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CAUSES FOR KIDNEY STONES AS PER AYURVEDA 

In Ayurveda, since from the Dhanwantari it is known and illustrated well. Dhanwantari had explained it as a “MutraAsmari” meaning urinary calculi. After him in the Ayurveda texts- AshtangaHridaya, Sushrutsanhita etc also explained in detail the causes, symptoms, diagnosis, precautions, and treatment. As per these references the causes are determined by factors like

• ApathyaAahara (unwholesome / odd food)

• Low water consumption.

• Urinary tract infection.

• Mutravirodha, Shodhanadosha (resistance in the urine elimination)

• Chemical drugs.

• Idiopathy etc.

Ayurvedic classical literature have emphasized two important factors as the reasons for urinary calculi.

Improper body detoxification (asmashodhana): If the person indulges in unwholesome food and habits for long and suppresses the natural urges like urination, bowel habits etc, naturally the toxins are retained in the body. Ultimately they sediment and precipitate in the bladder which is the organ related to the expulsion of kleda (moisture) from the body.

Improper food habits (apathya sevana): Untimely eating, over eating, indigestion, unwholesome food and beverages, sedentary lifestyle, less intake of water etc cause improper evacuation of metabolic wastes. Thus they are deposited in the path way of excretory systems leading to kidney stones.

Other than this,

heavy exercise (ativyayama) leading to dryness of the body,

spicy food (vidahiahara),

strong medicines (teekshnoushadha),

dry food (rookshaahara),

excess walking (atiadhwa),

riding the vehicles / horses (ashwa yana),

non vegetarian diet (mamsala ahara),

loss of sleep (nidraalpata),

salty food (lavana ahara) etc also stand as the supporting factors for Urinary calculi.

BASIC CAUSATIVE FACTORS FOR DOSHA AGGRAVATION:

Accordingly to the doshas / prakopa the causes are classified as Vatadosha, Pitta dosha, Kaphadosha and Shukrajdosha, called tridosh vyadhi.

Predominant cause is by kaphadosha. 

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SAMPRAPTI

DISEASE PROCESS AND PATHOGENESIS

Vatadosha- Due to vatadosha the vata is accumulated in the vasthi (urinary bladder), its qualities are rukshaguna (dry- rough), it stimulates drying up of mutra, (Urine), shukra, pitta and converts it to crystal form.

Kaphadosha –It is Guru (dominant), snigdha (oily), it build up the crystals together to form a stone. It forms soft stones that are whitish in colour.

Pitta dosha – It is due to highly acidic urine and forms blackish stones.

PATHOLOGY OF URINARY CALCULI

Due to the above said factors, the urine gets concentrated and its acidity increases. Reduced quantity of urine, leads to increased dryness, sedimentation of salts, leading to stone formation and obstruction to urine flow.

It results in painful urination. Often it is associated with burning sensation. As the muscular tone is reduced, the patient complains of fatigue in the localized area, pain is found in the nearby parts like bladder, flanks, back, urethra etc. Due to the accumulation of toxic substances (morbidity) headache is also caused. 

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SYMPTOMS OF TYPES OF ASHMARI 

Pain over nabhi (naval), bladder, veins, ducts.

Irritation on urination.

Frequently & obstructed urination. Mutravisarga dosh.

Hematuria.

Pain in navel, perineum, head of the bladder (upper part of the bladder).

Urine coming out in scattered and split streams (due to the stones blocking the urinary passages).

When the stone breaks in the urinary passages, the person passes the urine easily, the urine will be clear and will have reddish colour.

If the stone rubs within the bladder and causes wounds, bleeding occurs in the bladder and the blood is eliminated in the urine

When the passages are obstructed by stones, if the person tries to pass the urine forcibly, he will suffer from severe pain.

FEATURES OF ASHMARI BASED UPON TRIDOSHA DOMINANCE:

1. VATAJA ASHMARI

Severe pain during urination,

teeth biting,

shivering,

pain in the genitalia,

long persisting pain in the umbilicus,

expulsion of vayu during urination (obstruction to the free flow of urine) and defecation,

Blue or bluish red coloured urine,

and small sized stones are the features of Kidney stones due to Vata imbalance.

Excruciating pain.

Pain gnashes up to teeth, palms.

Irritation, burning in penis, painful defecation and belching.

Hematuria

VatajaAshmari presents with the below said symptoms:

Pain: The pain is so severe that the patient grinds his teeth and shivers

The patient presses his penis every now and then. He also presses his navel region

He excretes the stools with flatus but the urine dribbles in drops

Shape of the stone – looks like thorns

Colour of the stone – blackish brown, reddish yellow (golden yellow)

Vataj stones are-

– dusty coloured,

– rough

– Hard, faceted and nodular.

– it resembles uric acid stones.

2. PITTAJA ASHMARI

Burning sensation near the bladder,

warmth in the genitalia,

urinary calculi similar to the seeds of Bhallataka (marking nut) and

Reddish yellow coloured stones are the features of Pitta dominant urinary calculi.

Burning, sucking, drawing like sensation.

Urine colour yellowish red.

Associated with fever, chills.

PittajaAshmari symptoms are as follows:

Burning sensation

Heat, just like in the wound which is undergoing suppuration

The stone has a size of the seed of Bhallataka

Colour of the stone: Red, yellow or black

Pittaj stones are –

Reddish, Blackish, Yellowish, honey coloured.

look like seed by shape.

it resembles calcium oxalate stones, uric acid stone, cystine stone.

3. KAPHAJA ASHMARI

Pricking pain in the bladder,

Sensation of cold and heaviness,

Large-soft-honey or white coloured stones are the features of Kaphaja urinary calculi.

Part of bladder gets pains.

Stiffness at the region of pain.

Bursting type of pain in the organs.

Urine colour is whitish.

Kaphaja Ashmari presents with the below said symptoms:

Pricking pain in the region of urinary bladder

Coldness in the bladder region

Heaviness in the bladder region

The stone will be bigger in comparison to the other stones, it will be soft and have the colour of honey or white in colour.

Kaphaj stones are-

whitish, brilliant coloured.

it resembles calcium phosphate stones.

4. SHUKRAJA ASHMARI – SPERMOLITH

Constant suppression of semen results in this kind of stones in men. This is co-related to spermolith.

Pain in the bladder, dysuria, inflammation in the scrotum and decreased sexual libido are the features of this kind of stones.

Discharge of semen and sediment occurred by excessive coitus or abrupt or sudden stopping of sexual act.

Associated with dysuria, scrotum swelling.

Shukrashmari occurs in the adults who withhold the urge of seminal ejaculation. The semen leaves its site of production due to sexual urge or sexual intercourse. When the person withholds the semen at the point of ejaculation, the semen gets stagnated between the 2 testicles and is later dried up by vayu. This dried up semen attains the form of calculi (stone). This is called Shukrashmari and it produces the following symptoms:

Pain in the region of the bladder

Dysuria

Swelling in the testicles

When the site of seminal calculi is pressed (immediately after its formation), it breaks and flows by getting mixed in the urine) 

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LOCATION & COMPOSITION OF KIDNEY STONES 

1. DEPENDING ON LOCATION

1. Nephrolithiasis – These calculi are found in the kidneys.

2. Urolithiasis – These calculi originate anywhere in the urinary system, kidneys and urinary bladder.

3. Ureterolithiasis – These calculi are found in the ureter.

4. Cystolithiasis – These calculi are found in the urinary bladder.

5. Calyceal calculi – These calculi are found in the minor or major calyces.

2. DEPENDING ON CHEMICAL COMPOSITION

1. Calcium oxalate crystals :- These are formed by dietary oxalate containing vegetables, fruits and nuts. In this kind of calculi, urine becomes acidic and shows low pH value.

2. Calcium phosphate crystals :- These are due to alkaline urine and having high pH value.

3. Uric acid crystals :- These are formed by rich animal protein, purines, meat, fish etc. in the diet. In this urine is acidic and has high pH value.

4. Cystine crystals :- Cystine is a water soluble white coloured amino acid derived from protein diet. When it is released in kidneys, crystals are formed.

Struvite crystals :- It is a magnesium ammonium phosphate, derived from high magnesium based diet. These are formed due to the infection in alkaline urine. 

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COMPLICATION AND DIGNOSIS

COMPLICATIONS OF URINARY CALCULI

Debility, fatigue, emaciation, abdominal pain, tastelessness, anaemia, burning sensation during urination, thirst, chest pain and vomiting are the complications of urinary calculi.

DIAGNOSIS

Diagnosis of kidney stone is possible by physical examination, and other examinations.

1. Physical examination by observations of pain sites

2. Blood examination- for calcium, phosphorus, uric acid, electrolytes, blood urea nitrogen, creatinine, kidney function.

3. Urine examination – for crystals, bacteria, blood particles, pus cells.

4. Ultrasound examination – for size, shape and location of calculi.

5. X- ray of abdomen.

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LINE OF TREATMENT OF URINARY CALCULI 

Mild oleation (snehana),

Medicines which are penetrative (teekshnaushna) and break the stones (ashmaribhedana),

diuretics (mutraladravyas) – to flush out the small sized kidney stones,

sufficient water intake, watery food intake,

coolants (sheetalaupachara) and remedies to balance Vata (vatahara upachara) are helpful to relieve Ashmari (Urinary calculi).

According to Dosha imbalance, each variety of calculi is treated easily and successfully. 

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SINGLE DRUGS USEFUL IN ASHMARI 

Pashanabheda – Bergenialigulata (Wall.) Engl.

Shunti – Ginger – Zingiberofficinale Rose.

Varuna – Crataevanurvala Buch-Hem.

Shigru – Moringa – Drumstick tree – Moringaoleifera Lam.

Gokshura – Tribulus – Tibulusterrestris Linn.

Punarnava – Boerhaviadiffusa Linn.

Kooshmanda – Winter Melon – Benincasahispida (Thunb.) Cogn.

Shatavari – Asparagus racemosus Willd.

Kadali – Stem of banana – Musa paradisiaca Linn.

Kutaja – Holarrhenaantidysenterica (Linn.) Wall. Ex. G. Don.

Sukshma Ela – Cardamom – Elettariacardamomum Matom.

Trapusha – Cucumissativus Linn.

Kulattha – Horse gram – Macrotylomauniflorum (Lamk.) Verdc.

Shilajit – Asphaltumpunjabinum

Shaka – Tectonagrandis Linn. F.

Ervaru – Cucumismelo

Karpasa – Cotton tree – Gossypiumherbaceum Linn.

Tinduka – Diospyrus peregrine (Gaertn.) Gurke. 

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AYURVEDIC MEDICINES FOR KIDNEY STONES BASED ON STAGE 

Ayurvedic remedies are given as per situation considering the stages.

• First stage- ( severe pains in the abdomen region – Vataharchikitsa)

• Second stage– (burning sensation during urination – Pittaharachikitsa)

• Third stage- (Obstructed urination – Kaphaharachikitsa)

FIRST STAGE REMEDIES-

At this stage, diuretics and analgesic remedies are given. These are Gokhru – Gokshura powder (puncturepine), Varuna powder (caper tree), Kulthi powder (Dolichosbiforuslinn) Safed Musli powder, Talimkhana, etc.

SECOND STAGE REMEDIES –

Along with first stage remedies, punarvasa, varnadav, pashanbheda, tamilkhana, kolilaksh, mako – Solanumnigrum, pashanmed, vayavana etc.

THIRD STAGE REMEDIES –

At this stage remedies for breaking the stones are given – Kokilaksh, punarnava, avipathy, hingavasad, ardhvilva, balpunarnava, chandraprabha, gomutraharitaki, vatsamayantaka, dantaharitaki, pravalbhasma, abhrakbhasma, shilajit, kanmadabhasma, brihatyakashya, chandanasava, kalyankshar. Etc.

SURGERY

In acute cases surgery is needed. Nephrolithotomy and Lithotripsy are easier surgeries and are non invasive. 

PATHYA

Mushrooms, germinated beans, pulses, wheat, bajra, green peas, karela, sugar, jam, green chillies, papaya, mango, apple, wheat bran, bengal gram flour,

Ushnodaka (Warm water) – As per ayurveda, hot water relieves Vata and soothes the inner mucous membrane. Hot water benefits

Phalgu (Ficuscarica Linn.)

Draksha (Vitisvinifera Linn.)

Ervaru (Cucumismelo)

Puranashali (old rice)

Mudgayusha (green gram soup)

Sita (sugar candy)

Takra (buttermilk)

Peya (water) – drinking good amount of water throughout the day.

Kushmanda (ash gourd)

Narikela (coconut water)

Amalaki (goose berry) etc

APATHYA

Milk, milk derivatives, vanaspati ghee, tea, coffee, eggs, green vegetables, non veg having bones, crabs, etc.

Heavy exercise (Ativyayama), increases Vata and dryness of the body

Suppression of natural urges (Vegadharana) – lead to urine retention in urinary bladder for a long period of time, leading to sedimentation.

Dry food (Shushkahara-Rukshahara)

Grain flour (Pishtaanna)

Exposure to breeze (Pravatasevana)

Working in sunshine (Arkatapa)

Excess of sexual indulgence (Ati vyavaya)

Kapittha (Limoniaelephantianum (Correa) Panigrahi.)

Jamboo – Jamun seeds – (Syzygiumcumini (Linn.) Skeels.)

Bisa (Nelumbonucifera Gaertn.)

Excess of astringent food (Kashaya rasa sevana) 

1. EARLY STAGE

PANCHKOL KVATHA EMPTY STOMACH

2. ABHYANTER SNEHPANA – TRIPHALA GHRITA

3. VAMAN

4. VIRECHANA

5. BASTI(KAL BASTI)

ANUVASANA – DASHMULA TAILA (1ST AND LAST)

NIRUHA- GOKSHRADI KVATHA 50GM + VARUNADI KVATHA 50GM -> ADD 8 TIMES WATER AND MAKE 300 ML KVATHA -> 5GM SAINDHAV + 50ML TRIPHALA GHRITA +50ML MADHU + YAVAKSHAR 10GM

6. UTTER BASTI(20ML)

NIRUHA BASTI- GAMBHARI + KUTAJ KVATHA

ANUVASANA- PHAL GHRITA(3 DAYS THEN 3 DAYS REST – 3CYCLE)  

Formulations useful in Urinary calculi

1. Pashanabhedikashaya

2. Varanadikashayam

3. Veerataradikashaya

4. Chandraprabhavati

5. Punarnavashtakakashaya

6. Punarnavadikashaya

7. Punarnavadiguggulu

8. Gokshuradiguggulu

9. Elakanadikwatha

10. Trivikrama rasa

11. Shilajatuvati

12. Jawaharmohrapishti

13. Godanti (karpoorashilajatu) bhasma