Mutraghata Chikitsitam Adhyaya (Therapies of retention of urine)

Virechana, Vasti and Uttara Vasti

रेकार्थं तैल्वकं सर्पिर्वस्तिकर्म च शीलयेत् ।
विशेषादुत्तरान् वस्तीञ्छुक्राश्मर्यां तु शोधिते ॥४१॥
Tailvaka ghrta (chapter 3 of cikitsa sthana) needs to be used for purgation, enema remedy particularly the enema to the urinary bladder needs to be administered for elimination of seminal calculi.

Shukrashmari Chikitsa

तैर्मूत्रमार्गे बलवान् शुक्राशयविशुद्धये ।
पुमान् सुतृप्तो वृष्याणां मांसानां कुक्कुटस्य च ॥ ४२ ॥
कामं सकामः सेवेत प्रमदा मददायिनीः ।
In case of shukrashmari (seminal calculus) the person needs to be given robust enemas into the urinary tract (particularly the uttra basti – enema to the urinary bladder) to purify the receptacle of semen. Then the perso ought to partake mea which is aphrodisia or meat of the cock. Gsetting contented by this fashion, he ought to copulate with a lady who exhilarates him.

Choice for surgical therapy

सिद्धैरुपक्रमैरेभिर्न चेच्छान्तिस्तदा भिषक् ॥ ४३ ॥
इति राजानमापृच्छ्य शस्त्रं साध्ववचारयेत् ।
अक्रियायां ध्रुवो मृत्युः क्रियायां संशयो भवेत् ॥ ४४ ॥
निश्चितस्यापि वैद्यस्य बहुशः सिद्धकर्मणः ।
If by these strategies of remedies, the illness (urinary calculus) doesn’t subside, the doctor ought to then resort to using the sharp instrument appropriately, after acquiring permission from the king (or different administrative authority) explaining as follows:- Demise is certain if surgical treatment shouldn’t be carried out, even when carried out, there’s uncertainty (of life) “as a result of even physicians who’re specialists and modes of therapy thought-about as one of the best, could show in any other case, typically”.

Shalya Vidhi: Surgical therapy

अथातुरमुपस्निग्धशुद्धमीषच्च कर्शितम् ॥ ४५ ॥
अभ्यक्तस्विन्नवपुषमभुक्तं कृतमङ्गलम् ।
आजानुफलकस्थस्य नरस्याङ्के व्यपाश्रितम् ॥ ४६ ॥
पूर्वेण कायेनोत्तानं निषण्णं वस्त्रचुम्भले ।
ततोऽस्याकुञ्चिते जानुकूर्परे वाससा दृढम् ॥ ४७ ॥
सहाश्रयमनुष्येण बद्धस्याश्वासितस्य च ।
नाभेः समन्तादभ्यज्यादधस्तस्याश्च वामतः ॥ ४८ ॥
मृदित्वा मुष्टिनाऽऽक्रामेद्यावदश्मर्यधोगता ।
तैलाक्ते वर्धितनखे तर्जनीमध्यमे ततः ॥ ४९ ॥
अदक्षिणे गुदेऽङ्गुल्यौ प्रणिधायानुसेवनि ।
आसाद्य बलयत्नाभ्यामश्मरीं गुदमेढ्रयोः ॥ ५० ॥
कृत्वान्तरे तथा वस्तिं निर्वलीकमनायतम् ।
उत्पीडयेदङ्गुलीभ्यां यावद्ग्रन्थिरिवोन्नतम् ॥ ५१ ॥
शल्यं स्यात्सेवनीं मुक्त्वा यवमात्रेण पाटयेत् ।
अश्ममानेन न यथा भिद्यते सा तथाहरेत् ॥ ५२ ॥
समग्रं सर्पवक्त्रेण स्त्रीणां वस्तिस्तु पार्श्वगः ।
गर्भाशयाश्रयस्तासां शस्त्रमुत्सङ्गवत् ततः ॥ ५३ ॥
न्यसेदतोऽन्यथा ह्यासां मूत्रस्रावी व्रणो भवेत् ।
मूत्रप्रसेकक्षणनान् नरस्याप्यपि चैकधा ॥ ५४ ॥
वस्तिभेदोऽश्मरीहेतुः सिद्धिं याति न तु द्विधा ।
Subsequent, the affected person who has been given delicate oleation and purifactory therapies, made barely skinny (by fasting) needs to be anointed everywhere in the physique with oil, given delicate fomentation, prevented from consuming and allowed to carry out auspicious rites. He ought to then be made to lie on a picket sofa which has top of 1’s knee, going through upwards, the legs folded on the knees and positioned over the higher a part of the physique, elbows too positioned equally (knees and elbows), firmly sitting or mendacity or resting or leaning upon folded and certain collectively tight with bands of fabric. He ought to then be held tight by attendants and inspired with brave phrases. Subsequent, the area beneath the umbilicus, needs to be anointed with oil, and massaged, commencing from the left aspect. The doctor ought to knead the area (of the urinary bladder) by his palms in order to deliver the stone downward. Subsequent, the index and center fingers which have been intently pared of their nails and anointed with oil. These fingers needs to be launched into the rectum from the best aspect within the line of the perineum. Then by exerting power and strain the stone is made to come back to the center of the rectum and penis and held in place. Subsequent, the realm over the urinary bladder is constricted, the folds over it warded off. Squeezed by the fingers, (within the downward course) until the international physique (stone) bulges out like a tumor, then, avoiding the road of the sevani (vesico-rectal raphae) an incision of the dimensions of a barley or the dimensions of the stone needs to be made (barely to the left of the raphae) and the stone extracted fully through the use of the sarpamukha sastra (forked forceps to carry the stone). In girls, the uterus is situated by the aspect of the urinary bladder, so the instrument needs to be launched with its face downwards. In any other case, there’s chance of inflicting a wound via which urine flows out as a consequence of harm to the urethra. This chance is for males additionally. Incising the urinary bladder as soon as at one place for the rationale of eradicating the stone turns into profitable and will get healed however not for the second time (or carried out at two locations).

Observe up of surgical therapy

विशल्यमुष्णपानीयद्रोण्यां तमवगाहयेत् ॥ ५५ ॥
तथा न पूर्यतेऽस्रेण वस्तिः पूर्णे तु पीडयेत् ।
मेढ्रान्तः क्षीरिवृक्षाम्बु मूत्रसंशुद्धये ततः ॥ ५६ ॥
कुर्याद्गुडस्य सौहित्यं मध्वाज्याक्तव्रणः पिबेत् ।
द्वौ कालौ सघृतां कोष्णां यवागूं मूत्रशोधनैः ॥ ५७ ॥
त्र्यहं दशाहं पयसा गुडाढ्येनाल्पमोदनम् ।
भुञ्जीतोर्ध्वं फलाम्लैश्च रसैर्जाङ्गलचारिणाम् ॥ ५८ ॥
After the elimination of the international physique (stone) the affected person ought to lie in tub comprise heat water, in order that the urinary bladder doesn’t get crammed up with blood. Nonetheless if the blood collects inside, decoction of bark of timber having milky sap needs to be squeezed into the penis (as uttarabasti- douche into the bladder). Then, the wound needs to be smeared with a mix of honey and ghee.  The affected person is nourished with extra of jaggery/molasses; with a purpose to purify the urine. He ought to drink heat yavagu (skinny gruel) processed with herbs which purify the urine, added with ghee, at each occasions (of meals) for the primary three days. For the following ten days, he ought to eat little amount of boiled rice together with milk added with extra of jaggery/ molassess, adopted by ingesting the juice of bitter fruits and soup of meat of animals dwelling in desert-like areas.

Observe up of surgical therapy

क्षीरिवृक्षकषायेण व्रणं प्रक्षाल्य लेपयेत् ।
प्रपौण्डरीकमञ्जिष्ठायष्ट्याह्वनयनौषधैः ॥ ५९ ॥
व्रणाभ्यङ्गे पचेत्तैलमेभिरेव निशान्वितैः ।
The wound needs to be washed with the decoction of bark of timber yielding milky sap, paste of prapauṇḍarīka – Nelumbo nucifera, mañjiṣṭhā – Rubia cordifolia, yaṣṭyāhva – Glycyrrhiza glabra, and nayana auṣadhaiḥ – Symplocos crataegoids utilized over it. For anointing the wound, medicated oil needs to be ready with the above herbs solely with the addition of Curcuma longa.

Agnikarma: Cauterization with hearth

दशाहं स्वेदयेच्चैनं स्वमार्गं सप्तरात्रतः ॥ ६० ॥
मूत्रे त्वगच्छति दहेदश्मरीव्रणमग्निना ।
स्वमार्गप्रतिपत्तौ तु स्वादुप्रायैरुपाचरेत् ॥ ६१ ॥
The wound needs to be fomented for ten days. If inside seven days, the urine doesn’t movement out, via the conventional passage, the wound made for eradicating the stone needs to be branded (cauterized) with hearth. If the urine is discovered popping out via its regular passage, the affected person needs to be nursed with enemas that comprise extra of candy herbs (decoction enema with decoction of herbs of candy style).

Guidelines to be adopted after the injuries are healed

तं वस्तिभिर्न चारोहेद्वर्षं रूढव्रणोऽपि सः ।
नगनागाश्ववृक्षस्त्रीरथान् नाप्सु प्लवेत च ॥ ६२ ॥
Even after the wound has healed, the affected person ought to neither climb a hill, an elephant, horse, tree, girl or chariot, nor ought to he swim in water

Guidelines to be adopted after the injuries are healed

मूत्रशुक्रवहौ वस्तिवृषणौ सेवनीं गुदम् ।
मूत्रप्रसेकं योनिं च शस्त्रेणाष्टौ विवर्जयेत् ॥ ६३ ॥
Channels of urine and semen, the urinary bladder, testes, the raphae, rectum, urethra and vagina these eight, needs to be prevented in using sharp devices (shouldn’t be injured).

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने मूत्राघातचिकित्सितं नामैकादशोऽध्याय: ॥११॥
Thus ends the chapter mutraghata cikitsa- the eleventh in cikitsita sthana of Astangahrdaya Samhita composed by srimad Vagbhata, son of Sri Vaidyapati Simhagupta.