Madhava Nidana Chapter 32 Ashmari Nidanam

This article explains Madava nidana 32nd chapter “Ashmari Nidanam”. Causes, pathology and symptoms of Ashmari are explained in this chapter. Ashmari refers to urinary calculi.
Read – Acharya Madhavakara: His Work ‘Madhava Nidana’, Legacy, Amazing Facts

Table of Contents

Ashmari Bheda

Types of calculi
Asmari is of four types, one from each dosha i.e., vataja, pittaja and kaphaja and the fourth one is that formed from sukra (semen). All types of asmari have predominance of kapha (kapha as the basic dosha involved in the formation of all kinds of asmari). This disease is considered to be dreadful, like the God of Death. (1)
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Asmari Samprapti

Pathogenesis of Ashmari
Asmari (stone, calculi) gets formed when vata dries up the semen, urine, pitta or kapha located in the urinary bladder. These stones are formed in the same way as the bile gets dried up and solidified inside the gallbladder of the cow. All types of asmaris are caused by the combined vitiation of all the three doshas (no asmari is formed by predominance of only one dosha). Therefore, basically all types of asmaris are tridoshaja. (2)

Though all the asmaris are caused by all three doshas, they are named as vataja, pittaja etc. due to the predominance of that particular dosha in the combined vitiation. But for the formation of a stone or calculus kapha is the basic dosha which is required as a base substance or matrix. So, all kinds of asmaris are formed by tridoshas, any dosha may dominate the picture (and hence different types of asmari based on dosha predominance) and kapha is the basic dosha required for the formation of structure of calculi of any type.
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Ashmari Purvarupa

Premonitory symptoms of asmari
The premonitory symptoms of Ashmaris are distension of the urinary bladder, severe pain in and around the urinary bladder, the smell of urine resembling that of a goat, difficulty in urination, fever and loss of taste in food. (3-4)

Asmari Samanya Lakshana

General Symptoms of Ashmari
General signs and symptoms of asmari (calculi) include – pain in the region of the umbilicus, perineum and dome of the bladder. In this condition, since the urinary passage (flow) is interrupted or blocked by the stone, the flow of urine comes out in many streams. When the stone gets dislodged, the person easily voids urine which is clear, having the colour of gomedaka gem (yellowish red in colour), of blood coloured or mixed with blood (due to bleeding in the urinary tract). If the interior of the urinary bladder (and urinary passages) get injured due to the friction by stone, bleeding also occurs along with urine. When the person tries to void the urine forcibly in spite of the stone being present in the urinary passage, the pressure causes severe pain. (4-5)

Vataja Ashmari

Symptoms of Vataja Asmari – The pain is so severe that the person bites his lips with his teeth and he will have tremors. He would repeatedly squeeze his penis and would press his umbilicus constantly while crying. The faeces of the person are expelled along with flatus. Urine gets voided drop by drop frequently. The colour of the stone will be black or reddish black in colour and is surrounded by thorn like sprouts or projections. (6-7)
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Pittaja Asmari

Symptoms of Pittaja Asmari – The person would experience burning sensation inside the urinary bladder and heat similar to the ulcer which is in the process of being ripened (as though smeared by alkali). The region of the bladder is hot to touch. The stone resembles the seed of Bhallataka (Semecarpus anacardium). It is red, yellow or black in colour. (8)

Kaphaja Asmari

Symptoms of Kaphaja Asmari – In this type there is pricking pain, coldness and heaviness in the urinary bladder. The stone will be big in size, smooth, resembles honey (slightly brownish) in colour or is white in colour. (9)

Asmari in children

The above three types of asmari are common in young boys and girls. These stones can be easily removed through surgical process in children because of the small size of both the urinary bladder and the stone. (10)

Shukrasmari

Shukrashmari occurs in adults who withhold (suppress the urge) the ejaculation of the semen. Due to immense sexual excitation or during sex, the semen gets displaced from its seat (of production). In this condition if the person tries to withhold the urge for ejaculation the semen gets blocked (impacted) between the two testicles (in the urethra). The aggravated vata dries up this semen. Being dried by vata the semen becomes hard and assumes the shape and structure of a stone. This further leads to pain in the region of the urinary bladder, dysuria and swelling in the scrotum (testicles). On rubbing over the point of obstruction, the semen gets dissolved and released through the urethral passage. (11-13)

Sarkara – gravel

Sarkara (gravel) is the same as ashmari. The aggravated vata breaks the ashmari into minute pieces. Due to the downward course (movement) of vata, the stone particles are expelled out mixed with urine. If the vata has an opposite course i.e., moves in the upward direction they remain inside (and are not expelled out).
The sarkara having got impacted inside the urinary passages due to the reverse movement of vata causes many complications including debility, exhaustion, emaciation, pain in the lower part of the abdomen, loss of taste, anaemia, burning urination, thirst, pain in the region of the heart and vomiting. (14-16)

Symptoms of incurability of asmari

Asmari is going to kill the patient quickly if it is associated with severe swelling in the scrotum (testes) and umbilicus, total obstruction of urine, severe pain and presence of gravel in it (because such asmari is incurable). (17)