Mutrakruchha according to Ayurvedic Literature

Sanjay Babar; Asit Kumar; Chaturbhuj Bhuyan

Mutrakruchha according to Ayurvedic Literature

Babar S.^1*, Kumar A.², Bhuyan C.³

DOI:

^1* Sanjay Babar, HOD & Professor, Department of Shalya Tantra, Dr.D.Y.Patil College of Ayurved and Research Center, Dr.D.Y Patil Vidhyapeeth, Pimpri, Pune, Maharashtra, India.

² Asit Kumar, Final Year PG Scholar, Department of Shalya Tantra, Dr.D.Y.Patil College of Ayurved and Research Center, Dr.D.Y Patil Vidhyapeeth, Pimpri, Pune, Maharashtra, India.

³ Chaturbhuj Bhuyan, Professor & Guide (PhD), Department of Shalya Tantra, Dr.D.Y.Patil College of Ayurved and Research Center, Dr.D.Y Patil Vidhyapeeth, Pimpri, Pune, Maharashtra, India.

Difficulty in passing urine, associated with pain is termed as Mutrakruchha. According to Ayurvedic literature, Mutrakruchha has been classified as 8 types by Charak as well as Sushrut. The classification is made according to Doshas The term Mutrakrichha comes under the disorders of Mutravaha Srotas, description of this disease is mentioned in almost all classical texts which reflects its prevalence in ancient period. It is a disease involving Basti Marma. As Basti is one among the Trimarma (main three vital organs), it has great therapeutic importance. Acharyas has mentioned and elaborately explained the Mutrakriccha and its type in comprehensive manner. As manifestation of Mutrakriccha and lower urinary tract infection are similar, an attempt has been made in this article to understand the concept of Lower urinary tract infection in Ayurveda with comparison to Modern concept.

Keywords: Mutrakruchha, Ayurvedic Literature, Lower Urinary Tract Infection, Chikista

Corresponding Author	How to Cite this Article	To Browse
Sanjay Babar, HOD & Professor, Department of Shalya Tantra, Dr.D.Y.Patil College of Ayurved and Research Center, Dr.D.Y Patil Vidhyapeeth, Pimpri, Pune, Maharashtra, India. Email:	Sanjay Babar, Asit Kumar, Chaturbhuj Bhuyan, Mutrakruchha according to Ayurvedic Literature. J Ayu Int Med Sci. 2022;7(8):39-45. Available From https://www.jaims.in/jaims/article/view/2026

Introduction

“Dosha Dhatu Mala Mulam Hi Shareeram” Dosha, Dhatu and Mala are basic substratum of the Shareera. The painful voiding of urine is known as Mutrakrichha. In this disease patient has urge to micturate, but he passes urine with pain Mutra is one among Trimala and it plays a major role in Kledavahana. Mutravega is one among the Adharniya Vegas. Basti which is the Srotomula of the Mutra is among the Trimarma in our classical text the Dysuria is described in the form of 8 types of Mutrakruchha by Acharya Charak and Sushrut.

Urinary tract infections are the leading cause of gram-negative sepsis in hospitalized patients.

They are important cause of morbidity and might result in renal damage, often in association with vesicoureteric reflux (VUR).

Urinary tract infections are second in frequency after upper respiratory tract infections.

Incidence and degree of morbidity and mortality from infections are greater with those in the urinary tract than with those of the upper respiratory tract. Mutra is an outcome product digestion of food and metabolism in the body, it is passed through urethra.

In both Mutraghata and Mutrakrichha, Krichhrata (Dysuria) and Mutra-Vibhandhta are simultaneously present but in Mutrakrichha there is predominance of Krichhrata (dysuria)

Urinary tract infection refers to both microbial colonization of the urine and tissue invasion of any structure of the urinary tract.

Bacteria are most commonly responsible, although yeast, fungi and viruses may produce urinary infection.

Materials and Methods

Basti and Vankshana have been considered as the Moola of Mutravaha Strotas and its Dushti leads to excessive urination or oliguria, increased frequency, painful micturition etc.^[1]

Chikitsa Sthana, eight types of Mutrakrcchra have been defined along with its aetiopathogenesis and treatment.^[2] Here the term Mutrakrcchra has been used instead of Mutraghata.

Further in Siddhisthana, thirteen types of Bastiroga have been described under the caption of Mutradosha and are different from the disease Mutrakrcchra.^[3]

In Sushrut Samhita in Uttartantra, 'Mutrakrcchra Pratishedham Adhyayam' description of eight types of Mutrakrcchra including their Chikitsa is available.^[4]

Both the Vagbhattas have classified the disease of Mutravahasrotas according to its Pravritti i.e., Mutrakrcchra comes under Mutra Apravrittijanya Vyadhi while Prameha comes under Mutra Atipravrittjanya Vyadhi.^[5]

In Kashyap Samhita, Chikitsa Sthana one chapter named "Mutrakrcchra Chikitsa" is separately given.

Bhela Samhita, Sutrasthana one chapter is devoted to Mutrakrcchra Chikitsa that it is incomplete.^[6]

Madhava Nidana: Mutrakrcchra, Mutraghata and Ashmari have been dealt in separate chapters.^[7]

Nidana of Mutrakrcchra

Dosha Prakopa is cause for Vyadhi. Ahara and Vihara play an important role in this. All the factors involved, in provoking the imbalance of Doshas come under this heading. The main cause in the vitiation of Doshas is Ahita Sevana of Ahara and Vihara.^[8]

Nidanas can be classified as^[9]

1. Samanya

2. Vishishta

Mutravahasrotodushtikaraka^[10] and Mutrakrcchrakaraka Nidanas^[11] have been mentioned by Acharya Charaka in detail. Acharya Sushruta and Vagbhatta have not mentioned the aetiology. Madhava and Bhavaprakasha have mentioned similar aetiological factors as mentioned by Acharya Charaka.

Acharya Kashyapa has mentioned Katiskandhatidharnat as one of the aetiological factor^[12]

Symptoms wise comparison

Vataj Mutrakruchha

Vataj Mutrakruchha	Uretheral Stricture
There is severe pain in groin region, bladder and urethra. Patient passes scanty urine	Slow urine stream (commonest) Sudden urinary retention Painful micturation

Pittaj Mutrakruchha

Pittaj Mutrakruchha	Cystitis
The patient suffers from Burning Micturition, Difficulty in passing urine, Straining while passing the urine, Urgency for urination and blood-tinged urine Yellowish Discoloration	Painful urination, frequency, strangury, incomplete emptying with often retention. Occasionally Haematuria Burning urine, discolored foul smelling urine Fever, chills, rigors, suprapubic pain tenderness and often loin pain. Septicaemia can develop in severe cystitis

Kaphaj Mutrakruchha

Kaphaj Mutrakruchha	Nephritis
The Patients develops oedema and experiences a sensation of heaviness in the regions of kidney, bladder and penis. Patient passes small or large quantity of cold, whitish, sticky and thick urine Patient experiences slight pain and sometimes devlopes goose skin while passing urine	Pain in the pelvis Swelling of the body, commonly in the face, legs and feet Vomiting Cloudy urine Blood or pus in urine Foamy urine

Sannipatik Mutrakruchha

Sannipatik Mutrakruchha	Urethritis
Patient passes urine of various colours, frequently and with difficulty and pain. He experiences pain, burning sensation or chilly sensation all over body In addition, he becomes drowsy	Dysuria Burning Micturation Haematuria Increased Frequency Peripheral pain Tenderness over the site Suprapubic Pain and Tenderness

Shukraja Mutrakruchha

Shukraja Mutrakruchha	Prostatitis
Testes and Bladder are swollen and the patient experiences pain in the Bladder, Penis, inguinal region, testes. The patient passes urine mixed with semen	Pain, frequency Fever with chills and rigors Retention of Urine. Perineal Heaviness Pain on Defecation Tender prostate per rectal examination

Abhighataj Mutrakruchha

Abhighataj Mutrakruchha	Urethral Injury
Accidental or Surgical injury to the Urinary System gives rise to anuria, oliguria, retention of urine and severe pain	Bloody in external meatus. Failure or Difficulty in passing of urine Extravasation of Urine to Scrotum, perineum, and abdominal wall Shock with Pallor Hypotension

Raktaja Mutrakruchha

Accidental or instrumental injury or ematiation of various tissue with bleeding disorder gives rise to severe pain and blood strained urine, which is passed frequently in small quantities.

Formation of blood clots in urinary passages leads to distension and heaviness in the bladder which is relieved after passage of blood clots.

Ashmari Janya Mutrakruchha

Ashmari Janya Mutrakruchha	Renal Calculi
During urination pain in navi (umbilicus), Basti, Seevani, Medhra Mutra-dhar sanga Haematuria Scattering of urinary Cyst Sandy and Turbid Urination Blood in external meatus Failure of difficulty in passing Urine. Extravassation of urine to scrotum, perineum and abdominal wall	Pain (discomfort during jolting, jumping) Pyrexia Haematuria Pyuria Hydronephrosis

Sarkaraja Mutrkruchha

Sarkaraja Mutrkruchha
Ashmari due to Vata is crushed and becomes sand, when it comes out with urine it is called as Sarkara. Hrit Peeda Kampa (Tremor) Pain in Pelvis Agnidourbalya Murcha Severe Dysuria Haematuria	Urinary Calculi obstruct the urinary passage and lead to maintain in the kidneys, ureter, bladder, penis and perineal raphe The patient massages the penis in an attempt to relieve the pain. The stream of urine is sometimes bifurcated. He passes stools frequently and trembles while passing urine and stool. Injury by stones leads to blood-stained urine

Pathophysiology of Infection by Uropathogens in Lower UTI

Uropathogenic E. Coli organisms attach to receptors on superficial bladder cells with P fimbriae or type 1 pilli. Once contact is established, the bacteria are internalized into the cells, where they can replicate to high levels. However, attachment or invasion can result in the activation of apoptotic pathways, within the cells, leading to the event of exfoliation and clearance of infected host cells. Interactions between E. Coli and the cells can also result in the induction of inflammatory cytokines, leading to influx of polymorphonuclear leukocytes into the bladder epithelium. E.Coli can escape from lining cells, thereby avoiding clearance by exfoliation and infect surrounding and underlying epithelial cells. Within the bladder epithelium, E.Coli can escape immediate surveillance and persist at subclinical level.

Line of management of Ashmari^[14]

The management of Ashmari has been given due importance by all the three Samhita’s viz., Charaka Sushrutha & Vagbhata. In Mutrakrcchra, there is Apravritti of Mutra and Pratiloma of Apanavayu. Hence the Chikitsa should be such that it is Mutravirechaniya and pacifies the doshas.

Sushrutha has further given elaborate description of management of Ashmari in a separate chapter. The management of Ashmari has been described according to its various stages.

1. Nidana Parivarjana

2. Snehana

3. Swedana

4. Basti

5. Physical exercise

6. Horse riding after taking Madya

Nidan Parivajana: Patient should avoid Kaphavardaka Ahar & Vihar. All etiological factors, which are described.

Snehana & Swedana: These measures promote general well-being by eliminating the accumulated Doshas & purification of channels.

Vasti: Uttarabasti should be given to relieve obstruction to keep equilibrium of Basti Doshas. Dosa’s cannot accumulate due to lubrication.

Physical exercise: Charaka & Vagbhata advised horse riding or Journey by fast moving vehicles after taking old wine.

These measures may have been successful in small stone. It is conceivable that violent movement & along with diversified would dislodge the calculus & being small would be passed per urethra.

Samshamana line of management^[15]

Treatment of specific variety of Ashmari is going on in the form of Ghee, Kshara, Yavagoo, Kashaya, Milk etc. these preparations are made by various drugs according to their specific against Vata, Pitta, Kapha.

Text	Vataja	Pittaja	Kaphaja	General treatment
Sushrutha	Pashanabeda, Varuna Kulatta Sathavari etc.	Kushadi Gritha & Decoction	Varuna Gana Guggulu	Gokshuradi Churna Veeratharvadi Gana Decoction Apamarga, Yavakshara, Punarnava
Astanga Sangraha	-	-	-	Veeratharvadi Gana
Bhavapraksha	Eladi Decoction Varuna Veeratharvadi Ghritha	Kushadi Ghritha & Veeratharvadi Docoction	Varunadi Ghritha	Yavakshara, Trinapanchamoola Varuna Taila, Rushadi Taila Gokshuru Ghritha
Astanga Hridaya	-	-	- -	Veeretharvadi Gana
Charaka	-	-		Pashanabeda Churna Punarnava, Gokshura Trunapanchamoola
Sharangadhar	-	-	-	Veeratarvadi Gana
Harita	-	-	-	Pasanabedha Shigru Kashaya Kushadi Kashaya Shunti Etc.

Surgical management^[16]

In spite of all the medical treatment if patient do not get relieved then surgery is indicated. Besides this some other indications are as follows.

Chronicity of the disease

Stone is bigger in size

In children

Acute retention of urine caused by the stone impacting the urethra.

While describing the indications of surgical treatment of Ashmari, Sushrutha has mentioned that surgical removal may cause serious consequences & even death of the patient. So before performing operation surgeons should explain the situation about the graveness of the disease & permission should be taken from authority.

He has further explained that though operative interference may lead to serious consequences even death, but if the patient is not operated will ultimately die; there are chances of survival of patient after operation so patient should be operated.

After taking consent Sushrutha described operative procedure, which can be divided in to three steps.

Purva Karma (Preoperative procedure)

Pradhana Karma (operative procedure)

Paschat Karma (post operative procedure)

Purva Karma^[17]

First the patient is given Sneha Dravya later on his system is cleaned by Vamana & Virechana medicated oils are applied over the body & moderate Swedana is indicated. Then he is kept on light diet. After the psychological preparation of patient by consoling words & prayers to God etc. then patient was shifted to Operation Theater where every needful thing are ready.

Position of the patient in the operation room - the patient is placed in the lithotomy position with his arms & legs bent & tied & held in position by attendants over whose lap the patient lies. The buttocks are raised by placing a cotton pillow below the pelvic girdle. For proper illumination patient should be positioned towards sun.

Required medicine & instruments should be collected & placed in operation theatre & utilized at the time of requirement during Pradhana Karma.

Pradhana Karma: Mobilization of stone - for mobilization of stone Sneha Dravya should be applied over abdomen & pelvis & efforts should be made to mobilize the stone by applying pressure from left side of Nabhi to downward with the help of fist.

Fixation of stone - should be fixed near to Sevani with help of two fingers which is put inside the rectum preferably by the left hand.

Incision - Incision should be made on left side 1 Yava away from Sevani the length of the incision should be Ashmari Pramana. Incision should be preferably made on left side but for technical convenience incision should be on right side.

Removal of stone - All efforts should be made to remove the stone for which gentle pressure should be applied from rectal side by finger & stone should be held by Vakra Yantra.

Precaution: During the fixation of stone patient may go in a stage of shock he may be fixed, he may look like dead person, if this happens then operation should not be performed.

Paschat Karma: After removing the stone, patient should lie down in a boat of warm water by which blood will not get accumulated in Vasti. The bladder must be irrigated with by astringent decoction i.e., Pancha Ksheeri Kashayam. Then he must be removed from the boat & ghee & honey is applied over wound. Rice & ghee is given for 3 days orally. Then medicated Yavagu with ghee is given to the patient for another 3days. After this for 10 days he must take Guda, rice, milk & for another 10 days slight acidic juice like Dadima & juice of meat is given to him. After this light Swedan & Snehana is given to the patient & wound should be irrigated by Panchakshiri Kashyam. A paste of Lodhra, Yastimadhu is applied over the wound. If there is granules of a Sharkara in urethra. It should be removed by giving incision to urethra.

After wound-healing patient should avoid sexual intercourse, riding horse & other heavy exercise at least for one year.

Complication: During operation if the patient shows signs of shock the operation is to be discontinued.

In female, uterus is situated behind the urinary bladder. Surgeon should avoid the injury to Garbhashaya otherwise urinary fistula will occur so incision should be given ‘Utsangavat’.

Sushrutha mentioned a very important precaution that bladder must be injured only once, counter injury should be avoided otherwise healing will not takes place.

Exhaustive exercise & sexual indulgence should be avoided for one year after operation, diet should be light foods. The following things can happen.

Death: By cutting of Mutravaha Srotas, Vasti & Guda

Pain: If Yoni & Sevani is cut

Impotency: If Sukravaha Srotas is cut

Extravasation of urine: If Mutrapraseka Is cut

Prognosis: Asmari is difficult to cure in a patient who regularly passes gravels in urine.

Pathya Ahara: Purana Rakta Shali, Kshara, Yava, Cow's Milk, Curd and Buttermilk, Jangala Mamsa, Mudga, Sarakara, Kushmanda Phala, Patola, Ardraka (Wild Variety), Gokshura, Kumari, Supari, Kharjura, Narikela, Taladruma, Talasthimajja, Trapusa, Sukshma Ela, Pure River Water.

Pathya Vihara: Abhyanga, Svedana, Avagahana.

Apathya Ahara: Madyapana, Tambula, Matsya, Lavana, Ardraka, Taila Bhrishta Padartha, Pinyaka, Hinga, Tila, Sarshapa, Masha, Karirphala, Vishamashana, Virudhashana, Vidahi, Atitikshna, Ruksha and Amla Rasa.

Apathya Vihara: Ativyayama, Atimaithuna, Riding on elephant and horse, Striprasanga.

Discussion

Ashmari has been classified according to physical characters and Doshik symptomatology.

According to Sushrutha Kapha is responsible for manifestation of Ashmari but other Doshas like Vata and Pitta are also essential for further growth of Ashmari.

Samprapti of Ashmari which is mentioned for bladder calculi, this Samprapti we can apply in case of Mootrashmari even (renal calculus).

Ashmari being one among Astamahagada so it is Kastasadya or Asadya according to Sushrutha.

Etiopathogensis and symptomatology are described according to Doshas.

According to Susrutha urinary stone is formed in a similar way as muddy precipitation takes place even when clear water is kept in a new pitcher. Another example quoted is that just as air and fire of the lightening in the sky along with water forms hail stone similarly Pitta lodged in the bladder in combination with Vayu along with consolidation of Kapha to form the calculi.

According to modern intrinsic factors like Heredity, age and sex and extrinsic factors like geography, environment, less water intake, Diet, Occupation, etc. are predisposing factors of Calculi. Apart from these anatomical and physiological variations like impaired drainage of urine, congenital anomalies, biochemical factors like hypercalcioria, renal tubular acidosis, etc. are responsible for formation of Ashmari.

Conclusion

Medicaments are those which are employed by physicians, with a view to bringing about the equilibrium of Dhatu. Mutrakrcchra is described in all the Ayurvedic classics. But, is not mentioned under Garbhini and Sutika Vyadhis. The Linga of Mutrakrcchra are also present in Garbhini and Sutika. The properties Rasayana, Balya, Brumhana, Snehana, Jivaniya and Madhura Rasa And Vipaka; Sheeta Virya; Guru, Snigdha Guna of all the drugs promote Prakrita Kapha which is also considered as Bala, thus increases its Samana Guna Oja and thus Vyadhikshmatva of Garbhini and Sutika. Urinary tract infection refers to both microbial colonization of the urine and tissue invasion of any structure of the urinary tract. Bacteria are most commonly responsible, although yeast, fungi and viruses may produce urinary infection.

Reference

1. Charaka Samhita, Vol. I, II, Vidyotini Hindi Commentary, Choukhamba Bharti Academy, Varanasi., Vimansthana 5/8

2. Charaka Samhita, Vol. I, II, Vidyotini Hindi Commentary, Choukhamba Bharti Academy, Varanasi., Cikistanastana 26.

3. Charaka Samhita, Vol. I, II, Vidyotini Hindi Commentary, Choukhamba Bharti Academy, Varanasi., Siddhisthana 9/25.

4. Sushruta Samhita: Vol I & II, Hindi Commentary of Ayurveda Tatva Sandipika by Kaviraja Ambikadutta Shastri, Chaukhamba Sanskrit Sansthana, Varanasi Uttartantra/59.

5. Ashtanga Hrdya With Commentaries 'Sarvangasundara' of Arundatta and Ayurveda Rasayana of Hemadri, Chaukhamba Surbharti Prakashan, Varanasi, Nidansthana 9/40.

6. Bhela Samhita, Chowkhamba Surbharti Sanskrit Sansthana, Hindi Commentary Varanasi, Sutrastana/6.

7. Madhava Nidana With Madhukosha Sanskrit Commentary by Shri Vijay Rakshita, Chaukhamba Sanskrit Sansthana, Varanasi, Chapter 30/31-32.

8. Ashtanga Hrdya With Commentaries 'Sarvangasundara' Of Arundatta and Ayurveda Rasayana Of Hemadri, Chaukhamba Surbharti Prakashan, Varanasi, Nidansthana / 1

9. Kashyapa Samhita Or Vriddhajivakiya Tantra, Edited by Prof. P.V. Tewari, Chaukhamba Visvabharti, Varanasi Chi Mutrakrcchrachikitsitadhyaya /1

10. Charaka Samhita, Vol. I, II, Vidyotini Hindi Commentary, Choukhamba Bharti Academy, Varanasi. Vimansthana 5/20.

11. Charaka Samhita, Vol. I, II, Vidyotini Hindi Commentary, Choukhamba Bharti Academy, Varanasi. Chikistastana 26/.32.

12. Kashyapa Samhita Or Vriddhajivakiya Tantra, Edited by Prof. P.V. Tewari, Chaukhamba Visvabharti, Varanasi Chi Mutrakrcchrachikitsitadhyaya /1

13. Charaka Samhita, Vol. I, II, Vidyotini Hindi Commentary, Choukhamba Bharti Academy, Varanasi. Chikistastana 26/58.

14. Sushruta Samhita: Vol I & II, Hindi Commentary of Ayurveda Tatva Sandipika by Kaviraja Ambikadutta Shastri, Chaukhamba Sanskrit Sansthana, Varanasi Chikistastana Adhyaya 7/3-4.

15. Sushruta Samhita: Vol I & II, Hindi Commentary of Ayurveda Tatva Sandipika by Kaviraja Ambikadutta Shastri, Chaukhamba Sanskrit Sansthana, Varanasi Chikistastana Adhyaya7/8

16. Sushruta Samhita: Vol I & II, Hindi Commentary of Ayurveda Tatva Sandipika by Kaviraja Ambikadutta Shastri, Chaukhamba Sanskrit Sansthana, Varanasi Chikistastana Adhyaya 7/32-36.

17. Sushruta Samhita: Vol I & II, Hindi Commentary Of Ayurveda Tatva Sandipika By Kaviraja Ambikadutta Shastri, Chaukhamba Sanskrit Sansthana, Varanasi Chikistastana Adhyaya 7/22,30

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-07-25	2022-07-27	2022-08-03	2022-08-10	2022-08-17
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Review Article

Mutrakruchha

Journal of Ayurveda and Integrated Medical Sciences