Ashtanga Hridayam Chikitsa sthanam Chapter 11: Mutraghata Chikitsitam Adhyaya (Treatments of retention of urine)

The 11th chapter of Cikitsasthanam of Ashtanga Hridayam is named as Mutraghata cikitsitam Adhyayah. This chapter deals with the explanation of treatment of retention of urine.

The topics covered in this chapter include –

–     Vataja mutrakrcchra cikitsa
–     Dasamuladi Sneha
–     Pittaja mutrakrcchra cikitsa
–     Kaphaja mutrakrcchra cikitsa
–     Sannipataja mutrakrcchra cikitsa
–     Asmari Cikitsa – treatment of urinary calculus
–     Vataja Asmari Cikitsa
–     Pittaja Asmari Cikitsa
–     Kaphaja Asmari Cikitsa
–     Mutrasarkara Cikitsa
–     Mutraghata Cikitsa
–     Remedy for all urinary diseases
–     Method of dislodging the stone
–     Virataradi Gana
–     Virecana, Vasti and Uttara Vasti
–     Sukrasmari Cikitsa
–     Decision for surgical treatment
–     Shalya Vidhi – Surgical treatment
–     Follow up of surgical treatment
–     Agnikarma – cauterization with fire
–     Rules to be followed after the wounds are healed

Pledge by the author(s)

अथातो मूत्राघातचिकित्सितं व्याख्यास्याम: व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of retention of urine’. Thus say (pledge) Atreya and other sages.

Vataja mutrakrcchra chikitsa

कृच्छ्रे वातघ्नतैलाक्तमधोनाभेः समीरजे ।
सुस्निग्धैः स्वेदयेदङ्गं पिण्डसेकावगाहनैः ॥ १ ॥
In case of mutrakrcchra (dysuria) arising from vata, the body of the patient should be anointed with medicated oil which mitigates vata. Onthe region below the umbilicus, which has been properly anointed with medicated oil, should be given fomentation either with warm bolus herbs, or pouring warm liquids or tub bath.

Dashamuladi Sneha

दशमूलबलैरण्डयवाभीरुपुनर्नवैः ।
कुलत्थकोलपत्तूरवृश्चीवोपलभेदकैः ॥ २ ॥
तैलसर्पिर्वराहर्क्षवसाः क्वथितकल्कितैः ।
सपञ्चलवणाः सिद्धाः पीताः शूलहराः परम् ॥ ३ ॥
Medicated fat prepared with the decoction of daśamūla – group of ten roots, balā – Sida cordifolia, eraṇḍa – Ricinus communis, yavā – Hordeum vulgare, bhīru – Asparagus racemosus, punarnava – Boerhavia diffusa, kulattha – Dolichos biflorus, kola – Ziziphus mauritiana, pattūra – Caesalpinia sappan, vṛścīva – Boerhavia diffusa, upalabhedaka – Bergenia ligulata; oil, ghee, muscles-fat of a boar and a bear and added with the five salts, processed with the paste of the above mentioned herbs, (after cooking) and consumed in suitable dose, is best to relieve the pain (of dysuria).

Vataja mutrakrichra chikitsa

द्रव्याण्येतानि पानान्ने तथा पिण्डोपनाहने ।
सह तैलफलैर्युञ्ज्यात् साम्लानि स्नेहवन्ति च ॥ ४ ॥
These same herbs may be made to prepare drinks and eatables as well as for making bolus and paste for fomentation and poultices, along with fruits yielding oil, mixed with sours and fats.

Vataja mutrakricchra chikitsa

सौवर्चलाढ्यां मदिरां पिबेन् मूत्ररुजापहाम् ।
Medicated alcoholic drink added with more quantity of black salt should be drunk, for relief from pain of urinary elimination.

Pittaja mutrakricchra chikitsa

पैत्ते युञ्जीत शिशिरं सेकलेपावगाहनम् ॥ ५ ॥
In case of mutrakrcchra (dysuria) arising from pitta administer bathing with liquids, application of paste and tub-bath by substances thatarecold in nature.

Pittaja mutrakrIcchra chikitsa

पिबेद्वरीं गोक्षुरकं विदारीं सकसेरुकाम् ।
तृणाख्यं पञ्चमूलं च पाक्यं समधुशर्करम् ॥ ६ ॥
Decoction of varīṃ – Asparagus racemosus, gokṣurakaṃ – Tribulus terrestris, vidārīṃ – Pueraria tuberosa, kaseruka – Scirpus grossus, and herbs of trnapancamula (roots of five grasses) should be consumed added with honey and sugar.

Pittaja mutrakricchra chikitsa

वृषकं त्रपुसैर्वारुलट्वाबीजानि कुङ्कुमम् ।
द्राक्षाम्भोभिः पिबन् सर्वान् मूत्राघातानपोहति ॥ ७ ॥
vṛṣaka – Bergenia ligulata, seeds of: trapusa – Cucumis sativus, ervāru – Cucumis melo, laṭvā – Carthamus tinctorius, kuṅkumam – Crocus sativus (made into a paste) mixed with water, drākṣā piban – Vitis vinifera is squeezed and consumed, cures all kinds of difficulty or blocked urine flow.

Pittaja mutrakricchra chikitsa

एर्वारुबीजयष्ट्याह्वदार्वीर्वा तण्डुलाम्बुना ।
तोयेन कल्कं द्राक्षायाः पिबेत् पर्युषितेन वा ॥ ८ ॥
Seeds of ervāru – Cucumis melo, yaṣṭyāhva – Glycyrrhiza glabra, dārvī: vā – Berberis aristata should be consumed with rice-wash. Paste of drākṣā – Vitis vinifera mixed with water boiled and cooled should be consumed.

Kaphaja mutrakricchra chikitsa

कफजे वमनं स्वेदं तीक्ष्णोष्णकटुभोजनम् ।
यवानां विकृतीः क्षारं कालशेयं च शीलयेत् ॥ ९ ॥
In case of mutrakrccha (dysuria) due to high kapha, administration of emesis, sudation, ingestion of food which possess penetrating, hot and pungent properties, eatables prepared from Hordeum vulgare, alkaline substances and buttermilk should be done.

Kaphaja mutrakricchra chikitsa

पिबेन्मद्येन सूक्ष्मैलां धात्रीफलरसेन वा ।
सारसास्थिश्वदंष्ट्रैलाव्योषं वा मधुमूत्रवत् ॥ १० ॥
स्वरसं कण्टकार्या वा पाययेन्माक्षिकान्वितम् ।
शितिवारकबीजं वा तक्रेण श्लक्ष्णचूर्णितम् ॥ ११ ॥
धवसप्ताह्वकुटजगुडूचीचतुरङ्गुलम् ।
केम्बुकैलाकरञ्जं च पाक्यं समधु साधिताम् ॥ १२ ॥
तैर्वा पेयां प्रवालं वा चूर्णितं तण्डुलाम्बुना ।
सतैलं पाटलाक्षारं सप्तकृत्वोऽथवा स्रुतम् ॥ १३ ॥
Powder of Small sized sūkṣmailāṃ – Elettaria cardamomum should be consumed with either wine or juice of dhatriphala (Emblica officinalis) or (ash of) bones of Sarasa bird, powder of śvadaṃṣṭrā – Tribulus terrestris, elā – Elettaria cardamomum, vyoṣa – and Piper longum, Piper nigrum and Zingiber officinale along with honey kaṇṭakāri – juice of Solanum xanthocarpum should be drunk mixed with honey or fine powder of śitivārakabīja – seeds of Pongamia pinnata mixed with buttermilk; Decoction of : dhava – Anogeissus latifolia, saptāhva – Alstonia scholaris, kuṭaja – Holarrhena antidysenterica, guḍūcī – Tinospora cordifolia, caturaṅgulam – Cassia fistula, kembuka – Costus speciosus, elā – Elettaria cardamomum, karañja – Pongamia pinnata, should be prepared mixed with honey (should be consumed) or thin gruel prepared from the above herbs; or powder of coral mixed with rice-wash; or pāṭalā – ash of Stereospermum Suaveolens washed in water and filtered for seven times can be consumed mixed with oil.

Kaphaja mutrakricchra chikitsa

पाटलीयावशूकाभ्यां पारिभद्रात्तिलादपि ।
क्षारोदकेन मदिरां त्वगेलोषणसंयुताम् ॥ १४ ॥
पिबेद्गुडोपदंशान्वा लिह्यादेतान् पृथक् पृथक् ।
pāṭalī – Stereospermum suaveolens, yava śūka – straw of Hordeum vulgare, pāribhadra – Erythrina indica, tila – or Sesamum indicum their ash dissolved in water, is mixed with madira (alcoholic drink) powder of tvak – Cinnamomum zeylanica, elā – Elettaria cardamom ūṣaṇa – and Piper nigrum should be consumed, or powder of these herbs individually may be licked or drunk with powder of jaggery, treacle.

Sannipataja mutrakricchra chikitsa

सन्निपातात्मके सर्वं यथावस्थमिदं हितम् ॥ १५ ॥
अश्मन्यप्यचिरोत्थाने वातवस्त्यादिकेषु च ।
In case of mutrakrcchra (dysuria) of sannipata origin these treatments are good when adopted suitable to the stage / condition of the disease. This holds good even for asmari (urinary calulus) of recent onset and also for vatabasti etc. disorders.

Ashmari Chikitsa: Treatment of urinary calculus

अश्मरी दारुणो व्याधिरन्तकप्रतिमो मतः ॥ १६ ॥
तरुणो भेषजैः साध्यः प्रवृद्धश्छेदमर्हति ।
तस्य पूर्वेषु रूपेषु स्नेहादिक्रम इष्यते ॥ १७ ॥
Ashmari is a grave disease, simulating death. It is manageable with herbs when it is of recent onset but when greatly developed, it requires surgical operation. In its premonitory stage, oleation and other therapies are needed.

Vataja Ashmari Chikitsa

पाषाणभेदो वसुको वशिरोऽश्मन्तको वरी ।
कपोतवङ्कातिबलाभल्लूकोशीरकच्छकम् ॥१८॥
वृक्षादनी शाकफलं व्याघ्र्यौ गुण्ठस्त्रिकण्टकः ।
यवाः कुलत्थाः कोलानि वरुणः कतकात्फलम् ॥१९॥
ऊषकादिप्रतीवापमेषां क्वाथे शृतं घृतम् ।
भिनत्ति वातसम्भूतां तत्पीतं शीघ्रमश्मरीम् ॥ २० ॥
Medicated ghee prepared with the decoction of pāṣāṇabheda – Bergenia ligulata, vasuka – isvaramalika, sea salt, aśmantaka – Bauhinia vahlii, varī – Asparagus racemosus, kapotavaṅka – Cleome viscosa, atibalā – Abutilon indicum, bhallūka – Oroxylum indicum, uśīra – Vetiveria zizanioides, kacchaka – Xanthium indicum, vṛkṣādanī – Dendrophthoe falcate, śākaphala – Coccinia indica, vyāghryau – the two vyaghri (Solanum indicum and Solanum xanthocarpum), guṇṭha: – Typha angustata, trikaṇṭaka – Tribulus terrestris, yava – Hordeum vulgare, kulatthāḥ – Dolichos biflorus, kola – Ziziphus mauritiana, varuṇa – Crateva nurvula, katakātphalam – and Strychnos potatorum, paste of usaka etc. and ghrita (butter fat is prepared). This ghee consumed, breaks the stone produced by vata quickly.

Vataja Ashmari Chikitsa

गन्धर्वहस्तबृहतीव्याघ्रीगोक्षुरकेक्षुरात् ।
मूलकल्कं पिबेद्दध्ना मधुरेणाश्मभेदनम् ॥ २१ ॥
Paste of roots of gandharvahasta – Ricinus communis, bṛhatī – Solanum indicum, vyāghrī – Solanum xanthocarpum, gokṣuraka – Tribulus terrestris, ikṣura – Asteracantha longifolia / Hygrophila schulli consumed mixed with curds, which is sweet breaks the stone.

Pittaja Ashmari Chikitsa

कुशः काशः शरो गुण्ठ इत्कटो मोरटोऽश्मभित् ।
दर्भो विदारी वाराही शालिमूलं त्रिकण्टकः ॥२२॥
भल्लूकः पाटली पाठा पत्तूरः सकुरण्टकः ।
पुनर्नवे शिरीषश्च तेषां क्वाथे पचेद्घृतम् ॥ २३ ॥
पिष्टेन त्रपुसादीनां बीजेनेन्दीवरेण च ।
मधुकेन शिलाजेन तत् पित्ताश्मरिभेदनम् ॥ २४ ॥ Medicated ghee is prepared with the decoction of kuśa – Desmostachya bipinnata, kāśa – Saccharum spontaneum, śara – Saccharum munja, guṇṭha – Typha angustata, itkaṭa – Sesbania bispinosa, moraṭa – Saccharum officinarum, aśmabhit – Bergenia ligulata, darbha – Desmostachya bipinnata, vidārī – Pueraria tuberosa, vārāhī – Dioscorea bulbifera, śālimūlaṃ – roots of Oryza sativa, trikaṇṭakaḥ – Tribulus terrestris, bhallūka – Oroxylum indicum, pāṭalī – Stereospermum suaveolens, pāṭhā – Cissampelos pareira, pattūra – Caesalpinia sappan, kuraṇṭaka – Barleria cristata, punarnava – Boerhavia diffusa, śirīṣa – and Albizia lebbeck and paste of seeds of trapus – Cucumis sativus, indīvara – Monochoria vaginalis, madhuka – Glycyrrhiza glabra, and śilāja – Asphaltum, this recipe breaks the stone formed from pitta.

Kaphaja Ashmari Chikitsa

वरुणादिः समीरघ्नौ गणावेला हरेणुका ।
गुग्गुलुर्मरिचं कुष्ठं चित्रकः ससुराह्वयः ॥२५ ॥
तैः कल्कितैः कृतावापमूषकादिगणेन च ।
भिनत्ति कफजामाशु साधितं घृतमश्मरीम् ॥ २६ ॥
Medicated ghee prepared with the decoction of herbs of Varunadi gana, samiraghna gana – group of Vata balancing herbs, elā – Elettaria cardamomum, hareṇukā – Pisum sativum, guggulu: – Commiphora mukul, maricaṃ – Piper nigrum, kuṣṭhaṃ – Saussurea lappa, citrakaḥ – Plumbago zeylanica, surāhva – and Cedrus deodara; paste of herbs of usakadi gana (chapter 15 of sutrasthana) and ghee. This breaks the stone formed from kapha quickly.

Kaphaja Ashmari Chikitsa

क्षारक्षीरयवाग्वादि द्रव्यैः स्वैः स्वैश्च कल्पयेत् ।
Alkalies milk gruel etc. prepared with their own herbs (meant for them) should be administered.

Mutrasharkara Chikitsa

पिचुकाङ्कोल्लकतकशाकेन्दीवरजैः फलैः ॥ २७ ॥
पीतमुष्णाम्बु सगुडं शर्करापातनं परम् ।
क्रौञ्चोष्ट्ररासभास्थीनि श्वदंष्ट्रा तालपत्रिका ॥ २८ ॥
अजमोदा कदम्बस्य मूलं विश्वस्य चौषधम् ।
पीतानि शर्करां भिन्द्युः सुरयोष्णोदकेन वा ॥२९॥
Powder of picukā – Vangueria spinosa, aṅkolla – Alangium salviifolium, kataka – Strychnos potatorum, leaves and fruits of indīvara – Monochoria vaginalis, consumed along with hot / warm water added with jaggery is best to expel the urinary gravel.

Ash of bones of heron, camel, and donkey, powder of śvadaṃṣṭrā – Tribulus terrestris, tālapatrikā – leaves of Borassus flabellifer, consumed either ajamodā – Trachyspermum ammi,root of Kadamba ­- Neolamarckia cadamba and viśva – Zingiber officinale, consumed either with sura (beer) or warm water breaks the urinary gravels.

Mutra sharkara Chikitsa

नृत्यकुण्डकबीजानां चूर्णं माक्षिकसंयुतम् ।
अविक्षीरेण सप्ताहं पीतमश्मरिपातनः ॥३०॥
Powder of seeds of nṛtyakuṇḍaka – Zanthoxylum alatum mixed with honey and ewe’s milk consumed for seven days, eliminates the stone.

Mutrasharkara Chikitsa

क्वाथश्च शिग्रुमूलोत्थः कदुष्णोऽश्मरीपातनः ।
तिलापामार्गकदलीपलाशयवसम्भवः ॥ ३१ ॥
क्षारः पेयोऽविमूत्रेण शर्करास्वश्मरीषु च ।
कपोतवङ्कामूलं वा पिबेदेकं सुरादिभिः ॥ ३२ ॥
तत्सिद्धं वा पिबेत्क्षीरं वेदनाभिरुपद्रुतः ।
हरीतक्यस्थिसिद्धं वा साधितं वा पुनर्नवैः ॥३३॥
क्षीरान्नभुग्बर्हिशिखामूलं वा तण्डुलाम्बुना ।
Decoction of root of śigru – Moringa oleifera, consumed luke-warm, expels the stone.  Ash / alkali of tilā – Sesamum indicum, apāmārga – Achyranthes aspera, kadalī – Musa paradisiacal, palāśa – Butea monosperma, and yava – Hordeum vulgare consumed with sheep’s urine is good for both gravels and stones. powder of) roots of Bacopa monnieri alone consumed with sura etc. (wine) or milk boiled with it should be consumed by the patient suffering from pain. Or milk boiled with seeds of Terminalia chebula or processed with punarnava (Boerhavia diffusa), or roots of Adiantum incisum, along with rice-wash should be consumed and the person should eat, boiled rice and milk.

Mutraghata Chikitsa

मूत्राघातेषु विभजेदतः शेषेष्वपि क्रियाम् ॥ ३४ ॥
The above treatment may be adopted in different kinds of mutraghata also, as and how found suitable.

Remedy for all urinary diseases

बृहत्यादिगणे सिद्धं द्विगुणीकृतगोक्षुरे ।
तोयं पयो वा सर्पिर्वा सर्वमूत्रविकारजित् ॥ ३५ ॥
Decoction, milk or ghee prepared with herbs of brhatyadi- gana (chapter 5 of sutrasthana) with double the quantity of gokṣura – Tribulus terrestris cures all kinds of urinary diseases.

Mutraghata Chikitsa

देवदारुं घनं मूर्वां यष्टीमधु हरीतकीम् ।
मूत्राघातेषु सर्वेषु सुराक्षीरजलैः पिबेत् ॥ ३६ ॥
Powder of devadāru – Cedrus deodara, ghana – Cyperus rotundus, mūrvā – Marsdenia tenacissima, yaṣṭīmadhu – Glycyrrhiza glabra, harītakī – and Terminalia chebula, should be consumed either with beer, milk or water in all the varieties of mutraghata (retention of urine).

Mutraghata Chikitsa

रसं वा धन्वयासस्य कषायं ककुभस्य वा ।
सुखाम्भसा वा त्रिफलां पिष्टां सैन्धवसंयुताम् ॥ ३७ ॥
व्याघ्रीगोक्षुरकक्वाथे यवागूं वा सफाणिताम् ।
क्वाथे वीरतरादेर्वा ताम्रचूडरसेऽपि वा ॥ ३८ ॥
अद्याद्वीरतराद्येन भावितं वा शिलाजतु ।
Juice of dhanvayāsa – Alhagi camelorum or decoction of kakubha – Terminalia arjuna, or paste of triphalāṃ – Terminalia chebula, Terminalia bellirica and Emblica officinalis and rock salt with warm water should be consumed. Yavagu prepared with the decoction of vyāghrī – Solanum xanthocarpum, gokṣuraka – Tribulus terrestris mixed with half- cooked molasses or peya prepared with the decoction of herbs of virataradigana (chapter 15 of sutrasthan) with the soup of meat of tamracuda (cock) should be consumed. śilājatu – Asphaltum macerated with the decoction of herbs of Viratadigana should be partaken.

Method of dislodging the stone

मद्यं वा निगदं पीत्वा रथेनाश्वेन वा व्रजेत् ॥३९॥
शीघ्रवेगेन सङ्क्षोभात्तथास्य च्यवतेऽश्मरी ।
The patient (of urinary stone) should be given a drink of wine and taken for fast ride on a chariot of horses. By the resulting shaking the stone gets dislodged.

Virataradi Gana

सर्वथा चोपयोक्तव्यो वर्गो वीरतरादिकः ॥ ४० ॥
The herbs of virataradigana etc. should be made use of in all the ways (to prepare decoction, peya, yavagu, drinking water etc.)

Virechana, Vasti and Uttara Vasti

रेकार्थं तैल्वकं सर्पिर्वस्तिकर्म च शीलयेत् ।
विशेषादुत्तरान् वस्तीञ्छुक्राश्मर्यां तु शोधिते ॥४१॥
Tailvaka ghrta (chapter 3 of cikitsa sthana) should be used for purgation, enema therapy especially the enema to the urinary bladder should 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 man should be given strong enemas into the urinary tract (especially the uttra basti – enema to the urinary bladder) to purify the receptacle of semen. Then the perso should partake mea which is aphrodisia or meat of the cock. Gsetting contented by this manner, he should copulate with a woman who exhilarates him.

Decision for surgical treatment

सिद्धैरुपक्रमैरेभिर्न चेच्छान्तिस्तदा भिषक् ॥ ४३ ॥
इति राजानमापृच्छ्य शस्त्रं साध्ववचारयेत् ।
अक्रियायां ध्रुवो मृत्युः क्रियायां संशयो भवेत् ॥ ४४ ॥
निश्चितस्यापि वैद्यस्य बहुशः सिद्धकर्मणः ।
If by these methods of treatments, the disease (urinary calculus) does not subside, the physician should then resort to the use of the sharp instrument appropriately, after obtaining permission from the king (or other administrative authority) explaining as follows:- Death is sure if surgical operation is not done, even if done, there is uncertainty (of life) “because even physicians who are experts and modes of treatment considered as the best, may prove otherwise, sometimes”.

Shalya Vidhi: Surgical treatment

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 ।
Next, the patient who has been given mild oleation and purifactory therapies, made slightly thin (by fasting) should be anointed all over the body with oil, given mild fomentation, prevented from eating and allowed to perform auspicious rites. He should then be made to lie on a wooden couch which has height of one’s knee, facing upwards, the legs folded at the knees and placed over the upper part of the body, elbows too placed similarly (knees and elbows), firmly sitting or lying or resting or leaning upon folded and bound together tight with bands of cloth. He should then be held tight by attendants and encouraged with courageous words. Next, the region below the umbilicus, should be anointed with oil, and massaged, commencing from the left side. The physician should knead the region (of the urinary bladder) by his hands so as to bring the stone downward. Next, the index and middle fingers which have been closely pared of their nails and anointed with oil. These fingers should be introduced into the rectum from the right side in the line of the perineum. Then by exerting strength and pressure the stone is made to come to the middle of the rectum and penis and held in position. Next, the area over the urinary bladder is constricted, the folds over it warded off. Squeezed by the fingers, (in the downward direction) till the foreign body (stone) bulges out like a tumor, then, avoiding the line of the sevani (vesico-rectal raphae) an incision of the size of a barley or the size of the stone should be made (slightly to the left of the raphae) and the stone extracted completely by using the sarpamukha sastra (forked forceps to hold the stone). In women, the uterus is located by the side of the urinary bladder, so the instrument should be introduced with its face downwards. Otherwise, there is possibility of causing a wound through which urine flows out due to injury to the urethra. This possibility is for men also. Incising the urinary bladder once at one place for the reason of removing the stone becomes successful and gets healed but not for the second time (or done at two places).

Follow up of surgical treatment

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 removal of the foreign body (stone) the patient should lie in tub contain warm water, so that the urinary bladder does not get filled up with blood. Still if the blood collects inside, decoction of bark of trees having milky sap should be squeezed into the penis (as uttarabasti- douche into the bladder). Then, the wound should be smeared with a mixture of honey and ghee.  The patient is nourished with more of jaggery/molasses; in order to purify the urine. He should drink warm yavagu (thin gruel) processed with herbs which purify the urine, added with ghee, at both times (of meals) for the first three days. For the next ten days, he should eat little quantity of boiled rice along with milk added with more of jaggery/ molassess, followed by drinking the juice of sour fruits and soup of meat of animals living in desert-like regions.

Follow up of surgical treatment

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

Agnikarma: Cauterization with fire

दशाहं स्वेदयेच्चैनं स्वमार्गं सप्तरात्रतः ॥ ६० ॥
मूत्रे त्वगच्छति दहेदश्मरीव्रणमग्निना ।
स्वमार्गप्रतिपत्तौ तु स्वादुप्रायैरुपाचरेत् ॥ ६१ ॥
The wound should be fomented for ten days. If within seven days, the urine does not flow out, through the normal passage, the wound made for removing the stone should be branded (cauterized) with fire. If the urine is found coming out through its normal passage, the patient should be nursed with enemas that contain more of sweet herbs (decoction enema with decoction of herbs of sweet taste).

Rules to be followed after the wounds are healed

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

Rules to be followed after the wounds 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, should be avoided in the use of sharp instruments (should not 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.