Changes

Susruta describes ''pittaja'' and ''kaphaja'' types of ''mutraukasada'' (dense urine) as two different conditions. In ''pittaja mutraukasada'' he describes that on drying, the urine resembles ''gorochana churna'' (powder of a stone or 'bezoar' found in cattle) and in case of ''kaphaja'' variety, on drying the urine becomes like ''shankha churna'' (powder of conch shell).  

Susruta describes ''pittaja'' and ''kaphaja'' types of ''mutraukasada'' (dense urine) as two different conditions. In ''pittaja mutraukasada'' he describes that on drying, the urine resembles ''gorochana churna'' (powder of a stone or 'bezoar' found in cattle) and in case of ''kaphaja'' variety, on drying the urine becomes like ''shankha churna'' (powder of conch shell).  

Due to holding of natural urges, obstruction to the downward movement of vata makes vata gati in to upward and circular, manifesting in to severe condition called mutrajathara (accumulation of urine in abdominal cavity). Along with symptoms like retention of urine and stool, indigestion is also one of the symptoms.

Due to holding of natural urges, obstruction to the downward movement of ''vata'' makes ''vata gati'' in to upward and circular, manifesting in to severe condition called ''mutrajathara'' (accumulation of urine in abdominal cavity). Along with symptoms like retention of urine and stool, indigestion is also one of the symptoms.

 

Based on the descriptions, the condition seems to be a neurological disturbance of bladder function due to repeated withholding the urge of micturition.

Based on the descriptions, the condition seems to be a neurological disturbance of bladder function due to repeated withholding the urge of micturition.

All the above mentioned mutradoshas are in accordance with the nidanas described under Ca.Vi.5/20 ie, drinking water, consuming food, indulging in sexual intercourse when one feels the urge to micturate and withholding the urge of micturition especially in an emaciated or traumatized individual.   

All the above mentioned ''mutradoshas'' are in accordance with the ''nidanas'' described under Ca.Vi.5/20 ie, drinking water, consuming food, indulging in sexual intercourse when one feels the urge to micturate and withholding the urge of micturition especially in an emaciated or traumatized individual.   

 

 

 

The condition mutratita seems to be a physiological atony of bladder owing to prolonged withholding the urge to micturate, thereby the bladder contractions wean away and paves the way for atony. Recurrent withholding the urge may result in pathological atony as well as neurological disturbances in bladder function due to disturbances in the balance between symapathetic and parasympathetic functions. This concept may be practically found in patients of diabetes mellitus with recurrent urinary tract infections (cystitis), wherein USG reveals significant residual urine in bladder due to bladder atony. Such patients are immensely benefited by toilet training ie, developing a habit of regular micturition at timely intervals which in due course reduces the incidence of recurrent urinary tract infections  and in due course significantly reduces the residual urine, possibly improving the bladder tone and nervous integrity.

In clinical practice, simple rubber catheters no. 6 or 7 may be used for the procedure after sterilization by autoclaving and so should be the medicine used for ''uttarabasti''. With due aseptic precautions, the procedure should be carried out in a fumigated room preferably like an O.T. procedure which reduces the likely chances of U.T.I. Nevertheless, in the outcome the chances of asymptomatic pyuria or abacteriuric pyuria are always there. These possibly can be minimized with the use of filtered medicament (so as to ensure no particles), pre-autoclaved and administered with nozzle of gold or silver. Though the classical position of the patient is seating, lying down position is equally easy and the patient may be made to feel more comfortable. An hour after the procedure, the patient should be instructed to consume plenty of oral fluids to maintain a high urine output. The patients comfortably retain the medicament for 2-4 hours. The procedure may be done daily for 8 days after an initial ''gudagata asthapana basti''. The procedure is done after asking the patient to evacuate the bladder and bowel.  

The role of basti chikitsa and specifically uttarabasti in the management of apana vata vikrti and also sthana dushti (local vitiation) has been highlighted in the classical texts.

The drugs described are mostly ''ushna veerya, vatanulomana'' and hence are highly beneficial in clearing the ''avarodha''(obstruction) of ''aushadha''.

The drugs having mutrala (mutravirecaneeya and mutravirajaneeya) actions are all useful in the above mentioned mutradoshas. The mutravirajaneeya, mutravirecaneeya gana dravyas(Ca.Su.4/15 ) are very helpful. 

The indication of administration of ''varti'' into ''gudamarga'' as well, probably indicates that some reflex mechanisms are involved in the evacuation of bladder in case of retained medicament. This in the classical description may be explained as causing ''apanavatanulomana''.

The descriptions of the procedure with materials or equipments used thereby are clearly stated in the texts. Gold and silver are metals considered to be soft and malleable. The uttarabasti nozzle prepared out of these are specially suited for introducing into urethra as it is extremely vulnerable to trauma during the procedure which can be minimized by these metals. Primarily the chance of injury is due to the fact that male urethra is curved (‘S’ shaped) and straightened slightly when the penis is erect. Nevertheless, when fully straight there is a increased chance of trauma. Further these metals have a protective effect on the body.

In clinical practice, simple rubber catheters no. 6 or 7 may be used for the procedure after sterilization by autoclaving and so should be the medicine used for uttarabasti. With due aseptic precautions, the procedure should be carried out in a fumigated room preferably like an O.T. procedure which reduces the likely chances of U.T.I. Nevertheless, in the outcome the chances of asymptomatic pyuria or abacteriuric pyuria are always there. These possibly can be minimized with the use of filtered medicaments (so as to ensure no particles), priorly autoclaved and administered with nozzle of gold or silver. Though the classical position of the patient is seating, lying down position is equally easy and the patient may be made to feel more comfortable. An hour after the procedure, the patient should be instructed to consume plenty of oral fluids to maintain a high urine output. The patients comfortably retain the medicament for 2-4 hours. The procedure may be done daily for 8 days after an initial gudagata asthapana basti. The procedure is done after asking the patient to evacuate the bladder and bowel.

The modern gynecological texts describe per vaginal investigative procedures to be carried out soon after the menses after the stoppage of bleeding. In practice, it’s the ideal time for the ''uttarabasti'' as it’s the time wherein this is naturally open to shed the endometrium which almost closes by the period of ovulation. Further, not only do the medicament enter the uterus with ease but also it acts at a time ideal for it to receive the sperms as well as provides a conducive environment for implantation of fertilized ovum maximizing the chances to conceive.

The drugs described are mostly ushna veerya, vatanulomana and hence are highly beneficial in clearing the avarodha(obstruction) of aushadha.

The indication of administration of varti into gudamarga as well, probably indicates that some reflex mechanisms are involved in the evacuation of bladder in case of retained medicament. This in the classical description may be explained as causing apanavatanulomana.

Vitiated ''rakta, pitta'' and ''vata'' takes course of ''shirah''(head), especially ''shankha'' (temporal region), a ''marma'' of the type ''sadyahpranahara'' (acute life threatening), making the condition incurable. Involvement of ''raktadhatu'' in diseases of ''shirah'' is appreciated by Charaka in Ca. Su. 17/11. ''Pitta'' dominating symptoms like ''daha'' (burning sensation), ''raga'' (redness) and vitiation of ''raktadhatu'' brings in treatment of ''visarpa'' in to picture, as it also has both these entities vitiated.

The modern gynecological texts describe per vaginal investigative procedures to be carried out soon after the menses after the stoppage of bleeding. In practice, it’s the ideal time for the uttarabasti as it’s the time wherein the os is naturally open to shed the endometrium which almost closes by the period of ovulation. Further, not only do the medicaments enter the uterus with ease but also it acts at a time ideal for it to receive the sperms as well as provides a condusive environment for implantation of fertilized ovum maximizing the chances to conceive.

The consideration of ''shankhaka'' as ''pratyakhyeya vyadhi'' and the initiation of treatment in case of survival probably indicates the fact that there could be residual symptoms needing effective management and also that there is a likely chance of recurrence.

Pathogenesis of the disease indicates two different ways of vitiation of ''dosha, vata'' and ''vatakapha''. Further treatment can also be understood on this basis. Use of ''Chatusneha'' (all four ''snehas  ghrita, taila, vasa, majja''), procedures like ''shirobasti, anuvasanabasti,'' aimed at pacifying ''vata'' while more aggresive treatments like ''shirovirechana, virechana,'' use of 10 year old ghee, ''upanaha'' (poultice), ''dahana'' (cautery) are useful in ''vatakapha'' dominating condition.

Pathogenesis of the disease indicates two different ways of vitiation of dosha, vata and vatakapha. Further treatment can also be understood on this basis. Use of Chatusneha (all 4 snehas  ghrita, taila, vasa, majja), procedures like shirobasti, anuvasanabasti, aimed at pacifying vata while more aggresive treatments like shirovirechana, virechana, use of 10 year old ghee, upanaha (poultice), dahana (cautery) are useful in vatakapha dominating condition.

From the descriptions, it appears that this condition could possibly be Migraine. The possible triggering factors such as sleep deprivation, physical exhaustion, mental factors such as anxiety, stress etc, may all be understood under the nidanas described in the classics. The location of pain is also similar. The severity of pain and the disturbances of vision and audition are all classical being found in the stage of aura and may even associate with the proper stage.   

From the descriptions, it appears that this condition could possibly be migraine. The possible triggering factors such as sleep deprivation, physical exhaustion, mental factors such as anxiety, stress etc, may all be understood under the ''nidanas'' described in the classics. The location of pain is also similar. The severity of pain and the disturbances of vision and audition are all classical being found in the stage of aura and may even associate with the proper stage.   

Treatment is aimed at elimination of dosha initially followed by pacification of them by various means. Three sneha viz, taila, ghrita, vasa to be used in murdha taila form (holding these materials on head). Here majja is excluded as it is gurutara (most heavy amongst snehas). Seka(effusion) in the form of ghrita, milk will help in pacifying vata by acting as brumhana (nourishment), at the same time raktaprasadana (pacifying the impurities in blood) is achieved. Nasya with jeevaniya ghrita is also to pacify vata and to account for raktaprasadana.  

Treatment is aimed at elimination of ''dosha'' initially followed by pacification of them by various means. Three ''sneha'' viz, ''taila, ghrita, vasa'' to be used in ''murdha taila'' form (holding these materials on head). Here ''majja'' is excluded as it is ''gurutara'' (most heavy amongst ''snehas''). ''Seka''(effusion) in the form of ''ghrita'', milk will help in pacifying ''vata'' by acting as ''brimhana'' (nourishment), at the same time ''raktaprasadana'' (pacifying the impurities in blood) is achieved. ''Nasya'' with ''jeevaniya ghrita'' is also to pacify ''vata'' and to account for ''raktaprasadana''.  

In Bhavaprakasa Nighantu, due to non availability ''pratinidhi'' (substitutes) are described for ''ashtha varga'' (group of eight vitalizer herbs) drugs like ''vidarikanda'' (Pueraria tuberosa) for ''jeevaka'' and ''rshabhaka, ashvagandha'' (Withania somnifera) for ''kakoli'' and ''kshirakakoli, varahikanda'' (Dioscorea bulbifera) for ''riddhi'' and ''vriddhi, shatavari'' (Asparagus racemosus) for ''meda'' and ''mahameda''.

In Bhavaprakasa Nighantu, due to non availability ''pratinidhi'' (substitutes) are described for ''ashtha varga'' (group of eight vitalizer herbs) drugs like ''vidarikanda'' (Pueraria tuberosa) for ''jeevaka'' and ''rshabhaka, ashvagandha'' (Withania somnifera) for ''kakoli'' and ''kshirakakoli, varahikanda'' (Dioscorea bulbifera) for ''riddhi'' and ''vriddhi, shatavari'' (Asparagus racemosus) for ''meda'' and ''mahameda''.

It is uncontroversial that nose is the gateway of head as all the authors of ''brihattrayis'' and ''laghutrayis'' have shared the importance of ''nasyakarma'' in ''shirorogas''.

It is uncontroversial that nose is the gateway of head as all the authors of ''brihattrayis'' and ''laghutrayis'' have shared the importance of ''nasyakarma'' in ''shirorogas''.

Though the exact mode of action of ''nasya'' is not studied some hypotheses have been put forward by the scholars of Ayurveda. One of them is that the medicament directly penetrates into the brain, as fat soluble substances can easily diffuse through the cribriform plate of ethmoid bone (which forms the roof of the nasal cavity) which is porous and owing to the location of olfactory bulbs the medicament can percolate along the fibres of olfactory nerve. The second most agreeable hypothesis is the receptor theory, which believes stimulation of certain brain centres through specific receptors situated in the nasal cavity. The administration of Posterior pituitary extract into nostrils by means of sprays, practically and successfully followed in diabetes insipidus is a proof sufficient that through suitable formulation, medicaments may be made to act on the brain.

Though the exact mode of action of ''nasya'' is not studied some hypotheses have been put forward by the scholars of Ayurveda. One of them is that the medicament directly penetrates into the brain, as fat soluble substances can easily diffuse through the cribriform plate of ethmoid bone (which forms the roof of the nasal cavity) which is porous and owing to the location of olfactory bulbs the medicament can percolate along the fibers of olfactory nerve. The second most agreeable hypothesis is the receptor theory, which believes stimulation of certain brain centers through specific receptors situated in the nasal cavity. The administration of Posterior pituitary extract into nostrils by means of sprays, practically and successfully followed in diabetes insipidus is a proof sufficient that through suitable formulation, medicament may be made to act on the brain.

 

 

In Ashtanga Hridaya, ten specific timings  suitable for administration of ''pratimarsha'' are described.

In practice, especially in conditions of migraine, allergic rhinitis and atopic rhinitis we advise patients to smear medicated oil or ghee into the nostrils using an oleated finger. This may be considered a form of ''pratimarsha'' itself.

In practice, especially in conditions of migraine, allergic rhinitis and atopic rhinitis we advise patients to smear medicated oil or ghee into the nostrils using an oleated finger. This may be considered a form of pratimarsha itself.

=== Glossary ===

=== Glossary ===