A A M J Anveshana Ayurveda Medical Journal

Transcription

1 A A M J Anveshana Ayurveda Medical Journal ISSN: Review Article A conceptual Diagnostic study of Mūtrāśmarī w.s.r to Urolithiasis Sheetal V R. Shylaja Kumari 2 A b s t r a c t The Cultural Revolution & luxurious life style of the modern era have increased the popularity of fast food & also devastation of nature which have made us susceptible for diseases. Since ancient times human race is constantly challenged by diseases & it is an uphill task to combat them in the present scenario. Mūtrāśmarī is one among them which has been delineated as a Mahāgada. Mūtrāśmarī (Urolithiasis) is the most common cause and distressing disease among the group of Urinary disorders. Ayurveda classifies on the basis of symptomatology of Dośa and the features of stone. As the explanations in contemporary science are also based mainly on the symptoms and the characteristics of the calculus, comparative knowledge of it with Ayurveda may help the physician in proper diagnosis of the disease. Hence an effort is made here to diagnose this disease both in Ayurveda as well as modern view and they are interpreted with each other. Key words: Mūtrāśmarī, Urolithiasis, symptomatology. PG Scholar, 2 Professor & Head, Department of PG Studies in Roganidana, Govt. Ayurveda Medical College, Bengaluru, Karnataka. CORRESPONDING AUTHOR Dr. SHEETAL V PG Scholar, Department of PG Studies in Roganidana, Govt. Ayurveda Medical College, Bengaluru, Karnataka. drsheetalvavilal@gmail.com AAMJ / Vol. 2 / Issue 3 / May June 206

2 INTRODUCTION M ūtrāśmarī is associated with agonizing pain over nabhi, basti, sevani and medhra during micturition, sudden stoppage of urine flow, blood stained urine, twisting and splitting of urine, aggravation of pain during running etc. Among all the urological problems, most painful condition is Mūtrāśmarī. Mūtrāśmarī is one of the grave disease described by Acharya Sushruta [i]. In contemporary medical science it is correlated with Urolithiasis. Urolithiasis means the presence of stone/calculus in the urinary system. Urinary calculus is composed of urinary salts bound together by a colloid matrix or organic materials and consists of a nucleus or nidus around which concentric layers of urinary salts are deposited and gives a stone like appearance. Urolithiasis is the third most common disorder of the Urinary tract. The incidence of calculi varies as per geographical distribution, sex and age group. The highest incidence of calculi occurs between the ages of 30 to 50 years, with male to female ratio is 3:. The physician should first diagnose the disease and then should decide the line of treatment. As failure in the diagnosis will result into the failure of the treatment The important factor i.e. the diagnostic part in case of a stone, the advice given by ancient Acharyas seems to be true even at present who were of the idea that before going for the treatment sure shot diagnosis is important both for the physician and the patient. Etymology "Aśmanam Rati Dadati iti " [ii] Means the formation and presentation of a substance like stone. "Aśma " means "stone"- "Rati " means "to present". ii. As air & fire of electricity in the sky consolidate water (to form hail storms) similarly Pitta located in the bladder, along with Vayu consolidates Kapha to form calculi. Charaka s view: When Vata dries-up the Mūtra entered into the bladder along with Shukra, Kapha and Pitta then, gradually formation of occurs. Charaka has explained the process of formation of as similar to that of Gorochana (Gall stone) in the Pittashaya of cows. [iv] Classification of All Acharyas except Charaka have classified the disease into four types: i) Shleshmaja ii) Pittaja iii) Vataja iv) Shukraja Acharya Charaka has considered Mūtrāśmarī as a variety under Mūtrakrichhra and classified it into Mridu and Kathina on the basis of consistency. Shukraja, Pittaja and Kaphaja varieties are the Mridu where as Vataja variety is Kathina. Different varieties of, according to different Acharyas are as in under mentioned table. Table : Classification of according to different [v xii] Acharya s View S.N SU Ch A.Hr A.S M.N B.P Sha Y.R Kaphaja Pittaja Vataja Shukraja Mrudu Kathina Table 2: Features & Lakshanas of different [v xii] Pathogenesis of S. N AŚMARĪ FEATURES LAKSHANAS Sushruta's View: [iii] In asamshodhana sheela & apathyakari persons the prakupita kapha and mūtra combine to stay in the basti to form. Sushruta's examples for clear understanding of the mechanism of stone formation:- i. A new pitcher filled with clear water can also show settling down of muddy particles in due course of time. In the same way the calculi are formed in Basti. Vataja 2 Pittaja Black coloured, Hard, Irregular, Rough, Nodular like Kadambapushpa, Reddish/Yellowish-black or honey like colour, Resembles Bhallataka seed Patient experiences severe pain during micturition, pain at the umbilical region and passes Vata, Mutra and Purisha with high difficulty. Patient experiences different types of burning sensations (Dooshyana, Chooshana, Dahana, Pachana) AAMJ / Vol. 2 / Issue 3 / May June

3 3 Shleshmaja White, slimy, big like Kukkutanda, Colour-Madhuka Pushpavat Patient experiences cutting, incising, Pricking pain (Daalyana,Bhedana,Nistoda), heavy and cold sensation in the bladder area Calcium oxalates calculus most common type. These are hard, nodular like mulberries covered with a sharp projection and modified blood is precipitated on the surface of stone and is dark in color, usually single and radiopaque with a density of 0.8. Urolithiasis The process of forming stones in the Kidney, Ureter, Bladder and/or Urethra (Urinary tract) is called urolithiasis or urinary calculi. It can be defined as a nucleus of organic material around which salts are deposited in concentric layers which are bound together by a colloidal matrix of organic material in the urinary tract. Primary stones. Appears in healthy urinary tract without any antecedent inflammation. 2. Usually formed in the acidic urine. 3. Do not require performed nuclei. 4. Usually composed of a substance present in the urine. E.g. Calcium oxalates, Uric acid, urates, cysteine xanthine or calcium carbonates Secondary stones. Formed usually in infected urine as the result of inflammation. 2. Usually formed in the alkaline urine. 3. Require performed nuclei. 4. Composed of a substance which are not normally present in the urine. E.g. Calcium, magnesium ammonium phosphates Uric acid or Urates calculus Second most common type. These are usually multiple and occur in acidic urine. These type of stones are moderately hard, finely granular, round to oval in shape and color varies from yellowish to reddish brown and are not radiopaque i.e. radiolucent with a density of.7. Cysteine calculus are uncommon, formed due to inborn error of metabolism. These are pink or yellow in color and waxy in appearance. These are soft stones, slightly opaque with a density of 3.7. Xanthine calculus These are smooth, round, brick red/orange in color and sediment in the urine of children. These are non-opaque with a density of.2. Phosphate or staghorn calculus These are smooth, greyish white in color and chalky in consistency. Usually occur bilaterally and have tendency to reoccur on removal. These stones are composed of triple phosphate i.e. phosphate of calcium, magnesium and ammonium, often they grow to a large size and fill the cavity in which they lie. These are radiopaque in nature with a density of 6.0. Table 3: Showing clinical features of calculus depending upon the site of calculus [xii, xiv, xv & xvi] SIGNS SYMPTOMS RENAL URETERIC VESICULAR URETHRAL Renal angle tenderness, renal point tenderness, Swellingwhen there is hydronephrosis, Pyelonephritis, associated with renal calculus then swelling may be palpated in the flank, muscle rigidity- found only in cases with acute infection Patient is usually in agony, tossing over bed, tenderness over part where calculus lies, skin is cold and clammy and there may be other signs of mild shock Giant calculi can be felt in suprapubic region Rectal examination Relaxed anal Sphincter(neurogenic Bladder) - Pain in flanks, blood mixed urine, nausea and vomiting, cloudy or odorous urine, frequent urination, strangury, fever and chills Radiating, colicky, agonizing pain, Nausea and vomiting, Blood mixed urine, Urgency and frequency Increased frequency, Pain and discomfort at the end of micturition, terminal hematuria, Dysuria, Acute retention of urine. Male-Obstructed flow, dribbling of urine, radiating pain in glans penis. Female-Increased frequency, dysuria, nocturia, Pyuria and in rare hematuria AAMJ / Vol. 2 / Issue 3 / May June

4 Investigations 6 S.N 2 3 Ultrasonography (KUB) Plain X-ray KUB Urine microscopy-rbc S, Pus cells, casts, crystals Table.4: showing correlation of different with modern view SYMPTOMS Severe pain, obstruction to flow of urine or intermittent flow of urine, stone- blackish in color, hard, rough with uneven surface, and thorny like Kadamba flowers Obstruction to flow of urine, burning type of pain with hematuria, stone is reddish, yellowish, black in Color and surface is like kernel of marking nut or honey Colored Obstruction to the urine flow with mild ache, it is white in Color, unctuous in texture, large in size similar to hen s egg or having Color of Madhuka flower. CONCLUSION TYPE OF AŚMARĪ Vataja Pittaja Uric acid calculus, Urate Kaphaja TYPE OF Oxalate lime calculus Uric acid calculus, Urate calculus, Cystine calculus. Phosphate calculus By considering all the above review from various Ayurvedic texts and non Ayurvedic texts it can be concluded that vataja can be correlated with calcium oxalate calculus, pittaja can be correlated with uric acid, urate, cysteine calculus, kaphaja can be correlated with phosphate calculus because of its similar external appearance. Urological problems form an important part of medical abbreviations. In Ayurveda kapha Dośa in increased quantity has been accepted as the main reason of Mūtrāśmarī. Here an effort was made to diagnose the disease Mūtrāśmarī based on dosha predominance in Ayurveda as well as type of calculus in Modern view and interpreted each other.it helps the physician to know about the disease in detail so that they can treat successfully to this disease for the benefit of mankind. REFERENCES i. Sushruta, Sushruta Samhitaa Sootrasthaana 33/4, with Nibandhasamgraha commentary of Shri Dalhanaachaarya, edited by Vaidya Yaadavaji Trikamji Āchaarya Chaukhamba Surbhaarati Prakaashana, Vaaraanasi, reprint edition, 200; 44. ii. Shastri Pt. Hargovinda, Amarakosa of Amara Simha, Edition-Reprint edition, 202, Published by Chaukhamba Sanskrit Sansthan, Varanasi, India, Chapter-2/5/6, p iii. Acharya YT, editor. Sushruta Samhita with Nibandha Sangraha Commentary. 7 th ed. Varanasi: Chaukhamba Sanskrit samsthana; p (Ni. 3/ ) iv. Acharya YT, editor. Charaka samhita of Agnivesha. 5 th ed. Varanasi: Chaukhambha, Sanskrit Samsthana; 20. p v. Acharya YT, editor. Sushruta Samhita with Nibandha Sangraha Commentary. 7 th ed.varanasi: Chaukhamba Sanskrit samsthana; p (Ni. 3/7 ) vi. Acharya YT, editor. Charaka samhita of Agnivesha. 5th ed. Varanasi: Chaukhambha Sanskrit Samsthana; 20. p (Ch. 26/32-32) vii. Paradkar H, editor. Astanga Hridaya with Sarvangasundari and Ayurveda rasayana commentaries. 9th reprint. Varanasi: caukambha orintalia; p (Ni. 9/9-0) viii. Vagbhata, Ashtaanga Samgraha Nidaana Sthaana 9/0-3, Page 376, with hindi commentary by Kaviraj Atrideva Gupta, Choukhamba Krishnadas Academy, Varanasi, Reprint Edition 2005 ix. Maadhava, Maadhava Nidaanam 32/-7, Page , with Madhukosha Sanskrita Commentary by Shri Vijayarakshita and Shrikanthadatta with Vidyotini Hindi commentary and notes by Sudarshana Shastri, Revised & Edited by Prof. Yadunandana Upaadhyaaya, Part & 2, Choukhamba Sanskrita Bhawana, Varanasi, Reprint Edition 2005 x. Bhaavaprakaasha, Bhavaprakasha Madhya khanda8/37/2-5, Page , including Bhaavaprakaasha Nighantu portion, Edited with Vidyotini Hindi Commentary by Shree Brahmashankara Mishra and Shree Rupalaalaji Vaishya, part & 2, Choukhambaa Sanskrita Bhawana, Varanasi, Eleventh Edition 200. xi. Shaarangadhara, Shaarangadhara Samhitaa, Madhya Khanda 7/40-49, Page 200, with the commentaries Adhamalla s Deepikaa and Kaashirama s Goodhaartha Deepika; Edited by Pt. Parashuram Shastri Vidyasagar, Choukhamba Surbharati Prakashan, Varanasi, Ist edition xii. Yogaratnaakara 8/-5, Page 68, with Vidyotini Hindi commentary by Vd. Lakshmipati Shastri, Edited by Bhishagratna Brahmashankar Shastri, Choukhamba Prakaashan, Reprint Edition 200. xiii. Harrison s, fauci, braunwald, kasper,hauser, longo, jameson, loscalzo. Principles of internal medicine.7th ed, U.S.A:2008.vol 2, P AAMJ / Vol. 2 / Issue 3 / May June

5 xiv. Bailey & love s, Williams N S, Bulstrode C J K, Ronan O Connell P. Short Practice of surgery 25th ed, Britian :2008. P xv. Smith s, Tanagho E A, McAninch J W.General Urology 7th ed, New Delhi:20, P xvi. Das S. A concise Textbook of Surgery. 3rd ed, Calcutta: 200. p 65-85,208-.sayana commentaries. 9th reprint Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Sheetal & Shylaja Kumari : A conceptual Diagnostic study of Mūtrāśmarī w.s.r to Urolithiasis. AAMJ 206; 3: ΛΛΛΛ AAMJ / Vol. 2 / Issue 3 / May June