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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)
**************