MUTRASMARI PRESENTATION BY Dr. S. KAMALAKAR PURIPANDA This document summarizes the causes, types, formation, and treatment of urinary stones (mutrasmari) according to Ayurveda. It discusses the etiology and pathogenesis of stones based on Charaka and Vagbhata. Stones are classified based on their location in the kidney, ureter, or bladder. Treatment involves both medicinal herbs and surgical removal of large or chronic stones. Following a diet low in calcium, oxalate, and phosphate can help prevent stone formation.

1. MUTRASMARI

2. PRESENTATION BY
Dr. S. KAMALAKAR PURIPANDA
PRELIMINARY PG SCHOLAR
DEPARMENT OF SAMHITA SIDDHANTA

3. NIDANA
According to Charaka
 Ati Vyaayaama
 Ruksha Madya Sevana
 Aanoopamaamsa Sevana
 Matsya Sevana
 Adhyashana
 Ajeerna Bhojana
According to Vaagbhata
 Snigdha Aahaara Sevana
 Divaaswapna
 Ajeerna Bhojana
 Madhura Aahaara
 Adhyashana

4.  उष्ण गमन
Walking in hot sun.
An individual who have to work in direct sun, who
perspire a lot may generally cause concentrated
Urine and Urine volume is also reduced.Thus Ashmari
is formed.
HOT CLIMATE
It causes increase in concentration of solutes, which
results in precipitation of calcium that forms the
stones of calcium oxalate

5. असंशोधन शीलस्य
 An individual who needs Samsodhana and not
undergone the Therapy time to time and indulges
in kapha provoking food articles devolops Ashmari.
 Because increased Kapha Dosha travels along with
Mutra in Mootravaha Srotas and Ashmari is formed

6.  प्रायेण शीत स्स्नग्ध गुरु मधुर आहार
 Excessive intake of Madhura, Guru, Snigdha Ahara
such as Milk, Meat, Egg etc causes Ashmari
because such foods are Kapha provoking as well
as rich in Calcium, Phosphate etc hence, they help
in formation of Ashmari.
 The word प्रायेण explains that Kapha provoking
factors cause Ashmari only in those individuals
who are susceptible to it

7. DIET
 The food deficient in Vitamin ‘A’ causes
desquamation of Renal Epithelium which
precipitates Calcium and causes stone formation.
 The food such as Fish, Red meat, Eggs cause
Aciduria
 Food rich in Calcium,Tomato, Spinach, Milk causes
stones of Calcium Oxalate.

8. अध्यशन,दिवास्वप्न
 It causes increase of Kapha in the body. Increased
Kapha Dosha travels along with Mutra in
Mootravaha Srotas and Ashmari is formed

9. INFECTION
Organisms like Pseudomonas, Klebsiella etc causes
Renal infection. They produce Urease and cause
stasis of urine and causes stone formation.
GOUT: Serum Uric Acid levels raises in Gout and
causes Uric Acid stones.
RANDALL’S PLAQUES: Randall opines that initially
small erosion or an ulcer develops on Renal papillae.
On this erosion Urinary salts deposited and cause
formation of stones

10. SAMPRAPTI
 The vitiated Vata driesup the Urine in Mutravaha
Srotas, so that the Kapha, Pitta present in the
urine attains the form of Ashmari

11. Vaata Kapha
Aahaaraja & Vihaaraja
Vaata+Kapha Agnimaandya Aamotpatti
Vaata+Kapha
+Aama
Dosha Dooshya
Sammoorchanaa
Vata driesup
Prakopa
Kapha, Pitta present
in the urine attains
the form of Ashmari
Upadrava
Mootra Sharkaraa
Sikataameha
Bheda
Vyakta
Sthaana
samshraya
Prasara
Sanchaya
Enters into
Mutravaha Srotas
Ashmari
nirmana

12. SAMPRAAPTI GHATAKA
• Nidaana : Kapha, Vaata Prakopaka
• Dosha : Kapha Pradhaana Tridosha
• Dooshya : Mootra
• Srotasa : Mootravaha
• Srotodushti : Sanga
• Agni : Jatharaagnimaandya
• Aama : Jatharaagni
• Dosha Maarga : Koshtha, Shaakha
• Roga Maarga : Aabhyaantara
• Udbhava Sthaana : Pakvaashaya (Apaana
Kshetra)
• Adhishthaana : Basti (Mootravaha Srotasa)

13. P00RVA RUPA
THE POORVARUPAS MENTIONED IN CLASSICS ARE ALSO
OBSERVED IN RUPAVASTHA OF ASHMARI
 Severe pain at site of Ashmari
 Sedimentation of urine(िुष्ट सान्द्र मूत्रता)
 Turbidity of urine(आववल मूत्रता)
 The concentrated urine smells like goat’s urine
 Fever is indication of UTI due to Renal stone

14. P
K
S
V

15. The 4 types of Ashmari indicate 4
locations of Mutravaha Srotas where
Ashmari is stagnated or lodged.
1.Vaataja- Ureteric stone
2.Pittaja- Vesicle stone
3.Kaphaja-Kidney stone
4.Sukraja- Urethral stone

16. Urinary stones are typically classified by their location
in the
•Kidney (nephrolithiasis),
•Ureter (ureterolithiasis),
•Bladder (cystolithiasis),
CLASSIFICATION- BY LOCATION

17. POINTS TO REMEMBER
 Pain in Nabhi, Basti, Sevani and Mehana
 Bleeding with urine – Haematuria or Turbidity
 Double stream of urine with sudden stoppage
 Pain is relieved after expulsion of stone
 Pain aggravates on unusual position like Riding,
Travelling, Jumping

18. DIFFERENTIAL DIAGNOSIS

19. VATAJA ASHMARI URETERIC STONE
1 These are reddish black / black / grey
in colour. Stone is spiky, irregular,
rough, hard and they appear like
kadambha pushpa.
Calcium oxalate (have sharp projections,
irregular with rough surface and usually
single) stones produces hematuria resulting
in deposition of blood over the stone giving
dark brown colour to the stone
2 While migrating from one place to
other the spiky stones cause injury
and some times get obstructed in the
urinary passage. Pain is radiating from
Nabhi, Basthi, Sevani, & Mehana
The pain occurs typically at loin and
radiates to groin. When the stone descents
to lower ureter pain radiates to the testicle
(male), labia majora (female) and upper
portion of the inner part of thigh.
3 When the stone is descending from
kidney in to the ureter pain is severe
because, the diameter of renal pelvis
is 1 cm and the ureter is 2 to 3 mm in
some condition the abrupt narrowing
of the ureter causes stagnation of the
stone
The pain occurs when the stone is entering
in to the ureter but, it may also occur when
a stone becomes lodged in pelvi ureteric
junction .
4 The patient with pain passes urine
drop by drop with straining
Stranguary means passing of urine drop by
drop with painful straining

20. Ureter
• Ureter has 3
constrictions:
1. Pelvic-ureteric junction
2. When it crosses external
iliac vessel
3. Vesico-ureteric junction
V

21. 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)
2
1

22. CALCIUM OXALATE STOnES-VAATAJA

23. PITTAJA ASHMARI VESICLE STONE
1 The colour of the stone is
either yellow or moderately
red or black or honey colour
and it appears like ballataka
Uric acid stones
Yellowish,Reddish-Brown,Radio
Lucent,Small multiple hexagonal
shape.
2 When pitta is associated with
Kapha Dosa Pittaja Ashmari is
formed and obstruct the
urinary passage.Due to this
burning and sucking type of
pain in Basti region.
Burning and sucking type of pain
occurs.When the stone
approaches the bladder and
symptoms of vesicle irritability is
observed.Stone impacting very
near the bladder can exactly
mimic and acute cystis .This is
caused by abrasion of vesicle

24. URIC ACID STONES
PITTAJA

25. KAPHAJA ASHMARI KIDNEY STONES
Kaphaja Ashmari quite bigger
in size therefore pricking,
pulling type of dull ache.
Renal pain occurs when stone is
in kidney.It is fixed pain not
radiating. Patient typically
describes renal pain by putting
his hand on waist.
Stones are big,smooth, round,
appears like hen’s egg and
flower of Madhuka.It is white
sometimes light honey color.
Phospate stones are compared to
kaphaja ashmari. They are dirty
white/yellow white.They grow
bigger in size, they are smooth
and round like hen’s egg .
SHUKRASHMARI(SPERMOLITH)
The stone formed in Seminal Vesicle. After the formaton 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 driesup the sukra and stone is
formed.There is pain in Suprapubic region,difficulty in
micturation and swelling in scrotum.when sukra is expelled out
the Ashmari is relieved.

26. phosphate stone
KAPHAJA

27.  Stone present in the Kidney may not have severe pain, however dull,
constant ache fixed to renal angle.(Kaphaja)
 But same 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.(Vataja)
 When the same stone reaches U.B - burning type of pain in suprapubic
region.(Pittaja)
K
V
P
S

28. ASHMARI IN CHILDREN
 As the infants and children are found of sweets, milky
product, heavy food, day sleep and habit of eating before
previous meal is digested, they are more suspectible to
Ashmari
 In children sudden screaming(a high-pitched noise) during
micturation and pulling at the prepuce often indicate the
presence of stone in the bladder
 Pain at the end of micturation reffered to the tip of penis in
young boys indicates stone in the bladder. Usually in school
going children pain is increased by jumping etc

29. CHIKITSA

30.  Ashmari is a grave disease so that it is included in
Astamahagada. It is not easily curable.
 If Ashmari is recently formed and small in size it
can be treated with Medical management.
 But the Prognosis is not good if it is chronic and
bigger in size,hence Shastra Chikitsa is
recommended.
SHAMANOUSHADI
 Pasanabhedadhi ghrita.
 Kushmanda swarasa
 Varunamoola twak kwatha
 Trikantaka choorna
 Shwadamstradhi kasaya
 Sharapanchamooladhi ghritha
 Kshara prayoga

31. The drugs like Pashanabheda,Gokshura, Shilajitu,
Trapusa promote crushing of Urinary stones,they
have quick action.
MODE OF ACTION OF DRUGS
 Ashmari Bhedana, Pathana
 Mutrala/Basti Sodhaka
 Mutra Sulagnam/Basti Sulagnam
 Mutrakrichraharam
 Mutranulomaka/Mutra Vibandhagnam

32. COMPOSITION INDICATIONS
 Pashanbhed 60mg
Sweta Parpati 25mg
Apamarg Panchang
20mg
Varuna Ext. 20mg
Sudh Shilajit 15mg
Punarnava 50mg
Hajrul Yahood Bhasm )
45mg
Sahdevi 20mg
Gokhshura 20mg
Lajjalu Mool 15mg
Yavakshar 10mg
 Urinary calculi (Stone)
 Recurrent calculi
(Stone)
 Urinary Tract Infections
 Cystitis (Inflammation
of the urinary bladder
due to infection)
 Burning micturation
(Burning sensation
while passing urine)
NEERI

33. VARUNA:Kapha Vata Hara,Deepana.
IND:Ashmari,Vidradhi,Gulma,Krimi,Gandamala
GOKSHURA:VataPittaShamaka,Deepana,Vasti
Sodhana
IND: Ashmari,Mutrakricha.
PUNARNAVA:Kapha Vata Hara,Deepana.
IND:Shota,Shoola,Pandu.
PASANABHEDA:Tridosahara, Vasti Sodhana,
Mutra virechaniya

34. Inj.BUSCOPAN:IV/IM
HYOSINE
IND:G.U/G.I.T SPASM
D: 1AMP
Inj.DYNOPAR:IM
DICLOFENAC
Ind:Pain & Inflamation
D: 1AMP
Inj.LASIX: S.IV
FUROSEMIDE
IND: Accute/chronic renal infections
Hypertension
D:40mg
Inj.MANNITOL:is an Osmotic Diuretic.It works by increasing the
amount of fluid excreted by the kidneys.

35. LABORATORY FINDINGS
 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

36. Kidney
Transverse
process of
lumbar
vertebrae
(landmark
for Ureter)
Bladder
Psoas shadow

38. PATHYA IN ASHMARI
 Kulattha
 Godhuma
 Yava
 Tanduleeya
 Ardraka
 Mudga
 Jeerna shali
 Jeerna kusumanda phala
 Yavakshara

39. APATHYA
FOOD RICH IN
CALCIUM,OXALATE,PHOSPATE:
 Calcium: Leafy Vegetables, Milk products, Sesame
seed, Raagi.
 Oxalate: Leafy Vegetables, Beetroot, Spinach
 Phospate: whole Cereals, Legumes, Nuts and Oils,
Meat, Fish, Egg and Milk

40. REFERENCES
 SU.NI.3
 CHA.CHI.26
 A.H.NI.9
 A.S.NI.9
 M.NI.32

41. THANAK U
THANK U DOCTORS
“If one obeys pathyas ,no disease will
occur and if one never mind them and
continues apathyas, no treatment is
needed,as it is not going to be cured”