Chapter CLVIII - The Nidanam of Stangury etc.

DhanvantarI said:—Now, hear me, O Sushruta, discourse on the Ætiology and symptoms of Mutraghata (suppressed or scanty urination) and Mutrakrichchha (strangury). The urinary bladder, with its neck or region of outlet, as wall as the penis, the hip, the testes and the rectum are covered with one and the same peritonium, and are situated within the pelvic cavity. The urinary bladder is placed with its cervix (neck) hung downward and is filled with the help of the two ureters which open obliquely at the base of its fundus. The morbific principles of the body such as, the deranged Vayu, Pittam and Kapham, may enter the minute nerve vessels that transverse this membranous sac of the body, and may give rise to twenty different forms of disorder. Both Prameha and Mutraghata attack the Marma or the vulnerable part of the pelvis where the penis (urethra), inguinal ligaments, and ligaments of the pelvic bones meet one another, and in both these diseases, the patient constantly passes a very small quantity of urine with pain in the aforementioned localities. In the Vataja form of Mutraghata the urine is scanty and is constantly emitted with the greatest pain. In the Pittaja form the patient passes a high coloured or bloody urine attended with a burning sensation and pain at the external orfice of the urethra. In the Kaphaja type the patient complains of swelling and heaviness in the urinary bladder and the urethra (lit:—penis). The face of the patient assumes a withered, bluish aspect in the case where the deranged and aggravated bodily Vayu serves as the exciting factor of this disease (Mutraghata). The preponderance of the deranged Vayu, Pittam, and Kapham in a given case of Mutraghata is marked by the scanty emission of urine charged with sperm, bile matter, or mucous. The deranged Pittam in a case of the Pittaja type of Mutraghata may generate urinary calculi or concretions to the size and colour of Gorochana (hard biliary concretions occasionally obtained from the gall bladder of an ox.) The deranged and aggravated Kapham should be regarded as underlying all cases of urinary concretions (lit:—stone in the bladder).

A distended condition of the urinary bladder with an excruciating pain in regions around that organ is the premonitary symptom of a case of stone in the bladder—accumulation of urine in that membraneous sac, difficult and painful micturition, fever with a repugnance for food, and a pain about the umbilicus, bladder and the perineal suture, and headache being its general characteristics. These urinary concretions obstruct the external orfice of the bladder, and the patient passes a clear, crystal-coloured urine with extreme pain and difficulty A long retention of the urine in the bladder in these cases may produce local congestion followed by bleeding and a pain in the urethra. In the Vataja-type, the patient gnashes his teeth violently, and shakes. The incarcerated urine in this type of Ashmari produces an excruciating pain about the umbilicus, and the patient passes a sort of hot, frothy stool accompanied by emission of flatus, and the urine is dribbled out in drops with pain. In the Vataja type the urinary concretions become rough, and of a tawny-brown colour, and are found to be studded with thorns (crystaline.) In the Pittaja-type, the patient complains of a burning pain in the urinary bladder, and the concretions are found to resemble the stones of Bhallataka fruit, or become of a red, yellow, or white colour. In the Kaphaja type of urinary calculi, an excruciating pain is experienced in the bladder, and the concretions are felt to be cold and heavy. Urinary calculi found in the bladders of infants, usually become, small, heavy, white or honey-coloured. These calculi should be extracted from the bladder before they can grow in size, or attain their fullest development.

A stream of semen, anywise obstructed in its emission, may give rise to the genesis of dreadful seminal concretions. The deranged and aggravated Vayu of the locality dries up the drops of semen, thus disloged from its proper receptacle, and keeps them ensconced in the shape of hard crystals within the spermatic chords in the scrotum. The concretions are called Shukrashmaries, which produce a painful swelling of the bladder and difficulty in passing urine. The formation of semen in a man is at once arrested immediately upon the formation of seminal concretions in his spermatic chords.

An attack of fever, or an obstinate cough may tend to transform these urinary concretions into gravels or Sharkaras. These calculi, being split and crushed by the force of the aggravated bodily Vayu in the locality, may pass off with the urine in its normal course. Taking a contrary or upward direction they lie incarcerated in the urinary bladder, producing a kind of irritation in its cervix, which impedes the free emission of urine, and causes it to dribble out. The deranged Vayu, thus aggravated, fills up the cavity of the bladder, and thence it gradually permeates the peritonium of the abdomen, causing it to be distended and producing painful spasms in its inside, as well as tympanites.

The enraged and aggravated bodily Vayu by taking lodgment in the urinary bladder causes the urine to flow out in drops. The urine is invariably emitted in broken or obstructed jets. The disease, thus engendered, is called Vatavasti. This disease is extremely hard to cure, and becomes much more difficult when it is associated with the deranged Vayu. The deranged and aggravated bodily Vayu taking lodgment in that part of the perineum which lies between the rectum and the urinary bladder may give rise to a kind of thick, knotty, round, raised concretions which is called Vatashthila. It brings on profuse micturition and copious evacuations of the bowels. The enraged bodily Vayu is coiled up, and produces an excruciating pain, in the urinary bladder without in any way interfering with the flow of urine, but giving rise to vertigo, a sensation of numbness and heaviness in the limbs, and nausea.

The type of disease, which is known as Vatakundalika, and which is but an offspring of enforced continence or voluntary suppression of semen, is characterised by a scanty though constant urination. The urine suppressed in these cases produces a slight pain at the external orfice of the urethra. The suppressed flow (of urine), forced to recoil back upon itself through the obstruction of the enraged Vayu, tends to distend the abdomen from below the umbilicus, and gives rise to a kind of intolerable pain in the locality accompanied by tympanites and loose motions of the bowels. The enraged Vayu, in this disease, tends to send up the urine higher up in the abdominal cavity, whence results the scantiness of that fluid. The said enraged Vayu finds lodgment either in the intestines, urinary bladder, or in the umbilical region, giving rise to a constant, and, sometimes slightly painful, micturition. The urine is emitted in gusts (lit. in unbroken jets) and the residue of the fluid lies pent up in the scrotum, producing a sensation of heaviness in the scrotal sac. Sometimes, the urine, accumulated and pent up little by little in the bladder, gives rise to a kind of local nodular growths, which somewhat resemble urinary calculi in shape, and are called Mutragranthis. A sexsual intercourse in these urinary diseases, enrages the local Vayu, which may tend to dislodge and draw up the spermatic fluid from its receptacle. The semen, under the circumstance, is found to be emitted either before, or with the flow of urine, resembling washings of ashes. The disease is called Mutra Shukra (a type of spermatorrhœa).

The enraged Vayu, by bringing down fecal matter into the urinary channel of a weak, emaciated patient of parched temperament, causes the disease which is called Mutra-Vighata. The disease is characterised by loose motions of the bowels with tympanites, and emission of urine in drops, smelling like fecal matter. The bodily Vayu, enraged through the agency of the aggravated Pittam, inordinate physical exercise, excessive ingestion of sharp and acid substances, and retention of urine in the bladder, causes a disease, called Ushna Vata, its specific symptoms being an extreme burning sensation in the bladder, scanty urination followed by emission of hot bloody urine, or hematuria. The deranged Pittam and Vayu finding lodgment in the urinary bladder of a person of exhausted and parched up constitution, give rise to a disease which is called Mutrakshaya, characterised by scanty, painful, burning urination. When the local Vayu is affected by the deranged Pittam and Kapham, it produces a disease which is called Mutrasada. The urine is either red, yellow, or white and thick, attended with burning, or resembles the colour of oxbile, or, powdered conch-shell. The urine may be entirely absent in some cases, or may assume any of the aforesaid colours. Thus all diseases affecting the flow of urine have been described in detail.