Transcript The concept of Urolithiasis in Ayurveda

3rd International Conference and Exhibition on
Traditional & Alternative Medicine
August 03-05, 2015 Birmingham, UK
In Association with
Presented By
Name: Dr. Prathamesh V. Karpe BAMS, MS (shalyatantra)
Country: INDIA
By Dr. Prathamesh V. Karpe
BAMS, MS (shalyatantra)
Consulting surgeon and Lecturer in Dept of shalyatantra
Gomantak Ayurveda mahavidyalaya & Research centre, Shiroda
Goa- India
“Stones are precious but not in the
body”
What is Urolothiasis
 It is commonly known as kidney stone or urinary stone
 In sanskrit it is known as “Ashmari”
 In India, the “stone belt” occupies some parts of
Maharashtra, Gujarat, Punjab, Haryana, Delhi and
Rajasthan
तल्
ु यतामश्मना यान्तत तस्मात्ताश्मरी विदुःु /
(tulyataamshmana yaanti tasmaatashmari vidu)
Ashmari or calculus looks like small gravels/stones hence
they are termed as ashmari
What are its causes
तत्र संशोधनशीलस्यापथ्यकाररणुः प्रकुवपतुःश्लेष्मा
मत्र
ू सम्प्प्रक्
ु तोsनप्र
ु विश्य बन्स्तमश्मरी जनयतत//
(स.ु तन.४)
2. विशोषयेद् बन्स्तगतं सशुक्रं मत्र
ू ं सवपत्तं पिनं कफ़ं िा/
यदा तदाsश्मयप
ु जायते तु क्रमेण वपत्तेन्ष्िि रोचना गोुः//
1.
(च.चच.३६)
Due to improper purification of the body and by following
the improper diet and lifestyle, kapha dosha gets vitiated in
the urine and reaches in the basti to form ashmari.
According to charakacharya- the shukra dhatu in the basti
gets dried up along with Pitta or Kapha dosha by Vata
forms Ashmari like how Gorochana forms in Gallbladder of
cow.
Pathogenesis- samprapti
एिमेि प्रिेशन
े िातुः वपत्तुः कफ़ोsवप िा/ मुत्रयक्
ु त
उपस्नेहात ् प्रविश्य कुरुतेsश्मरीम ्//
Vata-Pitta-kapha dosha enters into basti like how mutra
enters into basti from Pakwashaya and with
Upasneha nyaya Ashamari is formed in Basti.
1.
अप्सु स्िच्छास्िवप यथा तनवषक्तासु निे घटे /
कालाततरे ण पंकुः स्यादश्मरीसम्प्भिस्तथा//
(सु.तन.२४-२६)
When clear water is placed in a new mud pot, after
sometimes some particles precipitates into the water,
similarly in the basti ashmari develops- this explains
the stagnation of the urine in the bladder due to
bladder outlet obstruction like BPH etc can form
calculus in the bladder.
1.
 संहत्यपो यथा ददव्या मारुतोsन्ननश्र्च िैद्यत
ु ुः/ तव्दद्बलासं
बन्स्तस्थमष्ू मा संहन्तत सातनलुः/
It explains the crystallization process- when dry air along
with the static electricity in the clouds forms the
crystalls of water present in the cloud, similarly
ashmari develops.
Purvaroopa
तासां पि
ु पाणण- बन्स्तवपडारोचकौ मत्र
ू रु
ु क्रुच्छं
बन्स्तशशरोमुष्कशेफ़सां िेदना ज्िरुः क्रुच्छािसादौ
बस्तगन्तध्िं मत्र
ू स्येतत //
Pain and discomfort in the bladder,
urethra,testicles/external genital organs.
Anorexia, dysuria, fever, debility, smell of goat’s
urine.
Colour of urine appears like that of individual
doshas and pain accordingly.
urine appears non-clear, increased specific gravity.
Types
Kaphaja
2. Vataja
3. Pittaja
4. shukraja
1.
Samanya lakshana
 Pain in the umbilicus,bladder, perineum, external




genitals eithr in any one of them while passing urine.
Obstruction to the urine stream
Hematuria
Urine appears clear as Gomeda or some crystals can be
seen in urine.
Discomfort or pain while performing the activities like
running, swimming, hanging, swimming,riding on
back of horse,camel.
Vataja Ashmari
 Vata and kapha dosha after combining together
obstructs the urine and causes pain as a result
person bites his teeth, presses navel, external
genitals,anus and shouts due to pain.
 Has to pass urine after putting force.
 The ashmari formed is Shyava, hard,
irregular,rough, it contains thorny structures like
of kadamba Pushpa.
Pittaja Ashmari
 Kapha dosha along with Pitta dosha attends
compactness and obstructs the urine and produces
discomfort like burning sensation in the bastimedhra, feeling of hot air coming out of bladder.
 Ashmari appears like red,yellow, dark in colour
and appears like seed of Bhallataka
Kaphaja ashmari
 The Kapha dosha attends compactness and
increases in size and obstructs the urine and
produces features like tearing type of pain in
bladder, heaviness in the bladder and feeling of
cold.
 Ashmari appears like hen’s egg, pale-white colour,
unctous to touch, large in size and like madhuka
flower.
kukkutanda
Madhuka pushpa
Shukrashmari
 Causes = shukraveghdharan or excessive coitus.
 The vitiated vata causes vimargagaman of shukra into
medhra or vrushana and after drying it up forms the
shukrashmari.
 The resultant ashmari obstructs flow of urine and
causes dysuria, pain in bladder and external genitals,
oedema in legs.
 On pressing the ashmari it gets broken into pieces
easily.
Ashmari in children
 Due to kapha avastha more chances of forming




ashmari
Occurs in those children who follows life style and diet
which increases and vitiates kapha
Ashmari can be of any 3 doshas
Due to thin bladder wall and under developing basti,
ashmari is small in size and can be easily removed with
instruments
Due to non development of shukra dhatu, there are no
chances of forming shukrashmari
chikitsa
 Newly formed ashmari can be treated with medicines
 Chronic- surgical removal
Medicinal treatment
 Vataja ashmari-
pashanbheda,vasuka,shatavari,gokshura,bhruhati,
kantakari etc drugs should be used in form of kshaar,
yavagu,kwatha,milk,food etc.
 Pittaja- kusha-kasha-sara-gundra-itkatamorata(sugarcane root),pashanbhedh,vidaarivarahkandashaalimoola,gokshura,shyonaka,punarnava,shirisha,lo
tus seed, evaru(cucumber) etc
 Kaphaja ashmari- varunadi gana,guggulu,ela,kushtha,
devdaru,haridra,maricha,chitraka etc drugs in form of
kshar, peya,kshira,yavagu,kwatha.
 Kshara prepared from tila,apamarga,kadali,palasha
and yava kalka with sheep’s urine prevents sharkara
formation
 Use of Ghrita, Kshara,kashaya, kshira and Uttarbasti
are advised.
 If no relief with above medications then surgical
extraction of calculus should be performed.
Surgical extraction
 Purvakarma- consent from the king, snehan-swedan-
vaman-virechana, food should be given to the patient.
 Mangala-swastik vachan
 Collection all required instruments and medicines
required during surgery
Pradhana karma
 This technique is Perineal Vesicolithotomy
 Position is lithotomy postion, head resting in lap of
attendant
 Sneh is applied on nabhi and pressure massaging in done
on left lateral region till ashmari decends into Basti.
 Lubricated middle and index finger is inserted into anal
canal of the patient.
 Calculus is then pushed with those fingers in upward
direction towards in between guda and external genital.
Ashmari can be seen as nodule
 While performing this procedure if patient becomes
unconscious or goes into shock, in such condition
procedure should be hold and extraction shouldn’t be
done.
 Site of incision- vamaParshwa (left lateral) 1
yava(grain) distance from the sevani(perineal raphe).
Incision should be adequate to remove stone
 While extracting the calculus, it should be brought out
without crushing it. Otherwise it can cause
recurrence.
 Instrument used is अग्रिक्र आहारण यतत्र (curved
forcep)
 In case of female – uterus should be protected,
incision should not be too deep otherwise it causes
vrana through which urine oozes out.
 Avoid damaging important structures like
mutravaha,shukravaha,mutrapraseka,sevani,
yoni,guda,basti.

1.
2.
3.
4.
5.
6.
Damage toMutravaha srotas and Basti-death due to
extavasation of urine
Shukravaha srotas-death or infertility
Mushkasrot- dhwajabhanga (erectile dysfunction)
Mutraprasek- vesical fistula urine discharge
Sevni and yoni- severe pain
Guda and basti- death
Paschat karma
 Patient should be kept in hot water tub, this prevents
collection of blood in bladder.
 If blood gets collected in bladder then Uttarbasti of
kshirvruksha kwatha should be administered, it
removes the collected blood out of bladder (bladder
wash)
 For mutramargavishodhana – rice mixed with jaggery
should be given.
 After removing from tub, apply honey+ghrita on the
incision wound
 For diuresis- trunapanchamoola,gokshura etc drugs in





the form of yavagu is given 2-3 times a day.
For rakta-mutra shodhan and vrana kledanarthajaggery mixed milk along with cooked rice is given in
small quantity for 10 days.
After 10 days- sour fruit like dadima and jangala
mamsa rasa is given.
Carefully snehan and drava swedan is performed.
Clean wound with kshiravruksha decoction.
Apply lepa of
rodhra,madhuka,manjishtha,prapaundarika kalka
 If urine doesn’t come through its normal route and
comes out from incision site (vrana), then it should be
thermally cauterized ( agnikarma).
 After urine comes out via normal route, uttarbasti,
anuvasan and niruha basti are given prepared from
kakolyadi gana or Kshiravrukshadi gana.
 Obstructed shukrashmari or sharkara should be
removed with badisha yantra
 Avoid coitus, horse-elephant-camel ride, climbing
mountain, riding chariots, swimming, heavy to
digest food for 1 year after healing of the wound.
Commonly used medicines in
treatment of Ashmari
Eranda
Kantakari
Gokshura
Ikshumoola
Apamarga
Shatavari
Brihati
Yava
kulattha
Above all drugs with sweet curd helps in breaking of Vataja
ashmari
1.
2.
3.
4.
5.
6.
7.
8.
9.












Kusha
Kasha
Shara
Pashanbheda
Darbha
Vidarikanda
Varahikanda
Shalimoola
Gokshura
Patha
Punarnava
Shirisha
Above drugs either in decoction of medicated ghee helps in
breaking the pittaja ashmari
Treatment of kaphaja ashmari
 Drugs from Viratarvadi gana
 Varunadi gana
 Mushakadi gana
The medicated ghee prepeared with either one of the
group along with guggulu, maricha, kushta,chitrak.
Also various types of kshar (alkalies), kshira(medicated
milk), yavagu(gruels) are used in the treatment.
Formulations used
1.
2.
3.
4.
5.
6.
7.
Suvarnarajvangeshwar rasa
Gokshuradi guggulu
Badarashma pishti
Sangehyahud bhasma
Yavak kshar
Apamarga kshar
Shwetaparpati
Panchakarma
 Before starting any formulations first purification of
the body should be performed depending on doshic
dominances
 Vaman (kapha dominant)
 Virechana (pitta dominant)
 Niruha Basti (vata dominant)
To do- pathya
 What to eat?
 Yava
 Kulattha
 Purana shali
 Purana kushmaand phala
 Shighru
Things to do
 Avagaha sweda
 Seasonal purification-vaman,virechan,basti
not to do
 Holding of natural urges like urine/faecal
 Foods which causes indigestion- acidic in nature
 Stale food
 Aerated drinks
 Incompatible food
 Dry food
Case presentation
A male 48years old came to the shalya OPD of the
GAM&RC Goa with recurrent pain in lower abdomen
shifting to the groin along with burning micturation and
nausea.
He is Truck driver by profession.
He was diagnosed with bilateral renal calculus at J&K by
private GP and was referred to urologist for sugrical
treatment.
He was not having any history of other major illness.
O/e all vitals were stable.
Nadi parikshan- Vata kapha
Prakruti- Kaphapradhan pittanubandi
Eyes-NAD
Tongue- saam (coated)
Mala- constipated
Mutra- burning micturation
Akruti- thin
Srotas- annavaha sroto and mutravaha srotodushti
USG abdomen on 19/2/14 showed 7 calculi in the left
kidney, two in the middle calyx 3mm & 2nd 4mm,
Three in the inferior calyx- 1st 3mm, 2nd 4mm & 3rd 4.3mm
and two in the superior calyx 1st is 5mm and 2nd 6mm in
size.
Six calculi in right kidneyTwo in middle calyx- 6.5mm and 4mm in size
Two in the inferior calyx- 5.7mm and 5mm in size
 Kidney function test was normal
 Urine analysis revealed oxalate crystals along with
increased pus cells and cast cells
 Ayurvediya diagnosis- Mutrashmari- Vata-kaphaja
Treatment
1) Ama pachan
2) Agni dipana
3) Vata-anuloman
4) Ashmari bhedan
5) Mutra virechana
 Drugs used
1) Combination of
gokshura+erandamoola+pashanbheda+punarnava+s
hatavari+chitraka+haritaki in the decoction form
40ml two times a day before meals
2) Yavakshar 200mg along with above decoction
3) Gandharva haritaki 2gm at night time with hot water
4)Pathya was advised
Post treatment USG
Date- 24/9/2014
Left kidney shows 5mm calculus in the middlecalyx &
3mm calculus in inferior calyx and 2.5mm in superior
calyx
Right kidney shows 4mm calculus in the middle calyx &
2mm calculus in inferior calyx and 5 mm in superior
calyx
Traditional Medicine-2016
Website: http://traditionalmedicine.conferenceseries.com/