Sushruta Samhita Chikitsasthana Chapter 7 Asmari Cikitsitam (Remedy of Urinary Calculi)

The seventh chapter of Chikitsasthana of Sushruta Samhita is called as Asmari Cikitsitam Adhyaya. This chapter offers with Remedy of Urinary calculi.

अथातोऽश्मरीचिकित्सितंव्याख्यास्यामः।।१।।
यथोवाचभगवान्धन्वन्तरिः।।२।।

We’ll now expound Asmarī Cikitsita – therapy of urinary calculi; as revealed by the venerable Dhanvantari.

Cikitsāvidha – modes of therapy

अश्मरीदारुणोव्याधिरन्तकप्रतिमोमतः।।

औषधैस्तरुणःसाध्यःप्रवृद्धश्छेदमर्हति।।३।।

तस्यपूर्वेषुरूपेषुस्नेहादिक्रमइष्यते।।

तेनास्यापचयंयान्तिव्याधेर्मूलान्यशेषतः।।४।।

Asmarī is a dreadful illness. The dreadful nature of the illness has been in comparison with ‘añtaka’ – the god of dying. If the illness is of current origin, it ought to be handled with medicines. When the scale of asmari has elevated and is bigger, chedana ought to be completed i.e. it must be lower off with the assistance of surgical process.

Therapies like oleation are fascinating within the premonitory stage of the illness. By these, not solely the illness will get cured however the root of the illness too will likely be destroyed.

Pāşāṇabhedādi Ghrta

पाषाणभेदोवसुकोवशिराश्मन्तकौतथा।।
शतावरीश्वदंष्ट्राचबृहतीकण्टकारिका।।५।।
कपोतवङ्काऽऽर्तगलःकच्चकोशीरकुब्जकाः।।
वृक्षादनीभल्लुकश्चवरुणःशाकजंफलम्।।६।।
यवाःकुलत्थाःकोलानिकतकस्यफलानिच।।
ऊषकादिप्रतीवापमेषांक्वाथैघृतंकृतम्।।७।।
भिनत्तिवातसंभूतामश्मरीक्षिप्रमेवतु।।
क्षारान्यवागू — षांश्चकषायाणिपयांसिच।।८।।
भोजनानिचकुर्वीतवर्गेऽस्मिन्वातनाशने।।
Equal amount of every of the beneath talked about components are taken and their Kashaya – decoction is ready –

– Pasanabheda,

– Vasuka,

– Vasira,

– Asmantaka,

– Satavari,

– Svadamstra,

– Brhati,

– Kantakärī,

– Kapotavañka,

– Artagala,

– Kaccaka,

– Usīra,

– Kubjaka,

– Vrkṣādani,

– Bhalluka

– Varuna,

– Sākaphala,

– Yava,

– Kulattha,

– Kola, and

– Katakaphala

To this decoction, herbs belonging to Usakadi Gana group of herbs and Ghrta – ghee are added and processed in order to organize the medicated ghee.

This ghee known as ‘Pasanabhedadi Ghrta’. When consumed each day, this recipe breaks asmari – calculus produced by aggravated vata.

For mitigating the aggravated Vata, alkali, thick gruel, soup, decoction, milk and meals ready with the above talked about group of herbs ought to be ready and administered.

Kusadi Ghrta

कुशःकाशःसरोगुन्द्राइत्कटोमोरटोऽश्मभित्।।९।।
वरीविदारीवाराहीशालिमूलत्रिकण्टकम्।।
भल्लूकःपाटलापाठापत्तूरोऽथकुरुण्टिका।।१०।।
पुनर्नवाशिरीषञ्चक्वथितास्तेषुसाधितम्।।
घृतंशिलाजमधुकबीजैरिन्दीवरस्यच।।११।।
त्रपुसैर्वारुकादीनांबीजैश्चावापितंशुभम्।।
भिनतिपित्तसंभूतामश्मरींक्षिप्रमेवतु।।१२।।
क्षारान्यवागू ! षांश्चकषायाणिपयांसिच।।
भोजनानिचकुर्वीतवर्गेऽस्मिन्पित्तनाशने।।१३।।
Kashaya – decoction is ready utilizing the beneath talked about components –

– Kusa,

– Kasa,

– Sara,

– Gundra,

– Itkata,

– Morata,

– Asmabheda,

– Vari,

– Vidari,

– Varahi,

– Root of śāli,

– Trikantaka,

– Binallūka,

– Patalā,

– Pāțhā,

– Pattūra,

– Kuruntakā,

– Punarnavā and

– Sirisa

To this Kashaya, ghee and paste of Silajatu, Madhuka, seeds of Indivara, Trapusa and Ervaruka are added and processed in order to organize the medicated ghee. This ghee known as ‘Kusadi Ghrta’. When consumed, this ghee helps in shortly breaking down the Asmari – calculus produced by aggravated pitta.

To mitigate pitta, alkali, thick gruel, soup, decoctions, milk and meals ready with the above talked about herbs ought to be used.

Varuņakādi Ghrta

गणोवरुणकादिस्तुगुग्गुल्वेलाहरेणवः।।
कुष्ठभद्रादिमरिचचित्रकैःससुराह्वयैः।।१४।।
एतैःसिद्धमजासर्पिरूषकादिगणेनच।।
भिनत्तिकफसंभूतामश्मरीक्षिप्रमेवतु।।१५।।
क्षारान्यवागू ! षांश्चकषायाणिपयांसिच।।
भोजनानिचकुर्वीतवर्गेऽस्मिन्कफनाशने
Decoction of the beneath talked about herbs is ready –

– Herbs belonging to Varunakadi Gana group of herbs,

– Guggulu

– Ela

– Harenu

– Kustha

– Bhadradaru

– Marica,

– Citraka and

– Surahva

To this Kashaya ghee extracted from goat’s milk and paste of herbs belonging to Usakadi Gana group of herbs are added and processed in order to organize medicated ghee. This ghee known as ‘Varunakadi Ghrta’. When consumed each day, this ghee helps in breaking down the asmari – calculi fashioned by aggravated kapha.

To mitigate aggravated kapha, alkali, thick gruel, soup, decoction, milk and meals ready with the above talked about group of herbs ought to be used.

Formulations for sarkara – urinary gravel

पिचुकाङ्कोलकतकशाकेन्दीवरजैःफलैः।।
चूर्णितैःसगुडंतोयंशर्कराशमनंपिबेत्।।१७।।
क्रौञ्चोष्टरासभास्थीनिवदंष्टातालमूलिका।।
अजमोदाकदम्बस्यमूलंनागरमेवच।।१८।।
पीतानिशर्करांभिन्द्युःसुग्योष्णोदकेनवा।।
Powder of the beneath talked about herbs is ready –

– Picukā,

– Añkola,

– Kataka,

– Sāka, and

– Fruits of Indivara

This powder when combined with jaggery and consumed together with heat water mitigates sarkara – urinary gravel.

Different recipe –

Powder of the beneath talked about components ought to be ready –

– Bones of krauñca chook – curlew, ustra – camel and rāsabha – donkey;

– Svadamstra,

– Talamulika / Musali,

– Ajamoda,

– Root of Kadamba and

– Nagara

This powder when combined with sugar and consumed both with sura – beer or heat water breaks down the urinary gravel.

Trikantaka Curna

त्रिकण्टकस्यबीजानांचूर्णमाक्षिकसंयुतम्।।१९।।
अविक्षीरेणसप्ताहमश्मरीभेदनंपिबेत्।।

Powder of Trikantaka seeds ought to be ready. This powder ought to be combined in honey and consumed together with the urine of sheep. This recipe will break down the asmari – stone in seven days.

Ksara (alkali) preparation for urinary stones and gravel

द्रव्याणांतुघृतोक्तानांक्षारोऽविमूत्रगालितः।।२०।।
ग्राम्यसत्त्वशकृत्क्षारैःसंयुक्तःसाधितःशनैः।।
तत्रोषकादिरावापःकार्यस्त्रिकटुकान्वितः।।२१।।
एषक्षारोऽश्मरीगुल्मंशर्करांचभिनत्त्यपि।।

The herbs talked about above, within the context of preparation of Pasanabhedadi, Kusadi and Varunakadi Ghrtas ought to be taken and their alkali ready after mixing them in sheep’s urine and filtering it. This alkali is combined with the alkali of excreta of home animals. Later to that is added the herbs belonging to Usakadi Gana group of herbs and Trikatu and the contents are processed on hearth.

This alkali when consumed each day, cures urinary stones and gravel and likewise stomach tumors.

तिलापामार्गकदलीपलाशयवकल्कजः।।२२।।
क्षारःपेयोऽविमूत्रेणशर्करानाशनःपरः।।
पाटलाकरवीरणांक्षारमेवंसमाचरेत्।।२३।।

Alkali ready from the beneath talked about components ought to be consumed together with sheep’s urine –

– paste of the stem of tila – sesame plant,

– apamarga,

– kadali,

– palasa, and

– yava – barley

Advantages – This recipe is finest to destroy urinary gravel. Equally, the ash of pātala and karavira might also be used.

Svadamstradi Kalka

श्वदंष्ट्रायष्टिकाब्राह्मीकल्कंवाऽक्षसमंपिबेत्।।
सहैडकाख्यौपेयौवाशोभाञ्जनकमार्कवौ।।२४।।

Svadamstrā, Yasti and Brāhmī collectively ought to be taken and their paste ready. This paste ought to be taken in a dose of 1 aksa – 10 grams and consumed together with sheep’s milk.

Equally ash of edaka / edagaja together with sobhāñjana and mārkava ought to be consumed together with sheep’s urine.

Different formulations for stones and associated ache

कपोतवङ्कामूलंवापिबेदम्लैःसुरादिभिः।।
तत्सिद्धंवापिबेत्क्षीरंवेदनाभिरुपद्रुतः।।२५।।
हरीतक्यादिसिद्धंवावर्षाभूसिद्धमेववा।।
सर्वथैवोपयोज्यःस्याद्गणोवीरतरादिकः।।२६।।

Paste of root of Kapotavanka ought to be consumed with –

– sours like sura – beer and so forth. or

– milk boiled with the talked about paste if the affected person is troubled by ache brought on by asmari

Equally milk ready with one of many beneath talked about ought to be consumed –

– harītakī and so forth. (triphalā) or

– varşābhū

In every kind of Asmari, the herbs belonging to Vīratarādi Gaņa bunch of herbs could also be consumed in every kind of recipes, like ghee, milk, decoction and so forth.

Chedana – surgery

घृतैःक्षारेःकषायैश्चक्षीरैःसोत्तरबस्तिभिः।।

यदिनोपशमंगच्छेच्छेदस्तत्रोत्तरोविधिः।।२७।।

कुशलस्यापिवैद्यस्ययतःसिद्धिरिहाधुवा।।

उपक्रमोजघन्योऽयमतःसंपरिकीर्तितः।।२८।।

अक्रियायांध्रुवोमृत्युःक्रियायांसंशयोभवेत्।।

तस्मादापृच्छयकर्तव्यमीश्वरंसाधुकारिणा।।२९।।

Chedana – Resorting to surgical procedure i.e. slicing (the urinary bladder open) and removing of calculi is the last word therapy for Asmari i.e. calculus situated within the urinary bladder if it doesn’t reply to or get decreased by administration of the beneath talked about measures –

– ghrta – medicated ghee

– kshara – alkali

– kashaya – decoctions

– ksheera – medicated milk and

– uttara basti – enema given contained in the urinary bladder (by way of urethral route)

Even for an clever and expert surgeon, success just isn’t sure in surgical therapies. Subsequently it shall be thought of because the final resort.

If surgical procedure just isn’t carried out on this state, the affected person could absolutely face dying. However, if the surgical procedure is finished, the outcomes could also be unsure. Therefore, the surgeon ought to conduct surgical procedure solely after having obtained consent of the household and well-wishers of the affected person.

Chedana vidhi – process of operation

अथरोगान्वितमुपस्निग्धमपकृष्टदोषमीषत्कर्शितमभ्यक्तस्विनशरीरंभुक्तवन्तंकृतबलिमङ्गलस्वस्तिवाचनमग्रोपहरणीयोक्तेनविधानेनोपकल्पितसम्भारमाश्वास्य,ततोबलवन्तमविक्लवमाजानुसमेफलकेप्रागुपविष्टान्यपुरुषस्योत्सङ्गेनिषण्णपूर्वकायमुत्तान-मुन्नतकटीकंवस्त्राधारकोपविष्टंसङ्कुचितजानुकूर्परमितरेणसहावबद्धंसूत्रेणशाटकैर्वा,ततःस्वभ्यक्तनाभिप्रदेशस्यवामपार्श्वविमृद्यमुष्टिनाऽवपीडयेदधोनाभेर्यावदश्मर्यधः-प्रपन्नति,ततःस्नेहाभ्यक्तेक्लप्तनखेवामहस्तप्रदेशिनीमध्यमेअङ्गुल्यौपायौप्रणिधायानुसेवनीमासाद्यप्रयत्नबलाभ्यांपायुमेढ़ान्तरमानीय,निळलीकमनायतमविषमंचबस्तिसन्निवेश्य,भृशमुत्पीडयेदङ्गुलिभ्यांयथाग्रन्थिरिवोन्नतंशल्यंभवति।।३०।।

These affected by Asmari ought to be administered with –

– delicate oleation,

– sudation and

– expulsion of doshas by way of cleaning therapies like vamana, virechana, vasti and so forth. and

– he ought to be made barely skinny

All the mandatory gear required for the therapy are stored prepared beforehand as enumerated in Agropaharaniya chapter of Sutrasthana (of the identical treatise). The affected person ought to be supplied with phrases of encouragement to endure surgical process.

On the day of operation, the affected person –

– ought to supply oblation to Gods,

– carry out auspicious rites,

– hear benedictory hymns and

– take meals

As soon as once more full physique natural oil therapeutic massage and sudation are given to the affected person.

A plank desk or a cot which is even, not shaky and is of the peak of the knee of the affected person is stored in place. The affected person who is powerful is now made to sit down on this desk / cot for a while.

Later, the affected person is made to lie down on the identical plank desk with the assistance of others. He ought to be sleeping together with his face up (going through the roof). His waist ought to be raised and supported by fabric pads or pillows. His knees and elbow ought to be bent and stored erect. Each are tied tightly with bands of fabric or binding ropes in order to stop actions and likewise held in place by the attendants thus stopping any motion of the physique elements.

Subsequent, to facilitate the motion of stone down into the bladder, the stomach area beneath the navel area ought to be anointed and given a therapeutic massage and later hit by the fist.

Then, the surgeon ought to insert the index and center fingers of his left hand into the anus of the affected person alongside the road of pure suture ie. urethro-coccygeal raphae and slowly deliver the stone into the area between the anus and penis by digital manipulation. On the similar time he ought to be sure that to make the bladder wrinkle free, not displaced upwards and never uneven. Then he ought to knead the bladder laborious with the assistance of his fingers to make sure that the stone assumes the form of a granthi – tumour.

सचेदृहीतशल्येतुविवृताक्षोविचेतनः।।
हतवल्लम्बशीर्षश्चनिर्विकारोमृतोपमः।।३१।।
नतस्यनिर्हरेच्छल्यंनिर्हरेत्तुम्रियेतसः।।
विनात्वेतेषुरूपेषुनिर्हर्तुंप्रयतेतवै।।३२।।

When the stone will get fastened on this manner, the stone ought to nonetheless not be pulled out within the beneath talked about situations / if the affected person develops beneath talked about signs –

– broad open eyes,

– lack of consciousness,

– elevation of head / head bent again like that of a dying individuals, with

– lack of all actions like a useless man

If the stone is pulled out, the affected person would face dying. This additionally means to say that the stone ought to be eliminated solely when the above mentioned signs are absent.

ततःसव्येपार्श्वेसेवनीयवमात्रेणमुक्त्वाऽवचारयेच्छस्त्रमश्मरीप्रमाणं,दक्षिणतोवाक्रियासौकर्यहेतोरित्येके,यथासानभिद्यतेचूर्ण्यतेवातथाप्रयतेत,चूर्णमल्यमप्यवस्थितंहिपुनःपरिवृद्धिमेति,तस्मात्समस्तामग्रवक्रणाददीत;स्त्रीणांतुबस्तिपार्श्वगतोगर्भाशयसन्निकृष्टः,तस्मात्तासामुत्सङ्गवच्छस्त्रंपातयेत्,अतोऽन्यथाखल्वासांमूत्रस्त्रावीव्रणोभवेत,पुरुषस्यवामूत्रप्रसेकक्षणनान्सूत्रक्षरणम्;अश्मरीव्रणादृतेभिन्नबस्तिरेकधाऽपिनभवति,द्विधाभिन्नबस्तिराश्मरिकोनसिध्यति,अश्मरीव्रणनिमित्तमेकधाभिन्नबस्तिर्जीवति,क्रियाभ्यासाच्छास्त्रविहितच्छेदान्निःस्यन्दपरिवृद्धत्वाच्चशल्यस्येति।उद्धृतशल्यंतूष्णोदकद्रोण्यामवगाहस्वेदयेत्,तथाहिबस्तिरसृजानपूर्यते;पूर्णेवाक्षीरवृक्षकषायंपुष्यनेत्रेणविदध्यात्।।३३।।

After this, an incision is made on the left facet of the raphae (pure suture), leaving an area equal to that of the scale of yava i.e. barley grain, with the assistance of a pointy instrument like scalpel. The lower (incision) ought to be of the scale of the stone.

As per the opinion of some students, the incision will also be made on the suitable facet of the raphae as a substitute of on the left facet, if discovered handy for surgical procedure.

Now, makes an attempt to take away the stone by way of the wound (now made) ought to be made. The stone ought to be eliminated in such a manner that it neither will get damaged nor powdered within the course of.

If even a small amount of powder of the stone stays inside, it will as soon as once more develop and develop into large in measurement. Therefore it ought to be completely eliminated with none remnants being left behind. It shall be eliminated utilizing an instrument having a mouth melancholy like a ladle (scoop) in its entrance tip (curette).

Garbhashaya i.e. uterus, in girls is located beside the urinary bladder. Subsequently, in girls, the sharp instrument i.e. scalpel ought to be moved from beneath upwards. If not, a wound which exudes urine would develop.

Even in males, urine would exude from the injuries if there may be damage to the urinary orifice contained in the bladder.

We have to be aware that –

– tear or lower within the urinary bladder in anyone facet / wall of the organ won’t occur besides from the stone

– there is no such thing as a treatment if tear or lower as a result of stone happens in two sides / partitions of the urinary bladder

– the particular person having tear on one facet / wall of the urinary bladder brought on by a stone would survive attributable to skilful surgery carried out by an professional surgeon in accordance to the procedures laid down within the treatises and likewise as a result of stone not growing in measurement attributable to absence of moisture / urine within the bladder

The affected person ought to be immersed in a bath crammed with lukewarm water and given fomentation after eradicating the stone. It will forestall accumulation of blood within the bladder. By probability if blood accumulates within the bladder, decoction of Ksiri Vrksas i.e. timber yielding milky sap (Panca Valkala) ought to be launched into the bladder by way of Puspa Netra i.e. nozzle with a small orifice.

भवतिचात्र–

One verse here-

क्षीरवृक्षकषायस्तुपुष्पनेत्रेणयोजितः।।
निहरेदश्मरीतूर्णंरक्तंबस्तिगतंचयत्।।३४।।

The stone and the blood from the bladder is shortly eliminated when decoction of Ksiri Vrksa is launched into the bladder by way of the small nozzle.

मूत्रमार्गविशोधनार्थंचास्मैगुडसौहित्यंवितरेत्;उद्धत्यचैनंमधुघृताध्यक्तव्रणंमूत्रविशोधनद्रव्यसिद्धामुष्णांसघृतांयवागूपाययेतोभयकालंत्रिरात्रं;त्रिरात्रादूर्ध्वंगुडप्रगाढेनपयसामृद्वोदनमल्पंभोजयेद्दशरात्रंमूत्राग्विशुद्धयर्थंव्रणक्लेदनार्थंच,दशरात्रादूर्ध्वंफलाम्लर्जाङ्गलरसैरुपाचरेत्;ततोदशरात्रंचैनमप्रमत्तःस्वेदयेत्स्नेहेनद्रवस्वेदेनवा;क्षीरवृक्षकयायेणचास्यवर्णप्रक्षालयेत्;रोधमधुकमञ्जिष्ठाप्रपौण्डरी-

ककल्कैव्रणंप्रतिग्राहयेत्;एतेष्वेवहरिद्रायुतेषुतैलंघृतंवाविपक्वंव्रणाभ्यञ्जनमिति;स्त्यानशोणितंचोत्तरवस्तिभिरुपाचरेत्;सप्तरात्राच्चस्वमार्गमप्रतिपद्यमानेमूत्रेव्रणंयथोक्तेनविधिनादहेदग्निना,स्वमार्गप्रतिपन्नेचोत्तरबस्त्यास्थापनानुवासनैरु-

पाचरेन्मधुरकषायैरिति;यदृच्छयावामूत्रमार्गप्रतिपन्नामन्तरासक्तांशुक्राश्मरींशर्करांवास्रोतसाऽपहरेत्,एवंचाशक्येविदार्यनाडीशस्त्रेणबडिशेनोद्धरेत्।रूढव्रणश्चाङ्गनाश्चनगनागरथगुमान्नारोहेतवर्षे,नाप्सुप्लवेत,भुञ्जीतवागुरु।।३५।।

After this, the affected person ought to be given liquid meals added with jaggery (treacle) with the aim of cleaning the urinary tract. Following this, the wound shall be bathed with a combination of honey and ghee and dressed. The affected person is then raised. Yavagu – thick gruel processed with herbs which cleanse the urine added with ghee is given for ingesting at each instances of the day, for 3 days.

After giving yavagu for 3 days, the affected person ought to be given delicate boiled meals. Such meals ought to be served together with milk together with extra amount of jaggery until ten days. The aim of those meals is to trigger cleaning of the urine and blood and likewise to maintain the wound moist.

Meals together with bitter fruit juices and soup of meat of animals belonging to arid areas ought to be served to the affected person after ten days, in order to offer nourishment.

Exterior oil therapies like therapeutic massage and so forth together with sudation ought to be administered after ten days. Alternatively, sudation ought to be given by pouring medicated liquids on the physique, immersion and so forth.

The wound shall be washed with the decoction of Ksiri Vrkshas (Panca Valkala). For software on the wound, the paste of Rodhra, Madhuka, Manjistha and Prapaundarika ought to be used.

For anointing the wound, oil or ghee processed with the identical herbs talked about above and added with Haridra – Curcuma longa / turmeric might also be used.

Uttara Vasti – urethral douches ought to be used to deal with the blood which has clotted contained in the urinary bladder.

If the urine doesn’t come out of its regular passage even after seven days, the wound ought to be subjected to thermal cautery (as defined in twelfth chapter of Sutra Sthana of the identical treatise).

The affected person ought to be handled with Uttara Basti – medicated enema given into the urinary bladder, if the urine flows out by way of its regular passage.

Asthapana Basti i.e. decoction enema and Anuvasana Basti i.e. oil enema ought to be administered utilizing decoction ready with herbs having candy style or oil ready with the identical herbs.

If Sukrasmari i.e. seminal calculi or Sarkara i.e. gravel are obstructing the urinary passage by probability, they need to be faraway from the passage. If removing just isn’t attainable, the urinary passage ought to be lower open utilizing a pointy instrument and the stone ought to be eliminated utilizing a badisa i.e. hook like instrument.

Regardless of the wound getting healed, the affected person ought to keep away from indulging within the beneath mentioned, for a interval of 1 yr –

– copulation,

– driving horses

– climbing mountains,

– driving elephants and chariots,

– climbing timber,

– swimming or

– meals that are heavy and laborious to digest

मूत्रवहशुक्रवहमुष्कस्रोतोमूत्रप्रसेकसेवनीयोनिगुदबस्तीनष्टौपरिहरेत्।तत्रमूत्रवहच्छेदान्मरणंमूत्रपूर्णबस्तेः,शुक्रवहच्छेदान्मरणंक्लैब्यंवा,मुष्कस्रोतउपघाताद्ध्वजभङ्गः,मुत्रप्रसेकक्षणनान्मूत्रप्रक्षरणं,सेवनीयोनिच्छेदागुजःप्रादुर्भावः,बस्तिगुदविद्धलक्षणंप्रागुक्तमिति।।३६।।

Under talked about eight locations ought to be prevented whereas conducting the operation for stone removing –

– Mutravaha Srotas – channels transporting urine

– Sukravaha Srotas – channels transporting semen

– Muska Srotas – scrotum / testes

– Mutra Praseka – urethra

– Sevani – raphae,

– Yoni – vagina,

– Guda – anus and

– Basti – urinary bladder

Impact of slicing / damage to the above constructions –

– Damage to Mutravaha Srotas – results in dying attributable to filling up of bladder with urine

– Damage to Sukravaha Srotas – results in dying or impotence,

– Damage to Muska Srotas – results in Dhvaja Bhanga – non-erection of penis / Erectile dysfunction

– Damage to Sevani and Yoni – results in ache

– Signs brought on attributable to damage of Basti and Guda have been described earlier (Chapter 6 of Sutra Sthana)

भवतिचात्र

Some verses right here

मर्माण्यष्टावसंबुध्यस्रोतोजानिशरीरिणाम्।।
व्यापादयेद्वहून्मान्शस्त्रकर्मापटुभिषक्।।३७।।
सेवनीशुक्रहरणीस्रोतसीफलयोर्गुदम्।।
मूत्रसेकंमूत्रवहंयोनिर्बस्तिस्तथाऽष्टमः।।३८।।
The eight marmas – deadly / very important spots are essential websites to be thought of whereas doing surgical procedure (to take away stones) and a doctor / surgeon who’s unskilled would positively kill many individuals whereas conducting surgical procedure with out the data of those eight marmas. The eight marmas are as beneath talked about –