Presented By Name: Dr. Prathamesh V. Karpe BAMS, MS (shalyatantra) - PowerPoint Presentation

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Presented By

Name: Dr. Prathamesh V. Karpe BAMS, MS (shalyatantra)Country: INDIA

3rd International Conference and Exhibition on Traditional & Alternative MedicineAugust 03-05, 2015 Birmingham, UK 

In A

ssociation with

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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- India

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“Stones are precious but not in the body”

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What is UrolothiasisIt is commonly known as kidney stone or urinary stoneIn sanskrit it is known as “Ashmari”In India, the “stone belt” occupies some parts of Maharashtra, Gujarat, Punjab, Haryana, Delhi and Rajasthan

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तुल्यतामश्मना यान्ति तस्मात्ताश्मरी विदुः/(

tulyataamshmana yaanti tasmaatashmari vidu)Ashmari or calculus looks like small gravels/stones hence they are termed as ashmari

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What are its causesतत्र संशोधनशीलस्यापथ्यकारिणः प्रकुपितःश्लेष्मा मूत्रसम्प्रुक्तो

sनुप्रविश्य बस्तिमश्मरी जनयति// (सु.नि.४)विशोषयेद् बस्तिगतं सशुक्रं मूत्रं सपित्तं पवनं कफ़ं वा/ यदा तदाsश्मर्युपजायते तु क्रमेण पित्तेष्विव रोचना गोः//

(च.चि.३६)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.

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Pathogenesis- sampraptiएवमेव प्रवेशेन वातः पित्तः कफ़ो

sपि वा/ मुत्रयुक्त उपस्नेहात् प्रविश्य कुरुतेsश्मरीम्//Vata-Pitta-kapha dosha enters into basti like how mutra enters into

basti from Pakwashaya and with Upasneha nyaya Ashamari is formed in Basti.

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अप्सु स्वच्छास्वपि यथा निषिक्तासु नवे घटे/ कालान्तरेण पंकः स्यादश्मरीसम्भवस्तथा//

(सु.नि.२४-२६)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.

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संहन्त्यपो यथा दिव्या मारुतोsग्निश्र्च वैद्युतः/ तव्दद्बलासं बस्तिस्थमूष्मा संहन्ति सानिलः/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.

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Purvaroopaतासां पूर्वरुपाणि- बस्तिपिडारोचकौ मुत्रक्रुच्छ्ं बस्तिशिरोमुष्कशेफ़सां वेदना ज्वरः क्रुच्छावसादौ बस्तगन्धित्वं मूत्रस्येति //

Pain and discomfort in the bladder, urethra,testicles/external genital organs.Anorexia, dysuria, fever, debility, smell of goat’s urine.Colour of urine appears like that of individual doshas and pain accordingly.

urine appears non-clear, increased specific gravity.

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Types KaphajaVataja

Pittajashukraja

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Samanya 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.

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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.

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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

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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 hen’s egg, pale-white colour, unctous to touch, large in size and like madhuka flower.

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Madhuka

pushpa

kukkutanda

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Shukrashmari 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.

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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 instruments

Due to non development of shukra dhatu, there are no chances of forming shukrashmari

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chikitsaNewly formed ashmari can be treated with medicinesChronic- surgical removal

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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) etc

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Kaphaja 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 sheep’s urine prevents sharkara formation

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Use of Ghrita, Kshara,kashaya, kshira and Uttarbasti

are advised.If no relief with above medications then surgical extraction of calculus should be performed.

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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

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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 nodule

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While performing this procedure if patient becomes unconscious or goes into shock, in such condition procedure should be hold and extraction shouldn’t 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

अग्रवक्र आहारण यन्त्र (curved forcep)

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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.

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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

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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 wound

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For 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

kalka

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If urine doesn’t 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.

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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.

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Commonly used medicines in treatment of AshmariEranda

KantakariGokshuraIkshumoolaApamargaShatavari

BrihatiYavakulatthaAbove all drugs with sweet curd helps in breaking of Vataja ashmari

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KushaKashaShara

PashanbhedaDarbhaVidarikandaVarahikandaShalimoolaGokshuraPathaPunarnavaShirisha

Above drugs either in decoction of medicated ghee helps in breaking the pittaja ashmari

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Treatment 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.

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Formulations used Suvarnarajvangeshwar rasa

Gokshuradi gugguluBadarashma pishtiSangehyahud bhasma

Yavak ksharApamarga ksharShwetaparpati

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Panchakarma Before starting any formulations first purification of the body should be performed depending on doshic dominances

Vaman (kapha dominant)Virechana (pitta dominant)Niruha Basti (vata dominant)

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To do- pathyaWhat to eat?Yava

KulatthaPurana shaliPurana kushmaand phalaShighruThings to doAvagaha

swedaSeasonal purification-vaman,virechan,basti

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not to doHolding of natural urges like urine/faecalFoods which causes indigestion- acidic in nature

Stale foodAerated drinksIncompatible foodDry food

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Case 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.

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O/e all vitals were stable.

Nadi parikshan- Vata kapha

Prakruti- Kaphapradhan pittanubandi

Eyes-NADTongue- saam

(coated)Mala- constipatedMutra- burning

micturation

Akruti

- thin

Srotas

-

annavaha

sroto

and

mutravaha

srotodushti

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USG abdomen on 19/2/14 showed 7 calculi in the left kidney, two in the middle calyx 3mm & 2

nd 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 size

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Kidney function test was normal

Urine analysis revealed oxalate crystals along with increased pus cells and cast cellsAyurvediya diagnosis- Mutrashmari-

Vata-kaphaja

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TreatmentAma pachan

Agni dipanaVata-anulomanAshmari bhedanMutra virechana

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Drugs 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 advised

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Post 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 calyx

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Thank you

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