In the following discussions we intend to present a scientific, objective view of amaroli - assessing all the points on the kidney, urine and its uses - in order to approach the subject with adequate understanding and a more balanced perspective. Much of this material has been collated from the seminar on amaroli held at the Bihar School of Yoga, IYFM Research Coordinating Center, in March 1978. The panel included Dr. Swami Shankardevananda Saraswati, MB, BS (Syd); Dr. Swami Vivekananda Saraswati, MB, BS (Syd), MANZCP, DPM; and Swami Buddhananda Saraswati, BA, Dip. Ac. (HK & Aust), DNMN, all of whom have had experience with amaroli. In the text they are referred to as Dr. S; Dr. V; and Sw. B respectively. Many of the swamis and visitors to the ashram who participated in the seminar also contributed their experiences, some of which have been recorded here. Other material was collated from various scriptures, books and magazines.
Dr. S: Perhaps we should run through some of the anatomy and physiology of the whole genitourinary tract to gain an objective view of the manufacture of urine. We know that the kidney is the most complicated, refined and highly developed filter known to man. It is far more sophisticated than any machine ever made. Humans have two of these, each with seventy miles of tubing and over one million tubules, called nephrons, which are no more than one and half inches long. Each nephron is a complicated structure able to accept what the body needs and reject unwanted substances. Through the action of the nephrons, the kidneys filter the blood, keeping it pure and free from harmful substances, and maintain the body's chemical, water and salt balance.
The process of manufacturing urine is complex and intricate. The blood passes through the glomerulus, a small pinpoint structure consisting of a fine semi-permeable membrane which permits only the passage of very small molecules. The filtered fluid contains water, salt and other small molecules.
Plasma passes along a very complex, convoluted channel called the nephron, where water, nutrients, and other valuable substances are reabsorbed into the bloodstream, leaving the 'wastes' such as urea and so on. The cells lining the nephrons do this work and a combination of pressure gradients and cellular pumps is required to follow the exact recipe for making urine - a process so complicated that it staggers the mind. Even today we are not sure exactly how the kidneys carry out their work.
Dr. V: Another amazing fact is that each day the kidneys filter out no less than ten times the body's weight in water and salts. Most of the fluid filtered by the kidneys is not lost, but reabsorbed into the bloodstream from the nephron. For instance, we might filter 300 litres of fluid per day, but recover 298 litres. The two litres remaining are excreted as urine, the essence of the filtered fluid.
The process of filtering is governed by hormonal, nervous and chemical reports from the body as a whole, all mediated by the brain. Perhaps the most potent factor in determining what is rejected is that of hydration, the amount of water in the body. If the body has plenty of water, salts and so on, the urine is copious and dilute. If water is in short supply, much more is retained in the cells.
The kidneys continually produce urine, day and night. At least 300 millilitres must be produced, but there is no maximum limit. Our environment, fluid intake, health and many other factors determine this amount. In this way the blood and cell chemistry and the normal internal environment of the body are maintained. The anatomy of the genito-urinary tract is quite simple to understand. Once the urine is manufactured in the kidney it collects in a wide space called the renal pelvis, just at the junction of the kidney and those long tubes, the ureters, which lead to the bladder. The kidneys are in the waist, at the back of the abdominal cavity, just under the rib cage. The bladder is in the bottom of the pelvis, a few inches below the navel. The ureters, which are about 14 to 16 inches long and ¼ inch across, convey the urine from the kidney to the pear-shaped sac called the bladder. This can hold up to a litre of urine and can expand like a balloon to the level of the navel. When enough urine has been stored in the bladder, a signal is sent to the brain which initiates the desire to urinate (the micturition reflex). A small muscular valve opens and urine passes down the urethra, which is 7 to 9 inches long in men and 1 to 1½ inches long in women. This complex process requires the coordination of several areas of the nervous system.
Dr. S: Perhaps we can sum up this brief description of the function and structure of the genito-urinary system by saying that its primary purpose is to regulate the water and salt balance, and to excrete unwanted materials.
There is no way to separate these functions in actual fact. They occur simultaneously and concomitantly. Urine is a 'waste product' but it is not the only means for wastes to be eliminated, we also have faeces, sweat and exhaled air. If the kidneys cease to work efficiently over a period of time, then poisons are eliminated more through the skin and breath while the kidneys concentrate on maintaining salt and water balance in the body. This then, must be taken to be its most important role since there is no other structure to replace the salt/water mechanism.
Sw. B: According to acupuncture, the kidneys are yin, solid organs and like the heart, liver and brain, are essential to life. In fact the kidneys are among the three most important organs of the body, the other two being the heart and the lungs. The kidneys work in equilibrium with the bladder, a yang, hollow organ.
Acupuncture theory supports the medical theory in that the kidneys' main function is to control the water element in the body. If the water control fails, then there is excessive heat in the body; water is required to keep the body's fire under control. We can see this water-fire relationship in terms of kidney (water) disease causing hypertension and other heart (fire) conditions, such as rheumatic heart disease. When the kidneys become diseased, they can no longer perform their water-balancing function.
At the same time, the kidneys filter impurities from the body water; they remove 'bad' chi (energy) which we see on the physical plane as toxins and poisons. This is essential so that the whole water/cooling mechanism can function correctly. From the acupuncture point of view, water regulation depends to a certain extent on the purity of the water itself. The two go hand in hand.
Sw. B: While we are discussing the structure and function of the urinary tract this might be a good time to talk about the bacterial content of urine. Normal urine in a healthy body has no bacteria in it. Why is this? Is it that urine contains some substance that prevents bacteria from growing in it? Or is it just that we pass a continuous flow of urine, sufficient to wash out the urinary tract and keep it clean? After all, we see a lot of urinary tract infections occurring when there is blockage and stasis, that is, the urine cannot flow freely. It appears that urine is bacteriologically sterile under normal conditions because there is no contact between external sources of bacteria and urine.
Dr. V: This is correct to a certain point. Women are much more prone to urinary tract infections (UTI) than are men. The urethra of a woman being a mere 1 or 1½ inches long, brings her urinary tract much closer to possible infection. Germs simply have freer access to the female urinary tract. On the other hand, the kidneys are sometimes infected without bacteria necessarily ascending from the urethra and bladder. We presume that these bacteria enter from the bloodstream.
Sometimes too, we find bacteria in the urine when we collect it for microscopic examination, say in the case of a suspected UTI. Medically speaking, we accept up to 100,000 bacteria per millilitre of urine as normal. This occurs because of a certain degree of contamination from the collecting jar, the hands, the urethra, etc. despite the most stringent precautions. What concerns us here is that if urine is, as it is claimed to be, an antiseptic with germicidal properties, then why is it that urine can be contaminated with bacteria?
To me it seems to be a simple mechanical thing. The germs can get to the urine in the normal way. If there were a chemical factor involved, we would suppose that the incidence of UTI would be equal in both men and women, even taking the different hormonal makeup into account.
Sw. B: Keeping the urethra clean through the regular excretion of urine may be one of the mechanisms which prevents many people from getting UTI, but there are other factors as well. When we develop UTI, no matter how much we urinate we cannot wash out the infection. So we can assume that some factor or substance is missing from unhealthy urine, though we are ignorant of the nature of this 'missing link'.
Dr. S: Dr. K.C. Kuruvilla, MD, MS (renal medicine), Chief Nephrologist of Jaslock Hospital and Research Center, Bombay, has stated that the urine of a healthy man is bacteriologically sterile and therefore it may have something to prevent germs from growing and breeding. If this could be isolated, we might have a treatment for infections.*1 I feel the key here is the word 'healthy'. It remains to be seen whether or not there is any substance produced which confers health. It may be the combined action of all the substances in the urine of a healthy person which acts to prevent bacteria forming and which gives urine its germicidal properties.
Scientifically, we say that the body as a whole, and urine specifically, remain disease free or germ free because of our constitution, that is, our innate tendency to remain healthy. Disease is an aberration of the natural healthy state. What maintains health has not yet been discovered or defined by medical science. There seems to be no single factor that maintains health.
In yoga, we say that a combination of physical health, emotional stability, mental clarity and concentration, and spiritual discipline are required to bring about optimum health. All these factors promote the balance and abundance of prana (inner vitality and energy) which makes us feel good when it is harmonious and plentiful. So this probably accounts for the absence of germs in healthy urine.
Some proponents of amaroli advise us to drink our urine no matter how bad it tastes or smells, even if it contains pus. It is debatable whether this is health promoting, apart from the question of whether people could bring themselves to drink contaminated urine at all. These proponents state that both 'good' and 'bad' tasting urine are to be used, for each contains specifically what is needed for that particular state from which we are suffering. The urine we produce is said to be specific to our illness- the urine we pass is the urine we need at that particular time. Something like a 'lock and key' mechanism seems to be appearing, in which the urine we throw out fits our particular requirements perfectly.
Sw. B: Acupuncture agrees with yoga and modern science in the matter of constitution and health. Prana was called chi in China and qi in Japan, where acupuncture developed. These cultures have an interesting and intricate philosophy of health and life in general. In terms of the kidneys and urine, it is said that the kidneys rule 'ancestral chi'. That is, they contain the prana (the source of sexual energy), and they also determine heredity, and so on. So we can understand why the kidneys were rated so highly. This ancient statement is supported by the more modern scientific discovery that, embryologically speaking, the ovaries and testicles develop in the same area as the kidneys and move downwards later on in the development of the foetus.
The life force which is generated by the transforming effect of prana or chi on food and water in the stomach is stored in the kidneys. Whenever life essence, chi, is required, the kidneys inject it into the body so that it can circulate to the other organs. Thus, the health of the body is maintained and the urine, for example, remains germ free.
However, this life essence can be damaged by excesses. For example, the 'six evils' of excess wind, cold, summer heat, dampness, dryness and fire; or the 'seven emotions' of excess joy, anger, fear, anxiety, concentration, grief and fright. These attack the body and injure it, depleting the body of energy. When energy is depleted, germs can grow.
The life essence is stored in the kidneys and 'bad' chi is thrown out into the urine. All fluid in the body contains life essence. The amount of fluid depends on the amount of water and food digested. The liquid in the stomach is metabolized by the action of the 'yin' fluid (the gastric and digestive fluids) already there, and as a result, it takes on a special duality which differentiates it from water outside the body. We say, in acupuncture terms, that it is living water, having acquired prana, chi, or life essence.
Therefore, the quality of fluid in the body is as important as its quantity. Too much or too little affects the balance in the body. The lungs control the process of energizing by the action of prana, the kidneys control the amount of water to be used or rejected, and the bladder stores the fluid, which is either impure or in excess. Thus urine may be thought of as 'bad fluid' by some people, and the 'excess of good fluid' by others. If we accept the latter term, then we have a good explanation 'pro' amaroli, that is, urine contains prana which revitalizes our body. If we accept the former, then it appears not to be a 'good' or 'healthy' thing to drink urine.
Another question that isn't clear is whether during disease urine changes and becomes 'bad'. That is, does it take on the impurities and qualities of the disease? Perhaps urine has a 'homeopathic' effect on disease - 'like cures like'.
Dr. S: One point relevant to the present discussion is that of midstream urine, as recommended by the ancient Indian texts. Midstream urine may have been used because the first flow of urine washes out from the urethra any harmful germs.
However, the Hatha Toga Pradipika states that the first flow of urine is 'too strong', although I don't understand why this should be so.
Dr. V: The most likely explanation for midstream urine is that the first part washes the urethra clean of bacteria. Why the last part is discarded is something else altogether. To my way of thinking, when we walk, move or go to the toilet we are continually mixing up the urine in the bladder so that it should not make much difference strength wise, as the solution would be uniform in its concentration.
Dr. S: On the other hand, we should consider that those people who use urine use it in three main states of body and mind: (i) on arising from sleep, (ii) in a fasting condition, (iii) on account of illness. In these states there would not be excessive movement, and I personally don't think the urine would be thoroughly mixed. When we awaken we stand up and the urine remains in relatively the same position, only the bladder shifts around it. While fasting, the person is advised to rest and not to exert himself or herself, and in illness this is especially so. Thus, a certain amount of layering of dissolved substances may take place. We can only assume that, on this presumption, the ancient rishis were correct when they stated that the first flow had too much 'bile' (pitta) and the last too little. That is, the mid portion stored in the bladder contained the best proportion of substances, giving the best results in therapy, sadhana, and daily life.
Many enthusiastic advocates of amaroli would say that this aspect has only secondary importance, if any at all. Armstrong, for example, in his book The Water of Life, recommends that one drink all the urine, and not discard any. Of course, he has a tremendous amount of faith in urine, in the same way that Hindus have fantastic faith in Ganges water, or Catholics believe in the water of Lourdes.