Journal of Kidney

Management of Renal Calculi with a combination of Viddha Karma and Shamana Chikitsa - A Case Study

Punam Sawarkar^1*, Kalpana Gholap² and Gaurav Sawarkar^{1 *}Correspondence: Punam Sawarkar, Department of Panchakarma, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Maharashtra, India, Email:

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Introduction

Renal stone is a global clinical condition that has a great recurrence rate with significant illness. It is also known as renal calculi, nephrolithiasis, or urolithiasis. Certain Calcium supplements and medications like steroids are among the major causes of kidney stones. 4 to 20 % of people suffer from nephrolithiasis due to consumption of steroids, especially Prednisone [1]. Recurrent hospitalization due to an acute attack of renal colic induces economic & mental stress over the patient. To date, many invasive and non-invasive modalities are there in modern science to treat this condition; however, still, there are certain limitations for these pharmacological and surgical interventions due to the high recurrence rate and expensive nature [2].

On the other hand, much clinical evidence showed the efficacy and safe nature of multiple Herbal and herbo-mineral compounds in Ayurveda to manage urolithiasis with radical cure and without undue effect. Though Shamana Chikitsa in Ayurveda to treat this condition successfully is already proved, to hasten this therapeutic outcome, Viddha Karma plays a crucial role, which is a very effective treatment modality that is Acharya Sushruta exclusively narrates. However, it is neglected in clinical practice. Thus, there is a need to prove the efficacy of this non-invasive tool in managing some surgical conditions, including renal calculi.

Aim

The current study was planned to assess the efficacy & safety of Viddhakarma & Shamana Chikitsa compromising of both herbal and herbo-mineral formulations in Ayurveda for managing Renal stone and associated clinical features.

Materials and Methods

A single case study

The demographic details of the patient are tabulated in table no.1.

Table 1: Demographic details.

Chief complaints

Chief & associated complaints of the patient are tabulated in Tables 2 &3, respectively.

Table 2: Chief complaints.

Table 3: History of the patient.

History of present illness

A 45-years-old female patient was suffering from associated complaints such as Constant Pain in both heels, Radiating Pain from the Right cervical region to right hand & Stiffness in the neck. Therefore, before six months, she was approached by an orthopedic physician who had diagnosed her with degenerative cervical spondylosis and bilateral calcaneus spur. She was prescribed Calcium supplements, analgesic medicines, and steroidal injections in both heels (weekly once). She had taken treatment described above consecutive for four months. However, she didn’t get any relief in her complaints. Before two months, she suddenly suffered from acute pain in the lower abdominal and left loin region along with other urinary complaints such as burning micturition, Hesitancy during micturition with the passage of scanty &Turbid Urine. So, she was admitted to a local hospital and managed with local antispasmodic & hydrotherapy to manage renal stone after radiological evaluation with U.S.G. abdomen and pelvis. The acute pain subsided, but later on, she developed constant dull Pain in the left loin region & lower abdomen, along with the persistence of other urinary complaints. Therefore, she was advised for laser surgery for stone. But, the patient and her relatives were not willing to undergo surgery; that’s why she approached Panchakarma O.P.D. Mahatma Gandhi Ayurveda Hospital & research center, Salod, Wardha, Maharashtra for Ayurvedic treatment. After proper history taking and thorough examination, treatment was initiated.

History of the patient

Detailed History of the patient is provided in (Table 4)

Table 4: History of the patient.

General examination (Clinical Findings)

General examination (Clinical Finding) is shown in (Table 5).

Table 5: General examinations.

Ashtavidha parikshana

Ashtavidha parikshana is given in (Table 6).

Table 6: Ashtavidha parikshana

Table 7: Treatment prescribed.

Investigations

U.S.G. Abdomen & pelvis dated 20/08/21 showed calculi of size 7 mm at the left vesico-uerteric junction in the urinary bladder. Minimal pelvi-calceal fullness noted in left kidney with prominent ureter suggestive of renal calculi with early changes of left hydroureter.

Diagnosis

Mootrashmari with Pittaja Mootrakruchha (Renal calculi in urinary bladder with cervical spondylosis and bilateral calcaneus spur)

Intervention

The Treatment prescribed for this patient is provided in Table 7 & 8.

Table 8: Assessment of the patient based on clinical features.

Results and Obeservations

Assessment of the patient was done with both radiological findings as well as clinical features. The Radiological assessment (U.S.G. Abdomen & Pelvis) was given in the (Figure 1-2).

Figure 1: Findings of U.S.G. Abdomen & Pelvis on 20/08/21 (Before Rx).

Figure 2: Findings of U.S.G. Abdomen & Pelvis on 22/09/21 (1 month after Rx).

The patient became symptom-free with all aforesaid prescribed treatment after one month. There was no event related to the patient's hospitalization for the emergency care in the modern hospital throughout the whole duration. To date, no recurrence has been obtained.

Calculus of size 7 mm at a left vesicoureteric junction in the urinary bladder. Minimal pelvi-calceal fullness noted in left kidney with prominent ureter suggestive of renal calculi with early changes of hydroureter.

No, calculi were observed & no other Obvious abnormality was noted in the present scan.

Discussion

As per the evaluation of the detailed History of the patient, both faulty Lifestyle (Ayogya Ahara-Vihara) and iatrogenic factors are responsible for the pathogenesis of the disease, i.e., Mootrashmari. Daily Intake of Katu & Amla Rasa Pradhan Dravya Sevan, Mental Stress leads to Pitta Dosha's provocation, which gets further aggravated by low Intake of water throughout the day. Vishamashana, i.e., Intake of food at Irregular times & intervals, Vegavrodha (Suppression of urges due to workload & responsibilities in a joint family) leads to vitiation of Vata Dosha. Moreover, Intake of calcium supplements and steroids for a prolonged time leads to more excretion of calcium through urine out of the body. However, due to Vata and Pitta's vitiation, urine formation gets reduced, which is produced, unable to excrete properly due to Vitiation of Apanavayu. Ultimately it gets saturated in the bladder, becomes turbid, and turns into calculi.

Treatment with drugs exhibiting Vatanulomak, Vata-pitta shaman but Ashmari Bhedak and Mootrala properties is highly expected in the management of such clinical entity by considering all abovesaid pathology of the disease. The probable mode of action of each procedure & drug prescribed can be justified based on all these principles as follows:

Viddha Karma increases the movement of the ureter and activates the smooth muscles of the urinary bladder that easily eliminates the crushed stone in a downwards direction. It is also an excellent pain relief tool exclusively elaborated by Acharya Sushruta. It helps to subside both intermittent colicky and constant dull pain in the left loin region & lower abdomen due to obstruction of the flow of Urine & flatus. The secretion of endorphins may induce its analgesic action due to painful mechanical stimulus at the time of procedure [3].

Patrapinda Swedana done with leaves of Erand+Arka+Nirgundi+ Agnimantha added with Dashmoola Oil relives the muscular swelling, Stiffness, and Pain. It subsides radiating Pain, Stiffness, spasms in the cervical muscles and right hand with the pacification of tingling sensation in the right hand due to its Ruksha-Snigdha Properties [4]. Agnikarma done with Panchadhatu Shalaka over both heels relives Pain due to its analgesic property [5].

All Shamana Chikitsa breaks the pathogenesis of Mootrashmari due to its Ashmari Bhedak, Mootral effects as a result of their properties, e.g., Ushna Veerya, Vatanulomana, etc. It also subsided the all associated complaints with gastrointestinal symptoms, e.g., loss of taste & appetite, bloated abdomen, indigestion, constipation & headache associated with nausea and vomiting due to its Agnidipak, Apanavatalomak, Amapachaka, Ruchikar, Malavshtambhahara properties.

Chandraprabha Vati excretes excess Kleda through Urine due to its Kaphaghna, Mootrala properties. It also corrects the vitiation of Apanavayu. It subsides all symptoms of Pittaja Mutrakruchha such as burning micturition & hesitancy while micturition due to its Shita Veerya[6,7].

Varunadi Kashaya acts as an excellent remedy to crush the calculi into minute particles which gets easy to wash out through Urine out of the body due to its Kaphaghna property [8,9].

Tab Neeri- Anti-urolithiasis effect of Tab Neeri is elaborated by an In- Vitro study conducted by Bhandari R et al. 2021[10]. It also relieves symptoms of U.T.I. such as burning micturition & hesitancy, while micturition is due to its anti-microbial effect stated by Bhusal N et al. 2011[11]. Hingashtak Choorna & Shankh Vati relives all symptoms of Annavaha Strotodushti Lakshana due to its Agnidipaka, Amapachaka, and Ruchya Properties. Both medicines also act as an emergency drug in managing renal colic due to its Shoolaghna property [12-19]. Hingashtak Choorna also corrects the Apanavata, which get vitiated due to Vegavarodha. It also subsides the symptom of the bloated abdomen that makes the patient more uncomfortable by correcting Apanavayu and Samavayu. Shankh Vati helps alleviate the intermittent Colicky Pain in the left loin region & also migrates the constant dull pain in the left loin region & lower abdomen due to analgesic properties of Ahifena(Opium).

Conclusion

This case showed the efficacy of a combination of Viddha Karma and Shamana Chikitsa to manage Renal colic due to renal stone in a very non-invasive manner within a short duration without recurrence of any symptom. It can be concluded that Shamana Chikitsa added with Viddhakarma, can successfully treat surgical conditions like urolithiasis. Viddhakarma plays a crucial role in hastening the therapeutic outcome of Shamana Chikitsa in Ayurveda. There is a need to prove the efficacy of this non-invasive tool in managing such surgical conditions, including renal calculi, through various multi-centric trials conducted on a large sample size.

The Conflict of Interest

Nil.

The Source of any Support Recieved

NIL.

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