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Sushruta SamhitaMutra dosa Pratisedha - Mutrakricchra - Treatment of the defects of urine...

Mutra dosa Pratisedha – Mutrakricchra – Treatment of the defects of urine – Sushrutasamhita Uttaratantra Chapter 59

एकोनषष्टितमोऽध्यायः अथातो मूत्रकृच्छ्रप्रतिषेधमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः॥१॥

Now we shall discourse on the chapter which deals with the symptoms and medical treatment of the defects of urine (Mutra-dosa Pratisedha)¹. 1

Classification of Mutra Roga

वातेन पित्तेन कफेन सर्वैस्तथाभिघातैः शकृदश्मरीभ्याम् । तथाऽपरः शर्करया सुकष्टो मूत्रोपघातः कथितोऽष्टमस्तु ॥ २ ॥

Classification – The disease known as Mutropaghata is divided into eight different types according to as an attack induced by the deranged action of the bodily Vayu, Pitta and Kapha separately, or is due to the concerted action of all of them, or to the effects of an external blow or hurt (on the locality), or to the pressure of the faeces incarcerated (in the intestine),-i.e. due to the constipation of the bowels- or due to the presence of any stone (Asmari in the bladder). The eighth type is the one due to the presence of gravels (Sarkara in the bladder). This disease is one of the most painful and distressing ailments which assail the human body. 2

1. Dalhana’s reading evidently is Mutra-krcchra (strangury), for he says that the variant here in some Mss. in Mutra-dosa. He says further that some do not read this chapter at all on the ground that the matter in this chapter is included in the chapters of Asmari, Mutraghata and Udavarta etc. But, according to him, it must be read here for treatment’s sake as well as on the ground of its being separately treated in other authoritative works. Madhava, Cakra-pani, Vrnda and other compilers have read this as Mutra-krcchra in a separate chapter as here.

Specific Symptoms of Mutra Roga

अल्पमल्पं समुत्पीड्य मुष्कमेहनबस्तिभिः । फलद्भिरिव कृच्छ्रेण वाताघातेन मेहति ॥ ३ ॥ हारिद्रमुष्णं रक्तं वा मुष्कमेहनबस्तिभिः । अग्निना दह्यमानाभैः पित्ताघातेन मेहति ॥ ४ ॥ स्निग्धं शुक्लमनुष्णञ्च मुष्कमेहनबस्तिभिः । संहृष्टरोमा गुरुभिः श्लेष्माघातेन मेहति ॥५॥ दाहशीतरुजाविष्टो नानावर्णं मुहुर्मुहुः । ६ ॥ ताम्यमानस्तु कृच्छ्रेण सन्निपातेन मेहति ॥

Specific Symptoms – A scanty flow of urine coming out in drops and producing oppressive and bursting pain in the scrotum, penis and bladder, is the specific feature of the Vataja type of the disease. The Pittaja type is characterised by the emission of bloody or high-coloured (lit. dark yellow) and (very) warm urine which produces a burning sensation in the scrotum, bladder and penis as being burnt by fire. A sense of weight or heavines in the scrotum, penis and bladder, an appearance of goose-flesh (on the skin) and the emission of cold, white and glossy (oily) urine, are the features which mark the Kaphaja type. Burning sensation (in the urethra, etc.), shivering (of the body), frequent emission of urine of varied colours, painful micturition and loss of consciousness are the indications which point to the Sannipatika origin of the disease which is very hard to cure. 3-6.

मूत्रवाहिषु शल्येन क्षतेष्वभिहतेषु च । स्त्रोतःसु मूत्राघातस्तु जायते भृशवेदनः । वातबस्तेस्तु तुल्यानि तस्य लिङ्गानि लक्षयेत् ॥७॥ शकृतस्तु प्रतीघाताद् वायुर्विगुणतां गतः । आध्मानञ्च सशूलञ्च मूत्रसङ्गं करोति हि ॥ ८ ॥

The presence of any ulcer or an injury to the urethra, by any external object gives rise to an extremely distressing stricture in the case of which the characteristic symptoms of Vata-basti manifest themselves. The suppression of the faeces leads to the aggravation of the local Vayu which, in its turn, produces a distension of the abdomen and a suppression of urine accompanied with cramps (in the bladder). 7-8

Ashmarija and Sarkaraja

अश्मरीहेतुकः पूर्वं मूत्राघात उदाहृतः ॥ ९॥ अश्मरी शर्करा चैव तुल्ये सम्भवलक्षणैः । शर्कराया विशेषन्तु शृणु कीर्तयतो मम ॥ १० ॥ पच्यमानस्य पित्तेन भिद्यमानस्य वायुना। श्रेष्मणोऽवयवा भिन्नाः शर्करा इति संज्ञिताः ॥ ११॥ हृत्पीडा वेपथुः शूलं कुक्षौ वह्निः सुदुर्बलः । ताभिर्भवति मूर्च्छा च मूत्राघातश्च दारुणः ॥ १२॥ मूत्रवेगनिरस्तासु तासु शाम्यति वेदना | यावदन्या पुनर्नैति गुडिका स्त्रोतसो मुखम् ॥ १३ ॥ शर्करासम्भवस्यैतन्मूत्राघातस्य लक्षणम्॥१४॥

Ashmarija and Sarkaraja —Mutra-ghata (obstructed urination) due to the presence of Asmari (stone) has been already mentioned (in the Nidana Sthana). Stones and gravels are of similar origin and exhibit similar symptoms. Now hear me describing the symptoms which are the distinguishing traits of a case of Sarkara (gravel or urinary calculus in the bladder). Flakes or particles of deranged and condensed Kapha when baked (dried?) by the action of the deranged and aggravated Pitta and severed in pieces by the deranged bodily Vayu, are called Sarkara (gravels) giving rise to such symptoms as cardiac troubles (pain in the heart, etc.) shivering, cramps in the loins, great diminution of the digestive fire, fainting fits and painful and obstructed urination. The pain, however, subsides with the subsidence of the desire for micturition (full evacuation of the bladder), the relief from the pain continuing until the orifice of the organ (urethra) is not again obstructed by the presence of other calculi. These are the symptoms which characterise a case of Mutraghata (obstructed urination) due to the presence of gravels in the bladder. 9-14.

General Treatment of Mutra roga

चिकित्सितमथैतेषामष्टानामपि वक्ष्यते । अश्मरीञ्च समाश्रित्य यदुक्तं प्रसमीक्ष्य तत् ॥ १५ ॥

यथादोषं प्रयुञ्जीत स्नेहादिमपि च क्रमम् ॥ १६ ॥

General Treatment – Now I shall describe the mode of medical treatment and active therapeutic agents to be employed in the eight cases of Mutra-ghata. Medical measures and remedies mentioned in connection with the treatment of Asmari (stone) should also¹ be employed in the present instance in due succession- commencing with the application of Sneha, etc. – – with proper regard to the Dosa or Dosas involved in each case. 15-16.

Treatment of Vataja Mutrakricchra

श्वदंष्ट्राश्मभिदौ कुम्भीं हपुषां कण्टकारिकाम् । बलां शतावरीं रास्त्रां वरुणं गिरिकर्णिकाम् । तथा विदारिगन्धादिं संहृत्य त्रैवृतं पचेत् । तैलं घृतं वा तत् पेयं तेन वाऽप्यनुवासनम् ॥ १७ ॥ दद्यादुत्तरबस्तिञ्च वातकृच्छ्रोपशान्तये ॥ १८ ॥ श्वदंष्ट्रास्वरसे सगुडक्षीरनागरम् । तैलं पक्त्वा तत् पूर्ववद्योज्यं तत्रानिलरुजापहम् ॥ १९ ॥

Treatment of Vataja type – Oil, clarified butter and lard mixed together should be duly cooked with sva-darmstra, Asmabheda, Kumbhi (a kind of moss), Hapusa, Kantakari, Bala, Satavari, Rasna, Varuna, Giri-karnika and the drugs of the Vidari-gandhadi group. Oil or clarified butter alone may also be similarly cooked and prepared with the above drugs. The above preparations should be internally administered, or injected into the intestines in the manner of an Anuvasana-basti, or into the urethra as an Uttara-basti for giving relief in cases of Vataja Mutra-krcchra. 17-19.

तृणोत्पलादिकाकोलीन्यग्रोधादिगणे कृतम् । पीतं घृतं पित्तकृच्छ्रं नाशयेत् क्षीरमेव वा ॥ २० ॥ दद्यादुत्तरबस्तिञ्च पित्तकृच्छ्रोपशान्तये ॥ २१ ॥ एभिरेव कृतः स्नेहस्त्रिविधेष्वपि बस्तिषु । हितं – विरेचनञ्चेक्षु-क्षीरद्राक्षारसैर्युतम् ॥ २२ ॥

1. Dalhana says that the presence of the particle “च” (meaning also) indicates that the mode of medical treatment prescribed in cases of Muraghata should also be applied in this case.

Pittaja and Kaphaja Mutrakricchra

सुरसोषकमुस्तादौ वरुणादौ च यत्कृतम् | तैलं तथा यवाग्वादि कफाघाते प्रशस्यते ॥ २३ ॥

Pittaja and Kaphaja Types – The internal use of the clarified butter duly cooked with the drugs of the Trina-panca-mula, Utpaladi, Kakolyadi and Nyagrodhadi groups, would give an instantaneous relief in a case of Pittaja Mutra-Krcchra. The use of this Ghrita as an Uttarabasti would also similarly give relief in a case of the present type. Any Sneha duly cooked with the preceding drugs should be similarly used in the manner of any of the three Basti-application. Purging with milk and the expressed juice of Iksu and of Draksa is also beneficial. Oils and yavagus duly cooked with the drugs of the Surasadi, Usakadi, Mustadi and the Varunadi groups would prove curative in a case of Kaphaja Mutra-krcchra. 20-23.

Tridosaja Mutrakricchra

यथादोषोच्छ्रयं कुर्यादेतानेव च सर्वजे । फल्गुवृश्चीरदर्भाश्म-सारचूर्णञ्च सुरेक्षुरसदर्भाम्बुपीतं वारिणा | कृच्छ्ररुजापहम् ॥

२४ ॥

Tridosaja Type – The foregoing measures and remedies should be employed in the Tri-dosaja type of Mutra-krcchra according to the nature and intensity of the predominance of the Dosa involvedPulverised compound of Phalgu (Kakodumbra ), Vrscira (white Punarnava), Darbha and Asma-sara (dead iron) taken with waterpotions of Sura (wine), the expressed juice of Iksu, and the decoction of Darbha would relieve pain in a case of Mutra-krcchra.24.

तथाऽभिघातजे कुर्यात् सद्योव्रणचिकित्सितम् ॥ २५ ॥ मूत्रकृच्छ्रे शकृज्जाते कार्या वातहरी क्रिया । स्वेदावगाहावभ्यङ्ग-बस्तिचूर्णक्रियास्तथा ॥ २६ ॥ ये त्वन्ये तु तथा कृच्छ्रे तयोः प्रोक्तः क्रियाविधिः ॥ २७ ॥

Medicines and medicinal measures mentioned in the chapter on the treatment of Sadyo-vrana should be employed in a case of stricture due to any hurt (Abhighata) to the urethra. Vayu-subduing remedies should be constantly used, and baths, fomentations, unguents, applications of Basti and powders should be employed in a case of Purisaja Mutra-krcchra. The treatment of the last two kinds (viz. Asmari-ja and Sarkara-ja) has already been described. 25-27.

इति सुश्रुत संहितायामुत्तरतन्त्रे मूत्रकृच्छ्रप्रतिषेधव्याख्यानामैकोनषष्टितमोऽध्यायः ॥ ५९ ॥

Thus ends the fifty-ninth chapter of the Uttara-Tantra in the Susruta Samhita which deals with the symptoms and medical treatment of Mutra-dosa.

Here ends the Kaya-Chikitsa


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