Mu Trash Mari

8/22/2019 Mu Trash Mari

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MUTRASHMARI

Ayurvedic review

Ayurveda the science of life and an upanga of Atharvaveda hasdescribed many diseases related to Basti.

The learned Ayurvedic Acharyas have described in detail about

various bodily systems in relation to their Anatomy, Physiology

and Pathology etc.

The Mutravaha Samsthana (Urinary system) is one of them,

and meant for the formation and excretion of Mutra.

The following is the short description of Mutravaha Samsthana

given in ancient classics :-

Basti

Vrikka

Gavini

Mutrapraseka

Mutravaha Srotansi

Mutravaha Nadies

Mutravaha Dhamanis

Mutravaha Siras.

Basti

The word Basti Its different meanings are, to cover, base, store

house and reservoir.

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Synonyms

Mutrashaya

Mutrabasti

Mutradhara

Mutraputa

Mutraputaka. (Su. Sa. 6/26, Su. Ni. 3/20)

Definition

In Ayurvedic texts though no clear cut definition of Basti hasbeen given, it can be defined as a store house which acts as a

reservoir of urine.

Embryological development

According to the fundamental principles of Ayurveda the human

body is constituted on the basis of the Five Mahabhutas and

the Tridosha at the time of combination of Shukra and Shonita.

These eight factors are responsible for the production of each

and every organ during the foetal life.

The Basti is a hollow structure made by the Vayu entering in

the combination of essence of Rakta, Kapha and Pitta.

It has been said by all the Acharyas that Basti is derived from

Matrija Bhava- the maternal constituents (Su. Sa. 4/26).

Situation

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Basti has been accepted one among the Kosthangas by all the

Acharyas Sushruta states that Basti is surrounded by Nabhi, Kati,

Muska, Guda, Vakshanas and Sepha (Su. Ni. 3/18).

Structure

The Basti is Alabu shaped and is fixed on all sides by Siras and

Sanayus according to Sushruta.

Basti is thin called and has a single out let directed downwards.

Vagbhatta has mentioned the shape of Basti as Dhanurvakra

i.e. a curve like a bow with a downward opening.

Basti has been counted as one of the vital parts i.e. Marmas of

the body. It is of the Snayu Marmas type with area of four

fingers. (Su. Sa. 6/7)

Vrikka

Synonyms :-

Vikka

Vrikka

No direct reference of Vrikka's relation to urine formation is

found in either of the Ayurvedic classics.

Vrikka are two in numbers and are situated in the lumbar

regions on either side in the posterior abdominal wall in Kostha.(Su. Ni. 9/18 Dalhana)

Like Basti Vrikka is also a maternal contribution derived from

essence of Rakta and Meda. (Su. Sa. 4/30)

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Sarangdhara has considered the Vrikka's as the nourishers of

the abdominal fats.

Gavini

They are two in number, situated one on each side of Basti,

receiving Mutra from the antras and sending it further to the

Mutrashaya.

(Atharvaveda 1/3/6)

Mutrapraseka

Synonyms :-

Mutrapatha

Mutramarga

Mutrasrota

It is one among the eight important organs, which are to be protected

from any injury at the time of performing surgery for Mutrashmari.

(Su. Chi. 7/38)

It is the outlet of the Basti, Which is two Angulas in females and

Twelve Angulas in males.

In male it carries both Mutra and Shukra, while in female only

Mutra. (Su. Sa. 4/22)

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Mutravaha Srotas

According to Charaka the word Srotas is 'Sravanat Srotamsi'

which means, where from something oozes out. This way the

channels which carry Mutra. Charaka says that Mutravaha Srotas has its origin from Basti

and two Vankshanas.

Sushruta believes Basti and Medhra as the roots of Mutravaha

Srotas.

Any trauma to this Mutravaha Srotamsi leads to acute retention

of urine, distension of urinary bladder and painful erection of the

penis, ultimately leading to death of the patients. (Su. Sa. 9/12)

Mutravaha Nadis

Sushruta in Ni 3rd chapter says that these are thousand in

number and are situated in between Pakvashaya and Basti and their

main function is to carry the Mutra from Pakvashaya to Basti, like the

rivers fill the ocean with water. (Su. Ni. 3/21-23)

Mutravaha Dhamanis

Sushruta termed as 'Adhogami Dhamani' which are meant for

Sara-Kitta Vibhajana and to transport Mutra, Purisha Sukra,Artava, Apana Vata etc. downwards.

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These same Dhamanis taking part in the Sarakitta vibhajana

process the functions of which stated are Dharana and Yapan

of Mutra and Basti.

Mutravaha Siras

There is no reference available with Brihattrayee about

Mutravaha

Siras.

Sharangadhara describes that the Maladrava of digested food

i.e. Mutra is transported to Basti by Siras.

Adhamalla in his commentary on Sharangadhara says that the

Siras are concerned with Aharajala transported to Basti through

Mutravaha Siras.

That above stated organs take an active part in the

transportation of urine in one or the other way.

So we find that mutravaha nadi, dhamani and siras have close

relation with the urinary system.

Mutranirmana Prakriya

Ingested food Digestive process starts Saman Vayu action

Digestive process completion

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SARA (PRASADA) KITTA

Nourishes the body Dravamsa Sandra

Mutra Purisha

Now according to Sushruta this Mutra goes into the Basti from

the several minute pores, as a new pitcher gets filled up with water

from the minute pores, when it is kept in water upto its mouth.

(Su. Ni.3/23)

Introduction

Mutrashmari is one of the most common and distressing

maladies among the group of urinary disorders.

Acharya sushruta, the pioneer in the art and science of surgery

has described widely and comprehensively about the

Mutrashmari with its classification, symptomatology, etiology,

pathology, complications and its management.

This is the proof for the depth of knowledge of the Acharyas on

the subject of urinary disorders as a whole.

Etymology

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"Ashmanam Rati Dadati iti Ashmari" means the formation and

presentation of a substance like stone.

"Ashma" means "stone"

"Rati" means "to present"

Definition

No satisfactory definition of the Ashmari is available in either of the

Ayurvedic texts,

"Ashmari Mutra Krichhra Syat " (Amarakosha)

"Ashmari Mutra Krichhra bheda" (Ayu. Shabdhakosha)

Ashmari - Stone, gravel, strangury (M. Williams)

Synonyms

* Sanskrit -Ashmari, Ashmarih

* Hindi - Pathari

* English - Stone, Gravel, Calculus, Vesical - Calculi.

* Latin - Calculus (singular)

Calculi (Pleural)

Description of Disease Nidana Panchaka

a) Nidana

According to Sushruta,

Who neglect the Samshodhana of internal channels

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Who are engaged in unwholesome dietary habits become the

victim of Ashmari.

Acharya Charaka has not given separate chapter for the

disease but explained it under the "Mutrakricchra".

Hence the nidanas of both Mutrakrichhra & Ashmari can be

taken as same. They are :-

Practice of excessive exercise

Strong medicines

Ruksha Madyapana

Excessive intake of anupa - mamsa

Adhyashana

Ajeerna-bhojana

Matsya sevana (Ch. Chi. 26/32)

According to Vagbhata, the Nidanas are

Intake of heavy, fatty & sweet food excessively.

Day sleep

Ajeerna-bhojana

Adhyashana

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According to Kashyapa

Bhar vahana on Kati and Skandha.

b) Samprapti

Samprapti can be defined as, it is the process which starts from

'Sanchayavastha' of Doshas to the 'Vyadhi Vayktavastha'.

It is possible through Samprapti to assess the Doshas,

Dushyas, Srotodusti or Khavaigunya, Agni etc.

It is also helpful because proper treatment is only fruitful if it is

applied according to Samprapti of disease.

As said 'Samprapti Vighatanama eva Chikitsa'.

Different views have been put forth regarding the Samprapti which

are as below :-

Sushruta's View

Apathya

Asamshodhan Sheela Shleshma Mixes with Mutra Dushti

Urinary bladder Attains shape of gravel Ashmari

(Su. Ni. 3/4 & 3/24)

Sushrata's examples for clear understanding of the mechanism of

stone formation :-

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A new pitcher filled with clear water can also show settling

down of muddy particles in due course of time.

In the same way the calculi are formed in Basti. (Su. Ni. 3/25)

As air & fire of electricity in the sky consolidate water (to form

hail storms) similarly Pitta located in the bladder, along with

Vayu consolidates Kapha to form calculi. (Su. Ni. 3/26).

Charaka

Nidana Vata increases Dries-up the urine

Sevana (Quantitatively in bladder

&

Qualitatively)

Which

associated with

Shukra, Pitta, Kapha

Gradually calculi

formation i.e. Ashmari.

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Charaka explained the process of formation of Ashmari as

similar to that of Gorochana (Gall stone) in the Pittashaya of

cows. Both Kashyapa and Vagbhata accept the views of Charaka and

further state that the increase or decrease in the Medodhatu is

directly related to the size of Ashmari.

Disease Process According to Shatkriyakala

Acharya Sushruta has very well mentioned the six stages of

disease, which are called 'Shatkriya Kala' which gives the full

idea of Samprapti of the disease and helpful in the diagnosis

and treatment.

Sushruta has given more stress towards these and further says that the

exact knowledge of these stages is the only path to reach upto disease

or treatment.

In reference to the production of the disease Mutrashmari,

following six stages are the proper time for the treatment :-

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1. Sanchaya

It is the stage when Doshas accumulate in their Ashayas more

than the normal range due to various etiological factors and in case of

Ashmari these excess accumulated Doshas develop the following

symptoms :-

Discomfort in hypogastrium

Anorexia

Pyrexial feeling

General debility

Stiffness and fullness of abdomen

Yellowish tinge of the skin

Concentrated urine etc.

Acharya Sushruta says that the treatment should start as soon

as the symptoms of first Kriyakala i.e. Sanchaya develops, for the

prevention of future disease. (Su. Su. 21/18)

Prakopa

It occurs when Sanchyavastha is neglected or proper corrective

steps are not taken.

All symtoms of Sanchyavastha with more prominence and in

addition to them are :-

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- Pain over the bladder region, anal region and testicular

region.

- Painful micturition with thickness

- Thirst- Nausea etc.

(Su. Su. 21/27)

Prasara

Prasara avastha is a progressive stage of Prakopa avastha.

Following symptoms develop in this stage :-

Anaha

Atopa

Daha

Burning micturition

Anorexia etc.

But the patient who suffer from Ashmari will complain of

Frequent pain over the bladder area

Dysuria

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Pain in the testicles along with previous symptoms.

(Su. Su. 21/32)

Sthanasanshraya

This stage is also known as Dosha Dushya Sammurchchana.

In the stage Dosha may finally settle down at a place where

they find maximum favourable place (Khavaigunya).

The following symptoms develop to a patient who is going to suffer

from Ashmari :-

Fever Pain in the bladder region

Dysuria

Pain in the region of the bladder neck the scrotum & the penis.

Goat like smell in urine

Distaste of food etc. (Su. Su. 21/33)

Vyakti

Vyakti is the fifth stage and here the disease comes out with

clear picture. hence called the Rupa Avastha.

Following are the symptoms which patient feels at this stage:-

Excruciating pain in umblical region during micturition

Pain in bladder, perineal raphe & penis

Obstruction to the flow of urine

Haematuria

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Turbid and sandy urine with a shining like Gomeda gem.

Bheda

Bheda Avastha has two natural courses

Spontaneous subsiding

Leading into chronicity

This is the last stage of management and it is suggestive stage for

the complications and the prognosis of the disease.

In case of spontaneous recovery, the patient of Ashmari

experiences gradual relief of all the symptoms and

improvement in general health.

If the disease leads to chronicity then the patient complains of

obstruction of the urinary outflow with a complication involving

the upper urinary system due to backward pressure i.e.

involving the ureter and kidneys.

Purvarupa

The signs & symptoms which are indicative of a future disease

are known as Purvarupa.

Purvarupa play a very important role in the diagnosis and

treatment of any disorder.

It is a stage where the disease is reversible with very littleresidual damage.

Different classics have mentioned about the prodromal signs and

symptoms of Ashmari viz.

S.No Purva-rupa Su. A.Hr. A.S. M.N. B.P. Y.R. G.N.

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1. Basti Pida + + + + + + +

2. Aruchi + + + + + + +

3. Mutrakricchra + + + + + + +

4. Bastisirovedana + - + - - - -

5. Mushka

Vedana

+ - + - - - -

6. Shepha Vedana + - - - - - -

7. Jwara + + + + + + +

8. Avasada + - - - - - -

9. Bastigandhatwa + + + + + + +

10. Sandra Mutra + - - - - - -11. Avila Mutra + - - - - - -12. Basti adhmana - + + + + - -

Rupa

Signs & Symptoms when fully manifested are called Rupa.

Different texts have mentioned the Rupas of Ashmari as shown

in following table :-

S.N Rupas Su. Ch. A. A. H K. M.N. B.P. Y.R.

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o Hr

.

S. ar

.

S.

1 Nabhi

Vedana

+ - + + + - + + +

2 Basti Vedana + + + + + - + + +3 Sevani

Vedana

+ + + + + - + + +

4 Mehana

Vedana

+ + - - + - - - -

5 Mutra Dhara

Sanga

+ - - + - - - - -

6 MutraVikirana

+ - - - - - - - -

7 Gomeda

Prakasha

+ - + + - - + + +

8 Atyavilam + - - + - - - - -9 Sasiktam + - - + - + + + +10 Dhavan,

Plavan etc.

+ - - + - - - - -

11 VishirnaDhara

- + + - - - - - -

12 Sarudhira

Mutra

+ + + + - - + + +

13 Mrudanti

Medhra

- + - - - - - - -

14 MakusakaranMunchati

Mehana

- = - -- - - - - -

15 Mutrarodha - - + - + - + + +16 Atimutratram - - - - - + + - -17 Pratatam

roditi- - - - - + - - -

18 Kasamana - - - - - + - - -

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Upashaya Anupashaya

The factors which relieve the signs and symptoms of disease

are called upashaya, while the factors which aggravate the

disease are called anupshaya.

None of the ayurvedic texts have mentioned about upashaya

anupashaya in relation to mutrashmari.

Main factor involved in ashmari formation is kapha dosha.

All the measures leading to control of kapha are considered as

upashaya and those which vitiate kapha are anupashaya of

ashmari.

Classification of Ashmari

All the Acharyas except Charaka have classified the disease

Mutrashmari into four types. i.e.

Shleshmaja Ashmari

Pittaja Ashmari

Vataja Ashmari

Shukraja Ashmari

Acharya Charaka has considered Mutrashmari as a variety under

Mutrakrichhra and classified it into Mridu Ashmari and Kathina.

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Different varieties of Ashmari,according to different Acharyas are as

in under mentioned table :-

S.No Ashmari Su. Ch. A.Hr

.

A.S. M.N B.P Sha. Y.R.

1 Shleshmaja + - + + + + + +2 Pittaja + - + + + + + +3 Vataja + - + + + + + +4 Shukraja + - + + + + + +5 Mridu - + - - - - - -6 Kathina - + - - - - - -

Laxanas of different Ashmari

1. Shleshmaja :-

Heavy & cold sensation in bladder area Cutting, incising,

pricking pain. ( Su. Ni. 3/8).

Pittaja :-

Burning hot sensation and inflammatory changes in urinary

tract. (Su. Ni. 3/9)

Vataja :

* Severe bladder pain, umblical pain and pain in the anus

* Frequent passage of flatus* Urethral burning

* Dysuria

* Difficulty in defecation. (Su. Ni. 3/10)

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Shukraja :-

* Dysuria

* Scrotal swelling

*Lower abdominal pain* Special characterstic feature is, it can be crushed into powder by

pressure. (Su. Ni. 3/12)

Features of Ashmari are

1. Shleshmaja

- White, slimy, big like Kukkutanda

- Colour - Madhuka Pushpavat

- Heavy in weight (Su. Ni. 3/8)

2. Pittaja :-

- Reddish / Yellowish - black or honey like in colour.

- Resembles Bhallataka seed. (Su.Ni. 3/9)

3. Vataja :

- Dusty coloured

- Hard

- Irregular

- Rough- Nodular like Kadambapushpa (Su. Ni. 3/10)

Sadhyasadhyata

In our classics Acharyas have described about 'Ashta

Mahagadas' and these Mahagadas are not easy to treat and

they are not having good prognosis.

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As Ashmari is mentioned as one of them, so it requires great

attention for its cure.

In children because of the smaller space occupying lesion and

less fat in subcutaneous and perinephric region the prognosis is

better.

Similarly early detected Ashmari can be treated with medicines

because of its recent origin and small size, while an Ashmari of

long time origin is difficult to cure and large Ashmari is also an

indication for surgical treatment. (Su. Chi. 7/3)

Ashmari associated with complications and Arishta Lakshanasshould be avoided.

Upadrava

No particular Upadravas of Ashmari are mentioned in Ayurvedic

classics except Mutra sharkara, described by Acharya Sushruta. It is

nothing but the disintegrated particles of Ashmari, passes along with

the stream of urine.

Laxanas of Upadrava

*. Pain in the pericardium

* Weakness of lower limbs

* Pain in the flanks and shivering

* Thirst

* Blackish discoloration of body

* Dislike for food and indigestion

* Pale appearance of the body etc. (Su. Ni. 3/15)

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