Mutravaha Srotas- Anatomical aspect
Dr. Vandana Verma , Assistant Professor, Department of Kriya Sharira
Faculty of Ayurveda, IMS, BHU, Varanasi
It is conceived in Ayurveda that whole body is made up of Srotas and they are of two kinds i.e. Sthoola(macroscopic) Srotas and Shukshma(microscopic) Srotas. There are 13 kinds of Srotas as described by Aacharya Charak among them three are related with the intake of nutrients from external environment i.e. prana, anna and Udakvaha srotas for body water balance , seven are related with the metabolism, transportation and nutrition saptadhatu , whereas three are related with formation, transport and release of Mala i.e. Mutra, purish & Sweda. Mutravaha Srotas is basically Sthoola(macroscopic) Srotas related with formation and transport of urine.
It is a channel which is related with the urine formation and transport it could be understood as urinary system. Since in view of functional and anatomical aspect, 13 macroscopic channels are closely related with the major system of the body.
Mutravaha Srotas are 2 in number; its mula is Basti (urinary bladder) and Medra (penis) (S.Sha9/12). Medra is a structure which is having urethra and it is the common pathway for release of urine and semen in male that’s why Shushruta has considered as Medra as the mula of Mutravaha srotas, but this medra may be considered as mutraindriya also.
Aacharya charak has also described Basti & vakshana(inguinal region) as mula of Mutravaha Srotas (C.vi5/8).
According to Dalhan vankshan is the junction area of the body between inguinal region and root of thigh. Few Scholars have considered it as as Vrikka i.e. kidney. However there is no direct description of Vankshan or Kidney in relationship to urine formation. Rather the description of kidney comes under Kosthanga and Sushruta has described it as site of Antarvridadhi(internal abscess) in the Chapter Vidradhi Nidanam.
Acharya Chakrapani has mentioned the purpose for description of Mula of any Shrotas, is to get the knowledge about the disorders or underlying pathology which have been developed in a particular Srotas. The Mool of any Shrotas is the site or organ where something is formed or synthesized. Thus the root of any Shrotas may be the site of clinical presentation of a disorder and may give knowledge about the pathological condition of the particular organs.
Body organs related to urine formation and transport
Urinary Bladder (Basti), Kidney(Vrikka), Inguinal region(Vankshan)
मूत्रवहे द्वे, तयोर्मूलं बस्तिर्मेढ्रं च I (S.Sha.9/12)
मूत्रवहानां स्रोतसां बस्तिर्मूलं वङ्क्षणौ च I (C.Vi. 5/8)
वङ्क्षण ऊरुमूलाश्रयः ‘गण्डक’ इति लोके (Dalhana commentary on S.Ni.9/17)
Basti (Urinary bladder)- Position and Visceral relations
Basti is called Mutra ashya and Maladhara, since it is a reservoir of urine. It is the site of Agni and Jal mahabhuta, also called as significant organ of vitality above all organs.
Bladder has been described under the category of tri Marma i.e. Shira(head/brain), Basti and Hridya(heart). Marma are the organs or the site in the body of very vital significance, if there is any injury to these points or organ may cause severe pathology or death.
This Basti is situated in the pelvic cavity in the waist area below the Nabhi. It is pelvic organ situated behind the pubis symphysis and there is a ligament called medial umbilical ligament which is connected with the pubis symphysis near by the bladder and extend up to the umbilicus.
Basti is present in the pelvis in the inverted manner and its opening is towards the down side of the body.
Basti shir is in relation to porush(prostate), coccyx, vrishan(testis) and Guda(anus). Although testis is an extra abdominal organ but here Aacharya Sushrut has considered its visceral relation with the bladder, since it is intra abdominal organs during the intrauterine life and after that it descends into the scrotum through the inguinal canal and become an extra abdominal organ. It has only one opening and in downward direction and its wall are very approx. 3 to 5 millimetres. It is a reservoir organ and stores about 1.5 liter of urine per day. Bladder is similar to Alaboo(a kind of sweet gourd) in appearance and connected with different kinds of vessels. (S. Ni3/18,19, 20)
पौरुषं मेढ्रम्| पुनर्बस्त्यवयवमाह- अलाब्वा इवेत्यादि| परिग्रह आश्रयः| मूत्राशयपर्यायो मलाधार इति| प्राणानामग्नीषोमादीनाम्, आयतनं स्थानम्| Dalhana commentary (S.Ni. 3/18,19,20)
नाभिपृष्ठकटीमुष्कगुदवङ्क्षणशेफसाम् | एकद्वारस्तनुत्वक्को मध्ये बस्तिरधोमुखः ||
बस्तिर्बस्तिशिरश्चैव पौरुषं वृषणौ गुदः | एकसम्बन्धिनो ह्येते गुदास्थिविवराश्रिताः ||
अलाब्वा इव रूपेण सिरास्नायुपरिग्रहः | मूत्राशयो मलाधारः प्राणायतनमुत्तमम् || (S.Ni. 3/18,19,20)
ऽभ्यन्तरतः कट्यां मूत्राशयो बस्तिः (S.Sha.6/25)
Basti – Structure and embryological development
The structure of bladder is made up of less Mamsa(muscle) and Shonita(blood) as bladder wall is thin and less vascular. During embryonic development Basti is formed by transformation of Rakta and kapha by Pitta dosha with the help of Vata dosha.
At the level of Trigone there is less vascularity and the thickness of wall is less. The surgical and clinical significance of Basti has been described, it is mentioned by Shushrut that if there is any kind of injury in bladder, except the injury because of stone, causes death. If the injury is on one side of the bladder, it causes Mutrasravi vrana (urine passing fistula) while the injury on the both side of the bladder leads to death. Basti is Snayu marma and has been considered under the category of Sadopranahara Udar marma.
अल्पमांसशोणितोऽभ्यन्तरतः कट्यां मूत्राशयो बस्तिः, तत्रापिसद्योमरणमश्मरीव्रणादृते, तत्राप्युभयतो भिन्ने न जीवति, एकतो भिन्ने मूत्रस्रावी व्रणो भवति, स तु यत्नेनोपक्रान्तो रोहति I (S.Sha.6/25)
असृजः श्लेष्मणश्चापि यः प्रसादः परो मतः | तं पच्यमानं पित्तेन वायुश्चाप्यनुधावति || ततोऽस्यान्त्राणि जायन्ते गुदं बस्तिश्च देहिनः (S.Sha.4/25,26)
बस्तिमुखे न तु बस्तौ, तत्र मांसमेदसोरभावात्| वङ्क्षण ऊरुमूलाश्रयः ‘गण्डक’ इति लोके| Dalhana commentary on S.Ni.9/17,18
In intraembryonic life Vrikka is formed by the Rakta, Meda by the action of Pitta dosha. According to Dalhan, this Vrikka is rounded structure (Mamsa Pind ) present in the abdomen, is 2 in number, one is situated on the right side and other on the left. Vrikka has been considered as mula of Medavaha srotas.
Acc to Sharangdhar, Vrikka is also responsible for the nourishment of Meda present in the abdomen. Just above the kidney there is adrenal gland and from its cortical part corticosteroids hormones are released which are related with the fat metabolism. Thus it may be the reason to consider kidney as the root of Medavaha srotas.
मेदोवहे द्वे, तयोर्मूलं कटी वृक्कौ च I (S.Sha. 9/12)
रक्तमेदःप्रसादाद्वृक्कौ I S.Sha.4/32
वृक्कौ कुक्षिगोलकौ Dalhana commentary on S.Ni.9/17,18
वृक्कौ मांसपिण्डद्वयम् (एको वामपार्श्वस्थितः, द्वितीयो दक्षिणपार्श्वस्थितः)| (Sharangdhar Purvardha 5/45)
Dhamni (Artery) related to bladder and kidney
Aacharya Shushrut has described three kinds of Dhamani according to their Anatomical position in relation to the umbilicus and to the organs which they are supplying. All the arteries supplying structure located above the umbilicus are known as Urdva dhamni and below to the umbilicus i.e. all the pelvic organs and to the lower limbs are known as Adhoga Dhamni. These are 30 in numbers.
These Adhoga Dhamni are related with the transport of Vata, Mutra,Purish ,Sukra, Aartava into downward direction in the body. Arteries related to the bladder are two in number and they carry urine to the Basti. This description refers to the ureters because it carry formed urine into the bladder, are two in number also. However this description has been made in the Dhamni vyakaranam chapter, so we can consider it as a renal artery also.
The formation of urine depends on the vascular flow and the perfusion of kidney, perfusion of kidney depends upon the flow of blood in the renal artery and it further depends on the cardiac activity as well as the blood volume, and blood volume depends on the intake of the kind of food in the form of nutrients.
The two Dhamnis which are related with the intestine help in separation of Rasa, Mutra and Purish. The water which is absorbed after the complete digestion of the food, when comes into the Basti then it is called as Mutra(urine). This description refers to the ureters as well as renal artery. Further it is described that the solid part of the kita bhaag when it comes into the Unduka part it is called as purish. Unduka part is caecum.
अधोगमास्तु वातमूत्रपुरीषशुक्रार्तवादीन्यधो वहन्ति |— मूत्रबस्तिमभिप्रपन्ने मूत्रवहे द्वे I (S.Sha. 9/7)
द्वे अन्नवाहिन्यावन्त्राश्रिते नहि पित्ताशये रसमूत्रपुरीषभावेन विविच्यमानस्याहारस्यान्नभावोऽस्ति , नापि तोयस्य तोयभावना; तेन तोयमत्र भविष्यतो मूत्रस्य कारणभूतं पक्वाहारविवेकजं द्रवमयमुदकमिवोदकं , तदपि द्वे एव वहतः; तदेवोदकं बस्तिविवरप्राप्तं मूत्रमित्युच्यते, तद्वहे द्वे मूत्रबस्तिसम्बद्धे| एवमन्नमत्र भविष्यतः किट्टस्य कारणभूतं पक्वाहारविवेकजं घनमन्नमिवान्नं, तदपि द्वे एव वहतः; तदेवोण्डु(न्दु)कप्राप्तं पुरीषमित्युच्यते|| Dalhana (S.Sha. 9/7)
Urethra is also called as Mutra Prasek or Mutra Srota, it is related with the basti mukha through which urine gets excreted out. In males this urethra is the pathway for the release of semen also. Acharya sarangadhar also described that in males the urethra is the common pathway for release urine as well as for the release of the semen. The length of the urethra is different in male and female is mentioned by Ayurveda scholars under the description of Uttar Basti. Uttar Basti is a therapeutic procedure in which the medicated decoction is introduced or infused into the bladder by the help of Basti yantra. The Basti yantra has basically long nozzle and the length of nozzle is different in male and female. The nozzle of Basti yantra has a prominence called as Kanika which is placed at the four angula from its tip in case of females whereas in case of male it is placed at 10 angula. The diameter of nozzle is also mentioned in male, the diameter is such through which seed of Phaseolus mungo can pass (mudagvahi).
मूत्रस्रोतःपथाच्छुक्रं पुरुषस्य प्रवर्तते I (S.Sha.4/22)
मूत्रप्रसेको नाम मूत्रं येन बस्तिमुखाश्रयेण स्रोतसा क्षरति, (S.Chi.7/36 Dalhana commentary)
निविष्टकर्णिकं मध्ये, नारीणां चतुरङ्गुलेI मूत्रस्रोतःपरीणाहं मुद्गवाहि दशाङ्गुलम् ||
मेढ्रायामसमं केचिदिच्छन्ति खलु तद्विदः | S.Chi.37/103,104 , Dalhana दशाङ्गुलमिति दैर्ध्येण
Assessment: Multiple Choice Questions
Q.1.According to Charak, Moola of Mutravahasrotas :
Q.2. Basti is correlated with which of the following:
Q.3. Basti is considered as this type of Marma:
- All of the above
Q.4. Length of Mutra srota(urethra) in females is___angula:
Q.5. Development of Vrikka takes place by:
Q.6. Dhamni related to the Basti are__ in number:
Q.7. Which of the following is considered as Pranaytanam?
- All of the above
Q.8. Which of the following is NOT present in Guda-asthivivar:
Q.9. Development of Basti takes place by:
- Mansa &Meda
- Mansa &Rakta
Q.10. Pranayatanamuttamam(most vital organ) is the term used by Shushrut for:
Answer sheet for MCQ