|Year : 2020 | Volume
| Issue : 3 | Page : 230-235
Management of Ksheena Shukra (Azoospermia) in Ayurveda prospect: A case report
Jitendra Varsakiya1, Alisha Dhaniya2, Divyarani Kathad3
1 Department of Kayachikitsa, CBPACS, New Delhi, India
2 PG Department of Kayachikitsa, Ch. Brahm Prakash Ayurveda Charak Sansthan, New Delhi, India
3 Department of Shalakya Tantra, Govertment Akhandanand Ayurved College, Ahmedabad, Gujarat, India
|Date of Submission||10-Jun-2020|
|Date of Decision||08-Sep-2020|
|Date of Acceptance||17-Sep-2020|
|Date of Web Publication||11-Nov-2020|
Dr. Jitendra Varsakiya
PG Department of Kayachikitsa, Ch. Brahm Prakash Ayurveda Charak Sansthan, Khera Dabar Najafgarh, New Delhi.
Source of Support: None, Conflict of Interest: None
In today’s scenario, cases of infertility are increased day by day and it is disturbing social as well as the mental health of people all over the world. Male infertility is a contributing factor in one-third of the couples with no children. There are so many modern therapeutics are there but result surety is not. It is need of time to explore fertility agents from herbal, herbomineral formulations with lifestyle and diet control. Azoospermia is the disorder in which there is a lack of measurable level of sperm in his semen in male. In Ayurveda classics, there is a description of Shukra Dushti, Ksheena Shukra, Ksheena Retasa, Alpa Retasa, and Shukra Dosha like conditions that result from the Shukra Dhatu vitiation by Doshas. Ayurveda can be the choice of this disease to manage. A case of 34-year-old, healthy male patient visited the OPD of Kayachikitsa with complaints of unable to conceive her partner even after having 7 years of married life. Semen analysis of this patient revealed a low sperm count (0 million/mL) with no other abnormalities. This case was managed with Virechana procedure followed by Tritiya Baladi Yapana Basti for 21 days and then the patient was administered Shaman Chikitsa for 4 months. After this treatment, sperm count increased to 68 million/mL. The detail of this case highlights the role of Shodhan and Shaman Chikitsa in the management of Azoospermia.
Keywords: Azoospermia, infertility, Shaman, Shodhan, Shukra, Virechana, Yapana Basti
|How to cite this article:|
Varsakiya J, Dhaniya A, Kathad D. Management of Ksheena Shukra (Azoospermia) in Ayurveda prospect: A case report. J Indian Sys Medicine 2020;8:230-5
|How to cite this URL:|
Varsakiya J, Dhaniya A, Kathad D. Management of Ksheena Shukra (Azoospermia) in Ayurveda prospect: A case report. J Indian Sys Medicine [serial online] 2020 [cited 2021 Jul 26];8:230-5. Available from: https://www.joinsysmed.com/text.asp?2020/8/3/230/300492
| Introduction|| |
Infertility is defined as the failure of a couple to achieve a clinical pregnancy with regular unprotected sexual intercourse after 12 months or more. Infertility is a problem of global proportion affecting an average of 8%–12% of couples worldwide. Among the present data, also a male factor is solely liable for infertility in approximately 20% and contributory in another 30-40% of couples; intrinsically, a male factor is implicated in additional than 50% of couples seeking out for conception. However there are a number of treatments like hormonal therapies, intrauterine insemination, test-tube baby, etc., available but it is cost-effective and not surety is there. That is the reason today to explore Ayurveda remedies to treat this type of condition. Azoospermia is a disorder in which there is a lack of any measurable level of sperm in the semen of male related to infertility or may be sterility.
Ayurveda also explained in detail about infertility, its cause’s pathophysiology, and treatment under the umbrella of Vajikarana Aphrodisiac, one of the branches of Ayurveda. In Ayurveda various terms related to infertility are explained like Klaibya, Napunsaka, and Shanda which are indicative of impotency and the conditions like Shukra Dosha, Shukra Doshja Klaibya, Alparetasa, and Kshinaretasa can be related terms with infertility. There is no any clear cut explanation regarding the term Azoospermia but at one point during explaining Doshaja Shandatva Acharya Vagbhata in Ashatangsangraha quoted term Abija that means incapable of producing embryo. Sushruta quoted terms Nirbeeja, Ashukrashanda which are indirectly related to Azoospermia. Vajikarana is one among the branches of Ayurveda that contend with the conservation and development of sexual strength of a person and conception of the healthy issue along with the management of imperfect semen, disturbed sexual power, and spermatogenesis also with the treatment of seminal-associated medical conditions in male. In the present case study, a patient suffering from Azoospermia has been treated with Virechana procedure followed by Tritiya Baladi Yapana Basti for 21 days and then administration of Shaman drugs like Bala (Sida cordifolia), Amalaki (Emblica Officinalis. Gaerten), Yastimadhu (Glycyrrhiza glabra Linn), Ashwagandha (Withania somnifera (Linn.) Dunal), Kapikachu Churna (Mucuna pruriens (L.) DC.), Haritaki Churna (Terminalia chebula Retz.), and herbomineral preparations, that is, Chandraprabha Vati, and Phala Ghrita.
| Case Report|| |
A 34-year-old male patient belonged to the lower middle class of the society from urban area New Delhi came to CBPACS, Kayachikitsa OPD with complaint of unable to conceive his partner since 8 years of his marital life. After taking full history, the patient was advised to investigate for semen analysis. Once report came with 0 million/mL sperm count, the patient was asked to report for 3 times after 3 days of coital act absence. After the investigation and taking proper history, the patient was diagnosed with Ksheena Shukra (Azoospermia) [Table 1]. The patient became treated with Shodhan (Virechana and Tritiya Baladi Yapana Basti) followed by Shaman Chikitsa (pacifying therapy) for 6 months [Table 2] and [Table 3]. After that, the patient was investigated again for semen analysis and was kept under observation with the advice of Pathya-Apathya (diet-lifestyle modification) for a further period.
|Table 2: Details of Virechana procedure (Purva, Pradhan, and Pachyat Karma)|
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| Chief Complaints|| |
The patient had 8 years of his married life and active–normal coital act without any contraceptive use, unable to conceive her partner since 7 years. The patient’s wife was completely normal at the endocrinological and clinical examination. She had failed to conceive in spite of unprotected frequent intercourse even during the 12 to 18th day of menstruation since the last 7 years. The patient had habit of smoking since 5 years and was also a habit of taking alcohol weekly. On inquiry, the patient was having extra salt in diet with oily, spicy food. By occupation, patient was working as sales manager in shifting duty. The patient had not any past medical history of mumps, gonadal trauma, orchitis, hydrocele, tuberculosis, or history of any other long-term attenuating diseases or deathly illness. He did not have any history of previous surgical procedures like vasectomy reconstruction, herniorrhaphy, and no history of taking of any gonadotoxic agent. No other parameters except sperm count, morphology, and motility were altered within the male patient. The patient was advised analysis of semen after proper abstinence of 3 days. Before starting the medicine, the semen examination report revealed 0 million/mL sperm count. Smear showed 3–4 pus cells, 1–2 HPF epithelial cells, and no RBC cells.
On examination of patient, pallor was absent, tongue was clear, and vegetarian in diet style. The patient appetite was good and usually prefers a salty and spicy diet. Also bowel habits were irregular with the complaint of constipation. Patient had disturbed sleep and frequency of micturition was 6–7 times in day time and 1–2 times in night time.
| Treatment Plan|| |
Before administration of Shamana drugs, the patient was advised to perform Shodhan: therapy (cleansing therapy): For the Deepan-Pachana (enhancing metabolic fire) with Agnitundi Vati, 500mg 2 tab twice a day with lukewarm water before the meal was done for 3 days. On the fourth day, after assessing the status of the patients, Phala Ghrita in the dose of 30mL was given in the early morning on empty stomach with lukewarm water. The patients were observed for Sneha Jeerna Lakshana and accordingly for the next 5–7 days, the dose of ghee was given in increased pattern according to Agni till the patients achieved proper Snehana features. After completion of internal Snehana, whole-body massage with Bala Taila and Vashpaswedana (sudation) was done daily morning for the next 3 days. During this period, patients were kept on a normal diet with precautions, to avoid excessive oil or heavy food items. On the day of Virechana, after massage and fomentation in the morning, Virechana Yoga of Triphaladi Kwatha, Draksha Kwatha, and Trivritta Avleha was given. Madhyam type of Shudhi (18 Vegas) was gained. Sansarjan Karma was advised for 5 days. Basti Karma: After Virechan Karma on the seventh day,Tritiya Baladi Yapana Basti was given for 21 days [Table 2].
Diet advised to patient
Patient was advised to take milk and milk products, cow ghee, and gruel in routine diet. He was also advised to include red variety of rice, wheat, vigna mungo, benincasa hispida, banana, phoenix sylvestre, banaba, coconut milk, supernated part of buttermilk, Sharkara, castor oil, honey, and old jaggery in his diet. Patient was also advised to do massage over body, Surya Namaskara, light exercises, meditation, and Yoga on daily basis.
Patient was asked to avoid excessive intake of pungent, bitter and salt, cicer arietinum, and dolichos biflorus in routine diet. Patient should ask to avoid stress, worry, excessive exercise, excessive coital activity, and suppression of natural urges.
| Results|| |
Results of this case report show that after performing Virechana procedure and Tritiya Baladi Yapana Basti followed by internal medications, sperm count increased 0 to 68 million/mL. The detail of this case highlights before the administration of Vajikarana drugs perform Shodhana therapy and Panchkarma procedures give definite results in such type of ailments i.e Azoospermia [Table 4].
| Discussion|| |
In the Ayurveda classics, it is clearly described that Ayurveda medicine for the treatment of infertility as well as sexual disorder should be administered after the proper cleansing of body by the Panchkarma therapies. It opens the channels, increases the bioavailability of drugs, and helps to improve the effect of medicine in the body. That’s why here is an attempt made to do Virechana Karma (biopurification) before the administration of any medicine.
Effect of Virechana Karma
In Ayurveda classics mentioned the fruitfulness of Shodhana Karma as, by the administration of these therapies disease are cured and his normal health is restored; the sense faculties, mind become clear; he gains strength, plumpness, offspring and virility. With the Shodhana procedure, Shukra also increased in qualitative as well as quantitatively. In Ksheen Shukra, the main vitiated Dosha are Vata and Pitta. Virechana is administered to eliminate the vitiated Pitta Dosha. It also removes the Srotoras Avrodha and activates the conversion or transformation of Dhatu through Dhatvagni Vyapara and therefore the most expendient Shuddha Shukra is acquired. The entire process supports in removing the free radicals (oxidants) present in the microcirculatory passage of Shukra Vaha Srotasa, which obstruct swith the function of Shukra and by doing so, increases the activity of Shukra (motility) along with Shukra Vaha Srotasa and the respective Dhatwagni which eases the production of more Shukra Dhatu. (volume, count). Virechana is a crucial modality and eminent biocleansing process for vitiated Pitta Dosha. Through Shodhana, Srotoshudhi (clearing of channels) can be accomplished.
Effect of Tritya Baladi Yapana Basti
Yapana Basti is specially indicated in Shukra Dosha and Klaibya.Basti therapy is specifically designated to treat Vata Vikaras.Basti by expelling out Vita, Shleshma, Pitta, Anila, and Mutra offers firmness of the body and enriches Shukra. Acharya Charaka also specifically mentioned Basti Karma for Shukra Doshas. Therefore, drugs that are administered in Basti form are said to enhance the quality and quantity of Shukra. The line of treatment of Kshina Shukra should be based on Brimhana Chikitsa and Vrishya drugs having Shukra Vriddhikara properties. Yapana Basti is said to possess the best Brimhana and Rasayana effect. So, Trutiya Baladi Yapana Basti is selected which is particularly indicated for this condition.
Ashwagandha (Withania somnifera) effectively removes free radicles as assessed by reducing levels of various oxidants and improved level of diverse antioxidants. In addition, the levels of testosterone, LH, FSH, and PRL were increased, which are good measure of quality of semen.Acharya Charaka included Ashwagandha drug in Balya and Brimhana-gana. It is imputed with Balya, Vrishya and Rasayana properties. It amplifies spermatogenesis through an assumed testosterone-like effect.Kapikacchu (Mucuna Pruriens Bak.) has been established to enhance sperm count and motility.Yashtimadhu (Glycyrrhiza glabra Linn.) was found to enhance the quality of semen.
Chandraprabha Vati is a potent anti-inflammatory Ayurveda remedy. It has Madhura rasa (sweet), Guru (heavy) and Snigdha Guna (quality), Sheeta Virya (cold in potency), Rasayana (rejuvenating), Vrushya (aphrodisiac), and Vatapittahara properties. In cases of Kshina Shukra, Vatapittahara Karma is very useful because it is Vata and Pitta predominant disorder. Although Madhura Rasa (sweet taste) and Snigdha and Guru Guna (heavy quality) enhance the Shukra Dhatu qualitatively and quantitatively. It is known for its utility in Mutravaha Strotas by correction of Apana Vayu its action on the Shukra also along the line similar to how Shukra Visarga is governed by Apana Vayu. Also, study reveals that administration of Chandraprabha Vati acts as a spermatopoietic agent. It is a choice of drug in urogenital diseases for treating the infection.
In classics, Phala Ghrita has been indicated in the management of Shukra Dosha and has been attributed as Ayushyam, Paushtika, and Pusanvana Karma. Also, a clinical trial especially effects of Phala Ghrita in the management of Oligozoopsrmia has been done with significant results.
A research study concluded that disturbing lifestyle and working stress resulting in changing dietary habits, sleeping habits leads to disturbance in metabolism of body as well as psychological stress and it affects all Dhatus includes Shukra Dhatu. In addition, it results in a hormonal imbalance. Finally, it concerns the male sexual activity, which is one of the major causes of male infertility.
| Conclusion|| |
To conclude, this study showed that treatment based on Ayurveda principles was found to be effective in male infertility patients with idiopathic Azoospermia in improving sperm count and sperm motility. It can be a field of research and recommend larger and more rigorous studies such as randomized control trials to get more conclusive results. Vajikarana or Vrishya Chikitsa is one of eight major specialties of the Ashtanga Ayurveda. Ayurveda remedies can be helpful for infertile patients to achieve healthy progeny.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al
; International Committee for Monitoring Assisted Reproductive Technology; World Health Organization. International committee for monitoring assisted reproductive technology (ICMART) and the world health organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril 2009;92:1520-4.
Inhorn MC Global infertility and the globalization of new reproductive technologies. Illustrations from Egypt. Soc Sci Med 2003;56:1837-51.
Jarow JP, Sharlip ID, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al
; Male Infertility Best Practice Policy Committee of the American Urological Association Inc. Best practice policies for male infertility. J Urol 2002;167:2138-44.
Varsakiya JN, Goyal M, Thakar A, Patel B Role of virechana and ashwatha phala churna in the management of ksheena shukra (oligozoospermia): A pilot study. Ayu 2016;37:113-9.
Aacharya YT Sushruta Samhita Sutra Sthan, Nibandhasangraha (commentary of sri Dalhanacharya), Chapter 1, shlok 8, Varanasi, India: Chaukambha Surabharati Prakashan, Reprinted 2008, p. 3.
Sharma SP, editor. Astanga Sangraha, Sharira Sthan, Chapter 1 shlok 21, Varanasi, India: Chaukambha Sanskrit Series Office, Reprinted 2008, p. 268.
Shastri AD, editor. Chapter 26, shloka 10–11. In: Susruta Samhita Chikitsa Sthana Ayurvedatatva Sandipika (Hindi Commentary). Varanasi, India: Chaukhmba Orientalia; 2016. p. 294.
Shastri SN, editor. Charaka Samhita of Agnivesha, Vidyotini (Hindi Commentary). Chikitsa sthana Chapter 1/1, Shlok 9-12. Varanasi, India: Chaukhamba Bharti Academy, Reprint 2011. p. 5.
Sharma HR Kashyap Samhita of Vriddha Jivaka, Sutra Sthana, chapter 2, sloka 4. Varanasi, India: Chaukhmbha Sanskrita Sansthan, Reprinted 2013. p. 78.
Srikanta Murthy KR Vagbhatas, chapter 34, Shloka-63–67, Ashtang Hridaya, Uttar Sthana. Varanasi, India: Chaukhambha Krishnadas Academy. Reprinted 2009. p. 326.
Aacharya YT, editor. Charaka Samhita of Agnivesha, Reprint ed. Ch. 1, Ver. 10. Varanasi: Chaukhamba Surbharati Prakashan; 2008. p. 678.
Shastri AD, editor. In: Susruta Samhita Chikitsa Sthana Ayurvedatatva Sandipika (Hindi Commentary). Chapter 36, shloka 51. Varanasi, India: Chaukhmba Orientalia; 2016. p. 396.
Jitendra V, Mandip G, Divyarani K Review on Ksheena Shukra (oligozoospermia) – male infertility: A medico social problem its management in Ayurveda. Eur J Biomed Pharm Sci 2018;5:306-13.
Shastri SN Charaka Samhita of Agnivesha, Vidyotini (Hindi Commentary). Chikitsa sthana Chapter 1/1, Shlok 24. Varanasi, India: Chaukhamba Bharti Academy; Reprint 2011. p. 9.
Shashtri AM Sushruta Samhita of Sushruta, Chikitsa Sthana. Chapter 16, shloka 17-18. Susruta samhita. Varanasi, India: Choukambha Orientalia; 2016. p. 315.
Sharma HR Kashyap Samhita of Vriddha Jivaka Chapter 2, Varanasi, India: Chaukhmbha Sanskrita Sansthan; 2013. p. 7.
Jitendra V, Mandip G, Babhatosh D Role of virechana karma in increasing sperm count in the case of oligozoospermia: An open labelled clinical trial. Int J Res Ayurveda Pharm 2017;8:134138.
Shastri SN, editor. Charaka Samhita of Agnivesha, Vidyotini (Hindi Commentary), Sidhi sthana Chapter 12, Shlok 15. Varanasi, India: Chaukhamba Bharti Academy; Reprint 2011. p. 1096.
Shastri SN, editor. Charaka Samhita of Agnivesha, Vidyotini (Hindi Commentary), Sutra Sthana Chapter 25, Shlok 40. Varanasi, India: Chaukhamba Bharti Academy; Reprint 2011. p. 468.
Shastri SN, editor. Charaka Samhita of Agnivesha, Vidyotini (Hindi Commentary), Sutra Sthana Chapter 1, Shlok 28. Varanasi, India: Chaukhamba Bharti Academy; Reprint 2011. p. 969.
Shastri SN, editor. Charaka Samhita of Agnivesha, Vidyotini (Hindi Commentary), Sidhi Sthana Chapter 12, Shlok 15/9. Varanasi, India: Chaukhamba Bharti Academy; Reprint 2011. p. 1099.
Ahmad MK, Mahdi AA, Shukla KK, Islam N, Rajender S, Madhukar D, et al
. Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertil Steril 2010;94: 989-96.
Nishteswar K, Hemadri K Dravyaguna Vijnana. New Delhi, India: Chaukhambha Samskrit Pratishthana; 2013, p. 121.
Lavekar GS Database on Medicinal Plants Used In Ayurveda & Siddha. New Delhi, India: Central Council for Research in Ayurveda; 2008. Vol. III. p. 88.
Mukund S Chemistry and Pharmacology of Ayurvedic medicinal Plant. 1st ed. Varanasi, India: Chaukhamba Amarabharati Prakashan; 2006. p. 235.
Lavekar GS, Database on Medicinal Plants Used In Ayurveda & Siddha. New Delhi, India: Central Council for Research in Ayurveda; 2008. Vol. III. p. 561.
Sushama B, Nishteswar K Pharmaco-therapeutic profiles of chandraprabha vati- an ayurvedic herbo-mineral formulation. Int J Pharm Biol Arch 2012;3:1368-75.
Varsakiya J, Goyal M, Thakar A, Donga S, Kathad D Clinical study to evaluate role of Ayurvedic Virechana (therapeutic purgation) and oral Phala Ghrita intake in the management of oligozoospermia. AAM 2019;8:114-25.
Varsakiya J, Goyal M, Thakar A, Donga S, Kathad D Oligozoospermia (Ksheena Shukra)––Infertility––current burning issue among habitat of Jamnagar, Gujarat: A cross sectional observational study. AYUHOM 2018;5:89-97.
[Table 1], [Table 2], [Table 3], [Table 4]