The concept of Urolithiasis in Ayurveda

Presented By Name: Dr. Prathamesh V. Karpe BAMS, MS (shalyatantra)Country: INDIA3rdInternational Conference and Exhibition onTraditional & Alternative MedicineAugust 03-05, 2015 Birmingham, UK

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The concept of Urolithiasis in AyurvedaBy Dr. Prathamesh V. KarpeBAMS, MS (shalyatantra)Consulting surgeon and Lecturer in Dept of shalyatantraGomantak Ayurveda mahavidyalaya & Research centre, Shiroda Goa- IndiaStones are precious but not in the bodyWhat is UrolothiasisIt is commonly known as kidney stone or urinary stoneIn sanskrit it is known as AshmariIn India, the stone belt occupies some parts of Maharashtra, Gujarat, Punjab, Haryana, Delhi and Rajasthan /(tulyataamshmana yaanti tasmaatashmari vidu)Ashmari or calculus looks like small gravels/stones hence they are termed as ashmariWhat are its causes s // (..) / s // (..)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 s / s//Vata-Pitta-kapha dosha enters into basti like how mutra enters into basti from Pakwashaya and with Upasneha nyaya Ashamari is formed in Basti.

/ // (..-)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.

s / /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 - //Pain and discomfort in the bladder, urethra,testicles/external genital organs.Anorexia, dysuria, fever, debility, smell of goats urine.

Colour of urine appears like that of individual doshas and pain accordingly.urine appears non-clear, increased specific gravity.Types KaphajaVatajaPittajashukrajaSamanya lakshana Pain in the umbilicus,bladder, perineum, external genitals eithr in any one of them while passing urine.Obstruction to the urine streamHematuriaUrine 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 AshmariVata 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 AshmariKapha 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

Kaphaja ashmariThe 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 hens egg, pale-white colour, unctous to touch, large in size and like madhuka flower.

Madhuka pushpakukkutandaShukrashmari 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 childrenDue to kapha avastha more chances of forming ashmariOccurs in those children who follows life style and diet which increases and vitiates kaphaAshmari can be of any 3 doshasDue to thin bladder wall and under developing basti, ashmari is small in size and can be easily removed with instrumentsDue to non development of shukra dhatu, there are no chances of forming shukrashmarichikitsaNewly formed ashmari can be treated with medicinesChronic- surgical removal

Medicinal treatmentVataja 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) etcKaphaja 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 sheeps 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 extractionPurvakarma- consent from the king, snehan-swedan-vaman-virechana, food should be given to the patient.Mangala-swastik vachanCollection all required instruments and medicines required during surgery

Pradhana karmaThis technique is Perineal VesicolithotomyPosition is lithotomy postion, head resting in lap of attendantSneh 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 noduleWhile performing this procedure if patient becomes unconscious or goes into shock, in such condition procedure should be hold and extraction shouldnt be done.Site of incision- vamaParshwa (left lateral) 1 yava(grain) distance from the sevani(perineal raphe).Incision should be adequate to remove stoneWhile extracting the calculus, it should be brought out without crushing it. Otherwise it can cause recurrence.Instrument used is (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.Damage to-Mutravaha srotas and Basti-death due to extavasation of urineShukravaha srotas-death or infertilityMushkasrot- dhwajabhanga (erectile dysfunction)Mutraprasek- vesical fistula urine dischargeSevni and yoni- severe painGuda and basti- death Paschat karmaPatient 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 woundFor 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 kalkaIf urine doesnt 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 yantraAvoid 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 AshmariErandaKantakariGokshuraIkshumoolaApamargaShatavariBrihatiYavakulatthaAbove all drugs with sweet curd helps in breaking of Vataja ashmariKushaKashaSharaPashanbhedaDarbhaVidarikandaVarahikandaShalimoolaGokshuraPathaPunarnavaShirishaAbove drugs either in decoction of medicated ghee helps in breaking the pittaja ashmariTreatment of kaphaja ashmariDrugs from Viratarvadi ganaVarunadi ganaMushakadi ganaThe 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 Suvarnarajvangeshwar rasaGokshuradi gugguluBadarashma pishtiSangehyahud bhasmaYavak ksharApamarga ksharShwetaparpati

Panchakarma Before starting any formulations first purification of the body should be performed depending on doshic dominancesVaman (kapha dominant)Virechana (pitta dominant)Niruha Basti (vata dominant)To do- pathyaWhat to eat?YavaKulatthaPurana shaliPurana kushmaand phalaShighruThings to doAvagaha swedaSeasonal purification-vaman,virechan,basti

not to doHolding of natural urges like urine/faecalFoods which causes indigestion- acidic in natureStale foodAerated drinksIncompatible foodDry foodCase presentationA 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 kaphaPrakruti- Kaphapradhan pittanubandiEyes-NADTongue- saam (coated)Mala- constipatedMutra- burning micturationAkruti- thinSrotas- 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 kidney-Two in middle calyx- 6.5mm and 4mm in sizeTwo in the inferior calyx- 5.7mm and 5mm in sizeKidney function test was normalUrine analysis revealed oxalate crystals along with increased pus cells and cast cells

Ayurvediya diagnosis- Mutrashmari- Vata-kaphajaTreatmentAma pachanAgni dipanaVata-anulomanAshmari bhedanMutra virechanaDrugs usedCombination of gokshura+erandamoola+pashanbheda+punarnava+shatavari+chitraka+haritaki in the decoction form40ml two times a day before meals2) Yavakshar 200mg along with above decoction3) Gandharva haritaki 2gm at night time with hot water4)Pathya was advisedPost treatment USGDate- 24/9/2014Left kidney shows 5mm calculus in the middlecalyx & 3mm calculus in inferior calyx and 2.5mm in superior calyxRight kidney shows 4mm calculus in the middle calyx & 2mm calculus in inferior calyx and 5 mm in superior calyxThank youTraditional Medicine-2016Website: http://traditionalmedicine.conferenceseries.com/Meet the eminent gathering once again atTraditional Medicine-2016London, UKOctober 03-05, 2016