The deranged Kapham (mucus) inordinately saturated with the bodily Váyu, acquires hardness and gains in dimensions, and these lying at the mouth of the bladder obstructs the passage of the urine. The incarcerated fluid causes extreme pain in the organ. The patient constantly under severe pain gnashes his teeth or presses his umbilical region, or rubs his penis, or fingers his rectum (Páyu) and loudly screams. A burning sensation is experienced in the penis, and urination, belching and defecation become difficult and painful. * The concretions in this type of Asmari arc found to be of a dusky colour, rough, uneven in shape, hard, facetted and nodular like a Kadamva flower. This type is called Vátásmari. 9.
Infants arc more susceptible to an attack of any of the three preceding types of As'mari, inasmuch as they are fond of day sleep or of food composed of both wholesome and unwholesome ingredients, and are in the habit of eating before the digestion of a previous meal, or of taking heavy, sweet, emollient and demulcent food. In children the bladder is of diminished size and poor in muscular structure. These facts contribute to the easy possibility of the organ being grappled (with a surgical instrument) and of the stone being extracted with the greatest ease in cases of infantile Asmari. 1-0.
Sukrásmaris or seminal concretions are usually formed in adults owing to the germination of semen in their organisms. A sudden or abrupt stoppage of a sexual act, or excessive coition tends to dislodge the semen from its natural receptacle in the body. The fluid thus dislodged, but not emitted, finds a wrong passage. The Váyu gathers up the fluid (semen), thus led astray, and deposits it (in a round or oval shape) at a place lying about the junction of the penis and the scrotum and dries up the humidity with which it is charged. The matter, thus formed, condensed, and hardened, is called the seminal stone (Sukrás'mari), which then obstructs the passage of the urine, giving rise to pain in the bladder, painful micturition, and swelling of the scrotum. The stone vanishes under pressure in its seat *. 11 - 12.
* Stool and urine can be voided only with the greatest straining.
Concretions, sands and sediments found to be deposited in the urine in a case of Bhashma-mcha arc but the modifications, or attendant symptoms of a case of stone in the bladder (As'mari). The same group of symptoms and the same kind of pain are exhibited and experienced in a case of gravel (Sarkara) as in a case of stone (Asmari) in the bladder. The local Váyu coursing in its natural direction helps the discharge of calculi (Asmari) with the urine in the event of they being extremely attenuated in structure. Particles of a stone broken by the Váyu are called urinary calculi (Sarkara). A pain about the cardiac region, a sense of weakness and lassitude in the thighs, a griping pain in the regions of the spleen and liver (Kukshi-sula), a shivering sensation, thirst, hiccough or eructations, darkness or sallowness of complexion, weakness, emaciation with a non-relish for food and
* We can not but contemplate with admiration the fact that Sushruta was aware of the formation of seminal or spermatic concretions in the seminal vesicles through degenerative changes of spermatozoa and other secretions and their subsequent calcification as lately discovered by the savants of the West. - Translator impaired digestion are the symptoms which are manifest in a gravel-patient. A gravel (S'arkara) obstructed at the mouth of the urinary channel is detected by the following indications: - viz., weakness, lassitude, emaciation, cachectic condition of the body, pain over the hepatic region (Kukshi-sula), a non-relish for food, sallowness of complexion, hot and high coloured urine, thirst, pressing pain at the cardiac region and vomiting. 13.
The bladder is situated in the pelvic cavity, surrounded on its different sides by the back, loin (Kati), umbilicus, scrotum, rectum (Guda), groins and penis. This organ is provided with a single aperture or opening and lies with its mouth downward, covered with nets of nerves (Sirá) and ligaments (Snáyu), in the shape of a gourd. The organ is extremely thin in structure; and thus situated within the pelvic cavity, it is connected, through its mouth or external orifice, with the rectum, the penis, and the testes. It is also known by the name of Maládhára (the receptacle of impure matter) and forms (one of) the primary seats of vital energy (Prána) *. The urinary ducts (ureters) pass close by the large intestines (Pakvas'aya) and constantly replenish the bladder and keep it moist with that waste product of the system in the same manner as rivers carry their contributions of water into the ocean. These passages or ducts (which are two) are found to take their origin from hundreds of branches (or mouths tubuli uriniferi), which arc not visible to the naked eyes, on account of their extremely attenuated structures and carry, whether in a state of sleep or wakening, the urine from below the region of the stomach† (Amásáya) into the bladder keeping it filled with this important fluid of the body, just as a new pitcher, immersed up to it:; neck in a vessel full of water, is filled by transudation through its lateral pores. 14.
* The text has Pránáyatanam, which means that an injury to the urinary bladder may be attended with fatal result.
In the same way the Váyu, Kapham and Pittam are carried into the bladder (through their respective ducts or channels), and in unison with the retained urine, give rise to the formation of stone, on account of the slimy character of the deposit produced. Stone is formed in the same way in the bladder as sediments are ultimately deposited from clear and transparent water at the bottom of a new pitcher which contains it. As the wind and lightning jointly condense the rainwater into hailstones, so the bodily Váyu and Pittam (heat) jointly contribute to the condensation of the Kapham in the bladder and transform it into stone.
The Váyu in the bladder, coursing in its natural downward direction, helps the full and complete emission of urine; while coursing in a contrary direction, it gives rise to various forms of maladies such as, Prameha, strangury, as well as seminal disorders; in short, it produces any urinary trouble to which the bladder may be subjected. 15.
† From the kidneys.
Thus ends the third Chapter of the Nidana Slhanam in the Sushruta Samhita which treats of the Nidanam of urinary calculi.