Critical view on nidhana panchaka in understanding of mutra ashmari

1. 22-11-2015 1

2. CRITICAL VIEW ON
NIDANA PANCHAKA
IN UNDERSTANDING OF
MUTRAASHMARI
22-11-2015 2

3. NEED OF THIS TOPIC ???
22-11-2015 3

4. The manifestation of any disease is described in
five steps in Ayurveda these are
1. Nidana
2. Purvarupa
3. Rupa
4. Upashaya
5. Samprapti
They helps the physician/surgeon to reach at a
proper diagnosis (A. H. Ni. 1/2).
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5. In the present era, persons are going away from
the nature and inviting many diseases in the
early stage of their life due to disturbed lifestyle
and Ashmari is one of them.
Ashmari is a grave disease so that it is included
in Astamahagada. It is not easily curable.
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6. The highest incidence of calculi occurs between
the age of 30 to 50 years, Male are more sufferers
than female. The male and female ratio is 3:1
The recurrence rate of Ashmari approximately
50% within 5 years.
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7. 22-11-2015 7

8. MUTRA NIRMANA PRAKRIYA
AHARA
AGNI
PRASADA KITTA
NOURISHMENT SAANDRA DRAVA
PURISHA MUTRA
BASTI
SU.NI.3/21-22
Pakvashaya and Amashaya are the chief organs
where Mutra is formed and then it comes into
Basti. Urine carrying channels saturate urine to
bladder as rivers do for the sea.22-11-2015 8

9. DEFINITION:
• अश्मन: समानाां अश्मरी माहु:
• तुल्यताां अश्मना याांतत तस्मात्ाां अश्मरीां विदु: Gayadasa,
Su.Ni.3/7
• Ashmari are the structures like hard stone
MUTRASHMARI:
• This disease is classified on the basis of signs and
symptoms as well as morphology of stone that are
formed in different part of Mutravahasrotas
• Tridoshaja vyadhi, kapha dosha takes important part in22-11-2015 9

10. &
22-11-2015 10

11. According to Charaka
 अतत व्यायामात्
रूक्ष आहार
मद्य सेवन
आनूपमाांस सेिन
मत्सस्या सेिन
अध्यशन
अजीर्ण
मूत्रिेगािरोध
Cha.Chi.26 VA.NI.9
According to Vaagbhata
स्ननग्ध आहार सेवन
अध्यशन
अजीर्ण
मधुर आहार
स्िवानवप्न
मूत्रिेगािरोध
22-11-2015 11

12. ACCORDING TO SUSRUTA
उष्र् गमन / घमणगमन
अध्िगमन/ दीघणमागण गमन
प्रायेर् शीत स्स्नग्ध गुरु मधुर आहार
अध्यशन/ समशन
 ददिास्िप्न
अपथ्य काररर्
SU.NI.3
22-11-2015 12

13. उष्र् गमन /घमणगमन
अध्िगमन/ दीघणमागण गमन
The vitiated Vata dries up the Mutra in Mutravaha Srotas, so
that the Kapha present in the Mutra attains the form of
Ashmari
The Vishoshana of Mutra refers to reduction in the volume
of urine, therefore the Kapha present in the Mutra is
supersaturated thus it helps in the formation of Ashmari
विशोषयेत् बस्स्तगतां मूत्रां – िायुना मूत्रशोषे क्रियामार्ो तद् गत: कफ
एिाश्मरररुप: क्रियते CP Cha.Chi.26/36
22-11-2015 13

14. प्रायेर् शीत स्स्नग्ध गुरु मधुर आहार;
अध्यशन, समशन, ददिास्िप्न
The word प्रायेर् explains that Kapha provoking factors
cause Ashmari only in those individuals who are
susceptible to it
 Excessive intake of Guru, Sheeta, Snigdha, Madhura
Ahara, irregular food habits, day sleep etc. may increase
Kapha leading to formation of Ashmari.
22-11-2015 14
CONT…..

15.  The predominant Kapha get hard and grows in the form
of Ashmari
 Vitiated Sleshma enters into Mutravaha Srotas along with
the Mutra the Ashmari is formed in urinary system
 Kapha is Samavayi Kaarana of Ashmari, because Kapha
posses Prithwi Tatwa in it, that helps in hardening of
Ashmari. Here Kapha refers to solutes present in the
urine
श्लेष्मा सांघातमुपगम्य पररव्रुद््धां प्रास्प्त Su.Ni.3/9
श्लेष्मा मूत्रसांप्रक्तो अनुप्रविष्य बस्स्तमश्मरीम् जनयस्तत
Dalhana
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16. अपथ्य काररर्
Due to Apathya-Sevana
Agnimandya and vitiation of Doshas occurred
which are responsible for Srotorodha
ultimately held responsible for improper
evacuation of the Mala
Thus they are deposited in the pathway of
urinary excretory systems leading to Ashmari.
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17. अङ्गभङ्गाश्मरीबस्स्तमेढ्रिांक्षर्िेदनााः||
मूत्रस्य रोधात्सपूिे च प्रायो रोगााः------
AH.SU.4/4
बस्स्तमेहनयोाः शूलां मूत्रकृ च्छ्रां शशरोरुजा|
विनामो िङ्क्षर्ानाहाः स्यास्ल्लङ्गां मूत्रतन्रहहे||
CH.SU.7/6
मूत्रिेगािरोध
22-11-2015 17
CONTD…..

18. Urination is normal, when movement of Vata (Anuloma
Gati) is normal in “Mutravaha Srotasa” (urinary system),
but when the abnormal movement of Vata (Pratiloma Gati)
is present, stagnation of urine in the system takes place.
Through urine the stone forming Dosha – Vata, Pitta and
Kapha comes in the system. The process of “Aņu
Pravesha” (diffusion layer wise) takes place in the
stagnated urine. Doshas with cementing substances
forms urinary stone of that particular dosha (Su. Ni. 3).
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19. • Sushruta's examples for clear understanding of the
mechanism of Ashmari formation :-
• i. A new pitcher filled with clear water can also show
settling down of muddy particles in due course of time. In
the same way the calculi are formed in Basti. (Su. Ni.
3/25)
• ii. As wind & atmospheric heat solidifies rain water (to
form hailstone) similarly Pitta located in the bladder,
along with Vayu solidifies Kapha to form calculi. (Su. Ni.
3/26)
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20. 22-11-2015 20
NIDANA
VITIATION OF KAPHA DOSHA
REACHES TO MUTRAVAHA SROTAS
WITH THE HELP OF VATA AND PITTA ,
DRIES UP OF KAPHA DOSHA
ASHMARI
SAMPRATI

21. SANCHAYA Vaata Kapha
Aahaaraja & Vihaaraja
PRAKOPA Vaata+Kapha
PRASARA
STHANA
SAMSRAYA
VYAKTHA Ashmari nirmana
BEDHA Upadrava
Mootra Sharkaraa
Sikataameha
Agnimaandy
a
Aamotpatti
Vaata+Kapha+Aama
Enters into
Mutravaha Srotas
Dosha
Dooshya
Sammoorchana
a
Vata
driesup
Kapha present in
the urine attains
the form of
Ashmari
22-11-2015 21

22. NIDAANA Kapha, Vaata Prakopaka
DOSHA Kapha Pradhaana Tridosha
DOOSHYA Mootra
SROTASA Mootravaha
SROTODUSHTI Sanga
AGNI Jatharaagnimaandya
DOSHA MAARGA Koshtha, Shaakha
ROGA MAARGA Aabhyaantara
UDBHAVA STHAANA Pakvaashaya (Apaana Kshetra)
ADHISHTHAANA Basti (Mootravaha Srotasa)22-11-2015 22

23. 22-11-2015 23

24. P
K
S
V
M.NI.32/1
चतस्रोऽश्मयो भिस्तत; श्लेष्मा्धष्ठानााः;
तद्यथा- श्लेष्मर्ा, िातेन, वपत्ेन, शुिे र् चेतत
SU.NI.3/3
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25. 22-11-2015 25

26. Distention of bladder due to retention of urine
(बस्त्सयाध्मानम्)
Severe pain at site of Ashmari (आसतनदेश रुज)
Difficulty in micturation due to irritation(मूत्रकृ र)
Sedimentation of urine(दुष्टसातर मूत्रता)
Turbidity of urine(आविल मूत्रता)
The concentrated urine smells like goat’s urine
(बस्तगांधत्सिम्)
Fever is indication of UTI due to Renal stone (ज्िर)
VA.NI.9/8
SU.NI.3/5
22-11-2015 26
THE POORVARUPAS MENTIONED IN CLASSICS ARE
ALSO OBSERVED IN RUPAVASTHA OF ASHMARI

27. 22-11-2015 27

28. नाशभबस्स्तसेिनीमेहनेष्ितयतमस्स्मन ् मेहतो िेदना
मूत्रधारासङ्गाः
सरु्धरमूत्रता
मूत्रविक्रकरर्ां
सशसकतां विसृजतत;
धािनलङ्घनप्लिनपृष्ठयानोष्र्ाध्िगमनैश्चास्यिेदनाभिस्तत
SU.NI.3/6
22-11-2015 28

29. 22-11-2015 29

30. KAPHAJA ASHMARI
• शुक्लिर्ण, महतत
• कु क्कु टाांड प्रततकाशाMORPHOLOGY
• Dull and constant ache
• Pricking & Pulling
• Heaviness
SYMPTOMS
SU.NI.3 VA.NI.9
22-11-2015 30

31. 22-11-2015 31

32. 22-11-2015 32

33. 22-11-2015 33

34. Patient (29/F, housewife, 011677). One day suddenly she
noticed dull and fixed pain in Abdomen - left flank region
Anteriorly and left renal angle Posteriorly.
1.SPREAD ALONG SUBCOASTAL AREA TOWARDS THE
UMBLICUS CORRESPONDING LEFT
HYPOCHONDRIC,LUMBAR REGION ANTERIORLY.
2.RENAL ANGLE POSTERIORLY MEANS ANGLE FORMED
BETWEEN OUTER BORDER OF ERECTOR SPINAE MUSCLE
AND LOWER BORDER OF 12TH RIB)
1
O/E Tenderness present in left
hypochondrium and lumbar
region
NIDANA:
Less in take of water
Day sleep
Sedentary life
Non- veg weekly twice
22-11-2015 34

35. 22-11-2015 35

36. 22-11-2015 36

37. Patient (29/M, Clerk, 030709). One day suddenly he noticed
dull and fixed pain in Abdomen – B/L flank region
Anteriorly and B/L renal angle Posteriorly.
NIDANA:
Day sleep
Sedentry life
Nonveg weekly twice
22-11-2015 37

38. 22-11-2015 38

39. 22-11-2015 39

40. VAATAJA ASHMARI
• श्यािारुर्ा, कां टका्चतम ्,
परुषम ्, विषमां, खर-कदठन,
• कदांब पुष्पित्
MORPHOLOGY
• नाशभ, मेहन, गुद शुल
• तीव्र िेदन
• बबांदु बबांदु मूत्रयतत(अ.ह्र्.तन.९)
SYMPTOMS
SU.NI.3
22-11-2015 40

41. 22-11-2015 41

42. Ureter
Ureter has 3 constrictions:
1.Uretro pelvic junction
22-11-2015 42
2.When it crosses external iliac
vessel
3.Vesico-ureteric junction

43.  When a stone is enters into ureter or obstructed in
ureter (constrictions) , ureteric pain occurs. The pain is
very severe and colicky; it is caused due to
hyperperistalisis and violent contraction of smooth
muscles of ureter
 The referred pain occurs due to common innervations of
upper ureter and testis, and lower ureter and inner side
of upper part of thigh.
22-11-2015 43

44. 22-11-2015 44

45. Patient (35/M, farmer, 027710). One day suddenly he
noticed severe colicky pain in right lumbar region.
Micturition is normal
O/E Tenderness present in right lumbar and umbilical
region
NIDANA:
Less in take of water
Working in hot sun
Walking longer distance
Excess intake of sweet items
VAATAJA ASHMARI22-11-2015 45

46. 22-11-2015 46

47. 22-11-2015 47

48. Patient (34/M, business, 087942). One day suddenly he
noticed severe radiating pain from right lumbar region to
supra- pubic region.
O/E Tenderness present in umbilical region
NIDANA:
Sedentary life
Less intake of water
Non- veg ..Weekly thrice
VAATAJA ASHMARI22-11-2015 48

49. 22-11-2015 49

50. 22-11-2015 50

51. Patient (45/F, Housewife, 033403). One day suddenly She
noticed severe radiating pain from right lumbar region to
thigh and labia majora.
O/E Tenderness present in hypo- gastric region
NIDANA:
Day sleep
Less intake of water
Non- veg Weekly twice
Oily foods
VAATAJA ASHMARI22-11-2015 51

52. 22-11-2015 52

53. 22-11-2015 53

54. PITTAJA ASHMARI
• सरक्ता, िु ष्र्ा, पीता,
मधुिर्ाण
• भल्लातक प्रततमा
MORPHOLOGY
• वपत्ेन दह्यते बस्स्त
• दह्यते, पच्छ्यते, दूष्यतेइिा
िेदना
SYMPTOMS
SU.NI.3
22-11-2015 54

55. 22-11-2015 55

56. Patient (54/M, Farmer) was Asymptomatic 1month ago.
One day he noticed sucking type of pain and burning
sensation in supra- pubic region
NIDANA
Work in hot sun
Less intake of water
Raagi mudde
Non- veg and alcohol
USG ABDOMEN:
4/3/15-
IMPRESSIONS
8mm Calculi in urinary bladde
Kidney size normal
PITTAJA ASHMARI22-11-2015 56

57. SHUKRA ASHMARI
 After the formation of Semen if Sukra Vega is
supressed, instead of expelling out it gets vimarga
gamana and lodged in between Vrushana and Medra.
 At this stage Vata dries up the sukra and stone is
formed.
 There is pain in Supra- pubic region, difficulty in
micturition and swelling in scrotum.
 when Sukra is expelled out the Ashmari is relieved.
22-11-2015 57

58. 22-11-2015 58

59. Urinary ph. is valuable clue to the cause of the possible
stone.
Normal-5.85
Uric acid-below 5.0
Phosphate-above 6.0
Renal Ultra Sound Examination will diagnose most
stones
KUB X-ray
22-11-2015 59

60. Kidney
Transverse process of
lumbar
vertebrae (landmark for
Ureter)
Bladder
Psoas shadow
22-11-2015 60

61. 22-11-2015 61

62. 22-11-2015 62

63. The factors which relieve the signs and symptoms of
disease are called Upashaya, while the factors which
aggravate the disease are called Anupshaya.
None of the Ayurvedic texts have mentioned about
Upashaya-Anupashaya in relation to Mutra Ashmari.
But main factor involved in Ashmari formation is Vata &
Kapha Dosha.
Hence, all the measures leading to control of Vata & Kapha
are considered as Upashaya and those which vitiate Vata &
Kapha are Anupashaya of Ashmari.
22-11-2015 63

64. 22-11-2015 64

65. PATHYA
• Kulattha
• Godhuma
• Yava
• Tanduleeya
• Ardraka
• Mudga
• Jeerna shali
• Jeerna kushmanda
phala
• Yavakshara
• Jalasevan
APATHYA
• Shushkahara-
Rukshahara
• Pishtanna
• Kapittha
• Jambu
• Kashaya rasa sevana
• Athivyayama
• Vegadharana
• Pravatasevana
• Arkatapa
22-11-2015 65

66. ASADHYA LAKSHANA
प्रशून नास्ि वृषण
Swelling in scrotum and umbilical region
बद्ध मूत्र
Obstruction in the channel of urinary system
अश्मरी स्सकता शकक रास्ववता
The patient of Ashmari passes gravels with the
urine
M.NI.32/1722-11-2015 66

67. UPADRAVA
उष्णवात Burning sensation in Basti, Medra, Guda
with passing of yellow or red coloured urine the
symptoms of Ushnavata are similar to that of
caliculi with cystitis
काश््क Kidney stone may give rise to wasting of
muscle
पाांडुता Kidney stone may leads to anaemia
M.NI.32/15-1622-11-2015 67

68. ARISTA LAKSHANA
Swelling in the scrotum, obstruction of urine due
to renal stone and severe pain are considered as
Arista Lakshana of Ashmari
V.SH.5/8422-11-2015 68

69. Signs Symptoms Mechanism
Generalized
oedema
Swelling Water retention due to a loss of GFR
leading to sodium and fluid
retention.
Anaemia
पाांडुता
Fatigue,
reduced
exercise
capacity,
and pallor
Erythropoietin (EPO), the major
erythropoiesis stimulator, is released
from the kidneys; with renal failure,
there is loss of EPO release.
Weight loss
काश््ण
Loss of lean
body mass
Protein-energy malnutrition due to
metabolic acidosis. Loss of kidney
function results in impaired H+
secretion from the body.
22-11-2015 69

70. 22-11-2015 70

71. DIAGNOSIS OF URINARY CALCULUS - AN AYURVEDIC PERSPECTIVE
Thameem Mohammed, Hemantha Kumar P, Rao P. N.
Dept. of Shalya Tantra, S. D. M. College of Ayurveda and Hospital,
Hassan, Karnataka
CONCLUSION
The explanations given by the authoritative texts of Ayurveda can
be converted into standard norms for the diagnosis of Ashmari
with the help of modern science.
By comparing the external appearance, symptoms of Ashmari
with renal calculus we find that both are similar.
By this comparison we may conclude that Vataja Ashmari is
calcium
Oxalate calculus, Pittaja Ashmari is uric acid calculus, Kaphaja
Ashmari is phosphatic calculus.22-11-2015 71
IAMJ: Volume 1; Issue 3; May – June 2013

72. A CONCEPTUAL PATHO-CLINICAL STUDY ON THE DISORDER OF
MUTRABAHA SROTAS W. S. R. TO MUTR ASHMARI (UROLITHIASIS)
Mutrashmari is one of the important diseases of Mutrabaha
Srotas.
This may caused due to the intake of adulterated food and
polluted water.
So, it becomes important to know the details about this disease
in terms of Nidana, Samprapti, lakshanas , Upadrava, Sadhya-
sadhyata and chikitsa of this disease, in order to treat or
prevent the disease.
Described details about this disease both in Ayurvedic as well
as modern view and interpreted each other.
22-11-2015 72
Available online at : http://ijapr.in

73. 22-11-2015 73

74.  Ashmari is a highly prevalent condition with a high
recurrence rate and it has a large impact on the quality
of life.
 Tridoshaja vyadhi, kapha dosha takes important part in
hardening the Ashmari and vata dries up the urine along
with kapha
 Variation in structure and function of kidney, ureter and
bladder the symptoms of Ashmari vary in its
presentation.
22-11-2015 74

75.  Stone present in the Kidney may not have severe pain,
however dull, constant ache fixed to renal angle.
 Stone start descending from Kidney to ureter, due to its
narrow passage, stone is arrested in ureter and sudden
severe colicky pain occurs in abdomen, which is
radiating from loin to groin.
 Stone reaches U.B – burning, sucking type of pain in
supra- pubic region.
K
V
P22-11-2015 75

76.  Morphology of stone is not useful in clinical diagnosis,
but Ashmari diagnosis depends on lakshinika
 Upadravas, Asadhya and arista Lakshanas of Ashmari
are similar to Chronic renal failure
 For prevention of Ashmari like adopting of
Pathyaahara, Jalasevana may be recommended in
routine life.
22-11-2015 76

77. REFERENCES
 Su.Ni.3
 Cha.Chi.26
 A.H.Ni.9
 A.S.Ni.9
 M.Ni.32
22-11-2015 77

78. THANAK U
“If one obeys Pathya, no disease will occur and
if one never mind them and continues Apathya,
no treatment is needed, as it is not going to be
cured”
THANK U DOCTORS22-11-2015 78