Ashmari is a disease of the Mutravaha Srotas characterized by stone formation in the urinary tract due to vitiation of Vāta, Pitta, Kapha, Rakta and Mutra. It is considered Aṣṭamahāgada (one of the eight grave diseases) in Ayurveda. Stones may lodge in kidney, ureter, bladder or urethra causing colicky pain, obstruction and hematuria. Modern medicine identifies it as urolithiasis / nephrolithiasis due to crystallization of urinary salts (calcium oxalate, uric acid, struvite, cystine).

"अश्मरी नाम रोगाणां महारोगः प्रकीर्तितः ।"
(सुश्रुत संहिता, चिकित्सा ७/३)

Classical texts describe four types of Ashmari: Vātaja, Pittaja, Kaphaja, and Śukraja. Kapha plays a central role by producing granthi (crystallization) in Mutra. Vāta drives the stone downward causing colicky pain. Pitta leads to burning sensation and hematuria. Sushruta provides detailed surgical management (Ashmari-bhedana). Modern nephrology views it as imbalance of urinary solutes (calcium, uric acid, oxalate, phosphate) and reduced inhibitors (citrate, magnesium) leading to supersaturation and stone formation.

• Ati-madhura, guru, abhishyandi ahara — curd, milk, jaggery, oily foods clog mutravaha srotas.
• Ati-lavana, katu, amla ahara — aggravate Pitta, causing burning urine and crystallization.

  "लवणाम्लकषायकृष्णगौरस्निग्धात्युपसेवनात्। अश्मरी सम्प्रवर्तते॥"
  (चरक संहिता, चिकीसा २६/७)

• Excessive meat, fish, dried foods (Sushruta – Mutra dushti).
• Less water intake, excess alcohol, tea/coffee (modern – dehydration).

• Diwaswapna, Avyayama — Kapha increase & srotorodha.
• Ati-vyayama, Ratrijagarana — Vata aggravation producing colic.
• Urinating suppression (Mutravega-dharana) — main hetu described in all texts.

  "विनिगृह्य मुत्रं जन्तूनां जनयत्यश्मरीं ध्रुवम्॥"
  (सुश्रुत संहिता, चिकित्सा ७/८)

• Exposure to heat (pitta vriddhi → burning urine → stone formation).

Nidana sevana → Kapha vriddhi + Mutra dushti → accumulation of kleda in Mutravaha srotas. Vata dries this sludge and molds it into stone-like granthi (ashmari). Pitta contributes to burning micturition, rakta dushti and ulceration. Vāta pushes stone downward → severe pain, colic, obstruction.

"कफेन कर्षितं मूत्रं वातेनाकुञ्चितं ततः। तत्राश्मरी सृजत्येव यथा शिलाः जलाशये॥"
(सुश्रुत संहिता, चिकित्सा ७/१०)

Ayurveda: Based on lakshana, urine exam (mutra pariksha), bhasma, gravels seen.
Modern: USG KUB, X-ray, CT scan, Urine microscopy, Serum calcium, uric acid.

• Heaviness in bladder
• Mild burning micturition
• Scanty urine
• Colicky abdominal discomfort
• Frequent urge to urinate

• Severe colicky abdominal pain radiating to groin
• Painful urination (dysuria)
• Blood in urine (hematuria)
• Obstructed urine flow / dribbling
• Frequent urge to urinate
• Nausea, vomiting during colic
• Heaviness and burning in bladder region

• Severe colicky pain in abdomen, radiating to groin
• Dysuria (painful urination)
• Hematuria (blood in urine)
• Obstructed urine flow / dribbling
• Nausea, vomiting in acute colic

"सशूलं सश्रमं मूत्रं रक्तयुक्तं च जायते।"
(माधवनिदान, अश्मरी ५)

• Vātaja Ashmari — severe colicky pain, scanty urine.
• Pittaja Ashmari — burning urine, hematuria, yellow urine.
• Kaphaja Ashmari — large smooth stone, heaviness, mucoid urine.
• Śukraja Ashmari — seminal vesicle stones.
• Modern types: Calcium oxalate, Uric acid, Struvite, Cystine stones.

• Hydronephrosis
• Pyelonephritis
• Urinary retention
• Renal failure (chronic)

Small stones (<5 mm) usually sadhya with medicines & diet. Large stones (>10 mm), recurrent or obstructive type = krichrasadhya/asadhya without surgery.

• Principles: Mutravirechana (diuretics), Lekhana, Shothahara, Shoolahara, Ashmari-bhedana.
• Panchakarma: Virechana, Basti (mutrala basti), Uttara basti in shukraja ashmari.
• Herbal medicines:
  • Pashanabheda (Bergenia ligulata)
  • Gokshura, Punarnava, Varuna
  • Shilapushpa, Kulattha
  • Yavakshara, Hazrul yahud bhasma
  • Classical yogas: Chandraprabha vati, Gokshuradi guggulu
• External therapies: Parisheka with mutrala kwatha for pain relief.
• Pathya: Barley, Kulattha, horse gram soup, coconut water, plenty of fluids.
• Apathya: Curd, heavy fried foods, excess milk, alcohol, red meat.
• Yoga/Pranayama: Pawanmuktasana, Ardha Matsyendrasana, Dhanurasana; Anuloma-Viloma, Sheetali pranayama for burning micturition.
• Mudra/Mantra: Apana mudra, chanting of Om Namah Shivaya (urinary purification).
• Modern management: Lithotripsy, URS, PCNL, stenting, surgical removal when required.

• Kulattha, Yava, Gokshura decoction
• Coconut water
• Plenty of warm water intake

• Curd, cheese, heavy fried items
• Red meat, alcohol
• Suppression of urine urge

Kidney stones form due to supersaturation of urine with calcium, oxalate, uric acid, struvite or cystine. Risk factors: dehydration, high protein/salt diet, obesity, metabolic syndrome, infections. Modern management: hydration, dietary regulation, medications (thiazides, citrate), ESWL, URS, PCNL. Ayurveda correlates with Ashmari, emphasizes mutravirechana, herbal lithotriptics, prevention through pathya-apathya and lifestyle regulation.

• USG KUB
• X-ray / CT KUB
• Urine microscopy
• Serum calcium, uric acid
• Renal function tests