Four kinds of aśmarī are described: those associated with kapha, vāta, pitta, and śukra. The text states that they have kapha as their underlying material basis.
The commentary qualifies the statement about kapha. It says only the first three stones are based in kapha, while śukrāśmarī is based in śukra. Other authorities hold that even śukrāśmarī has kapha as its basis because śukra is described as saumya, having a cooling and watery nature. 'Based in kapha' is explained as arising by taking kapha as the material cause. The final list expands the initial statement that there are four kinds.
Key terms
shleShmAdhiShThAna (śleṣmādhiṣṭhāna)
Having kapha as the supporting or material basis.
shukrAshmarI (śukrāśmarī)
The stone category associated with retained or altered śukra.
upAdAnakAraNa (upādāna-kāraṇa)
The material cause from which something is said to form.
saumya
Having a cooling or watery nature associated with soma.
In a person who does not regularly undergo purification and follows an unsuitable regimen, aggravated kapha is said to mix with urine, enter the bladder, and form a stone.
Prodromal features of aśmarī include fever, pain in the bladder, loss of appetite, difficult urination, pain at the upper bladder, testicles, and penis, painful bodily weakness, and urine with an odor compared to that of a goat. Before the stone is fully manifest, the person passes urine only with difficulty; its pain and color vary with the responsible doṣa, and the urine is abnormal, thick, and turbid.
The commentary identifies the bladder's head as its upper part, muṣka as the testicle, and śepha as the male organ. Kṛcchrāvasāda is bodily exhaustion accompanied by distress. The unusual odor is specified as like that of a large male goat. 'According to its own' means that the pain and urine color follow the particular doṣa without departing from its pattern. The urine is disturbed by vāta and the other doṣas, and āvila means cloudy or turbid. Aśman in the verse refers to aśmarī.
Key terms
pUrvarUpa (pūrvarūpa)
A prodromal sign before a disease is fully manifest.
mUtrakRucchra (mūtra-kṛcchra)
Difficulty or pain in passing urine.
bastishiras (basti-śiras)
The upper portion of the urinary bladder according to the commentary.
Once any type of aśmarī has formed, urination causes pain at one or more of the navel, bladder, perineal seam, or penis. The urine stream may be obstructed or scattered, blood may appear in the urine, and the urine may be very turbid, yellow like the gomedaka gem, and contain sand-like particles. Running, jumping, swimming, riding, walking in heat, and long travel provoke pain.
The commentary presents these as general features shared by all stone types. Saṅga means obstruction of the urine stream, and vikiraṇa means its scattering or going in different directions. Gomedaka is identified as a yellow gem, and sasikata means urine accompanied by sand-like grains. Jumping includes leaping across ditches, swimming means crossing water, heat-travel means going in hot conditions, and road-travel means a long journey.
In the kapha-associated type, consumption of kapha-promoting food is said to cause material to coat and accumulate below, enlarge, lodge at the bladder outlet, and block the urinary passage. From urinary obstruction, the bladder feels as though it is being split, torn, or pierced, and it feels heavy and cold. The stone is described as white, smooth, and large, resembling a hen's egg or having the color of a madhūka flower. This is identified as ślaiṣmika aśmarī.
The commentary says the kapha stone blocks the channel in a person eating kapha-promoting food. Coating is compared with mud adhering to a new pot. The stone grows below and takes its seat at the bladder outlet. The pain terms convey sensations as if the bladder were crumbling, being torn apart, or pricked by needles.
Key terms
shleShmAshmarI (śleṣmāśmarī)
The kapha-associated stone category.
bastimukha (basti-mukha)
The outlet or mouth of the urinary bladder.
srotonirodha (sroto-nirodha)
Obstruction of a bodily passage, here the urinary route.
In the pitta-associated type, kapha combined with pitta is said to consolidate, enlarge as previously described, lodge at the bladder outlet, and obstruct the urinary channel. Because urine is retained, the bladder feels heated, drawn or sucked, burned, or cooked, and uṣṇavāta is said to occur. The stone may be slightly red, yellowish, black, shaped like a bhallātaka seed, or honey-colored. This is identified as paittika aśmarī.
The commentary makes kapha joined with pitta the subject that hardens and blocks the passage. The successive pain descriptions are explained as sensations like heat from a nearby fire, drawing or suction, burning like a local flame, and being cooked as by alkali; some explain the last as boiling. Uṣṇavāta is identified as a urinary disorder discussed in Uttartantra. Sarakta means slightly red.
Key terms
pittAshmarI (pittāśmarī)
The pitta-associated stone category.
sa~gghAta (saṅghāta)
Consolidation or hardening into a compact mass.
mUtrapratIghAta (mūtra-pratīghāta)
Obstruction or retention of urine.
uShNavAta (uṣṇavāta)
A classical urinary disorder associated here with heat and obstruction.
Kapha joined with vāta is said to consolidate, grow as previously described, lodge at the outlet of the bladder, and obstruct the urinary passage. Urinary blockage then causes severe pain. In extreme distress, the person clenches or grinds the teeth, presses the navel, rubs the penis, touches the anus, passes noisy flatus, and experiences burning; flatus, urine, and stool are expelled only with difficulty during urination. The stone is described as dark, rough, irregular, hard, and covered with thorn-like projections resembling a kadamba flower; this is identified as a vāta-type stone.
The commentary carries forward the previously stated formation process. ‘Biting the teeth’ means pressing or grinding them together. Viśardhate means making an unpleasant sound through the anus. Some instead read vivardhate and explain that the penis enlarges because of rubbing. Vidahati means that the penis has a burning sensation; mehataḥ means while passing urine. Khara means hard.
Key terms
vAtikI ashmarI (vātikī aśmarī)
A urinary stone classified as vāta-predominant.
bastimukha (basti-mukha)
The outlet or mouth of the bladder.
mUtrapratIghAta (mūtra-pratīghāta)
Obstruction or suppression of urine flow.
vishardhate (viśardhate)
Makes a sound through the anus; a variant vivardhate is explained as penile enlargement.
The first three kinds of stone are said to occur especially in children because of fondness for daytime sleep, mixed or repeated eating, and cold, unctuous, heavy, and sweet foods. Because children have smaller bodies and bladders whose muscular tissue is not fully developed, the stones are described as easier to grasp and remove. In adults, a semen-origin stone may arise from causes involving semen.
The commentary connects the first three stone types mainly with children and the listed habits, while ‘generally’ also allows their occurrence in young people. The smallness of the bladder is interpreted in length, while undeveloped bladder tissue indicates reduced circumference. These features are offered as the reason stones are easier to grasp and extract in children.
Key terms
ashmarI (aśmarī)
A stone or calculus, principally urinary in this chapter.
samashana (samaśana)
Eating mixed combinations characterized elsewhere as wholesome and unwholesome together.
adhyashana (adhyāśana)
Eating again before the preceding meal has digested.
shukrAshmarI (śukrāśmarī)
A stone classified as arising in relation to semen.
From interruption of sexual activity or excessive sexual activity, semen that has moved but does not emerge is said to be diverted. Vāyu gathers it from above and below and forms it into a rounded mass between the penis and testicles, below the bladder outlet, then dries it. This mass obstructs the urinary passage and causes painful urination, bladder pain, and swelling of the testicles and also the groin. When pressure is applied to that region, the small stone or the swelling is said to disappear temporarily. This is called śukrāśmarī.
The commentary presents the cause, pathogenesis, and signs of semen-origin stone. Maithuna-vighāta means interruption of semen’s function during intercourse. Some read amaithuna, absence of intercourse, and explain abundance of semen as causing its movement. Anirgacchat, ‘not emerging’, qualifies semen; another reading, anirgacchan, qualifies vāyu. Vāyu is said to hold the diverted material from both above and below and round it below the bladder outlet between penis and testicles. Testicular swelling distinguishes this from doṣa-origin stones; the groin may also swell. One explanation says the small stone itself disappears into the area when pressed, while another says the swelling caused by the stone subsides.
Key terms
shukrAshmarI (śukrāśmarī)
A classical stone-like condition attributed to retained or diverted semen.
maithunavighAta (maithuna-vighāta)
Interruption of sexual activity or semen release; a variant reads amaithuna, absence of intercourse.
vimArgagamana (vimārga-gamana)
Movement along an improper or diverted pathway.
mUtrakRucchra (mūtra-kṛcchra)
Painful or difficult urination.
pravilaya
Temporary disappearance, interpreted as either the small mass receding or its swelling subsiding.
The commentary identifies bhasmākhya as a urinary disease also called mūtra-śukra in the Uttara-tantra. Aśmarī-vaikṛta means disorders or complications arising from stone disease.
Key terms
sharkarA (śarkarā)
Gravel-like fragmented stone material described as an aśmarī complication.
sikatA (sikatā)
Sand-like urinary material or a related classical condition.
bhasmAkhya (bhasmākhya)
A named urinary disorder identified with mūtra-śukra in a later section.
ashmarIvaikRuta (aśmarī-vaikṛta)
A complication or altered manifestation of urinary stone disease.
Śarkarā is understood as fragmented aśmarī and has similar signs and pain. When the fragment is small and vāyu moves favourably, it passes out. Because it is a stone whose form has been broken apart by vāta, it is called śarkarā.
The commentary says śarkarā should be recognized by signs and pain like those of aśmarī. When the stone is small and vāta is favourable to its movement, it exits the body.
Key terms
sharkarA (śarkarā)
A small, broken stone fragment or gravel-like calculus.
tulyavya~jjanavedanA (tulya-vyañjana-vedanā)
Having signs and pain similar to aśmarī.
bhinnamUrti (bhinna-mūrti)
Having a broken or fragmented form.
anuguNa pavana (anuguṇa pavana)
Vāta moving in a direction favourable to expulsion.
हृत्पीडा सक्थिसदनं कुक्षिशूलं च वेपथुः |
तृष्णोर्ध्वगोऽनिलः कार्ष्ण्यं दौर्बल्यं पाण्डुगात्रता ||१५||
अरोचकाविपाकौ तु शर्करार्ते भवन्ति च |१६|
Meaning of the śloka
A person afflicted by śarkarā may have pain in the heart or chest region, weakness of the thighs, abdominal or flank pain, tremor, thirst, upward-moving vāyu, darkening of complexion, weakness, pallor of the body, loss of appetite, and indigestion.
When an ashmari enters the urinary passage but remains lodged and does not come out, it is said to produce complications including weakness, bodily exhaustion, emaciation, pain in the abdomen or flank, loss of appetite, pallor, ushnavata, thirst, distress in the heart or chest region, and vomiting.
The commentary identifies the subject as an ashmari that has entered the urinary tract. Sakta means lodged and not expelled. Daurbalya is loss of strength, sadana is weariness of the limbs, and karshya is loss of flesh. Another reading gives sphutanika in place of sadana.
Key terms
ashmarI (ashmari)
A stone-like urinary concretion in this chapter.
saktA (sakta)
Lodged and not expelled.
sadana
Weariness or loss of strength in the limbs.
kArshya (karshya)
Emaciation or loss of flesh.
uShNavAta (ushnavata)
A named symptom or disorder term left untranslated because its precise contextual sense is uncertain.
The basti is described as a thin-walled, downward-facing organ with one opening, situated among the navel, back, waist, testes, rectum, groins, and penis. The basti, its head, the male organ, testes, and rectum are presented as mutually connected and supported in the pelvic bony space. Shaped like a gourd and held by siras and snayus, the urinary reservoir is called a receptacle of waste and an important seat of life. Urine-bearing nadis associated with the pakvashaya are said to supply it continuously, like rivers filling the sea. Their thousands of minute openings cannot be seen. Through these nadis, urine is conveyed from within the amashaya and pakvashaya, and the basti fills by oozing whether one is awake or asleep, like a new pot placed mouth-down in water filling through its sides.
The commentary explains the location, shape, and opening of the basti as the receptacle of ashmari. 'One opening' and 'downward-facing' imply no upper opening; its wall is delicate and its shape resembles a gourd. The nearby structures are then listed, with paurusha explained as the penis. Maladhara is a synonym for the urinary reservoir, and pranayatana means a seat of life-associated principles such as agni and soma. Two root urine-bearing dhamanis are said to divide into tens, hundreds, and thousands of branches whose openings are too subtle to perceive. The same siras and snayus surrounding the basti are described as filling it with urine conveyed from the amashaya-pakvashaya region by nishyanda, a process of oozing or permeation. The inverted-pot analogy explains how a downward-facing organ without an upper opening is understood to fill from its sides. The commentary ending is marked incomplete after verses 18-23 even though the source includes the line numbered 24.
Key terms
basti
The urinary reservoir or bladder in this classical anatomical description.
mUtrAshaya (mutrashaya)
Repository of urine, used as a synonym for basti.
sirAsnAyuparigraha (sirasnayuparigraha)
Supported or enclosed by siras and snayus.
mUtravaha nADI (mutravaha nadi)
A channel described as carrying urine to the basti.
niHsyanda (nihsyanda)
Oozing, permeation, or gradual inflow.
prANAyatana (pranayatana)
An important seat of life in the classical account.
The commentary says that vata and the other doshas enter in a way comparable to the previously described entry of urine. Upasneha is explained as moistening from nearby or through proximity. The commentary's ending is marked incomplete.
Key terms
ashmarI (ashmari)
A urinary concretion explained here through a classical dosha model.
mUtrayukta (mutrayukta)
Joined or associated with urine.
upasneha
Moistening from proximity or adjacent permeation.
pravesha
Entry by the process compared with the preceding account.
Just as sediment develops over time even in clear water placed in a new pot, the text says that ashmari develops similarly. As atmospheric water is condensed into hail by wind and lightning-fire, so heat together with anila is said to harden the balasa situated in the basti.
The commentary answers how substances described as fluid, and vayu as without tangible form, can produce something solid. Water placed in a vessel forms sediment over time. To explain how sediment can become stone-like, it gives the analogy of cloud-born water being hardened into hail by wind and lightning-fire. Likewise, balasa, identified as shleshma in the basti, is said to be hardened by ushman, interpreted as pitta, acting together with vata.
Key terms
pa~gka (panka)
Sediment or deposit used in the analogy for gradual formation.
balAsa (balasa)
Identified by the commentary as shleshma in the basti.
मारुते प्रगुणे बस्तौ मूत्रं सम्यक् प्रवर्तते |
विकारा विविधाश्चापि प्रतिलोमे भवन्ति हि ||२७||
मूत्राघाताः प्रमेहाश्च शुक्रदोषास्तथैव च |
मूत्रदोषाश्च ये केचिद्वस्तावेव भवन्ति हि ||२८||
Meaning of the śloka
When maruta functions favorably in the basti, urine flows properly. When its movement is contrary or impaired, various disorders arise. The text groups urinary obstruction, prameha, disorders of shukra, and other urinary disorders as conditions occurring in the basti.
The commentary presents vayu as the cause of other disorders located in the basti. Praguna means favorable or functioning properly; some read anuguna, with the same meaning. Pratiloma is explained as disordered or unfavorable. The conditions listed are examples of disorders occurring when vata in the basti is impaired.
Key terms
praguNa (praguna)
Favorable or functioning properly; anuguna is a variant with the same sense.
pratiloma
Contrary, disordered, or functioning unfavorably.
mUtrAghAta (mutraghata)
A classical category of urinary obstruction or retention.
prameha
A broad classical category of disorders involving abnormal urination.
shukradoSha (shukradosha)
A classical category of disorder affecting shukra.
The commentary colophon states that the third chapter of the Nidanasthana is complete in Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.
Key terms
ashmarInidAna (Ashmarinidana)
The chapter on causes and diagnostic description of ashmari.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.