The third chapter of Nidanasthana of Sushruta Samhita is known as as Ashmari Nidanam. This chapter offers with Illnesses of the Nervous System.
अथातोऽश्मरीणां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We’ll now expound Ashmari Nidanam – analysis of urinary calculi, as revealed by the venerable Dhanvantari.
Asmaribheda: Sorts of Calculii
चतस्रोऽश्मर्यो भवन्ति; श्लेष्माधिष्ठानाः; तद्यथा- श्लेष्मणा, वातेन, पित्तेन, शुक्रेण चेति ||३||
There are 4 sorts of Asmari (urinary calculi / urinary stone) which manifest by residing in (fashioned from) kapha (i.e. all 4 sorts of asmari are fashioned from kapha), resembling these born from kapha, vata, pitta and sukra (semen) individually.
Samprapti: Pathogenesis
तत्रासंशोधनशीलस्यापथ्यकारिणः प्रकुपितः श्लेष्मा मूत्रसम्पृक्तोऽनुप्रविश्य बस्तिमश्मरीं जनयति ||४||
In individuals who don’t endure purification commonly and who take pleasure in unhealthy meals and actions, Kapha will get aggravated, combines with urine, reaches the urinary bladder, and staying there produces Asmari i.e. calculi (stones).
Purvarupa: Premonitory signs
तासां पूर्वरूपाणि- ज्वरो बस्तिपीडारोचकौ मूत्रकृच्छ्रं बस्तिशिरोमुष्कशेफसां वेदना कृच्छ्रावसादो बस्तगन्धित्वं मूत्रस्येति ||५||
यथास्ववेदनावर्णं दुष्टं सान्द्रमथाविलम् |
पूर्वरूपेऽश्मनः कृच्छ्रान्मूत्रं सृजति मानवः ||६||
The premonitory signs of Asmari are as beneath talked about –
- fever,
- ache within the bladder,
- lack of style, problem in urination,
- ache within the head of the bladder, scrotum and penis;
- troublesome physique aches and
- urine having the scent of the goat
- particular signs and colour of the Dosha producing the illness,
- urine turning into vitiated, thick and turbid and
- the particular person passes urine with problem
Rupa: Indicators and signs
अथ जातासु नाभिबस्तिसेवनीमेहनेष्वन्यतमस्मिन् मेहतो वेदना मूत्रधारासङ्गः सरुधिरमूत्रता मूत्रविकिरणं गोमेदकप्रकाशमत्याविलं ससिकतं विसृजति; धावनलङ्घनप्लवनपृष्ठयानोष्णाध्वगमनैश्चास्य वेदना भवन्ति ||७||
After manifestation, the particular person has ache within the space of the umbilicus, bladder, raphae (perineal), penis and different areas close by throughout micturation, interruption of stream of urine, urine blended with blood, urine scattering (spreading in lots of streams), urine resembling gomedaka (dolomite stone) in colour (gentle yellow), very turbid, and containing sand (gravel). There may be ache throughout working, leaping, swimming, using, publicity to daylight, lengthy walks and so on.
Kaphaja Ashmari
तत्र श्लेष्माश्मरी श्लेष्मलमन्नमभ्यवहरतोऽत्यर्थमुपलिप्याधः परिवृद्धिं प्राप्य बस्तिमुखमधिष्ठाय स्रोतो निरुणद्धि, तस्य मूत्रप्रतिघाताद्दाल्यते भिद्यते निस्तुद्यत इव च बस्तिर्गुरुः शीतश्च भवति; अश्मरी चात्र श्वेता स्निग्धा महती कुक्कुटाण्डप्रतीकाशा मधूकपुष्पवर्णा वा भवति, तां श्लैष्मिकीमिति विद्यात् ||८||
In individuals who eat meals which enhance Kapha too typically, Kapha getting elevated types a coating on the backside of the bladder. Then reaching the orifice of the bladder blocks it. On account of such blocking, the particular person feels the bladder as if being torn, punctured and pricked, heavy and chilly. The stone is white, unctuous, large like a hen’s egg and just like Madhuka flower in colour (gentle yellow). That is to be understood as produced by shleshma (Kapha).
Pittaja Ashmari
पित्तयुतस्तु श्लेष्मा सङ्घातमुपगम्य यथोक्तां परिवृद्धिं प्राप्य बस्तिमुखमधिष्ठाय स्रोतो निरुणद्धि, तस्य मूत्रप्रतीघातादूष्यते चूष्यते दह्यते पच्यत इव बस्तिरुष्णवातश्च भवति; अश्मरी चात्र सरक्ता पीतावभासा कृष्णा भल्लातकास्थिप्रतिमा मधुवर्णा वा भवति, तां पैत्तिकीमिति विद्यात् ||९||
Kapha, mixed with Pitta, types lumps, which enhance in measurement contained in the bladder after which block the orifice of the bladder. On account of such blocking the particular person feels as if the bladder is sizzling inside, as being sucked (pulled), burnt and suppurating (ripening, forming an ulcer) and there may be Ushnavata (burning and problem of micturition). The stones are barely crimson, yellowish or black, resembling the seed of Bhallataka or honey in colour. This needs to be understood as produced by pitta.
Vataja Ashmari
वातयुतस्तु श्लेष्मा सङ्घातमुपगम्य यथोक्तां परिवृद्धिं प्राप्य बस्तिमुखमधिष्ठाय स्रोतो निरुणद्धि, तस्य मूत्रप्रतीघातात्तीव्रा वेदना भवति, तदाऽत्यर्थं पीड्यमानो दन्तान् खादति, नाभिं पीडयति, मेढ्रं प्रमृद्नाति, पायुं स्पृशति, विशर्धते, विदहति, वातमूत्रपुरीषाणि कृच्छ्रेण चास्य मेहतो निःसरन्ति; अश्मरी चात्र श्यावा परुषा विषमा खरा कदम्बपुष्पवत्कण्टकाचिता भवति, तां वातिकीमिति विद्यात् ||१०||
Kapha, mixed with Vata, types lumps which develop in measurement, attain the orifice of the bladder and block the passage. Due to such obstruction, there may be extreme ache; struggling enormously from this ache, the particular person grinds his enamel, presses the umbilicus, squeezes the penis, touches the rectum typically and makes sounds by it, feels burning sensation within the bladder, eliminates flatus, urine and feces with problem. Throughout micturition; the stone is blue, coarse (tough) irregular (uneven), laborious, and coated with thorns (projections) just like that of Kadamba flower. This needs to be understood as produced by Vata.
Stones and youngsters
प्रायेणैतास्तिस्रोऽश्मर्यो दिवास्वप्नसमशनाध्यशनशीतस्निग्धगुरुमधुराहारप्रियत्वाद्विशेषेण बालानां भवन्ति; तेषामेवाल्पबस्तिकायत्वादनुपचितमांसत्वाच्च बस्तेः सुखग्रहणाहरणा भवन्ति |
These sorts of Asmari (stones) typically develop in youngsters particularly, since they take pleasure in sleep through the day, eat each unhealthy and wholesome meals, over-eating, eat meals that are unctuous (fatty), heavy (laborious for digestion) and candy in style. Since their bladder is small in measurement and muscle tissue of the bladder usually are not totally grown, holding the stone (with forceps) and pulling it out are straightforward.
Shukrashmari
महतां तु शुक्राश्मरी शुक्रनिमित्ता भवति ||११||
मैथुनविघातादतिमैथुनाद्वा शुक्रं चलितमनिर्गच्छद्विमार्गगमनादनिलोऽभितः सङ्गृह्य मेढ्रवृषणयोरन्तरे संहरति, संहृत्य चोपशोषयति; सा मूत्रमार्गमावृणोति , मूत्रकृच्छ्रं बस्तिवेदनां वृषणयोश्च श्वयथुमापादयति, पीडितमात्रे च तस्मिन्नेव प्रदेशे प्रविलयमापद्यते; तां शुक्राश्मरीमिति विद्यात् ||१२||
Sukramari (seminal calculi) – develops solely within the aged (youth and outdated age) individuals. On account of both interruption of coitus or an excessive amount of of copulation, Sukra (semen) getting dislodged from its seat (testes) turns into obstructed from going out; then vata (aggravated) transferring in unsuitable path (instructions) withholds it (semen) between the penis and testicles and dries it up (stone), blocks the urinary passage, offers rise to tough urination; ache and swelling of the bladder and testicles. When squeezed by the hand, it (stone) breaks into small items in that place itself. This needs to be understood as Sukrasmari (seminal calculi).
Secondary illnesses of Ashmari
One other verse right here
भवन्ति चात्र-
शर्करा सिकता मेहो भस्माख्योऽश्मरिवैकृतम् |१३|
Sarkara (urinary gravel), sikata meha (quite a lot of diabetes) and bhasmakhya roga (illnesses referred to as additionally as mutra sukra described in ch.58 of Utarasthana) all are issues (secondary illnesses) of Asmari (renal calculi) solely.
Mutra sharkara-urinary gravel
अश्मर्या शर्करा ज्ञेया तुल्यव्यञ्जनवेदना ||१३||
पवनेऽनुगुणे सा तु निरेत्यल्पा विशेषतः |
सा भिन्नमूर्तिर्वातेन शर्करेत्यभिधीयते ||१४||
Sarkara (sand or gravel) needs to be understood as Asmari (urinary stone) itself, due to similarity in form and signs. When small in measurement, it (gravel) comes out when Pavana (Vata) is regular. The identical (stone) when damaged into items by Vata is named Sarkara (urinary gravel).
Indicators and signs of Sharkara: Urinary gravel
हृत्पीडा सक्थिसदनं कुक्षिशूलं च वेपथुः |
तृष्णोर्ध्वगोऽनिलः कार्ष्ण्यं दौर्बल्यं पाण्डुगात्रता ||१५||
अरोचकाविपाकौ तु शर्करार्ते भवन्ति च |१६|
Ache within the area of the guts, weak point of the thighs, ache within the stomach, tremors, thirst, upward motion of Vata (reverse peristalsis), emaciation, debility, yellowish-white colour / pallor of the physique, lack of style and improper digestion are the signs of the individuals affected by urinary gravel.
Signs brought on by obstructed calculi
मूत्रमार्गप्रवृत्ता सा सक्ता कुर्यादुपद्रवान् ||१६||
दौर्बल्यं सदनं कार्श्यं कुक्षिशूलमरोचकम् |
पाण्डुत्वमुष्णवातं च तृष्णां हृत्पीडनं वमिम् ||१७||
When obstructed whereas it’s popping out of the urinary passage, it offers rise to issues (secondary illnesses) resembling debility, exhaustion, emaciation, and belly ache, lack of style, anemia, burning micturition, thirst, ache in area of coronary heart and vomiting.
Mutrashaya: Urinary bladder
नाभिपृष्ठकटीमुष्कगुदवङ्क्षणशेफसाम् |
एकद्वारस्तनुत्वक्को मध्ये बस्तिरधोमुखः ||१८||
बस्तिर्बस्तिशिरश्चैव पौरुषं वृषणौ गुदः |
एकसम्बन्धिनो ह्येते गुदास्थिविवराश्रिताः ||१९||
अलाब्वा इव रूपेण सिरास्नायुपरिग्रहः |
मूत्राशयो मलाधारः प्राणायतनमुत्तमम् ||२०||
पक्वाशयगतास्तत्र नाड्यो मूत्रवहास्तु याः |
तर्पयन्ति सदा मूत्रं सरितः सागरं यथा ||२१||
सूक्ष्मत्वान्नोपलभ्यन्ते मुखान्यासां सहस्रशः |
नाडीभिरुपनीतस्य मूत्रस्यामाशयान्तरात् ||२२||
जाग्रतः स्वपतश्चैव स निःस्यन्देन पूर्यते |
आमुखात्सलिले न्यस्तः पार्श्वेभ्यः पूर्यते नवः ||२३||
घटो यथा तथा विद्धि बस्तिर्मूत्रेण पूर्यते |२४|
Basti (Mutrasaya) is located within the midst of the umbilicus, again, waist, scrotum, rectum, groins and penis, has one orifice (solely) and skinny pores and skin (layers, overlaying), positioned going through downwards. It’s formed like alabu (pitcher gourd) and supported by sira (veins / blood vessels) and snayu (ligaments).Basti (urinary bladder), Bastisira (fundus), Paurusa (prostate), Vrsana (testicles), and Guda (rectum) are interrelated (linked) and located contained in the cavity of the pelvis.
This mutrasaya (urinary bladder) is a receptacle of mala (waste merchandise) and an necessary seat of life.
Nadis (tubes / ducts) referred to as mutravaha (ducts of urine) current within the Pakvasaya (giant gut), fulfill the bladder (filling it) by bringing urine all the time (constantly) similar to the rivers (satisfying) the ocean. The mouths (openings) of those hundreds of ducts usually are not seen due to their minuteness; these carry urine from the inside of the amasaya (abdomen and small gut), fill the bladder by oozing by its wall, each throughout waking and sleeping states (all through day and night time constantly). Simply as a recent earthen pot saved immersed in water as much as its mouth (neck) will get full of water by its sides, in the identical approach, it needs to be understood that the bladder additionally will get full of urine.
In the identical method vata, pitta and kapha additionally enter into the urinary bladder, by oozing by its wall together with urine and produce calculi (stone).
Analogy for formation of stone in urinary bladder
एवमेव प्रवेशेन वातः पित्तं कफोऽपि वा ||२४||
मूत्रयुक्तमुपस्नेहात् प्रविश्य कुरुतेऽश्मरीम् |२५|
अप्सु स्वच्छा(स्था)स्वपि यथा निषिक्तासु नवे घटे ||२५||
कालान्तरेण पङ्कः स्यादश्मरीसम्भवस्तथा |
संहन्त्यापो यथा दिव्या मारुतोऽग्निश्च वैद्युतः ||२६||
तद्वद्बलासं बस्तिस्थमूष्मा संहन्ति सानिलः |२७|
Simply as water, although clear, when saved undisturbed for a while in an earthen pot, types slush (deposit) beneath in course of time, equally is the formation of stone contained in the bladder. Simply as rain water solidifies (within the sky) by (the motion of) wind, fireplace (warmth) and lightning, equally the fireplace (pitta), anila (vata) solidify the balasa (kapha) current within the urinary bladder.
Function of Vata positioned in urinary bladder in causation of many problems
मारुते प्रगुणे बस्तौ मूत्रं सम्यक् प्रवर्तते |
विकारा विविधाश्चापि प्रतिलोमे भवन्ति हि ||२७||
मूत्राघाताः प्रमेहाश्च शुक्रदोषास्तथैव च |
मूत्रदोषाश्च ये केचिद्वस्तावेव भवन्ति हि ||२८||
When Vata is regular within the urinary bladder, urine flows out correctly, however when it (vata) strikes (acts) in improper method, completely different sorts of illnesses develop; retention of urine, diabetes, problems of semen and all different urinary problems, come up from the urinary bladder itself.
इति सुश्रुतसंहितायां निदानस्थानेऽश्मरीनिदानां नाम तृतीयोऽध्यायः ||३||
Thus ends the Third chapter by title Asmari Nidanam In Nidana Sthana of Susruta Samhita.
