभेदकचूर्णं क्षौद्रेण लीद्वानुपिबेत् । तथा शीघ्रमेवाश्मरी भिद्यते च्यवते च ।। १५ ।।
The ash of patali is dissolved in mastu (whey), poured from one vessel to the other severeal times, decanted (or filtered) and the ash portion discarded. The thin fluid is boiled along with kulattha. This decoction should be made use of as an afterdrink, after licking the powder of roots of goksura ela, trapusa, seeds of kurantaka and pashanabheda mixed with honey; by this, the stone gets split and is eliminated out quickly. (15)
अश्मरीभेषजानां घृताक्तानामन्तर्धूमं दग्धानां क्षारं ग्राम्यपशुशकृत्क्षारं च गोनूत्रेण बहुकृत्वो गालयित्वा तमच्छमग्नौ साधयेत् । घनीभवति च तस्मिंस्त्र्यूषणोषकादिचूर्णं दद्याद्दर्वीप्रलेपंचाव तारयेत् । एष क्षीराशिनः क्षारावलेहोऽश्मरीं भिनत्ति पातयति चशर्कराम् ।।१६ ।।
The drugs prescribed for urinary stone are smeared with a little ghee, put inside a pot and converted into ash. This ash is mixed with the ash of the dung of domestic cow, both are dissolved in cows urine, pouring it from one vessel to another several times and then decanted.
This thin fluid is cooked over mild fire adding the powder of tryusana and of the drugs of usakadi gana (chapter 16 of sutrasthana) and the vessel removed from the oven when the mass beings to adhere to the laddle. This ksharavaleha (confection of alkaline ash) administered to patients, who subsist on only milk as food breaks the stones and eliminates the gravel. (16)
तिलकदलीयवापामार्गपलाशक्षारोऽविमूत्रेण पीतः समानः पूर्वेण । केतकपत्रक्काथेन हिङ्गु – क्रौञ्चास्थिक्षारयुक्तःपाटलीकरवीरक्षारश्च । क्रौञ्चोष्ट्रगर्दभास्थिश्वदंष्ट्राकदम्बमूलतालपत्रिकाजमोदनागरचूर्णश्च सुरामण्डोष्णोदकान्यतरप्रयुक्तः ।।१७।।
Ash of tila, kadali, yava, apamarga and palasa mixed with goats urine and consumed acts similarly; or the decoction of leaves of ketaki mixed with hingu and ash of bones of kraunca bird; or with the ash of patali and karavira; or ash of bones of kraunca bird, camel or donkey; or powder of svadamstra, root of kadamba, talapatrika (misreya) ajamoda, and nagara consumed either with the thin fluid of sura (beer) warm water or such other liquids (also act likewise). (17)
पिचुकाङ्कोलशाककतकेन्दीवरफलक्काथश्च सुखोष्णो गुडयुक्तः । नृत्यकुण्डकबीजचूर्णश्च समाक्षिकोऽविक्षीरयुक्तः ।।१८ ।।
Or fruits of picuka, ankola, saka, kataka and indivaraphala are made into a decoction mixed with guda (jaggery) and consumed warm; the powder of seeds of nityakundaka mixed with honey and taken along with ewe’s milk. (18)
कपोतवङ्कामूलं च सुरया । तत्सिद्धं वापयोऽश्मरीवेदनार्तः पिबेत् । सिद्धं वाभयास्थिभिः पुनर्नवेन वा ।। १९ ।।
Or root of kapotavanka, along with sura (beer); or the milk boiled with it can be consumed by the person suffering from pain of urinary stones; or the milk prepared from seeds of abhaya or from punarnava (may be used). (19)
शेषेष्वेवं मूत्राघातेष्वत एव चिकित्सांविभजेत् ॥ २० ॥
In the remaining types of mutraghata (retention of urine) the treatment should be planned suitably (with the drugs and therapies described further ). (20) ह्रस्वपञ्चमूलेन द्विगुणत्रिकण्टकेन साधितं तोयं पयो वा केवलं घृतमिश्रं वा पिबेत् सर्वमूत्राघातघ्नम् ॥ २१ ॥
Decoction or milk prepared with drugs of hrasva panchamula and double their quantity of trikantaka; or the powder of these mixed with only ghee, consumed daily cures all varieties lof retention of urine. (21)
गोक्षुरककण्टकारिकाकृतां वा सफाणितां यवागूम् । ताम्रचूडरससिद्धांवा | वीरतरादिक्वाथेन वा । तेन वा तद्भावितं शिलाजतु । वाजिरासभान्यतरशकृद्रसं वा । दुरालभास्वरसंवा । ककुभकषायं वा । मूर्वाभयामुस्तदेवदारुमधुककल्कं वा । वारुणीक्षीरोष्णोदकान्यतमेन । त्रिफलाकल्कं वा ससैन्धवं सुखाम्भसा | केवलमेववाबिभीतकबीजंसुरया। विहगपिशितोपदंशंवानिगदमदिरामण्डंमाकमासवान् वा विविधान् पिबेत् । पीतमद्यश्च शीघ्रवेगेन वाजिना रथेन वा यायात् । एवमश्मरी शर्करा च प्रच्यवते । सर्वेषु च मूत्राघातेषु विशेषतोऽश्मरीशर्करासु वीरतरादिः सर्वथा प्रयोज्यः । तिल्वकघृतं च विरेकार्थम् । बस्तिकर्मचाभीक्ष्णंविशेषेणोत्तरबस्तिः ||२२||
Yavagu (gruel) prepared from goksura and kantakarika mixed with phanita (halfcooked jaggery) that red from juice of meat of cock or that prepared from the decoction of drugs of virataradi gana (chapter 16 of sutrasthana) or silajatu macerated with this decoction or with juice of dung of horse or donkey; or with the fresh juice of duralabha or with decoction of kakubha (may be used).
Or paste of murva, abhaya, musta, devadaru and madhuka either with varuni (kind of liquor), milk or hot water, or paste of triphala mixed with saindhava with warm water; or (the paste of) seeds of vibhitaka only along with sura (beer) (any one of the above recipes should be userd).
Condiments prepared from meat of birds, scum of unspoiled madira (fermented liquor), asavas (fermented infusions) of mrdvika or other kinds (of liquids) should be made use of. After consuming liquors, the patient should ride on a swift running horse or a chariot. By this, the stone and gravel get dislodged downwards.
In all varieties of mutraghata (retention of urine) and especially in asmari and sarkara (urinary stone and gravel ), use of drugs of Virataradigana (chapter 16 of sutrasthana) in various forms should be adopted specially.
Tilvaka ghrta (described in vatavyadhi chapter, 23 of chikitsasthana) should be used for purgation therapy; enema therapies especially the uttarabasti (douche for the urinary bladder), should be done frequently. (22)
तत्र श्यामादिरर्धार्धविहितो गोमूत्रसिद्धो निरूहः । बिल्वादिमूलैश्च सुरासौवीरकादिसिद्धैस्तृणपञ्चमूलश्वदंष्ट्राशृतक्षीरवांश्च त्रपुसैर्वारुकशताह्वाबीजकर्षभकयवानीकल्कितः । पीतदारुसिद्धं तैलमनुवासनम् ||२३||
Niruha (decoction enema) should be administered with the decoction of drugs enumerated in every half verse of syamadigana (chapter 17 of sutrasthana) mixed with cows urine. Or with the decoction of bilvadi (pancha) mula mixed with sura or sauviraka (fermented liquors) or decoction of drugs of trnapanchamula and svadamstra mixed with milk and paste of trapusa, seeds of ervaruka, satahva, rsabhaka and yavani.
Medicated oil prepared from pitadaru should be used for anuvasana (oil enema ). ( 23 ) शतावरीगोक्षुरकबृहतीद्वयपुनर्नवोशीरमधुकद्विसारिवाश्रेयसीलोध्रतृणपञ्चमूलकषाये क्षीरचतुर्गुणंबलावृक्षकखराह्वोपकुञ्चिकावत्सकत्रपुसोर्वारुबीजशितिवारकमधुकषड्ग्रन्थाशताह्वाश्मभेद मदनहपुषाकल्कगर्भंतैलमुत्तरबस्तिः । तद्विशुद्धस्त्रोतसाचपुनः शुक्राश्मयशुक्राशयशोधनार्थंबलस्थेन पुंसा वृष्याण मांसानां कुक्कुटमांसस्य च तृप्तेनानुकूलाः प्रकर्षेण प्रियाः प्रमदा यथा कालमासेव्या इति ॥२४॥
Medicated oil is prepared from the decoction of satavari, goksuraka, the two brihati, punarnava, usira, madhuka, the two sariva sreyasi, lodhra and trnapanchamula, four parts of milk, paste of bala, vrikshaka, kharahva, upakunchika, vatsaka trapusa, urvarubija, sitivaraka, madhuka, sadgrantha, satahva, asmabheda, madana and hapusa. This oil should be used for uttarabasti (douche to the urinary bladder).
In case of sukrasmari (seminal stone) after purifying the alimentary tract and in order to purify (clear) the receptacle of semen, the patient is who strong should be asked to eat meat which increases sexual desire and the meat of cock, to his hearts content and then indulge in sexual intercourse with women, as appropriate to the season, (24)
Sastra chikitsa – surgical operation
क्रियाभिराभिः सिद्धाभिर्नचेच्छान्तिस्ततो भिषक् । इति राजानमापृच्छ्य शस्त्रं साध्ववचारयेत् ॥ २५ ॥
अक्रियायां ध्रुवो मृत्युः क्रियायां संशयो भवेत् । निश्चितस्यापि वैद्यस्य बहुशः सिद्धकर्मणः ॥ २६ ॥
If by this methods of treatment, the disease (urinary stone), does not subside, the physician should resort to surgical treatment, after seeking permission from the king (or the master or other authority), informing him as follows
“death is certain if surgical operation is not done, even if it is done there is doubt (of its success) though the physician is well read and very well experienced’. (25-26)
अथातुरमुपस्निग्धमपकृष्टदोषमीषत्कर्शितमभ्यक्तस्विन्नशरीरमभुक्तवन्तं कृतमङ्गलस्वस्तिवाचनमुपकल्पितसम्भारमाश्वास्य ततो बलवन्तमविक्लवमाजानुसमे फलके प्रागुपवेश्य पुरुषं तस्योत्सङ्गे सुनिषष्णपूर्वकायमुत्तानं वस्त्रचुंबलोपविष्टं सङ्कचितजानुकूर्परमितरेण पुंसा सहबद्धं सूत्रैः शाटकेन वा ततोऽस्य स्वभ्यक्तं नाभिप्रदेशं वामपार्श्वे विमृद्य मुष्टिनावपीडयेत् । अधोनाभेर्यावदश्मर्यः प्रतिपन्ना ततस्तैलाभ्यक्ते कृत्तनखे वामहस्तप्रदेशिनीमध्यमे पायौ प्रणिधायानुसेवन्यासाद्य च प्रयत्नबलाभ्यामशमरीं मेढ्रगुदयोरन्तरमानीय निर्वलीकमनायतमविषमं च बस्ति सन्निवेश्य भृशमुत्पीडयेदगुलीभ्यां यावत् ग्रन्थिरिवोन्नतं शल्यं भवति । ततः सेवन्याः सव्ये पार्श्वे सेवनीं यवमात्रंमुक्त्वानिदध्याच्छस्त्रमश्मरीप्रमाणेन । दक्षिणतोवाक्रियासौकर्यहेतोरित्येके । यथान विभिद्यते विचूर्ण्यते वा तथा प्रयतेत | तच्चूर्णमल्पमप्यवस्थितं पुनः परिवृद्धिमेति । तस्मात् समग्रामग्रवक्रेणाददीत ||२७॥
Then, the patient should be given oleation therapy, the doshas are eliminated out, his body made slightly thin, is anointed with oil and given sudation therapy; he should be advised to perform auspicious rites and chant benedictory invocations; the physician should then instill courage and confidence in his mind (of the patient); collect all the instruments and appliances needed for the operation; then the patient, who has not taken his food, is made to lie with his face up, on a strong and firm plank (couch, cot) of the height equal to ones knee; upper part of his body is slightly raised by the help of pieces (bundles) of cloth, his knees and elbows are flexed and held in position either by strong male attendants or tied with ropes or cloth. Then, the area around the umbilicus is anointed with oil, squeezed and hit hard with fists, below the umbilicus till the stone gets dislodged and comes down; then the physician should introduce the index and middle fingers of his left hand, which are lubricated and pared of their nails, into the rectum of the patient, moving up along the line of the suture (vesicorectal raphae), locate the stone and with foreceful upward push make it reach the space between the penis and the rectum, into the urinary bladder, which is neither wrinkled, nor distended nor irregularly placed. The foreign body (the stone) should be pressed with fingers from behind, forcibly so as to form an elevated mass. Then on the left side of the suture (raphae) allowing a little space of the size of a barley (from the raphae), an incision equal to the length of the stone should be made by the instrument; some authorities say that the incision can be made even on the right side (of the raphae) for reason of convenience of surgical work; the incision should neither break the stone nor make it powder, because even very little of such powder remaining inside forms into stone again; hence the entire stone should be removed by using instruments having a bend at their tip (hooks and scoops). (27)
स्त्रीणांतु बस्तिः पार्श्वगतो गर्भाशयसन्निकृष्टः । तस्मात्तासामुत्सङ्गवदधः शस्त्रं पातयेत् । अतोऽन्यथा खल्वासां मूत्रस्रावी व्रणो भवति पुरुषस्य च मूत्रप्रसेकक्षणनात् । अश्मरीनिमित्तमेकतो भिन्नो बस्तिः सिध्यति । क्रियाभ्यासाच्छास्त्रविहितच्छेदादीनष्पन्दपरिवृद्धत्वाच्च शल्यस्येति । न तु द्विधा भिन्नबस्तिरश्मरीमानमपि ॥ २८ ॥
In women, the urinary bladder is placed at a side and very near to the uterus. So, for them, the instrument should be used facing downwards. The incision should start at the top and proceed downwards otherwise, there is a wound exuding urine due to injury of the urethral passage; it (wound) might happen in males also. The urinary bladder that gets cut at one place only for the removal of the stone gets cured.
If, the surgical acts such as incising etc are not well practised by the physician or if by steady growth of the foreign body (stone), the bladder gets cut at two places, it does not (get cured) though the incisions are of the same size of the stone. (28)
उद्धृतशल्यं तूष्णोदकद्रोण्यामवगाह्य स्वेदयेत् । तथा बस्तिरसृजा नापूर्यते । पूर्णे तु क्षीरिवृक्षकषायं पुष्पनेत्रेण विदध्यात् । स हि तथा बस्तिगतमश्मरीचूर्णं रक्तं च निर्हरति । मूत्रविशुद्ध्यर्थं च गुडसौहित्यंकारयेत् ।।२९ ।।
After removing the foreign body (stone), the patient should be given fomentation by making him sit in a tub filled with warm water. So that the bladder does not get filled with blood. If it gets filled (with blood), decoction of ksiri vrikshas (trees yeilding milky sap) should be introduced (into the bladder) with the help of douche nozzle, that (douche) brings out the blood as well as the gravel. (29)
उत्थाप्य चैनं मधुघृताभ्यक्तव्रणं मूत्रविशोधनद्रव्यसिद्धामुष्णां यवागूं सघृतांपाययेदुभयकालं त्रिरात्रम् । त्रिरात्रादूर्ध्वं गुडप्रगाढेन पयसामृदुमोदनमल्पं भोजयेदादशरात्रात् । अत ऊर्ध्वं फलाम्लैर्जाङ्गलरसैः । व्रणं च क्षीरिवृक्षकषायेण प्रक्षाल्य लोभ्रमधुकमञ्जिष्ठाप्रपौण्डरीककल्केन लेपयेत् । द्वादशरात्रं चैनमप्रमत्तः स्वेदयेत् । एतेष्वेव च हरिद्रादियुक्तेषु तैलं विपक्वं व्रणाभ्यञ्जनम् । सप्तरात्राच्च स्वमार्गमप्रतिपद्यमाने मूत्रे यथोक्तमग्निना व्रणं दहेत् । स्वमार्गप्रतिपन्ने चोत्तरबस्त्यास्थापनानुवासनैर्मधुरप्रायैरुपाचरेत् ।।३० ।।
After the patient comes out of the tub, the wound should be smeared with honey and ghee, he should be asked to drink yavagu (gruel) along with ghee processed with drugs which purify urine, both times (of the meals) for three days. After three days and till the tenth day he can eat little quantity of soft, boiled rice along with milk which has been added with more of guda (jaggery); then afterwards with sour fruit juices and meat juices.
The ulcer should be washed with the decoction of ksirivrikshas (trees yeilding milky sap) and smeared with the paste of lodhra, madhuka, manjistha and prapaundarika. For twelve days he should be given sudation therapy very carefully (avoiding excess), the wound should be anointed with medicated oil prepared from these drugs along with drugs of haridradigana (chapter 16 of sutrasthana). If the urine does not begin to flow from its own passage by the seventh day, then the wound should be touched by fire (cauterised) in the prescribed procedure. When it (urine) gets its own normal passage, the patient should be treated with uttarabasti (bladder douche), asthapana (decoction enema) with drugs predominantly sweet in taste. (30)
यदृच्छया मूत्रमार्गप्रतिपन्नामन्तरासक्तां शुक्राश्मरीं शर्करां वा स्त्रोतसापहरेत् । विदार्यं वा नाडिं बडिशेनोद्धरेत् । रूढव्रणश्च वर्षमङ्गनाश्च नगनागरथद्रुमान् नारोहेत् । नाप्सु प्लवेत भुञ्जीत वा गुरूणि ॥ ३१ ॥
The seminal stone of gravel, which has by its own accord, is found stuck up on the middle of the urinary passage, should be removed from the passage, if necessary by cutting (incising) the passage and extracting it out by theuse of badisa (a kind of bent hook).
Till the wound heals, the patient should not engage himself in women (sexual intercourse), climbing mountains, riding on elephant, and chariots and climbing trees for one year; neither should swim in water nor partake heavy foods. (31)
कर्मणि तु मूत्रवहशुक्रवहमुष्कस्त्रोतोमूत्रप्रसेकसेवनीयोनिगुदबस्तयोऽष्टौ परिहर्तव्याः । तत्र मूत्रवहच्छेदात् मूत्रपूर्णबस्तेर्मरणम् । शुक्रवहच्छेदान्मरणं क्लैब्यं वा । मुष्कस्त्रोतसोरुपघातात् ध्वजभङ्गः । मूत्रप्रसेकच्छेदान्मूत्रस्त्रवणम् । सेवनीयोनिच्छेदनाद्रुजाप्रादुर्भावः । गुदबस्तिविद्धस्य सद्योमरणमुक्तंप्रागिति ॥ ३२ ॥
During the surgical operation (for the removal of the stone) the channel of urine, channel of semen, channel of the scrotum, channel of urinary elimination (urethra), the suture (vesico-rectal raphea), the vagina, the rectum and the bladder; these eight should be avoided (should not be injured); a cut in the passage of urine makes for accumulation of urine in the bladder and leads to death; cut in the passage of the semen will either cause death or impotence; injury to the channel of the scrotum will cause loss of erection of the penis; cut in the urinary passage leads to dribbling of urine; cut in the suture (raphea) and vagina leads to appearance of pain; injury to either rectum or bladder leads to immediate death, as told previously. (32)
Another verse here –
भवति चात्र
मर्माण्यमून्यविज्ञाय स्त्रोतोजानि शरीरिणाम् । शस्त्रपाणिर्ध्रुवंहन्ति साहसात् केवलो यथा इति ||३३ || He (physician) who holds the weapon (knife) in hand (performs surgery) without a full knowledge of these eight sroto marma (vital spots having predominance of channels) quickly kills the person just like a kevala (a mad man) weilding a weapon. (33)
॥ इतित्रयोदशोऽध्यायः ॥ Thus ends the Thirteenth chapter.
