E-ISSN:2456-3110

Case Report

Urolithiasis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

A Case Study on Ayurvedic management of Mutrashmari (Urolithiasis)

Hardik1*, Sengupta A2, Chinky3
DOI:10.21760/jaims.9.2.48

1* Hardik, Post Graduate Scholar, Dept of Rog Nidan Evum Vikriti Vigyan, Institute of Post Graduate Ayurvedic Education and Research, Kolkata, West Bengal, India.

2 Apala Sengupta, Professor Head, Dept of Rog Nidan Evum Vikriti Vigyan, Institute of Post Graduate Ayurvedic Education and Research, Kolkata, West Bengal, India.

3 Chinky, Post Graduate Scholar, Dept of Panchakarma, Ch Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, New Delhi, India.

Background: Mutrashmari is disease classified as Asthamahagada which means "difficult to cure." It is Kapha Pradhana Tridoshaja Vyadhi. Due to resemblance in clinical manifestations, Mutrashmari is compared to urolithiasis. Urolithiasis, a pathological condition of the urinary system where aggregation of urinary crystalloids takes place anywhere in the urinary tract, i.e., from the kidney to urinary bladder showing male predominance (Male: female = 3:1) and currently becoming a medico surgical and economical challenge for entire health care systems. Objectives: The aim of this study was to evaluate the efficacy of Viddhakarma and Shamana Chikitsa in Mutrashmari (Urolithiasis). Materials and Methods: It is a single case study. A 52 years old male patient who was clinically diagnosed case of Urolithiasis before 3 years visited to OPD with complaints of Vrikka Parshava Shoola (Pain in bilateral kidney and b/l flanks region) which was radiating from loin to groin region in late night usually, Mutrakriccha (difficulty in maturation) and Mutradaha (Burning micturition) from last 2 months. The patient was treated with total 4 sittings of Viddhakarma were given at the lateral border of the thumb of the bilateral legs on same day of every week along with Shamana Chikitsa. Results: The patient was showed highly significant results before and after the completion of treatment. All sign and symptoms of patient resolved and there was no trace of calculi in the both kidneys, according to the USG report after 1 month. Conclusion: Highly significant relief in symptoms was seen in patient after 1 month of Ayurvedic treatment.

Keywords: Mutrashmari, Urolithiasis, Viddhakarma, Shamana Chikitsa

Corresponding Author How to Cite this Article To Browse
Hardik, Post Graduate Scholar, Dept of Rog Nidan Evum Vikriti Vigyan, Institute of Post Graduate Ayurvedic Education and Research, Kolkata, West Bengal, India.
Email: 		Hardik, Sengupta A, Chinky, A Case Study on Ayurvedic management of Mutrashmari (Urolithiasis). J Ayu Int Med Sci. 2024;9(2):300-304.
Available From
https://jaims.in/jaims/article/view/3109

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-07 2023-12-17 2023-12-27 2024-01-06 2024-01-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.87

© 2024by Hardik, Sengupta A, Chinkyand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Mutrashmari is a condition in which there is formation of a substance like stone.[1] It is one among the Ashtamahagada (eight fatal conditions).[2] It is considered difficult to cure because of its Marma Ashrayatwa due to involvement of Basti, which is one of the Tri Marma (three vital parts), being the Vyakta Sthana.[3] It is Kapha Pradhana Tridoshaja Vyadhi.[4] Acharya Sushruta have described symptoms of this condition, including Jwara (fever), Basti Peeda (discomfort and pain in the bladder), Aruchi (anorexia), Mutrakriccha (difficulty in micturition), Bastishira Vedana (pain in the urethra), Mushka Vedana (pain in the testicles) and Shepha Vedana (pain in the penis). Due to resemblance in clinical manifestations, Mutrashmari is compared to urolithiasis. Urolithiasis, a pathological condition of the urinary system where aggregation of urinary crystalloids takes place anywhere in the urinary tract, i.e., from the kidney to urinary bladder[5] and major cause of morbidity in entire health‑care systems. The rate of occurrence is three times higher in men than women, because of enhancing capacity of testosterone and inhibiting capacity of oestrogen in stone formation.[6] Due to changes in lifestyle, dietary habits, and treatment approaches, its incidence and prevailing have increased significantly over the past few decades. The main etiological factors for the formation of urolithiasis include dietary factors like low fluid intake and high dietary intake of animal protein, sodium, refined sugars, fructose and high fructose corn syrup,[7] oxalate, grapefruit juice, apple juice, and aerated drinks. Stone formation commonly occur due to inadequate urinary drainage, foreign bodies in urinary tract, microbial infections, diet with excess oxalates and calcium, vitamin A deficiency, excess vitamin D, and metabolic diseases like hyperthyroidism, cystinuria, gout, intestinal dysfunction etc.[8]

Many treatment procedures have been adopted in medical sciences to treat the disease but mainly surgery is described it is quite costly and also the prognosis behind recurrence of stone formation cannot be avoided. Acharya Sushruta mentioned the treatment of Mutrashmari is Viddhakarma and oral medications such as medicated alkali preparation, decoction, medicated ghee, and medicated oil, which possesses the properties such as diuretic, splitting, scarification, breaking,

and cutting; it facilitates the dissolution of the urinary stones.[9] Hence, it is necessary to find out an economical, easily available, cost-effective, and acceptable management to treat Mutrashmari.

Aim

The current study was planned to evaluate the efficacy of Viddhakarma and Shamana Chikitsa in Mutrashmari (Urolithiasis).

Materials and Methods

It is single case study and the informed consent of the patient is taken in his own language.

The demographic details of the patient are tabulated in Table no.1.

Table 1: Demographic details.

SNDemographic details
1.NameXYZ
2.SexMale
3.Age52 yrs
4.AddressBehala, Kolkatta
5.OccupationBusinessman
6.Marital statusMarried
7.EducationLiterate
8.Socioeconomic statusUpper middle class
9.OPD No.08447

Chief complaints

Chief complaints of the patient are tabulated in Tables 2.

Table 2: Chief complaints

SNNature of symptomsDuration
1.Vrikka Parshava Shoola2 months
2.Mutrakriccha
3.Mutadaha

History of present illness

A 52-years-old male patient was suffering from Vrikka Parshava Shoola (Pain in bilateral kidney and b/l flanks region) which was radiating from loin to groin region in late night usually, Mutrakriccha (difficulty in micturition) and Mutradaha (Burning micturition) from two months. He had complained of heaviness and pain in lower abdomen from last three years. He took modern medication for this and had significant relief for some days. He approached Kayachikitsa O.P.D. Shyamadas Vaidya


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Shastra Pith Hospital, Kolkatta for Ayurvedic treatment. After proper history taking and thorough examination, treatment was initiated.

Past History

The patient had a history of gaseous and distended abdomen from 3 years.

Medication History

Patient had taken allopathic medicine tab Omeprazole twice a day before meal for 3years.

Personal History

a) Food habits: Non‑veg, spicy, and salty food; Ruksha Ahar (poha, bread, and toast).

b) Lifestyle: Insufficient water intake, sedentary lifestyle, and suppression of naturalurges.

c) Sleep: Disturbed due to pain and family stress.

d) Addiction: Alcohol occasionally once in a month.

Family History:

Not significant.

Examination history:

These are briefly mentioned in Tables 3 &4.

Table 3: General examination

SNHeadObservations
1.General conditionModerate, afebrile, conscious and well oriented.
2.P/ADistended but non tender, absence of rebound tenderness
Hepatomegaly/ Splenomegaly/Lymphadenopathy were absent.
3.Other systemic examinationNo puffiness over the face, No bipedal oedema, the rest of all systemic examination were normal.
4.Pulse78/mins
5.Blood pressure110/70 mm of Hg
6.Weight74kg
7.Height170 cm
8.PrakritiKapha Pradhana

Investigations

USG Report shows on 21/03/2023: The right kidney is normal in size and reported calculus measuring 16-17mm in right upper ureter 5 mm in lower calyx of right kidney and few tiny 3-4 mm in right kidney 5-4 mm in left kidney.

Treatment

By analysing the above pathogenesis of disease in this patient following treatment plan was prescribed, which can be categorized as Shaman Chikitsa shown in Table 4.

Table 4: Astavidha Pariksha

SNHeadObservations
1.Nadi (Pulse)Niyamita, Kapha Pradhana
2.Mala (Stool)Unsatisfactory, Aniyamit, Grathita (occasionally with straining)
3.Mutra (Urine)Asamyaka (Sadaha, Sakashta), Alpa Matra, Daha Yukta
4.Jiwha (Tongue)Sama
5.Shabda (Speech)Spashta (Clear)
6.Sparsha (Touch)Samashitoshna (Normal)
7.Druka (Vision)Prakrita
8.Aakriti (Posture)Madhyama

Table 5: Treatment given

SNType of ChikitsaMaterialSiteDuration
1.  1.VidhhakarmaNeedle no. 24At the lateral border of the thumb of the both legs on same day of every weekOnce a week (Total 4 sittings)
2.Internal medicationDoseAnupanaDuration
a.Mahatikta Ghrita20 ml BD ½ hour before mealWarm water1 month
b.Gokshura powder3 gm BD before mealLuke water1 month
c.Varunadi Kshaya30 ml BD before mealLuke water1 month

Observation and Result

Assessment of the patient was done with both radiological findings as well as clinical features. The Radiological assessment (U.S.G. Abdomen & Pelvis) was given taken. The patient became symptom-free with all aforesaid prescribed treatment after one month. There was no event related to the patient's hospitalization for the emergency care in the modern hospital throughout the whole duration. No, calculi were observed & no other obvious abnormality was noted in the scan after one month.


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Figure 1: Shows pictures of Mutrashmari which expelled out after one month
jaims_3109_01.JPG

jaims_3109_02.JPG

Discussion

As per the evaluation of the detailed history of the patient, both faulty lifestyle (Ayogya Ahara-Vihara) and iatrogenic factors are responsible for the pathogenesis of the disease, i.e., Mutrashmari. Daily intake of Katu & Amla Rasa Pradhan Dravya Sevan, Mental stress leads to Pitta Dosha's provocation, which gets further aggravated by low Intake of water throughout the day. Vishamashana, i.e., Intake of food at Irregular times & intervals, Vegavrodha (Suppression of urges due to workload & responsibilities in a joint family) leads to vitiation of Vata Dosha. Moreover, intake of calcium supplements and steroids for a prolonged time leads to more excretion of calcium through urine out of the body. However, due to Vata and Pitta's vitiation, urine formation gets reduced, which is produced, unable to excrete properly due to vitiation of Apanavayu. Ultimately it gets saturated in the bladder, becomes turbid, and turns into calculi.

Treatment with drugs exhibiting Vatanulomaka, Vata-Pitta Shamana but Ashmari Bhedaka and Mootrala properties is highly expected in the management of such clinical entity by considering all above said pathology

of the disease. The probable mode of action of each procedure and drug prescribed can be justified based on all these principles as follows:

Viddhakarma increases the movement of the ureter and activates the smooth muscles of the urinary bladder that easily eliminates the crushed stone in a downwards direction. It is also an excellent pain relief tool exclusively elaborated by Acharya Sushruta. It helps to subside both intermittent colicky and constant dull pain in the left loin region & lower abdomen due to obstruction of the flow of urine & flatus. The secretion of endorphins may induce its analgesic action due to painful mechanical stimulus at the time of procedure.

Gokshura powder is diuretic, aphrodisiac, tonic and rejuvenates with the ability to build lean muscle and strength. It has possessed Madhura Rasa, Madhura Vipaka and Sheeta Veerya which causes diuresis by increasing Kledainthebody.

Varunadi Kashaya acts as an excellent remedy to crush the calculi into minute particles which gets easy to wash out through urine out of the body due to its Kaphaghna property.

Conclusion

This case showed the efficacy of a combination of Viddhakarma and Shamana Chikitsa to manage Mutrashmari in a very non-invasive manner within a short duration without recurrence of any symptom. It can be concluded that Shamana Chikitsa added with Viddhakarma, can successfully treat surgical conditions like urolithiasis. Viddhakarma plays a crucial role in hastening the therapeutic outcome of Shamana Chikitsa in Ayurveda.

Limitation of Study

The study may be carried out with this treatment protocol in large sample size for its scientific validation.

References

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2. Sushruta M, Shastri AD. Avarniya Adhyaya In: Sushruta Samhita. Reprint-2014. Varanasi: Chaukhamba Sanskrit Sansthan; 2014. p. 163. (Kashi Sanskrit Series; vol. 1).


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3. Agnivesha, M. Trimarmiyasiddhi Adhyaya. In: Shashtri, K.N (ed.) Charaka Samhita. Reprint-2015.Varanasi, India: Chaukhambha Sanskrit Sansthan; 2015. p. 1051.

4. SharmaA, editor. Ashmarinidanam. Verse 1. In: Text book of Madhavnidan. Vol 1. Pune, India: Chaukhamba Sanskrita Pratishtan; 2007. p.506.

5. Available from: http://www.en.wikipedia.org. [Last accessed on 2023 Dec 12]

6. Kalpana Devi V, Baskar R, Varalakshmi P. Biochemical effects in normal and stone forming rats treated with the ripe kernel juice of Plantain (Musa Paradisiaca). Ancient Science of Life, 3 & 4, 1993, 451 – 461. 4.

7. Knight J, Assimos DG, Easter L, Holmes RP (2010)."Metabolism of fructose to oxalate and glycolate".

8. Suman Kumar Mekap, Satyaranjan Mishra, Sabuj Sahoo and Prasana Kumar Panda. Antiurolithiatic activity of Crataeva magna Lour. bark. Indian journal of natural products and resources, 1(2), 2011, 28-33.

9. Sushruta M, Shastri AD. Ashmarichikitsa Adhyaya In: Sushruta Samhita. Reprint-2014. Varanasi: Chaukhamba Sanskrit Sansthan; 2014. p. 315. (Kashi Sanskrit Series; vol. 1).


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