The Nidanam of Stangury, etc. ||158||

1Dhanvantari said: -Now, hear me, O Susruta, discourse on the Aetiology and symptoms of Mutraghata (suppressed or scanty urination) and Mutrakriccha (strangury). The urinary bladder, with its. neck or region of outlet, as well as the penis), the hip, the testes and the rectum are covered with one and the same peritoneum and are situated within the pelvic cavity.
2The 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.
3The 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.
4Both Prameha and Mutraghata attack the Manna 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.
5In the Vataja forth 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 at tended 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 (Iit. penis).
6The face of the patient assumes as 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.
7The deranged Pittam in a case of the Pittaja type of Mutraghata may generate urinary caicun or concretions to the size and colour of Gorooma (hard biliary concretions occasionally obtained from the gall bladder of an ox).
8The d-eranged and aggravated Kapham should be regarded as underlying all case of urinary concretions (lit:-stone in the bladder).
9-10A distended condition of the urinary bladder with an excruciating pain in regions around that organ is the premonitory symptom of a case of stone in the bladder accumulation of urine in that membranous 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 orifice of the bladder, and the patient passes a clear, crystal coloured urine with extreme pain and difficulty.
11A 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 Vitaja-type, the patient gnashes his teeth violently, and shakes.
12The incarcerated urine in this type of Manari 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.
13-14In 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 blader, and the concretions are felt to be cold and heavy.
15Urinary 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.
16A 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 dislodged from its proper receptacle, and keeps them ensconced in the shape of hard crystals within the spermatic chords in the scrotum.
17The concretions are called Sukragmaris, which produce a painful swelling of the bladder and difficulty in passing urine.
18The formation of semen in a man is at once arrested immediately upon the formation of seminal concretions in his spermatic chords.
19An attack of fever, or an obstinate cough may tend to transform these urinary concretions into gravels or darkaras. These calculi, being split and crushed by the force of the aggravated bodily Vayu in the locality, may pass of with the urine in its normal course.
20Taking 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,
21The deranged Vayu, thus aggravated, full up the cavity of the bladder, and thence it gradually permeates the peritoneum of the abdomen, causing it to be distended and producing painful spasms in its inside, as well as tympanites.
22The 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.
23The disease, thus engendered, is called Vitavasti. This disease is extremely hard to cure and becomes much more difficult when it is associated with the deranged Vayu.
24-25The 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 king of thick, knotty, round, raised concretions which is called Vatashthila, It brings on profuse micturition and copious evacuations of the bowels.
26The 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.
27Or voluntary suppression of semen, is characterized by a scanty though constant unnation. The urine suppressed in these cases produces a slight pain at the external orifice of the urethra.
28-31The 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 fo 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 king of local nodular growths; which somewhat resemble urinary calculi in shape, and are called Mutragranthis.
32-33A sexual intercourse in these urinary diseases, enrages the local Vayu, which may tend to dislodge and drow up the spermatic fluid from its receptacles. 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 Sukra (a type of spermatorroea).
34-35The 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 characterized by loose motions of the bowles with tympanites, and emission of urine in dorps, smelling like fecal matter. The bodily Vayu enraged through the agency of the aggravated Pittam.
36-37Inordinate 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.
38-39The 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 Mutraqaya, characterised by scanty, painful, burning urination.
40When the local Vayu is affected by the deranged Pittam and Kapham, it produces a disease which is called Miitrasada. The urine is either red, yellow, or white and thick, attended with burning, or resembles the colour of ox bile, 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 hen I described in detail.