|Year : 2016 | Volume
| Issue : 2 | Page : 113-119
Role of Virechana and Ashwatha Phala Churna in the management of Ksheena Shukra (oligozoospermia): A pilot study
Jitendra Nathabhai Varsakiya1, Mandip Goyal1, Anup Thakar2, Bhupesh Patel3
1 Department of Kayachikitsa, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Department of Panchakarma, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
3 Department of Dravyaguna, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
|Date of Web Publication||7-Nov-2017|
Jitendra Nathabhai Varsakiya
Department of Kayachikitsa, Institute of Postgraduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar - 361008, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Infertility is the inability of a sexually active, noncontracepting couple to achieve spontaneous pregnancy in 1 year. Low sperm count (oligozoospermia) is one of the main causes of male infertility and is correlated with Ksheena Shukra (oligozoospermia). Shodhana procedures are to be performed before the administration of Vajikarana drugs, especially Virechana karma has been indicated in the cases of Shukra Dushti. The fruit of Ashwatha (Ficus religiosa Linn.) has been indicated in premature ejaculation and low sperm count. Aim: This study aimed to evaluate the effect of Virechana and Ashwatha Phala Churna in the management of Ksheena Shukra (oligozoospermia). Materials and Methods: Eligible male participants between the age of 21 and 50 years, with sperm count <15 million/ml, received Ashwatha Phala Churna for 60 days in the dose of 3 g, after undergoing Virechana Karma. The primary outcomes measured were percentage changes in the seminal parameters and associated symptoms of Ksheena Shukra in comparison to baseline. Results: The Ashwatha Phala Churna administered after Virechana provided 59.78* increase in sperm count, 36.81* increase in semen volume, and 16.18* decrease in abnormal form of sperm and 91.34* of increase was reported in total sperm count after Virechana Karma which was also statistically significant. Conclusion: Overall assessment of the therapy showed that administration of Ashwatha Phala Churna after performing Virechana provided statistically significant improvement on seminal parameters, especially total sperm count.
Keywords: Ashwatha Phala Churna, Ficus religiosa Linn., Ksheena Shukra, oligozoospermia, Virechana
|How to cite this article:|
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
|How to cite this URL:|
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 [serial online] 2016 [cited 2018 Mar 19];37:113-9. Available from: http://www.ayujournal.org/text.asp?2016/37/2/113/217794
| Introduction|| |
Infertility is empirically defined as the inability of a couple to conceive even after 1 year of coital activity without contraception. Recent studies have indicated that the prevalence of oligozoospermia is extremely high in the metropolis as well as in the smaller towns of India. About 15% of couples do not achieve pregnancy within 1 year and seek medical treatment for infertility. Eventually, 5% remain unwillingly childless. In 50% of involuntarily childless couples, a male infertility-associated factor is found together with abnormal semen parameters.,
Historically, the concepts of infertility have changed over time, and also the problems. Increased mental stress, tobacco-alcohol addiction, pollution, faulty eating and clothing habits, change in culture, and so on have endangered the reproductive capacity of men, which may be attributed to the increased prevalence of oligozoospermia. Many measures are available to treat infertility, but most of the times, these approaches are expensive and time killing. In Ayurveda, it is advocated to use Vajikarana drugs, especially after performing Virechana for managing cases of Ksheena Shukra. Among many herbal drugs listed for Ksheena Shukra, Ashwatha is the one which is easily available and cost-effective. Hence, a pilot study was planned to evaluate the clinical efficacy of Ashwatha Phala Churna after performing Virechana Karma in the cases of Ksheena Shukra (oligozoospermia).
| Materials and Methods|| |
For the clinical study, twenty male patients suffering from primary or secondary infertility for >1 year and having sperm count <15 million/ml and willing to participate in the clinical trial were selected irrespective of religion and caste from the OPD of Kayachikitsa or referred from Streeroga and Prasruti Tantra Department. The study was initiated after getting approval from the Institutional Ethics Committee of the institute; vide Ref-PGT/7/-A/2013-14/1767, dated: 10/9/2013, and the study was also registered in CTRI (vide CTRI/REF/2014/01/006207). Consent was obtained from all participants before including them in the present study.
- Patients with clinical presentation of Ksheena Shukra (oligozoospermia), i.e., Daurbalya, Shukra Avisarga, and Pandu
- Sperm count <15 million/ml
- Male patients with age between 21 and 50 years.
- Patients of azoospermia and aspermia
- Patients suffering from varicocele, accessory sex gland infection, sexually transmitted diseases, severe systemic diseases, etc.
- Patients suffering from genetic disorders such as Klinefelter's syndrome
- Patients undergoing treatment for major psychiatric illness
- Patients with a history of previous medications and trauma leading to oligozoospermia
- Patients not eligible for Virechana procedure.
Semen analysis was carried out on registering the patients, which was taken as the baseline, and thereafter it was repeated after Samsarjana Krama and on the 60th day of the treatment. Serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), and serum testosterone were taken as biomarkers and were done before and after the treatment in selected patients. Routine hematological and urine examination was carried out to assess the present status of the patients and to exclude other pathologies. In suspected cases, ultrasonography was done to rule out hydrocele, varicocele, and other pathologies.
Virechana Karma was performed, before administration of Ashwatha Phala Churna. The details of drugs used for Virechana Karma have been mentioned in [Table 1]. After Virechana, Ashwatha Phala Churna was given in the dose of 3 g twice a day orally after meal with a cup of warm milk for 60 days.
Method of Virechana Karma
Before administration of Ashwatha Phala Churna, all the registered patients were given Virechana. For this purpose, patients who met inclusion criteria and gave consent for the Virechana were administered Trikatu Churna for the first 3 days for Deepana and Pachana in the dose of 2 g twice in a day with lukewarm water after meal. On the 4th day, after assessing the status of the patients, plain ghee (Accha Sneha) in the dose of 40 ml 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 till the patients achieved proper Snehana features. After completion of internal Snehana, whole body massage and fomentation with Bala Taila and Vashpaswedana was done daily 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 was given.
Method of preparation of Triphaladi Kwatha
For the preparation of Triphaladi Kwatha, 50 g of coarse powder of Triphala and 25 g of Trivritta were taken. To this, four times water was added and boiled until it was reduced to one-fourth. To this prepared Kwatha, Danti powder was added in the amount 6 g, 8 g, and 10 g respectively for Mridu Koshtha, Madhyam Koshtha and Krura Koshtha patient after taking into consideration the status of Koshtha of the patients.
Thereafter, according to the type of Shuddhi, at the end of Virechana procedure, 3, 5, and 7 days of dietary regimen was advised which included Peya, Vilepi, Akrita Yusha, and Krita Yusha in a sequential pattern.
After completion of Virechana, Ashwatha Phala Churna was administered for 60 days, where patients were asked to report fortnightly, and on every visit, the details regarding the status was recorded
Criteria for assessment
The efficacy of the treatment was assessed on the basis of improvement in the subjective as well as objective parameters. For the subjective parameters, an appropriate scoring pattern was adopted for parameters such as sexual desire, erection, rigidity, performance anxiety, ejaculation, orgasm, overall satisfaction, erectile function, and postact exhaustion [Appendix 1].
Improvement in the semenogram was observed, especially on the total sperm count. Changes in serum FSH, serum LH, and serum testosterone were also considered for assessment and they were assessed in comparison to the baseline score.
General data were subjected to suitable statistical analysis such as descriptive statistics for demographic data, Wilcoxon signed-rank test for nonparametric paired data, and paired t-test for quantitative parametric paired data.
After preparing the master chart of all the required data in Microsoft Excel worksheet, statistical calculations were made with the help of SigmaStat 3.5 software and InStat 3 software. The results were interpreted as significant (P < 0.05), highly significant (P < 0.01), very highly significant (P < 0.001), and insignificant (P > 0.05).
A total of twenty male patients of Ksheena Shukra (oligozoospermia) were registered for the present study, of which 19 patients completed the full course of treatment and one patient left the treatment due to personal reasons.
In the study, the maximum number of patients (62.5%) was in the age group of 21–30 years, belonged to the Hindu religion (92.5%), and had secondary education. 77.5% of the patients were from urban area and were belonging to poor socioeconomic class (67.5%) and 40% of them were labourer.
Around 67.5% of the patients were doing heavy physical exertion, 77.5% of the patients in the present trial were having Vishamagni, 87.5% of patients had irregular dietary habits, 67.5% of the patients had the habit of taking hot water bath, and 75% of the patients were wearing tight undergarment. About 62.5% of the patients had the habit of chewing tobacco followed by 27.5% having addiction of smoking tobacco, 62.5% of the patients were having reduced and disturbed sleeping pattern, and 75% of the patients were having psychological factor such as stress and worry.
The 67.5% of the patients had Vata Pitta Prakruti and were of Madhyama Bala. About 60% and 20% of the patients had Lavana and Katu Rasa predominant diet, respectively. Almost 63.89% of the patients had a history of consumption of Ushna Ahara, 90% of the patients had primary infertility while 10% of the patients had secondary infertility, 82% of the patients complained of Shrama Maithuna (exertion during intercourse), followed by 75% of patients with Alpa Cheshtata(less motivation), 70% of patients with loss of sexual desire and 57.5% of patients with Daurbalya(general debility). 47.5% of the patients complained of Alpa Shukra Pravriti(low semen volume), 50% of patients each had Sandhi Shula and premature ejaculation, 30% of patients had Shosha (dryness of mouth), and the remaining 10% of patients had Pandu (anemia).
| Discussion|| |
The etiological factors such as urban lifestyle including irregular eating and sleeping habits, lack of exercise, consumption of fast food, cold drinks, and stress with fast life were reported in the present clinical trial, which may hamper the metabolism and become a cause of poor nutritional status and oligozoospermia.
People from low strata of the society are unaffordable to the current costly private diagnostic and medical facilities. Persons under the conditions of poverty eat less nutritious, cheaper food which are usually Vata provoking. It is also noted that malnutrition causes hypogonadism which leads to a decrease of Leydig cell function which in turn causes reduced stimulation of LH, ultimately resulting in decreased testosterone secretion causing oligozoospermia. This is supported by findings that very low caloric or protein deficiency causes hypogonadism and decreases the function of Leydig cell, which may result in hampered testosterone secretion and further leads to infertility.
Most of the workers who are working in hot temperature zone are more prone to testicular hyperthermic changes. Further, a decrease in sperm output in testicular hyperthermia has also been reported.
Vishamagni reported in the patients is probably because of comparative hyperactivity of Vata on Agni. It may lead to Vata and Agni vitiation causing Amottpati, ultimately improper formation of Dhatu causing Shukra Kshaya, which can also be correlated with vitiation of Apana Vata.
Faulty food habits (Vishamashana) lead to improper formation of Rasa and subsequently irregular Dhatu metamorphosis. The data are also suggestive of the current trend of lifestyle and food habits in the present-day lifestyle.
Addiction of smoking tobacco and excessive use of tobacco hamper the normal digestive pattern, resulting in malnourished state, ultimately resulting in oligozoospermia. A study of infertility evaluation of Indian men who were addicted to tobacco chewing has associated its use with decrease in sperm quality. The study showed that nicotine causes degenerative changes in the seminiferous tubules, which was revealed by altered general tubular architecture, decreased thickness of the spermatogenic cell masses, sertoli cell vacuolation, and thickened basal lamina. Cigarette smoke has also effects on spermatogenesis which may be due to toxic substances in the cigarette or the histologic reactions due to hypoxemia induced by smoke.
Psychological factors such as stress and worry which were reported in the present clinical trial have been listed as the causes of Ajirna and hamper metabolism, ultimately causing oligozoospermia. Experimental studies show that there is hypothalamic testicular suppression due to stress which results in deranged spermatogenesis leading to oligozoospermia.
| Results|| |
Effect on seminal parameters
Ashwatha Phala Churna provided statistically highly significant (P < 0.001) result in increasing sperm count (59.78%), statistically significant result in abnormal form of sperm (16.18%), and statistically highly significant (P < 0.001) result in increasing semen volume (36.81%). Analysis of the effect on sperm count after Virechana Karma(91.34%) showed that a positive improvement was obtained, which was statistically significant [Table 2].
|Table 2: Effect of therapy in 19 patients Ksheena Shukra (oligozoospermia) on seminal parameters|
Click here to view
Effect on hormones
Serum testosterone and serum FSH were decreased by 13.58% and 8.27%, respectively, whereas serum LH was increased by 6.57% after the treatment with Ashwatha Phala Churna. All these changes reported on hormones were statistically insignificant [Table 3].
|Table 3: Effect of trial drugs on sex hormones in 10 patients of Ksheena Shukra (oligozoospermia)|
Click here to view
Effect on hematological parameters
There were no statistically significant changes (P > 0.05) in the hematological parameters such as hemoglobin, total red blood cell count, total leukocyte count, differential count, and all biochemical parameters such as fasting blood sugar, serum cholesterol, serum triglyceride, serum creatinine, blood urea, and serum glutamic pyruvic transaminase. This proves that there was no adverse effect of the treatment.
Discussion on the effect of therapy on subjective criteria
Ashwatha Phala Churna provided statistically highly significant (P < 0.001) result on Daurbalya (75%), Sandhi Shula (81.81%), Shrama (64.29%), Maithune Ashakti (60%), Alpa Shukra Pravriti (72.22%), sexual desire (53%), erectile dysfunction (62.50%), erectile rigidity (60%), orgasm function (53%), increase in overall satisfaction (61%), frequency of coitus (26%), and duration of coitus (64.47%) and significant (P > 0.05) result in ejaculatory function (50%).
Overall effect of therapy
Assessment of overall effect of the therapy showed that Ashwatha Phala Churna administered after Virechana Karma provided marked positive response in 20% of the patients, moderate positive response in 60% of the patients, and mild positive response in 20% of the patients.
Probable mode of action of Virechana Karma and Ashwatha Phala Churna
Vajikarana drugs (aphrodisiac recipes) should be administered after purifying the body, i.e., proper Shodhana either by Vamana or by Virechana. Statistically significant increase in sperm count was found after the completion of Virechana Karma (91.34%) and hence, it is clear from the generated data that Virechana enhances the level of Shukra definitely. Further, Virechana Karma increases the bio-availability of drugs by opening channels and improves the nutritional assimilation of the trial drug.
Due to Madhura Rasa, Shita Virya, Snigdha Guna of Ashwatha Phala, Vata, and Pitta Shamana take place which are the Doshas involved in the pathogenesis of Ksheena Shukra. It leads to Shukra Gata Vata-Pitta Shamana. In addition, Ashwatha Phala Churna possesses Vrishya effect, thus increasing the production of spermatozoa which ultimately causes increase in sperm count.
| Conclusion|| |
It can be concluded from the present clinical trial that Virechana Karma is a must procedure to be performed before the administration of Vajikarana drugs as it provides better and early changes in the total sperm count. After detailed analysis of observations made and results achieved, it can be concluded that Ashwatha Phala Churna is effective in the management of Ksheena Shukra when administered after Virechana Karma.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mehta RH, Makwana S, Ranga GM, Srinivasan RJ, Virk SS. Prevalences of oligozoospermia and azoospermia in male partners of infertile couples from different parts of India. Asian J Androl 2006;8:89-93.
World Health Organization. WHO Manual for the Standardised Investigation and Diagnosis of the Infertile Couple. Cambridge: Cambridge University Press;2000. Available from: http://www.uroweb.org/guidelines/online-guidelines/
. [Last accessed on 2017 Aug 28].
Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, et al.
European association of urology guidelines on male infertility: The 2012 update. Eur Urol 2012;62:324-32.
WHO Criteria for Normal Semenogram 2010. Impact of the New WHO Guidelines on Diagnosis and Practice on Male Infertility. Open Reprod Sci J 2010;3:7-15.
Aacharya Y T, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Reprint ed. Ch. 13, Ver. 61. Varanasi: Chaukhamba Surbharati Prakashan;2008. p. 85.
Aacharya Y T, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Reprint ed. Ch. 1, Ver. 10. Varanasi: Chaukhamba Surbharati Prakashan;2008. p. 678.
Aacharya Y T, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Reprint ed. Ch. 1, Ver. 11. Varanasi: Chaukhamba Surbharati Prakashan;2008. p. 678.
Mehra BL. Studies on Klaibya (Male Sexual Dysfunction) and its Management with Vājīkarana. Jamnagar: Department of Kayachikitasa, I.P.G.T. and R.A., G.A.U.;1996.
Said TM, Ranga G, Agarwal A. Relationship between semen quality and tobacco chewing in men undergoing infertility evaluation. Fertil Steril 2005;84:649-53.
Jurewicz J, Hanke W, Radwan M, Bonde JP. Environmental factors and semen quality. Int J Occup Med Environ Health 2009;22:305-29.
[Table 1], [Table 2], [Table 3]