Background: Gallbladder stones (cholelithiasis) represent one of the most prevalent hepatobiliary disorders globally, characterised by supersaturation and crystallisation of bile components including cholesterol and bilirubin. In Ayurvedic medicine, this condition is described as Pittashaya Ashmari, a subtype of Ashmari rooted in deranged Pitta and Kapha Dosha, impaired Agni, and Ama accumulation. Conventional management with cholecystectomy, while effective for acute obstruction, is associated with post-cholecystectomy syndrome in 20–30% of patients and does not address underlying metabolic dysregulation.[1,2,3] Case Presentation: A 48-year-old male presented with right upper quadrant (RUQ) abdominal pain radiating to the back, nausea, vomiting and bloating of 8 days' duration. Ultrasonography confirmed cholelithiasis with calculi measuring 4–5 mm and biliary sludge. The patient received a structured Ayurvedic Shamana Aushadhi protocol over 13 weeks across seven follow-up visits. Outcome: Following treatment, the patient achieved complete symptomatic relief and a reduction in stone size from 4–5 mm to 2 mm on follow-up ultrasonography, without surgical intervention. Conclusion: Ayurvedic Shamana formulations comprising Chandraprabha Vati, Cap. Plethorin, Cap. Grab, and Kalamegha syrup demonstrated clinically meaningful litholytic, hepatoprotective and Pittashamaka effects for small (<10 mm) cholesterol gallstones. Larger randomised controlled trials are warranted to validate these findings.