1. 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

2. The concept of Urolithiasis in Ayurveda
By Dr. Prathamesh V. Karpe
BAMS, MS (shalyatantra)
Consulting surgeon and Lecturer in Dept of shalyatantra
Gomantak Ayurveda mahavidyalaya & Research centre, Shiroda Goa- India

3. “Stones are precious but not in the body”

4. 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

5. तुल्यतामश्मना यान्ति तस्मात्ताश्मरी विदुः/ (tulyataamshmana yaanti tasmaatashmari vidu) Ashmari or calculus looks like small gravels/stones hence they are termed as ashmari

6. What are its causes
तत्र संशोधनशीलस्यापथ्यकारिणः प्रकुपितःश्लेष्मा मूत्रसम्प्रुक्तोsनुप्रविश्य बस्तिमश्मरी जनयति// (सु.नि.४)
विशोषयेद् बस्तिगतं सशुक्रं मूत्रं सपित्तं पवनं कफ़ं वा/
यदा तदाsश्मर्युपजायते तु क्रमेण पित्तेष्विव रोचना गोः// (च.चि.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.

7. Pathogenesis- samprapti
Vata-Pitta-kapha dosha enters into basti like how mutra enters into basti from Pakwashaya and with Upasneha nyaya Ashamari is formed in Basti.

8. अप्सु स्वच्छास्वपि यथा निषिक्तासु नवे घटे/ कालान्तरेण पंकः स्यादश्मरीसम्भवस्तथा//
(सु.नि.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.

9. संहन्त्यपो यथा दिव्या मारुतोsग्निश्र्च वैद्युतः/ तव्दद्बलासं बस्तिस्थमूष्मा संहन्ति सानिलः/
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.

10. Purvaroopa
तासां पूर्वरुपाणि- बस्तिपिडारोचकौ मुत्रक्रुच्छ्ं बस्तिशिरोमुष्कशेफ़सां वेदना ज्वरः क्रुच्छावसादौ बस्तगन्धित्वं मूत्रस्येति // 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.

11. Types
Kaphaja
Vataja
Pittaja
shukraja

12. 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.

13. 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.

14. Pittaja Ashmari
Kapha dosha along with Pitta dosha attends compactness and obstructs the urine and produces discomfort like burning sensation in the basti-medhra, feeling of hot air coming out of bladder.
Ashmari appears like red,yellow, dark in colour and appears like seed of Bhallataka

15. 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.

16. Madhuka pushpa
kukkutanda

17. Causes = shukraveghdharan or excessive coitus.
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.

18. 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

19. chikitsa Newly formed ashmari can be treated with medicines
Chronic- surgical removal

20. 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-itkata-morata(sugarcane root),pashanbhedh,vidaari-varahkanda-shaalimoola,gokshura,shyonaka,punarnava,shirisha,lotus seed, evaru(cucumber) etc

21. 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

22. Use of Ghrita, Kshara,kashaya, kshira and Uttarbasti are advised.
If no relief with above medications then surgical extraction of calculus should be performed.

23. 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

24. 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

25. 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 अग्रवक्र आहारण यन्त्र (curved forcep)

29. 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.

30. Damage to-
Mutravaha 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

31. 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

32. For diuresis- trunapanchamoola,gokshura etc drugs in the form of yavagu is given 2-3 times a day.
For rakta-mutra shodhan and vrana kledanartha- jaggery 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

33. 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.

34. 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.

35. 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

36. 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

37. 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.

38. Formulations used Suvarnarajvangeshwar rasa Gokshuradi guggulu
Badarashma pishti
Sangehyahud bhasma
Yavak kshar
Apamarga kshar
Shwetaparpati

39. 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)

40. To do- pathya What to eat? Yava Kulattha Purana shali
Purana kushmaand phala
Shighru
Things to do
Avagaha sweda
Seasonal purification-vaman,virechan,basti

41. 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

42. 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.

43. O/e all vitals were stable
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

44. 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 kidney- Two in middle calyx- 6.5mm and 4mm in size Two in the inferior calyx- 5.7mm and 5mm in size

45. Kidney function test was normal
Urine analysis revealed oxalate crystals along with increased pus cells and cast cells
Ayurvediya diagnosis- Mutrashmari- Vata-kaphaja

46. Treatment
Ama pachan
Agni dipana
Vata-anuloman
Ashmari bhedan
Mutra virechana

47. Drugs used
Combination of gokshura+erandamoola+pashanbheda+punarnava+shatavari+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

48. 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

49. Thank you

50. Meet the eminent gathering once again at Traditional Medicine-2016 London, UK October 03-05, 2016
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