Matravasti ksheenasukra pk019_gdg

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EVALUATION OF THE EFFICACY OF MATRABASTI IN KSHEENA SHUKRA, SIBA PRASAD , Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Matravasti ksheenasukra pk019_gdg

  1. 1. “EVALUATION OF THE EFFICACY OF MATRABASTI IN KSHEENA SHUKRA” BY Dr. SIBA PRASADDissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of DOCTOR OF MEDICINE (AYURVEDA VACHASPATI) IN PANCHAKARMA Under the guidance of DR. P. SHIVARAMUDU M.D. (AYU) Professor P.G.Dept. of Panchakarma And co-guidance of Dr. SANTOSH N. BELAVADI M.D. (Ayu) Lecturer P.G.Dept. of PanchakarmaPOST GRADUATE DEPARTMENT OF PANCHAKARMAD.G MELMALAGI AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER GADAG – 582103 2007
  2. 2. DECLARATION BY THE CANDITATE I hereby declare that this dissertation / thesis entitled “EVALUATION OFEFFICACY OF MATRABASTIIN KSHEENA SHUKRA” is a bonafide andgenuine research work carried out by me under the guidance of Dr.G.Purushothamacharyulu MD (Ayu), Professor and HOD and the co-guidance ofDr.Santosh N Belavadi MD (Ayu), Lecturer, Post Graduate Department of Panchakarma,Shri D.G.M.Ayurvedic Medical College, Gadag. Date: Signature of the CandidatePlece: Gadag (Dr. SIBA PRASAD)
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “EVALUATION OFEFFICACY OF MATRABASTIIN KSHEENA SHUKRA” is a bonafideresearch work done by Dr. SIBA PRASAD in partial fulfillment of therequirement for the degree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. P. Shivaramudu MD (Ayu) Professor P.G. Department of Panchakarma,
  4. 4. CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “EVALUATIONOF EFFICACY OF MATRABASTIIN KSHEENA SHUKRA” is a bonafideresearch work done by Dr. Siba Prasad in partial fulfillment of therequirement for the degree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Dr. Santosh N. BelavadiPlace: Gadag MD (Ayu). Lecturer P.G. Dept. of Panchakarma. SHRI D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAD POST GRADUATE DEPARTMENT OF PANCHAKARMA
  5. 5. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “EVALUATION OF EFFICACYOF MATRABASTIIN KSHEENA SHUKRA” is a bonafide research work done byDr. Siba Prasad under the guidance of Dr.P. Shivaramudu MD (Ayu), Professor,and co-guidance of Dr. Santosh.N.Belavadi , Lecturer, Post Graduate M.D. (Ayu)Department of Panchakarma, Shri D.G.M.A.M.C, Gadag and contributed good values tothe Ayurvedic research. Dr. G. Purushothamacharyulu Dr. G. B. Patil Professor and HOD PrincipalPost Graduate Department of Panchakarma.
  6. 6. COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate this dissertation /thesis in print or electronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag Dr. SIBA PRASAD © Rajiv Gandhi University of Health Sciences, Karnataka.
  7. 7. I ACKNOWLEDGEMENT “Knowledge is proud that he has learned so much; wisdom is humble that heknows no more.” This work is the result of the combined effort of a good number ofpeople who include researchers, academicians, friends, colleagues, parents and laymen. I dedicate this work to my Guru Swami Anand, respected parentsShri. Mukunda Prasad & Smt. Sachala and my uncle Shri. Durga Charana who arethe prime sources for all my success. The inspiring forces throughout this research work; was my guideDr. P. Shivaramudu M.D.(Ayu), Prof. P.G. Department of Panchakarma, P.G.S & R.C,D.G.M.A.M.C, Gadag, the person who has devoted his life for the upliftment of thisancient system of medicine, who became a source of light whenever I was in darkness. Iam deeply indebted for his guidance, broadmindedness and affection towards me. Words can not express the zeal of ecstasy while depicting my deep source ofgratitude to my proficient co-guide Dr. S. N. Belavadi M.D.(Ayu), Lecturer, P.G.Department of Panchakarma, P.G.S.& R.C, D.G.M.A.M.C, Gadag. His fruitfulsuggestions, optimistic view shower head on me during this whole period & inspired meto accomplish this work in all aspects. I express my deep gratitude to Dr. G. B. Patil, Principal, D.G.M.A.M.C, Gadag,for his encouragement as well as providing all necessary facilities for this research work. I express my sincere gratitude to Dr. G. Purushothamacharyulu M.D. (Ayu),Professor and H.O.D., P.G. Department of Panchakarma, P.G.S.& R.C, D.G.M.A.M.C,Gadag. I also pay my sincere gratitude to Dr. C.V. Rajsekar M.D. (Ayu), and Dr. YasmeenM.D. (Ayu), Lecturer P. G. Department of Panchakarma for their sincere advices andassistance. I express my sincere gratitude to Dr. V. Varadacharyulu M.D. (Ayu), Dr. M. C. PatilM.D. (Ayu), Dr. Mulgund M.D. (Ayu), Dr. K. S. R. Prasad M.D. (Ayu), Late. Dr. Dilip Kumar M.D.(Ayu), Dr. R.V. Shetter M.D. (Ayu), Dr. Kuber Sankh M.D. (Ayu), Dr. Girish. Danappagoudar M.D.(Ayu), Dr.M.D.Samudri M.D. (Ayu), and other PG staff for their constant encouragement. I also express my sincere gratitude to Dr.B.G.Swamy, Dr. U.V. Purad, Dr. S.D.Yerageri, Dr. Chapparnmath and other undergraduate teachers for their support in theclinical work.
  8. 8. II I am thankful to Shri. Nandakumar (Statistician), Shri. V.M. Mundinamani(Librarian) and other hospital and office staff for their kind support in my study. I cannot move further before thanking to my intimate friends Dr. Vijay Hiremath,Dr. Suresh Hakkandi, Dr. Manjunath Akki, Dr. Ashwini Dev, Dr. L. Biradar, Dr. Muttu,Dr. Prasannakumar, Dr. Madhushree, Dr. , Dr. Payappagoudar, Dr.Shivaleela,Dr.Sulochana, Dr.Kamalakshi, Dr.Shalinisharma, Dr.Kataraki, Dr.Ashok,Dr.Ravi,Dr.Kattimani, Dr.Ashwinivastrad, Dr.Jayashree, Dr.Rudrakshi, Dr.Natraj,Dr.Muktha, Dr.Uday, Dr.Adarsh, Dr.Jayashankar, and Dr.Deepak and other postgraduate scholars for their support. Finally I pay my special regards to Dr. Madhav Diggavi for his valuable support. I acknowledge my patients for their wholehearted consent to participate in thisclinical trial. I express my thanks to all the persons who have helped me directly andindirectly with apologies for my inability to identify them individually. Even though more words can never replace the emotions one feels, still I crave toconvey a cordial thanks to my elder sister Manaswini Sharma, younger brother Deviprasad and my best friend Dr. Jina Pattanaik whose belief & whole hearted co-operationhas always remained as the source of energy to me in this world of uncertainly.Date:Place: WÜA f|ut cÜtátwA
  9. 9. III LIST OF ABBREVIATIONS⇒ A. H. – Ashtanga Hridaya.⇒ B. P. – Bhavaprakasha.⇒ C. S. – Charaka Samhita.⇒ G. R. – Good response.⇒ M. R. – Moderate response.⇒ N. R. – No response.⇒ P. R. – Poor response.⇒ S. S. – Susruta Samhita.⇒ AS. – Ashtanga sangraha.⇒ BR. – Bhaishajya ratnavali.⇒ MN. – Madhava nidana.⇒ No. – Number.⇒ Pt.’s – Patients.⇒ Sl. – Serial number.⇒ Vag. – Vagbhata.⇒ VS. – Vangasena samhitha.⇒ YR. – Yogaratnakara.
  10. 10. IV ABSTRACT Bastikarma is the most important karma among the Panchakarmas. It has alreadybeen proved that the karmas are beneficial in managing the Vatavyadhees. Ksheenashukra is the upcoming disease that growing faster in the world. The study “Evaluation of the efficacy of MatraBasti in Kshena Shukra” isfocused on important techniques i.e. Matrabasti and also common clinical entity Kshenashukra. Matrabasti with Shatavari Ghrita are believed to have a appreciable role in themanagement of such conditions by enhancing spermatogenesis and sperm motility. The objectives of this study are: 1) To evaluate the efficacy of Matrabasti with Shatavarighrita enriching Bahulatwa in Ksheenashukra. 2) To evaluate the efficacy of Matrabasti with Shatavarighrita enriching Bahutwa in Ksheena shukra. The aim of this study was to find out the effect of Matrabasti in the managementof Ksheena shukra. Therefore, Single randomized group was made. The study designselected for the present study was Single randomized prospective clinical trial. Ksheena Shukra is a disease which can affect the males after the puberty. It maybe congenital or accuired. The disease is characterized by dhatu kshaya and lakshanasreflective of vitiated Vata and Pita. Therefore, the agents/therapies of brimhana-balya-vajikara-vrishya properties should be used in this disease. Matrabasti is prime treatment
  11. 11. Vfor Vatavyadhi inturn plays vital role in correcting pathology of the disease and givesremarkable results. This results the relief of symptomatology of the disease, when these procedureperformed with Shatavari ghrita, by acting systematically. Acharya Caraka has describedthis Shatavari ghrita in Vajikarana chapter as Vrishyottama. Thereby, it is an idealtreatment of choice in Ksheena shukra.Key words: - Matrabasti, Ksheenashukra, Dhatukshaya, Basti, Vrishya.
  12. 12. VI TABLE OF CONTENTS Chapters Page No.1. Introduction 1-42. Objectives 5-63. Review of literature 7-864. Methodology 87-995. Results 100-1286. Discussion 129-1477. Conclusion 148-1498. Summary 150 - 1529. Bibliography10. Annexure
  13. 13. VIILIST OF TABLESTable Table Showing the Page No. No. 01. Shuddha Shukra Lakshanas 20 02. Adhisthana bheda of Basti 50 03. Karma bheda of Basti 51 04. Sankhya Bheda of Basti 52 05. Matra bheda of Basti 52 06. Anuvasana Basti 52 07. Mesurement of Basti yantra 55 08. Netra Dosha 56 09. Indication of Matravasti 59 10. Dose of matra vasti according to age 61 11. RoopaA and Lahsana of Ksheena shukra 74 12. Observation of Patients based on age 100 13. Observation of patients based on Religion 101 14. Observation of patients based on Occupation 102 15. Observation of patients based on Socio-Economical status 103 16. Observation of patients based on Education 104 17. Observation of patients based on Diet 105 18. Observation of patients based on Habits 106 19. Observation of patients based on Duration of Marriage 107 20. Observation of patients based on Previous illness 108 21. Observation based on History of Mastrubation 109 22. Observation of patients based on Sexual relationship with partner 110 23. Observation of patients based on Psychological history 111 24. Observation of patients based on Ejaculation 112 25. Observation of patients based on Ksheena Shukra Lakshana 113 26. Observation of patients based on Impact of Shatavari ghrita on 114 Ejaculation 27. Observation of patients based on Impact of Shatavari ghrita on Sexual 115 desire 28. Observation of patients based on Impact of Shatavari ghrita on Erection 116 29. Observation of patients based on Impact of Shatavari ghrita on Rigidity 117 30. Observation of patients based on Impact of Shatavari ghrita on Orgasm 118 31. Observation of patients based on Impact of Shatavari ghrita on Alpa 119 Shukra
  14. 14. VIII 32. Observation of patients based on Impact of Shatavari ghrita on Medhra 120 and Vrishana Vedana 33. Observation of patients based on Impact of Shatavari ghrita on Semen 121 volume 34. Observation of patients based on Impact of Shatavari ghrita on Sperm 122 count 35. Observation of patients based on Impact of Shatavari ghrita on Sperm 123 Motility 36. Observation of patients based on Overall response 124 37. Showing on the assessment of individual on the Subjective parameter 125 38. Showing on the assessment of individual on the Objective parameter 126 39. Showing individual study on the assessment criteria 127 40. Showing statistical analysis on the assessment criteria 128 LIST OF GRAPHSGraph No. Graph Showing the 01. Observation of Patients based on age 02. Observation of patients based on Religion 03. Observation of patients based on Occupation 04. Observation of patients based on Socio-Economical status 05. Observation of patients based on Education 06. Observation of patients based on Diet 07. Observation of patients based on Habits 08. Observation of patients based on Duration of Marriage 09. Observation of patients based on Previous illness 10. Observation based on History of Mastrubation 11. Observation of patients based on Sexual relationship with partner 12. Observation of patients based on Psychological history 13. Observation of patients based on Ejaculation 14. Observation of patients based on Ksheena Shukra Lakshana 15. Observation of patients based on Impact of Shatavari ghrita on Ejaculation 16. Observation of patients based on Impact of Shatavari ghrita on Sexual desire 17. Observation of patients based on Impact of Shatavari ghrita on Erection 18. Observation of patients based on Impact of Shatavari ghrita on Rigidity 19. Observation of patients based on Impact of Shatavari ghrita on Orgasm
  15. 15. IX 20. Observation of patients based on Impact of Shatavari ghrita on Alpa Shukra 21. Observation of patients based on Impact of Shatavari ghrita on Medhra and Vrishana Vedana 22. Observation of patients based on Impact of Shatavari ghrita on Semen volume 23. Observation of patients based on Impact of Shatavari ghrita on Sperm count 24. Observation of patients based on Impact of Shatavari ghrita on Sperm Motility 25. Observation of patients based on Overall responseLIST OF PHOTOGRAPHSPhotograph Photograph showing No. 01. The anatomy of large intestine and rectum 02. Ingredients of Shatavati ghrita 03. Procedure of Matrabasti
  16. 16. objectives INTRODUCTION The person who is infertile is said to be Nindya according to Caraka. The personwithout a child is compared to the tree without branches. The grief of a man who facedthe infertility problem in no less in modern society than it was for our fore fathers.Infertility affects the psychological harmony, Sexual life and social functions of thecouples. Fatherhood has always been important in Indian society, but male infertility issurprisingly common. The global incidence of infertile couple is increasing day by dayand it has been estimated by WHO is 2,000,000 per year, 166,666 per month; 38,461 perweek ; 5,479 per day ; 228 per hour ; 3 per minute, couples are found infertile, and in50% of these, the problem is with the male. In India 7,831,401 people are suffering frominfertility. Fertility is an existential necessity and as such as assumed overwhelmingimportance from the time immemorial. The contribution of male factor alone to this totalinfertility is reported as 26.2% to 46.6% (Insler and Lunenfeld, 1993). The incidence of male infertility may vary from place to place and nation tonation. However, the magnitude of the problem remains the same. Even with advent ofmodern techniques, the success rate in conception is very low. Further, the quantity andquality of ejaculate are decreasing day by day which may be due to altered life styles,rapid industrialization etc. and may add to the problem of male infertility. The modernmedical field has now started realizing its importance and a new branch known asandrology has been developed recently. However, till date no satisfactory modernmedical management has been developed for this problem. The agony, sorrow of infertile EVALUVATION THE EFFICASY OF SHATAVARIGRITHA MATRABASTI IN KSHEENASHUKRA 1
  17. 17. objectivespatients remains almost same even today. The cost of the treatment is also not affordableby all. Since olden days the emphasis on getting a child preferably male was consideredas highest duty. To produce an offspring is a dream of every married couple. Since timeimmemorial humanity put a lot of emphasis on producing an offspring. Peers expect one another to join the parent hood and parents want the joy ofbecoming grand parents. Affection, strength, pleasure, livelihood, spread of bloodline,success and ultimate happiness all rest in the offspring. To produce a progeny four things are necessary i.e. Ritu, Ksetra, Ambu and Bija.Bija means both male and female fertility factors i.e. Shukra and Artava. If there is Dustiin any one of the above factors it will lead to infertility. Such a broad subject cannot bestudied in limited time. Hence I am limiting my studies to the male fertility factor i.e.Shukra. Ayurveda has realized this problem thousands of years back and maintains aseparate branch known as Vajikarana, which deals with promotion of sexual health andprevention and cure of disorders of semen resulting due to Shukra Dusti. Bastikarma has been doing wonders in the treatments of Ayurveda. Though it hasbeen indicated for almost all the diseases, the prime importance of Bastikarma has beenspecified in the management of Ksheena shukra. It would be the best way if one studies a particular subject to which it is highlyrelated to. As for this principle, the best way to understand or analyze Bastikarma is bychecking its effect over a Vata Vyadhi. Shukra Kshaya is one among Vata Vyadhi whereeven the Bastikarma itself has its prime importance. EVALUVATION THE EFFICASY OF SHATAVARIGRITHA MATRABASTI IN KSHEENASHUKRA 2
  18. 18. objectives Bastikarma is the best method of treatment in dealing with Vatavikaras and Vatadominating other Vikaras. On the other hand Vata is held responsible for all types ofKshaya and so for Shukra Kshaya also. Basti is indicated for providing rejuvenation, happiness, increasing the duration oflife, strength, improving memory, voice, digestive power and complexion. It removesnoxious matters from the tissues, pacifies the Dosha and rectifies the process ofexcretion. Consequently it affords stability and thus indirectly strengthens thereproductive capacity in man. Acharya Kashyapa has equated that the Bastikarma as‘Amrutam’, because of its wide application even in both children and also in geriatrics. Bastikarma is considered to be the treatment of prime importance in ShukraDosha by Charka’s statement, “Prashashtaha Shukra dosheshu Basti karma Visheshatha”. Basti given by using Vrishya Dravya is called as Vrishya Basti. The meaning ofthe word Vrishya says “Varshathi sinchati retah iti”, “Vrushaya hitaha” and “Prajananasamarthyam” i.e. to rain down or shower down or effuses the Retas, to bestow ordistribute abundantly. So the drugs containing all these properties and given through analroute will act more efficiently because of less degradation, since they avoid the contact ofAgni. Charaka in Vajikarana chapter has mentioned “Vrishya Shatavari Ghrita” for themanagement of Shukra doshas. This Shatavari ghrita contains Shatavari, Godugdha andGoghrita. All these three drugs are vrishya in nature. The therapeutic action of thisShatavari ghrita has explained as “Tad vrishyam uttamam”. Matra vasti is the sub typeAnuvasana basti. By explaining the qualities of Anuvasana vasti Acharya Caraka Says“Mana prasadam viryam balam varnam agnipustim” means it enhances the quality ofVirya, increases the bala, varna and Agni above all it keeps the person healthy EVALUVATION THE EFFICASY OF SHATAVARIGRITHA MATRABASTI IN KSHEENASHUKRA 3
  19. 19. objectivespsychologically. By taking this Matra vasti a person can get progeny as the tree gets newgreen leafs after watering in its root. Matra vasti is always considered as vrishya asVrishyam is one of the actions of hrusiyasi matra. As this Basti easy to administer and no Samsrajana krama are followed after thisBasti, so Matra Basti is selected for study. EVALUVATION THE EFFICASY OF SHATAVARIGRITHA MATRABASTI IN KSHEENASHUKRA 4
  20. 20. ObjectivesNEED FOR THE STUDY Shamana and Shodhana are the two basic principle of Ayurved chikitsa forKsheena Shukra. In shodhana chikitsa Basti karma is considered as the best treatment forShukra dosha. Acharya Charaka in Siddhi sthana 4th chapter has emphasizes on Bastikarma in Ksheena Shukra managenent. Bastikarma is pradhanakarma which is mentioned as Ardhachikitsa, Matrabasti isa type of Anuvasanabasti having wide indications. It is well tolerated by the patientsbecause of its dose, neither any complication nor any time restriction is there foradministering Matrabasti. Ksheena Shukra is most common disease among the infertilitypatients encountered in clinical practice. It can be compared with Oligospermia ofcontemporary science as both are similar in presentation with the symptometology- Lowsperm count, low motility and testicular pain etc. According to statistical report after fiftyyears this disease may touch 100% in the world population. Many researches have beendone in modern science to get effective treatment, as IVF but it is quite expensive alsonot so effective. Research is going on even with Ayurvedic therapeutic measures since 3-4 decades with Vajikarana Oushadhi and Shodhana measures. Vata is the main etiological factor for all kinds of kshaya. As Ksheena Shukra isone among the Dhatu kshaya janya vyadhi, therefore it can be considered underVatavyadhees. Now a day it is found very common in senile conditions. Matrabasti isexpected to give better results in this entity. Shatavari ghrita is used for this procedurewhich is declared as Vrisyatama by acharya Charaka. EVALUVATION THE EFFICASY OF SHATAVARIGRITHA MATRABASTI IN KSHEENASHUKRA 5
  21. 21. Objectives So present study entitled “EVALUATION OF THE EFFICACY OFMATRABASTI IN KSHEENA SHUKRA” is undertaken.OBJECTIVES OF THE STUDY 1. To evaluate the efficacy of Matrbasti with Shatavari ghrita enriching Bahulatwa in Ksheena Shukra. 2. To evaluate the efficacy of Matrbasti with Shatavari ghrita enriching Bahutwa in Ksheena Shukra.. EVALUVATION THE EFFICASY OF SHATAVARIGRITHA MATRABASTI IN KSHEENASHUKRA 6
  22. 22. REVIEW OF LITRETURE HISTORICAL REVIEWKARMABASTI KARMA Matrabasti is a vikalpa of Anuvasana basti which is a variety of Basti, sohistorical review is done along with Basti here. Charaka Samhita1: The scattered references regarding Basti are available invarious chapters of Charaka Samhita, but in Siddhisthana out of 12 chapters, 8 chapterscontribute to Basti. The first two chapters of Siddhisthana deals with properties of Bastisamyak yoga, Ayoga lakshanas, indications and contraindications of Basti. This denotesthe importance of Basti in the field of Panchakarma. Susruta Samhita2: In Susruta Samhita, four chapters (35th-38th) have beendevoted completely for the description of the Basti in Chikitsasthana. In which detailedinformation regarding Bastinetra, indication, contra-indications, complications,classification of Basti etc are available. Ashtanga Sangraha3: 28th chapter of Sutrasthana has been devoted to Basti only.In this chapter, classification, indication, contra-indication, dosage, process ofadministration etc. have been described in detail. Also four chapters of Kalpasthana havebeen contributed to Basti. In these chapters, description regarding importance of Basti,different types of Basti, Sneha Basti Vyapad etc are available. Ashtanga Hridaya4: In this Samhita, 19th chapter of Sutrasthana Basti Vidhi and4th and 5th chapter of Kalpasthana named as Basti Kalpa and Basti Vyapada Siddhiexplain the every aspect of Basti. 7 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  23. 23. REVIEW OF LITRETURE Kashyapa Samhita5: In Kashyapa Samhita, Basti has been explained in detail inSiddhisthana and Khilasthana. He equated Basti to Amruta. Bhela Samhita6: In Bhela Samhita, description of Basti is available in fourchapters of Siddhisthana namely Bastimatriyasiddhi, Upakalpasiddhi, Phalamatrasiddhiand Dasha Vyapadika Bastisiddhi. Chakradatta7: In this text, two chapters named Anuvasanadhikara andNiruhadhikara are dealt with Anuvasana and Niruha Basti respectively. Vangasena8: Vangasena has devoted “Basti Karmadhikara” chapter fordescription of Basti. Sharangadhara Samhita9: Three chapters of Uttarakhanda namely Basti KalpanaVidhi, Niruha Basti Kalpana Vidhi and Uttara Basti Kalpana Vidhi described variousaspects of Anuvasana Basti, Niruha Basti and Uttara Basti respectively. As the time progressed in the recent times authors of Ayurveda has alsocontributed for the Bastikarma by modifying the Bastiyantra, i.e. replacing the olderequipments by using rubber or plastic materials. The fundamental doctrines of Ayurveda have their firm roots in the Vedas. So, thepresent study necessitates tracking down all related aspects of Retas and Vajikarana fromthe Vedas. The Vedas: In Rigveda the term Retas finds an extensive coverage in the context ofreproduction and has been described as the Sara of all Dhatus. The term Retas has beenderived from "Ri Gatiresanayoh Sruribhyam Tat Ca”. Retas is also described as one,which flows and has a stream or current (alike water) . The simile to water is due to the 8 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  24. 24. REVIEW OF LITRETUREfact that water exhibits motion, and plays a prime role in germination, nourishment andgrowth of plants and Retas has similar attributes in humans. Papakarma has beendescribed as an etiological factor for Retodusti. Retas has been described as one which,when placed in the female vagina, unites with Sonita (female reproductive factor) to formGarbha. Virya is used synonymous to Retas (Rasarupam Retah Viryam). "Retah PrajananaSamartham,Viryam Sincitam",which means Retas is that part of Virya which has theability to produce offsprings. The word Virya has also been used in a broad sense todenote Paurusa" (manliness), Bala (strength), and Shakti (energy), Samarthya (capacityor power) The word Shukra denotes the male reproductive factor and in a broad sensestands for physical qualities like Deepta (bright), Nirmala (pure / spotless), Shubhra,Shveta and Shukla (white). Other than Shukra, the related anatomical structures likeSisna, Vrsana, Viryavahini nadi are described in Atharvaveda. Clinical aspects ofVajikarana like Madhuvidya, Garbhadana, Pumsavana, Garbhabramhana andKlibikarana, Garbhadosa Nivarana and surgical expertiese of AsviniKumaras are foundin different contexts in the management of infertility. In Atharvaveda in the context, when Varunadeva’s Virya had decreased, there isan instant of digging of the some medicine by Gandharva, which gives excitement toUpastha.. In the same sookta after medicine, mantra has been written, which has gotVajeekarana power. Brahmana and Upanishad : The formation of Garbha by the simultaneous entry ofShukra and Jyoti has been described in Taittiriya Aranyak . Shukra has been ascribed 9 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  25. 25. REVIEW OF LITRETUREwith divinity as is denoted by the terms such as Parabrahma, Agni (fire), Vayu (air),Surya (sun), Candra (moon), Apa (celestial water), Prajapati (creator) . Dual functions ofPenis have been described as Retosarjana (ejaculation of semen) and Mutravisarjana(micturition). Brhadaranyak Upanisad contains descriptions pertaining to Sexology. Thetechnique of withholding the breath so as to check semen flow during coitus and theresulting pregnancy has been described. Nirukta and Puranas: The dominance of Shukra and Shonita are said to be theresponsible factors for male and female progeny respectively. Twins are said to be bornwhen there is splitting of Shukra. Garuda Purana describes various recipes havingspermatopoeitic activity. Vidyapaharana (stealing others knowledge / work) is said to bea cause for sterility or infertility, which is the final outcome of Shukra Kshaya. Ramayana: The word Virya finds a mention at various contexts to denote strengthand power. Also there is illutration of Putrayestiyagya organized by emperor Dasratha tohave a progeny. Mahabharata: The terms Reta and Virya are preferentially used to denote semenas against Shukra. The story related to the birth of Dhrtarastra, Pandu, Vidura, Pandavas,and Kaurava reveals gross deformity in Shukra and its management. Kama Sutra: This being a comprehensive work on love and sex, describes sexuallove both as a science and as an art and therefore lays emphasis on the techniques of lovemaking, power and pleasure but lacks single meaning in the description of the termsShukra, Virya or Retas. The word Retas has been very sparsely used. However, thecommentator of KamaSutra, Yasodhara takes privilege to describe these terms. At the 10 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  26. 26. REVIEW OF LITRETUREcontext of Viryam Alpam’ he comments as either reduced activity or scarcity of ShukraDhatu thus, stating Shukra as a synonym of Virya. Reproduction is said to be possibleonly in the presence of Shukra Dhatu. The concept of Stri Shukra is also discussed.Samhita Period (1000B.C.-100A.D.) Samhita Period Charakacharya deals with Shukra Dosha in the YonivyapatChikitsa Adhyaya of Charaka Samhita10. Sushruta and Vagbhata have explained aboutShukra Dosha in Sharira Sthana11. Among Laghutrayees, only Sharngadhara has dealt thetopic of Shukra Dosha in the chapter of Roga Ganana, in Poorvakhanda12, Bhava Mishrahas mentioned only about Shukra Dhatu13.VYUTPATTI AND PARIBHASHABastiThe word Basti is derived form ‘bas + tich’ and is masculine gender.“Basu nivase”14 - Means residence.“Bas-aachadane” - That which gives covering“Bas vasane surabhikarane” - That which gives fragrance“Basti vaste aavrunothi moothram” - That which covers the urine.“Nabheradhobhage mootradhare” - The position of basti is just below the nabhi (umbilicus) and is the collecting organ of urine in the body i.e. urinary bladder. In the context of Panchakarma the term Basti is used in different meaning.“Bastina deeyate iti vasti”15“Bastibhir deeyate yasmat tasmat bastiriti smritha”16“Bastina deeyate bastini va Purvamanyattavasto basti”17 11 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  27. 27. REVIEW OF LITRETUREMatrabasti“Hraswaya snehapanasya matrayaha yojitaha samaha”18 Matrabasti is a type of Anuvasana which is having main ingredient sneha which isadministered in the hraswamatra. The word Basti gives the meaning of urinary bladder.As it is used as a device for Bastikarma. In Panchakarma therapy the term Basti is usedto designate the procedure. 12 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  28. 28. REVIEW OF LITRETURESHAREERA The word shareera comprises both structural and functional aspects of the body.As focus of this study is on Bastikarma, a discussion on the anatomy and physiology ofrectum where these procedures are applied is necessary prior to the discussion on theanatomy and physiology of Reproductory system which is the site of this disease. Guda Shareera In the context of Arsaroga Susruta has explained in detail about the anatomicalstructure of guda. Guda is a part, which is the extension of sthoolantra with 41/2 angulain length. It has got 3 valis (parts) named as Gudavalitrayam.19 Pravahini – That which does pravahana. Visarjini – That which does visarajana. Samvarani – That which does samvarana. Gudostha is a structure present about a distance of 1½ yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1 angula from gudostha. The width of each vali will be 1 angula and of the colour of elephant’s palate.20 Charaka considered uttaraguda and adharaguda while describing about the koshtangani. The modern commentators consider them as rectum and anus respectively.21 All acharyas have considered guda as one among the dashajeevitha dhamani and also one among the bahyasrotas.22-23 The rectum forms the last 15cm of digestive tract and is an expandable organ for the temporary storage of fecal material. Movement of fecal material into the rectum triggers the urge to defecate. 13 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  29. 29. REVIEW OF LITRETURE The last portion of the rectum, the ano-rectal canal, contains small longitudinal folds, the rectal columns. The distal margins of rectal columns are joined by transverse folds that mark the boundary between columnar epithelium of the proximal rectum and a stratified squamous epithelium like that in the oral cavity. Very close to the anus or anal orifice, the epidermis becomes keratinized and identical to the surface of the skin. There is a network of veins in the lamina propria and submucosa of the ano- rectal canal. The circular muscle layer of the muscularis externa in the region forms the internal sphincter and is not under voluntary control. The external anal sphincter guards the anus and is under voluntary control. Pudental nerves carry the motor commands.24Pakwashaya / Large intestine Susrutha25 and Vagbhata26 opine pakwashaya as one of the ashaya. According toArunadatta pakwashaya is the seat of pakwa anna i.e. that which attains pureeshatha.27Charaka and Vagbhata considered this as one among the koshtangas.28,29,30Sharangadhara has specified the location of pakwashaya (pavanasaya) as below the Tilai.e. the liver.31 The horseshoe shaped large intestine or large bowel begins at the end of ileumand ends at anus. Average length is about 1.5 meters and width of 7.5cms. It is dividedinto 3 parts: - Caecum – T portion (pouch like) Colon – Large portion. Rectum – The last – 15 cm portion. 14 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  30. 30. REVIEW OF LITRETURE The caecum collects and stores the chyme and begins the process of compaction.Colon is being subdivided into ascending, transverse, descending and sigmoid colon. Themajor characteristics of colon are the lack of villi. The abundance of goblet cells,presence of distinctive intestinal glands and mucosa does not exist produces anyenzymes. The reabsorption of water is an important function of large intestine (75%) andalso absorbs number of other substances that remain in the fecal matter or that weresecreted into the digestive tract along its length like Vit. K, B5, biotin, urobilinogen, bilesalts and toxins.32Ksheena ShukraNIRUKTI Acharya Susruta and Vagbhata mentioned the eight types of Shukra Dosha, whereKsheena Shukra is considered one of them. 33, 34The term Ksheena Shukra comprise softwords Ksheena and Shukra. The word Ksheena is originated from the dhatu “kshi” with“ktha” pratyaya which means diminished, wasted, expended, lost, destroyed, worn awaywaning, weakened, injured, broken, torn, emaciated, feeble. Dalhana the commentrator of Susruta Samhita explains it as “Kshinata hinashaktitwam” i.e. loss of strength to have progeny.35 The synonyms of ksheena are durbala, krusha, kshama, tanu, klata, talina,amamsa and pelava. In neuter gender shukra means bright, clear, pure etc. However, inrelation to the medicine it is stated as Majjatsamudbhavam, which means the thingproduced by the Majjadhatu. There are many number of synonyms used for shukra in theclassics such as majjajatadhatu, pumsatwam, retah, beejam, veeryam, pourusham,tejah, indriyam, annavikarah, Vaji, majjarasah, rohanam, balam. Hence the term 15 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  31. 31. REVIEW OF LITRETUREKsheena Shukra can be taken or any decrease in the shukra either Bahulatwa or Bahutwa.Thus the term Ksheena Shukra seems to be analogue with the term Oligospermia (Oligo-less in number, Spermia- Sperms).Paribhasha KsheenaShukra may be defined as a variety of shukradosha where in due to thenidana sevana the vitiated vata and pitta dosha inturn vitiate shukra dhatu and causesdecrease of it either quantitatively or qualitatively. In KsheenaShukra the Shukra is found moderately low or decreased in the middleage due to some etiology. In this variety the growth, pubertal development and the levelof Shukra may be normal earlier and the deficiency occurs later because of continuousprone to further etiological factors. Oligospermia is defined as the sub-normal concentration of sperm in the penileejaculate, the semen (Stedmann, Medical Dictionary, the normal range of sperm countbeing 20-250 million/ml). Hence the conditions where the sperm count is less than20million/ml (W.H.O. parameter) is considered as Oligospermia. It is also called asOligozoospematism.SHAREERAShukra Vaha Srotas The Srotos (channels) through which the Poshana (nutrition) of Shukra dhatu isgoing to takes place is called as Shukravaha srotas36. The moola (site of origin) of shukravaha srotas is vrushana (testis) and shepha (phallus) according to Charaka Samhita37,where as in Sushruta Samhita it is stated as vrushana and sthanau (breasts)38. Ganekar in 16 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  32. 32. REVIEW OF LITRETUREhis teeka (AyurvedaRahasyaDeepika) says that the word sthanau added here is used independently for sthanyavahasrotas. Before going through the disease entity of Ksheena Shukra it is essential to knowthe exact anatomical position, physiological function, production and the factors those arehelping in production of shukra. Ayurveda has the identified functional system regardingthe dhatu nirmana and poshana. According to it there are many srotas , whose function isto provide nutrition of dhatu and also formation of dhatu. Also Shukra dhatu is generatedfrom Majja dhatu as per Uttaratora dhatu nirmana prakriya. Modern science has theshukra or the process of spermatogenesis in the seminiferous tubules forms sperm.CONCEPT OF SHUKRA The term Shukra has got a very wider concept in Ayurveda. A careful appraisal ofthe concept of Shukra is propounded by the classical Ayurvedic texts suggest that thoughthe term Shukra, Virya and Retas are generally used as synonyms and more or less usedto denote semen, sperm or androgen hormones. The word Sukra is derived from the Sanskrit root Suc-Klede. It means purity. Literally Sukra means one, which is in pure state, bright and white. It can bedefined as the thing belonging to man, brings about conception when deposited in thewomb of a woman, during sexual act.In Amarakosa we get many synonyms. They are 1. Paurusam (virility): The character which is inherent in Purusa. (man) 2. Pumsatva (Fertility): The fertility factor essential for conception. 17 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  33. 33. REVIEW OF LITRETURE 3. Ananda Samudbhava (Born out of pleasure): This indicates the matter which is ejaculated at the time of orgasm or extreme pleasure. 4. Majja Samudbhava (Born out of Majja): The matter, which is formed out of Majja Dhatu. 5. Virya (Potency): The factor responsible for any action. 6. Retas (Ejaculate): The matter, which is ejaculated at the time of sexual intercourse. 7. Tejah (Resplendent): That which shines. 8. Bijam (Seed): This has the capacity to give rise new offspring.Physical Characteristics of Sukra: State : Drava Consistency : Bahalata, Picchilata and Snigdhata Nature : Sara, Soumya40 Colour : Sukla, Sphatika and Taila-Ksaudra Density : Guru Taste : Madhura Smell : Smell of Madhu or AvisraFormation of Sukra: Ayurvedic classics mention the formation of Sukra in three ways. i) Formed out of Mahabhuta ii) Formed out of Majja Dhatu iii) Formed from Ahara Rasa 18 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  34. 34. REVIEW OF LITRETUREi) Formed out of Mahabhuta: Sukra is considered as Soumya. Hence it is derived from Soma or Jalamahabhuta.41ii) Formed out of Majja Dhatu: Sukra Dhatu is named at last in the group of Sapta Dhatus. It is produced from Majja Dhatu. Sukra is the essence of Majja. Vayu and Akasa Mahabhutas produce porosity in Asthi Dhatu and from these pores Sukra Oozes out like water from a new earthen pitcher. 42iii) Formation of Sukra from Ahara Rasa: Ksira Dadhi Nyaya says previous Dhatu is the precursor for the next and higher dhatu. Thus from Anna Rasa, Rasa Dhatu is formed and from Rasa Dhatu, Rakta Dhatu is formed and so on, till Majja is transformed into Sukra Dhatu.Functions of Sukra: Garbhotpadana (Reproduction) is the predominant, superior and the mostimportant function of Sukra according to many authorities.43 The person with the excellence of Sukra is known as Sukra Sara Purusa. He ishaving Soumya nature, having gentle look, eyes appearing as if filled with milk,extremely happy, his teeth which are unctuous (Snigdha), round (Vrtta), dense (Sara), andeven (Samasamhata), he is pleasant (Prasanna), unctuous (Snigdha) has good complexionand voice. His appearance is dazzling (Bhrajisnu) has large buttocks (Maha sphika) He isloved by women (Stripriya), virile (Upabhogabalavanta), endowed with pleasure,prosperity (Aisvarya), health (Arogya), wealth (Vitta), honour (Sammana) and children(Apathya).44 19 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  35. 35. REVIEW OF LITRETURE When we go through the classical description of Sukra, its production, functionsand physical characteristics it seems both semen, as well as androgen resembles the wordSukra in one or other aspect.Table No. 1. Showing the Shuddha Shukra Lakshanas45 - 49Sl.No. Lakshanas CS SS AH BP01 Snigdha + + + +02 Ghanam/Baalam - + + +03 Picchilam + - - -04 Madhuram + + + +05 Avidahi + - - -06 Dravam - + - +07 Spatikabha + + - +08 Madhu gandhi - + + +09 Tailanibha - + + +10 Kshoudranibha - + + +11 Sowmyam - - - +12 Guru - - + -13 Shuklam - - + -14 Bahu - - + -15 Ghritanibha - - + +16 Sita - - - +17 Balapustikara - - - + 20 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  36. 36. REVIEW OF LITRETURESperm49: Each spermatozoon has three distinct regions: (1) the head, (2) the middlepiece, and (3) the tail . The head is a flattened ellipse containing a nucleus with densely packedchromosomes. At the tip of the head is the acrosomal cap, a membranous compartmentcontaining enzymes essential to the process of fertilization. During spermiogenesis,saccules of the Golgi apparatus fuse and flatten into an acrosomal vesicle that ultimatelyforms the acrosomal cap. A short neck attaches the head to the middle piece. The neck contains bothcentrioles of the original spermatid. The microtubules of the distal centriole arecontinuous with those of the middle piece and tail. Mitochondria in the middle piece arearranged in a spiral around the microtubules. Mitochondrial activity provides the ATPthat is needed to move the tail. The tail is the only flagellum in the human body. A flagellum, an organelle,moves a cell from one place to another. Whereas cilia beat in a predictable, wavingfashion, the flagellum of a spermatozoon has a complex, corkscrew motion. 21 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  37. 37. REVIEW OF LITRETUREUnlike other, less specialized cells, a mature spermatozoon lacks an endoplasmicreticulum, Golgi apparatus, lysosomes, peroxisomes, inclusions, and many otherintracellular structures. Because the cell does not contain glycogen or other energyreserves, it must absorb nutrients (primarily fructose) from the surrounding fluid.Semen50 A typical ejaculation releases 2-5 ml of semen. This volume of fluid, called anejaculate, contains: • Spermatozoa. A normal sperm count ranges from 20 million to 100 million spermatozoa per milliliter. • Seminal fluid. Seminal fluid, the fluid component of semen, is a mixture of glandular secretions with a distinct ionic and nutrient composition. A typical sample of seminal fluid contains the combined secretions of the seminal vesicles 22 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  38. 38. REVIEW OF LITRETURE (60 percent), the prostate (30 percent), the sustentacular cells and epididymis (5 percent), and the bulbourethral glands (less than 5 percent). • Enzymes. Several important enzymes are present in the seminal fluid, including (1) a protease that may help dissolve mucous secretions in the vagina; (2) seminalplasmin, an antibiotic enzyme from the prostate gland that kills a variety of bacteria, including Escherichia coli; (3) a prostatic enzyme that converts fibrinogen to fibrin after ejaculation; and (4) fibrinolysin, which subsequently liquefies the clotted semen.Shukra as a Hormone When we look into Acharya Sushrutha’s words the Shukra does not show itsappearance in Balaka avastha but as the age precedes it shows its presence. This has beencompared with that of an unblossomed bud that does not emit any smell, but as the timeproceeds, when it gets blossomed, and then the smell can be felt. So on emitting of smellin bud, does not indicate “the lack of smell in the bud”. In the same way the Shukra thatshows its appearances, as age proceeds do not indicate the absence of Shukra in balakas.However, the interesting point here to note is the presence of Shukra shows through theappearance of hairs on face and genital regions etc. in men and development of breastsand vagina, appearance of hairs on genital organs, and with the appearance ofmenstruation in women. AstangaSangrahakara has mentioned the age as 17yr for boysand 12yr for girls for appearance of these changes and also mentions that it will remainup to 70 years in men and 50 years in women. But what is this factor responsible forthese changes? When we think of puberty i.e., the onset of reproductive life, it is the timewhen gonads develop endocrine and gametogenic functions. 23 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  39. 39. REVIEW OF LITRETURE Steroidogenesis has been demonstrated in the human testis starting from 7th weekof gestation. Plasma testosterone levels of the male embryo then rise until late inpregnancy, and fall to concentration to those of females. During the first 3months afterbirth testosterone levels rise, then falls by one year and remain low (but are slightlyhigher in boys than in girls) until the onset of puberty. At about 11-12 years of age, thepituitary glands start to secrete gonadotrophins, thus stimulating testosterone production.Normally plasma testosterone concentrations reach adult level at approximately 17 yearsof age. The adult level is maintained until late middle age and then decrease slowly at theage of 70.The physiological effects of testosterone include; • The virilizing effects on genitalia • Stimulating of beard, axillaries of pubic hair • Enlargement of larynx and thickening of vocal cordsThe main functions attributed to Shukra are – • Praharsha (excitement, satisfaction, romantic or orgasm) • Dhairya (psychophysiological daring, not fearful) • Priti (affection towards opposite sex, instinct, sexual urge or love) • Chybvana (to secrete, cause to move to come out) • Bala (psycho physiological energy or strength, repeated action) • Garbotpatti (fertility)The malfunctioning, hypo functioning or defects in the above said function are directlyimperative when Shukra is disturbed due to various causes viz., apraharsha, adhairya,glani, atusti, dowrbalya etc. Maximum of the above said functions infer about the 24 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  40. 40. REVIEW OF LITRETUREandrogenic nature of shukra. The dominant proto element of Shukra is Apa along withagni vayu and prithvi. So decreased share of Aptatwa in Shukra or excessive agni tatwaleads to the decrease of quantity and quality in the same. The literal meaning ofimpotence in Greek is “lack of water”. The hormonal deficits are the facts to lead tosexual dysfunction here. Shukra dhara kala pervades the whole body of the living being; it can be taken asthe gonadal secreting membrane, testicular germinal epithelium and accessory sex glandsfunctioning in total. Male hormones are produced locally in the testis, systemically fromadrenal glands and regulated through hypo thalamo pituitary gonadal axis. Disturbance inany of the stage here leads to dysfunction in sexual arousal or response. Impotency and lack of desire for sexual act (klaibya and aharshana) are the majorconditions caused by the morbidity of Shukra. Both of the above are purely under controlof the androgen (testosterone) and now here related to seminal fluid. AstangaHrudayakara above states those upto 17th years of age is called as Balyavastha. At thisage, there is development of dhatu, indriya and ojas in the body. From19th till 70 years isthe madhyama vastha, after this period there will be decrease in these factors.Stree Shukra The human body is the conglomeration of seven dhatus, the last being ShukraDhatu and the women also should possess the Shukradhatu in their body. We get variousreference regarding Shukra associated with females in our classics, but the interestingthing to note here is that the Shukra in females is not responsible for garbhotpadana as inmales i.e., it is devoid of the beeja bhaga responsible for conception. During the coitus,stree also ejaculate shukra, but it is not capable for garbhadharana. According to western 25 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  41. 41. REVIEW OF LITRETUREview the only substance which can be possibly but forcibly expelled (squittered orejaculated) is the thin fluid which fills the glandular vestibular is major, ( bartholinglands) at the onset of orgasm. These glands begin to secrete immediately sexualexcitement manifests it self. This is the secretion that has been mentioned by our ancientscholars which has got nothing to do with conception. Another point of interest is that theappearance of axillary and pubic hair, breath in females is due to Shukra. Adrenalandrogens are continuously secreted by the adrenal cortex in both males and females. Theadrenal androgens also exist mild effects in the female, not only before puberty but alsothrough out the life. Much of the growth of the pubic and axillary hair in the femaleprobably results from the action of these hormones. Considering the above points StreeShukra can be considered as some glandularsecretions along with the hormones. 26 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  42. 42. REVIEW OF LITRETURETHE REPRODUCTIVE SYSTEM OF THE MALE51The principal structures of the male reproductive system are - Proceeding from a testis,the sperm cells, or spermatozoa, travel within the epididymis, the ductus- deferens/vasdeferens, the ejaculatory duct and the urethra before leaving the body. Accessory organs—the seminal vesicles, the prostate gland, and the bulb-urethralglands, secrete into the ejaculatory ducts and urethra. The external genitalia consist of theScrotum- that encloses the testes, and the Penis - an erectile organ through which thedistal portion of the urethra passes.The Spermatic Cords51 The spermatic cords consist of fascia layers, tough connective tissue, and muscleenclosing the blood vessels, nerves, and lymphatics that supply the testes. Each spermatic 27 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  43. 43. REVIEW OF LITRETUREcord contains a ductus deferens and its deferential artery, a testicular artery, thepampiniform (pampinus, tendril + forma, form) plexus of a testicular vein, and branchesof the genitofemoral nerve from the lumbar plexus. Each spermatic cord begins at thedeep inguinal ring, the entrance to the inguinal canal (a passageway through theabdominal musculature). After passing through the inguinal canal, the spermatic cord exitat the superficial inguinal ring and descends into the scrotum. The inguinal canals form during development as the testes descend into thescrotum; at that time, these canals link the scrotal cavities with the peritoneal cavity. Innormal adult males, the inguinal canals are closed, but the presence of the spermaticcords creates weak points in the abdominal wall that remain throughout life. As a result,inguinal hernias, are relatively common in males.SCROTUM & TESTESThe Scrotum and the Position of the Testes The scrotum is divided internally into two chambers. A raised thickening in thescrotal surface known as the perineal raphe marks the partition between the two. Eachtestis lies in a separate compartment, or scrotal cavity. Because the scrotal cavities areseparated by a partition, so that infection or inflammation of one testis does not ordinarilyspread to the other. A narrow space separates the inner surface of the scrotum from theouter surface of the testis. The tunica vaginalis, a serous membrane, lines the scrotalcavity and reduces friction between the opposing parietal (scrotal) and visceral(testicular) surfaces. The tunica vaginalis is an isolated portion of the peritoneum that 28 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  44. 44. REVIEW OF LITRETURElost its connection with the peritoneal cavity after the testes descended, when the inguinalcanal closed.SCROTUM The Scrotum consists of a thin layer of skin and the underlying superficialfascia. The dermis contains a layer of smooth muscle, the dartos. Resting muscle tone inthe dartos causes the characteristic wrinkling of the scrotal surface. A layer of skeletalmuscle, the cremaster muscle, lies deep to the dermis. Contraction of the cremasterduring sexual arousal or in response to changes in temperature tenses the scrotum andpulls the testes closer to the body.Normal sperm development in the testes requires temperatures about 1.1°C (2°F) lowerthan that elsewhere in the body. The cremaster relaxes or contracts to move the testesaway from or toward the body as needed to maintain acceptable testicular temperatures.When air or body temperature rises, the cremaster relaxes and the testes move away fromthe body. Cooling of the scrotum, as occurs when a man enters a cold swimming pool,results in cremasteric contractions that pull the testes closer to the body and keeptesticular temperatures from falling. The scrotum is richly supplied with sensory and motor nerves from thehypogastric plexus and branches of the ilioinguinal nerves, the genitofemoral nerves, andthe pudendal nerves. The vascular supply to the scrotum includes the internal pudendalarteries (from the internal iliac arteries), the external pudendal arteries (from the femoral 29 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  45. 45. REVIEW OF LITRETUREarteries), and the cremasteric branch of the inferior epigastric arteries (from the externaliliac arteries). The names and distributions of the veins follow those of the arteries.Testes or Vrishana The testis is the male gonad, it is suspended in the scrotum by the spermatic cord,and left testis is is slightly lower than the right.Synonyms: Anda, Phala, Mushka, Vrushana and Granthi It is two angulies in size and is originated from the essence of mamsa, raktha,kapha and medas during the foetal age. It has 2 peshis, 1 kurcha and one sevani, venousdrainage from veerya vahinisira.52 - 57Structure of the Testes Each testis has the shape of a flattened egg that is roughly 5 cm (2 in.) long, 3 cm(1.2 in.) wide, and 2.5 cm (1 in.) thick. Each has a weight of 10-15 g (0.35-0.53 oz). Thetestes hang within the scrotum, a fleshy pouch suspended inferior to the perineum,anterior to the anus and posterior to the base of the penis. Deep to the tunica vaginalis covering the testis lies the tunica albuginea, a denselayer of connective tissue rich in collagen fibers. The fibers of this network arecontinuous with those surrounding the adjacent epididymis. The collagen fibers of thetunica albuginea also extend into the substance of the testis, forming fibrous partitions, orsepta. These septa converge toward the area closest to the entrance of the epididymis.This region, located at the superior end of the testis, is called the mediastinum of the 30 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  46. 46. REVIEW OF LITRETUREtestis (or mediastinum testis). The connective tissues in this region support the bloodvessels and lymphatic that supplies the testis and the efferent ducts, which transportsperm to the epididymis.Histology of the Testes The septa subdivide the testis into a series of lobules. Roughly 800 slender, tightlycoiled seminiferous tubules are distributed among the lobules. Each tubule averagesabout 80 cm (31 in.) in length, and a typical testis contains nearly one-half mile ofseminiferous tubules. Sperm production occurs within these tubules. Eachseminiferous tubule forms a loop that is attached to a straight tubule (tubuli recti) at themediastinum of the testis. The straight tubule is connected to a maze of passagewaysknown as the rete testis. Fifteen to twenty large efferent ducts connect the rete testis tothe epididymis. Because the seminiferous tubules are tightly coiled, most histologicalpreparations show them in transverse section. Each tubule is surrounded by a delicatecapsule, and loose connective tissue fills the spaces between the tubules. Numerous bloodvessels and large interstitial cells (cells of Leydig) are there within those spaces.Interstitial cells are responsible for the production of androgens, the dominant sexhormones in males. Testosterone is the most important androgen. 31 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  47. 47. REVIEW OF LITRETURESpermatogenesis Sperm cells, or spermatozoa, are produced by the process of spermatogenesis.Spermatogenesis begins at the outermost layer of cells in the seminiferous tubules andproceeds toward the tubular lumen. Stem cells called spermatogonia divide by mitosis toproduce generations of daughter cells, some of which differentiate into spermatocytes.Through meiosis, a specialized form of cell division involved only in the production ofgametes (sperm in males, ova in females), spermatocytes give rise to spermatids. At each step in this process, the daughter cells move closer to the tubular lumen.The spermatids subsequently differentiate into spermatozoa. This differentiation process,called spermiogenesis, ends as the physically mature spermatozoa lose contact with thewall of the seminiferous tubule and enters the fluid in the lumen. Spermiogenesis is thelast step in spermatogenesis. Each seminiferous tubule contains spermatogonia,spermatocytes at various stages of meiosis, spermatids, spermatozoa, and largesustentacular cells (or Sertoli cells). Sustentacular cells are attached to the tubular capsuleand extend toward the lumen between the other cell types. 32 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  48. 48. REVIEW OF LITRETUREMitosis and Meiosis Mitosis and meiosis differ significantly in terms of the events that take place inthe nucleus. Mitosis is part of the process of somatic cell division, which produces twodaughter cells, each containing 23 pairs of chromosomes. Each pair consists of onechromosome provided by the father and another by the mother at the time of fertilization.Because the daughter cells contain both members of each chromosome pair (for a total of46 chromosomes), they are called diploid cells. Meiosis involves two cycles of celldivision (meiosis I and meiosis II) and produces four cells, each of which contains 23 33 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  49. 49. REVIEW OF LITRETUREindividual chromosomes. Because these cells contain only one member of each pair ofchromosomes, they are called haploid (haplo, single) cells. As a cell prepares to beginmeiosis, DNA replication occurs within the nucleus as if the cell were about to undergomitosis. As prophase of the first meiotic division, meiosis I, arrives, the chromosomescondense and become visible. As in mitosis, each chromosome consists of two duplicatechromatids. The corresponding maternal and paternal chromosomes now come together,an event known as synapsis. Synapsis involves 23 pairs of chromosomes; each memberof each pair consists of two chromatids. A matched set of four chromatids is called atetrad (tetras, four). Some exchange of genetic material can occur between thechromatids of a chromosome pair at this stage of meiosis. This exchange, calledcrossing-over, increases genetic variation among offspring. The nuclear envelopedisappears at the end of prophase I. As metaphase I begins, the tetrads line up along the metaphase plate. As anaphase I begins, the tetrads break up, and the maternal and paternalchromosomes separate. As anaphase proceeds, the maternal and paternal components arerandomly distributed. As a result, telophase I ends with the formation of two daughtercells containing unique combinations of maternal and paternal chromosomes. Both cellscontain 23 chromosomes. Because the first meiotic division reduces the number ofchromosomes from 46 to 23, it is called a reductional division. The cell then proceedsthrough prophase II, metaphase II, and anaphase II. During anaphase II, the duplicatechromatids separate. Telophase II thus yields four cells, each containing 23chromosomes. Because the number of chromosomes has not changed, meiosis IIrepresents an equational division. We shall now consider meiosis and the production of 34 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  50. 50. REVIEW OF LITRETUREspermatozoa. The mitotic divisions of spermatogonia produce primary spermatocytes. Asmeiosis begins, each primary spermatocyte contains 46 individual chromosomes. At theend of meiosis I, the daughter cells are called secondary spermatocytes. Every secondaryspermatocyte contains 23 chromosomes, each of which consists of a pair of duplicatechromatids. The secondary spermatocytes soon enter prophase II. The completion ofmetaphase II, anaphase II, and telophase II yields four spermatids, each containing 23chromosomes. 35 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  51. 51. REVIEW OF LITRETUREMeosis IIFor each primary spermatocyte that enters meiosis, four spermatids are produced.Because cytokinesis (cytoplasmic division) is not completed in meiosis I or meiosis II,the four spermatids initially remain interconnected by cytoplasmic bridges. Theseconnections assist in the transfer of nutrients and hormonal messages between the cells,thus helping ensure that the cells develop in synchrony. The interconnections are notbroken until the last stages of physical maturation. 36 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  52. 52. REVIEW OF LITRETURESpermiogenesis Each spermatid matures into a single spermatozoon, or sperm cell. Thismaturation process is called spermiogenesis. Developing spermatocytes undergoingmeiosis and spermatids undergoing spermiogenesis are not free in the seminiferoustubules. Instead, they are surrounded by the cytoplasm of the sustentacular cells. Asspermiogenesis proceeds, the spermatids gradually develop the appearance of maturespermatozoa. At spermiation, a spermatozoon loses its attachment to the sustentacularcell and enters the lumen of the seminiferous tubule. The entire process, fromspermatogonial division to spermiation, takes approximately 9 weeks.Spermatogenesis and Sustentacular CellsSustentacular cells play a key role in the process of spermatogenesis. These cells have siximportant functions that directly or indirectly affect mitosis, meiosis, and spermiogenesiswithin the seminiferous tubules: 1. Maintenance of the blood-testis barrier. The seminiferous tubules are isolated from the general circulation by a blood-testis barrier comparable in function to the blood-brain barrier. Transport across the sustentacular cells is tightly regulated so that conditions in the lumenal compartment remain very stable. Tubular fluid is very different from the surrounding interstitial fluid. Tubular fluid contains high in androgens, estrogens, potassium, and amino acids. The blood-testis barrier is essential to preserving the differences between tubular fluid and interstitial fluid. In addition, developing spermatozoa contain sperm-specific antigens in their cell membranes. 37 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  53. 53. REVIEW OF LITRETURE 2. Support of mitosis and meiosis. Spermatogenesis depends on the stimulation of sustentacular cells by circulating follicle-stimulating hormone (FSH) and testosterone. Stimulated sustentacular cells then in some way promote the division of spermatogonia and the meiotic divisions of spermatocytes. 3. Support of spermiogenesis. Spermiogenesis requires the presence of sustentacular cells. These cells surround and enfold the spermatids, providing nutrients and chemical stimuli that promote their development. 4. Secretion of inhibin. Sustentacular cells secrete inhibin , a peptide hormone, in response to factors released by developing sperm. Inhibin, depresses the pituitary production of FSH and perhaps the hypothalamic secretion of gonadotropin- releasing hormone (GnRH). The faster the rate of sperm production, the greater the amount of inhibin secreted. 5. Secretion of androgen-binding protein. Androgen-binding protein (ABP) binds androgens (primarily testosterone) in the fluid contents of the seminiferous tubules. The production of ABP is stimulated by FSH. 6. Secretion of Müllerian-inhibiting factor. Müllerian-inhibiting factor (MIF) is secreted by sustentacular cells in the developing testes. This hormone causes regression of the fetal Müllerian ducts, passageways that in females participate in the formation of the uterine tubes and the uterus.The Male Reproductive Tract The testes produce physically mature spermatozoa that are, as yet, incapable ofsuccessful fertilization. The other portions of the male reproductive system are 38 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  54. 54. REVIEW OF LITRETUREresponsible for the functional maturation, nourishment, storage, and transport ofspermatozoa.The Epididymis 59 The epididymis lies along the posterior border of the testis. It is firm and can befelt through the skin of the scrotum. The epididymis consists of a tubule almost 7 meters(23 ft) long, coiled and twisted so as to take up very little space. It has (1) a head, (2) abody, and (3) a tail. The superior head is the portion of the epididymis proximal to themediastinum of the testis. The head receives spermatozoa from the efferent ducts thatconnect the rete testis to the epididymis. The body begins distal to the last efferent ductand extends inferiorly along the posterior margin of the testis. Near the inferior border ofthe testis, the number of convolutions decreases, marking the start of the tail. The tailrecurves and ascends to its connection with the ductus deferens. Sperm are storedprimarily within the tail of the epididymis.The epididymis has the following three functions: 1. It monitors and adjusts the composition of the tubular fluid. 2. It acts as a recycling center for damaged spermatozoa. 3. It stores spermatozoa and facilitates their functional maturation. It takes about 2 weeks for a spermatozoon to pass through the epididymis; during this period, the spermatozoon completes its functional maturation. Transport along the epididymis involves some combination of fluid movement and peristaltic contractions of smooth muscle. 39 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  55. 55. REVIEW OF LITRETUREThe Ductus Deferens After passing along the tail of the epididymis, the spermatozoa enter the ductusdeferens. Each ductus deferens, or vas deferens, is 40-45 cm (16-18 in.) long. It begins atthe tail of the epididymis and, as part of the spermatic cord, ascends through the inguinalcanal. Inside the abdominal cavity, the ductus deferens passes posteriorly, curvinginferiorly along the lateral surface of the urinary bladder toward the superior andposterior margin of the prostate gland. Just before the ductus deferens reaches theprostate gland and seminal vesicles, its lumen enlarges. This expanded portion is knownas the ampulla. The wall of the ductus deferens contains a thick layer of smooth muscle.Peristaltic contractions in this layer propel spermatozoa and fluid along the duct, which islined by a pseudostratified ciliated columnar epithelium. In addition to transportingsperm, the ductus deferens can store spermatozoa for several months. During this time,the spermatozoa remain in a state of suspended animation and have low metabolic rates.The junction of the ampulla with the duct of the seminal vesicle marks the start of theejaculatory duct. This short passageway (2 cm, or less than 1 in.) penetrates the muscularwall of the prostate gland and empties into the urethra near the opening of the ejaculatoryduct from the opposite side.The Urethra 60 The urethra of the male extends from the urinary bladder to the tip of the penis, adistance of 18-20 cm (7-8 in.). It is divided into prostatic, membranous, and penileregions. In males, the urethra is a passageway used by both the urinary and thereproductive systems. 40 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  56. 56. REVIEW OF LITRETUREThe Accessory Glands Important glands include the seminal vesicles, the prostate gland, and thebulbourethral glands. Major functions of these glandular organs, which occur only inmales, include(1) Activating the spermatozoa;(2) Providing the nutrients spermatozoa need for motility;(3) Propelling spermatozoa and fluids along the reproductive tract, mainly by peristalticcontractions; and(4) Producing buffers that counteract the acidity of urethral and vaginal contents.The Seminal Vesicles The ductus deferens on each side ends at the junction between the ampulla and theduct that drains the seminal vesicle. Each seminal vesicle is a tubular gland with a totallength of about 15 cm (6 in.). The body of the gland has many short side branches. Theentire assemblage is coiled and folded into a compact, tapered mass roughly 5 cm x 2.5cm (2 in. x 1 in.).The seminal vesicles are extremely active secretory glands with an epithelial lining thatcontains extensive folds. The seminal vesicles contribute about 60 percent of the volumeof semen. In particular, the secretion of the seminal vesicles contains (1) relatively highconcentrations of fructose, which is easily metabolized by spermatozoa; (2)prostaglandins, which may stimulate smooth muscle contractions along the male andfemale reproductive tracts; and (3) fibrinogen, which after ejaculation will form atemporary clot within the vagina. The secretions of the seminal vesicles are slightlyalkaline. 41 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  57. 57. REVIEW OF LITRETUREThe Prostate Gland The prostate gland is a small, muscular, rounded organ with a diameter of about 4cm (1.6 in.). The prostate gland encircles the proximal portion of the urethra as it leavesthe urinary bladder.The prostatic glands produce prostatic fluid, a slightly acidic solution that contributes 20-30 percent of the volume of semen. In addition to several other compounds of uncertainsignificance, prostatic secretions contain seminalplasmin, an antibiotic that may helpprevent urinary tract infections in males. These secretions are ejected into the prostaticurethra by peristaltic contractions of the muscular wall.The Bulbourethral GlandsThe paired bulbourethral glands, or Cowpers glands, are situated at the base of the penis,covered by the fascia of the urogenital diaphragm. The bulbourethral glands are round,with diameters approaching 10 mm (less than 0.5 in.). The duct of each gland travelsalongside the penile urethra for 3-4 cm (1.2-1.6 in.) before emptying into the urethrallumen. These are compound, tubuloalveolar mucous glands that secrete a thick, alkalinemucus. The secretion helps neutralize any urinary acids that may remain in the urethraand provides lubrication for the glans, or tip of the penis.The Penis 50 The penis is a tubular organ through which the distal portion of the urethra passes.It conducts urine to the exterior and introduces semen into the female vagina duringsexual intercourse. 42 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  58. 58. REVIEW OF LITRETUREIt is a organ of Shukravaha Srotos. It has one kurcha, one sevani and one peshi. Shustutamentions that one ligament starts from neck and heart moves downward by ending inMedhra.Synonym: Sepha, Upastha, Mehana, Linga, Dwaja, purushanendriya, Mani, Manikanda,Shishna, Mutrapatha etc.The penis is divided into three regions: (1) the root, (2) the body, and (3) the glans. The root of the penis is the fixed portion that attaches the penis to the body wall.This connection occurs within the urogenital triangle immediately inferior to the pubicsymphysis. The body (shaft) of the penis is the tubular, movable portion. Masses of erectiletissue are found within the body. The glans of the penis is the expanded distal end that surrounds the externalurethral meatus. The neck is the narrow portion of the penis between the shaft and theglans. The skin overlying the penis resembles that of the scrotum. The dermis contains alayer of smooth muscle, and the underlying loose connective tissue allows the thin skin tomove without distorting underlying structures. The subcutaneous layer also containssuperficial arteries, veins, and lymphatics. A fold of skin called the prepuce, or foreskin, surrounds the tip of the penis. Theprepuce attaches to the relatively narrow neck of the penis and continues over the glans.There are no hair follicles on the opposing surfaces, but preputial glands in the skin of theneck and the inner surface of the prepuce secrete a waxy material known as smegma.Unfortunately, smegma can be an excellent nutrient source for bacteria. Mildinflammation and infections in this region are common, especially if the area is not 43 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  59. 59. REVIEW OF LITRETUREwashed thoroughly and frequently. Most of the body of the penis consists of threecylindrical columns of erectile tissue. In the resting state, the arterial branches areconstricted, and the muscular partitions are tense. This combination restricts blood flowinto the erectile tissue. The smooth muscles in the arterial walls relax when NO(Nitricoxide)is released, at which time (1) the vessels dilate, (2) blood flow increases, (3) thevascular channels become engorged with blood, and (4) erection of the penis occurs. Theflaccid (nonerect) penis hangs inferior to the pubic symphysis and anterior to the scrotum,but during erection the penis stiffens and assumes a more upright position. The corporacavernosa extend along the length of the penis as far as the neck. The erectile tissuewithin each corpus cavernosum surrounds a central artery. The relatively slender corpusspongiosum surrounds the penile urethra. This erectile body extends from the superficialfascia of the urogenital diaphragm to the tip of the penis, where it expands to form theglans.Hormones and Male Reproductive Function The anterior pituitary releases follicle-stimulating hormone (FSH) and luteinizinghormone (LH). The pituitary release of these hormones occurs in the presence ofgonadotropin-releasing hormone(GnRH), a peptide synthesized in the hypothalamus andcarried to the anterior pituitary by the hypophyseal portal system. GnRH secretion occursin pulses rather than continuously. In adult males, small pulses occur at 60-90 minuteintervals. As levels of GnRH change, so do the rates of secretion of FSH and LH (andtestosterone, which is released in response to LH). Unlike the situation in women, whichwe will consider later in the chapter, the GnRH pulse frequency in adult males remainsrelatively steady from hour to hour, day to day, and year to year. As a result, plasma 44 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  60. 60. REVIEW OF LITRETURElevels of FSH, LH, and testosterone remain within a relatively narrow range throughoutadult life.FSH and Spermatogenesis In males, FSH targets primarily the sustentacular cells of the seminiferoustubules. Under FSH stimulation, and in the presence of testosterone from the interstitialcells, sustentacular cells (1) Promote spermatogenesis and spermiogenesis and (2) Secreteandrogen-binding protein (ABP).The rate of spermatogenesis is regulated by a negative-feedback mechanism involvingGnRH, FSH, and inhibin. Under GnRH stimulation, FSH promotes spermatogenesisalong the seminiferous tubules. Inhibin inhibits FSH production in the anterior pituitaryand may also suppress secretion of GnRH at the hypothalamus.LH and Androgen Production In males, LH causes the secretion of testosterone and other androgens by theinterstitial cells of the testes. Testosterone, the most important androgen, has numerousfunctions, such as -(1) Stimulating spermatogenesis and promoting the functional maturation of spermatozoa,(2) Affecting CNS function, including the influence of libido (sexual drive) and related behaviors;(3) Stimulating metabolism throughout the body, especially pathways concerned with protein synthesis and muscle growth; 45 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  61. 61. REVIEW OF LITRETURE(4) Establishing and maintaining the secondary sex characteristics, such as the distribution of facial hair, increased muscle mass and body size, and the quantity and location of characteristic adipose tissue deposits; and(5) Maintaining the accessory glands and organs of the male reproductive tract.Testosterone functions like other steroid hormones. It circulates while bound to transportproteins; gonadal steroid-binding globulin (GBG) carries roughly two-thirds ofcirculating testosterone, and the rest binds to albumins. A small amount of DHT(dihydrotestosterone) diffuses back out of the cell and into the circulation, and DHTlevels are usually about 10 percent of circulating testosterone levels. Testosteroneproduction begins around the seventh week of embryonic development and reaches apeak after roughly 6 months of development. As a result of this prenatal exposure totestosterone, the hypothalamic centers will respond appropriately when the individualbecomes sexually mature. The factors responsible for regulating the fetal production oftestosterone are not known.Testosterone levels are low at birth. Up to puberty, background testosterone levels,although still relatively low, are higher in males than in females. Testosterone secretionaccelerates markedly at puberty, initiating sexual maturation and the appearance ofsecondary sex characteristics. 46 Shatavari ghrita matra vasti in the management of Ksheena Shukra
  62. 62. BASTI RIVIEW OF LITRETUREBASTI KARMA Among the Shodhana therapies Bastikarma is considered as the most important onedue to its wide spread application and effect. It is the procedure in which the drug preparedaccording to classical reference is administered through rectal canal reaches up to theNabhi pradesha, Kati, Parshava and Kukshi, churns the accumulated Dosha and Purishaspreads the unctuousness all over the body and easily comes out along with the churnedPurisha and Dosha. In Ayurveda Panchakarma has its own significance. Among the Panchakarmatreatment Bastikarma has given the prime importance. In kaya Chikitsa it is considered asArdha Chikitsa61 and in some condition it is considered as Purna Chikitsa depending uponthe Roga and Rogi. The word Basti is named so because the urinary bladder of animals is used to injectthe contents of either unctuous drugs or eliminatory drugs into the rectum of the body toproduce some effect “Vastina deeyate eti vastih”.62 According to vitiation condition ofSharirika tridosha Vata, Pitta, and Kapha; Basti, Virechana and Vamana is the choice oftreatment. Generally Basti term is used for all kind of Bastikarma. In Chikitsa it is used asAnuvasanabasti, Shirobasti, Uttrabasti, Katibasti etc. But Caraka has used this term foronly Nirooha Basti . Even though it resembles with enema therapy, it differs in many aspects likeprinciple, mode of application and the advantages it renders. Enema therapy is used onlyfor elimination of fecal matter. But Basti does wide range of actions depending upon themedicines used i.e. Sodhana of the vitiated Dosha, Sanshamana, Rasayana, Brihana,Karshana, Vayah sthapana, Bala vardhana etc63. 48 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  63. 63. BASTI RIVIEW OF LITRETUREBasti Sabdasya nirukti The word Basti is used in the following meaning to dwell, to inhibit, to live, to stay,to abide, to reside or to produce the effect of the aromatic drugs. The word Basti is usedwhere the urine is collected “Vas” is formed by the ‘tich’ pratyaya. It belongs to masculinegender. It lies below the umbilicus and which is used to inject the contents of the enemathrough it. Caraka has used this term Basti as Nirooha Basti. The commentators likeChakrapani, Jejjata are also of the same opinion. The procedure of sending the Oushadhasiddha kwatha, kshera, mamsa rasa etc. to the Pakwashaya through the Guda is calledBasti. Sharangdhar and Arunadatta are of the opinion that just because Basti is given withurinary bladder (Urinary Bladder of cow, buffalo, goat etc.)64, so it is called Basti.BASTI BHEDA One cannot find any uniformity in classification of Basti among the authors ofclassical texts. As it is an important method of therapy in ayurvrda it can be classified invarious ways. So rational thinking on various aspects of Bastikarma has brought about thefollowing classification65. 49 Shatavari ghrita Matra basti in the management of Ksheena Shukra

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