Ayurvedic management of Mutrashmari Multiple Renal Calculi - A case study.

Abstract

Mutrashmari is a disease explained in Ayurveda, Mutravaha srotovikara  and  is one among Ashtamahagada described in Sushruta samhita, the disease which is Asadhya or incurable in nature1. Mutrashmari is Kapha pradhana Tridoshaja Vyadhi2. Mutrashmari is compared with Urolithiasis. Urolithiasis, are hard deposits made of minerals and salts that are formed inside the kidneys3. Renal calculi occur one in 11 people at some time in their lifetimes, with men affected twice than women. Development of stones is related to decreased urine volume or increased excretion of stone forming components such as calcium, oxalate, uric acid, cystine, xanthine and phosphate. Calculi are caused by low urinary citrate levels or excessive urinary acidity.4 Urine has various wastes dissolved in it, when there is too much waste and too little liquid, crystals begin to form. The crystals attracts other elements and join together to form a solid that will get larger unless it is passed out of body with the urine. There are four types of kidney stones calcium oxalate, uric acid, struvite  and cystine stones. Common symptoms include severe pain in lower back & abdomen, blood in urine, nausea, vomiting, fever and chills5. Calcium oxalate and calcium phosphate are the most common types accounting for > 80% of stones, followed by uric acid (8-10%) and cysteine, struvite in remainders6. Calcium stones are more common in men, the average age of onset is third to fourth decade. Approximately 50% of people who form a single calcium stone eventually form another within next 10 years. Uric acid stones accounts 5-10% of kidney stones more common in men. The patients with uric acid stone have history of Gout and is familial7. The risk factors includes positive family history, recurrent urinary tract infections, dehydration, people residing in warm, dry climates who sweat a lot, diet rich in protein, salt and sugar, medications- vitamin C, dietary supplements, calcium based antacids, metabolic disorders- hyperparathyroidism and gout8. The recurrence rate is higher, dietary modifications includes fluid intake and dietary changes and medical management are essential. The management includes combined medical and surgical management. Oral Alpha- adrenergic blocker, Pain relief medications and antibiotics in presence of infection. In Ayurveda early treatment includes Oushadha chikitsa with Ghrita and Kashaya, in later stages Bhedana and Patanan Shastra chikitsa is adopted9. The present study focus on Ayurvedic management of Ashmari or Renal Calculi with oral medications.  Matra basti was given to stabilize Apana Vata (VataAnulomana) followed by Shamana Chikitsa.