A case study of Mutravirechaneeya Mahakashaya along with Erand Taila in the...

[Full title: A case study of Mutravirechaneeya Mahakashaya along with Erand Taila in the management of Mutrashmari w.s.r. to urolithiasis]

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Journal of Ayurveda and Integrated Medical Sciences 2025 Volume 10 Number 3 MARCH E-ISSN:2456-3110 Case Report Mutravirechaneeya Mahakashaya Publisher www.maharshicharaka.in A case study of Mutravirechaneeya Mahakashaya along with Erand Taila in the management of Mutrashmari w.s.r. to urolithiasis Aklesh 1* , Aruna O 2 , Rashmi D 3 , Aradhana K 4 DOI:10.21760/jaims.10.3.68 1* Aklesh, Post Graduate Scholar, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India 2 Ojha Aruna, Professor and HOD, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India 3 Diwan Rashmi, Lecturer, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India 4 Kande Aradhana, Lecturer, Department of Rognidana Evum Vikriti Vigyan, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India According to Susruta Samhita, Ashmari is classified under Mutravaha Srotovikara and Ashtamahagada.[1] Urinary stone disease affects 3 to 5% of the general population and is becoming more common worldwide mostly as a result of metabolic disturbances and changes in the global climate. According to Acharya Charaka, oral drugs such as Mutravirechaneeya Mahakashaya which have qualities like Chedana, Lekhana, Bhedana, and Mutrala that aid in the dissolution of urinary stones, should be tried before undertaking surgical methods. On April 02, 2024, a 50-year-old female visited the Outpatient department (OPD) at Shri Khudadad Dungaji Government Ayurved Hospital, Raipur, C.G. She complained of burning during his micturition, pain in his right flank that spread to his groin, and orange-colored urine for two days. Urolithiasis was the diagnosis, and surgery was recommended. Mutravirechaneeya Mahakashaya[2] and Erand Taila[3] was given continuously for 90 days in three regimens. Clinical assessment criteria were used to evaluate the effects of treatments on 15 days. After treatment for 90 days, excellent level also reducing the symptoms and stone size. During the follow-up period, symptoms and stone size were changed. In conclusion, this Mutrashmari patient’s quality of life was improved by the treatment of Mutravirechaneeya Mahakashaya and Erand Taila Keywords: Mutravirechneeya Mahakasaya, Erand Taila Corresponding Author How to Cite this Article To Browse Aklesh, Post Graduate Scholar, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India Email: Aklesh, Aruna O, Rashmi D, Aradhana K, A case study of Mutravirechaneeya Mahakashaya along with Erand Taila in the management of Mutrashmari w.s.r to urolithiasis . J Ayu Int Med Sci. 2025;10(3):435- 439 Available From https://jaims.in/jaims/article/view/4186/ Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted 2025-02-13 2025-02-26 2025-03-06 2025-03-15 2025-03-26 Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note None Nil Not required 10.54 © 2025 by Aklesh, Aruna O, Rashmi D, Aradhana K and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0] J Ayu Int Med Sci 2025 ; 10 ( 3 ) 435

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Introduction Mutrashmari , or urolithiasis, is a condition where stones form in the urinary system. The word Mutrashmari comes from the Sanskrit words mutra, which means urine, and Ashmari, which means a structure resembling stone. In Ayurveda, Mutrashmari is caused by an imbalance of Ahara (diet) and Vihara (living habits), which leads to aggravated Kapha Dosha in the urinary system Other factors that can contribute to Mutrashmari include sleeplessness, heavy consumption of fast food, and preserved foods. Symptoms of Mutrashmari include intermittent pain and burning micturition. The lifetime prevalence of symptomatic urolithiasis, or urinary stones, is about 10% in men and 5% in women. The prevalence of kidney stones is similar worldwide, at around 12%. In India. Urolithiasis is characterized by the formation of solid masses in the urinary system. It's a chronic and recurrent condition that has a significant impact on healthcare. Reducing discomfort while trying to improve and minimizing impairments in activities of daily living are goals of treatment. Analgesics and nonsteroidal anti-inflammatory medications (NSAIDs) are part of conventional pharmacological care of urolithiasis, yet their use does not effectively relieve pain. It is a persistent illness Case Report A 50-year-old female patient presented to the outpatient department of Shri Khudad Dungaji Government Ayurveda College & Hospital at Raipur with a history of pain in the Left Iliac region and radiating pain loin to groin region since 15 days, sometimes burning micturition since 1 week, sleep disturbed and complaint of constipation since 1 week OPD: 08149 Start of Medication: 02/04/2024 Name: xxxx Age: 50 Sex: Female Address: Gudhyari, Raipur, C.G. Religion: Hindu Education: Middle school Marital Status: Married Socio-economic Status: Middle Class Occupation: Housewife Habitation: Semi Urban Chief complaints with duration Table 1 Complaints Time duration Pain left Iliac region 15 days Radiating pain some time loin to groin 15 Days Sometime burning micturition 1 week Sometime constipation 1 weak Disturbed sleep 1 week History of present illness According to patient she was asymptomatic for one month, after that on date of 10 th March 2024 suddenly she had pain in left Iliac region radiating left loin to groin region. Along with sometimes burning micturition. She took some painkillers and antacids and got some temporary relief one week she also suffered from constipation. for someone's advice, she came to our hospital for treatment Table 2 Vedana (Renal pain) Present Since 15 days Sadah Mutrata (Burning micturition) Present Since 1 weak Mutrakrichta (Dysuria) Present Since 1 weak General Examination Table 3 B.P 120/70 mmhg P/R 74/min Height 158 cm Weight 58 kg Ashtavidha Pariksha Nadi (Pulse) - Pitta-Kaphaj Mutra (Urine) - Dark yellowish Mala (Stool) - Vibandha Some time Jivha (Tounge) - Shwetabha Mild Shabda (voice) - Prakrit Sparsh (Skin) - Sheet Drika (Eye) - Samanya Akriti (General Appearance) - Madhyam Dashavidha Pariksha Prakriti - PK, Vikriti - Dosha - VPK, Dushya - Rasa,Mutra Sara - Madhyam Samhanana - Madhyama Pramana - Madhyama Satmya - Madhyama Satva - Pravara Ahara Shakti - Madhyama Vyayam Shakti - Avara Vaya - Madhyam Aklesh et al. Management of Mutrashmari w.s.r. to urolithiasis J Ayu Int Med Sci 2025 ; 10 ( 3 ) 436

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Family History: No H/O - DM/HTN/Urolithiasis Assessment Criteria [7] G 0 - No Symptoms. G 1 - Mild Symptoms. G 2 - Moderate Symptoms sufficient to cause Distress/Difficulty in performing routine work. G 3 - Symptoms very severe/patient unable to perform routine work Pain: Symptom Grading Score No. Pain 0 Occasional pain did not required treatment 1 Occasional pain but, required treatment 2 Constant dull ache pain, required treatment 3 Severe constant pain, but did not show relief even after treatment 4 Burning micturition: Symptom Grading Score No Occasional burning micturition 0 Occasional burning micturition 1 Occasional burning micturition, required treatment 2 Constant burning micturition required treatment 3 Constant severe burning micturition but did not show relief even after treatment 4 Dysuria: Symptom Grading Score No Dysuria 0 Occasional dysuria 1 Occasional dysuria which requires treatment 2 Constant dysuria which requires treatment 3 Constant severe dysuria but did not show relief even after treatment 4 No. of RBC’s Present in urine: Symptoms Grading No RBC/Hpf 0 0-5 RBC/Hpf 1 6-10 RBC/Hpf 2 11-15 RBC/Hpf 3 >16 RBC/Hpf 4 No. of Pus Cells Present in urine: No. of Pus Cells Grading No pus cells/Hpf 0 0-5 pus cells/Hpf 1 6-10 pus cells/Hpf 2 11-15 pus cells/Hpf 3 >16 pus cells/Hpf 4 Total number of calculus in both side kidney: Total number of calculus Grading No calculus 0 1-2 calculus 1 3-4 calculus 2 5-6 calculus 3 >6 calculus 4 Size of calculus: Size Grading No calculus 0 0-3 mm 1 4-5 mm 2 6-8 mm 3 10 mm or <10 mm 4 Therapeutic Procedure 1. Oral medication: Mutravirechaneeya Mahakashaya was given 50 ml before meal two times a day 2. Erand Taila - 10 ml Duration of Treatment: 90 days Ingredient of: Mutravirechaneeya Mahakashaya [8] The presented compilation work helps towards proving its biological activities and pharmacology of its extracts which will contribute towards further exploration of this group of great clinical potential. However, further studies should be carried out to identify the mechanism of the pharmacological actions of these drugs. Ingredients are :- Vrikshadani Gokshura Punarnava Apamarg Pasanbhed Darbha Kush Kash Gundra Etkatmoola Clinical Study The patient was first administrated Sanjeevani Vati two tablets BD with lukewarm water and Eranda Taila 10 ml at night during sleep time with lukewarm water After seven days patient feels mild improvement in constipation and sleep disturbance First sitting (day 1-15): A volume of 40 ml of Mutravirechaneeya Amahakashaya empty stomach morning and evening for 15 days Day 16-90 days - again same management Aklesh et al. Management of Mutrashmari w.s.r. to urolithiasis J Ayu Int Med Sci 2025 ; 10 ( 3 ) 437

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Observations and Results Symptoms Before After Pain G 3 G 0 Burning micturition G 2 G 0 Dysuria G 2 G 0 Pus cells 1-2 hpf 0-1 hpf Size of calculus 6.2 mm 00 mm Number of calculus 01 00 Weight 58 kg 54 kg BMI 23.23 kg/m 2 21.63 kg/m 2 BMR 1256.90 K/Cal 1219.91 K/Cal USG Whole abdomen and pelvis Left kidney A calculus of 6.2 mm at lower calyx No stone BL kidney Discussion Nowadays, the prevalence of renal disorders is rising quickly worldwide, and the current medical treatment options have unfavourable effects on people's health. In the ancient Ayurvedic medical science, plants of Mutravirechaniya Mahakashaya, which are referred to as the 35 th Mahakashaya in the 4 th chapter of Charaka Samhita, Purvardha are primarily known for their ability to induce urine or increase urinary flow in addition to their ability to defend the urinary system In traditional Indian medicine, formulations with these plants as the primary ingredients have been frequently prescribed for cases of fluid accumulation in the lower extremities, renal calculi, abdominal fluid collection, and other cases of fluid overload. Research supports the ability to increase urine flow and the active ingredient's ability to destroy urinary calculi. However, according to the description in Ayurvedic text, the signs, symptoms, and signs with a scoring system were noted to evaluate the severity. This assessment was done twice (i.e., in pre and post-treatment phases). The severity of symptoms and sign was categorized as follows: Mild, moderate, and severe. A statistically significant relief was observed in cardinal symptoms of Mutrashmari (urolithiasis) in the patient. This proves that the medication is effective in reducing the cardinal symptoms of Mutrashmari . The Mutravirechaneey Mahakashaya have Tridosha Shamak Guna pacifying due to their Ushna (digestive and metabolism stimulating) and Tikshna (penetrating) properties It would have acted on vitiated Vata and helped to relieve in pain. Burning sensation and calculus are produced due to presence of Dushita Pitta and Kapha Dosha . Drugs have Deepana (enhance digestive power) and Srotoshodhaka (remove obstruction of microchannels) properties, which reduces Kupita Pitta and Kapha. Conclusion Mutravirechaneeya Mahakashaya is an unexplored drug in management of Ashmari having Ashmarighna , Anulomana and Mutrala and Dahashamak property. Even though it is difficult to treat disease Ashmari , Mutravirechaneeya Mahakashaya along with Eranda Taila shown significant results in Ureteric stone and be simple to use and cost-effective management. Present article has tried to give an account of updated information on various pharmacological properties of classical diuretic group as much as possible. However, some drugs in Mutravirechaniya Mahakashaya are controversial like Pashanbheda as their scientific names are lacking in original texts. While some plants like Gundra and Itkatmula are rarely seen They searched for available scientific studies with their Sanskrit names as well as botanical names derived from various concerned books. Classical books. mentioned in reference section are followed for such purposes Before Treatment Aklesh et al. Management of Mutrashmari w.s.r. to urolithiasis J Ayu Int Med Sci 2025 ; 10 ( 3 ) 438

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After Treatment References 1. Shastri KA. Sushruta Samhita Purvardh. Varanasi: Chaukhamba Sanskrit Sansthan; Vikram Samvat 2061. p. Sutra Sthana 33/3-4 [Crossref] [PubMed][Google Scholar] 2. Pandey K, Chaturvedi G. Charak Samhita Pratham Bhag. Varanasi: Chaukhamba Bharti Academy; 2017. p. Sutra Sthana 4/35 [Crossref] [PubMed][Google Scholar] 3. Pandey K, Chaturvedi G. Charak Samhita Pratham Bhag. Varanasi: Chaukhamba Bharti Academy; 2017. p. Sutra Sthana 27/289 [Crossref] [PubMed][Google Scholar] 4. Pandey K, Chaturvedi G. Charak Samhita Dwitiya Bhag. Varanasi: Chaukhamba Bharti Academy; 2017. p. Chikitsa Sthana 26/37-39 [Crossref] [PubMed][Google Scholar] 5. Pandey K, Chaturvedi G. Charak Samhita Pratham Bhag. Varanasi: Chaukhamba Bharti Academy; 2017. p. Viman Sthana 8/69-78 [Crossref][PubMed][Google Scholar] 6. Baghel MS, Rajgopalas R. Developing Guidelines for Clinical Research Methodology in Ayurveda. Jamnagar: Institute for Postgraduate Teaching & Research in Ayurveda, Gujarat Ayurved University; 2011. p. 77-78 [Crossref][PubMed][Google Scholar] 7. Pandey K, Chaturvedi G. Charak Samhita Pratham Bhag. Varanasi: Chaukhamba Bharti Academy; 2017. p. Sutra Sthana 4/35 [Crossref] [PubMed][Google Scholar] Disclaimer / Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content Aklesh et al. Management of Mutrashmari w.s.r. to urolithiasis J Ayu Int Med Sci 2025 ; 10 ( 3 ) 439

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Sushruta-samhita, Charakasamhita, Kayachikitsa, Kaphadosha, Burning sensation, Family history, Digestive power, Indian medicine, Ayurvedic medicine, Botanical name, Urinary calculi, Fast-food, Daily living, Patient symptoms, Urinary system, Clinical study, Follow Up Period, Management of Mutrashmari, Urolithiasis, Renal calculi, Acharya Charaka, Outpatient department, Ayurvedic text, General examination, Treatment effect, Ayurveda College, Mutrashmari, Oral medication, Clinical assessment criteria, Burning micturition, Cardinal symptom, Stone size, Urinary stone, Symptom grading, Kidney Stone, Sanjeevani vati, Patient's quality of life, Renal disorder, Oral drug, Erand taila, Urine flow, Patient's quality, Ureteric stone.