अथातो मूत्राघातचिकित्सितं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter – Mutraghata chikitsa treatment of retention of urine; thus said Atreya and other great sages.
Mutrakriccha Chikitsa – Dysria Treatment
Vataja mutrakriccha chikitsa
कृच्छ्रे वातघ्नतैलाक्तमधोनाभेः समीरजे। सुस्निग्धैः स्वेदयेदङ्गं पिण्डसेकावगाहनैः ॥ १॥
In case of mutrakricchra (dysuria) arising from samira (vata), the body of the patient should be anointed with medicated oil which mitigates vata, the region below the umbilicus should be given fomentation either with pindasveda (warm bolus drugs), seka (pouring warm liquids) or avagaha (tub bath). 1
दशमूलबलैरण्डयवाभीरुपुनर्नवैः कुलत्थकोलपत्तूरवृश्चीवोपलभेदकैः तैलसर्पिर्वराहर्क्षवसाः क्वथितकल्कितैः । । ॥२॥
सपञ्चलवणाः सिद्धाः पीताः शूलहराः परम् ॥ ३ ॥
Medicated fat prepared with the decoction of dasamula, bala, eranda, yava, abhiru, punarnava, kulattha, kola, pattura, vrsciva and upalabhedaka ( asmabheda); the paste of these drugs, oil, ghee, muscle-fat of a boar and a bear and added with the panca lavana (after cooking), and drunk (consumed internally in suitable dose) is best to relieve the pain (of dysuria). 2-3.
द्रव्याण्येतानि पानान्ने तथा पिण्डोपनाहने । सह तैलफलैर्युञ्यात्साम्लानि स्नेहवन्ति च ॥ ४ ॥
These same drugs may be made use of to prepare drinks and eatables as well as for making bolus and paste for fomentation and poultices, along with fruits yeilding oil, mixed with sours and fats. 4.
सौवर्चलाढ्यां मदिरां पिबेन्मूत्ररुजापहाम्।
Madira (alcoholic drink) added with more quantity of sauvaracala (salt) should be drunk, for relief from pain of urinary elimination. 5a.
Pittaja mutrakriccha chikitsa
पैत्ते युञ्जीत शिशिरं सेकलेपावगाहनम् ॥ ५ ॥
In case of mutrakriccha ( dysuria ) arising from pitta, bathing the part with liquids, application of paste and tub bath should be administered cold. 5b.
पिबेद्वरीं गोक्षुरकं विदारीं तृणाख्यं पञ्चमूलं च पाक्यं सकसेरुकाम् । समधुशर्करम् ॥ ६॥
Decoction of vari, goksuraka, vidari, kaseruka, and drugs of trna pancamula should be consumed added with honey and sugar. 6.
वृषकं त्रपुसैर्वारुलट्वाबीजानि कुङ्कुमम्। द्राक्षाम्भोभिः पिबन् सर्वान् मूत्राघातानपोहति ॥ ७ ॥
Vrisaka (pasanabheda), seeds of trapusa, ervaru and latva (kusunbha) and kumkuma (made into a paste) mixed with water, in which draksa is sqeezed, and consumed, cures all kinds of mutraghata (dysuria). 7.
एर्वारुबीजयष्ट्याह्वदार्वीर्वा तण्डुलाम्बुना ।
तोयेन कल्कं द्राक्षायाः पिबेत्पर्युषितेन वा ॥ ८ ॥
Seeds of ervaru, yasti or darvi-should be consumed with rice-wash or paste of draksa mixed with water boiled and cooled should be consumed. 8.
Kaphaja mutrakricchra chikitsa
कफजे वमनं स्वेदं तीक्ष्णोष्णकटुभोजनम् । यवानां विकृती: क्षारं कालशेयं च शीलयेत् ॥ ९ ॥
In case of mutrakricchra ( dysuria) arising from kapha, administration of vamana (emesis), sveda (sudation), ingestion of foods which posses penetrating hot and pungent properties, eatables prepared from yava, ksara (alkaline substances) and kalaseya (buttermilk) should be done. 9.
पिबेन्मद्येन सूक्ष्मैलां धात्रीफलरसेन वा । सारसास्थिश्वदंष्ट्र्लाव्योषं वा मधुमूत्रवत् ॥ १० ॥
स्वरसं कण्टकार्या वा पाययेन्माक्षिकान्वितम् । शितिवारकबीजं वा तक्रेण श्लक्ष्णचूर्णितम् ॥ ११ ॥
धवसप्ताह्वकुटजगुडूचीचतुरङ्गुलम् केम्बुकैलाकरचं च पाक्यं समधु साधितम् ॥ १२ ॥
तैर्वा पेयां प्रवालं वा चूर्णितं तण्डुलाम्बुना। सतैलं पाटलाक्षारं सप्तकृत्त्वोऽथवा स्रुतम् ।। १३ ।।
(Powder of) suksma ela should be consumed either with wine or juice of dhatriphala or (ash of ) bones of sarasa bird, (powder of) svadamstra, ela, and vyosa along with honey and cows urine; or fresh juice of kantakari mixed with honey; or fine powder of seeds of sitivaraka mixed with buttermilk; decoction of dhava, saptahva, kutaja, guduci, caturangula, kembuka, ela and karanja mixed with honey; or peya (thin gruel) prepared from the above drugs; or powder of pravala mixed with rice-wash; or ash of patala washed in water and filtered for seven times can be consumed mixed with oil. 10-13.
पाटलीयावशूकाभ्यां पारिभद्रात्तिलादपि ।
क्षारोदकेन मदिरां त्वगेलोषकसंयुताम् ॥ १४ ॥
पिबेद्गुडोपदंशान्वा लिह्यादेतान् पृथक् पृथक् ।
Ash of either patali, yavasuka, paribhadra, or tila dissolved in water, is mixed with madira ( alcoholic drink), powder of tvak, ela and usaka (usana) should be consumed, or powder of these drugs individually may be licked with powder of guda (jaggery, treacle). 14-15a.
Sannipataja mutrakriccha chikitsa
सन्निपातात्मके सर्वं यथावस्थमिदं हितम् ॥ १५ ॥ अश्मन्यप्यचिरोत्थाने वातबस्त्यादिकेषु च ।
In case of mutrakricchra (dysuria) of sannipata origin these treatments are good when adopted suitable to the stage/condition of the disease. This holds good even for ashmari (urinary calculus) of recent onset and also for vatabasti etc. 15b-16a.
Ashmari chikitsa – treatment of urinary stone / calculus
अश्मरी दारुणो व्याधिरन्तकप्रतिमो मतः ॥ १६ ॥ तरुणो भेषजैः साध्यः प्रवृद्धश्छेदमर्हति ।
तस्य पूर्वेषु रूपेषु स्नेहादिक्रम इष्यते ॥ १७ ॥ Ashmari is a grave disease, simulting death. It is manageable with drugs when it is of recent onset but when greatly developed, it requires surgical operation
.
In its premonitory stage, oleation and other therapies are needed. 16b-17.
Vataja ashmari chikitsa
॥ १८ ॥ पाषाणभेदो वसुको वशिरोऽश्मन्तको वरी ।
कपोतवङ्कातिबलाभल्लूकोशीरकच्छकम् वृक्षादनी शाकफलं व्याघ्री गुण्ठत्रिकण्टकम् ।
यवाः कुलत्थाः कोलानि वरुणः कतकात्फलम् ॥ १९ ॥
ऊषकादिप्रतीवापमेषां क्वाथे शृतं घृतम् । भिनत्ति वातसम्भूतां तत्पीतं शीघ्रमश्मरीम् ॥ २० ॥
Medicated ghee prepared with the decoction of pasanabheda, vasuka (isvara mallika), vasira (samudra lavana), asmantaka (malukaparna), vari, kapota vanka (sauvarcala), atibala, bhalluka (syonaka) usira, kacchaka, vrksadani, sakaphala, the two vyaghri, guntha, trikantaka, yava, kulattha, kola, varuna, and katakaphala, paste of usaka etc., and ghrita ( butter fat ), This ghee consumed, soon, breaks the stone produced by vata. 18-20.
गन्धर्वहस्तबृहतीव्याघ्रीगोक्षुरकेक्षुरात्
मूलकल्कं पिबेद्दध्वा मधुरेणाश्मभेदनम् ॥ २१ ॥
Paste of roots of gandharva hasta, brihati, vyaghri, goksuraka and iksuraka consumed mixed with sweet buttermilk, breaks the stone. 21.
Pittaja ashmari chikitsa
कुश: काशः शरो गुण्ठ इत्कटो मोरटोऽश्मभित् । दर्भों विदारी वाराही शालिमूलं त्रिकण्टकः ॥ २२ ॥
भल्लूक: पाटली पाठा पत्तूरः सकुरण्टकः । पुनर्नवे शिरीषश्च तेषां क्वाथे पचेद्धृतम् ॥ २३ ॥
पिष्टेन त्रपुसादीनां वीजेनेन्दीवरेण च। मधुकेन शिलाजेन तत्पित्ताश्मरिभेदनम् ॥ २४ ॥
Medicated ghee is prepared with the decoction of kusa, kasa, sara, guntha, itkata, morata, asmabhit, darbha, vidari, varahi, salimula, trikantaka, bhalluka, patali, patha, pattura, kurantaka, the two punarnava and sirisa, and paste of seeds of trapusa etc. ( mentioned in verse 7 ) indivara, madhuka, and silajatu. This recipe breaks the stone formed from pitta. 22-24.
Kaphaja ashmari chikitsa
वरुणादिः समीरघ्नौ गणावेलाहरेणुका |
गुग्गुलुर्मरिचं कुष्ठं चित्रकः ससुराह्वयः ॥ २५ ॥
तैः कल्कितैः कृतावापमूषकादिगणेन च । भिनत्ति कफजामाशु साधितं घृतमश्मरीम् ॥ २६ ॥
Medicated ghee prepared with the decoction of drugs of varunadigana samiraghna gana, viratarvadi gana (vide-chapter 15 of sutrasthana), ela, harenuka, guggulu, marica, kustha, citraka and surahvaya; paste of drugs of usakadi gana (chapter 15 of sutrasthana) and ghrta ( ghee ). This breaks the stone formed from kapha. 25-56.
क्षारक्षीरयवाग्वादि द्रव्यैः स्वैः स्वैश्च कल्पयेत् ।
Ksara (alkalies), ksira yavagu ( milk gruel) etc. prepared with their own drugs ( meant for them) should be administered. 27a.
Mutrasarkara chikitsa
पिचुकाङ्कोल्लकतकशाकेन्दीवरजैः फलैः ॥ २७॥
पीतमुष्णाम्बु सगुडं शर्करापातनं परम् । क्रौञ्चोष्टरासभास्थीनि श्वदंष्ट्रा तालपत्रिका ॥ २८ ॥
अजमोदा कदम्बस्य मूलं विश्वस्य चौषधम् । पीतानि शर्करां भिन्धुः सुरयोष्णोदकेन वा ॥ २९ ॥
(Powder of) picuka ( sitivaraka), ankolla, kataka, leaves and fruits of indivara, consumed along with water added with guda is best to expel the urinary gravel.
(Ash of) bone of kraunca ( heron ) , ustra (camel) and rasabha (donkey ), powder of svadamstra, talapatrika, ajamoda, root of kadamba and visvausadha, consumed either with sura (beer) or warm water breaks the gravel. 27b-29.
नृत्यकुण्डकबीजानां चूर्णं माक्षिकसंयुतम् । अविक्षीरेण सप्ताहं पीतमश्मरिपातनम् ॥ ३० ॥
Powder of seeds of nrtyakundaka (tumburu) mixed with honey and cow’s milk consumed for seven days, eliminates the stone. 30.
॥३१॥ क्वाथश्च शिग्रुमूलोत्थ: कदुष्णोऽश्मरिपातनः ।
तिलापामार्गकदलीपलाशयवसम्भवः क्षार: पेयोऽविमूत्रेण शर्करास्वश्मरीषु च ।
कपोतवङ्कामूलं वा पिबेदेकं सुरादिभिः ॥ ३२ ॥
तत्सिद्धं वा पिबेत्क्षीरं वेदनाभिरुपद्रुतः । हरीतक्यस्थिसिद्धं वा साधितं वा पुनर्नवैः ॥ ३३ ॥ क्षीरान्नभुम्बर्हिशिखामूलं वा तण्डुलास्बुना ।
Decoction of root of sigru, consumed lukewarm, expels the stone. Ksara ( ash) of tila, apamarga, kadali, palasa and yava consumed with sheep’s urine is good for both gravel and stone.
(Powder of) roots kapotavinka alone consumed with sura etc. (wines) or milk boiled with it should be consumed by the patient suffering from pain; or milk boiled with seeds of haritaki or with punarnava, or roots of barhisikha (mayurasikha) along with rice-wash should be consumed and the person should eat boiled rice and milk only. 31-34a.
Mutraghata chikitsa
मूत्राघातेषु विभजेदतः शेषेष्वपि क्रियाम् ॥ ३४ ॥
The above treatments may be adopted in different kinds of mutraghata also, as and how found suitable. 34b.
बृहत्यादिगणे सिद्धं द्विगुणीकृतगोक्षुरे । तोयं पयो वा सर्पिर्वा सर्वमूत्रविकारजित् ॥ ३५ ॥
Decoction, milk or ghee prepared with drugs of brhatyadigana (chapter 15 of sutrasthana) with double the quantity of goksura, cure all kinds of urinary diseases. 35.
देवदारुं घनं मूर्वां यष्टीमधु हरीतकीम् । मूत्राघातेषु सर्वेषु सुराक्षीरजलैः पिबेत् ॥ ३६ ॥
(Powder of) devadaru, ghana, murva, yasthimadhu and haritaki, should be consumed either with sura (beer ), milk or water in all the varieties of mutraghata (retention of urine). 36.
रसं वा धन्वयासस्य कषायं ककुभस्य वा । सुखाम्भसा वा त्रिफलां पिष्टां सैन्धवसंयुताम् ॥ ३७॥
व्याघ्रीगोक्षुरकक्वाथे यवागूं वा सफाणिताम् । क्वाथे वीरतरादेर्वा ताम्रचूडरसेऽपि वा ॥ ३८ ॥
अद्याद्वीरतराद्येन भावितं वा शिलाजतु ।
Juice of dhanvayasa or decoction of kakubha, or paste of triphala and saindhava with warm water should be consumed, yavagu prepared with the decoction of vyaghri and goksuraka mixed with phanita (half-kooked molasses) or peya prepared with the decoction of drugs of virataradigana ( chapter 15 of sutrasthana) with the soup of meat of tamracuda (cock) should be consumed. Silajatu macerated with the decoction of drugs of virataradigana should be partaken. 37-39a.
मद्यं वा निगदं पीत्वा रथेनाश्वेन वा वज्रेत् ॥ ३९ ॥
शीघ्रवेगेन सङ्क्षोभात्तथाऽस्य च्यवतेऽश्मरी ।
The patient (of urinary stone) should be given a drink of unspoilt wine and taken for a fast ride on a chariot of horses or on the horse. By the resulting shaking the stone 39b-40a. gets dislodged.
सर्वथा चोपयोक्तव्यो वर्गो वीरतरादिकः ॥ ४० ॥
The drugs of virataradigana etc. should be made use of in all the ways (to preapare decoction, peya, yavagu, drinking water etc.). 40b.
रेकार्थं तैल्वकं सर्पिर्बस्तिकर्म च शीलयेत् । विशेषादुत्तरान् बस्तीन्
Tailvaka ghrta ( chapter 3 of cikitsa sthana) should be used for producing purgations, basti karma, (enema therapy), especially the uttara basti ( enema to the urinary bladder) should be administered. 41.
Sukrashmari chikitsa
शुक्राश्मर्यां तु शोधिते ॥ ४१ ॥ तैर्मूत्रमार्गे बलवान् शुक्राशयविशुद्धये ।
पुमान् सुतृप्तो वृष्याणां मांसानां कुक्कुटस्य च ॥ ४२ ॥ कामं सकामाः सेवंत प्रमदा मददायिनीः ।
In case of sukrashmari (seminal calculus) the man should be given strong enemas especially the uttara basti (enema to the urinary bladder) to purify the receptacle of semen. Then the person should partake meat which is aphrodisiac or meat of the cock, getting contented by this manner, he should copulate with a women who exhilarates him.
Ashmari sastra chikitsa – surgical operation for urinary calculus
सिद्धैरुपक्रमैरेभिर्न चेच्छान्तिस्तदा भिषक् ॥ ४३ ॥
इति राजानमापृच्छ्य शस्त्रं साध्ववचारयेत् । अक्रियायां ध्रुवो मृत्युः क्रियायां संशयो भवेत् ॥ ४४ ॥
निश्चितस्यापि वैद्यस्य बहुश: सिद्धकर्मणः ।
If by these methods of treatments, the disease (urinary calculus) does not subside, the physician should then resort to the use of the sharp instruments appropriately, after obtaining permission from the king (or other administrative authority) explaining as follows
“Death is sure if surgical operation is not done, even if done, there is uncertainty ( of life ) because even physicians who are experts and modes of treatment considered as the best, may prove otherwise, sometimes”. 43b-45a.
अथातुरमुपस्निग्धशुद्धमीषच्च अभ्यक्तस्विन्नवपुषमभुक्तं कृतमङ्गलम् । कर्शितम् ॥ ४५ ॥
आजानुफलकस्थस्य नरस्याङ्के व्यपाश्रितम् ॥ ४६ ॥
पूर्वेण कायेनोत्तानं निषण्णं वस्त्रचुम्भले | ततोऽस्याकुञ्चिते जानुकूपर वाससा दृढम् ॥ ४७ ॥
सहाश्रयमनुष्येण बद्धस्याश्वासितस्य च । नाभेः समन्तादभ्यज्यादधस्तस्याश्च वामतः ॥ ४८ ॥
मृदित्वा मुष्टिनाऽऽक्रामेद्यावदश्मर्यधोगता । तैलाक्ते वर्धितनखे तर्जनीमध्यमे ततः ॥ ४९ ॥
अदक्षिणे गुदेऽङ्गुल्यौ प्रणिधायानुसेवनि। आसाद्य बलयत्नाभ्यामश्मरीं गुदमेढ्रयोः ॥ ५० ॥
कृत्वाऽन्तरे तथा बस्तिं निर्वलीकमनायतम् | यावद्ग्रन्थिरिवोन्नतम् ॥ ५१ ॥
उत्पीडयेदङ्गुलिभ्यां शल्यं स्यात्सेवनीं मुक्त्वा यवमात्रेण पाटयेत् । अश्ममानेन न यथा भिद्यते सा तथाऽऽहरेत् ॥ ५२
समग्रं सर्पवक्त्रेण, स्त्रीणां बस्तिस्तु पार्श्वगः । गर्भाशयाश्रयस्तासां शस्त्रमुत्सङ्गवत्ततः ॥ ५३ ॥
न्यसेदतोऽन्यथा ह्यासां मूत्रस्त्रावी व्रणो भवेत् । मूत्रप्रसेकक्षणनान्नरस्याप्यपि चैकधा ॥ ५४ ॥
बस्तिमेदोऽश्मरीहेतुः सिद्धिं याति न तु द्विधा ।
Next, the patient who has been given mild oleation and purifactory therapies, made slightly thin ( by fasting ) should be anointed all over the body with oil, given mild fomentation, prevented from eating and allowed to perform auspicious rites. He should then be made to lie on a wooden couch of the height of ones knee, facing upwards, the legs folded at the knees and placed over the upper part of the body, knees and elbows folded and bound together tight with bands of cloth. He should then be held tight by attendents and enthused with courageous words.
Next, the region below the umbilicus, should be anointed with oil, and massaged. Commencing from the left side, the physician should knead the region (of the urinary bladder) by his hands so as to bring the stone downward.
Next, the index and middle fingers which have been closely pared of their nails and anointed with oil should be introduced into the rectum from the right side. Then by exerting strength and pressure the stone is made to come to the middle of the rectum and penis and held in position.
Next, the area over the urinary bladder is constricted, the folds over it warded off, squeezed by the fingers, (in the downwards direction) till the foreign body (stone) bulges out like a tumor. Then, avoiding the line of the sevani (vesicorectal raphae) an incision of the size of a yava (barley) or the size of the stone should be made (slightly to the left of the raphae) and the stone extracted completely by using the sarpamukha sastra (forked forceps to hold the stone). In women, the uterus is located by the side of the urinary bladder, so the instruments should be introduced with its face downwards. otherwise there is the possibility of causing a wound through which urine flows out due to injury to the urethra. This possibility is for men also. Incising the urinary bladder once (at one place) for the reason of removing the stone becomes successful, gets healed but not for the second time (or done at two places).
After the removal of the region body (stone) the patient should lie in a tub containing warm water, so that the urinary bladder does not get filled up with blood. Still if the blood collects inside, decoction of bark of trees having milky sap should be squeezed into the penis (as uttarabasti-douche into the bladder). 45b-55a.
विशल्यमुष्णपानीयद्रोण्यां तमवगाहयेत् ॥ ५५ ॥
तथा न पूर्यतेऽस्त्रेण बस्तिः, पूर्णे तु पीडयेत् । मेढ्रान्तः क्षीरिवृक्षाम्बु मूत्रसंशुद्धये ततः ॥ ५६ ॥
कुर्याद्गुडस्य सौहित्यं मध्वाज्याक्तव्रणः पिबेत् । त्र्यहं, दशाहं पयसा गुडाढ्येनाल्पमोदनम् ।
भुञ्जीतोर्ध्वं फलाम्लैश्च रसैर्जाङ्गलचारिणाम् ॥ ५८ ॥
Then, the wound should be smeared with a mixture of honey and ghee, the patient is nourihed with more of guda jaggery/molasses); in order to purify the urine he should drink warm yavagu (thin gruel) processed with drugs which purify the urine, added with ghee, at both times (of meals) for the first three days, for the next ten days, he should eat little quantity of boiled rice along with milk added with more of guda (jaggery/molasses), followed by drinking the juice fo sour fruits of soup of meat of animals living in desert-like regions. 55b-58.
क्षीरिवृक्षकषायेण व्रणं प्रक्षाल्य लेपयेत् ।
प्रपौण्डरीकमञ्जिष्ठायष्ट्याह्वनयनौषधैः व्रणाभ्यङ्गे पचेत्तैलमेभिरेव निशान्वितैः । ॥ ५९॥
The wound should be washed with the decoction of bark of trees yeilding milky sap, paste of prapaundarika, manjistha yastyahva and nayanausadha (pattika rodhra) applied over it. For anointing the wound, medicated oil should be prepared with the above drugs only with the addition of nisa. 59-60a.
दशाहं स्वेदयेच्चैनं, स्वमार्गं सप्तरात्रतः ॥ ६० ॥
दहेदश्मरीब्रणमग्निना । मूत्रे त्वगच्छति स्वमार्गप्रतिपत्तौ तु स्वादुप्रायैरुपाचरेत् ॥ ६१॥ तं बस्तिभिः
The wound should be fomented for ten days. If within seven days, the urine does not flow out, through the normal passage, the wound made for removing the stone should be branded (cauterised) with fire; if the urine is found coming out through its normal passage, the patient should be nursed with enemas, containing more of sweet drugs (decoction enema with decoction of drugs of sweet taste). 60b-62a.
न चारोहेद्वर्षं रूढव्रणोऽपि सः ।
नगनागाश्ववृक्षस्त्रीरथान्नाप्सु प्लवेत् च ॥६२ ॥
Even after the wound has healed, the patient should neither climb a hill, an elephant, horse, tree, woman or chariot nor swim in water. 62.
मृत्रशुक्रवहौ बस्तिवृषणौ सेवनीं गुदम् । मूत्रप्रसेकं योनिं च शस्त्रेणाष्टौ विवर्जयेत् ॥ ६३॥
Channel of urine and semen, the urinary bladder, testes, the raphae, rectum, urethra, and vagina-these eight, should be avoided in the use of sharp instruments (should not be injured). 63.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने मूत्राघातचिकित्सितं नामैकादशोऽध्यायः ॥ ११ ॥
Thus ends the chapter Mutraghata chikitsa-the eleventh in chikitsa sthana of Astangahrdaya samhita, composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
