E-ISSN:2456-3110

Case Report

Glycyrrhiza glabra

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Management of Pittaj Mutrakruchhra (Urinary Tract Infection) with Vidariyadi Vati (Pueraria tuberosa Linn, Tribulus terrestris Linn, Glycyrrhiza glabra Linn, Mesua ferrea Linn, Magnatite) - A Single Case Report

Kamble RS1*, JM Shirke2, Joshi VN3, Rohani SG4
DOI:10.21760/jaims.9.7.55

1* Rohini Siddhartha Kamble, Post Graduate Scholar, Dept of Rog Nidan, Dr D Y Patil College of Ayurved and Research Centre, Pune, Maharashtra, India.

2 JM Shirke, Professor, Dept of Rog Nidan, Dr D Y Patil College of Ayurved and Research Centre, Pune, Maharashtra, India.

3 Vinayak N Joshi, HOD, Dept of Rog Nidan, Dr D Y Patil College of Ayurved and Research Centre, Pune, Maharashtra, India.

4 Sachin G Rohani, Associate Professor, Dept of Rog Nidan, Dr D Y Patil College of Ayurved and Research Centre, Pune, Maharashtra, India.

Urinary tract infections (UTIs) are very common and can be detrimental to health and quality of life. The overall prevalence of UTI was 33.54% of which 66.78% were females and scan be corelated to Mutrakruchhra. Vidaradi Vati having drugs Vidari Churna (Pureraria Tuberosa Linn), Gokshur Churn (Tribulus terrestris Linn), Madhuyashti Churn (Glycyrrhiza glabra Linn), Nagkeshar Churn (Mesua ferrea Linn), Loha Bhasm (Magnatite). Combinations of these all Churn create a good effect and are effective in reliving symptoms of Mutrakruchhra (Urinary Tract Infection). When there is recurrence of Urinary Tract Infection and patient is frustrated by taking allopathy medicine, there is need to find new medication which will give complete relief to patient. Patient has already invested so much of money for treatment there is need to find new cost effective treatment. As manifestation of Mutrakrucchra and urinary tract infection are similar, an attempt has been made in this article to understand the concept of urinary tract infection and to make formulation effective on Mutrakruchhra (Urinary Tract Infection).

Keywords: Mutrakruchhra, Urinary Tract Infection, Vidariyadi Vati, Pueraria Tuberosa Linn, Tribulus terrestris Linn, Glycyrrhiza glabra Linn, Mesua ferrea Linn, Magnatite

Corresponding Author How to Cite this Article To Browse
Rohini Siddhartha Kamble, Post Graduate Scholar, Dept of Rog Nidan, Dr D Y Patil College of Ayurved and Research Centre, Pune, Maharashtra, India.
Email: 		Kamble RS, JM Shirke, Joshi VN, Rohani SG, Management of Pittaj Mutrakruchhra (Urinary Tract Infection) with Vidariyadi Vati (Pueraria tuberosa Linn, Tribulus terrestris Linn, Glycyrrhiza glabra Linn, Mesua ferrea Linn, Magnatite) - A Single Case Report. J Ayu Int Med Sci. 2024;9(7):346-353.
Available From
https://jaims.in/jaims/article/view/3388

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-01 2024-05-08 2024-05-15 2024-05-22 2024-06-01
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.35

© 2024by Kamble RS, JM Shirke, Joshi VN, Rohani SGand 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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Rohini SK et al. Management of Pittaj Mutrakruchhra

Introduction

Health as well as quality of life of individuals is affected due most common disease Mutrakruchhra. Mutrakruchhra can be correlated to Urinary Tract Infection. The overall prevalence of UTI was 33.54% of which 66.78% were females and 33.22% were from males. High prevalence 2:1 was observed in females as compared to males.[12]

During whole life 50-80% of women have Urinary Tract Infection at least once. Globally more than 150 Million people are affected annually.Acharya Charak and Acharya Sushrut have described about Mutrakruchhra, it’s classification, symptoms and treatment.[1]

There are 8 types of Mutrakruccha and Pittaj Mutrakruchhra is one of them.[1,3] The Lakshanas of Pittaja Mutra Kruchha (Urinary Tract Infection) like Peet Mutrapravruti means yellowish discoloration of urine, Sadaha Mutrapravruti means burning sensation during maturation, Sashul means painful maturation & Muhur Muhur Mutrapravruti means with increased frequency. Sarkta Mutrapravruti means heamaturia All these signs and symptoms can be correlated to Urinary Tract Infection of modern science.[1]

Infection in Urinary Tract leads to arrange of symptoms and signs that reflect the location and severity of the infection.[9] Poor hygienic conditions and environment, poverty and illiteracy also contribute to the increasing percentage of Urinary tract Infection. The studies have shown that one in 5 adult women experience a UTI at some point,confirming that it is an exceedingly common worldwide problem.[3] E.coli is by farthe commonest cause of uncomplicated community-acquired UTIs in both outpatient and inpatient settings. Other common uropathogen other common uropathogens areEnterococcus faecalis, Enterobacter species, Staphylococc saprophyticus, Klebsiella pneumoniae,Proteus mirabilis and pseudomonas species.[2]

Need of Study

Pittaj Mutrakruchhra (Urinary Tract Infection) has lots of physical concern in day-to-day life of people. In modern science UTI is treated but the effect is temporary & patients come with recurrence for most of the time.

In Ayurveda Pittaj Mutrakruchhra (Urinary Tract Infection) can be treated effectively by using herbal medicines.[1,3] Modern treatment of UTI comprises of antibiotics, antispasmodics, alkalisers which have their own side effects and limitations. We have many Yogas formulation in Ayurvedic classics which are giving having good result, cost effective, can be taken by patient on OPD basis. There is need to find more effective medicine as an option to other market preparation Vallipanchmul Kwath, Syrup Ural.

There is need to find more effective, side effect free and economical treatment on Pittaj Mutrakruchha (Urinary Tract Infection).

Thus, Vidaradi Vati will be use on Pittaj Mutrakruchha (Urinary Tract Infection)

Case Report

A 38 years old female came to OPD of Dr. D Y Patil College of Ayurveda and Research Center resident of Pune, Maharashtra. She was having Peet Mutrapravrutti (yellowish discolouration of urine), Sadaha Mutrapravrutti (burning sensation during micturition), Sashul Mutrapravrutti (pain during/after micturition), Muhur Muhur Mutrapravrutti at night (increased frequency of micturition at night) i.e., 7 times Micturition at night.

Patient was suffering from above symptoms since 2year intermittently i.e., once in three months in past she has taken many therapies but there was recurrence of disease.

Neither history of major illness nor any past surgical history.

Personal Information

Name - XYZ
Age - 38 yrs
Sex - Female
Weight - 63kg
Height - 149cm
Occupation - Sweeper
Marritial status - married
Appetite - Good
Bala - Madhyam
Sleep - disturbed due to micturition at night
Prakruti - Pittapradhan
B.P. - 130/80mmhg

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Rohini SK et al. Management of Pittaj Mutrakruchhra

Ashtavidha Pariksha

Jiwha - Saam
Nadi - 81 beats/min
Mala - Regular defecation
Mutra - Peet Varna, burning, painful micturition
Shabda - Speech clear
Sparsh - Normal
Druk - Normal
Akruti - Madhyam

Nidanpanchak[2,3]

Hetu (Causes): Abhishandi Aahar, Tikshna Ushana Drav Aahar, Mutranighrah

Purvaroop: Ajirna, Aanah

Roop (Symptoms):Sashulmutra Pravrutti, Mutradaha, Muhurmuhur Mutrapravrutti, Peet Varn Mutrapravrutti.

Upashay: Upashayatmak Upaay (things to be done to get relief) such as drinking more amount of water. Drink coriander powder 1 tea spoon and Jirak powder 1 tea spoon mix in water daily 1-2 glass.

Samprapti

jaims_3388_01.JPG

Investigations

Urine (Routine/Microscopic) - Randomly freshly voided sample is usually adequate for most tests.[10]

Preparation of Vidaryadi Vati

Vidarikand Churna (Pueraria tuberosa Linn), Gokshur Churna (Tribulus terrestris Linn), Madhuyashti Churna (Glycyrrhiza glabra Linn), NagkesharChurna (Mesua ferrea Linn), Loha Bhasma (Magnatite) all are taken in Saam Pramana i.e., 50mg each Churna and Vati is made of 250mg.

Chikitsa

Vidaryadi Vati

For first 5 days: 250 mg - QID (4 times a day) with water

For day 6 to day 8: 250mg - TDS (Three times a day) with water

For day 9 to 12: 250mg BD - (Two times a day) with water

Importance of Drugs

Vidaryadi Churna (Pueraria tuberosa Linn) - It is used in Mutrakruchhra, Daha, Daurblya. It can be used as diuretic. It is used as carminative, nutritive, cardiotonic. It can be used in Yakrit Roga. Rasa, Vipak - Madhur; Veerya - Sheeta. Due to Madhur Rasa and Sheet Veerya, Vidari subsides Pitta Dosha predominantly. The drug is having Gamitva (affinity) towards Mootravaha Srotas. Vidari acts as potential drug to subside excess / vitiated / Prakupita Pitta Dosha within Mootravaha Srotas. Thus, Vidari can be enlisted as drug of choice to relive Pittaja Mutrakruchha.

Gukshur Churna (Tribulus terrestris Linn) - An infusion of fresh leaves and stem is used as an esteemed remedy for treating dysuria i.e., painful urination. The decoction is useful in irritation of urinary organs, it is given as remedy for incontinence of urine. Fruit powder is used in kidney and urinary troubles.[13] Rasa, Vipak - Madhur; Veerya - Sheeta. Due to Madhur Rasa, Gokshur subsides Pitta and Vata Dosha predominantly. This is the drug of choice in any pathological condition of Mutravaha Strotas. Gokshur acts as potential drug to subside excess / vitiated / Prakupita Pitta Dosha within Mutravaha Strotas. Thus, Gokshur can be enlisted as drug of choice to relive Pittaja Mutrakruchhra.

Madhuyashti Churna (Glycyrrhiza glabra Linn): The drug is used as laxative, diuretic, anticolic and herbal antacid. It is useful in dysuria.


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Rohini SK et al. Management of Pittaj Mutrakruchhra

It is Rasayan (health promotive), Jivaniya (life promotive and rajuvenative), Balya (body strengthened). Rasa, Vipak - Madhur; Veerya - Sheeta. Due to Madhur Rasa, Yashti subsides Pitta and Vata Dosha predominantly. This drug is enlisted under “Rasayan” category as the drug is having potential to rejuvenate and strengthen body cells. Yashtimadhu subsides excess Pitta in Mutravaha Strotas and strengthen urinary tract cells.[5]

Nagkeshar Churna (Mesua ferrea Linn) - The drug Nagkeshar is useful in several diseases and it is specifically valued as Amapachna. It can be used in Mutrakruchhra, Mutradaha and in Mutramargat Raktapitta.

Nagkeshar having Rasa - Kashay Tikta, Vipak - Ushna, Veerya - Katu due to this it is the potential drug to relieve any kind of bleeding from urethra, vagina and anus. This characteristic prove that the drug is good to treat excess Pitta / Raktadhatu get excess Pitta. This is the potential drug to vitiated Pitta in Mutravaha Strotas.[7]

Loha Bhasma (Magnetite) - Loha Bhasm is Rasayana,[14] thus very good quality of Rasadi Dhatu are formed which in turn causes all Indriyas to be perform in good way. All the Dhatu gets all the ingredient in proper quantity thus healthy body is obtain. When there is no relief by using much treatment we should use Loha Bhasma. When we use Loha Bhasm in Mutrakruchhra we get relief.[8]

Drugs in Vidariyadi Vati and their actions

DrugsBotanical NameRasViryaVipakaDosha KarmaActive contentAction
Vidari Kand ChurnPueraria tuberosa LinnMadhurSitaMadhurVatapittashamakaPuerarinAntibacterial,
Anti viral,
Anti inflammatory
Gokshur ChurnTribulus terrestris LinnMadhurSitaMadhurVatapittashamakaSaponinAntioxidative,
Diuretic
Madhuyashti ChurnGlycyrrhiza glabra LinnMadhurSitaMadhurVatapittashamakaGlycyrrhineAntimicrobial,
Anti inflammatory
Nagkeshar ChurnMesua ferrea LinnKasaya,
Tikta		Usna
(Isat)		KatuKaphapittashamakaCoumarinsAnalgesic,
Anti inflammatory
Loha BhasmaMagnatiteTikta Ushna /
Sita		MadhurTridosha ShamanIronStrength immune
system

Apathya

Mutrakruccha patients should avoid exercise, suppression of natural urges, oily food, Kapittha, Jambu, riding elephants or horses. The patient should also avoid taking incompatible meals, excessive or very less amount of food, betel nuts, fishes, Kalka of sesame seeds, sesame oil, mustard oil, Masa or foods prepared from it, hot, unctuous and citrus edible.[15] While taking Loha Bhasm things to be avoided are Kushmanda, sesame oil, Rajika, Rasona (garlic), Madya (liquor), Amla Rasa.[16]

Subjective Criteria For Assessment[4]

CriteriaCured (0 Grade)Mild (1 Grade)Moderate (2 Grade)Severe(3 Grade)
1. Pain during / after micturitionNo any pain.Referred pain at the tip of penis in males & at labia minora in females may/may notPain at tip of penis/ labia minoraPain at tip of penis/ labia minora continuously.
3. Burning during / after micturitionNo burning during micturition.Burning during micturition sometimesBurning after micturition upto 1 hour.Burning after micturition beyond 1 hour.
4. Frequency of micturition at nightNo micturition at night2-3 times in night.3-5 times in night.>5 times in night

Observation Follow-up as per assessment criteria

Days06th9th12th
Pain during /after micturitionSevereModerateMildNo
Burning micturitionSevereModerateMildNo
Frequency of micturition at night7 Times4 Times2 TimesNo micturition at night
No of grades14950

jaims_3388_02.JPG


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Objective Criteria

Urine routine / Microscopic Reports

Days06th9th12th
ColourDark yellowPale yellowPale yellowPale yellow
Quantity10ml10ml10ml10ml
AppearanceTurbidCloudySlightly cloudyClear
Specific gravity1.0301.0301.0151.015
Reaction (ph)AcidicAcidicAcidicAcidic
ProteinsAbsentAbsentAbsentNil
GlucoseAbsentAbsentAbsentNil
Ketone bodiesAbsentAbsentAbsentAbsent
Bile saltsAbsentAbsentAbsentAbsent
Bile pigmentAbsentAbsentAbsentAbsent
Pus cell23-2510-158-101-2
Epithelial cells14-158-106-81-2
OthersBacteria Present (more quantity)Bacteria present (less quantity)Bacteria occasionally presentBacteria absent

Grades according to Objective Criteria

GradesCured (0 Grade)Mild (1 Grade)Moderate (2 Grade)Severe (3 Grade)
ColourPale yellowPale yellowPale YellowDark yellow
AppearanceNormalSlight cloudycloudyturbid
Pus cells1-22-1212-20Above 20
Epithelial cells1-22-1010-15Above 15
BacteriaAbsentAbsent/Occasionally presentpresent (less quantity)Present (more quantity)

Microscopic observation of urine slides

0 jaims_3388_03.JPG

6thjaims_3388_04.JPG

9thjaims_3388_05.JPG

12thjaims_3388_06.JPG

Observation Follow-up as per Objective Criteria

Days06th9th12th
ColourSevereModeratemildcured
Appearance of urineSevereModeratemildcured
Pus cellsAbove 20Moderatemildcured
Epithelial cellsAbove 12Moderatemildcured
Bacteria present/ absentSevereModerateMildcured

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Result By using Assessment and Objective criteria:

1. Complete Relief: About more than 75% complete disappearance of known symptoms.
2. Marked relief: About 50 % to 75% disappearance of known symptoms and absence of complications.
3. Moderate relief: About 50 % reliefs in symptoms
4. Mild relief: 25 % relief in symptoms.
5. No relief: No relief in symptoms.

Result

From Assessment criteria we get grade-0 and from Objective Criteria we get grade-0. Thus, from both criteria patient get about more than 75% complete disappearance of known symptoms i.e., She got complete relief.

Discussion

Vidari Kanda Churn (Pueraria tuberosa Linn) is Madhurras and Madhur Vipak due to which it is Vatapittasamak. Vidari is Mutral, Dahaprashman, Balya, Bruhana, Rasayana.[6]

Goshur Churna (Tribulus terrestris Linn) causes Dipan of Jatharagni and Bhautikaagni. Goshur (Tribulus terrestris Linn) cause Pachan of Aama created by Pruthavi and Jalmahabhutadhikya

thus in turn decreased in symptoms of Mutrakruchha (Urinary Tract Infection). We get relief from Mutradushti.[13] Prabhav of Goshur is Mutral.

Madhuyashti (Glycyrrhiza glabra Linn) is Mutravirajniya, whatever Vaivarnya (Discoloration of Urine) caused due to Pitta Prakop is destroyed by Madhuyashti. Thus, normal color to urine is obtain by using Madhuyashti, due to Vatapittashamak pain & burning sensation is relieved in Mutrakruchhra.[5]

Nagkeshar (Mesua ferrea Linn) consist of Tikta Ras which causes Dipan Pachan of Ama. Thus aggravated Pitta in Mutramarg may cause shaman which in turn causes destruction of Paka Lakshan in Mutravah Strotas. Due to Mutral Karya painful maturation can be relieved.[7]

Loha Bhasma (Magnatite) - Loha is Rasayana, thus very good quality of Rasadi Dhatu are formed which in turn causes all Indriyas to be perform in good way. All the Dhatu gets all the ingredient in proper quantity carried by Rakta Dhatu thus healthy body is obtain.[14]

Vidari Kand Churn acts as Dahaprashmana, Goshur Churna act as Mutral, Madhuyashti is Mutravirjaniya, Nagkeshar is Mutral and does Dipan Pachan of Ama, Loha Bhasm is Rasayan collectively they contribute to form Vidaryadi Vati. All drugs used in Vidaryadi Vati Act as Vatpittashamak and helps to distruct the Samprapti of Mutrakruchha. Combining all ingredients Vidari, Madhuyashti, Gokshur, Nagkeshar are Vatpittashamak gives relief from Sadah Mutrapravrutti, Sashul Mutrapravrutti, Muhur Muhur Mutra Pravrutti. Loha Bhasm acts as Rasayan to make healthy and strong body.

Conclusion

Vidaryadi Vati is effective in reducing the symptoms of Pittaj Mutrakruchhra in patient and she got good relief. Thus, Vidariyadi Vati is effective in Pittaj Mutrakruchhra

References

1. Kaviraj Ambikadatta Shastri, Sushruts amhita, uttantantra 59/20. chaukhamba Prakashan Varanasi Edition 2011, Pg no=5.54

2. Watring NJ, Mason JD. Deciphering dysuria Emerg Med 2008:40(9):29-34. Kalyani s Pawan & RH Anilkanthwar

3. Ravidattatripathi and Vidyadhaishukla Charaksamhita dwitiyabhag Chikitsasthanamadhiyayam. shloka 26/32, 26/33, 26/34, 26/49. chankamba Krushnadas academy Varanasi 3rd edition 2010 Pg no 632

4. Kalyani S.Pawar, R H Amilkanthwar Study of Efficacy of of vallipanchmool Kwath in management of Pittaj mutrakrichara with Special Reference to Cystitis - A Case study IAMJ Volume 7, Issue 2; Feb-2019 http://www.iamj.in/posts/images/upload/268_272.pdf

5. Gyanendra Pandey. Dravgaguna Vijnang Part I, Third Edition 2005 Madhuyashti Pg.no. 456-468

6. V. Sharma Dravyaguna vijnana vol II (Vegetable drugs) Vidari Pg no 738-739

7. Pa. Deshpande, R. Ra Javaigekar, Dr. Subhash Ranade. Part 1 and 2 Pg Nagkeshar 380-361

8. Dhundusnathen Vicharit Rasendid chudamani: Navamadhaya, Mutrakruchha - Mutra ghata dhikya - 1- Lohaprayog Pg290


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9. Hutchison's Clinical Methods. An integrated approach to clinical practice 24th Edition. William M. Drake, Michael Glynn chap17 urogenital System Pg. 360

10. J. Mehta's Practical medicine by 21 Edition by late Dr Pradip J Mehta Chapter 13 clinical pathology Urine Examinations pg - 544

11. Recent Research into Urinary Tract Infections (UTIs) by I Sarah Moore Reviewed b Emily Henderson, B.Sc.

12. Indian Journal of Microbiology Research Official Publication of innovative Education and Scientific Research Foundation. Prevalence of urinary tract infections and current. Scenario of antibiotic susceptibility Pattern of bacteria causing UTI Author - - Pritam Pardeshi. Volunt - 5 Issue 3 year 2018 Article pg -334-338.

13. Gyanendra Pandey Dravgaguna Vijnang Vol I edition third 2005 Goshur pg no 685-694

14. Panchnan Gangadharshashtri Gopalrao Gune Ayurvedia Aushadhigundharma part 1-5. Lohabhasm pg no 110-123.

15. Neha Subhash Tambe and Dr. Jai Kiran Kini. A Literature Review on Mutrakriccha (Lower Urinary Tract Infection) Based on Ayurvedic and Modern Perspectives. International Journal of Advance Research. ISSN 2320- 5407 Article DOI:10.21474/IJAR01/11098 DOI URL: http://dx.doi.org/10.21474/IJAR01/11098

16. Damodar Joshi. Rasa Sastra. Jaikrishnadas Ayurveda Series. Chapter 4 Description of Lohas (metals) and Their Processes. Pg no. 131.


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