E-ISSN:2456-3110

Review Article

Pittaja Mutrakrichra

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

An insight into Pittaja Mutrakrichra w.s.r. to Lower Urinary Tract Infection with mechanism, risk factors & prevention

Sangeeta SH1*, Sahana M2, Banu W3
DOI:10.21760/jaims.9.9.32

1* Sangeeta SH, Post Graduate Scholar, Dept of PG Studies in Kayachikitsa, Karnataka Ayurvedic Medical College, Mangalore, Karnataka, India.

2 Sahana M, Associate Professor, Dept of PG Studies in Kayachikitsa, Karnataka Ayurvedic Medical College, Mangalore, Karnataka, India.

3 Waheeda Banu, Professor and HOD, Dept of PG Studies in Kayachikitsa, Karnataka Ayurvedic Medical College, Mangalore, Karnataka, India.

In Ayurveda, diseases are named after taking into consideration of certain criteria which are very much significant. A disease named on the basis of Pravrutti of Mootra associated with difficulty in Pravrutti is Mutrakrichra i.e., passing urine with difficulty or pain. Eight types of Mutrakrichhra are described in details in Madhav Nidana - i.e., Vattaja, Pittaja, Kaphaja, Sannipataja, Shalyaja, Ashmarija, Shukraja, Purishaja Mutrakrichhra. Pittaja Mutrakrichhra was well acknowledged in Samhitas with different treatment modalities, which can be concurrent to Lower urinary tract infections on theoretical and clinical symptomatology of disease. Urinary Tract Infection (UTI) is defined as multiplication of organism in urinary tract.[1] Urinary tract infection is the inflammation of the tissues of the urinary tract.[2] Upper urinary tract infection is infection involving the kidney and lower urinary tract infection is infection involving the bladder, prostate, and urethra.[3] Hence in the present study, an attempt is made to critically analyze the disease Pittaja Mutrakrichra with its Nidana, Samprapti, Lakshana and with the disease Lower urinary tract infection. Lower urinary tract infection can be reduced by drinking plenty of fluids and completely emptying the bladder frequently. Menstrual hygiene changes sanitary pads or tampons regularly to maintain cleanliness and to prevent bacterial growth.

Keywords: Pittaja Mutrakrichra, Lower Urinary tract infection, Preventive measures

Corresponding Author How to Cite this Article To Browse
Sangeeta SH, Post Graduate Scholar, Dept of PG Studies in Kayachikitsa, Karnataka Ayurvedic Medical College, Mangalore, Karnataka, India.
Email: 		Sangeeta SH, Sahana M, Banu W, An insight into Pittaja Mutrakrichra w.s.r. to Lower Urinary Tract Infection with mechanism, risk factors & prevention. J Ayu Int Med Sci. 2024;9(9):200-205.
Available From
https://jaims.in/jaims/article/view/3833

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-14 2024-08-26 2024-09-06 2024-09-16 2024-09-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.55

© 2024by Sangeeta SH, Sahana M, Banu Wand 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

Dosha, Dhatu and Mala are basic substratum of the Shareera.[4] Mala being one among them, Acharyas have given importance to their function and their different status in the body. Mutra is one among the Trimala[5] and it plays a major role in Kledavahana. Mutravega is one among the Adharaniya Vegas.[6]

Disorders related to Mutra have been elaborately explained by our Acharyas and Mutrakrichra is one among them. “Yena Mootrakricchre Mootram Kricchrena Vahati”[7], “Mootrakrichram Dukhena Mootrapravrutti:”[8], “Mootrakrichraniti Mootrasya Kricchrena Mahata Dhukhena Pravruti: Mutrakrichra”.[9] i.e., Mutrakrichra as passing urine with difficulty or pain.

Eight types of Mutrakrichhra are described in details in Madhav Nidana - i.e., Vattaja, Pittaja, Kaphaja, Sannipataja, Shalyaja, Ashmrija, Shukraja, Purishaja Mutrakrichhra. All the Nidana of Mutrakrichhra ultimately results in the Tridosha Prokopa and Mandagni (Aam production) which along with Kha Vaigunya initiates further pathogenesis and its features are Sadaha Mutrata, Peeta Mutrata, Sarakta Mutrata, Krichhra Mutrata, Saruja Mutrata and Muhur Muhur Mutrata.

While we analyse the disease Pittaja Mutrakrichra, it’s Nidanas, Samprapti and Lakshanas can be compared to Lower urinary tract infection. The lower urinary tract involves the urinary bladder, urethra and prostate.[10] In this article, the disease Pittaja Mutrakrichra has been critically reviewed for better understanding of why and how it can be compared to lower urinary tract infection.

Lower urinary tract infection is one among the most common infections to the mankind. Hence it is the most common condition encountered in general practice. Urinary tract infection affects more than 150 million people every year world wide. Lower urinary tract infection occurs far more commonly in females than males. As many as 50-80% of women in general population acquire at least one incidence of lower urinary tract infection during their lifetime.[11]

Aim and Objective

Critically analyze the concept of Pittaja Mutrakrichra by comparing with lower urinary tract infection.

Materials and Methods

All the relevant evidence pertaining to Mutrakrichra and lower urinary tract infection was collected from different Ayurvedic, Contemporary texts relevant research articles & relevant internet related articles. Analysis of concept of Pittaja Mutrakrichra was done by comparing with lower urinary tract infection.

Review of Literature

Table 1: Adhikarana of Mutrakrichra

SamhitasReferences
Charaka Samhita Sutrasthana & Chikitsasthana 26th Adhyaya
Chikitsa, Siddhi Sthana 12th Adhyaya
Sushruta Samhita Uttaratantra 59th Adhyaya
Ashtanga Hridaya Nidana Sthana 9th Adhyaya
Ashtanga Sangrah Nidana Sthana 9th Adhyaya
Madhava Nidana 30th Adhyaya

Table 2: Types of Mutrakrichra

SamhitasTypes of Mutrakrichra
Charaka Samhita[12]1) Vataja Mutrakrichhra
2) Pittaja Mutrakrichhra
3) Kaphaja Mutrakrichhra
4) Sannipataja Mutrakrichhra
5) Raktaja Mutrakrichhra
6) Shukraja Mutrakrichhra
7) Ashmarija Mutrakrichhra
8) Sharkaraja Mutrakrichhra
Sushruta Samhita[13]Eight types of Mutrakrichhra are described in Sushruta Samhita. Possibility of Shukara causing Mutrakrichhra was not recognized. However separate description of Mutrashukra under the heading Mutraghata is available.
Ashtanga Hridaya & Asthanga Sangraha[14]1) Vataja
2) Pittaja
3) Kaphaja
4) Sannipataja

Nidana
व्यायामतीक्ष्णौषधरूक्षमद्यप्रसङ्गनित्यद्रुतपृष्ठयानात्|
आनूपमत्स्याध्यशनादजीर्णात् स्युर्मूत्रकृच्छ्राणि नृणामिहाष्टौ|

Table 3: Nidanas of Mutrakrichra

Nidana[15],[16]Type of Nidana
Aharaja NidanasAtisevana of Rukshaahara, Madhyasevana, Aanupamatsya Sevana, Adhyashana, Ajeerna
Viharaja NidanasAtivyayama, Nityadrutha Prushtayana
Aoushadaja NidanaTeekshanaoushadha Sevana
Mutravaha Srotodushti Aahara Sevana while there is Mutravega, Streesevana while there is Mutravega, Mutranigrahana, Ksheena and Kshata

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Etiology of urinary tract infection

The uropathogens causing UTI vary by clinical syndrome but are usually enteric gram negative rods that have migrated to the urinary tract. Usually, the organisms involved in the infection are E. Coli & staphylosaprophyticus. Proteus mirabilis and Klebseilla Pneumoniae are rare causes. The route of urinary tract infection is either ascending route or through haematological route. In majority of UTI, bacteria ascend from urethra to bladder. It can continue its ascend upto kidney.

There are several factors which influence UTI like vaginal ecology, environmental and microbial factor. In women, vaginal ecology is an important factor affecting risk of UTI. An anatomically normal urinary tract presents a stronger barrier to infection than a compromised urinary tract. Thus, strains of E. coli that cause invasive symptomatic infection of the urinary tract in otherwise normal hosts often possess and express genetic virulence factor, including surface adhesions that mediate binding to the specific receptors on surface of epithelial cells.[17]

Samprapti[18]

पृथङ्मलाः स्वैः कुपिता निदानैः सर्वेऽथवा कोपमुपेत्य बस्तौ |
मूत्रस्य मार्गं परिपीडयन्ति यदा तदा मूत्रयतीह कृच्छ्रात् |

The Dosha (individual or altogether) are vitiated by the above mentioned aetiological factors. The vitiated Dosha entered into Vasti and cause Dosha-Dushaya Samurchana in individual where Kha-Vaigunya is already there. Hence Mutra Dushti manifests. Dushit Mutra causes irritation and spasm of urinary passage and leads to difficulty in micturition process.

Etiological Factors
↓
Vitiation of Vatadi Dosha (mainly Samana and Apana Vayu)
↓
Vasti (Dosha-Dushya Samurchana)
↓
Mutra Dusti
 ↓
Irritation of urinary tract by Dushita Mutra
 ↓
Difficulty in voiding urine
↓
Mutrakrichhra

Samprapti Ghataka

Dosha - Tridoshas (Vata Pradhana)
Dushya - Mootra, Rakta
Srothas - Mootravaha
Srotho Dushti Prakara - Sanga
Agni - Jatharagni & Dhatwagni
Ama - Jatharagni & Dhatwagni Mandya Janya
Udbhavasthana - Pakwashaya
Sanchara Sthana - Mootravaha/Mootramarga
Vyakta Sthana - Mootramarga
Rogamarga - Madyama

Samprapti Bheda

Sankya Samprapti: 8 types

Pradhana Samprapti:

Vata - Apana, Samana Vayu
Pitta - Pachakaa

Vikalpa Samprapti:

Vata - Gunah: Chala Guna increased, Karmatah: decreased as proper Nishkramana of Mootra will not take place.
Pitta - Gunatah: Daha Guna Vruddi and Kshaya in Saraguna
Acharya Harita mentions the involvement Pitta as main Dosha in the pathogensis of Mutrakruchra.[19] Acharya Kashyapa also conveys similar opinion & states Mutrakrichra as Pitta Pradhanatridoshaja Vyadhi.[20]

Pathogenesis of Lower UTI

The urinary tract can be viewed as an anatomic unit united by a continuous column of urine extending from urethra to kidneys. The entry of uropathogens into urinary tract is often from periurethral colonization in females and from preputial colonization in uncircumcised males. When host defenses are weakened, urethral colonization and mucosal adhesion of bacteria occur. Adherence of bacteria to uroepithelial cells is critical first step in initiation of infection. Fimbriae mediates attachment of bacteria to specific receptors on epithelial cells for both E. coli and Proteus. Haemolysin and aerobactin produced by uropathogenic strains of E. coli make them resistant to bactericidal action of human serum. The presence of O antigen, capsular K antigens, and production of siderophores, haemolysins, adhesions and urease enhance chances of a particular strain to cause infection.


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The virulence factors favor the release of bacterial toxins; replication and antibiotic resistance. Iron trapping characteristics of bacteria like E. coli also contribute to the pathogenicity.[21]

Samanya Lakshana

The Samanya Lakshana of Mutrakrichra has been mentioned in Madhukosha commentary of Madhava Nidana as Kruchrata in Mutravahana i.e., difficulty in micturition. According to Acharya Harita, Mutrakrichra is a Pitta Doshapradhana Vyadhi, the symptoms mentioned by him are all Pitta Dosha Pradhana Lakshanas. He mentions Kruchrapravrutti of Mutravahana - difficulty in micturition, Ushnadhara - burning micturition, Mutrasrotasharati - Dushti of Mutravaha Srotas and Raktapravrutti - hematuria as Samanya Lakshana.[22]

Pittaja Mutrakrichhra[23]

तीव्रा रुजो वङ्क्षणबस्तिमेढ्रे स्वल्पं मुहुर्मूत्रयतीह वातात् |
पीतं सरक्तं सरुजं सदाहं कृच्छ्रान्मुहुर्मूत्रयतीह पित्तात् |

  • Yellowish discolouration of urine
  • Hematuria
  • Painful micturition
  • Burning micturition
  • Difficulty in micturition
  • Increased frequency of micturition

Clinical features of Lower Urinary Tract Infection

Lower urinary tract infection involves the infection of urinary bladder. Patients with cystitis or urethritis may be asymptomatic or present with symptoms such as abrupt onset of frequency of urination and urgency; dysuria - burning pain in urethra during micturition, nocturia, urge incontinence, suprapubic pain, sensation of incomplete bladder emptying due to spasm of inflamed bladder wall, urine may have offensive smell, blood and cloudy appearance.[24]

Discussion

Critical appraisal of Pittaja Mutrakrichra v/s Lower UTI
Comparison on the basis of Nidana
The basic factors which contribute to the mechanism of pathogenesis of LUTI are the pH or concentration of urine along with healthy status of genitourinary tract and immunity.

Similarly, Nidanas of Mutrakrichra are either the factors which change the pH or concentration of urine or the one which is causing lowered immunity.

Comparison on the basis of Lakshana

Kruchrata in Mutravahana is the Pradhana Lakshana of all types of Mutrakrichra. Associated symptoms of Mutrakrichra depends upon the Dosha involved, like Ruja in Vataja, Daha in Pittaja and Gouravata in Kaphaja.

Muhurmuhurmutrata, Alpamutrata - Increased frequency of urination (Lower UTI)
Shotha of Basti - Sensation of incomplete bladder emptying due to spasm of inflamed bladder wall. (Lower UTI)
Sadahamutrata - Dysuria (Lower UTI)
Bastishula, Sarujamutrata - Suprapubic pain (Lower UTI)

Comparison on the basis of Samprapti

Vatadi Dosha Prakopa (mainly Samana and Apana Vayu) → Spreads all over body in search of Khavaigunya → Sthana Sansraya in Basti, Mootra Marga (First Step: The lower vagina and periurethral area is heavily colonized by uropathogens). → Vitiated Dosha’s produces Sankocha Samrodha, Kshoba in Mootramarga (Second step: These pathogens are transferred along urethra to bladder). → Krichrata in Mootrapravrutti (Third step: The third and most important step is establishment and multiplication of bacteria (pathogens) within bladder → difficulty in passing urine) → Mutrakrichra.

Conclusion

The Nidana, Lakshana and Chikitsa of Mutrakrichhra can be well correlated with that of urinary tract infections. Females likely to be more prone than men because of their shorter urethra. Signs and symptoms of Lower urinary tract infections mentioned in contemporary texts are similar to that of Pittaja Mutrakrichra.

Preventive measures

  • According to ayurveda Nidana Parivarjana is the main line of treatment i.e., avoiding oily spicy foods & unhealthy life style, incorporating foods rich in vitamin C and probiotics (yogurt & fermented foods) to support urinary health & bacterial growth.

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  • Lower urinary tract infection can be reduced by drinking plenty of fluids and completely emptying the bladder frequently.
  • Menstrual hygiene changes sanitary pads or tampons regularly to maintain cleanliness and to prevent bacterial growth.
  • Women in whom UTI tends to develop after sexual intercourse should be advise void before and specially after intercourse and may get benefit from a post coital use of single dose of antibiotic.
  • Postmenopausal women with recurrent UTI’s (three or more episodes per year) treated with vaginal estrogen either cream or ring have a significant reduction in infections.
  • The risk of acquiring a catheter - associated UTI in hospitalized patients can be minimized by using indwelling catheters only when necessary implementing systems to ensure removal of catheters when no longer needed, using antimicrobial catheters in high risk patients.
  • In men condom catheters to be used.[20]

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21. P. Munjal, API Textbook of Medicine, Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, Edition 10th, 2015; p. 1791-1792
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