सप्तमोऽध्यायः । अथातोऽश्मरीचिकित्सितं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the medical treatment of urinary calculus, etc. (Ashmari). 1
अश्मरी दारुणो व्याधिरन्तकप्रतिमो मतः । औषधैस्तरुणः साध्यः प्रवृद्धश्छेदमर्हति ।। २ ।।
तस्य पूर्वेषु रूपेषु स्नेहादिक्रम इष्यते । तेनास्यापचयं यान्ति व्याधेर्मूलान्यशेषतः ॥ ३ ॥
Metrical Texts : Ashmari (urinary calculus etc. ) is a dangerous disease and is as fatal as death itself. A case of recent origin (acute) proves amenable to medicines, while an enlarged or chronic one requires surgical operations. The remedial measures, in the order of anointing, etc., should be employed in the first or incipient stage of the disease, whereby the entire defects with their causes (i.e., roots of the disease) would be radically cured. 2-3
पाषाणभेदो वसुको वशिराश्मन्तकौ तथा । शतावरी श्वदंष्ट्रा च बृहती कण्टकारिका ।। ४ ।।
कपोतवङ्कार्त्तगलः कच्चकोशीरकुब्जका: । वृक्षादनी भल्लुकश्च वरुणः शाकजं फलम् ।। ५ ।।
यवाः कुलत्थाः कोलानि कतकस्य फलानि च । क्वाथैघृतं ऊषकादिप्रतीवापमेषां कृतम् । भिनत्ति वातसम्भूतामश्मरीं क्षिप्रमेव तु।। ६ ।।
क्षारान् यवागूर्यूषांश्च कषायाणि पयांसि च। भोजनानि च कुर्वीत वर्गेऽस्मिन् वातनाशने ।। ७ ।।
Treatment of Vataja Ashmari : Clarified butter cooked with a decoction of Pasanabheda, Vasuka, Vasira, Asmantaka, Satavari. Svadaistra, Brihati, Kantakarika, Kapotavanka, Artagala, Kakubha’, Usira, Kubjaka, Vrksadani, Bhalluka, Varuna, Saka-phala, barley, Kulattha, Kola and Kataka fruits and with the Kalka of the drugs constituting the group of Usakadi, speedily brings about the disintegration of Ashmari (urinary calculi, etc.) caused due to the action of the deranged Vayu. Milk, Yavagu (gruel), a decoction, soup, or an alkali, properly prepared with the above Vayu-subduing drugs should also be administered as food and drink in the above cases. 4-7
कुश: काश: सरो गुन्द्रा इत्कटो मोरटोऽश्मभित् । वरी विदारी वाराही शालिमूलत्रिकण्टकम् ।। ८ ।।
पुनर्नवा भल्लूकः पाटला पाठा पत्तूरोऽथ कुरुण्टिका ।
शिरीषश्च क्वथितास्तेषु घृतं शिलाजमधुकबीजैरिन्दीवरस्य बीजैश्चावापितं साधितम् ॥ ९ ॥ ।।
च। त्रपुसैर्वारुकादीनां भिनत्ति पित्तसम्भूतामश्मरीं क्षिप्रमेव तु ।। १० ।।
क्षारान् यवागूर्यूषांश्च कषायाणि पयांसि च । भोजनानि च कुर्वीत वर्गेऽस्मिन् पित्तनाशने ।। ११ ।। शुभम् ।
Treatment of Pittaja Ashmari : Similarly a medicated clarified buter cooked with the decoction of Kusa, Kasa, Sara, Gundra, Itkata, Marata, Asmabhit, Satavari, Vidari, Varahi, Sali-mula, Trikantaka, Bhalluka, Patala, Patha, Pattura, Kuruntika, Punarnava, Sirisa, with the paste (Kalka) consisting of Silajatu, Madhuka (flower) and
1. Cakradatta reads Kopotavaktra” in place of Kapotavanka” “Kancana’in place of “Kakubha”; and “Gulmaka” in place of Kubjaka” From an examination of Dalhana it appears that “Kaccaka” is also reading of Kakubha.’
2. Cakradatta reads “Punarnave” i.e., both the kinds of Punarnava. the seeds of Indivara¹, Trapusa and Ervaruka, would speedily bring about the disintegration of Pittaja Ashmari (caluculi, etc.). Alkalies (gruel), soups, a decoctions, or milk, properly prepared with the above Pitta-subduing drugs, should also be prescribed as food and drink in these cases. 8-11
गणो वरुणकादिस्तु गुग्गुल्वेलाहरेणवः । कुष्ठभद्रादिमरिच – चित्रकैः सिद्धमजासर्पिरूषकादिगणेन ससुराह्वयैः ।। १२ ।।
एतैः च। भिनत्ति कफसम्भूतामश्मरीं क्षिप्रमेव तु ।। १३ ।।
क्षारान् यवागूर्यूषांश्च कषायाणि पयांसि च । भोजनानि च कुर्वीत वर्गेऽस्मिन् कफनाशने ।। १४ ।।
Treatment of Kaphaja Ashmari : The use of medicated clarified butter prepared from the milk of a she-goat and cooked with the paste (Kalka) of the drugs constituting the Varunadi group 2, Guggulu, Ela, Harenu, Kustha, the Bhadradi group, Marica, Citraka, Surahva and Usakadi group, leads to the speedy disintegration and expulsion of the Ashmari (stone, etc.) caused due to the action of the deranged Kapha. So also the use of alkalies, Yavagus (gruel), soups milk, or a decoctions, properly prepared with the above Kapha-subduing drugs, is recommended as food and drink in such cases. 12-14
पिचुकाङ्कोलकतक-शाकेन्दीवरजैः फलैः । चूर्णितैः सगुडं तोयं शर्कराशमनं पिबेत् ।। १५ ।।
क्रौञ्चोष्ट्रारासभास्थीनि श्वदंष्ट्रा तालमूलिका । अजमोदा कदम्बस्य मूलं नागरमेव च ।
पीतानि शर्करां भिन्धुः सुरयोष्णोदकेन वा ॥ १६ ॥
त्रिकण्टकस्य बीजानां चूर्णं माक्षिकसंयुतम् । अविक्षीरेण सप्ताहमश्मरीभेदनं पिबेत् ।। १७ ।।
1. Jajjata explains “Indiyara’ as ‘Nilotpala’. But Gayadasa does not support this.
2. Some say that ‘‘Aja-sarpih’’ is superfluous, Chakradatta reads “गणे वरुणकादौ च गुग्गुल्वेलाहरेणुभिः” in place of “गणो वरुणकादिस्तु गुग्गुल्वेलाहरेणवः”meaning thereby that the decoction of the Varunadi-gana is to be used. Cakradatta’s reading seems to be the correct one and is observed in practice with good results.
A potion consisting of the powdered fruit of the Picuka, Amkola, Kataka, Saka and Indivara mixed with treacle¹ and water proves beneficial in cases of Gravel (Sarkara). The bones of the Kraunca, camel and ass, as well as the drugs known as Svadarnstra, Talamuli, Ajamoda, Kadamba-roots and Nagara pounded together and administered through the vehicle of wine (Sura) or hot water, leads to the disintegration of Sarkara (gravel). The milk of an ewe mixed with powdered Trikantaka-seeds and honey should be used for seven days for the disintegration and separation of an Ashmari. 15-17
द्रव्याणान्तु घृतोक्तानां क्षारोऽविमूत्रगालितः । ग्राम्यसत्त्वशकृत्क्षारैः संयुक्तः साधितः शनैः ।। १८ ।।
तत्रोषकादिरावापः कार्यस्त्रिकटुकान्वितः । एष क्षारोऽश्मरीं गुल्मं शर्कराञ्च भिनत्त्यपि । । १९ ।।
तिलापामार्गकदली- पलाशयवकल्कजः क्षार: पेयोऽविमूत्रेण शर्करानाशनः परः ।। २० ।। क्षारमेवं समाचरेत् ।। २१ ।। पाटलाकरवीराणां
Alkaline Treatments : An alkali should be prepared from the ashes of the drugs used in the preparation of the aforesaid medicated clarified butters, by dissolving and filtering them in ewe’s urine. The alkali should then be slowly boiled with an alkali similarly prepared from the dung of domestic animals, with the powders of Trikatu and the drugs of the Usakadi group thrown into them as an after-throw. It proves curative in cases of stone, Gulma, and gravel. Alkalies from burnt bark of sesamum, Apamarga, plantain, Pala’s and barley taken with the urine of an ewe destroy the gravel (Sarkara). As an alternative, the alkalies of Patala and Karavira should be used in the preceding manner. 18-21
श्वदंष्ट्रा यष्टिका ब्राह्मी कल्कं वाऽक्षसमं पिबेत् । सह्रैडकाख्यौ पेयौ वा शोभाञ्जनकमार्कवौ ।। २२ ।।
1. The quantity of treacle, to be taken, should be equal to the entire quantity of the powders : and hot water should be used. –Dalhana.
2. Some explain it as Goksura-seeds” and others as “Markataka-seeds.” 3. Four or six Tola weight of an alkali should be dissolved and filtered for a number of times before use.
कपोतवङ्कामूलं वा पिबेदम्लैः सुरादिभिः । तत्सिद्धं वा पिबेत् क्षीरं वेदनाभिरुपद्रुतः ॥ २३ ॥
हरीतक्यादिसिद्धं वा वर्षाभूसिद्धमेव वा । सर्वथैवोपयोज्यः स्याद् गणो वीरतरादिकः ॥ २४ ॥
Two Tola (Aksa) weights of the pastes of Syadarnstra, Yastimadhu and Brahmi (mixed with ewe’s urine) should be given to the patient; or the expressed juice of the Edaka, Sobhanjana and Markava (with the said urine) should be given, or a potion consisting of the pasted roots of the Kapotavarka with Kanjika, or Sura, etc., should be administered. Milk boiled with the afoesaid drug (Kapotavamka) should be taken by a patient in case there is pain (in urinating). Milk boiled with Triphala or Varsabhu should be administered as a drink and a decoction of the drugs of the Vira-taradi group should be employed in all these cases.¹ 22-24
घृतैः क्षारैः कषायैश्च क्षीरैः सोत्तरबस्तिभिः । यदि नोपशमं गच्छेच्छेदस्तत्रोत्तरो विधिः ॥ २५ ॥
कुशलस्यापि वैद्यस्य यतः सिद्धिरिहाध्रुवा । उपक्रमो जघन्योऽयमतः संपरिकीर्तितः। ः ।। २६ ।।
अक्रियायां ध्रुवो मृत्युः क्रियायां संशयो भवेत् । तस्मादापृच्छ्य कर्तव्यमीश्वरं साधुकारिणा ॥ २७ ॥
A physician should have recourse to the following measures ( surgical operations ) in cases where the above-mentioned decoctions, medicated milk, alkalies, clarified butter and Uttara-basti (urethral syringe) of the oresaid drugs, etc., would prove ineffective. Surgical operations in these cases do not prove successful even in the hands of a skilful and experienced surgeon; so a surgical (Lithotomic) operation should be considered a little remedy to be recommended. The death of the patient is almost certain without a surgical operation and the result to be derived from it is also uncertain. Hence a skilled surgeon should perform such operations only with the permission of the king. 25-27
1. Dalhana recommends the use of Triphala boiled with milk in cases of pain accompanying Pittaja Ashmari, while that boiled with Varsabhu is advised to be given for the alleviation of pain in a case of Vataja or Kaphaja Ashmari. The drugs of Vira-taradi group should be used with milk, clarified butter, a decoction, Yavagu (gruel), food, etc., and also for bath, immersion, etc.
अथ रोगान्वितमुपस्निग्धमपकृष्टदोषमीषत्कर्शितमभ्यक्तस्विन्नशरीरं भुक्तवन्तं कृतबलिमङ्गलस्वस्तिवाचनमग्रोपहरणीयोक्तेन विधानेनोपकल्पितसम्भारमाश्वास्य, ततो बलवन्तमविक्लवमाजानुसमे फलके प्रागुपविष्टान्यपुरुषस्योत्सङ्गे निषण्णपूर्वकायमुत्तानमुन्नतकटीकं वस्त्राधारकोपविष्टं सङ्कुचितजानुकूर्परमितरेण सहावबद्धं सूत्रेण शाटकैर्वा, ततः स्वभ्यक्तनाभिप्रदेशस्य वामपार्श्वं विमृद्य मुष्टिनाऽवपीडयेदधोनाभेर्यावदश्मर्यधः प्रपन्नेति । ततः स्नेहाभ्यक्ते क्लृप्तनखे वामहस्तप्रदेशिनीमध्यमे अङ्गुल्यौ पायौ प्रणिधायानुसेवनीमासाद्य प्रयत्नबलाभ्यां पायुमेढ़ान्तरमानीय निर्व्यलीकमनायतमविषमञ्च बस्तिं सन्निवेश्य भृशमुत्पीडयेदङ्गुलिभ्यां यथा ग्रन्थिरिवोन्नतं शल्यं भवति ।। २८ ।।
Modes of Surgical Operations : The patient should be soothed (Snigdha) by the application of oleaginous substances, his system should be cleansed with emetics and purgatives and be slightly reduced thereby; he should then be fomented after being anointed with oily unguents; and be made to partake of a meal. Prayers, offerings and prophylactic charms should be offered and the instruments and surgical accessories required in the cases should be arranged in the order laid down in the Agropaharaniya chapter of the present work (Sutra-sthana, ch. V.). The su: geon should use his best endeavours to encourage the patient and infuse hope and confidence in the patient’s mind. A person of strong physique and unagitated mind should be first made to sit on a level board or table as high as the knee-joint. The patient should then be made to lie on his back on the table placing the upper part of his body in the attendant’s lap, with his waist resting on an elevated cloth cushion. Then the elbows and knee-joints (of the patient) should be contracted and bound up with fastenings (Sataka) or with line. After that the umolical region (abdomen) of the patient should be well rubbed with oil or with clarified butter and the left side of the umblical region should be pressed down with a closed fist so that the stone comes within the reach of the operator. The surgeon should then introduce into the rectum, the second and third fingers of his left hand, duly anointed and with the nails well pared. Thn the fingers should be carried upward towards the rope of the perineum i.e., in the middle line so as to bring the stone between the rectum and the penis, when it should be so firmly and strongly pressed as to look like an elevated Granthi (tumour), taking care that the bladder remains contracted but at the same time eve. 28
स चेद् गृहीतशल्ये तु विवृताक्षो विचेतनः । हतवल्लम्बशीर्षश्च निर्विकारो न तस्यनिर्हरेच्छल्यं निर्हरेत् तु विना त्वेतेषु रूपेषु निर्हर्त्तं मृतोपमः ।। २९ । । म्रियेत सः । समुपाचरेत् ।। ३० ।।
Prognosis-M. Text: An operation should not be proceeded with nor an attempt be made to extract the stone (Salya) in a case where, the stone on being handled, the patient would be found to drop down motionless (i.e., faint) with the head bent down, and eyes fixed in a vacant stare like that of a dead man, as an extraction in such a case is sure to be followed by death. The operation should only be continued in the absence of such an occurrence. 29-30
ततः सव्ये पार्श्वे सेवनीं यवमात्रेण मुक्त्वाऽवचारयेत् शस्त्रमश्रमरीप्रमाणम्; दक्षिणतो वा क्रियासौकर्यहेतोरित्येके । यथा च न भिद्यते चूर्ण्यते वा तथा प्रयतेत, चूर्णमल्पमप्यवस्थितं हि पुनः परिवृद्धिमेति, तस्मात् समस्तामग्रवक्त्रेणाददीत ।। ३१ ।।
An incision should then be made on the left side of the raphe of the perineum at the distance of a barley-corn and of a sufficient width to allow the free egress of the stone Several authorities recommend the opening to be on the right side of the raphe of the perineum for the convenience of the operation. Special care should be taken in extracting the stone from its cavity so that it may not break into pieces nor leave any broken particles behind (i.e., inside the bladder), however small, as they would, in such a case, be sure to grow larger again. Hence the entire stone should be extracted with the help of an Agravaktra Yantra (a kind of forceps the points of which are not too sharp ). 31
स्त्रीणान्तु बस्तिपार्श्वगतो गर्भाशयः सन्निकृष्टः, तस्मात्तासामुत्सङ्गवच्छस्त्रं पातयेत्; अतोऽन्यथा खल्वासां मूत्रस्त्रावी व्रणो भवेत् । पुरुषस्य वा मूत्र-प्रसेकक्षणनान्मूत्रक्षरणम् । अश्मरीव्रणादृते भिन्नबस्तिरेकधाऽपि न भवति, द्विधा भिन्नबस्तिराश्मरिको न सिध्यति ।। ३२ ।।
अश्मरीव्रणनिमित्तमेकधाभिन्नबस्तिर्जीवति, क्रियाभ्यासात् शास्त्र विहित-च्छेदान्निःस्यन्दपरिवृद्धत्वाच्च शल्यस्येति । उद्धृतशल्यन्तूष्णोदकद्रोण्यामवतार्य स्वेदयेत्, तथा हि बस्तिरसृजा न पूर्यते । पूर्णे वा क्षीरवृक्षकषायं पुष्प नेत्रेण विदध्यात् ।। ३३ ।।
Lithotomic Operation in a female : In a woman, the uterus (Garbhasaya) is adjacent to the urinary bladder, hence the stone should be removed by making an oblique and upward incision, otherwise a urine-exuding ulcer might result from the deep incision in that locality. Any hurt to the urethra during the operation would be attended with the same result even in a male patient. An incision made only on one side of the organ in a disease other than that of stone, baffles all attempts at healing; while an ulcer incidental to an incision made on both its sides, should be deemed incurable. An ulcer incidental to an incision made on either side of the bladder in extracting a stone might be healed up, inasmuch as medicinal potions and fomentations, etc.. employed for the healing of a surgical wound, lead to the healing of the wound in the bladder; secondly because the surgical op ng is only made large enough for the extraction of the stone as recommended in the authoritative books; and thirdly because an increase in the quantity of urine contributes to an increase in the size of the stone and hence a slight secretion of that fluid or employment of diuretic Peyas, etc., are not attended with any injurious effects.
Post-Surgical Measures : After the extraction of a stone, the patient should be made to sit in a Droni (cauldron) full of warm water and be fomented thereby. In doing so the possibility of an accumulation of blood in the bladder will be prevented; however if blood is accumulated therein, a decoction of the Ksira-trees should be injected into the bladder with the help of a Puspa-netra (urethral Syringe). 32-33
भवति चात्र । क्षीरवृक्षकषायस्तु पुष्पनेत्रेण योजितः । निर्हरेदश्मरीं तूर्णं रक्तं बस्तिगतञ्च यत् ॥ ३४ ॥
Memorable Verse: Stones and the accumulated blood in the bladder should be speedily expelled by means of injecting a decoction of the Ksira-trees into it with the help of a Puspa-netra (urethral Syringe). 34
मूत्रमार्गविशोधनार्थञ्चास्मै गुडसौहित्यं वितरेत् । उद्धृत्य चैनं मधुघृताभ्यक्तव्रणं मूत्रविशोधनद्रव्यसिद्धामुष्णां सघृतां यवागूं पाययेदुभयकालं त्रिरात्रम्। त्रिरात्रादूर्ध्वं गुडप्रगाढेन पयसा मृद्रोदनमल्पं भोजयेद् दशरात्रं मूत्रासग्विशुद्ध्यर्थं व्रणक्लेदनार्थञ्च | दशरात्रादूर्ध्वं फलाम्लैर्जाङ्गलरसैरुपाचरेत् ।। ३५ ।।
For the clearance of the urinary passage, a treacle solution should be given to the patient; and after taking him out of the Droni. the incidental ulcer should be lubricated with honey and clarified butter. A Yavagit, boiled with the drugs’ possessed of the virtue of cleansing or purifying the urine, and mixed with clarified butter, should be given to the patient in a warm state every morning and evening for three consecutive days.
After that period a diet (meal) of rice well boiled and mixed with milk and a large quantity of treacle, should be given (to the patient) in small quantities for ten days for the purification of the blood and the secretion of urine as well as for the purpose of establishing secretion in the ulcer. The patient should be made to partake of a diet (of rice) with the soup of the flesh of Jangala animals and the expressed juice of acid fruits after the lapse of these ten days. 35
ततो दशरात्रञ्चैनमप्रमत्तः स्वेदयेत् स्नेहेन द्रवस्वेदेन वा । क्षीरवृक्षकषायेण चास्य व्रणं प्रक्षालयेत् । रोध्रमधुकमञ्जिष्ठाप्रपौण्डरीककल्कैर्व्रणं प्रतिग्राहयेत्; एतेष्वेव हरिद्रायुतेषु तैलं घृतं वा विपक्वं व्रणाभ्यञ्जनमिति । स्त्यानशोणितञ्चोत्तरबस्तिभिरुपाचरेत् । सप्तरात्राच्च स्वमार्गमप्रतिपद्यमाने मूत्रे व्रणं यथोक्तेन विधिना दहेदग्निना। स्वमार्गप्रतिपन्ने चोत्तरबस्त्यास्थापनानुवासनैरुपाचरेन्मधुरकषायैरिति । यदृच्छया वा मूत्रमार्गप्रतिपन्नामन्तरासक्तां शुक्राश्मरीं शर्करां वा स्त्रोतसाऽपहरेत् । एवञ्चाशक्ये विदार्य वा नाडीं शस्त्रेण बडिशेनोद्धरेत् । रूढव्रणश्चाङ्गनाश्वनगनागरथद्रुमान् नारोहेत वर्षं नाप्सु प्लवेत भुञ्जीत वा गुरु ।। ३६ ।।
After that period, the body of the patient should be carefully
1 The urine-purifying drugs are the Trna-Panchamulas, Goksura, Kasanarda, Pasanabheda, etc.
fomented for ten successive days by applying any warm oleaginous substane or with any warm medicinal fluid (Drava-Sveda). As an alternative, the ulcer should be washed with the decoction of (the bark of) the Ksira-Vrksas. A paste of Rodhra, Madhuka, Manjistha and Prapaundarika (pounded together), should be applied to the ulcer. A medicated oil or Ghrita cooked with turmeric and the preceding drugs should be applied to the ulcer. The coagulated blood in the affected part should be removed with the help of a Uttara-basti (urethral Syringe). The ulcer should be cauterized with fire in the manner described before in the event of the urine not flowing through its natural passage after the lapse of seven days. After the urine takes its natural course, Uttara-basti, Asthapana and Anuvasana measures should be employed with the decoction of the drugs belonging to the Madhura-Varga.
A seminial stone or gravel (Sarkara) spontaneously brought down into the urinary passage should be removed through the same passage. The urethra should be cut open and the stone should be extracted with a hook (Budisa) or any other instrument in the case of its not being expelled out by the passage. The patient should refrain from sexual intercourse, riding on horse back or on the back of an elephant, swimming, climbing on trees and up mountains and partaking of indigestible substances for a year even after the healing of the ulcer. 36
मूत्रवहशुक्रवहमुष्कस्रोतोमूत्रप्रसेक सेवनीयोनिगुदबस्तीन् परिहरेत् । तत्र मूत्रवहच्छेदान्मरणं मूत्रपूर्णबस्ते:, शुक्रवहच्छेदान्मरणं क्लैव्यं वा, मुष्कस्त्रोत- उपघाताद् ध्वजभङ्गः । मूत्रप्रसेकक्षणनान्मूत्रप्रक्षरणम्, सेवनीयोनिच्छेदागुजः प्रादुर्भावः, बस्तिगुदविद्धलक्षणं प्रागुक्तमिति ।। ३७ ।।
Parts to be guarded in Lithotomic Operations : The Mutravaha (urine-carrying, and the Sukra-vaha (semen-carrying) ducts or channels, the Muska-srotas (cords of the testes), the Mutra-praseka (urinary) channels, the Sevani (the raphe of the perineum), the Yoni (urerus, vagina, etc.), the Guda (rectum) and the Basti (bladder) should be carefully guarded at the time of performing a lithotomic operation. Death results in the even of the urine-carrying channels being in any way hurt during the operation owing to an accumulation of urine in the bladder. Similarly, any hurt or injury to the semen-carrying ducts at the time, results in death or in impotency of the patient; a hurt to the cords of the testes begets an incapacity of fecundation; a hurt to the urinary ducts leads to a frequent dribbling of urine; while a hurt to the Yoni (uterus, vagina, etc.), or to the raphe of the perineum gives rise to extreme pain. The symptoms which characterise a hurt to the rectum or to the bladder have been described before. 37
भवतश्चात्र ।
मर्माण्यष्टावसम्बुध्य स्त्रोतोजानि शरीरिणाम् । व्यापदयेद् बहून् मर्त्त्यान् शस्त्रकर्मापटुर्भिषक् ॥ ३८ ॥
सेवनी शुक्रहरणी स्त्रोतसी फलयोर्गुदम् । मूत्रसेकं मूत्रवहं योनिर्बस्तिस्तथाऽष्टमः ।। ३९ ।।
Memorable Verses: The surgeon who is not well cognisant of the nature and positions of the Marmas or vulnerable parts seated in the eight Srotas (ducts) of the body such as, the raphe of the perineum, the spermatic cords, the cords of the testes and the corresponding ones in females (Yoni), the anal region. the urinary ducts, the urine-carrying ducts, and the urinary bladder and is not practiced in the art of surgery brings about the death of many innocent victim. 38-39
इति सुश्रुत संहितायां चिकित्सितस्थाने अश्मरीचिकित्सितं नाम सप्तमोऽध्यायः ।। ७ ।।
Thus ends the seventh Chapter of the Chikitsa Sthana in the Susruta Samhita which deals with the treatment of Urinary calculus.
