Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract...

[Full title: Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection]

[Find the meaning and references behind the names: Priyanka, Mala]

REVIEW ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 379 Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection Dr. Priyanka 1 , Dr. Poornima B 2 1 Post Graduate Scholar, 2 Professor, Department of Roganidana, Ayurveda Mahavidyalaya, Hubballi, Karnataka, INDIA. I NTRODUCTION Dosha, Dhatu and Mala are the building blocks of the body [1] For a healthy body one should have equilibrium of Dosha and Dhatu , in the same way proper and continuous excretion of Mala is of equal importance. Among Trimala, Mutra is responsible for Bastipoorana and Kleda Vahanam. [2] When this physiology is hampered it leads to Mutravaha Sroto Dusti Vikaras . Amongst them Pittaja Mutrakrichhra is commonly occurring condition, in which subject Address for correspondence: Dr. Priyanka Post Graduate Scholar, Department of Roganidana, Ayurveda Mahavidyalaya, Hubballi, Karnataka, INDIA. E-mail: pckallihal@gmail.com Submission Date: 12/09/2020 Accepted Date: 16/10/2020 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA complaining the Shulayukta, Raktayukta, Dahayukta, and Muhurmuhur Mutrapravrutti etc . When person indulges in Nidana Sevana like intake of Ati Ruksha, Ushna, Tikshna Ahara and the person indulges in Vyavaya or intake of Ahara and Udakapana during the urge of micturation, Mutra Vegadharana , Ati Vyavaya and Atigamana on Gajavaji , leads to diseases of Mutravahasrotodusti Vikaras . In present era these above said Nidana’s are commomly observed due to working pattern or busy schedule or present life style of a person and indulging in such type of etiology causes vitiation of all the three Doshas which accumulates in urinary system and does the vitiation of Mutra and causes Pittaja Mutrakrichhra . It can be concurrent to lower UTI where dysuria, burning micturation and increased frequency of urination etc are most regular complaint. The clinical presentation of the Pittaja Mutrakrichhra can be correlated to lower urinary tract infection. Urinary tract infections are the second most common A B S T R A C T Pittaja Mutrakrichhra is one of the types of Mutrakrichhra and is well explained in classical texts of Ayurveda with its specific characters. In this disease due to consumption of Ushna, Tiksna, Ruksha Ahara , and Mutra Vegadharana , less water intake, maintaining poor hygiene leads to aggravation of Pitta followed by Kapha and Vata causes impairment in the functioning of Basti . The Lakshanas of Pittaja Mutrakrichhra are Peetamutrata, Sadahamutrata, Krichhramutrata, Saraktamutrata, Muhurmuhar Mutra Pravrutti . These Lakshanas have close resemblance with signs and symptoms of Lower UTI. Infections confined to Lower UTI commonly cause dysuria with burning micturation, frequency and urgency. Lower urinary tract infection includes cystitis and urethritis. These infections considered superficial (or mucosal) infections. Urinary tract infections are the second most common type of infection in the body, accounting for about 8.1 million visits to health care providers each year. Around 1% boys and 3% girls will develop UTI during childhood, and 50% of women will be treated for at least one UTI during their life time. Hence this attempt of present article made to define Pittaja Mutrakrichhra on scientific way w.s.r. LUTI. Key words: Pittaja Mutrakrichhra, Lower Urinary Tract Infection (LUTI).

[Find the meaning and references behind the names: Vega, Rupa, Yana]

Dr. Priyanka et al. Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 380 type of infection in the body, accounting for about 8.1 million visits to health care providers each year [3] And 50% of women will be treated for at least one UTI during their life time [4] The symptoms of Pittaja Mutrakrichhra such as Saruja/Kruchhra Mutrapravrutti , Sarakta Mutrata, Sadaha Mutrata , Muhurmuhu Mutrapravrutti [5] are coinside with the symptoms of lower urinary tract infection. Urinary tract infections such as abnormal colour of urine can be compared with Sarakta/ Sapeeta Mutrata , burning sensation while micturation can be compared with Sadaha Mutrapravrutti and pain while micturation can be compared with Krucchra Mutrapravrutti, Frequency and urgency can be compared with Muhurmuhu Mutrapravrutti and suprapubic pain and strangury can be compared with Saruja / Kruchhra Mutrata. Nidana - Pittaja Mutrakrichhra The manifestation of any disease is described in five steps in Ayurveda these are Nidana, Purvarupa, Rupa, Upashaya and Samprapti. These help in proper diagnosis of disease [6] 1) Samanya Nidana [7] The specific Nidana for Pittaja Mutrakrichhra are not available in classics. So etiological factors which have mentioned for Mutrakrichhra Roga can be taken as Nidana of Pittaja Mutrakrichhra . The Nidanas which are responsible for Mutravaha Srotodusti can also take as Samanya Nidana for Pittaja Mutrakrichhra . 1 Mutrito Udaka-Bhaksya-Strisevana (indulges in sex or eating or drinking under the urge of micturation). 2 Mutra Vega Dharana ( suppression of urge of micturation) 3 Kshina (weak or malnourished person ) 4 Abhighata ( injury to Mutravahasrotas) 2) Vishista Nidana [8] Aharaja Nidana Rooksha Ahara Sevana, Madhya Sevana, Tikshna Aushada Sevan, Anoopa Mamsa Sevana, Matsya Sevana, Adysana, Ajeerna Bhojana, Katu Amla Lavana Sevana. Viharaja Nidana Ativyayama, Ati Vyavaya, Nityadhrutaprushtayana, Sandharana, Katiskanda Bhara Vahana. [9] Sushruta and Vagbhata have not mentioned Nidana while Madhava,Yogaratnakara have mentioned similar Nidanas as that of Charaka. Nidanas according to different Acharyas for Pittaja Mutrakrichhra. Nidanas Charaka [8] Harita [10] Madava [11] Yogaratna kara [12] Tikshana Aushadha + - + + Ruksha Aahara Sevana + - + + Madya Sevana + + + + Anupa Mamsa Sevana + - + + Adyasana + - + + Ajirna + - + + Atikatu, Amla, Lavanarasa Sevana - + - - Ati Vyayama + + + + Ati Vyavaya + - + + Nitya Dhruta Pruta Yana + - + + Shrama - + - - Goura Strisevana - + - -

[Find the meaning and references behind the names: Ama]

Dr. Priyanka et al. Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 381 Samprapti From Nidana Sevana until the appearance of Vyadhi, there is sequence of pathological changes taking place in the body, all these put collectively under the name of Samprapti . Acharya Charak [13] has explained common Samprapti for Pittaja Mutra Krichhra which is as follows: When respective Doshas vitiated by their own Nidanas and get lodged in the Basti and Mutramarga and produces Samrodha, Sankocha, and Kshobha in Mutra Marga, then Pittaja Mutrakrichhra is produced [13] In Kashyapa Samhita, [14] it is described that Mutrakrichra is Pittapradhana Tridoshaja Vyadhi . Even Acharya Harita also said that Mutrakrichhra is Pitta Pradhana Vyadhi and he mentioned more etiological factors related to Pitta Prakopa Nidanas . Samprapti Ghataka ▪ Dosha : Pittapradhana Tridosha ▪ Dushya : Mutra, Rakta ▪ Srotas : Mutravaha,Raktavaha. ▪ Sroto Dusti Prakara : Sanga ▪ Agni : Jataragni And Dhatwagni ▪ Ama : Jataragni & Dhatwagni Mandya Janya ▪ Udbhavasthana: Pakwashaya ▪ Sanchara Sthana : Mutramarga ▪ Vyakt Stana : Mutramarga ▪ Rogamarga : Madyama Purvaroopa These are the characteristics which appear before the actual manifestation of Vyadhi and are expressed in milder or incomplete form. There is no textual reference regarding the Purvaroopa of Pittaja Mutrakrichhra but while Chakrapani says that Lakshnas of Vyadhi which are expressed in milder form are to be considered as Purvarupa . The different Lakshanas of Pittaja Mutrakrichhra when expressed in milder form are to be considered as Purvaroopa of Pittaja Mutrakrichhra. Rupa The symptoms which occur after the complete manifestation of Vyadhi. These become evident in Vyaktavasta of the Shatkriyakala . Rupa manifested in Vyaktavasta of Pittaja Mutrakrichhra are as follows: Samanya Laxanas [15] Ati srusta - Adika mutrata. Ati badhdha - Difficulty during mutra pravrutti. Prakupita - Changes in physical,chemical properties of mutra. Alpa alpa abheekshana - shoola yukta alpa pravrutti/ sacnty urination. Laxanas of Pittaja Mutrakrichhra [16] All Acharyas explained Lakshanas’s like Peeta Mutrata, Sarakta Mutrata, and Saruja, SadahayuIkta Mutra Pravrutti. Sushrutacharya added Haridra Mutrata and Daha in Mushka and Basti Pradesha . Atiushana Mutrata is told by both Sushrutacharya and Kashyapacharya Sadhyasadhyata [17] Gada Nigraha is the only text which explains about the Sadhyasadhyata of the disease Mutrakrichhra in general. Both Laghutrayis and Brihatrayis do not mention about Sadhayasahdyta of this disease Upadravas Upadravas of Mutrakrichhra in general are explained by Acharya Kasyapa. [18] Those are as: Karshya, Arati, Aruchi, Anavasthiti, Thrishna, Shoola, Vishada . Upashaya Upashaya means which gives pleasure to the person by the use of medicine, diets, and regimens. Their action may directly against the cause or the disease. Below mentioned Aushada, Ahara, Vihara are to be considered as beneficial for the Pittaja Mutrakrichhra .

[Find the meaning and references behind the names: Rasa]

Dr. Priyanka et al. Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 382 Aushada [19] Ahara [19] Vihara [19] Shatavari Kwatha, Kharjurdi Churna, Chandrakala Rasa, Kushakasadi Kwatha. Kushamanda, Kadalisara, Amalaka, Narikelajala, Draksaha, Takra, Dadhi. Jangala Pashu Pakshi Mamsa. Seka, Avagaha, Pradeha Regimens prescibed in Grishma Rutu. Apathya [20] Apathya is unwholesome food or regimens which adversly affect the body and mind. The following Ahara and Vihara are Apathya in Pittaja Mutrakrichhra Ahara: Food article having Kashaya, Amla Rasa, Tikshna, Shuska, Rukshaahara’s. Sangrahi and Vidhahi Ahara. Madhya Sevana, Pishtanna, Vatarka, Kharjura, Kapitta, Jambu, Tambula, Matsya, Hingu Tila, Sarshapa Taila Bharjita Lavana and Ardrak, Pinyaka. Vihara: Ati Vyayama, Mutra Vegadharana, Ativyavaya, Ativata Atapa , Shrama, Gajavaji Yana. Lower Urinary Tract Infection Definition Urinary Tract Infection is a common, disstressing and occasinally life threating condition UTI is defined as multiplication of organisms in the urinary tract [21] Acute infections of the urinary tract infection fall into two general anatomic categories: lower tract infection (Urethritis and Cystitis) and upper tract infection (Pyelonephritis, Prostaitis).Infections of the urethra and bladder are often considered superficial (or mucosal) infections. From microbiologic perspective, urinary tract infection exists when pathogenic microorganisms are detected in the urine, urethra, bladder. In most instances, growth of ≥ 10 5 organisms per milliliter from a properly collected midstream urine sample indicates infection [22] Etiology [23] Many microorganisms can infect the urinary tract, but by far the most common agents are the gram negative bacilli. Escherichia coli cause ~80% of acute infections in patients without catheters, urologic abnormalities, or calculi. Other gram negative rods, especially Proteus and Klebsiella spp, accounts for a smaller propotion of uncomplicated infections. Gram – positive cocci play a lesser role in UTIs. Pathogenesis In the vast majority of UTI’s bacteria gain access to the bladder via the urethra. The occurance and course of a UTI is influenced by the integrity of the host defence and by bacterial virulence factors. Disruption of the highly specialized transitional cell epithelium which lines the urinary tract. Incomplete bladder emptying, anatomical abnormalities, and the presence of forgein body, such as a urinary catheter, these contribute to disruption of the host defence and increase the likelihood of infection. Sexual intercourse, use of condoms, and use of spermicides all increase the risk. Bacterial characteristics that determine their ability to cause infection include specific mechanisms to adhere to the uroepithelium (‘pilli’ or ‘fimbrias’ in the case of certain E.coli), or adaptations allowing them to colonize foreign surfaces, such as a urinary catheter and subsequently cause infection [24] Clinical Features The clinical features depend on whether the infection involves the upper or lower urinary tract. Irritative voiding symptoms are more common in lower tract infection Common symptoms of lower UTI [25] ▪ Severe dysuria,worse towards the end of or immediately after micturiation. ▪ Abrupt onset of frequency of micturition. ▪ Suprapubic pain during and after voiding. ▪ Intense desire to pass more urine after micturition, due to spasm of the inflamed bladder wall (urgency). ▪ Microscopic or visible haematuria. ▪ Urine that may appear cloudy and have an unpleasant odour.

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Dr. Priyanka et al. Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 383 Diagnosis [26] Microscopic examination of urine is the crucial first step in confirming UTI. A properly collected early morning sample of urine is ideal. Random samples may also be used for regular testing. Pyuria is defined as presence of >5 WBC’s/hpf in a centrifuged u rine sample. Pyuria indicates either infection with unusaual bacteria. The gold standard for diagnosis of UTI is urine culture. Growth of 10 5 colony forming units of single strain signifies a positive culture. Rapid methods of detection of bacteriuria have been developed as alternatives to standard urine cultures. These methods detect bacterial growth by photometry or bioluminescence and provide results in 1 to 2 hours. Prophylatic measures to be adopted in UTI ▪ Fluid intake of at least 2 litres /day. ▪ Regular complete emptying of bladder. ▪ If vesico-ureteric reflux is present, practice double micturition (empty the bladder then attempt micturition 10-15 later.) ▪ Good personal hygiene. ▪ Emptying of the bladder before and after sexual intercourse. ▪ Cranberry juice may be effective. DISCUSSION In classics 8 types of Mutrakrichhra has been explained among them Pittaja Mutrakrichhra is having its own importance. The Laxanas are Shoolayukta, Raktayukta/Peetayukta, Dahayukta, and Muhurmuhu Mutra Pravrutti. Pittaja Mutrakrichhra can be correlated to lower UTI in modern science. LUTI refers to inflamation of urethra and bladder produce symptoms like haematuria, painfull urination with buring sensation, frequent micturation. In the present era due to consuming excess spicy, fried and junk foods leads to increase incidence of Pittaja Mutrakrichhra . And in working people absurd life style modification, abnormaly changed food and personal habits and supressing the urge of micturation are said to be the etiological factors for the manifestation of this disease. Pittaja Mutrakrichhra Nidana’s like Ativyayama, Ativyavaya , travelling on Ashwa , Shrama vitiate Vata Dosha and Tikshnaaushadha Sevana, Madhya Sevana, Katu Amla Lavanarasa Pradhana Ahara Sevana, Kati Skandha Ati Dharana aggravate Pitta Dosha and Samanya Mutravaha Sroto Dusti Karanas are also responsible for production of Kha-Vaigunya in Basti leads to Pittaja Mutrakrichhra . In modern science microorganisms are considered to be sole cause of UTI. Though Ayurvedic classical text contains references of Krimi causation of Mutrakrichhra by them has not been mentioned. The modern theories of pathogenesis suggest that bacteria gain access to bladder via urethra. From an Ayurvedic point of view even in Agantujakaranas Doshaprakopa is the main cause for the Vyadhi. Most of Nidana of Pittaja Mutrakrichhra causes vitiation of Pitta and Vata Dosha . Pitta spreads in to general circulation with the help of Vyana Vayu or Rasa . Then aggrevated Pachaka Pitta and Samana Vayu leads to Dhavagnimandyta . As a result Kleda is formed in excess. Dushita Kleda inturn affects the quantity of Mutra and disturbs the concentration of urine. Vitiated Pitta results in Haridra Mutra . Vitiated Pitta along with Pratiloma Gati of Apana Vayu obstructs the urinary pathway resulting in burning type of pain during micturation. The Laxanas like Daha, Peeta and Raktavarna Mutra Pravrutti or Haridra Varna indicative of Pitta Prakopa . It indicates incresed concentration of urine. Sarakta Mutra indicates high content of RBC’s in urine. Lower Urinary Tract Infection are often considered as superficial infections and are common in female patients. while Osha, Chosa, Daha are the Nantamaja Vikaras of Pitta . So, it can be inferred that, pain is burning type in Pittaja Mutrakrichhra . The Ruja reffered in this variety explains the result and effect of Pitta Dusti (inflamation). Daha is Pitta Prakopa Laxana and more accentuated in Pittaja Mutrakrichhra . Muhurmuhu Mutrapravrutti is due to inflamation of the bladder wall. It leads to reduction in bladder

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Dr. Priyanka et al. Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 384 capacity and stimulation of the strech receptors in bladder wall. Abrupt onset of dysuria (includes pain, burning, and strangury), incresed frequency, Urgency, suprapubic pain and pyuria are the symptoms of lower UTI i.e. cystitis and urethritis. Dysuria is the painfull & difficult urination that is usually caused by inflamation. Pain occuring at the start of urination may indicate urethral pathology, if pain occurs at the end of the micturation is usually of bladder origin and accompained by spasm of the pelvic musculature. Incresed frequency of micturition is due to decresed bladder capacity with resultant decrease in the volume of urine per voiding and irrition of inflamed bladder. Urgency is strong and sudden impulse to void. The sensation may be so strong enough to overcome sphincter control. Urgency is main symptom present in cystitis and absent in urethritis which distinguishes it from cystitis. Pyuria is presence of pus cells in urine. Urine pus cells diagnostic of urinary tract infection are living or dead leukocytes (white blood cells), specifically neutrophils, which attack the bacteria and prevent infection. Urine culture and antimicrobia susceptibility testing be performed for any patient with a suspected UTI. Pittaja Mutrakrichhra is a Pakwashaya Samutta Vyadhi . Basti is one of the three Marmas which is affected in Mutrakrichhra so, the disease is said to be of Madhyama Roga Marga . Upashaya is one which relives the symptoms. For Pittaja Mutrakrichhra Abhyanga and Avagaha , Pradeha are the Viharaja Upashaya. Snehana and Swedana in the form of Abhyanga and Avagaha . Avagaha Sweda is a Drava Sweda which specially indicated in Pitta Samsruta Vata, keeping in view of local lesions and inflammation. Sheeta Sheka and Sheeta Pradeha and Greeshma Vidhi is described in Pittaja Mutrakricchhra in order to pacify the Ushna, Tikshna Guna of Pitta which is responsible for Sadaha, Sapeeta and Sarakta Mutrapravrutti. Greeshma Vidhi includes avoiding Vyayama, Atapa, Madya etc. and Shita, Madura, Snighda Ahara Sevana . In Shamana Aushadi of Pittaja Mutrakrichhra , Truna Panchmoola, Shatavari Kwata, Kharjuradi Churna along with Anupana like Sharkara, Madhu, and Ghrita are most commonly used. All these drugs have Mutrala, Dahanashaka, Shoolahara, Pittahara properties by the virtue of Madhura and Kashaya Rasa , Shita Virya and Madhura Vipaka . Anupshaya is one which aggravates the symptoms. For Pittaja Mutrakrichhra measures causing alleviation and vitiation of Pitta can be considered as Upashaya and Anupashaya. By avoiding Apathya ( Nidana ) and following Pathya mentioned in Pittaja Mutrakrichhra prevents disease itself and furthur complications. CONCLUSION Analysis of textual references regarding etiology of Mutrakrichhra discloses the fact that Pittakara and Vatakara Nidana play a significant role in manifestation of Pittaja Mutrakrichhra. It is concluded that any abnormalities in Vyana Vayu, Samana Vayu, Pachaka Pitta and Apana Vayu due to Aharaja, Viharaja , and bacterial factors resulting in Pittaja Mutrakrichhra. Pittaja Mutrakrichhra when viewed under the lens of conventional medicine can be correlated to LUTI as both diseases and symptoms are similar. REFERENCES 1 Editor Yadavji Trikamji, Susuruta Samhita with Nibandhasangraha commentary of shri Dalhanacharaya, Sutrasthana, chapter 15, verse 3, Chaukambha Surbharati Prakashan, varanasi, reprint: 2014, p-67 2 Editor Yadavji Trikamji, Susuruta Samhita with Nibandhasangraha Commentary of shri Dalhanacharaya, Sutrasthana, chapter 15, verse 4\2, Chaukambha Surbharati Prakashan varanasi, reprint: 2014, p-68 3 www.urologic.niddk.gov.in retrived on 13\6\2020 at 3:00 pm 4 Editors: Yash pal munjal, David A warrell, Timothy M.Cox, Jonh D. firth, Oxford Text book of medicine, 5 th edition, vol 3, Oxford university press publication, p-4105 5 Editor Yadavji Trikamji, Charak samhita with Ayurveda Dipika Commentary of Chakrapanidatta, Chikitsa Sthana, chapter 26, verse 34, Chaukambha Surbharati Prakashan, reprint: 2014, p-599 6 Editor Dr. Brahmananda Tripati, Madava Nidanam of Sri Madavakara with Madhukosa Commentary by Vijayaraksita &

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Dr. Priyanka et al. Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 385 Srikantadatta, chapter 1, verse 4, Chaukambha Surbharati Prakashan, Reprint: 2014, p-11 7 Editor Vd. Haris Chandra Singh Kushwaha, Charak Samhita, Ayurveda Dipika’s Ayushi hindi Commentry, Vimana Sthana, chapter 5, verse 20, Chaukambha Surbhart Orientallia, reprint: 2011, p-634 8 Editor Yadavji Trikamji, Charak Samhita with Ayurveda Dipika Commentary of Chakrapanidatta, Chikitsa Sthana, chapter 26, verse 32, Chaukambha Surbharati Prakashan, reprint: 2014, p-599 9 Kashyapa Samhita, Hindi commentary by Hemaraj Sharma, Chikitsa Sthana, chapter 10, verse 1, Chaukhambha Sanskrit Sanstana, Varanasi; reprint: 2014, p-120. 10 Harita Samhita with Nirmala Commentary, Jaymini Pandaey, chapter 30, edition: 2010, Chaukhambha Krishnadas Academy, p- 472. 11 Editor Dr. Brahmananda Tripati, Madava Nidanam of Sri Madavakara with Madhukosa Commentary by Vijayaraksita & Srikantadatta, chapter 30, verse 1-2, Chaukambha Surbharati Prakashan, Reprint: 2014, p-621 12 Editor: Shri Brahmashankar Shastri, Yoga ratnakar, Uttarardha with Vidyaotini hindi Commentary by Vaidya Shree Lakshmipati Shastri, Mutrakruchhra Nidana, verse 1, Chaukambha Sanskrit Samsthana, Varanasi; reprint:1993, p- 50 13 Editor Yadavji Trikamji, Charak Samhita with Ayurveda Dipika Commentary of Chakrapanidatta, Chikitsa Sthana, chapter 26, verse 33, Chaukambha Surbharati Prakashan, reprint: 2014, p-599 14 Kashyapa Samhita, Hindi Commentary Hemaraj sharma, Chikitsa Sthana, chapter 10, verse 1, Chaukhambha Sanskrit Sanstana, Varanasi; reprint: 2014, p-120. 15 Editor Vd. Haris Hhandra Singh Kushwaha, Charak Samhita, Ayurveda Dipika’s Ayushi hindi commentry, Vimana Sthana, chapter 5, verse 8, chaukambha Surbharti Orientallia, reprint: 2011, p-634. 16 Editor Yadavji Trikamji, Charak Samhita with Ayurveda Dipika Commentary of Chakrapanidatta, Chikitsa Sthana, chapter 26, verse 34, Chaukambha Surbharati Prakashan, reprint: 2014, p-599 17 Editor: Sri Ganga Sahaya Pandeya, Gadanigraha of Sri Vaidya Sodhala with the Vidyotini Hindi Commentary, Part – II Kayachikitsa khanda, Mutra chikitsa Nidan Adyaya, verse 11, chaukhambha Sanskrit Sanstana, Varanasi; Reprint:2005, p- 627. 18 Kashyapa samhita, Hindi Commentary by Satypala Bhisagacharya, Chikitsa Sthana, chapter 7, verse 23, Chaukhambha Sanskrit Sanstana, Varanasi; reprint: 2006, p- 120. 19 Urology in Ayurveda by Dr. V.B. Athvale, 4 th chapter, Mutrakrichhra Adyaya, Chaukhambha Sanskrit Pratishthan Delhi, p-46,47. 20 Editor: Prof. Siddhi Nandan Mishra, Bhaisajya Ratnavali of Kaviraj Govind Das Sen, Mutrakrichhrarogadikara, 34 th chapter, verse 68, Chaukhambha Sanskrit Sanstana, Varanasi, p-682. 21 Davidson, Davidson’s Principles and practice of Medicine, 17 th chapter, Elsevier publications, 20 th edition, p-467 22 Editors: Longo. Dan L, Fauci.Anthony S Kasper, Dennis L, Hauser. Stephen L; Harrison, Harisson’s Principles of Internal Medicine, vol-2, chapter 282, 17 th edition, Mc Graw Hill Scompaines, p-1820. 23 Editors: Longo. Dan L, Fauci.Anthony S Kasper, Dennis L, Hauser. Stephen L; Harrison, Harisson’s Principles of internal Medicine, vol-2, chapter 282, 17 th edition, Mc Graw Hill compaines, p-1820. 24 Editors Yash pal munjal, David A Warrell, Timothy M. Cox, John D. firth, Oxoford Text book of medicine, Vol 3, chapter 21, 5 th edition, Oxoford Univwersity Press publication. P- 4105. 25 Davidson, Davidson’s Principles and practice of medicine, 17 th chapter, Elsevier publications, 20 th edition, p-469 26 Editor in chief Y P Munjal, API Text Book of Medicine, Vol-2, 9 th edition, Jaypee Brothers medical Publishers (p) Ltd, p- 1317. ******************************* How to cite this article: Dr. Priyanka, Dr. Poornima B. Conceptual study of Pittaja Mutrakrichhra w.s.r. to Lower Urinary Tract Infection. J Ayurveda Integr Med Sci 2020;5:379-385. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2020 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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