A conceptual study on the effect of Mahabala Ghrita Uttara Basti in Mootraghata

Vishwanath Dinnimani; P N Shilpa

A conceptual study on the effect of Mahabala Ghrita Uttara Basti in Mootraghata

Dinnimani V.^1*, Shilpa P.²

DOI:

^1* Vishwanath Dinnimani, Post Graduate Scholar, Department of Shalya Tantra, Government Ayurvedic Medical College and Hospital, Bengaluru, Karnataka, India.

² P N Shilpa, Associate Professor, Department of Shalya Tantra, Government Ayurvedic Medical College and Hospital, Bengaluru, Karnataka, India.

In Ayurveda classics, Mootraghata is described as the disease of Mutravaha Srotas which is caused due to vitiation of Vata and Kapha Dosha. The most common symptoms such as retention or obstruction of urine and known urinary tract symptoms, closely resembles with begin prostatic hyperplasia (BPH) in modern medicine. the present management of BPH includes conservative and surgical approach. In Ayurveda the drugs having Vata and Kapha pacifying action, Jeevaniya, Vrishya, Mutrala, Sophahara Lekhaniya are recommended for its management. As per the recent epidemiological data, the incidence rate of BPH is 8% in men aged 31-40 years to over 80% in men older than age 80 years. BPH is characterized by progressive enlargement of prostate gland from non-malignant proliferation of smooth muscles and epithelial cells. Androgen plays important role in for these changes in prostate gland. The present available surgical and minimal invasive methods have their own limitations. Hence, to find out a suitable Ayurvedic approach for the management of BPH. After critical literature review Mahabala Ghrita Uttara Basti is selected for study because Acharya Sushruta mentioned Uttara Basti is the choice of treatment in Mootraghata.

Keywords: Mootraghata, BPH, Uttara Basti, Mahabala Ghrita, Ayurveda

Corresponding Author	How to Cite this Article	To Browse
Vishwanath Dinnimani, Post Graduate Scholar, Department of Shalya Tantra, Government Ayurvedic Medical College and Hospital, Bengaluru, Karnataka, India. Email:	Vishwanath Dinnimani, P N Shilpa, A conceptual study on the effect of Mahabala Ghrita Uttara Basti in Mootraghata. J Ayu Int Med Sci. 2022;7(4):97-101. Available From https://jaims.in/jaims/article/view/1846

Introduction

Mootraghata is defined as Mutravarodha.^[1] Pratiloma Gati of Vata Dosha in Basti produces Avarodha to Mootravaha Srotas^[2] causing Vibandhata, Krichrata and Alpata of Mutra.^[3] Acharya Sushrutha has explained Mootraghata separately in Uttara Tantra. The signs and symptoms of Mootraghata closely resembles with Benign Prostatic Hyperplasia.

BPH is one of the geriatric diseases in males with features of incomplete emptying of urine, urgency, hesitancy, increased frequency and difficulty in micturition.^[4] The prevalence of BPH may be seen after the age of 40 years; Peak incidence is at 60-70 years of age.^[5] 50% of enlarged prostate gland presents with Bladder Outlet Obstruction.

The present modern conservative management includes use of 5alpha blockers or 5alpha reductase inhibitors or both in combination.^[6] But various side effects like headache, restlessness, insomnia, decreased libido, vertigo, dizziness, abnormal ejaculation, postural hypotension are noted. Holmium laser enucleation.^[7] Freyer's Suprapubic transversical prostatectomy, Young's perineal prostatectomy, Laser treatment, Microwave treatment, Prostatic artery embolization, Millin's Retro Pubic Prostatectomy or Trans Urethral Resection of Prostate (TURP) is the surgical approach to Benign Prostatic Hyperplasia.^[8] Patient may not be fit for surgery because of old age and other systemic disorders like DM, HTN and Asthma. Surgery is invasive, expensive, has postop complications like haemorrhage, hematoma, clot retention, bladder neck stenosis, recurrence, erectile dysfunction, urethral stricture, infection, and requires hospitalization.

Considering the complications, recurrence, age of the patient & cost of surgery, there is a need to evaluate an alternative conservative management. Acharya Sushrutha has mentioned use of Kashaya, Kalka, Ghrita, Kshara, Madhya and Uttara Basti in the management of Mootraghata.^[9] Mahabala Ghrita has properties of Jeevaniya, Vrishya, Sarva Rogahara and specially indicated in all types of Mutra Dosha.^[10] Hence, Mahabala Ghrita is taken for Uttara Basti. It is conservative, non invasive and cost effective. So, this study has been taken up to evaluate the effect of Mahabala Ghrita Uttara Basti in Mootraghata.

Preparation of Mahabala Ghrita

Materials required

Chitraka churna : 1 karsha(12gm)

Sariva churna: 1 karsha(12gm)

Bala churna: 1 karsha(12gm)

Krishna sariva: 1 karsha(12gm)

Draksha: 1 karsha(12gm)

Vishala churna: 1 karsha(12gm)

Pippali churna: 1 karsha(12gm)

Brhuta indravaruni: 1 karsha(12gm)

Madhuka churna: 1 karsha(12gm)

Haritaki churna: 1 karsha(12gm)

Amalaka churna: 1 karsha(12gm)

Ghrita: 1 aadaka (3 kg)

Kshira: 1 drona(12.28kg)

Jala: 1 drona(12.28kg)

Mahabala Ghrita^[10] was prepared according to the reference of Su. Utt. 58/65-72;791-792

Method of preparation

Initially the above said ingredients were made into course powder 1 Karsha (12gms) each and Kalka were prepared. To this Kalka, one Drona (12.28kg) of water, one Drona milk and one Adaka Ghrita was added and kept for Paaka under Madhyama Agni.
Snehapaka was done up to Madhyamapaka Siddhi Lakshanas. It was used for clinical trials.

Ghrita Siddha Lakshana

Take Kalka into two fingers and if Varti like structure is form then the Ghrita preparation is completed.
If prepared Kalka put into fire and confirm the absence of cracking sound indicating absence of moisture.
The smell and colour of obtained Ghrita is like the ingredient of the procedure. The Ghrita was taken for filtration and storage when the above said Ghrita Siddha Lakshana was found.

Filtration and Storage: Filtering was done by using muslin cloth when the Ghrita immediately

after preparation. The Ghrita was measured and packed in a tightly closed airtight sterile container to protect from light and moisture.

Uttara Basti Procedure^[11]

The entire procedure can be divided into three parts-

1. Purva Karma

2. Pradhana Karma

3. Pashchat Karma

1. Purvakarma

Procedure is explained and written consent taken.

1. Patient preparation is to be done.

2. Patient is asked to empty his bladder prior to the administration of the medicine.

3. Advised to have liquid diet such as milk, buttermilk prior the procedure.

4. Advised to take Avagaha Sweda for 15 minutes before the procedure.

Instruments

1. Infant feeding tube no-7 or 8 or 9.

2. Disposable syringes of 20 ml capacity.

3. Medicated Ghrita per patient - 110ml

4. Surgical gloves no-7.

Dose: 10 ml / day is instilled into the bladder for 3 days consecutively. Later dose is increased to 20 ml for next 4 days.
Duration: 2 sittings of 7days (with a gap of 7 days in between 2 sittings).

2. Pradhana Karma

The patient is made to lie in supine position.
Painting and draping are done.
Ghrita is taken in the syringe, infant feeding tube is attached to its tip. Air in the syringe and infant feeding tube is expelled out carefully before inserting it into the urethra.
Under all aseptic conditions infant feeding tube is inserted into the urethra till the natural resistance felt, patient is asked to take slow breaths. Once the external sphincter is crossed, ghrita is instilled and infant feeding tube is withdrawn slowly.

3. Pashchat Karma

Patient is advised to relax for 30 minutes; hot water bags are given for fomentation over supra pubic area.
Advised to take plenty of fluids i.e., hot water, butter milk, barley water throughout the course of day.
Patient is educated to note down the time of first micturition, frequency of micturition, character of micturition and any changes in the micturition throughout the entire schedule.

RT (Retention Time) = ET (Excretion Time) – IT (Instillation Time)

Discussion

In Ayurveda, Mootraghata can be considered as a syndrome, Acharya Sushruta have mentioned 12 types of Mootraghata based on the clinical symptomatology. Mootraghata is an entity in which vitiation of Vata Dosha, particularly Apana Vata along with vitiation of Kapha and Pitta Dosha due to Ritu Parivartana (seasonal changes), improper Ahara-Vihara (diet and activity or daily regimen) and Vaya (advancement of age) vitiated Doshas travel through Sukshma Srotasa and finally Doshas are settled down at the Kha Vaigunya (diseased area) and develops Mootraghata. The symptoms like retention of urine, incomplete voiding, dribbling, hesitancy etc. are found, which resembles the disease BPH. Though the concept of nodular hyperplasia in pathology of BPH has been established but its exact etiology and cause is still not known clearly. The only factors related to the development of disease are age and hormonal changes. Increased serum estrogen level in old age which acts on the hypothalamus causes decrease in secretion of luteinizing hormone releasing hormone (LHRH) and hence, causing decrease in serum testosterone level. Due to the steroid secreted by the adrenal cortex balance between dihydrotestosterone (DTH) and local peptide growth factors were disrupted then increasing the risk of BPH.

Acharya Sushruta have explained in detail about the management of Mootraghata with various treatment modality, Mahabala Ghrita used for Uttara Basti has the properties of Jeevaniya, Vrishya, Sarva Rogahara and specially indicated in all types of Mootra Doshas and the ingredients are having

Lekhana, Vata, Kapha Shamaka, Vatanulomana, Mutral, Shotohara properties.

Conclusion

The main principle of management should be Margashodhana and Vatanulomana in order to restore the normal functioning of Apana Vata. the ingredients of Mahabala Ghrita are well known for their Vata Kaphahara, Vatanulomana, Shotahara, Jeevaniya, Vrisya, Mootradoshahara effect. As these ingredients are processed in Ghrita which are having properties of Pitta Vatahara, Rasa Shukra Ojo Vardhaka and by its special action it is Mrudukaram. Uttara Basti gaining direct access to Basti the seat of Mootraghata with above mentioned properties of Mahabala Ghrita leads to thorough cleansing of Basti there by alleviating the Vimargagami Vata as the ingredients are Jeevaniya and Vrisya they produce strength to the structure of Basti leading to proper functioning of Apana Vata and therefore the act of micturition is restored to normalcy. Thus, by the virtue of all the properties of Mahabala Ghrita and the direct action to the seat of Dosha Dushya Sammurchana the Uttara Basti will disintegrate the Samprapti of the Mootraghata.

Fig. 1: Ingredients of Mahabala Ghrita

Fig. 2: Vessel containg Ghrita

Fig. 3: Kalka of Mahabala Ghrita ingredients

Fig. 4: Preparation of Ghrita

Fig. 5: Observation for Sneha Siddhi Lakshana

Fig. 6: Observation for Sneha Siddhi Lakshana

Fig. 7: Mahabala Ghrita

Fig. 8: Stored in air tight bottle.

Reference

1. Sushruta Samhita of Sushruta with the Nibandha Sangraha commentary of Sri Dalhana Acharya, Edited by Vaidya Yadavaji Trikamji Acharya, Chaukhambha Orientalia, Varanasi reprint edition-2019, Uttara Tantra Chapter 58/1-2 Pp.787.

2. Charaka Samhita, Agnivesha revised by Charaka Dridabala with Ayurveda Deepika commentary of chakrapani Datta Edited by Vaidya Yadavaji Trikumji Acharya, Chaukhambha Orientalia, Varanasi; 2015, Chikitsa Sthana 26/44 Pp.600.

3. Madhavakara Edited by Vijayarakshita and Srikantadatta, Madhava Nidana Madhukosh Sanskrit commentary and Vidyotini Hindi commentary by Sudarshan Shastry volume-1, Varanasi: Chaukhambha Sanskrit Series, 2006, Nidana Sthana 31/11 Pp.568.

4. Somen Das. A Concise text book of surgery. S.Das, 4th Edition, 2006, 59th chapter, Pp.1255.

5. Scientific reports; The global burden of lower urinary track symptoms suggestive of benign prostatic hyperplasia: A systemic review and meta-analysis.published in 11 august 2017.

6. SRB'S Manual of Surgery, Edited by Sriram Bhat M. Fourth Edition, Jaypee Brothers Medical Publishers (P) LTD. 2013,Pp:1336, Pg-986

7. Somen das- A Concise text book of surgery-by, S.Das,10th Edition, 2018, 50th chapter Pp.1277-78.

8. Davidson,s-Principles and practice of medicine. Sir stanley Davidson-edited by Brian R. Walker, Nicki R colledge, Start H. Ralston, Ian D. Penman, John A A Hunter-22nd edition-17th chapter-pg-514 to 515.

9. Sushruta Samhitaa of Sushruta with Nibandha Sangraha Commentary, Vaidya Jaadavji Trikamji Acharya, Chaukhamba Orientalia, Varanasi, Reprint 2019, Su. Utt. 58 /27-28 pp 789.

10. Sushruta Samhita of Sushruta with the Nibandha Sangraha commentary of Sri Dalhana Acharya, Edited by Vaidya Yadavaji Trikamji Acharya, Chaukhambha Orientalia, Varanasi. reprint edition-2019, Uttara Tantra Chapter 58/65-72 Pp.791-792.

11. Principles and Practice of Panchakarma, Dr. Vasant Patil, Chaukamba Publications, New Delhi, edition reprint, 2018, Pp.472-475

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-04-04	2022-04-06	2022-04-13	2022-04-20	2022-04-27
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	16%

Review Article

Mootraghata

Journal of Ayurveda and Integrated Medical Sciences