अथातो मूत्राघातनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
We will now expound the diagnosis of Mutraghata-obstruction to micturation; thus said Atreya and other great sages. (1)
Mutraghata
विंशतिर्मूत्राघाता भवन्ति । तद्यथा। वातपित्तकफसन्निपातकृच्छ्राणि । वातपित्तश्लेष्मशुक्राश्मर्यः । वातबस्त्यष्ठीलाकुण्डलिकामूत्रातीतजठरोत्सङ्गग्रन्थिशुक्र विविघातोष्णवातमूत्रक्षयावसादाश्चेति ॥२॥
Mutraghatas are twenty in number; such as the Mutrakrichra, ( dysuria) from vata, pitta and kapha individually and (one) from their combination; the Asmaris (urinary calculi) from vata, pitta and kapha and sukra (semen); vatabasti, astthila, kundalika, mutratita, (mutra) jathara, (mutra) utsanga, (mutra) granthi, (mutra) sukra, vidvighata, usnavata, mutra ksaya and (imutra ) avasada (2)
तत्र वातबस्त्यादयो नव वातोल्बणाः । ततो द्वौ वातपित्तोल्बणौ । अन्त्यः कफपित्तोल्बणः ॥३॥
Among these, the nine commencing with vatabasti are due to predominence of vata; the next two are due to predominance of vata and pitta; the last one is due to predominance of kapha and pitta. (3)
सर्वेषां पुनर्मूत्ररोगाणामधिष्ठानं बस्तिः । स मर्मस्वभिहितः प्राक् । स चाधोमुखोऽपि मूत्रवहासु नाडीषु सूक्ष्ममुखसहस्त्रनिष्यन्देन मूत्राख्येनाविरतं नवो घट इवाप्सु निमग्नमुखोपि पार्श्वेभ्योऽम्भसापूर्यते तैरेव च स्त्रोतोभिर्वातादयोऽपि दुष्टाः प्रविश्य बस्तिं यथास्वमाघातान् प्रमेहांश्च जनयन्ति ॥४॥
For all urinary disorders, the urinary bladder is the seat; it was described as a marma (vital spot) earlier; though having its mouth below, it recives the fluid known as mutra (urine) from the thousand and odd (innumerable) minute channels known as mutravaha nadi constantly, just like a new mud pot kept immersed in water upto the level of its mouth (neck) gets filled from all its sides; it is through these channels only, the aggravated (increased) vata and others (doshas) enter the urinary bladder and produce Mutraghata, Prameha etc. (4)
Mutrakrichra – dysuria
तत्राल्पशो मुहुर्मुहुर्बस्तिमेढ्रवड्ङ्क्षणेषु तीव्रशूलः कृच्छ्रान्मूत्रयति वातकृच्छे । सदाहं सरुजं रक्तं पीतं कृष्णं वा पित्तकृच्छे । बस्तिमेढ्रयोगौरवं शोफो मूत्रं च सपिच्छं मेहति कफकृच्छ्रे । सर्वलक्षणसन्निपातेन सन्निपातकृच्छ्रे । स च कृच्छ्रतमः ॥५॥
In vataja mutrakrichra (dysuria, strangury) the person voids urine often, with severe pain in the bladder, penis and groins and with difficulty, in pittaja krichra urine is voided with burning sensation, and pain, the urine is red, yellow or black in colour, in kaphaja krichra there is heaviness of the bladder and penis and swelling, the urine, is slimy, in the sannipataja krichra, symptoms of all the doshas are present, it is very difficult to cure. (5)
Asmari – ranal calculii
यदा तु वायुर्बस्तिमुखमावृत्य सपित्तं सकफं सशुक्रं वा मूत्रं परिशोषयति तदा क्रमेण गोरिव पित्ताद्रोचना मणिकस्येव स्वच्छादपि जलात् पङ्कस्तद्वदश्मर्यभिनिर्वर्तते । सर्वा च सा लेष्माश्रया | अथास्याः पूर्वरूपाणि ज्वरो बस्त्याध्मानमरुचिर्मूत्रकृच्छ्रं बस्तिशिरोमुष्कशेफसां वेदना बस्तगन्धित्वं मूत्रस्येति ॥ ६ ॥
When the vayu (vata) covers the mouth of the bladder, associating with pitta, kapha or sukra (semen) and dries up the urine, then stones get formed (inside the bladder) slowly, just as the formation of pebbles of gall from the bile in the cow; or like slush (silt) even in clean water kept in a hanger; all of them are supported (formed) by kapha.
Purvarupa-Prodromal symptoms
Their prodromal symptoms are: fever, enlargement of the bladder, loss of appetite, difficulty of micturition, pain in the head of the bladder (lower part), scrotum and penis and urine has the smell of a goat. (6)
Lakshana-clinical features
सामान्यलिङ्गानि तु नाभिबस्तिसेवनीषु मेहतस्तया मार्गनिरोधने वेदना मूत्रधारासङ्गस्तव्द्यपाये च गोमेदकप्रकाशमनाविलमसितं सुसुखं मूत्रं विसृजति । तत्सङ्क्षोभणाच्च सरुधिरम् । धावनलङ्घनादिभिश्चास्य विविधा वेदना भवन्ति । यथैव च पक्वाशयात् त्रस्तेन शकृताधिष्ठिते बस्तौ मूत्रं न प्रवर्तते तथाश्मर्यापि ॥७॥
Its general symptoms are-pain in the region of umbilicus, bladder and vasiculorectal raphea during micturition due to obstruction of the passages, discontinuity of urinary stream, when obstruction is cleared the person voids urine resembling gomedaka gem (which is red in colour), it has no precipitate, is black and eliminated with ease, urine is mixed with blood when injury occurrs due to its friction, the person feels different kinds of pain while running, jumping/and other activities. Just as urine does not flow out of the bladder when the pakvasaya (large intestine) is impacted with faeces, so also in case of (presence of) stone in the bladder. (7)
तत्र वायुना बस्तिसेवनीमेहनेषु तीव्रवेदनार्दितो दन्तान् खादति नाभिं प्रपीडयति मेढुं मृगाति । मुहुर्मुहुर्वेपथुमान् कृच्छ्रात्सवातं शकृद्विमुञ्चति । विशीर्णधारं च मूत्रयत्यश्मरी चास्य श्यावा परुषा विषमा कदम्बपुष्पवत् कण्टकाचिता भवति । पित्तेन पच्यमान इव दह्यते बस्तिः । अश्मरी च रक्ता पीतावभासा कृष्णा भल्लातकास्थिसंस्थाना । श्रेष्मण भिद्यते निस्तुद्यत इव गुरु: शीतश्च वस्तिरश्मरी च श्वेता महती कुक्कुटाण्डप्रतिमा मधुवर्णा वा भवति । प्रायैणैतास्तिस्त्रो मर्यो बालानां जायन्ते । तेषामेव चाल्पबस्तित्वादल्पमांसोपचयत्वाच्च सुखग्रहणाहरणा भवन्ति ॥८॥
In asmari (stone) caused by vata, there is severe pain in the bladder, raphea, and penis, due to that the patient grinds his teeth, presses the umbilicus, squeezes the penis, gets rigors (shivering) frequently, voids feaces with difficulty along with flatus, urinary flow is disrupted. The stone is blue, hard (rough), irregular, studded with thorns, like the flower of kadamba.
In that caused by pitta, there is burning sensation inside the bladder as though being cooked (or as though having ulcer), the stone is reddish yellow or black in colour, resembles the seed of bhallataka.
In that caused by slesma ( kapha) there is cutting or pricking pain, heaviness, cold feeling in the bladder, the stone is white, large, resembles a hens egg or has the colour of the honey.
The above three kinds of asmari are more common in children, and are easy to be held (by the hand or instruments) and extracted out because of smallness of the bladder and poor development of the muscles in them (children). ( 8 )
महतां तुशुक्राश्मरी शुक्रनिमित्ता भवति। मैथुनविघाताच्छुक्रमुपस्थितमनिरस्यमानं विमार्गगमनिलो विगृह्य वृषणयोरन्तरे संहरति संहृत्योपशोषयति ततः शुष्कमश्मरी भवति । सा शुक्रमार्गमावृणोति मूत्रकृच्छ्रं बस्तिवेदनां वृषणयोश्चश्वयथुमापादयति । उत्पन्नमात्रायां चशुक्रं निरेति । प्रपीडितमात्रे च तस्मिन्नेवावकाशे विलीयत इति ॥ ९ ॥
Sukrasmari (seminal calculus) gets formed in adults from sukra (semen), the semen obstructed in the middle, and not coming out due to sudden discontinuance of sexual intercourse is transported in the wrong path, into the testicles and gets solidified there by aggravated (increase ) vata, leading to the formation of stone of semen. It obstructs the passages of semen, producing difficulty of micturition, pain in the bladder, and testicles and also their swelling, soon after formation the stone obstructs the flow of semen and when squeezed (or pressed) it dissolves within the passage itself. (9)
अश्मर्येव तु वायुनाऽणुशो विभिन्ना शर्करेत्युच्यते । अनुलोमे च मारुते सा सिकतेव मूत्रेण सह च्यवते ॥१०॥
The stone itself, broken into small pieces by vata, is known as sarkara (urinary gravel), and eliminated mixed with urine, when vata gets the downward movements. (10)
Vata basti
वायुस्तु मूत्रवेगरोधाद्वस्तिमुखमावृणोति । ततो मूत्रसङ्गं वेदनां कण्डूं च करोति ।
कदाचिच्च बस्तिं स्वस्थानात् प्रच्याव्य गर्भमिवोद्वृत्तं स्थूलं परिप्लुतं च कुरुते । तत्र शूलस्पन्द – नदाहोद्वेष्टनानि बिन्दुशश्च मूत्रस्त्रवणम् ।
पीडिते चबस्तौ धारया प्रवृत्तिरयं द्विविधोऽपिवातबस्तिः कृच्छ्रसाध्यः तयोरपि द्वितीयोऽनिलप्रबलः कृच्छ्रसाध्यतरः ॥११॥
By suppressing the urge of micturition, vata getting increased covers the mouth of the bladder, produces obstruction to micturition pain and irritation, sometimes it displaces the bladder from its normal place, makes it move upwards, big and full like a pregnantuterus, there is pain, pulsations (or throbbings), burning sensation, twisting and urine flowing out drop by drop, or coming out in a stream when pressed to the bladder. Both these two kinds of Vata-basthi are difficult to cure especially the second kind which is more difficult because of great increase (powerful) and vata. (11)
Notes: The first kind is without displacement of the bladder and the second kind is with its upward movements / displacement.
Vatasthila
बस्तिविण्मार्गान्तरे वायुर्घनोन्नतं तीव्ररुजमचलमष्ठीलाभं ग्रन्थिं करोति । तेनानिलविण्मूत्रसङ्गो भवत्याध्मानंच । सा वाताष्ठीला |
विगुणो वायुः बस्तौ कुण्डली भूतस्तीव्रशूलस्तम्भगौरवान्वितो मूत्रमाविध्याल्पशो वा प्रवर्तयन् भ्रमति सा वातकुण्डलिका ।
मूत्रमतिवेलं विधार्य विमुच्यमानं न प्रवर्तते वाहमानस्य तु कृच्छ्रादल्पं प्रवर्तते तन्मूत्रातीतम् ॥ १२ ॥
Vata produces a hard, big, very painful and immovable tumor resembling a cobblers stone, in between the bladder and the rectum, this causes obstruction to the elimination of flatus, faeces and urine and distention of the abdomen. This is Vatasthila. Vatakundalika –
The aggravated (increased) vayu (vata) making a circular movement in the bladder produces severe pain, loss of movement, heaviness, obstruction to micturition or elimination of very little quantity, this is Vatakundalika.
Mutratita
Vata withholding the flow of urine for a long time, does not allow it to pass out freely, if the person uses force (strains ) it is eliminated in small quantity. This is Mutratita. (12)
Mutrajathara
मूत्ररोधादपानो वायुर्नाभेरधस्तात्तीव्ररुजमाध्मानं मलसङ्गं च कुर्वन्नुदरमभिपूरयेत् तन्मूत्रजठरम् ।
मारुतेनाक्षिप्तं छिद्रवैगुण्येन वा मूत्रयतो मूत्रमल्पं बस्तौ नाले मणौ वा स्थित्वा तच्छेषगुरुमेढ्रस्य
सरुजमरुजं वा शनैः स्रवेत् स मूत्रोत्सङ्गः । बस्तिद्वारेऽल्पो वृत्तः शीघ्रसम्भवोऽश्मरीतुल्यलिङ्गोमूत्रग्रन्थिः ॥१३॥
Apana vata getting aggravated (increased) by suppressing the urge of urination produces severe pain in the abdomen below the umbilicus, distention, obstruction to faeces and enlargement of the abdomen. This is Mutrajathara. Mutrotsanga
Either due to constiction caused by maruta (vata) or by abnormality of the passage (urethral passage), when the person tries to micturate, little amount of urine remaining in the bladder, urethra or the glans penis flows out either with or without pain but very slowly. This is Mutrotsanga.
Mutragranthi
Small, round, quick developing tumor at the orifice of the bladder, exhibiting the symptoms of asmari (calculus) is Mutragranthi. (13)
Mutrasukra
मूत्रितस्य व्यवायगमनाद्वातोद्धतं स्वस्थानाच्युतं शुक्रं मेहतो मूत्रस्य प्राक् पश्चाद्वा भस्मोदकसङ्काशं प्रवर्तते तन्मूत्रशुक्रम् ।
वायुना पीडितं शकृन्मूत्रस्त्रोतः प्रपद्यते ततो विड्गन्धि विट्संसृष्टं च कृच्छान्मूत्रयति स विड्विघातः ।
अत्यध्वातपोष्णभोजनादिभिः पित्तं प्रवृद्धमनिलेरितं बस्तिमेढ्रगुददाहं कुर्वद्धरितहारिद्ररक्तं सरक्तं वा मूत्रं कृछ्रात् प्रवर्तयेत् स तूष्णवातः ।
वातपित्तं बस्तिमाश्रित्य मूत्रं सशूल-दाहं क्षपयति स मूत्रक्षयः ।
पित्तं लेष्मोभयमपि वा वातेन बस्तौ संहन्यते ततो मूत्रं सदाहं सरक्तं पीतं श्वेतं सान्द्रं कृच्छ्रप्रवृत्ति शुष्कं च शङ्खरोचनान्यतरचूर्णवर्णं सर्ववर्णयुक्तं वा भवति । स मूत्रावसादः ॥१४॥
When the person who is under the urge of urination (but does not get relieved of it) indulges in sexual intercourse, vata getting aggravated makes the semen which has been expelled from its normal site to flow out either before or after urination, making the urine resemble a solution of ash. This is Mutrasukra.
Vidvighata
When the faeces, being directed by the aggravated vayu (vata) enters into the passges of urine, then it cause the urine to assume the smell of faeces and pass out mixed with it. This is Vidvighata.
Usnavata
Pitta, getting increased by too much of walking, exposure to sun and partaking very hot foods, etc, excited by anila (vata) produces burning sensation in the bladder, penis and rectum, the urine is green, turmeric (deep yellow) or red in colour, or even mixed with blood and eliminated with difficulty. This is Usnavata.
Mutraksaya
Vata and pitta together invading the bladder make for the decrease of the urine associated with pain and burning sensation. This disease is Mutraksaya.
Mutravasada
Pitta and slesma (kapha) together getting obstructed inside the bladder produce elimination of urine with burning sensation and mixed with blood, yellow or white, thick, passed out with difficulty, it is dry (non-viscid), resembles the colour of the conch shell, oxgall or other kinds of powders or possesses all kinds of colours. This is Mutravasada. (14)
इति विस्तरतः प्रोक्ता रोगा मूत्राप्रवृत्तिजाः । निदानलक्षणैरूर्ध्वं वक्ष्यन्तेऽतिप्रवृत्तिजाः ॥१५॥
Thus was described the diseases caused by non-elimination (or insufficient elimination) of urine, along with their causes and symptoms; further on will be described those due to over-elimination. (15)
॥ इति नवमोऽध्यायः ॥
Thus ends the Ninth chapter.
