A comparative clinical study to evaluate the efficacy of Mutravirechaneeya mahakashaya and Eladi kwath in the management of mutrashmari w.s.r. to urolithiasis

Purpose of ayurveda

 To maintain the health of a healthy person.

 To cure the diseases of patient.

In this, to fulfill the first purpose, daily routine, seasonal routine, night routine and diet. There is a description of adherence to apathya and use of chemicals and to achieve the second purpose, there is a description of the three sutras and the quadruples of treatment.

 In Ayurveda, Ashmari disease is one of the eight diseases.

 vatvyadhi, prameha, kustha, arsha, bhagandar, ashmari, mudhagarbha, these seven and eighth udergat disease, these eight are major diseases and are harmful by nature.

Ashmari is made up of two words, Ashm and Ari, Ashm means stone and Ari means enemy.

    12% of the world’s population is suffering from kidney stone disease, the recurrence rate of which is 70% to 81% in men and 47% to 60% in women.

97: Ashmari is found in kidney and ureter while the other 3: are found in urinary bladder and urethra.

Ashmari is a worldwide problem. Ashmari causes severe abdominal pain, burning sensation in urine, bloody urine and difficulty in urination.

    Ashmari is a terrible disease, it should be considered equal to Yamraj (deadly). For new cancer, medical treatment is possible, but for old cancer, there is a need for weapon treatment.

Ashmari is a serious and painful disease, since Acharya Sushruta has called new asthma treatable, hence asthma should be treated in the new stage itself, so that the disease remains treatable.

 Since the Samhita period, many Ayurvedic remedies are being used for the treatment of ashmari.

In the Samhita, Ashmari has been described under mutravaha shrotas. Which Tridoshaj is mainly Vatakafaj, which Acharya Charak has described under Samanjay Vikar.

Synonyms of Ashmari. stone, sarkara

Due to not correcting the body through vomiting, purging etc. and bad habits like wrong diet and behavior, the mucus which gets irritated by mixing with urine and enters the body, produces ashmari.

In the initial form of Ashmari, the symptoms are pain in the internal Urethral Orifice, loss of interest in food, dysuria, fever due to dysuria, and smell of goat in the urine.

 Just as even when a new pitcher is filled with very clean water, after some time, sludge gets collected in the form of a precipitate, in the same way, in the existing clean urine too, stone formation occurs after some time.

 When the air dries up the urine along with the semen or the phlegm along with the bile which has entered the urinary bladder, then the body becomes stoney, just like gorochan is formed in the gall bladder of a cow.

 Form of Ashmari: Due to Vata dosha it is like Kadamba flower and Triputi is triangular, due to Pitta dosha it is hard and smooth like a stone and due to Kapha and Shukra it is soft.

 Symptoms of kidney stone: When stone comes into the urinary tract, it blocks the passage and creates obstruction in urine output and causes pain in the colon. Then the urethra (from the root of the scrotum to the anus) causes pain in the penis and urinary bladder and produces many streams of urine and the patient urinates repeatedly.

UROLITHIASIS

DEFINITION

Stones is the urinary tract occur when urinary chemistry result in concentrations of stone salts that exceeds the limit of metastability for that salt in solution.

This most often reflects excessive excreation of one or more stone constituents,deficient inhibitory activity in urine, or simply a low urine volume resulting in excessively concentrated urine.

                                       Ø PATHOPHYSIOLOGY

Urinary calculi consist of aggregates of cristals ,usually containing calcium or phosphate  in combination with small amounts of proteins and glycoproteins. In devloped countries, however,most calculi occure in healthy young man, in whom investigation reveal no clear predesposing cause. Renal stone vary greatly in size. There may be particals like sand anywhare in the urinary tract, or large round stones are common, particularly in children.In developed countries,the incidence of childhood bladder stones is low,renal stones in  adults are more common.

Ø CAUSES

·        Low urine volumes, low fluid intake

·        Diet: high protien, high sodium, low calcium

·        High sodium, oxalate, urate excreation

·        Low citrate excretion

·        Renal tubular acidosis type1

·        Famillial hypercalciuria

 v TYPES OF UROLITHIASIS

1.Calcium 0xalate stones ( > 70%)

2.Uric acid stones (10%)

3.Struvite stones (15%)

4.Cystine stones (1%)

  v SYMPTOMS

 1.     Pain – (a) Ureteric colic – cramping, sharp, often excruciating pain,fluctuating in intensity but not completely remitting.

 (b) Loin  pain 

• independent of ureteric colicor infection.

Haematuria – accompanying the colic or even frank haematuria in absence of colic.

v SIGNS

 **1.**Loin tenderness – is usually manifestation of associated infection.

 **2.**Palpable kidney in the presence of staghorn calculus, or when obstruction has remitted.

 BASIS OF DRUG SELECTION:-

 The medicine for Asthmari has been described in detail in the scriptures, the selected combination of the medicine is effective in dissolving, eliminating and treating Asthmari, the component of urine-purifying Mahakashaya and Eladi Kwath, and is effective in preventing the recurrence of the disease.

 ï¶ Use of castor oil as a supplement reduces the friction caused by emetic, emphysema and diaphoretic expulsion.

 All the components of the selected yoga are easily available and accessible at low cost.

 Aushadha yoga will be used in the form of kashay kalpana. Due to which it is immediately effective due to its quick absorption. Therefore, I have selected Mahakashay and Eladi Kwath, which is a diuretic and has castor oil as a Kashay.

         ï¶  Before manufacturing the medicine, the medicine will be identified and tested by dravyaguna departmentof the college and NIScPIR new delhi .

 manufacureing of drugs will be done under the guidance of teachers of the rasasastra and bhaishgya kalpana Department of the college.

 ï¶ After studying the data obtained, a report was prepared for analysis.

For clinical  subjective criteria – wilcoxon rank sum test

For clinical  objective criteria – paired t test

For comparative   subjective criteria – Mann whitney u test

For comparative  objective criteria – independent sample test will be used.