An English Translation of the Sushruta Samhita, Vol. II — trans. Kaviraj Kunja Lal Bhishagratna (1911)

perineum, or about the penis, during micturition when •Tavel is fcnmin;^ in the bladder. The urine is stopped at intervals in its out-flow, or becomes charged with blood, or flows out twisted and scattered like spray, leaving a sediment of clear, sand}', red or yellow particles of stone, which resembles a Gomedha gem in colour. Moreover a pain is experienced in the bladder at the time of running or jumping or in swimming, or while ridin'4 <>n hnrsL'back, or after a long journey. 6.

The ^ICShmas'mari : — Stone or gravel, originated through the action of the deranged Kapham, saturated with an excessive quantity of that Dosha by the constant ingestion of phlegm-generating (Sle.shmala) substances, increases in size at the lower orifice of the bladder and ultimately obstructs the passage of the urine. The pressure and recoil of that incarcerated fluid on the walls of the urinar)' badder gives rise to a kind of crushing, bursting, pricking pain in that organ, which becomes cold and heavy. A Kapha-origined stone or gravel is white and glossy, attains to a large size, to that of a hen's egg, and has the colour of the Madhuka flower. This t\'pe is called S'lcshmas'mari. 7.

The Pittaja As'mari :— The Kapham

charged (dried) with the deranged Pittam becomes hard (condensed) and large in the aforesaid way, and lying at the mouth of the bladder obstructs the passage of the urine. The bladder, on account of the flowing back of the obstructed urine into its cavity, seems as if it has been exposed to the heat of an adjacent fire, boiling with the energy of an alkaline solution. A kind of sucking, drawing and burning pain is experienced in the organ. This type of As'mari is further marked by symptoms which characterise Ushna-vata (stricture). The concretion is found to be of a reddish, yellowish

Chap. III.] NIDANA STHANAM. 2^

black colour like the stone of the Bhallataka fruit, or it is coloured like honey. This type is called Pittaja As'mari. 8.

The Vatas'mari :— The deranged Kapham (mucus) inordinately saturated with the bodily Vayu, acquires hardness and gains in dimensions, and these l\-ing at the mouth of the bladder obstructs the passage of the urine. The incarcerated fluid causes extreme pain in the organ. The patient constantly under severe pain gnashes his teeth or presses his umbilical region, or rubs his penis, or fingers his rectum (Pd\-u) and loudly screams. A burning sensation is experienced in the penis, and urination, belching and defecation become difficult and painful.* The concretions in this type of As'mari are found to be of a dusk\- colour, rough, uneven in shape, hard, facetted and nodular like a Kadamva flower. This type is called Vdtds'mari. 9.

Infants are more susceptible to an attack of any of the three preceding t>'pes of As'mari, inasmuch as they are fond of day sleep or of food composed of both wholesome and unwholesome ingredients, and arc in the habit of eating before the digestion of a previous meal, or of taking heavy, sweet, emollient and demulcent food. In children the bladder is of diminished size and poor in muscular structure. These facts contribute to the easy possibility of the organ being grappled (with a surgical instrument) and of the stone being extracted with the greatest ease in cases of infantile As'mari. i-o.

The ^'ukras'mari : — Sukras'maris or seminal concretions arc usually formed in adults owing to the germination of semen in their organisms, A sudden or abrupt stoppage of a sexual act, or excessive coition tends to dislodge the semen from its natural receptacle * Stool and urine can be voided only with the greatest str.-iining.

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in the body. The fluid thus dislodged, but not emitted, finds a wrong passage. The Vayu gathers up the fluid (semen), thus led astray, and deposits it (in a round or oval shape) at a place lying about the junction of the penis and the scrotum and dries up the humidity with which it is charged. The matter, thus formed, condensed, and hardened, is called the seminal stone (Sukrds'mari), which then obstructs the passage of the urine, giving rise to pain in the bladder, painful micturition, and swelling of the scrotum. The stone vanishes under pressure in its seat*, ii — 12.