A brief description of urolithiasis (mutra ashmari ) as per ayurveda and modern

1. Syndicate JC Presentation
Mutrashmari (Urolithiasis)
Presenter-
Dr. Twinkle Joshi

2. Introduction
• Mootrashmari is a disease of mootravah srotas.
• It is considered as one amongst Ashtamahagad (eight most deadly
diseases).
Charak chikitsa 26
Sushrut Nidan 3, Chikitsa 7
Ashtang Hridaya Nidan 9, Chikitsa 11
Madhav Nidan 22
Bhav prakash 37
• “चतस्रोऽश्मर्यो भवन्ति; श्लेष्माधिष्ठानााः; तद्यथा
श्लेष्मणा, वातेन, धित्तेन, शुक्र
े ण चेधत ||” Su. Ni. 3/3
•Acharya Susrutha has described 4 types - Vataja, Pittaja, Kaphaja and
Shukraja.

3. Nidana and Samprapti
• “तत्रासंशोिनशीलस्यािथ्यकारिणाःप्रक
ु धिताः श्लेष्मा मूत्रस्पृक्ोऽनुप्रधव्य बन्ति
मश्मिींजनर्यधत ” Su. Ni 3/4
• Improper Shodhana
• Intake of unwholesome diet
• Indulgence in excessive kapha vardhak ahara and vihara
• “धवशोषर्येद्बन्तिगतं सशुक्र
ं मूत्रं सधित्तं िवनाः कफ
ं वा|
र्यदा तदाऽश्मर्युुिजार्यते तु क्रमेण धित्तेन्तिव िोचना गोाः” Cha Chi 26/36
• When the aggravated Vata dries up the semen, urine, Pitta and Kapha located
in the urinary bladder, then gradually stones are formed there, as Gorochana
(gall stone) is formed in bile inside the Gall- Bladder of cattle.

4. Samprapti Ghatak
Dosha Kapha pradhan tridosha
Dushya Mutra
Srotas Mutravaha srotas
Adhishthan Basti
Srotodushti Sanga
Sadhyaasadhyata Krichrasadhya

5. Purvarupa
• “तासाां पूर्वरूपाणि-
ज्विो बन्तििीडािोचकौ मूत्रक
पृक च्छ्
रं बन्तिधशिोमुष्कशेफसां वेदना क
पृक च्छ्
र ावसादो
बिगन्तित्वं मूत्रस्येधत ||५||
यथास्वर्ेदनार्िं दुष्टां सान्द्रमथाणर्लम् |
पूर्वरूपेऽश्मनः क
ृ च्छ्
र ान्मूत्रां सृजणत मानर्ःll” Su. Ni. 3/6
• Pain in bladder
• Fever
• Pain in scrotum, penis
• Anorexia
• Dysuria
• Smell of urine similar to goat

6. Samanya lakshan
• “नाधभबन्तिसेवनीमेहनेिन्यतमन्तिन् मेहतो वेदना मूत्रिािासङ्गाः सरुधििमूत्र
ता मूत्रधवधकिणं गोमेदकप्रकाशमत्याधवलं सधसकतं धवसपृकजधत; िावनलङ्घनप्ल
वनिपृकष्ठर्यानोष्णाध्वगमनैश्चास्य वेदना भवन्ति ” Su. Ni. 3/7
• Severe pain in region of umbilicus, bladder
• Pain in bladder
• Obstruction of urine
• Hematuria
• Resembles gomeda gem
• Pain while running, swimming

7. Types of Ashmari
• Vattaj ashmari –
• पीड्यमानो दन्तान् खादणत – grinding of teeth
• नाण ां पीडयणत – presses umbilical region
• र्ातमूत्रपुरीषाणि क
ृ च्छ्
रे ि चास्य मेहतो णनःसरन्तन्त – dysuria and painful
defecation
• श्यार्ा परुषा णर्षमा खरा कदम्बिुष्पवत्कण्टकाधचता र्णत – black, irregular,
rough calculus
• Pittaj Ashmari-
• दह्यते पच्यत इर् बन्तिरुष्णर्ातश्च र्णत – burning, sucking pain in bladder
• सरक्ता - hemeturia
• पीतार् ासा क
ृ ष्णा भल्लातकान्तथथप्रधतमा मिुवणाु वा र्णत – reddish –yellow
calculus

8. • Kaphaj Ashmari –
• द्दाल्यते ण द्यते णनिुद्यत इर् - crushing, pricking pain
• श्वेता णिग्धा महती – white, large calculus
• क
ु क्क
ु टाण्डप्रतीकाशा मिूकिुष्पवणाु र्ा र्णत
• Shukraj Ashmari -
• बन्तिर्ेदनाां र्ृषियोश्च - pain in bladder and scrotum
• श्वयथुमापादयणत swelling in scrotum
• पीणडतमात्रे च तन्तिन्नेर् प्रदेशे प्रणर्लयमापद्यते - liquefies on squeezing
• शक
व रा णसकता मेहो िाख्योऽश्मररर्ैक
ृ तम् - sharkara, sikta and
bhasmameha(mutra shukra) are also types of ashmari

9. Upadrava
• “दौबुल्यं सदनं का्यं क
ु धिशूलमिोचकम् |
िाण्डुत्वमुष्णवातं च तपृकष्णां हृत्पीडनं वधमम् ll” Su. Ni. 3/17
• Weakness and heaviness in body,
• emaciation ,
• pain in abdomen,
• anorexia,
• anaemia,
• polydypsia and vomiting.

10. Formation of Ashmari
• “आमुखात्सधलले न्यिाः िार्श्वेभ्याः िूर्युते नवाः ||२३||
घटो र्यथा तथा धवन्ति बन्तिमूुत्रेण िूर्युते |२४|”
• While explaining the formation of ashmari , Acharya Sushruta
narrates that, the manner in which even clean water collected
in pot precipitates in the bottom after sometime; similarly the
process of hardening of ashmari occurs with the kshara of
kapha dosha present in mutravaha strotas .

11. Chikitsa
• औषधैिरुिः साध्यः प्रर्ृद्धश्छे दमहवणत ||३||
तस्य पूर्ेषु रूपेषु िेहाणदक्रम इष्यते | Su. Chi 7/2
• घृतैः क्षारैः कषायैश्च क्षीरैः सोत्तरबन्तिण ः |
यणद नोपशमां गच्छ्े च्छ्े दित्रोत्तरो णर्णधः ll
• अणक्रयायाां ध्रुर्ो मृत्ुः णक्रयायाां सांशयो र्ेत् |
तिादापृच्छ्य कतवव्यमीश्वरां साधुकाररिा ll

12. Urolithiasis
• Refers to presence of stones within the kidneys.
• Stone formation occurs when there’s an excess of crystal-forming
substances that can’t be dissolved in the urine.
• High urinary excretion of calcium, oxalate, uric acid can promote stone
formation, whereas low excretion of citrate, has a protective effect.
Predisposing factors-
Environmental & Dietary Causes
• Low Urine volumes
• Diet : High protein, high sodium
• High sodium and oxalate excretion
• Low citrate excretion (hypocitraturia)
Acquired causes
• Hypercalcaemia
• Ileal disease
• Renal tubular acidosis type I
• Familial cysteinuria
• Primary hyperoxularia

13. Sites of Calculus Obstruction
•At the brim of lesser pelvis
•Opening of ureter into the urinary bladder
•Pelvi-ureter junction

14. Types of Kidney Stones
•Calcium oxalate stones - most common
•Cause – hypercalciuria and hyperoxaluria due to hyperparathyroidism. renal
tubular acidosis ,etc.
•Struvite stones aka infectious stones( associated with UTIs) especially those
caused by urea-splitting organisms Klebsiella , Staphylococcus, etc.
•Uric acid stones – hyperuricosuria due to high-protein diet , gout,
inflammatory bowel disease

15. Diagnosis and Management
• X-rays - calcium stones
• Non-contrast CT scan - uric acid (radiolucent) , cystine stones
• USG
• Management –
• Dietary modification and increase fluid intake
• Small stones ( 5-10 mm) without complications expectant
management using tamsulosin
• Larger stones - extracorporeal shock wave lithotripsy (ESWL)
shock waves to fragment the stone, breaking it into smaller pieces that
are excreted in the urine. It can only fragment low density stones, so
hard stones like cysteine or calcium oxalate can’t be treated with
lithotripsy.
• Percutaneous nephrolithotomy (PCNL) >2cm in size