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Ayurveda has given prime importance to Mutravaha srotas (urinary system) and Srotogata Vikaras (urinary disorders). Being a system responsible for homeostasis of fluids in the body it also detoxifies the body by eliminating certain waste products through urine. When diseased, people produce symptoms such as, increased or decreased urine production, painful maturition, formation of stones, and thereby obstructed micturition, increased frequency of micturition, and so on. There are many herbs with varied actions specifically aimed at mitigating urinary system disorders. Drugs such as Jambu, Amrasthi, and the like, reduce the increased flow of urine, and hence, are considered as Mutrasangrahaneeya, whereas, drugs like Ikshu, Kustha, and so on, increase the flow of urine, and hence, are considered as Mutravirechaneeya. There are drugs like Padma, Utpala, and so on, which impart normal color to the urine and are known as Mutravirajaneeya dravyas. Asmarighna dravyas break down the calculi and remove them through the urine. These dravyas, when used under proper direction, help in relieving the pain and apathy caused by the disease.
In homes and communities there are many solutions for waste management. Similarly several body systems cooperate to meet this need in the human body. One such system is the urinary system. The concept of the urinary system is explained under the mootravaha srotas, in Ayurveda. It discharges the waste products, while efficiently conserving water and other valuable substances. However, this homeostasis is hampered during disease conditions like Prameha, Somaroga, Mutrakrichra, Mutraghata, Ashmari, Udavarta, and so on. In such conditions many herbs are used, some of which act directly on the urinary system and some act indirectly, maintaining the normal functioning of the system. However, in certain physiological conditions, avoidance of the causative factor and dietetics are more important than drugs.
For better understanding of the drugs that are used for Mutravaha srotas ailments, they can be grouped as Mutrasangrahaneeya dravyas, Mutravirajaneeya dravyas, Mutravirechaneeya dravyas, Ashmarighna dravyas, Pramehagna dravyas, and so on. Some of these have been discussed here.
“Ati pravrttam mutram yat sangrhnaati tat mutrasangrahneeyanam” These dravyas cause stoppage of excess mutrapravritti rather than altering the normal quantity, and are hence utilized in kleda pradhana vyadhi like Prameha, where mutra atipravritti is seen. In such diseases medications that are kleda shoshaka, Shleshmedohara, Pramehaghna, and Shleshmavatahara are required. These functions are carried out efficiently by the Mutrasangrahaneeya dravyas. Most of them are tikta, Katu, kashaya Rasa, and Ruksha guna pradhana. Dravyas having such properties are said to cause baddhamutrata. Acharya Charaka has categorized some of these dravyas under Mutrasangrahaneeya dashemani, whereas, Nyagrodhadi and Saalasaradi gana of Sushruta serve the same purpose. In case of Jambu, phala is mutrasangrahaka[5In a clinical trial with 80 non-insulin-dependent diabetes mellitus (NIDDM) patients the seed powder (12 g/day in three divided doses) was administered for three months, the drug produced relief in symptoms like polyuria, along with regulation of blood sugar. Some drugs like Ketaki (Pandanus odoratissimus Linn. F.), Yashti (Glycyrrhiza glabra Linn.), Yava (Hordeum vulgare Linn.), and so on, even though not included under classical Ganas have been seen to reduce polyuria. Ketaki moola is said to be Mootrasngrahaneeya. Grains of Yava are medoghna and cause baddhamutrata. Yashtimadhu, when taken in large doses reduces urine output; the reason may be the presence of Glycyrrhetinic acid, which causes sodium retention. Certain purgatives like Senna (Cassia senna Linn.) and Aloe (Aloe vera Tourn.) reduce water reabsorption thereby reducing urine output. The combination of dravyas like Nishamlaki and Triphala is also Bahumutrashoshaka.
The dravyas causing increased urinary output are utilized in the management of Mutrakrichra, Mutraghata, and the like. Trinapanchamoola and Mutravirechaneeya dashemani of Charaka are considered to be the best diuretics. These dravyas cause diuresis by increasing the production of urine, causing easy flow of urine and stimulating the organs of the urinary system. Most of the Mutravirechaneeya dravyas like Ikshu (Saccharum officinarum Linn), Shali (Oryza sativa Linn.), Ksheera (Milk), Navadhanya, and so on, being sheeta, increase Kapha and dravata in the Shareera. Among them Ikshu and Gokshura (Tribulus terrestris Linn.) are considered to be shreshta, whereas, dravyas like Ela, Gomutra (Cow's urine), and Vana palandu (Urginea indica Roxb), being Ushna veerya, cause virechana of the mutra.
Certain active principles derived from the plants have been found to cause diuresis. Vidarikanda contains sugar and due to their osmotic activity these substances oppose the reabsorption of water from the glomerular filtrate. These substances produce more elimination of water than sodium, and hence produce diuresis. Many plants from Fabaceae, Liliaceae, Solanaceae, and so on, contain spironolactone, which is a diuretic steroid. Drugs like Arjuna (Terminalia arjuna Roxb.) contain triterpinoid saponin called arjunolic acid, which produces diuresis. Other saponins called Bacosides A and B found in Brahmi (Bacopa monneiri Linn.), also cause diuresis. Certain glycosides called Cardiac glycosides, are found in Vanapalandu and Shatavarin 1, found in Shatavari (Asparagus racemosus Linn.); and Flavonol glycoside Psoralen found in Bakuchi seeds also cause diuresis. Other than glycosides certain alkaloids like Punernavoside found in Punarnava (Boerhavia diffusa Linn.) and Purin alkaloids like Caffeine, Theobromine, Theophylline found in drugs like Coffee, Cocoa, Tea, and so on, are said to be diuretic.
Drugs like Gokshura contain potassium alkali. Watery extract of Gokshura possesses similar diuretic activity like urea, both in rats and dogs. The diuresis is due to the potassium content of the extract. Kushmanda (Benincasa hispida [Thunb.] Cong.) is said to be bastishuddikara and the srishta mutrakaraka and Mannitol content of Kushmanda has been attributed to these functions.
Dravyas, which reduce the dosha dushti and bring about normal varna to mutra, are known as Mutravirajaneeya dravyas. In some conditions like Agnimandya and Amajeerna, the pachana of Ahara and subsequent Sara kitta vibhajana do not take place properly leading to improper formation of urine or discolored urine. In conditions like Kamala, Pandu, Haridra meha, Manjishta meha, and so on, srotavarodha and dosha dushti leads to discolored urine. dravyas like Haridra (Curcuma longa Linn.), Chitraka (Plumbago zeylanica Linn.), Vidanga being Katu and Ushna cause samyak pachana and sroto shodhana. Drugs like Padma, Utpala, Nalina and so forth, of Mutravirajaneeya dashemani, being kashaya and sheeta, bring about dushita Pitta to the normal condition, and hence, are useful in the case of discolored urine. Many plants mentioned in the Mutravirajaneeya gana of Charaka have also found place in the Utpaladi gana of Sushruta, hence, similar properties may be expected from the Utpaladi gana dravyas also.
Ashmari in Ayurveda refers to urolithiasis; and the herbs that break the formed stones, expel it from the body, and prevent further formation of stones are known as Ashmarighna dravyas. Dravyas of Veeratarvadi gana and Laghu panchamoola serve this purpose. Other than these herbs, Pashanabheda (Bergenia ciliata Sternb.), Kulattha (Dolichos biflorus Linn.), Shigru mula (Roots of Moringa olifera Lam.), Varuna (Crataeva nurvala Buch-Ham.), Gorakshaganjja (Aerva lanata L.) have proved to be the best Ashmarighna dravyas.
A drug like Gokshura has potassium nitrates and thus helps in preventing urolithiasis. The aqueous extract of Tribulus terrestris (5 g/kg p.o./day) was tested in six male rats in whom hyperoxaluria was induced. A 24-hour urinary oxalate excretion reversed to normal, from 1.97 ± 0.314 to 0.144 ± 0.004 mg/mg creatinine (P < 0.001), within 21 days of administration of the drug and remained so until 15 days after withdrawal of the extract and sodium glycoate.
When describing the herbs and their actions, the terms ‘mutrala’ and ‘Mutravirechaneeya’ seem to be similar, although there is a minute difference in their understanding. Mutrala dravyas are those that increase the quantity of the urine and may not necessarily expel it. However, Mutravirechaneeya dravyas are those, which irrespective of the quantity of urine produced, cause easy expulsion. Mutravirajaneeya dravyas are believed to impart normal color to the urine. However, their action over urobilin, which is responsible for imparting color according to modern physiology is not clear, and further research in this field of science is expected.
The purview of Mutravaha srotas is large and hence the diseases under it are many. Even the conditions like hypertension, general edema, and so on, involve the urinary system. Based on this factor, dravyas, which act on the system, are categorized into many groups in the classics. Researches and experimental studies have contributed many newer drugs in this regard. Many dravyas perform varied actions in the urinary system. Drugs like Gokshura act as both a mutrala and an Ashmarighna. Punarnava has diuretic and hepatoprotective actions. It is left to the intelligence of the physician to decide the suitable herb in a particular condition.