Urinary calculi – Home Remedies, Ayurvedic Treatment, Diet, Recipes

This article is contributed by Dr MS Krishnamurthy and Dr Raghuram.
Urinary calculus is commonly known as kidney stones. In Ayurvedic literature it is referred to as Mutrashmari. Mutra means urine, Ashmari means stone. It is a troublesome complaint which may become an emergency at any point of time. Though it is a structural condition, Ayurveda offers varieties of remedies and treatment regimen. Let us have a look.

Home remedies for kidney stones

• Mix 1 teaspoon of Basil leaves juice with 1 teaspoon of honey, take it early in morning
• Take 4 teaspoon horse gram, add half litre of water, heat this mixture till it reduces to one fifth, collect soup, add 2 teaspoon crushed pomegranate seeds, mix, filter and consume once a day.
• Take a glass of tomato juice with a pinch of salt and pepper every morning.
• Take watermelon juice daily.
• Take a glass of lemon juice 4 times a day.
• Take 3 g Gokhru (Gokshura) and 7 g Kulthi (horse gram), soak for 6 hours in a litre of water. In the morning, boil and reduce it to half, filter and conume at regular intervals.
• Boil 2 figs – Anjeer in a cup of water and take it early in the morning.
• Regularly take celery.
•  Drink plenty of purified water, coconut water, barley water every day.

Common clinical features

Sudden pain in the right or left lower abdomen (flanks) which radiates from back to front,
Pain during urination,
Burning sensation during urination,
Pain in the bladder and urethra,
Reduced urine output,
Yellow or reddish-yellow coloured urine,
Lethargy,
Vomiting-sensation,
Headache, bodyache  etc.

Specific classical features

Severe pain in the umbilicus, median raphae, urinary bladder and inguinal region (nabhi-seevani-basti-kukshi shoola),
Obstruction to the flow of urine (visheerna dhara),
Pain during micturition (mootra pravritte sati shoola),
Feels comfortable after passing the stone / gravels in urine,
Bleeding during urination (rakta mutrata),  due to the abrasion caused by urinary calculi.

Distension of bladder, pain in pubic area, bad dodo of the urine, dysuria (difficulty in urination), fever and tastelessness are the other features seen in few of the cases.

Types of Kidney stones

There are mainly 5 basic kinds of stones.

• Calcium Oxalate stone
• Calcium Phosphate stone
• Ammonia –    Ammonium stone
• Uric acid –    Uric acid stone
• Cystine –    Amino acid stone.

Types of stones :-
Build up urinary calculi are classified according to their types depending on their location and the chemical properties.

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.

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.

Causes, risk factors

Below are some factors responsible for kidney stone formation –
General factors:
Due to bad lifestyle, sleeplessness, odd diets, heavy consumption of fast food, preserved foods etc.
Deficiency of Vitamin A.
Intake of antacid drugs.
Thyroid disease.
Excess intake of particular food item.
Long term use of catheter.
Gastric surgery.
Obesity.
Infection in kidneys.

Age.Generally calculi are found in the age group 20 to 45 years. In children these are rarely found. If it is found in the child then it is due to defect in metabolism and known as amino aciduria.

Sex. These are largely found in males than the females, because males remains away from home for a long time and their body water get lost due to exertion.

Geographical conditions – Peoples living in warm and dry region have dryness in their body, body water is evaporated.
Also may be due to the heavy water, fluoride containing water. Such heavy water resources are found in many districts of India, particularly Jabalpur, Gaya, Amritsar, Chandigarh, Delhi to Kanpur belt, Jamnagar, Rajkot, Indore, Bhopal, Saurashtra and the hilly areas, where this disease is found on large scale.

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 “Mutra Asmari” meaning urinary calculi. After him in the Ayurveda texts- Ashtanga Hridaya, Sushrut sanhita etc also explained in detail the causes, symptoms, diagnosis, precautions, and treatment. As per these references the causes are determined by factors like

• Apathya Aahara (unwholesome / odd food)
• Low water consumption.
• Urinary tract infection.
• Mutravirodha, Shodhana dosha (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 (ati vyayama) leading to dryness of the body,
spicy food (vidahi ahara),
strong medicines (teekshnoushadha),
dry food (rooksha ahara),
excess walking (ati adhwa),
riding the vehicles / horses (ashwa yana),
non vegetarian diet (mamsala ahara),
loss of sleep (nidra alpata),
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 Vata dosha, Pitta dosha, Kapha dosha and Shukraj dosha, called tridosh vyadhi.
Predominant cause is by kapha dosha.

Disease process and pathogenesis

Vata dosha- Due to vata dosha 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.
Kapha dosha –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.

Symptoms of Ashmari

Pain over nabhi (naval), bladder, veins, ducts.
Irritation on urination.
Frequently & obstructed urination. Mutravisarga dosh.
Hematuria.

Symptoms of Urinary calculi (stones in the urinary tract)

Saamaanya lingam ruk naabhi sevanee vasti moordhasu
Visheerna dhaaram mootram syaat tayaa maarge nirodhite
Tad vyapaayaat sukham mehet achcham gomedaka upamam
Tat sankshobhaat kshate sa asram aayaasaan cha ati ruk bhavet (Ref – Ashtanga Hridaya Nidaana)

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:

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

Tatra vaataad bhrusham cha arto dantaan khaadati vepan
Gruhnaati mehanam naabhim peedayati anisham kwanan
Saanilam munchati shakrut muhuhu mehati bindushaha
Shyaava arunaa ashmareehi cha asya syaat chitaa kantakaihi iva (Ref – Ashtanga Hridaya Nidaana)

Vataja Ashmari 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)

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.

Pittena dahyate vastihi pachyamaana iva ooshmavaan
Bhallataka asthi samsthaanaa rakta peeta asita ashmaree (Ref – Ashtaanga Hridaya Nidaana)

Pittaja Ashmari 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

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.

Vastihi nistudhyataa iva shleshmanaa sheetalo guruhu
Ashmaree mahatee shlakshnaa madhu varnaa athavaa sitaa (Ref – Ashtanga Hridaya Nidana)

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.

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.

Shukra ashmaree tu mahataam jaayate shukra dhaaranaat
Sthaanaat cyutam amuktam hi mushkayoho antare anilaha
Shoshayati upa sangruhya shukram tat shukraashmaree
Vasti ruk mootra kruchchratva mushka shvayathu kaarinee
Tasyaam utpanna maatraayaam shukrameti vileeyate (Ref – Ashtanga Hridaya Nidana)

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)

Structures of stones according to dosha

Vataj stones are-
– dusty coloured,
–  rough
– Hard, faceted and nodular.
– it resembles uric acid stones.

Pittaj stones are –
Reddish, Blackish, Yellowish, honey coloured.
look like seed by shape.
it resembles calcium oxalate stones, uric acid stone, cystine stone.

Kaphaj stones are-
whitish, brilliant coloured.
it resembles calcium phosphate stones.

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.

Line of treatment of Urinary calculi

Mild oleation (snehana),
Medicines which are penetrative (teekshna ushna) and break the stones (ashmari bhedana),
diuretics (mutrala dravyas) – to flush out the small sized kidney stones,
sufficient water intake, watery food intake,
coolants (sheetala upachara) 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.

Single drugs useful in Urinary calculi

Pashanabheda – Bergenia ligulata (Wall.) Engl.
Shunti – Ginger – Zingiber officinale Rose.
Varuna – Crataeva nurvala Buch-Hem.
Shigru – Moringa – Drumstick tree – Moringa oleifera Lam.
Gokshura – Tribulus – Tibulus terrestris Linn.
Punarnava – Boerhavia diffusa Linn.
Kooshmanda – Winter Melon – Benincasa hispida (Thunb.) Cogn.
Shatavari – Asparagus racemosus Willd.
Kadali – Stem of banana – Musa paradisiaca Linn.
Kutaja – Holarrhena antidysenterica (Linn.) Wall. Ex. G. Don.
Sukshma Ela – Cardamom – Elettaria cardamomum Matom.
Trapusha – Cucumis sativus Linn.
Kulattha – Horse gram – Macrotyloma uniflorum (Lamk.) Verdc.
Shilajit – Asphaltum punjabinum
Shaka – Tectona grandis Linn. F.
Ervaru – Cucumis melo
Karpasa – Cotton tree – Gossypium herbaceum Linn.
Tinduka – Diospyrus peregrine (Gaertn.) Gurke.

Formulations useful in Urinary calculi

1. Pashanabhedi kashaya
2. Varanadi kashayam
3. Veerataradi kashaya
4. Chandraprabha vati
5. Punarnavashtaka kashaya
6. Punarnavadi kashaya
7. Punarnavadi guggulu
8. Gokshuradi guggulu
9. Elakanadi kwatha
10. Trivikrama rasa
11. Shilajatu vati
12. Jawaharmohra pishti
13. Godanti (karpoora shilajatu) bhasma

Formulations mentioned in Sahasrayoa text book

1 Vastyamayantaka ghritam
2. Trikantaka Ghrritam
3. Mahakushmanda Ghritam
4. Kalyana kshara
5. Dasamoolarishtam
6. Chandabhaskara Rasa

Ideal diet for kidney stones

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 (Ficus carica Linn.)
Draksha (Vitis vinifera Linn.)
Ervaru (Cucumis melo)
Purana shali (old rice)
Mudga yusha (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

Unwholesome diet and habits

Milk, milk derivatives, vanaspati ghee, tea, coffee, eggs, green vegetables, non veg having bones, crabs, etc.
Heavy exercise (Ati vyayama), 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 (Pravata sevana)
Working in sunshine (Arkatapa)
Excess of sexual indulgence (Ati vyavaya)
Kapittha (Limonia elephantianum (Correa) Panigrahi.)
Jamboo  – Jamun seeds – (Syzygium cumini (Linn.) Skeels.)
Bisa (Nelumbo nucifera Gaertn.)
Excess of astringent food (Kashaya rasa sevana)

Pathya according to Yogaratnakara

Wholesome herbs, diet and habits

Horse ram, green gram, wheat, old rice, barley, flesh of animals living in desert areas, ginger, amaranth, old pumkin, alkali of barley etc.

Lost drop…
Dear readers of Easy ayurveda, Ayurveda system of medicine and lifestyle explains several ways to prevent the occurrence of urinary calculi. Ashmari (Urinary calculi) is a dreadful disease and its pain is intolerable and is often irritant and disturbs normal day-to-day activities. After manifestation of urinary calculi, the victim should be very careful about his / her diet and habits.
The altered food habits, busy life schedules and less intake of water or consumption of salty and packed foods are the true reasons for the formation of kidney stones as well as worsening of the disease.
The sedentary lifestyle and intake of chilled water is another major reason for this complaint. Even though the role of chilled water in the causation of calculi is evident, much scientific explanations are not available in this regard. But Ayurvedic classics have emphasized that warm water acts as Basti shodhaka (clear the bladder) and hence it is worth to take luke warm water in case of Urinary calculi.

Surgery for kidney stones – Further, quite interestingly, Acharya Sushruta is the first person who has explained in detail about the indication of surgery and surgical procedures to be adopted in case of Urinary calculi in Sushruta Samhita -Chikitsa  sthana- 7^th Chapter.
Acharya Vagbhata too explained the surgical procedure based upon the ideology of Sushruta in his treatise Ashtanga hridaya -Chikitsa sthana- 11th chapter.

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 – Vatahar chikitsa)
• Second stage– (burning sensation during urination – Pittahara chikitsa)
• Third stage- (Obstructed urination – Kaphahara chikitsa)

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

Second stage remedies –
Along with first stage remedies, punarvasa, varnadav, pashan bheda, tamilkhana, kolilaksh, mako – Solanum nigrum, 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, abhrak bhasma, shilajit, kanmada bhasma, brihatyakashya, chandanasava, kalyankshar. Etc.

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

Diet

Diet for oxalate stone:-

Avoid:- Cashew, spinach, tomato, figs- anjeer, strawberry, beat, koko, sapota, custard apple, chocolate, coffee, etc.

Take:- Apple, bajra, cauliflower, banana, karela, curd, carrot, egg, green chilli, guava, milk, green peas, potato, green gram, red gram.

Uric acid stone:-
Avoid:- Meat, fish, eggs.
Take: Green vegetables, fruits, fruity vegetables, milk, curd, wheat, potato, bajra, sorghum, rice, carrot, sabudana- tapioca.

Yoga

Yoga for Kidney stone patients:
Suggested Asanas of yoga for kidney stone patients are-

1. Varunasana
2. Paschimothanasana
3. Dhanurasana
4. Pawanmuktasana
5. Utta padasana

Panchakarma

Panchakarma is suggested as it removes all the bad elements out of the body by cleansing it.
Alternative remedies:

1. Magnetic water therapy
2. Warm water hydrotherapy
3. Morning walk, airbath
4. Wheat grass juice.

Conclusion and clinical experience:-

• Kidney stones are formed due to the worse lifestyle, uncontrolled diet.
• Water quality is also responsible.
• More than 95% of calculi can be bursted and expelled out without surgery by Ayurvedic remedies.
• In the emergency for acute cases only surgery may be recommended.
• Balanced diet can protect from calculi formation.
• Undergoing regular panchakarma every year keeps away kidney stones.
• Also after any surgery, regular intake of Ayurvedic remedies can avoid chances of repaeted calculi formation.

Dr. Mahesh Annapure
M.Sc., D. N., M.D. (A.M.)
Address:- 303, Chintamani Park, Shashtrinagar,
Bhawsar Chowk, Nanded. 431605, Maharashtra
EMail:- ngocentre07@gmail.com