Journal of Ayurveda and Integrated Medical Sciences

Sushruta has described the causative factors of Ashmari separately. The process of urinary calculi formation as described by Acharya Sushruta is as follows:

तत्रासंशोधनशीलस्यापथ्यकारिणः प्रकुपितः श्लेष्मा मूत्रसम्पृक्तोऽनुप्रविश्य बस्तिमश्मरीं जनयति|| (सुoनिo3/4)

When an individual who neglects to cleanse (Samsodhana) the internal channels of his organs or is in the habit of taking Mithyaahaar-Vihaar like Apathyakari then vitiated Shleshma mixed with Bastigatamootra entered in Basti form Mootra-Ashmari. Here, it becomes saturated with the stone forming substances and provides rise to the formation of concretion or gravels to pass through the urine. So, an abundance of vitiated Shleshma Dosha should be taken in to consideration because the underlying cause of Mootra-Ashmari.

According to Acharya Charaka^[6]

व्यायामतीक्ष्णौषधरूक्षमद्यप्रसङ्गनित्यद्रुतपृष्ठयानात् |
आनूपमत्स्याध्यशनादजीर्णात् स्युर्मूत्रकृच्छ्राणि नृणामिहाष्टौ ||च.चि.26/32

Ati Vyaayaama, Teekshna Aushadha, Ruksha Madya Sevana, Drutaprishthayaana, Aanoopamaamsa Sevana, Matsya Sevana, Adhyashana, Ajeerna Bhojana.

According to Vagbhata

Snigdha Aahaara Sevana, Divaaswapna, Ajeerna Bhojana, Madhura Aahaara, Adhyashana.

Poorvaroopa^[9]

According to Madhav Nidana

Bastyaadhmanam (distension of the urinary bladder), Aasandeshesu Parito Atiruja (severe pain around bladder), Mutre Bastasagandhatwam (uriniferous odour due to dribbling), Mutrakrichchhra (dysuria), Jwara (fever), Aruchi (anorexia)

As per Acharya Sushruta

Bastipeeda, Arochaka, Mutrakrichchhra, Bastishiromushkashephasa Vedana, Jwara, Bastigandhatwam.

Roopa^[4]

According to Acharya Sushruta: Common symptoms of Mootra-Ashmari are Mahati Vedana in Nabhi, Basti Sevani and Mehana during urination,

Clinical features of Sharkara (gravel)^[10]

Gravel, sand, or ash-like substances in urine are cause of altered appearances of urinary calculi. Urinary calculi and gravel share similarities in terms of discomfort. The stone come out with urine when Vayu is favourable and calculi are tiny.

Complication of Sharkara^[10]

Those (gravel) get stuck up on their passage through urethra and produce complications such as weakness, lethargy, emaciation, pain in flanks, dislike for food, pallor, Usna-Vata (cysto-urethritis), thirst, pain in pericardium and vomiting.

Samprapti^[4,7]

Acharya Sushruta gave two examples of how Ashmari forms: when clear water is kept in a new pitcher, slush forms over time. Similarly, stone forms in Basti from urine after sometime, and rainwater solidifies to form hail stones by action of air and fire of electricity. Similarly, in Basti Vata Pitta mixed with urine to form Ashmari by binding Kapha.^[4]

According to Acharya Charaka when Vayu covers mouth of bladder and dries up urine, then urine gets mixed with Pitta, Kapha, and Shukra giving rise to the formation of Ashmari just as Gorochana gets formed Pitta in body of Gau.^[7]

Samprapti Ghataka

• Nidana : Kapha, Vaata Prakopaka
• Dosha : Kapha Pradhaana Tridosha
• Dooshya : Mootra
• Shrotasa : Mootravaha
• Shrotodushti : Sanga
• Agni : Jatharaagnimaandya
• Aama : Jatharaagni
• Dosha Maarga : Koshtha, Shaakha
• Roga Maarga : Aabhyaantara
• Udbhava Sthaana : Pakvaashaya
• Adhishthaana : Basti (Mootravaha Shrotasa)

Upashaya - Anupashaya

The factors which relieve the signs and symptoms of a disease are called the Upashaya, where as the factors that provoke the disease is called Anupashaya.

• Prolonged immobilisation causes decalcification of bones and so hypercalciuria leading to stone formation.
• Hyperparathyroidism causes hypercalciuria causing multiple bilateral stones or often bilateral nephrocalcinosis (5%).
• Hyperoxaluria as a result of altered glycine metabolism.
• Cystinuria (Autosomal recessive)
• Stasis: due to obstruction to urine flow.
• Medullary sponge kidney.
• Randall’s plaque theory is erosion and deposition of urinary salts as Randall’s plaque at the apex of renal papillae.
• Carr’s postulates states that minute concretions called as microliths normally develop in the subendothelial part of the tubule which will be carried away as particles by renal lymphatic network vessels. If these lymphatics are blocked, microliths enlarge and act as a nidus for stone formation.
• Others: Sarcoidosis,myelomatosis,gout,idiopathic hypercalciuria,hypervitaminosis D,neoplasms on treatment, hypomagnesuria ( Mg++ in urine acts as complexing agent and prevents nucleation normally).
• Renal tubular acidosis:

  commonly calcium phosphate stone(10%).

Types of renal calculi^[15]: Two major groups-

1.Primary stones,
2.Secondary stones

1. Primary stones are those which appear in apparently healthy urinary tract without any antecedent inflammation. These stones are usually formed in acid urine. These stones usually consist of calcium oxalate, uric acid, urates, cystine, xanthine or calcium carbonate.

2. Secondary stonesare usually formed as the result of inflammation. The urine is usually alkaline. as urea splitting organisms are most often the causative organisms. Triple phosphates (mixed/struvite/staghorn), amorphous phosphates, ammonium urate, phosphates stones.

The diagnosis process in use now is limited to imaging methods, such as radiography, CT scanning, ultrasound, and so on, which have improved the disease's diagnostic potential.

Conclusion

When there is a stone or calculus in the urinary system, it is called urolithiasis. The existence of stone in the Mutravahashrotas is known as Mootra-Ashmari. Mootra-Ashmari is under the category of eight grave illnesses(Astamahagada)^[3] that Acharya Sushruta brought up. There are extrinsic as well as intrinsic causes of urolithiasis. As Asamshodhanasheela, Mutravegarodha, and Shukra Vegarodha are the main causes of it, according to various Acharyas. All other Acharyas, with the exception of Charaka, spoke about Vishesha Purvarupa of Mutrashmari.

Samprapti and Rupa are described in length in the classics. Urolithiasis is classified on the basis of size, X-ray characteristics, aetiological basis, stone composition and origin. Primary stones include oxalate calculi, uric acid stones, cystine calculi, xanthine calculi, and indigo calculi. Examples of secondary stones are phosphate and mixed stones. Treatment recommendations include surgery and conservatory management.

References

1. Shabdakalpadruma

2. Sastri Hara Govinda, Amarakosha, Chaukhambha publication 2006, page no 284

3. Shastri AD, Sushruta Samhita, Vol 1, Sutra Sthana 33/4, Varanasi, Chaukhamba Sanskrit Sansthan

4. Shastri AD, Sushruta Samhita, Vol 1, Nidana Sthana 3/3,4, Varanasi, Chaukhamba Sanskrit Sansthan

5. Shastri AD, Sushruta Samhita, Vol 1, Nidana Sthana 3/7-17, Varanasi, Chaukhamba Sanskrit Sansthan

6. Charaka Samhita Chikitsa Sthana 26/32, Vd Brahmanand Tripathi, Chaukhamba prakashan

7. Charaka Samhitaa Chikitsaa Sthana 26/36, Vd Brahmanand Tripathi, Chaukhamba prakashan

8. Ashtanga Samgraha Nidana Sthana 9/9