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AYURVEDIC ASPECT OF MUTRAGHATA

One symptom may be found in many diseases. For the patient, that symptom gives discomfort. But for a physician each and every symptom is important to understand the patho-pysiology (origin of the disease) and to exactly diagnose the case.

Dysuria – difficulty in urination (mutrakricchara) and urinary obstruction (mutraghata) are two such disease entities, where ‘difficulty in urination’ is the common feature.

Many a times, many diseases may have the same causative factors. But, based upon the nature of the individual, season of affliction, supporting food and habits, individual’s susceptibility and severity of the functional (often structural) entities, these two kinds of diseases are manifested.

Common causative factors of the disease urinary tract obstruction, its clinical features, disease classifications, probable line of treatment and common Ayurvedic remedies are discussed here below-

Obstructed urine (Mutraghata) is a diseased condition where ‘retention of urine’ is the cardinal feature, whereas in dysuria (mutrakricchara), difficulty in micturition is the typical characteristic feature. Obstruction and hence retention of urine may be caused by occlusion of the urinary tract or inflammation in the urinary pathway. Often injury, constriction / compressed stones or any other possible foreign bodies may result in this pathological condition. 

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URINARY OBSTRUCTION CAUSES 

1. Vegadharana (suppression of natural urges)-

2. Rookshaahara (intake of dry food and less intake of water) – Rooksha means dry, Ahara means food.

3. Srotorodha (obstruction to the urinary tract due to stones, gravel, foreign body etc). Sroto means body channel, rodha means obstruction. 

ORIGIN OF RETENTION OF URINE

Due to the above said causative factors the Doshas get aggravated. It is predominantly VataDosha. The vitiated Doshas mix up with (samsarga) urine and hence obstruct the flow of urine. Here, due to the influence over Apanavata, cited at Bastipradesha (bladder) the pathology continues and the urinary retention is caused.

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COMMON CLINICAL FEATURES 

Here, one can find several possibilities like interrupted flow of urine, complete obstruction of the urinary tract, non production of urine, reduced or incomplete production of urine, incomplete or complete excretion of urine etc. 

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CLASSIFICATION OF URINE OBSTRUCTION 

Based upon the clinical features, Ayurvedic text books explain 3 kinds of urinary obstruction.

1. VATAKUNDALIKA

Due to dry food, less intake of water or suppression of natural urges, Vatadosha is vitiated and it is lodged in the bladder. As it vitiates urine, it is retrograded (kundalikrita) and drive the urine in interrupted manner.

It is common in the people who work in night shift and in those who take junk and spicy food excessively.

The vata getting vitiated in the urinary bladder due to excessive consumption of dry foods and withholding the natural urges / reflexes of the body causes obstruction to the passage of urine and causes a condition called Vatakundalika.

Its symptoms are:

Pain in the bladder

Dysuria and scanty urination

Retention of urine

This disease is said to be difficult to treat

2. ASHTEELA (VATASHTEELA)

Specific causes aggravate Vatadosha and hence obstruct the urinary pathway by distending the bladder and rectum. This causes severe pain during urination as well as defecation.

This is common in the people who are used to a sedentary lifestyle.

The Vata vitiated in the urinary bladder causes distension in the bladder and anus. In the process, the vayu produces a mass which resembles a stone. This mass causes obstruction to the passage of urine and stools. This disease is called Ashteela.

3. VATABASTI

Due to constant suppression of urinary urge (due to various personal factors), aggravated Vata obstructs the urethral orifice of the urinary bladder. Thus, it inhibits the excretion mechanism of urine. This leads to partial or full retention of urine in the bladder. Ultimately it causes pain in the abdomen and supra pubic (lower abdomen) area. Often itching or irritation may be also associated as there is relaxation of muscular coat and contraction of sphincters.

It is very common in working women, executives and people who travel for long.

The vayu aggravated in the urinary bladder due to suppression or withholding of urine, blocks the exit route of the urine. This condition is called Vatavasti.

Its symptoms are:

Obstruction to the passage of urine (retention)

Pain in the bladder

Pain in the flanks and abdomen

This condition is said to be difficult to treat

4. MUTRATEETA

Withholding (suppression) the urinary urge for longer duration or post pone of the urge results in gradual (slow) excretion of urine when one goes for urination. This is called mutrateeta. In this condition often pain may complain passing little by little urine. This is usually caused due to fatigue of the muscles and sphincters due to constant withholding of urine.

This is common in women, drivers, executive officers, managers and those with high profession who are busy due to their work schedule.

When we withhold the urine for a longer time, the urine does not come out in one flow when we urinate. Rather, it comes very slowly, in bits and parcels. This condition is called Murtaateeta.

5. MUTRAJATARA

Constant suppression of urinary urge leads to back pressure and hence the bladder is distended. Further, vitiated ApanaVata occupies the whole bladder and nearby organs and causes severe distension due to exerted pressure. Thus, it creates excruciating pain in the lower part of the bladder. Often gaseous distension of abdomen and constipation are also associated. When the individual goes for urination, large amount of urine is passed with difficulty in prolonged time period. It is common in school children, security guards and officers, accountants, bank employees, painters etc.

Due to the habit of withholding the urge to urination, the Apana Vayu located in the urinary bladder gets vitiated and starts moving in a reverse or retrograde direction (upward). This condition is called Mutrajathara.

Its symptoms are:

Distension of the abdomen

Severe distension with pain below the navel

Obstruction to the passage of urine

6. MUTROTSANGA

When the urine is obstructed in the bladder or urethra for longer duration, due to various factors (functional or structural), there will be hematuria (blood with urine). Or else little urine is passed with difficulty (dribbling) or with pain. Such a condition is known as Mutrotsanga. Obstruction due to foreign bodies or urinary stones may also lead to such a condition.

This is commonly witnessed in patients with long standing diseases of urogenital system like urinary calculi, recto-vesicle fistula, chronic kidney disorders etc.

When the Vayu gets vitiated in the urinary bladder, it causes a condition called Mutrotsanga.

Its symptoms are:

The urine, on its way out gets stagnated in the urinary bladder, penis and the glans penis

If pressure is applied to bring out the urine, it comes out mixed with blood

Urination takes place slowly, in less quantity (scanty) with or without pain

Dysuria

7. MUTRAKSHAYA

In the individuals who are physically exhausted, those who suffer from dehydration (primary or secondary), the aggravated Vata and Pitta Doshas occupy the bladder. Due to this, the quantity of output of urine is reduced and hence pain and burning sensation are associated with the main complaint of dysuria. This condition is called Mutrakshaya in Ayurvedic classics. Kshaya means decrease. Mutra means urine.

This is common in the labourers who work near fire and in chemical factories, mines etc.

The vitiated Pitta and Vata located in the urinary bladder of a person who is debilitated due to diseases cause a disease called Mutrakshaya.

Its symptoms are:

Scanty urination

Dysuria

Burning sensation

This condition can be compared with anuria or suppression of urine or acute nephritis.

8. MUTRAGRANTHI

Due to the respective factors rakta (blood), vata and kapha are vitiated and they are lodged in the urethral orifice causing a cystic or nodular growth. Due to this, the person passes the urine with much difficulty. The patient will feel excruciating pain similar to the pain caused during urinary calculi. The condition is known as Mutragranthi.

This is commonly witnessed in bed ridden patients.

A small, rounded and firm cyst like structure resembling a stone getting manifested within the urinary bladder is called Mutragranthi.

Symptom: Dysuria

This condition can be compared to enlarged prostate or prostatitis.

9. MUTRASHUKRA

Shukra means semen. The person who indulges in sex, while he is having the urge of urination, will ejaculate the semen mixed with urine or excretes the urine before or after seminal ejaculation. In this condition, the semen appears like ash dissolved in urine.

This disease condition is found only in men and in those who have severe sexual urge and unplanned sexual indulgence.

When a person has sexual intercourse with a woman in the presence of urinary urge or reflex, his Vayu gets vitiated and causes Mutrashukra.

Its symptoms are:

The semen propelled from its site and not yet been ejaculated gets obstructed by this vitiated Vayu and gets discharged either before or after urination

Colour of the urine – similar to lime water.

10. USHNA VATA

Heavy exercise, long walk under extreme sunlight cause the aggravation of pitta and vatadosha. The aggravated doshas are lodged in the urinary pathway. There, it causes inflammation in the nearby areas – bladder, urethra, rectum etc. This leads to yellowish urine or blood mixed urine. In this condition, the individual passes urine with difficulty (dysuria) and very frequently. Severe pain is also associated. It is observed in outdoor workers, labourers, sports persons etc.

Due to excessive exercise and exertion, walking long distances and exposure to heat of sun, the Vayu vitiated along with Pitta gets lodged in the Vasti (bladder) and causes Ushnavata.

Its symptoms are:

Burning sensation in the urinary bladder, penis, anus

Dysuria

Colour of urine will be of turmeric colour, blood stained or blood mixed.

11. Mutrasada

Vitiated pitta and kaphadoshas together gets lodged in the urinary bladder. There, the urine is concentrated and consolidated by Vatadosha. It produces reddish yellow (hematuria) urine which is often associated with solids (cast cells). Burning sensation, dysuria and itching are also associated in this condition.

It is common in the patients with chronic renal failure or dehydration conditions.

Mutrasada is a condition in which pitta and kapha – either individually or together gets dried and solidified due to the affliction of vitiated Vayu.

Its symptoms are:

Dysuria

Burning sensation

Colour of the urine: yellow, white, red or will have the colours of all the Doshas

Consistency of the urine: Thick

Appears like the colour of: Gorochana (Bile of the cow) or Shankachurna (Conch powder)

12. VIDVIGHATA

Vit means faeces, Vighata means obstruction.

In the individuals with dry nature (vataprakriti) and who are debilitated, often vata aggravates and the stools are derived upwards (retrograded). Meanwhile, vitiated Vata moves through the urinary tract and enters the bladder. Due to this, the individual excretes urine with the smell of stools. Difficulty in micturition is associated with mild pain.

It is found as surgical complication in few of the surgeries related to the abdominal organs or uro- genital system.

When the vitiated Vayu carries the stools of an emaciated or weak person in a reverse (retrograde) direction and reaches the urinary bladder, the person suffers from a disease called Vidvighata.

Its symptoms are:

Passing of urine mixed with faeces

Passing of urine having smell of faeces

Dysuria

This condition can be compared to Recto-vesical fistula

13. BASTIKUNDALA

Long travelling or heavy brisk walk, jumping, falling, physical exertions, injury etc may cause the disposition / prolapse of the urinary bladder. Due to this, the bladder will bulge and attain upward protrusion. This causes severe pain, pulsation, burning sensation and distress. This ultimately leads to interrupted urine, pain and stiffness, cramps, distress in the lower abdomen (supra pubic area), heaviness etc.

This is common in accidental injuries, sports injuries, wrestling, stampede etc.

The Basti (urinary bladder) will get displaced from its place in an upward direction or will get inverted and starts looking like a foetus when the below said are done on a regular practise

Brisk walking

Jumping

Exertion exercises or activities

Or due to injury or pressure

Such a bladder presents the below said symptoms:

• Pain

• Fluctuation

• Burning

• Dribbling of urine

• Urine comes out in stream when the bladder is pressed

• Stiffness of the body

• Cramps

This disease is called Vastikundala.

This is a dangerous disease. It is harmful like a sharp instrument or poison. Vayu predominantly causes this condition and it is difficult to treat. 

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PRINCIPLE OF TREATMENT AND MEDICINE DIFFERENT CONDITIONS

• Snehana – Intake of medicated ghee / oils / both

• Swedana – Sudation / Sweating therapy / Fomentation

• SnehaVirechana – Therapeutic purgation using medicated ghee and oil, should be administered after Snehana and Swedana

• Uttaravasti – Enemas given through urethra and / or vagina – Should be preferred in presence of severe pain

• Mutrakrichra&MutraAshmarirogachikitsa – all the treatments and formulations mentioned in Mutrakrichra and MutraAshmari contexts should be administered for effective treatment of Mutraghata.

Medications:

1. Shilajit – (Mineral pitch, Mineral wax – Asphaltumpunjabianum)

• Shilajit should be taken mixed in VeeratarvadiGanaSiddaKashayam (decoction prepared using Veeratarvadi group of drugs)

• Shilajit mixed with sugar cures:

Mutrajathara

Mutraateeta

2. DashamulaKwatha – Decoction of Dashamula (10 roots) mixed with Shilajit and sugar is useful in Mutraghata (obstruction to urination)

It is especially prescribed in the effective treatment of:

• Vatakundalika

• Vatavasti

• Mutraghata

3. GokshuradiKwatha –

• Decoction of Tribulusterrestris

• ShuddhaShilajit (purified Shilajit)

• ShuddhaGuggulu (Purified Commiphoramukul)

All the above said should be mixed together and consumed

Useful in

• Mutraghata

• Mutrakrichra

• Mutrashukra

• Mutraroga – All urinary diseases

4. Trikantakadi Yoga –

Milk processed with:

• Trikantaka – Tribulusterrestris

• Erandamula – Root of Ricinuscommunis (castor plant)

• Shatavari – Asparagus racemosus

Added with – Jaggery and ghee

Useful in all types of

• Mutraghata

• Mutrakrichra

• Vata type of pains

5. NidagdhikaKashayam: Decoction of Soalnumxanthocarpum or its juice mixed in buttermilk is useful in

Mutraghata (all types)

Ushnavata associated with bleeding from urinary tract

6. Chandrakala Rasa – Useful in all types of Mutraghata 

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SINGLE DRUGS USEFUL IN URINARY RETENTION / OBSTRUCTION 

1 Punarnava – Boerhaviadiffusa Linn.

2 Usheera – Vetiveriazizanioides (Linn.) Nash.

3 Sariva – HemidesmusindicusSchult.

4 Chandana – Santalum alba Linn.

5 Gokshura – Tibulusterrestris Linn.

6 Pashanabheda – Bergenialigulata (Wall.) Engl.

7 Bala – Sidacordifolia Linn.

8 Shatavari – Asparagus racemosusWilld.

9 Phalgu – Ficuscarica Linn.

10 Ikshu – Sugar cane – Saccharumofficinarum Linn.

11 Durva – Cynodondactylon (Linn.) Pers.

12 Guduchi – Tinosporacordifolia (Willd.) Miers. 

PATHYA

1. Sugar cane juice (ikshurasa)

2. Milk (dugdha)

3. Warm water (ushnodaka)

4. Dry grapes – raisins (draksha)

5. Alkaline substances (kshara)

6. Water melon (karkati)

7. Musk melon (mamsakarkati)

8. Cucumber (trapusa)

9. Ash gourd (kooshmanda)

10. Fruit juice (phalarasa)

11. Thin rice gruel (manda)

12. Rest (vishrama) etc

APATHYA

1. Heavy exercise (vyayama)

2. Spicy food (vidahiahara)

3. Exhaustion (shrama)

4. Dry food (rukshahara)

5. Junk food (paryushiataahara)

6. Sexual indulgence (vyavaya)

7. Awakening / reduced sleep (jagarana)

8. Suppression of natural urges (vegarodha)

9. Bitter gourd (karavellaka)

10. Pulses – dicotyledons (shimbidhanya)

11. Frozen beverages (atishaityata)

12. Incompatible food stuff (viruddhashana) etc 

(MUTRAKRICCHA & MUTRAGHATA)

1. ABHYANTER SNEHPANA- DASHMULA TAILA/ SHATAVARI GHRITA

2. BAHYA ABHYANGA- SINHVADI TAILA

3. BASTI-(KAL BASTI)

A. (CERUM CRETININ RISE/ CRF? MUTRA GHATA/MUTRAKRICCHA)

GOKSHURA + PASHAN BHEDA + YASTIMADHU + PIPPALI + PUNARNAVA + VARUN CHAL (ALL 20GM)-> MAKE 300ML KVATHA ADD 50ML CHANDANADI TAILA + 50ML MADHU + 10GM YAVAKSHAR + 5GM SAINDHAV-> BASTI

B. LAGHUPANCHMULA KVATHA 300ML + CHANDANADI TAILA + 50ML MADHU + 10GM YAVAKSHAR + 5GM SAINDHAV-> BASTI

C. (CERUM CRETININ RISE/ CRF/ MUTRA GHATA/MUTRAKRICCHA)***

VARUNADI KVATHA 100GM + TRINPANCHMULA KVATHA 100GM -> MAKE 300ML KVATHA ADD 50ML CHANDANADI TAILA + 50ML MADHU + 10GM YAVAKSHAR + 5GM SAINDHAV-> BASTI

4. UTTER BASTI-

DASAMULA TAILA 30-40ML EVERY 3RD OR 5TH DAY (5-8 BASTI)  

AYURVEDIC MEDICINES FOR DYSURIA

KASHAYA (HERBAL DECOCTIONS)

• BrihatyadiKashayam

• Drakshadikashaya

• VaranadiKashayam

• TrikantakadiKashayam

• NishakatakadiKashayam

• KatakakhadiradiKashayam

• KokilakshamKashayam

• VaradiKashayam

• TiktakamKashayam

• AragwadhadiKashayam

• Pashanabhedikashaya

• Punarnavashtakakwatha

• Punarnavadikashaya

• Shatavaryadikashaya

ASAVA / ARISHTA

• Lodhrasavam

• Ayaskriti

• Devadarvarishtam

• Chandanasavam

• Kumaryasavam

• Dashamularishtam

• Punarnavarishtam

• Punarnavasavam

CHURNAM (POWDERS)

• ShaddharanaChurnam

• TriphaladiChurnam

• AmritamehariChurnam

• Kharjooradichoorna

VATI AND GULIKA (TABLETS AND PILLS)

• Chandraprabha Gulika

• Gokshuradi guggulu

• Saptavimshati Guggulu

• ShukramatrukaVati

• Shilajitvadi Vati

• Mehamudgara Vati

• Chandrakala Vati

• Chandanadi Vati

• Vishamajwarantaka Lauha

• Amlapittantaka Lauha

• Nishamalaki

• Shveta Gunjadi Gulika

• Valiya Marma Gulika

• Niruryadi Gulika

LEHAS AND RASAYANAM

• ShatavariGulam – Shatavarirasayana

• Narayana Gulam,

• Chyavanaprasham

• NarasimhaRasayanam

• Drakshadyaavaleha

• TrivritLeham

• AmrasaraRasayanam

• GandhakarajaRasayanam

• SukumaraLeham

PARPATI PREPARATIONS AND SATVA

• Shweta Parpati

• GiloySatva

GHRITA / TAILAM

• TrikantakadiGhrita

• TraikantakaGhritam

• ShatavaryadiGhritam

• DhanwantaramGhritam

• ShalmaliGhritam

• VirataradiGhritam

• VarahyadiGhritam

• Vastyamayantakaghrita

• VaranadiGhritam

• DhanwantaramTailam 101

• KsheerabalaTailam 101

BHASMA

• VangaBhasma

• AbhrakaBhasma

• LohaBhasma

• Naga Bhasma

• ShilajitBhasma / KanmadaBhasmam

• SvarnaBhasma

• ShringaBhasma

• RajataBhasma

• SpatikaBhasma

• RoupyaMakshika Rasa

• TrivangaBhasma

RASA AUSHADHAS

• Rasa Sinduram

• Hemanatha Rasa

• Somanatha Rasa

• Vangeshwara Rasa

• Vasantakusumakara Rasa

• PravalaPanchamrita Rasa

• Chandrakala rasa

• Kamadhenu Rasa

• Suvarna Raja Vangeshvara (SvarnaVanga)

• Siddha Makaradhwaja