Background: Renal colic due to ureteric calculi is an acute painful condition caused by ureteric obstruction and spasm. Conventional management mainly relies on analgesics and antispasmodics, which may have limitations or adverse effects. In Ayurveda, Viddhakarma is a parasurgical procedure indicated in acute pain conditions (Shoola) and is known for providing immediate pain relief. Objective: To evaluate the effectiveness of Viddhakarma in the Ayurvedic management of renal colic caused by ureteric calculus.

Methods: A 26-year-old male patient presented with severe left loin pain. Ultrasonography revealed a 5.8 × 3.6 mm distal ureteric calculus located 1.8 cm proximal to the ureterovesical junction with grade I hydroureteronephrosis. Viddhakarma was performed at the classical indicated site under aseptic precautions. Pain intensity was assessed using the Visual Analog Scale (VAS) before and after the intervention. Results: Immediate and significant pain relief was observed following Viddhakarma. The VAS score showed marked reduction within minutes of the procedure. No adverse effects or complications were reported, and the patient remained symptomatically improved during follow-up. Conclusion: Viddhakarma was found to be an effective, safe, and economical Ayurvedic intervention for instant pain relief in renal colic due to ureteric calculus. This single case study suggests its potential role as an alternative or adjuvant therapy in acute pain management.

Introduction:

Renal colic is an acute painful condition characterized by severe colicky pain radiating from the loin to the groin, commonly caused by ureteric obstruction due to Ashmari(renal calculi). In Ayurveda, such acute pain is described under Shoola(pain), which is predominantly caused by vitiated Vata Dosha, especially Apana Vata, obstructed by Kapha or Ashmari leading to Avarana and Margavarodha.[1]

Acharya Sushruta has described Viddhakarma as an important Anushastra Karma indicated in various Vata-dominant painful conditions.[2] Viddhakarma acts by relieving Srotorodha, pacifying Vata, and providing Sadyo Vedanashamana (instant pain relief). Classical texts mention specific Vedhya Sthana for Shoola related to urinary system disorders.[3]

Recurrent hospitalization due to acute renal colic causes considerable economic burden and psychological stress to patients. Although multiple pharmacological and surgical interventions are available in modern practice, their limitations—such as recurrence, cost, and procedural invasiveness—necessitate exploration of safe, cost-effective alternatives.

In this context, Viddhakarma emerges as a unique para-surgical modality exclusively described by Sushruta in the Sushruta Samhita. It is a minimally invasive therapeutic procedure indicated in various painful and obstructive conditions. In the management of Mutrashmari (urolithiasis), Viddhakarma is considered particularly effective for immediate pain relief by alleviating aggravated Vata and relieving obstruction within the urinary tract channels.

Despite its classical importance and therapeutic potential, Viddha Karma remains largely neglected in contemporary clinical practice. Therefore, there is a compelling need to scientifically evaluate and re-establish the clinical efficacy of Viddha Karma as a safe, rapid, and cost-effective modality in the management of renal calculi

This case study hi effective ghlights the efficacy of Viddhakarma in managing renal colic due to ureteric calculus with immediate pain relief.

Need of the Study

Renal colic is a medical emergency requiring instant pain relief.

Long-term use of analgesics has limitations and adverse effects. Viddhakarma is a cost-, OPD-based, instant pain relieving parasurgical procedure. There is limited documented clinical evidence of Viddhakarma in Ashmari-janya Shoola. Hence, this study was undertaken to evaluate the clinical efficacy of Viddhakarma in renal colic.

Case Presentation

Patient Information

Age: 26 years

Sex: Male

Occupation: Doctor

Socio-economic status: Middle class

Chief Complaints

Severe pain in left loin region, radiating towards groin, restlessness, nausea, burning micturition

Pain intensity: Severe, colicky

Duration: Acute onset (few hours)

History of Present Illness

The patient was apparently normal before the onset of symptoms. He developed sudden severe pain in the left loin region, which was intermittent, colicky in nature, and associated with restlessness. Pain aggravated on movement and was not relieved by rest.

Past History

No history of diabetes mellitus or hypertension

No previous episodes of similar pain

No surgical history

Personal History

Table no.1 Showing patient’s personal history

General Examination

Pulse: 92/min

Blood Pressure: 130/80 mmHg

Temperature: Afebrile

Built: Moderate

Tongue: Normal

Local Examination

Tenderness present in left renal angle

No palpable mass

No guarding or rigidity

Ashtavidha Pariksha

Table no.2 Ashtavidha Pariksha

Dashavidha Pariksha

Table no.3 Dashavidha Pariksha

Investigations

Ultrasonography (USG KUB):

5.8 × 3.6 mm left distal ureteric calculus Located 1.8 cm proximal to ureterovesical junction with resultant Grade I hydroureteronephrosis.

Samprapti

Nidana Sevana

(Alpa Jala Sevana, Viruddha Ahara)

↓

Kapha & Vata Prakopa

↓

Mandagni

↓

Kapha Sanchaya in Mutravaha Srotas

↓

Ashmari Nirmana

↓

Margavarodha in Mutravaha Srotas

↓

Avarana of Apana Vata

↓

Vata Prakopa (Teevra Gati)

↓

Ashmari-janya Mutrashoola

(Teevra, Bhedana, Toda Yukta Shoola)

Nidana such as inadequate water intake and improper dietary habits lead to Kapha and Vata Dushti. Kapha contributes to Ashmari formation, while Vata causes obstruction and severe pain. The Ashmari causes Margavarodha of Mutravaha Srotas, leading to Avarana of Apana Vata, manifesting as severe Shoola.[4]

Diagnosis

Ashmari-janya Mutrashoola

(Vata-pradhana Shoola due to Ashmari)

Table no.4 : Samprapti Ghataka

Intervention: Viddhakarma

Vedhya Sthana

Viparit paad Angushthamoola pradesh (lateral aspect of thumb of contralateral side of renal calculi) corresponding to classical Viddhakarma points indicated for Shoola and Mutravaha disorders.

Procedure

Informed consent taken

Patient placed in comfortable sitting position

Aseptic precautions followed

Sterile disposable 26 no. needle used

Vedhana performed at indicated site in perpendicular manner in ardha vrihi matra

No medication administered simultaneously.

Assessment Criteria

Table no. 5: VAS (Visual Analog Scale) Criteria

Table no.6 :Pain intensity assessed using Visual Analog Scale

Result

The patient experienced instant and significant relief from pain within minutes of the procedure. No complications, excessive bleeding, or adverse events were observed. The patient remained symptomatically improved during follow-up.

Discussion:

Viddhakarma at Vedhya Sthana

↓

Avarana Bhedana

↓

Vata Shamana

↓

Srotoshodhana

↓

Anulomana of Apana Vata

↓

Sadyo Vedanashamana

(Immediate Pain Relief)

Viddhakarma is indicated in Vata-dominant painful conditions, where immediate relief is required. The procedure helps in Avarana Bhedana, pacifies aggravated Vata, and restores normal flow of Apana Vata. By relieving Srotorodha, it reduces spasm and pain instantaneously.[5]

Viddha Karma increases the movement of the ureter and activates the smooth muscles of the urinary bladder that easily eliminates the crushed stone in a downwards direction. It is also an excellent pain relief tool exclusively elaborated by Acharya Sushruta. It helps to subside both intermittent colicky and constant dull pain in the left loin region & lower abdomen due to obstruction of the flow of Urine & flatus. The secretion of endorphins may induce its analgesic action due to painful mechanical stimulus at the time of procedure [6]

In Ashmari-janya Shoola, Viddhakarma acts at both Dosha and Srotas level, making it an effective parasurgical emergency intervention.

Conclusion:

Viddhakarma is a classical Anushastra Karma described in Ayurvedic literature as an effective intervention in Vata-dominant painful disorders. Acharya Charaka explains that aggravated Vata is the principal cause of severe Shoola and emphasizes its prompt management to prevent complications1. Acharya Sushruta specifically advocates parasurgical procedures like Vedhana in conditions of intense pain and obstruction, highlighting their immediate action in relieving Vata-prakopa2,3. Vagbhata also supports puncturing procedures in localized obstructive disorders, stating their role in rapid Vedanashamana4,5. The pathogenesis of Ashmari has been elaborately described in the Brihattrayi. Charaka attributes Ashmari formation to deranged Kapha along with Mutra Dushti6, while Sushruta provides a detailed description of Ashmari Nidana and its progression toward Mutravaha Srotas obstruction7. Vagbhata further correlates Kapha Sanchaya and Vata Avarana as the principal mechanisms behind Ashmari-janya Shoola[8’9]. The clinical manifestation of Teevra Toda-Bhedana Yukta Shoola due to Apana Vata obstruction is also supported by classical references[10,11,12,13]. Sushruta clearly mentions that removal of Avarana and restoration of Vata Gati leads to immediate relief of pain[14,15]. Charaka emphasizes Vata Anulomana as the cornerstone of Shoola Chikitsa[16], and similar principles are elaborated in Vatavyadhi management contexts[17]. The concept of Vedana Utpatti and its pacification through appropriate interventions is discussed in Ashtanga Hridaya[18]. Furthermore, understanding Srotodushti and Sanga as major pathological factors reinforces the rationale of Viddhakarma in relieving obstruction[19, 20]. The present clinical outcome—showing immediate reduction in VAS score—correlates precisely with these Ayurvedic principles. No adverse effects were observed, supporting its safety when performed under proper aseptic measures.Thus, integrating classical textual authority with clinical observation, Viddhakarma emerges as a safe, economical, OPD-based, and instant pain-relieving parasurgical procedure in renal colic due to ureteric calculus. Although this is a single case report, the outcome encourages larger controlled clinical trials to further establish standardized protocols and strengthen evidence for broader clinical application.

Patient Perspective

The patient reported immediate relief from severe pain without the need for analgesics and expressed satisfaction with the treatment.

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2. Sushruta Samhita. Sutrasthana, Anushastra Karma Adhyaya (8/16–18). In: Acharya YT, editor. Sushruta Samhita with Nibandhasangraha commentary of Dalhanacharya. Reprint ed. Varanasi: Chaukhambha Orientalia; 2019.
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4. Ashtanga Hridaya. Sutrasthana, Siravyadha Vidhi (26/3–8). In: Paradkar HS, editor. Ashtanga Hridaya with Sarvanga Sundara commentary. Reprint ed. Varanasi: Chaukhambha Surbharati Prakashan; 2018.
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6. Charaka Samhita. Nidanasthana, Ashmari Nidana (3/3–7). In: Acharya YT, editor. Reprint ed. Varanasi: Chaukhambha Surbharati Prakashan; 2019.

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