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Pharmacognostical Analysis Of Vidarikanda (Pueraria Tuberosa DC) And Its Effect On Mutrakrichra – A Clinical Study - SAVITHA D. BHAT, Department of Dravya Guna, Post Graduate Studies & Research ...

Pharmacognostical Analysis Of Vidarikanda (Pueraria Tuberosa DC) And Its Effect On Mutrakrichra – A Clinical Study - SAVITHA D. BHAT, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAG

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  • 1. PHARMACOGNOSTICAL ANALYSISOF VIDARIKANDA (PUERARIA TUBEROSA DC) AND ITS EFFECT ON MUTRAKRICHRA, A CLINICAL STUDY By: DR. SAVITHA D. BHAT Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATI M.D. IN DRAVYAGUNA Under the Guidance of Dr. G. V. MULAGUND M.D. (Ayu) And Co-guidance of Dr. SHASHIKANTH B. NIDAGUNDI M.D. (Ayu) DEPARTMENT OF DRAVYA GUNA POST GRADUATE STUDIES & RESEARCH CENTER SHRI D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG - 582103 2006-2009
  • 2. Declaration by the candidate I here by declare that this dissertation / thesis entitled “PharmacognosticalAnalysis Of Vidarikanda (Pueraria Tuberosa DC) And Its Effect On Mutrakrichra – AClinical Study” is a bonafide and genuine research work carried out by me under theguidance of Dr. G. V. Mulagund M.D. (Ayu), Professor & HOD, Dept of Dravya Guna,DGMAMC, PGS&RC, Gadag.Date: Signature of the candidatePlace: Gadag (Dr. Savitha D. Bhat)
  • 3. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 This is to certify that the dissertation “Pharmacognostical Analysis OfVidarikanda (Pueraria Tuberosa DC) And Its Effect On Mutrakrichra – A ClinicalStudy ” is a bonafide research work done by Dr. Savitha D. Bhat in partial fulfillment of therequirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Dravya Guna)”Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka. Dr. Shashikanth B. Nidagundi Dr. G. V. Mulagund M.D. (Ayu) M.D. (Ayu) Co-guide Guide Lecturer Professor & HOD Dept of Dravya Guna Dept of Dravya Guna DGMAMC, PGS&RC, Gadag DGMAMC, PGS&RC, Gadag Date: Date: Place: Gadag Place: Gadag
  • 4. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGEPOST 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 “PharmacognosticalAnalysis Of Vidarikanda (Pueraria Tuberosa DC) And Its Effect On Mutrakrichra – AClinical Study” is a bonafide research work done by Dr. Savitha D. Bhat under theguidance of Dr. G. V. Mulagund M.D. (Ayu), Professor & HOD, Dept of Dravya Guna, inpartial fulfillment of the requirement for the post graduation degree of “AyurvedaVachaspati M.D. in Dravya Guna” Under Rajeev Gandhi University of Health Sciences,Bangalore, Karnataka.. (Dr. G. V. Mulagund) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Dravya Guna DGMAMC, PGS&RC DGMAMC, PGS&RC Gadag Date: Date: Place: Gadag Place: Gadag
  • 5. © Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall havethe rights to preserve, use and disseminate this dissertation/ thesis in print or electronic format for the academic / research purpose.Date:Place: Gadag (Dr. Savitha D. Bhat) © Rajiv Gandhi University of Health Sciences, Karnataka
  • 6. ACKNOWLEDGEMENT I express deep sense of gratitude to my respected guide Dr. G. V. Mulagund,Professor and HOD of PG studies in Dravyaguna, DGMAMC, Gadag for hisguidance, whole hearted encouragement, inspiration and valuable suggestions duringmy dissertation work and throughout the pg studies. I am immensely grateful to my respected Co guide Dr. Shashikant B.Nidagundi, lecturer, dept of PG studies in Dravyaguna for his time to time help andvaluable suggestions throughout the PG studies. I express my thankfulness to our beloved Principal Dr. G.B. Patil for hisencouragement as well as for providing all necessary facilities for this research work. It gives me immense pleasure to thank my teacher Dr Kuber Sankh for hisexperienced and intellectual guidance, which made the completion of my researchwork smooth. Heartiest gratitude extends to my parents Dr. Divakar Bhat and Smt. AnupamaBhat for the support, encouragement and warmth bestowed on me. No words canexpress my deep feelings towards them. I will be ever thankful to my husband Dr.Ashok B.K whose timely help,guidance, support and encouragement made me accomplish this Herculean task andwithout whose help it would be impossible to finish this research work. I also thank my teachers Dr. G. S. Hiremath, Dr K. S. Paraddi, Dr. R. V.Shetter, Dr. Veena Kori for their inspiration and suggestions during the researchwork. I also thank Dr. S.D.Yerageri, RMO, DGMAMC hospital who providednecessary facilities during the health checkup camps.
  • 7. I owe a deep sense of gratitude to Shri Sunil, SRF, Captain Shrinivasa MurtiDrug Research Institute for Ayurveda and Siddha (CCRAS, New Delhi), Ministry ofHealth and Family Welfare, Govt. of India, Chennai who helped me in carrying outthe pharmacognostic study with special interest and care. I extend my gratefulness to Dr. Satish, PG scholar, Dept of panchakarma,IPGTRA, Jamnagar for his help during procurement of the Crude drug. I shall forever be obliged to Dr. Girish K. J, SDMAMC, Hassan for his timelyhelp and guidance throughout my PG studies. Hereby I want to convey my thanks to our Librarian Shri V. M. Mundinmaniand staff Shri Kerur for providing essential references for the study. Special thanks to my senior Dr Ashok M G, juniors Dr Asha M,Dr. C. C. Hiremath, Dr. Bhupesh sharma, Dr Sevantika Rotti and friends Dr NatarajC, Dr. Adarsh E. K, and Dr Mukta Arali for their affection and help during PGstudies. I convey my whole hearted thanks to my classmates, seniors and juniors fortheir constant coordination and support.My sincere thanks to the patients who cooperated for my research work. Finally and by no means least, I express my thanks to all those kind peoplewho have helped me directly or indirectly in my dissertation work with apologies formy inability to identify them individually.Date:Place: Dr. Savitha D. Bhat
  • 8. LIST OF ABBREVIATIONS USEDAh - Astanga HridayaAK - AmarakoshaAPI - Ayurvedic Pharmacopeia of IndiaAR - Abhidana ratnamalaAs - Ashtanga SangrahaBh.Ra - Bhaishajya RatnavaliBp - BhavaprakashaBPN - Bhavaprakash NighantuCD - ChakradattaCs - Charaka samhitaDH - Dravyaguna HastamalakaDN - Dhanvantari NighantuDrS - Dravyaguna sangrahaGn - GadanigrahaKN - Kaiyadeva NighantuKs - Kashyapa samhitaMD - Madhava dravyagunaMN - Madanapala NighantuMn - Madhava NidanaNA - Nighantu AdarshaNR - Nighantu ratnakaraPrN - Priya NighantuRN - Raja NighantuRVN - Rajavallabha nighantuSDN - Shodhala NighantuSGN - Shaligrama NighantuSha.sa - Sharangadhara samhitaSKD - Shabda KalpadrumaSs - Sushruta samhitaYr - YogaratnakaracÉ.ÍcÉ. – Charaka ChikitsaxÉÑ.ÍcÉ. – Sushruta ChikitsaA.WØû.ÍcÉ. – Ashtanga hrudaya ChikitsaA.WØû.Mü. – Ashtanga hrudaya Ka;pasthanapÉÉ.mÉë.qÉ. – Bhavaprakasha MadhyamakhandaMüÉ.xÉ.ÍcÉ. – Kashyapa Samhita Chikitsa sthanapÉå.xÉ.ÍcÉ. – Bhela Samhita Chikitsa sthana
  • 9. ABSTRACTThe study entitled “Pharmacognostical Analysis of Vidarikanda and Its Effect onMutrakrichra – A Clinical Study” comprises of detail pharmacognostic study ofVidarikanda tuber. Analytical and phyto chemical study revealed that the drug possessmany active principles like flavanoids, triterpinoids, steroids, sugar etc which formeda base to understand the probable mode of action. Based on the theoretical andclinical symptamatology, Mutrakrichra was correlated to UTI. The clinical study wasdone on 30 patients of Mutrakrichra where Vidarikanda (Pueraria tuberosa DC) wastaken as trial drug for 15 patients of group A and was given in the dose of 1 gm thricea day for 14 days. Varuna (Crateva nurvala) was taken as standard drug for 15patients of group B and was given in the dose of 2 gm bd for 14 days. The youngpatients showed good response to the treatment compared to old age patients. Krichramutrata and Dahayukta mutrata were found as most common presenting complaints ofthe patients. The present clinical trial showed pittaja variety of Mutrakrichra as moreprevalent compared to other classification. The trial drug Vidarikanda showedsignificant result in both subjective and objective parameters whereas standard drugVaruna showed highly significant result than Vidarikanda.Key words: Vidarikanda; Varuna; Mutrakrichra; UTI Pueraria tuberosa DC; Crataeva nurvala;
  • 10. INDEX OF “Pharmacognostical Analysis of Vidarikanda and Its Effect on Mutrakrichra – A Clinical Study”Chapter Content Pages 1 Introduction 1–2 2 Aims and Objectives 3–3 3 Review of literature - Drug review 4 – 49 - Disease review 50 – 90 4 Materials and Methods 91 – 99 5 Observations and Results 100 – 135 6 Discussion 136 – 145 7 Conclusion 146 – 147 8 Summary 148 – 149 9 Bibliographic References 150 – 162 10 Annex – Performa of case sheet 163 – 170
  • 11. LIST OF TABLESTable 1: Drug reviewTable No Title of Table Page No 1.1 Vargas of Vidarikanda according to different acharyas 6 1.2 Paryayas of Vidarikanda by various acharyas 7 1.3 Rasapanchaka of Vidarikanda by various acharyas 15 1.4 Doshakarma of Vidarikanda according to different authors 16 1.5 Anya karma of Vidarikanda according to different authors 16 1.6 Therapeutic indications of Vidarikanda 17 1.7 Folklore uses of Vidarikanda 19 1.8 Vishishta yogas of Vidarikanda 20 1.9 Vargas of Varuna according to different Acharyas 41 1.10 Synonyms of Varuna according to different acharyas 41 1.11 Different formulations of Varuna 44Table 2: Disease reviewTable No Title of Table Page No 2.1 Classification of mutrakrichra according to different scholars 62 2.2 Nidana of Mutrakrichra according to different scholars 64 2.3 Samprapti ghatakas of Mutrakrichra 74 2.4 Visista lakshana of Vataja Mutrakrichra 75 2.5 Visista lakshana of Pittaja Mutrakrichra 75 2.6 Visista lakshana of Kaphaja Mutrakrichra 75 2.7 Visista lakshana of Sannipataja Mutrakrichra 76 2.8 Visista lakshana of Ashmari and sharkara janya Mutrakrichra 77 2.9 Visista lakshana of Raktaja Mutrakrichra 77 2.10 Visista lakshana of Shalyabhighataja Mutrakrichra 78 2.11 Visista lakshana of Shukraja Mutrakrichra 78 2.12 Visista lakshana of Pureeshaja Mutrakrichra 78 2.13 Treatment modalities of Mutrakrichra 83 2.14 Pathya apathya of Mutrakrichra 89
  • 12. Table 3: Materials and methodsTable No Title of Table Page No 3.1 Gradation of Subjective parameters 98 3.2 Gradation of Objective parameters 98 3.3 Criteria for assessment of results 99Table 4: Observations and resultsTable No Title of Table Page No 4.1 Age wise distribution of 30 patients of Mutrakrichra 102 4.2 Sex wise distribution of 30 patients of Mutrakrichra 103 4.3 Distribution of patients according to marital status 104 4.4 Religion wise distribution of 30 patients of Mutrakrichra 105 4.5 Education wise distribution of 30 patients of Mutrakrichra 106 4.6 Occupation wise distribution of 30 patients of Mutrakrichra 107 4.7 Distribution of patients according to Economical status 108 4.8 Distribution of patients according to mode of onset 109 4.9 Distribution of patients according to recurrent attacks 110 4.10 Distribution of patients according to colour of urine 111 4.11 Distribution of patients according to type of mutrakrichra 112 4.12 Distribution of patients according to Treatment history 113 4.13 Distribution of patients according to nidana 113 4.14 Distribution of patients according to Symptoms 115 4.15 Distribution of patients according to Prakriti 117 4.16 Distribution of patients according to Agni 117 4.17 Distribution of patients according to Koshta 118 4.18 Distribution of patients according to Abhyavarana shakti 118 4.19 Distribution of patients according to Jarana shakti 119 4.20 Distribution of patients according to Pramana 119 4.21 Distribution of patients according to Sara 120 4.22 Distribution of patients according to Samhanana 120 4.23 Distribution of patients according to Satwa 121 4.24 Distribution of patients according to Satmya 121 4.25 Distribution of patients according to Vyayama shakti 122 4.26 Grades of Krichra mutrapravritti in Group A 122 4.27 Grades of Krichra mutrapravritti in Group B 122
  • 13. 4.28 Grades of Rujayukta mutrapravritti in Group A 123 4.29 Grades of Rujayukta mutrapravritti in Group B 123 4.30 Grades of Dahayukta mutrapravritti in Group A 123 4.31 Grades of Dahayukta mutrapravritti in Group B 123 4.32 Grades of Sakshobha mutrapravritti in Group A 124 4.33 Grades of Sakshobha mutrapravritti in Group B 124 4.34 Grades of Vega asahatva in Group A 124 4.35 Grades of Vega asahatva in Group B 124 4.36 Grades of Urine microscopy in Group A 125 4.37 Grades of Urine microscopy in Group B 125 4.38 Physical constants of Vidarikanda tuber 130 4.39 Preliminary Phytochemical analysis of Vidarikanda tuber 131 4.40 TLC of Vidarikanda tubers (Puereria tuberosa) 131 4.41 Physical constants of Varuna 132 4.42 Statistical analysis of parameters of group A after the treatment 132 4.43 Statistical analysis of parameters of group B after the treatment 133 4.44 Result of the study in group A 134 4.45 Result of the study in group B 135 4.46 Overall result of the study 135 LIST OF GRAPHSGraph No Title of Graph Page No 1. Distribution of patients according to age 102 2. Distribution of patients according to sex 103 3. Distribution of patients according to marital status 104 4. Distribution of patients according to religion 105 5. Distribution of patients according to educational status 106 6. Distribution of patients according to occupation 107 7. Distribution of patients according to economical status 108 8. Distribution of patients according to mode of onset 109 9. Distribution of patients according to recurrent attacks 110 10. Distribution of patients according to colour of urine 111 11. Distribution of patients according to type of mutrakrichra 112 12. Distribution of patients according to Treatment history 113 13. Distribution of patients according to Nidana 116 14. Distribution of patients according to Symptoms 116
  • 14. LIST OF PHOTOGRAPHSPlate no 1: Morphological structure of Pueraria tuberosa showing leaves, inflorescence and legume.Plate no 2: Fig 1 – Natural habitat of Vidarikanda. Fig 2 – Trifoliate leaves of Vidarikanda. Fig 3 – Large sized Pueraria tuber being dugged out.Plate no 3: Fig 4 – Medium sized tuber of Vidarikanda. Fig 5 – Dried gratings of tuber. Fig 6 – Fine powder of Vidarikanda tuber.Plate no 4: Fig 1 – Natural habitat of Varuna. Fig 2 – Bark of a young Varuna tree. Fig 3 – Matured bark of Varuna tree. Fig 4 – Trifoliate leaves of Varuna. Fig 5 – Branch of Varuna containing leaves and flowers. Fig 6 – Inflorescence of Varuna. Fig 7 – Market sample of Varuna bark. Fig 8 – Fine powder of Varuna bark.Plate no 5: TLC of Vidarikanda tuber.Plate no 6: TS of Vidarikanda tuber.Plate no 7: Microscopy of tuber and powder of Vidarikanda.Plate no 8: HPTLC graph of Vidarikanda
  • 15. INTRODUCTIONAyurveda, the Indian system of medicine is defined as science of life and is almost asold as the Indian civilization. The system was developed to reduce the ailments ofmankind. In the course of time several herbs were identified and used for therapeutics.Vidarikanda is one such drug whose existence is seen since purana kala and been usedfor therapeutics. It is botanically identified as Peuraria tuberosa DC and is distributedthroughout India1, 2, 3 . During the procurement of the drug for the study, there arechances of misidentification or adulteration which can alter the quality of the study.Hence pharmacognosy, analytical study and chromatography of Vidarikanda becomean important tool for confirming its genuinity. Classically Vidarikanda has been attributed with different properties likeBalya, Bastishodaka, Veerya vardhaka, Brimhana, Jeevaneeya, Shukrala etc.4Vidarikanda has been extensively used as Vrushya dravya. There are also ample ofreferences for its usage in urinary disorders especially mutrakrichra.5 The disease Mutrakrichra is an age old disease and has been documented inalmost all Ayurvedic texts. It is a condition in which difficulty in micturition is a mainsymptom affecting the daily activities of the person. Based on the theoretical andclinical symptamatology it is been correlated to UTI. UTI’s are a leading cause of morbidity and health care expenditures in thepersons of all ages. Each year urinary tract infections account for 9.6 millions doctorvisits. Women are especially prone to UTI. One in 5 women develops UTI during herlife time. Sexually active young women are disproportionately affected. An estimated40% of women reported having had UTI at some point in their lives.6 UTI in men arenot so common but they can be very serious when they occur.7 Unhygienic lifestyle 1
  • 16. viz. lack of frequent washing, unhygienic sex, alcohol, certain medications etc willtend person to have UTI which are more frequent events of modern life style.8 The management of UTI in modern contemporary science is mainly antibiotictherapy. Even though they are useful, they involve considerable amount of risk, sideeffects and are expensive. The chances of resistances and recurrences afteradministration of antibiotics are also high as fifty percent.9 In this regard management of UTI by herbal drugs is safe and rational. For thispurpose many acharyas have indicated drug like Vidarikanda in the management ofMutrakrichra. Even though there are a lot of textual references there are no researchwork carried out in this regard. Seeing the cost effectiveness of the drug and theprevalence of the disease in the community an attempt is made to know the effect ofVidarikanda on Mutrakrichra through this study. 2
  • 17. AIMS & OBJECTIVESa. Pharmacognistical evaluation of Vidarikanda. • Macroscopical evaluation • Microscopical evaluation • Standardization and Validation.b. Preliminary phyto chemical analysis of Vidarikandac. Chromatographic study of Vidarikandad. To evaluate the efficacy of Vidarikanda churna in Mutrakrichra 3
  • 18. DRUG REVIEWHistoryKnowledge about history of a drug is as much necessary as its therapeutics. Theexistence of a drug since hundreds of years, changes in its nature, identification bydifferent aptas is important for a complete understanding of the herb. It can be studiedunder Veda kala Upanishad and Purana kala Samhita kala Nighantu kala and Adhunika kalaVeda kalaDuring the time of Vedas, references regarding the usage of Vidarikanda have notbeen found.Upanishad and Purana kala In Koushika sutra 35/4 and Shankha likhita dharma sutra 2/20 Vidari has beenmentioned. It was used to clean the teeth during shraaddha and was also useful inpumsavana karma.10Samhita kala In Charaka samhita explanation of the drug by the name Vidari is found in 65different places whereas explanation of Vidarikanda is found only in one place.Similarly in Sushruta samhita description of Vidari is found in 20 different places 4
  • 19. whereas description of Vidarikanda is found in 4 different places. In Kashyapasamhita it has been mentioned in the context of Visarpa, Charma roga etc. whereas inHarita samhita it is mentioned in the context of Kshaya, Chardi roga, Rakta pitta etc.Nighantu kalaVidari has been mentioned in almost all the nighantus like Dhanvantari nighantu,Shodala nighantu, Kaiyadeva nighantu, Raja nighantu, Bhavaprakasha nighantu etc.Adhunika kaalaDr P V. Sharma has described it as Balya and Vaidya Bapalal has decribed it underPalashadi varga.11 Shaligrama vaidya has included it under Shaka varga.12 Otherauthors like Nadkarni, Kirtikar and Basu have dealt with different aspects of Vidarilike the habitat of the drug, morphology, phyto chemistry, therapeutic utility etc. 5
  • 20. Ganas and vargas Table 1.1 Showing Vargas according to different AcharyasCharaka samhita Kantya mahakashaya13 Snehopaga mahakashaya14 Madhura skandha15Sushrutasamhita Vidarigandadi gana16 Vallipanchamoola17 Pittasamshana varga18 Madhura varga19 Kanda varga20Ashtanga hridaya Madhura skanda dravya21 Vata nashaka dravya22 Vidaryadi gana23Ashtanga sangraha Shakha varga24Dhanvantari nighantu Guduchyadi varga25Kaideva nighantu Oushadi varga26Raja nighantu Mulakadi varga27Bhavaprakasha nighantu Guduchyadi varga28Shaligrama nighantu Guduchyadi varga29Madhava dravyaguna Shakha varga30Amarakosha Vanoushadhi varga31Nighantu adarsha Palaashadi varga32Dravyaguna sangraha Shakha varga33 6
  • 21. Synonyms Table 1.2: Showing Paryayas of Vidarikanda by various acharyasNo Paryaya Cs34 Ss35 Ah36 NA37 DN38 MN39 KN40 RN41 BPN42 SGN43 DS44 AK45 AR46 PrN471. pÉÔMÔüwqÉÉÎhQû - - - - - - - + - + - - - -2. pÉÔMÔüwqÉÉhQû - - - - - - - + - + - - - +3. aÉeÉuÉÉeÉϹû - - - - - - - - - - - - + -4. aÉeÉuÉÉeÉÏÌmÉërÉÉ - - - - - - + - - - - - - -5. aÉeÉå¹ - - - - - - - + - + - - - -6. C¤ÉÑaÉlkÉÉ - - - - - - - - + + - - - -8. MülSMüÉrÉ - - - - - - - - - - - - - +9. MülSmÉsÉÉzÉ - - - - - - + - - - - - - - 7
  • 22. No Paryaya Cs Ss Ah NA DN MN KN RN BPN SGN DS AK AR PrN10. MülSuÉÎssÉ - - - - - + + - - - - - - -11. MüÉæηí - - - - - - - - + + - - - -12. M×üwhÉuÉÎssÉMü - - - - - - + - - - - - - -13. ¤ÉÏUzÉÑYsÉÉ - - - - - - - - + + - - - -14. ¤ÉÏUuÉÎssÉ - - - - - - - - + + - - - -15. MÔüzqÉÉhQûÌMüü - - - - - - + - - - - - - -16. qÉ×aÉÉåÍsÉ - - - - - - + - - - - - - -17. mÉsÉÉzÉMü - - - - - + - - - - - - - -18. mÉrÉÎxuÉÌlÉ - - - - - - - - - + - - - -19. ´Éå¸ MülSMü - - - - - - + - - - - - - - 8
  • 23. No Paryaya Cs Ss Ah NA DN MN KN RN BPN SGN DS AK AR PrN20. ´É×aÉÉÍsÉMüÉ - - - - + + + + - + - - + -21. zÉÑYsÉÉ - - - - + - - + + + - - - -22. zÉÑYsÉMülS - - - - - - - - - - - - + -23 ÍxÉiÉÉ - - - - - - - + + + - - - -24. xuÉÉSÒ - - - - - - - - - - - - + -25. èxuÉÉSÒ MülS - - - - + + + + + + - - - -26. èxuÉÉSÒ sÉiÉÉ - - - - - - - + - + - - - -27. ̧ÉmÉhÉï - - - - - - - - - + - - - -28. uÉÉeÉÏuÉssÉpÉÉ - - - - - - - + - + - - - -29. uÉÎssÉmÉsÉÉÍzÉMüÉ - - - - - - + - - - - - - - 9
  • 24. No Paryaya Cs Ss Ah NA DN MN KN RN BPN SGN DS AK AR PrN30. ÌuÉQûÉÍsÉ - - - - - - - + - + - - - -31. ÌuÉQûÉÍsÉMüÉ - - - - - + + - - - - - - -32. ÌuÉSÉËU + + + - + - + + + + - - + +33. ÌuÉSÉËUMü - - - - + + + + - + - - + +34. ÌuÉSÉËUMülS + + + - - - - - - - - - - -35. uÉפÉuÉÎssÉ - - - - - + + - - + - - - -36. uÉ×wrÉ - - - - - - + - - - - - + -37. uÉ×wrÉMülS - - - - + - - + - + - - - -38. uÉ×wrÉmÉÍhÉï - - - - - - + - - - - - - -39. uÉ×wrÉuÉÎssÉMüÉ - - - - - - - + - + - - - - 10
  • 25. Nirukti of vidari48ÌuÉSÉËU – ÌuÉSÉUrÉiÉÏuÉ pÉÔÍqÉÍqÉÌiÉ, oÉ×WûiuÉÉiÉç MülSMüÉrÉxrÉ pÉÔÍqÉÇ SÉUrÉiÉÏuÉ xÉÉ CÌiÉ | It pierces the soil because of its big sizeMeanings of synonyms48C¤ÉÑaÉlkÉÉ – C¤ÉÉåËUuÉ aÉlkÉÉå AxrÉÉÈ | Has smell like sugarcane¤ÉÏUzÉÑYsÉÉ - ¤ÉÏUÍqÉuÉ zÉÑYsÉuÉhÉïMülSÉ | The tuber has colour like milkaÉeÉuÉÉeÉÏ¹É – aÉeÉÉlÉÉÇ uÉÉeÉÏlÉÉgcÉ ÌmÉërÉÉ | The elephant and the horses are fond of VidarikandamÉsÉÉÍzÉÌMü - mÉsÉÉzÉxrÉåuÉ mÉsÉÉzÉÉÌlÉ mɧÉÉhrÉxrÉÉ: | The leaves are similar to Palasha leavesÌoÉQûÉÍsÉMüÉ - ÌoÉQûÉsÉÉlÉÉÇ ÌmÉërÉÉ | The cats are fond of VidarikandapÉÔÍqÉMÔüwqÉÉhQû - pÉÔqrÉliÉaÉïiÉÈ MÔüwqÉÉhQû xÉSØzÉÈ MülSÉå AxrÉÉÈ | The tubers are like pumpkin growing under the grounduÉssÉÏMülSmÉsÉÉzÉÉÈ – mÉsÉÉzÉ xÉSØzÉÈ ÌMüliÉÑ uÉssÉÏÃmÉÈ xÉ MülS¶É | It is similar to Palasha but the structure of the plant is a climberuÉ×wrÉMülSÉ - uÉ×wrÉÈ MülSÉå AxrÉÉÈ | The tubers are aphrodisiaczÉÑYsÉMülSÉ - zÉÑYsÉ: µÉåiÉuÉhÉï: MülSÉå AxrÉÉÈ | The tuber is white in colour´É×aÉÉÍsÉMü - ´É×aÉÉsÉÌmÉërÉÉ | The fox is fond of VidarikandaxuÉÉSÒMülSÉ - xuÉÉSÒqÉïkÉÑUÈ MülSÉåAxrÉÉÈ | The tuber is sweet in tasteqÉWûɵÉåiÉÉ - qÉWûÌiÉ cÉÉxÉÉÇ µÉåiÉÉ cÉ CÌiÉ | The tuber is big in size and sweet in taste 11
  • 26. Vernacular names49, 50, 51, 52Hindi – Bilaikand, Bedarikand, badar, Billi, Bodar, DedarikandEnglish - Indian Kudzu rootKannada – Gumadigida, Dari, Nelagumbala gadde, NelagumbalaBengali - Shimibatraji, BhuikumdoGujarati – Karwinai, VidarikandMalayalam – Mutukku, MudakkuMarathi – Badra, Dari DarniOriya – BhuiankakharuPunjabi – Badar, SalohaTamil – NilapusaniTelgu – Darigummadi, GumodiUrdu – HandiphutaRegional names49, 50, 51, 52Almora - BisaluBhil - Bhoikohola, UdhkyaDehra Dun - saral, sarur, SuralGond - PatalHaldwani – BiraluKumaon – Bilaikand, BiliMerwara – GhorabelMundari – BirkakaruNepal – BiralikundNorthwestern province – Badar, Sarar 12
  • 27. Paharia – DebrelaraPorebunder – FagioRajputana – GorabelRamnagar – SiraluSadani – PatalkoraSaharanpur – SaralSantal – Jangtirra 13
  • 28. Prabheda (Varieties)Charaka in Madhura skanda has mentioned Vidari and Ksheeravidari as two varietiesof Vidarikanda. Chakrapani commenting on this mentions thatÌuÉSÉUÏ ÌuÉSÉËUMülSÈ xÉ Ì²ÌuÉkÉÈ, LMüÈ SÏbÉïMüÉhQûÉå oÉWÒû¤ÉÏUÈ ¤ÉÏUÌuÉSÉËU urÉuɾûÏrÉiÉå | AlrÉÉåWûÎxiÉmÉÉSMüÉåAsmɤÉÏUÈ ||One of the varieties is elongated and having large amount of milky sap and is calledKsheeravidari. The other variety called Vidari is similar to hasti paada in shape buthaving less milky sap.53Dalhana describes the varieties of Vidarikanda in the context of Vidarigandadi gana.His opinion is similar to Chakrapani’s.54xÉ cÉ Ì²ÌuÉkÉ: SÏbÉïMülSÈ oÉWÒû¤ÉÏUÉå WûÎxiÉmÉÉSMüÉå qÉWûÉsmɤÉÏUÈ CìÌiÉ (Dalhana)Nighantukaras mention two varieties of Vidarikanda. One is Vidari and anothervariety is Ksheeravidari. Vidari is identified as Pueraria tuberosa DC ofPapilionaceae. Ksheeravidari is identified as Ipomea digitata of Convolvulaceae.Kerala physicians also accept Ipomea mauritiana as the plant source ofKsheeravidari.55 14
  • 29. Rasa panchaka Table 1.3: Showing Rasapanchaka of VidarikandaAuthor Rasa Guna Veerya VipakaCs56 Madhura - Sheeta -Ss57 Madhura - Sheeta -As58 Madhura - Sheeta -Ah59 Madhura Guru - -DN60 Madhura Guru, Snigdha, Sheeta -MN61 Madhura Guru, Snigdha, - -KN62 Madhura Guru, Snigdha, Sheeta -RN63 Madhura Guru, Snigdha, Sheeta -BPN64 Madhura Guru, Snigdha, Sheeta -PrN65 Madhura Snigdha Sheeta -DS66 Madhura - SheetaNA67 Madhura Guru, Snigdha, Sheeta MadhuraCommonly all the authors have opined the properties of Vidarikanda as follows.Rasa – MadhuraGuna – Guru, SnigdhaVeerya – SheetaVipaka – Madhura 15
  • 30. Karmaa) Dosha karma Table 1.4 Showing Doshakarma of Vidarikanda according to different authors RVN68 BPN PrN MN MD KN DN RN Ah DS Cs As SsVatahara - + + + + - + - + + + + +Pittahara - + + + + + + + + + + + +Kaphakara - - - - - - - + - - - - -b) Anya Karma Table 1.5 Showing Anya karma of Vidarikanda according to different authorsKarma 68 RVN BPN PrN DrS MN MD KN DN RN Ah Cs As SsBalya + + - - + - + + + + + + +Brimhana + + - + - + + - + + - + -Jeevaniya + - - + - - + - + - - - -Kantya + - - + - - - - - - - - -Mutrala + + + + - - + - + - - + -Pushtikara + - - + - - - - - - - - -Rasayana + - - + - + + - + + + - +Stanya - - - - - + + - + + - - -Swarya - + - - - - + - + - - + -Varnya - - - - - - + - + - - - -Vrishya + + - + + - + - - + + + + 16
  • 31. Rogagnatha Table 1.6: Showing therapeutic indications of Vidarikanda Roga Ss69 DN70 MN71 KN72 RN73 BPN74 PrN75 CD76 Daha - - + + + + - Jwara - - - - - - + - Kshaya - - - - - - + - Raktaja roga - + + + + + - - Stanya nasha + - - - - - - - Pittaja mutrakrichra - - - - - - - +Upayukta anga77Kanda (Tuber)Matra77, 78Powder 3 – 6 gmTuber juice: 10 – 20 ml 17
  • 32. Prayoga • Vidari is processed with Shatahva, Madhuka, Yashti, Bala and ghrita is prepared. It is used as pradeha in Vatarakta.79 • Vidari along with Kadamba or Taala is processed with Ksheera and ghrita prepared. This ghrita is administered internally in case of Mutravaivarnya and Mutrakrichra.80 • It is eaten as vegetable in case of stanyanaasha.81 • Vidari churna is given bhavana with Vidari swarasa then licked after mixing it up with ghee and honey. It is said to be a good aphrodisiac.82 • Paste of Vidari root boiled in milk and consumed daily proves to be a better aphrodisiac.83 • Vidari churna along with rasasindura is given for improving the body tissues.84 • Vidari swarasa along with ksheera and mahisha ghrita administered orally in beneficial in Bhasmaka roga.85 • Ghee prepared of Draksha, Vidari, Ikshu given in the form of Seka, Avagaha, Basti etc is useful in Pittaja mutrakrichra.86 • Vidari and Ikshurasa processed with ghrita and is administered orally with madhu in Jwara.87 • Vidari swarasa added with sharkara is administered orally in case of Paitika shula.88 • Vidari churna, Mashachurna, Yashti churna along with madhu and sharkara is administerd in case of Shweta pradara.89 • Vidarikanda, Godhuma and Yava churna is administered orally in case of karshya.90 18
  • 33. • The root is given as a demulcent and refrigerant in fevers.91 • Peeled and bruised into a cataplasm it is used to reduce swellings of the joints.92 • In Nepal it is employed as an emetic and tonic and is also believed to be lactagogue.93Folklore uses94 Table 1.7: Showing Folklore uses of VidarikandaLocal Area of Mode of administration IndicationName collectionBhoikolhu Vapi (Gujarat) Paste of boiled Adhmana, tuber is applied over abdomen UdarashoolaBhoikolhu Pipladevi Paste of tuber is administered Atisara (Gujarat) orally with waterDaukar Rajendragaon 3 to 4 slices of rhizomes are Balyakand (MP) boiled in 300 – 400 ml milk and this milk is administered orally once daily in the nightGigavah Kalyanpura 20 gms of root powder is given Stanya (MP) orally twice daily for 5 to 7 days vardhaka to women 19
  • 34. Vishishta yoga Table 1.8: Showing Vishishta yogas of VidarikandaSl Name of the yoga Indication Referenceno1 cÉuÉlÉmÉëÉzÉ UxÉÉrÉlÉ cÉ.ÍcÉ. 1-/692 AÉqÉsÉMü bÉ×iÉ UxÉÉrÉlÉ cÉ.ÍcÉ. 1-2/43 uÉÉeÉÏMüUhÉ bÉ×iÉ uÉÉeÉÏMüUhÉ cÉ.ÍcÉ. 2-1/354. AmÉirÉMüU bÉ×iÉ uÉÉeÉÏMüUhÉ cÉ.ÍcÉ. 2-4/255. uÉ×wrÉ aÉÑÌOûMüÉ uÉÉeÉÏMüUhÉ cÉ.ÍcÉ. 2– 4/306. cÉlSlÉÉÌS iÉæsÉ euÉU cÉ.ÍcÉ. 3/2587. zÉiÉÉuÉrÉÉïÌS bÉ×iÉ U£üÌmɨÉ, euÉU, MüÉxÉ cÉ.ÍcÉ. 4/958. SìɤÉɱ bÉ×iÉ ÌmɨÉeÉaÉÑsqÉ, ÌmɨÉeÉÌuÉMüÉU cÉ.ÍcÉ. 5/1239. AqÉ×iÉmÉëÉzÉ bÉ×iÉ ¤ÉiÉ ¤ÉÏhÉ, lɹzÉÑ¢ü, MüÉxÉ cÉ.ÍcÉ. 11/3610. xÉÌmÉïaÉÑQû ¤ÉiÉ ¤ÉÏhÉ, ´ÉqÉ cÉ.ÍcÉ. 11/5011. §ÉrÉÔwÉhÉɱ bÉ×iÉ euÉU, aÉÑsqÉ, MüÉxÉ cÉ.ÍcÉ. 18/3912. ÌuÉSÉrÉÉïÌS rÉÉåaÉ ÌmɨÉeÉ MüÉxÉ cÉ.ÍcÉ. 18/9513. AqÉ×iÉ bÉ×iÉ ÌuÉwÉ, AmÉxqÉÉU, ¤ÉrÉ cÉ.ÍcÉ. 23/24214. zÉiÉÉuÉrÉÉïÌS YuÉÉjÉ ÌmɨÉeÉ qÉÔ§ÉM×ücNíû cÉ.ÍcÉ. 26/5015. oÉsÉÉSS iÉæsÉ eɧÉÔkuÉï UÉåaÉ cÉ.ÍcÉ. 26/16116. qÉWûÉqÉrÉÔU bÉ×iÉ ÍzÉUÉåUÉåaÉ, MüÉxÉ, µÉÉxÉ cÉ.ÍcÉ. 26/16617. AqÉ×iÉɱ iÉæsÉ uÉÉiÉurÉÉÌS, ElqÉÉS cÉ.ÍcÉ. 28/157 20
  • 35. 18. mÉÉÃwÉMü bÉ×iÉ uÉÉiÉU£ü, EUÈ ¤ÉiÉ cÉ.ÍcÉ. 29/82919. xÉÑMÑüqÉÉUMü iÉæsÉ qÉlrÉÉxiÉqpÉ, WûlÉÑaÉëWû cÉ.ÍcÉ. 29/9620. pÉÔÌiÉMüÉÌS iÉæsÉ uÉÉiÉurÉÉÍkÉ xÉÑ.ÍcÉ. 36/2221. qÉåSÉÌS bÉ×iÉ ÌmɨÉeÉ MüÉxÉ A.WØû.ÍcÉ. 3/3822. AqÉ×iÉmÉëÉzÉ bÉ×iÉ MüÉxÉ A.WØû.ÍcÉ.3/9423. kÉɧÉÏ bÉ×iÉ UÉeÉrɤqÉÉ, AmÉxqÉÉU A.WØû.ÍcÉ. 3/10824. SìɤÉÉÌS bÉ×iÉ ÌuÉSìÍkÉ A.WØû.ÍcÉ. 13/1625. UÉxlÉÉÌS MüsmÉ SÉWû, AÌiÉxÉÉU, mÉëSU A.WØû.Mü. 4/1226. OÉ×WûiÉç zÉiÉÉuÉUÏ bÉ×iÉ AxÉ×YkÉU cÉ¢üS¨É 9/4627. xÉmiÉmÉëxjÉ bÉ×iÉ U£üÌmÉ¨É cÉ¢üS¨É9/6428. mÉUÉzÉU bÉ×iÉ UÉeÉrɤqÉÉ cÉ¢üS¨É 10/6629. qÉWûÉcÉæiÉxÉ bÉ×iÉ AmÉxqÉÉU cÉ¢üS¨É 21/2330. qÉWûÉqÉÉwÉ iÉæsÉ uÉÉiÉurÉÉÍkÉ cÉ¢üS¨É 22/17431. MÑüzÉɱ bÉ×iÉ ÌmɨÉeÉ AzqÉËU cÉ¢üS¨É 34/1332. ÌuÉSÉrÉÉïÌS iÉæsÉ cÉsÉSliÉ cÉ¢üS¨É 56/4133. OÉ×WûiÉç eÉÏuÉMüɱ iÉæsÉ ÍzÉUÉåUÉåaÉ, oÉÉÍkÉrÉï cÉ¢üS¨É 60/2834. zÉÏiÉMüsrÉÉhÉMü bÉ×iÉ AxÉëÑMçükÉU cÉ¢üS¨É 61/2735. ÍzÉuÉÉaÉÑÌOûMüÉ UxÉÉrÉlÉ cÉ¢üS¨É 66/17536. AqÉ×iÉpÉssÉiÉMü UxÉÉrÉlÉ cÉ¢üS¨É 66/19637. lÉÉUÍxÉqWû cÉÑhÉï oÉsrÉ, uÉ×wrÉ cÉ¢üS¨É 67/18 21
  • 36. 38. xÉÑMÑqÉÉUMÑüqÉÉUMü UxÉÉrÉlÉ UxÉÉrÉlÉ pÉÉ.mÉë.qÉ.35/4939. pÉSìÉuÉWû bÉ×iÉ EwhÉuÉÉiÉ pÉÉ.mÉë.qÉ. 36/4240. ÌuÉSÉËU bÉ×iÉ ÌmɨÉmÉëpÉuÉ qÉѧÉÉbÉÉiÉ pÉÉ.mÉë.qÉ. 36/4741. oÉsÉÉiÉæsÉ uÉÉiÉurÉÉÍkÉ MüÉ.xÉ.ÍcÉ. 18/2942. ÌiÉsÉxÉÌmÉï qÉÉåSMü AxÉ×YkÉU, SÒoÉïsÉåÎlSìrÉ pÉå.xÉ.ÍcÉ. IV /4543. SzÉqÉÔsÉÌS iÉæsÉ EÂxiÉqpÉ, zsÉÏmÉS pÉå.xÉ.ÍcÉ. IV / 1244. qÉWûÉÌlÉqoÉÉÌS iÉæsÉ AzÉï pÉå.xÉ.ÍcÉ. VI / 70 22
  • 37. Modern review of VidarikandaPueraria = after Mr M.M.N Puerari – scientistTuberosa = tuberous rooted95, 96Taxonomical classificationKingdom - PlantaeDivision - SpermatophytaSubdivision - angiospermaeClass - DicotyledonaeSubclass - PolypetalaeGroup - CalycifloraeNatural order - RosalesFamily - PapilionaceaeGenus - PuerariaSpecies - tuberosa DCHabitat97, 98, 99Distributed almost throughout India in deciduous forests except in very humid or veryarid regions ascending up to 1200m. Especially seen in Assam, Punjab, Bihar,Karnataka, Bengal, Rajasthan and Gujarat. Outside India it is found in Pakistan, SriLanka, Malacca, Siam and Nepal. 26
  • 38. Features of Papilionaceae100Diagnostic features:-Herbs shrubs or trees, generally climbers; leaves alternate, stipulate, simple orcompound; flower zygomorphic, hermaphrodite, corolla papilionaceous, stamens 10or 9 diadelphous or monadelphous; carpel one, fruit legume.Distribution:-It is commonly called pea family. It includes 375 genera. The family beingrepresented in India by 70 genera and 754 species.Vegetative characters:-Habit – The plants may be herbs, shrubs, climbers, twinners and trees.Root – A much branched tap root system, bearing bacterial nodules.Stem – Herbaceous or woody, erect or twinner, branched, angular or cylindrical, solidor fistular.Leaves – Cauline or ramal; alternate, stipulate, compound mostly trifoliate sometimessimple; modified wholly or partly into tendril leafbase may be pulvinate.Floral charactersInflorescence – Racemose raceme, rarely solitary axillary.Flowers – Medianly zygomorphic, hermaphrodite, pedicellate, slightly perigynous,complete and pentamerous. The papilionaceous corolla is typical. The floralcharacters are rather uniform.Calyx – Sepals 5, polypetalous, papilionaceous, posterior petal outermost large – thevexillium or standard; next two lateral ones – the wings or alae; and the two anteriorand innermost united to form a boat shaped structure – the keel or carina; descendingimbricate or vexillary aestivation. 27
  • 39. Androecium – Stamens 10 or rarely nine, diadelphous or monadelphous,posteriorstamen is free and filaments of nine are fused to form a sheath around the ovary;Gynoecium – monocarpellary; ovary superior, unilocular, marginal placentation,numerous ovules on the ventral suture; style long slightly bent at the apex, flattened,hairy or without hair; stigma simple or capitate.Fruit – Legume or pod, indehiscent, LomentumSeed – Non endospermicPollination – EntomophilousFeatures of genus Peuraria DC101, 102, 103, 104, 105, 106Habit:- Twinning herbs or shrubs.Leaves:- Pinnately 3 foliate; stipules herbaceous, produced below their insertion insome species.Leaflets:- Entire or sinuately 3 lobed, stipellate.Flowers:- In long often compound racemes; pedicels densely fascicled along anodiform rachis; bracts and bracteoles small.Calyx:- Teeth long or short, the 2 upper connate into one, which is entire or 2 –dentate.Corolla:- Exerted; standard obovate or suborbicular with inflexed auricles at the base,equaling in length the obtuse wings and keel.Stamens:- Monadelphous; anthers uniform.Ovary:- Subsessile; ovules many; style filiform, inflexed above, beardless; stigmasmall capitate.Pod:- linear, more or less flattened. 28
  • 40. Morphology of Pueraria tuberosa DC107, 108, 109Habit:- A large perennial twinning shrub;Stem:- Woody, upto 12 cm in diameter.Leaves:- 3 foliate; petioles 10 – 15cm. long, more or less pubescent; stipules 4mm.long ovate – oblong, cordate.Leaflets: - subcoriaceous, 12.5 – 20 by 11.5 – 18cm. The terminal broadly ovate,acuminate, equal – sided, cuneate at the base, the lateral ovate oblong, inequilateral,truncate at the base, glabrous above, silky beneath; petiolules 4.5 – 6mm. long; stipelssmall, subulate.Flowers:- In lax, sometimes panicled leafless racemes, 15 – 30 cm. long; pedicels2 -3mm. long, silky pubescent, fascicled along a more or less pubescent rachis;bracteoles 1.5mm.long, oblong, silky.Calyx:- 6 – 8mm. long, densely silky; teeth shorter than the tube, oblong, obtuse,ciliate.Corolla:- Bluish; standard 1.3 cm long and as broad as long, spurred.Fruit:- Pods 5 – 7.5 cm. long, membranous, flat, constricted between the seeds,clothed with long silky bristly brown hairs.Seeds:- 3 – 6, reddish brown, ellipsoid – oblong.Root & Tuber:-110, 111, 112, 113 Macroscopy:- Pueraria tuberosa bears thick fleshy long roots which become swollen atintervals. The tubers thus formed are sub spherical or irregular and pear shaped,varying in diameter from 30 to 60 cm and in weight from 2.5 to 30 kg. The marketdrug consists of dried longitudinally cut decorticated flat thin slices or longitudinalcomparatively thick sectors, the former being of superior quality. The lateral surfaces 29
  • 41. are white to dirty white and uneven due to longitudinal furrows. External surface inthe case of un decorticated drug is yellowish brown wrinkled and furrowed with a fewlenticels. The internal part of the drug loses more water as compared to the peripheralcortical layer with the result that cortical part of the drug pieces converge inwards andpartly envelope the internal portion of the drug. The external surface of superiordecorticated samples is dirty white and longitudinally striated. Fracture brittle andstarchy, and the fractured surface is lamellate. It has a slight characteristic odour and apeculiar sweet tasteMicroscopy:-Mature tuber shows 20 – 30 layers of cork consisting of rectangular, thin walled,tangentially elongated and radially arranged cells filled with dark reddish browncontent except in a few inner layers; secondary cortex consists of 6 – 15 layers ofcircular, oval to rectangular and tangentially elongated, thin walled cells, yellow bandof 2 – 6 layers of compactly arranged stone cells present towards innerside of cortex;stone cells moderately thick walled, varying in shape and size and having well markedstriations and pits; a number of prismatic crystals of calcium oxalate found inparenchymatous cells and also rarely in stone cells. Secondary phloem consists ofsieve elements and phloem parenchyma having a number of strands of phloem fibersand a few stone cells, sieve elements somewhat collapsed in outer region formingtangential bands, phloem fibres much elongated, highly thickened, lignified withnarrow lumen, a no of tanniferous ducts filled with brown content distributedthroughout this region. Xylem forms whole of inner white spongy zone, consisting ofseveral concentric rings of one or a few xylem vessels associated with a few xylemelements; vessels mostly drum shaped having reticulate thickening; xylem raysmultiseriate and well marked consisting of thin walled, radially elongated cells and a 30
  • 42. few latex ducts are also present. Plenty of starch grains mostly simple, somewhatround, angular to oval, having central hilum and striations, measuring 5.5 – 13.75 u indiameter are present in all parenchymatous cellsPowder:-Buff colored; shows plenty of starch grains with central hilum and striationsmeasuring 5.5 – 13.75 u in diameter, fragments of cork, prismatic crystals of calciumoxalate, a few xylem vessels with reticulate thickening and phloem fibers. 31
  • 43. Phyto chemistry114, 115, 116, 117, 118, 119a) Contents of tubersDry matter – 85.1%Total carbohydrates – 64.6%Crude fibre – 28.4%Crude protein – 10.9%Ether extract – 0.5%Sucrose, Glucose and Fructoseβ – SitasterolStigmastirolDaidzein (Ramakrishna K. V 1988, Ind. J. Chem 27 (B), 285)Isoflavonoid – Puerarin (Ramakrishna K. V 1988, Ind. J. Chem 27 (B), 285) 32
  • 44. Principle allied to insulinSaccharine matterResinResin acidPterocarpan – Tuberosin (Krishnaprasad A V 1984, Ind .J. Chem 23(B)1165)Anhydroxy tuberosin3 – O – methyl anhydrotuberosinpuetuberosanolGluconic acidMalic acidFree amino acids (Mohd. A & quadry J. S 1986; Ind .J. Chem.Soc 63(10)918)Proteins (Ramakrishna K. V 1988, Ind. J. Chem 27 (B), 285)Vitamin B1 (Ramakrishna K. V 1988, Ind. J. Chem 27 (B), 285)Isoflavonoid – 4 – Methoxy purerin (Ramakrishna K. V 1988, Ind. J. Chem 27 (B),285)4 – 6 – di – O – purerin (Ramakrishna K. V 1988, Ind. J. Chem 27 (B), 285)Pueraone (Ramakrishna K. V 1988, Ind. J. Chem 27 (B), 285)Neobhava (Krishnaprasad A V 1984, Ind .J. Chem 23(B)1165)Deoxytuberosin (Krishnaprasad A V 1984, Ind .J. Chem 23(B)1165)Hydroxytuberosin (Krishnaprasad A V 1984, Ind .J. Chem 23(B)1165)Coumestan puerarostan (Krishnaprasad A V 1984, Ind .J. Chem 23(B)1165) 33
  • 45. Contents of rootsIsoflavonoid - 4′,6″ - DiacetylpuerarinContents of LeavesCrude protein - 23.8%Fat – 0.7%Crude fibre – 30.7%Other carbohydrates – 31.6%Ash – 12.0%Calcium – 1.6%Phosphorus 0.2% 34
  • 46. Pharmacological actions120,121 • Tuberosin showed protective effect on the ischaemic myocardium (Fan et al 1992) • Butanol extract of the root exhibited significant anti hepatotoxic activity against CCL4 induced liver damage (Shukla S. et al 1993) • Pharmacological studies with butanol, chloropharm and ethanol extracts of roots indicate very good oestrogenic activity (Shukla S. et al 1987), anti implantation activity (Gupta D N 1990) and anti fertility activity in rats (Mathur R 1983). The butanol extract being the most potent and without side effects • The extract of tuber was found to be active against Helminthosporium Sativum Pamm., (King & Bakke Fl. Assam, II, 80)Toxicity study122Toxicity studies with the butanol extract of Pueraria tuberosa, a prospective postcoitalcontraceptive agent, were carried out in rats. A dose of 150 mg/kg was administeredto rats for 6, 12, 18 and 24 days. The level of blood sugar, serum proteins, serum GPTand GOT showed variations with the normal range except at the highest dose regimen.Leucocyte counts and haemoglobin values were within normal limits. Protein content,glycogen content, activity of acid and alkaline phosphatase, level of total andesterified cholesterol, adenosine triphosphatase, and glucose – 6 phosphatase activityshowed no significant change at initial durations except with the 24 day regimen.However the adrenal glands showed significant change. No significant histopathological lesions were observed. The butanol extract appears to be generally safein rats at these acute and sub acute dosage regimens 35
  • 47. Therapeutic evaluation123In a clinical study ethanolic extract of the plant in the form of capsule wasadministered to 250 female patients. The drug proved highly effective forDysmenorrhoea, dysfunctional uterine bleeding, and menopausal syndrome. Acomposite herbal preparation CIHP – 1 containing Pueraria tuberosa as one of theingredients. It was clinically tried on 38 male subjects of age group of 23 – 40 yearswho were actively involved in anti insurgency activity of high anxiety and physicalendurance in northern Himalayan region. The results suggested that CIHP – 1supplementation to the subjects helped in faster recovery of antioxidants depressedduring combat stressSubstitute 124, 125, 126Vidari is a substitute (pratinidhi dravya) for Jeevaka and Rishabhaka. whereassubstitute for Vidari has not been mentioned in any of the classics. However inpractice Vidari and Ksheeravidari (Ipomea digitata) are being considered as substituteto each other. Ipomea mauritiana (Convolvulaceae) is also widely used as a source ofVidari. Adenia palmata Engl., Trichosanthes cordata Roxb., Lettsomia setosa Roxb.,Solanum verbascifolium Linn., Cycas rumphii Miq., Cycas pectinata Griff and Cycasbeddomei Dyers are reported to be the source of Vidari in Various Parts of India.Adulterants 127, 128, 129Stem tubers of Ipomea paniculata linn. locally known as Bhumi kumhra is sold in thename of Vidari in North India especially in Bihar, Bengal and Orissa. The freshly cuttuber of this plant exudes milky white sap. Stem tubers of Trichosanthes cordata isalso sometimes sold as Vidarikanda. The tubers in this case are smaller and lobed. In 36
  • 48. Kerala large spherical tubers of Adenia hondala (Passifloraceae) are sold in themarket. A market survey made by Chaudhuri et al. (1981) and nair et al.(1983) inGujarat, Karnataka, Tamilnadu revealed that the decorticated stem of Cycascircinalis, a gymnosperm, is being marketed there as Vidari.Propagation and Cultivation130 131It can be easily propagated from seeds and through root stalks (crowns).Flowering time – February to AprilFruiting time – May to JuneCollection and storage132Usually collected near the banks of rivers, seen in depth.Mature tuber is taken, cut into slices, dried well under direct sunlight and thenpreserved in air tight conditions.Non therapeutic uses133They taste like liquorice and are said to be eaten raw or boiled as a vegetable.They are often fed to horses and ponnies.The tubers can be used for the extraction of starch.Trade and commerceRetail market price of tuber – Rs.55/ kg (2007).The yield of tubers is reported to be about 5.0 to 7.5 tonnes per hectare.134 37
  • 49. Previous research works on VidarikandaIn Ayurvedic institutions • A clinical trial on the role of Vidarikanda as shukrala [Venkateshwarulu, 1998, Dr. BKRR Govt Ayurvedic College, Vijaywada.] • Shatavari evam Vidari ka guna karmatmaka adhyayana evam stanya janana prabhava ka tulanatmak adhyayana [Tyagi Savita, 1995,MMM Govt Ayurvedic College, Udaipur ] • A study on Vidarikanda w.s.r.t its vrishya karma [Acharya. R. N, 1996, Institute for post graduate teaching and research in Ayurveda, Jamnagar] • A clinical study on oligospermia with its management by Vidarikanda [Behra B S, 1996, Gopabandhu Ayurved mahavidyalaya, Puri]In other institutions • A pharmacognostic study of Vidarikanda [Atal, C.K. & Qadry, S.M.JS, 1962] • Components of the roots of Pueraria tuberosa: Isolation of of a new isoflavone – C – glycoside (Di-O-acetylpuerarin) [Bhutani, S.P.; Chibber, S.S & Seshadri, T.R.,1969] • Effect of Pueraria tuberosa on male reproductive system of rats [Daftari, P ; Chandhoke, N.; gupta, s. & Atal, C. K, 1981] • Oestrogenic activity of Pueraria tuberosa [Gaitonde, B B. et al 1975] • Post coital contraceptive efficacy and hormonal profile in Pueraria tuberosa [Gupta, d. N.; lakshmi, V.; Keshri, G.; 1990] 38
  • 50. • Antifertility efficacy of the butanolic extract of Pueraria tuberosa [Mathur, A. & Shukla, S,1986]• Effect of Pueraria tuberosa on the oestrous cycle of adult rats, [Mathur , R,; Vinitha, S. 1984]• Studies on the peptide and amino acids of Pueraria tuberosa [Mohd. Ali & Qadry, J.S.1986]• Hypoglycaemic studies of Indian Medicinal plant Pueraria tuberosa [Nigam, S. T. & Baxi, A.J.1981]• Toxicological studies Pueraria tuberosa, a potent antifertility plant, [Shukla, S.1995]• Protective action of butanolic extract of Pueraria tuberosa against carbon tetrachloride induced hepatotoxicity in adult rats, [Shukla, S.; Jonathan, S.1996] 39
  • 51. ShlokasmÉrÉÉïrÉ • ÌuÉSÉËU xuÉÉSÒMülSÉ cÉ xÉÉ iÉÑ ¢üÉå·íÏ ÍxÉiÉ xqÉ×iÉÉ | C¤ÉÑaÉlkÉÉ ¤ÉÏUuÉssÉÏ ¤ÉÏUzÉÑYsÉÉ mÉrÉÎxuÉÌlÉ || (pÉÉuÉmÉëMüÉzÉ ÌlÉbÉhOÒû) • ÌuÉSÉËU aÉeÉuÉÉeÉÏ¹É xuÉÉSÒ uÉ×wrÉ C¤ÉÑaÉÎlkÉMüÉ | ´ÉÑaÉÉÍsÉMüÉ uÉ×wrÉuÉssÉÏ zÉÑYsÉMülSÉ ÌuÉSÉËUMüÉ || (AÍpÉkÉÉlÉU¦ÉqÉÉsÉ) • ÌuÉSÉËU pÉÔÍqÉMÔüwqÉÉhQûÉ MüÍjÉiÉÉ cÉ ÌuÉSÉËUMüÉ | oÉ×WûiuÉÉiÉç MülS MüÉrÉxrÉ pÉÔÍqÉÇ SÉUrÉiÉÏuÉ xÉÉ || (ÌmÉërÉÉ ÌlÉbÉhOÒû) • ÌuÉSÉËU uÉ×wrÉMülSÉ ¤ÉÏUzÉÑYsÉÉ ÍxÉiÉÉ xqÉ×iÉÉ | C¤ÉÑaÉlkÉÉ Ì§ÉmÉhÉÉï cÉ zÉÑYsÉÉ aÉeÉuÉÉÎeÉÌmÉërÉÉ || (zÉÉÍsÉaÉëÉqÉ ÌlÉbÉhOÒû) (¢üÉå·íÏ, ÌuÉSÉËUMü, xuÉÉSÒMülSÉ, ´ÉÑaÉÉÍsÉMüÉ, uÉ×wrÉuÉÍkÉïÌlÉ, ÌoÉQûÉÍsÉ, uÉ×wrÉuÉÎssÉMüÉ, pÉÔMÔüwqÉÉÎhQû, xuÉÉSÒsÉiÉÉ, aÉeÉå¹É, uÉÉeÉÏuÉssÉpÉÉ, aÉlkÉTüsÉÉ, ¤ÉÏUuÉssÉÏ, mÉrÉÎxuÉÌlÉ, uÉפÉuÉssÉÏ, pÉÔÍqÉMÔüwqÉÉhQû) • ÌuÉSÉËUMüÉ qÉiÉÉ zÉÑYsÉÉ xuÉÉSÒMülSÉ ´ÉÑaÉÉÍsÉMüÉ | uÉ×wrÉMülSÉ ÌuÉSÉËU cÉ uÉ×wrÉuÉssÉÏ ÌuÉQûÉÍsÉMüÉ || (kÉluÉliÉËU ÌlÉbÉhOÒû) • ÌuÉSÉËU C¤ÉÑÌuÉSÉËU xrÉÉiÉç xuÉÉSÒMülSÉ ÌuÉSÉËUMüÉ | MÔüwqÉÉhQûÌMü MülSuÉssÉÏ uÉ×YzÉMülSÉ mÉsÉÉÌwÉMüÉ || aÉeÉuÉeÉÏÌmÉërÉÉ uÉ×wrÉÉ uÉפÉuÉssÉÏ ÌuÉQûÉÍsÉMüÉ | 40
  • 52. uÉssÉÏmÉsÉÉÌwÉMüÉ MülSmÉsÉÉzÉWèû ´ÉåwPûMülSMüÈ || ´ÉÑaÉÉÍsÉMüÉ uÉ×wrÉmÉÍhÉï qÉëÑaÉÉåÍsÉ M×üwhÉuÉÎssÉMüÉ | (MæürÉSåuÉÌlÉbÉhOÒû) • ÌuÉSÉËUMüÉ uÉפÉuÉssÉÏ uÉפÉMülSÉ ÌuÉQûÉÍsÉMüÉ | ´ÉÑaÉÉÍsÉMüÉ MülSuÉssÉÏ xuÉÉSÒMülSÉ mÉsÉÉÍzÉMüÉ || (qÉSlÉmÉÉsÉ ÌlÉbÉhOÒû)aÉÑhÉ MüqÉï • ÌuÉSÉËU qÉkÉÑUÉ ÎxlÉakÉÉ oÉ×ÇWûhÉÏ xiÉlrÉzÉÑ¢üSÉ | zÉÏiÉÉ xuÉrÉÉï qÉÔ§ÉsÉÉ cÉ eÉÏuÉÌlÉ oÉsÉuÉhÉïSÉ || aÉÑÂÈ ÌmɨÉÉxÉë mÉuÉlÉ SÉWûÉlÉç WûÎliÉ UxÉÉrÉÌlÉ | (pÉÉuÉmÉëMüÉzÉ ÌlÉbÉhOÒû) • ÌuÉSÉUÏ qÉkÉÑUÉ ÎxlÉakÉÉ zÉÏiÉÉ uÉ×wrÉÉ UxÉÉrÉÌlÉ | oÉ×ÇWûhÉÏ oÉsÉSÉ xiÉlrÉuÉÍkÉïÌlÉ oÉÎxiÉzÉÉåÍkÉÌlÉ || uÉÉiÉÌmɨÉÉmÉWûÉ SÉWûeuÉU ¤ÉrÉ ÌuÉlÉÉÍzÉÌlÉ | (ÌmÉërÉÉ ÌlÉbÉhOÒû) • ÌuÉSÉËU MülS zÉÉMü eÉÏuÉlÉÉå oÉ×ÇWûhÉÉå uÉ×wrÉÈ MühœÈ zÉxiÉÉå UxÉÉrÉlÉå | ÌuÉSÉËUMülSÉå oÉsrÉ¶É qÉÔ§ÉsÉÈ xuÉÉSÒzÉÏiÉsÉÈ || (cÉUMü) • ÌuÉSÉËU uÉÉiÉÌmɨÉblÉÏ qÉÔ§ÉsÉÉ xuÉÉSÒzÉÏiÉsÉ | eÉÏuÉlÉÏ oÉ×ÇWûhÉÏ MühœÉ aÉÑuÉÏï uÉ×wrÉÉ UxÉÉrÉlÉqÉç || (A¹É…¡ûWØûSrÉ) • ÌuÉSÉËU uÉÉiÉÌmɨÉblÉÏ uÉ×wrÉÉ oÉsrÉÉ UxÉÉrÉlÉÏ | (qÉÉkÉuÉ SìurÉaÉÑhÉ) 41
  • 53. • ÌuÉSÉËUMülSÉå oÉsrÉ¶É uÉÉiÉÌmɨÉWûU¶É xÉÈ | qÉkÉÑUÉå oÉ×ÇWûhÉÉå uÉ×wrÉ: zÉÏiÉ: xuÉUçÉåï AÌiÉqÉÔ§ÉsÉ: || (SìurÉaÉÑhÉ xÉÇaÉëWû)• qÉkÉÑUÉå oÉ×ÇWûhÉÉå uÉ×wrÉÈ zÉÏiÉÈ xuÉrÉÉåï AÌiÉqÉÔ§ÉsÉÈ | ÌuÉSÉËUMülSÉå oÉsrÉxiÉÑ ÌmɨÉuÉÉiÉ WûU¶É xÉÈ || (xÉÑ´ÉÑiÉ)• ÌuÉSÉËU uÉÉiÉÌmɨÉblÉÏ qÉÔ§ÉsÉÉ xuÉÉSÒ zÉÏiÉsÉÉ | ÌuÉSÉËU ÍzÉÍzÉUÉ xuÉÉSÒaÉÑÂÈ ÎxlÉakÉÉ xÉqÉÏUÎeÉiÉç | ÌmɨÉxÉëÎeÉiÉç iÉjÉÉ oÉsrÉÉ uÉ×wrÉÉ cÉæuÉ mÉëMüÐÌiÉïiÉÉ || (kÉluÉliÉËU ÌlÉbÉhOÒû) 42
  • 54. DRUG REVIEW OF VARUNAHistory Charaka has explained Varuna in four contexts but has not mentioned indashemani and under ashmari mutrakrichra. Sushruta has included it under tiktavarga,vatasamshamana varga and varunadi varga. For the first time vrinda was the one whoexplained single use of varuna in ashmari. Neither Dhanvantari Nighantu nor Raja Nighantu quote about the lithotripticproperty of varuna. Vaidya Bapalal describe it as an important drug for hepatomegalyand spleenomegalyNirukti of Varuna135uÉUåÌiÉ | uÉ×hÉÉåÌiÉ | uÉ×gÉç uÉUhÉå |uÉ×hÉÉåÌiÉ mÉÍhÉïMüÉ uÉפÉiuÉÉiÉçIts leaf resembles those of Bilva.Ganas and VargasTable 1.9: Showing Vargas of Varuna according to different acharyas.Sl Book Vargano1. Sushruta Samhita Varunadi136 Vatasamshamana1372. Ashtanga hridaya Varunadi1383. Raja Nighantu Prabadradi gana1394. Bhavaprakasha Nighantu Vatadi varga1405. Dhanvantari Nighantu Amradi varga1416. Kaiyadeva Nighantu Aushadhi varga 142 43
  • 55. ParyayaTable 1.10 Showing Synonyms of Varuna according to different acharyasMÉrÉÉïrÉ kÉ.ÌlÉ 143 UÉ.ÌlÉ144 Mæü.ÌlÉ145 pÉÉ.mÉë146 ÌlÉ.AÉ147ÌiÉ£üzÉÉMü + + + + +aÉlkÉuÉ×¤É + + - + +MÑüqÉÉUMü + + - + +UÉUhÉ - - + + -xÉåiÉÑuÉ×¤É - - - + -xÉÉkÉÑuÉ×¤É + - - - -IÉqÉÉsÉMü + - - + +µÉåiÉmÉÑwmÉ + + - - -µÉåiÉSìÓqÉ + + - - -ZÉÉMüSìÓqÉ - - - + +Vernacular names148English - Three leaved caperHindi - Barun, Barna, BilasiKannada - Nirvala, NarumbeleBengali - Barun, Tikto shakGujarati - Vayavarna, VaranaeMalayalam - Nirmatalam, NirvalMarathi - Vayavarna, HaravarnaPunjabi - Barna, BarnahiTamil - Varanam, NarvalaTelgu - Vivapatri, Usikmanu 44
  • 56. Properties149Rasa – Kashaya, TiktaGuna – Laghu, RukshaVeerya – UshnaVipaka – KatuPrabhava – AshmaribhedanaDoshaghnata – Kaphavatashamaka, PittavardhakaKarma – Raktotkleshaka, Deepana, Anulomana, Pittasaraka, Bhedana, Krimighna,Raktashodhaka, Mootrala, Ashmari bhedana, JwaraghnaRogagnata – Vrana shotha, Vidradhi, gandamala, Agnimandya, Shoola, Gulma,yakridvikara, Krimi, Vatarakta, Ashmari, Mutrakrichra, Bastishoola, Jwara,DaurbalyaUpayukta anga150Stem bark, leafMatra151Decoction - 50 to 100 mlPowder 3 – 5 gmsPrayoga 1. Varuna patra kwatha is prepared and used as avagaha in arsha.152 2. Varuna niryasa is dissolved in water and then applied as anjana in vishasamsrsta anjana.153 3. Varuna twak churna is added to Varuna mula twak kwatha and administered in case of ashmari.154 45
  • 57. 4. Varuna mula kwatha administered orally is beneficial in vidradhi. 155 5. Varuna twak is rubbed on a stone using ajadugda and applied over skin in case of vyanga.156Vishishta yogaTable 1.11 Showing different Formulations of Varuna1 uÉÂhÉÉÌS YuÉÉjÉ AzqÉËU cÉ¢üS¨É34/1, uÉ×lSqÉÉkÉuÉ 34/12 uÉÂhÉɱ iÉæsÉ AzqÉËU, zÉMïüUÉ qÉÔ§ÉM×ücNíû pÉÉ.mÉë.ÍcÉ.37/583 uÉÂhÉɱ bÉ×iÉ AzqÉËU, qÉÔ§ÉM×ücNíû pÉÉ.mÉë.ÍcÉ.37/834 uÉÂhÉɱ cÉÔhÉï AzqÉËU, qÉÔ§ÉM×ücNíû pÉÉ.mÉë.ÍcÉ.37/725 uÉÂhÉ ¤ÉÉUrÉÉåaÉ uÉÉiÉÉeÉlrÉ qÉÔ§ÉM×ücNíû pÉÉ.mÉë.ÍcÉ.37/746 uÉÂhÉMü aÉÑQû AzqÉËU pÉÉ.mÉë.ÍcÉ.37/76Modern review of Varuna 158Crateava nurvala Buch.- Ham.Crateava = Crativas – Greek botanist who lived in the time of cratesnurvala = (Nir - Malayalam) = WaterCrataeva religiosa Hook.f. & ThomsCapparidaceaeHabitat 159It is a deciduous tree, found almost all over India in Upper ganjetic plains, Bengal,Bihar and Orissa, Gujarat, Konkan and Tamil nadu, wild or cultivated. Often foundalong streams, but also in dry deep boulder formations in the sub Himalayan tract 46
  • 58. Propagation and Cultivation160It can be propagated through axillary bud and leaf culture.Trade and commerceRetail market price – Bark Rs. 80 per kg (Bangalore, Karnataka)Morphology of Varuna161MacroscopyHabit - A small tree with a much branched head.Leaves – Deciduous, 3 foliate; petioles 3.8 – 7.6 cm long; leaflets 5-15 by 3.8-6.3 cm.ovate, lanceolate or obovate, acute or acuminate, attenuateat the base, entire, glabrouson both surfaces, pale beneath and reticulately veined, the lateral leaflets oblique atthe base; petiolules 6-9mm long.Flowers – manyin dense terminal corymbs, greenish white; pedicels 2.5 – 4.4 cm longstout, glabrous. Sepals petaloid, small, distant, ovate, acute. Petals nearly 2.5 by 0.9cm; claw upto 6 mm long, very narrow. Stamens longer than the petals, spreading.Gynophore nearly 5 cm long, terete, smooth. Ovary ellipsoid; stigma flat.Fruit – Globose or ovoid, woody or smooth. Berry on the thickened gynophore.Seeds embedded in pulp, nearly smooth, brown.Microscopy 162Stem bark – The bark occurs in pieces, 6 – 15 cm long, 3-10 cm wide and 5 – 12mthick. Outer surface is ash coloured and rough due to the prescence of lenticels, innersurface is smooth, whitish brown or buff coloured. In transverse section, theepidermis consists of single layer of cubical cells followed by a cortex consisting of 6 47
  • 59. – 10 layers of collenchyma and 5 -10 layers of parenchyma containing chlorop[lastsand starch grains. The stele is represented by a large no of vascular bundles separatedby 1-3 cells wide medullary rays. Each vascular bundle is capped by strands oflignified pericyclic fibres. The mature bark is characterized by the presence ofsclerosed corky rhytidoma in the phelloderm and by a very wide zone of secondaryphloem possessing concentric strand of ceratenchyma alternating with strands of stonecells. Simple and compound starch grains and prismatic crystals of calcium oxalateare found in most of the parenchymaPhysical constants163 Bark – Total ash: 10.36 % Acid insoluble ash: 0.254 % Alcohol soluble extractive: 6.08 % Water soluble extractive: 50.47 %Phyto chemistry 164Root bark: Lauric, stearic, undecyclic, oleic and linolenic acids, triterpine alcohol –lupa – 21, 20, rutin, quercetin, lupen – 3 – epilupeol,pentacyclic triterpine alcohol.(API. P 540)Bark: Ceryl alcohol, friedelin, betulinic acid, diosgenin, lupeol, epiafzelechin – 5 – 0– β – D – glucoside, volatile components, pcymene, limonene, linalool and α & βionones. (API. P 540) 48
  • 60. Pharmacological actions165Oxitocic, antibacterial, spasmolytic, cholinergic, diuretic, anti arthritic, corticosteroidlike activity, lithotryptic, spasmodic, anti inflammatory antipyretic, antifertility. Plantinhibited phosphatic stone formation in rats.Therapeutic evaluation 166 Clinical trials to evaluate the efficacy of Varuna in urinary disorders wereconducted on patients of enlarged prostate and vesical calculi. The patients showedfairly good response to the treatment. The reduced tone of the urinary bladderimproved to normal. The overall effect of the drug was highly encouraging, since itprovided relief to about 80 % of the patients. It was also found helpful in preventingthe stone formation on one hand and in expelling out the formed stone on the otherhand. Clinical trial on 84 cases on urinary tract infections accompanied with painand burning micturition was conducted with varuna, it cured 55 % cases, showedimprovement in 40 % cases and 5 % cases did not show any relief.Substitutes and Adulterants 167It is reported that the samples of stem bark collected from markets of northern Indiatallied with genuine bark but the sample collected from madras was found to be littledifferent microscopically. All the bark powders except the madras sample whenmounted in nitrocellulose exhibited yellow fluorescence under U V light, while themadras sample showed brown fluorescence. 49
  • 61. Previous research worksEffect of crataeva nurvala in experimental urolithiasis, J. Ethnopharmacol.,Varalakshmi.P, Shamila.Y. (1990)Effect of crataeva nurvala on the biochemistry of the small intestinal tract of normaland stone - forming rats, J. Ethnopharmacol.,Study of use of Varunadi kwatha in Mutrakrichra, Suru, P.P & Kulkarni, P.H,Deerghayu International (1991)Evaluation of antilithic properties of Varuna (Crataeva nurvala) Singh, R.G &Kapoor, U.S (1991) 50
  • 62. Shlokas1. uÉÂhÉÈ µÉåiÉmÉÑwmÉ¶É ÌiÉ£üzÉÉMüÈ MÑüqÉÉUMüÈ | µÉåiÉSìÓqÉÉå aÉlkÉuÉפÉxiÉqÉÉsÉÉå qÉÉÂiÉÉmÉWûÈ || uÉÂhÉÈ zÉÏiÉuÉÉiÉblÉÎxiÉ£üÉå ÌuÉSìÍkÉ eÉliÉÑÎeÉiÉç | iÉjÉÉ cÉ MüOÒû EwhÉ¶É U£üSÉåwÉWûUÈ mÉUÈ || (kÉluÉliÉËU ÍhÉbÉhOÒû)2. uÉÂhÉÉå uÉUhÉÈ xÉåiÉÑ ÌiÉ£üzÉÉMüÈ MÑüqÉÉUMüÈ | uÉÂhÉÈ ÌmɨÉsÉÉå pÉåSÏ zsÉåwqÉ M×ücNíûÉzqÉ qÉÉÂiÉÉlÉç || ÌlÉWûÎliÉ aÉÑsqÉuÉÉiÉÉxÉë M×üÍqÉ cÉ EwhÉ AÎalÉ SÏmÉlÉÈ | MüwÉÉrÉÉå qÉkÉÑUÌiÉ£üÈ MüOÒûMüÉåäÉMüÉå sÉbÉÑÈ || (pÉÉuÉmÉëMüÉzÉ ÌlÉbÉhOÒû)3. uÉÂhÉÉå uÉUhÉÈ xÉåiÉÑÂÂqÉÉhÉÈ MÑüqÉÉUMüÈ | zÉÉMüSìÓqÉÈ xÉåiÉÑuÉפÉÉå UÉåkÉuÉפÉxiÉÉqÉsÉMüÈ || xÉkÉÑuÉפÉÈ µÉåiÉmÉÑwmÉÎxiÉ£üzÉÉMü¶ÉÉqÉsÉMüÈ | uÉÂhÉÉå qÉkÉÑUÎxiÉ£üÈ MüwÉÉrÉÉå MüOÒûMüÉå sÉbÉÑÈ || äÉÉåwhÉÈ ÌmɨÉsÉÉå pÉåSÏ SÏmÉlÉÈ MüTüuÉÉiÉÎeÉiÉç | ÌlÉWûÎliÉ M×üÍqÉ uÉÉiÉÉxÉë qÉÔ§ÉÉbÉÉiÉÉxÉë WØûªSÉlÉç || (MæüSåuÉ ÌlÉbÉhOÒû) 51
  • 63. DISEASE REVIEWHistorical review History is a part of description of any subject. From vedic period much hasbeen documented in Sutras, Shlokas regarding Mutrakrichra in particular andaffliction of urogenital tract in general. The historical aspect can be divided into 4parts as below.(1) Vedic Kala(2) Samhita Kala(3) Samgraha KalaVedakala168 Among the four Vedas, references regarding urogenital system have beenfound in Atharvaveda. In the first chapter of Atharvaveda, organs like Gavini andBasti are described. Urethral catheterization with Lohshalaka to drain the distendedbladder has been mentioned. But the disease by the name Mutrakrichra has not beenmentioned.Samhita kala Acharya Charaka has mentioned ganas pertaining to mutra likeMutrasangrahaneeya, Mutravirajaneeya and Mutravirechaneeya and enumerated 8types of Mutraghata in Sutrasthana and explained 8 types of Mutrakrichra in Chikitsasthana.He has mentioned Basti and Vankshana as srotomula of mutravaha srotas. 52
  • 64. Sushruta has dealt with Mutrakrichra in a separate chapter of Uttaratantracalled Mutrakrichrapratishedha adhyaya where he mentions 8 types of Mutrakrichraand their lakshanas separately. Both Ashtanga sangrahakara and Ashtanga hridayakara have explainedimportance of Basti and mutrakrichra under Mutraghata nidana adhyaya where thefour types of mutrakrichra have been explained followed by explanation of twentytypes of Mutraghata. Kashyapa has dedicated a separate chapter in Chikitsa sthana calledMutrakrichra chikitsa adhyaya. In Sutrasthana of Bhela samhita one chapter is devoted to MutrakrcchraChikitsa but is incomplete.Sangraha kala A separate chapter for mutrakrichra has been dedicated in Madhava nidanawhere the roga nidana, samprapti have been detailly explained. Similar explanationsalong with treatment have been found in Chakradatta, Yogaratnakara, SharangdharaSamhita and Bhavaprakasha Nighantu. Most of these texts follow the descriptionsgiven in Charaka and Sushruta.Vyutpatti of MutraThe word mutra is derived from qÉ賈 + bÉgÉç | qÉÔ§ÉÌiÉ CÌiÉ meaning to ooze or exudeprofusely.169 Hence mutra is the liquid which is secreted or which oozes fromkidneys.170 Other terms related to mutra are Prasavaha (meaning to flow or to ooze), 53
  • 65. mehanam (meaning to pass urine), guhyanisyanda (meaning to ooze), sravana,srava.171Swaroopa of mutrvaha srotas For understanding samprapti of any disease it is necessary to study the srotoshareera of the involved srotas. Acharya Charaka opines the mula of mutravaha srotasto be Basti and Vrishana.172 Sushruta opines that there are two mutravaha srotas andtheir mula is Basti and Medra.173 Only Mutrashaya, Vrishana and Medra have beenexplained in this context whereas Vrikka has been explained in the context ofmedovaha srotas.174 Hence Mutravaha srotas means the system, which is responsible for utpatti andvisarjana of mutra. In Ayurvedic classics, one may not get exact reference regardingthe detail description of the urinary system. Hence by taking the help of contemporaryscience and opinion of 20th century scholars, the word mutravaha srotas is co-relatedwith urinary system.Concept of Urine formation in Ayurveda It is the matter of concern that during the formation of urine the related organshave not being dealt in connection. In this regard Basti has been given importance andthe anatomical structure is elaborately explained in our science. But the upper urinarytrack i.e., Gavinis and Vrakkau have not been brought into picture, which makes usdifficult to draw a clear picture. All the Acharyas are of the same opinion that theingested food is digested by the action of Kledaka Kapha, Pachaka Pitta andSamanvayu and divides it into rasa, moothra, purisha and dosha. 54
  • 66. The ahara rasa after undergoing digestion by the help of pachaka pitta getsdivided into saara bhaga and saaraheena bhaga. The saara heena bhaga becomes mala.The dravaroopa mala through different channels comes to Mutrashaya or Basti. Thismala is known as mutra.175 Sushruta further explains the transport of mutra from Pakwashaya to Bastigiving a similie that the mutravaha nadi originating from Pakwashaya bring mutra toBasti just like the rivers flowing towards the ocean. Mutra comes to Basti by theprocess of upasneha vidhi from the numerous minute channels from Pakvashayawhich are invisible to naked eyes. Hence it is to be understood that the mutra which isformed in the Pakvashaya fills in the Basti just like a new earthen pot kept in waterimmersed up to the neck gets filled.176Formation of urine according to modern science Formation of urine starts from a Nephron. A Nephron consists of two portions:a renal corpuscle where plasma is filtered and a renal tubule into which the filteredfluid passes. Nephrons perform three basic functions – glomerular filtration, tubularsecretion and tubular reabsorption. In glomerular filtration substances in the bloodthat are small enough pass across the wall of the glomerular capillaries into the renaltubule. Then as the fluid moves along the renal tubule, many useful materials arereturned to the blood in peritubular capillaries and vasa recta; this is tubularreabsorption. As the fluid passes along the tubule, it also gains some additionalmaterials (wastes and excess substances) from tubule cells and blood capillaries; thisis tubular reabsorption Urine thus formed by the nephrons ultimately drains into large ducts calledpapillary ducts. They lead to cup like structures like minor and major calyces. From 55
  • 67. the major calyces, the urine drains into a large cavity called the renal pelvis and thenout through the ureter to the urinary bladder.177Mutravaha srotoavayavaThe main avayavas which are explained with regards to mutravaha srotas areMutravaha naadi, Mutravaha dhamani, Mutravaha sira, Mutra praseka, Basti, Gavini,Vrikka, Medra etc.Mutravaha nadi Acharya Sushrutha states that Basti is filled with mutra through many nadis,which are present in Pakvashaya.178 Astanga sangrahakara also has the same opinionand states that the Basti is continuously filled up by exudation of the mutra throughthousands of openings in the mutravaha nadis.179Mutravaha dhamani Mutravaha dhamani have been explained by sushruta under adhogamidhamanis which carry vata, mutra, pureesha, shukra, arthava etc and does thefunctions like dhmapana and yapana.180 Vagbhata adds that (All the ten) adhogamidhamanis divide in the pakvashaya into three branches, out of these two are concernedwith transportation of mutra.181 Bhavamishra has a difference of opinion regarding the functions of thesedhamanis. According to him, they are responsible for the dharan, chalana of mutraetc.182Mutravaha siras These terminologies have been used by Acharyas like Bhavamishra andSharangadhara. Bhavamishra states that the ‘jala bhaga” of the dravamala istransported by siras from the Grahani to the basti. Here it is converted in to mutra.183 56
  • 68. Sharangadhara in his description says that the watery portion of the mala ofthe digested food is carried to the basti by the siras and then it is called as themutra.184Moothrapraseka Sushruta has mentioned that it is present in the basti mukha.185 Thus it can becompared with the proximal part of the urethra linked with the urinary bladder. This isalso included as one among the ashta marmas and cautions the surgeon not to injureit.186 Mutrapraseka can be grossly compared to the urethra. The urethra is a smalltube leading from the internal urethral orifice in the floor of the urinary bladder to theexterior of the body. In females the urethra lies directly posterior to the pubicsymphysis the opening of the urethra to the exterior , the external urethral orifice islocated between the clitoris and the vaginal opening. In males the urethra extends from the internal urethral orifice and passesthrough the prostate gland, then through the urogenital diaphragm and finally throughthe penis. In both males and females the urethra is the terminal portion of the urinarysystem. It serves as the passage way for discharging urine from the body. The maleurethra also serves as the duct through which various reproductive secretions aredischarged from the body.187VrikkaVrikka is stated as being medovaha srotomula in Charaka vimanasthana and Susruthashareera sthana. Though the organ known as Vrikka is mentioned in Ayurveda itsrelation with the formation of mutra has not been clearly explained. They areclassified under the koshtanga and pratyangas, almost all the Acharyas have stated 57
  • 69. their position in the koshta. Vrikkas are two in number, round in shape and arecomposed of mamsa. They are situated on either side of the koshta. In embryologicalview Vrikka are classified under maternal (matruja avayava) part.188 Vrikka arederived from the prasadabhaga of raktha and meda.189 The Astangakara also hassimilar views. The writers of twentieth century have come out with different conclusions.Dr. Ghanekar and Acharya Gananath sen have identified Vrikka as the kidneys. Onthe ground of statement above stated, it can be concluded that Vrikka are two roundshaped bodies, composed of rakta, mamsa and meda. They are situated in theabdominal cavity in the lumbar region on either side. This conclusion specificallypoints towards the kidneys only.The kidneys are a pair of excretory organs, bean shaped, situated on the posteriorabdominal wall, one on each side of the vertebral column, behind the peritoneum. Thelateral border is convex and the medial border is concave. Its middle part shows adepression, the hilum. Naked eye examination of a coronal section of the kidneyshows: (a) an outer, reddish brown cortex; (b) an inner, pale medulla and (c) a space,the renal sinus.The renal medulla is made up of about 10 conical masses, called the renal pyramids.The renal cortex is divisible into two parts; (i) cortical lobules which forms caps overthe bases of the pyramids; and (ii) renal columns, which dip in between the pyramids.The renal sinus is a space that extends into the kidney from the hilus. It contains: (a)branches of the renal artery; (b) tributaries of renal vein; and (c) renal pelvis. Togetherrenal cortex and renal pyramids constitute the functional portion or parenchyma of thekidney. Within the parenchyma are about 1 million microscopic structures called 58
  • 70. nephrons which are the functional units of kidney. Arterial supply to kidneys are byrenal arteries one on each side. The lymphatics of the kidney drain into the lateralaortic nodes located at the level of origin of the renal arteries.The kidney is supplied by the renal plexus, an offshoot of the celiac plexus190, 191Functions of kidney: 192 1. It excretes waste products, especially the nitrogenous and sulphur containing end products of protein metabolism. 2. It helps to maintain the normal hydrogen-ion concentration of body fluids and electrolytes. 3. It helps to maintain water balance of the body and there by plasma volume. 4. It helps to maintain the optimum concentration of certain constituents of blood. 5. It eliminates various drugs and toxic substances from the body. 6. It helps in maintaining osmotic pressure in blood and tissue. 7. It helps in regulation of blood pressure during hypoxia, in condition of emergency, through the liberation of renin from juxta glomerular apparatus. 8. It helps in regulation of erythropoiesis through the formation of erythropoietin. 9. They play an important role in Vitamin D metabolism.GaviniReferences of Gavini are found in Atharvaveda in the context of mutra nissarininaadika prayoga. There Vrikka has been named as antra and gavini are said to besmall pipelines which carry mutra.193 In the samhitas there are no references regardingGavinis. Recent authors compare Gavini to Ureters.The Ureters are a pair of narrow, thick walled muscular tubes which convey urinefrom the kidneys to the urinary bladder. Each Ureter connects the renal pelvis of one 59
  • 71. kidney to the urinary bladder. They lie deep to the peritoneum, closely applied to theposterior abdominal wall in the upper part and to the lateral pelvic wall in the lowerpart. Peristalitic contractions of the muscular walls of the Ureters push urine towardsthe urinary bladder. As the Urinary bladder fills with urine, pressure inside theUrinary bladder compresses the openings and prevents back up of urine into theUreters.194, 195Basti and Basti sira Basti also known as mutrashaya is one of the koshtanga and pranaharamarma.196 According to Sushrutha it is derived from the essence of Rakta and Kaphasupported by Pitta in which Vayu also enters.197 It is situated between the Nabhi,Prishta, Kati, Vrishana, Guda and Vankshana. Having only one dwara (opening) it isstated to be of tanu twak. Its shape is like that of alabu and is surrounded by richnetwork of siras and snayus.198 Ashtanga Hridayakara mentions the shape ofmutrashaya as dhanurvakra.199 Basti has been included under koshtangas and ashayas by all the Acharyas.Charaka in Shaareera sthana considers it as one of the matruja avayava.200 and inSiddisthana he indicates that ‘Bastiputaka’ and ‘Mutraadhaara’ may be used assynonyms of Basti.201 The Bastisira and Bastidwara are other terms used in connection with the Bastiin various texts. The term Basti sirasha has been used as a synonym to the Bastisira.While the terms Bastibila, Bastimukha and Bastidwara have been used as synonyms.These are not different organs but in fact they are different parts of the Basti itself.Bastisira represents the upper end of the fundus of bladder, while Bastidwaraindicates the lower opening i.e., the internal urethral orifice. 60
  • 72. Acharya Gananatha sen has given an elaborate description of the rachanashareera of the basti and considered it as urinary bladder with the help of availablerecent knowledge. The urinary bladder is a hollow muscular organ situated in thepelvic cavity posterior to the pubic symphysis. In the male, it is directly anterior to therectum. In the female, it is anterior to the vagina and inferior to the uterus. The shapeof the urinary bladder depends on how much urine it contains. Empty, it is collapsed.It becomes spherical when slightly distended. As urine volume increases, it becomespear shaped and rises into the abdominal cavity. The apex is connected to theumbilicus and the base in females is related to the uterine cervix and to the vagina andin males related to rectum. In males the neck of the bladder rests on the base of theprostate and in females it is related to pelvic fascia. The superior surface is covered byperitoneum. In males the inferolateral surfaces are related to puboprostatic ligamentsand in females it is related to pubovesical ligaments. The main blood supply comesfrom the superior and inferior vesical arteries. Veinous drainage is to vesical venousplexus. The urinary bladder is supplied by vesical plexus of nerves.202MedraThis can be correlated to the penile urethral part which can be taken as thecontinuation of mutra praseka. Other organic structures related to medra which comethrough out the Ayurvedic literatures are Shepha, Mehana and Mushka. Grossly the tubular structure which continues from the mutarpraseka can beconsidered as Medra, while the muscular structure which covers the Medra can betermed as Shephas or Mehana. But Mushka as such can be referred to the scrotum.With above all references and difference in opinions, few tentative conclusions canbe drawn. 61
  • 73. 1. The direct relation between the Pakvashaya and Basti through mutravaha nadis, dhamanis and siras depends largely on assumptions. 2. Charaka’s description of mutra vaha nadis seems to indicate the Gavini. Sushruta and Vaghbhata while using the same term seem to indicate the glomerular capillaries especially in the light of Dalhana’s explanations. 3. Sushrutha and Vagbhata while describing the mutravaha Dhamanis must be pointing towards the renal arteries, which are two in number. These carry the essentials for the formation of mutra to the kidneys. 4. The mutravaha siras as described by Bhavamishra and Sharangadhara might be pointing to the blood vessels carrying the essentials for the formation of mutra.Vyutpatti of MutrakrichraThe term Mutrakrichra is made up of two words, qÉ賈 and M×ücNíû. As previouslymentioned mutra means the liquid which oozes from the Kidneys. The word"Krichra" has been derived from M×üÌiÉ NåûSlÉå kÉÉiÉÑ + ÂMçü mÉëirÉrÉ + Nû AÉSåzÉ, M×üliÉÉÌiÉ CÌiÉM×ücNíûqÉç203 mean Dukha. Krcchra means trouble or pain, painful, attended withdifficulty, with great exertion or scarcely.204 Hence the word mutrakrichra meansqÉÔ§ÉeÉlrÉ M×ücNíûÍqÉÌiÉ uÉÉ i.e., painful discharge of urine/ stranguary.205 and has a synonymcalled krichram (M×ücNíûÇ iÉÑ qÉÔ§ÉM×ücNíÇû xrÉÉiÉç ) 206 62
  • 74. Nirukti of MutrakrichraqÉÔ§ÉM×ücNíûÉÍhÉÌiÉ qÉÔ§ÉxrÉ M×ücNíåûhÉ qÉWûiÉÉ SÒÈZÉålÉ mÉëuÉ×̨ÉThe disease in which urine is passed with difficulty is called Mutrakrichra.207On the basis of symptamatology recent authors of Ayurveda consider Mutrakrichra tobe UTI.From a microbiological prospective, UTI exists when pathogenic micro organisms aredetected in the urine, urethra, bladder, kidney or prostate. In most instances, growth of≥ 105 per milliliter from a properly collected midstream “clean catch” urine sampleindicates infection. However significant bacteriuria is lacking in some cases ofUTI.208Classification of mutrakrichra according to different scholarsTable 2.1: Showing Classification of mutrakrichra according to different scholarsSn Types Mn213 Gn215 Ah212 Bp216 Ks214 Yr217 Cs209 As211 Ss2101. Vataja + + + + + + + + +2. Pittaja + + + + + + + + +3. Kaphaja + + + + + + + + +4. Dwidoshaja - - - - - + - - -5. Sannipataja + + + + + + + + +6. Ashamarijanya + + - - - - + + +7. Shukravegavarodhajanya + - - - - - - - -8. Shukraja + - - - + - + + +9. Raktaja + - - - - + - - -10. Abhighataja (Shalyaja) - + - - + - + + +11. Sharkarajanya - + - - - - - - -12. Shakritvighatajanya - + - - + - + + + 63
  • 75. Most of the acharyas accept mutrakrichra to be of 8 types. But vagbhatamentions only 4 types of doshaja Mutrakrichra. Dwandwaja type of mutrakrichra hasbeeen specifically mentioned by kashyapa. Acharya charaka has mentioned the term shonitaja in Sutrasthana and kshatajaMutrakrichra in chikitsasthana. According to chakrapaani , shonitaja and KshatajaMutrakrichra are one and the same. Acharya Sushruta has used the term AbhighatajaMutrakrcchra whereas Madhava has used the term Shalyabhighataja, Sharangdhara asKshataja and Bhavprakasha as Shalyaja Mutrakrcchra. Also Charaka opines Ashmarijanya mutrakrichra and Sharkarajanyamutrakrichra to be same as the cause and symptoms of both are same but sushrutaconsiders them to be separate.Classification of UTI UTI Upper UTI Lower UTI Symptomatic Asymptomatic Infective Non infective* Superficial / mucosal infection *Catheter associated (Nasocomial)* Tissue invasion. * Non catheter associated (Community acquired) 64
  • 76. UTI is classified mainly on the basis of anatomy of Urinary system. Urethritis andcystitis are considered under Lower UTI. Whereas Acute Pyelonephritis, prostatitis,intrarenal and perinephric abscesses. Infections of the urethra and bladder are oftenconsidered superficial (mucosal) infections while Prostatitis, pyelonephritis and renalsuppuration signify tissue invasion.Nidana of Mutrakrichra218-223 The aetiological factors for Mutrakrichra have been dealt in detail by AcharyaCharaka but not mentioned by Vagbhata and Sushruta. Madhava, Bhavaprakasha andother authors have mentioned similar etiological factors as mentioned by AcharyaCharaka. Acharya Kashyapa has mentioned Kati skandha ati dharanaat as one of theetiological factors. Even nidanas for mutravaha srotodushti can be considered asnidanas of Mutrakrichra. For better understanding nidanas of Mutrakrichra can beclassified as Aharajanya nidana Viharajanya Nidana Aushadajanya Table 2.2: Showing Nidana of MutrakrichraAaharajanya nidana Cs Mn Bp Yr Gn KsAanupa mamsa sevana + + + + + -Adhyashana + + + + + -Ajeerna bhojana + + + + + -Ati matsya sevana + + + + + -Ruksha aahara + + + + + -Ati Madhya sevana + + + + + - 65
  • 77. Viharajanya nidana Cs Mn Bp Yr Gn KsVyayama + + + + + -Nitya druta prushta yaana + + + + + -Ati prasanga + + + + + -Katiskandha ati dharana - - - - - +Aushadha janya Cs Mn Bp Yr Gn KsTeekshna aushadha sevana + + + + + -Ruksha aaharaMüwÉÉrÉ ÌiÉ£üÉåwhÉ Ã¤ÉpÉÉåerÉæÈ . . . . . .MüUÉåÌiÉ ÌuÉhqÉÉÃiÉqÉѧÉxÉ…¡ÇRuksha ahara along with katu tikta kashaya rasa causes mutaavarodha.224 Also theseproperties lead to vata prakopa because of similarity in its guna.225 The rukshapadartha causes shoshana of kleda or the dravabhaga all leading to difficulty inmicturition.Madya sevanaAs properties of madya like ushna, teekshna, vikasi etc are opposite to oja,consumption of ruksha variety of madya or madya ati sevana leads to oja kshaya inturn causing vata prakopa.Anupa mamsa matsya sevanaCirÉÉlÉÔmÉÉå qÉWûÉÍpÉwrÉÎlS qÉÉÇxÉuÉaÉÉåï urÉÉZrÉÉiÉÈIn anupa desha kapha dosha is predominant along with vata and the mamsa andmatsya are said to be maha abhishyandi in nature.226 Mahabhishyandi ahara increases 66
  • 78. kleda in dhatu, mala and srotas thus producing favourable conditions in the body forvarious diseases like MutrakrichraAdhyashana ajeerna bhojanaIntake of food before digestion of previous meal or excessive eating causesagnimandya which results in ama formation. This may lead to srotorodha causingMutrakrichra.VyayamaVyayama when done in excess leads to vata and pitta prakopa especially when aparticular type of exercise is done which influences Basti and Mutramarga. Also theheat generated during exercise further increase in body temperature may causedehydration leading to urinary symptoms.PrasangaStree sevana if done in excess again leads to vata prakopa and shoshna of kleda.Mutrapravritti is the normal function of apana vayu. If a person indulges in sex underthe urge of urination, the apana vayu gets vitiated and its pratiloma gati leads toseveral urinary symptoms.227 During the intercourse the bacteria of the infectedvagina may be transferred to urethra and this leads to ascending infection of theurinary tract.228Nitya druta prishta yaanaRiding on fast moving animals or vehicles frequently or for a long time causesincreased pressure and jerks over lower abdomen leading to vata prakopa mainlyapana vayu leading to mutrakrichra. 67
  • 79. Katiskandha atidharanatAccording to Acharya Kashyapa lifting of weight for long time on Kati and Skandhadirectly, vitiate the pitta dosha with vata and kapha, leading to Mutrakrichra.Teekshna oushadaWhile commenting on this word, acharya Bhavaprakasha says iÉϤhÉÉæwÉkÉÇ UÉÎeÉMüÉzÉÔUhÉÉÌSMürÉÑ£üqÉçû i.e., intake of excess of rajika, suranaadi etc as oushada leads toMutrakrichra.229 Intake of Tikshna aushadha leads to Pitta prakopa . This pitta withthe influence of Vata may accumulate in Basti and may cause Mutrakrichra.Nidana of mutravaha srotodushti can also be considered in this context. They areMutra nigrahanaIt is mentioned as one of the causative factors of mutravaha srotodushti 230oÉÎxiÉqÉåWûlÉrÉÉåÈ zÉÔsÉÇ qÉÔ§ÉM×ücNíÇû ÍzÉUÉåÂeÉÉ |ÌuÉlÉÉqÉÉå uÉǤÉhÉ AÉlÉÉWû xrÉÉiÉç ÍsÉÇaÉÇ qÉÔ§ÉÌlÉaÉëWåû ||Mutranigrahana means forceful suppression of urge for urination. It leads to vataprakopa causing pratiloma gati of apana vayu thereby producing shoola,mutrakrichrata etc.231qÉÔ§ÉxrÉ uÉåaÉå AÍpÉWûiÉå lÉUxiÉÑ M×ücNíåûhÉ qÉÔ§ÉÇ MÑüÂiÉå AsmÉqÉsmÉqÉçSushruta also has a similar opinion.232 Continuous suppression of urge causesstretching of bladder muscle beyond its capacity leading to weakening of the bladdermuscle. The urine may not be emptied fully and some residual urine is left in the 68
  • 80. bladder which increases the risk of UTI. Not only mutranigraha, even shukravegadharana causes vibaddha mutrata.233Mutrita udaka bhakshya sevanaWhen a person indulges in eating or drinking water under the urge of urination, theapana vayu gets vitiated and its pratiloma gati causes mutrakrichrata.KsheenaAcharya Charaka mentions that in a ksheena person, dhatu kshaya along withagnimandhya is present which effects the digestion and metabolism in the bodyaltering the functions of urinary system.AbhikshataInjury to mutravaha srotas may lead to mutranirodha thus causing mutrakrichra.234Role of host defense mechanism in preventing UTI 235The defense mechanism include 1. Washout of bacteria by periodic voiding 2. Dilution of bacteria by flow of urine from the kidney. 3. The secretory IgA concentration prevents organisms from attaching to uroepithelium. 4. The phagocytic properties of the uroepithelial cells may also play an important role. 5. In men, since a small amount of prostatic secretions containing antibacterial substance enter the urethra at the end of micturition, they help to prevent 69
  • 81. colonization of urethra. The presence of zinc in the prostatic secretions may have a favorable role in preventing UTI. 6. The bladder wall is coated with various mannosylated proteins, such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to the uroepithelium. 7. A competent anti reflux mechanism at the ureterovesical junction prevents massive leak of urine from the bladder to the kidneys.Aetiology of UTI 236, 237,238 Although urine contains a variety of fluids, salts, and waste products, itusually does not have bacteria in it and is considered to be sterile. However whenexposed to certain factors or when there is reduced host defence mechanism theperson becomes susceptible to UTI. The major cause of urinary tract infections are thebacteria which enter and multiply in the urinary tract. Organisms causing UTI in the community includeEscherichia coli derived from the gastro intestinal tract (about 75 % of infections)ProteusPseudomonas speciesStreptococciStaphylococcus epidermidis Common microorganisms responsible for UTI are gram negativeenterobacteria, E Coli being the most comman. The proteus groups of organisms arecommonly seen in the presence of calculus disease. Pseudomonas aeuriginosa is seenfollowing catheterization or instrumentation of the urinary tract in hospitals 70
  • 82. Some non bacterial organisms can also cause UTI in special situations.Chlamydia trachomatis and mycoplasma hominis may cause the urethral syndrome.Fungal infections supervene in subjects with longstanding urinary catheters orprolonged antibiotic therapy and in immuno compromised hosts. Gram positive cocciplay a lesser role in urinary tract infections.Predisposing factors239, 240, 241a) Gender and sexual activityThe female urethra appears to be particularly prone to colonization because of itsproximity to anus, its short length and termination beneath the labia. Sexualintercourse causes the introduction of bacteria into the bladder. Females with specificblood types are also said to be prone for UTIs. In males prostatitis and urethralobstruction due to prostatic hypertrophy are important predisposing factors.Homosexuality also associated with an increased risk of both bacteriuria andsymptomatic urinary tract infection in both neonates and young men.b) PregnancyDecreased ureteral tone, decreased ureteral peristalisis and temporary incompetenceof the vesicoureteral valves predispose upper tract infection. Bladder catheterizationduring or after delivery causes additional infections.c) ObstructionAny impediment to the free flow of urine – tumor, stricture, stone or prostatichypertrophy – results in hydronephrosis and a greately increased frequency of urinarytract infection. 71
  • 83. d) Neurogenic bladder dysfunctionInterference with the nerve supply to the bladder, as in spinal cord injury, tabesdorsalis, multiple sclerosis, diabetes and other diseases may be associated withurinary tract infection. The infection may be initiated with the use of catheters forbladder drainage and is favoured by the prolonged stasis of urine in the bladder.e) Vesicoureteral reflux.Vesicoureteral reflux occurs during voiding or with elevation of pressure in thebladder. An anatomically impaired vesicoureteral junction facilitates reflux of bacteriaand thus upper tract infectionf) Genetic factorsIncreasing evidence suggests that host genetic factors influence susceptibility tourinary infection.g) Other factorsLow water intake will cause less urination thereby reducing the flush mechanism.People with suppressed immune systems: Examples of situations in which theimmune system is suppressed are AIDS and diabetes. People who takeimmunosuppressant medications also are at increased risk.Persons having bubble baths – the chemicals in the bubble bath may irritate theurethra.Wearing tight fitting clothingSpicy foodsAcidic foods 72
  • 84. CaffeineAlcoholScented toilet paperDeodorantsSampraptiAcharya Charaka has elaborately explained samprapti of Mutrakrichra asmÉ×jɉsÉÉÈ xuÉæÈ MÑüÌmÉiÉÉ ÌlÉSÉlÉæÈ xÉuÉåï AjÉuÉÉ MüÉåmÉqÉÑmÉåirÉ oÉxiÉÉæ |qÉѧÉxrÉ qÉaÉïÇ mÉËUmÉÏSrÉÎliÉ rÉSÉ iÉSÉ qÉѧÉrÉiÉÏWû M×ücNíûÉiÉç || The nidana factors cause vitiation of vata, pitta and kapha either individuallyor together in basti pradesha to produce mutrakrichra.242 The pathogenesis has beenshown in the below chart. Nidana sevanaAbhigata Vata, pitta , kapha prakopaVata prakopa Prasara in sarva shareera Sthaana samshraya in basti and mutramarga (khavaigunya) Apaana vaayu vikriti Mutramarga paripeedana Krichra mutrata 73
  • 85. Samprapti ghatakasTable 2.3: Showing Samprapti ghatakas of MutrakrichraDosha Pitta pradhana apana vata (tridosha)Dushya Mutra, Rasa dhatuAgni Dhatwagni, JataragniAma Dhatwagni janya ama, Jataragni janya amaSrotas Mutravaha, RasavahaDushti prakara SangaUdhbhava sthana Amashaya, PakwashayaAdhishtana VastiVyakta sthana MutramargaSanchara sthana Mutravaha srotasRogamarga MadhyamaVyadhi swabhava Ashukari, chirakariVishishta Lakshanas1. Vataja mutrakrichra lakshana Table 2.4 Showing visista lakshana of Vataja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Vankshana ruja + - + + + + + + -2. Basti ruja + + + + + + + + -3. Medra ruja + + + + + + + + -4. Swalpa mutrapravritti + + + + + + + + +5. Muhur muhur mutrata + - + + + + + + -6. Mushka vedana - + - - - - - - +7. Sa phena - - - - - - - - +8. Aruna varna mutra - - - - - - - - +9. Malavarodha - - - - - - - - + 74
  • 86. 2. Pittaja mutrakrichra lakshana Table 2.5: Showing visista lakshana of Pittaja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Peeta mutra + - + + + + + + +2. Sa rakta mutra + - + + + + + + +3. Sa ruja mutra + - + + + + + + +4. Sa daaha mutra + - + + + + + + +5. Krichra mutrata + - - - - + + - -6. Muhur muhur mutrata + - - - + + + + -7. Agnivat daaha in - + - - - - - - - mushka, basti, mehana8. Haridra varna mutrata - + - - - - - - -9. Rakta varna mutrata - + - - - - - - -10. Ushna mutrata - + - - - - - - +11. Swedamaana mukha - - - - - - - - +3. Kaphaja mutrakrichra lakshana Table 2.6: Showing visista lakshana of Kaphaja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Basti gourava + + + + + + + + +2. Linga gourava + + + + + + + + -3. Basti shotha + - + + + + + + +4. Linga shotha + - + + + + + + -5. Sa piccha mutra + + + + + + + + +6. Mushka gourava - + - - - - - - -7. Shukla mutrata - + - - - - - - +8. Anushna mutra - + - - - - - - -9. Samhrishta roma - + - - - - - - -10. Sa vibanda - - - + - - - - -11. Bahala mutrata - - - - - - - - + 75
  • 87. 4. Sannipataja mutrakrichra lakshana Table 2.7: Showing visista lakshana of Sannipataja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Sarvani rupani + - + + + + + + -2. Sa daha - + - - - - - - -3. Sa ruja - + - - - - - - -4. Sa sheeta - + - - - - - - -5. Muhurmuhu mutrata - + - - - - - - -6. Krichra mutrapravritti - + - - - - - - -7. Peeta, rakta, varna mutra - + - - - - - - -8. Murcha - - - - - - - - +9. Bhrama - - - - - - - - +10. Pralapa - - - - - - - - +5. Ashmari and Sharkara janya mutrakrichra lakshanaTable 2.8: Showing visista lakshana of Ashmari and sharkara janya MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Basti shoola + + - - + - - - -2. Mehana shoola + - - - + - - - -3. Sevani shoola + - - - - - - - -4. Visheerna dhara + - - - - - - - -5. Mridgati medram + - - - - - - - -6. Muhur mutra pravritti + - - - - - - - -7. Muhur shakrit pravritti + - - - - - - - -8. Hrit peeda - + - - - + + + -9. Vepathu - + - - - + + + -10. Kukshi shoola - + - - - + + + -11. Durbalagni - + - - - + + + -12. Murcha - + - - - + + - -13. Daruna Mutraghata - + - - - + + - - 76
  • 88. 6. Raktaja mutrakrichra lakshana Table 2.9: Showing visista lakshana of Raktaja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Teevraarti + - - - - - - - -2. Aadhmana + - - - - - - - -3. Gourava + - - - - - - - -4. Basti laghuta after the blood + - - - - - - - - passes out7. Shalyabhighataja Mutrakrichra lakshana Table 2.10: Showing visista lakshana of Shalyabhighataja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Ati vedana yukta mutrapravritti - + - - + + + - -2. Vaata basti lakshana - + - - - - - - -3. Vataja mutrakrichra lakshana - - - - - + + + -8. Shukraja Mutrakrichra Lakshana Table 2.11: Showing visista lakshana of Shukraja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Vankshna vedana + - - - - - - - -2. Basti vedana + - - - + + + + -3. Medra vedana + - - - + + + + -4. Vrushana atishoola + - - - - - - - -5. Krichra mutrata + - - - + + + - -6. Stabdha andakosha + - - - - - - - -7. Sa shukra mutrapravritti + - - - + + + + - 77
  • 89. 9. Pureeshaja Mutrakrichra Lakshana Table 2.12: Showing visista lakshana of Pureeshaja MutrakrichraSl Lakshana Cs Ss As Ah Mn Bp Yr Gn Ks1. Udara adhmana - + - - + + + + -2. Sa shoola - + - - + + + + -3. Mutra sanga - + - - + + + + - 78
  • 90. Pratyatma lakshanaRuja 243, 244, 245Ruja is the main symptom in Vataja Mutrakrichra caused by Apana vata. Degrees ofpain and site of affliction have been described using various terms by Acharyas.Charakacharya mentions ruja to be teevra in Vankshana, Basti and Medra, Sushrutamentions it to be phaladbhiriva (sphutaadbhiriva - Dalhana) i.e., splitting type ofsevere pain in Mushka, Mehana, and Basti. Whereas vagbhata mentions it to beartiyukta. This symptom is correlated to strangury in urological vocabulary whichimplies that it is painful passage of urine accompanied with spasms and is commonlythe result of cystitis or prostitis.Swalpa mutrataThe vitiation of Apana vata causes margavarodha of mutravaha srotas leading toscanty urine.MuhurmutrataThe word muhurmutrata means suddenly or again and again. This indicates passingof urine frequently with urgency. Sushruta and Kashyapa have not mentioned the termmuhurmutrata. This symptom is also present in pittaja type. The difference is that incase of Pittaja mutrakrichra vata is aggravated by vitiated pitta, causing pratiloma gatiof vayu resulting in muhurmutra.Acharya Kashyapa has also mentioned other symptoms of vataja mutrakrichra like Saphena, Aruna varna mutra etc, swedamano mukha in case of Pittaja mutrakrichraPeeta mutrata and sarakta mutrata 79
  • 91. These are the cardinal symptoms of Pittaja mutrakrichra. Acharya sushruta has usedthe term haridra instead of peeta. Commenting on sarakta mutrata, Dalhana opines itto be raktavarna mutrata246DahaAcharya Charaka has mentioned both daha and ruja to be present in Pittajamutrakrichra. Sushruta mentions it to be agnivat daha along with ushna mutrapravritti. Kashyapa has used the term ‘atyushnam bashpa sahitam’Shotha and gurutvaAll the acharyas have mentioned Shotha and gurutva to be present in Linga and Bastiin case of Kaphaja mutrakrcchra. Whereas Sushruta opines that along with Linga andBasti, they are seen in Mushka (scrotum) also.Sapiccha Mutra Piccha means slimy or liquid like of boiled rice according to M. Williams.Hence, patient of Kaphaja Mutrakrcchra voids urine which is slimy or like scum ofboiled rice. Acharya Sushruta has used the term "Snigdha" and Acharya Kashyapa hasused the term "Ghanam" to denote characteristic of mutra.Shukla Mutra Only Acharya Sushruta and Kashyapa have mentioned that patient passesurine which is Shukla and Sita respectively which is also a characteristic of Kapha. 80
  • 92. Bahula Mutrata (Passing of large amount of urine) and Alpabadha (lesshesistancy) : Only Acharya Kashyapa has mentioned that patients of Kaphaja Mutrakrcchrapasses large amount of urine with less hesitancy.In addition to these acharya Sushruta has mentioned symptoms like anushna mutrataand samhrsta roma under kaphaja mutrakrcchraIn Sannipataja Mutrakrcchra all the symptoms of the three doshas are present and issaid to be krichratama.Clinical presentaion of UTIFeatures of Urethritis and Cystitis cannot be readily distinguished. They include • Abrupt onset of frequency of micturition • Scalding pain in the urethra during micturition • Suprapubic pain during and after voiding. • Intense desire to pass more urine after micturition, due to spasm of the inflamed bladder wall (urgency) • Urine that may appear cloudy and have an unpleasant odour • Microscopic or visible haematuria 247 Sometimes urethritis may be gonococcal. Such patients exhibit gradual onset of illness, without haematuria or suprapubic pain and more than 7 days of symptoms. Additional history of exposure to chlamydial or gonococcal infection confirms the diagnosis 248 81
  • 93. Most cases of Acute Pyelonephritis folow infection of the lower urinary tract,clinically it has an acute onset with chills, fever (≥1030F), loin pain, lumbartenderness, nausea, vomiting, diarrhea, symptoms of cystitis may or may not develop. Chronic Pyelonephritis results from repeated attacks of inflammation andscarring. The patients present with clinical picture of chronic renal failure or withsymptoms of hypertension. Sometimes the patient may present with features of acuterecurrent Pyelonephritis with fever, loin pain, lumbar tenderness, dysuria, pyouria,bacteriuria.249 Clinically, most catheter associated infections cause minimal symptoms andno fever and often resolve after withdrawal of the catheter.250 Asymptomatic bacteriuria: - This is defined as > 105/ml organisms in the urineof apparently healthy asymptomatic patients. It is increasingly common in those agedover 65.251Investigations252The single most important lab test is urine alysis. In certain circumstances, urine mayalso be sent for "culture." This is rarely necessary with a simple infection.Blood tests usually are not required unless a complicated condition, such asPyelonephritis or kidney failure, is suspected.In some cases, an imaging test may be indicated to detect any underlying problem inthe urinary tract that could cause an infection.An ultrasound examination can evaluate kidney and bladder problems. 82
  • 94. A fluoroscopic study can show any physical problems that predispose children tourinary tract infections.Intravenous Pyelogram (IVP) is a special series of x-rays used to highlight structuralabnormalities in the urinary tract.Cystoscopy allows detection of abnormalities inside the bladder that might contributeto infections. ACT scan gives a very detailed three-dimensional picture of the urinary tract. 83
  • 95. Vyavachedaka nidanaDifferential diagnosis is based on comparison between similar symptoms of two ormore disease to determine the actual disease which the patient is suffering from. Asfar as Mutrakrichra is concerned, it is distinguished from possible diseases likeVatakundalika, Mutrasanga, Mutragranthi, Ushnavata, Mutrasada, Bastikundala andAshmari The main difference between Mutrakrichra and Mutraghata isqÉÔ§ÉM×ücNíåû M×ücNíûiuÉÇ AÌiÉzÉrÉÇ CwÉiÉç ÌuÉoÉlkÉÈ | qÉÔ§ÉÉbÉÉiÉå iÉÑ ÌuÉoÉlkÉÉå oÉsÉuÉÉlÉç M×ücNíûiuÉqÉsmÉÍqÉÌiÉ |ie., Mutrakrichra is krcchra pradana and alpa vibanda yukta whereas Mutraghata isvibanda pradana and alpa krcchra yukta.253UpadravaUpadravas of Mutrakrichra have been specifically mentioned by kashyapa in thecontext of sannipataja mutrakrichra.254xÉuÉåïwÉÑ MüÉzrÉïqÉUÌiÉUÂÍcÉÈ xÉÉlÉuÉÎxjÉÌiÉÈ |iÉ×whÉÉzÉÔsÉÌuÉwÉÉSÉÌiÉxiÉ LuÉ xrÉÑÂmÉSìuÉÉÈ ||Symptoms like karshya, arati, aruchi, anavastiti (astirata of manas), trishna, shoola,vishada etc, are seen as upadravas in all types of mutrakrichra.Upashaya and anupashayaUpashaya and anupashaya of mutrakrichra has not been mentioned in classics. Buthowever, the causative factors themselves may be taken as anupashayas, especiallykatu, teekshna ahara, oushada etc increases the chances of dosha prakopa andmutravaha sroto dushti. 84
  • 96. SadhyaasadyataThe knowledge of sadyaasadyata is necessary to decide the prognosis and treatment ofthe disease. A newly started disease with alpa hetu, purvarupa, rupa and withoutupadrava is said to be sukhasadya. The roga in which the hetu, purvarupa and rupa arein madyama matra, having some upadravas and which needs shastra, kshara and agnikarma is said to be krichrasadya. Whereas the roga in which the upadravas are more,has vitiated the gambheera dhatus is said to be asadhya.255 This principle is applicable to Mutrakrichra also because in classics as far asprognosis is concerned, acharyas have not mentioned prognosis except for sannipatikavariety. Sannipatika variety when not cared properly or given treatment in time mayhave some complications like arati, aruchi etc and hence can be stated to bekrichrasadhya. However in ashmarijanya Mutrakrichra if it does not respond to themedicinal treatment, acharyas have mentioned shastrakarma. So Ashmarijanyamutrakrichra can be considered as krichrasadya.Prognosis of UTIIn patients with uncomplicated Cystitis or Pyelonephritis, treatment ordinarily resultsin complete resolution of symptoms. Cystitis may also result in upper tract infectionor bacteremia. When repeated episodes of cystitis occur, they are nearly always reinfections, not relapses. Acute uncomplicated Pyelonephritis in adults rarelyprogresses to renal functional impairment and chronic renal disease.256 85
  • 97. ChikitsaAcharyas have not explained specific chikitsa sutra for Mutrakrichra but consideringthe dosha praadhanyata chikitsa for each type of Mutrakrichra have been mentioned.The chikitsa can be categorized as shodana and shamana. Table 2.13: Showing different treatment modalities of MutrakrichraType of Shodana chikitsa Shamana chikitsa OthersMutrakrichrauÉÉiÉeÉ qÉÔ§ÉM×ücNíûè uÉÉiÉlÉÉzÉMü iÉæsÉ Apr…¡û §ÉæuÉ×iÉ iÉæsÉ EmÉlÉÉWû xlÉåWûlÉ ÎxjÉUÉÌSuÉaÉï wÉQû…¡û mÉÉlÉÏrÉ mÉËUwÉåMü xuÉåSlÉ qÉÉÇxÉUxÉ AuÉaÉÉWûlÉ ÌlÉÃWû oÉÎxiÉ mÉÑlÉlÉïuÉɱ ÍqÉ´ÉMüç E¨ÉUoÉÎxiÉÌmɨÉeÉ qÉÔ§ÉM×ücNíû ̧ÉìuÉkÉoÉÎxiÉ SìɤÉÉ, ÌuÉSÉËU, C¤ÉÑUxÉ xÉåuÉlÉ zÉÏiÉsÉ SìurÉ YuÉÉjÉ ¤ÉÏUmÉÉlÉ zÉiÉÉuÉrÉÉïÌS YuÉÉjÉ mÉËUwÉåMü ÌuÉUåcÉlÉ MüqÉsÉ/ ´ÉÑ…¡ûÉOûMü / AuÉaÉÉWû ÌuÉSÉËUMülS YuÉÉjÉ mÉëSåWû LuÉÉïÂoÉÏeÉÉÌS YuÉÉjÉ aÉëÏwqÉGiÉÑcÉrÉï mÉÉsÉlÉ mÉgcÉiÉ×hÉ YuÉÉjÉ EimÉsÉÉÌS aÉhÉ YuÉÉjÉ lrÉaÉëÉåkÉÉÌS aÉhÉ YuÉÉjÉ MüÉMüÉåsrÉÉÌS aÉhÉ ÍxÉ® bÉ×iÉ WûËUiÉYrÉÉÌS YuÉÉjÉMüTüeÉ qÉÔ§ÉM×ücNíû ÌiÉ£üÉæwÉkÉ ÍxÉ® iÉæsÉ urÉÉåwÉÉÌS cÉÔhÉï ¤ÉÉU, EwhÉ, iÉϤhÉ AprÉ…¡û, mÉÉlÉ ÍzÉÌiÉuÉÉU cÉÔhÉï + iÉ¢ü AÉæwÉkÉ A³ÉmÉÉlÉ xuÉåSlÉ xÉmiÉcNûSÉÌS rÉuÉÉaÉÑ, YuÉÉjÉ rÉuÉÉ³É 86
  • 98. uÉqÉlÉ xÉÑUxÉÉÌS aÉhÉ YuÉÉjÉ iÉ¢ü mÉërÉÉåaÉ ÌlÉÃWû FzÉMüÉÌS aÉhÉ YuÉÉjÉ qÉÑxiÉÉÌS aÉhÉ YuÉÉjÉ uÉÂhÉÉÌS aÉhÉ ÍxÉ® rÉuÉÉaÉÑ, iÉæsÉ mÉëuÉÉVû pÉxqÉ + iÉhQÒûsÉ kÉÉuÉlÉxÉͳÉmÉÉiÉeÉ uÉÉiÉ xjÉÉlÉ SÉåwÉ ÌlÉWïûUhÉ aÉlkÉMüÉÌS rÉÉåaÉqÉÔ§ÉM×ücNíû MüTümÉëÉkÉÉlrÉiÉÉ – uÉqÉlÉ mÉÉwÉÉhÉpÉåSÉÌS rÉÉåaÉ ÌmÉ¨É mÉëÉkÉÉlrÉiÉ – ÌuÉUåcÉlÉ oÉ×WûirÉÉÌS YuÉÉjÉ uÉÉiÉ mÉëÉkÉÉlrÉiÉ - oÉÎxiÉ aÉÑQÒûcrÉÉÌS rÉÉåaÉAzqÉËUeÉlrÉ uÉÉiÉeÉ& MüTüeÉ qÉÔ§ÉM×ücNíû mÉÉwÉÉhÉpÉåSÉÌS cÉÔhÉï ÌlÉaÉS qɱ xÉåuÉlÉ& ÍcÉÌMüixÉÉ aÉÉå¤ÉÑUÉÌS rÉÉåaÉ + UjÉ rÉÉlÉzÉMïüUÉeÉlrÉ mÉÑlÉlÉïuÉÉÌS rÉÉåaÉqÉÔ§ÉM×ücNíû §ÉÑšÉÌS cÉÔhÉï ÍzÉaÉëÑ mÉërÉÉåaɤÉiÉeÉlrÉ uÉÉiÉeÉ qÉÔ§ÉM×ücNíû ÍcÉÌMüixÉÉ EimÉsÉÉÌS mÉÉlÉMü mÉgcÉuÉsMüsÉ sÉåmÉqÉÔ§ÉM×ücNíû C¤ÉÑUxÉ ÌuÉSÉËUMülS cÉÔhÉï µÉSÇzOíûÉÌS bÉ×iÉ qÉkÉÑU aÉhÉ mÉërÉÉåaÉzÉÑ¢üeÉ qÉÔ§ÉM×ücNíû mÉëkÉÉlÉ SÉåwÉ ÍcÉÌMüixÉÉ ÍzÉsÉÉÎeÉiÉÑ + qÉkÉÑ xÉqÉSÉÇ mÉëqÉSÉÇ´ÉrÉåiÉç E¨ÉUoÉÎxiÉ MüÉmÉÉïxÉ qÉÔsÉÉÌS rÉÉåaÉ mÉÑUÉhÉ qÉkÉÑMüÉxÉuÉ 87
  • 99. uÉ×wrÉ rÉÉåaÉÌuÉOèû ÌuÉbÉÉiÉeÉ AprÉ…¡û cÉÔhÉï mÉërÉÉåaÉ AuÉaÉÉWûqÉÔ§ÉM×ücNíû xuÉåS - aÉÉå¤ÉÑU cÉÔhÉï + rÉuɤÉÉU oÉÎxiÉ UxÉÌ¢ürÉ mÉërÉÉåaÉ 88
  • 100. Pathya and Apathya 257, 258, 259 Table 2.14: Showing Pathya apathya of Mutrakrichra mÉjrÉ AmÉjrÉAÉWûÉU AÉWûÉUqÉkÉÑU mÉSÉjÉï MüwÉÉrÉ UxÉ mÉSÉjÉïmÉÑUÉiÉlÉ sÉÉåÌWûiÉ zÉÉÍsÉ Â¤ÉÉWûÉUC¤ÉÑÌuÉMüÉU AqsÉmÉSÉjÉï§ÉmÉÑwÉ xÉÇaÉëÉÌWû, ÌuÉSÉÌWû AÉWûÉUbÉ×iÉ AÌiÉ iÉϤhÉ AÉWûUmÉrÉ qɱmÉÉlÉiÉ¢ü ÌuÉ®ÉWûÉUSÍkÉ AlÉzÉlÉkÉluÉÉÍqÉwÉ A±zÉlÉqÉѪUxÉ ÌiÉsÉ ÌmÉ̹ÍxÉiÉÉ qÉÉwÉÌuÉM×üÌiÉmÉÑUÉhÉ MÔüwqÉÉhQû TüsÉ MüUÏU TüsÉmÉOûÉåsÉ zÉÉsÉÔMüLuÉÉï MüÌmÉijÉZÉeÉÔïU eÉqoÉÑlÉÉËUMåüsÉ ÌoÉxÉqÉÔsÉiÉhQÒûsÉÏrÉ zÉÉMü AÌiÉiÉÉqoÉÔsÉ xÉåuÉlÉAÉqÉsÉMü AÌiÉqÉixrÉ xÉåuÉlÉmÉëiÉÏU lÉÏU AÌiÉsÉuÉhÉ xÉåuÉlÉ AÌiÉ AÉSìïMü xÉåuÉlÉ iÉæsÉpÉÎeÉïiÉ mÉSÉjÉï xÉåuÉlÉ AÌiÉ ÌWÇûaÉÑ xÉåuÉlÉ 89
  • 101. ÌuÉWûÉU ÌuÉWûÉUzÉÏiÉsÉ uÉÉrÉÑxÉåuÉlÉ mÉËU´ÉqÉAuÉaÉÉWûlÉ WûÎxjÉ, AµÉ rÉÉlÉAprÉ…¡û qÉÔ§ÉÉÌS uÉåaÉkÉÉUhÉ AÌiÉurÉÉrÉÉqÉ AÌiÉurÉuÉÉrÉ AÌiÉmÉëuÉÉiÉ AÌiÉ AMïü(xÉÔrÉï)û xÉåuÉlÉPrevention260 • Periodic complete emptying of bladder every few hours during day and before going to bed. • Intake of plenty of fluids. • In case of reflux, emptying bladder twice at an interval of 15mins before retiring to bed. • Women should empty bladder before and after sexual intercourse and preferably apply antiseptic cream to periurethral area before sex. 90
  • 102. MATERIALS AND METHODSSource of dataLiterary sourceLiterary aspects were collected from classical Ayurvedic texts, modern texts, journalsand updated information was collected from internet search.DrugVidarikanda (Pueraria tuberosa) was taken for pharmacognostic study and as trialdrug for Group A of clinical study.Varuna (Crateva nurvala) was taken as standard drug for Group B.Collection of raw materials 1. Tubers of Vidarikanda were collected from its natural habitat at Una Taluk of Junagad District, (Gujarat). Before the collection, the plant was properly identified with the help of various floras and herbaria and authenticated by renowned botanist and Pharmacognosist of Institute of Ayurvedic medicinal plant sciences, Gujarat Ayurved University, Jamnagar. 2. Genuine quality bark of Varuna was purchased from reliable sources in Bangalore. Identification was confirmed by botanist and other experts.Method of preparation of medicine 1. Fresh tubers of Vidarikanda were taken, decorticated and grated. Later it was dried under direct sunlight until it was moisture free and finely powdered and sieved through 120 no sieve in Dept of Bhaishajya Kalpana Vijnana, Post graduate studies and research centre, Shri D.G.M Ayurvedic Medical College, Gadag. 91
  • 103. 2. Moisture free Varuna bark was finely powdered and sieved through 120 no sieve in Dept of Bhaishajya kalpana vijnana, Post graduate studies and research centre, Shri D.G.M Ayurvedic medical college, Gadag.Objectives1. Pharmacognostic study of Vidarikanda (Pueraria tuberosa)2. Analysis of Vidarikanda for physical constants and Chromatographic study.3. Preliminary phytochemical analysis of Vidarikanda4. Analysis of Varuna for physical constants.5. Clinical study to evaluate the efficacy of Vidarikanda in Mutrakrichra (UTI) incomparison with the standard drug Varuna.1. Pharmacognostic study of Vidarikanda (Pueraria tuberosa)The tuber of Vidarikanda was taken for pharmacognostic study both in wet as well asdry form. Its macroscopical and microscopical structures were studied in detail. Latercharacteristics of the powder were also studied.2. Analysis of Vidarikanda for physical constants and Chromatographic studyAnalysis of Vidarikanda tuber for physical constants and Chromatographic study wascarried out at Captain Shrinivasa Murti Drug Research Institute For Ayurveda AndSiddha (CCRAS, New Delhi), Ministry of Health and Family Welfare, Govt. of India,Chennai. 92
  • 104. a) TLC Methodology: 2 g of the sample was soaked in 20 ml of rectified spirit (90%) for 18 hrs. andboiled for 10 minutes and filtered. The filtrate was concentrated and made up to 10ml.25 l of alcoholic extract was applied on Merck Aluminium plate pre-coated withSilica gel 60 F 254 of 0.2 mm thickness using Linomat IV applicator. The plate wasdeveloped in Chloroform: Methanol: Acetic acid 8:2:1. The plate was visualized inUV 254 and 366 nm. The plate was then dipped in Vanillin -Sulphuric acid andheated in air oven at 105° C till the spots appeared. b) HPTLC Methodology: The given sample 2g was soaked in 20 ml of ethanol and made up to 10 mland 10 l of the solution was applied on Merck Aluminium plate pre-coated withSilica gel 60 F 254 of 0.2 mm thickness using Linomat IV applicator. The plate wasdeveloped in Chloroform: Methanol: Acetic acid 8:2:1. v/v. The plate was scanned at254 nm using Deuterium lamp in Camag HPTLC instrument provided with Cats 4.05version software.3. Preliminary phytochemical analysis of VidarikandaPreliminary Phyto chemical analysis of Vidarikanda tuber was carried out at CaptainShrinivasa Murti Drug Research Institute For Ayurveda And Siddha (CCRAS, NewDelhi), Ministry of Health and Family Welfare, Govt. of India, Chennai.4. Analysis of Varuna for physical constants261 Bark powder of Varuna was analyzed for physical constants at Dept ofDravyaguna Vijnana, Post graduate studies and research centre, Shri D.G.MAyurvedic Medical College, Gadag. 93
  • 105. a) Total ashMaterials: Sample, silica crucible, muffle furnaceMethod: About 2 g of the sample was accurately weighed and taken in a silicacrucible, which is weighed previously. It was heated at temperature not exceeding450°C for about four hours or until white coloured ash was obtained. It was thencooled and weighed. From the weight of the residue obtained, the ash value wascalculated in mg per gm of air-dried material.b) Acid insoluble ashMaterials: Total ash of the sample, Crucible, Dilute hydrochloric acid, Whattmanfilter paper, hot plate, physical balance.Method: The ash obtained was taken in a crucible and 25 ml of dilutedHydrochloric acid was added and covered with a watch glass. It was then boiledgently for 5 minutes. The watch glass was rinsed with 5 ml of hot water and thisliquid was added to the crucible and filtered through Whattman filter paper No.40. The insoluble matter on the filter paper was collected and washed with hotwater and transferred to a crucible and dried on a hot plate and subjected toconstant heat. The content of acid insoluble ash in mg per gram of air-driedmaterial was calculated.c) Water soluble extractiveMaterials: Sample, Conical flask, Water, Stirrer, measuring jar, porcelain dish, hotwater bath, weighing machine, oven.Method: For the determination of water soluble extractive 5g accurately weigheddried powder sample was taken in a conical flask, to it 100 ml of water was added,shaken well, closed tightly and allowed to stand for 24 hours with occasionalsharing, and filtered. 20 ml of filtrate was taken in a previously weighed porcelain 94
  • 106. evaporating dish; evaporated to dryness on a hot water bath and dried to constant weight in an oven. From the weight of the residue obtained, the extractive values, in percentage w/w was calculated with reference to the air-dried sample. d) Alcohol soluble extractive Materials: Sample, Conical flask, Water, Stirrer, measuring jar, porcelain dish, hot water bath, weighing machine, oven Method: An alcohol soluble extractive of the sample was determined in the similar way like water soluble extractive but by using ethyl alcohol instead of water. From the weight of the residue obtained, the extractive values, in percentage w/w was calculated with reference to the air-dried sample.5. Clinical study to evaluate the efficacy of Vidarikanda in Mutrakrichra (UTI) in comparison with the standard drug Varuna.Selection of patientsPatients suffering from mutrakrcchra were randomly selected from Health checkupcamps organized at Parshwanath Ded College, Anglo - Urdu Ded college, Shri RajivGandhi Ded college, Gadag and Sasivehalli (Annigeri, Gadag).Study designAn observational clinical study was adopted in which a trial group and a standardgroup were made.Sample sizeThe trial group and standard group consisted minimum of 15 patients each.MedicineVidarikanda was taken as trial drug and Varuna was taken as standard drug. 95
  • 107. PosologyVidarikanda was given 1 gm thrice a day after food with lukewarm water.Varuna was given 2 gms twice daily after food with lukewarm water.Criteria for selection of patientsInclusive criteria : • Patients of age between 15 – 60 years • Patients of either sex were selected • Uncomplicated UTI. • Gram negative and Gram positive infections viz. E – coli, Streptococci, Staphylococci etcExclusive criteria : • Patient of age below 15 and above 60 years. • Pregnant woman and lactating mothers. • Complicated UTI. • STD’s viz. Gonorrheal infection. • Neuralgic bladder dysfunction. • Congenital, anatomical defects. • Catheterized Patients. • Patients with other systemic disorders.Investigations : Urine routine (Albumin, Sugar, Microscopic examination) Blood Routine (Hb%, TC, DC, ESR) Urine Culture 96
  • 108. Diagnostic criteria : Diagnosis was made on the basis of subjective parameters mentioned in the classics and objective parameters of mutrakrichra.Parameters of the studya) Subjective parameters: – Krichra mutrapravritti (Stranguary) – Rujayukta mutrapravritti (Painful micturition) – Dahayukta mutrapravritti (Burning Micturition) – Sakshobha mutrapravritti (Hesistancy) – Vega asahatva (Urgency)b) Objective parameters: Urine microscopic examination.Study durationDuration of study was 35 daysThe patients were asked to report after 14 days and then after follow up of 21 days 1st assessment – Before treatment 2nd assessment – 14th day after initiation of medicine 3rd assessment – 35th day (end of follow up)To assess the overall results 1st and 2nd assessment were considered. 97
  • 109. Assessment of resultResults of the treatment were assessed on the basis of difference between base linedata and assessment data of both subjective and objective parameters. Theseparameters were subjected for the statistical analysis by applying unpaired t test.Table 3.1: Showing gradation of subjective parameters to assess the resultsGrade 0 Normal Absence of symptomsGrade 1 Mild Symptoms present but no interference with daily routines.Grade 2 Moderate Symptoms present but with some interference with daily routines.Grade 3 Severe Symptoms present with incapacitation Table 3.2: Grading of objective parametersGrade 0 Nil or occasional pus cells or epithelial cellsGrade 1 Presence of 5 to 10 pus cells or any other cells except RBCGrade 2 Presence of more than 10 pus cells and/ or any other cells except RBCGrade 3 Presence of more than abundant pus cells and / or any other cells including RBC 98
  • 110. ResultThe overall assessment of results made with the help of subjective and objectiveparameters are as follows Table 3.3: Showing criteria for assessment of results1. Complete • Total disappearance of signs and symptoms remission • No attacks of dukhena mootrapravritti and mootradaha even in follow up, after normal exposure to aggravating factors. • Nil or occasional pus cells2. Marked • More than 75% relief in signs and symptoms improvement • Occasional reoccurrence of some of the symptoms, when exposed to aggravating factors • Nil or occasional pus cells3. Mild • More than 50% relief in signs and symptoms improvement • Aggravation of some of the symptoms whenever exposed to aggravating factors • Marked decrease in pus cells4. Unchanged • No relief in signs and symptoms • Aggravation of many symptoms whenever exposed to aggravating factors. • No change in no of pus cells 99
  • 111. OBSERVATIONSThe observations of the study were divided into below sections.1. Observations pertaining to pharmacognostic study of Vidarikanda.2. Clinical observations.Observations pertaining to pharmacognostic study of VidarikandaMacroscopy:The tubers are moniliform in shape, thickening at regular intervals, the one at the baseare bigger, gradually becoming smaller towards the tip. Size of the tubers varies,depending upon the maturity a tuber as a whole may weigh up to 30 Kgs. Externallyreddish brown in color, rough in touch due to warts and peeling cork on the surface.Cut surface shows outer narrow skin and inner wide and off-white colored groundtissue.Dried slices of tubers are circular to lunar in shape, fibrous, off-white in color, showsdemarcation of xylem and phloem by a faint line of cambium, mealy, mucilaginousand sweet in taste and characteristic in odor.Microscopy:Diagrammatic TS shows outer narrow zone of cork, a very narrow cortex, acontinuous ring of stone cells forming pericycle, stele formed by phloem and widexylem.Detailed TS shows outermost layer of thick-walled cork formed by 8 to 10 rows ofrectangular shaped brick-like cells having 2 to 3 layers of brown-colored corkcambium below it. Cortex is very narrow and is formed by 5 to 6 layers of sphericalparenchyma with intercellular spaces. Endodermis is occasionally distinct with acontinuous ring of pericycle formed by 3 to 4 rows of stone cells embedding prismatic 100
  • 112. crystal of calcium oxalate completely filling its lumen. Phloem is formed by usualelements with occasional fibers and some tubular cells containing brown coloredpigment. Cambium is few layered and shows wider xylem region formed by pittedvessels and tracheids, fibers and parenchyma. Medullary rays are broad andmultiseriate in phloem region and gradually narrow down towards the central xylem.Parenchyma of the cortex, phloem, medullary rays and xylem are loaded withabundant, minute, simple to compound, circular to elliptical starch grains with centraldistinct hilum.Clinical observationsThe present clinical study was meant for evaluating the effect of Vidarikanda inMutrakrichra. Total 30 patients were taken randomly and assigned to trial group Aand standard group B comprising of 15 patients each. All the patients were assessedbefore and after treatment. Both subjective and objective changes were recordedaccording to the Performa of case sheetThe data was collected as follows1. General data of patients A) Demographic data B) Data related to disease C) Data related to atura pareeksha 101
  • 113. 2. Data related to effect of therapy 1. GENERAL DATA OF PATIENTS A) DEMOGRAPHIC DATA Table – 4.1 A1) Age wise distribution of 30 patients of Mutrakrichra A B Age (Yrs) % % TOTAL % n=15 N=15 15 – 25 4 26.6 1 6.6 5 16.6 25 – 35 2 13.3 1 6.6 3 10 35 – 45 5 33.3 6 40 11 36.6 45 - 55 2 13.3 4 26.6 6 20 55 - 65 2 13.3 3 20 5 16.6In the present study the criteria of age was taken between 15 and 65. It was observedthat a maximum of 11 (36.6 %) were from the interval of 35 – 45 age group followedby 6 patients (20 %) of 45 – 55 age group. Age groups between 15 – 25 and 55- 65had 5 patients (16.6 %) in each and only 3 patients (10 %) falling in the age group of25 – 35. Graph – 1: Distribution of patients according to age 40 36.6 35 % of total no of patients 30 25 20 20 16.6 16.6 15 10 10 5 0 15 – 25 25 – 35 35 – 45 45 - 55 55 - 65 Age of patients 102
  • 114. Table – 4.2 A2) Sex wise distribution of 30 patients of Mutrakrichra A B Sex % % TOTAL % n=15 N=15 Male 6 40 5 33.3 11 36.6 Female 9 60 10 66.6 19 63.3From both groups A and B, 11 patients (37 %) were male and 19 (63 %) werefemales. This shows the higher incidence of mutrakrichra in females. Graph – 2: Distribution of patients according to sex Male 37% Female 63% Table – 4.3 A3) Distribution of 30 patients of Mutrakrichra according to marital status A B Marital Status % % TOTAL % n=15 N=15 Married 9 60 11 73.3 20 66.6 Unmarried 6 40 4 26.6 10 33.3The data shows that among 30 patients, maximum of 20 (66.6 %) were married andrest 10 (33.3 %) were unmarried. 103
  • 115. Graph - 3: Distribution of patients according to marital status Unmarried 33% Married 67% Table – 4.4 A4) Religion wise distribution of 30 patients of Mutrakrichra A B Religion % % TOTAL % n=15 N=15 Hindu 13 86.6 13 86.6 26 86.6 Muslims 2 13.3 2 13.3 4 13.3 Christian 0 0 0 0 0 0 Others 0 0 0 0 0 0The data shows that among both groups, maximum of 26 (86.6 %) belonged to Hinducommunity whereas only 4 (13.3 %) belonged to Muslim community. This incidencerate depends upon the area from where the data was collected. Graph – 4: Distribution of patients according to religion 86.6 90 80 % of total no of 70 60 patients 50 40 30 20 13.3 10 0 0 0 Hindu Muslims Christian Others Religion 104
  • 116. Table – 4.5 A5) Education wise distribution of 30 patients of Mutrakrichra A B Education % % TOTAL % n=15 N=15 Uneducated 3 20 8 53.3 11 36.6Primary Education 5 33.3 1 6.6 6 20 Secondary 0 0 2 13.3 2 6.6 Education Higher Studies 7 46.6 4 26.6 11 36.6Among the 30 patients, 11 patients (36.6 %) were uneducated. An equal no of patients(36.6 %) had pursued higher studies whereas 6 (20%) had completed primaryeducation and 2 (6.6 %) had completed secondary education.Graph - 5: Distribution of patients according to educational status 40 36.6 36.6 35 % of total no of patients 30 25 20 20 15 10 6.6 5 0 Uneducated Primary Education Secondary Higher Studies Education Education wise distribution of patients 105
  • 117. Table – 4.6 A6) Distribution of 30 patients of Mutrakrichra according to Occupation A B Occupation % % TOTAL % n=15 N=15 Sedentary 0 0 0 0 0 0 Active 6 40 5 33.3 11 36.6 Labour 3 20 6 40 9 30 Student 6 40 4 26.6 10 33.3In the study maximum 11 (36.6 %) were active which includes housewives,merchants, employees etc. followed by 10 (33.3 %) students. Rest 9 patients (30 %)were labours. Graph – 6: Distribution of patients according to Occupation 36.6 40 33.3 35 30 % of total no of patients 30 25 20 15 10 5 0 0 Sedentary Active Labour Student Occupation of patients 106
  • 118. Table – 4.7 A7) Distribution of 30 patients of Mutrakrichra according to Economical status Economical A B % % TOTAL % Status n=15 N=15 Poor 3 20 5 33.3 8 26.6 Middle 10 66.6 9 60 19 63.3 Higher Middle 2 13.3 1 6.6 3 10 Higher Class 0 0 0 0 0 0Among 30 patients of mutrakrichra, maximum of 19 (63.3 %) belonged to middleclass followed by 8 patients (26.6 %) of poor economic status. Higher middleeconomy group consisted of 3 (10 %) patients Graph – 7: Distribution of patients according to Economical status 70 63.3 60 % of total no of patients 50 40 26.6 30 20 10 10 0 0 Poor Middle Higher Middle Higher Class Socio economic status of patients 107
  • 119. B) DATA RELATED TO DISEASE Table – 4.8 B1) Distribution of 30 patients of Mutrakrichra according to mode of onset A B Mode of onset % % TOTAL % n=15 N=15 Gradual 11 73.3 10 66.6 21 70 Acute 4 26.6 5 33.3 9 30In this study the mode of onset for the disease mutrakrichra was classified as gradualand acute. Among the two groups observed, the onset was gradual in 21 patients (70%) and was acute in 9 patients (30 %) Graph – 8: Distribution of patients according to mode of onset Acute 30% Gradual 70% 108
  • 120. Table – 4.9 B2) Distribution of 30 patients of Mutrakrichra according to recurrent attacks A BRecurrent attacks % % TOTAL % n=15 N=15 Present 5 33.3 6 20 11 36.6 Absent 10 66.6 9 60 19 63.3Data related to history of recurrent attacks revealed that there was no history ofrecurrent attacks in 19 patients (63.3 %) whereas 11 patients (36.6 %) suffered fromrecurrent attacks. Graph – 9: Distribution of patients according to recurrent attacks Present 37% Absent 63% 109
  • 121. Table – 4.10 B3) Distribution of 30 patients of Mutrakrichra according to colour of urine A B Colour of urine % % TOTAL % n=15 N=15 Clear 2 13.3 1 6.6 3 10 Cloudy 4 26.6 4 26.6 8 26.6 Deep yellow 9 60 10 66.6 19 63.3The colour of urine was observed in 30 patients of mutrakrichra among whichmaximum of 19 patients (63.3 %) complained of deep yellow colour of urine whereas8 patients (26.6 %) complained of cloudy urine. The colour of urine was clear in caseof 3 patients (10 %) Graph – 10: Distribution of patients according to colour of urine 63.3 70 60 % of total no of patients 50 40 26.6 30 20 10 10 0 Clear Cloudy Deep yellow Colour of urine 110
  • 122. Table – 4.11 B4) Distribution of patients according to type of mutrakrichra Type of A B % % TOTAL % mutrakrcchra n=15 N=15 Vataja (V) 4 26.6 3 20 7 23.3 Pittaja (P) 10 66.6 11 73.3 21 70 Kaphaja (K) 1 6.6 2 13.3 3 10 Sannipataja (S) 0 0 0 0 0 0Out of 30 patients observed maximum of 21 patients (70 %) had symptoms of Pittajamutrakrichra whereas 7 patients (23.3 %) had symptoms of Vataja mutrakrichra andonly 3 patients (10 %) suffered from Kaphaja mutrakrichra. Graph – 11: Distribution of patients according to type of mutrakrichra 70 70 60 % of total no of patients 50 40 23.3 30 20 10 10 0 0 (V) (P) (K) (S) Type of mutrakrichra 111
  • 123. Table – 4.12 B5) Distribution of 30 patients of Mutrakrichra according to Treatment history A B Treatment history % % TOTAL % n=15 N=15 Newly diagnosed 11 73.3 12 80 23 76.6 Previously diagnosed 4 26.6 3 20 7 23.3History of treatment received by the patients was observed among both the groups. 7patients were previously diagnosed and had taken medication whereas 23 patients(76.6 %) were newly diagnosed. Graph – 12: Distribution of patients according to Treatment history Previously diagnosed 23% Newly diagnosed 77% Table – 4.13 B6) Distribution of 30 patients of Mutrakrichra according to nidana A B Nidana % % TOTAL % n=15 N=15 Anupa mamsa/matsya 1 6.6 0 0 1 3.3 Adhyashana 3 20 1 6.6 4 13.3Katu, tikta, ruksha ahara 9 60 8 53.3 17 56.6 Ati madya sevana 4 26.6 5 33.3 9 30 Teekshna oushada 4 26.6 3 20 7 23.3 Ati vyayama 2 13.3 3 20 5 16.6 112
  • 124. Ati prasanga 4 26.6 2 13.3 6 20 Nitya druta prsta yana 5 33.3 6 40 11 36.6 Mutra vegadharana 10 66.6 6 40 16 53.3The causative factors for mutrakrichra were observed among 30 patients amongwhich maximum of 17 patients (56.6 %) consumed Katu, Tikta, Ruksha aharafollowed by 16 patients (53.3 %) doing Mutravegadharana. 11 patients (36.6 %) wereseen doing Nitya druta prshta yana and 9 patients (30 %) consuming excess alcohol.Teekshnoushada sevana was seen as a causative factor in 7 patients (23.3 %), Atiprasanga in 6 patients (20 %), Ati vyayama in 5 patients (16.6 %), Adhyashana in 4patients (13.3 %) and Anupa mamsa,matsya sevana only in 1 patient (3.3 %). Graph – 4.13: Distribution of patients according to nidana 56.6 60 53.3 50 % of total no of patients 40 36.6 30 30 23.3 20 16.6 20 13.3 10 3.3 0 TOTAL Nidana sevana by patients Anupa mamsa/matsya Adhyashana Katu, tikta, ruksha ahara Ati madya sevana Teekshna oushada Ati vyayama Ati prasanga Nitya druta prsta yana Mutra vegadharana 113
  • 125. Table – 4.14 B7) Distribution of 30 patients of Mutrakrichra according to Symptoms A B Symptoms % % TOTAL % n=15 N=15 Krichra mutrapravritti 10 66.6 1 6.6 21 70 Rujayukta mutrapravritti 4 26.6 3 10 7 23.3 Dahayukta mutrapravritti 13 86.6 12 80 25 83.3 Sakshobha mutrapravritti 3 10 2 13.3 5 16.6 Vega asahatwa 1 6.6 2 13.3 3 10 Peeta mutrata 13 86.6 12 80 25 83.3 Sarakta mutrapravritti 1 6.6 0 0 1 3.3 Swalpa mutrapravritti 1 6.6 1 6.6 2 6.6 Muhurmuhur mutrapravritti 1 6.6 2 13.3 3 10 Vankshana / Basti ruja 2 13.3 0 0 2 6.6Observations on complaints of patients revealed that 25 patients (83.3 %) complainedof Peeta and Daha yukta mutra pravritti followed by 21 patients (70 %) complainingof Krichra mutrapravritti. 7 patients observed Ruja during micturition while 5 patients(16.6 %) also had Sakshobha mutrapravritti. 3 patients (10 %) also complained ofVega asahatwa and Muhurmuhur mutrapravritti. 2 patients (6.6 %) complained ofRuja in vankshana pradesha and one patient (3.3 %) also complained of Saraktamutrapravritti. 114
  • 126. Graph – 4.14: Distribution of patients according to Symptoms 83.3 83.3 90 % of total no of patients 80 70 70 60 50 40 30 23.3 16.6 20 10 10 3.3 6.6 6.6 10 0 TOTAL Complaints of patients Krcchra mutrapravritti Rujayukta mutrapravritti Dahayukta mutrapravritti Sakshobha mutrapravritti Vega asahatwa Peeta mutrata Sarakta mutrapravritti Swalpa mutrapravritti Muhurmuhur mutrapravritti Vankshana / Basti ruja C) DATA RELATED TO ATURA PAREEKSHA Table – 4.15 C1) Distribution of 30 patients of Mutrakrichra according to Prakriti A B Prakriti % % TOTAL % n=15 N=15 Vata (V) 0 0 0 0 0 0 Pitta (P) 0 0 0 0 0 0 Kapha (K) 0 0 0 0 0 0 Vata Pitta (VP) 6 40 8 53.3 14 46.6Pitta Kapha (PK) 6 40 5 33.3 11 36.6Vata Kapha (VK) 3 20 2 13.3 5 16.6 Tridosha (TR) 0 0 0 0 0 0 115
  • 127. The data shows that among both the groups, maximum of 14 patients (46.6 %) hadVatapittaja prakriti followed by 11 (36.6 %) of Pittakaphaja prakriti. The rest 5 (16.6%) belong to Vata kaphaja prakriti. Table – 4.16 C2) Distribution of 30 patients of Mutrakrichra according to Agni A B Agni % % TOTAL % n=15 N=15 Sama 2 13.3 4 26.6 6 20 Vishama 5 33.3 3 20 8 26.6 Mandha 5 33.3 6 40 11 36.6 Teekshna 3 20 2 13.3 5 16.6Among both the groups 11 patients (36.6 %) had Mandagni followed by 8 patients(26.6 %) who had Vishama agni. 6 patients (20 %) had Sama agni and 5 (16.6 %) hadTeekshna agni. Table – 4.17 C3) Distribution of 30 patients of Mutrakrichra according to Koshta A B Koshtha % % TOTAL % n=15 N=15 Mrudhu 4 26.6 3 20 7 23.3 Madhyama 8 53.3 9 60 17 56.6 Krura 3 20 3 20 6 20According to the observations of both groups, 17 patients (56.6 %) had Madhyamakoshta whereas 7 patients (23.3 %) were of Mridu koshta and 6 patients (20 %) hadKrura koshta. 116
  • 128. Table – 4.18 C4) Distribution of patients of Mutrakrichra according to Abhyavarana shakti Abhyavarana A B % % TOTAL % Shakti n=15 N=15 Pravara 5 33.3 2 13.3 7 23.3 Madhyama 10 66.6 9 60.0 19 63.3 Avara 0 0 4 26.6 4 13.3The data revealed that maximum of 19 patients (63.3 %) had Madhyama abhyavaranashakti followed by 7 patients (23.3 %) who had Pravara abhyavarana shakti. Rest 4(13.3 %) had Avara abhyavarana shakti. Table – 4.19 C5) Distribution of 30 patients of Mutrakrichra according to Jarana shakti A B Jarana Shakti % % TOTAL % n=15 N=15 Uttama 4 26.6 4 26.6 8 26.6 Madhyama 4 26.6 3 20 7 23.3 Heena 7 46.6 8 53.3 15 50Among 30 patients of mutrakrichra maximum of 50 patients (53.3 %) had Heenajarana shakti followed by 8 patients (26.6 %) who had Uttama jarana shakti and 7(23.3 %) having Madhyama jarana shakti 117
  • 129. Table – 4.20 C6) Distribution of 30 patients of Mutrakrichra according to Pramana A B Pramana % % TOTAL % n=15 N=15 Supramanita 9 60 7 46.6 16 53.3 Adhika 2 13.3 4 26.6 6 20 Heena 4 26.6 4 26.6 8 26.6Among both the groups, 16 patients (53.3 %) were Supramanita, 8 patients (26.6 %)were Heena pramanita and 6 (20 %) had Adhika deha pramana. Table – 4.21 C7) Distribution of 30 patients of Mutrakrichra according to Sara A B Sara % % TOTAL % n=15 N=15 Pravara 2 13.3 3 20 5 16.6 Madhyama 7 46.6 5 33.3 12 40 Avara 6 40 7 46.6 13 43.3The data shows that maximum of 13 patients (43.3 %) had Avara sara followed by 12patients (40 %) who had Madhyama sara. Only 5 patients (16.6 %) had Pravara sara. Table – 4.22 C8) Distribution of 30 patients of Mutrakrichra according to Samhanana A B Samhanana % % TOTAL % n=15 N=15 Susamhita 5 33.3 2 13.3 7 23.3 Madhyama 9 60 9 60 18 60 Heena Samhita 1 6.6 4 26.6 5 16.6 118
  • 130. In the above observations it is noted that maximum of 18 patients (60%) hadMadhyama samhanana whereas 7 patients (23.3 %) were Susamhita and rest 5patients (16.6 %) were of Heena samhita. Table – 4.23 C9) Distribution of 30 patients of Mutrakrichra according to Satva A B Satva % % TOTAL % N=15 N=15 Pravara 3 20 2 13.3 5 16.6 Madhyama 8 53.3 8 53.3 16 53.3 Avara 4 26.6 5 33.3 9 30Among 30 patients of mutrakrichra, 16 patients (53.3 %) were of Madhyama satwafollowed by 9 patients (30 %) of Avara satwa. Rest 5 patients (16.6 %) were ofPravara satwa. Table – 4.24 C10) Distribution of 30 patients of Mutrakrichra according to Satmya A B Satmya % % TOTAL % n=15 N=15 Pravara 2 13.3 2 13.3 4 13.3 Madhyama 12 80 10 66.6 22 73 Avara 1 6.6 3 20 4 13.3Among the observed 30 patients maximum of 22 patients (73 %) had Madhyamasatmya whereas 4 patients (13.3 %) had Pravara satmya and 4 (13.3 %) had Avarasatmya. 119
  • 131. Table – 4.25C11) Distribution of 30 patients of Mutrakrichra according to Vyayama shakti A B Vyayama shakti % % TOTAL % n=15 N=15 Pravara 2 13.3 3 20 5 16.6 Madhyama 10 66.6 8 53.3 18 60 Avara 3 20 4 26.6 7 23.3The observations of both the groups revealed that 18 patients (60 %) had Madhyamavyayama shakti whereas 7 patients (23.3 %) had Avara shakti and 5 patients (16.6 %)had Pravara vyayama shakti. 2. DATA RELATED TO EFFECT OF THERAPY Table – 4.26:Showing the grades of Krichra mutrapravritti before and after treatment in Group ANo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 0 0 7 46.6 8 53.3 0 0 AT 1 6.6 9 60 5 33.3 0 0 Table – 4.27:Showing the grades of Krichra mutrapravritti before and after treatment in Group BNo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 0 0 6 40 9 60 0 0 AT 5 33.3 6 40 4 26.6 0 0 120
  • 132. Table – 4.28:Showing the grades of Rujayukta mutrapravritti before and after treatment in Group ANo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 4 26.6 3 20 8 53.3 0 0 AT 5 33.3 5 33.3 5 33.3 0 0 Table – 4.29:Showing the grades of Rujayukta mutrapravritti before and after treatment in Group BNo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 6 40 3 20 6 40 0 0 AT 10 66.6 3 20 1 6.6 0 0 Table – 4.30:Showing the grades of Dahayukta mutrapravritti before and after treatment in Group ANo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 1 6.6 4 26.6 10 66.6 0 0 AT 8 53.3 6 40 1 6.6 0 0 121
  • 133. Table – 4.31:Showing the grades of Dahayukta mutrapravritti before and after treatment in Group BNo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 2 13.3 3 20 10 66.6 0 0 AT 11 73.3 4 26.6 0 0 0 0 Table – 4.32:Showing the grades of Sakshobha mutrapravritti before and after treatment in Group ANo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 5 33.3 6 40 4 26.6 0 0 AT 8 53.3 6 40 1 6.6 0 0 Table – 4.33:Showing the grades of Sakshobha mutrapravritti before and after treatment in Group BNo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 6 40 6 40 3 20 0 0 AT 12 80 2 13.3 1 6.6 0 0 122
  • 134. Table – 4.34:Showing the grades of Vega asahatva before and after treatment in Group ANo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 4 26.6 4 26.6 7 46.6 0 0 AT 7 46.6 7 46.6 1 6.6 0 0 Table – 4.35:Showing the grades of Vega asahatva before and after treatment in Group BNo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 7 46.6 7 46.6 1 6.6 0 0 AT 11 73.3 4 26.6 0 0 0 0 Table – 4.36:Showing the grades of Urine microscopy before and after treatment in Group ANo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 0 0 4 26.6 11 73.3 0 0 AT 8 53.3 6 40 1 6.6 0 0 123
  • 135. Table – 4.37: Showing the grades of Urine microscopy before and after treatment in Group BNo of patients Grade 0 % Grade 1 % Grade 2 % Grade 3 % 15 BT 0 0 7 46.6 8 53.3 0 0 AT 7 46.6 8 53.3 0 0 0 0 124
  • 136. MASTER CHART – 1 Demographic data of group AS. OPD Age Sex Education Marital Religion Occupation Economical statusNo status PGDG M F U P S H M U H M C O S A L S P M H H E E E S R M U D T B T R D M C1 P14 19 + + + + + +2 P15 18 + + + + + +3 P37 32 + + + + + +4 A11 20 + + + + + +5 A21 26 + + + + + +6 A34 19 + + + + + +7 A53 21 + + + + + +8 B87 40 + + + + + +9 S10 60 + + + + + +10 S18 44 + + + + + +11 S51 43 + + + + + +12 S56 48 + + + + + +13 S63 56 + + + + + +14 S81 35 + + + + + +15 S107 49 + + + + + + TOTAL 9 6 3 5 0 7 9 6 13 2 0 0 0 6 3 6 3 10 2 0M = Male, F = Female, UE = Uneducated, PE = Primary Education, SE = Secondary education, HS = Higher Studies, MR = Married,UM = Unmarried, H = Hindu, MU = Muslim, C = Christian, O = Others, SD = Student, AT = Active, LB = Labour, ST = Student,PR = Poor, MD = Middle class, H M = Higher middle class, HC = Higher class 125
  • 137. MASTER CHART – 2 Demographic data of group BS. OPD Age Sex Education Marital Religion Occupation Economical statusN status PGDG M F U P S H M U H M C O S A L S P M H H E E E S R M U D T B T R D M C1 P9 19 + + + + + +2 P47 24 + + + + + +3 P48 32 + + + + + +4 P53 19 + + + + + +5 A7 19 + + + + + +6 A17 19 + + + + + +7 S15 25 + + + + + +8 S37 61 + + + + + +9 S40 56 + + + + + +10 S47 48 + + + + + +11 S70 46 + + + + + +12 S89 47 + + + + + +13 S91 38 + + + + + +14 S95 53 + + + + + +15 S102 58 + + + + + + TOTAL 6 9 8 1 2 4 11 4 13 2 0 0 0 5 6 4 5 9 1 0M = Male, F = Female, UE = Uneducated, PE = Primary Education, SE = Secondary education, HS = Higher Studies, MR = Married, UM =Unmarried, H = Hindu, MU = Muslim, C = Christian, O = Others, SD = Student, AT = Active, LB = Labour, ST = Student, PR = Poor, MD =Middle class, H M = Higher middle class, HC = Higher class 126
  • 138. MASTER CHART - 3 ASSESSMENT OF SUBJECTIVE AND OBJECTIVE PARAMETRES OF GROUP ASl. OPD Clinical parametersNo. No. Krichra Ruja Daaha Sakshoba Vega.As Urine Micro B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T01. PGDG14 1 1 0 0 2 1 2 1 1 0 1 002. PGDG15 1 1 0 0 2 1 1 1 1 0 2 003. PGDG37 1 1 2 2 0 0 0 0 0 0 1 004. PGDGA11 1 1 2 1 2 1 1 0 2 1 2 005. PGDGA21 1 1 2 2 2 0 1 1 2 0 2 106. PGDGA34 2 1 1 1 2 0 0 0 1 1 2 107. PGDGA53 2 2 1 1 2 0 2 1 0 0 2 008. PGDGB87 1 1 2 2 1 0 0 0 0 0 2 109. PGDGS10 2 2 2 2 2 2 2 2 2 2 2 210. PGDGS18 1 1 0 0 2 0 1 1 2 1 1 011. PGDGS51 2 2 1 1 2 1 1 0 2 1 1 012. PGDGS56 2 1 2 1 1 1 0 0 0 0 2 113. PGDGS63 2 1 2 2 1 0 0 0 1 1 2 114. PGDGS81 2 2 0 0 2 0 1 1 2 1 2 115. PGDGS107 2 2 2 1 1 1 2 0 2 1 2 0B.T = Before treatment, A.T = After treatment 127
  • 139. MASTER CHART - 4 ASSESSMENT OF SUBJECTIVE AND OBJECTIVE PARAMETRES OF GROUP BSl. OPD Clinical parametersNo. No. Krichra Ruja Daaha Sakshoba Vega.As Urine Micro B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T B.T A.T01. PGDG9 2 1 1 1 2 1 1 0 1 0 2 102. PGDG47 2 1 1 0 2 1 1 1 0 0 2 103. PGDG48 1 0 0 0 2 0 0 0 1 1 1 004. PGDG53 2 1 0 0 1 1 1 1 0 0 1 005. PGDGA7 1 1 0 0 2 0 2 1 1 1 2 106. PGDGA17 2 2 0 0 2 0 1 0 0 0 2 107. PGDGS15 1 1 0 0 2 1 0 0 2 1 1 008. PGDGS37 2 2 2 0 1 0 2 2 1 1 2 109. PGDGS40 2 1 1 1 2 1 0 0 0 0 1 010. PGDGS47 2 2 2 1 2 0 1 1 1 0 2 111. PGDGS70 1 1 2 2 2 1 0 0 1 0 1 012. PGDGS89 2 1 2 1 0 0 2 1 0 0 2 113. PGDGS911 1 1 0 0 2 0 0 0 0 0 1 014. PGDGS95 2 2 2 1 0 0 1 0 1 1 2 115. PGDGS102 1 1 2 1 1 0 0 0 0 0 1 1B.T = Before treatment, A.T = After treatment 128
  • 140. RESULTSThe results of the study are grouped as follows1. Results pertaining to analysis of Vidarikanda for physical constants.2. Results pertaining to preliminary phytochemical analysis of Vidarikanda.3. Results pertaining to Chromatographic study of Vidarikanda.4. Results pertaining to analysis of Varuna for physical constants.5. Results pertaining to Clinical study.1. Results pertaining to analysis of Vidarikanda for physical constants Table 4.38: Physical constants of Vidarikanda tuber S. No. Parameters Results 1. Ash (% w/w) 10.17 2. Water soluble ash 3.18 3. Acid-insoluble ash (% w/w) 0.38 4. Water-soluble extractive (% w/w) 47.83 5. Alcohol-soluble extractive (% w/w) 16.66 6. Loss on drying at 105° C (% w/w) 5.39 7. pH (10% aqueous solution) 7 129
  • 141. 2. Results pertaining to preliminary Phytochemical analysis of Vidarikanda. Table 4.39: Preliminary Phytochemical analysis of Vidarikanda tuber S.No Test for Alcohol extract 1. Steroid +ve 2. Triterpenoid +ve 3. Flavonoid +ve 4. Sugar +ve 5. Phenol +ve 6. Quinone -ve 7. Tannin +ve 8. Alkaloid -ve 9. Coumarin +ve 10. Furanoid -ve 11. Glycosides +ve 130
  • 142. 3. Results pertaining to Chromatographic study of Vidarikanda. a) TLC: Table 4.40: TLC of Vidarikanda tubers (Puereria tuberosa) UV 254 nm UV 366 nm With Spray reagentS.No. Color Rf Color Rf Color Rf 1. Blue 0.06 Pale blue 0.08 Black 0.06 2. Green 0.19 Pale blue 0.22 Grey 0.17 3. Green 0.36 Navy blue 0.28 Grey 0.22 4. - - - - Grey 0.31 b) HPTLC: Results of HPTLC have been enclosed. 4. Results pertaining to analysis of Varuna for physical constants. Table 4.41: Physical constants of Varuna S. No. Parameters Results 1. Total ash 10.28 % 2 Acid insoluble ash 0.238 % 3. Water soluble extractive 15.43 % 4. Alcohol soluble extractive 6.62 % 131
  • 143. 5. Results pertaining to Clinical study. Table 4.42:STATISTICAL ANALYSIS OF PARAMETERS OF GROUP A AFTER THETREATMENTSubjective Parameters Mean S.D. S.E. t. P. Remarks value valueKrichra mutrapravritti 0.4 0.632 0.163 2.448 <0.02 HSRujayukta mutrapravritti 0.105 0.296 0.066 1.59 > 0.05 NSDahayukta mutrapravritti 1.066 0.798 0.206 5.170 <0.001 HSSakshobha mutrapravritti 0.266 0.457 0.118 2.255 <0.05 HSVega asahatwa 0.105 0.296 0.066 1.59 > 0.05 NSObjective parametersUrine microscopy 0.333 0.487 0.126 2.645 < 0.02 HSAmong the parameters of Group A, the parameters Rujayukta mutrapravritti showsnon significance (P> 0.05) similar to that of Vega asahatwa (P> 0.05). The parameterKrichramutrapravritti shows higher significance with P < 0.02 than Sakshobamutrapravritti (P>0.05). The parameter Urine microscopy shows higher significance(P<0.02) than Krichra mutrapravritti whereas Dahayukta mutrapravritti shows mosthighly significant value (P<0.001)Table 4.43:STATISTICAL ANALYSIS OF PARAMETERS OF GROUP B AFTER THETREATMENTSubjective Parameters Mean S.D. S.E. t. P.value Remarks valueKrichra mutrapravritti 0.666 0.617 0.159 4.182 <0.001 HSRujayukta mutrapravritti 0.666 0.816 0.210 3.161 <0.05 HSDahayukta mutrapravritti 1.266 0.798 0.206 6.139 <0.001 HSSakshobha mutrapravritti 0.533 0.639 0.165 3.226 <0.01 HSVega asahatwa 0.333 0.487 0.126 2.645 <0.02 HSObjective parametersUrine microscopy 1 0.377 0.097 10.24 <0.001 HS 132
  • 144. Among the parameters of standard group B, parameter Vega asahatwa showshigher significance (P<0.02) than parameter Rujayukta mutrapravritti (P<0.05).Parameter Sakshobha mutrapravritti shows higher significance (P<0.01) than Vegaasahatwa. By comparing t value it can be noted that Dahayukta mutrapravritti showshighly significant value (P<0.001) than Krichra mutrapravritti (P<0.001) whereasUrine microscopy is highly significant (P<0.001) among all the parameters.By comparing the two groups for the parameter Krichra mutrapravritti, effectivenessof standard group is highly significant (P<0.001) than the trial group A (P<0.02).Similarly Rujayukta, Dahayukta mutrapravritti and urine microscopy of standardgroup B show higher significance than group A. whereas effectiveness of Group A ishighly significant for parameter Sakshobha mutrapravritti.Overall assessment of therapeutic response of group A & B is studied under followingheadings a) Complete remission b) Marked improvement c) Mild improvement d) Unchanged e) Discontinued 133
  • 145. Table – 4.44: Showing result of the study in group A Result No of patients % Complete remission 4 26.6 Marked improvement 7 46.5 Mild improvement 3 20 Unchanged 1 6.66 Discontinued 0 0 Unchanged Complete 7% remission Mild 27% improvement 20% Marked improvement 46% Table – 4.45: Showing result of the study in group BResult No of patients % Complete remission 6 40 Marked improvement 7 46.6 Mild improvement 2 13.33 Unchanged 0 0 Discontinued 0 0 134
  • 146. Mild improvement 13% Complete remission 40% Marked improvement 47% Table – 4.46: Showing overall result of the study Result No of % No of % Total % patients patients (Group A) (Group B)Complete remission 4 26.6 6 40 10 33.33Marked improvement 7 46.5 7 46.6 14 46.66Mild improvement 3 20 2 13.33 5 16.66Unchanged 1 6.66 0 0 1 3.33Discontinued 0 0 0 0 0 0 Unchanged 3% Mild Complete improvement remission 17% 33% Marked improvement 47% 135
  • 147. DISCUSSIONDrug VidarikandaThe existence of Vidarikanda has been cited since hundreds of years and being usedas a medicament since Samhita period. Various acharyas have ascribed manyproperties of Vidarikanda and have enlisted it in different vargas accordingly. As it isused as a medicament, it is included under Oushadi varga in Kaiyadeva Nighantu.Vidarikanda is also used as vegetable and hence mentioned under Shaka varga inAshtanga sangraha and Madhava Dravyaguna. As it is morphologically a twinner,Sushruta has included it under Vallipanchamula. Based on its dicotyledonous nature itis placed under Palashadi varga by Nighantu Adarsha. As tuber is the main usefulpart, it is included under Kanda varga by Sushruta and Mulakadi varga by RajaNighantukara. Charaka, Sushruta and Vagbhata have included it under Madhura vargabecause of its madhura rasa and on the basis of its therapeutic actions it is includedunder Kanthya Mahakashaya, Snehopaga Mahakashaya, Pittasamshamana varga,Vatanashaka dravya etc. Most of the synonyms described in the literatures point towards themorphological structure of the plant. Bhukushmanda refers to the big size of the tuberwhereas Ikshugandhika refers to the particular smell it possesses. Triparna refers to itstrifoliate nature whereas vallipalashika refers to its similarity with Palasha leaves andtwinning nature. There are some controversies regarding Vidari and ksheera Vidari in classics.Charaka while describing the drugs of madhura skandha specifically mentionedVidari, Ksheeravidari and Ksheerashukla as three different drugs. Though in samhitaperiod both Vidari and Ksheeravidari are mentioned separately the commentators 136
  • 148. have used some words like payasya, ksheerashukla, etc for both Vidari andKsheeravidari. In the nighantu period some authors mentioned Vidari andKsheeravidari under the heading of Vidari and described Ksheeravidari as a variety ofVidarikanda. Based on the above facts and synonyms, Vidarikanda is being identifiedbotanically as Pueraria tuberosa DC of Papilionaceae and Ksheeravidari beingidentified as Ipomea digitata of Convolvulaceae. Most of the authors opine that Vidari possess madhura rasa, guru snigdha gunaand sheeta veerya but its madhura vipaka has been mentioned only in NighantuAdarsha. As far as therapeutic properties are concerned, most of the acharyas mentionit to be vata and pitta hara whereas kaphavardhana property has been specified byRajanighantukara. Owing to its madhura samana pratyarabdata properties like Balya,Brimhana, Jeevaneeya, Mutrala, Shukrala and rasayana have been attributed. Stanyavardhana property has been mentioned by most of the nighantukaras whereas Kanthyaproperty has been specifically mentioned by Charaka and Vagbhata. Thus it has beentherapeutically indicated in Daha, Kshaya, Jwara, Raktaja roga, Stanya nasha,Mutrakrichra etc.Mutrakrichra Vis – Vis UTIThe disease Mutrakrichra finds its existence since puranakala. Even though there arereferences of draining the distended bladder in Atharvaveda the disease as such is notmentioned. It was in samhitakala where detail description of Mutrakrichra wasbrought to light. Mutrakrichra as name suggests is a disease in which urine is passedwith difficulty associated with many other symptoms and involving many structuresof urinary system. As one may not get a complete picture of mutravaha srotas inAyurvedic classics, recent scholars of Ayurveda have co – related mutravaha srotas toUrinary system. While explaining the formation of urine the related organs have not 137
  • 149. been dealt in connection. Importance has been given to basti and pakwashaya whereasgavini and vrikkou have not been brought into picture. Even then the description ofurinary disorders like mutrakrichra is in detail. Most of the authors have mentionedthat katu teekshna ahara, anupa mamsa, matsya sevana cause Mutrakrichra. Some ofthe nidanas like nitya drta prsta yana, atiprasanga, teekshna oushada sevana are veryspecific. Even nidanas of mutravaha srotodushti like mutranigrahana, mutrita udakabhakshya sevana etc lead to Mutrakrichra. Most of the acharyas have opined 8 types Mutrakrichra, the first four beingdoshaja and rest are Ashmarijanya, Shukravegavarodhajanya, Shalyabhighataja andShakrit vighataja. Acharya sushruta opines Ashmarijanya and Sharkarajanya areseparate whereas Charaka opines them to be same, as clinical manifestations seem tobe similar. Acharya kashyapa has specifically mentioned Dwandwaja variety. The pathogenesis of Mutrakrichra is by vitiation of tridosha either individuallyor together in basti pradesha to produce lakshanas particular to each typae. The vatajavariety is mainly characterized by ruja with krichra mutrapravritti whereas daha dahaand ruja is seen in Pittaja variety. Shotha and gourava are the cardinal symptoms ofkaphaja whereas a mixture of all these is seen in sannipataja variety. The personsuffering from Ashmarijanya mutrkrichra experience teevra shoola while voiding dueto the dislodgement of ashmari or sharkara and the person suffering from raktajaMutrakrichra feels basti laghuta after the blood passes out. In case of shalyabhighatajafeatures of vataja Mutrakrichra are seen but vedana being more where as sa shukramutrapravritti is seen in shukraja Mutrakrichra and the symptoms related to Udara areseen in Pureeshaja variety. Based on the symptamatology recent authors of Ayurveda have co – relatedMutrakrichra to Urinary Tract Infection which exists when pathogenic 138
  • 150. microorganisms >105 per milliliter are detected in the urine, urethra, bladder etc. Eachyear UTI accounts for 9.6 million doctor visits and one woman out of 5 develop UTIin her lifetime. It is classified as Upper UTI and Lower UTI on the basis of anatomyof urinary system among which lower UTI is the commonest. The major cause of UTIare the bacteria like E coli, Proteus etc and other factors like pregnancy, low waterintake, genetic factors, comparatively shorter Urethra in females, spicy foods etcpredispose UTI. Usually Urinary tract is kept sterile by the host defense mechanism ofthe body but any breech in this mechanism favours the production of UTI. Thedisease is clinically presented as inflammation of a particular structure like urethra,bladder etc and called as Urethritis, Cystitis etc. They are characterized by pain duringmicturition, increased frequency, cloudy urine etc.Pharmacognostic studyIn order to standardize the identification of Vidarikanda, a detailed pharmacognosticstudy including microscopic and macroscopic characters of the tuber and its powderwas carried out. The features observed are furnished in the related chapter andcompared with pharmacognostic study of Pueraria tuberosa DC done at IndianCouncil of Medical Research, New Delhi. Both the study seemed similar thus provingthe genuinity of the drug collected. Further study of leaves, Stem and flowers arerequired in order to establish the complete identification standard of the plant.Analytical studyThe results of the analytical study of Vidarikanda done at Captain Shrinivasa MurtiDrug Research Institute for Ayurveda and Siddha (CCRAS), Chennai was matchedwith the analytical study reports of previous research works and was found to be 139
  • 151. similar. The results of Physical constants in Varuna were also matched with thereports of previous works and have been found to be similar.Clinical studyClinical evaluation is mandatory to test the genuinity of any medicine as a part ofstandardization. Present study was planned to evaluate the effect of Vidarikanda inMutrakrichra. The clinical study was carried out on 30 patients of Mutrakrichra andwere divided into 2 group’s viz. Group A (Trial Group) which was given Powder ofthe Vidarikanda tuber and Group – B (Standard group) which was administered withVaruna twak churna internally. The patients were selected randomly irrespective ofage, sex, religion etc. The observation and results obtained are discussed here.a) Fixation of dose.Before fixing the dose of Vidarikanda references of previous study was considered. 262The clinical trial carried out by Dr. Rabinarayan Acharya et al reported thatgynaecomastia was reported by two patients out of five in the dose of 3gms bd andone patient out of ten in the dose of 2 gms bd. Hence the dose of Vidarikanda in thisstudy was fixed to 1 gm tid to avoid the adverse effect.b) Mutrakrichra in relation to AgeIt was observed that a maximum of 11 (36.6 %) were from the interval of 35 – 45 agegroup followed by 6 patients (20 %) of 45 – 55 age group. This shows that incidenceof the disease is more among middle aged persons 140
  • 152. c) Mutrakrichra in relation to SexFrom both groups A and B, 11 patients (37 %) were male and 19 (63 %) werefemales. This shows the higher incidence of mutrakrichra in females. The reason maybe due to shorter urethra, lack of hygiene during sex etc.d) Mutrakrichra in relation to ReligionMaximum of 26 (86.6 %) belonged to Hindu community whereas only 4 (13.3 %)belonged to Muslim community. This incidence rate depends upon the area fromwhere the data was collected and in particular Gadag is dominated by Hinducommunitye) Mutrakrichra in relation to educational statusAmong the 30 patients maximum of 11 patients (36.6 %) were uneducated followedby primary education and secondary education. This shows that unawarenessregarding the hygiene predisposes UTI.f) Mutrakrichra in relation to occupationIn the study maximum 11 (36.6 %) were active in work comprising of housewives,merchants etc. Lack of sufficient time for intake of ample amount of water, intake offast foods etc might be a reason for developing UTIg) Mutrakrichra in relation to marital statusAmong 30 patients, maximum of 20 (66.6 %) were married and rest 10 (33.3 %) wereunmarried. This shows that incidence of the disease is more in sexually active personswhere either the frequency of sex is more or the hygiene before and after the sex isless 141
  • 153. h) Mutrakrichra in relation to Economic statusThe study shows that maximum numbers of 19 (63.3 %) patients were from middleclass followed by 8 patients (26.6 %) of poor class. This data also is only thereflection of the socio-economic status of the patients visiting the health check upcamps and hence no conclusions can be drawn out of this.i) Mutrakrichra in relation to Shareera prakritiThe data shows that among both the groups, maximum of 14 patients (46.6 %) hadvatapittaja prakriti followed by 11 (36.6 %) of pittakaphaja prakriti. This may be dueto the role of desha, predominance of Vatapitta Prakrti people in Gadag andsusceptibility of Vatapitta Prakrti persons towards Vatapittaja rogas.j) Mutrakrichra in relation to agniIt is seen that maximum number, 11 patients (36.6 %) were having Mandagnifollowed by 8 patients (26.6 %) who had vishama agni and 6 patients (20 %) hadsama agni. This confirms the textual reference that Mandagni is one of factors forcausation of Mutrakrichrak) Mutrakrichra in relation to KoshtaAccording to the observations of both groups, 17 patients (56.6 %) had madhyamakoshta whereas 7 patients (23.3 %) were of mridu koshta and 6 patients (20 %) hadkrura koshta.With this normal inference no any definite relation with Kostha can be claimed. 142
  • 154. l) Mutrakrichra in relation to mode of onsetAmong the two groups observed, the onset was gradual in 21 patients (70 %) and wasacute in 9 patients (30 %). This may be due to the time factor taken for thecolonization of urinary tract and manifestation of symptoms.m) Mutrakrichra in relation to history of recurrent attacksData related to history of recurrent attacks revealed that there was no history ofrecurrent attacks in 19 patients (63.3 %) whereas 11 patients (36.6 %) suffered fromrecurrent attacks. The possible reason for the reoccurrence may be due to incompletecourse of medication taken previously and improper hygiene.n) Mutrakrichra in relation to NidanaMaximum of 17 patients (56.6 %) consumed katu, tikta, ruksha ahara followed by 16patients (53.3 %) doing mutravegadharana and 11 patients (36.6 %) were seen doingnitya drta prsta yana. As most of the patients in the study were obtained in thesummer season and people in the Gadag region generally consume katu ruksha ahara,chances of UTI was seen more in them.o) Mutrakrichra in relation to complaintsData of patients revealed that 25 patients (83.3 %) complained of peeta and dahayukta mutra pravritti followed by 21 patients (70 %) complaining of krichramutrapravritti. 7 patients observed ruja during micturition while 5 patients (16.6 %)also had sakshobha mutrapravritti. 3 patients (10 %) also complained of vegaasahatwa and muhurmuhur mutrapravritti. 2 patients (6.6 %) complained of ruja invankshana pradesha and one patient (3.3 %) also complained of saraktamutrapravritti. This shows that vitiation of pitta dosha was more dominant and hencePittaja mutrakrichra was common followed by Vataja mutrakrichra. 143
  • 155. Effect of therapyComparitive effect of both Groups on symptomatology. The results of the study were statistically analyzed and certain conclusions were drawn on the efficacy of individual drugs. The trial drug Vidarikanda proved more useful in relieving Krichra mutrapravritti and Dahayukta mutrapravritti similar to the standard drug Varuna. There was significant reduction in no of pus cells in group A but was comparatively less when compared with the group B where Varuna proved to reduce the colonization remarkably. Only few patients in Group A were relieved of Vega asahatwa and Sakshoba mutrapravritti. Whereas in Group B a larger population has been relieved of Vega asahatwa and Sakshoba mutrapravritti. Many patients have been relieved of Rujayukta mutrapravritti in group B whereas minimal no of patients were relieved in group A. This indicates that trial drug was comparatively less efficacious than standard drug in relieving Vega asahatwa, Sakshoba mutrapravritti and Rujayukta mutrapravritti.Comparitive effect of both groups on the disease.Among the 30 patients observed, 6 patients were completely relieved of the disease ingroup B whereas only 4 patients of group A had complete remission. 7 patients ineach group showed marked improvement whereas 3 patients in group A and 2 patientsin group B showed only mild improvement. One patient in group A had no relief inthe symptoms. This observation shows that maximum patients showed markedimprovement in both groups and relatively fewer patients had complete remission. Italso indicates that the trial drug has shown fewer efficacies than the standard drug. 144
  • 156. Probable mode of actionVidarikanda’s mode of action on mutrakrichra can be understood in three ways.1. Increasing the quantity of mutra and easy outflow.2. Improving the defence mechanism of the patient.3. Role of oestrogen in preventing UTI. Mutra is jaleeya and Vidarikanda being madhura rasa, snigdha guna andsheeta veerya yukta it increases the jala dhatu based on samanya vishesha siddhanta.Because of the sheeta veerya it is pittashamaka and reduces daha. Its snigda gunacauses snehana of mutramarga and helps in easy passage of urine. Vidarikandacontains sugar and due to their osmotic activity these substances oppose thereabsorption of water from the glomerular filtrate. These substances produce moreelimination of water than sodium and hence produce diuresis.262 Since Vidarikanda has antioxidant and immunomodulatory properties, alsobeing a good source of carbohydrate, proteins, Vit B1, it helps in boosting the defensemechanism of the urinary tract thereby preventing the disease. A study conducted at Department of Urogynaecology, King’s CollegeHospital, Denmark Hill, London revealed that sex steroids have an important effect onthe female lower urinary tract during adult life. Oestrogen receptors have beenidentified throughout the brain, pontine micturition centre and in the bladder, urethraand pelvic floor. Fluctuations in the circulating level of oestrogens and progesteroneinfluence the prevalence of urinary symptoms. Subsequent oestrogen deficiency hasbeen implicated in the etiology of a number of urogenital complaints includingincontinence, urgency and recurrent urinary tract infection (UTI). Since Vidarikandais a rich source of phyto oestrogens its role in the management of UTI can beunderstood in this regard. 145
  • 157. CONCLUSIONMutrakrichra is a common disease in the community and women are moreprone. Based on the symptoms it is been compared to UTI.Intake of katu teekshna ahara, mutravegavarodha, tobacco consumption andunhygienic life style are the major causative factors noted in this study.In the present study, the efficacy of Vidarikanda was evaluated in comparisonwith the standard drug Varuna.Pharmacognostical evaluation and analytical study including HPTLC ofVidarikanda was done to confirm its genuinity.The clinical study comprised of random sample of 30 patients divided into 2groups of 15 patients each. Trial drug Vidarikanda was given to group A in thedose of 1 gm tid with luke warm water and Varuna was given to group B inthe dose of 2 gm bd with luke warm water.Krichramutrapravritti, Ruja, Daha, Sakshobha and Vega asahatva were takenas subjective parameters and urine microscopy was taken as objectiveparameter.The young patients showed good response to the treatment compared to oldage.The present clinical trial showed male female ratio as 1:3The prevalence of disease is more in poor and lower middle class.Krichramutrata and dahayukta mutrata were found as most commonpresenting complaints of the patients. Lesser no of cases was observed withmutrasanga and kukshishoola. 146
  • 158. The present clinical trial showed Pittaja variety of mutrakrichra as more prevalent compared to other classification. The trial drug Vidarikanda showed significant result in both subjective and objective parameters where as standard drug Varuna showed highly significant result.Limitations The sample size is small to generalize the result and the study is limited to the patients who attended the health checkup camps. As only pus cell count is the objective parameter, the limitation is restricted to the urine microscopic study.Future prospects The study should be conducted on the large scale of population to obtain more promising and long lasting results. Anti microbial activity to the specific microorganisms is to be carried out to evaluate drug efficacy. As sample size is less and limited to doshaja variety of mutrakrichra the study can be conducted in other varieties also. 147
  • 159. SUMMARY The present dissertation entitled “Pharmacognostical Analysis OfVidarikanda And Its Effect In Mutrakrichra – A Clinical Study” involved studieson different aspects of test drug to ascertain its therapeutic utility as given in theclassics. The work was divided into several sections starting from introduction,literary review, methodology, observations, results, discussion and conclusion. IntroductionThis section gives a brief introduction of the drug and the disease, reason for selectionof the drug, procurement of the drug, prevalence of the disease in the community,nature of the study etc. Literary reviewDrug review includes detail description of Vidarikanda, its morphology, propertiesand indications. The drug review also indicates a brief description of the standarddrug Varuna.Disease review contains the details of Mutrakrichra and its comparison with UTI. MethodologyThe materials and methods followed in the present study are described inmethodology. It includes the pharmacognostic study, analytical study,Chromatography of Vidarikanda and analysis of Varuna for Physical constants.Clinical trial was conducted on two groups each containing 15 patients. ObservationsThe observations of Pharmacognostical study include the Macroscopy andmicroscopy of the tuber and the powder along with suitable pictorial representation. 148
  • 160. The observations of clinical study include the data pertaining to the disease in relationto age, sex, occupation, educational status, economic status, prakriti, sara, samhanana,agni, pramana, satmya, satva, koshta, abhyavarana shakti, jarana shakti of the patientwas observed. Also the mode of onset, history of reoccurrence, symptoms etc wereassessed and tabulated ResultsResults of the phytochemical analysis, TLC, HPTLC of Vidarikanda and analysis forphysical constants of both drugs are enlisted. In case of clinical study based on theobservations and relief in the symptoms the subjective and objective parameters werestatistically analyzed and results were drawn. The study showed that in group A (Trialgroup) 26.6 % of patients had Complete remission, 46.5 % of patients had Markedimprovement, and 20 % of patients had Mild improvement whereas 6.66 % of patientsshowed no response to the treatment. In case of group B (Standard group) 40 % ofpatients had Complete remission, 46.6 % of patients had Marked improvement, and13.33 % of patients had Mild improvement. DiscussionDifferent aspects of the study have been discussed with a view to ascertain thegenuinity and efficacy of Vidarikanda in Mutrakrichra ConclusionConclusions are drawn on the basis of detail study of Vidarikanda, observations of theclinical trial, results and some aspects of discussion 149
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  • 173. 256. Walter E Stamm, Harrison’s Principles of Internal Medicine, Chapter 131. 15th ed. McGraw Hill; 2003. p. 822.257. Vruddha Jeevaka, Kashyapa Samhita, Chikitsasthana, mutrakrichra chikitsa adhyaya, 4th ed. Varanasi: Chaukambha Sanskrit Samsthan; p.121258. Agnivesha, Charaka Samhita, Chikitsasthana, chapter 26, shloka 76, Rajeshwara Datta editor, Reprint. Varanasi: Chaukamba Bharati Academy; 2001. p.731.259. Yogaratnakara, Mutrakrichra nidana shloka 1, Vaidya Lakshmipathy Shastry editor, Varanasi: Chaukambha Sanskrit samsthan; 1988. p.61.260. API textbook of Medicine, G. S. Sainani editor, 6th ed. Mumbai: API. 1999. p. 649.261. Pharmacoepia of India, Vol 2, 3rd ed. New Delhi: The controller of Publishers; 1985. p. A-124.262. Acharya Rabinarayan, A study on Vidarikanda with special reference to its vrishya karma, Dept of Dravyaguna, IPGTRA, Jamnagar: March 1996. 162
  • 174. Department of Post Graduate Studies in Dravyaguna D.G.M. Ayurvedic Medical College & Hospital, GADAG Special case sheet for PHARMACOGNOSTICAL ANALYSIS OF VIDARIKANDA AND ITS EFFECT ON MUTRAKRICHRA – A CLINICAL STUDYGuide: Dr. G.V. Mulagund M.D (Ayu), Scholar: Dr. Savitha D.BhatCO Guide: Dr. Shashikanth B. Nidagundi M.D (Ayu)1) Name of the Patient2)Father’s / husband’s name Sl.No3) Sex Male Female OPD No4) Age (in yrs) Birth place IPD No5) Religion Hindu Muslim Christian Other6) Occupation Sedentary Housewife Merchant Labor Student7)Maritalstatus Married Unmarried8) Economical status Poor Middle Higher middle Higher class9) Address Contact No: Pin10) Selection Included Excluded11) Schedule Initiation Completion Date Date12) Result Complete Marked improvement remission Mild Unchanged Discontinued improvement 163
  • 175. 13) INFORMED CONSENTI Son/Daughter/Wife of amexercising my free will, to participate in above study as a subject. I have been informed tomy satisfaction, by the attending physician the purpose of the clinical evaluation andnature of the drug treatment. I am also aware of my right to opt out of the treatmentschedule, at any time during the course of the treatment.£Á£ÀÄ ²æÃ/²æêÀÄw ___________________________________________________£À£Àß ¸ÀéEZÉÒ¬ÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞwAiÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtðªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ AiÀiÁªÁUÁzÀgÀÄ aQvÉì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÉÛ£É. gÉÆÃVAiÀÄ gÀÄdÄ / Patient’s Signature 14) Pradhana vedana: Sl. Complaints Present/ Duration no Absent Fresh < 1 Yr < 5Yrs > 5Yrs . 1 Krichra mootrapravritti 2 Rujayukta mootrapravritti 3 Dahayukta mootrapravritti 4 Sakshobha mootrapravritti 5 Vega asahatva 6 Peeta mutrata 7 Sarakta mootrata 8 Swalpa mootrata 9 Muhurmuhu mootrata 10 Ruja in Vankshana pradesha / vasti / Medra 15) Anubandha vedana: Sl. Complaints Present/Absent Duration no Fresh <1Yrs < 5Yrs > 5Yrs 1 2 3 4 164
  • 176. 16) Adhyatana vyadhi vrittanta:Mode of onset Acute Chronic[Atanka samutpatti]Course of the disease Yrs / Month[Vedana samucchaya] Intensity Mild Moderate Severe Aggravating [Anupashaya]factors Relieving [Upashaya]Others17) Poorva vyadhi vrittanta:H/O Recurrent atacks Yes NoIf Yes, Frequency of attacks Less MoreIntermittent time between attacks18) Kula vrittanta: (Related to genitor urinary disorders)Disorder Relation Disorder Relation 19) Chikitsa vrittanta:Newly Diagnosed Previously DiagnosedPrevious MedicationDrug 1. 2.used Dose Duration Dose DurationResponse Controlled Not controlledPresent status20) Vyasna:None Smoking Alcohol Tobacco Others 165
  • 177. 21) Vyaktika vrittanta:Nidra Night sleep Hours Day sleep Hours Nature of sleep Sound Disturbed Dreams Yes NoAhara Vegetarian Madhura Amala Mixed food Rasa Lavana Katu Oil/Ghee predominance Tikta Kshaya Stored foodVihara Vyayama Ati Heena Samyak Vyavaya Ati Heena Samyak Mutra nigraha Ati Heena Samyak Nitya druta Ati Heena Samyak prstayana Kosta Krura Madhyama MruduJatharagni bala Manda Teekshna Vishama SamaOccupational history Type of employmentStudent Labour Executive SedentaryWork involving any mental stress Yes No 22) Rutuchakra vrittanta: (For women)Menopause attained Yes No No.of days of flowRegular Irregular23) Mansika vrittanta:24) Samanya Pareeksha: Pulse /min Weight /kgs Respiration /min rate Temp °F Height Heart rate /min BP mm/hg25) Atura pareeksha:a) Ashta vidha pareeksha :- 1.Nadi VP PK VK Others 4. Jihwa 2.Mala Varna Times/day 5. Shabda Consistency 6. Sparsha 3.Mootra Varna 7. Druk Times/day 8. Akruti Times/night 166
  • 178. b) Dashavidha pareeksha:- Shareerika V P K VP VK PK Sama Prakruti Twak Rakta Mamsa Meda Asthi Shukra Majja Satwa Sara Susamhita Madhyama Heena Samhanana samhita Samhita Pravara Madhyama Avara Satmya Satwa Pravara Madhyama Avara Vyama Pravara Madhyama Avara shakti Vaya Balya Madhya Vruddha Pramana Supramanita Adhika Heena Ahara shakti Abhyvarana Jaranac) Sroto pareeksha: Sl Srotas Observed lakshana no involved 1 2d) Systemic examination:- • Cardiovascular systemInspectionPalpationPercussionAuscultation • Respiratory System: Inspection Palpation Percussion Auscultation • Abdomen: Inspection Palpation Percussion Auscultation 167
  • 179. • Central Nervous system:26) Roga pareeksha1 Dosha V P K VP PK VK2 Dushya3 Srotodushti Atipravritti Sanga Siragranthi Vimargagamana prakara4 Agni Sama Vishama Manda Teekshna5 Rogamarga Bahya Madhyama Abhyantara6 Udbavasthana Amashaya Pakwashaya7 Vyaktasthana8 Vyadhiprabhava Ashukaari Chirakaari Daruna Mridu9 Saadya Asaadyata27) Laboratory investigations:Investigations B/T A/TUrine routine Albumin Sugar Micro Epi Pus RbcBlood routine HB TC DC Neutro Lympho Eosino Mono ESRUrine cultureUSG (if required)X Ray (if required) 168
  • 180. 28) Type of mutrakrichraVataja AbhighatajaPittaja AshmarijanyaKaphaja SharkarajanyaSannipataja Shakrit vighatajaRaktaja Shukraja29) Treatment protocol: Group A Group BMedicine Trial StandardDose 1 gm tid 2 gm bdDuration 14 days 14 daysAnupana Jala JalaFollow up 21 days 21 days30) Assessment of results: a) Subjective parametersParameter Day 0 Day 14 Follow up Day 21Krichra mutrpravritti(Stranguary)Rujayukta mutrapravritti(Pain during micturition)Dahayukta mutrapravritti(Burning micturition)Sakshobha mutrapravritti(Hesistancy)Vega asahatwa(Urgency) 169
  • 181. b) Objective parametersParameter Day 0 Day 14 Follow up Day 21Urine microscopicexamination30) Investigators note:Signature of ScholarSignature of Co GuideSignature of Guide 170