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Background: Urinary stone disease is common worldwide and in India, with high recurrence. Ayurveda describes Ashmari (urinary stones) as one of the eight difficult diseases, and Sushruta described both medical treatment and a perineal operation for bladder stones. Herbs such as Pashanabheda (Bergenia ligulata), Varuna (Crataeva nurvala) and Gokshura (Tribulus terrestris) are widely used, often in proprietary polyherbal products. Objective: To review the classical understanding and management of Ashmari, modern evidence-based management of urolithiasis, and the experimental and clinical evidence for Ayurvedic antiurolithic herbs. Methods: Narrative review of Sushruta Samhita, urological guidelines, systematic reviews, clinical trials and experimental studies. Results: Sushruta classified Ashmari into four types and described medical management, alkaline preparations and a perineal lithotomy, one of the earliest recorded stone operations. Modern management includes analgesia, medical expulsive therapy for some ureteric stones, shock-wave lithotripsy and endoscopic surgery, together with fluid intake and dietary measures for prevention. Bergenia ligulata showed antiurolithic effects in vitro and in animals through inhibition of crystal formation, diuresis and antispasmodic actions. Varuna has experimental antiurolithic effects. A systematic review of clinical studies of medicinal plants found the evidence promising but insufficient. A one-year study of a popular polyherbal product found no change in urine chemistry or stone burden. Conclusion: Ayurvedic herbs may have diuretic and crystal-inhibiting effects useful for small stones and prevention, but clinical evidence is limited and inconsistent. They should complement, not replace, imaging-guided urological management, particularly for obstructing or infected stones.

KEYWORDS: Mutrashmari; Ashmari; urolithiasis; kidney stones; Pashanabheda; Bergenia ligulata; Varuna; Gokshura; Sushruta