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,

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‘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

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[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.

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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.

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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.

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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.

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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.

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“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 ?

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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.

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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).

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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.

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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

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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

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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.

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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:

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• 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)

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• 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:

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• 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).

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