The commentary says that after the chapter on arocaka, mūtrāghāta is begun by elimination, since mūtrāghāta and mūtrakṛcchra are treated as one and no further chapter remains in Kāyacikitsā. Mūtrāghāta is obstruction of urine; some say āghāta means spoiling, not obstruction, since obstruction is not possible in the conditions mūtraśukra and mūtrasāda.
वातकुण्डलिकाऽष्ठीला वातबस्तिस्तथैव च |
मूत्रातीतः सजठरो मूत्रोत्सङ्गः क्षयस्तथा ||३||
मूत्रग्रन्थिर्मूत्रशुक्रमुष्णवातस्तथैव च |
मूत्रौकसादौ द्वौ चापि रोगा द्वादश कीर्तिताः ||४||
Meaning of the śloka
Vātakuṇḍalikā, aṣṭhīlā, vātabasti, mūtrātīta, mūtrajaṭhara, mūtrotsaṅga, mūtrakṣaya, mūtragranthi, mūtraśukra, uṣṇavāta, and the two mūtraukasāda: twelve diseases are described.
The commentary says the names are given for ease of understanding. Aṣṭhīlā here means vātāṣṭhīlā; the vātāṣṭhīlā described in the context of causes is a different one, since it lacks distension and the like. The number 'twelve' is stated to prevent counting the greater numbers given in other tantras.
From dryness or suppression of urge, vāta lodges inside, seizes the urine and moves about with it, deranged and coiled; it passes urine little by little or slowly with pain: that is to be known as the very severe vātakuṇḍalikā.
The commentary gives the cause, pathogenesis and signs. 'Lodged inside' means in the middle of the bladder; 'moves about' means circulates; 'coiled' means round like a ring. The urine is painful. The first line gives distant and near causes; 'vāta lodged...' the pathogenesis; 'coiled' the sign. Some read 'the urine is passed little or with pain'. Vāta is mostly the cause of all mūtrāghātas.
Vāta lodged between the stool-passage and the bladder produces a hard, immovable, raised knot like an aṣṭhīlā stone; there is retention of stool, urine and wind, distension in the bladder region, and great pain in the bladder: that they know as vātāṣṭhīlā.
The commentary explains: the stool passage is the anus; the bladder is the urine reservoir; the vāyu here is apāna, which causes disorders of anus and bladder; 'between' means in the middle. Aṣṭhīlā is a long, round stone in the north, or a leather-worker's iron pot per others. 'Immovable' means slightly mobile. The distension is in the bladder region.
Key terms
vātāṣṭhīlā
A hard, stone-like swelling from vāta between anus and bladder.
When an unskilled man holds back the urge to urinate, the vāta in the bladder blocks the bladder's mouth; from that, retention of urine occurs, with the bladder and abdomen pressed and pained: know it as vātabasti, a disorder that is difficult to treat.
The commentary gives cause, pathogenesis and signs of vātabasti. 'Unskilled' means foolish; 'retention of urine' is non-passage; the pain is in the bladder and abdomen. 'Difficult to treat' means curable with difficulty.
Key terms
vātabasti
Bladder disorder from vāta blocking the bladder mouth.
वेगं सन्धार्य मूत्रस्य यो भूयः स्रष्टुमिच्छति |
तस्य नाभ्येति यदि वा कथञ्चित्सम्प्रवर्तते ||११||
प्रवाहतो मन्दरुजमल्पमल्पं पुनः पुनः |
मूत्रातीतं तु तं विद्यान्मूत्रवेगविघातजम् ||१२||
Meaning of the śloka
One who, having held back the urge to urinate, later wishes to pass it, and the urine does not come, or comes with difficulty by straining, with mild pain, little by little, again and again: know it as mūtrātīta, arising from suppression of the urine urge.
The commentary gives cause, pathogenesis and signs of mūtrātīta. 'By straining' means by forcing out; the disease is stated again as arising from suppression to show it is vātaja arising from suppression. The cause is the suppression; the pathogenesis begins with 'later wishes to pass it'; the rest are signs.
Key terms
mūtrātīta
Urine that has passed the proper time: retention after suppression.
When the urge to urinate is obstructed, through the cause of that udāvarta, the aggravated apāna vāyu fills the abdomen greatly, produces distension below the navel with severe pain: know it as mūtrajaṭhara, which blocks the lower channels.
The commentary gives cause, pathogenesis and signs of mūtrajaṭhara. 'That udāvarta' means urinary udāvarta itself as the cause. The aggravated apāna fills the abdomen and produces distension with severe pain below the navel; it obstructs the channels of urine and stool. Some read 'adhobastinirodhajam'. Those who read 'the aggravated apāna...' as the definition itself place the earlier line among the mūtrātīta lines; the commentary finds this unsatisfying to the learned, since the cause of aggravation would then be unstated.
बस्तौ वाऽप्यथवा नाले मणौ वा यस्य देहिनः |
मूत्रं प्रवृत्तं सज्जेत सरक्तं वा प्रवाहतः ||१५||
स्रवेच्छनैरल्पमल्पं सरुजं वाऽथ नीरुजम् |
विगुणानिलजो व्याधिः स मूत्रोत्सङ्गसञ्ज्ञितः ||१६||
Meaning of the śloka
When, in a person, urine that has started gets stuck at the bladder, the tube (nāla) or the glans, and comes out slowly with straining, little by little, with blood or with pain or without pain: that disorder arising from deranged vāta is called mūtrotsaṅga.
The commentary gives cause, pathogenesis and signs. Nāla is the urinary channel of the penis; maṇi is the tip of the penis; although 'tube' already includes the tip, the tip is named to show extreme obstruction there. Some read 'saṃsaktam' (attached) for 'saraktam' (with blood). 'By straining' means by forcing. 'Painful' from great vāta aggravation; 'painless' from little. 'From deranged vāta' means from vāta gone astray, from blocked path or its own causes; some think blockage of the path is the only cause of straying.
In one who is dry and tired in body, pitta and vāta, lodged in the bladder, cause difficult and burning, painful urination with depletion of urine (mūtrasaṅkṣaya).
The commentary gives cause, pathogenesis and signs of mūtrakṣaya. Dryness and fatigue are not normally causes of pitta aggravation, but they aggravate pitta when it is joined with vāta. 'Difficult' means bringing on trouble; mūtrasaṅkṣaya is a disease from drying up of urine. Some read 'in the bladder, always moving', which the commentary rejects as non-original.
अभ्यन्तरे बस्तिमुखे वृत्तोऽल्पः स्थिर एव च |
वेदनावानति सदा मूत्रमार्गनिरोधनः ||१८||
जायते सहसा यस्य ग्रन्थिरश्मरिलक्षणः |
स मूत्रग्रन्थिरित्येवमुच्यते वेदनादिभिः ||१९||
Meaning of the śloka
When a small, round, firm and always painful knot with the signs of a stone, blocking the urinary path, suddenly forms inside the mouth of the bladder in someone, it is called mūtragranthi by its pains and other features.
The commentary gives the description. 'Inside the bladder mouth' means within the door of the bladder. 'Signs of a stone' attaches to pain: it resembles a stone by its pains, not by its seat and so on; this is the difference between stone and mūtragranthi. In stone there is no relation to blood; in mūtragranthi, another tantra says there is: 'blood spoiled by vāta and kapha at the bladder mouth makes a knot, terrible; with difficulty he passes urine covered by it; this is called mūtragranthi, with pain like stone'. The cause is not stated but is understood to be pitta, by the association with hot-vāta; vāta is not the cause since the disease is described out of order, which is why it follows.
Key terms
mūtragranthi
A knot-like growth at the bladder mouth blocking the urine.
One who, with urine ready to be passed, gives in to sexual intercourse: semen mixed with urine flows out suddenly; either before or after the urine, at times, it is called mūtraśukra, resembling ash-water.
The commentary describes mūtraśukra. 'With urine ready' means when the urge to urinate has arisen. The semen resembles water mixed with ash. Because vāyu is of varied action, this occurs sometimes before and sometimes after the urine. The reader should supply cause, pathogenesis and signs.
From exertion, travelling and heat, pitta reaching the bladder, covered by vāta, burns the bladder, penis and anus, and makes the urine flow downward yellow, or blood-tinged, or pure blood, with difficulty: that they call uṣṇavāta.
The commentary describes uṣṇavāta. 'Covered by vāta' means pitta with vāta; the urine is turmeric-coloured, slightly blood-coloured or purely blood. An objection: from the summary list the next after mūtragranthi and mūtraśukra would be mūtrakṣaya, so why is uṣṇavāta taken out of order? Answer: its causes are the same as those of mūtrakṣaya (vāta and pitta); and uṣṇavāta is placed after mūtrakṣaya in the summary to keep pure pitta in mūtragranthi.
Key terms
uṣṇavāta
A burning urinary disorder from pitta covered by vāta.
Urine that is clear, yellowish, burning, thick, that dries and looks like gorocanā powder: the wise know that as the pitta-caused mūtraukasāda. Urine that is slimy, clotted, white, passing with difficulty, and dries to look like conch powder, pale: know that as the kapha-caused mūtraukasāda, the twelfth disease.
The commentary gives the signs of the two mūtraukasādas. Clear (viśada) is the opposite of slimy; thick means dense; 'dries' means dries in the sun and the like; gorocanā is a yellow cow-derived pigment. The second: slimy is the opposite of clear; clotted is thick; white; 'passes with difficulty' means comes out with distress. 'Twelfth' is repeated so that, since both are called mūtraukasāda, dull minds do not count them as one.
Key terms
mūtraukasāda
Urine with a settled deposit.
gorocanā
A yellow pigment; used as a comparison for colour.
The wise physician should apply decoctions, pastes, ghṛtas, foods, licks, milks, alkalis, wines (āsavas), sweatings, and the bastis called uttara; and the regimen that destroys stones.
The commentary gives the treatment of the urinary obstructions. Kaṣāya is decoction; kalka is a paste ground on a stone, with liquid; bhakṣya includes laddūs; āsava is a kind of madya; sweatings include poultices; uttara-basti is urethral (or genital) enema; by 'ca', snehavirecana too. 'The wise' means one who reasons and weighs. 'The regimen' is that for stones. An objection: as the disorders differ by vāta and the rest, the treatments should differ; why is a general treatment given? Reply: vāta is the cause in all of them; pitta and kapha are only obstructing, so one treatment is stated, to be applied by the physician after assessing the strength of the doṣas, the substance and the disease. Some read a different set of lines here, including one on 'excess of women', which the commentary rejects as not original.
The commentary extends treatment by reference: the yogas stated for mūtrodāvarta, such as 'madirā rich in sauvarcala', are to be applied here, in the stage each suits. Kārttikakuṇḍa is said to have argued at length about 'completely', which is omitted for fear of confusing students and length.
The commentary says ervāru is summer cucumber (grīṣmakarkaṭikā); akṣa measure is a karṣa; dhānyāmla is kāñjika. Some read the verse differently; not shown.
The commentary says surā is flour-made; madhu here is madya, made with honey, as a similar tantra shows: 'let a man drink madya with honey, with meat as accompaniment'. Gauḍika is jaggery liquor.
The roots of the pṛthakparṇyādi group and of gokṣura, cooked with half a prastha of water and four times milk; the milk left, cooled, drunk with sugar and honey, wards off urinary obstruction arising from vāta and pitta.
... or with honey; or the pressed juice of āmalakas, a kuḍava in measure, drunk: the person afflicted with urinary disorder and pain becomes free of disease.
Or the tender root of tāla, ground and drunk with cold water in which śāli rice was washed; or the juice of trapusa (cucumber); or white karkaṭaka; drunk in the morning with milk.
The commentary says tender tāla root is ground and drunk with rice-washing water; or the cucumber juice is drunk; trapusa is cucumber; white karkaṭaka (cucumber) is drunk with milk, as a similar tantra says: 'or cucumber with milk, removing urinary disorder'.
बलाश्वदंष्ट्राक्रौञ्चास्थिकोकिलाक्षकतण्डुलान् |
शतपर्वकमूलं च देवदारु सचित्रकम् ||४४||
अक्षबीजं च सुरया कल्कीकृत्य पिबेन्नरः |
मूत्रदोषविशुद्ध्यर्थं तथैवाश्मरिनाशनम् ||४५||
Meaning of the śloka
Balā, śvadaṃṣṭrā, the seed of krauñca, kokilākṣaka seed, śataparvaka root, devadāru, citraka and akṣa seed, made into a paste with surā, drunk by the man for cleansing urinary disorder, and likewise stone-destroying.
The commentary says balā is well known; śvadaṃṣṭrā is gokṣura; krauñca is a bird, commonly called 'kaicara' (the ingredient is a plant with that name); kokilākṣaka is khaggalī; śataparvaka is water-gaṇḍīra; akṣabīja is bibhītaka kernel. The stone regimen is mentioned repeatedly to stress how beneficial it is. Some, following Bhoja, count the balā and the rest as four yogas; the commentary rejects this as not accepted by elders.
The commentary says the alkali is filtered seven times; the alkali water is made by the rule given in the kṣāra chapter, with four times water; 'a little oil' means a small amount, as in the expression 'a small measure'.
The commentary explains: nala is a hollow-jointed reed; aśmabheda is pāṣāṇabheda; ervāru is summer cucumber; bījaka is asanasāra. Kārttikakuṇḍa reads it as the seeds of trapusa and ervāru alone, quoting Vṛddhakāśyapa, saying that the word 'bījaka' does not go beyond the natural gender and number, so it is masculine.
The wise physician should give the bark powder of ela and uṣaṇa with the alkali water of pāṭalī, yavaśūka, pāribhadra and tila, drunk, or mixed with jaggery and licked, as separate licks, one by one.
The commentary explains: yavaśūka is yavakṣāra; pāribhadra is parvatanimba, though others say a red-flowered thorny tree called phalabhadra; ūṣaṇa is pippalī. The powder of tvac-ela-ūṣaṇa is drunk with the alkali water of pāṭalī and the others, or licks made with the alkali water and jaggery are licked. Kārttikakuṇḍa reads 'tvageloṣaṇasaṃyutam' and explains the powder of pāṭalī to tila with muṣkaka-alkali water, quoting Viśvāmitra. Others read 'madirā' for 'the wise', and 'jaggery as relish', which the commentary calls non-original.
Now I shall tell the beneficial sequence in urinary disorders: for those prepared by oleation and sweating, purgation is beneficial; after which, for those whose bodies are well cleansed, uttarabastis are beneficial.
The commentary gives the general treatment sequence. Some read 'snehavirecana' for 'virecana'. Kārttikakuṇḍa does not read this verse, since it is implied by 'decoctions, pastes, ghṛtas' and the like; Jejjaṭācārya reads it to indicate that the earlier yogas are used in the oleated and cleansed; the commentator follows Jejjaṭa.
In one in whom blood is seen (in the urine) from excessive indulgence with women, abstinence from intercourse and a nourishing regimen are recommended.
The commentary says some state, on the occasion of urinary disorders, a regimen for blood passed by the urinary path. 'Excess indulgence' is over-use; abstinence is stopping intercourse; a nourishing regimen means eating meat, milk, ghṛta and the like. Kārttikakuṇḍa does not read this verse, since it is implied by the signs of semen depletion and to avoid exceeding the count; Jejjaṭa reads it for context and ease of students; the commentator follows Jejjaṭa.
The commentary asks whether this alone is beneficial in blood in the urine or other things too. Tāmracūḍa-vasā is cock's fat; the procedure is in the uttarabasti treatment; some read 'vyāpadaḥ' (complications) for 'vyāsataḥ' (fully).
क्षौद्रार्धपात्रं दत्त्वा च पात्रं तु क्षीरसर्पिषः |
शर्करायाश्च चूर्णं च द्राक्षाचूर्णं च तत्समम् ||५३||
स्वयङ्गुप्ताफलं चैव तथैवेक्षुरकस्य च |
पिप्पलीचूर्णसंयुक्तमर्धभागं प्रकल्पयेत् ||५४||
तदैकध्यं समानीय खजेनाभिप्रमन्थयेत् |
ततः पाणितलं चूर्णं लीढ्वा क्षीरं ततः पिबेत् ||५५||
एतत् सर्पिः प्रयुञ्जानः शुद्धदेहो नरः सदा |
मूत्रदोषाञ्जयेत् सर्वानन्ययोगैः सुदुर्जयान् ||५६||
जयेच्छोणितदोषांश्च वन्ध्या गर्भं लभेत च |
नारी चैतत् प्रयुञ्जाना योनिदोषात् प्रमुच्यते ||५७||
Meaning of the śloka
A half-vessel of honey and a vessel of milk-ghṛta, sugar powder and grape powder in equal amounts, kapikacchū fruit and ikṣuraka in the same way, with half a part of pippalī powder: all this is brought together and churned with a stick; then a handful of the powder is licked and milk is drunk after it. One who uses this ghṛta, with a purified body, always overcomes all urinary disorders that are otherwise very hard to overcome; it overcomes disorders of blood; a barren woman obtains a child; a woman who uses it is freed from disorders of the womb.
The commentary explains: 'half-vessel of honey' is half an āḍhaka of honey; the ghṛta is from churned milk; the powders of kapikacchū fruit through pippalī are in half part; svayaṃguptā is kapikacchū; ikṣuraka is kokilākṣaka; 'with a stick' is with the churning rod; 'a handful' means a palm without the fingers, or a karṣa per others.
A long ghṛta (balāghṛta) formula: balā, kola-stone kernel, madhuka, śvadaṃṣṭrā, śatāvarī, lotus stalk, kaseru, ikṣuraka seeds, sahasravīryā, aṃśumatī, payasyā, kālā, śṛgālavinnā, atibalā and the nourishing group, in equal parts, boiled with four times milk and a tulā of jaggery; reduced to a droṇa, strained; an āḍhaka of ghṛta is cooked with it and stored in a jar with a prastha of honey. One who uses this ghṛta is freed from urinary disorder. Powders of tugākṣīrī and sugar, equal to honey, are mixed and licked on an auspicious day, in a dose as suits, followed by milk: a man well restrained overcomes disorders of semen; one whose semen has been wasted by intercourse quickly gains comfort; vigorous and strong, he delights even as he drinks.
The commentary explains the balā ghṛta. Kola-asthi is jujube kernel; śvadaṃṣṭrā is gokṣura; ikṣuraka is kokilākṣa; sahasravīryā is dūrvā; aṃśumatī is śālaparṇī; payasyā is arkapuṣpī, or dugdhikā per others; kālā is kālānusārivā, or śrīparṇikā per others; śṛgālavinnā is pṛśniparṇī; the nourishing group is kākolī and the rest except guḍūcī, by agreement with another tantra. 'Four times milk' means milk (some say water). 'Strained' means through cloth; the ghṛta is cooked with the decoction alone, without paste. Kārttikakuṇḍa reads and explains this yoga differently; omitted for length. Some call this yoga non-original, but the commentary says the earlier commentators Sukīra, Sudhīra and others described it as original.
Key terms
balāghṛta
A named ghṛta made with balā and a nourishing drug group.
Citraka, sārivā, balā, kālānusārivā, drākṣā, viśālā, pippalī, citraphalā, madhuka, pathyā and āmalaka are given as pastes in karṣa measure; an āḍhaka of ghṛta is cooked with them in a droṇa of milk and a droṇa of water; the cooked ghṛta is taken down, cooled and strained, mixed with a prastha of sugar and tugākṣīrī, all well combined by the wise. Then he should drink a measure at the proper time according to doṣa and strength: a man with vāta-, kapha-, pitta-, blood- or knot-type semen, wishing to be free of disease. This ghṛta is life-giving and virilising, strength-bringing, good for intelligence, wealth-giving, removing all diseases, auspicious; a woman using this ghṛta soon conceives; it overcomes blood disorders and clotted disorders of the womb; this is the treatment in all urinary disorders.
The commentary describes the mahābalā ghṛta. Citraphalā is guḍadugdhikā, a synonym of indravāruṇī. 'And tugākṣīrī' also takes 'with a prastha'. Mita means in measure; 'according to strength' is understood as 'according to the strength of digestive fire'. Some do not read this ghṛta.
Key terms
mahābalā ghṛta
A named ghṛta formula.
citraphalā
Indravāruṇī (Citrullus colocynthis), a strong purgative.
vṛṣya
Virilising, aphrodisiac.
Adhikarana પુષ્પિકા · Śloka ૫૮
ઇતિ સુશ્રુતસંહિતાયામુત્તરતન્ત્રાન્તર્ગતે કાયચિકિત્સાતન્ત્રે મૂત્રાઘાતપ્રતિષેધો નામ (વિંશોઽધ્યાયઃ, આદિતઃ) અષ્ટપઞ્ચાશત્તમોઽધ્યાયઃ ||૫૮||
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इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे मूत्राघातप्रतिषेधो नाम (विंशोऽध्यायः, आदितः) अष्टपञ्चाशत्तमोऽध्यायः ||५८||
Meaning of the śloka
Thus ends the fifty-eighth chapter (the twentieth from the beginning of this section), named Mūtrāghātapratiṣedha, in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the fifty-eighth chapter, named Mūtrāghātapratiṣedha, in the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.
Key terms
mūtrāghātapratiṣedha
The chapter on measures against urinary obstruction.