MUTRASMARI

PRESENTATION BY Dr. S. KAMALAKAR PURIPANDA

PRELIMINARY PG SCHOLAR

DEPARMENT OF SAMHITA SIDDHANTA

NIDANAAccording to Charaka Ati Vyaayaama Ruksha Madya Sevana Aanoopamaamsa Sevana Matsya Sevana Adhyashana Ajeerna Bhojana

According to Vaagbhata Snigdha Aahaara Sevana Divaaswapna Ajeerna Bhojana Madhura Aahaara Adhyashana

उष्ण गमनWalking in hot sun.An individual who have to work in direct sun, who perspire a lot may generally cause concentrated Urine and Urine volume is also reduced.Thus Ashmari is formed.

HOT CLIMATEIt causes increase in concentration of solutes, which results in precipitation of calcium that forms the stones of calcium oxalate

असंशो�धन शो�लस्य

An individual who needs Samsodhana and not undergone the Therapy time to time and indulges in kapha provoking food articles devolops Ashmari.

Because increased Kapha Dosha travels along with Mutra in Mootravaha Srotas and Ashmari is formed

प्रा�य�ण शो�त स्निस्नग्ध ग�रु मध�र आहा�र Excessive intake of Madhura, Guru, Snigdha Ahara such

as Milk, Meat, Egg etc causes Ashmari because such foods are Kapha provoking as well as rich in Calcium, Phosphate etc hence, they help in formation of Ashmari.

The word प्रा�य�ण explains that Kapha provoking factors cause Ashmari only in those individuals who are susceptible to it

DIET The food deficient in Vitamin ‘A’ causes desquamation

of Renal Epithelium which precipitates Calcium and causes stone formation.

The food such as Fish, Red meat, Eggs cause Aciduria

Food rich in Calcium,Tomato, Spinach, Milk causes stones of Calcium Oxalate.

अध्यशोन,दि�वा�स्वाप्न

It causes increase of Kapha in the body. Increased Kapha Dosha travels along with Mutra in Mootravaha Srotas and Ashmari is formed

INFECTIONOrganisms like Pseudomonas, Klebsiella etc causes Renal infection. They produce Urease and cause stasis of urine and causes stone formation.

GOUT: Serum Uric Acid levels raises in Gout and causes Uric Acid stones.

RANDALL’S PLAQUES: Randall opines that initially small erosion or an ulcer develops on Renal papillae. On this erosion Urinary salts deposited and cause formation of stones

SAMPRAPTI

The vitiated Vata driesup the Urine in Mutravaha Srotas, so that the Kapha, Pitta present in the urine attains the form of Ashmari

Vaata Kapha Aahaaraja & Vihaaraja

Vaata+Kapha Agnimaandya Aamotpatti

Vaata+Kapha+Aama

Dosha Dooshya Sammoorchanaa

Vata driesup

Prakopa

Kapha, Pitta present in the urine attains

the form of Ashmari

UpadravaMootra Sharkaraa

SikataamehaBheda

Vyakta

Sthaanasamshraya

Prasara

Sanchaya

Enters into Mutravaha Srotas

Ashmari nirmana

SAMPRAAPTI GHATAKA• Nidaana : Kapha, Vaata Prakopaka• Dosha : Kapha Pradhaana Tridosha• Dooshya : Mootra• Srotasa : Mootravaha• Srotodushti : Sanga• Agni : Jatharaagnimaandya• Aama : Jatharaagni• Dosha Maarga : Koshtha, Shaakha• Roga Maarga : Aabhyaantara• Udbhava Sthaana : Pakvaashaya (Apaana Kshetra)• Adhishthaana : Basti (Mootravaha Srotasa)

P00RVA RUPA

THE POORVARUPAS MENTIONED IN CLASSICS ARE ALSO OBSERVED IN RUPAVASTHA OF ASHMARI

Severe pain at site of Ashmari Sedimentation of urine(दुष्ट सं�न्द्र म&त्रत�) Turbidity of urine(आविवाल म&त्रत�) The concentrated urine smells like goat’s urine Fever is indication of UTI due to Renal stone

The 4 types of Ashmari indicate 4 locations of Mutravaha Srotas where Ashmari is stagnated or lodged.

1.Vaataja- Ureteric stone2.Pittaja- Vesicle stone3.Kaphaja-Kidney stone4.Sukraja- Urethral stone

Urinary stones are typically classified by their location in the

•Kidney (nephrolithiasis),

•Ureter (ureterolithiasis),

•Bladder (cystolithiasis),

CLASSIFICATION- BY LOCATION

POINTS TO REMEMBER

Pain in Nabhi, Basti, Sevani and Mehana Bleeding with urine – Haematuria or Turbidity Double stream of urine with sudden stoppage Pain is relieved after expulsion of stone Pain aggravates on unusual position like Riding,

Travelling, Jumping

DIFFERENTIAL DIAGNOSIS

VATAJA ASHMARI URETERIC STONE

1 These are reddish black / black / grey in colour. Stone is spiky, irregular, rough, hard and they appear like kadambha pushpa.

Calcium oxalate (have sharp projections, irregular with rough surface and usually single) stones produces hematuria resulting in deposition of blood over the stone giving dark brown colour to the stone

2 While migrating from one place to other the spiky stones cause injury and some times get obstructed in the urinary passage. Pain is radiating from Nabhi, Basthi, Sevani, & Mehana

The pain occurs typically at loin and radiates to groin. When the stone descents to lower ureter pain radiates to the testicle (male), labia majora (female) and upper portion of the inner part of thigh.

3 When the stone is descending from kidney in to the ureter pain is severe because, the diameter of renal pelvis is 1 cm and the ureter is 2 to 3 mm in some condition the abrupt narrowing of the ureter causes stagnation of the stone

The pain occurs when the stone is entering in to the ureter but, it may also occur when a stone becomes lodged in pelvi ureteric junction .

4 The patient with pain passes urine drop by drop with straining

Stranguary means passing of urine drop by drop with painful straining

Ureter• Ureter has 3 constrictions:

1. Pelvic-ureteric junction

2. When it crosses external iliac vessel

3. Vesico-ureteric junction

V

1.SPREAD ALONG SUBCOASTAL AREA TOWARDS THE UMBLICUS CORRESPONDING LEFT HYPOCHONDRIC,LUMBAR REGION ANTERIORLY.2.RENAL ANGLE POSTERIORLY MEANS ANGLE FORMED BETWEEN OUTER BORDER OF ERECTOR SPINAE MUSCLE AND LOWER BORDER OF 12TH RIB)

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CALCIUM OXALATE STOnES-VAATAJA

PITTAJA ASHMARI VESICLE STONE

1 The colour of the stone is either yellow or moderately red or black or honey colour and it appears like ballataka

Uric acid stones Yellowish,Reddish-Brown,Radio Lucent,Small multiple hexagonal shape.

2 When pitta is associated with Kapha Dosa Pittaja Ashmari is formed and obstruct the urinary passage.Due to this burning and sucking type of pain in Basti region.

Burning and sucking type of pain occurs.When the stone approaches the bladder and symptoms of vesicle irritability is observed.Stone impacting very near the bladder can exactly mimic and acute cystis .This is caused by abrasion of vesicle

URIC ACID STONES

PITTAJA

KAPHAJA ASHMARI KIDNEY STONES

Kaphaja Ashmari quite bigger in size therefore pricking, pulling type of dull ache.

Renal pain occurs when stone is in kidney.It is fixed pain not radiating. Patient typically describes renal pain by putting his hand on waist.

Stones are big,smooth, round, appears like hen’s egg and flower of Madhuka.It is white sometimes light honey color.

Phospate stones are compared to kaphaja ashmari. They are dirty white/yellow white.They grow bigger in size, they are smooth and round like hen’s egg .

SHUKRASHMARI(SPERMOLITH)

The stone formed in Seminal Vesicle. After the formaton of Semen if Sukra Vega is supressed, instead of expelling out it gets vimarga gamana and lodged in between Vrushana and Medra. At this stage vata driesup the sukra and stone is formed.There is pain in Suprapubic region,difficulty in micturation and swelling in scrotum.when sukra is expelled out the Ashmari is relieved.

phosphate stone

KAPHAJA

Stone present in the Kidney may not have severe pain, however dull, constant ache fixed to renal angle.(Kaphaja)

But same stone start descending from Kidney to ureter,due to its narrow passage, stone is arrested in ureter and sudden severe colicky pain occurs in abdomen, which is radiating from loin to groin.(Vataja)

When the same stone reaches U.B - burning type of pain in suprapubic region.(Pittaja)

KV

PS

ASHMARI IN CHILDREN As the infants and children are found of sweets, milky product,

heavy food, day sleep and habit of eating before previous meal is digested, they are more suspectible to Ashmari

In children sudden screaming(a high-pitched noise) during micturation and pulling at the prepuce often indicate the presence of stone in the bladder

Pain at the end of micturation reffered to the tip of penis in young boys indicates stone in the bladder. Usually in school going children pain is increased by jumping etc

CHIKITSA

Ashmari is a grave disease so that it is included in Astamahagada. It is not easily curable.

If Ashmari is recently formed and small in size it can be treated with Medical management.

But the Prognosis is not good if it is chronic and bigger in size,hence Shastra Chikitsa is recommended.

SHAMANOUSHADI Pasanabhedadhi ghrita. Kushmanda swarasa Varunamoola twak kwatha Trikantaka choorna Shwadamstradhi kasaya Sharapanchamooladhi ghritha Kshara prayoga

The drugs like Pashanabheda,Gokshura, Shilajitu, Trapusa promote crushing of Urinary stones,they have quick action.

MODE OF ACTION OF DRUGS

Ashmari Bhedana, Pathana Mutrala/Basti Sodhaka Mutra Sulagnam/Basti Sulagnam Mutrakrichraharam Mutranulomaka/Mutra Vibandhagnam

COMPOSITION INDICATIONS

Pashanbhed 60mgSweta Parpati  25mgApamarg Panchang 20mgVaruna Ext. 20mgSudh Shilajit 15mgPunarnava 50mgHajrul Yahood Bhasm ) 45mgSahdevi 20mgGokhshura 20mgLajjalu Mool 15mgYavakshar  10mg

Urinary calculi (Stone) Recurrent calculi (Stone) Urinary Tract Infections Cystitis (Inflammation of

the urinary bladder due to infection)

Burning micturation (Burning sensation while passing urine)

NEERI

VARUNA:Kapha Vata Hara,Deepana.IND:Ashmari,Vidradhi,Gulma,Krimi,Gandamala

GOKSHURA:VataPittaShamaka,Deepana,Vasti Sodhana

IND: Ashmari,Mutrakricha.

PUNARNAVA:Kapha Vata Hara,Deepana.

IND:Shota,Shoola,Pandu.

PASANABHEDA:Tridosahara, Vasti Sodhana,

Mutra virechaniya

Inj.BUSCOPAN:IV/IMHYOSINEIND:G.U/G.I.T SPASMD: 1AMP

Inj.DYNOPAR:IMDICLOFENACInd:Pain & InflamationD: 1AMP

Inj.LASIX: S.IVFUROSEMIDEIND: Accute/chronic renal infections HypertensionD:40mg

Inj.MANNITOL:is an Osmotic Diuretic.It works by increasing the amount of fluid excreted by the kidneys.

LABORATORY FINDINGS Urinary ph is valuable clue to the cause of the possible

stone. Normal-5.85 Uric acid-below 5.0 Phosphate-above 6.0

Renal Ultra Sound Examination will diagnose most stones

KUB X-ray

Kidney

Transverse process of lumbarvertebrae (landmark for Ureter)

Bladder

Psoas shadow

PATHYA IN ASHMARI Kulattha Godhuma Yava Tanduleeya Ardraka Mudga Jeerna shali Jeerna kusumanda phala Yavakshara

APATHYA FOOD RICH IN CALCIUM,OXALATE,PHOSPATE:

Calcium: Leafy Vegetables, Milk products, Sesame seed, Raagi.

Oxalate: Leafy Vegetables, Beetroot, Spinach

Phospate: whole Cereals, Legumes, Nuts and Oils, Meat, Fish, Egg and Milk

REFERENCES

SU.NI.3 CHA.CHI.26 A.H.NI.9 A.S.NI.9 M.NI.32

THANAK U

THANK U DOCTORS

“If one obeys pathyas ,no disease will occur and if one never mind them and continues apathyas, no treatment is

needed,as it is not going to be cured”