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Mutraghata
Written by Dr. Hemant Bhatia

Mutraghata

The term Mutraghata comprises two words viz. Mutra and Aghata, which stands for low urinary output either by retention, absoulute or relative anuria or oliguria.
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Definition : Acharya Dalhana defines Mutraghata as –Mutraghatena mutravarodhah i.e. a Clinical entity of Mutravaha srotas where in the Obstruction to the flow of urine is the Pahognomic sign, but further states that some experts ascribe the term ‘Dushti’ to Aghata as Mutrashukra, Mutrasada, UshnaVata types are not characterized by Mutravarodha. The mechanical obstruction to the outflow of urine may be located in the lower tract, or in the upper tract alone and on one or both the sides; sometimes the obstruction may be complete or partial, temporary or intermittent. A complete obstruction of the lower tract results in a complete retention but complete obstruction is rare as compared to the partial types of obstruction. Many partial types slowly progress to a more or less complete block but during this time, there also has been a gradually developing decompensation in the emptying ability of the bladder in cases of lower tract obstruction, and in the secreting of the kidneys in the obstruction of lower and upper tracts. The block increases more and more complete, as the function of the bladder and kidneys becomes more and more inefficient. In all the obstructions of the lower tract the effect of backpressure will be felt in the upper tract sooner or later, but the changes of back pressure from Obstruction in the lower tract may be very unequal on the two sides of the upper tract. Changes in lower tract are basically vesicle where as those in upper tract are Uretero-renal.

NIDANA

Ancient Acharyas have not mentioned any specific causative factors for Mutraghata, but those factors which are responsible for Mutrakricchra can be taken into account [ref. Acharya Gangadhara – Ch.Chi. 26/32].
Acharya Charaka has mentioned these factors as – Vyayamateekshnoushadha rookshamadhyaprasanga nitya drutaprishta- yaanaat anupa matsya adhyashanat ajeernat…….[Ch.Chi.26/32].
Viz.
1. Ativyayama – excessive exercise
2. Teekshna aushadha – drugs of strong potency
3. Rukshamadhya prasanga – excessive indulgence in dry alcohol
4. Nityadrata prishtayanat – riding on the back of fast moving animals regularly
5. Anupamatsya – ingestion of flesh of wet land creatures
6. Adhyashana – eating before digestion of previous meal
7. Ajernat – indigestion

CLASSIFICATION

Vatakundalika
Ashteela
Vata Basti
Mutrateeta
Mutrajathara
Mutrotsanga
mutrakshaya
Mutragranthi (Raktagranthi)
Pittaja mutroukasada
Mutroukasada
Vidvighata
Basti kundalika

ETIOLOGY OF BPH

The exact mechanism of prostatic hyperplasia is not completely understood, but the major two factors necessary for the onset of BPH in men are presence of testes & ageing. Consequently much research has been directed at identifying a hormonal cause. Although there is conflicting information, there are several factors supporting the possibility that BPH in men is under endocrine control.
Viz.
1. BPH does not occur who are castrated before puberty.
2. Regression of established BPH has been reported to occur following castration.
3. In animal models, BPH can be produced by hormones.
Considering these factors, several theories have been enlighted in the field of scientific explanation & these are:
1. Role of Testis.
2. The Dihydrotestosterone thesis.
3. The role of Oestrogen / Androgen synergism.
4. The role of Stromal epithelial interaction.

CLINICAL FEATURES

To facilitate taking a history, it is helpful to divide the symptoms into -
1. Symptoms due to mechanical obstruction.
2. Those superimposed by infection.
3. Those caused by Uraemia.
4. Symptoms related to sexual activity.
But it can also be divided into:
a. Obstructive Symptoms.
b. Irritative symptoms.
a. Obstructive Symptoms : Early in the disease process the patient usually has minimal symptoms because the detrusor musculature is capable of compensating for the increased outlet resistance to urine flow. With progressive obstruction, the patient develops:-
1. Diminution of the caliber & force of the urine stream.
2. Hesitency in initiating urination.
3. Inability to terminate micturition with post void dribbling.
4. A sense of incomplete emptying of the bladder.
5. Occasionally urinary retention.
b. Irritative symptoms:
With increased vesical compliance and the development of bladder instability, Frequency, Nocturia, Urgency and overflow incontinence develop.
The severity of the symptoms is not correlated with the size of the prostate. Many men with great enlargement of prostate have no symptoms, whereas others, sometimes, with lesser enlargement, experience severe symptoms. The severity of clinical symptoms experienced by an individual patient may also fluctuate unpredictably, as stress, cold and the use of sympathomimetic agents can cause symptoms to worsen.

CHIKITSA OF MUTRAGHATA

According to Sushruta
- i.e. drugs in the form of Kashaya, Kalka, Sarpi, Bhakshya, Avaleha, Payas, Kshara, Madya, Asava, Svedana, Basti, Uttara Basti and the formulations told in context of Ashmari, and Mutrodavarta diseases are useful
According to Charaka
The measures adopted for Mutrakricchra are to be followed and Uttara Basti is to be administered in all the varieties of Mutraghata. The measure told for Mutrakricchra are – Abhyanga, Sneha, Niruha Basti, Snehapana, UttaraBasti, Seka, Pradeha, Virechana, Kshara, Ushna – Tikshna Aushadha and Annapana, Takra, Tikta Aushadhasiddha Taila are advised for the individual Doshas respectively [Ch. Ci. 26/45, 49, 59]
PATHYA AND APATHYA [ Bh. R. 35]
Lastly, the most important and the most neglected aspect of the treatment is that of Pathya and Apathya. Dietetic control will give boost to the drugs administered and therefore enhance the results of the given drugs.
Abhyanga, Snehana, Virechana Basti Svedana Uttara Basti are again descried to be Pathya indicating their importance. Purana Shali, Yava, Madya, Takra, Dugdha, Mashayusha, Kushmanda Phala, Patola, Talaphala etc. are all Pathya to the patients of Mutraghara; hence the food articles of above advised things will definitely be beneficial in alleviating the symptomatology of Mutraghata, atleast to a certain extent and mostly that of Vata vitiation. (Bh.R.35/50-52)
Here is an effort to collect different Yogas told by different Acharyas in context to Mutraghata
Swarasa – Nidigdhikadi (B.P; Su), Amalaka swarasa (Su), Elayukta dhatri swarasa (A.S;Su), Nilotpaladi (Ch), Kantakari (A.S,A.hr), Duralabha (A.S;B.P) etc.
Kalka – Ervaru (Su & AS), Mustadi (Su), abhayadi (su), draksha (Su & AS), baladi (Su), Sigru mula (Ch) , Trapushadi (AS), Simhyadi (A.S), Murvadi (A.S), Sasaindhava triphala (A.S), Pasanabedhadi (A.hr), Kukuma (B.P.) etc.
Kwatha – Devadarvyadi (A.hr), Shatavaryadi (Ch), Haritakyadi (A.S & Shar), Kamalotpala (Ch), Shrngastaka (Ch, & A.S), Trinapanchamuladi (A.S & B.P), Kandekshurakamula (A.S), Dhavadi (A.S), Pashanabhedhadi (A.S), Gokshura (Sha & B.P), Naladi (B.P & Y.R) Vasa (B.P) etc.
Churna – Vyoshadi , Ela, Pravala, Pashanabhedhadi etc (Ch), Pippali, Surasa, Bibhitaka Churna etc (A.S), Hinguadi Churna (Sha), Asdabhadradi Churna (B.P); Chandana Churna (B.P); Ushiradi Churna (Y.R).
Vati / Gutika – Chandraprabha vati, Gokshuradi Guggulu (Shar).
Kshirapaka – Kakolyadi, Naladi, Mutradosahara (Su), Trikantakadi (BP & YR).
Sneha Kalpana – Mutrarakta yonidoshahara ghrita, Bala ghrita, Mahabala ghrita, (Su); Punarnavadi Mishraka sneha, Pashanabhedadi ghrita, Svadanstra ghrita, Sthiradi ghrita, Katakadi ghrita (Ch); Dashamuladi ghrita, Tilvaka ghrita (AS); Changari ghrita, Dhaturadi taila, Tilvaka ghrita (Shar); Vidari ghirta, Bhadravaha ghrita (BP).
Kshara – Patala, Patalyadi dsharodaka (Su, BP, AS, A. Hr).
Avaleha – Swaguptadi (BP)
Panayoga – Punarnavadi (Ch)
Sandhana Kalpana – Sura (Su), Nigada Madya, Madhukasava (Ch), Tilaadi kshara yukta sura (AS).
Upanaha – Punarnavadi (Ch)
Yavagu – Saptacchadadi (Ch)
Gokshurakantakari Siddha (AS)
Basti – Dashamuladi taila, Biwadi, Shatavaryadi (AS).Vasottara (Su)
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