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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 3  |  Page : 189-193

Ayurveda management of Mutrashmari with special respect to urolithiasis: A case study


Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital and Research Center, Wardha, Maharashtra, India

Date of Submission19-Dec-2019
Date of Decision06-Jan-2020
Date of Acceptance09-Jan-2020
Date of Web Publication19-Feb-2020

Correspondence Address:
Dr. Snehal V Bhende
Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital and Research Center, Salod Wardha 442001, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_61_19

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  Abstract 

Background: Mutrashmari (urinary stones) is one among the Ashtamahagada (eight fatal conditions) and is Kaphapradhan Tridoshaja Vyadhi, which is correlated with urolithiasis. It is the major cause of morbidity. The lifetime prevalence of symptomatic urolithiasis is approximately 10% in men and 5% in women. Many treatment modalities have been adopted in medical sciences, but it is quite expensive and also the pathogenesis behind recurrence of formation of stone cannot be avoided. Hence, it is necessary to find out an economical effective, easily available medicine to treat Mutrashmari. Objectives: The aim of this study was to evaluate the efficacy of Shaman Chikitsa in Mutrashmari w.r.t. to urolithiasis. Materials and Methods: It is a single case study. A 50-year-old man who was already diagnosed before 20 years approached to outpatient department of Panchakarma with complaints of pain in abdomen and back, which was radiating from loin to groin region; burning micturition; and dysuria. The patient was administered with Shaman Aushadhi. Results: The patient got 80% results in chief and associated complaints, and during and after the completion of therapy there was an improvement in the quality of life of the patient. Conclusion: Satisfactory relief in symptoms was seen in patient after 1 month of Shaman Chikitsa.

Keywords: Mutrashmari, Shaman Chikitsa, urolithiasis


How to cite this article:
Bhende SV, Parwe S. Ayurveda management of Mutrashmari with special respect to urolithiasis: A case study. J Indian Sys Medicine 2019;7:189-93

How to cite this URL:
Bhende SV, Parwe S. Ayurveda management of Mutrashmari with special respect to urolithiasis: A case study. J Indian Sys Medicine [serial online] 2019 [cited 2020 Apr 4];7:189-93. Available from: http://www.joinsysmed.com/text.asp?2019/7/3/189/278722




  Introduction Top


Ashmari (urinary stones) is the condition in which there is formation of a substance like stone.[1]Mutrashmari (urinary stone) is one among the Ashtamahagada (eight fatal conditions).[2] It is considered difficult to cure because of its Marma Ashrayatwa due to involvement of Basti, which is one of the Tri Marma (three vital parts), being the Vyakta Sthana.[3] It is Kapha predominance Tridoshaja Vyadhi.[4] As per the clinical features, it is compared to urolithiasis. It is the formation of stony concretions in the bladder and urinary system. It is the common diseases of Mutravaha strotas (urinary tract) that occur due to disequilibrium between stone inhibiting and promoting factors in the urinary system.

Urolithiasis is an effect of complex physic-chemical process, which involves sequence of events in the formation of any urinary stone, including urinary saturation, super saturation, nucleation and the growth of crystals, aggregation and retention of crystal, and finally formation of stone.[5]

The lifetime prevalence of symptomatic urolithiasis is 10% in men and 5% in women, and the chance of the second stone formation within 5–7 years is approximately 50%. Of population due to the daily lifestyle and the dietary pattern of the peoples.[6]

Increased percentage of urolithiasis in this world is associated with improved standard of living. A urinary stone is the major cause of morbidity and is strongly associated with race, ethnicity, and region of residence.[7] A diet that is rich in cereals and pulses, intake of fruits such as grapes and oranges and fluoride-rich water, and intake of fruits such as oranges and grapes plays a vital role in the occurrence of urinary stone.[8]

Many treatment procedures have been adopted in medical sciences to treat the disease but it is quite costly and also the prognosis behind recurrence of stone formation cannot be avoided. In alternative medicines, mainly surgery is described but as per Acharya Sushruta he said that before going for surgical procedures one should try with oral medications such as medicated alkali preparation, decoction, medicated ghee, and medicated oil, which possesses the properties such as diuretic, splitting, scarification, breaking, and cutting; it facilitates the dissolution of the urinary stones.[9] Hence, it is necessary to find out an economical, easily available, cost-effective, and acceptable medicine to treat Mutrashmari. Hence, in this clinical study, a Yava Kshara[10] and other Shaman Aushadhi were selected for the management of Mutrashamri.

Aims and Objectives

The aim of this study was to evaluate the efficacy of Shaman Chikitsa in the management of Mutrashmari with special respect to urolithiasis.


  Materials and Methods Top


It is a single case study and the informed consent of the patient is taken in his own language.

History of Present Illness

A 50-year-old man was in a healthy condition before 3 months, then he started complaining of abdominal pain and it was found that the pain was intermittent and colicky in nature and it was present on either side of the abdomen, which was radiating from loin to groin region; difficulty in urination normally at the beginning of urination which is of pricking type; burning micturition sometimes; and occasionally smoky urine since 3 months. These chief complaints are briefly mentioned in [Table 1] and [Table 2].
Table 1: Demographic details

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Table 2: Chief complaints with duration

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Past History

The patient had a history of the same complaint, for that he underwent lithotripsy in 2004.

He had known case of diabetes mellitus type 2 and was on regular medication since 4 years.

Medication History

Patient had taken allopathic medicine tab Tamfil twice a day, tab Spasmelan at bed time, and tab Co2 at bed time for 1 month.

Personal History

Food habits: Non-veg, spicy, and salty food; Ruksha Ahar (poha, bread, and toast).

Lifestyle: Insufficient water intake, sedentary lifestyle, and suppression of natural urges.

Sleep: Disturbed due to pain and family stress.

Addiction: Alcohol occasionally once in a month.

Family History

Not significant.

Examination History

These are briefly mentioned in [Table 3] and [Table 4].
Table 3: Ashtavidha pariksha

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Table 4: Vitals examination

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Nidan Panchak[11]

Hetu (etiology or causative factors): Excess exercise, spicy food, urinary retention, and emaciation.

Purvaroop (prodromal symptoms): Abdominal distension, indigestion, and burning micturition.

Roop (manifestation): Abdominal pain, burning micturition, and Sarujamutrapravruti (pain while urination).

Samprapti (patho-physiology of the disease): In the present case, above causative factors provoked Vata and Pitta Dosha and also urinary retention, which causes Kha-Vaigunya at Basti (urinary bladder) and Mutravahasrotas (urinary tract). Therefore, these Doshas enter in Basti and Mutravahasrotas leading to Bastishoth and Mutravahasrotas Dushti (cystitis) with Dysuria at the same time due to Mandagni (hampering of digestive power); it disturbs the function of Pachaka Pitta (digestive fire), so there is no proper separation of Dosha, Mutra (urine), and Purisha (feces). Because of Apana Vayu, Dushti Mala is not excreted completely from body, which leads to accumulation of these mala in body so there is initiation of disease.[12]

Ultrasonography finding: A single, large, oval calculus within upper part of right ureter of 25 mm from right pelviureteric junction with no ureter dilation. One small crystal measuring 3 mm of size in middle calyx of left kidney [Figure 1].
Figure 1: (A) USG report after treatment. (B) USG report before treatment

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Diagnosis: Kaphaj Mutrashmari (urolithiasis).

Treatment Advised

By analyzing the above pathogenesis of disease in this patient following treatment plan was prescribed, which can be categorized as Shaman Chikitsa shown in [Table 5].
Table 5: Treatment advised

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Assessment of Patient

Overall assessment of the therapy was made based on the improvement in pain, Mutra Pravrutti and ultrasonography (USG) finding [Table 6].
Table 6: Assessment of patient

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Criteria for Assessment of Results

  1. Complete relief: More than 75% complete disappearance of known symptoms.


  2. Marked relief: Approximately 50%–75% disappearance of known symptoms and absence of complications.


  3. Moderate relief: Approximately 50% relief in symptoms


  4. Mild relief: 25% relief in symptoms.


  5. No relief: No relief in symptoms.



  Observations and Result Top


In the first follow-up, the patient informed that three to four stones of irregular size expelled out at the time of urination. When the stone was expelled through urine, he experienced extreme pain and disturbance in the urine flow.

Repeated USG showed that there was a single calculus measuring 5 mm in the ureterovesical junction with mildly dilated ureter and the clinical features were absent except pain in abdomen, which was mild in intensity.

In the second follow-up, the patient got completely relief from pain in abdomen and did not experience dysuria. He reported that the right renal calculus was also expelled out through urination.

Other assessment of before and after observation is mentioned in [Table 7] and [Table 8].
Table 7: USG findings

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Table 8: Investigation

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  Discussion Top


Many treatment modalities have been adopted in medical sciences to treat the disease in the Chikitsasutra of Mutrashmari. Acharya Charak explain that in the Kaphaj Mutraashmari, Kshara (medicated alkali preparation) and use of Ushna Tiksna Dravyapana is advisable.[13]Acharya Sushrut said that before going for surgical procedures one should try with oral medications such as Kshara Kalpana (medicated alkali preparation), Ghrita (medicated ghee), and Taila (medicated oil), which possesses the properties such as Chhedana (cutting/breaking), Bhedana (splitting), Lekhana (scarification), and Mutrala (diuretic), and Kwath (decoction) for facilitating the disintegration of the urinary stones.[14] Hence, as per Chikitsa Sutra in this clinical study, a Yavakkshar and other Shaman Aushadhi were selected for the management of Mutrashamri.

Yavakkshara: It has properties such as Shodhana, Lekhana, Bhedhan, Pachana, and Tridoshagna.[15]Yava is Sheet Virya, which acts as an alkalizer. Further, as it is a Kshar it possesses alkalic properties. The synergetic action of alkalizer is enhanced and appreciating the results in disintegration and elimination of urinary stones from urinary tract. As Yavakkshar is having Deepana and Pachana properties, so it may relieve the indigestion and it helps to breaking the pathogenesis of the urolithiasis. Because of its Bhedana (splitting) and Lekhana (scarification) properties, it breaks the urinary stones in small particles. Yavakshar is a potent urinary alkalizer with mild diuretic activity. Thus, it reduces burning micturition.

Poly Herbal Syrup: was a proprietary medicine, which facilitates the passage of urinary calculi by diuretic, anti-inflammatory, and analgesic properties.[16]Yavakshar is a potent urinary alkalizer with mild diuretic activity. Thus, it reduces burning micturition. Shwetaparpati has diuretic and anti-inflammatory properties, so it can be responsible for reducing erythrocyte sedimentation rate (ESR) level and the color of the urine.

Varunadi Kshaya: The Varundigana formulation pacifies Kapha Dosha by virtue of their Ruksha Guna, Katu Vipak, and Ushna Virya. Its Vatanulomana Shothahara and Mutrala properties help to relieve pain and Shotha.[17] It is an effective remedy in management of urinary problems, including diuretic, lithotriptic (remove calculi or stones), and anti-spasmodic (removes spasm and pain) properties.[18] Because of its lithotriptic property, it can tear the urinary stones and its diuretic property helps to flush out small stones from the urinary tract. Its spasmodic property may help to relive pain and spasm. Thus, in total this formulation has the capacity to disintegrate the pathogenesis of the disease Ashmari and recurrence of urinary stone.

Polyherbal Tablet This tablet contains Punarnava, Ushira, Chandana, Shweta Parpati, and Hajarulyashood Bhasma, which is used in urinary retention, difficulty in urination, urinary calculi, hematuria, burning, and difficulty in urination due to acidic urine.[17] Medicine was given in the tapering dose to overcome the severity of the symptoms. Punarnava is used to improve the digestive strength, which is weak in the present person as Punarnava is anti-inflammatory in nature so it can be helpful to relieve pain and difficulty while urination.

By taking all the above mentioned discussion into consideration that the overall effect of all treatment regimen planned in this patient is diuretic, splitting, scarification, breaking, and cutting, it facilitates the dissolution of the urinary stones.[9]


  Conclusion Top


The result revealed that renal calculi can be cured with ayurvedic Shaman Chikitsa and lithotripsy and other surgical interventions can be avoided. Now till date there is no need to patient to undergo any surgical intervention as well as there is no recurrence of symptoms. This study is about the presentation of the single case study only. An attempt must be made for further exploration of effect of this Shaman therapy in large population for establishing standard treatment protocol. To combat the disease in minimum duration, we have used multitreatment approach to get synergistic effect.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
  References Top

1.
Sharma PV, editor. Ashmarinidan adhyaya. Verse 1. In: Sushruta, Sushruta Samhita, Nidan sthana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2013. p. 481.  Back to cited text no. 1
    
2.
Sharma PV, editor. Ashmarichikitsa adhyaya. Verse 3. In: Sushruta, Sushruta Samhita, Chikitsa sthana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2013. p. 234.  Back to cited text no. 2
    
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Sharma PV, editor. Ashmarichikitsa adhyaya. Verse 37-38. In: Sushruta, Sushruta Samhita, Chikitsa sthana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2013. p. 240.  Back to cited text no. 3
    
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Sharma A, editor. Ashmarinidanam. Verse 1. In: Text book of Madhavnidan. Vol 1. Pune, India:Chaukhamba Sanskrita Pratishtan; 2007. p. 506.  Back to cited text no. 4
    
5.
Smith DR, editor. Urinary stones. In: General Urology. 8th ed. CA: Lange Medical Publications. Mumbai. [Last accessed on 2003 Sept 16]. p. 216.  Back to cited text no. 5
    
6.
Stuart Wolf JJr; chief editor:Bradley Field Schwartz. Nephrolithiasis. Author:. Available from: http://emedicine.medscape.com/article/437096-overview. [Last accessed on 2020 Jan 13]. p. 216.  Back to cited text no. 6
    
7.
Trinchieri A. Epidemiology of urolithiasis: An update. Clin Cases Miner Bone Metab 2008;5:101-6.  Back to cited text no. 7
    
8.
Swaminathan M. Handbook of food and nutrition. Mysore, India: Bappco Publisher; 2014. p. 560.  Back to cited text no. 8
    
9.
Sharma PV, editor. Ashmarichikitsa adhyaya. Verse 40-43. In: Sushruta, Sushruta Samhita, Chikitsa sthana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2013. p. 241.  Back to cited text no. 9
    
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Mishra S, editor. Mutrakrucharogadhikara. Verse 15. In: Govinddas, Bhaisajya ratnavali. Varanasi, India: Chaukhamba Surbharati Prakashan; 2007. p. 676.  Back to cited text no. 10
    
11.
Sharma PV, editor. Trimarmiya chikitsa adhyaya. Verse 32. In: Charaka Samhita of Agnivesha, Chikitsa sthana. 8th ed. Varanasi, India: Chaukhamba Orientalia; 2007. p. 629.  Back to cited text no. 11
    
12.
Sharma PV, editor. Trimarmiya chikitsa adhyaya. Verse 33. In: Charaka Samhita of Agnivesha, Chikitsa sthana. 8th ed. Varanasi, India: Chaukhamba Orientalia; 2007. p. 629.  Back to cited text no. 12
    
13.
Sharma PV, editor. Trimarmiya chikitsa adhyaya. Verse 54, 59. In: Charaka Samhita of Agnivesha, Chikitsa sthana. 8th ed. Varanasi, India: Chaukhamba Orientalia; 2007. p. 874-5.  Back to cited text no. 13
    
14.
Sharma PV, editor. Ashmarichikitsa adhyaya. Verse 40-43. In: Sushruta, Sushruta Samhita, Chikitsa sthana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2013. p. 242.  Back to cited text no. 14
    
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Sharma PV, editor. Ksharapakvidhi adhyaya. Verse 5. In: Sushruta, Sushruta Samhita, Sutrasthana. Varanasi, India: Chaukhambha Surbharati Prakashan; 2013. p. 78.  Back to cited text no. 15
    
16.
Mishra S, editor. Ashmarirogadhikara. Verse 69. In: Govinddas, Bhaisajyaratnavali. Varanasi, India: Chaukhamba Surbharati Prakashan; 2007. p. 688.  Back to cited text no. 16
    
17.
Mishra S, editor. Madhya khanda, chikitsasthana. Verse 70. In: Bhavprakash Samhita. Varanasi, India: Chaukhamba Surbharati Prakashan; 2012. p. 383.  Back to cited text no. 17
    
18.
Available from: https://www.google.co.in/amp/s/ayurmedinfo.com/2012/08/01sheetprabha-tablet-benefits-dosage-side-effects-ingredients/amp/. [Last accessed on 2016 Sept 12].  Back to cited text no. 18
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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