अथातो मूत्राघातनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We will now expound on the chapter Mutraghata nidana diagnosis of retention of urine; thus said Atreya and other great sages.
बस्तिबस्तिशिरोमेढ्रकटीवृषणपायवः ।
एकसम्बन्धनाः प्रोक्ता गुदास्थिविवराश्रयाः ॥ १॥
The urinary bladder, head of the urinary bladder, penis, waist, testicles and rectum are all related to one another and situated within the cavity of the rectal bone (pelvis). 1. Notes: Head of the urinary bladder means the two ureters, which connect the kidneys with the bladder; penis hereafter refers to the urethral passage, testecles are outside the pelvis and not connected to the bladder so also the rectum. Mutraghata is the inability to pass urine though the bladder is full ( retention of urine).
अधोमुखोऽपि बस्तिर्हि मूत्रवाहिसिरामुखैः । पार्श्वेभ्यः पूर्यते सूक्ष्मैः स्यन्दमानैरनारतम् ॥ २ ॥
यैस्तैरेव प्रविश्यैनं दोषाः कुर्वन्ति विंशतिम् । मूत्राघातान् प्रमेहांश्च कृच्छ्रान्मर्मसमाश्रयान् ॥ ३ ॥
Though situated with its mouth downwards, the urinary bladder gets filled from (all) its sides through the minute channels carrying urine, which are secreting (oozing ) without break (continuously throughout day and night ). The dosas entering (the bladder) through these channels produce the twenty kinds of mutraghata (retention of urine) and prameha (diabetes) residing in this marma (vital organ, the urinary bladder). 2-3.
Mutrakrcchra – dysuria strangury
बस्तिवड्ङ्क्षणमेढ्रार्तियुक्तोऽल्पाल्पं मुहुर्मुहुः । मूत्रयेद्वातजे कृच्छ्रे पैत्ते पीतं सदाहरुक् ॥ ४ ॥
रक्तं वा कफजे बस्तिमेढ्रगौरवशोफवान् ।
सपिच्छं सविबन्धं च सर्वैः सर्वात्मकं मलैः ॥ ५ ॥
In mutrakrcchra ( dysuria) caused by vata, there is pain in the region of the bladder, groins and penis; the person voids small quantity of urine frequently; in that caused by pitta the urine is yellow, voided accompanied with burning sensation or he may void only blood; in that arising from kapha, the person has heavyness and oedema of the bladder and (region of the) penis, voids urine which is slimy and with disrruption; in that caused by all the dosas all the symptoms will be present. 4-5.
Ashmari – urinary calculus
यदा वायुर्मुखं बस्तेरावृत्य परिशोषयेत् । मूत्रं सपित्तं सकफं सशुक्रं वा तदा क्रमात् ॥ ६ ॥
सञ्जायतेऽश्मरी घोरा पित्ताद्गोरिव रोचना । श्लेष्माश्रया च सर्वा स्यात्
When the vayu (vata) covers the mouth of the bladder and dries up the urine (inside); then urine getting mixed with pitta, kapha or semen, gives rise to the formation of asmari (stone, calculii) just as goracana (oxgall) gets formed from pitta (bile ) in the ( body of) ox; all of these are having kapha as their receptacle (their mass). 6-7b.
Purvarupa – premonitory symptoms
अथास्याः पूर्वलक्षणम् ॥ ७ ॥ बस्त्याध्मानं तदासन्नदेशेषु परितोऽतिरुक् । मूत्रे च बस्तगन्धत्वं मूत्रकृच्छ्रं ज्वरोऽरुचिः ॥ ८ ॥
Its premonitory symptoms are-distention of the bladder, severe pain in and around the site of stone, urine emitting the smell of goat, difficulty for elimination of urine, fever and loss of appetite. ‘7b-8.
Rupa – clinical features
सामान्यलिङ्गं रुड्नाभिसेवनीबस्तिमूर्धसु । विशीर्णधारं मूत्रं स्यात्तया मार्गनिरोधने ॥ ९ ॥
तद्व्यपायात्सुखं मेहेदच्छं गोमेदकोपमम् । तत्सड्क्षोभात्क्षते सास्त्रमायासाच्चातिरुग्भवेत् ॥ १० ॥
Its general symptoms are-pain near the umbilicus, raphae, and head of the bladder; stream of urine inturrupted when its path is obstructed (by the stone) and easy flow when its path is free; urine is clear, resembles gomedaka gem (dolomite) in colour ( yellow), when it ( stone) causes a wound by friction, the urine will be mixed with blood, pain becomes more on exertion ( straining to pass urine). 9-10.
Vataja Ashmari
तत्र वाताद्धृशार्त्यात दन्तान् खादति वेपते । मृद्राति मेहनं नाभिं पीडयत्यनिशं क्वणन् ॥ ११ ॥
सानिलं मुञ्चति शकृन्मुहुर्महति बिन्दुशः ।
श्यावा रूक्षाऽश्मरी चास्य स्याच्चिता कण्टकैरिव ॥ १२ ॥
In that caused by vata, the pain is very severe, so the person grinds his teeth, shivers, squeezes the penis, rubs the umbilicus, crying constantly; voids faeces accompanied with flatus, urinates too frequently and in drops; the stone is black, rough, and studded with thorny prejections. 11-12.
Pittaja Ashmari
पित्तेन दह्यते बस्तिः पच्यमान इवोष्मवान् ।
भल्लातकास्थिसंस्थाना रक्ता पीताऽसिताऽश्मरी ॥ १३ ॥
In that caused by pitta, there is burning sensation in the bladder, as though ulcerated, and is very warm, the stone resembles the seed of bhallataka (in shape ), red, yellow or black in colour. 13.
Kaphaja Ashmari
बस्तिर्निस्तुद्यत इव श्लेष्मणा शीतलो गुरुः । अश्मरी महती श्लक्ष्णा मधुवर्णाऽथवा सिता ॥ १४ ॥
In that caused by slesma (kapha) there is pricking pain in the bladder feeling of cold and heavyness; the stone is big, smooth, of the colour of honey ( golden) or white. 14.
एता भवन्ति बालानां तेषामेव च भूयसा । आश्रयोपचयाल्पत्वाद् ग्रहणाहरणं सुखाः ॥ १५ ॥
These (above three kinds) occur more commonly in children and are easy to grasp (with instruments) and to pull out because the receptacle (urinary bladder) is small, being not fully grown. 15.
Sukrasmari – seminal calculii
शुक्राश्मरी तु महतां जायते शुक्रधारणात् । स्थानाच्युतममुक्तं हि मुष्कयोरन्तरेऽनिलः ॥ १६ ॥
शोषयत्युपसङ्गृह्य शुक्रं तच्छुष्कमश्मरी । बस्तिरुक्कृच्छ्रमूत्रत्वमुष्कश्वयथुकारिणी तस्यामुत्पन्नमात्रायां शुक्रमेति विलीयते । पीडिते त्ववकाशेऽस्मिन् ॥१७॥
Seminal stone gets formed in adults due to suppression of the flow of semen which has left its seat (of production) but not released (ejected out); it gets dried (of its moisture ) by (the action) vata inside the scrotum by withholding it, that is sukrasmari (seminal calculii). There is pain in the bladder, difficult urination, produces swelling of the scrotum, soon after its formation; the semen begins to flow but stops in the middle and comes out through the channel when squeezed.
अश्मर्येव च शर्करा ॥ १८ ॥
अणुशो वायुना भिन्ना सा त्वस्मिन्ननुलोमगे । निरेति सह मूत्रेण प्रतिलोमे विबध्यते ॥ १९॥
Sarkara (urinary gravel) is urinary stone itself, but broken to small pieces by vata, coming out along with urine when vata is having downward movement and obstructing the flow of urine when (vata is ) having upward movement.
Vata basti
मूत्रसन्धारिणः कुर्याद्रुद्धवा बस्तेर्मुखं मरुत् । मूत्रसङ्गं रुजं कण्डूं कदाचिच्च स्वधामतः ॥ २० ॥
प्रच्याव्य बस्तिमुद्धत्तं गर्भाभं स्थूलविप्लुतम् । करोति तत्र रुग्दाहस्पन्दनोद्वेष्टनानि च ॥ २१ ॥
बिन्दुशश्च प्रवर्तेत मूत्रं बस्तौ तु पीडिते । धारया द्विविधोऽप्येष वातबस्तिरिति स्मृतः ॥ २२ ॥ दुस्तरो दुस्तरतरो द्वितीयः प्रबलानिलः ।
In persons who suppress the urge of micturition habitually, maruta (vata) becoming aggravated, blocks the mouth of the urinary bladder, produces blockage of urine, pain and irritation; sometimes the bladder gets too much distended, displaced upward resembling a gravid uterus, hard and full of fluid, accompanied with pain, burning sensation, throbbing and twistings; urine comes out in drops and in a continuous stream when it (bladder) is squeezed. This disease is known as Vatabasti and is of two kinds, viz, dustara (difficult to bear and to treat) and dustaratara (very difficult to bear and treat) the second one caused by the powerful anila (vata). 20-23a.
Vata asthila
शकृन्मार्गस्य बस्तेश्च वायुरन्तरमाश्रितः ॥ २३ ॥
अष्ठीलाभं घनं ग्रन्थिं करोत्यचलमुन्नतम् । वाताष्ठीलेति साऽऽध्मानविण्मूत्रानिलसङ्गकृत् ॥ २४ ॥
Vata (aggravated) getting localised in between the rectum and the urinary bladder, gives rise to a hard, elevated, immovable tumor resembling the cobblers stone, this is known as Vatasthila, and causes distention of the abdomen and hindrence to urine, faeces and flatus. 23b-24.
Vatakundalika
विगुण: कुण्डलीभूतो बस्तौ तीव्रव्यथोऽनिलः । आविष्य मूत्रं भ्रमति सस्तम्भोद्वेष्टगौरवः ॥ २५ ॥
मूत्रमल्पाल्पमथवा विमुञ्चति शकृत्सृजन् । वातकुण्डलिकेत्येषा
Vata aggravated and moving in a circular way in the bladder, causes severe pain, circular movement of urine inside the bladder itself, obstruction to its flow and heaviness of the bladder; urine is released out, little by little, accompanied with elimination of faeces. This disease is called Vata kundalika. 25-26b.
Mutratita
मूत्रं तु विधृतं चिरम् ॥ २६ ॥ न निरेति विबद्धं वा मूत्रातीतं तदल्परुक् ।
By suppressing the urge of micturition for a long time, urine fails to come out being hindered, and with mild pain; this is Mutratita. 26b-27a.
Mutra jathara
विधारणात्प्रतिहतं वातोदावर्तितं यदा ॥ २७ ॥ नाभेरधस्तादुदरं मूत्रमापूरयेत्तदा । कुर्यात्तीव्ररुगाध्मानमपक्तिं मलसङ्गग्रहम् ॥ २८ ॥ तन्मूत्रजठरम्
By the habbit of suppressing the urges, vata getting obstructed begins to move upwards, the bladder, full of urine causes distention of the abdomen below the umbilicus, severe pain, indigestion and accumilation of faeces. This (dis27b-28a. ease ) is Mutra jathara.
Mutrotsanga
छिद्रवैगुण्येनानिलेन वा। आक्षिप्तमल्पं मूत्रं तद्वस्तौ नालेऽथवा मणौ ॥ २९ ॥
स्थित्वा स्रवेच्छनैः पश्चात्सरुजं वाऽथ नीरुजम् । मूत्रोत्सङ्गः स विच्छिन्नतच्छेषगुरुशेफसः ॥ ३० ॥
Either due to abdomalities of the urinary passage or by aggravation of anila (vata) little quantity of urine staying either in the bladder, urethra or the glanspenis, gets obstructed, comes out slowly with or without pain; the residual urine produces heaviness of the penis, this disease is Mutrotsanga. 29b-30.
Mutragranthi
अन्तर्बस्तिमुखे वृत्तः स्थिरोऽल्पः सहसा भवेत् । अश्मरीतुल्यरुक् ग्रन्थिर्मूत्रग्रन्थिः स उच्यते ॥ ३१ ॥
A round, immovable, hard and small tumor developing suddenly inside the mouth (cavity) of the urinary bladder, producing pain resembling that of urinary stone, is known as 31. Mutragranthi.
Mutrasukra
मूत्रितस्य स्त्रियं यातो वायुना शुक्रमुद्धतम् ।
स्थानाच्युतं मूत्रयतः प्राक् पश्चाद्वा प्रवर्तते ॥ ३२ ॥ भस्मोदकप्रतीकाशं मूत्रशुक्रं तदुच्यते ।
The person who has the urge of micturition well manifest, but indulges in sexual intercourse inspite of it, the semen displaced from its place gets obstructed in the middle, comes out either prior to or after micturition, the urine resembling solution of ash. This is called as Mutrasukra. 32-33a.
Vidvighata
रूक्षदुर्बलयोर्वातादुदावर्तं शकृद्यदा ॥ ३३ ॥ मूत्रस्त्रोतोऽनुपर्येति संसृष्टं शकृता तदा । मूत्रं वितुल्यगन्धं स्याद्विविघातं तमादिशेत् ॥ ३४ ॥
In persons who are dry (with loss of fat) and debilitated, when vata begins to move upwards, it brings the faeces (small quantity of faecal matter) into the channels of urine (bladder and urethra); then the persons void urine having the odour of faeces. This disease is Vidvighata. 33b-34.
Usnavata
पित्तं व्यायामतीक्ष्णोष्णभोजनाध्वातपादिभिः । प्रवृद्धं वायुना क्षिप्तं बस्त्युपस्थार्तिदाहवत् ॥ ३५ ॥
मूत्रं प्रवर्तयेत्पीतं सरक्तं रक्तमेव वा । उष्णं पुनः पुनः कृच्छ्रादुष्णवातं वदन्ति तम् ॥ ३६॥
Pitta getting aggravated (increased ) by exercise, foods which are penetrating and hot, long distance walk, basking in the sun for long periods, etc. gets displaced (into the bladder) by aggravated vata, causing pain and burning sensation in the bladder and penis, urine is yellow, mixed with blood or only blood flows out, urine is warm, comes out again and again with difficulty. This is spoken of as Usnavata. 35-36.
Mutrahsaya
रूक्षस्य क्लान्तदेहस्य बस्तिस्थौ पित्तमारुतौ । मूत्रक्षयं सरुग्दाहं
जनयेतां तदाह्वयम् ॥ ३७ ॥ In persons who are dry and debilitated, pitta and maruta (vata) getting localised in the urinary bladder produce loss (diminition) of urine associated with pain and burning sensation. This is known as Mutraksaya. 37.
Mutrasada
पित्तं कफो द्वावपि वा संहन्येतेऽनिलेन चेत् । कृच्छ्रान्सूत्रं तदा पीतं रक्तं श्वेतं घनं सृजेत् ॥ ३८ ॥
सदाहं रोचनाशङ्खचूर्णवर्णं भवेच्च तत् । शुष्कं समस्तवर्णं वा मूत्रसादं वदन्ति तम् ॥ ३९ ॥
Pitta and kapha either seperately or in combination, if get aggravated by anila (vata), then they produce difficult micturition, urine is yellow, red or white and thick; accompanied with pain, resembling the colour of oxgall or powder of onch shell or of all colours mixed together and is dry (nonunctuous, nonsticky); this is called Mutrasada. 38-39.
इति विस्तरतः प्रोक्ता रोगा मूत्राप्रवृत्तिजाः । निदानलक्षणैरूर्ध्वं वक्ष्यन्तेऽतिप्रवृत्तिजाः ॥ ४० ॥
Thus, were described in detail, the diseases produced by non-elimination of urine, along with their causes and clinical features; those diseases produced by over-elimination will be discribed further on ( in the next chapter). 40.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने मूत्राघातनिदानं नाम नवमोऽध्यायः ॥ ९॥
Thus ends the chapter Mutraghata nidana-the ninth in of Astangahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
