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2 CASE REPORT Impact Factor (2014) by International Scientific Indexing (ISI) UAE MANAGEMENT OF MUTRASHMARI (UROLITHIASIS) BY KADALIKSHAR A CASE STUDY Amilkanthwar R.H. 1, Rathod R.B. 2* 1. Associate Professor, Dept. of Shalyatantra. Govt. Ayurved College, Nanded, Contact No PG Scholar. Dept. of Shalyatantra. Govt. Ayurved College, Nanded, Contact no , - dr.rathodrb1111@gmail.com Article Received on - 20 th Feb 2015 Article Revised on - 24 th Feb 2015 Article Accepted on - 27 th Feb 2015 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below). (Full Text Page IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 CASE REPORT MANAGEMENT OF MUTRASHMARI (UROLITHIASIS) BY KADALIKSHAR A CASE STUDY *Corresponding Author Rathod R.B. PG Scholar. Dept. of Shalyatantra. Govt. Ayurved College, Nanded, Contact No , dr.rathodrb1111@gmail.com QR Code IJAAM ABSTRACT: The formation of urinary stone is a complex physio chemical process which involves sequence of events i.e. consequences of imbalance between stone promoters and inhibitors in the kidney. The persons suffering from urinary stone are very high and the rate is increased day by day, this is strongly associated with changing of standard of living, Geographic area, Climatic changes due to industrialisation, Diet and Occupational factors. The identification of common modifiable risk factors for urinary stone formation may result in new approach for treatment. With the objective of study the drug Kadalikshar mentioned in Ayurvedic texts for the management of Mutrashmari. Kadalikshar has Ushna, Tikshna, Pachan, Daran and Ropan gunas due to that it has Urolithiatic property and due to Mutral and Shodhan gunas it has diuretic property. Due to these gunas it breaks the Kaphavataj sanghat which is main Doshdushya sammurcchana in the samprapti of mutrashmari. It results in disintegration/ expulsion of calculi. Key Words: Mutrashmari, Urolithiasis, Kadalikshar INTRODUCTION The Mutrashmari [1] is one of the commonest diseases in our country and the pain due to that is known as worse than that of labour pain. The disease was described one among the Asthamahagadas. [2] Acharya Sushruta and others described it in detailed with its Classification, Aetiology, Pathology, Symptomatology, Complication and its Management in detailed. [3] According to modern science it is compared with Urolithiasis. The formation of urinary stone is a complex physio chemical process which involves sequence of events as Urinary saturation-super saturation-nucleation-crystal growth-crystal aggravation-crystal retaintion-stone formation. [4] The lifetime prevalence of symptomatic Urolithiasis is approximately 12% in male and 7% in female and the probability of secondary stone formation within 5-10 years is 52%. [5] Various risk factors has been identified for stone formation and these includes hot climate, Vitamin A deficiency, excessive administration of Vitamin D, Metabolic desorders, Hyperthyroidism, Gout, Ideopathic Hypercalciurea, Acidurea, Family history of urinary stone, Geographic area, Dietary factors rich with calcium like red meat, fish, cereals and pulses, Fluoride rich water and recurrent urinary tract infection also plays an important role as a risk factors. [6, 7, 8] Sushruta said asanshodhanshilata and mithaya aahar which causes kapha prakop and by strotovaigunya lead to Mutrashmari. [9] Now a day s various treatment modalities are available but they are too expensive and available at higher centres only and even after surgical intervention the pathogenesis behind recurrent stone formation cannot be avoided therefore it is necessary to find out economical, effective, easily available and acceptable medicine to treat Mutrashmari. Acharyas described various treatment modalities including surgical intervention for Mutrashmari. Acharya Sushruta said that before going to surgical procedure one should try with Ghrut, Kshar, Kashay and Uttarbasti. [10] Acharya Sushruta said Kshar is pradhantam and shrestha in Shastra and Anushastra. [11] Due to its Chedan (cutting), Bhedan (splitting), Lekhan (scarification), Mutral (diuretic), Shodhan, Ropan and Tridoshaghana properties. [12, 13] Kadalikshar [14, 15, 16 ] is one of them. Kadali (Musa Sapientum) is easily available and preparation of its kshar is very easy, there is no chance of adulteration and it is economical. So in the present case study Kadalikshar (paniya) [12] is selected for management of Mutrashmari. CASE HISTORY A 27 years old male patient presented with complaint of abdominal pain associated with difficulty in urination and reddish discolouration of urine since one month. Patient was the history of bilateral renal calculi and he was undergone for PCNL before one year. Then after he was asymptomatic, one month ago he was suddenly suffers from severe pain in abdomen associated with fever and vomiting. He was consulted nearby physician and got temporary relief from those complaints. Later he observed that pain in abdomen, dysurea, and hematurea were persisting after few days. Due to previous history of calculi Page68

4 and even after surgical intervention he was recurrence within one year, and for which he was approached our hospital for alternative medicine. According to his statement he was found that the pain was intermittent and colicky in nature and it was appreciated on either side of the abdomen, dysurea felt by the patient at the beginning of urination which was of pricking type and hematurea which was intermittent in nature. There is no history of Diabetes mellitus or Hypertension. Diet history reveals that his food intake was irregular in term of quality and quantity due to his stressful occupation. His vitals are within normal limits, on examination of abdomen he was no organomegaly but tenderness elicited in both side of lumber region and renal angle. As per advice patient underwent Ultrasonography of abdomen and pelvis, X-ray KUB and routine investigation of blood, urine and KFT was done on and the report reveals that there are three calculi of size 7 mm and 5 mms were noted in lower and mid pole of right kidney and 5 mm in mid pole of left kidney. X-ray shows bilateral radio opacity, blood, urine and KFT investigations were within normal range. As per classic features of Mutrashmari such as vedana, sadaha mutrata, sarakta mutrata were observed on the basis of nidan and rupa, this clinical condition was diagnosed as Mutrashmari. As described above Kadalikshar is administered to him for a period of one month in the dose of 500 mg twice a day, before meal, packaged in capsule. Patient was asked to adhere to prescribed wholesome diet and activity and follow up after every 7 days interval. During first follow up it was noticed that all the clinical features were absent except pain and it was also less in intensity, he was advised USG and it shows that there was single calculus of size 5 mm in mid pole of right kidney. During second follow up it was noticed that all the clinical features were absent he was advised USG and it shows that there was single calculus of size 5 mm in mid pole of right kidney. During third follow up it was noticed that all the clinical features were absent he was advised USG and it shows that there was single calculus of size 3 mm in mid pole of right kidney. During last follow up it was noticed that all the clinical features were absent he was advised USG and it shows right VUJ oedema noted secondary recently pass out VUJ calculus. Now he was advised to stop medicine and adhere to pathayapathaya and follow up after 15 days. Patient visited back after 15 days and stated that he was no any complaints, he was again advised USG and it was confirmed that there is no calculus. Later he was advised that to adhere to pathayapathaya. Table 1: CBC, Urine and KFT investigation Blood Value Urine Value KFT Value Hb% 13.1 gm% Alb. Nil Sr.Creatinine 1.3 TLC 6.7 Χ 10 3 u/l Sug Nil Blood urea 26 ESR 18 ph Acidic BSL(R) 93 Micro Table 2: USG reports Date Clinical features USG findings Pain, Burning micturation, Hematurea RK- 7 mm, 5mm in lower and mid pole respectively. LK- 5 mm lower pole Pain RK- 5mm in mid pole No RK- 5mm in mid pole No RK- 3mm in mid pole No VUJ oedema noted. No calculus is seen No Normal USG findings. X-ray- Bilateral radio opaque density is noted. DISCUSSION The pathogenesis according to modern science the stone formation is mainly due to Hypercalciurea, High uric acid level and low volume of urine [4]. Kadalikshar contains potassium which decreases the level of phosphate and carbonate in urine which are the main causative factors in the formation of oxalate and phosphate stones [16]. It decreases the saturation of urine and helps in dissolution of calculi. Kadalikshar is strong alkaliser it convert the ph of urine from acidic to alkaline. So it lowers the uric acid level. It works as a diuretic which increases the urine formation and urine output, that s results in disintegration and elimination of urinary stone from urinary tract. However the Kadalikshar has Ushna, Tikshna, Pachan, Daran and Ropan gunas due to that it has Urolithiatic property and due to Mutral and Page69

5 Shodhan gunas it has diuretic property. Due to its Chedan (cutting), Bhedan (splitting), Lekhan (scarification), Mutral (diuretic), Shodhan, Ropan and Tridoshaghana properties. [12, 13] Due to these gunas it breaks the Kaphavataj sanghat which is main Doshdushya sammurcchana in the samprapti of mutrashmari. It results in disintegration/ expulsion of calculi. CONCLUSION In the observation it was found that it is capable of reducing pain, dysurea, heamaturea and reducing the size of calculi and promotes to its disintegration and expulsion. Due to its Ushna, Tikshna, Pachan, Daran gunas it has Urolithiatic property due to Mutral and Shodhan gunas it has diuretic property. As this is a single case study the same intervention can be used on larger population to see the efficacy of Kadalikshar in the management of Mutrashmari. REFERENCES 1. Sushrut samhita Nidansthan by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p Sushrut samhita Sutrasthan by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p Sushrut samhita Nidansthan, Chikitsasthan by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p Boyd s pathology by A. C. Riteche, 9 th Indian ed. Bombay 1990, p Nephrolithiasis- Author J Stuart Jr. MD, FACS. Chief editor Bradely Fields Schwartz DO,FACS. 6-overview#a0156. Accessed date Manipal manual of surgery by K. Rajgopal Shenoy. CBS publisher & distributors New delhi 4 th ed p Text book of surgery by S. Das. Published at Kolkata 7 th ed. July 2012 p.1203, Short practice of surgery by Bailey & love s. Published CRC press Landon New York, 26 th ed 2013 p Sushrut samhita Nidansthan, by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p Sushrut samhita Chikitsasthan by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p Sushrut samhita Sutrasthan by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p Sushrut samhita Sutrasthan by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p. 45, 46, Rastarangini by Pandit Kashinathshastri, Prakashaka Motilal banarasidas New delhi 11 th ed. reprint p Sushrut samhita Chikitsasthan by Dr. Ambikadatta Shastri, Varanasi. Chaukhamba prakashan ed. reprint p Astang Hriday Chikitsasthan by Dr. Brahmanand Tripathi, Delhi Chaukhambha Sanskrit pratisthan ed. reprint 2007, p Rastarangini by Pandit Kashinathshastri, Prakashaka Motilal banarasidas New delhi 11 th ed. reprint p Indian Materia Medica by Dr. M.K.Nadkarni. Vol- 1, Popular prakashan Mumbai 3 rd ed. reprint p 822. CITE THIS ARTICLE AS Amilkanthwar R.H. et.al., Management of Mutrashmari (Urolithiasis) by Kadalikshar A Case Study, Int. J. Ayu. Alt. Med., 2015; 3(1):67- Source of Support Nil Conflict of Interest None Declared Page

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