The Diagnosis of Urinary Obstruction and Urinary Difficulty

Verse 1 (garuda.1.158.1)

धन्वन्तरिरुवाच । अथातो मूत्रघातस्य निदानं शृणु सुश्रुत । बस्तिबस्तिशिरोमेढ्रकटीवृषणपायु च

dhanvantariruvāca athāto mūtraghātasya nidānaṁ śṛṇu suśruta bastibastiśiromeḍhrakaṭīvṛṣaṇapāyu ca

Dhanvantari said: O Sushruta, now hear the diagnosis of Mutraghata, urinary obstruction. The bladder, the bladder's neck, the penis, the waist, the testicles, and the anus —

Verse 2 (garuda.1.158.2)

एकसंवहनाः प्रोक्ता गुदास्थिविवराश्रयाः । अधोमुखोऽपि बस्तिर्हि मूत्रवाहिशिरामुखैः

ekasaṁvahanāḥ proktā gudāsthivivarāśrayāḥ adhomukho'pi bastirhi mūtravāhiśirāmukhaiḥ

these are said to be connected by a single channel-system, lodged in the cavity of the bone near the anus. The bladder, though its opening faces downward —

Verse 3 (garuda.1.158.3)

पार्श्वेभ्यः पूर्यते श्लक्ष्णै (सूक्ष्मैः) स्यन्दमानैरनारतम् । तैस्तैरेव प्रविश्यैवन्दोषान्कुवन्ति विंशतिम्

pārśvebhyaḥ pūryate ślakṣṇai (sūkṣmaiḥ) syandamānairanāratam taistaireva praviśyaivandoṣānkuvanti viṁśatim

is continuously filled from the sides through fine, ceaselessly flowing channels. Entering through these very channels, the vitiated humors produce twenty kinds of disease.

Verse 4 (garuda.1.158.4)

मूत्राघातः प्रमेहश्च कृच्छ्रान्मर्म समाश्रयेत् । बस्तिवङ्क्षणमेढ्रार्तियुक्तोल्पाल्पं मुहुर्मुहुः

mūtrāghātaḥ pramehaśca kṛcchrānmarma samāśrayet bastivaṅkṣaṇameḍhrārtiyuktolpālpaṁ muhurmuhuḥ

Mutraghata and Prameha, through their severity, can affect the vital points as well. In these there is pain in the bladder, groin, and penis, with urination occurring frequently in small amounts —

Verse 5 (garuda.1.158.5)

मूत्राण्यावातजे कृच्छ्रपीत्ते पीतं सदाहरुक् । रक्तं वा कफजो बस्तिमेढ्रगौरवशोथवान्

mūtrāṇyāvātaje kṛcchrapītte pītaṁ sadāharuk raktaṁ vā kaphajo bastimeḍhragauravaśothavān

in the Vata type, urine is passed with difficulty; in the Pitta type, it is yellow and burning; in the Kapha type, it may be red, with heaviness and swelling of the bladder and penis —

Verse 6 (garuda.1.158.6)

सपिच्छं सनिरुद्धं च सर्वैः सर्वात्मकं मलैः । यदा वायुर्मुखं बस्तेर्व्यावर्त्य पारिशोषयन्

sapicchaṁ saniruddhaṁ ca sarvaiḥ sarvātmakaṁ malaiḥ yadā vāyurmukhaṁ bastervyāvartya pāriśoṣayan

slimy and obstructed; and in the tridoshic type, all these signs appear together from all the humors combined. When Vata, turning aside the mouth of the bladder, dries it completely —

Verse 7 (garuda.1.158.7)

मूत्रं सपित्तं सकफं सशुक्रं वा तदा क्रमात् । संजायतेऽश्मरी घोरा पित्तं गोरिव रोचना

mūtraṁ sapittaṁ sakaphaṁ saśukraṁ vā tadā kramāt saṁjāyate'śmarī ghorā pittaṁ goriva rocanā

then urine, mixed with Pitta, Kapha, or semen, in due course gives rise to the dreadful stone, Ashmari; the Pitta-caused stone resembles gorochana, the bright bile-pigment of a cow —

Verse 8 (garuda.1.158.8)

श्लेष्माश्रया च सर्वा स्यादथास्याः पूर्वलक्षणम् । बस्त्याध्मानं तदासन्नदेशोहि परितोऽतिरुक्

śleṣmāśrayā ca sarvā syādathāsyāḥ pūrvalakṣaṇam bastyādhmānaṁ tadāsannadeśohi parito'tiruk

and all these types may also have kapha as their basis. Its premonitory signs are: distension of the bladder, and severe pain throughout the adjacent region —

Verse 9 (garuda.1.158.9)

बस्तौ च मूत्रसङ्गित्वं मूत्रकृच्छ्रं ज्वरोऽरुचिः । सामान्यलिङ्गं रुङ्नाभिसीवनीबस्तिमूर्धसु

bastau ca mūtrasaṅgitvaṁ mūtrakṛcchraṁ jvaro'ruciḥ sāmānyaliṅgaṁ ruṅnābhisīvanībastimūrdhasu

retention of urine in the bladder, painful urination, fever, and loss of appetite. Its common sign is pain in the navel, perineum, bladder, and the tip of the penis —

Verse 10 (garuda.1.158.10)

विस्तीर्णवा सं मूत्रं स्यात्तथा मार्गनिरोधने । बद्धं बद्ध्वा सुखं मेहेदच्छं गोमेदकोपमम्

vistīrṇavā saṁ mūtraṁ syāttathā mārganirodhane baddhaṁ baddhvā sukhaṁ mehedacchaṁ gomedakopamam

the urine may be either profuse or scanty, and likewise when the passage is obstructed. Retained urine is passed only with difficulty, though comfortably once released, clear and resembling the gomeda gem in color.

Verse 11 (garuda.1.158.11)

तत्संक्षोभाद्भवेत्सासृङ्मांसमध्वनि रुग्भवेत् । तत्र बाताभिसृत्यार्तोदन्तान् खादति वेपते

tatsaṁkṣobhādbhavetsāsṛṅmāṁsamadhvani rugbhavet tatra bātābhisṛtyārtodantān khādati vepate

From its disturbance, urine mixed with blood and flesh-like matter occurs, and pain arises along the urinary tract; there, afflicted by aggravated Vata, the patient gnashes his teeth and trembles —

Verse 12 (garuda.1.158.12)

गृह्णाति मेहनं नाभिं पीडयत्यतिलक्षणम् । सानिलं मुञ्चति शकृन्मुहुर्मेहति बिन्दुशः

gṛhṇāti mehanaṁ nābhiṁ pīḍayatyatilakṣaṇam sānilaṁ muñcati śakṛnmuhurmehati binduśaḥ

he grips his penis and navel, greatly distressed by pain. He passes stool mixed with wind, and urinates repeatedly, drop by drop —

Verse 13 (garuda.1.158.13)

श्यामरूक्षाश्मरी चास्य स्याच्चिता कण्टकैरिव । पित्तेन दह्यते बस्तिः पच्यमान इवोष्णवान्

śyāmarūkṣāśmarī cāsya syāccitā kaṇṭakairiva pittena dahyate bastiḥ pacyamāna ivoṣṇavān

his stone is dark, rough, and as if studded with thorns — this is the Vata type. From Pitta, the bladder burns as if being cooked, with heat —

Verse 14 (garuda.1.158.14)

भल्लातकास्थिसंस्थाना रक्ता पीता सिताश्मरा । बस्तिर्निस्तुद्यत इव श्लेष्मणा शीतलो गुरुः

bhallātakāsthisaṁsthānā raktā pītā sitāśmarā bastirnistudyata iva śleṣmaṇā śītalo guruḥ

the stone is shaped like the seed of the bhallataka fruit, and is red, yellow, or white — this is the Pitta type. From Kapha, the bladder feels as if being pierced, cold and heavy —

Verse 15 (garuda.1.158.15)

अश्मरी महती श्लक्ष्णा मधुवर्णाथ वा सिता । एता भवन्ति बालनां तेषामेव च भूयसाम्

aśmarī mahatī ślakṣṇā madhuvarṇātha vā sitā etā bhavanti bālanāṁ teṣāmeva ca bhūyasām

the stone is large, smooth, and honey-colored or white — this is the Kapha type. These arise in children, and mostly recur in the same children —

Verse 16 (garuda.1.158.16)

आशयोपचयाल्पत्वाद्गहणाहरणे सुखी । सुक्राश्मरी तु महती जायते शुक्रधारणात्

āśayopacayālpatvādgahaṇāharaṇe sukhī sukrāśmarī tu mahatī jāyate śukradhāraṇāt

because their bladder-reservoir is small, taking hold of and removing the stone is relatively easy. But Shukrashmari, a large stone, arises from the suppression of semen —

Verse 17 (garuda.1.158.17)

स्थानच्युतमभुक्तं वा अण्डयोरन्तरेऽनिलः । शोषयत्युपसंगृह्य शुक्रं तच्छुक्रमश्मरी

sthānacyutamabhuktaṁ vā aṇḍayorantare'nilaḥ śoṣayatyupasaṁgṛhya śukraṁ tacchukramaśmarī

when semen, dislodged from its place, or left unspent, remains between the testicles, Vata seizes and dries it, and that semen becomes the stone —

Verse 18 (garuda.1.158.18)

बस्तिरुक्कृच्छ्रमूत्रत्वं शुक्ला श्वयथुकारिणी । तस्यामुत्पन्नमात्रायां शुष्कमेत्य विलीयते

bastirukkṛcchramūtratvaṁ śuklā śvayathukāriṇī tasyāmutpannamātrāyāṁ śuṣkametya vilīyate

causing pain in the bladder, painful urination, and swelling; it is white in color. As soon as it forms, being dry, it soon dissolves.

Verse 19 (garuda.1.158.19)

पीडिते ज्वरकासेऽस्मिन्नश्मर्येव च शर्करा । असौ वा वायुना भिन्ना सा त्वस्मिन्नमुलोमगे

pīḍite jvarakāse'sminnaśmaryeva ca śarkarā asau vā vāyunā bhinnā sā tvasminnamulomage

When afflicted by fever and cough, gravel forms just like the stone; or it, broken apart by Vata, moves in the wrong direction —

Verse 20 (garuda.1.158.20)

निरेति सह मूत्रेण प्रतिलोमे विपच्यते । मूत्रसंधारणं कुर्यात्क्रुद्धो बस्तेर्मुखे मरुत्

nireti saha mūtreṇa pratilome vipacyate mūtrasaṁdhāraṇaṁ kuryātkruddho bastermukhe marut

and passes out with the urine when moving in the proper direction, but becomes more solidified when it moves against it. Aggravated Vata at the mouth of the bladder causes retention of urine —

Verse 21 (garuda.1.158.21)

मूत्रसङ्गं रुजं कण्डूं कदाचिच्च सुवामतः । प्रच्छाद्य बस्तिमुद्धृत्य गर्मान्तं स्थूलविप्लुताम्

mūtrasaṅgaṁ rujaṁ kaṇḍūṁ kadācicca suvāmataḥ pracchādya bastimuddhṛtya garmāntaṁ sthūlaviplutām

producing retention of urine, pain, itching, and sometimes vomiting; covering the bladder and pulling it upward, it swells and extends into the region of the groin —

Verse 22 (garuda.1.158.22)

करोति तत्र रुग्दाहं स्पन्दनोद्वेष्टनानि च । बिन्दुशश्च प्रवर्तेत मूत्रं बस्तौ तु पीडिते

karoti tatra rugdāhaṁ spandanodveṣṭanāni ca binduśaśca pravarteta mūtraṁ bastau tu pīḍite

producing pain and burning there, along with throbbing and twisting sensations; and, while the bladder is under pressure, urine is released only drop by drop —

Verse 23 (garuda.1.158.23)

धारावरोधश्चाप्येष वातबस्तिरिति स्मृतः । दुस्तरो दुस्तरतरो द्वितीयः प्रबलोऽनिलः

dhārāvarodhaścāpyeṣa vātabastiriti smṛtaḥ dustaro dustarataro dvitīyaḥ prabalo'nilaḥ

this obstruction of the urine's stream is called Vatabasti. It is difficult, and its second variety, caused by even more powerful Vata, is still more difficult —

Verse 24 (garuda.1.158.24)

शकृप्मार्गस्य बस्तेश्च वायुरन्तरमाश्रितः । अष्ठीलाभं घनं ग्रन्थिं करोत्यच (ब) लमुन्नतम्

śakṛpmārgasya basteśca vāyurantaramāśritaḥ aṣṭhīlābhaṁ ghanaṁ granthiṁ karotyaca (ba) lamunnatam

Vata lodged between the passage of the stool and the bladder produces a dense, round knot-like swelling that is weak yet raised —

Verse 25 (garuda.1.158.25)

वाताष्ठीलेति सात्मानं विष्णूत्रानिल (ति) सर्गकृत् । विगुणः कुण्डलीभूतो बस्तौ तीव्रव्यथोनिलः

vātāṣṭhīleti sātmānaṁ viṣṇūtrānila (ti) sargakṛt viguṇaḥ kuṇḍalībhūto bastau tīvravyathonilaḥ

this is called Vatashthila, which obstructs the release of urine and wind. In another form, deranged Vata, coiled like a serpent in the bladder, causes intense pain —

Verse 26 (garuda.1.158.26)

आबध्य मूत्रं भ्रमति संस्तम्भोद्वेष्टगौरवम् । मूत्रमल्पाल्पमथवा विमुञ्चति सकृत्सकृत्

ābadhya mūtraṁ bhramati saṁstambhodveṣṭagauravam mūtramalpālpamathavā vimuñcati sakṛtsakṛt

it obstructs the urine and roams about, with stiffness, twisting, and heaviness; urine comes out only in small amounts, again and again —

Verse 27 (garuda.1.158.27)

वातकुण्डलिकेत्येव मूत्रं तु विधृतेऽचिरम् । न निरेति निरुद्धं वा मूत्रातीतं तदल्परुक्

vātakuṇḍaliketyeva mūtraṁ tu vidhṛte'ciram na nireti niruddhaṁ vā mūtrātītaṁ tadalparuk

this is called Vatakundalika. When retained urine does not soon come out, or remains fully blocked and unpassed, this is called Mutratita, with only mild pain —

Verse 28 (garuda.1.158.28)

विधारणात्प्रतिहतं वातादावर्तितं यदा । नाभेरधस्तादुदरं मूत्रमापूरयेत्तदा

vidhāraṇātpratihataṁ vātādāvartitaṁ yadā nābheradhastādudaraṁ mūtramāpūrayettadā

when Vata, obstructed through suppression and thrown into reverse motion, fills the abdomen below the navel with urine —

Verse 29 (garuda.1.158.29)

कुर्यात्तीव्ररुगाध्मानमशक्तिं मलसंग्रहम् । तन्मूत्रं जाठरच्छिद्रवैगुण्येनानिलेन वा

kuryāttīvrarugādhmānamaśaktiṁ malasaṁgraham tanmūtraṁ jāṭharacchidravaiguṇyenānilena vā

it produces severe pain, distension, weakness, and retention of stool. That urine, through a defect in an opening of the abdomen, or through deranged Vata —

Verse 30 (garuda.1.158.30)

आक्षिप्तमल्पमूत्रस्य वस्तौ नाभौ च वा मले । स्थित्वा प्लवेच्छनैः पश्चात्सरुजं वाथवारुजम्

ākṣiptamalpamūtrasya vastau nābhau ca vā male sthitvā plavecchanaiḥ paścātsarujaṁ vāthavārujam

is drawn in, and, settling in the bladder, navel, or bowel, later discharges slowly, either with pain or without —

Verse 31 (garuda.1.158.31)

मूत्रोत्सर्गं सविच्छिन्नं तच्छ्रेयो गुरुशेफसोः । अन्तर्वस्ति मुखे तृष्णा स्थिराल्पं सहसा भवेत्

mūtrotsargaṁ savicchinnaṁ tacchreyo guruśephasoḥ antarvasti mukhe tṛṣṇā sthirālpaṁ sahasā bhavet

with an intermittent flow of urine; this is more manageable in one with a heavy phallus. Within the bladder's opening there is thirst, and suddenly a fixed, small mass forms —

Verse 32 (garuda.1.158.32)

अश्मरीतुल्यरुग्ग्रन्थिर्मूत्रग्रन्थिः स उच्यते । मूत्रितस्य स्त्रियं यातो वायुना शुक्रमुद्धृतम्

aśmarītulyaruggranthirmūtragranthiḥ sa ucyate mūtritasya striyaṁ yāto vāyunā śukramuddhṛtam

causing pain like that of a stone — this is called Mutragranthi. In one who has urinated and then approached a woman, semen forcibly ejected by aggravated Vata —

Verse 33 (garuda.1.158.33)

स्थानाच्च्युतं मूत्रयतः प्राक्पश्चाद्वा प्रवर्तते । भस्मोदकप्रतीकाशं मूत्रशुक्रं तदुच्यते

sthānāccyutaṁ mūtrayataḥ prākpaścādvā pravartate bhasmodakapratīkāśaṁ mūtraśukraṁ taducyate

having been dislodged from its place, is discharged either before or after urination; this urine, resembling ash-water in appearance, is called Mutrashukra.

Verse 34 (garuda.1.158.34)

रूक्षदुर्बलयोर्वातेनोदावर्तं शकृद्यदा । मूत्रस्रोतोऽनुपर्येति संसृष्टं शकृता तदा

rūkṣadurbalayorvātenodāvartaṁ śakṛdyadā mūtrasroto'nuparyeti saṁsṛṣṭaṁ śakṛtā tadā

In a dry, weak person, when stool, driven by Vata into Udavarta, reverse-flowing colic, follows along the urinary channel, mixed with stool —

Verse 35 (garuda.1.158.35)

मूत्रबिन्दुं तुल्यगन्धं स्याद्विघातं तमादिशेत् । पित्तव्यायामतीक्ष्णाम्लभोजनाध्मानकादिभिः

mūtrabinduṁ tulyagandhaṁ syādvighātaṁ tamādiśet pittavyāyāmatīkṣṇāmlabhojanādhmānakādibhiḥ

urine passed drop by drop with the same odor as stool should be recognized as a type of Mutraghata. From Pitta, exertion, and excessively sharp, sour foods, along with distension —

Verse 36 (garuda.1.158.36)

प्रवृद्धवायुना मूत्रे वस्तिस्थे चैव दाहकृत् । मूत्रं वर्तयते पूर्वं सरक्तं रक्तमेव वा

pravṛddhavāyunā mūtre vastisthe caiva dāhakṛt mūtraṁ vartayate pūrvaṁ saraktaṁ raktameva vā

aggravated Vata makes the urine lodged in the bladder produce a burning sensation; the urine passed at first is blood-tinged or entirely red —

Verse 37 (garuda.1.158.37)

उष्णं पुनः पुनः कृच्छ्रादुष्णवातं वदन्ति तम् । रूक्षस्य क्लान्तदेहस्य बस्तिस्थौ पित्तमारुतौ

uṣṇaṁ punaḥ punaḥ kṛcchrāduṣṇavātaṁ vadanti tam rūkṣasya klāntadehasya bastisthau pittamārutau

and hot, coming with difficulty again and again — this is called Ushnavata. In a dry, exhausted person, Pitta and Vata lodged together in the bladder —

Verse 38 (garuda.1.158.38)

मूत्रक्षयं सरुग्दाहं जनयेतां तदाह्वयम् । पित्तं कफो द्वादपि वा संहन्येतेनिलेनचेत्

mūtrakṣayaṁ sarugdāhaṁ janayetāṁ tadāhvayam pittaṁ kapho dvādapi vā saṁhanyetenilenacet

produce Mutrakshaya, diminished urine flow, with pain and burning; it is known by that very name. If Pitta and Kapha, or both together, become combined with Vata —

Verse 39 (garuda.1.158.39)

कृच्छ्रान्मूत्रं तदा पीतं रक्तं श्वेतं घनं सृजेत् । सदाहं रोचनाशङ्खचूर्णवर्णं भवेच्च तत्

kṛcchrānmūtraṁ tadā pītaṁ raktaṁ śvetaṁ ghanaṁ sṛjet sadāhaṁ rocanāśaṅkhacūrṇavarṇaṁ bhavecca tat

then urine is passed with difficulty, yellow, red, white, or thick, with burning, and takes on the color of gorochana or powdered conch-shell —

Verse 40 (garuda.1.158.40)

शुष्कं समस्तवर्णं वा मूत्रसादं वदन्तितम् । इति विस्तारतः प्रोक्ता रोगा मूत्रप्रवर्तिताः

śuṣkaṁ samastavarṇaṁ vā mūtrasādaṁ vadantitam iti vistārataḥ proktā rogā mūtrapravartitāḥ

or it becomes dry and shows a mixture of all these colors — this is called Mutrasada. Thus, in detail, the diseases arising from disorders of urination have been described.