The ninth chapter of Nidanasthanam of Ashtanga Hridayam is called as Mutraghata Nidanam Adhyayah. This chapter offers with the reason of ‘prognosis of retention of urine’.
The subjects lined on this chapter embody –
– Gudasthi vivara angani – organs of pelvic cavity
– Pathogenesis of mutraghata and prameha
– Mutrakrichchra – dysuria
– Ashmari – urinary calculi, its premonitory signs and signs
– Vataja, Pittaja, Kaphaja forms of calculi
– Shukrashmari – seminal calculi
– Vatabasti
– Vatashtila
– Bastikundalika
– Mutratita
– Mutrajathara
– Mutrotsanga
– Mutragranthi
– Mutrashukra
– Vidvighata
– Ushnavata
– Mutrakshaya
– Mutrasada
Pledge by the writer(s)
अथातो मूत्राघातनिदानं व्याख्यास्याम ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having provided prayers to the God, henceforth we’re going to clarify the chapter pertaining to the reason of ‘prognosis of retention of urine’. Thus say (pledge) Atreya and different sages.
Gudasthi Vivara Angani: Organs of pelvic cavity
बस्तिबस्तिशिरोमेढ्रकटीवृषणपायवः ।
एकसम्बन्धनाः प्रोक्ता गुदास्थिविवराश्रयाः ॥ १ ॥
The urinary bladder, head of the urinary bladder, penis, waist, testicles, rectum are all associated to at least one one other and located throughout the cavity of the rectal bone (pelvis).
Notes: Head of the urinary bladder means the 2 ureters, which join the kidneys with the bladder; penis hereafter refers back to the urethral passage, testicles are outdoors the pelvis and never related to the bladder so additionally the rectum. Mutraghata is incapacity to cross urine although the bladder is full (retention of urine).
Pathogenesis of mutraghata (retention of urine) and prameha (diabetes)
अधोमुखोऽपि बस्तिर्हि मूत्रवाहिसिरामुखैः ।
पार्श्वेभ्यः पूर्यते सूक्ष्मैः स्यन्दमानैरनारतम् ॥ २ ॥
यैस्तैरेव प्रविश्यैनं दोषाः कुर्वन्ति विंशतिम् ।
मूत्राघातान् प्रमेहांश्च कृच्छ्रान्मर्मसमाश्रयान् ॥ ३ ॥
Although located with its mouth downwards, the urinary bladder will get crammed from(all) its sides by the minute channels carrying urine, that are secreting (oozing) with out break (repeatedly all through day and evening). The doshas coming into (the bladder) by these channels produce the twenty sorts of mutraghata (retention of urine) and prameha (diabetes) that are tough to deal with, residing on this marma (important organ, the urinary bladder).
Mutrakrichchra (dysuria, strangury)
बस्तिवङ्क्षणमेढ्रार्तियुक्तोऽल्पाल्पं मुहुर्मुहुः ।
मूत्रयेद्वातजे कृच्छ्रे पैत्ते पीतं सदाहरुक् ॥ ४ ॥
रक्तं वा कफजे बस्तिमेढ्रगौरवशोफवान् ।
सपिच्छं सविबन्धं च सर्वैः सर्वात्मकं मलैः ॥ ५ ॥
In mutrakrccha (dysuria) brought on by vata, there’s ache within the area of he bladder, groins and penis; the particular person voids urine in small portions, ceaselessly; in that brought on by pitta, the urine is yellow, voided accompanied with burning sensation he might void urine with ache or together with urine in that arising from kapha, the particular person has heaviness with edema, and voids urine which is slimy, with disruption; in that brought on by all of the doshas, all of the signs are exhibited.
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 covers the mouth of the bladder and dries up the urine, then urine getting blended with Pitta, Kapha or semen, provides rise to the formation of Ashmari (stone, calculi) simply as Gorochana (ox gall) will get shaped from Pitta (bile) within the ox; all of those are having Kapha as their receptacle (their mass).
Purvarupa (premonitory signs) of Ashmari
अथास्याः पूर्वलक्षणम् ॥ ७ ॥
वस्त्याध्मानं तदासन्नदेशेषु परितोऽतिरुक् ।
मूत्रे च बस्तगन्धत्वं मूत्रकृच्छ्रं ज्वरोऽरुचिः ॥ ८ ॥
Its premonitory signs are distention of the bladder, extreme ache in and across the websites of stone, urine emitting the scent of goat, problem for elimination of urine, fever lack of urge for food.
Rupa (Medical options) of Ashmari
सामान्यलिङ्गं रुङ्नाभिसेवनीबस्तिमूर्धसु ।
विशीर्णधारं मूत्रं स्यात्तया मार्गनिरोधने ॥ ९ ॥
तद्व्यपायात्सुखं मेहेदच्छं गोमेदकोपमम् ।
तत्सङ्क्षोभात्क्षते सास्रमायासाच्चातिरुग्भवेत् ॥ १० ॥
Its basic signs are ache close to the umbilicus, raphae, and head of the bladder; stream of urine interrupted when its path is obstructed (by the stone) and straightforward circulation when its path is free; urine is evident, resembles Gomedaka gem (dolomite) in color (yellow), when it (stone) causes a wound by friction / irritation, the urine will probably be blended with blood, ache turns into extra on exertion (straining to cross urine).
Vataja Ashmari
तत्र वाताद्भृशार्त्यार्तो दन्तान्खादति वेपते ।
मृद्नाति मेहनं नाभिं पीडयत्यनिशं क्वणन् ॥ ११ ॥
सानिलं मुञ्चति शकृन् मुहुर्मेहति बिन्दुशः ।
श्यावा रूक्षाश्मरी चास्य स्याच्चिता कण्टकैरिव ॥ १२ ॥
In Ashmari brought on by Vata, the ache may be very extreme, so the particular person grinds his tooth, shivers, squeezes the penis, rubs the umbilicus, crying always; voids faeces accompanied with flatus, urinates too ceaselessly and in drops; the stone is black, tough, and studded with thorny projections.
Pittaja Ashmari
पित्तेन दह्यते बस्तिः पच्यमान इवोष्मवान् ।
भल्लातकास्थिसंस्थाना रक्ता पीतासिताश्मरी ॥ १३ ॥
In Ashmari brought on by Pitta, there’s burning sensation within the bladder, as if suppurated, ulcerated, and may be very heat, the stone resembles the seed of Bhallataka (in form), purple, yellow or black in color.
Kaphaja Ashmari
बस्तिर्निस्तुद्यत इव श्लेष्मणा शीतलो गुरुः ।
अश्मरी महती श्लक्ष्णा मधुवर्णाथवा सिता ॥ १४ ॥
In Ashmari brought on by Kapha, there’s pricking ache within the bladder feeling of chilly and heaviness; the stone is massive, easy, of the colour of honey or white.
Urinary calculus in kids
एता भवन्ति बालानां तेषामेव च भूयसा ।
आश्रयोपचयाल्पत्वाद्ग्रहणाहरणे सुखाः ॥ १५ ॥
These (above three forms of Ashmari) happen extra generally in kids Ashmari are simple to know (with devices) and to drag out, as a result of the receptacle (urinary blander) is small, not absolutely grown.
Shukrashmari (seminal calculi)
शुक्राश्मरी तु महतां जायते शुक्रधारणात् ।
स्थानाच्च्युतममुक्तं हि मुष्कयोरन्तरेऽनिलः ॥ १६ ॥
शोषयत्युपसङ्गृह्य शुक्रं तच्छुष्कमश्मरी ।
बस्तिरुक्कृच्छ्रमूत्रत्वमुष्कश्वयथुकारिणी ॥ १७ ॥
तस्यामुत्पन्नमात्रायां शुक्रमेति विलीयते ।
पीडिते त्ववकाशेऽस्मिन्न्
Seminal stone will get shaped in adults resulting from suppression of the circulation of semen which has left its seat (of manufacturing) however not ejaculated it will get dried of its moisture by Vata Dosha contained in the scrotum by withholding the semen, that’s Sukrasmari ( seminal calculi). There’s ache within the bladder, tough urination, produces swelling of the scrotum, quickly after Shukra Ashmari formation; the semen liquefies and flows however stops within the center and comes out by the channel when squeezed.
Shukrashmari (seminal calculi)
अश्मर्यैव च शर्करा ॥ १८ ॥
अणुशो वायुना भिन्ना सा त्वस्मिन्ननुलोमगे ।
निरेति सह मूत्रेण प्रतिलोमे विबध्यते ॥ १९ ॥
Sharkara (urinary gravel) is urinary stone itself, however damaged to small items by Vata, popping out together with urine when Vata is having downward motion and obstructing the circulation of urine when (Vata is) having upward motion.
Vatabasti
मूत्रसन्धारिणः कुर्याद्रुद्ध्वा बस्तेर्मुखं मरुत् ।
मूत्रसङ्गं रुजं कण्डूं कदाचिच्च स्वधामतः ॥ २० ॥
प्रच्याव्य बस्तिमुद्वृत्तं गर्भाभं स्थूलविप्लुतम् ।
करोति तत्र रुग्दाहस्पन्दनोद्वेष्टनानि च ॥ २१ ॥
बिन्दुशश्च प्रवर्तेत मूत्रं बस्तौ तु पीडिते ।
धारया द्विविधोऽप्येष वातबस्तिरिति स्मृतः ॥ २२ ॥
दुस्तरो दुस्तरतरो द्वितीयः प्रबलानिलः ।
In an individual who suppress the urge of urination habitually, Vata being aggravated, blocks the mouth of the urinary bladder, causes blockage of urine, ache itching sensation and generally the bladder will get an excessive amount of distended, displaced upward, resembling a gravid uterus, exhausting and filled with fluid, accompanied with ache, burning sensation, throbbing ache and twisting kind of ache; urine comes out in drops upon squeezing the bladder. This illness is named Vatabasti and is of two varieties based mostly on urine circulation viz, Dustara (tough to bear and deal with). The second extra grave and is brought on by the highly effective Vata
Vatasthila
शकृन्मार्गस्य बस्तेश्च वायुरन्तरमाश्रितः ॥ २३ ॥
अष्ठीलाभं घनं ग्रन्थिं करोत्यचलमुन्नतम् ।
वाताष्ठीलेति साध्मानविण्मूत्रानिलसङ्गकृत् ॥ २४ ॥
Vata (aggravated) getting localized in between the rectum and the urinary bladder, provides rise to a tough, elevated, immovable tumor resembling the cobblers stone, this is named Vatasthila, and causes distention of the stomach and hindrance to urine, feces, and flatus.
Bastikundalika
विगुणः कुण्डलीभूतो बस्तौ तीव्रव्यथोऽनिलः ।
आविध्य मूत्रं भ्रमति सस्तम्भोद्वेष्टगौरवः ॥ २५ ॥
मूत्रमल्पाल्पमथवा विमुञ्चति शकृत्सृजन् ।
वातकुण्डलिकेत्येषा
Vata aggravated shifting in a round approach within the bladder causes extreme ache, round motion of urine contained in the bladder itself, inflicting obstruction to its circulation, native Vata vitiation and heaviness of the bladder; urine is launched out little by little, or accompanied with elimination of faeces. This illness is known as Vata kundalika.
Mutratita
मूत्रं तु विधृतं चिरम् ॥ २६ ॥
न निरेति विबद्धं वा मूत्रातीतं तदल्परुक् ।
By Suppressing the urge of micturition for very long time, urine fails to come back out being obstructed, or urination occurs with gentle ache;
मूत्रातीतं तत् – mūtrātītaṃ tat – that’s Mutratita.
Mutrajathara
विधारणात्प्रतिहतं वातोदावर्तितं यदा ॥ २७ ॥
नाभेरधस्तादुदरं मूत्रमापूरयेत्तदा ।
कुर्यात्तीव्ररुगाध्मानमपक्तिं मलसङ्ग्रहम् ॥ २८ ॥
तन्मूत्रजठरं
By the behavior of suppressing the urge to urinate, Vata getting obstructed when begins to maneuver upwards, then the bladder, filled with urine, causes distention of stomach under the umbilicus, and causes extreme ache, distension of the stomach, indigestion and accumulation of faeces. That illness is Mutra jathara.
Mutrotsanga
छिद्रवैगुण्येनानिलेन वा ।
आक्षिप्तमल्पं मूत्रं तद्वस्तौ नालेऽथवा मणौ ॥ २९ ॥
स्थित्वा स्रवेच्छनैः पश्चात्सरुजं वाथ नीरुजम् ।
मूत्रोत्सङ्गः स विच्छिन्नतच्छेषगुरुशेफसः ॥ ३० ॥
Both resulting from abnormalities of the urinary passage by aggravation of Vata, small amount of urine staying both within the bladder, urethra or the glans-penis, will get obstructed comes out slowly, or urination occurs with delay, with or with out ache; the residual urine causes heaviness of the penis, and interrupted urination such a illness is Mutrotsanga.
Mutragranthi
अन्तर्वस्तिमुखे वृत्तः स्थिरोऽल्पः सहसा भवेत् ।
अश्मरीतुल्यरुग्ग्रन्थिर्मूत्रग्रन्थिः स उच्यते ॥ ३१ ॥
A spherical, immovable, exhausting and small tumour growing abruptly contained in the mouth (cavity) of the urinary bladder, producing ache resembling that of urinary stone, is named Mutragranthi.
Mutrashukra
मूत्रितस्य स्त्रियं यातो वायुना शुक्रमुद्धतम् ।
स्थानाच्च्युतं मूत्रयतः प्राक्पश्चाद्वा प्रवर्तते ॥ ३२ ॥
भस्मोदकप्रतीकाशं मूत्रशुक्रं तदुच्यते ।
The particular person with urge to urination, indulges in sexual activity, Shukra which is displaced from its place by aggravated Vata Shukra comes out both previous to or after urination, the urine resembles resolution of ash. That illness is known as Mutrashukra.
Vidvighata
रूक्षदुर्बलयोर्वातादुदावर्तं शकृद्यदा ॥ ३३ ॥
मूत्रस्रोतोऽनुपर्येति संसृष्टं शकृता तदा
मूत्रं विट्तुल्यगन्धं स्याद्विड्विघातं तमादिशेत् ॥ ३४ ॥
In individuals who’re dry (with lack of fats) and debilitated, when feces is moved upwards resulting from aggravated Vata, then it brings obstructed feces (small amount of fecal matter) into the channels of urine (bladder and urethra); the urine has the odor of feces. This illness is Vidvighata
Ushnavata
पित्तं व्यायामतीक्ष्णोष्णभोजनाध्वातपादिभिः ।
प्रवृद्धं वायुना क्षिप्तं वस्त्युपस्थार्तिदाहवत् ॥ ३५ ॥
मूत्रं प्रवर्तयेत्पीतं सरक्तं रक्तमेव वा ।
उष्णं पुनः पुनः कृच्छ्रादुष्णवातं वदन्ति तम् ॥ ३६ ॥
Pitta getting aggravated by train, meals that are penetrating and scorching, long-distance stroll, basking within the solar for lengthy intervals, and many others. Pitta is shortly aggravated together with Vata, will get lodged in bladder and urethra inflicting ache and burning sensation urine is yellow, blended with blood or solely blood flows out, urine is heat, comes out many times with problem.Thus is known as as Ushnavata.
Mutrakshaya
रूक्षस्य क्लान्तदेहस्य बस्तिस्थौ पित्तमारुतौ ।
मूत्रक्षयं सरुग्दाहं जनयेतां तदाह्वयम् ॥ ३७ ॥
In individuals with dry and debilitated physique, Pitta and Maruta (Vata) getting localized within the urinary bladder generates burning sensation and ache, causes decreased manufacturing of urine and is known as Mutrakshaya.
Mutrasada
पित्तं कफो द्वावपि वा संहन्येतेऽनिलेन चेत् ।
कृच्छ्रान्मूत्रं तदा पीतं रक्तं श्वेतं घनं सृजेत् ॥ ३८ ॥
सदाहं रोचनाशङ्खचूर्णवर्ण भवेच्च तत् ।
शुष्कं समस्तवर्णं वा मूत्रसादं वदन्ति तम् ॥ ३९ ॥
Pitta and Kapha both individually or together will get aggravated by Vata, then they produce tough urination, urine is yellow, purple or white and thick; related to burning sensation, resembling the colours of ox-gall or powder of conch shell or of all colours blended collectively and is dry (non-unctous); that is referred to as Mutrasada.
Chapter abstract
इति विस्तरतः प्रोक्ता रोगा मूत्राप्रवृत्तिजाः ।
निदानलक्षणैरूर्ध्वं वक्ष्यन्तेऽतिप्रवृत्तिजाः ॥ ४० ॥
Thus had been described intimately, the ailments characterised with problem or absence of urination together with their causes and medical options; these ailments characterised with extra urination will probably be described additional within the subsequent chapter.
इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थाने मूत्राघातनिदानं नाम नवमोऽध्याय: ॥९॥
Thus ends the chapter Mutraghata Nidana- the ninth in Nidanasthana of Astangahrudaya Samhita composed by Srimad Vagbhata, son of Sai Vaidyapati Simhagupta.
