Chapter 32 – Ashmari Nidanam

The 32nd chapter of Madhava Nidana is Ashmari Nidanam which deals with Vesical Calculus.Bladder stones form when minerals in urine (pee) crystalize and clump together in the bladder. The medical term for bladder stones is bladder calculi. Bladder stones generally develop when some urine stays in the bladder after you pee. Without treatment, stones can cause infections, bleeding and long-term problems in the urinary tract.

Causes and types of Ashmari — 

वात – पित्त – कफैस्तिस्रश्चतुर्थी शुक्रजा अपरा |
प्रायः श्लेष्माश्रयाः सर्वा अश्मर्यः स्युर्यमोपमाः || १ ||

vāta – pitta – kaphaistisraścaturthī śukrajā aparā |
prāyaḥ ślēṣmāśrayāḥ sarvā aśmaryaḥ syuryamōpamāḥ || 1 ||

Ashmari is of four types. Three of them are due to vata, pitta and kapha. The fourth type is caused by semen. Generally, all the ashmaris are based in kapha and all of them are akin to Yama or god of death. (That is to emphasize that the disease is deadly). 1

विशोषयेद्बस्तिगतं सशुक्रं मूत्रं सपित्तं पवनः कफं वा |
यदा तदा अश्मर्युपजायते तु क्रमेण पित्तेष्विव रोचना गोः || २ ||
नैकदोषाश्रयाः सर्वाः —

viśōṣayēdbastigataṁ saśukraṁ mūtraṁ sapittaṁ pavanaḥ kaphaṁ vā |
yadā tadā aśmaryupajāyatē tu kramēṇa pittēṣviva rōcanā gōḥ || 2 ||
naikadōṣāśrayāḥ sarvāḥ —

When Vata dries up the semen, urine, pitta or kapha stored in the urinary bladder stone (Ashmari) is formed. It gradually develops into a calculus as the gall is solidified into stones in the gall bladder of the cow. Not all the ashmaris are of one dosha base. 2

Purvarupa (Prodromal Features) —

— अश्मर्याः पूर्वलक्षणम् |
बस्त्याध्मानं तदासन्नदेशेषु परितो अतिरुक् || ३ ||
मूत्रे बस्तसगन्धत्वं मूत्रकृच्छ्रं ज्वरो अरुचिः |

— aśmaryāḥ pūrvalakṣaṇam |
bastyādhmānaṁ tadāsannadēśēṣu paritō atiruk || 3 ||
mūtrē bastasagandhatvaṁ mūtrakr̥cchraṁ jvarō aruciḥ |

These are the premonitory features of Ashmari —

• Distension of the bladder
• Severe Pain in and around it,
• The smell of urine resembling goat,
• Difficulty in micturition
• Fever and
• Loss of appetite.

Common Symptomatology of Ashmari —

सामान्यलिङ्गं रुङ्ग् नाभि – सेवनी – बस्तिमूर्धसु || ४ ||
विशीर्णधारं मूत्रं स्यात्तया मार्गे निरोधिते |
तद् व्यपायात् सुखं मेहेदच्छं गोमेदकोपमम् || ५ ||
तत्सङ्घक्षोभात् क्षते सास्रमायासाच्चातिरुग्भवेत् |

sāmānyaliṅgaṁ ruṅg nābhi – sēvanī – bastimūrdhasu || 4 ||
viśīrṇadhāraṁ mūtraṁ syāttayā mārgē nirōdhitē |
tad vyapāyāt sukhaṁ mēhēdacchaṁ gōmēdakōpamam || 5 ||
tatsaṅghakṣōbhāt kṣatē sāsramāyāsāccātirugbhavēt |

The general characteristics and features are —

• Pain in the region of the Umbilicus, Perineum, and the
• dome of the bladder.

The urinary flow is interrupted when blocked by the stone and it resumes on its dislodging. Then the urine is clear, having the colour of yellowish red (gomedaka gem) mixed as it is with blood causing by friction. There is severe pain on movement due to bleeding. 4-5

Vata Type of Ashmari —

तत्र वाताद्भृशं चार्तो दन्तान् खादति वेपते || ६ || 
गृह्णाति मेहनं नाभिं पीडयत्यनिशं क्वणन |
सानिलं मुञ्चति शकृन्मुहुर्मेहति बिन्दुशः || ७ ||
श्यावारुणा अश्मरी चास्य स्याच्चिता कण्टकैरिव |

tatra vātādbhr̥śaṁ cārtō dantān khādati vēpatē || 6 ||
gr̥hṇāti mēhanaṁ nābhiṁ pīḍayatyaniśaṁ kvaṇana |
sānilaṁ muñcati śakr̥nmuhurmēhati binduśaḥ || 7 ||
śyāvāruṇā aśmarī cāsya syāccitā kaṇṭakairiva |

The symptoms of Vataja Ashmari are —

• Severe pain making the person to grind his teeth and tremble,
• To weep and squeeze his penis and umbilicus constantly,
• Faeces expelled along with flatus;
• Drop by drop and frequent passing of urine;
• urine with the stone black or reddish black in colour with thorns. 6-7

Pitta type of Ashmari —

पित्तेन दह्यते बस्तिः पच्यमान इवोष्मवान् || ८ ||
भल्लातकास्थिसंस्थाना रक्त – पीता असिता अश्मरी |

pittēna dahyatē bastiḥ pacyamāna ivōṣmavān || 8 ||
bhallātakāsthisansthānā rakta – pītā asitā aśmarī |

The symptoms of Pittaja Ashmari are —

• Severe burning sensation inside the bladder as though it has been smeared with alkalis,
• Region of the bladder turning warm in touch;
• The calculus resembling the seed of Bhallataka (Semecarpus anacardium) having red, yellow, or black colour; 8

Kapha Type of Ashmari —

बस्तिर्निस्तुध्यत इव श्लेष्मणा शीतलो गुरुः || ९ ||
अश्मरी महती श्लक्ष्णा मधुवर्णा अथवा सिता |

bastirnistudhyata iva ślēṣmaṇā śītalō guruḥ || 9 ||
aśmarī mahatī ślakṣṇā madhuvarṇā athavā sitā |

The symptoms of Kaphaja Ashmari are —

• Pricking pain in the bladder,
• Passing of urine that is cold to touch,
• Feeling of heaviness of the bladder;
• Appearance of the calculus that is big in size, is smooth, slightly brown or white in colour. 9

Curability of Ashmari —

एता भवन्ति बालानां तेषामेव च भूयसा || १० ||
आश्रयोपचयाल्पत्वाद् ग्रहणाहरणे सुखः |

ētā bhavanti bālānāṁ tēṣāmēva ca bhūyasā || 10 ||
āśrayōpacayālpatvād grahaṇāharaṇē sukhaḥ |

In young boys and girls, the above three types of ashmari are common. However, by surgical operation, it is very easy to remove them because of the smallness of the bladder and the stone’s small size. 10

Shukrashmari (Calculus caused by holding semen) —

शुक्राश्मरी तु महतां जायते शुक्रधारणात् || ११ ||
स्थानाच्च्युतममुक्तं हि मुष्कयोरन्तरे अनिलः |
शोषयत्युपसंगृह्य शुक्रं तच्छुक्रमश्मरी || १२ ||
बस्तिरुङ्ग् – मूत्रकृच्छ्रत्व – मुष्कश्वयथुकारिणी |
तस्यामुत्पन्नमात्रायां शुक्रमेति विलीयते || १३ ||
पीडिते त्ववकाशे अस्मिन् –

śukrāśmarī tu mahatāṁ jāyatē śukradhāraṇāt || 11 ||
sthānāccyutamamuktaṁ hi muṣkayōrantarē anilaḥ |
śōṣayatyupasaṅgr̥hya śukraṁ tacchukramaśmarī || 12 ||
bastiruṅg – mūtrakr̥cchratva – muṣkaśvayathukāriṇī | tasyāmutpannamātrāyāṁ śukramēti vilīyatē || 13 ||
pīḍitē tvavakāśē asmin –

In adults who withhold the excretion of semen, shukraja ashmari is formed in the middle of the urethra. When the semen has been dislodged from its origin and has not been ejaculated, the vayu between both the testes consolidates it and dries it up; these are called Spermoliths (Shukrashmari). They give rise to pain in the bladder region, and produce dysuria, and a swelling of the scrotum. 11-13

Sharkara (Scanty Urination) —

— अश्मर्येव च शर्करा

— aśmaryēva ca śarkarā |

Transformation of Ashmari into Sharkara —

अणुशो वायुना भिन्ना सा तस्मिन्ननुलोमगे || १४ ||
निरेति सह मूत्रेण प्रतिलोमे निरुध्यते |
मूत्रस्रोतः प्रवृत्ता सा सक्ता कुर्यादुपद्रवान् || १५ ||
दौर्बल्यं सदनं कार्श्यं कुक्षिशूलमथारुचिम् |
पाण्डुत्वमुष्णवातं च तृष्णां हृतपीडनं वमिम् || १६ ||

aṇuśō vāyunā bhinnā sā tasminnanulōmagē || 14 ||
nirēti saha mūtrēṇa pratilōmē nirudhyatē |
mūtrasrōtaḥ pravr̥ttā sā saktā kuryādupadravān || 15 ||
daurbalyaṁ sadanaṁ kārśyaṁ kukṣiśūlamathārucim | pāṇḍutvamuṣṇavātaṁ ca tr̥ṣṇāṁ hr̥tapīḍanaṁ vamim || 16 ||

When compared to ashmari, it may be noted that the gravel (sharkara) is similar in nature. Nonetheless, it is broken into smaller pieces by Vata and it comes down when Vata has downward movement. As such, it could be eliminated out with urine as well. When the Vata has an upward movement, it is obstructed. If sharkara comes down and is obstructed in the urinary tract, it causes weakness, depression, emaciation, pain in the stomach, anorexia, burning sensation, thirst, pain in the heart and vomiting. 14-16

Incurability of Ashmari —

प्रशूननाभि – वृषणं बद्धमूत्रं रुजातुरम् |
अश्मरी क्षपयत्याशु सिकता शर्करान्विता || १७ ||

praśūnanābhi – vr̥ṣaṇaṁ baddhamūtraṁ rujāturam |
aśmarī kṣapayatyāśu sikatā śarkarānvitā || 17 ||

Ashmari accompanied with gravel causes severe distension of the umbilical region and scrotum, total blockage to micturition. There is a severe pain in it and the disease kills the patient soon. 17

इति श्री माधवकरविरचिते माधवनिदाने अश्मरीनिदानं समाप्तम् || ३२ ||
iti śrī mādhavakaraviracitē mādhavanidānē aśmarīnidānaṁ samāptam || 32 ||

Thus concludes the chapter of Ashmari Nidana.

Source — 

1. Bladder stones