Chapter XI - The diseases of the urinary tracts

Now we shall discourse on the medical treatment of the diseases of the urinary tracts (Prameha). 1.

This disease may be ascribed to two causes, such as the congenital (Sahaja) and that attributable to the use of injudicious diet. The first type (Sahaja) is due to a defect in the seeds of one’s parents and the second is originated from the use of unwholesome food. The symptoms, which mark the first of these two types, are emaciation and a dryness (of the body), diminished capacity of eating, too much thirst and restlessness; while the symptoms, which usually attend the latter type of the disease, are obesity, voracity, gloss of the body, increased soporific tendency and inclination for lounging in bed or on cushions. A case of emaciation, etc., (viz., the first kind of Prameha) should be remedied with nutritious food and drink, etc., whereas Apatarpana, etc., (fasting, physical exercise, depletory measures etc.), should be adopted in cases of obesity viz., the second kind of (Prameha). 2.

Forbidden Articles of Food & Drink:—

All patients suffering from Prameha should forego the use of (the different species of wine and fermented liquor known as) Sauviraka, Tushodaka, Shukta, Maireya, Sura, and asava, water, oil, clarified butter, milk, any modification of the expressed juice of sugarcane, cakes, milk-curd, acid, Panaka^[1], the flesh of domestic and aquatic animals and of those which frequent swamps or marshy places 3.

Articles of diet:—

The use of sufficiently old and matured, Shali and Shashtika rice, barley, wheat, Kodrava, Uddalaka, with the different preparations of Chanaka, Adhaki, Kulattha or Mudga pulse is recommended; or the meal should be taken with the Shakas (potherbs) of bitter or astringent taste cooked with the oils of Nikumbha, lngudi, mustard or. linseed oil; or with the soup of the lean flesh of Jangala animals which are possessed of anti-diuretic properties cooked without any clarified butter and unseasoned with any acid juice. 4.

Preliminary Treatment:—

The patient should be first anointed with any of the oils (of Nikumbha, lngudi, Sarshapa, Atasi, etc.); or with the medicated clarified butter^[2] cooked with the drugs of the Priyangvadi group and should also be treated with strong emetics and purgatives^[3]. After the application of purgatives, an Asthapana measure with a decoction of the drugs of the Surasadi group, mixed with honey and Saindhava salt and with the powders of Shunthi, Bhadradaru and Musta by way of an after-throw, should be resorted to. (On the eighth day) in a case attended with a burning sensation, a decoction of the Nyagrodhadi group without (i.e., mixed with a little quantity of) Sneha (oil or clarified butter) should be used (in the manner of an Asthapana).

The five Medicinal remedies:—

After cleansing the system, the expressed juice^[4] of Amalaka mixed with Haridra (powder) and honey should be administered. As an alternative, a decoction^[5] of Triphala, Vishala, Deva-daru and Musta or an Aksha (two Tola) measure of the Kalka (powders)^[6] of Shala, Kampillaka and Mushkaka (both of them) sweetened with honey and the expressed juice of Amalaka should be taken; or powders^[7] of the flowers of Kutaja, Kapittha, Rohita, Vibhitaka and Saptaparna (should be taken with honey, Haridra and the expressed juice of Amalaka), or a decoction of the roots, leaves, barks, flowers and fruits of Nimba, Aragvadha, Saptaparna, Murva, Kutaja, Soma-vriksha, Palasha should be given to the patient. All cases of Meha are often found to yield to the use of any of these five medicinal preparations. 5.

Specific Treatments:—

Now we shall specifically describe the course of treatment to be adopted in each particular type of the disease (Prameha). A decoction of Parijata should be given in a case of Udaka-meha; a decoction of Vaijayanti in that of Ikshu-meha; a decoction of Nimba in a case of Sura-meha; a decoction of Citraka in a case of Shikata-meha; a decoction of Khadira in a case of Shanair-meha; a decoction of Patha and Aguru in a case of Lavana-meha; a decoction of Haridra and Daru-haridra in a case of Pishta-meha; a decoction of Shaptaparna in a case of Sandra-meha; a decoction of Durva, Shaivala, Plava, Hatha-karanja and Kasheruka, or that of Kakubha and red-sandal wood in a case of Shukra-meha; and a decoction of Triphala, Aragvadha and Draksha mixed with honey in a case of a Phena-meha. All decoctions, to be employed in the foregoing ten types of Kaphaja-meha, should be sweetened with honey (slightly sweetened with honey—D. R).

Treatment of Pittaja Prameha:—

In the Pittaja types of the disease, a decoction of the drugs of the Shala-saradi group or that of Ashvattha should be administered in a case of Nila-meha; similarly a decoction of Raja-vriksha should be given in a case of Haridra-meha; a decoction of the Nyagrodhadi group, mixed with honey, in a case of Amla-meha; a decoction of Triphla in a case of Kshara-meha; a decoction of Manjishtha and (red) Chandana in a case of Manjishtha-meha; and a decoction of Guduci, seeds of Tinduka, Kashmarya and Kharjura, mixed with honey, in a case of Shonita-meha^[8]. 6.

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Palliative Measures:—

Now we shall describe the palliative measures to be adopted even in cases of incurable types of the disease. A Kalka compound of Kushtha, Kutaja, Patha, Hingu and Katu-rohini should be taken with a decoction of Guduci and Citraka in a case of Sarpir-meha. A patient afflicted with an attack of Vasa-meha should be made to drink a decoction of Agni-mantha or of Shimshapa. Similarly a decoction of Khadira, Kadara and Kramuka should be given in a case of Kshaudra-meha; a decoction of Tinduka, Kapittha, Shirisha, Palasha, Patha, Murva, and Dusparsa (Duralabha) mixed with honey,^[10] or the Kshara, (alkaline water) prepared from the ashes of the bones of an elephant, horse, hog, ass or camel, in a case of Hasti-meha. A gruel (Yavagu prepared in the manner of Shadanga-kalpa) with a decoction of aquatic bulbs and sweetened with milk and the juice of sugarcane should be prescribed in a case attended with a burning sensation. 7.

Medicinal Arishtas, asavas, Yava gus, etc.:—

Likewise Arishtas, Ayaskritis, lambatives and Asavas should be prepared (in the manner hereinbefore described) with Priyangu, Ananta, Yuthika, Padma (Bhargi), Trayantika, Lohitika, Ambashtha, bark of pomegranate, Shala-parni, (D.R.—Tala-parni), Padma (lotus), Tunga, Keshura, Dhataki, Vakula, Shalmali, Shri-veshtaka and Mocarasa, should be administered to the patient. As an alternative, similar preparations made of Shringataka, Gilodya,, Mrinala, Kasheruka, Madhuka, Amra, Jambu, Asana, Tinisha, Arjuna, Katvanga, Lodhra, Bhallataka, Charmi-vriksha, Giri-karnika, Shita-shiva, Nichula, Dadima, Aja-karna, Hari-vriksha, Rajadana,Gopaghonta and Vikamkata should be prescribed. Different preparations of Yavagu, etc. should be given to the patient as diet. A gruel (Yavagu) cooked with the decoction of the preceding medcinal drugs or (only these) decoctions should be given to the patient as drinks.

Potions of any of the aforesaid Asavas thickened with an admixture of powdered Patha, Citraka and Haritaki and sweetened with a liberal quantity of honey should be prescribed for a rich or royal patient of injudicious conduct and refusing to take medicines; or he should be made to drink frequent potions of Madhvika liquors (prepared from honey)^[11] with meat roasted on gridiron over a charcoal fire. Food and drinks mixed with honey, Kapittha and pepper should be prescribed for him. 8.

The powdered dung of a camel, a mule, or an ass should be administered to him in food; he should take his meal with soups saturated with a compound of asafetida and Saindhava salt or with mustard preparations (Raga).^[11] His food and drink should be fragrant and well flavoured iwith ingredient not incompatible with the nature of the disease. 9–10.

The practice of regular physical exercise, wrestling, active sports, riding on a horse or an elephant, long walks, pedestrial journeys, practising archery, casting of javelines, etc., should be resorted to in a case where the disease has made a decided advance. 11.

A poor and friendless patient should live on alms, lead a life of perfect continence like an ascetic, forego the use of shoes and umbrella and walk a hundred Yojanas^[12] or more on foot without staying for more than one night at a single village. A rich man (suffering from Prameha) should live on Shyamaka, Kapittha, Tinduka and Ashmantaka and live among the deer. He should constantly follow the tracks of cows and take their dung and urine (for food and drink). A Brahman patient should live on the grain, spontaneously fallen from plants, constantly study the Vedas and draw chariots occupied by Brahmanas.^[13] A patient belonging to the lower orders of society (Sudras, etc.) should be made to sink wells (under such circumstances) and the strength of a weak or emaciated patient should be preserved (with nutritive diets, etc.). 12.

Memorable Verse:—

A poor patient, carefully following these directions of his medical advisers without the least demur or delay, should be able to get rid of the disease (Prameha) in the course of a year or even in less than that time. 13.

 

Thus ends the eleventh Chapter of the Chikitsita Sthana in the Sushruta Samhita which deals with the medical treatment of Prameha.

Footnotes and references:

[1]:

Made of sugar, lemon-juice, or fermented rice-gruel bojled together.

[2]:

The patient should be anointed with the medicated clarified butter in a case of Pittaja-meha.

[3]:

Emetics in cases of Kaphaja-meha and purgatives in those of Pittaja-meha, should be applied.

[4]:

This is also found in Charaka and has been quoted by Chakradatta in his compilation.

[5]:

This is quoted by Chakradatta but he reads “darunisha” in place of “devadaru” and does not mention the use of the expressed juice of Amalaka. The practice, however, is to follow the recipe of Chakradatta.

[6]:

The third Yoga of the text is also quoted by Chakradatta but no addition of Haridra powder is prescribed there. Chakradatta is more generally followed in the case.

[7]:

The fourth Yoga of the text is found also in Charaka although with some variation. Charaka adds the flowers of Kampilla and Shala in the list, but does not recommend the use of Haridra powder nor of the expressed juice of Amalaki as the medium of taking the medicine. Charaka, however, is quoted verbatim by Chakradatta and is followed in practical use.

[8]:

Honey should be added to all of these decoctions prescribed in cases Pittaja-meha.—Dallana.

[9]:

Honey should also be added to these decoctions prescribed in cases of Vatja Meha—Dallana.

[10]:

Jejjata interprets it as grape-wine, but Gayadasa does not support this view.

[11]:

Some read “shakaiḥ” i.e., potherb (of mustard) in place of “ragaiḥ”

[12]:

A Yojana is equal to eight miles.

[13]:

Some explain the phrase “brahmarathamupadharayet” to mean that he should retain in his memory (the teachings of) the Vedas..—Dallana.