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CASE REPORT
Impact Factor (2014) – 0.815 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.
9890569621
2. PG Scholar. Dept. of Shalyatantra. Govt. Ayurved College, Nanded, Contact no+919404416171, Email- dr.rathodrb1111@gmail.com
Article Received on - 20th Feb 2015
Article Revised on - 24th Feb 2015
Article Accepted on
- 27th Feb 2015
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Amilkanthwar R.H. et.al., Management of Mutrashmari (Urolithiasis) by Kadalikshar – A Case Study, Int. J. Ayu. Alt. Med., 2015; 3(1):6770
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eISSN
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eISSN 2348- 0173
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- +919404416171,
Emaildr.rathodrb1111@gmail.com
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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
Now a day’s various treatment modalities are
available but they are too expensive and available
at higher centres only and even after surgical
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
Amilkanthwar R.H. et.al., Management of Mutrashmari (Urolithiasis) by Kadalikshar – A Case Study, Int. J. Ayu. Alt. Med., 2015; 3(1):6770
68
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.
Page
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]
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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 25-3-2014 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
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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
Hb%
TLC
ESR
BSL(R)
Value
13.1 gm%
6.7 Χ 103 u/l
18
93
Urine
Alb.
Sug
pH
Micro.
Value
Nil
Nil
Acidic
-------
KFT
Sr.Creatinine
Blood urea
-------------
Value
1.3
26
-------------
Clinical features
25-03-14
Pain, Burning micturation,
Hematurea
03-04-14
11-04-14
20-04-14
Pain
No
No
29-04-14
No
15-04-14
No
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
USG findings
RK- 7 mm, 5mm in lower and
mid pole respectively. LK- 5
mm lower pole.
RK- 5mm in mid pole.
RK- 5mm in mid pole.
RK- 3mm in mid pole.
VUJ oedema noted. No calculus
is seen
Normal USG findings.
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
Amilkanthwar R.H. et.al., Management of Mutrashmari (Urolithiasis) by Kadalikshar – A Case Study, Int. J. Ayu. Alt. Med., 2015; 3(1):6770
Page
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69
Table 2: USG reports
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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.
4.
5.
6.
7.
8.
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.
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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):67-70
Conflict of Interest – None Declared
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Amilkanthwar R.H. et.al., Management of Mutrashmari (Urolithiasis) by Kadalikshar – A Case Study, Int. J. Ayu. Alt. Med., 2015; 3(1):6770
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