E-ISSN:2456-3110

Case Report

Ashmari Janya Mutrakruccha

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 8 September
Publisherwww.maharshicharaka.in

Ayurvedic treatment in Ashmari Janya Mutrakruccha - A Single Case Study

Kumar A.1*, Babar S.2, Bhuyan C.3
DOI:

1* 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.

2 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.

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.

Ayurveda gives guidelines to treat this confidently and increase quality of life of an individual. There are different modalities for management of Mootrakruchra. Nephrolithiasis or kidney disease is a global disease. It is a common painful and costly condition. A stone may form due to crystallization of lithogenic factors in the upper urinary tract, it can subsequently move into the ureter and cause renal colic. In ancient text of Ayurveda, Renal Calculi, Ureteric calculi, Vesical calculi have been mentioned categorically as under the topic Mutrakruchha, which has been classified 8 types according to their cause and symptoms and for each type separate ayurvedic drugs has been mentioned. In this case of Ashmari Janya Mutrakruccha, Haritakyadi Kwath was used for 15 days and the results were very satisfying and encouraging.

Keywords: Mootrakruchra, Nephrolithiasis, Renal Calculi, Ureteric calculi, Vesical calculi, Haritakyadi Kwath, Ashmari Janya Mutrakruccha

Corresponding Author How to Cite this Article To Browse
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.
Email: 		Asit Kumar, Sanjay Babar, Chaturbhuj Bhuyan, Ayurvedic treatment in Ashmari Janya Mutrakruccha - A Single Case Study. J Ayu Int Med Sci. 2022;7(8):125-130.
Available From
https://www.jaims.in/jaims/article/view/2036

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-07-27 2022-07-29 2022-08-05 2022-08-12 2022-08-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Asit Kumar, Sanjay Babar, Chaturbhuj Bhuyanand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Kumar A et al: Ayurvedic treatment in Ashmari Janya Mutrakruccha

Introduction

In Siddhisthana Charaka has discussed 13 types of Mootravaha Srotogata Roga mainly affecting Basti marma,[1] which are similar to Mootrakruchra. Middle Eastern literature and Egyptian literature has got extensive description of urogenital affliction. Anatomic interest in lower Urinary Tract and male genital system grew rapidly in the early Greece.

Diagnostic evaluation of the lower Genito Urinary Tract involved with the endoscopic techniques and other imaging technologies.[2]

Daha (Burning micturation)

It is main symptom of Pittraj Mootrakruchra and Ashamrijanya Mutrakruccha.

It is purely Paittika Lakshana. Due to increase in the Ushna, Tikshna, Ruksha, Guna of Pitta patient feels burning sensation on urination Sushruta has used the term ‘Agninadahyamanabhi’ which means Atyanta Dahapravritti.[3]

Ruja (pain on urination)

Ruja means pain during micturition is obviously produced by Vata Vatadrute Nasti Ruja. According to Charaka and Sushruta, patient feels pain at various sites while passing urine.[4]

Epidemiology[5]

Most patients tend to present between 30-60 years of age. The lifetime incidence of renal stones is high, seen in as many as 5% of women and 12% of males. By far the most common stone is calcium oxalate, however, the exact distribution of stones depends on the population and associated metabolic abnormalities (e.g., struvite stones are more frequently encountered in women, like urinary tract infection as are common. The Nidana Panchaka is nothing but a full horoscope of disease, right from the indulgence in the causative factor up to the complete manifestation of the disease, including prognosis of disease. The perfect knowledge of disease which is very much essential for a proper diagnosis and line of treatment.

Sarakta Mootra Pravrutti (urine with blood)

Vruddhi in Vidagdha Guna of Pitta may vitiate the Rakta also and leads to Sarakta Mootra Pravrutti. Also, any injury to Mootravaha Srotas


Case Report

A 30 yrs old female came with complaints of colicky pain which radiates from loin to groin to the tips of the genitalia. Hematuria on & off. While micturition dysuria frequency strangury. Tenderness in iliac fossa and renal angle,

History of Past Illness: No

Personal History

  • Bowel - regular, sometimes constipated.
  • Appetite - Good.
  • Micturition -
    • Diurnal : 2-3times per day
    • Nocturnal: 1-2 times per night.
    • Hematuria -on and off
  • Sleep - good
  • Diet - mixed diet
  • Addictions - No

General Examination

  • Pulse - 74 /Mins
  • Temperature - 98.6°F
  • BP - 130/90 mmhg
  • RR - 18/ Mins
  • Height - 162 Cm
  • Weight - 63 Kg
  • Tenderness - Suprapubic tenderness is present.

Urine Examination: The urine may have an unpleasant odour and appears cloudy.

Atibaddham: Dribbling micturition / drop by drop or complete suppression of Urine.

Kupeetam: Viguna Mootra

Alpalpa: Less in quantity

Abhikshna: Painful maturation

Bahalam: Concentrated urine

Results of Pathological tests and other investigation

USG (17TH May 2021)

Left kidney shows mild hydronephrosis with hydroureter due to 4mm calculus in


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lower ureter, about 1.6 cm above the UV junction. There are calyceal calculi measuring 5mm, 3mm, 3mm, 3mm each.

Right Kidney shows moderate hydronephrosis with hydroureter due to a 1.9 x 0.7 cm calculus in upper ureter about 1.3 cms below the PU junction. There are calyceal calculi measuring 3mm 3mm each.

Treatment Plan

Haritakyadi Kwath[7]

हरीतकीगोक्षुरराजवृक्ष पाषाणमिद्धन्वयवासकानाम् ।

क्वाथं पिबेन्माक्षिकसम्प्रयुक्तंकृच्छ्रे सदाहे सरुजे विबन्धे ।। Bhaishajya Ratnavali 34/27

Ingredients: Haritaki, Gokshura, Raja Vriksha, Pasanabheda, Yavasa, Water and Honey.

jaims_2036_01.PNGHaritakijaims_2036_02.PNGGokshurajaims_2036_03.PNGAraghwadha

jaims_2036_04.PNGDhanwayasjaims_2036_05.PNGPashanabheda

Procedure: Dry drug has been taken; it was sent for authentication to laboratory and then final drug preparation has been done in our college pharmacy. Haritakyadi Kwath was prepared as mentioned method according to Baishajya Ratnavali. 25 gm [1 Part] of Dry coarse powder (5gm each of Haritaki, Gokshura, Raja Vriksha, Pasanabheda, Yavasa) and added 400 ml [16 Part] of water. Decoct the preparation till the original content is reduced to 1/8th part (50 ml). After cooling the decoction, add 20 gm of Honey. 50 ml of Haritakyadi Kwath with Anupan Madhu is given to patient before food twice a day for 15 days

a) Route of administration Oral
b) Dose 50 ml
c) Anupan Honey
d) Time of Administration Twice daily, Before Food
e) Duration 15 days

Result

The result was a bit surprising for us because on the 10th day of the treatment she had severe pain as her largest stone came out along with her urine which was the exact size mentioned her in USG she completed the course and on few follow-up she had no previous pain as she was completely relieved from her ailments. A repeat USG was done and the report says


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Kumar A et al: Ayurvedic treatment in Ashmari Janya Mutrakruccha

USG REPORT (28/12/2021) B/L Renal Non obstructive Concentration / tiny calculi

Mild Hydronephrosis on right - likely residual after recent passage of Ureteric calculus.

Pathyapathya[9]

Pathya is the food and regimen which maintains the health and at the same time help in the regression of the disease. On the contrary Apathya is that food and regimen which aggravates the diseased condition and diminishes the Vyadhikshamatwa. Pathya plays an important role in prevention and recurrence of the disease as well as in treatment.

Pathya

Ahara

  • Shooka Dhanya Varga: Purana Rakthashalee, Purana Yava
  • Shami Dhanya Varga : Mudhga
  • Mamsa Varga: Jangala Pashupakshi Mamsa
  • Shaka Varga: Patola, Tanduleya, Trapusha
  • Phala Varga: Narekela Phala, Kushmanda, Karjura, Ela, Amalaki, Haritaki
  • Ikshu Varga: Madura Ikshu, Sita
  • Gorasa Varga: Godughda, Dadhi, Takra, Gritha
  • Anya Dravyas: Mahardraka, Gokshura, Kumari, Guvaka, Talastimajja, Sheetala Annapana, Nadijala, Karpura, Kshara

Vihara

Sheeta Vayu Sevena, Sheeta Graham

Apathya

Ahara

  • Rasa: Kashya, Lavana, Amla.
  • Anna: Shushka, Rooksha, Pistanna, Viruddashana, Vishamashana, Grahiahara, Vidahi.
  • Shooka Dhanya: Tila, Sarshapa.
  • Shami Dhanya: Masha.
  • Kritanna Varga: Tilabrasta Peenyaka.
  • Mamsa Varga: Mastya
  • Madya Varga: Madya.
  • Anya Dravyas: Hingu, Tambula, Atiteekshna Ahara, Shaluka, Kapitta, Jambu, Kamalamoola.

Vihara

  • Vyayama
  • Vegadharana
  • Vyavaya
  • Adika Shrama
  • Gaja-Ashwayana

Discussion

Daha: Is main symptom of Ashmarijanya Mootrakruchra. It is purely Paitika Lakshana. Due to increase in Ushna, Tikshna, Ruksha Guna of Pitta patients feels burning sensation at the time of urination.

Ruja: Pain at time of urination is by Vata. In present study patients giving history feeling pain at genital region, lower abdomen, sand pelvic region and sometimes due to infections pain can spreads up to kidneys and both lumbar regions is observed.

Peeta Mootrata: It is due to the vitiated Pitta which causes Vivarnata of Peeta.

Muhur Muhur Mootra Pravrutti: due to Ashmarijanya Mutrakruchhra Is due to vitiation of Apan Vayu, which becomes Pratiloma in Mootrakruchra and causes on and off micturition.

Sarakta Mootrata: Is due to vitiation of Rakta by Vidagdha Pitta and Ashmarijanya Mutrakruchha.

Mode of action of Kwatha

Kwatha is prepared by using the coarse powder form of a drug with water by using the theory of decoction. In this water soluble and thermostatic active principles of the drugs are extracted out. Hence water is used as the base for the formulation. Water is absorbed in the body faster than any other solvent. As the therapeutics active principles of the drugs are absorbs in the water in Kwatha form and hence when it is administered to the patient it acts very fast. Faster is the absorption of the drugs faster being the drug action. Radial absorption of the Kwatha in GIT facilitates the drug to reach its site of action. The drug theory suggests that every drug has the affinity towards their host organ to exhibit its action. The both Kwatha taken for clinical study are mainly formulated for Mootravaha Srotas and aimed for Mootravirechana and Ashmarinashak, the base used as water increases the urine output and cleans up the channels.


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Thus the mode of action of Kwatha makes easier for the therapeutic management of the undertaken clinical trial on the Ashmarijanya Mootrakruchra.

Mode of action of Haritakyadi Kwath

  • It contains the drugs Haritaki, Gokshura, Pashenbheda, Aragvada and Although drugs in Haritakyadi Kwatha are of different properties i.e., Rasa, Veerya, Vipakaa and Gunas, we found the common qualities - as the four Dravyas of them except Haritaki having Sheeta Veerya and except Pashanbheda all having Madhura Vipakaa and Madhura Rasa as a Pradhan Rasa or Anurasa.
  • Madhura Rasa: It is of Seeta, Snigdha, Guru Guna, Prithvi and Jala Mahabhoota Pradhan. These Mahabhootas has Guru Guna which are responsible for natural downward movement. Jala Mahabhoota is of Snigdha Guna combined effects of this are Vatanuloman e., relieves Vata, facilitates excretion of urine and stool. Also gives strength to all Dhatus and brings softness of Srotasa. Seeta Guna alleviates burning sensation reduce the symptoms produced by Pitta.
  • Madhura Vipaka: It is Vata Pitta Hara and Kapha Vardhak. It gives strength to Dhatus. It is Sukral. It increases quantity of stool and urine.
  • Seeta Veera: It is Pitta Hara, Vata Kapha Vardhak. Jivaniya Balya, Rakta Prasadan.
  • Snigdha Guna: It acts as Vatashamak Pittashamak and Ashmarinashak.
  • Haritaki due to its Madhura and Tikta Rasa acts as Pittaghna and due to Madhura Rasa and Ushna Veerya it does Vata Shamana and Prabhava is Tridoshahara, Vedanasthapaka, Shothahara it is having Anuloma property. By these properties vitiated Dosha and Malas are excreted out of body. Aragwadha due to its Madhura Rasa and Seeta Veerya increase urine output acts Mootral and Pittashamak. Dhanwayas with Snigdha and Laghu Guna acts Mootral and Pittashamak. Gokshur with Madhura Rasa and Snigdha Guna increases Kapha and Ulitimately Kleda increases “Mootrasya
  • Kledavahanama” therefore due to increased Kleda the Mootra is increased.
  • Pashanbhed due to its Laghu and Teekshna Guna helpful for action of Ashmaribhedan and Kapha Pittashaman. Thus Haritkyadi Kwath works in Ashmarijanya Mutrkricchra

Conclusion

From treatment aspect modern antibiotic acts on property of bacteriostatic, but may produce same effect on the tissue of body, as they kill invading bacteria, they may simultaneously kill friendly organism and may impair the normal function of renal tissue. So, they may again cause for recurrence of disease. On the Ayurvedic side Prakruti Vighata i.e., Ayurvedic medicine boost immunity against organism. Also nourishes and rejuvenate body tissue. The drug Haritakyadi Kwath Dravyas are Mootravirechaniya and Pittavatashamak and Basti Shodaka, and acts as Ashmarinashak. So, the drug does both Karma i.e., Shodhana and Shaman by their properties. Shodhan followed by Shaman is best line of treatment according to Ayurveda.

The drugs of Haritakyadi Kwatha are Seeta Veeryatmaka, Madhua Vipakaia, they are Tridosha Shamaka and Vatanulomaka.

The Haritaki is Ushna Veeryatmaka does the Vata Shamana and Vatanulomana. All together they play important role in Samprapti Vighatana of Pittaja Mootrakruchra. So, they contribute for pacification of Doshas which are vitiated in Ashmarijanya Mootrakruchra. Ativyayam, Teekshna Aushadha, Atimadhayapana, Adhyashana and Ajirna are main striking causes of Ashmarijanya Mootrakruchra. For Ashmarijanya Mootrakruchra Vishesha Nidana are elicited from Mootrakruchra Vyadhi Nidana, and on basis of Kriyakala Vishesha Samprapti can be drawn.

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