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Abstract
Mutrashmari is one of the commonest diseases of urinary tract caused mainly due to dietary and
behavioural changes. Also, Acharyas have considered it as Ashtamahagad, i.e., one of the most dreadful 8
diseases which are threat to life and difficult to treat. The description regarding its classification, clinical
features, management and complication is mentioned in various Ayurvedic texts. However, diagnosis of
Mutrashmari using modern diagnostic techniques is not mentioned clearly. Hence, the study was
conducted to develop easy and convenient method for diagnosis of Doshaj bheda of Mutrashmari.
Minimum of 200 patients diagnosed with Mutrashmari were chosen for study with informed consent.
Patients were examined for symptoms and their grades, and urine microscopy. Vataj Ashmari was
diagnosed in 78 out of 200 patients, Pittaj Ashmari in 73 out of 200 patients and Kaphaj Ashmari in 49 out
of 200 patients. Urine microscopic examination may prove to be useful in this study to make observations
regarding types of crystals and their association with swarupa of Ashmari mentioned in traditional texts.
Thus, the research work is to develop urine microscopic examination as a diagnostic method as well as
assessment of Doshaj bheda of Mutrashmari.
Keywords : Mutrashmari, Doshaj, Diagnostic, Urine Microscopic Examination
P
ISSN No. : 2584-2757
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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding author: Dr. Renuka Sawant
Article Info: Published on : 15/04/2025
Impact Factor : 1.013
Diagnostic Method For Doshaj Bhed Of Mutrashmari: A Study Of Urine
Microscopic Examination
Dr. Renuka Sawant
1
, Dr. Ujwala Pawar
2
1
PG Scholar Dept. of Roga Nidana Government Ayurved College , Nanded.
2
Professor & HOD Dept. of Roga Nidana Government Ayurved College , Nanded.
Cite this article as: - Dr. Renuka Sawant (2025) ; Diagnostic Method For Doshaj Bhed Of Mutrashmari: A Study Of Urine
Microscopic Examination;Inter.J.Dignostics and Research 2 (3) 8-14, DOI: 1 0 . 5 2 8 1 / z e n o d o . 1 5 1 9 3 2 0 5
G
A
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Issue : 03
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 02
Copyright @ : - Dr.Renuka Sawant Inter. J.Digno. and Research IJDRMSID00041 |ISSN :2584-2757
9
Introduction:
Mutrashmari, which means urinary calculi, is one of
the commonest diseases of urinary tract. Ashmari
comprises of two words, i.e., Ashma and Ari. Ashma
means stone and Ari means enemy. Hence, the name
itself suggests its potential of being painful, difficult to
cure, making it dreadful. In modern science, it can be
correlated with urinary calculi on basis of its sign and
symptoms.A calculus is polycrystalline aggregates
composed of varying amounts of crystalloids and
organic matrix. They can be classified on basis of their
composition, shape, color and number.
[1]
The fine
particles of these crystals are found in urine of patients
suffering from urinary calculi, i.e., passing gravels in
urine. These gravels are nothing but tiny sections of the
actual crystal. These urinary gravels are mentioned as
Mutrasharkara in Ayurvedic context and are similar in
morphological characteristics to that of the actual
Ashmari.
[2]
Hence, research work is to establish results
of Urine Microscopic Examination, which can pave the
way for the assessment of diagnosis of Doshaj bheda
of Mutrashmari. This can help the disorder to be
treated precisely as per the present circumstances.
Therefore, an observational study was carried out about
association between Doshaj bheda of Mutrashmari and
Mutrasharkara with special reference to urine
microscopic examination, with following aim and
objective.
Aim: To assess association between Mutrashmari
(Doshaj Bhed) and Mutrasharkara with special
reference to urine microscopic examination.
Objectives:
1) Primary objective – To study the association
between Mutrashmari (Doshaj Bhed) and
Mutrasharkara with special reference to urine
microscopic examination.
2) Secondary objective –
To study Doshaj bheda of Mutrashmari.
To study Mutrasharkara.
To study urine microscopic examination in
detail.
Review of Literature:
1) Mutrashmari (Urinary Calculus)- In the
Ayurvedic text like Charak, Sushrut and Vaghbhat
Samhita Mutrashmari is described very scientifically
along with its Chikitsa. The word Ashmari is derived
from two words- Ashma - Stone like structure
Ari – Enemy.It suggests that Ashmari means a
disease which act like enemy.
2) Classification of Ashmari :
Table 1: According to different Acharyas are as in
under mentioned
[3,4,5]
3) Urolithiasis : Urolithiasis is
a crystallopathy where a solid piece of material (renal
calculus) develops in ]the urinary tract.
[6]
4)Types of Urinary calculi - According to
composition, most commonly found urinary calculi
are
[7]
:
S.N
o.
Ashm
ari
S
u.
A.
Hr.
A.
S.
M.
Ni.
B.
P.
Sh
a.
Y.
R.
1.
Kapha
j
+
+
+
+
+
+
+
2.
Pittaj
a
+
+
+
+
+
+
+
3.
Vataj
a
+
+
+
+
+
+
+
4.
Shukr
aja
+
+
+
+
+
+
+
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Calcium oxalate and phosphate (80%)
Uric acid (10%)Triple phosphate
(9%)Cystine (1%)
Other types found are Calcium carbonate,
Sulphonamide, Amorphous phosphate and
urate and Leucine calculi.
5) Urine microscopy :
Many laboratorial tests and techniques have been
mentioned to examine the changes in constitution of
urine to diagnose a particular disease. Although
there are advances in technique for the same, ancient
findings recorded can also be found in modern era.
Thus, it makes necessary to interpret modern results
from ayurvedic aspect.
[8]
Microscopic examination
of urine of Ashmari patient shows crystals which are
similar in characteristic features to that of Ashmari
in urinary tract of patient.
Sample – First morning stream freshly
voided sample is preferred
Microscope - Optical microscope or light
microscope with binocular lenses was used
for this study.
Findings
[9]
–
Cells
RBCs
WBCs
Epithelial cells – Squamous, transitional,
renal tubular
Casts
Cellular
Non-cellular
1) RBC Cast
2) WBC Cast
3) Epithelial cell
Cast
Hyaline cast
Waxy cast
Granular cast
Fatty cast
Materials & Methods:
Materials: Diagnosis is made on the basis of Case
Recording Proforma prepared for the study in
relation to Mutrashmari and urine microscopy. This
research work was approved by the Institutional
Ethics Committee of Government Ayurved College
and Hospital, Nanded, No. IEC/GACN/940/2024.
Methods:
Source of Data: The patients visiting O.P.D. and
I.P.D. of Government Ayurved Hospital
Patients Selection: Minimum 200 patients
diagnosed with Urinary calculi
Inclusion Criteria:
Age group – upto 50 years
Either sex
Diagnosed patients of Mutrashmari with
crystalluria (Mutrasharkara)
Exclusion Criteria:
Urinary Tract Infection
BPH
Nephropathies
Osteoporosis
Crystals
Normal
Abnormal
Acidic
Alkaline
Acidic
Alkaline
1)Uric
acid
(diamond,
rosette,
plates,
barrel)
2)Ca
oxalate
(dihydrate,
monohydr
ate)
3)Amorph
ous urates
1)Ca
carbonate
2)Phosphat
es
3)Ammoni
um urate
1)Cysteine
2)Cholesterol
3)Bilirubin
4)Leucine
5)Tyrosine
6)Sulphonam
ide
-
-
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Gout
Severe metabolic disorders like diabetic
mellitus, hypo/hyper parathyroidism
Study design :
Screening subject for inclusion criteria
Selection of 200 patients diagnosed with
Mutrashmari having Mutrasharkara
Collection of urine sample
Observe Mutrasharkara in collected sample
Analyze the types of crystals seen in urine
microscopy
Data will be collected and appropriate statistical
test will be applied
Conclusion
Observation and Result:
In the present study, 200 patients of Mutrashmari
who are already diagnosed as Mutrashmari with
help of case record format were registered. The
obtain data is discussed table wise under the heading
observation-
1) Shape of crystals – Table No. 2 shows
distribution of shapes of crystals :
Shape of crystals
No. of observations
Needle
28
Octahedral
13
Dumbbell
23
Blackish granules
8
Shocks of wheat
6
Irregular
17
Prism
16
Fern
16
Rosette
20
Barrel
15
Yellow granules
13
Rectangular
13
Brownish concentric
12
Total
200
2) Swarupa of Sharkara :Table /no. 3 shows
distribution of Swarupa of Sharkara-
Swarupa of Sharkara
No. of observations
Kantakachita
33
Kadambpushpvata
36
Shyava
9
Shwet
18
Madhukpushpvata
31
Pitavbhasa
40
Madhuvarna
21
Bhallatakasthipratima
12
Total
200
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3)Distribution of Ashmari according to Doshajbheda
-Table No.4 shows distribution of Ashmari
according to Doshaj bheda -
Doshaj bheda of
Ashmari
No. of observations
Vataj
78
Pittaj
73
Kaphaj
49
Total
200
4)Association between Sharkara (crystals) and
Swarupa of Ashmari -Following Table No. 5, 6 and 7
show association between Sharkara (crystals)
Swarupa of Ashmari –
1) Vataj Ashmari:
Kadam
b
pushpv
ata
Kanta
ka
chita
Shyav
a
X
2
P
value
Needle
2
25
1
56.34
17
<0.00
001
Octahed
ral
9
3
1
Dumbbe
ll
20
1
2
Blackish
granules
2
2
4
Shocks
of wheat
3
2
1
From above table it is observed that, p value is
<0.00001. Hence, null hypothesis is rejected at p <
0.10, i.e., there is significant association between
needle shaped, octahedral shaped, dumbbell shaped,
blackish granular and clumped shocks of wheat like
crystals and Vataj Ashmari.
2) Pittaj Ashmari :
Pitavb
hasa
Madhu
varna
Bhallat
akasthi
pratima
X
2
P
valu
e
Rosett
e
16
3
1
39.7
151
<0.0
0001
Barrel
3
10
2
Yellow
granul
es
11
1
1
Rectan
gular
9
3
1
Brown
ish
concen
tric
1
4
7
From above table it is observed that, p value is
<0.00001. Hence, null hypothesis is rejected at p <
0.10, i.e., there is significant association between
rosette shaped, barrel shaped, yellow granular
shaped, rectangular shaped and brownish concentric
crystals and Pittaj Ashmari.
3) Kaphaj Ashmari :
Shwe
t
Madhukpushpv
ata
X
2
P
value
Prism
5
11
6.00
3
<
0.0000
1
Fern
3
13
irregul
ar
10
7
From above table it is observed that, p value is
<0.00001. Hence, null hypothesis is rejected at p
<0.10, i.e., there is significant association between
prism shaped, fern shaped, irregular shaped crystals
and Kaphaj Ashmari.
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Discussion:
It is observed that, out of 200 patients, Vataj
Ashmari was present in maximum number of
patients (78) followed by Pittaj Ashmari (73) and
Kaphaj Ashmari (49) in urine microscopic
examination. Out of 78 patients diagnosed with
Vataj Ashmari, 28 needle shaped crystals can be
associated with Kantakachita Vataj Ashmari; 23
dumb bell shaped, 13 octahedral shaped and 6
shocks of wheat like crystals can be associated with
Kadambpushpvata Vataj Ashmari; whereas 8
blackish granular shaped crystals can be associated
Shyava Vataj Ashmari.
Out of 73 patients diagnosed with Pittaj Ashmari, 20
rosette shaped, 13 yellow granular shaped and 13
rectangular shaped crystals can be associated with
Pitavbhasa Pittaj Ashmari; 15 barrel shaped crystals
can be associated with Madhuvarna Pittaj Ashmari
and 12 brown concentric crystals can be associated
with Bhallatakasthipratima Pittaj Ashmari. Out of
49 patients diagnosed with Kaphaj Ashmari, 16
prism shaped and 16 fern shaped crystals can be
associated with Madhukpushpvata Kaphaj Ashmari,
whereas 17 irregular shaped crystals can be
associated with Shwet Kaphaj Ashmari. Above data
is statistically significant. Hence, it is concluded that
there is significant correlation between Calcium
crystals and Vataj Ashmari; Uric acid and leucine
crystals and Pittaj Ashmari; phosphate crystals and
Kaphaj Ashmari with special reference to urine
microscopic examination.
Conclusion:
Hence, we can conclude that patients diagnosed with
Mutrashmari having crystalluria can be diagnosed
further of Doshaj bheda of Mutrashmari with help
of urine microscopic examination. The crystals
observed in urine sample of patients suffering from
Ashmari closely resembles the morphological
features of Sharkara described in Ayurvedic texts
and Doshaj bheda can be ruled out to plan a precise
treatment as per Ayurvedic principles which are
based on Dosha predominancy. Also, it can be
stated as urine microscopy is easy and convenient
method to find out composition of stone and
generate appropriate line of treatment not only
conservative but also surgical.
References:
1. Drs Amy Gammill, Edith Canby-Hagino and
Dan Van Synco; Clinical Practice Guidelines
for Renal and Ureteral Stones
(Nephrolithiasis)
http://www.asams.org/guidelines/Completed/
NEW%20Renal%20Stones.htm
2. Maharshi Susruta, Susrutasambhita, edited
by Ayurveda Tatva Sandipika, Hindi
Commentary, Kaviraj Ambikadutta Shastri,
Chaukhamba Publication, Navi Delhi Vol 1,
Sushruta samhita, Nidan Sthanam, Adhyay
No. 3, Shlok No. 13.,Pg No. 313
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Brahmananda Tripathi, Chaukhamba
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14
Surbharati Prakashan, Varanasi, Vol 1,
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