E-ISSN:2456-3110

Case Report

Urolithiasis (Mutraashmasri)

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER
Publisherwww.maharshicharaka.in

Stones Unearthed: A Journey to Wellness with Ayurvedic Urolithiasis (Mutraashmasri) Management

Chaudhary V1*, Goudar SA2
DOI:10.21760/jaims.9.11.46

1* Vishal Chaudhary, Post Graduate Scholar, Department of Dravyaguna, Kahers Shri Bm Kankanwadi Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.

2 Soumya A Goudar, Post Graduate Scholar, Department of Dravyaguna, KAHERs Shri BM Kankanwadi Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.

Urolithiasis is a prevalent clinical condition impacting over 10% of the population in industrialized nations, causing symptoms like intense renal pain, lower abdominal discomfort, painful urination, and cloudy or foul-smelling urine. Despite various medical treatments, managing renal calculi proves financially burdensome, with recurrent stone formation posing a persistent challenge. Ayurvedic diagnostics, including assessing individual constitution (Prakriti), urine (Mutra), and pulse (Nadi), lay the foundation for understanding Mutraashmari causes. Renal calculi are closely linked to Agni (digestive fire) imbalances and the accumulation of Ama (toxins). Ayurvedic interventions aim to enhance Agni, eliminate Ama, and restore Doshic equilibrium, encompassing dietary changes, lifestyle adjustments, and herbal formulations. This case report presents a 45-year-old male with renal calculi (7.7mm at ureteropelvic junction and 7.4mm at ureter-bladder junction) experiencing severe pain, backache, hematuria, and recurrent urinary tract infections. After ineffective allopathic treatment, the patient sought Ayurvedic care, achieving complete urolithiasis dissolution within one month.

Keywords: Ayurveda, Urolithiais, Mutraashmari, Ashtamahagada

Corresponding Author How to Cite this Article To Browse
Vishal Chaudhary, Post Graduate Scholar, Department of Dravyaguna, Kahers Shri Bm Kankanwadi Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.
Email: 		Chaudhary V, Goudar SA, Stones Unearthed: A Journey to Wellness with Ayurvedic Urolithiasis (Mutraashmasri) Management. J Ayu Int Med Sci. 2024;9(11):314-317.
Available From
https://jaims.in/jaims/article/view/3712

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-10-07 2024-10-17 2024-10-26 2024-11-07 2024-11-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.52

© 2024by Chaudhary V, Goudar SAand 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].

J Ayu Int Med Sci 2024;9(11)314
Download PDFBack To ArticleIntroductionCase PresentationResultsDiscussionConclusionReferences
Vishal Chaudhary et al. A Journey to Wellness with Ayurvedic Urolithiasis Management

Introduction

Renal calculi, the third most prevalent urinary ailment, affect over 10% of individuals in industrialized countries. In India, the estimated prevalence is 12%, with higher rates in men aged 20-40. Kidney stone formation stems from various causes, including diet, metabolic issues, temperature, immobility, elevated urine citrate, and inadequate urine outflow. Mutrashmri, a common urinary tract ailment, aligns with Ayurvedic Ashmari concepts, representing a challenging-to-treat disease. Surgical interventions like lithotripsy, while common, are time-consuming, costly, and fail to prevent recurrence. Ayurvedic treatments offer a potentially effective alternative.

Case Presentation

A 45-year-old male from Shimla, Himachal Pradesh, working in a sedentary profession, presented with renal calculi-related symptoms for a year. Allopathic treatments provided only temporary relief. Ayurvedic intervention resulted in complete urolithiasis dissolution within one month.

Personal History

  • Marital Status: Married
  • Smoker: Absent
  • Tobacco: Absent
  • Alcohol: Absent

Family History

  • Father: Hypertension
  • Mother: No significant medical history

On Examination

  • General Condition: Fair
  • Pulse: 78/min
  • Blood Pressure: 130/90mmHg
  • SPO2: 96%
  • Respiratory Rate: 20/min
  • Pallor: Absent
  • Icterus: Absent

Asthavidh Pariksha

  • Nadi: Vata-Pitta
  • Mala: Samyak
  • Mutra: Daha
  • Jivha: Aam Yukta
  • Shabda: Prakrit
  • Sparsha: Ushna
  • Druka: Prakrit
  • Akruti: Mahaan

Samprapti Ghatak

  • Dosha: Apana Vayu, Shleshmak Kapha
  • Dushya: Shukra, Mutra
  • Srotas: Mutravaha Srotasa
  • Srotodushti: Sanga
  • Rogamarga: Abhyantar
  • Agni: Jathar Agnimandya
  • Adhishtana: Basti
  • Vyaktasthana: Mutravaha Sansthan

Nidanpanchak

  • Hetu: Katu, Amla, Lavan Rasa Atisevan, Diwaswapan, Krodh, Mutra Vegvidharan
  • Poorvaroop: Aruchi, Jwara, Aadhman, Bhrama
  • Roop: Vama Kukshishool, Sada Mutrapravritti, Saarujamutrapravritti
  • Rog Vinishchay: Pittaj Mutrashmari

Therapeutic Intervention

A dietary plan for Mutraashmari (renal calculi or kidney stones) in Ayurveda focuses on harmonizing the doshas, particularly Vata, Pitta, and Kapha, with the goal of preventing stone formation. It is crucial to consider individual variations in dietary requirements based on one's constitution (Prakriti) and the specific dosha imbalance. All three Doshas-Vata, Pitta, and Kapha-play a role in the Samprapti (pathogenesis) of Mutrashmari. Understanding the Samprapti is imperative for effective treatment, as the resolution of the Samprapti Sanghatan (pathological process) is a key aspect of Chikitsa (treatment).

Srotasa, which refers to the body channels involved in the disease process, is a significant factor in the formation of Mutrashmari. Following a Pathya diet, which is compatible with the Srotasa, becomes essential. The concept of Pathya involves consuming foods that are conducive to the proper functioning of the Srotasa, thereby preventing Srotovarodha (obstruction of channels) and, consequently, averting the development of the disease.


J Ayu Int Med Sci 2024;9(11)315
Vishal Chaudhary et al. A Journey to Wellness with Ayurvedic Urolithiasis Management

To safeguard Srotasa and prevent Mutrashmari, it is crucial to avoid factors that contribute to the causation of the disease. Additionally, incorporating foods that are in harmony with the specific Srotasa involved is instrumental in maintaining the health of the urinary system and preventing the onset of kidney stones. Individualized dietary recommendations based on Prakriti and Dosha imbalance further enhance the effectiveness of the Ayurvedic approach to managing Mutraashmari.

Medication Given

MedicationDoseTimeDuration
Bruhatyadi Kashay Tablet1 With Varunadi KwathBd1 Month
Gokhshuradi Guggulu2 With Varunadi KwathBD1 Month
Punarnavadi Guggulu2 With Varunadi KwathBD1 Month
Arogyavardhini Vati2 With Luke Warm WaterBD1 Month
Varunadi Kwath15ml+30 Ml Luke Warm WaterBD1 Month
Shweta Parpati125mg In Varunadi KwathBD1 Month

Results

SymptomsBefore TreatmentAfter Treatment
HematuriaPresentAbsent
Pain At Renal AnglePresentAbsent
Painful MicturationPresentAbsent
NauseaPresentAbsent

Non-Contrast Computed Tomography Findings

Left Kidney measures 9.3*4.7 cm with PT of 17 mm at upper pole and is normal in size outline, orientation and position. No calculus or HDN seen.

Discussion

The five components in Bruhatyadi Kashayam are Laghupanchamoola as per Acharya Vagbhata, forming part of Dashamoola. Shalparni having Madhur, Tikta Rasa Guru, Snigdha Guna, Madhur Vipaka and Ushana Veerya and Tridosha Shamaka in nature. Prishanparni having Madhura, Amla, Katu, Tikta Rasa Laghu and Sara Guna, Ushana Veeraya and Madhur Vipaka. Brihati having Katu Tikta Rasa, Laghu Ushana Tikhshana Guna, Ushana Veeraya and Katu Vipaka. Kantkari having Katu Tikta Rasa, Laghu Ushana Teekhshana Guna, Katu Vipaka and Ushana Veeraya, Kapha Vatahara in nature. Gokhshura having Madhura Rasa, Guru-Snigdha Guna, Sheeta Veerya, Madhura Vipaka, and pacifies Vata and Pitta. Bhavaprakasha highlights the properties of Laghupanchamula, including Madhura, Laghu, Ushna, Balya, Brihmana, Grahi,

Pittavatahara, which are beneficial in conditions like Jwara and Ashmari.

In Gokshuradi Guggulu, Gokshura (Tribulus terrestris) exhibits Madhura Rasa, Guru-Snigdha Guna, Sheeta Veerya, Madhura Vipaka, and pacifies Vata and Pitta. Consequently, it proves effective in various urinary tract disorders, promoting urine flow, smoothing urinary tract membranes, and aiding stone removal. Gokshura fruits are credited with diuretic and tonic properties, used in the treatment of calculus affection and painful micturition. Guggulu possesses Sukshma-Sara & Tikshana Guna, Tikta-Katu Rasa, Ushana Veerya, Katu Vipaka, and Tridoshahara properties. Due to its Tikshna Guna, Guggulu acts as Ashmari Bhedana and a diuretic. Pippali is a diuretic due to Madhura Vipaka. Maricha stimulates kidney function owing to Tikshana Guna, increasing urine volume and quantity. Musta is diuretic. Gokshuradi Gugulu contains diuretic, stimulant, and Ashmari Bhedana drugs that facilitate calculus expulsion.

Punarnavadi Guggulu, mentioned in Bhaishajya Ratnavali in Shothaadhikara, combines herbs like Punarnava (Boerhavia diffusa Linn.), Devadaru (Cedrus deodara Roxb. Loud.), Haritaki (Terminalia chebula Retz.), Guduchi (Tinospora cordifolia Willd), and Guggulu (Commiphora mukul Engl.). These components, along with Gomutra, collectively exhibit Vata Kapha Shamaka properties. Punarnavadi Guggulu acts as a Vata Kapha Shamaka with Ushna Virya, preventing calculus formation and contributing to the destruction of renal calculus.

Arogyavardhini Vati, containing Shodhit Parada having Shadrasa Tridoshanashak, Snigdha, Shodhit Gandhaka having Katu Rasa Ushna Veeraya and Sara Guna, Loha Bhasma having Tikta, Kashaya Rasa, Sheeta Veeraya, Madhura Vipaka, Kapha Pitta Shamaka and Ruksha, Guru Guna.

Abhraka Bhasma having Madhura, Kashaya Rasa Sheeta Veeraya, Madhura Vipaka, Kapha Vata Shamaka and Snigdha Guna. Tamra Bhasma having Tikta, Kashaya, Madhura Rasa, Ushna Veeraya Katu Vipaka and Kapha Pittaghna Teekshna, Ushna, Snigdha Guna. Shodhit Shilajatu having Katu, Tikta Rasa Ushna Veeraya, Katu Vipaka Guru, Snigdha Guna. Shodhit Guggulu having Katu Rasa Ushna Veeraya Katu Vipaka Kapha Vataghna, Pittashodhak and Laghu, Vishada, Snigdha Guna.


J Ayu Int Med Sci 2024;9(11)316
Vishal Chaudhary et al. A Journey to Wellness with Ayurvedic Urolithiasis Management

Haritaki Kashaya Pradhana Ushna Veeraya Madhura Vipaka Tridoshaghna and Laghu, Ruksha Guna. Amalaki is Amla Pradhana Sheeta Veeraya Madhura Vipaka, Tridoshghna having Laghu, Ruksha Guna. Katuki having Tikta Rasa Sheeta Veeraya, Katu Vipaka, Kaphapittaghna and Laghu, Ruksha Guna in nature. Chitrak having Katu Rasa Ushna Veeraya, Katu Vipaka Vatakapha Shamak and Teekshna Guna. Nimba Patra having Tikta, Kashaya Rasa Sheeta Veeraya, Katu Vipaka, Kapha Pitta Shamaka and Laghu in nature. All in one with Katu Tikta Rasa and Chedana properties, incorporates Shilajatu and Tamra Bhasam as major components. These components possess Chedana properties, contributing to the dissolution of renal calculi.

Varunadi Kwath includes Varuna, Gokshura, Shunthi, and Yavakshara. It exhibits Chedana, Bhedana, Lekhana, Tridoshaghna, Mutrala, Anulomana, and Krimighna properties. The Kaphavataghna property of Varunadi Kashaya aids in breaking down the pathogenesis of Ashmari and granthi. The bark of Varuna contains saponin and tannin, making it demulcent, diuretic, tonic, and useful in calculus affections and urinary disorders. Yavakshara, with pH 11.73, neutralizes acidic media and prevents calculus formation. Its Ruksha, Laghu, Teekshna, and Shigragami properties reduce stone growth and favor its breakdown.

Shweta Parpati, containing Surya Khsar and Sphatika, exhibits Kashay, Amla Rasa, Guru, Snigdha, Tiksna Guna, Ushna Virya, Madhur Vipaka, Mootral, Agnivardhak properties. Navsadar Lavan, present in Shweta Parpati, has Amla Rasa, Snigdha, Sukshma, Laghu Guna, Ushna Virya, and Tridoshaghana properties. Surya Khsar has Bhedana, Bastishodhana, Ashmarighna, Mutravirechaniya Karma, and Sphatika exhibits Mutrala, Pachana Karmas. Shweta Parpati, with these properties, demonstrates its action against Ashmari.

Conclusion

Ayurveda, through its holistic approach, successfully managed the presented case of Ashmari, demonstrating that small-sized calculi can be effectively treated without resorting to surgery. Regular Ayurvedic Shamana treatment should be explored before opting for surgery, aligning with Aacharya Sushruta's recommendations.

Patient Perspective

The patient was satisfied with the treatment. His Non contrast computed tomography finding reports show drastic change with complete dissolution of stone within 1 month of treatment and complete relief from all the symptoms.

References

1. Chaithra G. T and Radhika Ranjan Geethesh P. An outlook on the role of Brihatyadi Kwatha in Mutrakrichra. Int. J. Res. Ayurveda Pharm. 2019;10(6):4-5 http://dx.doi.org/10.7897/2277-4343.1006113

2. Aaditya B. Shah, Poonam Mohod, V C Deep, Gopesh Kumar Sharma. Mutrashmari (Urolithiasis): A case successfully treated with Gokshuradi Guggulu. InternationalJournal of Ayurveda and Pharma Research. 2020;8(3):76-78

3. Sushruta Samhita- Ayurveda Tattava-Sandipika Hindi commentary by Kavi Raj Ambica Dutt Shastri.

4. Agnivesh Charak Samhita edited by Acharya Vidyadhara Shukla and Ravidatta tripathi Chaukhamba Sanskrit pratishthan, Delhi, Chikitsa Sthan, 630: 26-36.

5. Shrimad Vagbhat, AshtangHrudaya edited by Brahmanand Tripathi, Chaukhamba Sanskrit Pratishthan Delhi, Nidansthan, 2015; 14: 489-490

6. Bulusu Sitaram. BhavaPrakasa. 1st Guduchyadi Varga Chapter No. 6, Verse No. 15-16, Chukhambha Orientalia. P. 251

Disclaimer / Publisher's NoteThe statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.


J Ayu Int Med Sci 2024;9(11)317