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Chapter 31 — Mutraghata Nidana

The 31st chapter of Madhava Nidana deals with Mutraghata Nidana i.e,.,
Suppression of Urine and its diseases.

जायन्ते कुपितैर्दोषैर्मूत्राघातास्त्रयोदश | 
प्रायो मूत्रविघाताध्यैर्वातकुण्डलिकादयः || १ ||

jāyantē kupitairdōṣairmūtrāghātāstrayōdaśa |
prāyō mūtravighātādhyairvātakuṇḍalikādayaḥ || 1 ||

Thirteen kinds of mutraghata beginning with vatakundalika are caused by one or more of the tridoshas and suppression of natural urges and the like.1

Vatakundalika (Spasmodic stricture) —

रौक्ष्याद्वेगविघाताद्वा वायुर्बस्तौ सवेदनः |
मूत्रमाविश्य चरति विगुणः कुण्डलीकृतः || २ ||
मूत्रमल्पाल्पमथवा सरुजं सम्प्रवर्तते |
वातकुण्डलिकां तां तु व्याधिं विध्यात् सुदारुणम् || ३ ||

raukṣyādvēgavighātādvā vāyurbastau savēdanaḥ |
mūtramāviśya carati viguṇaḥ kuṇḍalīkr̥taḥ || 2 ||
mūtramalpālpamathavā sarujaṁ sampravartatē |

vātakuṇḍalikāṁ tāṁ tu vyādhiṁ vidhyāt sudāruṇam || 3 ||

The symptoms of the dreadful disease of Vatakundalika appear through the following:

  • Indulgence in dry eatables,
  • Suppression of urges and the like.

These factors induce morbid increase in Vata in the urinary bladder, which moves all around with severe pain and the scanty urination. 2-3

Asthila —

आध्मापयन् बस्तिगुदं रुद्ध्वा वायुश्चलोन्नताम् |
कुर्यात्तीव्रार्तिमष्टीलां मूत्र – विण्मार्गरोधिनाम् || ४ || 

ādhmāpayan bastigudaṁ ruddhvā vāyuścalōnnatām | kuryāttīvrārtimaṣṭīlāṁ mūtra – viṇmārgarōdhinām || 4 ||

The symptoms of the disease of Asthila Vata include the following:

  • Excess of vata causes enlargement of prostate gland (asthila)
  • Producing distension of the bladder and rectum,
  • Severe pain and
  • Blockage in the passage of urine and feaces. 4

Vatabasti (Retention of Urine) —

वेगं विधारयेध्यस्तु मूत्रस्याकुशलो नरः |
निरुणद्धि मुखं बस्तेर्बस्तिगतो अनिलः || ५ ||
मूत्रसङ्गो भवेत्तेन बस्ति – कुक्षिनिपिडितः |
वातबस्तिः स विज्ञेयो व्याधिः कृछ्रप्रसाधनः || ६ ||

vēgaṁ vidhārayēdhyastu mūtrasyākuśalō naraḥ |
niruṇaddhi mukhaṁ bastērbastigatō anilaḥ || 5 ||
mūtrasaṅgō bhavēttēna basti – kukṣinipiḍitaḥ |
vātabastiḥ sa vijñēyō vyādhiḥ kr̥chraprasādhanaḥ || 6 ||

The Vata located in the bladder blocks the urinary passage, causing retention of urine and pain in the region of the bladder in an unwise person who suppresses the urge of urination for long. This condition is known as Vata Basti and it is curable with difficulty. 5-6

Mutraatita (Incontinence of urine) —

चिरं धारयतो मूत्रं त्वरया न प्रवर्तते |
मेहमानस्य मन्दं वा मूत्रातीतः स उच्यते || ७ ||

ciraṁ dhārayatō mūtraṁ tvarayā na pravartatē |
mēhamānasya mandaṁ vā mūtrātītaḥ sa ucyatē || 7 ||

That condition in which the person, who has suppressed the urge of Urination for a long time, fails to void the urine with the normal speed but voids it very slowly is known as Mutraatita. 7

Mutrajathara (Distended Bladder) —

मूत्रस्य वेगे अभिहते तदुदावर्तहेतुकः |
अपानः कुपितो वायुरुदरं पूरयेद् भृशम् || ८ ||
नाभेरधस्तादाध्मानं जनयेत्तीव्रवेदनम् |
तन्मूत्रजठरं विध्यादधोबस्तिनिरोधनम् || ९ ||

mūtrasya vēgē abhihatē tadudāvartahētukaḥ |
apānaḥ kupitō vāyurudaraṁ pūrayēd bhr̥śam || 8 ||
nābhēradhastādādhmānaṁ janayēttīvravēdanam |
tanmūtrajaṭharaṁ vidhyādadhōbastinirōdhanam || 9 ||

The cause of Udavarta is the suppression of the urge of urination. The condition, in which the apana vata gets disturbed, begins to move upwards, accumulates in the stomach, and causes distension of the stomach below the umbilicus and produces severe pain and blockage in the urinary bladder, has been known as Mutrajathara. 8-9

 Mutrotsanga (Stricture of Urethra) —

बस्तौ वा अप्यथदा नाले मणौ वा यस्य देहिनः |
मूत्रं प्रवृत्तं सज्जेत सरक्तं वा प्रवाहतः || १० ||
स्रवेच्छनैरल्पमल्पं सरुजं वा अथ नीरुजं |
विगुणानिलजो व्याधिः स मुत्रोत्सङ्गसंज्ञितः || ११ ||

bastau vā apyathadā nālē maṇau vā yasya dēhinaḥ |
mūtraṁ pravr̥ttaṁ sajjēta saraktaṁ vā pravāhataḥ || 10 ||
sravēcchanairalpamalpaṁ sarujaṁ vā atha nīrujaṁ |
viguṇānilajō vyādhiḥ sa mutrōtsaṅgasañjñitaḥ || 11 ||

Mutrotsanga is the condition in which the flow of urine in a person is obstructed at the level of the bladder or urethra, and penis. It flows out only after straining, slowly and in small quantities, with or without pain. It is mixed with blood as well. It is caused by excess of Vata. 10-11

Mutrakshaya (Suppression of Urine) —

रुक्षस्य क्लान्तदेहस्य बस्तिस्थौ पित्त – मारुतौ |
मूत्रक्षयं सरुग्दाहं जनयेतां तदाह्वयम् || १२ ||

rukṣasya klāntadēhasya bastisthau pitta – mārutau |
mūtrakṣayaṁ sarugdāhaṁ janayētāṁ tadāhvayam || 12 ||

In condition of Mutrakshaya, the patient is habituated to dry eatables and physical fatigue. He faces a morbid increase in pitta while Vata in his urinary bladder makes for reduction of urine. The urine is passed only with association of pain and burning sensation inside. 12

Mutragranthi (Tumor of the bladder) —

अन्तर्बस्तिमुखे वृत्तः स्थिरो अल्पः सहसा भवेत् |
अश्मरीतुल्यरुग्ग्रन्थिर्मूत्रग्रन्थिः स उच्यते || १३ ||

antarbastimukhē vr̥ttaḥ sthirō alpaḥ sahasā bhavēt | aśmarītulyaruggranthirmūtragranthiḥ sa ucyatē || 13 ||

That condition in which a round, stationary mass develops quickly inside the urinary bladder, presenting features equivalent to that of calculus (ashmari) is called Mutragranthi. 13

Mutrashukra (Spermaturia) —

मूत्रितस्य स्त्रियं यातो वायुना शुक्रमुद्धतम् |
स्थानाच्च्युतम् मूत्रयतः प्राक् पश्चाद्वा प्रवर्तते || १४ ||
भस्मोदकप्रतिकाशं मूत्रशुक्रं तदुच्यते |

mūtritasya striyaṁ yātō vāyunā śukramuddhatam |
sthānāccyutam mūtrayataḥ prāk paścādvā pravartatē || 14 ||
bhasmōdakapratikāśaṁ mūtraśukraṁ taducyatē |

The person who frequently indulges in sexual intercourse, suppresses the urge of urination at time, gets his semen dislodged. As a result, his semen flows out of the body either before or after micturition, making the urine to resemble a solution of ash. This condition has been identified as Mutrashukra. 14

Ushna Vata (Haematuria) —

व्यायामाध्वातापैः पित्तं प्राप्यानिलान्वितम् ||१५ ||
बस्तिं मेढ्रं गुदं चैव स्रावयेदधः |
मूत्रं हारिद्रमथवा सरक्तं रक्तमेव वा || १६ ||
कृच्छ्रात् पुनः पुनर्जन्तोरुष्णवातं ब्रुवन्ति तम् | 

vyāyāmādhvātāpaiḥ pittaṁ prāpyānilānvitam ||15 ||
bastiṁ mēḍhraṁ gudaṁ caiva srāvayēdadhaḥ |
mūtraṁ hāridramathavā saraktaṁ raktamēva vā || 16 ||
kr̥cchrāt punaḥ punarjantōruṣṇavātaṁ bruvanti tam |

Causes for morbid increase in pitta include the following:

  • Over indulgence in physical exercise
  • Walking long distances and
  • Exposure to sun.

The pitta thus getting vitiated, on occasions gets associated with Vata in the urinary bladder. This condition generates

  • burning sensation in the bladder,urethra and rectum.

In that condition, the urine turns turmeric – coloured or it consists of only blood. This symptom has been identified as Usna Vata. 15-16

Mutrasada (Scanty urination) —

पित्तं कफो द्वावपि वा संहन्येते अनिलेन चेत् || १७ || 
कृच्छ्रान्मुत्रं तदा पीतं श्वेतं रक्तं घनं सृजेत् |
सदाहं रोचना – शङ्खचूर्णवर्णं भवेत्तु तत् || १८ ||
शुष्कं समस्तवर्णं वा मूत्रसादं वदन्ति तम् |

pittaṁ kaphō dvāvapi vā sanhanyētē anilēna cēt ||17 ||
kr̥cchrānmutraṁ tadā pītaṁ śvētaṁ raktaṁ ghanaṁ sr̥jēt |
sadāhaṁ rōcanā – śaṅkhacūrṇavarṇaṁ bhavēttu tat || 18 ||
śuṣkaṁ samastavarṇaṁ vā mūtrasādaṁ vadanti tam |

That condition in which the pitta and kapha are either alone or in combination with vata produce difficulty in voiding urine is known as Mutrasada. It is characterized by difficulty in micturition. Urine passed in this condition is yellow coloured, white or red resembling the colour of ox bile (yellow) or of the conch shell (white) or other different colours, is thick, non viscid. Moreover, there is the feeling of burning sensation caused by it. 17-18

Vidvighaata (Recto – vesical fistula?) —

रुक्ष – दुर्बलयोर्वातेनोदावृत्तं शकृध्यदा || १९ ||
मूत्रस्रोतो अनुपध्येत विट्संसृष्टं तदा नरः |
विड्गन्धं मूत्रयेत् कृच्छ्राद्विड्विघातं विनिर्दिशेत् || २० ||

rukṣa – durbalayōrvātēnōdāvr̥ttaṁ śakr̥dhyadā || 19 ||
mūtrasrōtō anupadhyēta viṭsansr̥ṣṭaṁ tadā naraḥ |
viḍgandhaṁ mūtrayēt kr̥cchrādviḍvighātaṁ vinirdiśēt || 20 ||

That condition in which the feaces of a dehydrated and weak person move upwards due to vayu and enter the urinary passage causing difficulty in micturition is known as Vidvighata. The urine passed in this condition smells very bad, too. 19-20

Bastikundala (Atony of the bladder) —

द्रुताध्वलङ्घनायासैभिघातात् प्रपीडनात् |
स्वस्थानाद्बस्तिरूद्ध्रुत्तः स्थूलस्तिष्टति गर्भवत् || २१ ||
शूल – स्पन्दन – दाहार्तो बिन्दुं बिन्दुं स्रवत्यपि |
पीडितस्तु सृजेद्धारां संस्तम्भोद्वेष्टनार्तिमान् || २२ ||
बस्तिकुण्डलमाहुस्तं घोरं शस्त्र – विषोपमम् |
पवनप्रबलं प्रायो दुर्निवारमबुद्धिभिः |

drutādhvalaṅghanāyāsaibhighātāt prapīḍanāt |
svasthānādbastirūddhruttaḥ sthūlastiṣṭati garbhavat || 21 ||
śūla – spandana – dāhārtō binduṁ binduṁ sravatyapi |
pīḍitastu sr̥jēddhārāṁ sanstambhōdvēṣṭanārtimān || 22 ||
bastikuṇḍalamāhustaṁ ghōraṁ śastra – viṣōpamam |
pavanaprabalaṁ prāyō durnivāramabuddhibhiḥ |

Major symptom of the disease Vastikundala is difficult urination. The patient is able to pass urine drop by drop.

This condition is produced due to

  • Walking in speed
  • By jumping along
  • by indulging in excessive labour or
  • by injury to the lower abdomen, which is vasti.

Due to such causative factors, the vasti turns heavy like a womb that has been fertilized. This condition subsequently produces

  • Burning sensation
  • Pain and
  • Tremors in the lower abdomen.

As this condition develops, the patient passes urine only drop by drop. However, if the lower abdomen is pressed externally, the discharge of urine becomes ceaseless and normal. There is the feeling of squeezing and piercing pain in this ailment. This is a dangerous disease like a poisoned arrow. In this prominent role is played by Vata. The wise physician should avoid such type of case. It is not curable.

Dosha Wise symptomatology of Vasti Kundala —

तस्मिन् पित्तान्विते दाहः शूलं मूत्र विवर्णता || २३ ||
श्लेष्मणा गौरवं शोथः स्निग्धं मूत्रं घनं सितम् |

tasmin pittānvitē dāhaḥ śūlaṁ mūtra vivarṇatā || 23 ||
ślēṣmaṇā gauravaṁ śōthaḥ snigdhaṁ mūtraṁ ghanaṁ sitam |

Condition of the colour of urine passed by the patient of Vastikundala changes if the condition has been complicated by different doshas. If there is vitiation of Pitta dosha, the natural colour of the urine is changed. The form of burning sensation and type of pain are also changed. If there is further complicated by vitiation of Kapha the urine passed by the patient gets thickened, smooth and its colour turns white. There is also feeling of heaviness and swelling in the lower abdomen.

Prognosis of Vasti Kundala —

श्लेष्मरुद्धबिलो बस्तिः पित्तोदीर्णो न सिध्यति || २४ ||
अविभ्रान्तबिलः साध्यो, न तु यः कुण्डलिकृतः |
स्याद्बस्तौ कुण्डलीभूते तृणमोहः श्वास एव च || २५ ||

ślēṣmaruddhabilō bastiḥ pittōdīrṇō na sidhyati || 24 ||
avibhrāntabilaḥ sādhyō, na tu yaḥ kuṇḍalikr̥taḥ |
syādbastau kuṇḍalībhūtē tr̥ṇamōhaḥ śvāsa ēva ca || 25 ||

If the orifice of the bladder is blocked by thick kapha or if the bladder is ulcerated by pitta or it turns rolled up like a ball, if it gets associated with morbid thirst, delusion and dyspnea, the disease becomes incurable. 24 – 25

इति श्रीविजयरक्षितकृतायां मधुकोशव्याख्यायां मूत्राघातनिदानं समाप्तम् || ३१ ||

iti śrīvijayarakṣitakr̥tāyāṁ madhukōśavyākhyāyāṁ mūtrāghātanidānaṁ samāptam || 31 ||

Thus concludes the Chapter of Mutraghata.