158 - Diseases

Dhanvantari said:

1-3. Now I shall explain the pathology of Mutraghata (suppression of urine or strangury), Sushruta, please listen. The urinary bladder, its top or outlet, the penis, the hip, the scrotum and the rectum, all these are covered by a single peritoneum and are situated in the pelvic cavity. Though the bladder is placed with its face down it is continuously filled with urinary secretions through the ducts carrying them and always exuding them. Doshas entering these secretions produce twenty diseases. 

4-3. Strangury and diabetes affect the vulnerable joints of the pelvis containing the bladder, thigh joints and the penis. In the Vataja type the urine is scanty and emitted constantly with the greatest pain. In the Pittaja type it is yellow giving rise to pain and burning sensation. In the Kaphaja type it is red. The patient feels heaviness in the bladder and penis. Intumescence is also found there. 

6-7. The urinary discharge is lubricious or tawny in colour in a combined action of all doshas. When the deranged Vayu turns the face of the bladder and dries it up the urine is charged with Pitta, Kapha or semen and a terrible gravel is formed like a lump of Gorochana which is a limb of the pitta matter. 

8. In all cases the deranged Kapha is an exciting factor in Ashmari. Its premonitory symptoms are: -Inflammation of the urinary bladder and excruciating pain all round it in that region. 

9. The urine gets obstructed in the bladder. There is difficulty in passing urine. There is fever and nonrelish for food. The general indications are pain in the umbilical region, foreskin of the prepuce and the top of the urinary bladder, etc. 

10. When there is obstruction in the passage by the gravel the micturition is delayed and painful. If the patient passes urine after a long retention the urine is clear and crystal coloured and he feels great pain. 

11. If it is excited it comes out with blood and fleshy matter. There is pain in the passage. In the Vayuja concretion of urine the patient grinds his teeth and shakes violently.

12. The patient feels that something stops the urine and afflicts the navel, he evacuates the bowel with a gaseous discharge and urinates in drops frequently. 

13. The Ashmari is tough and dark in colour. It appears to be studded with thorns. Pitta brings about a burning sensation in the bladder. It appears hot as if being cooked. 

14. The concretions appear like the stones of Bhallataka fruit red, yellow and white in colour. Due to the affliction of Kapha the bladder appears to be inflicted upon and is heavy and cool to the touch. 

15. In infants the Ashmari is large, glossy and honey coloured or white. Many children are affected by it. 

16-17. Since they have not grown large or fully developed they can be extracted easily. The Shukrashmari or concretion in semen is generated by suppression of emission and it is dreadful. The aggravated vayu collects and dries up the semen unreleased or dislodged from its original seat within the scrotum. It is then called Shukrashmari. 

18. It produces a painful swelling in the bladder and micturition is very painful. The semen secreted becomes dry if there are Shukrashmari formations. 

19. An attack of fever or chronic cough makes the urinary concretions into Sharkara (gravel). The internal Vayu splits and crushes these concretions and sends them out along with the urine. If the Vayu takes an averse course they lie within the bladder and mature. 

20. The aggravated Vayu may make the top of the bladder let out urine. Sometimes it may obstruct the flow of urine and from its seat it may generate pain. 

21. It may cover up the bladder or lifting it, it may scatter it about, then a great pain is felt with throbbings and irritation. 

22. When the bladder is thus afflicted the urine may come out in drops. The continuous flow is obstructed; this disease is called Vatavasti. 

23. It is difficult to be cured. The second one is still more difficult to be cured. The powerful Vayu comes in between the path of faeces and the bladder. 

24. It generates a kind of thick knotty round raised concretions called Vatashthila (Globular seed like concretions caused by Vayu.) They are found both in the faeces and in the urine. 

25-26. A sickness called Vatakundalika is produced when semen is retained for a long time without emission. The deranged Vayu lies within the bladder in a coil and gives great pain. It whirls after obstructing the urine. There is rigidity, heaviness and convolution in the bladder. Urine is passed out bit by bit. 

27-28. The urine being obstructed does not pass out completely. After the passage of urine there is a slight pain. When the Vayu is obstructed by the collection of urine it returns to the umbilical region or lower abdomen and produces pain. There is no distension but due to loss of strength faeces are collected and obstructed. 

29-30. Urine may enter the abdominal passage by the pressure of wind and stay in the bladder or umbilical region and flow out gradually. It may or may not be painful. It is without cessation. Its residue is dried up. 

31. Inside the bladder near its entrance there is a knotty small firm concretion like gravel. It is called Mutragranthi. 

32. Sometimes a man in his sexual intercourse may not discharge semen immediately although it might have been dislodged from its seat. This is due to the action of Vayu. But when he begins to urinate the semen may come out either before or after urination. 

33. The urine then appears like water washing down ashes. The stuff is called Mutrashukram (Spermatorrhoea) Sometimes weak persons or those of harsh nature are afflicted by Vayu when passing stools. 

34. The faecal matter may get into the urinary tract and hence the urine drop may have the smell of faeces. This is called Mutravighata. 

35-36. The Vayu aggravated by Pitta, physical exercises, excessive intake of sharp acid food stuffs and inflammation may generate a burning sensation in the urinary bladder and urine mixed with blood or blood alone comes out in hot jets. It is called Ushnavata. 

37. Pitta and Vayu in the urinary bladder of a constitutionally parched up person or thoroughly weary man may cause deficiency of urine accompanied by pain and burning sensation. The ailment is called Mutrakshaya. 

38-40. If either kapha or pitta or both are affected by Vayu the passage of urine is very painful. It is a thick fluid yellow, red or white in colour. There is a burning sensation. It may have the colour of bile or powdered conch shell. It may be dry in some cases. It may have all the colours too. The ailment is called Mutrasada. Thus, all ailments in the context of urination have been explained in detail.