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MUTRAGHATA
The ‘Vrikkas’ are the Koshtangas situated on the either side of the vertebral
column
Ch. Sha. 7/10; A. Hr. Sha. 3/12; Jejjata –Su.Ni.9/8)
Dalhana speaks that they are ball-shaped, compact and dense, covered by fleshy
masses and lie in the Kukshi – region
(Dalhana on Su. Sha. 4/331).
It could be well assumed that the description of Dalhana indicate towards the
‘Kidneys’. Throughout the centuries, many texts have been lost to us may be those texts
dealing with the Anatomical description are unavailable today. So there is room for
controversy in identifying an Anatomically correct description of the entire Urinary tract
in the existing Ayurvedic classics.
The term ‘Mutraghata’ comprises two words viz. ‘Mutra’ and ‘Aghata’, which
stands for low urinary output either by retention, absoulute or relative anuria or oliguria.
DEFINITION:–
Acharya Dalhana defines Mutraghata as,
‘Mutraghatena mutravarodhah’
i.e. a Clinical entity of Mutravaha srotas where in the obstruction to the flow of
urine is the pahognomic sign, but further states that some experts ascribe the term
‘Dushti’ to ‘Aghata’ as Mutrashukra, Mutrasada, UshnaVata types are not characterized
by Mutravarodha.
[Dalhana – Su.U. 58/1]
According to Chakrapani,
‘Mutraghatena Mutram shoshyate pratihanyate va’
i.e. a condition characterized by Drying up or Retention of urine is Mutraghata
[Ch.Chi 26/44].
Acharya Vijayarakshita in his commentary states that,
1
‘Mutraghata tu vibhandho balavan, kricchratvamalpamiti’
i.e. a condition with violent obstruction but with little difficulty in micturition is
Mutraghata.
[Ma.Ni. 31/11].
According to Sir Monier Williams,
The swelling of the abdomen in consequence of Retention of Urine is called
asMutraghata .
[Sanskrit – English Dictionary]
The mechanical obstruction to the outflow of urine may be located in the lower
tract, or in the upper tract alone and on one or both the sides; sometimes the
obstruction may be complete or partial, temporary or intermittent.
A complete obstruction of the lower tract results in a complete retention but
complete obstruction is rare as compared to the partial types of obstruction.
Many partial types slowly progress to a more or less complete block but during
this time, there also has been a gradually developing decompensation in the
emptying ability of the bladder in cases of lower tract obstruction, and in the
secreting of the kidneys in the obstruction of lower and upper tracts.[
The block increases more and more complete, as the function of the bladder and
kidneys becomes more and more inefficient.
In all the obstructions of the lower tract the effect of backpressure will be felt in
the upper tract sooner or later, but the changes of back pressure from Obstruction
in the lower tract may be very unequal on the two sides of the upper tract.
Changes in lower tract are basically vesicle where as those in upper tract are
Uretero-renal.
NIDANA:
Ancient Acharyas have not mentioned any specific causative factors for
Mutraghata, but those factors which are responsible for Mutrakricchra can be taken into
account
2
[ref. Acharya Gangadhara – Ch.Chi. 26/32].
Acharya Charaka has mentioned these factors as,
‘Vyayamateekshnoushadha rookshamadhyaprasanga nitya drutaprishta- yaanaat
anupa matsya adhyashanat ajeernat…….
[Ch.Chi.26/32].
Viz.
1. Ativyayama – excessive exercise
2. Teekshna aushadha – drugs of strong potency
3. Rukshamadhya prasanga – excessive indulgence in dry alcohol
4. Nityadrata prishtayanat – riding on the back of fast moving animals regularly/Bike
ride
5. Anupamatsya – ingestion of flesh of wet land creatures
6. Adhyashana – eating before digestion of previous meal
7. Ajernat – indigestion.
In addition to the above factors, the aetiology of Mutra vaha srotodushti is
also to be taken into consideration, which is described by Acharya Charaka in
Vimana Sthana as below,
“ Mutritodaka bhakshya stree sevanat mutranigrahat
mutravahini dushyanti ksheenasyabhikshatasya cha ..”
[Ch. Vi. 5/20]
Viz.
1. Mutritodaka bhakshya stree sevanat – indulging in sex or drinking or eating under the
urge of micturition.
2. Mutranigrahat – suppression of the urge of micturition
3. Ksheena – emaciated person
4. Abhikshat – trauma to urinary passage
Each of the above enumerated Nidana are discussed below separately in relation
to their role towards the manifestation of Mutraghata.
3
ATIVYAYAMA:
This means over exertion of the body and the ill effects of it are mentioned as
Shrama (exertion), Klama (exhaustion), Kshaya (consumption), Trishna (thirst)
Raktapitta (bleeding disorder), Pratamaka (dyspnoea), Kasa (cough), Jwara (fever) and
Chhardi (vomiting)
[Ch. Su. 7/33];
And is described that it brings a violent end to the body
(Ch. Su. 7/35).
Thus it is clear that Ativyayama leads to extreme vitiation of Vata and other
Doshas & thus could serve as causative factor for the onset of Mutraghata.
TEEKSHNA AUSHADHA:
Teekshna means sharp or acute and Aushadha means drug. Hence, the excessive
intake of the drugs having sharp potency will definitely lead to Vata vitiation.
RUKSHA MADYA PRASANGA:
Bhavaprakasha has elaborated on this term as “Ruksheti Madya Visheshanam”
and “Prasanga – Satatam Seva”
[Bh.Pr.Ut. 35/1]
Thus continuous use of excess quantity of Ruksha [dry] variety of Madya
[alcohol] leads to Mutraghata.
In western medical science too, it has been reported to cause Haematuria and
micturition syncope (French’s index).
As Madya is having opposite qualities of Ojas, it causes destruction of Ojas. Thus
Oja-kshaya again leads to Vata vitiation thus providing a base of causation of
Mutraghata.
4
NITYA DRUTA PRISHTAYANAT:
Excessive riding or driving of vehicles, horses etc. lead to fatigue and exertion
thus vitiates Vatadosha.
Furthermore, it can be understood that in the present era of mechanical life
style, due to constant stress, strain and having to ride long distances to reach the
destinations, everybody is in the habit of suppression of natural urge of
micturition and therefore the conditions such as Mutraghata can be manifested.
ADHYASHANA AND AJEERNA:
Improper dietetic habits lead to the production of Ama in the body thus lead to
Sroto Avarodha, which is one of the main causes for Vata vitiation. This may contribute
to manifestation of “Mutraghata”.
ANUPA MATSYA:
Kapha is the dominant Dosha of Anupa Desha and creatures of such land are
Maha-abhishyandi by nature (Su.Su. 36/49; 46/124).
Maha-abhishyandi Ahara is responsible for excessive Kledatva in Dosha, Dhatu,
Mala and Srotas, thus producing favourable conditions in the body for various
diseases.
Mutra being the watery constituent of Sara – kitta Vibhajana, it can be thought
that excess of Kledatva is imparted to Mutra and there by allowing the vitiated
Doshas to be lodged in it and thus gains access to Mutrashaya, giving rise to
various conditions of Mutraghata.
KSHEENA:
An emaciated person is more prone for Mutraghata, as it is one of the cause of
Mutravaha Srotodushti.
Also “Rukshasya Klantadeshasya” has been a causative factor of Mutrakshaya,
type of Mutraghata.
5
Here, it is worth to note the symptoms of Ksheena person as put forth by Charaka
in Kshataksheena chapter viz., Sarakta Mutrata (Haematuria), Parshvaprishta
Katigraha (stiffness of loins, back and waist regions) [Ch. Chi. 11/13].
Thus, an emaciated person is more likely to be a sufferer of Mutraghata and
related complaints.
ABHIKSHATA:
A person suffering with injury to the organs of Mutravaha Srotas no doubt will
suffer from Mutraghata and related complaints.
This can be substantiated by Sushruta’s verse – “Mutravahedve, Tayormulam
Vasti Medhram Cha, Tatra Viddhasya Anaddha Vastitaa Mutra-nirodhah
Stabdha-medhrata. Cha” [Su.Sha.10/12]
There are two Srotases, carrying urine. Their origin is from urinary bladder and
penis.
Any injury to them will give rise to bladder distension, urine retention and
stiffness of penis.
Tatra mutravahacchedan --- mutrapoorna basteh!. (Su. Chi. 7/36)
- Vasti is enumerated under Sadhyopranahara Marma and therefore in operative
procedure of Ashmari, the following structures are to be protected:-
- Mutravaha Shukravaha Mushkasroto Mutrapraseka Sevani Yoni Vastinashtou
Pariharet…. (Su. Chi.7/36).
- Injury to Mutravaha Srotas leads to death or retention of urine in the bladder. Thus
it is obvious that any sort of injury will lead to retention of urine or Haematuria and may
even be fatal.
MUTRAVEGA NIGRAHA / MUTRA VEGARODHA
This is one of the prime factor mentioned in the causation of Mutraghata.
6
First it is to be understood that Apana Vata, being seated in pelvic region must be
functioning normally for evacuation of urine; any impairment in it’s function such
as Pratiloma - gati, leads to various affliction of Mutravaha Srotas such as
Mutraghata, Ashmari, Prameha etc.
“ Marute pragune bastou mutram samyak pravartate vikara vividhanshchapi pratilome bhavanti hi Mutraghatah pramehashcha
shukradoshastathaiva cha mutradoshascha ye kechid Vastireva bhavanti hi “ ( Su.Ni. 3/27,28)”.
Also, the Laxanas of suppression of Mutraghata have been mentioned by
Sushruta under the Laxanas of Mutrodavarta viz.,
“ Mutrasya vege abhihate narastu kricchrena mutram kurute alpam alpam medhre gude vankshna Vasti mushka nabhi
pradeshesvathapi murdhni anaddha Vastischa bhavanti tivrah shoolascha shoolairiva bhinnamurteh.”
( Su. Utt.55/9-10).
Thus scanty micturition with increased frequency and distention of the bladder
along with pain in the penis, rectum , groin, bladder and umbilical regions are caused due
to voluntary suppression of the urge of micturition.
Here Vata is the root factor in the manifestation of all the varieties of Mutraghata
i.e.
“ Sarveshu mutraghateshu yatha Vatah karanam”.
(Da. On Su. Utt. 58/27).
And it is Vata which is responsible for the onset of urge of micturition.
The involvement of Vata in Mutraghata can be further substantiated by the
following conditions as described by
Acharya Charaka-
“Tatra koshtashrite dushte nigraho mutra varchasau”
(Ch. Chi. 28/24)
Vata provoked in Koshta produces Nighrahana (retention) of urine and faeces.
7
“Graho vinmutraVatanam ……….gudasthite anile” (Ch.Chi. 28/26)
Vata situated in Guda produces Graha of Mutra, Purisha and Vata etc.
“Mutrapravrittiradhmanam bastau mutravrite anile” (Ch.Chi.28/60)
when Vata gets Avrita by Mutra, it causes Mutra-apravritti and Adhmana in Vasti.[
Acharya Sushruta states:-
“Pakvashayasto .. kricchramutra purishatvam anaham ..” (Su.Ni.1/23-24)
Vata vitiated in Pakvashya, produces Antrakujana, Nabhi - Shula, Mutrakrichhra,
Anaha etc.
Ayurved believes that ’Vata’ is the factor responsible for movement and as seen
above, it’s functioning has been correlated with that of the nervous system.
Therefore it could be possible that a vitiated rather than deranged functioning of
“Apana Vayu” may bring about neural transmission of the bladder.
This is just a speculation and therefore we could probably say that Mutravegarodha
or voluntary suppression of the urge of micturition for longer period may be even
upto many years, will cause changes in the functioning of bladder and therefore
leading to various disorders.
SAMPRAPTI (AETIO-PATHOGENSIS OF MUTRAGHATA) :-
Acharya Sushruta states the importance of Pratiloma Vata in the Vasti- Rogas
such as Mutraghata, Prameha, Shukra Dosha and Mutradosha i.e.
“Marute pragune bastau ….. vikara vivdanschapi pratilome bhavantihi”
(Su.Ni.3/27-28)
Acharya Vagbhata states –
“ Adhomukho api … …I parshwebhyah puryate sukshmaihi syandamanairanaratam II yaistaireva pravishyenam doshah kurvanti vimshatim I Mutraghatan ‘ pramehanscha kricchran marmasamashrayan” II (A. Hr.Ni.9/2-3).
The commentator Arunadatta raises a doubt that, if Vasti were to be facing
downwards with a single outlet, then how do the Doshas enter to produce
Mutraghata ?
8
The clarification is that even though the Vasti facing downwards, minute vessels
fill the bladder from the sides and these are the routes for the entry of Doshas, to
produce Mutraghata.
Acharya Dalhana quotes that Vata is the main factor in the pathogenesis of
Mutraghata i.e.
“Sarvesham Mutraghatanam vayureva prayashah karanam”
(Da. on Su. Utt. 58/6)
Acharya Charaka states that when Amavisha gets localized in the urine it leads to Mutra Rogas i.e.-
“………….mutrarognscha mutrastham”. (Ch.Chi.15/49)
SHATAKRIYAKALA:
Shatakriyakala explains the pathogenesis of a disease in stages right from the
incubation period to the complete manifestation and later consequences there of.
SANCHAYA:
This is the initial accumulation of a Dosha due to individual vitiating factors.
Mutravegarodha has been mentioned as one of the prime Nidana in almost all the
types of Mutraghata.
The Apana Vayu being vitiated by indulging in the afore mentioned Nidanas starts
accumulating in it’s own places- the Kati, Vasti, Pakwashaya and Medhra .
Along with this the bodily Vayu is vitiated by Vatakara ahara and Vihara. In this
stage, the individual experiences occasional discomfort in the act of micturition,
which seems to be tolerable and he neglects it.
There may be feeling of Adhmana and Atopa in Vata Pradesha along with a very
mild discomfort in passage of urine.
In this stage, the person presents with vague symptomatology and the physician
has to be clear enough to elicit the history and symptoms to prevent further
vitiation.
If not, the symptom will not seem to be those of the Mutravaha Srotas and
treatment can be missed altogether.
9
PRAKOPA:-
If a person neglects above stage and, passes into this stage, there will be further
vitiation of Vata, due to the indulgence in the above said Nidanas.
This vitiation occurs in all the Vata stanas and lead to hampering of the
functioning of both Pitta and Kapha in terms of ”Vishamagni” which lays the
foundations for the production of Ama.
Here, again the symptomatology experienced may not be directly related to
Mutravaha Srotas but rather to those of initial Ama formation i.e. Amlika, Pipasa
etc. and further Adhmana and Atopa.
Therefore, again the possibility of not arriving at a diagnosis of the Mutravaha
Srotas.
Only an experienced physician can foretell the consequences.
PRASARA:
In this stage there will be the spread of the vitiated Doshas from their locations to
other sites and therefore a mixed symptomatology may be found.
The process of Ama formation already set in is further carried on. As it is already
known that the Mutra is result of Sara-Kitta Vibhajana of Ahara, which is a
combined effort of Tridoshas with Agni.
The Mutranirmanaprakriya (formation of urine) has been nicely presented in
Sushruta Samhita. The Dhamanis are classified into Urdhwa, Adhah, and Tiryak
traversing.
It has been explained that there are two Adhogami Dhamanis, which carry Mutra
from the Antras to be expelled out. (Su.Sha. 9/7).
But Acharya Dalhana comments that it is not the Mutra that is carried out but
rather the Toya, which is the product of Ahara Vivechana.
This Toya is further converted into Mutra (Bhavishyato mutrasya karanabhutam)
by the time it enters the Vasti (Tadevodakam Vastivivarapraptam
mutramityucchyate) and it is Toya part of Kitta, which is carried by the above
said two downward traversing Dhamanis (Da. Su. Sha. 9/7).
10
Thus this process of Sara-Kitta Vivechana is hampered and the Doshas gain the
access to the Mutravaha Dhamani and start spreading.
And also due to Ama there exist Sroto Avarodha, which further vitiates the Vata,
which lead to Vimarga Gamana and Atopa due to the blockage in its course
through the channels.
And there will be the manifestation of the Laxanas due to Ama such as Avipaka,
Paridaha, Arochaka, Agnisada etc.
In this stage, the Laxanas related to Mutra may be more pronounced than the
previous stages, with increased difficulty in micturition.
But, again there is no evidence which exists to pinpoint a diagnosis.
STHANA SAMSHRAYA:
In this stage, the premonitory features of a disease are manifested and in this stage
only the vitiation of Dhatus starts.
The vitiated Doshas along with Ama traversing through the Sukshma Siras,
Dhamanis get lodged in Vasti and forms a base for the complete manifestation of
Mutraghata.
The terminologies like Chidravaigunya and Mutra Srotonirodha used in the
types of Mutraghata further substantiate the lodging of Ama in Vasti to manifest
Mutraghata.
Acharya Charaka states that Ama attaining its seat in Vasti causes Vasti Rogas
(Ch. Chi. 15).
As mentioned in the literary contrive, a doubt is raised in Astanga Hridaya in
Mutraghata Nidana as to how the Doshas reach the Vasti?
It is said that it is through the Sukshma Siras pouring in to Vasti from the sides
and thus the entered Doshas produce various Vasti Rogas.
Further, Acharya Dalhana clarifies that fact that all the varieties are not purely of
Mutraghata but the conditions like Mutroukasada, Ushna Vata and Mutra Shukra
are Mutradoshas as there is no Aghata in these conditions.
Thus, Vasti is the Sthana for the Sthana Samshraya of Doshas.
11
In this stage, the premonitory symptoms are manifested. As there are thirteen
varieties of Mutraghata, no set of Purvarupa is described.
But it can be evaluated that the obstruction to the flow of urine is more
pronounced and occurs more often than the previous stages.
The symptoms of Vasti Adhmana and Vasti Shula are also experienced in a
greater degree. Mutra Vivarnata too is noticed occasionally.
It is the expert physician, who recognizes the seat of the disease as Vasti and
labels a person suffering from afore mentioned symptoms to be proceeding
towards either of the variety of Mutraghata.
This can be further supported if a careful analysis and proper investigations are
carried out.
VYAKTI:
This is a stage, where complete manifestation of a disease sets in. each and every
symptom of individual variety of Mutraghata is identified in this stage.
BHEDA:
If the disease is miss-diagnosed and miss-managed or properly not treated in the
various stages, they proceed towards complications and involvement of other
bodily systems thereby complicating the management, probably due to extensive
damage sustained or irreversible structural changes having taken place, on
account of the negligence of early diagnosis and prompt treatment.
In Mutraghata, there may be Acute obstruction or Chronic obstruction followed
by Incontinence, Haematuria, Diverticulaformation, Ureteral Dialation and
Ascending Hydronephrosis there by leading to fatal outcome.
SAMPRAPTI GHATAKA:
Dosha – Vata (Apana) predominant Tridoshas
Dushya – Rasa, Rakta, Kleda, Sveda, Mutra
Agni – Jatharagni Mandya
Udbhava Sthana – Koshta
Adhishtana – Vasti
12
Srotas – Mutravaha
Stotodushti Prakara – Sanga, Vimarga Gamana, Siraja Granthi.
Roga Marga – Madhyama
PROGNOSIS OF VARIOUS TYPES OF MUTRAGHATA:
Vatakundalika - difficult to cure
Ashteela -- -
VataVasti – difficult to cure.
Mutrateeta – -
Mutra jathara – -
Mutrasanga – -
Mutrakshaya – curable with great difficulty
Mutragranthi – serious
Mutrashukra – -
Ushna Vata - -
Mutroukasada – -
Vidvighata – -
Vasti Kundalika – dreadful condition with accompaniment colic, cardiac
failure, fainting, dyspnoea due to displacement of bladder.
CLASSIFICATION:
The types of Mutraghata as per the view of different Acharyas is given below-
Types Su Cha Va DoshaVatakundalika + + + VataAshteela + + + VataVata Vasti + + + VataMutrateeta + + + VataMutrajathara + + + VataMutrotsanga + + + VataMutrakshaya + + + Vata –PittaMutragranthi(Raktagranthi)
+ + + Vata-Pitta,Rakta
Mutrashukra(mutrakricchra)
+ + + Vata
13
Pittaja mutroukasada + + + Vata,PittaKaphaja mutroukasada + - - Vata,kaphaMutroukasada + - - Vata,KaphaVidvighata - + + VataVasti kundalika - + + Vata
Thus, Mutrashukra of Sushruta is described as Mutrakricchra by Charaka.
Mutroukasada is divided into Pittaja and Kaphaja types by Sushruta whereas Charaka
dealt it under one heading i.e. Mutroukasada. Vidvighata and Vastikundala types are not
described by Acharya Sushruta.
If these types of Mutraghata can be classified into three categories as projected
below, then we may be in a position to understand the varieties more clearly and it will
help us to analyze a patient presenting with related complaints –
A. Vatakundalika, Vata Vasti and Mutrajathara can be grouped under Neurogenic
disturbances of bladder.
B. Ashteela, Mutragranthi, Mutrotsanga and Vastikundalika can be grouped
under Organic disturbances, where the symptoms of retention of urine, increased
frequency of micturition, distension of abdomen and mass felt per rectum are due to a
growth either in
the bladder, urethra, prostate or other growths.
C. Mutrateeta, Mutrakshaya, Ushna Vata, Mutroukasada, Vidvighata and
mutrashukra can be grouped under category “Others”, where the disturbance in urinary
function is either due to physiologic reasons or injury etc.
We can analyze the various varieties of Mutraghata under the three categories
and possible explanation on modern lines is presented, which is completely based on
thorough discussions. Though the classification may not be complete but it may prove to
be an aid in approaching a case of Mutraghata with varied symptomatology and to plan
the treatment accordingly.
14
A table is presented here on the lines of modern symptomatology, to identify the various types.
Types A B C D E F G H I J K LVatakundalika + + + - - - + - - + - -Vata Vasti + - - + - - - - - + - -Vasti kundalika + - + + - - - - - + + -Mutra jathara + - + - - - + - + - - -Mutra granthi + - + - + - - + - - - -Mutrotsanga + + + + + - - - - - + -Ashteela + + - - - + + + - - - -Mutrateeta + + + - - - - - - - - -Mutrakshaya - - + - - + - - + - - +UshnaVata - - - - + - - - - - + -Mutroukasada - - + - - - - - - - + -Vidvighata - - + - - - + - - - - +Mutrashukra - - + - - - - - - - + -
A – Retention of urine
B – Increased frequency
C – Dysuria
D – Dribbling Micturition
E – Haematuria
F – Oliguria
G – Constipation
H – Granthi
I – Abdominal distension
J – Pain in Abdomen
K – Discoloured urine
L – Faecum through urine
VATA KUNDALIKA [Ref : Su.Ut.58/5-6, Ch.Si.9/39,40, A.Hr.Ni.9/25]
Nidana:
• Rukshannapana (Ingestion of un-unctuous substance)
• Vega Vidharana (Suppression of the natural urges)
Sampapti:
15
• Vayurantramashritah, gatisangadudavrittah
• Aavidhya mutram bhramati
• Vayurbhagna vyaviddha kundali
• Mutram charati sangrihya vigunah kundali kritah
i.e., owing to clogging in the urinary passages, the Vata is turned upwards and
thus its motion, becoming broken or vitiated, it assumes either a crooked or circum-
gyratory motion in the bladder as well as in the urinary channels and vitiates the urinary
function.
Laxanas:
• Srijedalpam alpam shanaih shanaih (scanty and dribbling micturition with increased
frequency)
• Sarujaska (painful micturition)
• Samstambha bhanga gaurava veshtana (rigidity, breaking pain, heaviness, girdle pain)
• Teervaruja (severe colic)
• Vitsanga (retention of faeces)
Commentary (Teeka) : Here “Stambha” is explained as “Vasti Kathinyam”
“Alpam Alpam” indicates “Stokam Stokam”; i.e. in obstructed jets with increased
frequency (Arunadatta – A. Hr. Ni. 9/25).
VATA – VASTI ( Ref. Su. Ut. 58/9-10, Ch. Si. 9/37, A. Hr. Ni. 9/ 20-22)
Nidana:
Mutravegadharana (suppression of the urge of micturition).
Samprapti:
Nirunaddhi mukham tasya basterVastigato anilah i.e. the Vata gets provoked owing to
suppression of its action and causes obstruction to the bladder outlet.
Laxana:
• Mutrasanga (retention of urine)
16
• Vasti kukshi nipiditah (pain in bladder and loin region)
• Kandu (itching sensation in the bladder region)
MUTRAJATHARA (Ref. Su. Ut. 58/13-4, Ch. Si. 9/29-30, A.Hr. Ni. 9/27,26)
Nidana:
• Mutrasya vihate vege (voluntary suppression of the desire of micturition)
Samprapti:
• Apanah kupito vayurudaram purayedbhrisham (i.e. in consequence of suppression of
the urge of urination, the Vayu gets aggravated and causes painful distention of abdomen)
Laxana:
• Nabhera dhostadhmanam janaye tteevra vedanam adha hsroto
nirodhanam (distension below the umbilical level resulting into indefinite pain
accompanied by retention of urine and faeces).
• Apakti (indigestion) The Laxanas mentioned in these varieties seem to simulate with
the conditions of bladder due to neurogenic disturbances. Therefore a brief review of this
aspect is presented here:-
VASTIKUNDALIKA (Ch. Si. 9/44-46)
Nidana:
• Drita (Excessive running)
• Adhvagamana (excessive way faring)
• Langhana (fasting)
• Ayasa (exertion)
• Abhigata (trauma)
• Prapeedanat (compression)
Samprapti:
17
• Svastanad Vastirudvrittah shulastishtati garbhavat (due to the above mentioned
Nidanas, the bladder is displaced upwards and becoming enlarged and it appears like a
gravid uterus).
Laxana:
• Shula (colic)
• Spandana (throbbing)
• Daharti (burning pain)
• Bindum bindum sravatyapi (passes urine drop by drop)
• Peeditastu srijeddharam (when the bladder region is pressed the urine comes out in
jets) This condition is characterized by rigidity (Stambha) and girdle pain and is termed
as “Vastikundala” or circular distension of the bladder.
Note: This condition appears similar to that of Vata Vasti type of Mutraghata as
explained by Vagbhata (A. Hr. Ni. 9/20 – 22). In addition to this, Acharya Charaka has
further explained the involvement of Pitta and Kapha in this disease. He says that when
this condition is accompanied of urine, while when it is accompanied with morbid
Kapha, there will be heaviness, swelling and unctuous,dense condition of the urine.
Further, he states that, where the orifice of the bladder gets obstructedby Kapha and
where there is provocation of Pitta too, there the prognosis is poor and if the orifice of the
bladder is not displaced, then the condition is curable.
MUTRA GRANTHI / RAKTA GRANTHI:(Su. Ut. 58/18-19; Ch. Si. 9/41; A. Hr. Ni. 9/31)
Nidana:
Raktam Vatakaphad dushtam (Rakta vitiated by Vata and Kapha)
Samprapti:
“Abhyantare Vastimukhe mutramarga nirodhanah jayate sahasayasya granthihi” i.e.
abrupt or sudden manifestation of the Granthi in the interior side of the bladder which
obstructs the flow of urine is called as Mutragranthi or Raktagranthi. Here, Rakta, Vata
and Kapha are vitiated factors and are responsible for the onset of Raktagranthi
according to Acharya Charaka. Acharya Sushruta doesn’t mention the Doshic
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involvement but Dalhana specifies that Pitta is the responsible factor in the manifestation
of Mutragranthi.
Laxana:
• “Vritta, Alpah, Sthira Granthih” i.e. a round small and immobile Granthi in the
interior side of the bladder. (Acharya Dalhana clarifies
“Abhyantare Vastimukhe” as “Vastidwarasyabhyantare iti”)
• Vedanavan (continuous pain)
• Mutramarganirodhana (Retention of urine)
• Kricchrena srajenmutram (urine passed with difficulty & pain)
• Ashmari sama shoolam (pain similar to that experienced in Urolithiasis)
VATASHTEELA / ASHTEELA (Su. Ut. 58/7-8; Ch.Si.9/36; A.Hr.Ni. 9/23-24)
Nidana:
• Vayurantaramashritah i.e. vitiated Vata.
Samprapti:
• “Shakrinmargasya basteshcha ashteelavat ghanam granthim”
i.e. the vitiated Vata gets lodged between the bladder and rectum and produces the stony
hard swelling.
Laxana:
• Achala unnata granthih (singly immovable and elevated)
• Vinmutranila sanga (retention of urine, faeces and flatus)
• Vasti adhmana (distention of the urinary bladder)
• Vedana ca parabastou (excruciating pain in the bladder)
MUTRASANGA ( Su. Ut. 58/15-16; Ch. Si. 9/33; A.Hr.Ni. 9/29-30)
Nidana:
• Viguna anila (vitiated Vata)
• Khavaigunya (abnormality of the urinary outlet)
• Chidravaigunya (abnormality of urinary outlet)
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Samprapti:
• Bastou va api athava nale manou va yasya dehinah. i.e. in consequence of the Nidana,
the urinary flow is obstructed at the level of either Vasti or Nala (urethra) or Mani
(external urethral meatus).
Laxana :
• Mutram pravrittam sajjet (obstructed flow of urine)
• Saraktam (with blood) Va Pravahatam (staining)
• Sthitva sravecchanaih (intermittent flow)
• Vicchinnatacchesha guru shephasah (dribbling of urine)
Commentary (Teeka) - Acharya Dalhana explains the process of vitiation of Vata & the
disease as follows –
a. The Viguna Anila i.e. Vimarga Gami Vata aggravated by it’s own factors lead to
Margavarodha ( obstruction of the outlet ) or conversely Margavarodha ( obstruction of
the outlet) may lead to aggravation of Vata.
b. Sarakta has been analyzed as “Samsakta’ meaning ‘obstructed’.
c. ‘Saruja’ is due to ‘Ati Vata Prakopa” , whereas ‘Niruja’ due to ‘ HinaVata Prakopa’.
d. Even though ‘Nala’ (urethra) signifies the ‘Mani’ (ext. urethralmeatus) also, it is
commented that more importance is stressedupon Mani – region as the Utsanga of Mutra
(obstruction of urine)(upward / reverse direction) is felt at that area.
e. Arunadatta and Todaramalla in their commentary on AstangaHridaya have nicely
analyzed the condition of Mutrasanga as below
–
i. ‘Yadakshiptam mutramalpam’ has been explained as
‘kinchicchesari mutram tadhastou sthitamathara nale manikande va sthitam’ i.e. the
obstructed flow resulting in residual urine may be situated either in the Vasti (urinary
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bladder), Nala (urethra) or the Manikanda (glans penis),depending upon;
‘Chidravaigunya’ i.e. Mutradvara dosha. Here, the Mutradvara dosha may be
considered as either theUreteral orifices or the Urethral orifice.
ii. Furhter he quotes – Tatra sthitva paschat anantaram, shanaih i.e. Mandam mandam
kritva sravet, i.e. the residual urine then dribbles out in small jets frequently.
iii. Mukta mutrasyah, Sheshatacchesah, Savicchinah ChitvaChitva Bhavati
Vayoschalatvena. Due to the Chalaguna of Vata, the urine flow is obstructed, small in
jets and therefore thepatient has sense of incomplete emptying of the bladder and asa
result of this, he experiences heavyness in the penis (Guru Sephas).
This category of diseases, predominantly show obstructive as well as Irritative symptoms
of the bladder due to an in growing Ganthi and therefore these symptomatologies of
retention of urine, increased frequency of micturition, incontinence etc. are individually
presented in order to understand the possibilities of the condition we may come across
when presented with a patient of above complaints. Again this is just an attempt to
analyze the varieties of Mutraghata for better understanding.
MUTRATITA (Su.Ut.58/11-12; Ch. Si. 9/35; A.Hr.Ni. 9/20)
Nidana:
• Vegam sandharya mutrasya (suppression of the natural urge of micturition)
Laxana:
• Pravahato mandarujam (stream with mild pain)
• Alpam alpam (obstructed flow with little quantity)
• Punah punah (increased frequency) i.e., a person habituated to withholding to urge of
micturition wanting to pass urine (Sristamicchati) finds difficulty in starting the urine
flow (Kanthancitsam pravartate) and experiences mild pain on straining and the flow is
obstructed and frequency is increased due to the incomplete emptying. This variety can
be very well understood by referring back to the “Mutra vegavarodha” part of this study.
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MUTRA-KSHAYA (Su. Ut. 58/17; Ch.Si.9/34; A.Hr.Ni.9/37)
Nidana:
• Rukshasya klantadehasya
Samprapti:
• Vastisthou pittamarutou mutrasanksayami.
- i.e., even though a Ruksha person has no pitta aggravating factors, but still the
involvement of the Pitta along withVata has been stressed upon. This leads to the drying
up of the urine (Mutrashoshana – Da.Su.Ut.58/17)
Laxana:
• Sadaha (burning micturition)
• Savedana (painful micturition)
• Mutrakricchra (troublesome/small quantity of urine)
Note: Acharya Charaka has not given the involvement of Pitta in this condition. The
definition given by Chakrapani i.e. “Pratihanyate shoshyate va” seems to be applicable
here and it could well define a case of Anuria. Hence, description of Anuria is being
presented here.
USHNA-VATA: (Su.Ut.58/22-23; Ch.Si.9/38; A.Hr..Ni 9/35-36)
Nidana:
• Ati vyayama (excessive exercise)
• Ati adhvagamana (excessive walking)
• Ati atapasevana (wandering/sitting in sunlight)
Samprapti:
• Pittam Vastim Prapyanilavritam
• Vastim medram gudam chaiva pradahan sravayedadhah.
- Because of indulgence in causative factors, Vata accompanied with Pitta enters Vasti
and causes burning pain in the Vasti, Medhra and Guda, and the person passes urine with
difficulty.
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Laxana:
• Mutram haridram (haridra coloured urine)
• Saraktam (with blood or high red coloured urine)
• Raktamevava (only blood)
• Kricchrat pravartate (difficulty in micturition)
Commentary (teeka) – Acharya Dalhana clarifies the Laxana as follows (Su. Ut. 58/22-
23) –
• Saraktam ishadraktavarnamishacchonitam va ; i.e., a high red coloured urine or
bloody urine.
• Raktam va iti kevalam shonitam, atyanta raktavarna mutram iti;
i.e., gross haematuria. As can be seen from the clarification of teeka, haematuria seems to
be the prominent symptom. Hence, the description of haematuria is presented here.
MUTROUKASADA: (Su. Ut. 58/24-26; Ch.si. 9/27-28; A.Hr.Ni. 9/38-39)
Definition:
“ Mutrasya prasravanasya okam ashraya sthanam sidati iti ”. i.e., affliction of Ashraya
sthana of Mutra (Vacaspatyam & Amarakosha)
Nidana and Samprapti:
“Pittam kaphodvavapi va samhanyate anilena” i.e., Pitta and Kapha combined together
along with Vata enter the bladder and produce Mutroukasada.
Laxana: Pittaja variety:
• Vishada mutra (clear urine)
• Pita mutra (yellowish urine)
• Sadaha (burning micturition)
• Bahala ( thick urine)
• Shuska Gorocana Sannibha (yellowish)
Kaphaja variety:
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• Picchila (slimy)
• Samhata (dense/cloudy urine)
• Shveta (white urine)
• Kricchrapravartana (burning micturition)
• Shankhachurna prapanduram (whitish discolouration)
The main entity recognizable here is the passage of discoloured urine
VIDVIGHATA (Ch. Si. 9/42-43; As. Hr. Ni. 9/33-34)
NIDANA –
“ Ruksha Durbala”- person who are emaciated & parched.
SAMPRAPTI –
“Vatenodavrittam shakridyada mutrasrotah prapadyet
vitsamshritam tada”
i.e. the morbid Vata enter into the urinary passage along with faeces and produces a
condition characterized by foul smelling urine mixed with stools.
LAXANA –
Acharya Vagbhata makes use of the terms- “mutrasroto anuparyeti” instead of
“mutrasrotah prapadyet” of Charaka, which is commented upon by Todaramalla as “
Mutravaha srotovivaram prapnoti” i.e. vitiated Vata along with the Shakrit ( faecal
matter) enter the Mutravaha Srota Vivara ( urinary passage). The condition very aptly
describes the entities wherein faeces is passed through urethra but again we have to
recollect the conditions leading to this-
MUTRASHUKRA (Su. Utt. 58/20-21, Ca,Si. 9/32: A.Hr. Ni. 9/32)
Nidana –“ Pratyupasthita mutrastu maithunam yo abhinandati” ; i.e.,performing coitus in the presence of natural urge of micturition.
Samprapti –“ Tasya mutrayutam retah sahasa sampravartate.”
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Laxana –“ Purastadvapi mutrasya pascat va api kadachana bhasmodakapratikasham.”Due to the aforesaid Nidana, the seminal fluid ejected by Vata will either precede or
follow the urine stream, which is similar to Bhasmodaka (ash coloured).
This seems to be the physiological disturbance of the sphincteric mechanism & therefore
a brief review of the sphincteral region & the mechanism has been included here -
Throughout the most of the length of the prostatic urethra, the posterior wall possess a
midline ridge, the urethral crest, which projects into the lumen causing it to appear
crescent in transverse section. On each side of the crest, there is shallow depression called
“prostatic sinus”, the floor of which has orifices of the prostatic ducts. About the middle
of the length of the urethral crest, ‘the verumontanum’(colloculus- seminalis) forms an
elevation, on which the ejaculatoryduct open. A distinct collar of circularly oriented non-
striated muscle occurs in the bladder neck, prostatic urethra, continues distally with
themuscular components of the genital tract distally. This smooth muscleis supplied with
a rich plexus of sympathetic nerve fibres, which onstimulation cause the sphincter to
contract thereby prevent theretrograde ejaculation of semen in to the bladder. During
seminalemission, the sympathetic nervous system too prevents coincidental
contraction of detrusor smooth muscle.The epithelium lining of the prostatic urethra and
the proximal part of the prostatic urethra is of typical urothelial type and is
in continuity withthe lining of the bladder; it is also continuous with the ducts of
theprostate and bulbo-urethral glands and with the linings of the seminal vesicles and
ejaculatory ducts.At the time of seminal ejaculation, with a full bladder,when the external
sphincter is completely open, the internal sphincter must function as voluntary muscle,
otherwise there would be leakageof urine or passage of semen in to the bladder.
Thus completes the classification of various types of Mutraghata and their near possible
correlations to make the subjectmore vivid and understandable. As said earlier, this
attempt is just toenhance our prospective viewing of Mutraghata but certainly a
stepforward in helping us to approach a patient with varied symptomatology of the entity.
PATHYA AND APATHYA: [ Bh. R. 35]
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Lastly, the most important and the most neglected aspect of the treatment is that
of Pathya and Apathya.
Dietetic control will give boost to the drugs administered and therefore enhance
the results of the given drugs.
Abhyanga, Snehana, Virechana Vasti Svedana Uttara Vasti are again descried to
be Pathya indicating their importance. Purana Shali, Yava, Madya, Takra,
Dugdha, Mashayusha, Kushmanda Phala, Patola, Talaphala etc. are all Pathya to
the patients of Mutraghara; hence the food articles of above advised things will
definitely be beneficial in alleviating the symptomatology of Mutraghata,atleast
to a certain extent and mostly that of Vata vitiation. (Bh.R.35/50-52)
Mutravegavarodha, Viruddhahara, Ativyayama, Ruksha – Vidahi Annapana
Ativyavaya, Vamana etc. are Apathya as they all lead to vitiation of Vata and
results in further deterioration of the condition ofAghata or urine retention
(Bh.R.35/53).
26
Recommended