अथातो मूत्रकृच्छ्रप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
Meaning of the śloka
Now, therefore, we shall explain the chapter on the treatment (pratiṣedha) of mūtrakṛcchra (painful, difficult urination). Thus spoke Lord Dhanvantari.
The commentary says that after the chapter on mūtrāghāta, beginning mūtrakṛcchra is fitting because both concern the bladder. Mūtrakṛcchra is passage of urine with difficulty. Some read the title as 'mūtropaghāta' or 'mūtradoṣa', with the same sense. An objection: mūtrakṛcchra was already mentioned under stone, urinary obstruction and udāvarta, so why again? Reply: because treatment and signs differ, and it is listed separately in a similar tantra. Some do not read this chapter, from fear of repetition.
From vāta, pitta, kapha, all together, from injury, from stool and from stone, and another very difficult one from gravel (śarkarā): the eighth (kind) of urinary trouble (mūtropaghāta) is stated.
The commentary says mūtropaghāta is the same as mūtrakṛcchra. The number 'eighth' shows that the many kinds arising from stone are counted as one. Some read the second half as 'born of śuktī (a kind) and from gravel, difficult; they call it mūtrakṛcchra', which the commentary rejects as non-original.
Key terms
mūtropaghāta
Injury or impairment of urination (here, mūtrakṛcchra).
The commentary gives the signs of vātaja kṛcchra. 'Pressing' means, by necessity, squeezing the testes, penis and bladder; 'as if bursting' means as if splitting; 'with difficulty' attaches to 'passes urine'. Kārttikakuṇḍa reads this verse differently; not shown.
Key terms
vātakṛcchra (vātāghāta)
Painful urination from vāta.
phaladbhiriva
As if bursting.
Adhikarana ൪ (൫) · Śloka ൫
ഹാരിദ്രമുഷ്ണം രക്തം വാ മുഷ്കമേഹനബസ്തിഭിഃ |
അഗ്നിനാ ദഹ്യാമാനാഭൈഃ പിത്തഘാതേന മേഹതി ||൫||
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हारिद्रमुष्णं रक्तं वा मुष्कमेहनबस्तिभिः |
अग्निना दह्यामानाभैः पित्तघातेन मेहति ||५||
Meaning of the śloka
He passes yellow, hot or blood-coloured urine, with the testes, penis and bladder as if burning in fire: (that is) by the pitta type of obstruction.
The commentary says yellow is turmeric-coloured and blood-coloured is red; the two colours arise from lesser or greater pitta aggravation; 'as if burning' means with great burning.
स्निग्धं शुक्लमनुष्णं च मुष्कमेहनबस्तिभिः |
संहृष्टरोमा गुरुभिः श्लेष्माघातेन मेहति ||६||
Meaning of the śloka
He passes unctuous, white, not hot urine, with the testes, penis and bladder heavy, and hair standing on end: (that is) by the kapha type of obstruction.
The commentary says āviṣṭa means possessed of; many colours means yellow, red, white and so on; 'sinking' means going into darkness; 'with great difficulty'.
मूत्रवाहिषु शल्येन क्षतेष्वभिहतेषु च |
स्रोतःसु मूत्राघातस्तु जायते भृशवेदनः ||८||
वातबस्तेस्तु तुल्यानि तस्य लिङ्गानि लक्षयेत् |
शकृतस्तु प्रतीघाताद्वायुर्विगुणतां गतः ||९||
आध्मानं च सशूलं च मूत्रसङ्गं करोति हि |१०|
Meaning of the śloka
When the urine-carrying channels are wounded by a foreign body (śalya) or struck, obstruction of urine occurs with severe pain; one should recognise signs like those of vātabasti. And by obstruction of stool, vāyu, deranged, produces distension with pain and retention of urine.
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മൂത്രവാഹിഷു ശല്യേനേത്യാദി||൮-൯||
Meaning of the commentary
The commentary gives no separate explanation in this passage; verses 8-9 are stated together with the following half-verse on stool-caused obstruction.
Key terms
abhighātaja mūtrakṛcchra (abhighātaja)
Painful urination from injury.
śakṛjja mūtrakṛcchra (śakṛtpratīghāta)
Painful urination from obstruction by stool.
Adhikarana ൮ (൧൦) · Śloka ൧൦
അശ്മരീഹേതുകഃ പൂര്വം മൂത്രാഘാത ഉദാഹൃതഃ ||൧൦||
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अश्मरीहेतुकः पूर्वं मूत्राघात उदाहृतः ||१०||
Meaning of the śloka
The urinary obstruction that arises from stone was described earlier.
Stone (aśmarī) and gravel (śarkarā) are alike in their origin and signs; hear me describe the distinguishing features of gravel. The parts of kapha, cooked by pitta and broken by vāta, become fragments called śarkarā. Pain in the heart, trembling, colic, and weak agni in the abdomen, extreme weakness; from these fragments there is fainting and terrible urinary obstruction. When the fragments are expelled by the urge of urine, the pain settles, until another pellet comes to the mouth of the channel. This is the sign of gravel-caused urinary obstruction.
The commentary says that although gravel-kṛcchra and stone-kṛcchra are alike, gravel-kṛcchra is given separately by a slight difference. 'Cooked' means ripened, of kapha by implication; 'broken' means broken up, by figure of speech of the future as the past. Vepathu is trembling; sudurbala is very weak. 'Expelled by the urge' means expelled by the downward pressure of urine. Kārttikakuṇḍa reads this passage in a confused way; omitted for length. Although stone, gravel and mūtrakṛcchra were described in the section on causes, they are described again here by context and for additional signs.
Key terms
śarkarā
Gravel: small fragments formed from kapha cooked by pitta and broken by vāta.
mūtrāghāta
Urinary obstruction.
Adhikarana ൧൦ (൧൫) · Śloka ൧൫
ചികിത്സിതമഥൈതേഷാമഷ്ടാനാമപി വക്ഷ്യതേ ||൧൫||
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चिकित्सितमथैतेषामष्टानामपि वक्ष्यते ||१५||
Meaning of the śloka
The treatment of all eight of these will now be described.
The commentary extends the treatment by reference: the oleation and other measures stated in the stone treatment by vāta and other types should be applied likewise; by 'ca', the treatment of urinary obstruction given earlier is included.
श्वदंष्ट्राश्मभिदौ कुम्भीं हपुषां कण्टकारिकाम् |
बलां शतावरीं रास्नां वरुणं गिरिकर्णिकाम् ||१७||
तथा विदारिगन्धादिं संहृत्य त्रैवृतं पचेत् |
तैलं घृतं वा तत् पेयं तेन वाऽप्यनुवासनम् ||१८||
दद्यादुत्तरबस्तिं च वातकृच्छ्रोपशान्तये |१९|
Meaning of the śloka
Śvadaṃṣṭrā, aśmabhid, kumbhī, hapuṣā, kaṇṭakārikā, balā, śatāvarī, rāsnā, varuṇa, girikarṇikā, and the vidārigandhādi group are brought together; oil or ghṛta cooked with the triple fat (traivṛta) is to be drunk, or given as anuvāsana, and also as uttarabasti, to pacify vātaja kṛcchra.
The commentary gives treatment of vāta-type kṛcchra. Śvadaṃṣṭrā is gokṣura; aśmabhid is pāṣāṇabheda; kumbhī is sthalakumbhī; girikarṇikā is a kind of aparājitā. Traivṛta oil is oil mixed with three fats (ghṛta, vasā and majjā), or ghṛta mixed with three (oil, vasā and majjā). The choice of oil or ghṛta depends on suitability or on the strength of the doṣas.
Key terms
traivṛta
A preparation with three fats.
anuvāsana
Oil enema.
uttarabasti
Enema through the urethra.
Adhikarana ൧൩ (൧൯) · Śloka ൨൦
ശ്വദംഷ്ട്രാസ്വരസേ തൈലം സഗുഡക്ഷീരനാഗരമ് ||൧൯||
പക്ത്വാ തത് പൂര്വവദ്യോജ്യം തത്രാനിലരുജാപഹമ് |൨൦|
The commentary says that although milk is listed among the paste drugs, it is to be understood as a liquid. The oil is used as a drink, as anuvāsana and as uttarabasti; it destroys pain of vāta-caused kṛcchra.
The commentary gives medicine for pittaja kṛcchra. Ghṛta prepared with the tṛṇa group and the rest is meant. Milk alone is an alternative, depending on suitability and the strength of digestive fire.
Key terms
tṛṇapañcamūla (tṛṇādi)
The grass-root group.
nyagrodhādi gaṇa (nyagrodhādi)
The nyagrodha group of drugs.
Adhikarana ൧൫ (൨൧) · Śloka ൨൧
ദദ്യാദുത്തരബസ്തിം ച പിത്തകൃച്ഛ്രോപശാന്തയേ ||൨൧||
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दद्यादुत्तरबस्तिं च पित्तकृच्छ्रोपशान्तये ||२१||
Meaning of the śloka
One should also give an uttarabasti to pacify pitta kṛcchra.
The commentary says the uttarabasti is given with sneha prepared with the tṛṇa and other groups. Although the three kinds of basti to be mentioned include uttarabasti, it is named separately to indicate that it is especially beneficial in pitta kṛcchra.
The commentary says 'these same' means the tṛṇa, utpala and other groups; the three bastis are nirūha, anuvāsana and uttarabasti (some read the first as a head basti, rejected by agreement with similar tantras). 'Juice' includes sugarcane juice as well.
The commentary gives treatment of kaphaja kṛcchra. 'Gruels and the like' includes thick porridges (vilepī); they are understood to be prepared with the surasādi group.
Key terms
kaphāghāta
Kapha-type obstruction.
surasādi
The surasa (tulasī) group.
Adhikarana ൧൮ (൨൪) · Śloka ൨൪
യഥാദോഷോച്ഛ്ര്യം കുര്യാദേതാനേവ ച സര്വജേ |൨൪|
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यथादोषोच्छ्र्यं कुर्यादेतानेव च सर्वजे |२४|
Meaning of the śloka
And in the type from all (doṣas), one should apply these same according to the excess of doṣa.
The commentary gives the treatment of sannipātaja kṛcchra: the yogas for vāta and the other types, stated just before, are combined, giving preference to those of whichever doṣa is in excess.
The commentary says phalgu is kākodumbarikā; vṛścīra is white punarnavā; aśmasāra is śilājatu. The powder drunk in water, or with surā, sugarcane juice and the like, relieves the pain of sannipātika kṛcchra by implication.
Key terms
aśmasāra
Śilājatu (mineral pitch).
vṛścīra
White punarnavā.
Adhikarana ൨൦ (൨൫) · Śloka ൨൫
തഥാऽഭിഘാതജേ കുര്യാത് സദ്യോവ്രണചികിത്സിതമ് ||൨൫||
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तथाऽभिघातजे कुर्यात् सद्योव्रणचिकित्सितम् ||२५||
Meaning of the śloka
In (kṛcchra) from injury, one should do the treatment for a fresh wound.
The commentary extends treatment by reference: in injury-born kṛcchra, the treatment stated for a fresh wound applies, with the vāta-relieving measures.
The commentary says that in stool-born kṛcchra, the vāta-relieving treatment is explained as sweating and the rest; these are those stated in the vāta-disease chapter.
The commentary says the two other kṛcchras are those arising from stone and gravel; their treatment is as stated in the treatment of stone and gravel. Some read 'the other two kṛcchras that are...', with the same sense.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे मूत्रकृच्छ्रप्रतिषेधो नाम (एकविंशतितमोऽध्यायः, आदितः) एकोनषष्ठतमोऽध्यायः ||५९||
Meaning of the śloka
Thus ends the fifty-ninth chapter (the twenty-first from the beginning of this section), named Mūtrakṛcchrapratiṣedha, in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.