Ashmari bhavan ; ayurved and modern approach ;
Nephrolithiasis, or kidney stone, is the presence of renal calculi caused by a disruption in the balance between solubility and precipitation of salts in the urinary tract and in the kidneys. In other words there is disruption of ratio between the parthiv and jaliya concentration. Either there is increase in parthiv substrates or decrease in jaliya (fluid) concentration or both.
Kidney stones develop when urine becomes “supersaturated” with insoluble compounds (parthiv) containing calcium, oxalate (CaOx), and phosphate (CaPO4 ), resulting from dehydration or a genetic predisposition to over-excrete these ions in the urine.25 Modern lifestyle, dietary habits and obesity emerge to be the promoters of idiopathic stone disease. Flesh of animals of marshy area, fish, and indulgence in overeating are the aetiological factors mentioned for madhumeha, sthaulya and ashmari too.
High protein diet: From a urinary point of view, it has been demonstrated a long time ago that the main effect of a high protein intake is a rise in urinary calcium excretion, independent from other dietary factors such as salt intake. Dietary proteins, especially of animal origin (Flesh of animals of marshy area, fish), actually lead to a high potential renal acid load (PRAL), and decrease in urinary pH and a state of mild chronic metabolic acidosis. There are also other urinary factors driving the risk for kidney stones in high protein diets. For example, a significant reduction in urinary citrate levels has been demonstrated. These modifications may be due to the lower content of citrate in diet, since high protein diets usually do not include large amounts of fruit and vegetables.Moreover, a habitual high dietary intake of sucrose is associated to a high risk of kidney stone onset.Further high purine intake diet is cause for hyperuricemia which further leads to uricosuria a cause for dysuria.26
Excessive salt intake: The strong connection between salt intake and nephrolithiasis has also been demonstrated by Curhan & coll. in a large epidemiologic study on healthy middle-aged women, highlighting a higher risk for calcium stone onset or recurrence in those who have a daily salt intake in the highest quintile.If the patient continues to consume a high sodium diet, sodium will reach the distal nephron and increase the excretion of calcium and potassium along with citrate, resulting in a change in the urinary pH that will eventually increase the risk of stone formation.27
Vegetarian diet has been recognized as protective against kidney stone disease. Fruit and vegetables, the main components of vegetarian diets, actually have a low content in proteins and sodium chloride and a high content in lithogenesis inhibitors such as magnesium, citrate and alkaline potassium.28
High intakes of potassium and phytate, which are considered reliable indexes of fruit and vegetables consumption, are actually associated with lower risk of incidence of nephrolithiasis in groups with different age and sex.29
But Dietary oxalate may be important in stone development; spinach, beets and rhubarb in particular, contain large amounts of oxalate and they may increase urinary oxalate excretion and predispose to the development of calcium oxalate stones.30
Milk and milk products
These findings have also been confirmed by the large epidemiologic studies carried out by Curhan & coll, showing that people in the highest quintile of milk and dairy product consumption are at the lowest risk for kidney stone onset.31
Anyway, a dietary approach with low salt, low animal protein and high fruit and vegetable intake, together with a normal and balanced consumption of milk, dairy products, carbohydrates and fats, is the best way to prevent kidney stone and relapse at the current state of knowledge. Phytates are present in whole grains and legumes and they can inhibit CaOx stone formation.
Decreasing the consumption of meat, chicken and seafood will decrease the intake of purine and, therefore, production of uric acid. Higher intake of fruits and vegetables should raise urinary pH and reduce the risk of uric acid crystal formation.32
Intestinal hyperoxiluria is best avoided by restricting cocoa drinks, chocolate, candies, black tea, excessive coffee intake, spinach rhubarb, asparagus, celery, parsley and tomatoes. Calcium oxalate stone formers should limit intake of almonds, peanuts, cashews walnuts, beetroot, cheeko, cocoa, chocolate, tomato, strawberries, eggplant, soy products, wheat bran and rice bran.33
Treatment of ashmari (calculus):
Pashanbheda: Pashan- Litho Bheda- tripsy.
Treatment should be directed in multiple directions. Drugs such as pashanbheda, varun, gokshura, haritakiwhich have impact of breaking the calculi. Drugs like punarnava, dasamula, ushira, sariva, helps in flushing out the crystals. Shatavari, sariva, sneha helps in preventing haematuria.
Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..