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

Authoritative verses on the subject : — Concretions, sands and sediments found to be deposited in the urine in a case of Bhashma-meha are but the modifications, or attendant symptoms of a case of stone in the bladder (As'mari). The same group of symptoms and the same kind of pain are exhibited and experienced in a case of gravel {S'ar^ard) as in a case of stone (As'mari) in the bladder. The local VAyu coursing in its natural direction helps the discharge of calculi (As'mari) with the urine in the event of they being extremely attenuated in structure. Particles of a stone broken by the Vayu are called urinary calculi {S'arkard). A pain about the cardiac region, a sense of weakness and lassitude in the thighs, a griping pain in the regions of the spleen and liver (Kukshi-s'ula), a shivering sensation, thirst, hiccough or eructations, darkness or sallowne's of complexion, weakness, emaciation with a non-relish for food and

• We can not but contemplate with admiration the fact that Sushruta was aware of the formation of seminal or spermatic concretions in the seminal vesicles through degenerative changes of spermatozoa and other secretions and their subsequent calcification as lately discovered by the savants of the 'West. — Translator

Chap. III.] NIDANA STHANAM. 29

impaired digestion are the symptoms which are manifest in a gravel-patient. A gravel {S'arkard) obstructed at the mouth of the urinary channel is detected by the following indications : — via., weakness, lassitude, emaciation, cachectic condition of the body, pain over the hepatic region (Kukshi-s'ula), a non-relish for food, sallowness of complexion, hot and high coloured urine, thirst, pressing pain at the cardiac region and vomiting. 13.

The bladder is situated in the pelvic cavity, surrounded on its different sides by the back, loin (Kati), umbilicus, scrotum, rectum (Guda), groins and penis. This organ is provided with a single aperture or opening and lies with its mouth downward, covered with nets of nerves (Sira) and ligaments (Snayu), in the shape of a gourd. The organ is extremely thin in structure ; and thus situated within the pelvic cavity, it is connected, through its mouth or external orifice, with the rectum, the penis, and the testes. It is also known by the name of Maladhara (the receptacle of impure matter) and forms (one of) the primar^^^ seats of vital energy (Prana)*. The urinary ducts (ureters) pass close by the large intestines (Pakvas'aya) and constantly replenish the bladder and keep it moist with that waste product of the system in the same manner as rivers carry their contributions of water into the ocean. These passages or ducts (which are two) are found to take their origin from hundreds of branches (or mouths tiibuli uriniferi), which are not visible to the naked eyes, on account of their extremely attenuated structures and carry, whether in a state of sleep or wakening, the urine from below the region of the

• The text has Frdndyalanam, which means that an injury to the urinary bladder may be attended with fatal result.

p. 30

stomachf (Amasaya) into the bladder keeping- it filled with this important fluid of the body, just as a new pitcher, immersed up to it;? neck in a vessel full of water, is filled by transudation through its lateral pores. 14.

In the same way the Vayu, Kapham and Pittam are carried into the bladder (through their respective ducts or channels), and in unison with the retained urine, give rise to the formation of stone, on account of the slimy character of the deposit produced. Stone is formed in the same way in the bladder as sediments are ultimately deposited from clear and transparent water at the bottom of a new pitcher which contains it. As the wind and lightning jointly condense the rainwater into hailstones, so the bodily V^iyu and Pittam (heat) jointly contribute to the condensation of the Kapham in the bladder and transform it into stone.

The Vayu in the bladder, coursing in its natural downward direction, helps the full and complete emission of urine ; while coursing in a contrary direction, it gives rise to various forms of maladies such as, Prameha, strangury, as well as seminal disorders ; in short, it produces any urinary trouble to which the bladder ma\- be subjected, i 5.

t From the kidneys.

Thus ends the third Chapter of the Nidana Sthanam in the Sushruta Samhita which treats of the Nidanani of urinary calculi.

CHAPTER IV.

Now \vc shall discourse on the Nidanam of Bhag"- a.ncla.ra.m t, fistula in ano and fistular ulcers), i.