“CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN

PITTAJA MOOTRAKRICHRA w.s.r. TO URINARY TRACT

INFECTIONS” By

DR. ARCHANA TRIPATHI

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of

Ayurveda Vachaspati M.D.

In

KAYACHIKITSA

Under the Guidance of

DR. SHARADA MD (Ayu)

PROFESSOR &HOD DEPT. OF KAYACHIKITSA

RAJIV GANDHI EDUCATION SOCIETY’S AYURVEDIC MEDICAL

COLLEGE, HOSPITAL PG STUDIES & RESEARCH CENTRE.

RAJIV GANDHI EDUCATION SOCIETY’S AYURVEDIC MEDICAL

COLLEGE, HOSPITAL PG STUDIES & RESEARCH CENTRE. RON-582209,

DIST- GADAG KARNATAKA.

2015 – 2018

Declaration by the candidate

I hereby declare that this dissertation /rhesis entitled ,.CLINICAI EVALUATION

OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTPAKRTCHRA w.s.r. TO

URINARY TRACT INFECTIONS" is a bonafide and genuine research work carried

out by me under the guidance of Dr. SHARADA n o 1.rvq professor in Kayachikitsa,

RCES AMC-H & RC, RON.

Date : )G J f $.Place : RON

ArL)Clr\-(Dr.Ar6[-na Tripathi.)

RGES AYURVEDIC MBDICAL COLLICN

POST CRADUATE STU'IUS AND RTSTARCI] CENTIID

RON

f,ndorsemcnt bY the H.O.D. Principal/ Hesd ofthe institution

This is to certify that the dissenadon entitled "Clinical tYduatior Ol Guda-

Dugdha ?rll}oga In Pittnin i{oolrakrichra W.S.R. To tlfitnr! Tract lrfeclions"

is a bonafied researoh work done by Dr, Archan.'frirrtria urdtr the Suidance oi

Dr. Sh,rrrda \1 D {^}.r,) Pr ofessor irl pn(ial iu lti I lmeni of tlc req u irenlenl lbr lhc post

gradualion degrce of "r\yurveda VichisPflti M.D (Kirynchiliits.) tldcr Rajiv

Gandhi Univelsily oiHcalth Sciences, Bangalorc, Ka ritalin

,k .),za-Dr. Sh{radr ir.D. (,\",1

PrcIessot & HOD

P.G. DctL lt Ktrflchikitsn

Li!.. ".'i.r,,

-, J

,.. l*z \. 2Dr. [. B. I(otlxrsliclli rLD. (,ru)

Pri,icilxl

RGDS A\:utt'cli( Mdlical Co eg..

Ro

oat.9G {'lDPlacc: Ron

?BINCIPAL E C. M,O.Pdiit Gda'lhi F'ducotion Socialt

f yu',.dir M di!.i CollcZP & Hospitat

BON - 582 209 (Dist. Gadas)

dr08381-26745?

Oarc: ![, ]. f $Plrce: Ron

t/:

Qo;r- ---

najiv Gandhi nducstion Society'$ Ayurvedic Medical College

DepartDent of?ost Gradurte Sludies in DralTa (;ura,

Ron-582 209

gf;&?[r'ne&Ttr

This is to certify tlat the dissertntion cntkled "CLlNlCAl. LVALLIA'IION Ol

CUDA-DUCDHA PITAYOGA IN PITTAIA MOO]'IiAI(RICI IRA ry.s.r. TO

URINARY TRACT INFEC'IIO\S" is a bonafide research lvork done by

Dr.Archrn:r Tripathi in partial full'illnent ofthe reqnirement ,ir lhc post grddration

degree of 'Ayu.vedr Vechnspati M.D, (K.JNchikitsa)'' tjnder Rajiv Gandhi

Unilersiry_ of Uealth Sciences. Bangalore. Kirfi alaka.

DR, SIIARADA. yutn,r

PROFESSOR & HOD

DEPT. OT- &' YAC TIIKITSA

Rajiv Candhi Education Soci€ty's

Ayurvedic Medical College, Hospitirl

PC Strdies & Research Centrc.

oare:20 Z l9 .

O Copvrieht

Declaration bv the candidate

I hereby declare that the Rajiv Gandhi Universify of Health

Sciences, Kamataka shall have the rights to preserve, use and

disseminate this dissertatior/ thesis in print or electronic format for the

academic / research purpose.

Date

Place

176

: RON

.z lA.

A/+:lDr. Ar6[-ana Tripathi

O Rajiv candhi University of Health Sciences, Kamataka

Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGEMENT

First and foremost I pray to the almighty God, who is omnipresent, omniscient and

omnipotent. He is the possessor of the ocean of knowledge and wisdom to which I

would like to contribute a drop in the form of my dissertation. As it is said, each and

every drop goes to make an ocean, so this is my humble endeavor towards its goal of

wisdom.

This dissertation represents not only my efforts as a student but also the earnest

measures of several heads guiding me from the beginning till the day I am able to

inscribe my thanks to all of them.

I express my deep gratitude to my beloved and respected guide Dr.Sharada (H.O.D.

Dept.of Kayachikitsa),whose sympathetic scholarly suggestions and guidance at

every step have inspired me not only to accomplish this work but in all aspects I am

extremely thankful to her for providing such a nice support and guidance, although

she had busy schedule managing the departmental responsibilities.

A special thanks to Dr. Annapurna Dambal , Asst.Prof, Dept.of Kayachikitsa. I

am thankful to her and fortunate enough to get constant encouragement, support and

guidance from her which helped me in successfully completing my Dissertation

work.

I am extremely thankful to Dr. S.C. Sarvi, Professor, Dept.of Kayachikitsa for his

guidance and support.

I acknowledge my gratitude to Dr.I.B. Kotturshetti, Ph.d, Principal & C.M.O of

RGES Ayurvedic Medical College, Hospital & Research centre Ron, for his

valuable guidance and providing the facilities for conducting this research work &

requirements needed during the work.

I acknowledge my gratitude to Sri. G. S. PATIL, Chairman of RGES Ayurvedic

Medical College; Hospital & Research center Ron, for providing me facilities for

conducting this research work & Graduation study.

I express my sincere thanks to Dr. Habib A. Balikai ,Prof. Department of Rasa

Shastra, RGES Ayurvedic Medical College, Hospital & Research center Ron, for

his invaluable guidance.

I sincerely thank to Dr.Shashikala Bani, Professor, Dr. Manjunath Ajanal, Asst

prof, Dept of Dravya Guna, suggestions in Drug authentication.

I am very much thankful to my college Lecturers Dr.Basavraj Pujar,

Dr.Sharanprasad, Dr. Ronad, Dr. Barker, Dr. Raghavendra Shetter,Dr.

Annapurna Dambal, RGES AMC Ron, for their support.

It’s my pleasure to recall here the timely co-operation from my seniors Dr.Abhishek

Singh, Dr. Sandip Kulkarni, Dr. Rohit Maurya, Dr. Kunal Bhoir, Dr. Abhijit

Patil and Dr. Badal Rao for their help during my work

I express my sincere thanks to hospital unit mainly Dr.B.B. Kataraki and Dr. Raju

Kenchareddy for their kind co-operation, in completing the work successfully.

I express my sincere thanks to library madam Mrs. Drakshyani Gadaginamath for

their co-operation & support by issuing the books as and when required

There is no joy in work without companions. So, here is a big thanks to my Best

Friend fellowmates - Dr.Anita Pal, for his brilliant technical support in my thesis

work and also thankful to my fellowmates Dr. Yogendra Kumar, Dr. Yuvraj

Bachkar, Dr. Vishal and Dr. Pradeep Jaiswal for their support and guidance.

I pay my humble respect to all the teaching staff and hospital staff of

my mother institute RGES Ayurvedic Medical College, Ron for their kindly co-

Operation in Clinical study.

My thanks to laboratory technician, Mr. Praveen, RGES and AMC Hospital, Ron and

Mr. Anand for his help. Lastly, I would like to express my profound gratitude to all the

patients for co-operating and supporting me during this study, as without them everything

was just a dream.

Thank you all from the bottom of my heart for making this possible..

Date: Signature of Candidate

Place: Ron Dr. ARCHANA TRIPATHI

ABBREVIATION

A.H.

Astanga Hrudaya

A.K.

Amara kosha

A.P.I.

Ayurvedic Pharmacopoeia of India

A.R.

Abhidana Ratnamala

A.S.

Astanga sangraha

B.P.

B.R.

BP.N.

C.S.

D.N.

Bhavaprakasha

Bhaishajya Ratnavali

Bhavaprakasha Nighantu

Charaka samhita

Dhanwantari Nighantu

DG.PV

Dravyaguna Vijnana by Priyavat Sharma

DG.VMG

Dravyaguna vijnana

By V.M. Gogte

I.M.M.

Indian Materia Medica

I.M.P.

Indian Medicinal Plants

K.N.

Kaiyadeva Nighantu

M.D.

Madhava Dravyaguna

M.N.

Madanapala Nighantu

Mau.N.

Mahausadha Nighantu

N.A.

Nighantu Adarsha

R.N.

Sha.S.M

Su.S

V.N

Raja Nighantu

Sharangadhara Samhita Madhyama Khanda

Sushruta Samhita

Vanoushadhi Nidarn

LIST OF TABLES

Table No Description Page No

1. Mootrakrichra Classification according to different authors 6

2. Showing Nidana of Mootrakrichra mentioned in classics. 8

3. Samprapti ghatakas 17

4. Showing visista Lakshana of vataja Mootrakricchra 19

5. Showing visista Lakshana of pittaja Mootrakrichra 20

6. Showing visista Lakshana of kaphaja Mootrakrichra 20

7. ShowingthevisistaLakshana ofSannipataja 21

Mootrakrichra

8. Showing the visista Lakshana of Asmari & sharkara janya 22

Mootrakrichra

9. Showing the visista Lakshana of Raktaja Mootrakrichra 23

10. Showing the visista Lakshana of Shalyabhighata 23

Mootrakrichra

11. Showing the visista Lakshana of Sukraja Mootrakrichra 23

12. Showing the visista Lakshana of Pureeshaja Mootrakrichra 24

13. Showing the relationships of right and left kidney 36

14. According to modern anatomy the organs in association 38

with the bladder

15. Showing the patients based on age 58

16. Distribution of patients by Gender 59

17. Distribution of patients by religion 60

18. Showing the patients based on Occupation 61

19. Distribution of patients by economic status 62

20. Distribution of patients by marital status 64

21. Distribution of patients by mode of on set 65

22. Distribution Of Patients By Prakruti 66

23. Distribution Of Patients By Frequency Of Attacks 67

24. Distribution Of Patients By Colour Of Urine 68

25. Distribution Of Patients By Reaction Of Urine 69

26. Distribution Of Patients By Vyasana 70

27. Distribution of patients by nidana 71

28. Showing the result on Peeta mootrata & Saraktha mootrata 72

29. Showing the result on Sa daha mootrata 73

30. Showing the result on Krichchra mootrata 74

31. Showing the result on Muhur muhur mootrata 75

32. Showing the result on Albumin Discharge 76

33. Showing the result on Puss cells 77

34. Showing the result on Epithelial cells 78

35. Master chart showing Subjective Parameters 79-80

36. Master chart showing Objective Parameters 81-82

37. Master chart showing demographic data 83-85

38. Showing the effect of Guda Dugdha yoga on subjective 86

parameters:

39. Showing the effect of Guda Dugdha yoga on objective 86

parameters:

40. Overall effect of the Guda Dugdha Yoga in Pittaja 87

Mootrakrichra

LIST OF GRAPHS

Graph No Graphs Page No

1. Showing the patients based on age 59

2. Distribution of patients by Gender 60

3. Distribution of patients by religion 61

4. Showing the patients based on Occupation 62

5. Distribution of patients by economic status 63

6. Distribution of patients by marital status 64

7. Distribution of patients by mode of on set 65

8. Distribution Of Patients By Prakruti 66

9. Distribution Of Patients By Frequency Of Attacks 67

10. Distribution Of Patients By Colour Of Urine 68

11. Distribution Of Patients By Reaction Of Urine 69

12. Distribution Of Patients By Vyasana 70

13. Distribution of patients by nidana 71

14. Showing the result on Peeta mootrata & Saraktha 72

mootrata

15. Showing the result on Sa daha mootrata 73

16. Showing the result on Krichchra mootrata 74

17. Showing the result on Muhur muhur mootrata 75

18. Showing the result on Albumin Discharge 76

19. Showing the result on Puss cells 77

20. Showing the result on Epithelial cells 78

21. Showing the Overall effect of treatment 87

List of photographs

Photo no Photo Page no

1. Showing the Guda and Dugdha 57(a)

2. Showing the preparation of Guda and Dugdha yoga 57(b)

ABSTRACT

Title: “Clinical Evaluation Of Guda-Dugdha Prayoga In Pittaja Mootrakrichra W.S.R. To

Urinary Tract Infections”

Mootrakrichra is one of the elaborately explained rogas in all major Ayurvedic

classics. As the name suggests, it means the Krucrata or difficulty during mootra pravrutti

Mootra pravrutti is considered one among the Adharaniya Vegas. In general

Mootrakrichra is classified into 8 types according to the nidana and lakshanas, among

which Pittaja Mootrakrichra is most common and frequently occurring problem. The

formulation of Guda-Dugdha pryoga is explained in Bhava Prakash and Yoga Ratnakar.

Hence to evaluate the efficacy of Gud-Dugdha prayoga in the management of Pittaj

Mootrakrichra the present study had been undertaken.

In the present study total 40 patients of Pittaja Mootrakrichra were included after

fulfilling the diagnosing and inclusive criteria. The Guda Dugdha yoga was given for 7

days and the patients were followed up after 7 days and 14 days. The gradation for the

assessment of result were taken on day 1, day 7 and day 14.

Assessment was done by the z test at P 0.05 level. All the subjective and objective

parameters were highly significant. But the percentage of overall effect was 32.78% out

of which 45% of patients shown less than 25% improvement and 55% of patients shown

between 25% to 50% improvement.

Key words: Pittaja Mootrakrichra, Urinary Tract Infection, Guda, Dudha

INTRODUCTION

Disease has been man’s heritage from beginning of its existence and search for remedies

to combat it, perhaps is equally old. The age old ancient Ayurveda is “an arrow shot by

divine bow”, through which confidence of millions of people has been won. This

traditional medicine is much popular for managing most of diseases.

The disease Mootrakrichra is documented in classical texts of Ayurveda. Ayurveda gives

guidelines to treat this confidently and increase quality of life of individual. With

different modalities for management of Mootrakrichra can be correlated to urinary tract

infection on theoretical and clinical symptomatology of diseases. UTI i.e. bacterial UTI is

the most common, painful and annoying cause of health, usually by

E.coli, affecting any part of urinary tract 1.

Need and significance of study: -

Urinary tract infections (UTIs) are one of the most common bacterial infections seen in

primary care, second only to infections of the urinary tract. 2 They are particularly

common among the female population with an incidence of about 1% of school-aged

girls and 4% of women through child-bearing years. Incidence of infection in females

increases directly with sexual activity and child-bearing. In the women, 25-30% of

women between 20-40 years of age will get UTIs. 3 These infections account for about

8.3 million doctor visits each year. 2 UTIs have been well-studied in Sweden and other

parts of Europe. 4 These studies have shown that one in 5 adult women experience a UTI

at some point, confirming that it is an exceedingly common worldwide problem. 4 In

2007, approximately 3.9% of office visits in USA were related to symptoms involving

the genitourinary tract. 5 Sixty-one percent of all UTIs are managed in the primary care

setting. It is also common for these episodes to recur. 6

Mootrakrichra is a Vyadhi where difficulty in micturition is pradhan laxan, affecting

daily activities of life, it is having its impact upon physical, mental, spiritual health of

persons causing person very distressed and annoying 7.

As Mootrakrichra involves basti which is pradhan sthan of Vata 8 and also it is one of tri-

marma, which has to be protected 9.

The pathological process of UTI is going to be induced by E.coli, staphylococci etc.

bacteria, which may affect any part of urinary system 10

. The methods of management of

UTI are mainly by antibiotics. Even though they are useful, they involve considerable

amount of risk, side effects and also expensive. The chances of resistance’s and

recurrences after administration of antibiotics are also high as fifty percent 11

.

The goal of UTI’s in modern contemporary science is antibiotic therapy. Although this 7

days regimen was highly efficacious, it was associated a certain frequency of side effects

single dose therapy now a days appears efficacy. The risk was attributed to failure of

single dose antibiotics to eradicate gram negative bacteria from rectum, the source, and

reservoir of ascending Uro-pathogens. Self-management plans are currently advocated in

most international guidelines on managing UTI 12

.

In recent years new trend is developing in Ayurveda for search of new therapeutic option.

Considering this, the present study had been framed in the management of

Mootrakricchra.

OBJECTIVES OF THE STUDY

To evaluate the efficacy of Guda-Dugdha prayoga in the management of Pittaja

Mootrakrichra.

To study the disease Pittaja mootrakrichra as per Ayurvedic literature

To study the detail about Aetiopathogenesis of Urinary tract infection as per

modern literature.

DISEASE REVIEW

Historical review and prevalence

The first and foremost source of knowledge is classic books, which are most ethical, trust

worthy and ever-available ‘Apta’ now a day. The evolution and progress of study of

Mootrakrichra and its management can be traced chronologically in 3 historical period’s

viz. Ancient period, medieval period and modern period.

Ancient period: -

It can be subdivided into vedakala and samhitakala.

Vedakala: -

In olden literature available viz. Rigveda and Yajurveda there is no references related to

diseases of mootravaha srothas like gavinis. However one can find references regarding

physiology of formation of urine which is compared to collection of water to ocean and

to that of basti and mootrashmari diseases but no direct references about

Mootrakricchra16

.

Samhita kala: -

This was golden period of Ayurveda and two great works viz. Charaka Samhita 17

and

Susruta Samhita were produced in this period. The other texts like Kashyap, Bhela,

Hareeta Samhita were written in this era. Elaborated discussions on physiology, anatomy

and management of mootravaha sroto vyadhis were undertaken in the exclusive

allotments of Mootrakrichra chapter.

NIRUKTI AND PARIBHASHA

The word mootra is derived from the root ‘mootra prasravane’ meaning ‘to ooze or exude

profusely, which throws light on the exactness of this nomenclature, according to the

Ayurvedic concept of its being collected in Vasti, by a process of exudation’18.

The other roots are -

‘mucyate’ – meaning to be loosed to be set free or released.

‘muchyayoho’ – meaning that which has been set free 19

‘mootra’ is defined as that of that which is secreted or that which oozes or exudes 20

.

Paryayas of mootra

prasravaha – prasravae upasthatksharitajalae – meaning flowing, oozing urine 21

Mehanam – meaning passing urine, urine etc. 22

Guhyanishyandaha –urine i.e., that which flows trickles from the genital organ 23

Sravanam – meaning exudation, tickling, oozing 24

Sravaha – meaning flow, tickling oozng etc. 25

Upatha uirgata jalam – meaning water excreted through the genital organ 26

Sharangadhara has described that the watery portion of the maladrava of the digested

food after being transported to ‘Vasti’ is called as ‘mootra’. 27

By observing above reference in the context of the word Mootrakricchra, the krichra

means painful situation or difficulty during act of micturition. The definition of

Mootrakrichra is painful discharge of urine or strangury.

CLASSIFICATION OF MOOTRAKRICCHRA

All Acharyas expect Vagbhata considered Mootrakrichra is of 8 types. Charaka

considers no difference between Ashmarijanya and Sharkarajanya Mootrakricchra, as

pathogenesis of both is same. Susruta considered Sharkarajanya differently from

Ashmarijanya Mootrakricchra.

Mootrakrichra Classification according to different authors

Collection of symptoms from are depicted as follows – Ca = Charaka28,

Su = Susruta29,

Ah = Astanga Hrudaya 30,

As = Astanga sangraha 31,

Ks = Kashyapa Samhita 32,

Mn =

Madhava Nidana 33,

Bp = Bhavaprakasha 34,

Cd = Chakradutta 35,

Yr =

Yogaratnakara36,

Br = Bhaishajya Ratnavali 37

and Gn = Gadanigraha 38.

Table -1 Mootrakrichra Classification according to different authors

Sn Prakaras Ca Su Ah As Ks Mn Bp Cd Yr Br Gn

1 Vataja + + + + + + + + + + +

2 Pittaja + + + + + + + + + + +

3 Kaphaja + + + + + + + + + + +

4 Sannipataja + + + + + + + + + + +

5 Dwandwaja +

6 Rakthaja + + + - +

7 Shalyabhigataja + + + + + +

8 Ashnarijanya + + + + + + +

9 Sharkarajanya + + + + + + + +

10 Pureeshajana + + + + + + +

11 Sukrajanya + + + + + + -

Nidana of Mootrakrichra

It is wisdom of Acharyas, that they have clearly elicited list of etiological factors of

Mootrakrichra on bases of their theoretical and clinical experiences. Morbidity except

viddhata are concerned, they are caused mainly due to the faulty dietetic habits faulty

behavioural habits which in turn vitiate the doshas, dushyas or malas as the case may

be. These vitiated body constituents in turn vitiate the body channels, manifestation

would be their mismanage.

In case of Mootrakrichra Nidana which cause khavaigunyata in the region of

basti pradesha, mootramarga (lower urinary tract) etc. play in an important role. As a

supporting factor, the other sahayaka nidanas can be considered.

The etiological factors of Mootrakrichra presented by Charaka would appear to be of-

1) Tridosha kopaka nidanas and

2) Mootra margavarodha nidanas

Though acharya Sushruta and Vagbhata have not pointed the etiological factors of

Mootrakrichra specifically, but they mention the causative factors like Ashmari,

shalyaja etc.. Madhavakara, Bhavamisra, Yoga Ratnakara and others have said the

causative factors of Mootrakrichra appear directly to be the same kinds referred to

Charaka

The below Nidana can be differentiated under 3 headings 1.Aharaja

2.Viharaja

3.Aushadhi Janya (Iatrogenic)

Table 2.Showing Nidana of Mootrakrichra mentioned in classics.

Nidan 39

Ma

dh

av

a

Bh

av

ap

ra

k

Yo

ga

ratn

a

k

Ga

da

nig

ra

4 4

Ch

ara

k

a

4 0

Ast

an

ga

san

gra

ha

Nid

an

a

4 1

42

as

ha 4 3

a r a h a

Aharajanya

Rooksha ahara + + + + + +

Madhya sevana + + + + + -

Anoopa mamsa sevana + + + + + -

Matsya sevana + + + + + -

Adhyashana + + + + + -

Ajeerna bhojan + + + + + -

Katu amla lavan sevan - - - - - +

Viharajanya

Vyayam + + + + + -

Nitya drita pristaya + + + + + -

Sthree sevan - - - - - +

Vega dharan - - - - - +

Teekshna oushadi + + + + + -

Astanga Hrudaya Vagbhata, Susruta and Kashyapa did not narrate the Nidana of

Mootrakricchra.

Abhighata

All the Acharyas also list Abhigata or injury as causative factor of mutravaha srotodusti,

particularly in the context of Mootrakricchra.

Vyayama

Here in Mootrakrichra the particular type of vyayama, which will have an influence over

the basti and mutra, marga is taken for consideration. The excessive exercise gives rise to

over exertion and rookshata in turn provokes the Vata45

.

Druta pristayana

All the Acharyas has considered ‘ druta prista yana i.e., riding on horse and travelling in

fast moving vehicles’, as one of the causative factor. In travelling fast moving vehicles

and riding on horse for long time causes increase of pressure in abdomen in particular

friction over basti predesha due to constant sitting on hard surface, and jerks in fast

moving. Due to travelling, veganigrahana may also be present leading to the disease.

Bharavahana

Bharavahana i.e., keeping the heavy loads on kati, skanda pradesha and carrying the

loads can be considered as one of the main causative factor of Mootrakricchra. Due to

heavy loads on kati, skanda pradesha, maximum pressure will be thrown on basti

pradesha because of forward bending in carrying the loads. Even carrying the loads

during the urge of micturition leads to antagonistic pressure over basti pradesha by

external pressure results into srotodusti and causes the disease.

Sankshaya

Sankshaya is also stated to be a condition leading to the mootravaha srotodusti. Here the

commentators have not clarified anything, but with reference to the context, the loss of

urine i.e.

lesser production or non-production of urine would be inferred. In the context of

Mootrakricchra, charakapani commented on ‘kshaya’ as ‘ativyavayat sukra kshaya sati

vayuno udeerya bastimanitam’ inferred that due to shukra kshaya, prakopa of vayu

results46

.

Ruksha ahara sevana

The rooksha padaratha will decrease kledatwa entity so that shoshan of dravabhaga is

going to increase. So there will be decrease in output of mootra giving rise to change for

manifestation of difficulty in micturition (UTI).

All these four qualities are having the drying capacity and as such the urine gets

dried and reduced in quantity. Similarly kashaya and ruksha properties are having the

capacity of Srotas constriction and Mootra badhdhata47

. Moreover these four qualities are

having the capacity in vitiation of Vata because of their samana yoni 48

and samana

Guna49

.

Madhyapana is included in the list of causative factors of Mootrakricchra. Some sort of

madhyas like seedhu, karjoora madhyas are stated as vatakara and if consumed in excess

causes the vitiation of Vata. The Ushna, teekshana, rooksha, ashukari Gunas will cause

vitiation of Vata and Pitta. Madhyas are Amla in nature. So madya sevana will change

urine pH and giving rise to environment for invasion of bacteria into epithelial cells of

urinary tract 50

.

Anoopa mamsa, matsya sevana - These causative factors are of Vata and Kapha

prokopaka and also Agni-nashak in nature51

. This result in vikriti in (chala Guna)

continues movements of Drava Dravyas through urinary tract and makes an environment

to acquire UTI52

.

Adhyasan, Ajeerna bhojana –

As these causative factors (viprakrista Nidana) makes prakopa of all Tridosha, resulting

in Samprapti of the Mootrakricchra. Because of the above factors the vataprakopa takes

place. Increased rooksha Guna of Vata will decrease the matra of the mootra by its

shosana karma. There by concentration of the urine will increase giving rise the chance

for development of UTI.

Vyavaya – Sexual intercourse

Can transfer the bacteria from ano-vaginal area to urethra. May irritate the tissue53

.

Oushadhijanya –

Teekshna Oushadhis 54

–

The ushna, teekshna Gunas of Oushadhi will decrease the Aapmahabhoota of mootra,

there by decrease the formation and easy flow of mootra so that concentration is going to

increase and volume of urine decrease. That makes environment for development of UTI.

Teekshna Guna is having function of daha and paka karma so they will do the prakopa

Vata and pita giving rise to Mootrakricchra. Ex: - vacha, rajika, pippali, sura etc.

The Nidana of mootra vaha srotou dusti are also relevant in the context of

Mootrakricchra. It includes –

Vegadharana: -

Because of habit of doing dharana of mootra Vega, the stretching of bladder muscle

beyond its capacity, which overtime can weaken the bladder muscle. When the bladder is

weakening, it may not empty completely and some residual urine is left in bladder which

may increase risk of UTI.

Apart from these factors, certain obstructive or margavarodha causative factors

are stated to be responsible for sanga type of srotodusti in mutra marga causing the

disease Mootrakricchra. In classics, Ashmari, Sharkara, Sukra and Purisha are considered

as causative factors of Mootrakrichra and explained their clinical variety with symptoms.

Purisha, Mootra and Sukra come under vega dharana Nidana. The suppression of any one

of the above leads to vitiation of Apanavata and in turn the vitiated Dosha obstructs the

urinary passage causing the difficult in micturition i.e. Mootrakricchra55

. It is evident

from above analysis that most of the Nidana or of Dosha hetu variety. Some of nidanas

such as mootravega dharana, teekshna Oushadhis sevana, ativyavaya, also act as both

vyadhihetu and Dosha hetu.

Aetiology

Urine is normally sterile -- that is, it does not normally contain bacteria. Usually several

things keep bacteria out of the urine. These include -

1) The urethral sphincter: when the urethra is squeezed shut, bacteria cannot

climb up the urethra from the "meatus" (the outside opening) into the

bladder56

.

2) The length of the urethra: it's a long way up to the bladder for a bacterium57

.

(Since a woman's urethra is shorter than a man's, women are much more likely

than men to get UTI's.)

3) Frequent washing: any bacteria that make it into the urethra are flushed out

the next time of micturition urinate, and since bladder empties almost

completely when person does urinate any bacteria that get that far will be

flushed out too. Furthermore, there are valves at the points where the ureters

enter the bladder to prevent urine from "refluxing" from the bladder to the

kidneys, so that even if the bladder and its urine is infected the bacteria

shouldn't travel up to the kidneys58

Usually, the infection stems from a strain or type of bacteria that is different from the

infection before it, indicating a separate infection. National Institutes of Health (NIH)

suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach to

cells lining the urinary

tract. A recent study has also shown that women with recurrent UTIs tend to have certain

blood types.

Some scientists speculate that women with these blood types are more prone to

UTIs because the cells lining the vagina and urethra may allow bacteria to attach more

easily. Further research will show whether this association is sound and proves useful in

identifying women at high risk for UTIs59

.

E. coli causes more than 90 % of cystitis cases, a bacterium normally found in the

intestines 60

. Other organisms—including chlamydia and mycoplasma—also cause

urinary tract infections. Infections by these organisms usually are limited to the urethra

and reproductive organs. Chlamydia and mycoplasma infections may be sexually

transmitted, in which case both partners must be treated 61

.

The most common cause of UTI is bacteria from the bowel that lives on the skin

near the rectum or in the vagina, which can spread and enter the urinary tract through the

urethra. Once bacteria enters the urethra it travels upward causing infection in the bladder

and sometimes other parts of the urinary tract 62

.

Sexual intercourse is a common cause of urinary tract infections because the female

anatomy can make women more prone to urinary tract infections 63

. During sexual

intercourse bacteria in the vaginal area is sometimes massaged into the urethra by the

motion of the penis 64

.

Women who change sexual partners or begin having sexual intercourse more frequently

may experience bladder or urinary tract infections more often than women in monogomus

relationships. Although it is rare, some women get a urinary tract infection every time

they have sex.

Risk Factors associated with acute urinary infection include the following 65

:

Urinary tract infections are common in women, and many women experience more than

one infection during their lifetimes. Risk factors specific to women for UTIs include:

Female anatomy. A woman has a shorter urethra than a man does, which

shortens the distance that bacteria must travel to reach the bladder.

Sexual activity. Sexually active women tend to have more UTIs than do women

who aren't sexually active. Having a new sexual partner also increases your risk.

Certain types of birth control. Women who use diaphragms for birth control

may be at higher risk, as well as women who use spermicidal agents.

Menopause. After menopause, a decline in circulating estrogen causes changes in

the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

Urinary tract abnormalities. Babies born with urinary tract abnormalities that

don't allow urine to leave the body normally or cause urine to back up in the

urethra have an increased risk of UTIs.

Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap

urine in the bladder and increase the risk of UTIs.

A suppressed immune system. Diabetes and other diseases that impair the

immune system — the body's defense against germs — can increase the risk of

UTIs.

Catheter use. People who can't urinate on their own and use a tube (catheter) to

urinate have an increased risk of UTIs. This may include people who are

hospitalized, people

with neurological problems that make it difficult to control their ability to urinate

and people who are paralyzed.

A recent urinary procedure. Urinary surgery or an exam of your urinary tract

that involves medical instruments can both increase your risk of developing a

urinary tract infection.

UTIs typically occur when bacteria enter the urinary tract from the outside, usually

through the urethra, and begin to multiply. The urinary system is designed to keep out

such microscopic invaders 66

. The bladder secretes a protective coating that prevents

bacteria from attaching to its wall. Urine also has antibacterial properties that inhibit the

growth of bacteria. However, certain factors increase the chances that bacteria will take

hold and multiply into a full-blown infection

67.

Contributing Factors

68

Some factors that may result in urinary tract infections are:

1) Birth Control Methods:

2) Ill-fitting diaphragms may place pressure on the bladder

3) The chemicals in spermicides may irritate vaginal tissues

Physical Structural Problems:

Some women may have an actual physical problem, which predisposes them to urinary

tract infections (UTIs). A physical examination and medical history will determine if

there is any problem.

In Adults

69

1) Low water intake will cause less urination, which flushes out the system

2) People with diabetes have a higher risk of infection because of changes in the

immune system

3) Sexually active teenagers and adult women because of friction occurring at

the meatus during intercourse

4) Wiping from back to front after using the toilet can expose the vaginal and

meatal area to rectal bacteria, often Escherichia coli (E. coli)

5) Women with specific blood types

Other Factors

70

1) Catheters or tubes placed in the bladder:

on those with nervous system disorders such as spinal cord injury where loss of

bladder control may require catheters permanently

Having bubble baths

Wearing tight-fitting clothing

Urinary irritants Spicy foods

Acidic foods

Caffeine

Alcohol

Hygiene product reaction

Soap allergy

Scented toilet paper

Douches

Deodorants

Bubble bath chemicals

Pathological consideration: - Samprapti ghatakas Table – 3. Samprapti ghatakas

Dosha Tridoshajanya pitta pradhanApana Vata

Dushya Mootra,Rasa dhatu

Agni Dhatwagni, jatharagni

Ama Jatharagnijanya ama Dhatwagni janya ama

Srothas Mootravaha, Rasavaha

Dustiprakara Sanga

Udbhavasthana Amashaya, Pakwashaya

Adhistana Vasti

Vyaktasthana Mootra marga

Sanchara Rasayani-mootravaha

Rogamarga Madhyama

Vyadhi swabhava Ashukari, chirakari

Samprapti The events responsible for the retention (complete or partial) of mutra are either concerned with

blockage of the passages (srotorodha) or the failure of the neural mechanism apana vayu dusti. In

turn these events are responsible for causation of the disease, mutra krichra. Inclassics,

Mootrakrichra considered to be one of the apana vayu rogas 71-72

.

Figure –1 Samprapti of Mootrakrichra

Nidana sevana

Tridosha prakopa (Vata, Pitta, Kapha)

Abhighata

Agnimandya

Vata Dosha dusti

Amotpatti

Prasara in sarva Shareera

Mootravaha Srotas

Khavaigunyata

Stanasamshrayavasta in Vasti

Stanika Apanavata &

Kapha Dosha Vikruti

Mootramargavarodha

Krichra mootrata

Roopa

As the Mootrakrichra is named on the basis of pradhana lakshana or samnya lakshana

that is dukhena mootra pravritti or dysuria.

Mootra vaha srotha dusti Lakshana are –

1. Ati srasta – adhika mootrata (increased frequency)

2. Ati badhdha – interruption during mootra pravritti

3. Prakupita – vikruta mootra

4. Alpa alpa abheekshana – shoola yukta alpa alpa pravritti

Many Acharyas had explained lakshana for each type of Mootrakrichra based on

doshic predominance.

Table – 4 : Showing visista Lakshana of vataja Mootrakricchra. 73 to 81

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Vankshan shoola + - + + + + + + -

2 Basti shoola + - + + + + + + -

3 Medhra shoola + - + + + + + + -

4 Muhur muhur mootra + - + - + + + + -

5 Alpa mootratha + + + + + + + + +

6 Kricchra mootratha + + + + + + + + +

7 Aruna varna - - - - - - - - +

8 Teevra shoola + - + - + + + + +

9 Sasushka mehana basti - + - - - - - - -

Table – 5 : Showing visista Lakshana of pittaja Mootrakrichra 82 to 90

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Peeta mootrata + - + + + + + + -

2 Sarakta mootrata + + + + + + + + -

3 Saruja + - + + + + + + +

4 Sadaha + - + + + + + + +

5 Haridra mootrata - + - - - - - - -

6 Mushka daha - + - - - - - - -

7 Basti daha - + - - - - - - -

8 Atiushna mootrata - + - - - - - - +

Table –6 Showing visista Lakshana of kaphaja Mootrakrichra

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Basti gouravata + + + + + + + + +

2 Shotha + - + + + + + + +

3 Picchil mootrata + - + + + + + + -

4 Mushka gouravata - - + - - - - - -

5 Mootrendriya - - - + - - - - -

gouravata

6 Snighda mootrata - + - - - - - - -

7 Swetha mootrata - + - - - - - - -

8 Anshna mootrata - + - - - - - - -

9 Samhrista roa - + - - - - - - -

10 Savibandhata - - - + - - - - -

11 Alpa mootrata - - - - - - - - +

Table –7 Showing the visista Lakshana of Sannipataja Mootrakrichra

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Sarvani roopani + - + + + + + + +

2 Muhur muhur mootrata - + - - - - - - -

3 Nana varna mootra - + - - - - - - -

4 Mootra daha - + - - - - - - -

5 Vedana - + - - - - - - -

6 Moorcha - - - - - - - - +

7 Bhrama - - - - - - - - +

8 Vilapa - - - - - - - - +

Table –8. Showing the visista Lakshana of Asmari & sharkara janya Mootrakrichra 109 to 112

no Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Basti shoola + - - - + - - + -

2 Veeshirna dhara + - - - + - - + -

3 Medhra vedana + - - - + - - + -

4 Dourbalya - + - - - - - - -

5 Sadha mootrata - + - - - - - - -

6 Karshnaya - + - - - - - - -

7 Kukshi shoola - + - - - - - - -

8 Aruchakata - + - - - - - - -

9 Pandutwam - + - - - - - - -

10 Thrishna - + - - - - - - -

11 Hritpeeda - + - - - - - - -

12 Moorcha - + - - - - - - -

Table –9. Showing the visista Lakshana of Raktaja Mootrakrichra 113-114

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Adhmana + - - - - - - - -

2 Vibandhata + - - - - - - - -

3 Gouravatwam + - - - - - - - -

4 Basti laghuta + - - - - - - - -

5 Sarkta mootrata - - - - - - - - +

Table –10. Showing the visista Lakshana of Shalyabhighata Mootrakrichra 119

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Basti kukshi shoola - + - - + + + + -

2 Kricchra mootrata - + - - + + + + -

Table –11. Showing the visista Lakshana of Sukraja Mootrakrichra 120 to 124

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Kricchra mootrata + - - - - - - - -

2 Vankshana, basti, + - - - + + + + -

medhra

shoola

3 Sashukra mootrata - - - - + + + + -

Table –12. Showing the visista Lakshana of Pureeshaja Mootrakrichra 125 to 129

SL Lakshana Ca Su As Ah Mn Bp Yr Gn Ks

1 Adhmana - + - - + + + + -

2 SaShoola - + - - + + + + -

3 Mootra sanga - - - - - + + - -

4 Mootra kricchra - - - - - - - - +

Among all these kricchrata, mootra daha, muhur muhur mootra pravritti, shoola

considered as important clinical features. The shoola, muhur muhur mootra pravritti

are due to Vata Dosha, peeta mootrata, mootra daha are due to Pitta Dosha and alpa

mootrata due to Kapha Dosha. The rest of symptoms are either due to sroto rodha or

Tridosha prakopata.

The roopa are the appearance of actual symptoms commences from vyaktavastha - the

fifth stage.

The word ‘Roopa’ indicate the sign and symptoms by which a disease is identified.

As far as the sign and symptoms of Mootrakrichra are concerned, depend on the

degree of affliction of the Dosha and their permutation and combination, the disease

is described as having eigth clinical varieties.

Charaka has mentioned eight types of Mootrakrichra viz., Vataja, Pittaja, Kaphaja,

Sannipataja ashmarija and raktaja Mootrakrichra sushruta has described pureeshaja

variety leaving shukraja Mootrakricchra. Kashyapa has described based on

permutation and combination of doshas as vataja, pittaja, kaphaja, dwandwaja,

sannipatika and raktaja Mootrakrichra 130

.

Pratyatma Lakshana

Krichramutra pravritti

Mootra is one among the mals of the body. Its function is stated to be clear the kleda out

of the body (mutrasya kledavahanam) 131.

Apanavayu is responsible for its excretion from

the body. There are conditions, which discussed in Samprapti chapter, responsible for the

retention of urine completely or partially are either concerned with blockage of the

urinary passage (srotorodha) or the failure of the neural mechanism (apana vayu dusti).

By these conditions, patient feels difficulty during the micturition. This symptom is

subjective and considered as cordinal symptom of Mootrakricchra. In modern urology,

this symptom is correlated to dysuria, refers to difficult urination and is usually due to

urinary tract bacterial infection and inflammation.

Ruja or shoolayuktamutra pravritti

The word ‘ruk or ruja’ here refers pain and the word shola means any sharp or acute

pain132

. The constriction or narrowing of the mutra marga (urinary passage) due to

mutrashaya kala shotha, the mutrapravritti is accompanied with shoola or ruja133

. This

shoola or ruja may occur due to Vata vriddhi (apanavayu) also. These symptoms are

subjective. This symptom is correlated to strangury in urological vocabulary implies the

difficult or painful passage of urine accompanied by spasms and is commonly the result

of very severe cystltis orprostltis

This symptom is important in differentiating the other pathological conditions by

considering the following points – pain may be present during and after micturition and it

is important to ascertain not only the period at which it is present, but also the actual

location of the pain. If pain is present in urethra during micturition is usually indicates a

stricture or inflammatory process. If pain is experienced immediately after micturition

and felt as tingling or pricking sensation in the glans penis, there is some inflammation or

irritant process at the tirgonal region of the bladder.

Pain may be felt in the perineum during and after micturition in case of prostatic disease.

In the female, pain is felt at the urethral orifice and in the vulva after micturition in cases

of cystitis or vescical carcinoma.

Samanya lakshanas

Mootra sambhandhi

Mootrakrichra considered as one of the Vasti rogas. Involvement of mutra in the

pathogenesis of the Mootrakrichra exhibits some lakshanas, which are pertaining to

mootra. These symptoms can be studied as follows:

Varna of mootra

The tejodhatu, according to Ayurveda, is responsible for the production of all colours –

‘tatra tejodhatuh sarva varnanam prabhavah’134. Therefore any abnormal colour

appearing in the urine, if not derived directly from the ingested food in the form of dyes

or drugs, may be consider to originate inside the body from morbid products or

metabolism or disease states. Tridosha play an important role in afflicting colours of the

urine in the Mootrakricchra135

.

Quantitative change in urine

An increase in the urinary output may result, either from an excess of food and drink or

production of mala in excess. On account of Agnimandya or srotorodha or the vitiation of

Kapha when it converts the vitiated sharira kleda into the mutra or in case of disturbed

functioning of Vata136

. This symptom is objective and quantity of urine output in

Mootrakrichra patients can be assessed by taking measurement of urine out-put per 24

hrs.

Changes in transparency of the urine

Normal urine is stated to be a transparent thin liquid, which on standing for

sometime becomes turbid137

. In kaphaja Mootrakricchra, the transparency of urine

becomes ghana 138.

Froth in urine:

Samples of freshly passed urine appear to be slightly frothy. In vataja Mootrakricchra, the

frothy urine is seen. This is objective sign.

Ruja or shoola:

This means pain in the part of the body. The root factor of shoola in general is considered

as Vata. In this context, due to margavarana of mootra and Purisha by the pathological

events causes provocation of Vata. Depending on place where it is obstructed, shoola

occurs on those organs or structures. Muska, mehana, basti, basti shoola etc. are

mentioned as symptoms in clinical varieties of Mootrakricchra. In our classics, we do not

find descriptions of nature of shoola and its degree of variation from place to place in the

context of Mootrakrichra disease. But this can be understood by considering the

descriptions of urology texts.

Two types of pain have their organs in the genitourinary organs, local and referred. The

later is usually common. Local pain is felt in or near the involved organ. Referred pain

originates in a diseased organ, but is felt at some distance from that organ.

Kidney pain

Typical renal pain is usually felt as a dull and constant ache in the costa-vertebral angle

lateral to that of the sacrospinalls muscle and just below the 12th

rib. This pain often

spreads along the subcostal area toward the umbilicus or lower abdomen quadrant139

.

Ureteral pain

It is typically stimulated by acute obstruction (passage of a stone or a blood clot). In this

instance, there is back pain from capsular distension combined with severe colicky pain

that radiates from the costo-vertebral angle down towards the lower anterior abdominal

quadrant along the course of the ureter. In men it may also felt in the bladder, scrotum or

testicle. In women it may radiate into the vulva140

.

Vesical pain

The over distended bladder of the patient in acute urinary retention will cause agonizing

pain in the suprapubic aea. The patient in chronic urinary retention due to bladder neck

obstruction or to a neurogenic (neuropathic) bladder may experience little or no

suprapubic discomfort even though the bladder reaches the umbilicus141

. The common

cause of bladder pain is infection, the pain is usually not felt over the bladder but is

referred to the distal urethra and is related to the act of urination terminal dysuria may be

severe.

Testicular pain:

Testicular pain due to trauma, torsion of the spermatic cord, or infection is very severe

and is felt locally, although there may be some radiation of the discomfort along the

spermatic cord into the lower abdomen. Pain from a stone in the upper urolor may be

referred in the testicle142

.

Pravrutti Sambandhi

Muhrmutrapravritti

Under normal circumstances, the urinary bladder in the adult has a capacity of

approximately 500-ml, resulting in periodicity of urination of about 4-5 hrs, depending on

fluid intake. Physiologically, the Apanavata is responsible for urination at properties.

Vitiation of Apanavata causes the increased times of urination, is considered as muha

mutrapravritti. Mainly the ‘chala’

Guna of vayu is responsible for this symptom. This symptom can be assessed by

Darshana pareeksha. In urological vocabulary, this symptom is correlated to frequenc143

.

The reduced capacity of urinary bladder will obviously lead to a reduced interval between

the needs to urinate, thus resulting in that common symptom of frequency. Frequency

will also result when the bladder de-compensates in response to de-nervation or long-

standing obstruction. In these later instances, the absolute bladder capacity may be

markedly increased, but the effective capacity i.e. the volume difference between residual

urine and the bladder capacity, may be markedly reduced, leading to frequent urination144.

A very low or very high urine pH can irritate the bladder and cause frequency of

urination145

.

Dahayukta mutrapravritti

Daha may occur in Pitta predominance of the Mootrakrichra pathogenesis. Teekshana,

chala Gunas of Pitta are responsible in causing the daha during micturition. Daha is a

subjective symptom, correlated to burning sensation during micturition. In men, it is

usually felt in the distal uretura just proximal to or in the glans. In women, it is ordinarily

referred to the urethra. This burning sensation occurs in association with the act of

urination, although it may be more marked at the beginning of during, at the end of, or

occasionally after urination. It may be very severe. In men it is apt to be a psychosexual

symptom, in women however it may occasionally be caused by chronic urethritis146

.

Sarakta mutrapravritti

Raktamootrata is seen predominance of Pitta Dosha and obstructive clinical varieties viz.,

Ashmari, Sharkara Mootrakricchra. Teekshana, Ushna, Gunas of Pitta are responsible for

presence of Rakta in mootra. Sarakta mutrapravritti is darshnajneyabhava.

Haematuria may be initial, total or terminal. Initial haematuria is noted chiefly at the

beginning of urination and most commonly indicates diseases in the urethra. Blood noted

mainly at the end of urination is called ‘terminal haematuria and is usually indicates

diseases near the bladder neck or the posterior urethra. Haematuria persisting throughout

the passage of urine is referred to as ‘total haematuria’ and usually indicates a pathologic

disorder sat the level of bladder neck or higher147.

Anushangika Lakshana

Admana - is bloating of the abdomen due to accumulation of the gas inside the

Amashaya and Pakvashaya. ‘adhmanam ghoram vatanirodhojam148

, associated with

increase in the size of the abdomen, diminished movement (due to sanga), a feeling of

stretching pain - Atyugra rujam' and gurgling noise (atopa) occasionally. Here adhmana

refers to basti adhmana, which is due to Vata nirodha by Pureesha or Sukra etc. adhmana

is sparshajneyabhava and shabdha (percussion) pareeksha is employed to elicit this

symptom.

Gauram - guru, sthira Gunas of the Kapha is responsible for gauravata. Here it refers to

basti and Linga gurutva may be due to increased volume of mootra. This is objective

symptom.

Stabdhata - this may be due to combined effect of ruksha and parushya of Vata here, the

word stabhata refers to vrushana stabdhata. This is objective symptom.

Dwandaja and sannipataja Lakshana

Kashyapa has enumerated the dwandaja type of Mootrakricchra. Depend on affliction of

doshas and permutation and combination of Dosha in the pathogenesis, dwandaja type of

Mootrakrichra exhibit the respective lakshanas to its combinations.

Symptoms 149

1. Not everyone with a UTI has symptoms, but most people get at least some.

2. A urinary tract infection causes the lining of the urinary tract to become red and

irritated, producing the following symptoms:

Pain in the flank (side), abdomen or pelvic area

Pressure in the lower pelvis

Frequent need to urinate (frequency)

Painful urination (dysuria)

Urgent need to urinate (urgency)

Incontinence (urine leakage)

Abnormal urine colour (cloudy urine)

Blood in the urine

Strong or foul-smelling urine

Other symptoms that may be associated with a urinary tract infection include:

Pain during sex

Penis pain

Fatigue

Fever (temperature above 100

oF)

Chills

Vomiting

Mental changes or confusion Headache

Diarrhoea

Asymptomatic

Signs of a urinary tract infection

Sediment (gritty particles) or mucus in the urine or cloudy urine

Bad smelling urine (foul odor)

Blood in urine (pink or red urine)

The most of Lakshanas of vataja, pittaja, kaphaja, sannipataja Mootrakrichra can be

compared with clinical features of UTI. The other four types of Mootrakrichra indirectly

results in formation of UTI. For example formation of ashmaris in mootra marga causes

kshata during its movement indirectly leading to UTI.

UPADRAVAS

150

The upadravas of Mootrakrichra is explained in Kashyapa Samhita Chikitsa sthan only.

The occurrence of another disease in the wake of a primary disease as a complication or

sequelae, is termed as upadrava and is meant as rogautharakalaja, rogashraya and

rogaeva, since it is out come of an already existing disease, it may gradually disappear

with the disappearance of the primary disease.

The following have been described as upadravas of Mootrakricchra, i.e.,

1. karshya

2. arati

3. aruchi

4. sanavasthiti

5. thrishna

6. shoola

7. vishada

8. arti

karshya - this may occur due to increased rukshata of Vata or dhatwagnimandya

(medhogni) which are involved in the pathogenesis of mutrakrichra, leads to karshyata of

the body.

Arati - Dalhana has commented on the word arti s aratini shayana asanadou sarvatrapi

sukhabhava Due to marked degree of mutravibhanda and krichrata in mutrapravritti, this

condition may occur as a complication in mutrakrichra.

Aruchi - Is a term loosely applied to mean different conditions such as arochaks inability

to eat in spite of hunger or desire for food, due to distaste or disorders of taste perception

by the tongue and aswadhutwavabhodana -–loss of relish to food due to absence of

hunger or other disorders or stomach due to amadosha. Aruchi is one of the symptoms of

impaired Annavaha Srotas, may arise as a complication in mutravaha sroto vikaras.

Aruchi is considered as one of the rasapradoshaja rogas and involvement of Rasa in the

pathogenesis of Mootrakrichra shows occurrence of aruchi as a complication.

Sanavasthiti - This may occur due to increased chalaguna of vayu. The word sanavasthiti

means instability or unsteadiness. This condition may occur as a complication due to

marked unbearable burning sensation, painful and difficult in micturition.

Thrishna - Thrishna will manifest as a upadrava due to loss of excessive kleda through

mutra.

Shoola - Here shoola can be unerstood as udarashoola, which is due to retention or

vibhanda of mutra and udavarta of mutra. Shoola can occur due to increased pressure in

the Vasti by causative factors, which are dealt earlier.

Vishada – Means, drooping, languoor or lassitude states. This may occur due to strain in

the initiation of urination and pain in the micturation.

Arti - Means pain sorrow, grief. Due to the serious manifestation of the clinical

symptoms and disease condition, this condition may arise as a complication.

Sadhyasadhyata

151

The mode of termination of a disease may, in general be stated to depend upon the seat of

its origin and severity of the course of its development or Samprapti.

A newly started disease, with an extremely early beginning is easily curable with little

efforts. If it becomes continuous or chronic should be deemed as marking or forming one

of its particular stage i.e., termination or becomes krichrasadhya or asadhya. Due,

probably extensive damage sustained or irreversible structural changes having taken

place. Acharya Charaka says in this context, “incurable diseases never becomes curable

while curable disease may pass into the stage of incurable on account of the short-

comings in any of the four basic therapeutic factors or as the result of destiny”.

This principle is applicable to Mootrakrichra also. If Mootrakrichra is newly started it is

curable with efforts. It is becomes continuous or chronic it becomes yapya or curable

with difficulty (krichra sadhya) in a person who adapts to wholesome or conducive diets

and habits on controlling the self.

In classics, as far as prognosis of Mootrakrichra is concerned, Acharyas have not

mentioned prognosis except to sannipatika variety. It shows other clinical varieties of

Mootrakrichra may be sukha sadhya. In sannipatika mutrakrichra, when not cared

properly and in time, may have some complicate symptoms like emaciation, excessive

thirst, colicky pain etc. and prognosis is concerned included under the group ‘krichra

sadhya’ diseases.

But, however, in ashmarija mootrakrichra, when not respond to the medicinal treatment,

acharayas have mentioned saastra vidhi. So ashmarija mootrakrichra can be considered as

a shastra sadhya or kashta sadhya152

.

Vrikkaou (kidneys)

The description of vrikkas is available in Ayurveda in various ways like its formation in

the foetal state, its situation in the body, its shape size and its functions.

Surface anatomy of the vrikkas 153

Different references regarding the situation of vrikkas are available at different places in

different treatises. The vrikkas have been included under the group of koshtangas by all

the ancient authorities. Dalhana has used the word kukshigolakou according to which the

place of vrikkas appears to be at kikshi or the koshta. In koshta, their seat is stated to be

in the back part of the abdomen in the lumbar region, as can be inferred from the

description of the vrikka vidradhi. Yogendranath senhas stated that one is situated in the

right part while other one is situated at the left part.

According to modern anatomy, kidneys lie between the 12th

thoracic and 2nd

lumbar

vertebrae and thus to a considerable extent within the thoracic cage. Anteriorly, the

kidneys may be localized as extending from the interchondral articulation of the 6th

and

7th

rib crosses the kidney at 45 degree angle in such a way that one third of more lies

above and is under the cover of the last two ribs154

.

Anteriolaterally the kidneys are covered by periotoneum and the sufaces of both adrenal

glands.

The adjacent organs vary on the right and left sides.

Table –13. Showing the relationships of right and left kidney

Right Left

Liver, right lobe stomach spleen

Duodenum, right colic flexture of the large colon-spleene flexture pancreas jejunum

intestine hapatic flexture beginning.

Gavinis (ureters) The word gavinis has been used since the time immemorial in Atharvanveda.

References are available regarding the gavinis and sayancharya has explained its role in

transportation of the by-product of the metabolism, which is known as urine. In

Ayurvedic classics, we do not find any word the gavinis. However, some authorities

have tried to correlate between the two-adhogarni dhaminis and the gavinis.

Kaviraj gananath sen has written in Pratyaksha sharira, those channels, which

come towards the mutrabasti, are the two mutravahadhamini and by this statement

Susruta has indicated about the gavinis or ureters. B.G. Ghanakar has disagreed with

this approach.The ureters are the two tubes, which convey the urine from the kidneys to

the urinary bladder.Each tube measures approximately 25 –30cm. In length and its

diameter 3 mm approximately.It passes downwards through abdominal cavity. Behind

the peritoneum and in front of the psoas muscle into the pelvic cavity and opens into

the posterior aspect of the base of the urinary bladder157

. The ureter passes obliquely

through the bladder wall. Because of this arrangement the ureters are compressed and

the opening

occluded when the pressure rises in the bladder. This occurs when it fills with urine and

when its muscular walls contract during micturition158

.

Basti (urinary bladder)

Literally the term ‘basti’ means bladder. In this context, ’bast’ means ‘mutra basti’

(urinary bladder). It is derived from the root ‘vasa nivase’ which means ‘vasati mutra

matra’. The terms Vasti, mutravasti, vastiputa, mutrashaya, mutradhara, seem to have

been used as synonyms in Ayurvedic texts159

.

Surface anatomy of Basti

Susruta has stated that its shape is like that of alabu (gourd), full of siras (blood vessels)

and snayus (tendinous structures) all around. It is stated to be of tanu twak i.e., thin

walled organ or its coverings are thin and membranous. It has one exit only with its

mouth downwards160

. Vagbhata has described its shape as ‘dhanur vakra i.e. bent like a

bow, having one opening downwards and composed of little muscle and blood161

. It has

towards its terminal portion, sushira snayus (sphincter muscles). Adhamalla describes its

shape as charma khallwatwakar i.e. like a bag of leather.

Vasti has been included under koshtangas and ashayas by all Acharyas. It is stated to be

one in number Charaka describing the location of Basti, has stated that Vasti is situated in

between the sthula-guda (rectum) mushka (scrotum), sevani (perineal raphe), shukravaha

nadis and mutravaha nadis (ureters). Susruta also shares the views of Charaka. He says

that Vasti is surrounded by nabhi (naval, prishta (back) kati loin) mushkas (scrotum) guda

(rectum) vankshanas (groins) and shepha (penis) 162.

Bhavamisra and sharangadhara says

that it is located below the pakwashya (large intestine).

Table –14. According to modern anatomy the organs in association with the bladder 163

In the female In the male

Anteriorly – symphysis pubis Anteriorly – symphysis pubis

Posteriorly-uterus Posteriorly-rectum and seminal vesicles

Superiorly-small intestine Superiorly-small intestine

Inferiorly- urethra and muscles forming the Inferiorly- urethra and prostate gland

pelvic floor

Basti as marma

Vasti is stated to be a marma (vital organ) included under the category of snayu

marmas, which shows the prominence of its tendinous and membranous structure.

Injury to it is stated to cause rapid death. The location of this marma is said to be

inside the loin and its dimensions four finger164

.

Mutraseka (urethra)

Mutraseka or mutrapraseka is the urethra through which collected urine in bladder is

excreted. Charaka has used the term ‘mutrasrotas’ to indicate the urethral canal.

Madhavakara has used the term ‘mutra Srotas’ while explaining the Ashmari

Nidana165

.

The other details like size and shape etc. are not available in the Ayurvedic literature.

According to modern anatomy, the urethra is a canal, which extends from the neck of

the bladder to the exterior and its length differs in the male and in the female. The

male urethra is associated with the urinary and reproductive system.

The female urethra is approximately 4-cm. length. It runs downwards and forwards

behind the symphysis pubis and opens at the external urethral orifice just in front of the

vagina. A sphincter muscle guards the external urethral orifice, which is under the control

of will166

.

The same is expressed in atharvana Veda that urine collected in Vasti (bladder) from two

gravinis (ureters) which emerge from antra (intestine). Antra in this context should be

considered as from the region near and about the intestines. By intestines if we interpret

or understood that our ancestors meant kidneys there is major contradiction for the

modern physiological concept to agree with that of Atharvaveda. Ayurvedic scholars and

ancient Indians had the practice of expressing regions instead of organ at many places.

For ex. While counting koshtangas they counted all organs including Vasti hridaya yakrit,

pleeha etc. which were near and about koshta alimentary tract.

“hrudi vyadha” while describing the effect of jwara, means pain in the region of heart and

not in the heart. The location of Vasti, gavini is described by Charaka and Susruta in such

clear anatomical terms that both have to be identified as bladder and ureters and noting

else. The two ureters from bladder are not connected to intestines but to kidneys on either

side. It cannot be said that the ancient was so blind and foolish as not to trace. We have

inferred that this discrepancy had arisen due to their usual method of expression or to

faulty tradition. Hence the description atharvaveda does not find much opposition from

modern physiological findings if we accept that the ancestors meant kidneys by their

nearness and location just below the intestine while observing the formation of urine.

Ayurvedists consider that mootra is formed or nourished from the wastage or kitta after

digestion of ingested food. While commenting in Susruta Shareera 9th

chapter, Dalhana

says that the remaining fluid that is found after absorption of nourishing portion in

Pakvashaya is not to be termed as mutra, but as fluid or water only167

.

He says that the same fluid entering Vasti gets the designation as mutra. The digestion

and separation of nutrition’s and waste portions is done by samana vayu, whose zone or

sphere of action is whole kosta and which keeps Agni indigestion. The main excretory

action of urine is controlled by apanavayu which expels other malas, sukra, garbha,

artava etc. thus in the formation and expulsion of mutra samana vayu and apana vayu

take part. According to sharangadhara the waste peortions of digested food in the form of

fluid mala entering Vasti becomes mutra. Similar view is expressed by Susruta and

Vagbhata.

Dr. Dwarakanath in his introduction to Kayachikitsa opines that there is some evidence

found in modern contributions that mutra formation has got relation in someway with the

absorption of water in large intestines168

. According to the same author the waste

products are an index of life activities. The living body can never be without the

formations of malas and certain amount of residual malas are always present in it169

.

Applied anatomy

Ureters these are a pair of muscular tubes and extend inferiorly and medically. The paths

taken by ureters in men and women are different due to variations in nature, size and

position of reproductive organs. In males the base of u- bladder lies between rectum and

pubic symphysis in females the base of bladder sits inferior to uterus and anterior to

vagina170

.

The uterus penetrates position wall of bladder at any oblige angle and ureteral openings

are slit like rather than rounded. This shape help prevents back flow of urine towards

uterus and kidneys when u bladder contracts171

.

About every 30 seconds a peristalic contraction begins at renal palvis and sweeps along

ureter forcing urine towards bladder172

. If peristalsis and fluid pressure are in sufficient to

dislodge them they may be destroyed.

Urinary bladder

It is a hollow, muscular organ that function as a temporary reservoir. In sectional view,

mucosa lining urinary bladder is usually thrown in folds or rouge that disappears as it

fills. The mucosa here is smooth and very thick. The triangular area bounded by uretral

openings and the entrance to urethra constitutes trigone which acts as funnel this channels

urine into urethra, when urinary bladder173

.

Urethra

The female and male Urethra differ in length. In females urethra is very short, extending

3-5 cm (1-2 inch) from bladder to vestibule. The extension urethra opening is situated

near anterior wall of vagina174

. In males, Urethra extends from neck of urinary bladder to

the tip of penis, a distance that may be of 18-20 cm175

.

Physiological interpretations

Anti-microbial properties of bladder mucosa 176

Flushing action associated with periodic voiding of urine. However failure of these 1-2

defensive mechanisms of bladder are overwhelmed setting stage for UTI. Micturition is

the process by which urinary bladder empties when it becomes filled, involving 2 steps

177 -

1. Progressive filling up of bladder until it’s on rise above threshold level

2. Nerve reflex that empties bladder or at least causes a conscious desire to urinate.

Muscles of bladder 178

Smooth muscle cells of detrusor muscle fuse with one another so that low resistance

electric pathways exists from one cell to another cell to cause contraction of entire

bladder at once, so that residual urine no to be found in bladder. Bladder muscle tone

normally prevents emptying of bladder until critical threshold rises. External sphincter

muscle is under voluntary control and can be used to consciously prevent urination even

when involuntary controls are attempting to empty bladder.

The principal nerve supply of bladder is pelvic nerve through which sensory and motor

functions are governed, connecting with s2 and s3.

For easy flow of urine, peristaltic contractions in ureter are enhanced by parasympathetic

stimulation and in inhibited by sympathetic stimulation.

The normal tone of detrusor muscle compress under thereby by preventing back flow of

urine from bladder when pressure builds up in bladder doing micturition, that reflexes

called vesico-ureter reflex.

When bladder is partially filled, these micturition contractions usually relax

spontaneously so that it allows micturition reflex is self regenerative, starting from

contraction of bladder and activating stretch receptors to cause increase in sensory

impulse to bladder, which in reflex causes contraction of bladder in repeated cycle it

automatically ceases after few seconds, permitting bladder to relax179

.

Upashaya and Anupashaya

Upashaya is a form of diagnosis by applied therapeutics. The medicine or the hygienic

treatment (vihara) which will give relief is known as Upashaya. If the patient feels worse

on the other hand, is termed as Anupashaya, says Charaka in Vimana sthanas ‘goodha

Linga vyadhin upashayanupashayabhyam pareekshat’ upashaya and Anupashaya may

investigate i.e. an un-manifested or obscure disease180

.

It is not mentioned in classics about Upashaya and Anupashaya regarding

Mootrakricchra. As far as there is no goodha Linga in this disease, Acharyas might not

have mentioned the Upashaya and Anupashaya for this disease181

.

But however, the causative factors themselves may be taken as Anupashayas,

especially kashaya, katu, tikta, ruksha and other Nidana may be ascribed as to

Anupashaya of Mootrakricchra.

Vyavachedaka Nidana

It is a fact that disease is usually recognised by their signs and symptoms. Whenever a

symptom is noticed in a patient that must be taken as the lead in the study of the vitiated

doshas dushayas and sthanas (organs) involved. But it is often seen that a particular

symptom appears in more than one disease. In such cases the cordinal symptoms

(pratyatma Linga) with the associated symptoms would give a clue to the correct

diagnosis of the disease.

Differential diagnosis is based on comparison of symptoms of two or more similar

diseases to determine which the patient is suffering from.

As far as Mootrakrichra is concerned, differential diagnosis is made by the cordinal

symptoms and adhistana of the disease (basti), which is involved in the pathogenesis of

Mootrakricchra. So it is distinguished from possible diseases that are likely to answer this

syndrome viz., Vata kundalika, Mutrautasangam, Mutragranthi, Ushnavata, Mutrasada,

Vastikundala and Ashmari182

.

According to Chakrapani and others, the main difference between Mootrakricchraand

mutraghata is, Mootrakricchrais krichra pradhana and vibhanda alpata where as

mutraghata is vibhandha pradhana and alpa krichrata present during micturition. Thus

differential diagnosis is made by degree of obstruction and pain during micturition183

.

Thus, the possible diseases that are likely to answer this syndrome are considered and

physician comes to a tentative diagnosis of course, to be confirmed on further

examination by seeking assistance of laboratory.

Chikitsa of Mootrakrichra

Chikitsa can be classified under three categories viz., Samshodana, Samshamana, and

Nidana parivarjana. 184

Shodana is adopted to disintegrate Dosha Dushya Samurchana, thus ensuring the

expulsion of vitiated pittadi doshas. Shamana chikitsa also causes the destruction of

factors responsible for manifestation of disease185

. This is achieved by the properties of

medicine, which are antagonistic and counteracting to the vitiated doshas and to the

disease.

As the Nidana is inevitable for the formation of the disease, Nidana parivarjana i.e.

avoidance of causative factors is the best management. Unless this is done the disease

becomes further aggravated.

The medicament, and food, which are opposite to those explained for Prameha roga,

should be adopted here and Mootrakrichra should be managed with proper snehana and

mridu shodhana186

.

As there is no specific Chikitsa sutra mentioned for the disease Mootrakrichra,

considering the doshaja lakshanas, Acharyas explained separate shodhana and shamana

Chikitsa for each type of Mootrakrichra.

SHODHANA CHIKITSA

187

Vataja Mootrakrichra Chikitsa

Vatanashaka Taila sevana and Abhyanga

Sneha and Niruha Basti

Uttara Basti

Pittaja Mootrakrichra Chikitsa

Guda - Dugdhapana

Ghritapana

Virechana

Basti

Kaphaja Mootrakrichra Chikitsa

Tikta rasa sadhita taila Abhyanga and Pana

Swedana

Niruha Basti

Sannipataja Mootrakrichra Chikitsa

Considering the Vata sthana, chikitsa to be adopted (Anulomana)

In case of Pitta adhikata – Virechana

In case of Vata adhikata – Basti

Ashmari –Sharkara Chikitsa

The Chikitsa, which are useful in Kaphaja and Vataja Mootrakrichra, are to be adopted

here. Management of Mootrakrichra with Shodana therapy helps in checking the dosha-

dushya samurchana itself. Except Vamana and Nasya other types of Panchakarma can be

adopted for this disease considering the vitiated doshas. As it is a tridoshaja vyadhi,

Snehapana, Swedana, Verechana, Basti (both Niruha and Uttara basti) are considered to

be useful.

Shamana Chikitsa

Mootrakrichra can be successfully treated with shamana Chikitsa. This can be classified

into two categories.

i) Samanya Chikitsa: -Some specific yogas, which can be adopted in all kinds of

Mootrakrichra.

ii) Vishesha Chikitsa:-The one which can be used in particular variety of

Mootrakrichra specific to the predominance of doshas.

The drugs such as Pashanabheda, Gokshura, Varuna etc., act not only against the doshas,

They also act as vyadhihara. It is also logical to state that usage of such mutrala dravyas

helps in relieving the krichchrata (dysuria) flushing out the causative organisms from the

mutramarga.

Samanya Bahyopachara

188

Abyanga by using Eranda Taila over basti pradesha. Next swedana or sinchana is done

using Palasha pushpa kwatha. This helps in shamana of Mootrakrichra.

Lepa: Gokshura, Bidalavana, Arvarubeeja are mixed with kanji and made a paste. This

lepa is applied over basti pradesha, there by Mutrakrichchra will be relieved immediately.

DRUG REVIEW

The formulation of Guda-Dugdha prayoga is explained in Bhava Prakash189

and

Yoga Ratnakara190

.

Guda 191

:-

Sanskrita Name- Guda

Botanical Name-Soccharum officinarum

English name- jaggery

Rasa- madhura,

Guna- guru, snigdha,

Veerya-Ushna,

Vipaka- Madhura

Doshghnata- Tridoshahara

Karma- veeryavardhaka, mutrashodhaka,

Chemical composition:-

The good quality jaggery contains moisture 3.6%, sucrose 6.85%, invert sugar 10-

15%, ash 2.5%, protein 4%, mineral matter 6%, calcium 80 mg/100 gm, and

phosphorus 40 mg/100 gm, iron 11.4 mg/100 gm. It also contains carotene,

vitamin A, Thiamine 0.02 mg, Nicotinic acid 10 mg/100 gm.

Godugdha 192

Pharmaco dynamics:

Rasa – Madhura,

Guna – Snigda, Mridu, Slaksna and Picchila

Veerya – Sheeta

Vipaka - Madhura.

Dosha karma – Vata pitta shamaka

Karma – Vrishya, Balavardhaka,Bramhana, Madhya, Jeevaniya &

Asthisandhanakara

Rogaghnata – Pandu, Rakta pitta, Yoni roga, Shukra dosha, Mootra roga, Pradara

roga etc & it is pathya in vata pittaja vikara

Cows milk promotes long life it is rejuvenator good for those emaciated after

injury, increases intelligence, strength & breast milk. It cures shrama, kasa, thrishna,

jeerna jwara, mootra krichra & rakta pitta.

MATERIALS AND METHODS

The therapeutic measures, drugs and procedures of Ayurveda have remained in the

practice since long on the basis of methodology prevalent in ancient times. This is the

time that the rationality of Ayurvedic therapeutic approach is explained on rational lines.

Clinical trial is a way of research and its best method to evaluate any drug or line of

treatment. The trial is a carefully designed experiment with the aim of solving

unrewarding problems conducted on scientific lines.

MATERIALS:

The materials taken for the study were:-

A) Drugs:

Guda

Go-dugdha

B) Patients: Total 40 patients diagnosed as Pittaj Mootrakrichra i.e. having Urinary tract

infection were selected for the clinical study.

Drug:

Guda Go-dugdha formulation was prepared with the ingredients and method of

preparation as mentioned in Bhavaprakash and Yogaratnakara.

METHODS

A. Aim of the study:

In the present study Guda Go-dugdha formulation is used.

So, the objectives of the study can be listed as follows.

To evaluate the efficacy of Guda-Dugdha prayoga in the management of

Pittaja Mootrakrichra.

To study the disease Pittaja mootrakrichra as per Ayurvedic literature

To study the detail about Aetiopathogenesis of Urinary tract infection as per

modern literature.

B. SOURCE OF DATA:

Patient suffering from symptoms of Pittaja Mootrakrichra having Urinary tract

infection were selected from O.P.D. of Raiv Gandhi Education Society`s Ayurvedic

Medical College, Hospital and research Centre for PG studies, Ron and other local

practitioner`s clinic/hospitals in Ron after fulfilling the inclusion and exclusion criteria.

Patients selected are thoroughly examined with both subjective and objective

parameters. Detailed general history and physical examination findings were noted.

Laboratory investigations such as complete Urine examinations including the pus cell

count are done along with the ensuring Random Blood Sugar, Blood Urea and serum

Creatinine for exclusion. Routine investigations of blood were undertaken to exclude

other pathology under veined.

C. LITERARY :

Literary aspect of the study pertaining to Pittaja Mootrakrichra and Urinary tract infection

are collected from both Ayurvedic as well as modern text books and updated with recent

medical journals, internet etc.

D. STUDY DESIGN–

It is an observational clinical study.

E. SAMPLE SIZE –

The sample size for the present study consists of total 40 patients of Pittaja Mootrakrichra

excluding the 3 drop outs.

F. SELECTION CRITERIA:

The cases were selected as per-set inclusion and exclusion criteria

a) Inclusion Criteria:

Patients presenting with classical signs and symptoms of Pitttaja Mootrakrichra

like Peeta mootrata, Krichra mootrata, Sa daha mootrata, Sa rakta mootrata and

Muhur muhur mootrata.

The age group between 20 years to 40 years irrespective of sex, religion,

socioeconomic status and food habits.

b) Exclusion Criteria:

Patient below 20 years and above 40 years. Patients presenting with the signs and symptoms due to obstructed pathology like

BPH, renal calculi.

Patients having other systemic disorders like DM, STDs and Pregnant women.

C) Diagnostic Criteria:

Peetha mootrata

Kruchra mootrata

Sa daha mootrata

Sa rakta mootrata

Muhur muhur mootrata.

G. POSOLOGY:

GUDA - DUGDHA PRAYAOGA

DOSAGE: 30 gm of Guda with 100 ml of Go-dugdha in two divided dosage (Before

food)

DURATION: 7 days

FOLLOW UP: 7 days

Source of formulations:

Agnitapa was done in R.G.E.S. Bhaisajyakalpana Department to convert naveen guda

into puran guda.

H. CRITERIA FOR ASSESSMENT OF RESULTS :

The subjective and objective parameters of base line data to pre and post medication were

compared with gradation for assessment of results. All the results were analyzed

statistically for ‘p’ value using ‘z’ test.

1. Subjective Criteria:

1. Peeta mootrata & Saraktha mootrata

No Colour – 0

Slight yellow – 1

Yellow Urine – 2

Dark Yellow Urine – 3

Red Urine – 4

2. Sa daha mootrata

No Burning Sensation – 0

Burning micturition while Passing – 1

Burning Persist after passing – 2

Continuous burning micturition – 3

3. Kruchra mootrata

No difficulty during micturition – 0

Mild difficulty during micturition – 1

Moderate difficulty during micturition – 2

Severe difficulty during micturition – 3

4. Muhur muhur mootrata

Passes urine once in three hours – 0

Passes urine once in one hour – 1

Passes urine 4 times in one hour – 2

Passes urine more than 4 times in one hour – 3

Urges persist throughout – 4

OBJECTIVE CRITERIA:

Urine microscopy

1. Albumin discharge

a) No Albumin discharge – 0

b) Albumin discharge + – 1

c) Albumin discharge ++ – 2

d) Albumin discharge +++ – 3

2. Pus Cells

a) No Pus cells – 0

b) Pus cells 1-5 – 1

c) Pus cells 6-10 – 2

d) Pus cells 11-16 – 3

e) Pus cells 16 and more – 4

3. Epithelial Cells

a) No Epithelial Cells – 0

b) Epithelial Cells 1-5 – 1

c) Epithelial Cells 6-10 – 2

d) Epithelial Cells 11-16 – 3

e) Epithelial Cells plenty – 4

I. INVESTIGATIONS :

Urine Analysis / Routine test

1. pH

2. Protein

3. Albumin

4. Epithelial Cells

5. Pus Cells

Materials for laboratory investigation: The laboratory investigations were done in

Rajiv Gandhi Education Society`s Ayurvedic Medical College and Hospital, Ron.

OVERALL ASSESSMENT:

For the overall assessment of the therapy, the formula used was,

Total before treatment parameters - Total after treatment parameters

Total before treatment parameters X 100

CURED= >75 % relief

MODERATE RESPONSE= 50% to 75% relief

MILD RESPONSE= 25% to 50% relief

NOT RESPONDED= < 25% relief

Presentation of data:

The data collected and compiled from this clinical trial is sorted out and processed further

by implying various statistical methods and presented with tabular form in the following

sequence.

General observations viz. age, sex, religion, etc.

Lakshanatmaka Parikshana

Results of therapy evaluated on the basis of improvement in subjective and

objective parameters of various rating scales.

Statistical Analysis:

The information gathered on the basis of observation made about various parameters was

subjected to statistical analysis in terms of Mean, Standard Deviation and Standard error

(SE). z test was carried out at p<0.05, p<0.01, p<0.001 level. The obtained results were

interpreted as:

Not significant = P > 0.05

Significant = P < 0.05

Highly Significant = P < 0.01 and P < 0.001

OBSERVATIONS

OBSERVATIONS AND RESULTS

43 patients were registered for the present study. Out this, 3 patients were discontinued,

hence their data has not been included here. The remaining 40 patients of Mootrakrichra,

fulfilling the criteria for diagnosis, were treated.

All the patients were examined before and after the treatment, according to the case sheet

format given in the annexure. Both the subjective and objective criteria were recorded.

The details of age sex, religion, and occupation etc. of the 40 patients is as

follows.

1. Observation of patients based on Age

Among the 40 patients 8 patients were in the age of 21-25 years (20%), 15 patients were

of 26– 30 years (37.5 %) , 08 patient s were in the age group of 31 – 35 years (20%) and

09 patient s were in the age group of 36 – 40 years (22.5%).

This table shows that maximum number of patients were found in the age group 26-30

year.. Table No. 15 Showing the patients based on age

Sl. No. Age in No. of Percentage

years Patients

1 21-25 8 20%

2 26-30 15 37.5%

3 31-35 08 20%

4 36-40 09 22.5%

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 58

OBSERVATIONS

Graph No-1, DISTRIBUTION OF PATIENTS BY AGE

36-40 20-25

20.00% 22.50%

0.00%

26-30

37.50%

31-35

20.00% DISTRIBUTION OF PATIENTS BY AGE

2. DISTRIBUTION OF PATIENTS BY

GENDER Table- 16 Distribution of patients by Gender

Sl.no Religion No. of Percentage

. Patients

01 Male 17 42.5

02 Female 23 57.5

Observation:

The percentage of the distribution does show the gender differentiation to get

this disease. The observations are 23 Patients i.e. (57.5%) were female and 17 patients

i.e. (42.5%) were male.

Graph – 2 DISTRIBUTION OF PATIENTS BY GENDER

OBSERVATIONS

Graph No.- 2, GENDER

17 male

female

23

3. DISTRIBUTION OF PATIENTS BY RELIGION

The present study explains all the communities are reported with the problem of Pittaja

Mutrakrichra. The Hindu community was shown more prone to this disorder. This does

not mean that other communities have less risk towards this problem. In fact the area

where the study underwent has the dominancy of Hindu community. Out of 40 patients

recorded 36 (90%) patients belong to Hindu, 4(10%) patients belong to Muslim.

Sl.no Religion No. of Percentage

. Patients

01 Hindu 36 90

02 Muslim 04 10

Table- 17 Distribution of patients by religion

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 60

OBSERVATIONS

Graph – 3 DISTRIBUTION OF PATIENTS BY RELIGION

Graph No.- 3, RELIGION

4

HINDU

MUSLIM

36

4. Observation of patients based on Occupation

Table No.18, Showing the patients based on Occupation

Sl.no. Occupation No. of Percentage

Patients

01 Laborious 21 52.5

02 Sedentary 5 12.5

03 Active 14 35

In this study we considered three categories of occupation for the convenience of study.

Out of 40 patients 21 (52.5%) are of laborious in nature, 5 (12.5%) patients do sedentary

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 61

OBSERVATIONS

job and 14 (35%) patients were of active group. The people who are working as long

standing, sports men, lecturers, contractors etc. are taken in active group. Below depicted

graph describes the above statement.

Observation of patients based on Occupation

Graph No. 04

30

25

21

20

14

15

Labor

10

Sedentary

Active

5

5

0

No. of Patients

5. DISTRIBUTION OF PATIENTS BY ECONOMIC

STATUS Table- 19 distribution of patients by economic status

Economic status Total patients

%

Poor 14 35

Middle 17 42.5

High 09 22.5

Aristocrat 0 0

Total 40 100

Observation:

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 62

OBSERVATIONS

In this study the common four groups of economical statues are considered. They are 1) Poor, 2)

Middle, 3) Higher class and 4) Aristocrat. Out of 40 patients reported, maximum numbers of

14+17= 31 (77.5%%) patients are either from middle or poor class. 9 (22.5%) patient reported

from the higher middle class.

Graph – 5, DISTRIBUTION OF PATIENTS BY SOCIO ECONOMICAL STATUS

18

17

16

14

14

12

9

10

8

6

4

2

0 0

Poor

Middle

High

Aristocrat

Patients by economical status

6. DISTRIBUTION OF PATIENTS BY MARITAL STATUS

Observation:

The marital life ratio as unmarried to married is observed as 1:3. The observations are 30

Patients i.e. (75%) were married and 10 patients i.e. (25%) were unmarried.

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 63

OBSERVATIONS

Table- 20 distribution of patients by marital status

Total patients

Marital status %

Married 30 75

Unmarried 10 25

Total 40 100

Graph – 6 DISTRIBUTION OF PATIENTS BY MARITAL STATUS

Unmarried 25.00%

Married

75.00%

MARITAL LIFE DISTRIBUTION

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 64

OBSERVATIONS

7. DISTRIBUTION OF PATIENTS BY MODE OF ON

SET Table- 21, distribution of patients by mode of on set

Total patients

Mode of on set %

Gradual 34 85

Acute 06 15

Total 40 100

Observation:

In this study the common two groups of onset states are considered. They are 1) gradual class and

2) acute class. Out of 24 patients reported, maximum numbers of 34 (85%) patients are from

gradual class and 6 (15%) patients are reported from the acute class.

Graph –7 : DISTRIBUTION OF PATIENTS BY MODE OF ON SET

Acute

15%

Gradual

85%

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 65

OBSERVATIONS

8. DISTRIBUTION OF PATIENTS BY PRAKRUTI

Table-22, Distribution Of Patients By Prakruti

Prakruti Total

patients %

Vata Pitta 28 70

Pitta Kapha 7 17.5

Vata Kapha 5 12.5

Tridosha 0 0

Total 24 100

Observation:

In this study the common groups of Prakruti are considered as three dwandaja and sannipataja, as

it is not possible to exist individual Prakruti. Out of 24 patients reported, maximum numbers of

13 (54.1%) patients are with Vata Pitta in nature and the rest of 11 are distributed as 6 and 5 for

the groups of Pitta Kapha and Vata Kapha Prakruti respectively. Tridosha Prakruti patients were

not reported in the study.

Graph -8 DISTRIBUTION OF PATIENTS BY PRAKRUTI

Vata Kapha

Pitta Kapha 12.50% Tridosha

0.00%

17.50%

Vata Pitta

70.00%

Distribution by Prakruti

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 66

OBSERVATIONS

9. DISTRIBUTION OF PATIENTS BY FREQUENCY OF

ATTACKS TABLE- 23, Distribution Of Patients By Frequency Of Attacks

Frequency in Number %

a year of

patients

No History 33 82.5

Less than 3 04 10

More than 3 - 03 7.5

Less than 6

Total 40 100

Observation on Frequency of attacks:

In this study the frequency of attacks are enumerated. In the class less than 3 times frequency of

attacks in a year are 4 patients (10%) are reported. In the class more than 3 times and less than 6

times in a year frequency of attacks in a year are 3 patients (7.5%) are reported, 33 (82.5%)

patients reported no history of recurrent attacks.

Graph – 9, Distribution of patients by frequency of attacks in a year

More No

than 3 -

History

Less than

82.50%

6

7.50%

Less than

3

10.00%

Frequency in a year

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 67

OBSERVATIONS

10. DISTRIBUTION OF PATIENTS BY COLOUR OF

URINE Table- 24, Distribution Of Patients By Colour Of Urine

Colour Total patients

%

Clear 11 27.5

Cloudy 7 17.5

Hazy 7 17.5

Deep yellow 15 37.5

Observation on colour of Urine:

In this study the colour of urine is enumerated. Even though 11 (27.5%) of patients show clear

urine, out of the rest 72.5% of patients cloudy, hazy and deep yellow colours are observed with

the patients 7 (17.5%), 7 (17.5%), and 15 (37.5%) respectively.

Graph – 10. DISTRIBUTION OF PATIENTS BY COLOUR OF URINE

Deep

yellow, 15

Hazy, 7

Cloudy, 7

Clear, 11

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 68

OBSERVATIONS

11. DISTRIBUTION OF PATIENTS BY REACTION OF

URINE Table- 25, Distribution Of Patients By Reaction Of Urine

Total

pH patients

%

4.5 to 5.5 34 85

5.5 to 6.5 6 15

Total 40 100

Observation on reaction of Urine:

In this study the reaction of urine is enumerated. At this study 34 (85%) of patients shown 4.5 to

5.5 pH urine, out of the rest 6 (15%) of patients it is 5.5 to 6.5 pH.

Graph – 11, Distribution of patients by reaction of urine

DISTRIBUTION OF PATIENTS BY REACTION

pH5.5to

6.5

15.00%

pH4.5to

5.5

85.00%

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 69

OBSERVATIONS

12. DISTRIBUTION OF PATIENTS BY VYASANA

Table-26, Distribution Of Patients By Vyasana

VYASANA Total no of patients Percentage

Alcohol 11 27.5

Tobacco chewing 18 45

Smoker 13 38.5

Tea /coffee 34 85

Graph – 12, DISTRIBUTION OF PATIENTS BY VYASANA

DISTRIBUTION OF PATIENTS BY VYASANA

Tea /coffee

Smoker

Tobacco

chewing

Alcohol

34

13

18

11

0 20 40

Observation on Vyasana: In this study the Vyasana are enumerated as concerns with tobacco and alcohol. It is not certainly

a cause of the Mootrakricchra, but in routine the habits are examined. The alcohol consumers are

11 (27.5%), Tobacco chewing 18 (45%), smokers 13 (38.5%) and Tea/Coffee user are 34 (85%)

patients.

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 70

15. Subjective Parameters

1. Impact of Guda Godugdha Yoga on Peeta mootrata & Saraktha

mootrata Table No.28, Showing the result on Peeta mootrata & Saraktha mootrata

Grade No. of patients

B.T. % A.T. %

00 - - 1 2.5

01 5 12.5 10 25

02 19 47.5 25 62.5

03 15 37.5 04 10

04 1 2.5 - -

Before treatment: Among 40 patients, 5 patients i.e. 12.5 % patients were observed under Grade

1, 19 patients i.e. 47.5% were observed under Grade 2 and 15 patients i.e. 37.5% were observed

under Grade 3 and 1 patient was having grade 4.

After treatment: Among 40 patients, 10 patients i.e. 25% patients were observed under Grade 1,

25 patients i.e. 62.5% were observed under Grade 2, 4 patients were having grade 3, and 1 patient

was having grade 0.

Impact of Treatment on Peeta mootrata & Saraktha mootrata Graph no 14.

100%

4 10

04

15 37.5

03

50%

25 62.5

02

19 47.5

10 25

01

0% 5 12.5

00

B.T. %

A.T. %

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 72

2. Impact of Guda Godugdha Yoga on Sa daha

mootrata Table No. 29 , Showing the result on Sa daha mootrata

Grade No. of patients

B.T. % A.T. %

00 - - 1 2.5

01 6 15 12 30

02 21 52.5 22 55

03 12 30 05 12.5

04 1 2.5 - -

Impact of Treatment on Sadaha mootrata Graph no 15.

100% 1 2.5 0 0

12 30 5 12.5

80%

22 55

60%

21 52.5

40%

20%

12 30 6 15

0%

B.T. %

A.T. %

04 03

02

01

00

Before treatment: Among 40 patients, 6 patients i.e. 15 % patients were observed under Grade 1,

21 patients i.e. 52.5% were observed under Grade 2 and 12 patients i.e. 30% were observed under

Grade 3 and 1 patient was having grade 4. After treatment: Among 40 patients, 12 patients i.e.

30% patients were observed under Grade 1, 22 patients i.e. 55% were observed under Grade 2, 5

patients i.e. 12.5% were having grade 3, and 1 patient was having grade 0

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 73

3. Impact of Guda Godugdha Yoga on Krichchra mootrata

Table No.30 , Showing the result on Krichchra mootrata

Grade No. of patients

B.T. % A.T. %

00 - - - -

01 7 17.5 13 32.5

02 20 50 23 57.5

03 12 30 04 10

04 1 2.5 - -

Before treatment: Among 40 patients, 7 patients i.e. 17.5 % patients were observed under Grade

1, 20 patients i.e. 50 % were observed under Grade 2 and 12 patients i.e. 30% were observed

under Grade 3 and 1 patient was having grade 4.

After treatment: Among 40 patients, 13 patients i.e. 32.5% patients were observed under Grade

1, 23 patients i.e. 57.5% were observed under Grade 2, 4 patients i.e. 10% were having grade 3,

Impact of Treatment on Krichchra mootrata

Graph no 16.

100%

1 2.5 4 10

80%

12 30

23 57.5

04

60%

03

40%

20 50

02

01

20%

13 32.5

00

7 17.5

0%

B.T. %

A.T. %

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 74

4. Impact of Guda Godugdha Yoga on Muhur muhur mootrata

Table No. 31, Showing the result on Muhur muhur mootrata

Grade No. of patients

B.T. % A.T. %

00 - - - -

01 6 15 8 20

02 18 45 26 65

03 14 35 06 15

04 2 5 - -

Before treatment: Among 40 patients, 6 patients i.e. 15 % patients were observed under Grade 1,

18 patients i.e. 45 % were observed under Grade 2 and 14 patients i.e. 35% were observed under

Grade 3 and 2 patient s were having grade 4.

After treatment: Among 40 patients, 8 patients i.e. 20% patients were observed under Grade 1,

26 patients i.e. 65% were observed under Grade 2, 6 patients i.e. 15% were having grade 3,

Impact of Treatment on Muhur Muhur mootrata

Graph no 17.

100%

2 5 6 15

80%

14 35

04

60%

26 65

03

02

40%

18 45

01

20%

8 20

00

6 15

0%

B.T. %

A.T. %

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 75

16. Objective Parameters

1. Impact of Guda Godugdha Yoga on Albumin

Discharge Table No.32 , Showing the result on Albumin Discharge

Grade No. of patients

B.T. % A.T. %

00 4 10 16 40

01 20 50 18 45

02 13 31.5 6 15

03 3 7.5 - -

04 - - - -

Before treatment: Among 40 patients, 4 patients i.e. 10 % patients were observed under Grade 0,

20 patients i.e. 50 % were observed under Grade 1 and 13 patients i.e. 31.5% were observed

under Grade 2 and 3 patients were having grade 3.

After treatment: Among 40 patients, 16 patients i.e. 40% patients were observed under Grade 0,

18 patients i.e. 45% were observed under Grade 1, 6 patients were having grade 2

60

50

50

45

40

31.5

30

20

18

20

15

13

7.5

6

10

3

0

B.T. %

A.T. %

00

01

02

03

Graph 18. Impact of Guda Godugdha Yoga on Albumin Discharge

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 76

2. Impact of Guda Godugdha Yoga on Puss

cells Table No.33 , Showing the result on Puss cells

Grade No. of patients

B.T. % A.T. %

00 0 0 6 15

01 10 25 20 50

02 22 55 12 30

03 8 20 2 5

04 - - - -

Before treatment: Among 40 patients, 10 patients i.e. 25 % patients were observed under Grade

1, 22 patients i.e. 55 % were observed under Grade 2 and 8 patients i.e. 20% were observed under

Grade 3.

After treatment: Among 40 patients, 6 patients i.e. 15% patients were observed under Grade 0,

20 patients i.e. 50% were observed under Grade 1, 12 patients i.e. 30% were having grade 2 and 2

patients had grade 3.

60

55

50

50

40

30

30

25

22

20

20

20

10

8

12

10

2

5

0

B.T. %

A.T. %

00

01

02

03

Graph no- 19, Impact of Guda Godugdha Yoga on Puss cells

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 77

OBSERVATIONS

3. Impact of Guda Godugdha Yoga on Epithelial cells

Table No.34 , Showing the result on Epithelial cells

Grade No. of patients

B.T. % A.T. %

00 0 0 5 12.5

01 11 27.5 18 45

02 20 50 14 35

03 9 22.5 3 7.5

04 - - - -

Before treatment: Among 40 patients, 11 patients i.e. 27.5 % patients were observed under

Grade 1, 20 patients i.e. 50 % were observed under Grade 2 and 9 patients i.e. 22.5% were

observed under Grade 3.

After treatment: Among 40 patients, 5 patients i.e. 12.5% patients were observed under Grade 0,

18 patients i.e. 45% were observed under Grade 1, 14 patients i.e. 35% were having grade 2 and 3

patients had grade 3.

Graph no- 20, Impact of Guda Godugdha Yoga on Epithelial cells

60

50

50

45

40

27.5

35

30

20

22.5

18

20

11 9 14 12.5 7.5 10

0

0 5

3

0

B.T. %

A.T. %

00

01

02

03

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA

W.S.R. TO URINARY TRACT INFECTIONS Page 78

Table No: 35, MASTER CHART NO.-1, SUBJECTIVE PARAMETERS

Peeta mootrata

& Sa daha Kruchra Muhur muhur

Saraktha mootrata mootrata mootrata

S.N0 mootrata

BT AT BT AT BT AT BT AT

1 2 2 2 2 3 3 3 2

2 3 1 2 1 2 2 2 2

3 3 2 2 2 2 2 1 1

4 2 2 3 1 3 2 2 2

5 3 2 1 0 2 1 2 2

6 2 2 1 2 1 1 2 2

7 1 1 2 2 2 2 3 2

8 2 2 2 1 2 1 3 3

9 1 1 2 2 2 2 1 1

10 3 2 2 2 3 2 2 2

11 2 2 3 1 3 3 3 3

12 3 2 2 3 1 1 4 3

13 3 3 3 2 2 2 1 1

14 2 2 2 2 3 2 1 1

15 3 2 3 3 4 3 2 2

16 4 3 3 2 1 1 2 1

17 3 2 2 1 1 1 3 2

18 2 2 2 1 2 2 2 2

19 2 2 1 2 2 2 2 2

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 79

20 2 2 3 2 3 2 3 3

21 2 1 3 3 2 2 2 2

22 3 2 3 2 2 1 3 2

23 1 1 2 2 3 2 2 2

24 1 0 2 2 2 1 3 2

25 2 2 1 1 3 3 2 2

26 2 2 2 1 2 2 1 1

27 2 1 2 2 3 2 2 2

28 2 2 1 1 2 2 1 1

29 3 2 2 2 2 2 3 2

30 2 1 2 1 3 2 2 2

31 3 3 2 2 1 1 3 3

32 2 2 3 2 3 2 3 2

33 3 2 3 1 2 2 2 2

34 3 3 4 3 2 1 3 2

35 2 2 2 2 3 2 4 3

36 2 1 1 1 1 1 3 2

37 1 1 2 2 1 1 2 2

38 3 2 3 3 2 2 3 2

39 3 2 3 2 2 1 2 1

40 2 1 2 2 2 2 2 2

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 80

Table No: 36, MASTER CHART NO.-2, OBJECTIVE PARAMETERS

S. NO. Albumin discharge Pus Cells Epithilial Cells

BT AT BT AT BT AT

1 2 1 2 2 1 0

2 2 1 2 0 2 1

3 1 1 2 1 1 1

4 2 2 3 1 1 1

5 0 0 1 1 2 1

6 1 1 2 2 2 1

7 1 0 1 1 2 0

8 1 0 2 1 2 1

9 2 1 1 0 3 2

10 1 1 2 1 2 2

11 1 1 3 2 3 2

12 0 0 3 2 2 1

13 2 1 2 1 3 2

14 1 0 3 2 2 1

15 1 1 1 1 3 2

16 1 1 1 1 2 1

17 3 2 2 1 3 3

18 2 1 2 1 1 1

19 2 0 2 2 2 2

20 3 2 2 2 1 1

21 1 0 3 3 2 2

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA

W.S.R. TO URINARY TRACT INFECTIONS Page 81

22 1 0 3 2 1 0

23 1 1 3 3 3 3

24 1 1 2 1 2 2

25 1 0 1 1 1 1

26 1 0 2 0 2 1

27 0 0 1 0 2 1

28 0 0 2 1 1 0

29 3 2 1 0 2 2

30 2 1 2 1 3 3

31 2 1 2 2 2 2

32 2 2 2 1 3 2

33 2 2 1 1 2 2

34 1 1 2 2 1 1

35 1 0 3 2 1 1

36 1 0 2 1 2 2

37 2 1 2 1 2 1

38 2 0 2 2 1 0

39 1 1 2 1 3 2

40 1 0 1 0 2 1

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 82

Table No: 37, MASTER CHART NO.-3 DEMOGRAPHIC DATA

Marital

mode Frequency Colour of Ph of

Gender Age Religion Occupation of E.status Vyasana Prakruti S.N status of attacks urine urine

onset

1. M 21 H UN L GL p T+C+S VP NH Clear 1ph

2. F 27 H M S GL h S+C VK < 3 Cloudy 2ph

3. F 28 H UN L GL p T+C+S VP NH Hazy 2ph

4. NH Deep

M 32 H M A GL m T+C+S VP yellow 1ph

5. F 24 H M L GL p C PK NH Cloudy 2ph

6. M 26 H M L GL m S+C VP NH Clear 1ph

7. F 31 H M L GL h T+C VP NH Hazy 2ph

8. M 29 H M S AC p S+C VP NH Cloudy 1ph

9. F 23 M UN L GL m C VK NH Hazy 1ph

10. F 34 H M A GL p C VK < 3 Cloudy 1ph

11. M 30 H M A GL h S+C VP NH clear 1ph

12. F 25 H UN L GL m T VP NH Cloudy 1ph

13. Deep

M 28 H M S AC p T PK 3 TO 6 yellow 1ph

83

14. F 30 H M L GL m S+C VP NH Clear 1ph

15. NH Deep

M 22 H UN A GL p C VP yellow 1ph

16. F 29 H M L GL p T+C VK NH Cloudy 1ph

17. NH Deep

M 24 H UN A GL m S+C VP yellow 1ph

18. F 26 H M L GL h T+C+S VP < 3 clear 1ph

19. NH Deep

M 33 M M S GL p T+C PK yellow 1ph

20. NH Deep

F 23 H UN L AC m T+C VP yellow 1ph

21. NH Deep

M 27 H M A GL h T+A VP yellow 1ph

22. F 21 H UN L GL m T+C+S PK NH Hazy 1ph

23. M 39 H M A GL h S+C VP 3 TO 6 clear 1ph

24. F 34 H M L GL p T+C VP NH clear 1ph

25. < 3 Deep

M 38 M M A GL h T+C VK yellow 1ph

26. Deep

F 30 H M L GL p T+A VP NH yellow 2ph

27. F 37 H M A GL h T+C+S VP NH Cloudy 1ph

84

28. M 27 H UN L AC m T+C VP NH clear 1ph

29. M 40 H M L GL m T+A PK NH Hazy 1ph

30. F 29 H M A GL p T+A VP NH Cloudy 1ph

31. Deep

F 39 H M L GL M T+C VP 3 TO 6 yellow 1ph

32. F 30 H M L GL m T+C VP NH Cloudy 1ph

33. M 38 H M S GL p T+A VP NH Cloudy 1ph

34. Deep

F 26 H UN L AC m T+A VP NH yellow 1ph

35. F 35 H M A GL M T+C+S VP NH Cloudy 1ph

36. M 37 H M L GL m T+C+S VP NH clear 1ph

37. M 31 M M L AC H T+C PK NH Hazy 1ph

38. F 38 H M A GL m T+C VP NH clear 1ph

39. F 32 H M A GL P T+C PK NH clear 2ph

40. Deep

F 39 H M A GL m T+C VP NH yellow 1ph

Religion: H= Hindu, M= Muslim Sex: M=male, F= female Marital status: M= married, UN= unmarried Occupation: L= laborious, A= active, S= sedentary Frequency of attacks: NH=no history, < 3= less than 3,

Mode of Onset: GL=gradual, AC= acute E. status: p=poor, m=middle, h=higher Vyasana: T=tea, C= tobacco chewing, A=alcohol Prakriti: VP=vata-pitta, PK=pitta-kapha, VK=vata-kapha PH: 1ph= 4.5 tov5.5, 2ph= 5.5 to 6.5

85

RESULTS

EFFECT OF GUDA DUGDHA YOGA ON SUBJECTIVE PARAMETERS.

TABLE NO: 38 Showing the effect of Guda Dugdha yoga on subjective parameters:

PARAMETER MEAN Net SD SE T- P- Remarks Mean Valu Value

AT BT e

Peeta mootrata & 2.3 1.8 0.5 0.554 0.08 5.7 < 0.01 HS Saraktha mootrata

Sa daha mootrata 2.2 1.77 0.42 0.747 0.11 3.59 < 0.05 S

Kruchra mootrata 2.17 1.77 0.4 0.496 0.07 5.09 < 0.01 HS

Muhur muhur mootrata 2.3 1.95 4.58 0.483 0.07 4.58 < 0.01 HS

To know about the which Subjective factors are more effective, the statistical analyses is

done by using z-test, by assuming that the drug is not responsible for changes in before and after

the administration of Guda Dugdha yoga.

From the analysis it is clear that the parameter Sadaha Mootrata is statistically significant

and all other subjective parameters are highly significant and are more effective than sadaha

mootrata.

EFFECT OF GUDA DUGDHA YOGA ON OBJECTIVE PARAMETERS.

TABLE NO: 39 Showing the effect of Guda Dugdha yoga on Objective parameters:

PARAMETER MEAN Net SD SE T- P- Remarks Mean Valu Value

AT BT e

Albumin discharge 1.37 0.75 0.62 0.585 0.09 6.74 < 0.01 HS

Pus Cells 1.95 1.25 0.7 0.607 0.09 7.28 < 0.01 HS

Epithilial Cells 1.95 1.37 0.57 0.549 0.08 6.61 < 0.01 HS

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA

W.S.R. TO URINARY TRACT INFECTIONS Page 86

To know about the which Objective factors are more effective, the statistical analyses is

done by using Annova-test, by assuming that the drug is not responsible for changes in before and

after the administration of Guda Dugdha yoga.

From the analysis it is clear that all the subjective parameters are highly

significant statistically.

Overall effect of Guda Dugdha Yoga in Pittaja Mootrakrichra The results of the assessment are based on the cumulative effect of the Guda Dugdha

yoga over the patients of Pittaja Mootrakrichra vis-à-vis UTI. The patients are observed no-

relapse symptoms even at the follow-up are considered as cured and when relapsed with partial

symptoms either of the manners is considered as the relieved group. The next category of the

result is with reference to relief of the symptoms partially at the time of or during the treatment

schedule continued to respond for the management is said as partially relived and the last as not

responded with the management by all means.

The result declared following the assessment criteria is as follows – Table No- 40 – Overall effect of the Guda Dugdha Yoga in Pittaja Mootrakrichra

Category Relief in percentage Number of patients

Cured 00 00

Moderate Response 00 00

Mild Response 22 55

Not responded 18 45

Total 40 100

Out of 40 patients, 22 patients were partially relieved by the trial drug and 18 patients

were responded poorly. Where as no patients were relieved or cured completely.

OVERALL EFFECT OF TREATMENT

0 0

18

No Improvement

Mild Improvement

22

Moderate Improvement

Marked Improveent

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 87

Calculation of Percentage of Overall result of Guda Dugdha Yoga in Mootrakrichra =

Total of all BT grading - Total of all AT grading

…………………………………………………... * 100

Total of all AT grading

Total of all BT grading=569 Total of all AT grading=427

569-427 * 100 = 427

14000 = 32.78% 427

Hence, the percentage of overall effect of the Guda Dugdha Yoga in Mootrakrichra

is 32.78%

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 88

Discussion

Discussion is the main substratum of any type of research work. It comprises of

discussion of results obtained from applied Study. Discussion is nothing but the logical

reasoning of observations. If all the points are discussed with proper reasoning then they

help to draw proper conclusions. It is a bridge which connects the findings with

conclusions.

The Discussion part is divided into the following parts-

Discussion on Review of literature

Discussion on Observations.

Discussion on Results

Discussion on probable mode of action of Guda Dugdha Yoga.

Discussion on Review of literature

The disease Mutrakrichra finds its existence since puranakala. Even though there are

references of draining the distended bladder in Atharvaveda the disease as such is not

mentioned. It was in samhitakala where detail description of Mutrakrichra was brought to

light. Mutrakrichra as name suggests is a disease in which urine is passed with difficulty

associated with many other symptoms and involving many structures of urinary system.

As one may not get a complete picture of mutravaha srotas in Ayurvedic classics, recent

scholars of Ayurveda have co – related mutravaha srotas to Urinary system. While

explaining the formation of urine the related organs have not been dealt in connection.

Importance has been given to basti and pakwashaya whereas gavini and vrikkou have not

been brought into picture. Even then the description of urinary disorders like

mutrakrichra is in detail. Most of the authors have mentioned that katu teekshna ahara,

anupa mamsa, matsya sevana cause Mutrakrichra. Some of the nidanas like nitya drta

prsta yana, atiprasanga, teekshna oushada sevana are very specific. Even nidanas of

mutravaha srotodushti like mutranigrahana, mutrita udaka bhakshya sevana etc lead to

Mutrakrichra.

Most of the acharyas have opined 8 types Mutrakrichra, the first four being

doshaja and rest are Ashmarijanya, Shukravegavarodhajanya, Shalyabhighataja and

Shakrit vighataja. Acharya sushruta opines Ashmarijanya and Sharkarajanya are separate

whereas Charaka opines them to be same, as clinical manifestations seem to be similar.

Acharya kashyapa has specifically mentioned Dwandwaja variety.

The pathogenesis of Mutrakrichra is by vitiation of tridosha either individually or

together in basti pradesha to produce lakshanas particular to each typae. The vataja

variety is mainly characterized by ruja with krichra mutrapravritti whereas daha and ruja

is seen in Pittaja variety. Shotha and gourava are the cardinal symptoms of kaphaja

whereas a mixture of all these is seen in sannipataja variety. The person suffering from

Ashmarijanya mutrkrichra experience teevra shoola while voiding due to the

dislodgement of ashmari or sharkara and the person suffering from raktaja Mutrakrichra

feels basti laghuta after the blood passes out. In case of shalyabhighataja features of

vataja Mutrakrichra are seen but vedana being more where as sa shukra mutrapravritti is

seen in shukraja Mutrakrichra and the symptoms related to Udara are seen in Pureeshaja

variety.

Based on the symptamatology recent authors of Ayurveda have co related

Mutrakrichra to Urinary Tract Infection which exists when pathogenic microorganisms

>105 per milliliter are detected in the urine, urethra, bladder etc. Each year UTI accounts

for 9.6 million doctor visits and one woman out of 5 develop UTI in her lifetime. It is

classified as Upper UTI and Lower UTI on the basis of anatomy of urinary system among

which lower UTI is the commonest. The major cause of UTI are the bacteria like E coli,

Proteus etc and other factors like pregnancy, low water intake, genetic factors,

comparatively shorter Urethra in females, spicy foods etc predispose UTI.

Usually Urinary tract is kept sterile by the host defense mechanism of the body but any breech in

this mechanism favours the production of UTI. The disease is clinically presented as

inflammation of a particular structure like urethra, bladder etc and called as Urethritis,

Cystitis etc. They are characterized by pain during micturition, increased frequency,

cloudy urine etc.

Anatomy and physiology

Female urethra was shorter (3-5cm) than males (18-20cm). This helps in easy

entry of bacteria though ascending route is most common type of spread of infection in

UTI. The lining of mucous membrane of urethra is continuos with that of bladder in

upper part of urethra, which helps in spread of infection. Urinary bladder is made of

detrusor muscle prevents back flow of urine or collection of residual urine, which

prevents chances of development of infections. The proper contraction of entire bladder

muscle is being governed by pudenda nerve of 2nd

& 3rd

sacral segment (parasympathetic

pathway). Apanvata vikriti leads to malfunctioning of bladder muscle, failure of

defensive mechanism of bladder mucosa predisposes to develop UTIs.

The ureters are two tubes, which passes obliquely through bladder wall. Because

of this arrangement ureters are compressed and opening occluded when pressure rises in

bladder. Failure of this mechanism or regurgitation of urine from bladder to ureter leads

to UTI.

Kidneys

The urinary tract infection can manifest under 2 headings

1.Inflammatory involvement of tubules and interstitial,

2. Renal pelvis inflammation, which is caused by bacterial infection and is

always, associated with lower urinary tract.

3. Dwarkanath substantiates formation of mootra, which is being carried out at

Jataragni, as some of the constituents of mootra can be evidently found in Pakvashaya

also. Ama, which is formed at Amashaya level under the influence of the Jataragni, is

capable to cause the Mootrakrichra. According to Charaka basti seat of Mootravaha

Srotas viz. KUB systems and also resort of all the channels conveying aqueous elements.

4. Though Susruta and Vagbhata have not pointed the etiological factors of

Mootrakrichra specifically, but they mention the causative factors like Ashmari, shalyaja

etc.. All the Acharyas also list Abhigata or injury as causative factor of mutravaha

srotodusti, particularly in the context of Mootrakrichra.

5. Madhyapana is included in the list of causative factors of Mootrakricchra. So

madya sevana will change urine Ph and giving rise to environment for invasion of

bacteria into epithelial cells of urinary tract.

6. The nidanas of mootra vaha sroto dusti are also relevant in the context of

Mootrakricchra. Because of habit of doing dharana of mootra vega, the stretching of

bladder muscle beyond its capacity which overtime can weaken the bladder muscle.

When the bladder is weakening, it may not empty completely and some residual urine is

left in bladder which may increase risk of UTI. There by concentration of the urine will

increase giving rise the chance for development of UTI.

7. Apart from these factors, certain obstructive or margavarodha causative factors

are stated to be responsible for sanga type of srotodusti in mutra marga causing the

disease Mootrakricchra. In classics, ashmari, sharkara, shukra and purisha are considered

as causative factors of Mootrakrichra and explained their clinical variety with symptoms.

8. Usually several things keep bacteria out of the urine. It’s a long way up to the

bladder for a bacterium. (Since a woman's urethra is shorter than a man's, women are

much more likely than men to get UTI's.) UTIs typically occur when bacteria enter the

urinary tract from the outside,

usually through the urethra, and begin to multiply. The bladder secretes a protective

coating that prevents bacteria from attaching to its wall. Urine also has antibacterial

properties that inhibit the growth of bacteria. Other organisms—including chlamydia and

mycoplasma—also cause urinary tract infections. Once bacteria enters the urethra it

travels upward causing infection in the bladder and other parts of the urinary tract, even

some time to the kidneys also.

Mushka, basti, shoola mehana, basti, shoola etc. are mentioned as symptoms in

clinical varieties of Mootrakrichra. In our classics, we do not find descriptions of nature

of shoola and its degree of variation from place to place in the context of Mootrakrichra

disease. Two types of pain in the genitourinary organs, local and referred. Local pain is

felt in or near the involved organ. Referred pain originates in a diseased organ, but is felt

at some distance from that organ.

Physiologically, the apana vayu is responsible for urination. Mainly the ‘chala’

Guna of vayu is responsible for this symptom. The reduced capacity of urinary bladder

will obviously lead to a reduced interval between the needs to urinate, thus resulting in

that common symptom of frequency. A very low or very high urine pH can irritate the

bladder and cause frequency of urination.

In females urethra is very short, extending 3-5 cm (1-2 inch) from bladder to

vestibule. In males, Urethra extends from neck of urinary bladder to the tip of penis, a

distance that may be of 18-20 cm.

The triangular area bounded by urethral openings and the entrance to urethra

constitutes trigone which acts as funnel this channels urine into urethra, when urinary

bladder.

Mootra vaha srotha dusti Lakshana are –

1. Ati srasta – adhika mootrata (increased frequency)

2. Ati badha – interruption during mootra pravritti

3. Prakupita – vikrita mootra

4. Alpa alpa abheekshana – shoolayuta alpa alpa pravritti

What causes a UTI?

Bacteria (germs) getting into the bladder or the kidneys cause UTIs. The following things

can sometimes cause germs to get into the bladder or kidney:

Having bubble baths

Wearing tight-fitting clothing

Holding urine for a long time

Girls wiping from back to front, instead of front to back after a bowel movement

Some children have a condition that keeps their bladder from emptying all the

way. These children may have UTIs often.

The most common cause of UTI is bacteria from the bowel that lives on the skin near

the rectum or in the vagina, which can spread and enter the urinary tract through the

urethra. Once bacteria enters the urethra it travels upward causing infection in the bladder

and sometimes other parts of the urinary tract. Other bacteria that cause urinary tract

infections include Staphylococcus saprophyticus (5 to 15% of cases), Chlamydia

trachomatis, and Mycoplasma hominis. Men and women infected with chlamydia

trachomatis or mycoplasma hominis can transmit the bacteria to their partner during

sexual intercourse, causing UTI.

Sexual intercourse is a common cause of urinary tract infections because the female

anatomy can make women more prone to urinary tract infections. During sexual

intercourse bacteria in the vaginal area is sometimes massaged into the urethra by the

motion of the penis.

Women who change sexual partners or begin having sexual intercourse more

frequently may experience bladder or urinary tract infections more often than women in

monogomus relationships. Although it is rare, some women get a urinary tract infection

every time they have sex.

Another cause of bladder infections or UTI is waiting too long to urinate. The bladder

is a muscle that stretches to hold urine and contracts when the urine is released. Waiting

very long past the time you first feel the need to urinate causes the bladder to stretch

beyond its capacity, which over time can weaken the bladder muscle. When the bladder is

weakened it may not empty completely and some urine is left in the bladder, which may

increase the risk of urinary tract infection or bladder infection.

Factors associated with acute urinary retention include the following:

Alcohol consumption

Allergy or cold medications containing decongestants or antihistamines

Certain prescription drugs (e.g., ipratropium bromide, albuterol, epinephrine) that

cause the urethra to become narrow

Delaying urination for a long time

Long period of inactivity or bed rest

Prolonged exposure to cold temperatures

Spinal cord injury/nerve damage

Surgery (e.g., complication of anesthesia)

Urinary system obstruction (e.g., benign prostatic hyperplasia (BPH), kidney

stones)

urinary tract infection

In Ayurveda, Abhigata or injury as causative factor of mutravaha srotodusti,

particularly in the context of Mootrakrichra in association with the vyayama, which will

have an influence over the basti and mutra, marga is taken for consideration is mentioned.

Because of habit of doing dharana of mootra vega, obstructive or margavarodha,

responsible for sanga type of srotodusti in mutra marga causing the disease

Mootrakricchra.

It is evident from the analysis made at literary review analysis that most of

nidanas or of Dosha hetu variety. Some of nidanas such as mootravega dharana, teekshna

Oushadhis sevana, ativyavaya, also act as both vyadhihetu and doshahetu.

Among all the symptoms, kricchrata, mootra daha, muhur muhur mootra pravritti,

shoola considered as important clinical features. The shoola, muhur muhur mootra

pravritti are due to Vata Dosha, peeta mootrata, mootra daha are due to Pitta Dosha and

alpa mootrata due to Kapha Dosha. The word ‘Roopa’ indicate the sign and symptoms by

which a disease is indentified.

This symptom is subjective and considered as cordinal symptom of Mootrakricchra. In

modern urology, this symptom is correlated to dysuria, refers to difficult urination and is

usually due to urinary tract bacterial infection and inflammation.

Mootrakrichra considered as one of the Vasti rogas. Involvement of mutra in the

pathogenesis of the Mootrakrichra exhibits some lakshanas, which are pertaining to

mootra. These symptoms can be studied as follows:

Tridosha play an important role in afflicting colours of the urine in the

Mootrakricchra. In Mootrakricchra, the quantitative change of mootra is seen. In kaphaja

Mootrakricchra, the transparency of urine becomes ghana. In vataja mutrakrichra, the

frothy urine is seen.

The over distended bladder of the patient in acute urinary retention will cause

agonizing pain in the suprapubic aea. The patient in chronic urinary retention due to

bladder neck obstruction or to a neurogenic (neuropathic) bladder may experience little or

no suprapubic discomfort even though the bladder reaches the umbilicus.

The common cause of bladder pain is infection, the pain is usually not felt over

the bladder but is referred to the distal urethra and is related to the act of urination

terminal dysuria may be severe.

Daha is a subjective symptom, correlated to burning sensation during micturition.

In women, it is ordinarily referred to the urethra.

Blood noted mainly at the end of urination is called ‘terminal haematuria and is

usually indicates diseases near the bladder neck or the posterior urethra. This symptom is

darshnajneya. In urological vocabulary, this symptom may refer to prostatism.

A urinary tract infection causes the lining of the urinary tract to become red and irritated,

producing the following symptoms:

1. Pain in the flank (side), abdomen or pelvic area

2. Painful urination (dysuria)

3. Incontinence (urine leakage)

4. Abnormal urine colour (cloudy urine)

5. Blood in the urine

6. Strong or foul-smelling urine

7. Other symptoms that may be associated with a urinary tract infection include:

8. Pain during sex

9. Penis pain

10. Signs of a urinary tract infection

11. Sediment (gritty particles) or mucus in the urine or cloudy urine

12. Bad smelling urine (foul odor)

13. Blood in urine (pink or red urine)

Discussion on Observations.

The study design made for the present study is prospective clinical trial. The study

was done in one group. Patient of age between 20 and 40 years are considered. Patients

selected are thoroughly examined with both subjective and objective parameters. Along

with the subjective parameters Urine microscopic examination is selected as objective

parameter.

Urine frequency, Painful urination (dysuria), Penis pain, Incontinence (urine

leakage), Abnormal urine colour (cloudy urine), Blood in the urine and Strong or foul-

smelling urine are evaluated along with the Other symptoms that may be associated with

a urinary tract Infection.

For examination, fresh morning mid-stream urine is collected. As Pus cells more than 5

indicate bacterial infection of urinary tract, Urine Culture is advised.

Out of 43 patients registered for the present study, 40 patients of Mootrakricchra,

fulfilling the criteria for diagnosis, were treated with the Guda Godugdha Yoga. The

demographic data are discussed as under.

Among the 40 patients 8 patients were in the age of 21-25 years (20%), 15

patients were of 26– 30 years (37.5 %) , 08 patient s were in the age group of 31 –

35 years (20%) and

09 patient s were in the age group of 36 – 40 years (22.5%). It doesn’t show any

specific relationships regarding and cannot be substantiated relations with in.

The percentage of the distribution does show the gender differentiation to get this

disease. The observations are 23 Patients i.e. (57.5%) were female and 17 patients

i.e. (42.5%) were male. UTIs are about equally common in males and females

during the first year of life. This may be because females have shorter urethras

than men do. Response of treatment is almost same in both sexes by comparison.

As the data collection area is dominant by Hindu community, Out of the 40

patients reported 36 are Hindus and 4 patients are Muslims. However,

uncircumcised males are about 10 times more likely than circumcised males to

develop a UTI.

Occupational observation show that more housewives i.e. 19 (47.5%) and almost

equal distribution with the labours reported as 21 (52.5%) patients. The rationality

or probability behind these observations cast either to the genital hygiene is lack

or to that of over sweating. Both may lead to the growth facilitation of unwanted

bacteria or else organisms to grow and effect most frequently exposed area such

as urethra mucous membrane, which leads to the Mootrakrichra.

At the economical survey of the patients, out of 40 patients reported, maximum

numbers of 14+17= 31 (35%+42.5%= 77.5%) patients are either from middle or

poor class, which is a clear evident for the conclusion drawn from the above

paragraph, is practically difficult to maintain the genital hygiene. It does not have

any impact over treatment response.

One more interesting observation over the marital status and coital connectivity to

the infection proon group. In this observation 30 Patients i.e. (75%) were married

and only 10 patients i.e. (25%) were unmarried, which substantiates the

involvement of the exposure to the sex and after sex poor hygiene.

This disease said to be developed gradual as many as 34 (85%) patients are from

gradual class and only 6 (15%) patients are reported from the acute class. It

clearly implicates that the hygiene maintenance is breaches for a longer period

only offers the susceptibility to the infection other wise is not.

Nidinas (aetiology)

Vyayam and bharavahan

In the present clinical trial the most of patients (57.5%) were from labour community.

The excessive laborious work gives rise to over exertion and rookshata in turn provokes

Vata. And have influence over basti and mootra marga to get vitiated.

Vyavaya

In present clinical trial, the most common (85%) etiological factor is atiprasanga or

vyavaya, which vitiates Vata and which in turn aggravates mootravaha sroto dusti

lakshanas. Chakrapani commented on kshaya as ‘ativyavayat sukra kshaya sati vayano

udderya bastimanitam’ inferred that due to sukra kshaya, prakopa of vayu results.

Sexual intercourse is common cause of observed cases because of entry of

bacteria into urethra while doing sexual intercourse, as urethra and vagina are near. In

many observed cases the complaints of UTI got elevated every time they have sex.

Unhygienic style of sexual intercourse can transfer bacteria from ano-vaginal area into

urethra, which irritates tissue.

Abhighata

Injury or abhighata by external environment causes manifestation of shotha giving rise to

mootravaha srotodusti. The examples like injury during masturbation or sexual

intercourse are being observed in 25% of cases.

Mootranigraha

In present clinical trial, labours having habit of mootravegadharan causes stretching of

bladder muscle and its capacity which overtime can weaken it, allowing in complete

emptying of bladder. This is observed in 17.5% of cases.

Madhayapana

This is observed in 27.5% of cases. It is customary of alcoholic consumption by males in

Indian society hence out of 10 males 7 patients were of alcohol consumers.

Anoopa mamasa, matsya sevan

22.5% of patients are non-vegetarian. The Vata and Kapha get vitiate by matsya mamsa

sevana and kleda in turn produced causes Agni nasha. Increased kleda in mootravaha

srotas causes Mootrakrichra.

Adhyasana and ajeerna bhojana

It is observed in 30% of patients. These two are of Tridosha prakopaha and predisposes to

Mootrakrichra.

Oushadhi janya

About 25% of patients were given previous history of medicines viz. Spermicides,

aspirin, NSAIDs, ill filling diaphragm and decongestants for longer duration. In the

present clinical trial it was observed that most of the patients were showed less intake of

water.

From the Ayurvedic point of view, distribution by Prakruti is assessed in this

study. The observations are Tridosha Prakruti patients were not reported in the

study. Out of 40 patients reported, maximum numbers of 28 (70%) patients are

with Vata Pitta in nature

and the rest of 11 are distributed as 7 and 5 for the groups of Pitta Kapha and Vata

Kapha Prakruti.

When Vyasana are discussed in this study out of 40 patients reported, 18 patients

(45%), 34 patients (85%) were having history of tobacco consumption and tea-coffee

respectively.

The results of the assessment are based on the cumulative effect of the Guda

Dugdha yoga over the patients of Pittaja Mootrakrichra vis-à-vis UTI. The

patients are observed having > 75% relief of symptoms even at the follow-up

are considered as cured, the patients having relief of symptoms between 50% to

75% are considered under Moderate response group. The next category of the

result is with reference to relief of the symptoms between 25% to 50% is

considered under mild response group. And the last as not responded with the

management by relief of symptoms less than 25%.

The result declared following the assessment criteria is as follows –

Category Result Percentage

Cured 00 00

Moderate Response 00 00

Mild Response 22 55

Not responded 18 45

Total 40 100

Probable mode of action

The ingredients of Guda Dugdha yoga are rich in Madhura Rasa and madhura

vipaka which help in alleviation of Pitta Dosha and daha.

The Snigdha and guru Guna of ingredients of Guda Dugdha yoga are elevating

Vata and does the upalepana (lubrication) of mootravaha srothas.

As the Guda is having the properties of mootravaha srotho Shodhaka,

Krichramootra is relieved.

Go dugdha is having Madhura rasa, Madhura Vipaka, Sheeta veerya. By virtue

of all these qualities it helps in allievating the Pittaja lakshanas like Peeta

Mootrata, dahayukta mootrata, lowering the pH values of urine.

The combined effect of Guda and Godugdha were of sheta Veerya, madhura

Rasa and madhura vipaka relieves dhukena mootra pravurti and dhaha by their

diuretic and anti microbial properties. Their action on mucous membrane of

urinary tract significantly showed in elevation of pathogenesis.

CONCLUSION

Mootrakrichra became common compliant in daily practise. Each year UTI accounts for

9.6 millions, where women are prone. One in 5 women develop UTI during her life time.

Unhygienic life style viz. Lack of frequent washing, unhygienic sex, alcohol, self

medication etc., will tend the person to have UTI.

1. The percentage of overall effect of the Guda Dugdha Yoga in Mootrakrichra is

32.78%.

2. The present clinical trail has not shown any specific relationships regarding

prevalence of age and UTI..

3. The present clinical trial showed male female ratio as 5:7

4. There is more prevalence in poor and low middle class people (77.5%) as present

clinical trial.

5. Ativyayam and vyavaya are found to be main causative factors in the patients.

6. Tobacco consumption is most risk factor for development of UTI in present clinical

trial.

7. The gradual onset of UTI is more in prevalence than of acute onset.

8. There is more recurrent attack of UTI in females (5 patients) than of males.

9. Pittakapha prakritis showed moderate response to treatment showing Prakruti and

Dosha of Vyadhi tulyatwam is always difficult to treat.

10. The effect of Guda Dugdha yoga showed highly significant result in subject to

parameters Peetha mootrata, Kruchra mootrata, Sa daha mootrata, Sa rakta mootrata,

Muhur muhur mootrata and objective parameter like urine microscopic examination.

Recommendations

1. Present study is limited to the cumulative effect of Guda Dugdha yoga in the

management of Pittaja Mootrakrichra W.S.R. to non-specific UTI.

2. Anti-microbial activity to the specific micro-organisms is to be carried out to evaluate

drug efficacy.

3. As sample size is less, and limited to Pittaja variety of Mootrakrichra, the study can

be conducted in other varieties of Mootrakrichra

4. As the UTI are serious systemic disorders of Urogenital system and its influence is

well known. As the study duration was less and number of samples underwent are

small the same study can be under taken in large sample.

Limitations

1. The study is limited to the patients who attended the OPD of Rajiv Gandhi

Education Society`s Ayurvedic medical college, Ron.

2. As the only Pus cell count is the objective parameter, the limitation is restricted to

the urine microscopic study.

3. The study must include more analysis, scan and other investigations, but limited

to the format as the study is a pilot study and for the partial fulfillment of M.D.

degree.

4. Gender differentiation is not made in the study even though researches state that

the females are prone.

SUMMARY

The present dissertation work entitled “Clinical Evaluation Of Guda-Dugdha

Prayoga In Pittaja Mootrakrichra W.S.R. To Urinary Tract Infections”. In this study an

attempt was made to assess the efficacy of Guda Godugdha yoga in the management of

Mootrakrichra by following classical procedures, and the effect was observed by clinical

study.

This study includes the following chapters i.e., Introduction, Objectives, Review

of Literature, Methodology which contains Diagnosing Criteria, Inclusion and exclusion

criteria etc related to Clinical study. Next parts observation and results of clinical study,

Discussion, Summary and Conclusion.

Introduction covers, general introduction, need of the study, brief introduction of

Mootrakrichra and necessity for the assessment of this research work was discussed

briefly. After the introduction, aims and objectives of the present study are mentioned in

the objective chapter.

Review of literature is dealt in two main headings i.e., drug review and disease

review. The drug review commence with the description regarding Guda and Godugdha.

Next part of the same chapter deals about disease review commence with

historical and general description of Mootrakrichra, brief description of Mootravaha

Srotas, Nirukti, paribhasha, Paryaya, Nidana, Samprapti, Roopa, Upashaya, anupashaya,

Sapeksha Nidana, Upadrava, Sadhyasadhyata, Chikitsa and Pathyapathya explained in

the context of Ayurvedic literature. The modern literature review commence with Urinary

trct Infection i.e., definition, etiology, pathogenesis, Clinical features, Differential

diagnosis, Complications and management.

The next part dealt with Materials and Methodology. The study design made for

the present study is prospective clinical trial. Patients are of age between 20-40 years

with Uncomplicated UTI and where Symptomatic and primary UTI are selected.

Common symptoms of presenting are observed as - Mootra daha, Krichra mootrata, and

Muhur muhur Mootrata. The Urine microscopic examination is considered as the

objective parameter for the assessment criteria. Pus cells more than 5 indicate the

bacterial infection of urinary tract. The sample size for the present study consists of 40

patients in a single group. All the parameters in the present study including the urine

microscopic examination are graded.

The patients of Pittaja Mootrakrichra by complete diagnosis were selected. 43

patients were registered for the present study. The remaining 40 patients of Pittaja

Mootrakrichra, fulfilling the criteria for diagnosis, were treated.

Clinical study contains research approach, research design, selection criteria of

the patients, grouping of patients, examination methodology, diagnostic criteria,

treatment schedule and criteria for clinical assessment.

Observation and results. In this part the results obtained are systematically

presented. The observation was divided in to 3 sections which are demographic data, data

related to disease Pittaja Mootrakrichra and data related to response to the treatment.

The results are statistically analyzed and presented in the form of tables and

graphs along with short description of the same. Logical interpretation of drug, disease

and results were dealt in discussion.

In clinical discussion about the Pittaja Mootrakrichra patients and clinical

response to the treatment has been explained. A probable mechanism of action was

discussed in this part also.

1. http/womensheath.about.com/cs/bladderhealth/a/uti/htm.acccesed on 21/08/17.

2. Pushpalatha KS. Urinary tract infection and management. J Nighting Nursing

Times 2008; 4(5) : 28-32.

3. Wilma JP. Shafers Medical Surgical Nursing. 7th edition, B.I. Publications: New

Delhi 2002: p. 637-40.

4. Naber KG, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe

and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in

Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol 2008;

54 (5):1164-75.

5. Hsiao CJ, Cherry DK, Beatty PC, Rechtsteiner EA. National Ambulatory Medical

Care Survey: 2007 summary. Natl Health Stat Report 2010; (27):1-32.

6. Medina-Bombardó D, Jover-Palmer A. Does clinical examination aid in the

diagnosis of urinary tract infections in women? A systematic review and meta-

analysis. BMC Fam Pract 2011; 12:111.

7. Dr.G.Prabhakar.Rao, management of mootrakrichra, Ayurveda vikas, Dec-Jan

2002.p.31.

8. Agnivesa, Charakasamhitha Sutrasthana chapter 20 sloka 8. 4th

ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

9. Ibid, chapter 26 sloka 3-4

10. Bapat, Mohite, Rohandia, Salgaonkar, Karndikar, authors of Evaluation of

efficacy and safety of sparfloxacin in urinary tract infections and skin and soft

tissue infections, vol-53. no:2, published by the Indian practicener journal in

February 2000. p.116.

11. http/www.wrongdiagnosis.com/uti/introduction accessed on 23/06/04

12. http/www.wrongdiagnosis.com/uti/manegement accessed on 23/06/04

13. Baghel M S Dr, Researches in Ayurveda chapter 4. Jamnagar: Mrudu Ayurvedic

Publications; p. 48-54.

14. Baghel M S Dr, Researches in Ayurveda chapter 4. Jamnagar: Mrudu Ayurvedic

Publications; p. 98-101.

15. Baghel M S Dr, Researches in Ayurveda chapter 4. Jamnagar: Mrudu Ayurvedic

Publications; p. 113-118.

16. Atharvana veda vol-2, uttaradha, published by Gorakhanatha publications,

Varanasi 1/3/6-9

17. Acharya Vidhyadhar Shukla & Ravidatt Tripathi Charaka Samhita of Agnivesa

with Hindi Commentary. Edition Reprinted 2005, Varanasi Publisher

Chaukhambha Sanskrit Sansthan Part-2, Chikitsa Sthan Chapter – 26, Shloka No.-

32, 33, 34, 49 Page No.- 628, 629, 632.

18. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 2, 3rd

ed. Varanasi:

Chaukhambha Sanskrit Series; p. 755. (Chaukhambha Samskrita Granthamala-

93).

19. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970. p. 820.

20. .Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 2, 3rd

ed. Varanasi:

Chaukhambha Sanskrit Series; p. 755. (Chaukhambha Samskrita Granthamala-93

21. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970. p. 720.

22. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970 p. 855.

23. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970 p. 648.

24. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970. p 1039.

25. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970 p. 1039.

26. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European

languages. New Delhi: Motilal Banarasi Das; 1970 p. 358.

27. Sharangadhara, Sharngadharasamhitha Poorvakhanda chapter 5 sloka 34-35. 3rd

ed. Varanasi: Chaukhambha Orientalia; 1983. (Jaikrishnadas Ayurveda

Granthamala 53)

28. Agnivesa, Charakasamhitha Chikitsasthana chapter 26 sloka 32. 4th

ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

29. Sushrutha, Sushruthasamhitha Uttarathantra chapter 59 sloka 3. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

30. Vagbhata, Ashtangahridaya Nidanasthana chapter 9 sloka 6. Varanasi: Krishnadas

Academy; 1982.. (Krishnadas Academic series 4).

31. Ashtangasangraha Nidanasthana chapter 9 sloka 3.Prof.K.R.Shrikhantamurthy

editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series

79).

32. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 10 sloka 2. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 154).

33. Madhavakara, Madhavanidana chapter 30 sloka 2. Varanasi: Chaukhambha

Surbharathi Prakashan; 1998.. (Chaukhambha Ayurvijnana Granthamala 46).

34. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 10 sloka 2. 5th

ed.

Varanasi: Chaukhambha Orientalia; 1988. (Chaukhambha Sanskrit series 130).

35. Chakrapanidatta, Chakradatta chapter 32. sloka 4-5 P.V.Sharma, editor.

Varanasi: Chaukhambha Publishers; 1998. (Kasi Ayurveda series 17).

36. Yogaratnakara Mootrakrichra Nidana sloka 10 . Vaidya Lakshmipatisastry editor.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 51. (Kasi Sanskrit series

160).

37. Govindadasa, Bhaishajyaratnavali Mootrakrichra prakarana. Sloka 2 7th

ed.

Kaviraj Ambikadatta Shastri editor. Varanasi: Chaukhambha Orientalia; 1983.

(Kasi Sanskrit series 152).

38. Srimat Vaidya Sodhala, Gadanigraha Motrakrichra adhikara Vol-2 chapter 27

Sloka 2 Edited by Gangasahaya pandey. Varanasi: Chaukambha Sanskrit series;

1969.

39. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 32. 4th

ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

40. Madhavakara, Madhavanidana chapter 30 sloka 1. Varanasi: Chaukhambha

Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46).

41. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 1. 5th

ed.

Varanasi: Chaukhambha Orientalia; 1988. (Chaukhambha Sanskrit series 130).

42. Yogaratnakara Mootrakrichra nidana sloka 1. Vaidya Lakshmipatisastry editor.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 160).

43. Srimat Vaidya Sodhala, Gadanigraha Motrakrichra adhikara Vol-2 chapter 27

Sloka 2 Edited by Gangasahaya pandey. Varanasi: Chaukambha Sanskrit series;

1969.

44. Ashtangasangraha Nidanasthana chapter 9 sloka 5.Prof.K.R.Shrikhantamurthy

editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series

79).

45. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 43-44. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

46. Ibid, chapter 26 sloka 52.

47. Ibid, chapter26 sloka 5.

48. Sushrutha, Sushruthasamhitha uttaratantra chapter 41 sloka 5. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

49. Ibdi, chapter 41 sloka 6-7

50. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 20 sloka 26-27. 5th

ed.

Varanasi: Chaukhambha Orientalia; 1988. p. 786. (Chaukhambha Sanskrit series

130).

51. Sushrutha, Sushruthasamhitha sutrasthana chapter 46 sloka 352-355. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

52. Ibdi, chapter 46 sloka 356-357

53. Smith,General Urology, 15th

ed by A.Tango,Jack.W.Mc Aninch, p.253.

54. Agnivesa, Charakasamhitha sutrasthana chapter 26 sloka 32. 4th

ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

55. Vagbhata, Ashtangahridaya Sutrasthana chapter 4 sloka 4. Varanasi: Krishnadas

Academy; 1982.. (Krishnadas Academic series 4).

56. Guyton and Hall Text Book of Medical Physiology chapter 31. 10th

ed. New

Delhi: Harcourt India Pvt Ltd; 2001. p. 365

57. Ritchie A C, Boyd’s Textbook of Pathology Volume II. 9th

ed.Philadelphia:Lea &

Febriger (U.K); 1990. p .1235.

58. Ritchie A C, Boyd’s Textbook of Pathology Volume II. 9th

ed.Philadelphia:Lea &

Febriger (U.K); 1990. p .1236.

59. Smith, General Urology, 15th

edition by A.Tango, Jack.W.Mc Aninch, p.255 .

60. Ritchie A C, Boyd’s Textbook of Pathology Volume II. 9th

ed. Philadelphia: Lea

& Febriger (U.K); 1990. p .1236.

61. Cotran SR, Pathologic Basis of Disease chapter14. 6th

ed. Philadelphia: Saunders;

2003. p. 453.

62. Walter E Stamm, Harrison’s Principles of Internal Medicine Chapter- 131. 15th

ed. McGraw-Hill2003. p. 819.

63. Cotran SR, Pathologic Basis of Disease chapter 14. 6th

ed. Philadelphia:

Saunders; 2003. p. 454.

64. Walter E Stamm, Harrison’s Principles of Internal Medicine Chapter- 131. 15th

ed. McGraw-Hill2003. p. 818.

65. https://www.mayoclinic.org/diseases-conditions/urinary-tract-

infection/symptoms-causes/syc-20353447 accessed on 11/03/2018

66. Cotran SR, Pathologic Basis of Disease chapter 14. 6th

ed. Philadelphia:

Saunders; 2003. p. 453.

67. Ritchie A C, Boyd’s Textbook of Pathology Volume II. 9th

ed. Philadelphia: Lea

& Febriger (U.K); 1990. p .1236.

68. www.mayoclinic.com/invoke.cfm/symptoms accessed on 14/02/05

69. www.wrongdiagnosis.com/uti/causes accessed on 25/08/04

70. https://www.aafp.org/afp/1999/0301/p1225.html accessed on 11/03/2018

71. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 33. 4th

ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994.. (Kasi Sanskrit series 228).

72. Madhavakara, Madhavanidana chapter 30 sloka 2. Varanasi: Chaukhambha

Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46).

73. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 34. 4th

ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

74. Sushrutha, Sushruthasamhitha Uttaratantra chapter 59 sloka 4. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

75. Ashtangasangraha Nidanasthana chapter 9 sloka 6-7.Prof.K.R.Shrikhantamurthy

editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series

79).

76. Vagbhata, Ashtangahridaya Nidanasthana chapter 9 sloka 4.Varanasi:

Krishnadas Academy; 1982. (Krishnadas Academic series 4).

77. Madhavakara, Madhavanidana chapter 30 sloka 3. Varanasi: Chaukhambha

Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46).

78. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 3. 5th

ed.

Varanasi: Chaukhambha Orientalia; 1988.p.354 (Chaukhambha Sanskrit series

130).

79. Yogaratnakara Mootrakrichra nidana sloka 3 Vaidya Lakshmipatisastry editor.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 160).

80. Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2 chapter 27

Sloka3Edited by Gangasahaya pandey. Varanasi: Chaukambha Sanskrit series;

1969.

81. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 10 sloka 3. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 154).

82. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 34. 4th

ed. Varanasi:

Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

83. Sushrutha, Sushruthasamhitha Uttaratantra chapter 59 sloka 5. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

84. Ashtangasangraha Nidanasthana chapter 9 sloka 8.Prof.K.R.Shrikhantamurthy

editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series

79).

85. Vagbhata, Ashtangahridaya Nidanasthana chapter 9 sloka 4. Varanasi: Krishnadas

Academy; 1982. (Krishnadas Academic series 4).

86. Madhavakara, Madhavanidana chapter 30 sloka 3. Varanasi: Chaukhambha

Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46).

87. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 4. 5th

ed.

Varanasi: Chaukhambha Orientalia; 1988. p. 354. (Chaukhambha Sanskrit series

130).

88. Yogaratnakara Mootrakrichra Nidana sloka 4. Vaidya Lakshmipati sastry editor.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 160).

89. Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2 chapter 27

Sloka 3Edited by Gangasahaya pandey. Varanasi: Chaukambha Sanskrit series;

1969.

90. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 10 sloka 4. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 154).

91. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 35-36. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

92. Sushrutha, Sushruthasamhitha Uttaratantra chapter 59 sloka 6. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

93. Ashtangasangraha Nidanasthana chapter 9 sloka 10.Prof.K.R.Shrikhantamurthy

editor. Varanasi: Chaukhambha Orientalia; 1996. (Jaikrishnadas Ayurvedic series

79).

94. Vagbhata, Ashtangahridaya Nidanasthana chapter 9 sloka 5. Varanasi: Krishnadas

Academy; 1982. (Krishnadas Academic series 4).

95. Madhavakara, Madhavanidana chapter 30 sloka 5. Varanasi: Chaukhambha

Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46).

96. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 5. 5th

ed.

Varanasi: Chaukhambha Orientalia; 1988. p. 354. (Chaukhambha Sanskrit series

130).

97. Yogaratnakara Mootrakrichra nidana sloka 5. Vaidya Lakshmipatisastry editor.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 160).

98. Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2 chapter 27

Sloka 4 Edited by Gangasahaya pandey. Varanasi: Chaukambha Sanskrit series;

1969.

99. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 10 sloka 5. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 154).

100. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 37-38. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228).

101. Sushrutha, Sushruthasamhitha Uttaratantra chapter 59 sloka 7. Varanasi:,

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

Ashtangasangraha Nidanasthana chapter 9 sloka

11.Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia;

1996. (Jaikrishnadas Ayurvedic series 79).

103. Vagbhata, Ashtangahridaya Nidanasthana chapter 9 sloka 11. Varanasi:

Krishnadas Academy; 1982.. (Krishnadas Academic series 4).

104. Madhavakara, Madhavanidana chapter 30 sloka 4. Varanasi:

Chaukhambha Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana

Granthamala 46).

105. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 6. 5th

ed. Varanasi: Chaukhambha Orientalia; 1988. (Chaukhambha Sanskrit series

130).

106. Yogaratnakara Mootrakrichra nidana sloka 6. Vaidya Lakshmipatisastry

editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

160).

107. G Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2

chapter 27, Sloka 4 Edited by Gangasahaya pandey. Varanasi: Chaukambha

Sanskrit series; 1969.

108. K Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 10 sloka 6. 4th

ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 154).

109. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 37-38. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994.. (Kasi Sanskrit series 228)

110. Sushrutha, Sushruthasamhitha Uttaratantra chapter 59 sloka 7. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

111. Madhavakara, Madhavanidana chapter 30 sloka 7. Varanasi: Chaukhambha

Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46).

112. G Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2

chapter 27, Sloka 5 Edited by Gangasahaya pandey. Varanasi: Chaukambha

Sanskrit series; 1969.

113. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 43-44. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228)

114. K Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 10 sloka 7. 4th

ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series 154).

115. Sushrutha, Sushruthasamhitha Uttaratantra chapter 50 sloka 8. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

116. Madhavakara, Madhavanidana chapter 30 sloka 5. Varanasi:

Chaukhambha Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana

Granthamala 46).

117. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 7. 5th

ed. Varanasi: Chaukhambha Orientalia; 1988. p. 354. (Chaukhambha Sanskrit

series 130).

118. Yogaratnakara Mootrakrichra nidana sloka 7. Vaidya Lakshmipatisastry

editor., Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

160).

119. G Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2

chapter 27 Sloka 5 Edited by Gangasahaya pandey. Varanasi: Chaukambha

Sanskrit series; 1969.

120. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 42. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228) 121.

Madhavakara, Madhavanidana chapter 30 sloka 8. Varanasi: Chaukhambha,

Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana Granthamala 46).

122. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 9. 5th

ed. Varanasi: Chaukhambha Orientalia; 1988. p. 355. (Chaukhambha Sanskrit

series 130).

123. Yogaratnakara Mootrakrichra nidana sloka 10. Vaidya Lakshmipatisastry

editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

160).

124. G Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2

chapter 27,Sloka 8 Edited by Gangasahaya pandey. Varanasi: Chaukambha

Sanskrit series; 1969.

125. Sushrutha, Sushruthasamhitha Uttaratantra chapter 59 sloka 9. Varanasi:,

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

126. Madhavakara, Madhavanidana chapter 30 sloka 6. Varanasi:

Chaukhambha, Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana

Granthamala 46).

127. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 35 sloka 8. 5th

ed. Varanasi: Chaukhambha Orientalia; 1988. p.355(Chaukhambha Sanskrit

series 130).

128. Yogaratnakara Mootrakrichra nidana sloka 7. Vaidya Lakshmipatisastry

editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

160).

129. G Srimat Vaidya Sodhala, Gadanigraha Mootrakrichra adhikara Vol-2

chapter 27 Sloka 8 Edited by Gangasahaya pandey. Varanasi: Chaukambha

Sanskrit series; 1969.

130. K Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 10 sloka14-16.

4th

ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

154).

131. Vagbhata, Ashtangahridaya Sutrasthana chapter 11 sloka 5. Varanasi:

Krishnadas Academy; 1982. (Krishnadas Academic series 4).

132. Vagbhata, Ashtangahridaya Sutrasthana chapter 12 sloka 9. Varanasi:

Krishnadas Academy; 1982. (Krishnadas Academic series 4).

133. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 2, 3rd

ed.

Varanasi: Chaukhambha Sanskrit Series; (Chaukhambha Samskrita Granthamala-

93.) p.130.

134. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 2, 3rd

ed.

Varanasi: Chaukhambha Sanskrit Series;(Chaukhambha Samskrita Granthamala-

93.) p.281

135. Kanai.L.Mukherjee, Medical Laboratory Technology Vol.2. Published by

Tata Mc-Graw Hill 1997.p.809.

136. Sushrutha, Sushruthasamhitha Sutrasthana chapter 21 sloka 15. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

137. Kanai.L.Mukherjee, Medical Laboratory Technology Vol.2. Published by

Tata Mc-Graw Hill 1997.p.809.

138. K Vrudhajeevaka, Kashyapasamhita Chikitsasthana chapter 10 sloka18-

19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

154).

139. Smith, General Urology, 15th

edition by A.Tango,Jack.W.Mc Aninch,

p.252.

140. Smith, General Urology, 15th

edition by A.Tango,Jack.W.Mc Aninch,

p.253

141. Smith, General Urology, 15th

edition by A.Tango,Jack.W.Mc Aninch,

p.254.

142. Smith, General Urology, 15th

edition by A.Tango,Jack.W.Mc Aninch,

p.255.

143. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-

European languages. New Delhi: Motilal Banarasi Das; 1970. p.825

144. Camphell, Camphells neurology 7th

ed. Edited by Patrick.C.Walsh, Vol.1.

published by w.B.Saunders Company in Philadelphia. p.536

145. Camphell, Camphells neurology 7th

ed. Edited by Patrick.C.Walsh, Vol.1.

published by w.B.Saunders Company in Philadelphia, p.536

146. Camphell, Camphells neurology 7th

ed. Edited by Patrick.C.Walsh, Vol.1.

published by w.B.Saunders Company in Philadelphia p.536

147. Ritchie A C, Boyd’s Textbook of Pathology Volume II. 9th

ed.

Philadelphia: Lea, & Febriger (U.K); 1990. p .1236.

148. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 88. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

149. Walter E Stamm, Harrison’s Principles of Internal Medicine Chapter- 330.

15th

ed. McGraw-Hill2003. p. 820.

150. K Vrudhajeevaka, Kashyapasamhita Chikitsasthana chapter 10 sloka12-

13. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

154).

151. Agnivesa, Charakasamhitha sutrasthana chapter 10 sloka 11-20. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228)

152. Sushrutha, Sushruthasamhitha Uttaratantra chapter 59 sloka 28. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

153. Sushrutha, Sushruthasamhitha Sareerasthana chapter 6 sloka 27. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

154. Chaurasia B D, Human Anatomy Vol-2 chapter 24 .3rd

ed. 1995.CBS

publishers and distributors New Delhi p.247

155. Chaurasia B D, Human Anatomy Vol-2 chapter 24 .3rd

ed. 1995.CBS

publishers and distributors New Delhi p. 258.

156. Vagbhata, Ashtangahridaya Nidanasthana Chapter 9. -4 varanasi

Krishnadas academy (Krishnadas Academic series 4).

157. Chaurasia B D, Human Anatomy Vol-2chapter 243rd

ed. 1995.CBS

publishers and distributors New Delhi p. 261.

158. Guyton and Hall Text Book of Medical Physiology chapter 3110th

ed.

New Delhi: Harcourt India Pvt Ltd; 2001. p. 366.

159. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 2, 3rd

ed.

Varanasi: Chaukhambha Sanskrit Series; p.425Chaukhambha Samskrita

Granthamala-93).

160. Sushrutha, Sushruthasamhitha sareerasthana chapter 6 sloka 25 Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

161. Vagbhata, Ashtangahridaya sareerasthana chapter 4 sloka 10. Varanasi:

Krishnadas Academy; 1982. (Krishnadas Academic series 4).

162. Sushrutha, Sushruthasamhitha Sareerasthana chapter 6 sloka 33. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

163. Chaurasia B D, Human Anatomy Vol-2 chapter 30.3rd

ed. 1995.CBS

publishers and distributors New Delhi p. 305.

164. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 12. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228)

165. Sushrutha, Sushruthasamhitha Sareerasthana chapter 6 sloka 26. Varanasi:

Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51).

166. Chaurasia B D, Human Anatomy Vol-2 chapter 30.3rd

ed. 1995.CBS

publishers and distributors New Delhi p. 307-310

167. Sushrutha, Sushruthasamhitha Sareerasthana chapter 6 sloka 10 Varanasi:

Krishnadas Academy; 1980.. (Krishnadas Ayurveda series 51).

168. Dwarakanath.C, Introduction to Kayachikitsa 2nd

ed. Published by

Varanasi Chaukhambha Orientalia; 1986. p. 370. (Chaukhambha Sanskrit series

130).

169. Dwarakanath.C, Introduction to Kayachikitsa 2nd

ed. Published by

Varanasi Chaukhambha Orientalia; 1986 p.198.

170. Chaurasia B D, Human Anatomy Vol-2chapter 24, 3rd ed.1995. CBS

publishers and distributors New Delhi p. 135.

171. Guyton and Hall Text Book of Medical Physiology chapter 31. 10th

ed.

New Delhi: Harcourt India pvt Ltd; 2001. p.365

172. Guyton and Hall Text Book of Medical Physiology chapter 31. 10th

ed.

New Delhi: Harcourt India pvt Ltd; 2001 p. 366.

173. Guyton and Hall Text Book of Medical Physiology chapter 31. 10th

ed.

New Delhi: Harcourt India pvt Ltd; 2001. p. 364.

174. Chaurasia B D, Human Anatomy Vol-2 chapter 30.3rd

ed. 1995.CBS

publishers and distributors New Delhi p. 310.

175. Chaurasia B D, Human Anatomy Vol-2 chapter 30.3rd

ed. 1995.CBS

publishers and distributors New Delhi , p-307.

176. Cotran SR, Pathologic Basis of Disease chapter 14. 6th

ed. Philadelphia:

Saunders; 2003. p. 453.

177. Guyton and Hall Text Book of Medical Physiology chapter 31. 10th

ed.

New Delhi: Harcourt India Pvt Ltd; 2001. p. 364.

178. Guyton and Hall Text Book of Medical Physiology chapter 31. 10th

ed.

New Delhi: Harcourt India Pvt Ltd; 2001, p. 365.

179. Guyton and Hall Text Book of Medical Physiology chapter 31. 10th

ed.

New Delhi: Harcourt India Pvt Ltd; 2001, p. 366.

180. Madhavakara, Madhavanidana chapter 1 sloka 10. Varanasi:

Chaukhambha, Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana

Granthamala 46).

181. Vagbhata, Ashtangahridaya Nidanasthana chapter 9 sloka 18-19.

Varanasi: Krishnadas Academy; 1982. (Krishnadas Academic series 4).

182. Madhavakara, Madhavanidana chapter 31 sloka 2-11. Varanasi:

Chaukhambha, Surbharathi Prakashan; 1998. (Chaukhambha Ayurvijnana

Granthamala 46).

183. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 34-35. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228)

184. Agnivesa, Charakasamhitha chikitsasthana chapter 7 sloka 30. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 96).

185. Chakrapani commentary, on Agnivesa, Charakasamhitha chikitsasthana

chapter 7 sloka 15. 4th

ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.

(Kasi Sanskrit series 228)

186. K K Vrudhajeevaka, Kashyapasamhita Chikitsasthana chapter 10 sloka 12.

4th

ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

154).

187. Agnivesa, Charakasamhitha chikitsasthana chapter 26 sloka 45. 4th

ed.

Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit series 228)

188. Yogaratnakara Mootrakrichra nidana sloka 20. Vaidya Lakshmipatisastry

editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. (Kasi Sanskrit series

160).

189. Pt. Shri Brahma Sankara Mishra, Bhavaprakash of Shri Bhavamisra with

Hindi Commantry Edition Eight 2003, Varanasi Publisher Chaukhambha Sanskrit

Sansthan, Part 2nd

, Chikitsaprakaranam, Chapter – 35, Shloka – 2, 3, 30 Page No.

– 354, 357.

190. Dr.Indradev Tripathi, Yogaratnakara of Vaidyaprabha with Hindi

Commentary, Edition First- 1998, Varanasi Publisher, Krishnadas Academy,

Mootrakruchra Nidan - Chikitsaprakaranam

191. Dr. G.S.Pandey ed. Bhavaprakash Nighantu of Bhavamishra, Ikshuvarga

chapter 22/24-28, revised ed. 2010, Chaukhambha Bharati Academy, Varanasi, pp

779

192. Kashinath shastri edited Charaka samhita, Sutrasthanachapter 9th

,shloka

108- 113, 17th

edition1991,Pub: Chawkhambha Bharati academy Varanasi; pp-

46.

Post Graduate Studies and Research Center (Kayachikitsa) Rajiv Gandhi

Education Society’s Ayurvedic Medical College, Ron.

INFORMED CONSENT

I ………………............................................Son/Daughter/Wife of……………………...………………………...am

exercising my free will, to participate in above study as a subject. I have been informed

to my satisfaction, by the attending physician the purpose of the clinical evaluation and

nature of the drug treatment. I am also aware of my right to opt out of the treatment

schedule, at any time during the course of the treatment.

Patient's Signature Investigator’s Signature:

CONSENT

ನಾನು............................................................................ ನಾನು............ ........................... ... ವಿಷಯದ ಮೇಲಿರುವ ಅಧ್ಯಯನದಲಿ ಿ ಪಾಲ್ಗೊಳ್ಳಲು ನನನ ಉಚಿತ ಇಚ್್ೆಯನುನ ವಯಕ್ತಪಡಿಸುವುದು. ವ್ೈದಯಕೇಯ

ತಪಾಸಣ್ ಮತುತ ಔಷಧ್ ಚಿಕತ್್ೆಯ ಸವಭಾವದ ಉದ್ದೇಶದಿಂದ ವ್ೈದಯರಿಗ್ ಹಾಜರಾಗುವ ಮಗಲಕ್ ನನನ ತೃಪ್ತತಗ್ ನನಗ್ ತಿಳಿಸಲಾಗಿದ್. ಚಿಕತ್್ೆಯ ಸಮಯದಲಿ ಿ ಯಾವುದ್ೇ ಸಮಯದಲಾಿದರಗ ಚಿಕತ್್ೆ ವ್ೇಳಾಪಟ್ಟಿಯನುನ ಹ್ಗರಗುಳಿಯುವ ನನನ ಹಕ್ಕನುನ ನಾನು ತಿಳಿದದ್ದೇನ್.

ರ್ಗೇಗಿಯ ಸಹಿ

ತನಿಖಾದಾರರ ಸಹಿ:

Rt.I''GA}&HSMTIIo}IqrcEffSAruh,EC rmur utE$ a HosFmL Ro.l

ETHICAL CTEARANCE COMMITTEE

CERTIFICATE OF ETHICAL CLEARANCE

This is to certify that or. f,R(HP'l'Jfi I RIPP'TH, admitted

during the year-? o / ( - / (" in the Department of

submitted the Dissertatlon entitled "all,\/I a' ( t-!t'tl.: frL €v nLUfi to\t oF

has

Rfr ut,srt

0{:is scrutinized and approved by the Ethical Clearance

Committee in the meeting held on 2 A . o 2, . I 0

On behalf of the Ethical Clearance Committee, I undersigned hereby

certify the Ethical Clearance of above said research proposal.

/1.*chf^!"

Ethical Clearance CommitteeR.G.E.S. Ayurvedic Medical College, Hospital

Post Graduate Studies and research Centre

Ron - 582209IRIIIEIPAL ) } ,JI

iaii.' Gandtr.i Educadon s'.,.cd,arw-veai. M edical Colle^e & H1roheRON - 582 209 @trr, G.iret

tE otatr - aiTagl

Annexure-1

Rajiv Gandhi Education Society`s Ayurvedic Medical College, Ron. DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA

CASE SHEET

“CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA

MOOTRAKRICHRA w.s.r. TO URINARY TRACT INFECTIONS”

GUIDE:DR.SHARADA, M.D (Ayu PG SCHOLAR: DR. ARCHANA TRIPATHI

1) Name of the Patient Sl.No

2) Sex Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labour

6) Economical status Poor Middle Higher middle Higher class

7) Address

Contact No: Pin

8) Schedule Initiation Date Completion Date

9) Result Good response Moderate response

Poor response No response Discontinued

Annexure-1

Pradhana vedana: Avadhi Peetha mootrata

Kruchra mootrata

Sa daha mootrata

Sa rakta mootrata

Muhur muhur mootrata.

Anubandhi vedana: Avadhi

1.

2

3

4

Poorva Vyadhi Vrittanta:

Annexure-1

Chikitsa Vrittanta: Modern Medicines: Ayurveda Medicines:

Other system:

Relief with previous treatment: Relieved/Partial/No relief

Kula Vrittanta

Vyavasaya Vrittanta

1. Nature of work:

2. Working condition:

3. Other details:

Vaiyaktika Vrittanta

Ahara □Shakhahara □Mishrahara Nidra □Sound □Disturbed

Vihara Vastra

Vyayama

□Tight □Laghu

□Loose □Madhyama

□Praghada

Vyasana

Duration Regular Stopped Smoking Alchohol Tobacco Chewing Drug addiction Others

Menstrual history:

131

ROGI PAREEKSHA

Samanya pareeksha

Asta sthāna Pareeksha : Vital examination

1 Nadi /Min

2 Mala pravritti

3 Mootra pravritti Frequency

Day Night

4 Jihwa

5 Shabda

6 Sparsha

7 Druk

8 Akruti

1 Temp /F

2 Pulse /min

3 Resp.rate /min

4 B.P __mm of Hg

Aturabala Pramana Pareeksha:

(Dashavidha Pareeksha) : Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sanipataja ( )

Sāra Pravara. ( ) Madhyama. ( ) Avara ( )

Samhanana Pravara ( ) Madhyama. ( ) Avara ( )

Pramana Pravara ( ) Madhyama. ( ) Avara ( )

Sātmya Ekarasa. ( ) Sarva rasa ( )

Rooksha satmya ( ) Snigda satmya ( )

Satva Pravara ( ) Madhyama ( ) Avara ( )

Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( )

b) Jarana shakti P ( ) M ( ) A ( )

Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )

Vaya Bala ( ) Yuva ( ) Vrudda ( )

Angapratyanga Pareeksha

Shiras:

Greeva:

Uras:

Darshana Sparshanata: Akhotana: Shravana:

Shwasana samsthana(RS): Rakthavaha Samsthana(CVS):

Udara:

Darshana: Sparshana: Akhotana: Shravana:

Vikrutitah Pareeksha:

Nidana: Aharaja:

Viharaja:

Manasika:

Others:

Poorvaroopa:

Roopa:

Upashaya:

Anupashaya:

Samprapti Ghataka: Dosha:

Dushya: Srotas:

Dushtiprakara:

Rogamarga:

Utpatttisthana:

Sancharasthana:

Vyaktasthana:

Adhisthana:

Vyadhiswabhava:

Prayoga shala Pareeksha

Urine: Albumin:

Pus cells:

Epithelial cells::

Sapeksha Nidana:

Roga Nirnaya:

Upadrava:

Vyadhi Avastha:

Sadhyasadhyatha:

Assessment criteria (Scoring)

GRADE 0 1 2 3 4

Peeta No Colour Slight Yellow Dark Red Urine

mootrata & yellow Urine Yellow

Saraktha Urine

mootrata

Sa daha No Burning Burning Burning Continuous

mootrata Sensation micturition Persist after burning

while passing micturition

Passing

Kruchra No Mild Moderate Severe

mootrata difficulty difficulty difficulty difficulty

during during during during

micturition micturition micturition micturition

Muhur Passes urine Passes urine Passes urine Passes urine Urges

muhur once in once in one 4 times in more than 4 persist

mootrata three hours hour one hour times in one throughout

hour

GRADE 0 1 2 3 4

Albumin No Albumin Albumin Albumin Albumin

discharge discharge discharge + discharge discharge

++ +++

Pus Cells No Pus cells Pus cells 1-5 Pus cells 6- Pus cells 11- Pus cells 16 10 16 and

more

Epithelial No Epithelial Epithelial Epithelial Epithelial

Cells Epithelial Cells 1-5 Cells 6-10 Cells 11-16 Cells plenty

Cells

Treatment Protocol:

Patient is advised to take treatment modalities oral consumption of Guda-Dugdha for

7 days.

Patient is advised to take 30gms with 100ml of Godugdha in two times a day before milk.

observations

Subjective 0 day 3rd

day 7th

day BT AT DIFF After parameters fu

Peeta mootrata

Sa daha mootrata

Kruchra

mootrata

Muhur muhur

mootrata

Saraktha

mootrata

Objective 0 day 3rd

day 7th

day BT AT DIFF After

parameters fu

Albumin discharge

Pus Cells

Epithelial Cells

Result:

Conclusion:

Signature of Researcher: Signature of Guide (H.O.D)

Table No: 35, MASTER CHART NO.-1, SUBJECTIVE PARAMETERS

Peeta mootrata

& Sa daha Kruchra Muhur muhur

Saraktha mootrata mootrata mootrata

S.N0 mootrata

BT AT BT AT BT AT BT AT

1 2 2 2 2 3 3 3 2

2 3 1 2 1 2 2 2 2

3 3 2 2 2 2 2 1 1

4 2 2 3 1 3 2 2 2

5 3 2 1 0 2 1 2 2

6 2 2 1 2 1 1 2 2

7 1 1 2 2 2 2 3 2

8 2 2 2 1 2 1 3 3

9 1 1 2 2 2 2 1 1

10 3 2 2 2 3 2 2 2

11 2 2 3 1 3 3 3 3

12 3 2 2 3 1 1 4 3

13 3 3 3 2 2 2 1 1

14 2 2 2 2 3 2 1 1

15 3 2 3 3 4 3 2 2

16 4 3 3 2 1 1 2 1

17 3 2 2 1 1 1 3 2

18 2 2 2 1 2 2 2 2

19 2 2 1 2 2 2 2 2

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 79

20 2 2 3 2 3 2 3 3

21 2 1 3 3 2 2 2 2

22 3 2 3 2 2 1 3 2

23 1 1 2 2 3 2 2 2

24 1 0 2 2 2 1 3 2

25 2 2 1 1 3 3 2 2

26 2 2 2 1 2 2 1 1

27 2 1 2 2 3 2 2 2

28 2 2 1 1 2 2 1 1

29 3 2 2 2 2 2 3 2

30 2 1 2 1 3 2 2 2

31 3 3 2 2 1 1 3 3

32 2 2 3 2 3 2 3 2

33 3 2 3 1 2 2 2 2

34 3 3 4 3 2 1 3 2

35 2 2 2 2 3 2 4 3

36 2 1 1 1 1 1 3 2

37 1 1 2 2 1 1 2 2

38 3 2 3 3 2 2 3 2

39 3 2 3 2 2 1 2 1

40 2 1 2 2 2 2 2 2

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA W.S.R. TO URINARY TRACT INFECTIONS Page 80

Table No: 36, MASTER CHART NO.-2, OBJECTIVE PARAMETERS

S. NO. Albumin discharge Pus Cells Epithilial Cells

BT AT BT AT BT AT

1 2 1 2 2 1 0

2 2 1 2 0 2 1

3 1 1 2 1 1 1

4 2 2 3 1 1 1

5 0 0 1 1 2 1

6 1 1 2 2 2 1

7 1 0 1 1 2 0

8 1 0 2 1 2 1

9 2 1 1 0 3 2

10 1 1 2 1 2 2

11 1 1 3 2 3 2

12 0 0 3 2 2 1

13 2 1 2 1 3 2

14 1 0 3 2 2 1

15 1 1 1 1 3 2

16 1 1 1 1 2 1

17 3 2 2 1 3 3

18 2 1 2 1 1 1

19 2 0 2 2 2 2

20 3 2 2 2 1 1

21 1 0 3 3 2 2

CLINICAL EVALUATION OF GUDA-DUGDHA PRAYOGA IN PITTAJA MOOTRAKRICHRA

W.S.R. TO URINARY TRACT INFECTIONS Page 81