Introduction

Introduction:  

The physiological functions are managed by the Tridosha for example, Pachanaprakriya, Ras-Rakta Samavahana, Mala-Mutra Nirmana, Dharana and Nishkasana Prakriya etc. These, the Shayyamutra are the disease of Mutradharana and Nishakasna  Prakriya. Acharya Sushruta has quoted, 1 As the root of a tree, are Dosha, Dhatu, Malas form body. Whereas Acharya Sharangdhara said 2 When they vitiate the body, they are called Dosha, when they hold (Dharayati) the whole body entire human body in the homeostasis condition, they are called Dhatu and the  substances that should be excreted from the body after a certain period are called Mala. They are accumulated in the body. While Acharya Sushruta said that Avalambaka Kapha holds and controls the ‘Trika’.3                                                                          It supports the ‘Trika’ by its own power, the Hridaya together with the power of nutrient elements present in it and the other Sthanas of Kapha by the virtue of its watery nature. Mala-Mutra Nishakasana and Dharana is the function of Apana Vayu. Acharya Charaka has mentioned that Apana Vayu maintains the Mutrapravritti (micturation) and controls the Basti.4 According to Acharya Vagbhatta, in its normal state is said to govern enthusiasm (mental state), respiration, motor-activities of the body, mental, vocal and physical, and the regulation of Natural Urges-Vegas (Spino-cerebral reflexes) which can be volitionally inhibited or provoked.5 Acharya Charaka has quoted “Indriyabhigraha” as the main Karma of Mana.6  Among all the physiological functions of Dosha the Mutra Dharana Prakriya is directly related to the disease Shayyamutra.  So the essence of this Karma is that the Manas controls & holds the voluntary & involuntary functions of all the Indriyas. Thus in nut shell, it can be considered that Apana Vata and Avalambaka Kapha manage Mutradharana Prakriya along with Manasika Bhava.

CONCEPT OF MUTRA NIRMANA PRAKRIYA :-

Mutranirmana Prakriya elaborated by Acharya Sushruta. Just as the ocean is being continually filled by incoming rivers, similarly the urine carrying channels originating from Pakwashaya always fills the bladder with the urine. Their mouths and opening are thousands in number.7 The bladder gets filled up with urine through these channels, in the same manner, as a new pitcher sunk into water up to mouth filled from sides.  Mutra is Dravamala of Ahara.8 At the end of Paka [digestion] two kinds of Mala [waste products] are formed, they are solid portion i.e. Purisha (feces) evacuated by Guda [rectum] and liquid portion i.e. Mutra (urine) excreted by bladder through external urethral orifice. Ahara Rasa [nutrient portion] continue to circulate all over the body from which the Dhatus derive their Poshaka Amsha [nutrients] and leave off their Kitta [waste] into it. This fluid passes through the

Mutrotseka [nephrons] where most of water and waste material [of Dhatus and other waste roducts of food] get separated. The quantity of Jala [water] required for the body is reabsorbed [Shoshana] and the excess quantity is eliminated along with other Kittas [waste materials] dissolved in it to be termed as Mutra. 

 Mutra thus gets formed throughout day and night, passes down through the two Gavinis [ureters] and get collected in the Mutrashaya i.e. Basti – reservoir of urine – the bladder. When it gets filled to 3/4th of its capacity, the Vega to expel it is initiated. The urine can be retained voluntarily by the help of Vyana and Prana Vayu. The first sensation for voiding on filling of bladder is felt by Prana Vayu, later the process of voiding starts by Apana Vayu which is to be assisted by Prana and Vyana Vayu. [Fadke G. A., 1979]. 

Role of Mana, Nidra and Sadhaka Pitta in the pathogenesis of disease: 9

Shayyamutra: 

1. After reviewing centers for controlling emotions, sleep mechanism in brain, modern medical explanation gave some resemblance with Mana and Nidra told in classics. In  this regard functions of reticular formation, hypothalamus and limbic system along  with diencephalon, some part of thalamus including brain stem come in light.  
2. Hypothalamus is said as main controller of endocrine and vegetative functions along with emotional
3. In recent  study it was hypothesized that there may be some problem occurs in these area while sleep, as a result of daytime emotional conflicts.
4. Sadhaka Pitta which plays main role in governing emotional behaviors may lies somewhere in these surrounding areas.
5. As hypothalamus controls endocrine functions as well emotional behaviors, so it becomes clear that emotional conflicts affect endocrine mechanism, and by this one could understand role of Sadhaka Pitta in controlling endocrine system.
6. In context of sleep mechanism, Reticular formation, hypothalamus and lower nuclei in brain stem show some resemblance with functions described for Mana.
7. This way it could be seen that Mana, Sadhakapitta and Nidra are almost related to the similar structure or surroundings of brain and are closely associated with the functions of each other and also influence each other.
8. Sadhaka Pitta vitiation due to any cause may be the cause for stimulation of the areas of hypothalamus such as ventromedial and lateral area which may lead to increased general activity, rage, fear and punishment reactions. 
9. Recently for enuresis Urine volume, Bladder contraction and sleep are thought as main etiological factors. 
10. Hence role of Mana may be correlated with function of hypothalamus and its endocrine functions in Shayyamutra manifestation and Sadhaka Pitta could be the responsible factor for hormones and biochemicals in surrounding of limbic with hypothalamus.

Discussion

Modern science considers Shayyamutra – Primary Nocturnal Enuresis as a voiding disorder or a behavioral disorder. The central component of voiding and continence of urine are namely – Cortical inhibitory center, pontine micturition centre and Spinal micturition centre. The names of the centers are self suggesting of their location. Their functions are also highlighted by their respective names. Thus the Cortical inhibitory center lies in the cerebral cortex and functions while for the inhibition of the urge for urination.  This disease is rampant in today’s society and become threatening as a burden of shame and guilt to the child. It is also a cause for inflicting stress upon the parents too.  When the child wants to sleep dry and parents want to come out of related stress due to bedwetting, an active treatment is needed to be instituted at the earliest possible time and age.

Conclusion

In Ayurveda, the above correlation is shown by the essence of the Karma that the Mana controls & holds the voluntary & involuntary functions of all the Indriyas. Sadhaka Pitta which makes Mana to become able in coping with the all-emotional conflicts and keeping it free from its untoward effects by negating it with wisdom which is provided by the individual’s Medha only.  Enuresis Urine volume, Bladder contraction and sleep are thought as main etiological factors.