INTRODUCTION

India suffers the most on the health front. Now a days due to unchecked growth of population we are facing so many problems like Diabetes Mellitus, Hypertension, Heart disease, Respiratory diseases and very commonly now a days the RENAL STONE. The renal diseases are mainly the consequence of other disease prevailing in the society due to the stress and tension factors, adulteration of food due to the modernization of society. The inability of the kidneys to maintain normal function flair with iatrogenic cause and over use of drugs and steroids used in so-called curing of other prevailing diseases and ultimately landing up the patient in a more severe chronic renal disease. So looking at the above statement comes here the Efficacy Of Homoeopathy in Renal Stones. The existence of kidney stones has been recorded since the beginning of civilization, and lithotomy for the removal of stones is one of the earliest known surgical procedures. In 1901, a stone was discovered in the pelvis of an ancient Egyptian mummy, and was dated to 4,800 BC. Medical text from ancient Mesopotamia, India, China, Persia, Greece and Rome all mentioned calculous disease. Part of the Hippocratic oath contains an admonition about the dangers of operating on the bladder for stones. The Roman medical treatise De Medicina by Cornelius Celsus contained a description of lithotomy, and this work served as the basis for this procedure up until the 18th century. The famous persons who had suffered from kidney stones are Emperor Napoleon Bonaparte, Emperor Napoleon III, Benjamin Franklin, the philosopher Sir Francis Bacon, the scientist Sir Issac Newton etc. New techniques in lithotomy began to emerge starting in 1520, but the

operation remained risky. It was only after Henry Jacob Bigelow popularized the technique of litholapaxy in 1878 that the mortality rate dropped from about 24% down to 2.4%. However, other treatment techniques were developed that continued to produce a high level of mortality, especially among inexperienced urologists. In 1980, Dornier MedTech introduced extracorporeal shock wave lithotripsy for breaking up stones via acoustical pulses, and this technique has come into widespread use. Kidney stones are one of the most painful and common disorders of the urinary tract. A recent survey shows that there has been rapid increase in the number of people suffering from Kidney stones. Men are affected more frequently than women. Depending on where they are located, kidney stones are known as urinary calculi, urinary tract stone disease, renal calculi, nephrolithiasis, ureterolithiasis and urolithiasis. Kidney stones are small, solid crystals that develop when salts or minerals in urine become solid inside the kidneys or uterus. The solid masses may be too small as a grain of sand or as large as a lemon. Tiny crystals leave the body while urinating without any pain or harm. However, they can build up inside the kidney. These large kidney stones when move out of the kidney and progress through the tubes that carry urine from kidney to bladder may cause severe pain. While passing if it gets stuck to ureter; it will cause infections that will lead to permanent kidney damage. They may be smooth, staghorn or jagged to make the situation even worst or better. Within the United States, about 1015% of adults will be diagnosed with a kidney stone and the total cost for treating this condition was US$2 billion in 2003. The incidence rate increases to 2025% in the Middle East, because of increased risk of dehydration in hot climates. (The typical Arabian diet is also 50% lower in calcium and 250% higher

in

oxalates

compared

to

Western

diets,

increasing

the

net

risk.).Recurrence rates are estimated at about 10% per year, totaling 50% over a 510 year period and 75% over 20 years. Men are affected approximately 4 times more often than women. Recent evidence has shown an increase in pediatric cases.

AIMS AND OBJECTIVES

 To understand Efficacy of Homoeopathy in Renal Stone according to modern and homoeopathic concept.

To understand Efficacy of Homoeopathy in Renal Stone and its miasmatic approach.

Management of Efficacy of Homoeopathy in Renal Stone with homoeopathic medicines.

REVIEW OF LITERATURE

ANATOMY

The human renal system is made up of two kidneys, two ureters, the urinary bladder and the urethra.

KIDNEY The normal adult kidney is bean shaped and is located

retroperitonially between the level of twelfth thoracic and third lumbar vertebrae. The kidneys are 11-14cm in length, 5-6cm in breath and 3-4cm in depth. Each kidney weighs approx 150gm. The right kidney lies slightly lower than the left because of displacement by the liver. The left kidney is slightly longer than the right and lies closely to the midline. The kidneys are richly supplied by blood vessels which give them their reddish brown colour. There is a depression in the medial border of kidney called Hilum through which renal vein, artery, nerve and ureter passes. A heavy cushion of fat keeps the kidney in position. As they lies between the abdominal organs and the muscles of back, the kidneys are well protected from trauma. Enclosed by a fibrous capsule, the kidneys functional element consists of outer cortex and inner renal medulla. The medulla is divided into a series of wedges, called as renal pyramids that open into renal calyces. The major renal calyces join to from the renal pelvis, an extension of the upper end of the ureters. Renal columns extend from the cortex down between the renal pyramids. The basic structural and functional unit of kidney is NEPHRON. Approximately 1.2million nephrons are contained in each kidney and form the urine. Each nephron consists of Bowmans capsule that surrounds the glomerular capillary tuft, the proximal convulated tubule, the loop of henle, the distal convulated tubule which empties into collecting duct.

RENAL BLOOD SUPPLY The kidneys are highly vascular organs perfused with approximately 1200ml of blood per minute. This equals 20% to 25% of the body's cardiac output. Approximately 80% of the renal plasma flows through the efferent arterioles to the peritubular capillaries. The other 20% is filtered at the glomerulus and passes into Bowman's capsule. The filtration of the plasma per unit of time is known as the glomerular filtration rate (GFR). The GFR is directly related to the perfusion pressure in the glomerular capillaries. The blood is supplied to the kidney by the renal artery, which arises directly from abdominal aorta and enters the kidney through the hilus. While passing through renal sinus, the renal artery divides into many segmental arteries, which subdivides into interlobar arteries. Each interlobar artery passes in between the medullary pyramids. At the base of the pyramid, this turns and runs parallel to the base of pyramid forming the arcuate artery. From the arcuate arteries, interlobular arteries arise. The interlobular artery runs perpendicular to the arcuate artery up to the surface. From each interlobular artery numerous afferent arteriole arise. The afferent arteriole enters the Bowmans capsule forming glomerular capillary tuft. The afferent arteriole divides into large and small capillaries, which forms the loop. And the capillary loops unite to form the efferent arteriole, which leaves the Bowmans capsule. The efferent arterioles give rise to the renal portal system i.e., they form a second capillary network surrounding the tubular portion of the nephrons. These are called peritubular capillaries. One of these run parallel to the renal tubule into the medulla and ascends up towards the cortex called as Vasa Recta. The peritubular capillaries drain into the venous system, which includes the peritubular venules, interlobular veins, arcuate veins,

interlobar veins, segmental veins and finally the renal vein. This leaves the kidney through the hilus.

URETERS - The ureters are tubes that measure from 27 to 30 cm long

and are approximately 1 to 5 mm in diameter. They extend from the kidneys to the bladder. Their function is to move urine from the kidney pelvis to the bladder by peristaltic contractions.

URINARY BLADDER - The urinary bladder is located midline in

the abdominal pelvis. It is a pyramid shaped muscular organ. The main

function of the bladder is to collect and store urine. The normal bladder can hold up to 500 mls of urine. The bladder has three openings, two ureteral openings to receive urine from the kidneys and one urethral opening to drain the urine. These openings form the trigone of the bladder. This area is smooth and triangular shaped. The stored urine will be excreted through the urethra when the controlling sphincters are relaxed after receiving signals from the brain.

URETHRA - The urethra is a tube like organ which drains urine from
the bladder to the exterior. It is lined with endothelium and surrounded by involuntary muscles. Generally it is 6mm wide in healthy patients. In females it is about 5 to 6 cm long and in males it is about 15-22 cm long. The urinary meatus opens to allow urine to be expelled from the urethra.

PHYSIOLOGY
The kidneys principal role is the elimination of waste material and the regulation of the volume and composition of body fluids. The kidneys have a unique system involving the free ultra-filtration of water and nonprotein-bound low molecular weight compounds from the plasma and the selective reabsorption and/or excretion of these as the ultra-filtrate passes along the tubule.

An essential feature of renal function is that a large volume of blood -25% of cardiac output or approximately 1300ml per minutepasses through the two million glomeruli. A hydrostatic pressure gradient of approximately 10mmHg (a capillary pressure of 45mmHg minus 10mmHg of pressure with Bowmans space and 25mmHg of plasma oncotic pressure) provides the driving force for ultra-filtration of virtually protein-free and fat-free fluid across the glomerular capillary wall into Bowmans space and so into the renal tubule. The ultra-filtration rate or glomerular filtration rate (GFR) vary with age and sex but is approximately 120-130 ml\min per 1.73m2 surface area in adults. This means that each day ultra-filtration of 170-180 L of water and unbound small molecular-weight constituents of blood occurs. The need for this high filtration rate relates to the elimination of compounds present in relatively low concentration in plasma e.g. urea. If these large volumes of ultra-filtrate were excreted unchanged as urine, it would be necessary to ingest huge amounts of water and electrolyte to stay in balance. This is avoided by selective reabsorption of water, essential electrolytes, and other blood constituents, such as glucose and amino acids, from the filtrate in transit along the nephron. Thus 60-80% of filtrated water and sodium is reabsorbed in the proximal tubule along with virtually all the potassium, bicarbonate, glucose and amino acids. Further water and sodium chloride are reabsorbed more distally, and fine tuning of salt and water balance is achieved in the distal and collecting tubules under the influence of aldosterone and anti diuretic hormone. The final urine volume is thus 1-2 L daily. Calcium, phosphate and magnesium are also selectively reabsorbed in proportion to the need to maintain a normal electrolyte composition of body fluids.

The urinary excretion of some compounds is more complicated. For example potassium is freely filtered at the glomerulus, almost completely absorbed in the proximal tubule, and excreted in the distal tubule and collecting ducts. An important clinical consequence of this is that the ability to eliminate unwanted potassium is less dependent on GFR than is the elimination of urea or creatinine. Other compounds filtered and reabsorbed or excreted to a variable extent include urate and many organic acids, including many drugs or their metabolic breakdown products. The more tubular secretion of a compound occurs the less dependent is elimination on the GFR; penicillin and cefradine are examples of compounds secreted by the tubules.

URINE CONCENTRATION AND THE COUNTERCURRENT SYSTEM

Urine is concentrated by the complex interaction between the loops of Henle, the medullary interstitium, medullary blood vessels (vasa recta) and the collecting tubules. The purposed mechanism of urine concentration is termed the counter current mechanism. The countercurrent hypothesis states that a small difference in osmotic concentration at any point between the fluid flowing in opposite direction in two parallel tubes connected in a hairpin manner is multiplied many times along the length of the tube. Tubular fluid moves from the renal cortex towards the papillary tip of the medulla via the proximal straight tubule and the thin descending limb of the loop of Henle which is permeable to water and impermeable to sodium. The tubule then loop back towards the cortex so that the direction of fluid movement is reversed in the ascending limb, which is impermeable to water and permeable to sodium. This results in large osmolar concentration difference between the corticomedullary junction and the hairpin loop at the tip of the papilla, and hence countercurrent multiplication.

FUNCTIONS OF KIDNEY
1. EXCRETION As the body metabolizes the food, certain waste products are created and these products are needed to be excreted from the body. One of the main waste products is urea, which comes from protein metabolism. Other waste products from metabolic reactions within the body include ammonia (from the breakdown of amino acids), bilirubin (from the breakdown of haemoglobin), and creatinine (from the breakdown of creatine

phosphate in muscle fibres). Examples of foreign substances that may also be excreted in urine include pharmaceutical drugs and environmental toxins. 2. REGULATION OF BLOOD VOLUME the kidneys conserve or eliminate water from the blood, which regulates the blood volume in the body. 3. MAINTAIN pH VALUE OF HUMAN BODY The human body is designed to function optimally at the pH value of 7.35 to 7.45. The kidney play a vital role in maintaining the pH by excreting the H+ ion in the urine and also by conserving the bicarbonate ions, which are an important buffer of H+ ions. 4. REGULATION OF BLOOD PRESSURE Kidney help to regulate the bodys blood pressure by excreting sodium. If too little blood is excreted, blood pressure likely to rise. Kidneys also regulate the blood pressure by producing an enzyme renin. When blood pressure falls below the normal levels, the kidneys secrete renin into the blood stream, thereby activating the reninangiotensin-aldosterone system, which in turn raises the blood pressure. 5. PRODUCTION OF RED BLOOD CELLS Kidneys contribute to the production of red blood cells by the secretion of hormone erythropoietin, which stimulate the production of red blood cells in the bone marrow. 6. SYNTHESIS OF VITAMIN D The kidneys help to regulate the level of calcium and phosphorus, minerals that are critical to bone heath. They do so by converting the inactive form of vitamin D

which is produced in the skin and is also present in many foods, to an active form of vitamin D (calciterol) that acts like a hormone to stimulate absorption of calcium and phosphorus from the small intestine.

Kidney Stones (Renal Stones, Nephrolithiasis)

What is a kidney stone?
Renal calculi {kidney stones,nephrolithiasis} are abnormal concretions occurings in the kidneys ,consisting of crystalline components and an organic matrix. They are typically located within the calyces or pelvis ,and may become lodged in the ureter or bladder as they are passed. A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of are sometimes called renal calculi. One in every 20 people develops a kidney stone at some point in their life. The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis.

Who gets kidney stones?

For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.

Epidemiology in Adults
Epidemiology of nephrolithiasis varies acc to the geographical area and socio-economic conditions. In a study conducted in South Africa, it was found that racial factors contributed to the high incidence of renal stone disease in some groups. There was a high incidence of renal tubular acidosis among Indians which was responsible for the high incidence of stones in the Indians. A study was done in the tribal population of India to find out the association b/w the Fluoride and urolithiasis in humans. The results showed that fluoride in vivo may behave as a mild promoter of urinary stone formation by the excretion of insoluble calcium fluoride, increasing the oxalate excretion and mildly increasing the oxidative burden. In a study conducted in USA revealed that individuals who had normal calcium intakes, low intake of dietary proteins & salt had significantly reduced rate of calcium oxalate stone recurrence. A study in the University College London reveals that the main factor which leads to the development of bladder stones in children is a nutritionally poor diet that is low in animal protein, cereal, calcium and phosphate but is high in cereal and is acidogenic. This leads to the formation of urine with a relatively high content of ammonium and urate ions and consequently to the formation of ammonium acid urate crystals and stones. In countries where there is also a high intake of oxalate from local leaves and vegetables,

urinary oxalate is also increased & as a result, oxalate stones may also form. There may be a geographic predisposition to form kidney stones. There are regional "stone belts," with people living in the southern United States, having an increased risk of stone formation. The hot climate and poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.

What causes kidney stones?

Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine. Dehydration from reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones. Men are especially likely to develop kidney stones, and Caucasians are more often affected than blacks. The prevalence of kidney stones begins to rise when men reach their 40s, and it continues to climb into their 70s. People who have already had more than one kidney stone are prone to develop more stones. A family history of kidney stones is also a risk factor for developing kidney stones. A number of different medical conditions can lead to an increased risk for developing kidney stones: Gout results in an increased amount of uric acid in the urine and can lead to the formation of uric acid stones. Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.

Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.

People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.

Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.

Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible. A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation. In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.

Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones. Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine

causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract. Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine. Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones. People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV who take the medication indinavir (Crixivan) can form indinavir stones. Other commonly prescribed medications associated with stone formation include dilantin and antibiotics like ceftriaxone (Rocephin) and ciprofloxacin (Cipro). Common types of kidney stones There are various types of renal stones depending on its components. Calculi of the urinary tract vary in size. They may be microscopic crystalline stones or large stones that are several centimeters in size. 90% of these stones usually consist of calcium in combination

with oxalate or phosphate. There are about 5 distinct types of urinary tract stones that are classified according to the material that it is composed of. They are: Calcium phosphate stones Calcium oxalate stones Ammonium phosphate stones Cystine stones Uric acid stones Struvite or infection stones

Oxalate calcus [calcium oxalate]- These stones are irregular in shape and covered with sharp projections which tend to cause bleeding and are easily visible on x-rays.

Phosphate calculs[calcium phosphate] - These stones are smooth and look dirty white. They tend to grow in alkaline urine and occasionally form a stag-horn calculus which may be clinically silent unless it signal its presence by causing haematuria and are easy to see on x-rays.

Uric acid and urate calculi-These stones are hard, smooth and often multiple. Their colour varies from yellowish to reddish brown and they sometimes have attractive, multifaced appearance. Most uric acid stones contains some calcium, so they cast a radiological shadow.

Cystine calculi-These stones are uncommon and appear in patients with congenital defect of metabolism and lead to cystineuria. Cystine crystals are hexagonal, translucent white

and appear only in acid urine. Cystine stones are hard, often multiple and radio-opaque because of presence of sulphur. Xanthine calculi-These stones are extremely rare.They are smooth and round, brick red in colour and show lamellation on cross-section.

Activity of Stone Disease

Active disease means that new stones are forming or that preformed stones are growing. Sequential radiographs of the renal areas are needed to document the growth or appearance of new stones and to ensure that passed stones are actually newly formed, not preexistent ones.

Pathogenesis of Stones
Urinary stones usually arise because of the breakdown of a delicate balance. The kidneys must conserve water, but they must excrete materials that have a low solubility. These two opposing requirements must be balanced during adaptation to diet, climate and activity. The problem is mitigated to some extent by the fact that urine contains substances that inhibit crystallization of calcium salts and others that bind calcium in soluble complexes. These protective mechanisms are less than perfect. When the urine becomes supersaturated with insoluble materials, because excretion rates are excessive and/or because water conservation is extreme, crystals form and may grow and aggregate to form a stone. Supersaturation- In a solution in equilibrium with crystals of calcium oxalate, the product of the chemical activities of the calcium and oxalate ions in the solution is termed the equilibrium solubility product. If the crystals are removed, and if either calcium or oxalate ions are added to the solution, the activity product increases, but no new crystals form. Such a solution is metastably supersaturated. If new calcium oxalate seed crystals are now added, they will grow in size. Ultimately, as calcium or oxalate are added to the solution, the activity product reaches a critical value at which a solid phase begins to develop spontaneously. This value is called the upper limit of metastability. Stone growth in the urinary tract

requires a urine that, on average, is above the equilibrium solubility product. Excessive supersaturation is common in stone formation. Calcium, oxalate, and phosphatase form many stable complexes among themselves and with other substances in urine, such as citrate. As a result, their free ion activities are below their chemical concentrations and can be measured only by indirect techniques. Reduction in ligands such as citrate can increase ion activity, and therefore supersaturation, without changing total urinary calcium. Urine supersaturation can be increased by dehydration or by over excretion of calcium, oxalate, phosphate, cystine, or uric acid. Urine pH is also important; phosphate and uric acid are weak acids that dissociate readily over the physiologic range of urine pH. Alkaline urine contains more dibasic phosphate, favoring deposits of brushite and apatite. Below a urine pH of 5.5, uric acid crystals (pK 5.47) predominate, whereas phosphate crystals are rare. The solubility of calcium oxalate, on the other hand, is not influenced by changes in urine pH. Measurements of supersaturation in a pooled 24-hr urine sample probably underestimate the risk of precipitation. Transient dehydration, variation of urine pH, and postprandial bursts of over excretion may cause values considerably above average. Nucleation- In urine that is supersaturated with respect to calcium oxalate, these two ions form clusters. Most small clusters eventually disperse because the internal forces that hold them together are too weak to overcome the random tendency of ions to move away. Large ion clusters can remain stable because attractive forces balance surface losses. Once they are stable, nuclei can grow at levels of supersaturation below that needed for their creation. Cell debris, calcifications on the renal papillae, and other urinary crystals can serve as templates for crystal

formation, a process known as heterogenous nucleation. Heterogenous nucleation lowers the level of supersaturation required for crystal formation and is likely the mechanism by which stones form in human urine. Inhibitors Of Crystal Formation- Stable nuclei must grow and aggregate to produce a stone of clinical significance. Urine contains potent inhibitors of nucleation, growth, and aggregation for calcium oxalate and calcium phosphate but not for uric acid, cystine, or struvite. Inorganic pyrophosphate is a potent inhibitor that appears to affect calcium phosphate more than calcium oxalate crystals. Citrate inhibits crystal growth and nucleation, though most of the stone inhibitory activity of citrate is due to lowering urine supersaturation via complexation of calcium. Other urine components such as glycoproteins inhibit all three processes of calcium oxalate stone formation. As a consequence of the presence of these inhibitors, crystal growth in urine is slow compared with growth in simple salt solutions, and the upper limit of metastability is higher.

Clinical features of Renal Stones

Symptoms
Silent calculs: Few stone particularly phosphate remains silent unless accidentally discovered by X-ray for some other reasons. Fixed renal pain: Dull aching boring pain in renal angle posterioly and corresponding hypochondrium anterioly. Uretric colic: Occurs when the stone tends to pass down the ureter or temporarily blocks the pelvic ureteric disease. Referred pain: To all over abdomen often mimic peptic ulcer or gall bladder disease. Haematuria: occasionally a leading symptom. Pyuria: occasional. Dysuria: rare, mostly with infection. Oligouria: caused by obstruction of bladder by stones. Hydronephrosis: complaints of a lump in the loin and a dull ache

Signs
Tenderness: mostly the renal angle posteriorly and at the tip of 9th costal cartilage anteriorly[renal point]. Muscle rigidity: over the kidney may be found in few cases. Swelling: in renal stone with hydro nephrosis, a swelling may be felt in the flank.

 Abdominal

distension:

with

diminshed

peristalisis

may

accompany ureteric colic.

Manifestations of Stones
As stones grow on the surfaces of the renal papillae or within the collecting system, they need not produce symptoms. Asymptomatic stones may be discovered during the course of radiographic studies undertaken for unrelated reasons. Stones rank, along with benign and malignant neoplasms, and renal cysts, among the common causes of isolated hematuria. Much of the time, however, stones break loose and enter the ureter or occlude the ureteropelvic junction, causing pain and obstruction.

Stone Passage
A stone can traverse the ureter without symptoms, but passage usually produces pain and bleeding. The pain begins gradually, usually in the flank, but increases over the next 20 to 60 min to become so severe that narcotic drugs may be needed for its control. The pain may remain in the flank or spread downward and anteriolaterly toward the ipsilateral loin, testis, or vulva. Pain that migrates downward indicates that the stone has passed to the lower third of the ureter, but if the pain does not migrate, the position of the stone cannot be predicted. A stone in the portion of the ureter within the bladder wall causes frequency, urgency, and dysuria that may be confused with urinary tract infections. The vast majority of ureteral stones less than 0.5cm in diameter will pass spontaneously. It has been standard practice to diagnose acute renal colic by intravenous pyelography; however, helical computed tomography (CT) scan without radiocontrast enhancement is now the preferred procedure. The advantages of CT include detection of uric acid stones in addition to the traditional radio-opaque stones, no exposure to the risk of

radiocontrast agents, and possible diagnosis of other causes of abdominal pain in a patient suspected of having renal colic from stones. Ultrasound is not as sensitive as CT in detecting renal or uretral stones.

Other Syndromes
Staghorn Caculi- Struvite, cystine and uric acid stones often grow too large to enter the ureter. They gradually fill the renal pelvis and may extend outward through the infundibula to the calyces themselves. Nephrocalcinosis- Calcium stones grow on the papillae. Most break loose and cause colic, but they remain place so that multiple papillary calcifications are found by x-ray, a condition termed nephrocalcinosis. Papillary nephrocalcinosis is common in hereditary distal renal tubular acidosis (RTA) and in other types of severe hypercalciuria. In medullary sponge kidney disease, calcification may occur in dilated distal collecting ducts. Sludge- Sufficient uric acid or cystine in the urine may plug both ureters with precipitate. Calcium oxalate crystals do not do this because less than 100 mg oxalate usually is excreted daily in the urine even in severe hyperoxaluric states, compared with 1000 mg uric acid in patients with hyperuricosuria and 400 to 800 mg cystine in patients with cystinuria. Calcium phosphate crystals can render the urine milky but do not plug the urinary tract.

Infection
Although urinary tract infection is not a direct consequence of stone disease, it can occur after instrumentation and surgery of the urinary tract, which are frequent in the treatment of stone disease. Stone disease and urinary tract infection can enhance their respective

seriousness and interfere with treatment. Obstruction of an infected kidney by a stone may lead to sepsis and extensive damage of renal tissue, since it converts the urinary tract proximal to the obstruction into a closed, or partially closed, space that can become an abscess. Stones may harbor bacteria in the stone matrix, leading to recurrent urinary tract infection. On the other hand, infection due to bacteria that possess the enzyme urease can cause stones composed of struvite.

Diagnosis of renal stones

Straight x-ray of the KUB region will reveal 90% of the renal stones except the pure uric acid stones.

Laboratory investigations
Blood examination: 1. 2. 3. 4. Low Hb%. Increased WBC count. Blood urea, N.P.N. and creatinine. Blood calcium level.

Urine examination: 1. 24hr urine collection to measure total daily urinary volume, Mg, Na, uric acid, calcium, citrate, oxalate and phosphate. 2. Microscopic study of urine which may show protein, RBCs, bacteria, cellular cast and crystals. 3. Culture of urine sample to exclude urine infection.

Imaging examination
1. Straight x-ray abdomen: At least a 90% of renal stones are identified by x-ray of KUB reason unless they are very small or overlies bones. 2. A staghorn calculus can be easily diagnosed from x-ray film.

Star shaped bladder urolith on an X-ray of the pelvis.

Bilateral kidney stones on abdominal X-ray. Not to be confused with phleboliths seen in the pelvis.

The relatively dense calcium renders these stones radioopaque and they can be detected by a traditional X-ray of the abdomen that includes the Kidneys, Ureters and BladderKUB.This may be followed by an IVP (Intravenous Pyelogram; (IntraVenous Urogram (IVU) is the same test by another name)) which requires about 50 ml of a special dye to be injected into the bloodstream that is excreted by the kidneys and by its density helps outline any stone on a repeated X-ray.

These can also be detected by a Retrograde pyelogram where similar "dye" is injected directly into the ureteral opening in the bladder by a surgeon, usually a urologist. About 10% of stones do not have enough calcium to be seen on standard x-rays CT-scan: This is particularly helpful to diagnosed the non-opaque stones.

CT of abdomen without contrast showing right proximal ureteric stone causing mild obstruction and hydronephrosis ( marked by an arrow ).

Computed tomography without contrast is considered the gold-standard diagnostic test for the detection of kidney stones. All stones are detectable by CT except very rare stones composed of certain drug residues in the urine. If positive for stones, a single standard x-ray of the abdomen (KUB) is recommended. This gives a clearer idea of the exact size and shape of the stone as well as its surgical orientation. Further, it makes it simple to follow the progress of the stone by doing another x-ray in the future. Draw back of CT scans include radiation exposure and cost.

Ultra-sonography: This helps to distinguish b/w opaque and nonopaque stones. Ultrasound imaging is useful as it gives details about the

presence of hydronephrosis (swelling of the kidneysuggesting the stone is blocking the outflow of urine). It can also be used to detect stones during pregnancy when x-rays or CT are discouraged. Radiolucent stones may show up on ultrasound however they are also typically seen on CT scans. Some recommend that US be used as the primary diagnostic technique with CT being reserved for those with negative US result and continued suspicion of a kidney stone. This is due to its lesser cost and avoidance of radiation. Intavenous pyelogram. Retrograde pyelogram. Renal scan. Clinical diagnosis is usually made on the basis of the location and severity of the pain, which is typically colicky in nature (comes and goes in spasmodic waves). Pain in the back occurs when calculi produce an obstruction in the kidney. Imaging is used to confirm the diagnosis and a number of other tests can be undertaken to help establish both the possible cause and consequences of the stone.

Preventing Kidney Stones

Rather than having to undergo treatment, it is best to avoid kidney stones in the first place when possible. It can be especially helpful to drink more water, since low fluid intake and dehydration are major risk factors for kidney stone formation. A person who has had more than one kidney stone may be likely to form another; so, if possible, prevention is important. To help determine their cause, the doctor will order laboratory tests, including urine and blood tests. The doctor will also ask about the patients medical history, occupation, and eating habits. If a stone has been removed, or if the patient has passed a stone and saved it, a stone analysis by the laboratory may help the doctor in planning treatment. The doctor may ask the patient to collect urine for 24 hours after a stone has passed or been removed. For a 24-hour urine collection, the patient is given a large container, which is to be refrigerated between trips to the bathroom. The collection is used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatininea product of muscle metabolism. The doctor will use this information to determine the cause of the stone. A second 24-hour urine collection may be needed to determine whether the prescribed treatment is working. Preventive strategies include dietary modifications and sometimes also taking drugs with the goal of reducing excretory load on the kidneys: Drinking enough water to make 2 to 2.5 liters of urine per day. A diet low in protein, nitrogen and sodium intake.

 Restriction of oxalate-rich foods, such as chocolate, nuts, soybeans, rhubarb and spinach, plus maintenance of an adequate intake of dietary calcium. There is equivocal evidence that calcium supplements increase the risk of stone formation, though calcium citrate appears to carry the lowest, if any, risk. Taking drugs such as thiazides, potassium citrate, magnesium citrate and allopurinol, depending on the cause of stone formation. Some fruit juices, such as orange, blackcurrant, and cranberry, may be useful for lowering the risk factors for specific types of stones. Orange juice may help prevent calcium oxalate stone formation, black currant may help prevent uric acid stones, and cranberry may help with UTIcaused stones. Avoidance of cola beverages. Avoiding large doses of vitamin C. For those patients interested in optimizing their kidney stone prevention options, a 24 hour urine test can be a useful diagnostic [citation needed]. a. Restricting oxalate consumption Calcium plays a vital role in body chemistry so limiting calcium may be unhealthy. Since calcium in the intestinal tract will bind with available oxalate, thereby preventing its absorption into the blood stream, some nephrologists and urologists recommend chewing calcium tablets during meals containing oxalate foods. However, a more reliable approach is to restrict the intake of food that is high in oxalate (see oxalate for a list). This is only helpful in those patients who are absorbing

excess oxalate which is a minority of patients as most oxalate excreted in the urine is actually made by the liver.[citation needed]

b. Diuretics Although it has been claimed that the diuretic effects of alcohol can result in dehydration, which is important for kidney stone sufferers to avoid, there are no conclusive data demonstrating any cause and effect regarding kidney stones. However, some have theorized that frequent and binge drinkers create situations that set up dehydration: alcohol consumption, hangovers, and poor sleep and stress habits. In this view, it is not the alcohol that creates a kidney stone but it is the alcohol drinker's associated behavior that sets it up. One of the recognized medical therapies for prevention of stones is thiazides, a class of drugs usually thought of as diuretics. These drugs prevent calcium stones through an effect independent of their diuretic properties: they reduce urinary calcium excretion. Nonetheless, their diuretic property does not preclude their efficacy as stone preventive. Sodium restriction is necessary for clinical effect of thiazides, as sodium excess promotes calcium excretion. Thiazides work best for renal leak hypercalciuria - a condition in which the high urinary calcium levels are from a primary kidney defect. They work well initially for absorptive hypercalciuria - a condition in which high urinary calcium is a result of excess absorption from the GI tract. With this condition they lose effectiveness over time, typically around 2 years, and patients need a period of treatment to regain effectiveness. Thiazides will cause hypokalemia and reduced urinary citrate levels so should be given with supplements for each, usually as a potassium citrate preparation.

c.

Allopurinol Allopurinol (Zyloprim) is another drug with proven benefits

in some calcium kidney stone formers. Allopurinol interferes with the liver's production of uric acid. Hyperuricosuria, too much uric acid in the urine, is a risk factor for calcium stones. Allopurinol reduces calcium stone formation in such patients. The drug is also used in patients with gout or hyperuricemia. However, hyperuricemia is not the critical feature of uric acid stones, which can occur in the presence of hypouricemia. Uric acid stones are more often caused by a combination of high urine uric acid and low urine pH. Even relatively high uric acid excretion will not be associated with uric acid stone formation if the urine pH is alkaline. Therefore prevention of uric acid stones relies on alkalinization of the urine with citrate (in the form of Shohl's solution (sodium citrate), sodium bicarbonate, potassium citrate, potassium bicarbonate or acetazolamide, a carbonic anhydrase inhibitor). Allopurinol is reserved for patients in whom alkalinization is difficult. For patients with increased uric acid levels and calcium stones, allopurinol is one of the few treatments that has been shown in doubleblinded placebo controlled studies to actually reduce kidney stone recurrences. Dosage is adjusted to maintain a reduced urinary excretion of uric acid. Serum uric acid level at or below 6 mg/dL is often the goal of the drug's use in patients with gout or hyperuricemia. d. Decreased protein diet A high protein diet might be partially to blame. Protein from meat and other animal products is broken down into acids, including uric acid. The most available alkaline base to balance the acid from protein is calcium phosphate (hydroxyapatite) from the bones (buffering). The

kidney filters the liberated calcium which may then form insoluble crystals (i.e., stones) in urine with available oxalate (partly from metabolic processes, partly from diet) or phosphate ions, depending on conditions. High protein intake is therefore associated with decreased bone density as well as stones. The acid load is associated with decreased urinary citrate excretion; citrate competes with oxalate for calcium and can thereby prevent stones. In addition to increased fluid intake, one of the simplest fixes is to moderate animal protein consumption. However, despite epidemiologic data showing that greater protein intake is associated with more stones, randomized controlled trials of protein restriction have not shown reduced stone prevalence. In this regard, it is not just dietary calcium per se that may cause stone formation, but rather the leaching of bone calcium. Some diseases (e.g., distal renal tubular acidosis) which cause a chronically acidic state also decrease urinary citrate levels; since citrates are normally present as potent inhibitors of stone formation, these patients are prone to frequent stone formation. e. Other modifications Potassium citrate is also used in kidney stone prevention. This is available as both a tablet and liquid preparation. The medication increases urinary pH (makes it more alkaline), as well as increases the urinary citrate level, which helps reduce calcium oxalate crystal aggregation. Optimal 24 hour urine levels of citrate are thought to be over 320 mg/liter of urine or over 600 mg per day. There are urinary dipsticks available that allow patients to monitor and measure urinary pH so patients can optimize their urinary citrate level.

Though caffeine does acutely increase urinary calcium excretion, several independent epidemiologic studies have shown that coffee intake overall is protective against the formation of stones. Measurements of food oxalate content have been difficult and issues remain about the proportion of oxalate that is bio-available, versus a proportion that is not absorbed by the intestine. Oxalate-rich foods are usually restricted to some degree, particularly in patients with high urinary oxalate levels, but no randomized controlled trial of oxalate restriction has been performed to test that hypotheses.

Kidney Stones Treatment

Self-Care at Home
Prevention is always the preferable way to treat kidney stones. Remaining well hydrated and keeping the urine dilute will help prevent kidney stones from forming. Those who have never passed a kidney stone may not appreciate the severity of the symptoms. There is little a person can do at home to control the debilitating pain and vomiting that can occur with a kidney stone other than to seek emergency care. If this is the first episode and no previous diagnosis has been established, it is important to be seen by a health-care provider to confirm the diagnosis. For those who have a history of stones, home therapy may be appropriate. Most kidney stones, given time, will pass on their own, and treatment is directed toward symptom control. The patient should be instructed to consume oral fluids. Ibuprofen may be used as an antinflammatory medication if there is no contraindication to its use. If further pain medication is needed, the primary-care provider may be willing to prescribe stronger narcotic pain medications. Please note, if a fever is associated with the symptoms of a kidney stone, this becomes an emergency, and medical care should be accessed immediately. Urinary tract infections associated with a kidney stone often require urgent assessment and may need intervention by a urologist to remove or bypass the stone.

Home Remedy for kidney stones Stones lesser than 4mm in size usually pass out spontaneously, without any complications. Follow these guidelines if the stones are relatively small and can pass out while urinating. Dried French beans or Rajmah is an effective ingredient to get rid of all kidney problems including Kidney stones. Remove the beans from the pods, and slice the pods in small sizes and boil it in 4 liter of hot water in low flame for six hours continuously. Strain the liquid twice through fine muslin and cool it for eight hours. A glass of this fluid should be given to the patient every two hours throughout the day. The patient may consume it several times a week. Make sure you don't prepare the decoction in plenty, as it will not work if it is more than 24 hours old. Take one teaspoon each of basil juice and honey daily for six months. Intake of vitamin B6 or pyridoxine is the best treatment for kidney stones. A daily therapeutic dose of 100 to 150 mg of Vitamin B6 combined with other B complex vitamins helps in getting a permanent cure. Take a tablespoon of pomegranate seed and grind it into a fine paste and give it to the patient with a cup of horse gram soup. A cup of horse gram soup should be prepared by using two tablespoon of it. Drink a lot of water that you will be able to pass 2 quarts of urine a day.

Nettle helps to keep crystals from forming into stone. It even helps to wash away the bacteria. Drink 2-3 cups of nettle leaf per day to prevent kidney stones. Mix 1-2 tablespoon of dried nettle leaf with 1cup of hot water and steep for 10-15 minutes. Consult your physician in case of severe pain. Majority of

stones greater than 6mm will require surgical treatments. The treatments include dietary modifications, drinking plenty of water, medications and lithotriptor. In severe cases, extracorporeal shock wave lithotripsy, retrograde interregnal surgery or open surgery may be necessary. It is done especially if the stone is struck and causing any infection in the urinary track.

Management Conservative Management

About 90% of stones 4 mm or less in size usually will pass spontaneously, however 9% of stones larger than 6 mm will require some form of intervention. There are various measures that can be used to encourage the passage of a stone. These can include increased hydration, medication for treating infection and reducing pain, and diuretics to encourage urine flow and prevent further stone formation. Caution should be exercised in eating certain foods, such as starfruit, with high concentrations of oxalate which may precipitate acute renal failure in patients with chronic renal disease. In most cases, a smaller stone that is not symptomatic is often given up to four weeks to move or pass before consideration is given to any surgical intervention as it has been found that waiting longer tends to lead to additional complications. Immediate surgery may be

required in certain situations such as in people with only one working kidney, bilateral obstructing stones, intractable pain or in the presence of an infected kidney blocked by a stone which can cause sepsis. Straining the urine allows collection of the stone when it passes. Analysis can help establish preventative options.

Analgesia
Management of pain often requires intravenous administration of NSAIDS or opioids in an emergency room setting. Orally-administered medications are often effective for less severe discomfort (NSAIDs or opioids). Intravenous acetaminophen also appears to be effective. After treatment, the pain may return if the stone moves but re-obstructs in another location.

Alpha adrenergic blockers

Alpha adrenergic blockers such as tamsulosin (Flomax) may increase the spontaneous passage of the stone by 30%. Recent studies have, however, questioned this claim, finding no benefit from these medications.

Urologic interventions

A kidney stone at the tip of an ultrasonic instrument. Most kidney stones do not require surgery and will pass on their own. Surgery is necessary when the pain is persistent and severe, in

renal failure and when there is a kidney infection. It may also be advisable if the stone fails to pass or move after 30 days. Finding a significant stone before it passes into the ureter allows physicians to fragment it surgically before it causes any severe problems. In most of these cases, non-invasive extracorporeal shock wave lithotripsy (ESWL) will be used. Otherwise some form of invasive procedure is required; with approaches including ureteroscopic fragmentation (or simple basket extraction if feasible) using laser, ultrasonic or mechanical (pneumatic, shock-wave) forms of energy to fragment the larger stones. Percutaneous nephrolithotomy or rarely open surgery may ultimately be necessary for large or complicated stones or stones which fail other less invasive attempts at treatment. A single retrospective study in the USA, at the Mayo Clinic, has suggested that lithotripsy may increase subsequent incidence of diabetes and hypertension, but it has not been felt warranted to change clinical practice at the clinic. The study reflects early experience with the original lithotripsy machine which had a very large blast path, much larger than what is used on modern machines. Further study is believed necessary to determine how much risk this treatment actually has using modern machines and treatment regimens. More common complications related to ESWL are bleeding, pain related to passage of stone fragments, failure to fragment the stone, and the possible requirement for additional or alternative interventions.

Three-dimensional reconstructed CT scan image of a ureteral stent in the left kidney (indicated by yellow arrow). There is a kidney stone in the pyelum of the lower pole of the kidney (highest red arrow) and one in the ureter beside the stent (lower red arrow).

One modern medical technique uses a ureteral stent (a small tube between the bladder and the inside of the kidney) to provide immediate relief of a blocked kidney. This is especially useful in saving a failing kidney due to swelling and infection from the stone. Ureteral stents vary in length and width but most have the same shape usually called a "double-J" or "double pigtail", because of the curl at both ends. They are designed to allow urine to drain around any stone or obstruction. They can be retained for some length of time as infections recede and as stones are dissolved or fragmented with ESWL or other treatment. The stents will gently dilate or stretch the ureters which can facilitate instrumentation and they will also provide a clear landmark to help surgeons see the stones on x-ray. Most stents can be removed easily during a final office visit. Discomfort levels from stents typically range from minimal associated pain to moderate discomfort. However, it isn't uncommon for patients to experience severe discomfort too, especially upon removal of said stent.

The use of ureteral stents is of particular significance in the treatment of ureteral stones. Their use, non use, and circumstances peculiar to stents should be well understood in order to maximize the benefits.

Homoeopathy and Kidney stones

Homoeopathy offers symptomatic relief without having to go through the throes of surgery. Homeopathic remedies are prescribed on the basis of symptoms presented in the sick person. Different individuals, suffering from the same disease, can display entirely different symptoms. At times a patient may display certain symptoms that are not associated with kidney stones at all. However, to make it easier to pinpoint the remedies that are most commonly used to treat a particular condition, the symptoms experienced by previous patients are grouped together in the homoeopathic repertory. Symptoms that are commonly experienced by patients who have kidney stones are listed along with the most commonly used medicines that would ease the symptoms. Common Homoeopathic remedies for renal stones Some of the most common remedies used for kidney stones are listed below: Aconite Napellus Common Name- Monkshood Parts Used- Tincture of the whole plant with root when beginning to flower

Family- Ranunculacee Historical Dose- All potencies, esp the 30c or 200c in acute diseases Prover- Dr. Hahnemann in 1805 Planets- Mars, moon Suited to plethoric persons of a lively character; bilious and nervous constitution; high color, brown or black hair; persons leading a sedentary life; warm blooded patient. Useful in the acute stage. Urine is scanty, red and hot to feel. Urine is at times bloody. Tenesmus and burning at neck of bladder. Burning in urethra. Chiefly left sided. Anxiety always on beginning to urinate. Retention with screaming and restlessness and handling of genitals. Retention or suppression of urine in new born due to cold exposure. Kidney region sensitive. Agonizing dysuria. Patient perspires profusely. Colic, no position relieves. Abdomen hot, tense, sensitive to touch. Modalities- Better in open air from rest. better from warm sweat. Worse from fright, shock, violent emotions and vexation. Worse from being chilled by cold winds, dry weather, while sweating. Worse from pressure touch in bed, noise, light, sleeping in the sun. Worse lying on affected side. Worse from music from tobacco-smoke inspiration. Worse in warm room. Worse evening and at night. Belladonna Common Name- Deadly Nightshade Parts Used- Tincture of the whole plant when beginning to flower Family- Solanaceae

Historical Dose- All potencies, first to thirtieth potency and higher Prover- Dr. Hahnemann in 1805 Planets- Mars, Sun, Moon Suited to plethoric persons with red face and to conditions where there is local plethora; to persons with bilious and lymphatic temperament; light hair and complexion and blue eyes; chilly patient. Useful remedy when urine is scanty, dark and cloudy, with lots of phosphate stones or when the region over bladder is sensitive. Retention of urine with paralysis of bladder. Acute urinary infections. Sensation of motion in bladder as of a worm. Involuntary urination, on lying down or when standing or at night, when sleepy during day. Prostatic hypertrophy. Frequent and profuse urination. Also used in the treatment of blood in urine. Hematuria where no pathological condition can be found. Right sided remedy. Modalities- Better from light covering, bending backward, rest in bed, standing. Better from leaning head against something, bending or turning the affected part. Worse from heat of sun, if heated, drafts, on head, haircut, washing head. Worse after taking cold, light, noise, jarring, checked sweat, company, pressure, motion, worse from hanging down the affected part afternoon, looking at shining objects or running water. Worse afternoon, 3pm, 11pm, after midnight. Benzoic Acid[ Benzoicum Acidum] Source- It is obtained by sublimation from gum benzoin or from several aromatic hydrocarbons

Historical Dose- Trituration tincture and all potencies, third to sixth potency Planets- Venus, Saturn Suited to gouty constitutions; chilly persons. Excess of uric acid. Cystits. Kidney insufficiency. Kidney gravel, stones. Renal stones particularly in gouty subjects with a h/o of suppression of gonorrhoea. A granular kind of mucosa mixed with phosphate in sediment; urine dark, reddish-brown; acid reaction, or very hot, high coloured and odor is exceedingly strong as of horse urine. Bedwetting, sheets are, unusually, stained brown. Dribbling of urine. Offensive urine of old men. Bladder catarrh from suppressed gonorrhoea. Symptoms appear left side first, then right. Pains suddenly change their locality but are mostly felt in the region of the heart or they alternate with urinary symptoms. Modalities- Better from heat, profuse urination. Worse from open air, cold, changing weather, by uncovering. Motion aggravates most symptoms. Berberis vulgaris Common Name- Barberry Parts Used- Bark of the root Family- Berberidacae Historical Dose- Tincture and all potencies, tincture to sixth potency Prover- Dr. Hesse in 1834 Planets- Venus, Jupiter, Saturn

Suited to fleshy persons, good liver but with little endurance; prematurely old and worn out men and women; old gouty constitutions; bilious diathesis. Used in the renal colic from renal stones. Radiating pains from kidneys into bladder. Pain from kidney, extending along ureter or to liver, stomach, spleen, arresting breathing. Bubbling sensation in region of kidneys. Burning, soreness in kidney region. Pain in the thighs and loins on urinating. Clear discharge from meatus before urinating. Dysuria, frequent urination. Urethra burns when not urinating. Sensation as if some urine remained after urinating. Urine with thick mucus and bright-red, turbid, yellow, mealy, sandy or slimy sediment. Left sided remedy. Modalities- Worse from motion, standing. It brings on or increase, urinary complaints. Worse from jarring, stepping hard, rising from sitting, fatigue, urinating, twilight. Cantharis Common Name- Spanish fly Parts Used- The whole dried fly Family- Cantharideae Historical Dose- Trituration, tincture and all potencies, sixth to thirtieth potency. Externally in burns and eczema, 1x or 2x in water or as cerate. Prover- Dr. Hahnemann Planets- Mars, Venus It is best suited to ppl who are uneasy, restless, dissatisfied and want to move about constantly, sometimes moaning or crying

violently; hot patient. Acc to H.N. Guernsey Cantharis is almost always the remedy for whatever other sufferings there may be, when there is as well frequent urination with burning, cutting pain or if cutting burning pain attends the flow, even when urination is not very frequent. It action is very rapid and intense. Inflammations are violently acute or rapidly destructive in the mucous and serous membranes. The inflammations Cantharis produce (bladder, kidneys, meninges, pleuritic and pericardial membranes) are usually associated with bladder irritation. Painful urination, as a concomitant in any diseased condition. Pains are cutting, smarting or burning, bitting or as if raw, causing mental excitement. Intolerable, constant urging to urinate is most characteristic. Sexual excitement during pains. Convulsions with dysuria.Great thirst, with burning pain in throat and stomach. Thirst, with aversion to all fluids. Acute cystitis, nephritis, nephritic colic. Constant desire to urinate. Intolerable tenesmus, cutting before during and after urine. Dropsy. Kidneys region oversensitive. Atony of bladder from long retention of urine. Fearful tenesmus or dribbling. Bloody urine. Urine is passed drop by drop. Membranous scales looking like bran in water. Urine jelly-like, shreddy. Right sided remedy. Modalities- Better from rubbing from warm applications. Better from warmth, rest. Worse urinating, drinking, cold water or coffee. Worse touch especially larynx. Worse bright objects, sound of water. Colocynthis Common Name- Bitter Cucumber Parts Used- Pulp of fruit excluding seeds Family- Cucurbitaceae

Historical Dose- All potencies, sixth to thirtieth potency Prover- Dr. Hahnemann in 1821 Planets- Mars It is suitable to easily angered, irritable persons with tendency to corpulence. To women of sedentary habits with copious mensturation. To blondes, persons of choleric temperament and those liable to cramps and colic from fruit, lead-poisoning or excessive venery. Complaints occurring from the ill-effects of anger, indignation, chagrin, grief, catching cold, or excessive venery. Useful in kidney colic with diuresis, bladder spasms after operation on the orifices. Itching at orifice. Tenesmus of bladder. Bladder catarrh, discharge like fresh white of egg, viscid. Burning along urethra during stools. Pain on urination over the whole abdomen. Urine, gelationus, sticky, stringy. Red hard cyrstals adhering to the vessels. Urine, milky white coagulates on standing, diabetes. Pains on urinating over whole abdomen. Fetid, small quantities of urine with frequent urging. Cutting in abdomen, especially after anger. Agonizing cutting pain in abdomen causing patient to bend over double and pressing on the abdomen. Violent, cutting, gripping, grasping, clutching or radiating, coliky. Pains, comes in waves, better doubling up, hard pressure, worse least food or drink, except coffee and tobacco smoking. Colic with cramps in calves. Modalities- Warmth ameliorates most pains. Better doubling up, hard pressure, warmth. Better lying with head bent forward. Worse from emotions, vexation, chagrin, anger and indignation. Worse from lying on painless side, night in bed, taking cold. Worse before and after urination. Worse evening and night.

 Chimaphila Umbellata Common Name- Pipsissewa Parts Used- Tincture of root and leaves or of flesh plant in flower Family- Ericaceae Historical Dose- Tincture and all potencies, tincture to third potency Planets- Venus, Moon It is suited to cachectic, scrofulous individuals and brokendown constitutions. Abdominal and kidney dropsies in broken-down constitutions and intemperate subjects. Women with large breasts or plethoric women with dysuria. Acute inflammation of urinary tract. Suppressed urine in infants. Urging to urinate. Urine turbid offensive, containing ropy or bloody mucus and depositing a copious sediment. Burning and scalding during urination and straining afterwards. Must strain before flow comes. Scanty urine. Acute prostatitis with retention and dysuria and feeling of a ball in perineum, as if sitting on a ball (canni). Gonorrhea and prostatitis. Fluttering in region of kidney. Bladder tenesmus worse sitting better walking. Cannot pass urine without standing with feet apart and body inclined forwards. Clots of blood pass with urine. Sugar in urine. Modalities- Better from walking. Worse in damp weather from sitting on cold stones or pavements, left side, beginning urination. Eupatorium Purpureum Common Name- Gravel root Parts Used- Root

Family- Composite Historical Dose- Tincture and all potencies, first potency Planets- Venus The common name, "gravel root" indicates the traditional use of the drug and in the hands eclectics it has done good work in cases of irritable bladder, diabetes insipidus, incontinence of urine and kidney stones. Cystits in pregnant women from riding over rough roads. Albuminuria, diabetes, strangury, irritable bladder, enlarged prostate are a special field for this remedy. Chills and pains run upwards. Deep, dull pain in kidneys. Diabetes insipidus. Dysuria. Bladder irritability in women. Burning in bladder and urethra on urinating. Insufficient flow, milky. Stranguary; hematuria. Constant desire, even after frequent urination, the bladder feels full. Urine smells sweet. Urinary stream smaller. Modalities- Worse from motion. Worse changing position ever so little causes chilliness down back. Worse left side and there is sensation as if falling to left side. Lycopodium Clavatum Common Name- Club Moss Parts Used- Spores Family- Lycopodiaceae Historical Dose- All potencies Prover- Dr. Hahnemann in 1828

Planets- Jupiter, Venus The spores from which the potencies are made have been called "vegetable sulphur" probably on account of their use for producing stage-lightning at theaters. Lyco affects the nutrition, due to weakness of digestion. It is suited to: Persons of keen intellect, but feebler muscular development, upper part of body wasted, lower semidropsical, lean and predisposed to lung and hepatic conditions, herpectic and srofulous constitutions. Grauvogle's carbo-nitrogenoid constitution. Hypochondriacs subject to skin diseases, lithic acid diathesis, much red sediment in urine, urine itself transparent, sallow people with cold limbs, haughty disposition, when sick, mistrustful, low of comphrehension, weak memory. Persons with poor circulation, it seems to stand still with cold numb limbs or numbness may appear in spots, lack vital heat. Frequent urging to urinate better riding in cars. Pain in back before urinating, ceases after flow, slow in coming, must strain. Retention. Polyuria during the night. Red sand in urine. Kidney colic in ureter (right) to bladder. Urine milky, turbid. Involuntary urination in fever or from fright during sex. Urine bloody with paraplegia or sometimes with constipation. Urine burning hot. Intolerable of cold drinks, craves everything warm. Stones, gall stones, gravel. Lithic acid diathesis. Symptom characteristically run from right to left, acts especially on right side of body. Modalities- Better by motion, after midnight. Better from warm food and drink. Better on getting cold from being uncovered, cold applications, belchings, urinating. Worse right side from right to left from above downward, 4 to 8pm. Worse from pressure of clothes, awakening, wind, eating even a little, overeating, oysters. Worse from wet, stormy weather. Worse before or from suppressed menses. Worse from milk,

vegetables. cabbages, beans, broad, pastry. Worse from heat, warm room, hot air, bed, warm applications, except throat and stomach which are better from warm drinks. Nitric Acid[Nitricum Acidum] Common Name- Aqua fortis Chemical Formula- HNO Historical Dose- All potencies, sixth potency Prover- Dr. Hahnemann Planets- Mercury, Saturn It is suited to persons who have chronic diseases and takes cold easily and disposed to diarrhea. Acts best on dark complexioned and middle age or older. Ppl with swarthy complexion, black hair and eyes, lean persons of rigid tissue. Brunette rather than blonde nervous temperament. Old ppl with great weakness. Hydrogenoid constitution. Complaints occurring from ill effects of loss of sleep from nursing the sick; Injury to spine; antibiotics drugs, penicillin, mercury. Cramps from kidney to bladder. Infective nephritis. Contracted kidney. Burning and stinging as of a hot tire in urethra. Dyspepsia with excess of oxalic-acid, uric acid, and phosphates in urine and great mental depression. Scanty, dark, offensive urine; urine smells strong as horses or offensive. Urine feels cold when it passes, alternately profuse and scanty. Urine bloody and albuminous. Alteration of cloudy, phosphatic urine with profuse secretion in old prostatic cases. Hematuria with shuddering along the spine. Stream thin, as from stricture. Painless retention or incontinence of urine.

Modalities- Better from gliding motion. Better in a carriage. Better mild weather, steady pressure. Worse slight causes from touch. Worse from jarring, noise, rattling, motion. Worse milk, fat food after eating. Worse cold air, dampness, evening and night, changing weather, heat of bed. Worse mental exertion or shock. Worse mercury, loss of sleep. Worse cold climate and also hot weather. Sarsaparilla Common Name- Wild Liquorice Parts Used- Dried rhizome Family- Smilaceae, by some as a sub-order of the Liliaceae Historical Dose- Tincture and all potencies, first to sixth potency Planets- Venus, Saturn. Sarsaparilla was used as a restorative and blood purifier after exhausting course of mercury. It covers the syphilitic, sycotic and psoric constitutions. It is suited to persons with faces like old people and enlarged abdomens to dark-haired persons, especially children with enlarge abdomen. Bladder distended and tender. Tenesmus of bladder. Pain from right kidney downward. Urging to urinate before menses. Severe pain at conclusion of urination. Gravel. Kidney colic and painful urination in children. Kidney colic due to venereal disease. Child screams before and while passing urine. Sand on diaper. Can pass urine only when standing. Urine dribbles while sitting. Urine passes in thin, feeble stream. Pain at meatus. Urine scanty, slimy, flaky, sandy, pus, bloody. Crusty urinary sediment. Air passes from bladder during urination. Pain in urethra going back to abdomen. Jerking along the urethra. Pus in urine.

Modalities- Better from uncovering neck and chest. Standing improves difficult urination. Warmth better. Worse at the close of urination. Worse from cold, wet, dampness at night. Worse from suppressed gonorrhea, motion, going up and down stairs. Worse after urinating, when yawning in spring, before menses. Worse by touch, pressure, tight clothes, scratching. Sitting worse.

Other remedies to look at:

Many other remedies will come up especially when the case is individualized to each individual patient. Sulphur Calc Carb Kali Carb Lachesis Sepia Medorrhinum Nux-vomica

Mother tincturesfor renal stones

The use of these mother tincture are mainly based on symptom present in patient with renal calculi

1. Renal colic with tenderness in kidney region 2. Suppression of urine, strangury 3. Renal colic in rheumatism and gouty subjects 4. Renal colic, pain in the thighs and loins on urinating 5. Renal colic

: Atista-ind : Apocyn-can, Liat-spicata, Eryngiumaqu : Berb-vulg : Berb-vulg : Boerrhav-diff, Galium-apar, Hydrangea, Pareira-brav, Sarsa, Stigmata-mayd : Chimaphilla, Pareira-brav, Stigmatamayd : Equisteum-h : Eryngium-aqua : Stigmata-mayd : Sarsparilla, Stillingia

6. Retention of urine

7. Renal colic extending to lower abdomen, with desire to urinate 8. Renal colic extending down the ureters and limbs 9. Red sand in urine 10.White sand in urine

Conclusion
Although we live in an age when quick fixes are the order of the day, more and more people are testing the waters of complementary medicine. This is probably due to the increased awareness regarding the adverse side effects of the long-term use of conventional medicines .Homeopathy not only treats the symptoms of a disease but also tries to root out the underlying cause. Besides providing individualized treatment, this system of medicine has very little side effects and is entirely affordable by all. Kidney stones may be something that could come up acutely following a constitutional remedy. This would be something that needed to come up and be expelled from the body. If the indicated acute remedy does not palliate a low dose of the constitutional may help. Although allopathic treatment may be the best alternative until the stone passes and then continue to monitor the constitutional treatment repeating the constitutional remedy when indicated.

HOMOEOPATHIC VIEW DISEASE - HOMOEOPATHIC CONCEPT

"Homoeopathy treats the Man not the Disease".
It is homoeopathy only which stresses the existence and operation of vital force in the living organism. Disease per se Hahnemann say, nothing more than an alteration in the state of health of a healthy individual caused by the dynamic action of extreme inimical forces upon the life principle of the living organism mankind itself known only by preferable signs and symptoms the totality of which represents and for all practical purpose constitutes the disease Sickness is always the result of a want of harmony of the vital forces, associated by a cause which produces in the organism an abnormal impression. This want of harmony, simple perhaps at first become complex the functional alteration becomes general and manifest itself in symptoms and finally sickness results. Disease is the totality of the effects by which we recognize or perceive the action of peculiar order subversive forces upon an organism The exciting cause of disease act by means of their virtual quality on the state of our life only in dynamic, almost spiritual manner and in as much as they first derange the organs of higher rank and of the vital force, there occurs from this state of derangement from this dynamic alteration of the living whole, an altered sensation and an altered activity of each individual organ and of all of them collectively. Whereby there

must also of necessity secondarily occurs alteration of the juices in our vessel and secretion of abnormal matters. The inevitable consequences of the altered vital character which now differs from the healthy state hence it is obvious that the disease human being excited by the dynamic and virtual influences of morbific noxae can be originally only dynamic derangement (caused solely by a spiritual process) When a person fall ill, it is only this spiritual, self acting (automatic) vital force, everywhere present in his organism that is primarily damaged by the dynamic influence upon it of a morbific agent inimical to life ; it is only the vital principle, deranged to such an abnormal state, that can furnish the organism with its disagreeable sensations and incline it to irregular processes which we call disease; for as power invisible in itself and only recognizable by the effect on the organism; its morbid derangement only makes itself known by the manifestation of the disease in the sensation and function of those part of the organism exposed to the senses of observer and physician that is by morbid symptoms and in no other way can it make itself known. Hahnemann wishes to teach that it is a disorder of activities of the internal man, a lack of harmony or lack of balance which gives forth the sign and symptoms by which we recognize diseases. These sensations constitute the language of disorder i.e. the means by which we recognize the disorder and disease. The immaterial vital principle, this simple substance, everywhere pervades the organism, and in disease this disorder everywhere pervades the organism, it pervades every cell and every portion of the human economy. We will see in due course of time that the change in form of a cell is the result first of disorder, that the derangement of the immaterial vital principle is the very beginning of the disorder, and that with this beginning there are changes in sensation by

which man may know this beginning which long before there is any visible change in the material substance of the body. Whether it is an affection of the body or the mental faculties, ultimately it is the individual as a whole or the I that suffers. Internal man is composed of will and understanding and external man is the physical body of the internal and is controlled by it. Disease is the result of disorder between the will and understanding; is a disturbance of the vital force and the processes not properly performed. As Hahnemann puts in aphorism in 16 as our vital force, as a spirit live dynamic, can not attacked and affected by injurious influences on the healthy organism caused by the external forces that disturb the harmonious way of life. Again in aphorism 148 :- the natural disease is never to be considered as a noxious material situated somewhere within the interior or exterior of man, but as one produced by an inimical spirit live (conceptual) agency which, like a kind of infection, disturbs in its instinctive existence of the spirit like (conceptual) principle of life with in the organism torturing it as an evil spirit and compelling it to produce certain ailments and disorders in the regular course of its life these are known as symptoms (disease). Disease, strictly speaking, is neither an action nor a reaction, but only a new or changed state of the organism caused by the interaction of an external cause with the internal constitutes of the organism, resulting in a new form of the whole of a reciprocal action in which cause and effect are ever conjoined. Disease is an abnormal vital process a changed condition of life, which is inimical to the true development of the individual and tends to organic dissolution. Functional symptoms always precede structural changes. In

biology function creates and develops the organ. In disease, function, the effort of the vital energy to function under adverse circumstances precedes and develops the pathological states. For the homoeopathic physician the totality of the functional symptoms of the patient is the disease and constitutes the only preferable form of disease, and therefore only basis of curative treatment. Symptoms are the outward and visible signs of the inward disturbance of the vital force states, and when these symptoms are removed disease ceases to exist. Predisposition to disease is produced in each individual according to peculiar characteristic habits, environmental condition and other injurious influences as Hahnemann puts in foot note aphorism 7881 as some of these causes that exercise a modifying influence on the transformation of psora into chronic disease manifestly depends sometimes on the climate and the peculiar physical character of the place of abode sometimes of the very great verities in the physical and mental training of youth both of which may have been neglected, delayed or carried to excess or on their abuse in the business conditions of life, in the matter of diet and regimen, passions, manners, habits and customs of various kinds. By susceptibility we mean the general quality or capability of the living organism of receiving impression, the power to react to stimuli. Susceptibility is one of the fundamental attitudes of life upon it depends all functioning, all vital processes, physiological and pathological digestion, assimilation, nutrition, repair, secretion, excretion, metabolism, and catabolism as well as all disease processes arising from infection or contagious depends upon the power of the organism to react to specific stimuli.

Susceptibility as a state may be increased, diminished or destroyed. Either of these is a morbid state which must be considered therapeutically from the stand point of the individual patient. Morbid susceptibility may be regarded as a negative or minus condition a state of lowered resistance. Susceptibility in an organism, mental or bodily is equivalent to state. Sate involves the attitude of organizations to internal cause and to external circumstances. It is all the resources of defence or the way of yielding. The taking on of states is the history of human life. The health we live and act and resist without knowing it. In disease we live but suffer and knew ourselves in conscious or unconscious exaggeration.

INDIVIDUALIZATION
Individualization is the key to homoeopathic prescribing. Individualization means that in any particular case we have to consider those symptoms which make that particular sick individual different from other patients suffering from the same disease. Homoeopathic system is based on infallible law of nature, similia simlibus curentur i.e. a weaker dynamic affection is permanently extinguished in the living organism by a stronger one if the latter (whilst differing in kind) is very similar to the former in its manifestation (aphorism 26) The more striking, singular, uncommon & peculiar (characteristic) signs and symptoms of the case of disease are chiefly and most solely to be kept in view for it is most particularly these that very similar ones in the last of symptoms of the selected medicine must correspond to in order to constitute it the most suitable for effecting the cure. (Aphorism 153)

The age of the patient his mode of living and diet, his occupation, his domestic position, his social relation and so forth must next be taken into consideration, in order to ascertain whether these things have tended to increase his malady or in how far they may favors or hinders the treatment. In like manners the state of his disposition & mind must be attended to, to learn whether that presents any obstacle to the treatment or requires to be directed encouraged or modified (aphorism 208) Comparison, individualization and difference in the nature of things most similar are parts that must be carefully considered. The substitution of one remedy for author can not be thought of or entertained in homoeopathy. The homoeopathic physician must individualize, he must discriminate. He must individualize things dissimilar in one way, yet similar in other ways. Homoeopathy recognizes the individuality of each patient or case. The entire examination of a patient is conducted with a view to discover not only the general or common features of the case by which it may be classified diagnostically and pathologically, but by the special and particular symptoms which differentiate the case form other of the same general class. It recognize the fact that no two cases or patients, even with the same disease, are exactly alike and maintains that a true science of therapeutics must enable the practitioner to recognize these difference and find the needed remedy for each individual.

MIASMATIC CONCEPT
According to common definition, a miasm is defined as polluting exhalations or malarial poisons. But this does not interpret Hahnemanns meaning intelligently. Therefore the residual poisons of syphilis & gonorrhoea that have become the miasms of syphilis & sycosis might better be termed as stigmata of syphilis & gonorrhoea. Miasm denotes the dynamic disease producing power which pollutes the human organism & become the producer of every possible disease condition. Chronic miasm go on increasing worse inspite of best mental and corporeal regimen and torment to the end of his life. They are ineradicable by the vital force alone without proper medicinal treatment. Eventually, Hahnemann described three basic miasms which he believed to be the underlying causes of chronic disease. In any given patient there could be one miasm, or any combination of them. The first he described was the psoric miasm (derived from the Greek word psora, meaning itch). Hahnemann considered this the earliest miasm affecting the human race, and thus the most fundamental underlying layer of weakness upon which the others have subsequently been built. Specific disease which Hahnemann associated with psora ranged from virtually all physical ailments including cancer, diabetes, arthritis etc. to the most severe mental illness of epilepsy, schizophrenia & imbecility. The second miasm to effect the human race Hahnemann considered to be the syphilytic miasm. The specific disease syphilis was

considered to be one of the manifestations of this predisposition but it also was implicated in a wide range of the other disorders found as well in late stages of other miasms. Hahnemann believed that patients suffering from the syphilis miasm acquired its influence by exposure to syphilis or by inheritance from an infected ancestor the trait then being transmitted from generation to generation. The third Hahnemann miasm was the sycosis miasm (from the Greek word syco meaning fig). This miasm he considered to have arisen out of gonorrhoea, either contracted by the patient or by one of the patients ancestors.A common misunderstanding about the miasmatic theory is that specific pathological conditions result from specific miasm. In reality, however, all three miasms can result in any pathological change P S Ortega confirms that , in the last edition of

ORGANON there are many references to the miasms, considered by Hahnemann as diatheses or constitutional diseases . We need only refer to paragraphs 78, 82, and 203 to 208 especially, although in paragraph 5, noting everything which may aid the curative process, he states: useful to the physician in assisting him to cure are the particulars of: 1. 2. The most probable exciting cause of the acute disease. The most significant points in the whole story of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm.... The most illustrative and precise paragraph in the ORGANON relating to the miasms is 204 which states : If we deduct all

chronic affection and disease that depend on a persistently unhealthy mode of living, as also those innumerable medicinal maladies caused by the irrational, persistent, harassing and pernicious treatment of diseases often only of trivial character by physicians of the old school, most of the remainder of chronic diseases result from the development of these three chronic miasms, internal syphilis, internal sycosis, but chiefly and in infinitely greater proportion, internal psora. Each of these infections WAS ALREADY IN POSSESSION OF THE WHOLE ORGANISM, AND HAD PENETRATED IT IN ALL DIRECTIONS BEFORE THE APPEARANCE OF THE PRIMARY, VICARIOUS LOCAL SYMPTOM OF EACH OF THEM (in the case of the psora the scabious eruption, in syphilis the chancre or the bubo, and in sycosis the condylomata) that prevented their outburst; and these chronic miasmatic diseases, if deprived of their local symptom, are inevitably designed by mighty Nature sooner or later to become developed and to burst forth, and thereby propagate all the nameless misery, the incredible number of chronic diseases which have plagued mankind for hundreds and thousands of years, none of which would so frequently have come into existence had physicians striven in a rational manner to cure radically and to extinguish in thcve organism these three miasms without employing local remedies for their corresponding external symptoms, relying solely on theproper external homoeopathic remedies for each.

PSORA
Dr. Hahnemann used this term Psora with some special commonation of his own. By this term he meant an original disease condition which does after the completion of the internal infection of the whole organism announced by the peculiar cutaneous eruptions. Psora is the most important chronic miasm which is the only real fundamental cause and producer of innumerable forms of disease. Some characters of Psora

It produces functional disturbance in the organism all kinds of functional complaints when arising from emotional disturbance. Intelligent, dirty, easily fatigue and depressed. Apprehensive, always afraid of dying, but lives on for years. Cannot stand still, the patient must walk or lean against something if he is on his feet. Always hungry after eating, a bloating sensation that is sensitive to touch. Itching by scratching but skin burns and smarts afterwards Itching, skin dry, unwashed appearing with numerous eruptions. Oversensitive patients, sensitive to noise, light and odours.

SYCOSIS

Sycosis or the veneral fig wart disease is a veneralchronic miasm primarily manifested externally by the condylomatous and cauliflower like growth or genitals (primary manifestation of sycosis) following impure coition. When these excresences are removed by allopathic physician in the most violent external way by cauterizing, burning and cutting or by ligatures the fig wart disease after having been deprived of the local symptom would appear in other and much worse ways in secondary ailments. Some characters of Sycosis

Suspicious, cross, irritable, deceitful, jealous, cruel and vindictive. One that meets with sudden death. Disease associated with excessive proliferation and infilteration of tissue. Slow recovery of all complaints. Desire food hot or cold and meat. Complaints > by abnormal discharge (e.g. leucorrhoea/coryza) The pains are > from dryness. Complaints < while resting > by moving or stretching. Discharge acrid, corroding the parts, characteristic odour.

SYPHILIS

Syphilis is a veneral chronic miasm primarily manifested outwardly by the veneral chancre developed following an impure coition. When the allopathic physicians destroy this chancre, by means of corroding cauterizing and desiccating substances, it (the chancre) is replaed by more painful substitute the bubo, which hastens onward to suppuration. It destroy the tissue, organs and bones and this produces ulceration, bines caries etc. Some characters of Syphilis

Dull, stupid, slow in comprehension and forgetful. Stubborn, sulky, sullen, morose, melancholic. Fixed ideas and one cannot reason with them. Usually suspicious, condemn themselves. Silent type of patients that goes out and commit suicide. Disease with ulceration and destruction of tissue. Complaints < at night, restless and anxious. Complaints < at summer > in winter. Desire cold food aversion to meat. Discharge of offensive pus which > the complaints. Bone pains deformities, gangrenous conditions.

MIASMATIC CONCEPT OF UROLOGICAL DISEASES

Key Word 1. Clinical

Psoric Urinary Symptom

Enuresis of functional origin is psoric.

Sycotic Urinary Symptom

Nephroblastoma, tumors of the kidneys, papillomas of the bladder and nephrotic syndrome where edema predominates are sycotic. Sycosis also has renal dropsy, renal calculi and calcareous deposits in other parts of the genitourinary tract.

Syphilitic Urinary Symptom

Destructive & degenerative types of malignant tumours in the kidneys or bladder are syphilitic.

Tubercular Urinary Symptom

Enuresis, diabetes mellitus(generally trimiasmatic) and diabetes insipidus(sycotubercul ar).

Nephritis, pyelitis, cystitis and urethritis are psoric in origin because of their infective nature(as well inflammation begins with psora) but strongly sycotic in their manifestations.

Pyaemia with oozing of pus.

Polyps and papillomas of the bladder with haemorrhage are tubercular.

Hypertrophy of the prostate, and prostatitis from sexual over indulgence.

Stricture of the urethra.

Haematuria.

Key Word 2.Characteris tic

Psoric Urinary Symptom

Phosphaturia after febrile complications occurs in the psoric miasm.

Sycotic Urinary Symptom

Calculi, complications of the genito-urinary tract and various pains of the urinary tract are generally sycotic in manifestation.

Syphilitic Urinary Symptom

All advanced conditions of the kidneys and genitourinary tract, with pyogenic inflammations can be associated with structural and pathological changes, and are therefore syphilitic in origin.

Tubercular Urinary Symptom

The tubercular miasm is responsible for the production of haematuria resulting from different types of pathological manifestations of KUB.

After fevers and acute diseases, the deposit in the urine is white or yellowish white. Anuria, oliguria, and stoppage or scanty urine from fright, tension or becoming chilled are psoric manifestations.

Diabetes mellitus and enuresis are secondary symptoms of the tuberculopsoric diathesis.

Key Word 3. Sensation

Psoric Urinary Symptom

Psoric patients, especially those advancing in age, experience a sensation of fullness in the bladder. There may be a feeling of constriction. Smarting & burning in the urinary meatus or in the lumbar area unrelated to any pathological causes might be present. Psora experiences aggravation from cold.

Sycotic Urinary Symptom

Stitching and pulsating sensations with wandering pains are sycotic.

Syphilitic Urinary Symptom

Burning and bursting sensations in the bladder or loin area syphilitic.

Tubercular Urinary Symptom

A tickling sensation in the urethra is characteristic of the tubercular miasm.

4. Modalities

Sycotic urinary symptoms are aggravated in damp, rainy weather and from the changes of the season.

All symptoms of syphilis are aggravated at night, in summer & from warmth.

Tubercular urinary manifestations are aggravated at night. Amelioration is from the open air.

Amelioration of psoric urinary symptoms

comes from natural discharges such as urination.

Key Word

Psoric Urinary Symptom

Sycotic Urinary Symptom

Syphilitic Urinary Symptom

Tubercular Urinary Symptom

5.Concomita nts

Psoric urinary problems may be associated with anxiety, apprehension & fear of incurable diseases.

Diabetes & albuminuria are tubercular, yet if the conditions are extremely severe, sycosis may also be present & they can become tri-miasmatic.

In syphilis, all kidney & prostatic symptoms are associated with depression & melancholia.

Restlessness, anxiety & weakness after micturation occurs in the tubercular miasm.

6. Flow

Psoric patients suffer from stress incontinence. The urine passes involuntarily & often frequently, when sneezing, coughing or laughing.

Most urinary In sycosis, micturation complications are of is painful. There may sycotic origin, but be contraction of the when in combination urethra, and children with syphilis the will scream while result is diminished urinating. flow & frequent desire for micturation with burning & irritation during the flow. Scanty urination(psora is mainly responsible for scanty discharges/excretions ), but during the rainy season is a characteristic of this miasm. Irritation & burning of the parts, wherever the urine touches, indicates the acridity of this miasm.

Colourless, profuse urination, thus diabetes is strongly tubercular.

There may be burning & smarting while urinating resulting from acidic urine.

The tubercular miasm is responsible for involuntary urination in children. Nocturnal enuresis in children should therefore undergo antitubercular treatment.

Key Word

Psoric Urinary Symptom

Sycotic Urinary Symptom

In sycosis, there is a frequent desire to urinate before a thunderstorm. Urinary cramps & painful spasms affecting the urethra & bladder may be present in sycosis.

Syphilitic Urinary Symptom

Tubercular Urinary Symptom

7.Kidneys

Fibrous changes in the kidneys are psoric in origin.

Fibrous changes with destructive Sycotic patients suffer manifestations in from renal calculi with kidneys. pains, which are stitching and wandering in character.

In the tubercular miasm there may be recurrent, intermittent & periodic renal spasm with bleeding(haematuria), often noticed particularly during the new and full moon.

Pain in kidney area, with inflammation of functional origin, nephritis, pyelitis, Sycotic tumours of cystitis, and urethritis. the kidneys or bladder are

encapsulated & malignant.

Key Word

Psoric Urinary Symptom

Sycotic Urinary Symptom

Syphilitic Urinary Symptom

Tubercular Urinary Symptom

8. Prostate

Psora has prostatitis(which incorporates a sycotic element) with oozing of prostatic fluid.

Enlargement of the prostate gland & complaints arising from it are sycotic.

Syphilitic patients suffer from carcinoma of the prostate with degenerative changes.

Prostate problems with bleeding per urethra are characteristic of the tubercular miasm.

9. Enuresis

Enuresis is In psora, enuresis characterized by the occurs esp. in children patient waking up as a result of anxiety during urination due & fear(particularly a to some discomfort; & fear of going to enuresis when habit is school), or from other the only ascertainable functional causes. cause(features of incoordination), are sycotic.

Syphilitic enuresis is characterized by a complete absence of the sense of realization. The patient does not remember anything in the morning, lies on the wet bed & cannot be aroused.

The bed wetting of children soon after going to bed is tubercular with a sycotic element unless the patient wakes up during micturation, in which case the sycotic miasm predominates. Bed-wetting of chronic & recurrent character; which may also be periodic & intermittent is also tubercular as in nocturnal polyuria.

Key Word

Psoric Urinary Symptom

Sycotic Urinary Symptom

Syphilitic Urinary Symptom

Tubercular Urinary Symptom

10. Urine

Psoric urine is generally dark but can also be yellowish or brownish.

A yellow colour represents sycosis.

Red, the colour of destruction, represents syphilis. Red coloured urine with streaks of pus is characteristic.

Albuminuria & urine loaded with phosphate, sugar or protein are tubercular.

Tubercular urine is pale, colourless & copious. An offensive, musty & putrid, even carrion like odour may be present. Haematuria occurs during sleep.

MATERIAL AND METHODOLOGY

(A) Materials
(a) Project site - The study will be conducted at OPD of Lord Mahavira Homoeopathic Medical College and Hospital, Ludhiana. (b) (c) No. of cases - 10 cases will be included in the study. Duration of study - Duration of study will be 6 months.

(B) Methodology
(a) Case selection - Cases will be selected by random sampling method. (b) Inclusion criteria - Patients with rheumatic diathesis will be included in the study regardless of their religion and caste. (c) Exclusion criteria - Cases without regular follow up will be excluded from the study. (d) Diagnostic criteria - Diagnosis will be made on the basis of complete homeopathic case taking standards and with the help of laboratory investigations wherever needed.

(C) Case taking Performa - Performa used at Lord Mahavira

Homeopathic Medical College and Hospital, Ludhiana will be used to study with approval of the guide.

(D) Analysis and evaluation - will be done according to the case. (E) Selection of medicine - The SIMILIMUM will be searched by
repertorisation with homeopathic repertory (kent) (and computer software programme which are available (on the basis of totality of symptoms with miasmatic analysis) depending upon the case.

(F) Advice & Psychotherapy - Patients on recent allopathic

treatment would be advised to curtail the dose of allopathic drugs gradually. case. Supportive psychotherapy will be provided to each

(G) Follow up - The patient will be kept under observation

continuously for at least three months, evaluation of the state of the patient will be carried out at regular intervals.

(H) Records - Proper records will be maintained to draw the

conclusions.

(I) (J)

Result criteria Cure - Feeling of complete mental and physical well being with
disappearance of all the symptoms & signs for which the patient originally approached with no relapse.

(K) Improvement - Considerable amelioration in mental condition

of patient with amelioration in related physical condition later on.

(L) Status Quo - No change in any complaint of patient despite the

treatment.

(M) Worse - Despite the treatment complaints become worse in every

respect.

(N) Observation and results

Statistical date will be drawn.

(O) Discussion - In every stage the cases will be discussed with the
guide and study will be carried out as per his valuable advice.

(P) Conclusions - The conclusions will be drawn on the basis of

discussion, observations and result.

(Q) Appendix
Master chart.

CASE TAKING

General directions
What to Do 1. The symptoms should be written from three sources,

(a) (b) (c) 2.

Patient's complaints Attendant's report Physician's observation The exact expression used by the patient and his friends should be written down accurately.

3. 4.

At the beginning the physician advises them to speak slowly. The physician should note down the important parts of what the speaker says.

5.

He should begin a fresh line with every new circumstances mentioned one below the other, and subsequently when more explicitly explained, be added up.

6.

The physician is to remind the patient in general terms when in his narration he omits to say anything about several parts and functions of his body or about his mental state.

7.

Special questions are to be asked only when the physician feels that the peculiar, uncommon and characteristic symptoms of the case has not yet come in the case taking.

8.

Finally the physician has to note down his own observations about the individual peculiarity of the patient in disease and in health.

What not to do
1. 2. 3. Don't interrupt unless the narrator wanders of to other matters. Don't ask any direct question that can be answered by yes or no. Don't ask any leaking question that suggests an answer.

B. 1.

Patient coming from other physician. In chronic diseases the original disease picture is to be obtained by referring to the original symptoms appearing before taking medicine or after discontinuing if for several days, when the medical effects go away.

2.

In acute diseases which are of rapid course, a complete picture of the conjoint malady (i.e. of the disease and of the drug used) is to be taken into account and a suitable homoeopathic medicine is to be prescribed.

Special directions
In chronic cases 1. Consideration of causative factor or maintaining cause by enquiring the personal history of the patient. 2. Careful attention to minute particulars by investigating

circumstantial and accessory symptoms. 3. Caution in collecting the exact symptoms from hypochondriac and indolent patients. In acute cases 1. Less inquiry to be done in acute diseases as they are spontaneously described. 2. (a) In epidemic and sporadic disease consideration to be made as a new and unknown one. (b) Investigations of several patients of different constitution in order to obtain the characteristic portrait of the epidemic or

sporadic diseases. Next duty of the physician 1. 2. Investigation of psora (a) Picking one of the characteristic in order to select homoeopathic medicine. (b) Recording when the patient comes in the second time, the physician has to. (i) (ii) (iii) Mark the symptoms still existing Add new symptoms, if appeared Stoke out the symptoms if appeared

Hence a fresh examination of the patient should be done and a second medicine is to be prescribed on the basis of new totality of the case.

CASE TAKING PERFORMA

Name: Age:

Date: Sex: Marital Status:

Address:

1.

CHIEF COMPLAINT:-

2.

HISTORY OF PRESENT ILLNESS

3.

HISTORY OF PAST ILLNESS

a) Acute diseases: b) Chronic diseases: c) Surgical operation/Mental trauma/injury: d) Vaccination and after effects: e) Drug reactions: f) Suppresion:

4.

FAMILY HISTORY

Father Mother Brother/Sister Grandparents

5.

GYNAECOLOGICAL HISTORY

Menstruation: Menarche: Character of discharge and flow: Symptoms before, during and after menstruation Menopause:

6.
Pregnancy Labour

OBSTETRIC HISTORY
Gravida Puerperium Abortion Lactation Para

7.

PERSONAL HISTORY
Year of Marriage widower/separated

Single / Married Marital relations No. of Children Occupation Interpersonal Relation Diet Habit -

Job Satisfaction Financial Status -

Habits (Drug, Alcohol, Smoking):

8.

GENERALITIES

a) General Modalities - (Time, circumstances, season, periodical, motion, walking etc.)

b) Thermal Reactions c) General Tendencies d) General Sensations & complaints e) Digestion Appetite Cravings -

 Aversions Thirst Salivation dryness of mouth/ offensive breath -

f) Stool and defecation g) Urine and urination h) Perspiration -

i) Abnormal Discharges -

9.
a)

MENTAL GENERALS
Will-love/ hates/ emotions/ fear/ suspicious/ suicidal tendencies/ jealousy/ anxiety/ depression/ loquacity/ desires and aversions/ company/ weeping/ laughing/ impatience.

b)

Understanding - delusion, delirium, hallucination, mental confusion, loss of time sense

c)

Intellect - Memory, concentration, mistakes in writing and speaking

d)

Behaviour mild hysterical/ paranoid/ shizophranic

10.
Pulse B.P. Wt.

PHYSICAL EXAMINATION
Nutrition Oedema Ht. Nails Clubbing Tongue Hair Attitude Gait Temp. Respiration Facies Teeth and Gums Eyes

Anaemia Cyanosis Jaundice Build

Skin (Colour moisture/ pigmentation/ dry rough etc.)

11.

LOCAL EXAMINATION

Inspection

Palpation

Percussion

Auscultation

12.

INVESTIGATIONS AND REPORTS

13.

PROVISIONAL DIAGNOSIS

14.

REPERTORY USED (KENT, BBCR, BOERICKE) -

15.

ANALYSIS OF SYMPTOMS Evaluation of symptoms S.NO. Rubrics with page no.

S.NO. 1. 2.

3. 4. 5.

16.

GRADING OF MEDICINES
-

Ist grade IInd grade IIIrd grade

17.

PRESCRIPTION
RX

18.

FOLLOW UP Symptoms Prescription

Date

19. REMARKS

RESULTS
Total no. of patients Cured Improved Not improved 7 3 2 2

APPENDIX
MASTER CHART
S. Name No. 1. Mrs. Abida Kumari Age 24 Sex F Treatment Syphlinum-200/1 dose Placebo T.D.S 2. Mr. Qumar Siddiqui 38 M Lyco-200/ 1 dose Placebo T.D.S 3. Mr. Krishan Gupta 44 M Lyco-1M/1 dose Placebo T.D.S 4. Mr. Ramandeep Singh 25 M Lachesis-200/ 1 dose Placebo T.D.S 5. Mrs. Rupinder Kaur 28 F Puls-200/1 dose Placebo T.D.S 6. Mr. Jaspreet Singh 41 M Not Cured Not Cured Cured Cured Result Cured

Sarsaparilla-200/1 dose Improving Placebo T.D.S Sarsaparilla-200/1 dose Improving Placebo T.D.S

7.

Mrs. Swati Kohli

41

SUMMARY AND CONCLUSION

We know that every chronic disease has some fundamental cause i.e. chronic miasm (Psora, Syphilis & Sycosis) and some exciting or maintaining Cause. We have studied many cases of RENAL STONE due to different etiologies leading to the formation of increase content of different toxic products in the body. All these cases represent with different signs and symptoms. But homoeopathic treatment is based upon totality of symptoms, indivisualisation and similimum . So after giving similimum to different patients of renal stone we concluded that malfunction of kidneys is manageable with homoeopathy as homoeopathic medicines act as immunomodulators and they help in correcting the metabolism of body and reversing the pathologies when coupled with correction of diet and exercises like yoga . During the course of study we have seen that many cases with advanced pathologies did not get cured but shown little improvement. So , with homoeopathic treatment we can improve general condition of patients in cases which cannot be cured .

BIBLIOGRAPHY
1.

Wyngarden and smith Cecil textbook of medicine volume 2 edition sixteenth WB Sainders company p - 832 T.R. Harison Principles of internal medicine volume 2 edition fourteenth the MC Grow Hill Companies p 334 W.S.C. Copeman Textbook of rheumatic disease edition Fourth E and S Livingstone p - 564 Davidson Davidsons Principles and practice of medicine Edition Seventeenth ELBS p 783-785 Robert Hutchison Hutchisons Clinical Methods Edition Twentieth ELBS p 412 Harsh0mohan Textbook of Pathology Edition Third jaypee p- 401- 407 J. T. Kent Lectures on Homoeopathic Philosphy B.Jain Publishers p 147, 149, 150 H.A. Roberts The Principles and Art of cure by Homoeopathy B.Jain Publishers p- 229, 184, 186 J.T.Kent Repertory of the Homoeopathic material medicaB.Jain Publishers W.Boericke Pocket Manual of Homoeopathic material medica B.Jain Publishers. P.S. Ortega Notes on the Miasms- National Homoeopathic Pharmacy p- 28,29,3 J.H.Allen The Chronic Miasms volume- 2 B. Jain Publisher.

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EFFICACY OF HOMOEOPATHY IN RENAL STONE

DISSERTATION
Submitted to the

LORD MAHAVIRA HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, LUDHIANA

For the award of degree of B.H.M.S

Submitted by: ARUN GUPTA

Under the guidance and supervision of

DR. SUSHIL CHALOTRA M.D. (HOM) Guide

DEPARTMENT OF MATERIA MEDICA LORD MAHAVIRA HOMOEOPATHIC MEDICAL COLLEGE.

Session - 2009-10

LORD MAHAVIRA HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, LUDHIANA

LORD MAHAVIRA HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, LUDHIANA

Certificate

This is to certify that dissertation entitled Efficacy of Homoeopathy in Renal Stone is a bonafide work of ARUN GUPTA. All the work has been carried out under my guidance and supervision. His approach to the subject has been sincere, scientific, and analytical. This work is recommended for the award of degree of B.H.M.S.

Place:

Dr. Sushil Chalotra MD (HOM)

Date:

Guide

LORD MAHAVIRA HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, LUDHIANA

Certificate
This is to certify that dissertation entitled Efficacy of Homoeopathy in Renal Stone is a bonafide work of ARUN GUPTA. All the work has been carried out under the guidance and supervision of Dr. S.K. Chalotra (Prof & HOD, Department of Homoeopathic Materia Medica). This work is recommended for the award of Degree of B.H.M.S.

Place:

Dr. Ravinder Kochhar MD (HOM)

Date:

Principal

DECLERATION

I ARUN GUPTA, student of B.H.M.S. hereby declares that this dissertation entitles Efficacy of Homoeopathy in Renal Stone have been submitted by me is not submitted fully or partially for the award of any degree or diploma in any other university by me or copied from any other dissertation work. This statement is made by me to the best of my knowledge and ability.

Date:

(Arun Gupta)

ACKNOWLEDGEMENT
First of all, I offer my reverences to the almighty God, my parents by whose blessings I have been able to fulfill my dream of doing B.H.M.S. The man who groomed my efforts and matured my thoughts is none other than my revered Dr. Sushil Chalotra, my Guide. I feel highly privileged to express my sincere regards and gratitude to him for this dynamic headship guidance, careful supervision, valuable suggestions and liberal attitude during the course of the present study. He has been instrumental in inculcating in me the sense of hardworking and tackling each and every aspect of this investigation to thread base details. I am equally indebted to Dr. Monika Gupta, who was always striving hard for her students by arranging seminars of stalwarts in homoeopathy and also left no stone unturned to see that we had the best coaching and guidance. She was always a morale booster for her students. Last but not the least I express my sincere gratitude to all my friends and colleagues who always stood by me in time of need throughout my dissertation work. I also thank those whose names have not been given but never forgotten for their whole hearted support provided by them.

DATE:

CONTENTS

SR. NO. 1. 2. 3. 4. 5. 6. 7. 8. 9. INTRODUCTION AIMS AND OBJECTIVES REVIEW OF LITERATURE MATERIAL AND METHODOLOGY CASE TAKING OBSERVATION AND RESULT APPENDIX (Case-Record with progress report) SUMMARY AND CONTENTS CONCLUSION BIBLIOGRAPHY