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–        Eight types of Mutrakrichchra are – Vataja, Pittaja, Kaphaja, Tridoshaja, Abhighataja, Shakrudja, Ashmarija and Sharkaraja.

–        In Vataja Mutrakrichchra – there is splitting pain, In Pittaja Mutrakrichchra – there is burning sensation and in Kaphaja Mutrakrichchra – there is heaviness of the scrotum, penis and urinary bladder.

–        Symptoms of Abhighataja Mutrakrichchra are similar to symptoms of Vata Basti (Mutraghata).

–        Symptoms of Shakrut Vighataja (Pratighataja) Mutrakrichchra are – Adhmana, Sashula Mutra Pravritti and Mutrasanga.

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The 59th chapter of Uttaratantra of Sushruta Samhita is named as Mūtrakṛchra Pratiședha. This chapter deals with Treatment of Dysuria.

अथातो मूत्रकृच्छ्रप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Mütrakṛcchra pratisedha- treatment of dysuria, strangury; as revealed by the venerable Dhañvañtari.

Bheda – kinds

वातेन पित्तेन कफेन सर्वैस्तथाऽभिघातैः शकृदश्मरीभ्याम् |
तथाऽपरः शर्करया सुकष्टो मूत्रोपघातः कथितोऽष्टमस्तु ||३||

Mūtropaghāta or Mütrakṛcchra is of eight kinds. They are –

–        one from each dosha – vataja, pittaja and kaphaja,

–        one from all the three doshas together – tridoshaja,

–        one by abhighata – trauma,

–        one by sakrt – faeces,

–        one by asmari – urinary calculus and

–        one by sarkara – urinary gravel

These conditions are very difficult to cure.

Lakşana – clinical features

अल्पमल्पं समुत्पीड्य मुष्कमेहनबस्तिभिः |
फलद्भिरिव कृच्छ्रेण वाताघातेन मेहति ||४||
हारिद्रमुष्णं रक्तं वा मुष्कमेहनबस्तिभिः |
अग्निना दह्यामानाभैः पित्तघातेन मेहति ||५||
स्निग्धं शुक्लमनुष्णं च मुष्कमेहनबस्तिभिः |
संहृष्टरोमा गुरुभिः श्लेष्माघातेन मेहति ||६||
दाहशीतरुजाविष्टो नानावर्णं महुर्मुहुः |
ताम्यमानस्तु कृच्छ्रेण सान्निपातेन मेहति ||७||

मूत्रवाहिषु शल्येन क्षतेष्वभिहतेषु च |
स्रोतःसु मूत्राघातस्तु जायते भृशवेदनः ||८||
वातबस्तेस्तु तुल्यानि तस्य लिङ्गानि लक्षयेत् |

Abhighataja Mutrakrcchra –

Dysuria arises when the urinary passage is injured by foreign bodies.

Its symptoms are –

–        urination is very painful,

–        presence of other symptoms which are similar to vatabasti (described in the previous chapter)

शकृतस्तु प्रतीघाताद्वायुर्विगुणतां गतः ||९||
आध्मानं च सशूलं च मूत्रसङ्गं करोति हि |
अश्मरीहेतुकः पूर्वं मूत्राघात उदाहृतः ||१०||

Sakrt janya mutrakrcchra – When a person retains faeces for long periods of time, vata would get aggravated.

Symptoms include –

–        flatulence,

–        painful urination and

–        obstruction to micturition

Asmari janya mutrakrcchra – Mutraghata or Mutrakrcchra caused by asmari – urinary calculus has been described earlier in Nidana Sthana – chapter 3.

अश्मरी शर्करा चैव तुल्ये सम्भवलक्षणैः |
शर्कराया विशेषं तु शृणु कीर्तयतो मम ||११||
पच्यमानस्य पित्तेन भिद्यमानस्य वायुना |
श्लेषमणोऽवयवा भिन्नाः शर्करा इति सञ्ज्ञिताः ||१२||
हृत्पीडा वेपथुः शूलं कुक्षौ वह्निः सुदुर्बलः |
ताभिर्भवति मूर्च्छा च मूत्राघातश्च दारुणः ||१३||
मूत्रवेगनिरस्तासु तासु शाम्यति वेदना |
यावदन्या पुनर्नैति गुडिका स्रोतसो मुखम् ||१४||
शर्करासम्भवस्यैतन्मूत्राघातस्य लक्षणम् |१५|

In terms of causes and symptoms, asmari – urinary calculus and sarkara – urinary gravel are similar. Now, I will explain special symptoms of sarkara (dysuria caused by gravel), and listen to the same.

Sarkara i.e. urinary gravel is formed when Asmari – calculus is cooked by pitta, broken into pieces by vata and separated into parts by kapha.

Below mentioned symptoms are caused by sarkara –

–        pain in the region of the heart,

–        shivering,

–        abdominal pain,

–        weakness of digestive fire,

–        fainting and

–        severe dysuria

Pain subsides when the urge for urination is cleared and when the urinary passage is not blocked by another lump or gravel.

These are the symptoms of mutrakrcchra caused by asmari and sarkara.

Cikitsa: Treatments

चिकित्सितमथैतेषामष्टानामपि वक्ष्यते ||१५||

Now, the treatment of these eight kinds of mutrakrcchra will be described.

अश्मरीं च समाश्रित्य यदुक्तं प्रसमीक्ष्य तत् |
यथादोषं प्रयुञ्जीत स्नेहादिमपि च क्रमम् ||१६||

Treatments of asmari like oleation etc. described previously in chikitsa sthana chapter 7 should also be administered in these diseases. The treatments should be done according to the doshas.

Vataja mūtrakṛcchra cikitsă

श्वदंष्ट्राश्मभिदौ कुम्भीं हपुषां कण्टकारिकाम् |
बलां शतावरीं रास्नां वरुणं गिरिकर्णिकाम् ||१७||
तथा विदारिगन्धादिं संहृत्य त्रैवृतं पचेत् |
तैलं घृतं वा तत् पेयं तेन वाऽप्यनुवासनम् ||१८||
दद्यादुत्तरबस्तिं च वातकृच्छ्रोपशान्तये |१९|

Decoction of the below mentioned ingredients is prepared –

–        Svadamstra,

–        Asmabheda,

–        Kumbhi,

–        Hapusa,

–        Kantakarika,

–        Bala,

–        Satavari,

–        Rasna,

–        Varuna,

–        Girikarnika and

–        Other herbs of Vidarigandhadi Gana group

With this decoction and three kinds of fats i.e. oil, ghee and muscle fat together is processed so as to prepare their Trivrt Sneha.

Alternatively, only taila – oil or ghrta – ghee may be cooked with this decoction and their sneha is prepared.

This is used for drinking, oil enema or urethral enema. This recipe cures dysuria caused by vata.

श्वदंष्ट्रास्वरसे तैलं सगुडक्षीरनागरम् ||१९||
पक्त्वा तत् पूर्ववद्योज्यं तत्रानिलरुजापहम् |२०|

Oil is boiled and processed with fresh juice of svadamstra, guda, ksira and nagara. This oil may be used as indicated earlier. This cures dysuria caused by vata.

Pittaja mutrakrcchra cikitsă

तृणोत्पलादिकाकोलीन्यग्रोधादिगणैः कृ(शृ)तम् ||२०||
पीतं घृतं पित्तकृच्छ्रं नाशयेत क्षीरमेव वा |
दद्यादुत्तरबस्तिं च पित्तकृच्छ्रोपशान्तये ||२१||

Decoction is prepared with the herbs belonging to the below mentioned groups –

–        Trna Pancamula,

–        Utpaladi Gana,

–        Kakolyadi Gana and

–        Nyagrodhadi Gana

Ghee is cooked with this decoction so as to prepare medicated ghee. Alternatively milk may be boiled with these herbs and medicated milk is prepared.

When these recipes are consumed, they cure dysuria. The same may be administered as urethral enema. It cures dysuria caused by pitta.

एभिरेव कृतः स्नेहस्त्रिविधेष्वपि बस्तिषु |
हितं विरेचनं चेक्षुक्षीरद्राक्षारसैर्युतम् ||२२||

Oil or ghee prepared with the same herbs should be used for all three kinds of enema i.e. niruha (decoction), anuvasana (unctuous) and uttara (urethral) basti. Similarly, purgative recipes too shall be given along with juice of sugarcane, milk or juice of draksha. These recipes are ideal for producing purgation.

Kaphaja mūtrakṛcchra cikitsă

सुरसोषकमुस्तादौ वरुणादौ च यत् कृतम् |
तैलं तथा यवाग्वादि कफाघाते प्रशस्यते ||२३||

Decoction should be prepared with the below mentioned groups of herbs –

–        surasadi gana

–        usakadi gana,

–        mustadi gana and

–        varunadi gana

Medicated oil is prepared with this decoction.

This oil is beneficial in treatment of dysuria caused by kapha.

Yavagu etc. prepared from these herbs is also beneficial in this condition.

Sannipätaja kṛcchra cikitsā

यथादोषोच्छ्र्यं कुर्यादेतानेव च सर्वजे |
फल्गुवृश्चीरदर्भाश्मसारचूर्णं च वारिणा ||२४||
सुरेक्षुरसदर्भाम्बुपीतं कृच्छ्ररुजापहम् |२५|

The same herbs shall be used suitably in the treatments of dysuria caused by all the three doshas together.

Powder of Phalgu, Vrschira, Darbha and Asmasara (Shilajatu) should be prepared. This powder should be consumed mixed with either water, beer, sugarcane juice or decoction of darbha. It cures the discomfort of dysuria caused by all the three doshas together.

Abhighataja kṛcchra cikitsa

तथाऽभिघातजे कुर्यात् सद्योव्रणचिकित्सितम् ||२५||

The treatments indicated for accidental wounds should be adopted in treating dysuria due to injury.

Sakrija kṛcchra cikitsa

मूत्रकृच्छ्रे शकृज्जाते कार्या वातहरी क्रिया |
स्वेदावगाहावभ्यङ्गबस्तिचूर्णक्रियास्तथा ||२६||

Below mentioned treatments mitigating vata shall be administered in the treatment of dysuria caused by faeces –

–        sudation,

–        tub-bath,

–        anointing or massage with oils,

–        enema and

–        consuming powder of herbs meant to mitigate vata

Asmari- Sarkaraja kṛcchra cikitsa

ये त्वन्ये तु तथा कृच्छ्रे तयो प्रोक्तः क्रियाविधिः ||२७||

Treatments which have already been described in Chikitsa Sthana, Chapter 7 shall be administered in treatment of the other two kinds of dysuria i.e. those caused due to asmari and sarkara.

इति श्री सुश्रुतसंहितावामुत्तरतन्त्रान्तर्गत कायचिकित्सातन्त्रे मूत्रकृच्छ्रप्रतिषेधो नाम (एकविंशतितमोऽध्यायः, आदितः) एकोनषष्टितमोऽध्यायः।।५९।।

Thus ends the fifty ninth chapter by name Mütrakrechra pratişedha- in Uttara sthana of Susruta samhita.