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CLINICAL RESEARCH
Year : 2010  |  Volume : 31  |  Issue : 3  |  Page : 332-337  

Effect of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in benign prostatic hyperplasia


1 Department of Shalya Tantra, Institute for Post-Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Department of Shalakya Tantra, Institute for Post-Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Web Publication26-Feb-2011

Correspondence Address:
S K Gupta
Associate Professor, Department of Shalya Tantra, I.P.G.T. & R.A., Gujarat Ayurved University, Jamnagar - 361 008, Gujarat
India
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DOI: 10.4103/0974-8520.77168

PMID: 22131735

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   Abstract 

Vatastheela is a disease of Mutravahasrotasa, one among the 12 types of Mutraghata disorders elaborated by Sushruta in his seminal work, the Sushruta Samhita. Vatastheela, as described in Ayurveda, closely resembles benign prostatic hyperplasia (BPH) of modern medicine in its signs and symptoms. It is a senile disorder and chiefly affects individuals above the age of 40 years. The symptoms are those of bladder outflow obstruction, with increased frequency of micturition, dribbling, hesitancy, and the features of chronic urinary retention. Surgical management has been accepted as the standard management but is associated with many disadvantages as well as complications, which may not be acceptable at this age. Conservative management with modern medicines is also not free from side effects. So, in this age-group, there is a need for much safer alternative method of management. In this regard, many works have been carried out and shown that the Ayurvedic approach, using natural medicines, is a far better approach. We carried out a comparative study of Mahayavanala Roma Kshara (MRK) and Dhanyaka Gokshura Ghrita (DGG), which are the compounds prescribed for Mutraghata in Ayurvedic literature. The patients were randomly selected from the OPD and IPD of IPGT and RA hospital, Jamnagar, Gujarat, and divided into two groups. In first group, one (500 mg) capsule of MRK was given twice a day with lukewarm water for 45 days; in second group, 10 gm of DGG was given orally twice a day with lukewarm water for 45 days. DGG showed significantly greater relief in the subjective parameters as per International Prostate Symptoms Score (IPSS) than MRK. However, reduction in the size of the prostate and in the volume of the post-void residual urine was found much better in the MRK group.

Keywords: Benign prostatic hyperplasia, Dhanyaka Gokshura Ghrita, Kshara, Mahayavanala Roma Mutraghata, Mutravahasrotasa, Vatastheela


How to cite this article:
Vasava YR, Bhuyan C, Rajagopala M, Gupta S K, Dudhamal T S. Effect of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in benign prostatic hyperplasia. AYU 2010;31:332-7

How to cite this URL:
Vasava YR, Bhuyan C, Rajagopala M, Gupta S K, Dudhamal T S. Effect of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in benign prostatic hyperplasia. AYU [serial online] 2010 [cited 2014 Oct 30];31:332-7. Available from: http://www.ayujournal.org/text.asp?2010/31/3/332/77168


   Introduction Top


The Sushruta Samhita, one of the prime texts among Brihatrayee, describes 12 types of Mutraghata. [1] Vatastheela[2] is one of them and, in its signs and symptoms as well as in anatomical considerations, it bears a close resemblance to benign prostatic hyperplasia (BPH).

BPH is a nonmalignant enlargement of the prostate gland caused by excessive growth of prostatic tissue and is the most common benign neoplasm of aging men. [3] It affects mainly those individuals over the age of 40 years. In modern medicine the management of BPH is either through a surgical approach (e.g., open prostatectomy, transurethral resection of prostate, cryotherapy, etc.) or by conservative treatment using drugs (e.g., chemotherapy, hormonal therapy, etc.). Among the many approaches, prostatectomy is the best, but it is associated with many problems and complications, e.g., postoperative morbidity, impotence, retrograde ejaculation, etc. The second most acceptable procedure is TURP which is also not free from complications, with the cumulative probability of re-operation estimated to be around 15% at 5-8 years after TURP. [4] In case of hormonal therapy, although there are some advantages, there are many complications like loss of libido, impotence, gynecomastia, etc. Generally, the conservative treatments mentioned above have to be continued indefinitely and, therefore, treatment can be expensive. The surgical approach has provided a great deal of relief for many people but, as mentioned earlier, there are many associated problems.

In this situation, it is possible that Ayurveda will be able to provide a treatment that is natural and free from any adverse effects. Acharya Sushruta has mentioned successful treatment of Mutraghata with Kasaya, Kalka, Ghrita, Kshara, etc. preparations of different drugs. [5] This research work was carried out with the ultimate aim of finding the best treatment available in Ayurveda for BPH.


   Aims and Objectives Top


To compare the effects of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in the management of Vatastheela, with special reference to BPH.

Materials and Methods

Selection of patients

Total 15 male patients having signs and symptoms of Vatastheela / BPH, were selected randomly from those attending the OPD and IPD of IPGT and RA Hospital, Jamnagar, Gujarat, irrespective of religion, occupation, caste, etc.

Inclusion criteria

  • Male patients in the age range of 40-70 years
  • Patients having signs and symptoms of Vatastheela / BPH
Exclusion criteria

  • Patients below 40 years and above the 70 years of age
  • Patients having systemic diseases like tuberculosis, hypertension, renal failure, diabetes mellitus, urinary calculi, and carcinoma prostate
Diagnostic criteria

Diagnosis was based on the clinical signs and symptoms of the disease, which was collected using a specially prepared proforma. We used subjective parameters based on International Prostate Symptoms Score and objective parameters (e.g., size of the gland, residual urine volume, etc.) for diagnosis.

Drugs tested

  1. Mahayavanala Roma Kshara: Mahayavanala Roma was obtained from Zea mays and the Kshara was prepared by the standard method described in Sushruta Samhita.
  2. Dhanyaka Gokshura Ghrita: Dhanyaka (Coriandrum Sativum) [6] and Gokshura (Tribulus terrestris) [7] were the two ingredients of this Ghrita; it was prepared as per the standard guidelines given by Bhaishajya Ratnawali.
Clinical study design

The patients were divided into two groups and treated as per the schedule given below:

Group A: MRK [8] capsules, 500 mg BD orally with lukewarm water before meals, for 45 days.

Group B: DGG [9] 10 gm BD orally with lukewarm water before meals, for 45 days.

Assessment criteria

Subjective criteria:


  1. Improvement in the symptoms of the disease was assessed using the International Prostate Symptom Score sheet (of the American Urologists Association).
Objective criteria

  1. Assessment of residual urine volume
  2. Assessment of urine flow rate
  3. Prostatic size as assessed by per rectal digital examination and ultrasonographic study
  4. Laboratory investigations
Overall assessment criteria




   Observations and Results Top


The general observations are shown in [Table 1], [Table 2], [Table 3]. The effect of therapy on various parameters is shown in [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14].
Table 1: General observations (n=15)

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Table 2: Subjective findings (n=15)

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Table 3: Objective findings (n=15)

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Table 4: Effect of Mahayavanal Roma Kshara on subjective parameters (n=6)

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Table 5: Effect of Dhanyaka Gokshura Ghrita on subjective parameters (n=9)

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Table 6: Effect of Mahayavanal Romakshara on residual urine volume and urine flow rate (n=6)

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Table 7: Effect of Dhanyaka Gokshura Ghrita on residual urine volume and urine flow rate (n=9)

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Table 8: Effect of Mahayavanal Romakshara on prostate volume (n=6)

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Table 9: Effect of Dhanyaka Gokshura Ghrita on prostate volume (n=9)

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Table 10: Total effect of the Mahayavanal Romakshara on subjective parameters (n=6)

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Table 11: Total Effect of Dhanyaka Gokshura Ghrita on subjective parameters (n=9)

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Table 12: Total effect of Mahayavanal Romakshara on objective parameters (n=6)

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Table 13: Total effect of Dhanyaka Gokshura Ghrita on objective parameters (n=9)

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Table 14: Comparative analysis of group A and group B (Student's unpaired 't' test)

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   Discussion Top


The disease Vatastheela, one of the 13 Mutraghata disorders, can be correlated with BPH on the basis of its Sthana (place), which is between Guda and Basti, and also on the basis of the correspondence of the symptoms and signs. Most of the features of Vatastheela described by Sushruta, such as retention of urine (Mutrasanga), pain in suprapubic region, etc., are similar to the symptoms of BPH. To make it more scientific for treatment as well as assessment point of views certain features like age above 40 years, increased frequency of urine, nocturia, reduced urine flow rate, intermittency which are not described by Acharya Sushruta, are necessary.

Most of the patients in our study (75%) were from the age-group of 61-70 years, which is to be expected since BPH is a disease related to aging. Maximum individuals were of the Hindu religion, which is due to the predominance of Hindus in this area. Most of the patients reported agriculture as their occupation, which is not surprising in this rural region. Most of the patients had had symptoms for 1-2 years. One reason for this long duration is that patients often neglect to seek treatment in the early phase of disease; also, many patients may have tried other forms of treatment before seeking Ayurvedic treatment.

Vishamashana was found in the majority of the patients. Ama is the chief causative factor in the pathogenesis of Vatastheela as described by Charaka, and Vishamashana is responsible for Ama formation which leads to making the firm background for disease. Disturbed sleep was found in almost all the patients, which might be due to the increased frequency of micturition at night. Constipation was found in 91.66% of the patients, which might be due to faulty dietary habits such as Vishamashana. In group A, i.e., the Mahayavanal Roma Kshara group, highly significant relief was found in frequency of micturition, hesitancy, and dysuria, while significantly result was observed in the symptoms of urgency and nocturia. Kshara made from Roma of Mahayavanala contains properties like Tridoshghna, Pachana, Vilayana, and Lekhana[10] and it is by the virtue of these Gunas that it causes decrease in prostate size and increase in urine flow rate. Kshara also has the capacity to change the pH of urine from acidic to alkaline and by virtue of this it helps reduce the symptoms due to irritation of the lower urinary tract (e.g., dysuria, frequency).

Another probable reason for such relief may be the anti-testosteronic effect of the Kshara. As mentioned by the Acharyas, Kshara can cause impotency and the impotency is certainly due to decrease in the testosterone level. Thus, it is likely that the anti-testosteronic properties of Kshara helps to reduce the size of the prostate gland and give symptomatic relief. This hypothesis requires further evaluation.

Treatment with Dhanyaka Gokshura Ghrita provided highly significant relief in incomplete voiding, intermittency, hesitancy, and nocturia. There was also significant relief of symptoms like frequency of micturition, urgency, and weak urine stream.

Dhanyaka Gokshura Ghrita contains only two drugs, i.e., Dhanyaka and Gokshura. Dhanyaka is Tridoshahara, Dipana, Pachana, and Strotovishodhana, [11] while Gokshura has properties like Vatahara, Mutrala, Anulomana, Basti Shodhaka, Dipana, and Pachana, [12] etc. Both drugs were processed with Ghrita which carried all the properties of above drugs, as Ghrita is Yogavahi. Thus, the actions of Dhanyaka Gokshura Ghrita were by virtue of the properties mentioned above.


   Conclusion Top


In this study we compared two Ayurvedic treatments for BHP, i.e., Mahayavanal Roma Kshara and Dhanyaka Gokshura Ghrita. It was found that Mahayavanal Roma Kshara had better effect on the objective parameters, whereas Dhanyaka Gokshura Ghrita showed better effect on the subjective parameters.

 
   References Top

1.Sushruta. Sushruta Samhita. Ayurveda Tatvasandipika Hindi commentary. Shashtri AD. Uttaratantra- 58/3-4. 17 th ed. Varanasi: Chaukhambha Sanskrita Sansthana; 2003. p. 423.  Back to cited text no. 1
    
2.Sushruta. Sushruta Samhita. Ayurveda Tatvasandipika Hindi commentary. Shashtri AD. Uttaratantra- 58/3-4. 17 th ed. Varanasi: Chaukhambha Sanskrita Sansthana; 2003. p. 424.  Back to cited text no. 2
    
3.Campbell's Urology. In: Walsh PC, Retik AB, Vaughan DE, Wein AJ, editors. 7 th Edition, W.B. Soundess Company, Tokyo. 1992. p.1036.   Back to cited text no. 3
    
4.Short Practise of Surgery. Bailey's and Love's. 23 rd ed. Londan and Oxford university. New York: Hodder Headline group; 2000. p.1247.   Back to cited text no. 4
    
5.Sushruta. Sushruta Samhita. Ayurveda Tatvasandipika Hindi commentary. Shashtri AD. Uttaratantra 17 th ed. Varanasi: Chaukhambha Sanskrita Sansthana; 2003. p. 427.  Back to cited text no. 5
    
6.Dravya Guna Vignan. Sharma P. Varanasi; Chaukhambha Bharati Academy; 2006. p. 322.   Back to cited text no. 6
    
7.Dravya Guna Vignan. Sharma P. Varanasi; Chaukhambha Bharati Academy; 2006. p. 632.  Back to cited text no. 7
    
8.Kembhavi AS. A clinical evaluation of Kshara and Uttarabasti in the management of Mutraghata. 1998. p. 58-59.  Back to cited text no. 8
    
9.Ayurveda Pharmacopoeia- Bhaishaja Samhita by Gujarata Rajya Bheshaja Samiti. 1966. p. 645.   Back to cited text no. 9
    
10.Sushruta. Sushruta Samhita. Ayurveda Tatvasandipika Hindi commentary. Shashtri AD. Sutrasthana. Varanasi: Chaukhambha Sanskrita Sansthana; 17 th ed. 2003. p. 34.  Back to cited text no. 10
    
11.Dravya Guna Vignan. Sharma P. Varanasi; Chaukhambha Bharati Academy; 2006. p. 322.  Back to cited text no. 11
    
12.Dravya Guna Vignan. Sharma P. Varanasi; Chaukhambha Bharati Academy; 2006. p. 632.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14]


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