A Literature Review on Ayurvedic Management of Pittaj Mutrakruccha in Children

Abstract

Mutrakruchhra causes discomfort and difficulties during urinating. Muhurmuhu Mutrapravruttis, Sadaha, and Saruja are its primary characteristics. Pittaja Mutra Kruchhra is one of the several varieties of Mutrakruchhra that are formed due to Vatadi doshas. In contemporary science, Pittaj Mutrakruchchra is comparable to a lower urinary tract infection. A frequent medical issue in youngsters is urinary tract infection (UTI), which affects 1% to 3% of males and 3% to 10% of girls. The urinary disorders are under two broader heading in Ayurveda Mutrakruchhra and Mutraghata. The difference in two clinical scenarios is based on the intensity of obstruction. Painful micturition is being predominant symptom in UTI, it can be correlated with Mutrakruchhra, more preciously with Pittaj Mutra kruchhra that occurs due to vitiation of doshas which reach urinary bladder are compressing the urinary tract leading to difficulty in urination and give rise to following features burning sensation, yellow colored urine, dysuria while micturition. Various drugs have been described in Ayurvedic texts to treat urinary tract infection (Pitta Mutrakruchhra) like Amalaki, Gokshura, Laghu panchmula gana, Shatavari, Trin panchmula gana etc. to be given in various combination with proper Anupana (adjuvant or vehicle) and in appropriate forms i.e. Kwatha (Decoction), Heem etc.

Introduction

I. INTRODUCTION

Urinary system is one of them which is frequently affected showing signs and symptoms like dysuria, burning urination, continence, hesitancy, dribbling micturition etc. Urinary system affected by ascending infections and common symptom is burning micturition. It is generally common in obstructive uropathy.

Ayurveda claims that several strotasa's Vyadhi are dependent upon them, and Mutrakruchhra of the Mutravaha strotasa is one of them. According to Acharyas, Doshas are triggered by their own etiological elements, which can reach Basti[1] and Strotasa Mutramarga alone or together, resulting in the illness Mutrakruchhra.

Sadaha, Saruja, Muhurmuhu, and Haridra—raktavarna Mutrapravrutti[2]—are its defining characteristics. Treatments for the condition include Shamana and Shodhana therapy, which include Vyadhi pratyanika Chikitsa. It comprises of the Shamana yogas. Avagaha, Parisheka, and Pradeha are a few of the methods that have been documented. Mutrakruchhra has characteristics with other disorders such as Mutraghata and Mutrashmari.

Pittaj Mutrakruchchra can be compared with urinary tract infection (UTI) in modern science. As clinical presentation of Mutrakruchhra resemble with that of lower Urinary tract infection. Lower urinary tract infection (LUTI) is a disease condition which includes Urethritis and Cystitis and is often superficial infection.

One of the prevalent conditions among the pediatric population is mutrakruchhra. Age and sex have an impact on illness’s incidence and prevalence. UTIs, or urinary tract infections, are also prevalent in people of young age. There are several predisposing factors that contribute to children's susceptibility to urinary tract infections, including immune system deficiencies, hormonal shifts and genitourinary system abnormalities. Because UTIs can result in immediate morbidity as well as long-term consequences including hypertension and chronic renal insufficiency, they require medical attention. Three to five percent of girls and one percent of boys get UTIs. It peaks in infancy and happens by the time a female is five years old. Within 18 months following their initial UTI, 60% to 80% of females will get another UTI. Uncircumcised boys have UTIs far more frequently[3].

A frequent medical issue in youngsters is urinary tract infection (UTI), which affects 1% - 3% of males and 3% - 10% of females. They frequently induce renal injury in conjunction with vesico-ureteric reflux and are a significant cause of morbidity[4].

Although some have questioned the significance of UTI as an individual risk factor, given that only 2% of children with renal insufficiency have a history of UTI. UTIs have been identified as a risk factor for the development of renal insufficiency or end stage renal disease in children.

In addition to treating immediate issues, early detection, diagnosis, and appropriate treatment are crucial for avoiding long-term complications. Antibiotics are the only treatments available in modern medicine for urinary tract infections. Modern science explains why there are so many antibiotics, diuretics, antipyretics, and other medications, yet each one has its own adverse effects. Therefore, finding an inexpensive, safe and preventative medication made from natural materials is necessary for Mutrakruchchra Chikitsa.

II. AIM AND OBJECTIVE

1. To study the detail literature review on Pittaj mutrakruchchra.
2. To the principles of management of pittaj mutrakruchchra according to Ayurved.

III. MATERIALS AND METHODS

Numerous Ayurvedic books, such as Sushruta Samhita, Ashtanga Sangrah, Ashtanga Hridya, Chakraditta, Sharangadhara Samhita,Kashyapa Samhita,Yogratnakar, Bhavpraksha, and Madhav nidana, were thoroughly reviewed by the researchers. This review's objective was to thoroughly examine mutrakruchchra and their Ayurvedic treatment.

In ancient Ayurvedic classic literatures, description of urinary system in scattered form. After studying different classic texts of Ayurveda, urinary system along with anatomy and physiology are compiled here. According to Ayurveda, the anatomical structures related to urinary system (mutravaha strotas) are Vrukka, Gavini, Basti, Mutrapraseka, Nadi, Sira and Dhamani[5].

A. Vyutpatti

The words Mutra and Kruchhra come together and forms word Mutrakruchhra.

According to Amarkosh, the word Mutra is formed by adding Ghana pratyaya to mutrasravane Dhatu. It means urine which is a type of fluid is stored in bladder.

Adding "Ruka" pratyaya and "chaa" to "Kruti Chedana" Dhatu, the word "kruchhra" is formed. The word Kruchhra is meaning of difficulty, painful.

B. Nirukti

The commentator of Charak, Sushruta, Madhav Nidana has stated the nirukti of Mutrakruchhra, as follows

Chakrapani Stated[6],  

 "???????????????? ?????? ????????? ???? ?"

Dalhana Stated[7],

                " ????????????? ?????? ?????????????? ?"

Madhava stated[8]

                  " ????????????????? ???????? ????????? ?????? ???????????"

Niruktis mentioned above, Mutrakruchhra means that the Rugna (patient) passes urine with difficulty or with pain.

C. Paribhasha[9]:

"???????? ????????? ???? ?????? ?????????? ????????????|

Mutrakruchhra is a disease (Vyadhi) of Mutravaha Strotasa which is characterized by painful and difficulty in urination.

D. Paryaya

Kruchhra mutrata, Jalamaya, Krichhram, Mutropaghata.

E. Bheda[10,11,12]:

 According to all acharyas, depending upon nidaan and dosha of vyadhi. There are 8 types of Mutrakruchhra but Acharya Vagbhat mentioned 20 types of Mutraghata which also has 4 types of Mutrakruchhra.

Acharya Vagbhata has described mainly two types, Mutra Apravruttijanya and Mutra Atipravrutti janya of Mutravaha Strotasa in nineteenth adhyay of nidan sthana. Mutrakruchhra is included in Mutra Apravruttijanya Vikar.

F. Hetu

Nidana (Hetu) is mentioned for Mutrakruchhra vikar in Ayurvedic classical references. Etiological factors of Mutravaha Strotas Dushti can be taken as Hetu of Mutrakruchhra Roga. Nidanas are classified according to which Dosha is involved to cause Mutrakruchhra.

1. Samanya Hetu[13]

Hetu of Mutrakruchhra are mutra Vegadharan, Kshina, Kshata.

a. Mutra Vegadharana: Mutra vegadharana is directly lead to Mutrakruchhra Vyadhi 2, The suppression of urination leads to various problems of mutravaha strotasa by vitiation of Apan Vayu. Acharya Sushrut, Lakshanas of mutra Vegadharan are person passes urine with painful, difficulty and decrease in volume of urine. It causes pain at Basti, Nabhi, Vankshana and Medhra Pradesha. Pain at Medhra Pradesha indicates Pratiloma Gati.

b. Kshina: Kshina means a person who is undernourished. Such kind of person has lost his strength. It is due to long standing diseases like Rajayakshama. It is state in which the immunity decreased. Vrukka is made up Rakta and meda dhatu. Kshaya of these two Dhatus lead to structural and functional inability of vrukka resulting in Mutrakruchhra.

c. Abhikshata: Any trauma to the organ related to Mutravaha Strotas causes various diseases like Mutrakruchhra. The injury to Mutravaha Strotasa can lead to Mutra Dushti.

2. Vishishta Hetu

Vishishta Dosha causes particular type of Mutrakruchhra Roga produces symptoms of that Dosha. Acharya Sushrtua and Vagbhata have not mentioned Hetu while Bhavaprakasha, Yogratnakar and Vangasena have mentioned similar Hetus for Mutrakruchhra as that of Acharya Charaka. According to different acharays, hetu are as follows Table No. 1 -

G. Purvarupa

Textual references for purvarupa in the Mutrakruchhra state that a disease's lakshana, whether in its mild or incomplete form, qualifies as purvarupa. This is according to Chakrapani. Acute onset urinary tract infections occur. At this point, it is difficult to distinguish purvarupa. The illness appears before Vyadhi Vyaktavasta's following stage or progresses through it.

H. Rupa

Pittaja Mutrakruchhra

The Pratyatma lakshana of Pittaja Mutrakruchhra are Sadaha, Saruja, Haridravarni and Raktavarni Mutra Pravrutti. Some additional symptoms like Varmavarena and Pidayukta mutrapravruttiare mentioned by Acharya Charaka. Lakshana of Pittaja Mutrakruchhra in different classicsis given in tabulated form. (Table no. 4)

Table no. 2 Lakshanas of Pittaja Mutrakruchhra according to different Acharyas.

Acharya Sushruta and Acharya Kashyapa are mentioned ushna Mutrata only. Acharya Kashyapa has added one more symptom Swidyaman Mukha.

I. Mutravaha Strotodushti Lakshana[25]

Atisrushtam: Increasesd output of urine.

Atibaddham: Dribbling urination / drop by drop or complete suppression of urine.

Kupitam: Viguna mutra.

Bahalam: Concentrated urine.

Abhikshna: Painful urination.

J. Samprapti Of Mutrakruchhra By Acharya Charaka[26]

Dosha - Vatapradhan Tridoshas

Dushya - mutra

Adhishthan – Basti

K. Upadrava

Acharya Kashyapa has described Upadrava of Mutrakruchhra, mentioning Sannipataja Mutrakruchhra[27], as follows

• Bhrama (Giddiness)
• Murchcha (Fainting)
• Aruchi
• Karshya
• Trushna (Thirst)
• Anavasthita
• Hridpida (Chest pain)
• Ruja
• Pida
• Vishad

L. Sadhya-Asadhyata

According to Acharya Sushrut, it is a disease of basti which is one of Marmas. It is Madhyam Marga Roga. So, it is Vyadhi which is Kruchhra Sadhya[28].

M. Chikitsa

1. Samanya Chikitsa

According to Kashya Samhita, Management of mutrakruchhra, the Sharamulani Kwatha after cooling it with Sharkara or Madhu. Other preparation of Kwatha is Madhuk, Sharmula, Triphala, Sinhal Pippali with Sharkara or Madhu. One another Kwatha is Trunpanchmul Kwatha with Sharkara or Madhu. Avaleha of Shatavari, Prushnaparni, Kulaththa, Badar with Sharkara and Madhu.

In Mutrakruchhra treatment should be like opposite to treatment of prameha. It should be treated opposite to direction of Prameha of medicine, drinks, food and routine workup. Mutakruchhra should be treated by snigdha and mrudu shodhana (Vamana, Virechana)[29].

As per Acharya Sushruta, treatment of Mutrashmari should be done as per Dosha Dushti and Snehadi Karma should be done in Mutrakruchhra.

2. Vishesha Chikitsa

Pittaja Mutrakruchhra

7In Charaka Samhita, Chikitsasthana 26th Adhyaya, Chikitsa of Pittaj mutrakruchhra[30] explained as follow,

• Parisheka: pouring of liquids like decoction (Kwatha) medicated milk
• Avagaha: Sheeta Dravyas.

• Lepa: Pradeha Lepa with Sheeta Dravyas. Lepa applied locally as per to symptoms.
• Rutucharya: Grishma rutucharya should be followed
• Kshirapana: Kshra or Siddha Kshira is used to drink.
• Basti: Siddha Kshira Basti and Uttarbasti is used.
• Virechana: it is Shodhana Chikitsa for Pitta. Dravyas Ervarubeejadi yoga and Shatavryadi Kwatha are explained by Acharya Charaka.
• Compound preparations used in Pittaja Mutrakruchhra[31]: - Shatavaryadi Kwatha, Ervarubeejadi Drakhadi, Harikyadi, Urvaruka Beeja, Truna panchamuladi, Gokshura Guggul etc.

Acharya Sushruta has described chikitsa of Pittaj Mutrakruchhra in Mutrakruchhra Pratishedha Adhyaya of Uttartantra. Dravyas Utpaladi, Trunapanchamuladi Gana, Nyagrodhadi Gana, Kakolyadi Gana are collected Kwatha (decoction) is prepared and medicated Ghee cooked. Milk is boiled with these Aushadhi Dravyas[32], it is used in Pittaj Mutrakruchhra by orally or Uttarbasti of these Dravyas can be given. Oll or Ghee prepared with same drug can be used for three types of Basti i.e. Anuvasana, Niruha and Uttarbasti. Purgatives or laxatives are along with juice of milk, sugarcane, Draksha is ued for Virechana. According to Acharya Vagbhat, Parisheka, Lepa and Avagaha with Sheetal Dravyas is used for Pittaj Mutrakruchhra[33]. Chakradutta, Yogratnakar, Bhaishajya Ratnavall, Bhavaprakash etc. have discussed Chikitsa of Pittaja Mutrakruchhra in detailed.

N. Pathyapathya[34]:

1. Pathya

As described in Yogratnakar Purana Yava, Purana Raktashali, Mudga, Jangala Pashupakshi Mansa, Patola, Tanduliya, Kushmanda, Kharjura, Haritaki, Aamalaki, Ela Madhur Ikshu, Dadhi, Ghrita,  Takra, Kumara, Gokashura, Sheeta Vayu Sevana. As described in Kashyapa Samhita, Madhur Rasatmaka Ahara, juice of sugarcain, Ghrita, Dugdha.

2. Apathya

According to Acharya Charaka Vegasandharana, Ruksha-Shuksha Pishtanna Sevana, Vayu and Dhupa Sevana, Kaittha, Jambu should be avoided in Mutrakruchhra.

According to Yogaratnakara Amla, Lavana, Virudhashana, Vidahi, Tila, Sarshapa, Masha, Pinakya, Mutravegadharana.

Conclusion

Pittakara and Vatakara Nidana are important factors in Pittaja Mutrakrichhra expression, according to an analysis of literary references pertaining to the etiology of Mutrakrichhra. It is determined that Pittaja Mutrakrichhra is caused by any anomalies in Vyana Vayu, Samana Vayu, Pachaka Pitta, and Apana Vayu owing to Aharaja, Viharaja, and bacterial causes. From a traditional medical perspective, Pittaja Mutrakrichhra and urinary tract infections (UTI) are comparable in terms of their respective symptoms and illnesses. Ayurvedic management with no adverse effect as per their dosha adhikya is very important for treatment.

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