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Urine (mutra) is an essential metabolic waste product (mala). It excretes excess water (udaka), moisture (kleda) and other non-usable waste products from the body (SAT-B.460).<ref>Available from  http://namstp.ayush.gov.in/#/sat</ref>  

Urine (mutra) is an essential metabolic waste product (mala). It excretes excess water (udaka), moisture (kleda) and other non-usable waste products from the body (SAT-B.460).<ref>Available from  http://namstp.ayush.gov.in/#/sat</ref>  

== Etymology and derivation ==

== Etymology and derivation ==

 

Urine is known by the Sanskrit word ‘mutra’. It is derived from the word root “mutr-prasrave” that means to piss, to lose water etc.<ref>Jha Srujan. Amarkosha online application</ref> It is also known by the synonyms  'prasrava' and 'drava mala'.  

Urine is known by the Sanskrit word ‘mutra’. It is derived from the word root “mutr-prasrave” that means to piss, to lose water etc.<ref>Jha Srujan. Amarkosha online application</ref> It is also known by the synonyms  'prasrava' and 'drava mala'.  

 

==Formation of urine==

==Formation of urine==

 

The waste products of digestion of food get diluted in water in the intestine. After absorption, products are circulated for filtration and metabolic transformation to form urine which goes through ureter to urinary bladder and then excreted through urethra.[Sha.Sa.Purva khanda 4] The urinary system consists of the kidneys, ureters, urinary bladder and urethra.

The waste products of digestion of food get diluted in water in the intestine. After absorption, products are circulated for filtration and metabolic transformation to form urine which goes through ureter to urinary bladder and then excreted through urethra.[Sha.Sa.Purva khanda 4] The urinary system consists of the kidneys, ureters, urinary bladder and urethra.

==Normal composition of urine==

==Normal composition of urine==

 

The urine is composed of various nitrogen-based products formed during cellular metabolism and other electrolytes.  

The urine is composed of various nitrogen-based products formed during cellular metabolism and other electrolytes.  

|Phosphate (PO42−)||20–50 mmol/d (>18)

|Phosphate (PO42−)||20–50 mmol/d (>18)

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==Quantity==

==Quantity==

 

The total quantity of mutra is four anjali (personified measurement unit). [Cha.Sa.[[Sharira Sthana]] 7/15] In normal human being, 800 ml to 2 litres of urine is excreted per day.  

The total quantity of mutra is four anjali (personified measurement unit). [Cha.Sa.[[Sharira Sthana]] 7/15] In normal human being, 800 ml to 2 litres of urine is excreted per day.  

 

==Functions==

==Functions==

 

Urine carries following functions:

Urine carries following functions:

1.Separation and excretion of excess moisture from the body  

1. Separation and excretion of excess moisture from the body  

2.Filling the urinary bladder or maintaining fluid volume in bladder.[Su. Sa. [[Sutra Sthana]] 15/5], [A.Hr. [[Sutra Sthana]] 11/5]

2. Filling the urinary bladder or maintaining fluid volume in bladder.[Su. Sa. [[Sutra Sthana]] 15/5], [A.Hr. [[Sutra Sthana]] 11/5]

The overall function of urinary system is to filter approximately 200 liters of fluid a day from blood. It excretes toxins, metabolic waste products, and excess ions through urine.Essential substances in the blood are reabsorbed.Apart from this, plasma osmolarity and acid-base metabolism is regulated.<ref>Ogobuiro I, Tuma F. Physiology, Renal. [Updated 2020 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538339/</ref>   

The overall function of urinary system is to filter approximately 200 liters of fluid a day from blood. It excretes toxins, metabolic waste products, and excess ions through urine.Essential substances in the blood are reabsorbed.Apart from this, plasma osmolarity and acid-base metabolism is regulated.<ref>Ogobuiro I, Tuma F. Physiology, Renal. [Updated 2020 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538339/</ref>   

==Channels carrying urine (mutravaha srotas)==

==Channels carrying urine (mutravaha srotas)==

 

The channels carrying urine originate from pelvic region including kidneys and the urinary bladder (basti and vankshana).[Cha.Sa.[[ Vimana Sthana]] 5/8] It involves the urinary system.

The channels carrying urine originate from pelvic region including kidneys and the urinary bladder (basti and vankshana).[Cha.Sa.[[ Vimana Sthana]] 5/8] It involves the urinary system.

*Long time and frequent suppression of urge of micturition  

*Long time and frequent suppression of urge of micturition  

*Especially in persons suffering from wasting and trauma.[Cha.Sa.[[Vimana Sthana]]5/20]  

*Especially in persons suffering from wasting and trauma.[Cha.Sa.[[Vimana Sthana]] 5/20]  

*Retention of urine is observed on suppression of urge to ejaculate [Cha.Sa.[[Sutra Sthana]] 7/10]

*Retention of urine is observed on suppression of urge to ejaculate [Cha.Sa.[[Sutra Sthana]] 7/10]

*Intake of food before the previous meal is digested and chronic indigestion  

*Intake of food before the previous meal is digested and chronic indigestion  

These are causes of eight type of dysuria (mutrakricchra).[Cha.Sa.[[Chikitsa Sthana]]26/32-33]

These are causes of eight type of dysuria (mutrakricchra).[Cha.Sa.[[Chikitsa Sthana]] 26/32-33]

 

==Abnormal states==

==Abnormal states==

 

The increase or decrease in quality and/or quantity of urine can lead to various abnormal conditions.  

The increase or decrease in quality and/or quantity of urine can lead to various abnormal conditions.  

Suppression of the urge of micturition causes pain in the bladder and phallus, dysuria, headache, bending of the body and distension of the lower abdomen.[Cha.Sa.[[Sutra Sthana]]7/6]

Suppression of the urge of micturition causes pain in the bladder and phallus, dysuria, headache, bending of the body and distension of the lower abdomen.[Cha.Sa.[[Sutra Sthana]]7/6]

 

==Urine Examination (mutra pareeksha)==

==Urine Examination (mutra pareeksha)==

 

Hippocrates (400 BC), in his text De Urinis Theophilus, mentioned the use of urine to interpret human body functioning, urine was mainly used as a means for prognosis and prediction of outcomes of illness. Theophilus (700 AD) treated uroscopy in a sophisticated objective manner, and contributed to the birth of medieval medical studies.<ref>Kouba E, Wallen EM, Pruthi RS. Uroscopy by Hippocrates and Theophilus: prognosis versus diagnosis. J Urol. 2007 Jan;177(1):50-2. doi: 10.1016/j.juro.2006.08.111. PMID: 17161998.</ref>

Hippocrates (400 BC), in his text De Urinis Theophilus, mentioned the use of urine to interpret human body functioning, urine was mainly used as a means for prognosis and prediction of outcomes of illness. Theophilus (700 AD) treated uroscopy in a sophisticated objective manner, and contributed to the birth of medieval medical studies.<ref>Kouba E, Wallen EM, Pruthi RS. Uroscopy by Hippocrates and Theophilus: prognosis versus diagnosis. J Urol. 2007 Jan;177(1):50-2. doi: 10.1016/j.juro.2006.08.111. PMID: 17161998.</ref>

   

   

d) Bacterial screening –Gram staining, colony count.

d) Bacterial screening –Gram staining, colony count.

 

==Ayurvedic perspective of urine examination==

==Ayurvedic perspective of urine examination==

 

Ayurvedic text describe detailed methodology for collection, examination and interpretation of the results. This was used to diagnose the disease condition based on urine examination.Some of the practices, which are rarely practiced and seem obsolete, are given below. These can be researched further for better understanding of the pathological changes through urine examination.  

Ayurvedic text describe detailed methodology for collection, examination and interpretation of the results. This was used to diagnose the disease condition based on urine examination.Some of the practices, which are rarely practiced and seem obsolete, are given below. These can be researched further for better understanding of the pathological changes through urine examination.  

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* *[Y. R. mutra pariksha /4]

* *[Y. R. mutra pariksha /4]

 

==Method of examination of urine – oil-drop method (taila bindu pariksha)==

==Method of examination of urine – oil-drop method (taila bindu pariksha)==

 

Oil drop method was widely practiced for diagnosis and prognosis of disease conditions. Researches are being conducted to study application of this test in current times.The physician should drop one or two drops of sesame oil (tila taila) into the sample of urine collected.

Oil drop method was widely practiced for diagnosis and prognosis of disease conditions. Researches are being conducted to study application of this test in current times.The physician should drop one or two drops of sesame oil (tila taila) into the sample of urine collected.

 

===Observations and interpretations===  

===Observations and interpretations===  

{| class="wikitable"

{| class="wikitable"

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|-  

|Mixed shades of different colors||Sannipata type of fever

|Mixed shades of different colors||Sannipata type of fever

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===Prognosis===

===Prognosis===

*'''Prognosis of disease as per mode of spread of oil in urine''' [Y. R. mutra pariksha /5-6]

*'''Prognosis of disease as per mode of spread of oil in urine''' [Y. R. mutra pariksha /5-6]

{| Class="wikitable"

{| Class="wikitable"

Above listed disorders are observed in current clinical practices.

Above listed disorders are observed in current clinical practices.

 

==Management of urinary disorders ==

==Management of urinary disorders ==

===Management of increased state===

===Management of increased state===

*Increased state of urine is treated by removing the cause by either cleansing (shodhana) procedures or medicines to facilitate the natural excretion.[Su.Sa.Sutra Sthana 15/17]  

*Increased state of urine is treated by removing the cause by either cleansing (shodhana) procedures or medicines to facilitate the natural excretion.[Su.Sa.Sutra Sthana 15/17]  

*Sugar cane juice, varuni type of wine, thin gruel (manda), liquid food articles and substances having sweet (madhura), salty (lavana) and sour (amla) tastes and moist in nature are administered. [Cha.Sa.[[Sharira Sthana]] 6/11]

*Sugar cane juice, varuni type of wine, thin gruel (manda), liquid food articles and substances having sweet (madhura), salty (lavana) and sour (amla) tastes and moist in nature are administered. [Cha.Sa.[[Sharira Sthana]] 6/11]

===Treatment of dysuria (mutra krichra)===

===Treatment of dysuria (mutra krichhra)===

In all types of dysuria,[[vata]] pacifying therapies are administered at first and then other dosha are considered.[Cha.Sa.[[Chikitsa Sthana]] 26/58].  

In all types of dysuria,[[vata]] pacifying therapies are administered at first and then other dosha are considered.[Cha.Sa.[[Chikitsa Sthana]] 26/58].  

*Trunapanchamula [Su. Sa. Sutra Sthana 38/76]

*Trunapanchamula [Su. Sa. Sutra Sthana 38/76]

 

== Therapeutic use of urine ==

== Therapeutic use of urine ==

Urine is a product of  animal origin (jangama dravya) used in therapeutics.[Cha.Sa.[[Sutra Sthana]] 1/68-69]  

Urine is a product of  animal origin (jangama dravya) used in therapeutics.[Cha.Sa.[[Sutra Sthana]] 1/68-69]  

   

   

Urines possess activity as digestive stimulants, antidotes to poison and vermicides. These are excellent in the treatment of anemia(pandu). [Cha. Sa. [[Sutra Sthana]] 1/97] Oral administration of urine pacifies [[kapha]], regulates peristaltic movement of [[vata ]] and evacuates morbid [[ pitta ]] through lower channels. [Cha. Sa.[[ Sutra Sthana ]] 1/98-99]

Urines possess activity as digestive stimulants, antidotes to poison and vermicides. These are excellent in the treatment of anemia(pandu). [Cha. Sa. [[Sutra Sthana]] 1/97] Oral administration of urine pacifies [[kapha]], regulates peristaltic movement of [[vata ]] and evacuates morbid [[ pitta ]] through lower channels. [Cha. Sa.[[ Sutra Sthana ]] 1/98-99]

 

== Current Researches==

== Current Researches==

 

*Urine is a very useful and widely used bio fluid for research purpose in metabolomics. An online database containing the complete set of 2651 confirmed human urine metabolite species, their structures (3079 in total), concentrations, related literature references and links to their known disease associations are freely available now.<ref>Souhaila Bouatra et al, The Human Urine Metabolome, Plos One, September 2013 | Volume 8 | Issue 9 | e73076.</ref>  

*Urine is a very useful and widely used bio fluid for research purpose in metabolomics. An online database containing the complete set of 2651 confirmed human urine metabolite species, their structures (3079 in total), concentrations, related literature references and links to their known disease associations are freely available now.<ref>Souhaila Bouatra et al, The Human Urine Metabolome, Plos One, September 2013 | Volume 8 | Issue 9 | e73076.</ref>  

*The mechanism of urine formation in the intestine and its connection with the renal system may provide substantial solutions in management of chronic kidney diseases. A recent experimental study conducted on rats with impaired renal function (induced by intragastric administration of adenine), has proven that intestinal tract had excretory function compensative for renal function.<ref>Yu Yun et al, Excretory Function of Intestinal Tract Enhanced in Kidney Impaired Rats Caused by Adenine, The Scientific World Journal ,Volume 2016, Article ID 2695718, https://doi.org/10.1155/2016/2695718.</ref>

*The mechanism of urine formation in the intestine and its connection with the renal system may provide substantial solutions in management of chronic kidney diseases. A recent experimental study conducted on rats with impaired renal function (induced by intragastric administration of adenine), has proven that intestinal tract had excretory function compensative for renal function.<ref>Yu Yun et al, Excretory Function of Intestinal Tract Enhanced in Kidney Impaired Rats Caused by Adenine, The Scientific World Journal ,Volume 2016, Article ID 2695718, https://doi.org/10.1155/2016/2695718.</ref>

A study showed good improvement in microalbuminuria in diabetic patients after therapeutic enema (basti) with ayurvedic formulation of Tribulus terrestris (gokshura) and Borrhavia diffusa (punarnava).<ref>Ramteke RS, Thakar AB, Trivedi AH, Patil PD. Clinical efficacy of Gokshura-Punarnava Basti in the management of microalbuminuria in diabetes mellitus. AYU [serial online] 2012 [cited 2020 Dec 23];33:537-41. Available from: https://www.ayujournal.org/text.asp?2012/33/4/537/110535</ref> Another study showed significant improvement in cases of chronic renal failure.<ref>Patel MV, Gupta S N, Patel NG. Effects of Ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy). AYU [serial online] 2011 [cited 2020 Dec 23];32:483-6. Available from: https://www.ayujournal.org/text.asp?2011/32/4/483/96120</ref> The relation of gut and kidneys can be explored more to find better management solutions for kidney diseases.

*A study showed good improvement in microalbuminuria in diabetic patients after therapeutic enema (basti) with ayurvedic formulation of Tribulus terrestris (gokshura) and Borrhavia diffusa (punarnava).<ref>Ramteke RS, Thakar AB, Trivedi AH, Patil PD. Clinical efficacy of Gokshura-Punarnava Basti in the management of microalbuminuria in diabetes mellitus. AYU [serial online] 2012 [cited 2020 Dec 23];33:537-41. Available from: https://www.ayujournal.org/text.asp?2012/33/4/537/110535</ref> Another study showed significant improvement in cases of chronic renal failure.<ref>Patel MV, Gupta S N, Patel NG. Effects of Ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy). AYU [serial online] 2011 [cited 2020 Dec 23];32:483-6. Available from: https://www.ayujournal.org/text.asp?2011/32/4/483/96120</ref>

 

The relation of gut and kidneys can be explored more to find better management solutions for kidney diseases.

==Related theses works==

==Related theses works==

1. Sharma Anilkumar(2001) : Role of imaging techniques in the diagnosis of Mootrashmari (urolithiasis) and Shikhadi compound it its management, Department of Shalyatantra, IPGT&RA, Jamnagar.

1. Sharma Anilkumar(2001) : Role of imaging techniques in the diagnosis of Mootrashmari (urolithiasis) and Shikhadi compound it its management, Department of Shalyatantra, IPGT&RA, Jamnagar.

25. Singh Sarita (2018) : Urine examination by Tailabindu pariksha of pre-diabetes and Diabetes Mellitus conditions - An observational study. Dept. of Rognidana, Pt. K. L. Sharma Govt. Ayurveda Institute, Bhopal.

25. Singh Sarita (2018) : Urine examination by Tailabindu pariksha of pre-diabetes and Diabetes Mellitus conditions - An observational study. Dept. of Rognidana, Pt. K. L. Sharma Govt. Ayurveda Institute, Bhopal.

==References==

==References==