Cholelithiasis (Pittashmari) –A comprehensive Case report with clinical insights.

Abstract

Cholelithiasis, a chronic hepatobiliary condition caused by abnormalities in the metabolism of bile acids, cholesterol, and bilirubin, is becoming increasingly common in India, with an incidence of 2–29%. While conventional management depends mostly on cholecystectomy, non-surgical medical treatment remains limited. Ayurveda conceptualises gallstone disease as Pittashmari by understanding the development of calculi within the gallbladder (Pittashaya) as an outcome of Pitta–Kapha vitiation, Strotorodha (blockage of channels), and crystallisation. Management aims to normalize Dosh Dushya Samprapti (pathogenesis) through Shamana (pacification), Shodhana (purification), and Rasayana (rejuvenation). The present case report documents successful non-surgical management of Pittashmari in a male patient aged 18 years with a complaint of pain in the abdomen radiating to the back, distension of the abdomen, constipation, and indigestion. Ultrasonography report showed a few 2-3 mobile calculi, with the largest measuring about 10mm in the gall bladder, suggesting the diagnosis of Cholelithiasis (Pittashmari). The patient had a treatment history of allopathic medicine with temporary relief. Physical examination showed Pitta-Kapha predominance with Vata involvement, and the patient was diagnosed through ultrasound as cholelithiasis. Treatment included Shamana Chikitsa (Shad-Dharan yoga, Shankhavati, Dashmula Haritaki Leha, Arogyavardhini Vati), Ashmarighna Dravyas (Pashan Bheda, Narikel Lavan), Shodhana (Virechana with Dadimadi Ghrit and Abhayadi Modak), and Rasayana therapy (Amalaki Rasayana). Regimen was reinforced with Bhaishajya Kala–specific administration and rigorous dietary and lifestyle modification. Marked clinical improvement was achieved within weeks, with resolution of distension, pain, and constipation. No recurrence was observed on followup. The findings indicate that a structured Ayurvedic regimen may treat both symptoms and underlying metabolic factors, supporting gallstone dissolution, metabolic correction, and preventing recurrence.