Journal of Ayurveda and Integrated Medical Sciences

Introduction

Sushruta describes Vatashteela among the 12 types of Mutraghata. In this condition Apana Vayu, gets localised in between Basti (urinary bladder) and Shakritmarga (rectum), produces a dense fixed stone like glandular swelling, leading to obstruction of Vit, Mutra and Anila with Adhmana and produces Teevra Ruja in Basti Pradesha. Vatashteela reflects the symptoms of urine retention, incomplete voiding, increased frequency, urgency, hesitancy, difficulty in micturition, weak stream, dribbling and straining during micturition. These  features have striking similarities with Benign Prostatic Hyperplasia (BPH).

It is one of the most prevalent obstructive uropathy of advanced age group in males, rises markedly after the age of 40 years. Peak incidence of 8% in the 4^th decade of life, 50% in the 6^th decade and 80% in the 9^th decade of life is observed. It is the most common cause of Bladder Outlet Obstruction.^[4]

The conservative treatment includes either α 1n adrenoreceptor blockers or 5 α reductase inhibitors or both in combination which are known to cause dizziness, decreased libido, retrograde ejaculation, impotence, postural hypotension, gynaecomastia, skin rashes and few vascular side effects.^[5]

Withdrawal of these drugs result in regrowth of prostate. Surgical procedures includes Transurethral Resection of Prostate (TURP), Freyer’s suprapubic transvescical Prostatectomy, Millin’s Retrograde prostatectomy, Microwave treatment, Holmium laser treatment, Intraurethral stents, etc. The surgical interventions are difficult because of old age and with the association of conditions like CVD, Pulmonary conditions, HTN and DM. However, surgery is invasive, expensive and has post-op complications like haemorrhage, infection, incontinence, perforation of bladder, stricture urethra, retrograde ejaculation, impotence and recurrence.

Ayurveda advocates various treatment modalities like Kashaya, Kalka, Ghrita, Bhakshya, Lehya, Paya, Kshara, Madya, Asava and Swedana and Uttarabasti in Mutraghata. One such formulation described by Acharya Vangasena in Chikitsasaara Sangraha is Ksharapippali. It includes ingredients like Bala and Manakanda which have Mutrala (diuretic) property.

Types:
Acharya Sushrutha has explained Mutraghata in Uttaratantra in the 58^th chapter, wherein he mentions 12 types viz,

1. Vatakunadalika
2. Vatashteela
3. Vatavasti
4. Mutraateeta
5. Mutrajathara
6. Mutrasanga
7. Mutrakshaya
8. Mutragranthi
9. Mutrashukra
10. Ushnavata
11. Mutrouksada pittaja
12. Mutrokusada kaphaja

Acharya Vagbhata has also described 12 types of Mutraghata^[8], last one being Vidvighata. Acharya Caraka^[9] and Madhavakara has explained 13 types, adding Vastikundala to the above list.

Samprapti:
Mityaahara and Vihara/Abhigata/Vega Nigrahana
↓
Apana Vata Dushti
↓
Sthanasamshraya in between Guda and Basti
↓
Ashteelavat Ghana Granthi is formed
↓
Vatashteela

Chikitsa:

The treatment prescribed for Mutraghata can also be applied to Vatashteela since there is no distinct treatment specified for Vatashteela, which includes modalities like Nidana Parivarjana, Shodhana, Shamana, Shastra Pranidhana, Rasayana and Pathya-Apathya.

Yoga Ratnakara has advised Snehana and Swedana therapies first followed by Sneha Virechana and Uttarabasti. Various Kashaya, Kalka, Ghrita, Bhakshya, Lehya, Paya, Kshara, Madya, Asava and Swedana and Uttarabasti is been advised in Mutraghata by Acharya Sushrutha.

Acharya Vangasena in his Cikitsasaara Sangraha, has advised Ksharapippali in the management of Vatashteela, Yakrit-Pleeha Roga and in Tridoshaja Gulma in Udararogadhikara Adhyaya.

Akshota: has essential nutrients, minerals and vitamins B, A and C.
Apamarga having Tikta, Katu Rasa with Ushna Virya has Mutrajanana^[12] and Kaphaghna properties.
Sirisha: is Ushna, with Tikta Kashaya Rasa is Tridoshaghna. And has saponin and tannin 7-11%.
Lodhra: is Shothaghna and Balya.
Punarnava: has Mutravirechana property.
Manakanda: has Mutrajanana property.
Snuhi latex: is Teekshna Virechaka.
Ajagandha: is Anulomaka and Shoolahara. And contains β-sitosterol.
Aragwadha: is Kaphaghna and Mutrajanaka.
Varuna: has Saponin and tannins. Has Vatanashaka, Mutrajanana, Ashmarighna and Shothaghna properties. It’s bark is indicated in Mutravikaras.^[13]
Shigrumoola: has Vatanulomaka, Vatahara, Kaphahara, Mutrajanana and Shothahara properties.
Bala: is Sheeta Virya and has Balya, Rasayana and Sangrahi properties.
Chitraka: is Agnideepaka, Rasayana, Vata-Kaphahara.
Yavakshara: is Agnideepaka, Mruduvirechaka and mild diuretic.
Bala, Manakanda, Punarnava, Varuna and Yavakshara are diuretics.Sirisha, Citraka, Varuna, Punarnava, Ajagandha contains β-sitosterol, which has been proved potential in reducing BPH by improving urologic symptoms and flow measures.

Conclusion

Ksharapippali, a formulation explained by Vangasena indicated in Vatashteela contains the ingredients with diuretic properties and the chemical constituents like β-sitosterol. Various studies show β-sitosterol has been proved potential in reducing BPH by improving urologic symptoms and flow measures. Hence Ksharapippali can be considered a potent formulation in treating Vatashteela (BPH).

References

1. Sushruta, Sushruta samhita, with the Nibandha Sangraha commentary of Sri Dalhana Acharya, Edited by Vaidya Yadavaji Trikumji Acharya, Chaukhambha Surabharati Prakashama, Varanasi reprint 2003, Uttara Tantra Chapter 58/1-2 pp824

2. Madhava Nidanam of Madhavakara with English Translation by Prof. K.R.Srikantha Murthy, Chaukambha Orientalia, Varanasi, Second Edition. Chapter 31/4 Pg No.110