The chapter on the treatment of ashmari is introduced according to the teaching of Dhanvantari. Ashmari is described as a severe disorder, comparable to death. When newly arisen it is said to be manageable with medicines; when advanced, the text states that cutting may be required. At the preliminary-sign stage, a regimen beginning with unctuous measures is prescribed, by which the underlying factors of the disorder are said to diminish completely.
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अश्मरीत्यादि| तरुणः तत्कालोत्पन्नः||१-४||
Meaning of the commentary
The commentary explains taruna as an ashmari that has arisen recently. It otherwise accepts the passage's distinction between early medicinal management and cutting for an advanced condition.
Key terms
ashmarI (ashmari)
The classical urinary-stone disorder discussed in this chapter.
taruNa (taruna)
Newly arisen or recent, as explicitly explained by the commentator.
cheda
Cutting or operative intervention proposed by the historical text for an advanced case.
snehAdikrama (snehadi-krama)
A therapeutic sequence beginning with unctuous measures.
The text lists pashanabheda, vasuka, vashira, ashmantaka, shatavari, shvadamshtra, brihati, kantakarika, kapotavanka, artagala, kaccaka, ushira, kubja, vrikshadani, bhalluka, varuna, the fruit of shaka, barley, kulattha, kola, and kataka fruit. Ghee is prepared with their decoction and with a paste from the Ushakadi group. The formulation is said to break down ashmari arising from vata quickly.
The commentary presents this formulation as the regimen intended to quiet the dosha and dushya factors underlying the disorder. It identifies vasuka as bakapushpa; vashira as a grass called markata, though others call it a variety of suryavarta; and ashmantaka as amlalota, with leaves resembling kovidara. Kapotavanka is described as a tree known in the central region. Artagala is variously identified as fragrant-rooted kakubhaka called kauha in the eastern region, as kukhaka, or as a thorny-fruited tree with external stamens. Kaccaka is described as an upright-leaved plant with a central leaf-line and slightly red root, called kavahaka in Malava; another reading has kakubha. Kubja is gunja, vrikshadani is bandaka, and bhalluka is shyonaka. Shaka is identified by its rough upper and smooth lower leaf surfaces, and its fruit is used. Kataka fruit is described as water-clearing and resembling dried hare droppings. Under the general rules for medicated ghee, the listed plants supply the decoction and the Ushakadi substances supply the paste in one-quarter proportion.
Key terms
pAShANabheda (pashanabheda)
One of the principal plants listed for this historical formulation.
vAtasambhUtA ashmarI (vata-sambhuta ashmari)
Ashmari classified in the text as arising from vata.
doShadUShya (dosha-dushya)
The causative and affected factors that the commentary says are to be pacified.
pratIvApa (prativapa)
The paste or additive incorporated while preparing the medicated ghee.
kataka
A fruit identified here by its traditional water-clearing property.
Adhikarana ३ (८) · Śloka ९
क्षारान् यवागूर्यूषांश्च कषायाणि पयांसि च ||८||
भोजनानि च कुर्वीत वर्गेऽस्मिन् वातनाशने |९|
Meaning of the śloka
Within this vata-pacifying group, the text directs the use of alkalis, yavagu, yusha, decoctions, milk preparations, and suitable foods.
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घृतौषधवर्गं सङ्क्षेपार्थमन्यत्राप्यतिदिशन्नाह- क्षारानित्यादि| क्षाराश्चात्र पातव्याः, ते च चूर्णत्वात् कर्षमात्रया सलिलेन मस्त्वादिबस्तिशोधनद्रव्येण वा पलद्वयचतुष्टयप्रमाणेन; क्षारोदकपक्षे तु कर्षद्वयं त्रयं वा षड्गुणेनाष्टगुणेन वा जलेन बहुशः परिस्राव्य पूतं पेयम्| यवाग्वादयश्चात्र पलद्रव्यक्वाथेन कर्तव्याः| भोजनानि भक्तादयः| चकाराच्चूर्णानामपि समुच्चयः कर्तव्यः| एवं पित्तकफहरद्रव्यवर्गेऽप्यूह्यम्| क्षारादीनां कल्पना परिभाषाबलात्; स्वयमप्यूहः कर्तव्यः||८||-
Meaning of the commentary
The commentary says this verse extends the preceding medicated-ghee ingredient group to other preparations for brevity. It gives detailed historical quantities and liquids for drinking powdered or dissolved alkali, and states that yavagu and related preparations are made with a decoction of the substances. Bhojana includes rice meals and other foods, while the conjunction also includes powders. The same method is to be inferred for the pitta- and kapha-reducing groups. The commentator grounds these preparations in general formulation rules while also allowing reasoned adaptation.
Key terms
kShAra (kshara)
An alkaline medicinal preparation in the historical regimen.
yavAgU (yavagu)
A gruel preparation made here using an herbal decoction.
yUSha (yusha)
A soup or broth preparation included in the regimen.
vAtanAshana (vata-nashana)
Intended in this passage to reduce or pacify vata.
The passage lists kusha, kasha, sara, gundra, itkata, morata, ashmabhit, vari, vidari, varahi, shali root, trikantaka, bhalluka, patala, patha, pattura, kuruntika, punarnava, and shirisha. Ghee is prepared in their decoction with shilaja, madhuka, indIvara seeds, and the seeds of trapusa, varuka, and related plants. It is said to break down ashmari arising from pitta quickly. For this pitta-pacifying group, alkalis, yavagu, yusha, decoctions, milk preparations, and foods are also prescribed.
The commentary identifies this as treatment for pitta-type ashmari. It explains itkata as the large khagali and morata as sugarcane root. Pattura is sharabalika, and kuruntika is a red-flowered variety of sharabalika. Shilaja means shilajatu. Indivara is identified by this commentator as a long-leaved, abundantly flowering variety of sharabalika; Jejjata instead identifies it as blue lotus, an identification that Gayi rejects. The disagreement is left unresolved.
Key terms
pittasambhUtA ashmarI (pitta-sambhuta ashmari)
Ashmari classified in the text as arising from pitta.
shilAja (shilaja)
Identified in the commentary as shilajatu.
indIvara (indivara)
A disputed plant identity: a sharabalika variety here, but blue lotus according to Jejjata.
ghRuta (ghrita)
Ghee used as the base of the historical preparation.
Adhikarana ५ (१४-१६) · Śloka १६
गणो वरुणकादिस्तु गुग्गुल्वेलाहरेणवः |
कुष्ठभद्रादिमरिचचित्रकैः ससुराह्वयैः ||१४||
एतैः सिद्धमजासर्पिरूषकादिगणेन च |
भिनत्ति कफसम्भूतामश्मरीं क्षिप्रमेव तु ||१५||
क्षारान् यवागूर्यूषांश्च कषायाणि पयांसि च |
भोजनानि च कुर्वीत वर्गेऽस्मिन् कफनाशने ||१६||
Meaning of the śloka
Ghee is prepared with the Varunaka group, guggulu, ela, harenu, kushtha, the Bhadradi substances, marica, citraka, surahvaya, and the Ushakadi group. The text says this quickly breaks down ashmari arising from kapha. It also prescribes alkalis, yavagu, yusha, decoctions, milk preparations, and foods from this kapha-pacifying group.
The commentary identifies the Bhadradi group as the series beginning with bhadradaru, kushtha, and the two haridras. Some witnesses do not read goat's ghee; on the basis of the preceding context, those readers use cow's ghee under the general rule. The commentator further says that this kapha-type treatment should also be understood as the treatment for shukra-type ashmari because kapha and shukra are held to have similar qualities.
Key terms
kaphasambhUtA ashmarI (kapha-sambhuta ashmari)
Ashmari classified in the text as arising from kapha.
varuNakAdi gaNa (varunakadi gana)
The medicinal group beginning with varunaka.
ajAsarpiH (aja-sarpis)
Goat's ghee, a reading absent from some textual witnesses.
shukrAshmarI (shukrashmari)
A classical type that the commentary treats by analogy with kapha-type ashmari.
For bringing about the passage or calming of sharkara, the text instructs drinking water mixed with jaggery and the powdered fruits of picuka, ankola, kataka, shaka, and indivara.
The commentary presents this formula either for expelling sharkara or for pacifying it. Picuka is identified as karira fruit, though some identify it as cotton fruit. Indivara is described as the large-flowered, ear-ornament plant that is a variety of sharavalika; others call it blue lotus, but Gayi rejects that identification. Ankola is ankota, while kataka and shaka were explained earlier. The jaggery is said to equal the powder in quantity, based on a general formulation rule, and the preparation is historically directed to be taken with warm water.
Key terms
sharkarA (sharkara)
A gravel-like or smaller urinary concretion distinguished in this chapter from ashmari.
picuka
Identified as karira fruit, with cotton fruit preserved as an alternative.
indIvara (indivara)
A disputed plant identification; the commentary rejects the alternative of blue lotus.
guDa (guda)
Jaggery combined with the powdered ingredients in the historical formula.
Adhikarana ७ (१८) · Śloka १९
क्रौञ्चोष्ट्ररासभास्थीनि श्वदंष्ट्रा तालमूलिका |
अजमोदा कदम्बस्य मूलं नागरमेव च ||१८||
पीतानि शर्करां भिन्द्युः सुरयोष्णोदकेन वा |१९|
Meaning of the śloka
The text lists bones of the krauncha bird, camel, and donkey together with shvadamshtra, talamulika, ajamoda, kadamba root, and nagara. Taken with sura or warm water, these substances are claimed to break down sharkara.
The commentary identifies krauncha as the krauncha bird. It identifies talamulika as mushali, whose root is described as resembling a mouse's tail. It does not further explain the animal-bone preparation or the claimed action.
Key terms
krau~jca (krauncha)
A bird whose bone is included in the historical formula.
tAlamUlikA (talamulika)
Identified by the commentary as mushali with a mouse-tail-like root.
sharkarA (sharkara)
The urinary gravel or smaller concretion the formula is claimed to break down.
surA (sura)
A fermented drink named as one of the historical vehicles.
The powder of trikantaka seeds, combined with honey, is historically directed to be taken with sheep's milk for seven days and is described as breaking down ashmari.
The commentary identifies trikantaka as gokshuraka. It preserves an alternative reading, 'seeds of markataka,' but says that the intended meaning remains the same. It distinguishes the claimed outcomes: this formula is said to break ashmari, whereas sharkara is said to become pacified.
Key terms
trikaNTaka (trikantaka)
Identified in the commentary as gokshuraka.
markaTaka (markataka)
An alternative textual reading that the commentator understands as referring to the same substance.
mAkShika (makshika)
Honey used with the seed powder.
avikShIra (avi-kshira)
Sheep's milk, named as the historical vehicle.
ashmarIbhedana (ashmari-bhedana)
The claimed breaking action on ashmari in the source.
The text describes an alkali prepared from the substances previously prescribed for medicated ghee. Their ash-derived liquid is filtered with sheep urine, combined with alkalis from the dung of domesticated animals, and cooked slowly. Ushaka and related substances, together with trikatu, are added during preparation. The resulting alkali is traditionally said to break down ashmari, gulma, and sharkara.
The commentary understands the earlier ghee substances to include the groups prescribed for all three doshas, selected according to availability. Their portions are converted to alkali by burning sesame stalks and similar material. This is combined with equal portions of alkali made from the dung of domesticated animals such as horses and filtered with six times its quantity of sheep urine. When the alkaline liquid reaches the proper stage of cooking, a mixture containing equal portions of ushaka and trikatu is added in the amount of one quarter. The transmitted commentary closes after verses 20-21 and does not separately explain the therapeutic claim in verse 22.
Key terms
kShAra (kshara)
A strongly alkaline preparation produced from burned substances in the historical formulation.
avimUtra (avi-mutra)
Sheep urine used as the filtering liquid in this preparation.
trikaTuka (trikatu)
The three-pungent group added to the alkaline preparation.
ashmarI (ashmari)
The classical urinary stone disorder addressed in the chapter.
sharkarA (sharkara)
A gravel-like or granular urinary concretion in this context.
The text prescribes an alkali derived from preparations of sesame, apamarga, kadali, palasha, and barley, taken with sheep urine. It praises this as especially effective for destroying sharkara.
The commentary says that alkali is prepared separately from each of sesame and the other named plants. It then gives two closely related descriptions: an equal amount is taken with two pala of sheep urine, or two or three karsha of the plant alkali is repeatedly filtered and purified with six times as much sheep urine before being taken. The exact relation between these alternatives is compressed in the source and requires textual review.
Key terms
tila
Sesame, one of the plants used to produce alkali.
apAmArga (apamarga)
A plant named as a source of the alkali.
palAsha (palasha)
A tree named among the sources of alkali.
yava
Barley, included among the alkali-producing substances.
sharkarA (sharkara)
A granular urinary concretion that the preparation is claimed to remove.
Adhikarana ११ (२३) · Śloka २३
पाटलाकरवीराणां क्षारमेवं समाचरेत् ||२३||
Meaning of the śloka
The text says that alkali preparations from patala and karavira should be made in the same manner.
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पाटलेत्यादि| एते च वातकफसम्भूतायामश्मर्यां मधुरक्षीरघृताशिनः क्षारयोगा योज्याः||२३||
Meaning of the commentary
The commentary groups these with the preceding alkaline preparations and says they are to be used when ashmari is understood to arise from vata and kapha. During their use, the person is described as taking sweet substances, milk, and ghee. This is a historical treatment classification rather than a modern diagnostic rule.
Key terms
pATalA (patala)
A named plant from which alkali is to be prepared.
karavIra (karavira)
A toxic plant named as another source of alkali.
kShArayoga (kshara-yoga)
An alkaline medicinal preparation in the historical system.
vAtakapha (vata-kapha)
The dosha combination by which the commentary classifies the indicated ashmari.
ashmarI (ashmari)
The classical urinary stone disorder addressed by the formulation.
The commentary identifies yashtika as yashtimadhu and brahmi here as lavanika. It adds that the vehicle for drinking this paste is sheep urine, continuing the vehicle specified in the preceding context.
Key terms
shvadaMShTrA (shvadamshtra)
A named medicinal plant in the paste.
yaShTikA (yashtika)
Identified by the commentary as yashtimadhu.
brAhmI (brahmi)
Identified specifically as lavanika in this commentary.
kalka
A paste of the named substances.
akSha (aksha)
The classical measure assigned to the paste.
Adhikarana १३ (२४) · Śloka २४
सहैडकाख्यौ पेयौ वा शोभाञ्जनकमार्कवौ ||२४||
Meaning of the śloka
The text gives another alternative: shobhanjana and markava are to be taken together with the substance called edaka.
The commentary explains that shobhanjana and markava are to be drunk together with the substance called eda, again using sheep urine as the vehicle. It identifies markava as bhringaraja. The precise identity of edaka or eda is not explained in the supplied commentary and should remain uncertain.
Key terms
eDAkhya (edakhya)
A named substance combined with the two plants; its precise identity is not supplied here.
shobhA~jjana (shobhanjana)
One of the plants prescribed in the combination.
mArkava (markava)
Identified by the commentary as bhringaraja.
bhRu~ggarAja (bhringaraja)
The commentary's identification of markava.
avimUtra (avi-mutra)
Sheep urine, supplied by the commentary as the vehicle.
Adhikarana १४ (२५) · Śloka २५
कपोतवङ्कामूलं वा पिबेदम्लैः सुरादिभिः |
तत्सिद्धं वा पिबेत् क्षीरं वेदनाभिरुपद्रुतः ||२५||
Meaning of the śloka
The root of kapotavanka may be taken with sour liquids such as fermented preparations. Alternatively, a person afflicted by pain may drink milk processed with that root.
The commentary treats kapotavanka as a recognized plant. It explains the sour liquids as including kanjika and names sura, sauvira, maireyaka, and medaka among the fermented vehicles. For the alternative, it clarifies that the milk is processed with kapotavanka and refers to the general rule beginning with milk in eight times the quantity of the medicinal substance. The supplied passage does not explain the plant's identity beyond its name.
Key terms
kapotava~gkA (kapotavanka)
The named plant whose root is used in the historical preparation.
kA~jjika (kanjika)
A sour fermented liquid cited as a vehicle.
surA (sura)
A fermented alcoholic preparation included among the possible vehicles.
kShIra (kshira)
Milk processed with the named root as an alternative preparation.
vedanA (vedana)
Pain afflicting the person for whom the milk preparation is mentioned.
Adhikarana १५ (२६) · Śloka २६
हरीतक्यादिसिद्धं वा वर्षाभूसिद्धमेव वा |२६|
Meaning of the śloka
Alternatively, milk processed with haritaki and the associated group, or milk processed with varshabhu, may be used.
The commentary identifies the haritaki group as triphala. Milk processed with triphala is assigned to pain associated with pittaja ashmari, while milk processed with the root of punarnava is assigned when pain accompanies ashmari attributed to vata and kapha. Thus it identifies varshabhu in this context with punarnava and differentiates the two preparations according to the classical dosha classification.
Key terms
harItakyAdi (haritakyadi)
Haritaki and its associated group, identified here as triphala.
triphalA (triphala)
The three-fruit group used to process milk in the pittaja classification.
varShAbhU (varshabhu)
Identified in this context with punarnava.
punarnavA (punarnava)
The plant whose root is used to process milk for the vata-kapha classification.
pittajAshmarI (pittaja ashmari)
Ashmari classified as arising from pitta in the commentary.
Adhikarana १६ (२६) · Śloka २६
सर्वथैवोपयोज्यः स्याद्गणो वीरतरादिकः ||२६||
Meaning of the śloka
The text says that the Virataradi group should be employed in every appropriate manner.
Introducing preparations not stated individually in the verse, the commentary explains 'in every manner' broadly. The Virataradi group may be incorporated into ghee, milk, decoction, gruel, and food, and may also be used in forms such as immersion bathing and fomentation. The text names categories of use rather than giving complete procedures here.
Key terms
vIratarAdigaNa (Virataradi-gana)
The classical group of substances recommended throughout this passage's treatment context.
kaShAya (kashaya)
A decoction listed as one possible form of use.
yavAgU (yavagu)
A medicinal gruel listed as a form of preparation.
avagAha (avagaha)
Immersion or sitz-bath application mentioned by the commentary.
sveda
Fomentation or induced warming mentioned as an external mode of use.
If relief is not obtained through ghee preparations, kshara, decoctions, milk preparations, and uttara-basti therapies, the subsequent method is surgical cutting.
The commentary says that this verse introduces cutting when the preceding measures have failed. Here uttara-basti means both evacuative and unctuous bladder-directed preparations processed with substances traditionally regarded as removing ashmari. It explains uttara vidhi, the subsequent method, as cheda, surgical cutting.
Key terms
ashmarI (ashmari)
The stone-like urinary disorder treated in this chapter.
kShAra (kshara)
An alkaline preparation included among the preceding treatments.
uttarabasti (uttara-basti)
A historical bladder- or urinary-tract-directed therapeutic administration.
ccheda (cheda)
Surgical cutting, presented as the later method after other measures fail.
The commentary glosses adhruva as uncertain. It also preserves another reading, nishcitasyapi vaidyasya. Under that reading, nishcita describes a physician who performs an action determined and authorized by the shastra, that is, one whose operative action is grounded in the text. The two readings should remain distinct.
Key terms
kushala vaidya
A physician skilled in the procedure.
siddhi
Successful outcome of the treatment.
adhruva
Uncertain or not assured.
jaghanya upakrama
The least desirable or last-ranked therapeutic measure.
nishcita (nishchita)
In the alternative reading, one who performs an action determined by the shastra.
Without intervention, death is said to be certain; with intervention, the outcome remains uncertain. Therefore, one who wishes to act properly should perform it only after seeking permission from the ishvara, the person in authority.
The commentary raises the objection that the operation may injure vital structures, cause extreme suffering, or cause death, and asks why it should be undertaken. The verse answers that death is otherwise regarded as certain, while treatment at least leaves an uncertain possibility. The commentary adds that if the operation were done without first asking the person in authority and the patient died, the physician could be punished.
Key terms
akriyA (akriya)
Non-performance of the intervention.
saMshaya (samshaya)
Uncertainty regarding the outcome when treatment is attempted.
marmopaghAta (marmopaghata)
Injury to a vital structure, cited as a danger of the operation.
Ishvara (ishvara)
The person in authority whose permission is to be sought in this context.
The passage gives an extended historical account of cutting for ashmari: preparation and positioning of the patient, manipulation intended to bring the stone into reach, signs in which extraction should be abandoned because death is feared, removal through an incision while protecting nearby structures, and postoperative care. It stresses removing the stone whole because retained fragments are said to enlarge again. It distinguishes anatomical risks in women and men, describes measures for bleeding, wound care, and failure of urine to follow its proper path, and mentions further cutting when an obstruction cannot otherwise be removed. After healing, it prescribes prolonged restrictions. It closes by naming eight structures to avoid and the grave consequences attributed to their injury, including death, loss of sexual function, persistent urine leakage, pain, and the previously described signs of bladder or rectal injury.
The commentary presents this as the same surgical cutting together with its preparatory and postoperative measures. It explains that insufficient reduction does not bring the stone within reach, whereas excessive depletion leaves the patient unable to withstand the operation. It defines several positioning and manipulation terms and preserves the variant opening reading 'for one seeking health.' Fixed or open eyes, loss of consciousness, a hanging head, and a motionless, death-like state are explained as signs for not proceeding; variant readings nirvyapara and nirvihara are said to convey the same lack of activity. The curved-ended extractor is understood as blunt rather than sharp. The commentary then explains a special concern in women because another receptacle identified as the garbhashaya lies close to the bladder, and quotes Vaitarana in support of a different direction of incision; it interprets injury to the urinary outlet in either sex as producing a urine-leaking wound. It states that a bladder opened in two places does not recover and explains why a single opening associated with the stone is considered survivable. Two textual interpretations are retained: one attributes this to practiced postoperative measures, the prescribed incision, and the stone enlarged by urinary flow; Gayi omits 'of the foreign body' and understands enlargement of the urinary flow itself, connecting this with foods intended to increase urine. Subsequent terms are explained as warm-water immersion, administration through a pushpanetra, wound coating, morning and evening gruel, careful fomentation, plant decoctions, pastes, oils or ghee, and uttara-basti for congealed blood. For urine not returning to its path, the text's cautery is explained; when the path is restored, sweet and astringent preparations are discussed, with an alternative interpretation that these are decoctions of sweet substances. A stone or gravel lodged in the urinary passage is to be removed through that channel if possible; the source then describes incision and hook extraction if this is impossible. Finally, the commentary glosses the consequences of injury and refers back to earlier descriptions of vital structures.
Key terms
ashmarI (ashmari)
The stone-like urinary obstruction targeted by the operation.
sevanI (sevani)
A midline perineal structure that the passage repeatedly warns the operator to avoid.
basti
The urinary bladder in this operative context.
agravakra
A curved-ended, blunt extraction instrument described for removing the stone whole.
puShpanetra (pushpanetra)
An instrument through which a preparation is historically described as being administered.
mUtrapraseka (mutrapraseka)
The urinary outlet or channel whose injury is said to cause continuous leakage.
uttarabasti (uttara-basti)
A historical urinary-tract-directed administration mentioned in postoperative care.
garbhAshaya (garbhashaya)
A female internal receptacle described by the commentary as lying near the bladder.
A physician who is unskilled in operative work and does not understand the eight vital, channel-derived structures of the body may cause the deaths of many people.
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अतः परं सङ्ग्रहश्लोकमाह- भवत इत्यादि||३७||
Meaning of the commentary
The commentary identifies this as a summarizing verse of the preceding surgical warning and adds no further interpretation.
Key terms
marman
A vital structure whose injury is considered especially dangerous.
srotoja
Arising from or belonging to bodily channels.
shastrakarma (shastra-karma)
Operative work performed with surgical instruments.
The eight structures are listed as the sevani, the two channels carrying shukra, the guda between the two phala, the urinary outlet, the urine-carrying channel, the yoni, and, as the eighth, the basti.
The commentary says that the verse names these same vital structures so they can be understood easily. A physician experienced in the operation and properly trained should perform it while avoiding all of them; in this way, the action is said to be properly done.
Key terms
sevanI (sevani)
A protected perineal midline structure in the operative account.
shukraharaNI srotasI (shukra-harani srotasi)
The paired channels said to carry shukra.
phala
A paired anatomical structure between which the guda is located in this list.
mUtraseka (mutraseka)
The urinary outlet or passage.
mUtravaha (mutravaha)
The urine-carrying channel.
yoni
A female reproductive or genital passage named among the protected structures.
basti
The urinary bladder, counted as the eighth protected structure.
Adhikarana पुष्पिका · Śloka ७
इति सुश्रुतसंहितायां चिकित्सास्थानेऽश्मरीचिकित्सितं नाम सप्तमोऽध्यायः ||७||
Meaning of the śloka
Thus ends the seventh chapter, entitled Treatment of Ashmari, in the Cikitsasthana of the Sushruta Samhita.