MUTRASHMARI (UROLITHIASIS): AN AYURVEDIC AND CONTEMPORARY REVIEW OF CONCEPT, PATHOGENESIS AND INTEGRATIVE MANAGEMENT

Abstract

Mutrashmari, described in Ayurveda as the formation of ashma (stone) within the mutravaha srotas, closely corresponds to urolithiasis of modern medicine. Acharya Sushruta lists Ashmari among the Ashtamahagada, the eight diseases that are difficult to cure, and devotes separate chapters to its nidana and chikitsa. Urolithiasis is among the commonest urological disorders, affecting roughly one in ten people during their lifetime, and is notorious for recurrence even after successful surgical or endoscopic clearance. The classical texts attribute Ashmari to vitiated Kapha, which is dried and consolidated in the basti by Vata and Pitta, much as sediment is left behind when water evaporates. Four types are described: Vataja, Pittaja, Shleshmaja and Shukraja. Management follows a graded approach: nidana parivarjana, shodhana, aushadha with mutrala and ashmarihara drugs, kshara, basti and, when these fail, shastrakarma. This review compiles the classical and contemporary understanding of Mutrashmari, offers a tentative correlation between the Ayurvedic types and the chemical composition of stones, and discusses the probable mode of action of commonly used formulations, with emphasis on prevention of recurrence.