1

AYURVEDIC ASPECT OF DYSURIA 

DYSURIA – AYURVEDIC CONCEPTS AND TREATMENT

In Ayurveda, Dysuria is explained under the context of Mutrakrichra. The term seems to fit the comparison as Mutrakrichra is a word composed of 2 words,

• Mutra – meaning Urine,

• Krichra – meaning difficulty.

Thus Mutrakrichra means difficulty in passing urine.

MUTRAKRICHRA DENOTES:

• The predominant symptom of the disease and

• The disease itself – unlike Dysuria which is a symptom (presentation) of various conditions

There are other contexts also in which pain and difficulty in passing urine is a symptom. In these, Mutrakrichra or dysuria appears as a symptom of other diseases. They may be considered as differential diagnosis of Mutrakrichra vis-à-vis dysuria with an Ayurvedic perspective. These conditions are –

• Mutraghata (Obstruction to the passage of urine)

• Mutrashmari (Urinary calculi – stone in urinary tract including kidney, ureter, urinary bladder or urethra)

Causes of Dysuria according to Ayurveda

• The above said conditions i.e. Mutrakrichra (as a disease), Mutraghata and Mutrashmari can themselves be considered as causes of Mutrakrichra vis-à-vis dysuria

• Though we have another set of diseases, in fact, 20 of them called Prameha in which different clinical presentations of urine w.r.t its colour, consistency, flow, quantity etc has been explained. But we cannot find the word mutrakrichra in any of these 20 conditions. Thus dysuria is not a feature of Prameha. Prameha has famously been correlated with Diabetes Mellitus, but Diabetes can only be a later manifestation of untreated or neglected Prameha.

All the causes of Mutrakrichra, Mutraghata and Mutrashmari can be considered under the causes of Dysuria. 

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MUTRAKRICHRA – CAUSES AND PATHOGENESIS

• Vyaayaama – Excessive exercise, physical exertion

• Teekshnaaushada – strong and intense medication

• Ruksha – dry food substances

• Madhya – Excessive addiction to alcohol

• Prasanga – excessive and unprotected sex

• Nityadrutaprishtayanat – Riding on the back of animals like horse etc (daily)

• Anupamamsa – Excessive consumption of meat / flesh of animals living in marshy areas

• Adhyashana – eating in excess or eating even before the food taken previously has not yet been digested

• Ajeerna – indigestion

PATHOGENESIS:

When the Dosha’s i.e. Vata, Pitta and Kapha vitiated by their own causative factors enter the Vasti (urinary bladder) either individually or together and cause constriction, obstruction, pressure or irritation in the mutramarga’s (urinary passages/tracts) they cause difficulty in the passage of urination. This condition is called Mutrakrichra.

Mutrakrichra vis-à-vis dysuria as a symptom is not only found in the above said conditions, it is also present as one of the symptoms in the below said diseases. These diseases too can be considered under the aetiology (causative factors) of Dysuria. They are as enlisted below:

• Pakvashayasthita Vayu

• Vastividradhi

• Rajayakshma

• Gulma

• KaphajaArshas

• MutranigrahajaUdavarta

• Visuchika

MUTRAVEGADHARANA

When the body wants to eliminate something, we just need to co-operate. Mutra Vega or urge to urinate or urination reflex is one among the many urges which the body produces on a daily basis. An urge or reflex is a call from our system to attend to it immediately.

When the body wants to eliminate something, we just need to co-operate. Mutra Vega or urge to urinate or urination reflex is one among the many urges which the body produces on a daily basis. An urge or reflex is a call from our system to attend to it immediately.

If we get habituated to holding the reflex due to our busy schedules, the urinary system will be trained to withhold the urine and cause many diseases especially those related to the uro-genital system. Dysuria is also one of the symptoms which occur due to withholding or suppressing the natural call to urinate. Therefore, to keep our urinary system healthy we need to follow the body basics by developing a habit of healthy and timely toileting.

Diseases presenting with Dysuria as a symptom:

Since we can find Dysuria as a presenting complaint in 3 main diseases i.e. Mutrakrichra, Mutraghata and MutraAshmari 

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MUTRAKRICHRA TYPES 

Mutrakrichra is of 8 types. They are:

1. VATAJAMUTRAKRICHRA

Presents with –

• Teevrarti – Severe pain

• Rukvankshana – Pain in groins and flank

• Rukvasti – Pain in urinary bladder

• Rukmedra – Pain in the penis

• Svalpam – muhurmutrayati – Urination in small quantity, with frequent urination.

2. PITTAJA MUTRAKRICHRA

Presents with –

• Peetammutram – Yellow coloured urination

• Saraktammutram – Urine with blood (Haematuria) or reddish coloured urination

• Sarujammutram – painful urination

• Sadahammutram – Burning urination

• Krichrammurmutrayati – Frequent and difficult urination

3. KAPHAJA MUTRAKRICHRA

Presents with –

• Vastilingagurutva – heaviness in the urinary bladder and penis

• Vastilingashota – swelling in the urinary bladder and penis

• Pichchilamutra – sticky urine

4. SANNIPATAJA MUTRAKRICHRA

This is manifested when all the 3 morbid Dosha’s get involved in the disease pathology. The symptoms too will be of mixed type i.e. the symptoms in all the above said DoshicMutrakrichra’s will be present in mixed proportions.

5. SHALYABHIGHATAJAM MUTRAKRICHRAM

When the passages of urinary tract get injured by a Shalya (foreign body) either internally or externally, they will cause severe pain during urination. This is called ShalyabhighatajaMutrakrichra. Its symptoms are similar to those of VatajaMutrakrichra.

6. SHAKRUTVIGHAATAJA MUTRAKRICHRA

On withholding the urge / reflex for defecation and having habituated to it, the Vata gets aggravated and moves in a reverse direction (upwards) and causes –

• Adhmana – Distension of the abdomen

• Shula – Pain in the abdomen (region of the bladder)

• Mutrasanga – Obstruction to the passage of urine

7. ASHMARIJANYA MUTRAKRICHRA

Formation of stones and gravel in the urinary passages leads to the manifestation of Ashmari (calculi / stone) janyamutrakrichra or dysuria due to stone.

8. SHUKRAJA MUTRAKRICHRA

When the shukra or semen which has been displaced from its site of formation (ejaculated but not come out of the urethra) gets obstructed by the vitiated Dosha’s in the urinary passages, the following symptoms are manifested:

• Sashukrakrichramutra – Urine mixed with semen is eliminated with difficulty

• Vastishula – Pain in the urinary bladder

• Mehana Shula – Pain in the penis 

4

AYURVEDIC TREATMENT PRINCIPLES 

Dysuria should be treated on the lines of treatment principles and medicines described in the context of:

• Mutrakrichra

• Mutraghata

• Mutrashmari

Since dysuria vis-à-vis mutrakrichra manifests secondarily to the below said diseases, they too should be treated. When the primary disease is treated, the patient will be relieved of Mutrakrichra. The diseases (already mentioned above in causes) are –

• Pakvashayasthita Vayu

• Vastividradhi

• Rajayakshma

• Gulma

• KaphajaArshas

• MutranigrahajaUdavarta

• Visuchika 

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TREATMENT OF MUTRAKRICHRA 

1. VATAJA MUTRAKRICHRA CHIKITSA

• Abhyanga – massage

• Snehana – intake of medicated oils and ghee

• Niruhavasti – Decoction enemas

• Svedana –Steaming / Fomentation / Sudation

• Upanaha – herbal poultices

• Uttaravasti – Enemas given through urethral or vaginal route

• Seka – Stream pouring of herbal decoctions or processed milk or oils

• Mamsarasa – Meat soup prepared from Vata alleviating drugs like Sthiradi group of medicines

MEDICINES:

Amritadikwatha:

Decoction prepared from –

• Guduchi – Tinosporacordifolia

• Shunti – Zingiberofficinale

• Amalaki – Emblicaofficinalis

• Ashwagandha – Withaniasomnifera

• Gokshura – Tribulusterrestris

2. PAITTIKA MUTRAKRICHRA CHIKITSA

• Seka – Stream pouring of herbal decoctions or processed milk or oils

• Avagahana – Making the patient seated dipped in a river or lake

• Shishirapradeha – Application of pastes made up of drugs which are cold in potency like Chandana (sandal) etc, all over the body, especially over the lower abdomen

• Vasti – Enemas, especially with milk processed with pitta alleviating drugs (ksheeravasti) and enemas with medicated ghee (anuvasana / matra)

• Payapana – drinking of milk

• Virechana – Therapeutic purgation

• Medicated ghee for intake – Ghee processed with Draksha (Vitisvinifera), Vidarikanda (Puerariatuberosa) and Sugar cane juice.

MEDICINES:

• Trinapanchamoolakashaya / Ghrita / dugdha (Decoction or ghee or milk prepared from the Trinapanchamula group of drugs)

• ShatavaryadiGhrita

• Drakshakalka – Paste of Vitisvinifera mixed with sugar should be taken with Mastu (curd water).

• GudaKsheera – Jaggery mixed in hot milk should be taken many times.

• NarikelaJalam – Coconut water mixed with jaggery and coriander powder.

3. KAPHAJA MUTRAKRICHRA TREATMENT

• Kshara – Alkalis

• Ushnaaushadha&annapana – medicines, food and drinks with a hot potency

• Teekshnaaushadha&annapana – Medicines, food and drinks which have an intense and deep penetrating nature

• Svedana – Sudation / Fomentation / Sweating therapy

• Yavanna – Food predominantly prepared using Yava (Barley – Hordeumvulgare)

• Vamana – Therapeutic emesis

• Niruhavasti – Decoction enemas

• Takra – buttermilk

• Tiktapadartha – Things and food that have bitter taste

• Marichataila – intake and enema with oil processed with Piper nigrum (black pepper).

MEDICINES:

• Ela churna (Elettariacardamomum) – should be administered with Gomutra (cow’s urine) or kadalisvarasa (juice of stem of plantain tree)

• Pravalabhasma (ash of coral) with rice water.

4. SANNIPATAJA MUTRAKRICHRA TREATMENT

Treatment should be done according to the predominance of Dosha’s.

In Sannipata,

• If Kapha is predominant – Vamana (therapeutic emesis) should be given

• If Pitta is predominant – Virechana (therapeutic purgation) is the best option

• If Vata is predominant – Vasti (enemas) should be preferred.

MEDICINES:

Shatavarimulakwatha – Decoction prepared from the roots of Asparagus racemosa

5. ABHIGHATAJA MUTRAKRICHRA TREATMENT

Treatment on the lines of treatment of VatajaMutrakrichra

Lepa –

Paste made out of: Panchavalkala (5) bark, i.e. Barks of –

• Vata – Ficusbengalensis

• Ashwatha – Ficusreligiosa

• Udumbara – Ficusglomerata

• Plaksha – Ficuslacor

• Parisha – Thespesiapopulenea

The powders of the above said Panchavalkala drugs are made into a paste and mixed with mud. This paste is made warm and applied on the abdomen.

MEDICINES: Amalaki (Emblicaofficinalis) juice should be mixed with sugarcane juice and honey and given for intake.

6. SHUKRAVIBANDHAJA MUTRAKRICHRA CHIKITSA

• Shilajatvadi yoga – Shilajit (Mineral pitch, Mineral wax – Asphaltumpunjabianum), honey, milk, sugar and ghee should be mixed together and consumed

• Pramadaamshrayate – Sex with a healthy and excited partner

• Trinapanchamulaghrita

• Shilajit with honey

• Balakwatha – Decoction of Sidacordifolia mixed with asafoetida, milk and ghee.

7. ShakrudvighatajaMutrakrichraChikitsa

Also called Vidvighatajamutrakrichra.

• Swedana – Sudation / Fomentation / Steaming / Sweating therapy

• Abhyanga – Massage with herbal oils

• Vasti – Enemas.

MEDICINES:

Gokshuradi kwatha: Decoction prepared with – Gokshurabeeja – Seeds of Tribulusterestris mixed with YavaKshara (alkali of Hordeumvulgare – barley).

8. ASHMARIJANYA MUTRAKRICHRA CHIKITSA

• Swedana – Sudation / Fomentation / Steaming / Sweating therapy

• Vatashamaka – All treatments and medications that will alleviate Vata.

MEDICINES: Pashanabhedakwatha – Decoction of Bergenialigulata 

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SINGLE HERBS USEFUL IN DYSURIA 

• Narikela – Coconut – Cocusnucifera Linn.

• Gokshura – Tribulusterrestris

• Amalaki – Amla – Emblicaofficinalis Gaertn.

• Draksha – Raisin – Vitisvinifera Linn.

• Sukshma Ela – Cardamom – Elettariacardamomum Matom.

• Usheera – Vetiveriazizanoides

• Pashanabheda – Bergenialigulata

• Varuna – Crataevanurvala

• Ikshu – Saccharumofficinarum

• Amalaki – Emblicaofficinalis

• Shatavari – Asparagus racemosus

• Durva – Cynodondactylon (Linn.) Pers.

• Draksha – Vitisvinifera

• Ela – Elettariacardamomum

• Punarnava – Boerhaviadiffusa

• Vidari – Puerariatuberosa

• Kushmanda – Benincasahispida

• Yava – Hordeumvulgare

• Kumari – Aloe vera

• Urvaru – Cucumissativus Linn. 

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EFFECTIVE DECOCTIONS FOR DYSURIA FROM SAHASRAYOGAM

1. MUTRAKRICCHRAHARA KASHAYAS

a. DasamooladiKashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 39

b. VyaghryadiKashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 39c

c. PathyadiKashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 43d

d. VaryadiKashayam

Ref – Sahasrayogam, Kashaya Prakaranam, 39e

e. Brihatyadi Kashayam

2. VARINELLU TIPPALYADI KASHAYAM

Ref – Sahasrayogam, ParishishtaPrakaranam, 52

3. KALLURVANJYADI KASHAYAM

Ref – Sahasrayogam, ParishishtaPrakaranam, 53

4. HARITAKYADI KASHAYAM

Ref – Sahasrayogam, ParishishtaPrakaranam, 54 

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CLASSICAL FORMULATIONS 

Other effective classical medicines/formulations for Mutrakrichra:

1. Eladi Churna –

Powder prepared from

• Ela – Elettariacardamomum (Cardamom)

• Pashanabheda – Bergenialigulata

• Shilajit – (Mineral pitch, Mineral wax – Asphaltumpunjabianum),

• Pippali – Piper longum

This powder should be taken with rice water or with honey.

2. Yavakshara –

Alkali of Hordeumvulgare should be taken with

• Sugar

• Buttermilk

• Kushmanda rasa (juice of Benincasahispida) and sugar

• Gokshurakwatha (Decoction of Tribulusterrestris).

3. NidagdhikaKwatha – Decoction of Solanumxanthocarpum with honey.

4. Dadimadi yoga –

• Juice of Dadima (pomegranate – Punicagranatum)

• Jeerakachurna – cumin powder

• Saindhavalavana – Rock salt

The above said should be mixed in Arjunarishta and consumed.

5. Triphaladi Yoga –

Paste of the powders of:

• Haritaki – Terminalia chebula

• Bibhitaki – Terminalia bellirica

• Amalaki – Emblicaofficinalis

• Badara – Ziziphus jujube (Indian jujube)

The paste of the above said should be mixed with Saindhavalavana (rock salt) and consumed.

6. EladiKashayam – The decoction prepared with the roots of the drugs mentioned in Eladi Yoga (above) can be used to treat Mutrakrichra.

7. LohaBhasma – Ash of Iron- LohaBhasma should be taken with honey

8. TrikantakadiGhritam

9. ShatavaryadiGhritam

10. Chandrakala Rasa 

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