EFFECTIVENESS OF THIRIKANDAGATHI KIYAAZHAM IN TREATING AZHAL NEERCHURUKKU (URINARY TRACT INFECTION) – A CASE SERIES

EFFECTIVENESS OF THIRIKANDAGATHI KIYAAZHAM IN TREATING AZHAL NEERCHURUKKU (URINARY TRACT INFECTION) – A CASE SERIES

P. Kantha Meena * and A. Justus Antony

Department of Pothu Maruthuvam, Government Siddha Medical College, Palayamkottai, Tamil Nadu, India.

ABSTRACT: Urinary tract infections (Azhal Neerchurukku) are among the most common bacterial infections, causing significant discomfort and reduced daily functioning. This descriptive case series aimed to observe outcomes following the administration of the Siddha medicine Thirikandagathi Kiyaazham (TKK) in the management of Azhal Neerchurukku (UTI). Methods: Twenty participants diagnosed with Azhal Neerchurukku (UTI) were administered 50 ml of TKK twice daily for 10 days. Clinical symptoms (using the UTISA questionnaire), total WBC count, and urine culture results were assessed before and after the intervention. Results: Observational data indicated improvements in clinical symptom scores and urine culture findings in post-intervention. Notably, a transition to culture-negative status was observed in 50% of cases where Escherichia coli was initially isolated. Conclusion: In this case series, a 10-day course of TKK was associated with observed improvements in clinical and laboratory parameters among participants, particularly in E. coli-associated cases. These preliminary findings suggest that TKK may serve as a promising Siddha therapeutic option for managing Azhal Neerchurukku (UTI). Definitive conclusions regarding therapeutic efficacy require future controlled studies.

Keywords: Neerchurukku, Siddha, UTI, E. coli, Siruneer noigal

INTRODUCTION: Urinary tract infections (UTIs) represent a significant global health burden, particularly among women ¹. It is estimated that approximately 150 million cases occur worldwide each year, resulting in substantial morbidity and an economic burden exceeding 6 billion US dollars ². Epidemiologically, about 40% of women and 12% of men experience at least one UTI in their lifetime ². The most common causative agents are Gram-negative bacteria of the Enterobacteriaceae family, with Escherichia coli being the predominant pathogen in acute community-acquired infections ¹.

Overall, Gram-negative bacteria account for roughly 90% of UTIs, while Gram-positive bacteria are responsible for the remaining 10% ³. Pseudomonas aeruginosa is typically implicated in specific clinical contexts, such as following catheterization, urological instrumentation, or in hospital-acquired (nosocomial) infections ⁴. Within the Siddha system of medicine, urinary disorders (siruneer noigal) are classified into categories including neerinai arukkal noi.

The clinical presentation of Azhal Neerchurukku within this framework shares significant symptomatic similarities with the modern diagnosis of UTI, allowing for a clinical correlation to be drawn ⁵. Understanding the prevalence, rising antibiotic resistance, and associated risk factors of UTIs is crucial for effective management. This study aimed to evaluate the therapeutic outcomes associated with the Siddha formulation Thirikandagathi Kiyaazham (TKK) in patients presenting with symptoms of Azhal Neerchurukku (correlated with UTI) at the outpatient department of the Government Siddha Medical College & Hospital, Palayamkottai.

Literature Review

Thirikandagathi Kiyaazham:

Book Reference: Anubava Vaithiya Deva Ragasiyam (Part-4) ⁶.

Page no: 527

Year of Publication: 1926

The pharmacological properties attributed to the individual ingredients of TKK are based primarily on in-vitro, in-vivo, and review literature. While the reported bioactivities are relevant to the pathophysiology of urinary tract infections, direct clinical evidence for TKK's efficacy in UTI in humans is being investigated in the present study.

TABLE 1: INGREDIENTS OF TKK WITH REPORTED PHYTOCHEMICALS AND BIOACTIVITIES RELEVANT TO UTI MANAGEMENT

TABLE 2: SHOWS THE PROPERTIES OF TRIAL DRUG TKK AS PER MATERIA MEDICA ¹⁰

MATERIALS AND METHODS: Ingredients of Thirikandagathi kiyaazham as shown in Fig. 1.

1. Kadukkai thol (Terminalia chebula) - 1 palam
2. Nellivatral (Emblica officinalis) -1 palam
3. Sirukanpeelai (Aerva lanata) – 1 palam

FIG. 1: SHOWS THE INGREDIENTS OF THE TRIAL DRUG TKK

Standard Operative Procedures: The raw drug 1, 2 were purchased from raw drug store, Tirunelveli district. Sirukanpeelai was collected from nearby village in Tirunelveli district. They were dried and purified. Required quantity was coarse powdered as kudineer chooranam formulation with a shelf life of 3 monthsas shown in Fig. 2. Then the kudineer chooranam was stored in air tight container. The prepared drug is dispensed to the participants in pockets and advised to prepare decotion (kudineer) in 1:4 ratio ¹¹. A dose of 50 ml of decoction was advised to be mixed with honey as an adjuvant (Anubanam). The quantity of honey varied according to the participant’s thegi as mentioned in Anubava vaithiya deva ragasiyam.

• For Vatha thegi: 12.5 ml (a 1:4 ratio) was specified.
• For Pitha thegi: 6.25 ml (a 1:8 ratio) was specified.
• For Kapha thegi: 3.13 ml (a 1:16 ratio) was specified

FIG. 2: SHOWS THE PREPARED TRIAL DRUG TKK

TABLE 3: SHOWS THE DETAILED DESCRIPTION OF DRUG PROFILE AND STUDY DESIGN

 Methodological Limitations: A major limitation of this study design is the absence of a control or comparator group and the sample size (n=20). Consequently, while the study can describe changes in outcomes following the intervention, it cannot definitively attribute these changes to the drug's efficacy. The findings should therefore be interpreted as preliminary observations.

Methodology: This study was conducted on the campus of the Government Siddha Medical College (GSMC), Palayamkottai. The study protocol was approved by the Institutional Ethics Committee (IEC) (Ref No: GSMC-XIII IEC-Br I/2/24.05.2024) and was prospectively registered with the Clinical Trials Registry - India (CTRI/2024/07/069808). Following these approvals, potential participants were informed about the study's terms and objectives in the regional language, and written informed consent was obtained prior to enrollment. Clinical symptoms were assessed using the UTISA Questionnaire ¹², and laboratory investigations (Total WBC count and Urine culture) were performed. Outcomes for each participant were analyzed by comparing pre-treatment and post-treatment data points

TABLE 4: SHOWS THE CRITERIA FOR INCLUSION, EXCLUSION IN THIS STUDY

The exclusion of patients with diabetes mellitus, while limiting the generalizability of findings, was implemented as a safety precaution due to the carbohydrate content of the honey used as an adjuvant, which posed a potential risk for blood glucose dysregulation

Method of Approach:

Clinical Assessment:

Utisa Questionnaire: used at baseline and follow-up.

Laboratory Assessment: Total WBC count, Urine culture.

RESULTS:

FIG. 3: SHOWS THE AGE GROUPING OF STUDY PARTICIPANTS               

FIG. 4: SHOWS THE NADI DISTRIBUTION OF STUDY PARTICIPANTS

FIG. 5: SHOWS THE CLINICAL SYMPTOMS OF AZHAL NEERCHURUKKU (UTI). (BT- Before Treatment; AT- After treatment)

FIG. 6: SHOWS THE SEVERITY OF CLINICAL SYMPTOMS BY UTISA QUESTIONNAIRE

TABLE 5: SHOWS THE STATISTICAL ANALYSIS OF CLINICAL SYMPTOMS BASED ON UTISA (BEFORE AND AFTER TREATMENT)

TABLE 6: SHOWS THE MEAN AND STANDARD DEVIATION OF TOTAL WBC COUNT (BT & AT)

It is important to note that the clinical significance of this shift is ambiguous. The post-treatment mean remains well within normal physiological limits, and the high variability suggests the change may not be universally applicable or therapeutically meaningful.

TABLE 7: SHOWS THE STATISTICAL ANALYSIS OF WBC COUNT

FIG. 7: SHOWS THE URINE CULTURE REPORTS IN TWO POINTS (BEFORE & AFTER TREATMENT). (EC- Escherichia coli; KP- Klebsiella pneumoniae; SS- Staphylococcus saprophyticus)

TABLE 8: SHOWS THE STATISTICAL ANALYSIS OF URINE CULTURE REPORTS

DISCUSSION: Urinary tract infecions (UTI’s) rank as one of the most prevalent bacterial infections affecting humans. These infections can vary in severity, but their high incidence makes them a common health concern across both genders.   Antibiotic resistance is a critical issue that is escalating globally. In siddha literature, Azhal neerchurukku has been found to be equivalent to urinary tract infection ¹³.  Due to the deranged pitha humor in Azhal neerchurukku, drugs like kadukkai thol and nelli vatral have an effect on burning micturition related to pitha characteristics, owing to their properties of being sweet in taste and cold in potency which increases kabam.  Sirukanpeelai have bitter taste.   The taste sweet (Kadukkai thol & Nelli vatral) and bitter (Sirukanpeelai) soothens the aggravated pitham.  In this trial drug TKK, Terminalia chebula was shown to have significant antimicrobial and antipyretic activity by suppressing the enhanced formation of various cytokines, thereby inhibiting the synthesis of prostaglandin E (PGE), which is involved in fever induction ¹⁴. Emblica officinalis was found to possess antibacterial activity ⁸. Aerva lanata was found to have antimicrobial properties and potent diuretic effects ¹⁵, while Aerva lanata promotes diuresis to expel vitiated humor (Pitham). With this background, Thirikandagathi Kiyaazham was selected for this case series.  In this study, 20 cases were recruited, with a minimum age of 37 and a maximum of 59, over a period of 10 days. Thirikandagathi Kiyaazham was administered orally in honey as an adjuvant, with a dosage of 50 ml twice daily. Participants had a mean age of 47.55(50% male, 50% female) and their Naadi was reported graphically. The most common types of Naadi observed in this study were Vaathapitham and Pithavatham. After the intervention with Thirikandagathi Kiyaazham, the overall severity of UTISA Questionnaire and total WBC count improved significantly, with a mean difference of 1,285 cells/cu.mm (from 9,402 cells/cu.mm to 8,117 cells/cu.mm).  The prevalence of E. coli in urine cultures decreased from 70% of samples pre-treatment to 20% post-treatment. Smaller reductions were observed for Klebsiella pneumoniae (from 10% to 5%) and Staphylococcus saprophyticus (from 20% to 15%)."A student’s t-test was performed on urine culture reports before and after treatment, yielding statistically significant results (p value < 0.05) for E. coli. In this preliminary case series, the use of Thirikandagathi Kiyazham was associated with observable improvements in clinical symptoms and laboratory parameters in participants with Azhal neerchurukku (UTI). Given the uncontrolled design, these findings should be interpreted as generating hypotheses for future rigorous clinical trials.

CONCLUSION: In this case series of 20 patients with Azhal neerchurukku, a 10-day intervention with Thirikandagathi Kiyazham was associated with observable improvements in clinical symptoms (UTISA score) and microbiological parameters. The formulation was well-tolerated, with no adverse events reported during the study period, and was found to be affordable and easy to administer. These preliminary findings suggest that Thirikandagathi Kiyazham may be a promising intervention worthy of further investigation in controlled clinical trials to formally establish its efficacy and safety profile.

ACKNOWLEDGMENT: I sincerely express my gratitude to Head of the department, other faculties and friends who helped me a lot in finalizing this study within the limited time frame and also in completing my project.

CONFLICTS OF INTEREST: Nil

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    How to cite this article:

    Meena PK and Antony AJ: Effectiveness of Thirikandagathi Kiyaazham in treating Azhal Neerchurukku (urinary tract infection) – a case series. Int J Pharm Sci & Res 2026; 17(5): 1669-74. doi: 10.13040/IJPSR.0975-8232.17(5).1669-74.

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