Shaista Asmeen khan et al.
, AYUSH: International Research Journal of Ayurveda Teachers Association
AYUSH: International Research Journal of
Ayurveda Teachers Association
Journal Home Page: www.airjata.org
Open Access Full Text Article Case Report
Title of Article:
An Ayurvedic Approach in the Management of Ashmari (Kidney Stone)
Shaista Asmeen khan1, Toufik Sheikh2, Pankaj Tiwari3, Roshani Yawale4
1. Final year UG scholar, Shri Ayurved Mahavidyalaya, Nagpur, Maharashtra.
2. Final year UG scholar, Shri Ayurved Mahavidyalaya, Nagpur, Maharashtra.
3. MD (ayu), Agnikarma & viddhakarma specialist, panchakarma specialist.
4. Assistant professor, Dept. Of Rachana Sharir, Govt. Ayurved College, Nagpur, Maharashtra.
Article Info: ABSTRACT
Article History: Nephrolithiasis also known as kidney stones or renal calculi is a
Received: 9 June 2023 common disorder characterized by the formation of aggregates of
Accepted: 1 Ausust 2023 microscopic crystals into solid objects i.e. stones. Kidney stones
Published: 14 July 2023 resemble the description of ashmari in Ayurveda and they behave like
an enemy for the body. In modern science, the treatment of kidney
Address for Correspondence: stones is PCNL (Percutaneous Nephrolithotomy) and ESWL (Extra
Shaista Asmeen khan, Final year UG Corporeal Shock Wave Lithotripsy). On the other hand, conservative
scholar, Shri Ayurved Mahavidyalaya, management is also done i.e. Flush therapy, iv fluid, anti-inflammatory,
Nagpur, Maharashtra. anti-spasmodic, analgesic, anti-emetic, and hydration. The present case
Email-
[email protected] study is of a 60-year-old male patient having symptoms of abdominal
ISSN No.: 2583-5971 pain from the loin to the groin region, burning micturition, pain during
micturition, nausea, and abdominal distention. The clinical diagnosis
made on the basis of the symptoms was ashmari (kidney stone). He was
on allopathic medications for the past 6 months but not relieved with
symptoms. Hence he was taking ayurvedic medications for 1 month.
The patient was much relieved with symptoms and investigations after
the ayurvedic medication. This case study aims to a: study ashmari
(kidney stone) from a modern and ayurvedic point of view, b: study the
safe and effective ayurvedic medication to avoid surgical intervention
and also to avoid the recurrence of kidney stones.
Keywords: Ashmari, Kidney stone, Treatment, Ayurveda.
INTRODUCTION
Renal calculus is the most common oldest known and 90% are radiolucent ).[2] It is caused due to various factors
most widespread disease in the urinary tract system. It is such as diet, climate, citrate level in urine, infection in the
recurrent in nature and 3rd most common disorder among kidney, hyperthyroidism, renal tubular acidosis, etc.[3]
urinary diseases.[1] It is more common in males; 90% are Calcium oxalate stone is more
radio-opaque (gallstones are more common in females;
AYUSH: Int. J Ayu. Teach. Asso. 2023;2(2)32:36.
Shaista Asmeen khan et al., AYUSH: International Research Journal of Ayurveda Teachers Association
common at 60%, followed by calcium phosphate at 15%, did not relieve. So he shifted to ayurvedic medication for
uric acid at 10%, struvite at 15%, and cystine & other at 1 month.
1%.[4] Kidney stone resembles the description of ashmari.
Ashmari is a grave disease, that simulates death. It is
manageable with drugs when it is of recent onset but Past history
when greatly developed, it requires surgical There was no history of HTN, DM, BA, TB, IHD, CVE,
intervention.[5] Ashmari comes under ashtamahagada i.e. Thyroid, or any other symptomatic ailment, but due to his
eight difficult to cure diseases. In Ayurveda, four kinds of lifestyle and routine schedule, there was a qualitative and
ashmari are described – these are caused by 1-salesman, quantitative disturbance in water intake.
2-vata, 3-pitta & 4-shukra.[6] Etiopathogenesis, clinical
features, types, and prognosis of ashmari are well Personal history
described in Charaka Samhita and Sushruta Samhita. Marital status - Married
Causative factors like ayogya ahara-vihara, and not Smoker - Yes
observing proper cleansing procedures aggravate the Tobacco - No
shleshma, which mixes with the urine, enters the bladder, Alcohol - No
and thereon produces calculi.[7] Sleep - Adequate
Bowel & Bladder - Not Adequate
According to charak acharya, the aggravated vata dries Appetite - Normal
the shukra (semen) and mutra (urine) along with the pitta
and kapha which are located in the Basti (urinary
Family history
bladder), and ashmari (calculus) is formed gradually like
Father - HTN, Mother - NAD
gallstone in the cow.[8] Acharya Vaghbhata says that
suppression of the urge of micturition results in
On Examination (O/E)
crystallization and precipitates into calculus formation.[9]
CNS – the patient is conscious, cooperative, and well-
Ashmari can be morbid if it is associated with severe
oriented to time, place, and person.
swelling in the scrotum (testes) and umbilicus, total
CVS - Pulse: 76/min, BP:120/80mmHg, SPO2: 99%,
obstruction of urine, severe pain, and the presence of
S1S2: Heared no cardiac murmur,
gravel in it (because such ashmari is incurable).[10]
RS: AE= BE, RR: 20/min,
GIS - Liver, Spleen, and Kidney not palpable
Case study
GC - Fair
A 60-year-old male patient came in OPD with symptoms
Pallor/Icterus/Cyanosis/Edema/Lymphadenopathy -
of pain in the abdomen (from loin to groin region),
Absent
burning micturition, pain during micturition, nausea, and
distension of the abdomen.
Ashthavidh pariksha
All the parameters in asthavidha pariksha are within the
History of present illness
normal range.
The patient was apparently all right 8 months back. Then
he started complaining of abdominal pain from the loin to
the groin region on both sides. The pain was gradual in Report
onset and progressively increased with time. One day he (CT urography)
experienced severe pain in the abdomen, nausea, and Date: 14-01-2019
abdominal distention. Impression: B/L renal calculi
(Right kidney) - VU junction - 6mm
The patient consulted a physician and got temporary Lower pole calyx - 3mm (two calculi)
symptomatic relief but in a few days, he again Mild HN and HU present
experienced severe pain and nausea. As per the patient, (Left kidney)- Lower ureter - 14*7mm & 4mm
the pain was severe, radiating in nature from the loin to Lower pole - 5mm
the groin up to the thigh on both sides. The physician (LT >RT) - HN and HU present.
advised him of CT urography. CT urography showed 6
calculi, 3 in the right kidney and 3 in the left kidney. The Management and outcome
condition was diagnosed as ashmari (kidney stone). He The patient was given a course of medication for 1month.
took allopathy medicine for 6 months but the complaints
AYUSH: Int. J Ayu. Teach. Asso. 2023;2(2)32:36.
Shaista Asmeen khan et al., AYUSH: International Research Journal of Ayurveda Teachers Association
Treatment Plan
Sr.no Medicines Dose Duration Anupan
1. Varunadi kwath 4TSF BD Luke warm water
2 Gokshuradi guggul 2Tab BD Water
3 Arogyavardhini vati 2Tab BD Water
4 Chandraprabha vati 2Tab BD (Before food) Water
Pashanbheda+gokshur 1TSF BD (Before food) Luke warm water
5 +varun+punarnava+kutki
+harjal yahud bhasma
Along with these medications, diet, and lifestyle restrictions were also advised to the patient. The patient was advised to
drink plenty of water and avoid a protein-rich diet that excluded eggs, meat, soybean, dairy products, etc, and oxalate-
rich foods like spinach, tomatoes, lady finger, chocolate, cold, drinks, etc, and also avoid calcium and Vit. D
supplements
Result
Sr.
Symptoms Before treatment After 15 days After 1 month
No.
1. Abdominal pain(loin to groin) +++ ++ -
2. Nausea ++ + -
3. Burning micturition ++ + -
4. Pain during micturition +++ + -
5. Abdominal distention ++ + +
Result of investigation
Sr.
Investigation Date Impression
No.
1. CT urography 14-01-019 (Right kidney) - VU junction - 6mm
Lower pole calyx- 3mm (2 calculi)
Mild HN and HU present
(Left kidney) - Lower ureter - 14*7mm & 4mm
Lower pole - 5mm
(LT >RT) - HN and HU present.
2. USG abdomen 18-02-019 Moderate left HN & HU
Ureteric calculus?
3. X-ray KUB 18-02-019 No urolithiasis seen
AYUSH: Int. J Ayu. Teach. Asso. 2023;2(2)32:36.
Shaista Asmeen khan et al., AYUSH: International Research Journal of Ayurveda Teachers Association
Before and after investigation reports
1.CT urography 3. x-ray KUB
DISCUSSION
Ashmari (kidney stone) is one of the most common
diseases of the urinary system. In the prodromal stage of
ashmari, oleation etc is advisable by which the disease
may be totally eradicated.[11] In the modern view, the
process of calculi formation takes place in various stages
i.e. the stage of supersaturation, the stage of nucleus
formation, the stage of crystallization, the stage of
aggregation, the stage of matrix formation, and the stage
of stone.[12] Acharya Sushruta has described ashmari
under ashtamahagada i.e. incurable diseases.[13] The
ayurvedic drug has the potential to act as an antilithogenic
by various actions like mutral (diuretic), shothahar (anti-
inflammatory), vedanasthapana (analgesic), deepan-
pachana (digestive & metabolism adjuvant), ashmari
bhedana (lithotriptic) and basti shodhan (improves
bladder function). By means of these medicinal
properties, the administered drugs have effectively
disintegrated the pathogenesis of ashmari & lead to the
expulsion of ashmari from the urinary tract in the present
case.
Ashmari can be managed with ayurvedic treatment if the
2. USG Abdomen size is small. Although acharya sushrut has suggested
AYUSH: Int. J Ayu. Teach. Asso. 2023;2(2)32:36.
Shaista Asmeen khan et al., AYUSH: International Research Journal of Ayurveda Teachers Association
surgery if the ashmari case is not relieved by shaman 6. Prof.G.D.singhal & colleagues (Editor), Sushruta
chikitsa Conclusion Small kidney stones with a diameter Samhita of Shushruta part 1,sutrasthan, chapter no.3,
of less than 5mm can be flushed out in the urine with the verse no.3, Reprint year 2021, Chaukhamba Sanskrit
above-mentioned ayurvedic medications. These pratishthan;p.522
medications are easily available and cost-effective. 7. Prof.G.D.singhal & colleagues (Editor), Sushruta
Ayurveda mentions that nidanparivarjan (prevention of Samhita of Shushruta part 1,sutrasthan, chapter no.3,
cause) is the first line of treatment. Here, along with verse no.4, Reprint year 2021,chaukhamba sanskrit
medication diet therapy is also advised to the patient. it pratishthan;p.522
also prevents the recurrence of the disease. This case 8. Dr. Shashirekha H.K, Dr.Bargale Sushant Sukumar
shows the effective conservative management of ashmari (Editor), charak Samhita of Agnivesh, part-4, chikitsa
with ayurvedic medicines with no adverse effects. Further sthan, chapter no.26, verse no,36, First 2020,
clinical trials can be conducted on a large scale. This is a chaukhambha publications; p.455
single case study, large-scale study is needed with this 9. Aaditya B. Shah, Poonam Mohod, V C Deep, Gopesh
ayurvedic management. Kumar Sharma. Mutrashmari (Urolithiasis): A case
successfully treated with Gokshuradi Guggulu.
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