07/04/2023 Ashmari chikitsa acc to Bhruhattrayees 1

ASHMARI CHIKITSA ACC. TO BRUHATTRAYEE

Presented by-Dr. Haresh E. Memane.P.G.Scholar (Dept of Dravya guna)

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OBJECTIVE• INTRODUCTION• NIDAN & SAMPRAPTI• SAMPRAPTI GHATAKA & PURVARUPA• ASHMARI BHEDA• PLACES OF OBSTRUCTION• PAIN AT DIFFERENT SITES• CHIKITSA• DRUGS IN PRACTICE • DRUGS NOT IN PRACTICE BUT EASILY AVAILABLE• FORMULATION IN PRACTICE • SCIENTIFIC BASIS FOR DRUGS• CONCLUSION• DISCUSSION

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INTRODUCTION

• Among the vyadhis occuring in mutravaha srotovikruti , Ashmari

is the most commenest one.

• The Word " AzqÉUÏ" derived from the “AzqÉlÉ” sanskrit

word.

• Literally means a structure resembling stone.

• Acc. to Sushruta AzqÉUÏ one of the qÉWûÉaÉS .

• Refferences:-

Charaka Samhita chi.26 chapter, Susruta Samhita Chi.7 chapter,

Astangsangraha chi.13 chapter , Astanghrudaya chi.11 chapter.

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Nidana & Samprapti

“ ÌuÉzÉÉåwÉrÉåiÉç oÉÎxiÉaÉiÉÇ xÉzÉÑ¢Çü qÉÔ§ÉÇ

xÉÌmɨÉÇ mÉuÉlÉ: MüTÇü uÉÉ|

rÉSÉ AzqÉrÉÑïmÉeÉÉrÉiÉå iÉÑ ¢üqÉåhÉ ÌmɨÉåwÉÑ

CuÉ UÉåcÉlÉÉ aÉÉå:|| “ (cÉ. ÍcÉ. 26/36)

"iɧÉÉxÉÇzÉÉåkÉlÉzÉÏsÉxrÉÉmÉjrÉMüÉËUhÉ:

mÉëMÑüÌmÉiÉ:

zsÉåwqÉÉqÉÔ§ÉxÉqmÉ×£üÉåÅlÉÑmÉëÌuÉzrÉ

uÉÎxiÉqÉzqÉUÏÇ eÉlÉrÉÌiÉ||" (xÉÑ. ÌlÉ.

3/4)

“ AÇaÉpÉÇaÉÉzqÉUÏ

oÉÎxiÉqÉåRíûuÉǤÉhÉuÉåSlÉÉ:|

qÉÔ§ÉxrÉ UÉåkÉÉiÉç mÉÔuÉåï cÉ mÉëÉrÉÉå

UÉåaÉÉ:ç||" (A. xÉÇ. xÉÔ. 5/5)

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Samprapti Ghataka• Dosa : Tridosa ( Kapha pradhana )• Dusya : Mutra• Adhisthana : Vasti• Srotas : Meda & Mutravaha• Srotodusti : Sanga ( Obstruction )

mÉÔuÉïÂmÉ :

pain in the bladder , anorexia , dysuria , jwar , urine

smell like goat’s urine and pain in head of urinary

bladder , scrotum and penis indicates formation of

Ashmari.

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Ashmari Bheda( Su.Ni.3)VATAJA ASHMARI

• Dusty in color, hard, irregular, rough andNodular or spiny like kadamba flower.

• Experience severe pain, pull out the prepuce , and have difficulty when passing flatus , urine, and stools.

• oxalate stones

PITTAJA ASHMARI• Reddish, yellowish, and

blackish and resemble the color of honey.

• Produce a sucking type of pain , burning sensation,

• A warm feeling over the bladder region, and ushnavata.

• Urate stones

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Conti…

SHLESHMAJ ASHMARI SHUKRAJ ASHMARI

• occurs in adults. • due to suppression of

ejaculation for months or years and frequent coitus or coitus interruption.

• This causes dysuria, scrotal swelling, and lower abdominal pain.

spermolith.

• White, unctuous, and as big as ahen’s egg or colour of madhuka flowers.

• Produce symptoms such as dysuria, cutting, incising, pricking pain, heaviness, and a cold sensation over area the bladder region.

• phosphatic stone

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PLACES OF OBSTRUCTION

Ureteric colic starts as soon as the stone enters into the pelviureteric junction and at uretero-vesical junction.

Ureteric colic stops when the stone is ejected into the bladder or impacted in the ureter.

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PAIN AT DIFFERENT SITES

In the upper one third of the ureter PAIN occurs in the loin or near the renal angle and gradually radiates to the groin.

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CHIKITSAManagement of Ashmari acc. to Bruhatrayi’s Depends upon avastha of Ashmari.

Ashmari in Tarunavastha can be cured by following

treatment procedures-

• Ek mulika prayog

• Formulations

• Internal administration of Kshar

But Pravrudha Ashmari has to be treated by chedana karma.

( Su.Chi.7/3,4)

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EK MULIKA PRAYOG

• Shigru mula kalka ( Charaka & Vagbhata).

• Shrungatak kwatha.

• Vidarikanda kwatha ( Charaka )

• Gokshura beej churna ( Susruta )

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FORMULATIONAcc to Susruta & Vagbhata

Vataja Ashmari

• Kwatha :- pashana bheda, vasuka, ashmantaka, satavari,gokshura, brihati,

kantakari, bhramhi, artagala, usira, kubjaka, vrukshadani, bhalluka, and

varuna,and fruits of saka, yava, kulutha, kola, and kataka

• Kalka :- ushakadi gana

• GHRUTA- above drugs added in Ghruta and siddha Ghruta will prepared.

• Kshara , gruels, soups, decoctions, milk preparations, and food prepared from

this drugs should be administered.

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Ctd……….Pittaja Ashmari

• Kwatha: kusa, kasa, sara, morata, satavari,pashana

bheda ,vidari,varahi,shalimula, trikantaka, bhalluka, patala,

patha, kuruntika, punarnava, and shirisha.

• Ghritha :-prepared by using kwatha of above drugs to

which silajit, madhuka, seeds of indivara and trapusa, and

seeds of eravaruka are added.

• Kshara , gruels, soups, decoctions, milk preparations, and food

prepared from this drugs should be administered.

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Ctd…….Kaphaja Ashmari

• Kwatha :- varunadi gana, guggulu, ela, renuka, kushta,

and drugs of bhdraadi , maricha, chitraka, and devadaru.

• Kalka:- ushakadi gana drugs.

• Ghruta- Above drugs added in Ajasa Ghruta and siddha

Ghruta will prepared.

• Kshara , gruels, soups, decoctions, milk preparations, and

food prepared from this drugs should be administered.

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Ctd….

Acc to Charaka

• Pashanabhedadi churna , trutyadi churna.

• Goksuradi yoga ,Punarnavadi yoga.

• Punarnavadi mishraka sneha.

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KSHAR PRAYOG• Kshara prepared from Kalka of Tila , apamarga ,

kadali, palasa , yava.

Anupana :- Urine of Sheep

• Kshara prepared from patala and karavera .

Anupana :- Urine of Goat

• Kshara prepared from kalka of Gokshur, Yashtimadhu,

Brahmi.

Anupana :- Urine of Goat

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SHASTRA KARMA• Acharya Susruta mentioned

VITAPA CHEDA KARMA

• In male :-An incision of about the size of the stone then

made just a few millimeters away from the perineal raphe on

the left side.

• In Female:-An incision in the bladder made at one place

superficially .

• Instrument:-Agravaktra (small-tipped forceps, like mosquito

forceps).

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Drugs in practice• Pashanabheda• Gokshura• Varuna• Kanthakari• Kusha , Kasha, sara , Ikshumula • Punarnava• Guggulu• Kulatha

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Drugs not in practice but easily available

* Gunja * Marich* Changeri * Shunthi* Apamarga * Brahmi * Chitraka * Shirisha * Pippali * Yashtimadhu* Ankola

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FORMULATIONS IN PRACTICE

• Gokshuradi guggulu 3 g/day with pashana

bheda kwatha.

• Ashmari hara kashaya churna 48 g/day

• Varuna kwatha churna 48 g/day.

• Trikantaka ghritha 12 g/day with warm water

or warm milk.

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Ctd….

• Mulaka kshara 1 g/day with water

• Yava kshara 1/2–1 g/day with water

• Palasha kshara 1/2–1 g/day with water

• Chandra prabha vati 250–500 mg two times/day

with water, milk, or ginger powder

• Sweta Parpati 725 mg–1.25 g two times/day with

coconut water or cold water

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Scientific basis for drugs

• Aqueous extracts of Tribulus terrestris and Bergenia ligulata. 

Shows Inhibition activity of the growth of urinary calcium

hydrogen phosphate dihydrate crystals.

• Tribulus Terrestris shows - Antiurolithiatic Activity .

• Pashanabheda (Bergenea ligulata) - Acetone extract shows

devoid of possessing antilithiatic activity but exhibited a mild

diuretic effect when tested on rats and dogs.

• Varuna (Cratevea nurvala)-cytoprotective activity &

Antiurolithiatic activity.

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Conclusion• The Herbs which are used in the teatment of Ashmari,

were also considered in Pathya aahara. That is why

Aacharya Susruta suggested to used the same Herbs in

the form of Peya, Yavagu, Yush, Ksheerpaka etc.

• The tarunavastha of Ashmari may be consider as the

calculi size < 6mm & Pravruddha avastha can be

consider as > 7mm.

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Conti….

• Treatment principle is same in Ayurveda &

modern system only difference is advance

technology.

• Drugs which are not in practice but easily

available as mentioned in Bhruhattrayees

have to be proved by using those in clinics .

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Discussion• Mutravirechaniya mahakashaya• Shothahara DashemaniyaMentioned by Acharya Caraka can be used in Ashmari

chikitsa• Considering the size of Ashmari Acharya Susruta

might have mentioned both Shamana & shastra chikitsa.

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THANK YOU