E-ISSN:2456-3110

Review Article

Mutraghata and Mutrakrucchra

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 10 October
Publisherwww.maharshicharaka.in

Clinical understanding of the Mutraghata and Mutrakrucchra in purview of Sushruta Samhita

Jambavathi S1*, Masalekar S2
DOI:10.21760/jaims.8.10.15

1* Jambavathi S, Phd Scholar, Department Of Pg And Phd Studies In Shalya Tantra, Government Ayurveda Medical College, Bangalore, Karnataka, India.

2 Srinivas Masalekar, Professor HOD, Department of PG and PhD Studies in Shalya Tantra, Government Ayurveda Medical College, Bangalore, Karnataka, India.

Sushruta Samhita has immense explanation of all the diseases including the Mutravaha Srotas Vikara (Urological disorders). Diseases like Mutrashmari, Mutraghata and Mutrakrucchra are well explained in this Samhita. Mutrashmari is explained in Nidana and Chikitsa Sthana of Sushruta Samhita since it is one among the Ashta Mahagada, whereas the detailed explanation regarding Mutaghata and Mutrakrucchra can be noted in Uttara Tantra which is the contribution of Acharya Nagarjuna. Mutraghata and Mutrakrucchra comprises of broad spectrum of several Urological disorders. Hence the understanding the Nidana, Samprapti, Lakshana and Chikitsa of Mutraghata and Mutrakrucchra are clinically very important. Hence an attempt is made to review about the Clinical understanding of these conditions in the present article.

Keywords: Mutraghata, Mutrakrucchra, Urological disorders, Sushruta Samhita

Corresponding Author How to Cite this Article To Browse
Jambavathi S, Phd Scholar, Department Of Pg And Phd Studies In Shalya Tantra, Government Ayurveda Medical College, Bangalore, Karnataka, India.
Email: 		Jambavathi S , Masalekar S, Clinical understanding of the Mutraghata and Mutrakrucchra in purview of Sushruta Samhita. J Ayu Int Med Sci. 2023;8(10):103-111.
Available From
https://jaims.in/jaims/article/view/2727

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-08-14 2023-08-21 2023-08-26 2023-09-01 2023-09-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 23.89%

© 2023by Jambavathi S, Masalekar Sand 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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Introduction

Acharya Sushruta has explained the diseases Mutrakrucchra and Mutraghata in 58th and 59th chapters of Uttara Tantra in Sushruta Samhita[1] under the chapter names Mutraghata Pratisheda and Mutra Krucchra Pratisheda respectively.

Dalhanacharya[2] in Nibandha Sangraha commentary explains Mutraghata as

  • 1st opinion - ‘Mutraghato Mutravarodha’- Any obstruction in the urinary system
  • 2nd opinion - ‘Aghata Shabdena Dushtimahuhu Na Tu Avarodham’- Any type of vitiation in Urinary system just not the obstruction.

Dalhanacharya[3] in Nibandha Sangraha commentary explains Mutrakrucchra as

  • ‘Mutrakrucchram Dukhena Mutra Pravruttihi’ - Mutrakrucchra is any discomfort to pass urine
  • Instead of Mutrakrucchra Pratisheda the chapter is also read as Mutra Upaghata Pratisheda. ‘Upaghata Shabdena Krucchrataa Vadanti’ - which means difficulty in micturition. 
  • Some authors do not consider Mutrakrucchra as a separate condition because the diseases like Mutrashmari, Mutraghata and Mutraja Udavarta has Mutrakrucchra as a Lakshana (clinical feature).
    However, Mutrakruccchra has specific Chikitsa (treatment), Lakshana (clinical features) and Karyabheda (variety). Hence Acharya has explained it in the separate chapter.

Types

Mutraghata - 12 types[4]Mutrakrucchra - 8 types[5]
§   Vatakundalika§   Vataja Mutrakrucchra
§   Ashthila§   Pittaja Mutrakrucchra
§   Vatabasti§   Kaphaja Mutrakrucchra
§   Mutratita§   Sannipataja Mutrakrucchra
§   Mutrajathara§   Abhighataja Mutrakrucchra
§   Mutrotsanga§   Shakrut Vegadharana Janya Mutrakrucchra
§   Mutrakshaya§   Ashmarijanya Mutrakrucchra
§   Mutragranthi§   Sharkarajanya Mutrakrucchra
§   Mutrashukra 
§   Ushnavata 
§   Pittaja Mutraukasada 
§   Kaphaja Mutraukasada 


Nidana, Samprapti and Lakshana of Mutraghata

MutraghataNidana and SampraptiLakshanaDosha dominance
Vatakundalika[6]Due to the Rukshata of the Vayu and Vegadharana, Vayu gets Antaramashrita (localised in urinary bladder) and involving mutra moves in Kundalakara (circular direction)Passing Alpalpa (small quantity) Mutra, Sarujaska (painful), Shanaih Shanaih Mutra (frequent micturition)Vata
Ashthila[7]Vayu gets localised between Shakrut Marga (rectum) and Basti (urinary bladder) and produces Ashtilavat (stone like) Ghana (dense) Granthi (cyst like elevation)Vit, Mutra, Anila Sangha (obstruction of faeces, urine and flatus), Adhmana (distension of bladder) and Vedana in Basti (pain in urinary bladder)Vata
Vatabasti[8]Person who is not wise indulge in Vega Dharana (suppression of natural urges like micturition), Vayu in the Basti (urinary bladder) obstructs its Mukha (opening of the bladder)Mutrasanga (obstruction of urine), pain in Basti (urinary bladder) and Kukshi (lower abdomen)Vata
Mutratita[9]Person who does Mutra Vega Dharana (suppression of urine), and tries to micturate after suppressionUrine does not come out and on straining Manda Ruja (with mild pain), Alpalpa (in small quantities), Punah Punah (repeated flow)Vata
Mutrajathara[10]On Vega Dharana (suppression of natural urges like micturition), because of upward movement of Vata, Apana Vayu gets aggravated and fills the abdomenNabheradha Adhmana (distention of abdomen below the umbilicus), Teevra Vedana (severe pain). Obstruction of Adha Strotas (downward passage of urine and faeces)Vata (Apana)
Mutrotsanga[11]If mutra gets obstructed in Basti (bladder), Nala (urethra), Mani (glans penis),On straining, will pass Sarakta (urine with blood), Alpalpa (small quantities), with or without painVata
Mutrakshaya[12]Ruksha and Klanta (Person who is having dryness and debilitated), Pitta and Vata in Basti (urinary bladder)Urine with Daha (burning sensation) and Vedana (pain)Vata and Pitta
Mutragranthi[13]Abhyantare Bastimukhe (inside the opening of urinary bladder) Vrutta (round), Alpa (small), Sthira (fixed) swelling appearsVedana (pain), Mutramarga Nirodha (obstructs urinary passage), having features of Mutrashmari (renal calculi) 
Mutrashukra[14]Person with the urge of micturition indulges in sexual activitySemen is discharged suddenly before or after micturition, Bhamodaka Pratikasha (resembles ash mixed water) 
Ushnavata[15]Due to Vyayama (exercise), Adhwa (walking), Atapa (exposure to sun), Pitta entera Basti and does Avarana of VataBurning sensation in Basti (urinary bladder), Medra (penis), and Guda (anus) during micturition, Haridra (deep yellow) coloured urine or Rakta (reddish) urine is passed with difficultyPitta, Vata
Pittaja Mutraukasada[16] Urine is Vishada (clear), Pitaka (yellow), Sadaha (burning) and Bahala (thick) and on drying resembles Gorochana (cow’s bile)Pitta
Kapahaja Mutraukasada[17] Urine is Picchila (slimy), Samhata (concentrated), Shweta (white), difficult to pass and on drying resembles Shanka Churana (powdered cunch-shell)Kapha

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Lakshana of Mutrakrucchra

MutrakrucchraLakshana
Vataja Mutrakrucchra[18]Urine is passed Alpalpa (small quantity), Samudpidya (on straining tearing pain) in Mushka (scrotum), Mehana (penis), Basti (urinary bladder)
Pittaja Mutrakrucchra[19]Urine is passed Haridra (deep yellow), Ushna (hot), or Rakta (red), burning sensation in Mushka (scrotum), Mehana (penis), Basti (urinary bladder)
Kaphaja Mutrakrucchra[20]Urine is passed Snigdha (unctuous), Shukla (white) and Anushna (warm) with Samshrusta Roma (horripulation) and Guruta (heaviness) in Mushka (scrotum), Mehana (penis), Basti (urinary bladder)
Sharkarajanya Mutrakrucchra[21]Sharkara is the Shleshma Avyava (disintegrated part of Kapha) undergoes Pachana by pitta, Bhedana by Vata.Hrutpeeda (cardiac pain), Vepathu (shivering), Shoola (colicky pain), Mandagni, Durbala (weakness), Murcha (fainting) and severe dysuria.When Sharkara is passed with urine, pain will subside until some other Sharkara obstructs the passage.
Abhighataja Mutrakrucchra[22]If there is injury in Mutravahini (urinary channels) due to Shalya (foreign body) dysuria with severe painFeatures like Vatabasti
Shakrut Vegadharana Janya Mutrakrucchra[23]Vayu get Viguna (vitiated) Adhmana (distention), Sashula (painful), Mutrasanga (retention of urine)
Ashmarijanya Mutrakrucchra[24]Features like Mutrashmari
Sannipataja Mutrakrucchra[25]Urine passed is Daha (hot), Sheeta (cold), Ruja (painful) and Nanavarna (different colours) and Muhurmuh (frequent), Tama Avarana (patient feels darkness) with difficulty.

Chikitsa Sutra / Treatment Principle of Mutraghata

  • Mutrashmari Chikitsa[26] - Kashaya (Decoctions), Kalka (Pastes), Sarpi (Ghee), Bhakshya (Medicated food), Lehya (Electuaries), Payas (milk), Kshara (alkali), Madya (wine), Asava (medicated fermented preparations), Sweda (sudation), Basti (enema), Uttara Basti (urethral douches) and other procedures explained in Ashmari Chikitsa (Treatment of Renal calculi) can also be adopted.
  • Mutraja Udavarta Chikitsa[27] - the treatment explained in Mutraja Udavarta can also be adopted
  • After Snehana (unction), Swedana (sudation), Virechana (purgation) body is cleansed, later Uttara Basti (urethral douches) can be applied.[28]

Yoga / Formulations

  • Kalka of Ervaru Beeja (paste of snake cucumber seeds) in Aksha Matra (10-12g) mixed with Saindhava Lavana along with Dhanyamla (sour gruel) is specially indicated for [29]
  • Sura (wine) mixed with Souvarchala Lavana or Sura (wine) made of honey and jaggery should be taken while having meat is specially indicated for [30]
  • 1 Karsha (10-12g) Kumkuma (saffron) kept in honey water overnight should be taken in morning is specially indicated for [31]
  • Sura (chief wine made of flour) should be taken with Dadima (pomegranate) and mixed with Ela (cardamom), Jiraka (cumin), Shunti (ginger) and Lavana (salt) is specially indicated for [32]
  • Roots of Vidarigandadi Gana and Gokshura should be boiled in half Prasta water (320ml) with four times milk and reduced to milk only. When cooled should be taken with sugar and honey. This alleviates Mutraghata caused by Vata and [33]
  • Intake of rasa (juice) of the faeces of Raasabha (donkey) and Vaji (horse) which is strained well through a piece of cloth in the dose of one Kudava (160 ml) removes disorders of urine.[34]
  • Kalka (paste) of Haritaki, Amalaki and Vibhitaki (Triphala) in Badara Pramana (5-6g) with Saindhava Lavana should be taken with water removes disorders of urine.[35]
  • Paste of Draksha 10g kept in water overnight removes the painful disorders of urine.[36]
  • Swarasa (juice) of Kantakari 160ml in the morning eliminates disorders of the urine.[37]
  • Amalaki Swarasa (juice) 160ml mixed with honey alleviates pain in urine.[38]
  • Amalaki Swarasa (juice) 160ml mixed Ela (cardamom powder).[39]
  • Tala root which is freshly pounded should be taken with Shali rice water which is cooled[40]
  • Rasa (juice) of Trapusa mixed with milk should be taken in the morning[41]
  • Milk processed with Madhura Dravya (sweet predominant herbs) mixed with ghee, it eliminates disorders of urine and destroys calculus.[42]
  • Bala, Gokshura, Krouncha, Kokilaksha, roots of Shataparvaka, Devadaru, Chitraka, Vibhitaka Beeja should be pounded and taken along with sura (wine) eliminates disorders of urine and destroys calculus.[43]
  • Patala Kshara (alkali) decanted 7 times and mixed with a bit of oil removes disorders of urine.[44]

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  • Nala, Pashanabheda, Darbha, Ikshu and Trapusa Beeja, Ervaru boiled in milk and mixed with ghee.[45]
  • Alkali water of Patala, Yavashuka, Paribhadra, Tila mixed with Twak, Ela and Pippali or should take these separately as Lehya (electuaries) mixed with jaggery.[46]
  • Ghrita,[47] Bala ghrita[48], Mahabala Ghrita,[49]

Chikitsa Sutra/ Treatment Principle of Mutrakrucchra

Mutrashmari Chikitsa - Formulations and treatment procedures like Snehana explained in Mutrashmari can be adopted in Mutrakrucchra also.

Vishesha Chikitsa according to the types of Mutrakruchhra

Vataja Mutrakrucchra[50]

Gokshura, Pashanabheda, Kumbhi, Hapusha, Kantakari, Bala, shatavari, Rasna, Varuna, Girikarnika, and Vidarigandadi Gana drugs - should add oil or ghee mixed with other three fats and cooked. This can be used for internal administration or Anuvasana Basti or Uttara Basti.

Taila (oil) cooked in Swarasa of Gokshura with Guda (jaggery) and Shunti (ginger) along with milk.

Pittaja Mutrakrucchra[51]

Ghrita (ghee) or milk processed with Surasadi, Ushakadi, Mustadi and Varunadi Gana Dravyas helps in Pittaja Mutrakrucchra. Sneha processed with same drugs should be applied in three types of Basti namely - Ashtapana Basti, Anuvasana Basti and Uttara Basti.

Virechana with Ksheera (milk), Ikshu Rasa (sugarcane milk) and Draksha are also useful.

Kaphaja Mutrakrucchra[52]

Taila (oil) and Yavagu (gruel) processed with Surasadi, Ushakadi, Mustadi and Varunadi Gana Dravyas are useful.

Sannipataja Mutrakrucchra[53]

Treatment according to Dosha predominance

The mixture of Kakodumbara powder, Shweta Punarnava, Darbha, and Shilajatu, when consumed with water, Sura (wine), Ikshu Rasa (sugarcane juice), and a decoction of Darbha,

tailored to the individual's Dosha, effectively alleviates the pain associated with Mutrakrucchra.

  • Abhighataja Mutrakrucchra[54] - Treatment like Sadyovrana
  • Shakrut Vegadharana Janya Mutrakrucchra[55] - Swedana (sudation), Avagaha (sitz bath), Abhyanga (massage), Basti (enema), Churna Kriya (as mentioned in Vata Vyadhi)
  • Ashmarijanya Mutrakrucchra and Sharkarajanya Mutrakrucchra[56] - treatment like Mutrashmari.

Discussion

  • In cognizance to the explanation of Dalhanacharya, Mutraghata can be understood as any disorders of Urinary system including the conditions which has obstructive pathology. Mutrakrucchra can be understood as any difficulty to pass urine (Dysuria).
  • Exact correlation of each type of Mutraghata and Mutrakrucchra according to modern disease classification is not possible because the Nidana and Samprapti explained in Sushruta Samhita is in accordance with the Gati and vitiation of Doshas.
  • Based on the similarities in the clinical presentations, the condition BPH (Benign Prostatic Hypertrophy)[57] can be perceived as Mutrashteela or Vatashteela type of Mutraghata. The conditions Vatabasti, Mutratita, Mutrajathara are having clinical features of the Acute Retention of Urine.[58] Mutrashukra has similar presentation to Spermaturia. Mutrotsanga and Pittaja Mutrakrucchra have haematuria as clinical presentation. Mutragranthi may be any neoplasms in the Urinary Bladder.
  • The Yoga (formulations) explained in the treatment are having Madya, Sura, Asava (various alcoholic preparations) and Ikshu Rasa (Sugarcane juice). This might be owing to the diuretic properties of these preparations.
  • Usage of Paneeya Kshara (caustic alkali) and Mutra (urine) of animals is observed in the Yoga (formulations). These are alkaline in nature and are very helpful in these conditions.
  • Sushruta Samhita has explained both Shamana

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  • and Shodhana line of treatment in Mutrakrucchra and

Conclusion

Mutraghata and Mutrakrucchra comprises of broad spectrum of several Urological disorders. Hence the understanding the Nidana, Samprapti, Lakshana and Chikitsa of Mutraghata and Mutrakrucchra are clinically very important. The treatment of Mutrashmari and Mutraja Udavarta can be adopted in Mutraghata and Mutrakrucchra based on the Dosha predominance. The treatments both Shamana as well as Shodhana are explained in the Sushruta Samhita. It should be decided based on the condition of the patient and the severity of the disease.

References

1. Acharya Sushruta. Sushruta Samhita with the Nibandhasangraha Commentary of Dalhanacharya. Uttara Tantra Chapter 58, 59. In: Vaidya Jadvji Trikamji Acharya, Narayana Ram Acharya ‘Kavyatirtha’ (eds). Chaukamba Sanskrit Sansthan, Varanasi; 2009. p. 824, pp. 787-794.

2. Acharya Sushruta. Sushruta Samhita with the Nibandhasangraha Commentary of Dalhanacharya. Uttara Tantra Chapter 58, commentary of Verse no. 1-2. In: Vaidya Jadvji Trikamji Acharya, Narayana Ram Acharya ‘Kavyatirtha’ (eds). Chaukamba Sanskrit Sansthan, Varanasi; 2009. p. 824, pg. 787.

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8. Acharya Sushruta. Sushruta Samhita with the Nibandhasangraha Commentary of Dalhanacharya. Uttara Tantra Chapter 58, Verse no. 9-10. In: Vaidya Jadvji Trikamji Acharya, Narayana Ram Acharya ‘Kavyatirtha’ (eds). Chaukamba Sanskrit Sansthan, Varanasi; 2009. p. 824, pg. 787.

9. Acharya Sushruta. Sushruta Samhita with the Nibandhasangraha Commentary of Dalhanacharya. Uttara Tantra Chapter 58, Verse no. 11-12. In: Vaidya Jadvji Trikamji Acharya, Narayana Ram Acharya ‘Kavyatirtha’ (eds). Chaukamba Sanskrit Sansthan, Varanasi; 2009. p. 824, pg. 787.

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12. Acharya Sushruta. Sushruta Samhita with the Nibandhasangraha Commentary of Dalhanacharya. Uttara Tantra Chapter 58, Verse no. 17. In: Vaidya Jadvji Trikamji Acharya, Narayana Ram Acharya ‘Kavyatirtha’ (eds). Chaukamba Sanskrit Sansthan, Varanasi; 2009. p. 824, pg. 788.

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21. Acharya Sushruta. Sushruta Samhita with the Nibandhasangraha Commentary of Dalhanacharya. Uttara Tantra Chapter 59, Verse no. 11-14. In: Vaidya Jadvji Trikamji Acharya, Narayana Ram Acharya ‘Kavyatirtha’ (eds). Chaukamba Sanskrit Sansthan, Varanasi; 2009. p. 824, pg. 792.

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