An English Translation of the Sushruta Samhita (Bhishagratna ed.)

Now we shall discourse on the Nidanam of As'« mari (urinary calculi). I.

The disease admits of being divided into four several
types, such as the Vdtaja, the Pittaja, the Kaphaja and
the Sukraja (Seminal) concretions. An exuberance or
preponderance of the deranged Kapham should be under-
stood as the underlying cause of all invasions of this
disease. 2.

General aBtioIOgy :— The Kaphah of a man,
who neglects to cleanse (Samsodhana) the internal
channels of his organism, or is in the habit of taking
unwholesome food, enraged and aggravated by its own
exciting causes, is carried into the urinary bladder.
Here it becomes saturated with the urine, and gives rise
to the formation of concretions or gravels in its cavity. 3,

Premonitory Symptoms:— An aching

pain in the bladder, with a non-relish for food, difficulty in urination, an excruciating pain in the scrotum, penis, and the neck of the bladder, febrile symptoms, physical lassitude, and a goat-like smell in the urine are the symptoms, which indicate the formation of gravel in the bladder. 4.

Metrical Text ;— The deranged Doshas involv-
ed in a particular case respectively impart their specific
colour to the urine, and determine the character of the
accompanying pain. The urine becomes thick, turbid,
and vitiated with the action of the aggravated Doshas,
and micturition becomes extremely painful. 5.

Leading Indications :— A sort of excru-
ciating pain is experienced either about the umbilicus,
or in the bladder, or at the median rape of the

26 THE SUSHRUTA SAMHITA. [Chap. III.

perineum, or about the penis, during micturition when
gravel is forming 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, sandy, 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 riding on horseback, or after a long journey. 6.

The ^leshmas'mari:— Stone or gravel, ori- ginated through the action of the deranged Kapham, saturated with an excessive quantity of that Dosha by the constant ingestion of phlegm-generating (Slesh- mala) 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 urinary 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 type is called S'leshmas'mari. 7.

The Pitta ja 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-v^ta (stricture).
The concretion is found to be of a reddish, yellowish

Chap. III.] NIDANA STHANAM. 2;

black colour like the stone of the Bhalldtaka 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 Vdyu,
acquires hardness and gains in dimensions, and these
lying 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 (Pdyu) 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 dusky colour,
rough, uneven in shape, hard, facetted and nodular like
a Kadamva flower. This type is called Vdtas'mari. 9.

Infants are more susceptible to an attack of any of
the three preceding types of As'mari, inasmuch as they
are fond of day sleep or of food composed of both whole-
some and unwholesome ingredients, and are 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. 10.

The ^UkraS'mari : — Sukras'maris or seminal
concretions are 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 straining.

2^ THE SUSHRUTA SAMHITA. [Chap. III.

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
swellino; of the scrotum. The stone vanishes under
pressure in its seat^'. ii — -12.

Authoritative verses on the sub- ject : —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 (Asmari). The same group of symptoms and the same kind of pain are exhibited and experienced in a case of gravel {S'arkard) as in a case of stone (Asmari) in the bladder. The local Vayu coursing in its natural direction helps the dis- charge of calculi (Asmari) 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 recfion, a sense of weakness and lassitude in the thiojhs, a griping pain in the regions of the spleen and liver (Kukshi-sula), a shivering sensation, thirst, hiccough or eructations, darkness or sallowness 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 "Wesi. — Translator

Chap. III.] NIDANA STIIANAM. 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 : — viz., 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, sur- rounded 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 primaiy 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 tubuli 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 Prdndyatanam^ which means that an injury to the urinary bladder may be attended with fatal result.

30 THE SUSHRUTA SAMHITA. t^hap. III.

stomach-f- (Amasaya) into the bladder keeping it filled
with this important fluid of the body, just as a new-
pitcher, immersed up to its 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 Vayu 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 may be subjected. 15.

t From the kidneys.

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

Now we shall discourse on the Nidatnam of Bhag^- ancla.ram (fistula m ano and fistular ulcers), i.

The deranged Vayu, Pittam, Kaphah and Sannipatah
(a simultaneous derangement of the three bodily Doshas)
and extraneous causes (such as a blow etc.) give rise
to the types of Bhagandaram known as Sataponaka,
Ushtragriva, Parisrdvi, Samvukdvarta and Unmargi.
The disease is so named from the fact that it bursts
the rectum, the perineum, the bladder and the place
adjoning to them (thus setting up a mutual communica-
tion between them). The pustules, which appear in this
regions are called as Pidakds in their unsuppurated
stage, while they are called Bhagandaram when they are
in a stage of suppuration. A pain about the sacral
bone and an itching about the anus, accompanied by a
swelling and burning sensation, are the premonitory
symptoms of this disease. 2.

The ^ataponakah Type :— The Vayu,

excited, condensed, and rendered motionless by a course of unwholesome food, gives rise to a pustule within one or two fingers' length from the rectum (anal region, — Guda), by vitiating the flesh (areolar tissue) and blood (of the locality). It assumes a vermilion colour and is characterised by a variety of pricking, piercing pain. If neglected at the outset, the pustule runs into suppuration. Owing to its vicinity to the bladder, the abscess or the suppurated pustule exudes a kind of slimy secretion and becomes covered with hundreds of small sieve-like holes, through which a constant frothy discharge is secreted in large quantities. The ulcer, thus formed, seerns as if it is being thrashed with a rod, pierced

32 THE SUSHRUTA SAMHITA. CChap. IV.

with a sharp instrument, cut with a knife, and pricked by
needles. The region of the anus cracks and bursts, and
jets of urine, fecal matter, flatus (Vata) and semen
are emitted through these sieve-like holes. This type
of fistula is called Sataponakah (Sieve-like fistula
in ano). 3.

The Ushtra-grivah Type: -The enraged

Pittam, carried down by the Vayu (into the rectum) finds lodgmeit therein, and there gives rise to a small, raised, red pustule, which resembles the neck of a camel in shape, and is characterised by a varied kind of pain, such as sucking etc. The pustule, not medicinally treated at the beginning, runs into suppuration. The incidental ulcer seems as if it is being burnt with fire or alkali, and emits a hot, fetid discharge. Jets of urine, flatus (Vata), fecal matter and semen flow out of the ulcer in the event of it not being healed up with proper medicinal remedies. This type is called Ushtragrivah. 4.