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Evaluation of the efficacy of Baladi Yoga in the Management of Mootrakrichra, Diwakar Papu Joshi, 2002-2005, Department of Kayachikitsa,Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

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Mutrakrichra kc018 gdg

  1. 1. Evaluation of the efficacy ofBaladi Yoga in the Management of Mootrakrichra By Diwakar Papu Joshi Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. V. Varada Charyulu M.D. (Ayu) (Osm) Dr. R.V.Shettar M.D. (Ayu) Department of Kayachikitsa Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2002-2005
  2. 2. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 This is to certify that the dissertation entitled Evaluation of the efficacy of Baladi Yogain the Management of Mootrakrichra is a bonafide research work done by “Diwakar PapuJoshi” in partial fulfillment of the requirement for the post graduation degree of “AyurvedaVachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore,Karnataka.Dr. R V SHETTAR Dr. V. VARADA CHARYULU M.D. (Ayu) M.D. (Ayu) (Osm)Co- Guide GuideLECTURER IN KAYACHIKITSA Professor & HODDGMAMC, PGS&RC, Gadag Dept. of KayachikitsaDate: PGS&RCPlace: Gadag Date: Place: Gadag
  3. 3. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 Endorsement by the H.O.D, Principal/ head of the institution This is to certify that the dissertation entitled Evaluation of the efficacy of BaladiYoga in the Management of Mootrakrichra is a bonafide research work done by “DiwakarPapu Joshi” under the guidance of Dr. V. VARADA CHARYULU, M.D. (Ayu) (Osm),Professor & HOD and Dr. R V SHETTAR, M.D. (Ayu), in partial fulfillment of the requirementfor the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under RajeevGandhi University of Health Sciences, Bangalore, Karnataka.. (Dr. V. Varada charyulu) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Kayachikitsa DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place:
  4. 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled Evaluation ofthe efficacy of Baladi Yoga in the Management of Mootrakrichra is abonafide and genuine research work carried out by me under the guidance ofDr.V. Varada Charyulu M.D.(Ayu) and Dr. R. V. Shettar, M.D. (Ayu), lecturerin Kayachikitsa, DGMAMC, PGS&RC, Gadag.DatePlace (Diwakar Papu Joshi)
  5. 5. © Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation/ thesis in print or electronic format for the academic / researchpurpose.DatePlace (Diwakar Papu Joshi)© Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. Table of contents Evaluation of the efficacy ofBaladi Yoga in the Management of Mootrakrichra Heading Page number Chapter -1 Introduction 1 to 3 Chapter –2 Objectives 4 to 4 Chapter –3 Review of literature 5 to 46 Chapter –4 Methodology 47 to 63 Chapter –5 Results 64 to 92 Chapter –6 Discussion 93 to 111 Chapter –7 Conclusion 112 to 114 Chapter –8 Summary 115 to 122 Bibliographic References 123 to 131 Annex – Case sheet 1 to 11
  7. 7. List of tablesSno Table Heading Page1 Mootrakrichra Classification according to different authors 72 Showing Nidana of Mootrakrichra mentioned in classics 93 Samprapti ghatakas 164 Showing visista Lakshana of vataja Mootrakrichra 185 Showing visista Lakshana of pittaja Mootrakrichra 196 Showing visista Lakshana of kaphaja Mootrakrichra 197 Showing the visista Lakshana of Sannipataja Mootrakrichra 208 Showing the visista Lakshana of Asmari & sharkara janya Mootrakrichra 209 Showing the visista Lakshana of Raktaja Mootrakrichra 2110 Showing the visista Lakshana of Shalyabhighata Mootrakrichra 2111 Showing the visista Lakshana of Sukraja Mootrakrichra 2112 Showing the visista Lakshana of Pureeshaja Mootrakrichra 2113 Showing the relationships of right and left kidney 3414 According to modern anatomy the organs in association with the bladder 3615 Grades of Muhrmutrapravritti as frequency of micturition 5016 Grading of Subjective parameters 5217 Grading of urine in UTI with reference to the presence of Pus cells 5418 Distribution of patients by Age 6519 Distribution of patients by Gender 6720 Distribution of patients by religion 6821 Distribution of patients by Occupation 7022 Distribution of patients by Economic status 7123 Distribution of patients by Marital status 7324 Distribution of patients by Mode of on set 7425 Distribution of patients by Recurrent attacks 7526 Distribution of patients by Prakruti 7627 Distribution of patients by Nidana 7828 Distribution of patients by Upadrava 7929 Distribution of patients by frequency of micturition by grades 8030 Distribution of patients by frequency of attacks 8131 Distribution of patients by colour of urine 8232 Distribution of patients by reaction of urine 8433 Distribution of patients by type of Mootrakrichra 8534 Distribution of patients by Vyasana 8635 Distribution of patients by Subjective Parameters 8736 Statistical analysis of the parameters after the treatment 8937 Statistical analysis of the parameters after the follow-up 8938 Result of the Baladi Yoga in Mootrakrichra 91
  8. 8. List of figuresSno Pictures heading Page1 Samprapti of Mootrakrichra 172 Ingredients of Baladi Yoga 57 List of graphsSno Graph heading Page1 Distribution of patients by Age 652 Distribution of patients by Gender 673 Distribution of patients by religion 694 Distribution of patients by Occupation 705 Distribution of patients by Economic status 726 Distribution of patients by Marital status 737 Distribution of patients by Mode of on set 748 Distribution of patients by Recurrent attacks 759 Distribution of patients by Prakruti 7710 Distribution of patients by Nidana 7911 Distribution of patients by Upadrava 8012 Distribution of patients by frequency of attacks in a year 8213 Distribution of patients by colour of urine 8314 Distribution of patients by reaction of urine 8415 Distribution of patients by type of Mootrakrichra 8516 Distribution of patients by Vyasana 8617 Distribution of patients by Subjective Parameters 8818 Showing the over all results of Baladi yoga on Mootrakrichra 92
  9. 9. Evaluation of the efficacy of Baladi Yoga in the Management of Mootrakrichra By Diwakar Papu Joshi The disease Mootrakrichra is documented in classical texts of Ayurveda. Withdifferent modalities for management of Mootrakrichra can be correlated to urinary tractinfection on theoretical and clinical symptomatology of diseases. The definition ofMootrakrichra is painful discharge of urine or strangury The present clinical trial shows the pittaja variety of Mootrakrichra as moreprevalent in comparison to other varieties. Unhygienic life style viz. Lack of frequentwashing, unhygienic sex, alcohol, self medication etc., will tend the person to have UTI. The young patients showed good response to treatment compared to old age.The study reveals the male female ratio as 5:7 and recurrent attacks are in females thanof males. The gradual onset is prevalent than acute. Patients of more severity infrequency of micturition are having lesser rate of relief. More poor and low middle class (95.8%) is reported. Ativyayam and vyavayaare the main causative factors of UTI. Dukhen mootra pravritti and mootra daha arecommon presenting complaints in the study. Fewer cases are observed withmootrasanga and kukshishoola. Arati, aruchi and thrisna are most frequent upadravasin the study observed. The effect of Baladi yoga show high significance in the results of subjectiveparameters, such as dukhen mootra pravritti, mootra daha, basti shoola, mootrendriyashoola, jwara and urine pus cell count as objective parameter with p value as <0.001.Mootra sanga and Kukshishoola are not significant, where the p value became >0.05.When we compare before to that of follow-up, all parameters show high significance. Inthe parameter mootradaha, basti shoola and mootrendriya shoola show still highsignificance. From the tables generated in the study when compared, the t-value asp=<0.001, the mean net effect of the drug in Duhkhena mootra pravrutti and mootradaha parameters, is same and more.
  10. 10. Acknowledgement I express my deep gratitude to my guide Dr. V. Varadacharyulu M.D.(Ayu),Professor & H.O.D., for his timely advises and encouragement in every step of mysuccess. I express my gratefulness to my co-guide Dr R. V. Shettar, M.D (Ayu) lecturer inKayachikitsa, for his time to time help and critical suggestions associated with expertguidance at the completion of this dissertation. I express my thankfulness to beloved principal Dr. G. B. Patil, Principal for hisencouragement as well as providing all necessary facilities for this research work. I express my profound sense of acknowledgment to various departments H.O.D.s,teachers and colleagues of sister concern departments along with the ministerial and substaff of the D.G.M. Ayurvedic Medical College, Gadag. I express my sincere thanks to Dr. K. Shiva Rama Prasad, Dr. Shashidar. H.Doddamani, Dr. Kuber Sankh, Dr. P. Shivaramudu, Dr. M.C. Patil, Dr. Danappagoudar, Dr.Santhosh Belavadi, Dr. Mulkipatil and Dr Kona. I express my sincere thanks to Mr.Nandakumar for his help in statistical analysis of results. I express my deepest gratitude to my beloved parents, Late P.B. Joshi, and Smt.M.P. Joshi, to my relatives and well wishers Sweatha, Shankaragouda, Dr. SrinivasaReddi, Dr.Chetan, Harun Kowshik and Umesh, for their inspiration. At first my sincere thanks to the subjects who cooperated at my dissertation, without of them it would have been not a success.Place:Date: (Diwakar Papu Joshi)
  11. 11. Chapter -1 Introduction Disease has been man’s heritage from beginning of its existence and search forremedies to combat it, perhaps is equally old. The age old ancient Ayurveda is “an arrowshot by divine bow”, through which confidence of millions of people has been won. Thistraditional medicine is much popular for managing most of diseases. The disease Mootrakrichra is documented in classical texts of Ayurveda. Ayurvedagives guidelines to treat this confidently and increase quality of life of individual. Withdifferent modalities for management of Mootrakrichra can be correlated to urinary tractinfection on theoretical and clinical symptomatology of diseases. UTI i.e. bacterial UTI isthe most common, painful and annoying cause of health, usually by E.coli, affecting anypart of urinary tract 1.Need and significance of study: - UTI’s are a leading cause of morbidity and health care expenditures in the persons ofall ages. Each year urinary tract infections account for 9.6 millions doctor visits women areespecially more prone to UTI. One in 5 woman develops UTI during her lifetime. Sexuallyactive young women are disproportanetly affected an estimated 40% of women reportedhaving had UTI at some point in their lives 2. UTI in men are not so common but they can bevery serious, when they occur3. However uncircumcised males about 10 time more likelythan circumcised male to develop UTI4. Some health cares professionals believe theseestimates are low because, many case of UTI goes unreported or undetected5. Baladi Yoga on Mootrakrichra 1
  12. 12. Unhygienic life style viz. Lack of frequent washing, unhygienic sex etc. alcohol,certain medications etc, will tend person to have UTI which are most frequent events ofmodern life style6. Mootrakrichra is a Vyadhi where difficulty in micturition is pradhan laxan, affectingdaily activities of life, it is having its impact upon physical, mental, spiritual health ofpersons causing person very distressed and annoying7. As Mootrakrichra involves basti which is pradhan sthan of Vata 8 and also it is one oftri-marma, which has to be protected 9. The pathological process of UTI is going to be induced by E.coli, staphylococci etc.bacteria, which may affect any part of urinary system10. The methods of management of UTIare mainly by antibiotics. Even though they are useful, they involve considerable amount ofrisk, side effects and also expensive. The chances of resistance’s and recurrences afteradministration of antibiotics are also high as fifty percent 11. The goal of UTI’s in modern contemporary science is antibiotic therapy. Althoughthis 7days regimen was highly efficacious, it was associated a certain frequency of sideeffects single dose therapy now a days appears efficacy. The risk was attributed to failure ofsingle dose antibiotics to eradicate gram negative bacteria from rectum, the source, andreservoir of ascending Uro-pathogens. Self-management plans are currently advocated inmost international guidelines on managing UTI 12. In recent years new trend is developing in Ayurveda for search of new therapeuticoption. Considering this, by taking drugs in management of Mootrakricchra. Baladi Yoga on Mootrakrichra 2
  13. 13. Recent studies The present 21st century advances in postgraduate research regarding Mootrakrichraand concerned can be viewed as follows 1. Studies on mootra roga by Dr. P.S.Chaure, B.H.U.1973 13 2. Effect of varura (creteeva nurvata) in urinary disease by Dr.R.P. singh. B.H.U.1973. 3. Studies on the etiology of renal calculus and its management with indigenous drugs by Dr.S.K.Mishra, B.H.U.1974 4. Indigenous urinary antiseptics- a clinical and microbiological study by B.B.Upadhyaya, Ph.D, B.H.U.1976 14 5. Clinical and laboratory studies on U.T.I – an Ayurvedic approach by Brij Bihari B.H.U.1972 6. A study of the patho-physiological effect of vitiated Pachakapitta on urogenital system by R.V.Patel, G.A.U 1981 7. Physiology and pathlogy of mutravaha Srotas with differential diagnosis by Rana kundan GAU 1964. 8. Comparative clinical and microbiological studies on the effect of chandraprabha vati and gokshuradi Guggulu in the urinary tract infection by G.P.Upadhyaya, B.H.U.1979 9. Clinical and experimental studies on the management of Mootrakrichra by P.D.Gupta, BHU, 1974 10. Role of trivanga in U.T infection by Bhupendra sharma, BHU 1975 11. Urinary tract infections and effect of trinapancha moola on them15 by muralidhar sharma, BHU 1983. Baladi Yoga on Mootrakrichra 3
  14. 14. Chapter -2 ObjectivesØ To evaluate the efficacy of Baladi Yoga in Mootrakrichra The Mootrakrichra is a disease entity, which is pertaining to mutravaha srothas. Theprevalence rate is 3:1 of female to male. The aetiology of Mootrakrichra is said ativyavayaand ativyayama etc. which leads to the Sroto sanga of Mootravaha srotas. In contemporaryscience UTI is because of unhygienic life style, reduced intake of water etc. which will leadsto UTI. So the cases appear for general practitioner needs the attention, as it is recurrent innature. Although several medicines recommended in Ayurveda and allied sciences forMootrakrichra seldom they are successful either because of the repeated infectious origins ordue to the anatomical considerations. So the study is undertaken to find the efficacy ofBaladi yoga in the management of Mootrakrichra. As we know the Baladi yoga is one of the compound herbal drugs, which are havingproperties to act over mootravahasrothas. Baladi yoga constitutes are Bala, Gokshura,Kokilaksha, etc., with the properties of mootrala, shothhara, vedanashamak and krimigna.The phalasruti of yoga is told as basti Dosha vishodhanartham, which helps in alleviation ofbastigata or mootravahasrotogata vikaras. Baladi Yoga on Mootrakrichra 4
  15. 15. Chapter -3 Literary reviewHistorical review and prevalence The first and foremost source of knowledge is classic books, which are most ethical,trust worthy and ever-available ‘Apta’ now a day. The evolution and progress of study ofMootrakrichra and its management can be traced chronologically in 3 historical period’s viz.Ancient period, medieval period and modern period.Ancient period: - It can be subdivided into vedakala and samhitakala.Vedakala: - In olden literature available viz. Rigveda and Yajurveda there is no references relatedto diseases of mootravaha srothas like gavinis. However one can find references regardingphysiology of formation of urine which is compared to collection of water to ocean and tothat of basti and mootrashmari diseases but no direct references about Mootrakricchra16.There are good references of importance of krimisnashak yogas for krimis in atharvauVeda17.Samhita kala: - This was golden period of Ayurveda and two great works viz. Charaka Samhita andSusruta Samhita were produced in this period. The other texts like Kashyap, Bhela, HareetaSamhita were written in this era. Elaborated discussions on physiology, anatomy andmanagement of mootravaha sroto vyadhis were undertaken in the exclusive allotments ofMootrakrichra chapter. Baladi Yoga on Mootrakrichra 5
  16. 16. Nirukti and paribhasha The word mootra is derived from the root ‘mootra prasravane’ meaning ‘to ooze orexude profusely, which throws light on the exactness of this nomenclature, according to theAyurvedic concept of its being collected in Vasti, by a process of exudation’18. The other roots are - ‘mucyate’ – meaning to be loosed to be set free or released. ‘muchyayoho’ – meaning that which has been set free 19 ‘mootra’ is defined as that of that which is secreted or that which oozes or exudes 20.Paryayas of mootra prasravaha – prasravae upasthatksharitajalae – meaning flowing, oozing urine 21 Mehanam – meaning passing urine, urine etc. 22 Guhyanishyandaha –urine i.e., that which flows trickles from the genital organ 23 Sravanam – meaning exudation, tickling, oozing 24 Sravaha – meaning flow, tickling oozng etc. 25 Upatha uirgata jalam – meaning water excreted through the genital organ 26 Sharangadhara has described that the watery portion of the maladrava of the digestedfood after being transported to ‘Vasti’ is called as ‘mootra’. 27 By observing above reference in the context of the word Mootrakricchra, the krichrameans painful situation or difficulty during act of micturition. The definition ofMootrakrichra is painful discharge of urine or strangury. Baladi Yoga on Mootrakrichra 6
  17. 17. Classification of Mootrakricchra All Acharyas expect Vagbhata considered Mootrakrichra is of 8 types. Charakaconsiders no difference between Ashmarijanya and Sharkarajanya Mootrakricchra, aspathogenesis of both is same. Susruta considered Sharkarajanya differently fromAshmarijanya Mootrakricchra.Mootrakrichra Classification according to different authors Collection of symptoms from are depicted as follows – Ca = Charaka28, Su =Susruta29, Ah = Astanga Hrudaya 30, As = Astanga sangraha 31, Ks = Kashyapa Samhita 32, 33, 34, 35,Mn = Madhava Nidana Bp = Bhavaprakasha Cd = Chakradutta Yr =Yogaratnakara36, Br = Bhaishajya Ratnavali 37 and Gn = Gadanigraha 38. Table -1 Mootrakrichra Classification according to different authors Sn Prakaras Ca Su Ah As Ks Mn Bp Cd Yr Br Gn 1 Vataja + + + + + + + + + + + 2 Pittaja + + + + + + + + + + + 3 Kaphaja + + + + + + + + + + + 4 Sannipataja + + + + + + + + + + + 5 Dwandwaja + 6 Rakthaja + + + - + 7 Shalyabhigataja + + + + + + 8 Ashnarijanya + + + + + + + 9 Sharkarajanya + + + + + + + + 10 Pureeshajana + + + + + + + 11 Sukrajanya + + + + + + - Baladi Yoga on Mootrakrichra 7
  18. 18. Nidana of Mootrakrichra It is wisdom of Acharyas, that they have clearly elicited list of etiological factors ofMootrakrichra on bases of their theoretical and clinical experiences. Morbidity exceptviddhata are concerned, they are caused mainly due to the faulty dietetic habits faultybehavioural habits which in turn vitiate the doshas, dushyas or malas as the case may be.These vitiated body constituents in turn vitiate the body channels, manifestation would betheir mismanage. In case of Mootrakrichra Nidana which cause khavaigunyata in the region of bastipradesha, mootramarga (lower urinary tract) etc. play in an important role. As a supportingfactor, the other sahayaka nidanas can be considered. The etiological factors of Mootrakrichra presented by Charaka would appear to beof- 1) Tridosha kopaka nidanas and 2) Mootra margavarodha nidanas Though acharya Susruta and Vagbhata have not pointed the etiological factors ofMootrakrichra specifically, but they mention the causative factors like Ashmari, shalyajaetc.. Madhavakara, Bhavamisra, Yoga Ratnakara and others have said the causative factorsof Mootrakrichra appear directly to be the same kinds referred to Charaka. The below Nidana can be differentiated under 3 headings 1.Aharaja 2.Viharaja 3.Aushadhi Janya (Iatrogenic) Baladi Yoga on Mootrakrichra 8
  19. 19. Table 2 Showing Nidana of Mootrakrichra mentioned in classics.Nidan Madhava Yogaratn Gadanigr akasha 41 sangraha Charaka Astanga Bhavapr Nidana akara42 aha 43 39 40 44AharajanyaRooksha ahara + + + + + +Madhya sevana + + + + + -Anoopa mamsa sevana + + + + + -Matsya sevana + + + + + -Adhyashana + + + + + -Ajeerna bhojan + + + + + -Katu amla lavan sevan - - - - - +ViharajanyaVyayam + + + + + -Nitya drita pristaya + + + + + -Sthree sevan - - - - - +Vega dharan - - - - - +Teekshna oushadi + + + + + - Astanga Hrudaya Vagbhata, Susruta and Kashyapa did not narrate the Nidana ofMootrakricchra.Abhighata All the Acharyas also list Abhigata or injury as causative factor of mutravahasrotodusti, particularly in the context of Mootrakricchra.Vyayama Here in Mootrakrichra the particular type of vyayama, which will have an influenceover the basti and mutra, marga is taken for consideration. The excessive exercise gives riseto over exertion and rookshata in turn provokes the Vata45.Druta pristayana All the Acharyas has considered ‘ druta prista yana i.e., riding on horse andtravelling in fast moving vehicles’, as one of the causative factor. In travelling fast movingvehicles and riding on horse for long time causes increase of pressure in abdomen in Baladi Yoga on Mootrakrichra 9
  20. 20. particular friction over basti predesha due to constant sitting on hard surface, and jerks infast moving. Due to travelling, veganigrahana may also be present leading to the disease.Bharavahana Bharavahana i.e., keeping the heavy loads on kati, skanda pradesha and carrying theloads can be considered as one of the main causative factor of Mootrakricchra. Due to heavyloads on kati, skanda pradesha, maximum pressure will be thrown on basti pradesha becauseof forward bending in carrying the loads. Even carrying the loads during the urge ofmicturition leads to antagonistic pressure over basti pradesha by external pressure resultsinto srotodusti and causes the disease.Sankshaya Sankshaya is also stated to be a condition leading to the mootravaha srotodusti. Herethe commentators have not clarified anything, but with reference to the context, the loss ofurine i.e. lesser production or non-production of urine would be inferred. In the context ofMootrakricchra, charakapani commented on ‘kshaya’ as ‘ativyavayat sukra kshaya sativayuno udeerya bastimanitam’ inferred that due to shukra kshaya, prakopa of vayu results46.Ruksha ahara sevana The rooksha padaratha will decrease kledatwa entity so that shoshan of dravabhagais going to increase. So there will be decrease in output of mootra giving rise to change formanifestation of difficulty in micturition (UTI). All these four qualities are having the drying capacity and as such the urine getsdried and reduced in quantity. Similarly kashaya and ruksha properties are having thecapacity of Srotas constriction and Mootra badhdhata47. Moreover these four qualities arehaving the capacity in vitiation of Vata because of their samana yoni 48 and samana Guna49. Baladi Yoga on Mootrakrichra 10
  21. 21. Madhyapana is included in the list of causative factors of Mootrakricchra. Some sortof madhyas like seedhu, karjoora madhyas are stated as vatakara and if consumed in excesscauses the vitiation of Vata. The Ushna, teekshana, rooksha, ashukari Gunas will causevitiation of Vata and Pitta. Madhyas are Amla in nature. So madya sevana will change urinepH and giving rise to environment for invasion of bacteria into epithelial cells of urinarytract 50. Anoopa mamsa, matsya sevana - These causative factors are of Vata and Kaphaprokopaka and also Agni-nashak in nature51. This result in vikriti in (chala Guna) continuesmovements of Drava Dravyas through urinary tract and makes an environment to acquireUTI52.Adhyasan, Ajeerna bhojana – As these causative factors (viprakrista Nidana) makes prakopa of all Tridosha,resulting in Samprapti of the Mootrakricchra. Because of the above factors the vataprakopa takes place. Increased rooksha Guna ofVata will decrease the matra of the mootra by its shosana karma. There by concentration ofthe urine will increase giving rise the chance for development of UTI.Vyavaya – Sexual intercourse Can transfer the bacteria from ano-vaginal area to urethra. May irritate the tissue53.Oushadhijanya –Teekshna Oushadhis 54 – The ushna, teekshna Gunas of Oushadhi will decrease the Aapmahabhoota ofmootra, there by decrease the formation and easy flow of mootra so that concentration isgoing to increase and volume of urine decrease. That makes environment for development Baladi Yoga on Mootrakrichra 11
  22. 22. of UTI. Teekshna Guna is having function of daha and paka karma so they will do theprakopa Vata and pita giving rise to Mootrakricchra. Ex: - vacha, rajika, pippali, sura etc. The Nidana of mootra vaha srotou dusti are also relevant in the context ofMootrakricchra. It includes –Vegadharana: - Because of habit of doing dharana of mootra Vega, the stretching of bladder musclebeyond its capacity, which overtime can weaken the bladder muscle. When the bladder isweakening, it may not empty completely and some residual urine is left in bladder whichmay increase risk of UTI. Apart from these factors, certain obstructive or margavarodha causative factors arestated to be responsible for sanga type of srotodusti in mutra marga causing the diseaseMootrakricchra. In classics, Ashmari, Sharkara, Sukra and Purisha are considered ascausative factors of Mootrakrichra and explained their clinical variety with symptoms. Purisha, Mootra and Sukra come under vega dharana Nidana. The suppression of anyone of the above leads to vitiation of Apanavata and in turn the vitiated Dosha obstructs theurinary passage causing the difficult in micturition i.e. Mootrakricchra55. It is evident fromabove analysis that most of the Nidana or of Dosha hetu variety. Some of nidanas such asmootravega dharana, teekshna Oushadhis sevana, ativyavaya, also act as both vyadhihetuand Dosha hetu.Aetiology Urine is normally sterile -- that is, it does not normally contain bacteria. Usuallyseveral things keep bacteria out of the urine. These include - Baladi Yoga on Mootrakrichra 12
  23. 23. 1) The urethral sphincter: when the urethra is squeezed shut, bacteria cannot climb up the urethra from the "meatus" (the outside opening) into the bladder56. 2) The length of the urethra: its a long way up to the bladder for a bacterium57. (Since a womans urethra is shorter than a mans, women are much more likely than men to get UTIs.) 3) Frequent washing: any bacteria that make it into the urethra are flushed out the next time of micturition urinate, and since bladder empties almost completely when person does urinate any bacteria that get that far will be flushed out too. Furthermore, there are valves at the points where the ureters enter the bladder to prevent urine from "refluxing" from the bladder to the kidneys, so that even if the bladder and its urine is infected the bacteria shouldnt travel up to the kidneys58. Usually, the infection stems from a strain or type of bacteria that is different from theinfection before it, indicating a separate infection. National Institutes of Health (NIH)suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach tocells lining the urinary tract. A recent study has also shown that women with recurrent UTIstend to have certain blood types. Some scientists speculate that women with these blood types are more prone to UTIsbecause the cells lining the vagina and urethra may allow bacteria to attach more easily.Further research will show whether this association is sound and proves useful in identifyingwomen at high risk for UTIs59. E. coli causes more than 90 % of cystitis cases, a bacterium normally found in theintestines60. Other organisms—including chlamydia and mycoplasma—also cause urinarytract infections. Infections by these organisms usually are limited to the urethra and Baladi Yoga on Mootrakrichra 13
  24. 24. reproductive organs. Chlamydia and mycoplasma infections may be sexually transmitted, inwhich case both partners must be treated61. The most common cause of UTI is bacteria from the bowel that lives on the skin nearthe rectum or in the vagina, which can spread and enter the urinary tract through the urethra.Once bacteria enters the urethra it travels upward causing infection in the bladder andsometimes other parts of the urinary tract62. Sexual intercourse is a common cause of urinary tract infections because the femaleanatomy can make women more prone to urinary tract infections63. During sexualintercourse bacteria in the vaginal area is sometimes massaged into the urethra by themotion of the penis64. Women who change sexual partners or begin having sexual intercourse morefrequently may experience bladder or urinary tract infections more often than women inmonogomus relationships. Although it is rare, some women get a urinary tract infectionevery time they have sex.Factors associated with acute urinary infection include the following65: 1) Alcohol consumption 2) Allergy or cold medications containing decongestants or antihistamines 3) Certain prescription drugs (e.g., Ipratropium bromide, Albuterol, Epinephrine) that cause the urethra to become narrow 4) Delaying urination for a long time 5) Long period of inactivity or bed rest 6) Prolonged exposure to cold temperatures 7) Spinal cord injury/nerve damage Baladi Yoga on Mootrakrichra 14
  25. 25. UTIs typically occur when bacteria enter the urinary tract from the outside, usuallythrough the urethra, and begin to multiply. The urinary system is designed to keep out suchmicroscopic invaders66. The bladder secretes a protective coating that prevents bacteria fromattaching to its wall. Urine also has antibacterial properties that inhibit the growth ofbacteria. However, certain factors increase the chances that bacteria will take hold andmultiply into a full-blown infection67.Contributing Factors 68 Some factors that may result in urinary tract infections are: 1) Birth Control Methods: 2) Ill-fitting diaphragms may place pressure on the bladder 3) The chemicals in spermicides may irritate vaginal tissuesPhysical Structural Problems: Some women may have an actual physical problem, which predisposes them tourinary tract infections (UTIs). A physical examination and medical history will determineif there is any problem.In Adults 69 1) Low water intake will cause less urination, which flushes out the system 2) People with diabetes have a higher risk of infection because of changes in the immune system 3) Sexually active teenagers and adult women because of friction occurring at the meatus during intercourse 4) Wiping from back to front after using the toilet can expose the vaginal and meatal area to rectal bacteria, often Escherichia coli (E. coli) 5) Women with specific blood types Baladi Yoga on Mootrakrichra 15
  26. 26. Other Factors 70 1) Catheters or tubes placed in the bladder: v on those with nervous system disorders such as spinal cord injury where loss of bladder control may require catheters permanently v Having bubble baths v Wearing tight-fitting clothing v Urinary irritants v Spicy foods v Acidic foods v Caffeine v Alcohol v Hygiene product reaction v Soap allergy v Scented toilet paper v Douches v Deodorants v Bubble bath chemicalsPathological consideration: -Samprapti ghatakas Table – 3 Samprapti ghatakas Dosha Tridoshajanya pitta pradhanApana Vata Dushya Mootra,Rasa dhatu Agni Dhatwagni, jatharagni Ama Jatharagnijanya ama Dhatwagni janya ama Srothas Mootravaha, Rasavaha Dustiprakara Sanga Udbhavasthana Amashaya, Pakwashaya Adhistana Vasti Vyaktasthana Mootra marga Sanchara Rasayani-mootravaha Rogamarga Madhyama Vyadhi swabhava Ashukari, chirakari Baladi Yoga on Mootrakrichra 16
  27. 27. Samprapti The events responsible for the retention (complete or partial) of mutra are eitherconcerned with blockage of the passages (srotorodha) or the failure of the neural mechanismapana vayu dusti. Inturn these events are responsible for causation of the disease, mutrakrichra. Inclassics, Mootrakrichra considered to be one of the apana vayu rogas 71-72. Figure –1 Samprapti of Mootrakrichra Nidana sevana Tridosha prakopa (Vata, Pitta, Kapha) Abhighata Agnimandya Vata Dosha dusti Amotpatti Prasara in sarva Shareera Mootravaha Srotas Khavaigunyata Stanasamshrayavasta in Vasti Stanika Apanavata & Kapha Dosha Vikruti Mootramargavarodha Krichra mootrata Baladi Yoga on Mootrakrichra 17
  28. 28. Roopa As the Mootrakrichra is named on the basis of pradhana lakshana or samnyalakshana that is dukhena mootra pravritti or dysuria. Mootra vaha srotha dusti Lakshana are – 1. Ati srasta – adhika mootrata (increased frequency) 2. Ati badhdha – interruption during mootra pravritti 3. Prakupita – vikruta mootra 4. Alpa alpa abheekshana – shoola yukta alpa alpa pravritti Many Acharyas had explained lakshana for each type of Mootrakrichra based ondoshic predominance. Table – 4 : Showing visista Lakshana of vataja Mootrakricchra. 73 to 81SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks1 Vankshan shoola + - + + + + + + -2 Basti shoola + - + + + + + + -3 Medhra shoola + - + + + + + + -4 Muhur muhur mootra + - + - + + + + -5 Alpa mootratha + + + + + + + + +6 Kricchra mootratha + + + + + + + + +7 Aruna varna - - - - - - - - +8 Teevra shoola + - + - + + + + +9 Sasushka mehana basti - + - - - - - - - Baladi Yoga on Mootrakrichra 18
  29. 29. Table – 5 : Showing visista Lakshana of pittaja Mootrakrichra 82 to 90SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks1 Peeta mootrata + - + + + + + + -2 Sarakta mootrata + + + + + + + + -3 Saruja + - + + + + + + +4 Sadaha + - + + + + + + +5 Haridra mootrata - + - - - - - - -6 Mushka daha - + - - - - - - -7 Basti daha - + - - - - - - -8 Atiushna mootrata - + - - - - - - + Table –6 Showing visista Lakshana of kaphaja Mootrakrichra 91 to 99SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks1 Basti gouravata + + + + + + + + +2 Shotha + - + + + + + + +3 Picchil mootrata + - + + + + + + -4 Mushka gouravata - - + - - - - - -5 Mootrendriya - - - + - - - - - gouravata6 Snighda mootrata - + - - - - - - -7 Swetha mootrata - + - - - - - - -8 Anshna mootrata - + - - - - - - -9 Samhrista roa - + - - - - - - -10 Savibandhata - - - + - - - - -11 Alpa mootrata - - - - - - - - + Baladi Yoga on Mootrakrichra 19
  30. 30. Table –7 Showing the visista Lakshana of Sannipataja Mootrakrichra 100 to 108SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks1 Sarvani roopani + - + + + + + + +2 Muhur muhur - + - - - - - - - mootrata3 Nana varna mootra - + - - - - - - -4 Mootra daha - + - - - - - - -5 Vedana - + - - - - - - -6 Moorcha - - - - - - - - +7 Bhrama - - - - - - - - +8 Vilapa - - - - - - - - + Table –8 Showing the visista Lakshana of Asmari & sharkara janya Mootrakrichra 109 to 112no Lakshana Ca Su As Ah Mn Bp Yr Gn Ks1 Basti shoola + - - - + - - + -2 Veeshirna dhara + - - - + - - + -3 Medhra vedana + - - - + - - + -4 Dourbalya - + - - - - - - -5 Sadha mootrata - + - - - - - - -6 Karshnaya - + - - - - - - -7 Kukshi shoola - + - - - - - - -8 Aruchakata - + - - - - - - -9 Pandutwam - + - - - - - - -10 Thrishna - + - - - - - - -11 Hritpeeda - + - - - - - - -12 Moorcha - + - - - - - - - Baladi Yoga on Mootrakrichra 20
  31. 31. Table –9 Showing the visista Lakshana of Raktaja Mootrakrichra 113-114 SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks 1 Adhmana + - - - - - - - - 2 Vibandhata + - - - - - - - - 3 Gouravatwam + - - - - - - - - 4 Basti laghuta + - - - - - - - - 5 Sarkta mootrata - - - - - - - - + Table –10 Showing the visista Lakshana of Shalyabhighata Mootrakrichra 115 to 119 SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks 1 Basti kukshi shoola - + - - + + + + - 2 Kricchra mootrata - + - - + + + + - Table –11 Showing the visista Lakshana of Sukraja Mootrakrichra 120 to 124 SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks 1 Kricchra mootrata + - - - - - - - - 2 Vankshana, basti, + - - - + + + + - medhra shoola 3 Sashukra mootrata - - - - + + + + - Table –12 Showing the visista Lakshana of Pureeshaja Mootrakrichra 125 to 129 SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks 1 Adhmana - + - - + + + + - 2 SaShoola - + - - + + + + - 3 Mootra sanga - - - - - + + - - 4 Mootra kricchra - - - - - - - - + Among all these kricchrata, mootra daha, muhur muhur mootra pravritti, shoolaconsidered as important clinical features. The shoola, muhur muhur mootra pravritti are due Baladi Yoga on Mootrakrichra 21
  32. 32. to Vata Dosha, peeta mootrata, mootra daha are due to Pitta Dosha and alpa mootrata due toKapha Dosha. The rest of symptoms are either due to sroto rodha or Tridosha prakopata. The roopa are the appearance of actual symptoms commences from vyaktavastha -the fifth stage. The word ‘Roopa’ indicate the sign and symptoms by which a disease isidentified. As far as the sign and symptoms of Mootrakrichra are concerned, depend on thedegree of affliction of the Dosha and their permutation and combination, the disease isdescribed as having eigth clinical varieties. Charaka has mentioned eight types of Mootrakrichra viz., Vataja, Pittaja, Kaphaja,Sannipataja ashmarija and raktaja Mootrakrichra sushruta has described pureeshaja varietyleaving shukraja Mootrakricchra. Kashyapa has described based on permutation andcombination of doshas as vataja, pittaja, kaphaja, dwandwaja, sannipatika and raktajaMootrakrichra 130.Pratyatma LakshanaKrichramutra pravritti Mootra is one among the mals of the body. Its function is stated to be clear the kleda 131.out of the body (mutrasya kledavahanam) Apanavayu is responsible for its excretionfrom the body. There are conditions, which discussed in Samprapti chapter, responsible forthe retention of urine completely or partially are either concerned with blockage of theurinary passage (srotorodha) or the failure of the neural mechanism (apana vayu dusti). Bythese conditions, patient feels difficulty during the micturition. This symptom is subjectiveand considered as cordinal symptom of Mootrakricchra. In modern urology, this symptom is Baladi Yoga on Mootrakrichra 22
  33. 33. correlated to dysuria, refers to difficult urination and is usually due to urinary tract bacterialinfection and inflammation.Ruja or shoolayuktamutra pravritti The word ‘ruk or ruja’ here refers pain and the word shola means any sharp or acutepain132. The constriction or narrowing of the mutra marga (urinary passage) due tomutrashaya kala shotha, the mutrapravritti is accompanied with shoola or ruja133. Thisshoola or ruja may occur due to Vata vriddhi (apanavayu) also. These symptoms aresubjective. This symptom is correlated to strangury in urological vocabulary implies thedifficult or painful passage of urine accompanied by spasms and is commonly the result ofvery severe cystltis orprostltis This symptom is important in differentiating the other pathological conditions byconsidering the following points – pain may be present during and after micturition and it isimportant to ascertain not only the period at which it is present, but also the actual locationof the pain. If pain is present in urethra during micturition is usually indicates a stricture orinflammatory process. If pain is experienced immediately after micturition and felt astingling or pricking sensation in the glans penis, there is some inflammation or irritantprocess at the tirgonal region of the bladder. Pain may be felt in the perineum during andafter micturition in case of prostatic disease. In the female, pain is felt at the urethral orificeand in the vulva after micturition in cases of cystitis or vescical carcinoma. Baladi Yoga on Mootrakrichra 23
  34. 34. Samanya lakshanasMootra sambhandhi Mootrakrichra considered as one of the Vasti rogas. Involvement of mutra in thepathogenesis of the Mootrakrichra exhibits some lakshanas, which are pertaining to mootra.These symptoms can be studied as follows: Varna of mootra The tejodhatu, according to Ayurveda, is responsible for the production of all colours – ‘tatra tejodhatuh sarva varnanam prabhavah’134. Therefore any abnormal colour appearing in the urine, if not derived directly from the ingested food in the form of dyes or drugs, may be consider to originate inside the body from morbid products or metabolism or disease states. Tridosha play an important role in afflicting colours of the urine in the Mootrakricchra135. Quantitative change in urine An increase in the urinary output may result, either from an excess of food and drink or production of mala in excess. On account of Agnimandya or srotorodha or the vitiation of Kapha when it converts the vitiated sharira kleda into the mutra or in case of disturbed functioning of Vata136. This symptom is objective and quantity of urine output in Mootrakrichra patients can be assessed by taking measurement of urine out-put per 24 hrs. Baladi Yoga on Mootrakrichra 24
  35. 35. Changes in transparency of the urine Normal urine is stated to be a transparent thin liquid, which on standing for sometime becomes turbid137. In kaphaja Mootrakricchra, the transparency of urine becomes ghana 138. Froth in urine: Samples of freshly passed urine appear to be slightly frothy. In vataja Mootrakricchra, the frothy urine is seen. This is objective sign.Ruja or shoola: This means pain in the part of the body. The root factor of shoola in general isconsidered as Vata. In this context, due to margavarana of mootra and Purisha by thepathological events causes provocation of Vata. Depending on place where it is obstructed,shoola occurs on those organs or structures. Muska, mehana, basti, basti shoola etc. arementioned as symptoms in clinical varieties of Mootrakricchra. In our classics, we do notfind descriptions of nature of shoola and its degree of variation from place to place in thecontext of Mootrakrichra disease. But this can be understood by considering the descriptionsof urology texts. Two types of pain have their organs in the genitourinary organs, local and referred.The later is usually common. Local pain is felt in or near the involved organ. Referred painoriginates in a diseased organ, but is felt at some distance from that organ. Kidney pain Typical renal pain is usually felt as a dull and constant ache in the costa-vertebral angle lateral to that of the sacrospinalls muscle and just below Baladi Yoga on Mootrakrichra 25
  36. 36. the 12th rib. This pain often spreads along the subcostal area toward theumbilicus or lower abdomen quadrant139.Ureteral pain It is typically stimulated by acute obstruction (passage of a stone or ablood clot). In this instance, there is back pain from capsular distensioncombined with severe colicky pain that radiates from the costo-vertebralangle down towards the lower anterior abdominal quadrant along the courseof the ureter. In men it may also felt in the bladder, scrotum or testicle. Inwomen it may radiate into the vulva140.Vesical pain The over distended bladder of the patient in acute urinary retentionwill cause agonizing pain in the suprapubic aea. The patient in chronicurinary retention due to bladder neck obstruction or to a neurogenic(neuropathic) bladder may experience little or no suprapubic discomfort eventhough the bladder reaches the umbilicus141. The common cause of bladderpain is infection, the pain is usually not felt over the bladder but is referred tothe distal urethra and is related to the act of urination terminal dysuria may besevere.Testicular pain: Testicular pain due to trauma, torsion of the spermatic cord, orinfection is very severe and is felt locally, although there may be someradiation of the discomfort along the spermatic cord into the lower abdomen.Pain from a stone in the upper urolor may be referred in the testicle142. Baladi Yoga on Mootrakrichra 26
  37. 37. Pravrutti Sambandhi Muhrmutrapravritti Under normal circumstances, the urinary bladder in the adult has a capacity of approximately 500-ml, resulting in periodicity of urination of about 4-5 hrs, depending on fluid intake. Physiologically, the Apanavata is responsible for urination at properties. Vitiation of Apanavata causes the increased times of urination, is considered as muha mutrapravritti. Mainly the ‘chala’ Guna of vayu is responsible for this symptom. This symptom can be assessed by Darshana pareeksha. In urological vocabulary, this symptom is correlated to frequenc143. The reduced capacity of urinary bladder will obviously lead to a reduced interval between the needs to urinate, thus resulting in that common symptom of frequency. Frequency will also result when the bladder de- compensates in response to de-nervation or long-standing obstruction. In these later instances, the absolute bladder capacity may be markedly increased, but the effective capacity i.e. the volume difference between residual urine and the bladder capacity, may be markedly reduced, leading to frequent urination144. A very low or very high urine pH can irritate the bladder and cause frequency of urination145. Dahayukta mutrapravritti Daha may occur in Pitta predominance of the Mootrakrichra pathogenesis. Teekshana, chala Gunas of Pitta are responsible in causing the Baladi Yoga on Mootrakrichra 27
  38. 38. daha during micturition. Daha is a subjective symptom, correlated to burning sensation during micturition. In men, it is usually felt in the distal uretura just proximal to or in the glans. In women, it is ordinarily referred to the urethra. This burning sensation occurs in association with the act of urination, although it may be more marked at the beginning of during, at the end of, or occasionally after urination. It may be very severe. In men it is apt to be a psychosexual symptom, in women however it may occasionally be caused by chronic urethritis146. Sarakta mutrapravritti Raktamootrata is seen predominance of Pitta Dosha and obstructive clinical varieties viz., Ashmari, Sharkara Mootrakricchra. Teekshana, Ushna, Gunas of Pitta are responsible for presence of Rakta in mootra. Sarakta mutrapravritti is darshnajneyabhava. Haematuria may be initial, total or terminal. Initial haematuria is noted chiefly at the beginning of urination and most commonly indicates diseases in the urethra. Blood noted mainly at the end of urination is called ‘terminal haematuria and is usually indicates diseases near the bladder neck or the posterior urethra. Haematuria persisting throughout the passage of urine is referred to as ‘total haematuria’ and usually indicates a pathologic disorder sat the level of bladder neck or higher147.Anushangika Lakshana Admana - is bloating of the abdomen due to accumulation of the gas inside the Amashaya and Pakvashaya. ‘adhmanam ghoram vatanirodhojam148, associated with Baladi Yoga on Mootrakrichra 28
  39. 39. increase in the size of the abdomen, diminished movement (due to sanga), a feeling of stretching pain - Atyugra rujam and gurgling noise (atopa) occasionally. Here adhmana refers to basti adhmana, which is due to Vata nirodha by Pureesha or Sukra etc. adhmana is sparshajneyabhava and shabdha (percussion) pareeksha is employed to elicit this symptom. Gauram - guru, sthira Gunas of the Kapha is responsible for gauravata. Here it refers to basti and Linga gurutva may be due to increased volume of mootra. This is objective symptom. Stabdhata - this may be due to combined effect of ruksha and parushya of Vata here, the word stabhata refers to vrushana stabdhata. This is objective symptom.Dwandaja and sannipataja Lakshana Kashyapa has enumerated the dwandaja type of Mootrakricchra. Depend onaffliction of doshas and permutation and combination of Dosha in the pathogenesis,dwandaja type of Mootrakrichra exhibit the respective lakshanas to its combinations.Symptoms 149 1. Not everyone with a UTI has symptoms, but most people get at least some. 2. A urinary tract infection causes the lining of the urinary tract to become red and irritated, producing the following symptoms: v Pain in the flank (side), abdomen or pelvic area v Pressure in the lower pelvis v Frequent need to urinate (frequency) v Painful urination (dysuria) v Urgent need to urinate (urgency) Baladi Yoga on Mootrakrichra 29
  40. 40. v Incontinence (urine leakage) v Abnormal urine colour (cloudy urine) v Blood in the urine v Strong or foul-smelling urine Other symptoms that may be associated with a urinary tract infection include: v Pain during sex v Penis pain v Fatigue v Fever (temperature above 100oF) v Chills v Vomiting v Mental changes or confusion v Headache v Diarrhoea v Asymptomatic v Signs of a urinary tract infection v Sediment (gritty particles) or mucus in the urine or cloudy urine v Bad smelling urine (foul odor) v Blood in urine (pink or red urine) The most of Lakshanas of vataja, pittaja, kaphaja, sannipataja Mootrakrichra can becompared with clinical features of UTI. The other four types of Mootrakrichra indirectlyresults in formation of UTI. For example formation of ashmaris in mootra marga causeskshata during its movement indirectly leading to UTI. Baladi Yoga on Mootrakrichra 30
  41. 41. UPADRAVAS 150 The upadravas of Mootrakrichra is explained in Kashyapa Samhita Chikitsa sthanonly. The occurrence of another disease in the wake of a primary disease as a complicationor sequelae, is termed as upadrava and is meant as rogautharakalaja, rogashraya androgaeva, since it is out come of an already existing disease, it may gradually disappear withthe disappearance of the primary disease. The following have been described as upadravas of Mootrakricchra, i.e., 1. karshya 2. arati 3. aruchi 4. sanavasthiti 5. thrishna 6. shoola 7. vishada 8. arti karshya - this may occur due to increased rukshata of Vata or dhatwagnimandya (medhogni) which are involved in the pathogenesis of mutrakrichra, leads to karshyata of the body. Arati - Dalhana has commented on the word arti s aratini shayana asanadou sarvatrapi sukhabhava Due to marked degree of mutravibhanda and krichrata in mutrapravritti, this condition may occur as a complication in mutrakrichra. Aruchi - Is a term loosely applied to mean different conditions such as arochaks inability to eat in spite of hunger or desire for food, due to distaste or disorders of taste perception by the tongue and aswadhutwavabhodana -– loss of relish to food due to absence of hunger or other disorders or stomach Baladi Yoga on Mootrakrichra 31
  42. 42. due to amadosha. Aruchi is one of the symptoms of impaired Annavaha Srotas, may arise as a complication in mutravaha sroto vikaras. Aruchi is considered as one of the rasapradoshaja rogas and involvement of Rasa in the pathogenesis of Mootrakrichra shows occurrence of aruchi as a complication. Sanavasthiti - This may occur due to increased chalaguna of vayu. The word sanavasthiti means instability or unsteadiness. This condition may occur as a complication due to marked unbearable burning sensation, painful and difficult in micturition. Thrishna - Thrishna will manifest as a upadrava due to loss of excessive kleda through mutra. Shoola - Here shoola can be unerstood as udarashoola, which is due to retention or vibhanda of mutra and udavarta of mutra. Shoola can occur due to increased pressure in the Vasti by causative factors, which are dealt earlier. Vishada – Means, drooping, languoor or lassitude states. This may occur due to strain in the initiation of urination and pain in the micturation. Arti - Means pain sorrow, grief. Due to the serious manifestation of the clinical symptoms and disease condition, this condition may arise as a complication.Sadhyasadhyata 151 The mode of termination of a disease may, in general be stated to depend upon theseat of its origin and severity of the course of its development or Samprapti. A newly started disease, with an extremely early beginning is easily curable withlittle efforts. If it becomes continuous or chronic should be deemed as marking or forming Baladi Yoga on Mootrakrichra 32
  43. 43. one of its particular stage i.e., termination or becomes krichrasadhya or asadhya. Due,probably extensive damage sustained or irreversible structural changes having taken place.Acharya Charaka says in this context, “incurable diseases never becomes curable whilecurable disease may pass into the stage of incurable on account of the short-comings in anyof the four basic therapeutic factors or as the result of destiny”. This principle is applicable to Mootrakrichra also. If Mootrakrichra is newly startedit is curable with efforts. It is becomes continuous or chronic it becomes yapya or curablewith difficulty (krichra sadhya) in a person who adapts to wholesome or conducive diets andhabits on controlling the self. In classics, as far as prognosis of Mootrakrichra is concerned, Acharyas have notmentioned prognosis except to sannipatika variety. It shows other clinical varieties ofMootrakrichra may be sukha sadhya. In sannipatika mutrakrichra, when not cared properlyand in time, may have some complicate symptoms like emaciation, excessive thirst, colickypain etc. and prognosis is concerned included under the group ‘krichra sadhya’ diseases. But, however, in ashmarija mootrakrichra, when not respond to the medicinaltreatment, acharayas have mentioned saastra vidhi. So ashmarija mootrakrichra can beconsidered as a shastra sadhya or kashta sadhya152.Vrikkaou (kidneys) The description of vrikkas is available in Ayurveda in various ways like its formationin the foetal state, its situation in the body, its shape size and its functions.Surface anatomy of the vrikkas 153 Different references regarding the situation of vrikkas are available at differentplaces in different treatises. The vrikkas have been included under the group of koshtangas Baladi Yoga on Mootrakrichra 33
  44. 44. by all the ancient authorities. Dalhana has used the word kukshigolakou according to whichthe place of vrikkas appears to be at kikshi or the koshta. In koshta, their seat is stated to bein the back part of the abdomen in the lumbar region, as can be inferred from the descriptionof the vrikka vidradhi. Yogendranath senhas stated that one is situated in the right part whileother one is situated at the left part. According to modern anatomy, kidneys lie between the 12th thoracic and 2nd lumbarvertebrae and thus to a considerable extent within the thoracic cage. Anteriorly, the kidneysmay be localized as extending from the interchondral articulation of the 6th and 7th ribcrosses the kidney at 45 degree angle in such a way that one third of more lies above and isunder the cover of the last two ribs154. Anteriolaterally the kidneys are covered by periotoneum and the sufaces of bothadrenal glands. The adjacent organs vary on the right and left sides. Table –13 Showing the relationships of right and left kidneyRight leftLiver, right lobe stomach spleenDuodenum, right colic flexture of the large colon-spleene flexture pancreas jejunumintestine hapatic flexture beginning.Gavinis (ureters) The word gavinis has been used since the time immemorial in Atharvanveda.References are available regarding the gavinis and sayancharya has explained its role intransportation of the by-product of the metabolism, which is known as urine. In Ayurvedic Baladi Yoga on Mootrakrichra 34
  45. 45. classics, we do not find any word the gavinis. However, some authorities have tried tocorrelate between the two-adhogarni dhaminis and the gavinis. Kaviraj gananath sen has written in Pratyaksha sharira, those channels, which cometowards the mutrabasti, are the two mutravahadhamini and by this statement Susruta hasindicated about the gavinis or ureters. B.G. Ghanakar has disagreed with this approach. The ureters are the two tubes, which convey the urine from the kidneys to the urinarybladder. Each tube measures approximately 25 –30cm. In length and its diameter 3 mmapproximately. It passes downwards through abdominal cavity. Behind the peritoneum and in frontof the psoas muscle into the pelvic cavity and opens into the posterior aspect of the base ofthe urinary bladder157. The ureter passes obliquely through the bladder wall. Because of thisarrangement the ureters are compressed and the opening occluded when the pressure rises inthe bladder. This occurs when it fills with urine and when its muscular walls contract duringmicturition158.Basti (urinary bladder) Literally the term ‘basti’ means bladder. In this context, ’bast’ means ‘mutra basti’(urinary bladder). It is derived from the root ‘vasa nivase’ which means ‘vasati mutramatra’. The terms Vasti, mutravasti, vastiputa, mutrashaya, mutradhara, seem to have beenused as synonyms in Ayurvedic texts159.Surface anatomy of Basti Susruta has stated that its shape is like that of alabu (gourd), full of siras (bloodvessels) and snayus (tendinous structures) all around. It is stated to be of tanu twak i.e., thinwalled organ or its coverings are thin and membranous. It has one exit only with its mouth Baladi Yoga on Mootrakrichra 35
  46. 46. downwards160. Vagbhata has described its shape as ‘dhanur vakra i.e. bent like a bow,having one opening downwards and composed of little muscle and blood161. It has towardsits terminal portion, sushira snayus (sphincter muscles). Adhamalla describes its shape ascharma khallwatwakar i.e. like a bag of leather. Vasti has been included under koshtangas and ashayas by all Acharyas. It is stated tobe one in number Charaka describing the location of Basti, has stated that Vasti is situated inbetween the sthula-guda (rectum) mushka (scrotum), sevani (perineal raphe), shukravahanadis and mutravaha nadis (ureters). Susruta also shares the views of Charaka. He says thatVasti is surrounded by nabhi (naval, prishta (back) kati loin) mushkas (scrotum) guda(rectum) vankshanas (groins) and shepha (penis) 162.Bhavamisra and sharangadhara says thatit is located below the pakwashya (large intestine). Table –14 According to modern anatomy the organs in association with the bladder 163In the female In the maleAnteriorly – symphysis pubis Anteriorly – symphysis pubisPosteriorly-uterus Posteriorly-rectum and seminal vesiclesSuperiorly-small intestine Superiorly-small intestineInferiorly- urethra and muscles forming Inferiorly- urethra and prostate glandthe pelvic floorBasti as marma Vasti is stated to be a marma (vital organ) included under the category of snayumarmas, which shows the prominence of its tendinous and membranous structure. Injury toit is stated to cause rapid death. The location of this marma is said to be inside the loin andits dimensions four finger164. Baladi Yoga on Mootrakrichra 36
  47. 47. Mutraseka (urethra) Mutraseka or mutrapraseka is the urethra through which collected urine in bladder isexcreted. Charaka has used the term ‘mutrasrotas’ to indicate the urethral canal.Madhavakara has used the term ‘mutra Srotas’ while explaining the Ashmari Nidana165. The other details like size and shape etc. are not available in the Ayurvedic literature.According to modern anatomy, the urethra is a canal, which extends from the neck of thebladder to the exterior and its length differs in the male and in the female. The male urethrais associated with the urinary and reproductive system. The female urethra is approximately 4-cm. length. It runs downwards and forwardsbehind the symphysis pubis and opens at the external urethral orifice just in front of thevagina. A sphincter muscle guards the external urethral orifice, which is under the control ofwill166. The same is expressed in atharvana Veda that urine collected in Vasti (bladder) fromtwo gravinis (ureters) which emerge from antra (intestine). Antra in this context should beconsidered as from the region near and about the intestines. By intestines if we interpret orunderstood that our ancestors meant kidneys there is major contradiction for the modernphysiological concept to agree with that of Atharvaveda. Ayurvedic scholars and ancientIndians had the practice of expressing regions instead of organ at many places. For ex.While counting koshtangas they counted all organs including Vasti hridaya yakrit, pleehaetc. which were near and about koshta alimentary tract. “hrudi vyadha” while describing the effect of jwara, means pain in the region ofheart and not in the heart. The location of Vasti, gavini is described by Charaka and Susrutain such clear anatomical terms that both have to be identified as bladder and ureters and Baladi Yoga on Mootrakrichra 37
  48. 48. noting else. The two ureters from bladder are not connected to intestines but to kidneys oneither side. It cannot be said that the ancient was so blind and foolish as not to trace. Wehave inferred that this discrepancy had arisen due to their usual method of expression or tofaulty tradition. Hence the description atharvaveda does not find much opposition frommodern physiological findings if we accept that the ancestors meant kidneys by theirnearness and location just below the intestine while observing the formation of urine. Ayurvedists consider that mootra is formed or nourished from the wastage or kittaafter digestion of ingested food. While commenting in Susruta Shareera 9th chapter, Dalhanasays that the remaining fluid that is found after absorption of nourishing portion inPakvashaya is not to be termed as mutra, but as fluid or water only167. He says that the same fluid entering Vasti gets the designation as mutra. Thedigestion and separation of nutrition’s and waste portions is done by samana vayu, whosezone or sphere of action is whole kosta and which keeps Agni indigestion. The mainexcretory action of urine is controlled by apanavayu which expels other malas, sukra,garbha, artava etc. thus in the formation and expulsion of mutra samana vayu and apanavayu take part. According to sharangadhara the waste peortions of digested food in the formof fluid mala entering Vasti becomes mutra. Similar view is expressed by Susruta andVagbhata. Dr. Dwarakanath in his introduction to Kayachikitsa opines that there is someevidence found in modern contributions that mutra formation has got relation in somewaywith the absorption of water in large intestines168. According to the same author the wasteproducts are an index of life activities. The living body can never be without the formationsof malas and certain amount of residual malas are always present in it169. Baladi Yoga on Mootrakrichra 38
  49. 49. Applied anatomy Ureters these are a pair of muscular tubes and extend inferiorly and medically. Thepaths taken by ureters in men and women are different due to variations in nature, size andposition of reproductive organs. In males the base of u- bladder lies between rectum andpubic symphysis in females the base of bladder sits inferior to uterus and anterior tovagina170. The uterus penetrates position wall of bladder at any oblige angle and ureteralopenings are slit like rather than rounded. This shape help prevents back flow of urinetowards uterus and kidneys when u bladder contracts171. About every 30 seconds a peristalic contraction begins at renal palvis and sweepsalong ureter forcing urine towards bladder172. If peristalsis and fluid pressure are insufficient to dislodge them they may be destroyed.Urinary bladder It is a hollow, muscular organ that function as a temporary reservoir. In sectionalview, mucosa lining urinary bladder is usually thrown in folds or rouge that disappears as itfills. The mucosa here is smooth and very thick. The triangular area bounded by uretralopenings and the entrance to urethra constitutes trigone which acts as funnel this channelsurine into urethra, when urinary bladder173.Urethra The female and male Urethra differ in length. In females urethra is very short,extending 3-5 cm (1-2 inch) from bladder to vestibule. The extension urethra opening issituated near anterior wall of vagina174. In males, Urethra extends from neck of urinarybladder to the tip of penis, a distance that may be of 18-20 cm175. Baladi Yoga on Mootrakrichra 39
  50. 50. Physiological interpretationsAnti-microbial properties of bladder mucosa 176 Flushing action associated with periodic voiding of urine. However failure of these1-2 defensive mechanisms of bladder are overwhelmed setting stage for UTI. Micturition isthe process by which urinary bladder empties when it becomes filled, involving 2 steps 177 - 1. Progressive filling up of bladder until it’s on rise above threshold level 2. Nerve reflex that empties bladder or at least causes a conscious desire to urinate.Muscles of bladder 178 Smooth muscle cells of detrusor muscle fuse with one another so that low resistanceelectric pathways exists from one cell to another cell to cause contraction of entire bladder atonce, so that residual urine no to be found in bladder. Bladder muscle tone normallyprevents emptying of bladder until critical threshold rises. External sphincter muscle isunder voluntary control and can be used to consciously prevent urination even wheninvoluntary controls are attempting to empty bladder. The principal nerve supply of bladder is pelvic nerve through which sensory andmotor functions are governed, connecting with s2 and s3. For easy flow of urine, peristaltic contractions in ureter are enhanced byparasympathetic stimulation and in inhibited by sympathetic stimulation. The normal tone of detrusor muscle compress under thereby by preventing back flowof urine from bladder when pressure builds up in bladder doing micturition, that reflexescalled vesico-ureter reflex. When bladder is partially filled, these micturition contractions usually relaxspontaneously so that it allows micturition reflex is self regenerative, starting from Baladi Yoga on Mootrakrichra 40
  51. 51. contraction of bladder and activating stretch receptors to cause increase in sensory impulseto bladder, which in reflex causes contraction of bladder in repeated cycle it automaticallyceases after few seconds, permitting bladder to relax179.Upashaya and Anupashaya Upashaya is a form of diagnosis by applied therapeutics. The medicine or thehygienic treatment (vihara) which will give relief is known as Upashaya. If the patient feelsworse on the other hand, is termed as Anupashaya, says Charaka in Vimana sthanas ‘goodhaLinga vyadhin upashayanupashayabhyam pareekshat’ upashaya and Anupashaya mayinvestigate i.e. an un-manifested or obscure disease180. It is not mentioned in classics about Upashaya and Anupashaya regardingMootrakricchra. As far as there is no goodha Linga in this disease, Acharyas might not havementioned the Upashaya and Anupashaya for this disease181. But however, the causative factors themselves may be taken as Anupashayas,especially kashaya, katu, tikta, ruksha and other Nidana may be ascribed as to Anupashayaof Mootrakricchra.Vyavachedaka Nidana It is a fact that disease is usually recognised by their signs and symptoms. Whenevera symptom is noticed in a patient that must be taken as the lead in the study of the vitiateddoshas dushayas and sthanas (organs) involved. But it is often seen that a particularsymptom appears in more than one disease. In such cases the cordinal symptoms (pratyatmaLinga) with the associated symptoms would give a clue to the correct diagnosis of thedisease. Baladi Yoga on Mootrakrichra 41
  52. 52. Differential diagnosis is based on comparison of symptoms of two or more similardiseases to determine which the patient is suffering from. As far as Mootrakrichra is concerned, differential diagnosis is made by the cordinalsymptoms and adhistana of the disease (basti), which is involved in the pathogenesis ofMootrakricchra. So it is distinguished from possible diseases that are likely to answer thissyndrome viz., Vata kundalika, Mutrautasangam, Mutragranthi, Ushnavata, Mutrasada,Vastikundala and Ashmari182. According to Chakrapani and others, the main difference betweenMootrakricchraand mutraghata is, Mootrakricchrais krichra pradhana and vibhanda alpatawhere as mutraghata is vibhandha pradhana and alpa krichrata present during micturition.Thus differential diagnosis is made by degree of obstruction and pain during micturition183. Thus, the possible diseases that are likely to answer this syndrome are consideredand physician comes to a tentative diagnosis of course, to be confirmed on furtherexamination by seeking assistance of laboratory.Chikitsa of Mootrakrichra Chikitsa can be classified under three categories viz., Samshodana, Samshamana,and Nidana parivarjana. 184 Shodana is adopted to disintegrate Dosha Dushya Samurchana, thus ensuring theexpulsion of vitiated pittadi doshas. Shamana chikitsa also causes the destruction of factorsresponsible for manifestation of disease185. This is achieved by the properties of medicine,which are antagonistic and counteracting to the vitiated doshas and to the disease. Baladi Yoga on Mootrakrichra 42
  53. 53. As the Nidana is inevitable for the formation of the disease, Nidana parivarjana i.e.avoidance of causative factors is the best management. Unless this is done the diseasebecomes further aggravated. The medicament, and food, which are opposite to those explained for Prameha roga,should be adopted here and Mootrakrichra should be managed with proper snehana andmridu shodhana186. As there is no specific Chikitsa sutra mentioned for the disease Mootrakrichra,considering the doshaja lakshanas, Acharyas explained separate shodhana and shamanaChikitsa for each type of Mootrakrichra.SHODHANA CHIKITSA 187Vataja Mootrakrichra Chikitsa § Vatanashaka Taila sevana and Abhyanga § Sneha and Niruha Basti § Uttara BastiPittaja Mootrakrichra Chikitsa § Ghritapana § Virechana § BastiKaphaja Mootrakrichra Chikitsa § Tikta rasa sadhita taila Abhyanga and Pana § Swedana § Niruha Basti Baladi Yoga on Mootrakrichra 43
  54. 54. Sannipataja Mootrakrichra Chikitsa v Considering the Vata sthana, chikitsa to be adopted (Anulomana) v In case of Pitta adhikata – Virechana v In case of Vata adhikata – BastiAshmari –Sharkara Chikitsa The Chikitsa, which are useful in Kaphaja and Vataja Mootrakrichra, are to beadopted here. Management of Mootrakrichra with Shodana therapy helps in checking thedosha-dushya samurchana itself. Except Vamana and Nasya other types of Panchakarma canbe adopted for this disease considering the vitiated doshas. As it is a tridoshaja vyadhi,Snehapana, Swedana, Verechana, Basti (both Niruha and Uttara basti) are considered to beuseful.Shamana Chikitsa Mootrakrichra can be successfully treated with shamana Chikitsa. This can be classifiedinto two categories. i) Samanya Chikitsa: -Some specific yogas, which can be adopted in all kinds of Mootrakrichra. ii) Vishesha Chikitsa:-The one which can be used in particular variety of Mootrakrichra specific to the predominance of doshas. The drugs such as Pashanabheda, Gokshura, Varuna etc., act not only against the doshas,They also act as vyadhihara. It is also logical to state that usage of such mutrala dravyashelps in relieving the krichchrata (dysuria) flushing out the causative organisms from themutramarga. Baladi Yoga on Mootrakrichra 44
  55. 55. Formulations used in different types of Mootrakrichra Vataja Mootrakrichra 1) Shwadamstra Taila (S.S) 2) Dashamooladi Taila (A.S) 3) Amritadi Kwatha (B.R) 4) Mishraka Sneha (C.S) Pittaja Mutrakrichchra 1) Shatavaryadi Kwatha (C.S) 2) Kamalotpaladi Kashaya (C.S) 3) Hareetakyadi Kwatha (Y.R) 4) Narikeladi Yoga (Y.R) 5) Vidaryadi Kwatha (B.R) Kaphaja Mutrakrichchra 1) Patala Kshara (A.H) 2) Shwadamstradi Kwatha (C.D) 3) Trikatvadi Gutika (B.P) 4) Tiladikshara Yoga (A.S) 5) Vyoshadi Yoga (C.S) Sannipataja Mutrakrichchra 1) Yavakshara Yoga (A.S) 2) Shatavarimoola Yoga (H.S) 3) Brahatyadi Kwatha (B.P) 4) Kooshmanda Yoga (G.N) Ashmari-Sharkarajanya Mutrakrichchra 1. Erandamooladi Kwatha (H.S) 2. Pashanabedha Kwatha (Y.R) 3. Ervarubeeja Yoga (B.P) 4. Shilajitwadi Yoga (Y.R) 5. Trapushabeejadi Yoga (G.N) Raktaja Mutrakrichchra 1) Utpalanala Yoga (C.S) 2) Madyapana Yoga (Y.R) 3) Dhatri Yoga (Y.R) 4) Ushakadi Ghrita (K.S) Shalyabhighataja Mutrakrichchra 1) Sadyovrana Chikitsa (S.S) 2) Mruttika Lepa (Y.R) 3) Manyadi Yoga (Y.R) 4) Dhatri Yoga (Y.R) Sukraja Mutrakrichchra 1) Karpamooladi Yoga (C.S) 2) Shilajatu Yoga (C.D) 3) Trinapanchamoola Ghrita (Y.R) 4) Baladi Ksheera (B.P) Purishaja Mutrakrichchra 1. Gokshuradi Kwatha Baladi Yoga on Mootrakrichra 45
  56. 56. 188Samanya Bahyopachara Abyanga by using Eranda Taila over basti pradesha. Next swedana or sinchana isdone using Palasha pushpa kwatha. This helps in shamana of Mootrakrichra.Lepa: Gokshura, Bidalavana, Arvarubeeja are mixed with kanji and made a paste. This lepais applied over basti pradesha, there by Mutrakrichchra will be relieved immediately.Pathya and Apathya 189-190-191 Pathya Apathya Madhura Padartha Sangrahi Ikshuras Vidahi Tanduleeya Sushka Ahara Trapusa Pistanna sevana Yavakshara Kharjura Mudga Shalooka Ghruta Kapitha Ardraka Jambu Pranimamsa Vyayama Dugdha Vega dharana Jeerna Kushmanda Kulutha kwatha Excessive water intake Baladi Yoga on Mootrakrichra 46