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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 71-75

Efficacy of trinapanchamoolkwath in the management of urinary tract infection during pregnancy (Mutrakruccha in Garbhini) - A case study


1 Departments of Prasuti Tantra, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
2 Department of Dravyaguna, Shri Krishna Ayurvedic Medical College, Varanasi, Uttar Pradesh, India

Date of Submission08-Oct-2020
Date of Decision11-Sep-2021
Date of Acceptance22-Sep-2021
Date of Web Publication19-Mar-2022

Correspondence Address:
Preeti Chouhan
B-18, New Teachers Residential Flat, Near University Club, Jodhpur Colony, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_211_20

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  Abstract 


Introduction: Urinary tract infection during pregnancy and postpartum is a common obstetric complication. The term Mutrakruchhacomes under the disorders of MutravahaSrotas, and mainly deals with shool (pain) and krucchrata (dysuria). This article discusses a female patient with a history of 6 months 24 days of pregnancy seen in the OPD of Prasuti Tantra, Sir SundarlalHospital, IMS, BHU. Main Clinical Finding: Her chief complaints were painful, difficult urination with burning along with pain in the suprapubic region for 8 days. Diagnosis: In this case, the patient has an urge to micturate, but she passes urine with pain. The painful voiding of urine is diagnosed as Mutrakruchha. Interventions: After appropriate analysis based on ayurvedic and modern parameters, the patient was treated with Trinapanchmulakwath. Outcome: Before treatment, her scoring of subjective parameters was 13 and after treatment, her score decreased to 2. Thus, the treatment module showed significant relief in the symptoms by 84.62%. Laboratory investigation showed marked improvement as pus cells were reduced to 0–1/high power field (HPF) from 10 to 12/HPF and epithelial cells were reduced to 1–2/HPF from 9 to 10/HPF. Conclusions: All the symptoms and investigations showed highly significant results, hence it can be concluded that this medicine is very effective in patients of garbhinimutrakruchha.

Keywords: Ayurveda, dysuria, GarbhiniMutrakruccha, pregnancy, Trinapanchmoolkwath


How to cite this article:
Chouhan P, Garg AK. Efficacy of trinapanchamoolkwath in the management of urinary tract infection during pregnancy (Mutrakruccha in Garbhini) - A case study. J Ayurveda 2022;16:71-5

How to cite this URL:
Chouhan P, Garg AK. Efficacy of trinapanchamoolkwath in the management of urinary tract infection during pregnancy (Mutrakruccha in Garbhini) - A case study. J Ayurveda [serial online] 2022 [cited 2022 Sep 28];16:71-5. Available from: http://www.journayu.in/text.asp?2022/16/1/71/339983




  Introduction Top


Urinary tract infections (UTIs) are a common medical urinary complication of pregnancy, occurring in 10%–15% of pregnant women. Asymptomatic bacteriuria is found in 4%–7% of pregnant women and acute cystitis occurs in 1.3% and acute pyelonephritis in 1% of pregnant women.[1] The effect of asymptomatic bacteriuria on pregnancy is controversial, but the bulk of evidence supports the view that bacteriuria does not by itself lead to an increased incidence of low birth weight or prematurity. However, these women are at an increased risk of acute pyelonephritis (40% of these will develop acute infection), a frequent indication for hospitalization in pregnancy.[2]

Urinary tract changes predispose women to infection during pregnancy. Ureteral dilation is seen due to compression of the ureters from the gravid uterus. Hormonal effects of progesterone also may cause smooth muscle relaxation leading to dilation, vesicoureteral reflux increases, and urinary stasis. This immunocompromise condition may be another cause for the increased frequency of UTIs seen in pregnancy because pregnancy is already a state of relative immune compromise.[3] Acute urinary retention during pregnancy is rare. Retention secondary to an impacted, gravid uterus is an emergency. Further Retroversion of the uterus, a history of pelvic inflammatory disease, and large fibroids are also predisposing factors.[4]


  Case Report Top


A 28-year-old female patient with a history of 6 months 24 days pregnancy visited the outpatient department (OPD) of Prasuti Tantra at Sir Sundarlal Hospital, IMS BHU on February 11, 2020 with the following complaints:

  • Patient name: XYZ
  • OPD/IPD No.: 1XXX27
  • Age/Sex: 28 years/female.


Chief complaints

  • Painful and difficult urination-since 8 days
  • Burning micturition-since 8 days
  • Scanty and Yellowish discoloration of urine-for 8 days
  • Pain in lower abdomen-for 8 days.


History of present illness

According to the patient, she has amenorrhea of 6 months. The patient was healthy during her antenatal period till the completion of her 6th month. She visited the OPD of Prasuti Tantra with a complaint of painful, difficult and burning micturition with pain in the lower abdomen for 8 days.

Menstrual history

  • Menarche-11 years
  • LMP-August 18, 2019
  • EDD-May 25, 2020
  • Past menstrual history-2–3/28–30 days/regular cycle
  • Married life-5 years.


Obstetric history

G2 P1 A0 L1 (P1-3-year-old male baby, delivered vaginally active and healthy).

History of past illness

  • Medical history-not significant
  • History of blood transfusion–not significant
  • Drug history-not significant
  • Surgical history-not significant.
  • Family history-not significant


Functional history

  • Bowel: Mild constipation
  • Bladder-Painful, difficult and painful micturition
  • Sleep: Disturbed due to pain
  • Appetite: Normal.


General examination

  • Built-Average
  • Nutrition-Average
  • Height-158 cm
  • Weight-64 Kg
  • Temperature-97.4 F (by Axillary)
  • Pulse rate–88/min
  • B. P-124/70 mm of Hg
  • Pallor–Absent
  • Swelling–Absent
  • Clubbing–Absent
  • Cyanosis–Absent
  • Icterus–Absent
  • Tongue–coated.


Systemic examination

  • C. N. S.-well oriented to person, time and place
  • C. V. S. system– S 1, S 2 is audible, No murmur
  • Respiratory system: No obvious deformity, with B/L equal air entry, no added sound present
  • Digestive system: Normal and mild constipation.


P/A examination

  • Inspection-Linea nigra + and Straie gravidarum+
  • Palpation-fundal height = 26–27 weeks, lie longitudinal, cephalic presentation, No active uterine contractions, fetal movement +
  • Auscultation-FHS-132 bpm, regular
  • Local examination of external genitalia-no vulvovaginitis present, P/S examination not done.


Dashvidhaparikshsa

  1. Prakriti-Vata Pradhan kaphaja
  2. Vikriti-Vataj, Pittaja
  3. Sara-Rasa
  4. Samhanan-Madhayam
  5. Pramana-Madhayam
  6. Satmaya-Madhayam
  7. Satva-Madhayam
  8. Ahara shakti-Madhayam
  9. Vyayamshakati-Alpa
  10. Vaya-Madhayama.


Investigations

  1. Blood group– A positive
  2. VDRL–nonreactive
  3. HIV-nonreactive
  4. HBsAg–nonreactive
  5. Anti HCV–Negative
  6. Hb-10.8 g %
  7. Fasting blood sugar-78 mg/dl
  8. Urine complete:
    • Color dark yellow,
    • pus cells 10–12/high power field (HPF)
    • epithelial cells 09–10/HPF
  9. Urine for culture and sensitivity-Escherichia coli present
  10. High vaginal swab for culture and sensitivity-Sterile
  11. USG (OBS LEVEL 2) January 2, 2020-Single live intrauterine pregnancy of gestational age 22 weeks 2 days, cephalic presentation:
    • Placenta–posterior grade I maturity
    • Liquor–Adequate
    • FHR–150 bpm
    • EFW–578 GMS
    • USEDD-May 15, 2020
    • No congenital anomalies seen, normal level 2 scan.


Oral medicine

Freshly prepared TrinanapanchmoolaKwath was administered in the dose of 20 ml. orally twice a day for 15 days after food. Guidance was taken for the preparation of kwath as per the instruction mentioned in Sharangdhar Samhita.

Criteria of assessment

Parameters of assessment are taken according to subjective parameters given by the American Association of Urology [Table 1].
Table 1: Questionnaire for assessment of urinary tract infection

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  Results Top


The treatment was started on February 12, 2020, and she started getting relief in symptoms after 2 days of treatment. Pain and burning micturition subside after the 5nd day and the rest of the symptoms subside gradually. The patient got complete relief in symptoms after 15 days of treatment. All the observations obtained in the trial suggest that TrinpanchmoolKwath produces symptomatic relief in burning micturition (100%), discoloration of urine (100%), painful and difficult urination (100%), frequency (50%), and lower abdominal pain (66%). At the end of treatment, the patient had got significant improvement in subjective parameters which were 84.92% [Table 2].
Table 2: Effect of therapy on subjective parameterswith percentage relief

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Pus cells in the urine of the patient before the treatment were 10–12/HPF which was reduced after treatment to 0–1/HPF, epithelial cells in the urine of the patient before the treatment were 9–10/HPF which was reduced after treatment to 1–2/HPF and urine for culture and sensitivity was sterile at the end of treatment [Table 3].
Table 3: Effect of therapy on laboratory investigations of patient

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  Discussion Top


During pregnancy, because of changes in the urinary tract the Srotodushti as well as Dosha Prakopa mainly Vata. Due to pressure of the gravid uterus on the urinary bladder or due to the Vega Dharana by the pregnant woman kha-vaigunya occurs in the Basti and VataPrakopa mainly Apana Vayu takes place. This Apanavayu also vitiates Vyanavayu. The vitiated Vyanavayu will cause the Sthanapkarsha of Kapha and Pitta and leads to mutra krichra.[5] Acharya Harita has mentioned the involvement of Pitta as the main Dosha in the pathogenesis of Mutrakruchra.[6] Trinapanchmoolkwath is one of the best remedies for the management of urinary tract disorders of Pitta origin.

TrinapanchmoolKwath is a decoction of roots of five types of grasses. It is used in the treatment of urinary tract disorders of Pitta origin.[7]

In ayurvedic classical texts, Trinpanchmool is frequently used for relieving urinary infections, burning micturition, and dysuria. It reduces vitiated Pitta. Herbs of Trinpanchmool eliminates excess water with toxins from the body without unbalancing electrolytes thus supports kidneys and cures mutrakruccha. In classics, various kalpna (formulation) of Trinapanchmool is described such as kwath, ksheerpaka, basti, etc., for the management of pittajroga, mutrakrucha, ashmari, etc., [Table 4].
Table 4: Various formulation of trinapanchmooldescribed in classics with their therapeutic indications

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Kusha (Desmostachyabipinnata Linn.) grass delivers effects as a diuretic known as sacred grass in classics. It is also used where pitta is elevated like dysentery and menorrhagia.[8] Kasha (Saccharum spontaneum Linn.) is mentioned as diuretic, lithotriptic, emollient, refrigerant, tonic, etc., in Ayurveda. Therefore, Kasha (Saccharum spontaneum Linn) is useful in burning micturition, renal, and vesicle calculi. It is also helpful in gynecological problems, dyspepsia, etc., It balances vitiated pitta and vata due to which it corrects burning sensations.[9] Darbha (Imperata cylindrica Linn.) diminishes the burning sensation of the body as well as the eyes, reduces thirst, increases urine volume, and hemorrhagic conditions. Shar (Saccharum munja Linn.) is useful in thirst, erysipelas, burning sensation, and blood troubles because of its cooling properties. Ikshu (Saccharum officinarum. Linn.) has potent cooling agents and a wonderful diuretic. It is useful in uropathy, seminal weakness, fatigue, and general weakness.[10]

The results of this research suggested that a combination of all five drugs (Trina panchmool) may be used as a potential remedy to treat several ailments. The above experiments clearly show the diuretic and antioxidant properties of individual components of Trina PanchmoolKwath. Thus performs the act of excretion of vitiated doshasand malas, enhancing the patient's condition.


  Conclusion Top


The above study clearly shows the diuretic and renal protective properties of various components of TrinapanchmoolKwath, hence when orally helps in restoring the renal function and acts as a diuretic agent to remove the mutrakruchha. In patients of mutrakruccha there was a marked reduction of symptoms such as painful, difficulty, and burning urination. No unwanted effect of therapy was observed during treatment and during follow-up period. Hence, it can be concluded that TrinapanchmoolKwath is very effective in the management of Garbhinimutrakruccha.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Barber AE, Norton JP, Spivak AM, Mulvey MA. Urinary tract infections: Current and emerging management strategies. Clin Infect Dis 2013;57:719-24.  Back to cited text no. 1
    
2.
Virkud A. Modern Obstetrics. 3rd ed. Mumbai, APC Publisher: 2017.   Back to cited text no. 2
    
3.
Garmel SH, Guzelian GA, D'Alton JG, D'Alton ME. Lumbar disk disease in pregnancy. Obstet Gynecol 1997;89:821-2.  Back to cited text no. 3
    
4.
Garg AK, Singh A, Vishnoi H, Singh C, Adlakha MK. Traditional dietary pattern of indian food and its scientific basis: An overview. Ayushdhara 2016;4:983-5.   Back to cited text no. 4
    
5.
Charak Samhita, Siddhisthana, Trimarmiyasiddhiadhyaya, 9/23. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Aug 25].  Back to cited text no. 5
    
6.
Harita. In: Harihara Prasad Tripathi, 30/6. Harita Samhita. 1st ed. Varansi: Chaukhambha Krushnadas Academy; 2005.  Back to cited text no. 6
    
7.
Sen GD. Bhaishajya Ratnavali. 2nd ed., Ch. 34., Ver. 20. Varanasi: Chaukhambha Bharati Academy; 2009. p. 67.  Back to cited text no. 7
    
8.
Garg AK, Chouhan P, Madanaphala (Randia Dumetorum): A pharmacological and pharmacognostical review. Int J Recent Sci Res 2019;10:32061-4.  Back to cited text no. 8
    
9.
Chouhan P, Garg AK. A case study on ayurvedic management of kamala W.S.R. to jaundice. Int J Sci Res 2020;9:36-8.  Back to cited text no. 9
    
10.
Garg AK, Chouhan P, Sharma B. Fundamental tenets of Nipah virus infection in ayurveda and its management: A multidisciplinary investigation. Int J Ayu Pharm Chem 2019;10:49-64.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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