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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.

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 Matravasti ksheenasukra pk019_gdg Document Transcript

  • “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
  • 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)
  • 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,
  • 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
  • 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.
  • 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.
  • 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.
  • 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
  • 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.
  • 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
  • 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.
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • BASTI RIVIEW OF LITRETUREAdhisthana Bheda: According to the site of application of Basti it is classified into twotypes – a. Internal b. ExternalTable no. 2 InternalPakwashayagata Basti The administration of medicine via Gudamarga to PakwashayaGarbhasayagta Basti The administration of medicine via Yonimarga to GarbhashayaMutrashayagata Basti The administration of medicine via Mutramarga to MutrashayaVranagata Basti The of medicine is administered through the Vranamukhaby the process of Bastikarma.External In certain diseases the medicated oil is kept over the part of the body using a cap orwith flour paste for prescribed period of time and named after the site of application of oilsuch as - Shirobasti, Katibasti, Grevabasti, Prusthabasti, Janubasti, Urobasti etc. Dravya bheda : The dravya that is used in Basti is either Kwatha or Sneha.So according to this Basti is two types- Nirooha and Anuvasana Basti Nirooha Basti – In Nirooha basti, Kashaya (Decoction) is the predominantcontent. With the kashaya Madhu, Saindhava, Sneha, Kalka are the ingredientscommonly used.. it is also known as Asthapanabasti66, Kashaya basti etc. its actionon the body is beyond the perception of physician67. Anuvasana Basti – Sneha is the chief ingredient of Anuvasana Basti. Theterm Anuvasana is coined due to unharmful effect of Bastidravya even if it retained 50 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETUREinside the kostha. Moreover this type of Basti can be practiced daily without anyserious precautionary measure68.Table no. 3 Karma Bheda69,70Sodhana Basti It removes the vitiated Dosha and mala from the body as it contain the Sodhana dravya.Lekhana Basti It reduces Medodhatu and produces Lekhana in the body.Snehana Basti This Basti contains more sneha and Snehana in the body.Brumhana Basti It increase the rasadi dhatu and indirectly it helps the growth of the body.Utkleshana Basti This causes utklesha of mala and Dosha by increasing its pramana and causes dravabhoota.Doshahara Basti This is a variety of nirooha basti but its effect is shodhana.Shamana Basti Causes Shamana (Alleviatation) of Dosha.Sarangadhar has contributed Shodhana, Lekhana, Vrihana, Deepana-Pachana typesof basti71. Vataghna basti, Balavarnakrita basti, Snehaneeya basti, Shukrakrit basti,Krimighna bastiVrishatwakrit basti has been explained in various contexts byCharaka72.Sankhya Bheda It is stated that neither Snehabasti nor Nirooha bastican be applied alone73. Socaraka has made the classification based on numbers of Snehabasti and Niroohabasti in atreatment i.e. Karma basti, Kala basti and Yoga basti74-75. 51 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETURETable no. 4Karma The total basti is to given are 30 in number (18 anuvasana basti and 12Basti nirooha basti)Kala Basti This consists of 16 basti (10 anuvasana basti and 6 nirooha basti)Yoga Basti This consista of 8 bati (5 anuvasana basti and 3 nirooha basti)Matra Bheda76-78Table no. 5 NiroohaDwadashaprasruta In Nirooha the maximum dose or quantity of Basti dravyaBasti prescribed is Dwadashaprasruta i.e. 24 pala.Prasritayogika Basti Caraka has prescribed various types of Nirooha in different dose like 4,5,6,7,8,10 prasruta considering the strengthof the patient and condition of the diseasePadaheena Basti 9 prasritiAnuvasana : It is also classified into 3 types according to the dose used79-81.Table no.6Sneha Basti 6 pala (¼ of nirooha )Anuvasana Basti ½ of the quantity of Sneha bastiMatra Basti The quantity of sneha that will get digested within 6 hours. 52 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETUREAnusasangika bheda81-89a) Yapana Basti b) Siddha Basti c) Yuktaratha Bastid) Vaitarana Basti e) Ksheera Basti f) Ardhamatrika norooha Bastig) Picha B h) Mutra Basti I) Rakta BastiIn general approximately 216 kinds of Basti are mentioned by Achrya Caraka in variouschapters of Siddhi sthana.IMPORTANCE OF BASTIKARMA All the Acharyas of Ayurveda have emphasized this Basti therapy in their textsconsidering its efficacy. It stands unique among all the shodhana therapies because itexpels the vitiated Dosha rapidly and easily from the body and also cause reducing as wellas nourishing the body very fast.90 It is considered as best and unique therapy as it pacifiesthe vitiated Vayu. Vata is the causative factor for all kind of diseases. Vata is responsiblefor each and every kind of movements and activities. On the other hand Vata isfunctionally required to coordinate with Pitta and Kapha in order to accomplish variousduties assigned to them in the organization of life.91 Even though Vamana and Virechana eliminates the vitiated Dosha from the body,the drugs are used in these therapies contain Katu rasa, Ushna guna and teekshna guna,which can not be taken easily by children and older people. But Basti can give in all agegroups without any hesitation.92 As the main seat of Vata is considered as Pakwashaya, by the administration ofBasti into it, the proper regulation and co-ordination of the functions of the Vata Doshaoccur in its own site and also control the related Dosha, which are involved in thepathogenesis of disease.93 Hence Basti is so called Ardha Chikitsa.94 53 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETURE Vata is the main cause for manifestation of any kind of disease occurs in Sakha,Kostha, Marma Pradesha, Urdhawbhaga and in all parts of the body. Vayu is the onlyconnective mechanism through which Mala-Mootra-Pitta etc. are connected and evacuatedfrom malashaya. So in the vitiation of Vata Basti is the first line of treatment. There foreBasti is called as Ardha Chikitsa or Purna Chikitsa in Ayurveda.[Atobastivavardhachikitsarupata tatha sarvachikitsarupata cha yuktaiiva (Chakrapani)]95 By explaining the importance of Basti Shusruta had explained that among thePanchakarma therapies Basti is the pradhana karma as it does Samsodhana, Samsamana,Samgrahana, makes Shukravan to Ksheena Shukra purasha, makes healthy to the weakenedpeople, it can reduce fat from obese people, it accomplishes rejuvenation, happiness,longevity, strength, improving memory, voice, digestive power and complexion. 96 According to Acharya Kashyapa there is no other treatment is better than Basti, as itcure the disorders that occur in the Sakha, Kostha and Sampoorna Shareera. So it is calledArdha Chikitsa according to him(Tadupardha chikitsayah). Acharya Kashyapa equated this Basti karma as ‘Amrutam’, because of its wideapplication even both in infants and old aged people. 97BASTI YANTRAThe instrument or device used in Bastikarma is called as Basti Yantra. It comprises of twoparts 1. Basti Netra 2. Basti Putaka 54 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETUREBASTI NETRA (Nozzle/Cannula) & PUTAKA The general meaning of netra is eye, but here netra means Nalika (Tube). Vastinetra may be prepared from Gold, Silver, Copper, Iron, Brass, Tusk, Horn, Beads, Pith oftrees, bamboo, bone, wood. It should be smooth, strong, resembling cow’s tail in shapewith a tapering end and wider base and its face similar to a pill. According to Caraka it istubular apparatus with round ends and smooth surface.98 The following table furnishes themeasurement of Basti Yantra. Table no. 7Mesurement of Basti Yantra 99-101 No. Age in Length in Lumen of the Netra years Angula Diameter of narrow end Diameter of broad end 1 <1 5 1 angula 2 1-6 6 Size of green gram 1 angula 3 7-1 7 Size of blackgram 1 ½ angula 4 12-15 8 Size of kalayam 2 angula 5 16-20 9 Sizeof wet kalayam 2 ½ angula 6 >20 12 Size of karkandhu 3 angula Shusrutha’s opinion 7 1 6 Gren gram Feather ofkanku bird must pass through. 8 8 8 Black gram Feather ofeagle must pass through. 9 16 10 Kalayam Feather of peacock must pass through. 10 >25 21 Kolasthi Feather of vulture must pass through. 55 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETURE Karnika : In order to prevent undur prnrtration of the Basti netra deep into therectum, a karnika or rim has to made. It is to be placed at a required point above the distalend. Two karnikas are provided on the netra at distance of 2 angula between one another atproximal end to tie the Bastiputaka properly.102Basti Putaka : The container or bag used to carry the Basti dravya, ready for application is knownas Basti Putaka. In ancient days the urinary bladder of matured animals like cow, buffalo,goat, deer etc. were used. It was processed to make soft colorful by removing the bloodvessels and other impurities. It should be suitable for well fitting with the basti netra and should not have anyfoul smell. If good bladder is not available some other materials are recommended for thepurpose. They are the skin of lower limb or neck of monkeys or other animals, thick clothwith sufficient strength and size may also be used.103 Now a day, due to technological development various types of materials areavailable to make up Basti putaka even disposable Basti netra are available. The rubberbladder and Polythene bags are best choice. Presently in most Panchakarma theatres thedisposable Bastiyantra with polythene bags are in use.Table no. 8 Netra Dosha104-105No. Netra Dosha Features Effect1 Hraswata Too short Dravya will not reach Pakwashaya.2 Deerghata Too long Dravya go beyond Pakwashaya.3 Tanuta Too thin Produses kshobha4 Sthoolata Too big Produces Karshana in the guda 56 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETURE5 Jeernata Old dhatu used Injury to guda6 Sithila Not fixed properly to Dravya will come out. Bandhanata putaka7 Parshwachidra Hole on side Leakage of dravya happens8 Vakrata Curved/irregular Dravya becomes irregular.9 Assannakarnika Karnika too near Karma becomes no use10 Prakrustakarnika Karnika too far Causes raktasrava by gudu marma peedana.11 Anusrotata Small hole Cannot perform properly12 Mahasritata Broad hole Cannot perform properlyMATRA BASTI Anuvasana vasti is divided into three types depending upon the administration ofdose. Those are Anuvasana basti, Sneha basti and Matra basti. Matra basti is termed sobecause of the dose of sneha used in it is very less (hrashwa matra) compared to the dose ofsneha basti.106,107 The term Matra has different meaning according to its use i.e.Measurement, Quantity, Size, Duration, Number, Degree, Movement, Unit of time. In thispresent context the term matra is used for mesurement i.e.for the quantity of vasti dravya. Vasti is also having different meanings according to various contexts, but in presentcontext it is considered as the therapeutic procedure of panchakarma. Acharya Caraka andVagbhata had defined that the dose of Matra vasti is equivalent to the dose of hrashawamatra of Snehapana.108,109 57 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETUREMATRA BASTI PROCEDUREPOORVA KARMA The body of the patient should be anointed with suitablesneha and gently fomentedwith hot water. Then he is advised to have his prescribed meal and made to take a shortwalk. Having passed stool and urine he is laid on couch, which is not very high and thehead must be at lower level. No pillows are used. The patient should lie down on his leftside drawing up the right leg straightening the left leg.PRADHANA KARMA The Ghrita/Oil prescribed for Matra basti taken in the Basti Yantra. The trapped airin Enema syringe is expelled out. Then the anal region and the netra should be smearedwith oil. Gently probe the anal orifice with the index finger of the left hand and introducethe nozzle of the enema syringe into the rectum. Introduce the medicine into the rectum byasking the patient to take the deep breath and not shake his body. Release carefully thenozzle when a little quantity of sneha remained inside the enema syringe.PASCHAT KARMA The patient is keep lying in supine position as long as it would take count up tohundred. The patient should be gently struck three times on each of the soles and over thebuttocks. The distal part of the cot should be raised thrice. Allow him for some time in thesame position. After sometime patient was advised to get up from the table and take rest onhis bed and also not to take day sleep.Indications : Acharya caraka has explained that the Matra vasti is always applicable to those whogot emaciated due to overwork, physical exercises, weight lifting, way faring, repeated 58 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETUREjourney on vehicles, sexual indulgence with women, in debilitated person as well as inthose who got afflicted with Vata disorders. Astanga samgrahakara emphasized on regularadministration of matra vasti and it can be administered at all times and in all seasons justas madhutailk vasti.Table no. 9 Indication of Matravasti110-111Sl. No. Indications Caraka A.H. A.S.01 Karma karsita + - -02 Bhara karshita + + +03 Adhva karshita + + +04 Vyayama karshita + + +05 Yana karshita + - +06 Stree karsita + + +07 Durvala + + +08 Vata rogi + + +09 Bala - + +10 Vriddha - + +11 Chintatura - + +12 Stree - - +13 Nripa - + +14 Sukumara - - +15 Alpagni - + +16 Sukhatma - + - 59 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETUREContraindication : There are no contraindication quoted by Acharya in classics exceptvagbhata in astanga samgraha has stated that Matra vasti should not be administered inAjirna condition.112Qualities : The matra basti promotes the strength without any strict regimen or diet,causes easy elimination of Mala and Mutra. It performs the function of brihana and curesvata vyadhi. It can be administered at all times in all seasons and is harmless.113 AchryaVagbhata opines that Matrabasti improves Varna and Bala, it can given regularly, which isindicated for bala, briddha and alpagni personhe mentioned it as Varnya, doshaghna etc.112Acharya Hemadri commenting on the term Sukha stated that , it is devoid ofcomplications.114Dose : “Hraswayaha snehamatrayaha matrabasti samo bhaveth ”115 Matra basti is gotpopular because of its dose only. According to Vagbhata it is recommended in the doseequal to the dose of harswa snehapana.116 The pachana of matra basti takes 2 yama i.e. 6hours. Shusruta has given the dose as ½ of the dose of Anuvasana vasti and according tohim the dose of Anuvasana vasti is ½ of of the dose of sneha vasti. Hence the dose of matrabasti is 1½ pala = 6 tola= 72ml.117 According to Chakrapani the dose of the sneha basti is 6pala, dose of Anuvasana basti is 3 pala, and of matra vasti is 1½ pala.118 Acharya kasyapaprescribed the quantity of matra bastias 2 palas as uttama matra, 1½ pala as as madhyamamatra, and 1 prakuncha as hraswa matra. He even stated that half pala of sneha can begiven in newborn baby, it can be administered without any hesitation and complicationtoo.119 Sarangadhar mentions sneha matraof matra basti as 2 palas (8 tola).120 On the basis 60 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETUREof the above references,it can be said that the dose of matra basti is 1 ½ pala of sneha i.e. 6Tola= 72ml.Table no. 10 Dose of matra vasti according to ageSl.. no. Age in Years Matra in Tola Sl. No. Age in Years Matra in Tola01 01 ¼ 11 11 2¾02 02 ½ 12 12 303 03 ¾ 13 13 3½04 04 1 14 14 405 05 1¼ 15 15 4½06 06 1½ 16 16 507 07 1¾ 17 17 5½08 08 2 18 18 609 09 2¼ 19 19-70 610 10 2½ 20 70 and above 5Food before Basti procedure: Neither excessively Singdha nor excessively Ruksha aharashould consumed by the patient. Because the excessive Snigdha ahara leads to cause Madaand Murcha. The excessive Ruksha ahara causes depletion of Bala and Varna. There forethe diet containing Alpa sneha should advised to the patient.121Pathya- Apthya : Matra vasti has neither have any specific limitation nor anycontraindication. It can be given at any time and in any seasons. However, Vagbhata hasgiven some restriction regarding day sleep during the treatment of matrabasti.122 61 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETURERetention of Matra basti: The normal Pratyagamana kala of matra basti is 3 yama i.e. 9hours. There is no harm if it retains in the body. Because as the dose of sneha is very small,which can get easily absorbed in the body without coming out. It is believed that the snehabasti should be retained in the body. If basti material returns much earlier, it cannotproduce the desire effect.123Samyak yoga Lakshana of Matrabasti : Being a type of sneha basti, the samyak yogalakshana of sneha basti are to be taken as samyaka yoga lakshana of matra basti. Thesamyaka lakshana of Anuvasana are the return of sneha with fecal matterwithout beingstuck up anywhere, the quality of Rakta, Mamsa etc. dhatus increased. The patient feelslightness of body, increases of strength, quality increased in sense organs, regulation of theexcretory urges and gets good sleep.124Importance of Matrabasti We can summarize the importance of matrabasti by considering its advantages byfollowing points : o It can be given to Bala, Vriddha, Sukumara, Stree and all to the diseased and healthy persons. o It can also be given to Durbala purusha where other basti are contraindicated. o There is no restriction of ahara and vihara, even one can perform routine works after administration of matrabasti. o It does not give any complications as other basti leads, even thoughmatra is less it has wide spread action throughout the body 62 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETURE o The Anuvasana basti should followed by nirooha basti but Matrabasti can administered alone everyday continuously without any complication. o Matrabasti has no restriction as Asthapana and Anuvasana. o No Samsrajana karma is followed after matrabasti. o It eliminates vitiated doshaalong with malafrom the body. It acts as shodhana, shamana, bruhana and even balya. BASTI KARMUKATA “Guga mulam hi shareeram” means that the guda is the mula of Shareera and also it is the pratisthana siras. Vasti produce tarpana of the moordhagata sirasand increases the strength (bala), potency(Veerya) and there by it produces Santana. The correctly given basti will stay in the pakwasaya, sroni, nabhiand adhobhaga. Vasti dravya will reach the entire Srotas, in view of its veerya and produce s alleviating actionsshamanadi karmas. When water is sprinkled to the root of a tree, it will rteach the entire wingsand the parts of a tree, like wise basti will do its work. After administration of basti, it will come out, but it does shodhana of mala etc. it comes out due to the effect of apana vayu. It also causes shodhana of doshas from pada to the shiras, just like the sun which is millionsof miles awayfrom the earth, due to its ushna teekshna pradhana produces apakarshana of rasas, so also the basti which is in pakwashaya will remove the sanchita doshaa in the pristha, kati, kostha etc. and removes the doshas outside. 63 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • BASTI RIVIEW OF LITRETURE Chakrapani in caraka siddhi strongly suggested that the proper given basti will reach all the parts of the bodywithin no timeand it becomes dissolved. The basti is given in the vama parshwa i.e. (The left lateral position) as the guda(anus), pakwashaya(Large intistine), grahani(Duodenum) are situayed on the same side. They are agni adhisthana. Jejjata comments agni is present left side over the nabhi, guda has got a left sided relation with Sthoolantra. So basti dravya can reach to the large intestine and grahani, as they are present in same level. Indu in Astanga samgraha siddhi explained that the action of basti ismainly due to the Veerya. After giving the basti the veerya of basti dravya is spreaded to the Samana vayu through the Apana Vayu. Then it spreads respectively to Vyana vayu, Udana vayu and Prana vayu. Like this the five vayus after getting the veerya of medicine they keep the body in equilibrium state. The prabhava of basti dravya spreads in Tiryaka pradesha due to Vyana vayu, Adho pradesha due to Apana vayu and in urdha pradesha due to Prana vayu. Like this the basti dravya spreads through the whole body by the help of Vata and Siras.(Ast. Sam. Si.5) As an opinion says about the spread of basti dravys till grahani and grahani is the seat of Agni, the nutrients may gets absorbed and thereby nourished. As there is a relation between Pittadharakala and Majjadharakala so the majjadharakala gets nourished. Therefore the production of Shukra can be enhanced due to poshana of Majjadharakala. 64 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • DISEASE RIVIEW Based on the available references it is clear that Shukra term is used for wholetesticular secretions, which contains sperms and androgens. Term Retas for total ejaculatemeans semen and Virya for only androgens. Hence the term Shukra Kshaya can be taken as any decrease in the Shukra eitherquantitatively or qualitatively. Thus the term Shukra Kshaya seems to be analogue withthe term Oligospermia.Nidana of Ksheena Shukra In the classics the etiology of Ksheena Shukra is described in detail. For betterunderstanding, these causative factors can be divided into the factors pertaining toAharaja, Vihara, Manasika, Nidanarthakara and Vaidya Krit, Avasthajanya hetu, Anyahetu. Accordingly they are being described here in detail under separate headings. 1. Aharaja Hetu: a. Asatmya ahara b. Rooksha, Laghu, Ushna, ahara c. Excessive intake of Teekta, Kashaya, Amla, Lavana ahara d. Anashana 2. Manasika Hetu a. Chinta b. Soka c. Krodha d. Bhaya Shatavari ghrita Matra basti in the management of Ksheena Shukra 65
  • DISEASE RIVIEW 3. Maithuna Janya Hetu a. Atimaithuna b. Akalamaithuna c. Ayonimaithuna d. Maithuna asevanam e. Streenam arasadynatha 4. Vaidya krit a. Shastrakarma Vibramsha b. Ksharakarma Vibramsha c. Agnikarma Vibramsha 5. Avasthajanya Hetu a. Vriddha avastha b. Vyadhi avastha 6. Anya Hetu a. Ativyayama b. Swapnadosha c. Vegavarodha d. Kshata e. Krishata Asatmya Ahara Sevana:125 It means the substances or practice, which is incompatible to the body. Here wecan list alcohol, tobacco etc. Excessive consumption of alcohol (more than 60 gm/day),tobacco, and narcotics leads to infertility. Alcohol consumption lowers plasma Shatavari ghrita Matra basti in the management of Ksheena Shukra 66
  • DISEASE RIVIEWtestosterone synthesis. Ethanol increases the metabolic clearance rate of testosteroneconcomitants with an increase in hepatic 5 alpha reductose activities and increasedconversion of androgen into estrogen. Thus testicular dysfunction may occur in patientsprior to alcohol liver cirrhosis.126 Excessive consumption of Ruksha, Tikta, Kashaya, Katu, Lavana and Amla Rasaleads to Shukra Dushti in terms of Ksheena Shukra. Excessive intake of Lavana and Katu Rasa leads to Pumsatva Upghata127. In thesame manner excessive intake of Tikta Rasa leads to Shukra Shoshana andsrotokharatya128, consumption of excessive Kashaya Rasa leads to Sukravarodha andSrotovibandha. On the basis of above, it may be said that excessive usage of the abovesaid Rasa might be in any form i.e. Ahara or Aushahdi will lead to the impairment ofShukra either qualitatively or quantitatively. Anashana - Ati Ananashana or fasting which is one of the main reasons forKsheena Shukra, is the Vata Prakopaka Nidana. Sport star, High proportion of trainedathlete, ballet dancers and gymnasts, who practice regular light diet i.e. stringent weightcontrol are reported to have infertility. Thus there must be an optimal body weight forsuccessful reproductive function. Restoration of body weight near to ideal body weight(IBW) results in restoration of normal gonadotrophin secretary pattern. Serumtestosterone level decreases during fasting and intense exercise in healthy individual.2. Viharaja Hetu:129 Over indulgence exercises leads to Vata Prakopa, this in turn causes depletion ofsuccessive tissue elements and finally Shukra Kshaya. The physical effects of strenuousexercise on hypothalamic, pituitary gonadal function in male have been established, Shatavari ghrita Matra basti in the management of Ksheena Shukra 67
  • DISEASE RIVIEWdecreased testicular androgens (testosterone and dihydrotestosterone) and increasedadrenal androgen have been noted in the plasma of highly trained male athlete. Thisreference clearly supports the view of Charaka that Ati Vyayama is a causative factor ofKsheena shukra. The causative factors such as Ati Vyavaya (excessive intercourse),Akala Yonigamana (intercourse in improper time), Ayoni Gamana (intercourse in otherthan vagina / perverted sexual activities) and Atishukra Sravana directly lead to thePratiloma Kshaya of Shukra Dhatu. Now it is a fact that the silent infection(asymptomatic) of semen also leads to male infertility because of poor semen quality. Ati Ushna Sevana: Ati Ushna Sevana means exposure to excessive hotzones as well as intake of hot articles. The temperature within the scrotum is normally 1to 2 degree lower than ambient body temperature. It is generally believed that this lowertemperature is necessary for normal testicular function. Therefore thermal exposure orworking near hot furnaces, radiation (X-ray exposure), and routine use of hot tubs is thecause where the elevated temperature directly applied to the testis can impairspermatogenesis. The testis are sensitive to radiation damage, decreased secretion of testosteroneappears to be a consequence of diminished testicular blood flow. 3. Manasika Hetu130: The main culprit involved here may be taken as Vyana Vata because Manas andVyana Vata are inter related, by the virtue of their common site i.e. Hridaya and the inter-site disturbances or disequilibrium can lead to the dysfunction of both factors. So anydisturbances in Vyana Vata and Manas may lead to disturbance in Shukra Vaha Srotas, asit is present all over the body, where Vyana Vayu moves around. Shatavari ghrita Matra basti in the management of Ksheena Shukra 68
  • DISEASE RIVIEW Among the above said factors Chinta, Shoka, Bhaya and Krodha are the factors,which are having root cause in depression/anxiety. Recent research categorized losses inadulthood, which are of greatest importance or etiological factors in depression These include losses of relationships, health status or prestige, self-esteem, self-confidence, security, a fantasy or hope of fulfilling an important fantasy and somethingand someone of great symbolic value. Any one of these losses may precipitate adepressive reaction in adult 131. 4. Vaidyakrita Nidana (Iatrogenic Causes): Under this we can consider Shastra,Kshara and Agni Karma Vibhrama which are mentioned in Charaka Samhita as theNidana for Shukra Dushti. The patients, who have had a bladder neck surgery along with urethralre-implantation during childhood, may be infertile. Because the bladder neck surgery hasablated the internal sphincter. These individuals often experience retrograde ejaculationand their ejaculate will be less than 1ml in volume and Oligospermic are Azoospermic innature. Shatavari ghrita Matra basti in the management of Ksheena Shukra 69
  • DISEASE RIVIEW Apart from surgery, many drugs may interfere with spermatogenesis eitherdirecting or through alterations in the endocrine system. Medication such assulphasalazine cimetidine, nitrofurontin or ingestants such as caffene, nicotine, alcohol,marijuana and cocaine has also been implicated as gonadotoxic agents. Withdrawal fromthese substances enables the return of normal spermatogenesis. The use of anabolicsteroids, usually by athletes may also interfere with normal spermatogenesis. Hence different surgical, para surgical measures, medications may leads toabnormality of semen. It has been carefully analyzed and mentioned in our classics thatwhile doing Shastra karma especially in the pelvic region Vitapa marma should beavoided. If any injury to Vitapa-marma it may lead to Shukra-dusti. While dealing withKshara, it has been directly labeled as the cause for Pumsatwa Nasha. 5. Vyadhi Karshana Janya (Disease Induced): Vyadhi-Karshana is told as oneof the cause for the Sukradusti 132. But there is no exact reference for Sukra Dushti beingone of the Upadrava in any one of the diseases in Charaka except Sthaulya. Atisthulata isconsidered as undesirable and the person with over weight will have krichra Vyavayata(difficult in copulation) due to the less quantity of Shukra 133. Sushruta while dealing withSahaja Arsha mentions that the person suffering from Sahaja Arsha will have KsheenaRetas. In Madhava Nidana Parishishta Atisara is mentioned as one of the disease, whichwill cause Sukra dushti. The review of andrological / Urological literature as well as other literaturepertaining to medicine gives many diseases that will ultimately lead to poor semen Shatavari ghrita Matra basti in the management of Ksheena Shukra 70
  • DISEASE RIVIEWquality. For the purpose of better understanding the diseases causing Oligospermia maybe classified into a) Congenital, b) AcquiredCongenital factors (Syndromes):a. Cryptorchidism (Testicular malposition): Failure of testes to descend duringembryonic life or after birth will result in impairment of the spermatogenic process andandrogen production.b. Germ Cell Aplasia: Here there is near absence of germ cells in the testes of unknowncause but presumed to be congenital. The testis is not so small and histology is lessgrossly altered. Many cases are partial, with a few fertile tubules, producingOligospermia rather than Azoospermia134.c. Chromosomal Abnormalities: It is low among Oligospermic men and high amongAzoospermic men.Acquired Diseases: They can be studied under the following headings,I. Systemic disease Alcoholic Liver Disease: In Cirrhosis of Liver, a combined pituitary and testicular abnormality leads to decreased testosterone production independent of direct toxic effects of ethanol. Chronic Renal Failure: In this, decreased androgen synthesis and diminution of sperm production develop in the setting of elevated plasma gonadotrophins. Histological changes consisting of reduced numbers of Leydig cells, hyalinization of the tubular basement membranes and paucity of spermatogonia may also occur in children and adolescents with chronic renal failure. Shatavari ghrita Matra basti in the management of Ksheena Shukra 71
  • DISEASE RIVIEW Cystic Fibrosis: It is an autosomal disease characterized by abnormally thick secretions affecting primary mucous glands. The sterility is affected to structural defect in the ejaculatory tract. There is obstruction or absence of the epididymis, seminal vesicles and the vas deferens. Diabetes Mellitus: Diabetic men have several well-recognized problems, which impair their fertility but are unrelated to actual gonadal function. The existence, extent and importance of gonadal damage or dysfunction are less clearly understood. Thyroid Disease: Severe Myxedema is associated with abnormal spermatogenesis and Leydig cell atrophy.II. Infectious disease: The most common cause of acquired testicular failure inthe adult is viral orchitis. The responsible virus includes mumps virus, echovirus,lymphocytic choriomeningitis virus and Group B arboviruses. The Orchitis is due toactual infection of the tissue by virus rather than to indirect effect of the infection.Orchitis is most common complication of mumps. The testis may undergo atrophy.Atrophy is believed to be both due to direct effects of the virus on the seminiferoustubules and to ischemia secondary to pressure and edema within the tunica albugenia.Genitourinary Tract Infection: Infection has been proposed to cause male infertilitybecause it is reasonable that inflammation of the genital ducts might alter the seminalplasma and render sperm abnormal.III. Vascular: Varicocele - (Scrotal Vericocele is the most common causative findingin infertile men). The veins of the pampiniform plexus are dilated in about 20 to 40% ofinfertile men. The lesion develops as a result of back flow of blood secondary to the Shatavari ghrita Matra basti in the management of Ksheena Shukra 72
  • DISEASE RIVIEWincompetent or absence of valves in the spermatic veins. The valve insufficiency togetherwith the long vertical course of left spermatic veins leads to the formation of thevaricocele in the scrotum of left testis. Scrotal Varicocele normally leads to abnormalspermatogenesis due to:a) Increased testicular temperature due to venous stasisb) Retrograde flow of toxic metabolites from adrenal or kidneysc) Blood stagnation leading to germinal epithelial hypoxiad) Alteration in the Hypothalamus pituitary gonadal axisIV. Sexually Transmitted Disease: The common complications of SexuallyTransmitted Disease pathogens especially gonorrhea and chlamydia is epididymitis.Acute epididymitis leads to decreased spermatogenesis.6. Jara (Ageing): During old age the Kshaya of all the Dhatu takes place. Hence Shukra Kshayaoccurs as a physiological process. Effect of age on Spermatogenesis - Human testicularparenchyma is significantly reduced in aged men135. Other age related changes includedecreased volume of seminiferous epithelium, increased thickness of the tubular wall,and decreased length of the tubule. Lower seminiferous epithelial volume in older men is associated with lower dailysperm production per man. Age related reduction in daily sperm production in humans issignificantly correlated with loss of sertoli cells. Further more old men have additionalgerm cell degeneration during the prophase of meiosis, in addition to the physiologicalgerm cell loss at the end of meiosis in the normal cycle136. Shatavari ghrita Matra basti in the management of Ksheena Shukra 73
  • DISEASE RIVIEW7. Ksata (Trauma): It can be taken as any external injuries due to trauma, accident, 137surgery etc. Vitapa Marmabhighata may lead to Sukravaha Sroto Dushti . VitapaMarma is Vaikalyakara Marma and Saumya, therefore it may show its effect after certaintime and not immediately. So the external injuries to vital organs Vrishana, Shepha andthe surrounding Marma when get injured will develop grave disturbances in SukravahaSroto Moola, to vitiate Shukra, hence these are to be handled carefully. Injury to testis,testicular torsion may lead to atrophy of the testis and impaired fertility.POORVAROOPA Poorvaroopa are the premonitory features occurring before exhibiting of the mainsymptoms indicating a disease are known as poorvaroopa. No specific poorvaroopa havebeen mentioned for Ksheena shukra in the classics, the lakshna in the avyakta stage canbe taken as poorva roopa of ksheena shukra.Table no. 11 ROOPA AND LAKSHANA 138 - 142Sl. No. Lakshana C.S. S.S. A.S. A.H. VS1. Medhra Vedana - + - + -2. Vrishna Vedana - + + + -3. Ashaktimaithuna - + - - -4. Chiradwa praseka - + + + -5. Alparaktashukra - + + + -6. Dourbalya + - - - +7. Mukhashosha + - - - + Shatavari ghrita Matra basti in the management of Ksheena Shukra 74
  • DISEASE RIVIEW8. Panduta + - - - +9. Sadana + - - +10. Shrama + - - - -11. Klaibya + - +12. Shukra avisarga + - - - +13. Timira darshana - - + - -14. Medhra daha - - + + -15. Bhrama + - - - +Samprapti of Ksheena Shukra According to modern view emotional stress may interfere with the GnRHGonadotrophin releasing hormone, which initiates the release of LH and FSH fromanterior Pituitary (FSH – Follicle Stimulating Hormone and LH – Lutinizing Hormone),which are responsible for spermatogenesis. Thus disturbance in GnRH secretionultimately results in defective spermatogenesis. Dosha Prakopa here may be interpretedas hormone imbalance. Pitta Prakopa may be caused increased temperature due to thermal exposure,radiation, hot tubs, where elevated temperature directly applied to testis can impairspermatogenesis. Khavaigunya Karaka Nidana like Abhigata, Shastra, Kshara, Agni KarmaVibrama mentioned in the classics directly affects the Shukravaha Srotas especially testisand resultant Shukra Kshaya. Any surgery or drugs (Sulphasalazine, Cimitedin, Alcohol),which are gonadotoxic agents, that affects spermatogenesis, can be considered here. Shatavari ghrita Matra basti in the management of Ksheena Shukra 75
  • DISEASE RIVIEWSamprapti of Ksheena Shukra Based on Kriyakala:Sanchaya and Prakopa: In this stage the causative factors vitiate Sharirika andManasika Dosha initially. The Manasa and Sharira Hetu are interacting i.e. they disturbeach other depending on the indulgence in Hetu and/or severity and susceptibility of thesite. The vitiated Sharirika Dosha in turn vitiates Agni to resulting in the production ofAma. The whole process might be mediated by Manas and Manasa Dosha at any level toproduce Ama . Further Ama vitiates the functioning capacity of Dosha. The site of thismanifestation has its base at Hridaya, Vyana Vata. At this stage the vitiation of Doshacan also be produced by external factors like Kshata, improper use of Shastra, Kshara,and Agni Karma. Hence this state of Vaishamya of Dosha might be at the level ofHridaya being able to be named as Sanchaya and Prakopavastha, the first and secondstages of disease manifestation.Prasaravastha: In the extension of Prakopavastha, the enough strong Doshas will movefrom this site to the next place for further vitiation of Dhatu, as the whole of sentientbody is both the vehicle and the field of operation. The Rasadi Dhatus are vitiated andfurther provoked by Manas, Manasa Vikara and Hetu along with morbid Dosha at RasadiSrotas. The role of Manas cannot be neglected in this context. Manas vitiated by its ownNidana, moves through Dashadhamani to the level of Shukra Vaha Sira to vitiate thesame, as Shukra is also traversed in the whole body and Manas is also Sukshma andpervading in whole body . The vitiation of Rasa Dhatu and the extension of the samefurther to Raktadi Dhatu, which come later to Rasa in the ladder of metabolic descrete, isnamed as Anuloma type of Dushti. Here another process of manifestation is also possible Shatavari ghrita Matra basti in the management of Ksheena Shukra 76
  • DISEASE RIVIEWwhen the enough potent Hetu directly vitiate Shukra and Shukra Vaha Srotas, there thebelow upward type of Dusti starts from Shukra Dhatu to Rasa Dhatu. The same thing istermed also as Pratiloma type of Dusti e. g, Ativyavaya without consuming VajikaranaYoga. This complete mechanism can be named as Prasara Stage of pathogenesis.Sthana Samshraya: The vitiated Sharirika and Manasika Dosha vitiate the ShukraVaha Srotas, thereby disturbing the functioning balance of Sarva Sharirastha Shukra(Endocrine function) and Svasthanastha Shukra (Retas) at the level of Moola of ShukraVaha Srotas (Vrishana and Sepha). This is termed as Dosha Dushya Sammurchana. Hereif due to any reason either due to Bija dosha or any other external factors like Kshata toShukravaha Srotas (scrotal injury), the Srotas is having any susceptibility that becomesthe best site accordingly for the symptom presentation and may be termed asKhavaigunya. This stage is the endogenous presentation of Sthana Samshraya of KsheenaShukra. In other way, some external causes at the level of Sarva Sharira or Vrushana andSepha can lead to direct Sthana Samshraya for Ksheena Shukra viz., Sephabhighata,Shashtra karma Vibrama. This is the 4th stage of Samprapti i.e. Sthana Samshraya. This is also the stage when Poorvarupa are noticed. Though specific prodromalsymptoms are not explained in the classics, the Avyakta or Ishat Vyakta Lakshanapresent all over the body or locally can be anticipated according to the severity of Hetu aswell as Doshic vitiation.Vyakta: The Dosha Dushya Sammurchana at Shukravaha Srotomoola further extendsand lands up in Shukra Dusti in general and in Ksheena Shukra in particular producingthe Lakshana pertaining to Sarva Shareera and also Vrushana and Medra. Shatavari ghrita Matra basti in the management of Ksheena Shukra 77
  • DISEASE RIVIEWBheda: It is the 6th stage, wherein if the disease progresses due to non-availability orfailure of treatment the Upadrava appear and makes the disease impossible to cure.Samprapti GhatakaDosha: Tridosha with dominate Vata and Pitta doshaDushya: Rasa, Majja, ShukraAgni: Jatharagni, DhatwagniSrotas: Rasavaha, Sukravaha, ManovahaUdbhava Sthana: AmashayaSanchara Sthana: RasayaniAdhisthana: Vrushana and MedraRogamarga: MadhyamaVyakta Sthana: Shukra DhatuDosha: The disturbance of equilibrium of Dhatu cannot occur without the vitiation ofVata, Pitta and Kapha. So considering the location, signs and symptoms and cause ofvitiation of Vata, Pitta and Kapha, all the diseases by them are diagnosed on the basis ofvitiation of respective Dosha.Vata: It is considered to be the vital cellular force for movement or Gati in the bodyhaving Sukshma (subtle) property to pierce minute channels in the body and to carryother morbid Dosha into different parts of the body to cause the diseases according to 143specific Samprapti . Further Sushruta has referred another authentic thing that Shukra Dosha arespecifically caused by the vitiation of Vyana and Apana Vayu 144. Ksheena Shukra beingone of the major varieties of Shukra Dosha, the affliction of Vyana and Apana Vata Shatavari ghrita Matra basti in the management of Ksheena Shukra 78
  • DISEASE RIVIEWcannot be denied. Here Vyana seated in Hridaya which circulates in the whole body actas central controlling system and Apana seated in Basti which circulate in Medra acts asperipheral controller of physiology of ejaculation of Shukra. Moreover the qualities ofVata like Ruksha, Laghu etc., are quite opposite to the qualities of Shukra. So increasedRuksha Guna of Vata, decreases the Snehamsha of Shukra leading to Shukra Shoshana. Therefore it can be concluded that Vyana and Apana Vatadusti causes SukravahaSroto Dusti and further leads to Shukra Kshaya i.e. disturbance in the functioning ofVyana Vata leads to the defect in the production of Shukra by affecting SarvadaihikaShukra (Androgens) whereas in Apana Vata Dusti production of Shukra will be normalbut there will be difficulty in ejaculation due to loss of Snigdhamsha in Shukra.Pitta: Aggravated Pitta due to its Ushna Guna dries up the Somatmaka Shukra leading toShukra Shoshana and intern Ksheena Shukra. Vitiated Agni due to Anashana etc., Nidana leads to Mandagni and production ofAma. This Ama is responsible for improper production of Rasa Dhatu which finallyresults in improper nourishment of Shukra Dhatu present in whole body as well as inShukra Vaha Sroto Moola i.e. Vrishana and Sepha. Over exposure to Ushnata alsoincreases Pitta, which may be taken as increased temperature in the Vrushana Pradeshaleading to defective spermatogenesis.Kapha: Though Shukra Kshaya is a disease in which Vata and Pitta are the main morbidDosha but the role of Kapha Dosha cannot be ruled out. Kapha and Shukra have theAshraya Ashrayi Bhava. Kapha is sheltered in Shukra and both have almost similarGuna. So by seeing the Shukra Kshaya Lakshana Kapha Kshaya can be inferred. Shatavari ghrita Matra basti in the management of Ksheena Shukra 79
  • DISEASE RIVIEW In the Samprapti Kapha gets vitiated by the Ama i.e., the Picchila Guna of Kaphais increased by Ama and this causes the obstruction in the micro circulatory channels ofShukra Vaha Srotas leading to Ksheena Shukra.Dooshya: It includes Rasa and Shukra. Though from Rasa to Shukra all the Dhatu areinvolved in the pathogenesis, but apart from Rasa and Shukra the involvement of otherRaktadi Dushya are negligible. In Ksheena Shukra as explained earlier due to Agnimandya and Ama theformation of Rasa Dhatu is hampered. As Khale Kapota Nyaya refers to the need forspecific ingredients for generation of each tissue form, this mechanism will be interruptedby the improper formation of Rasa i.e., the further Dhatu especially Shukra will bedevoid of its nourishing material.Agni: As Dhatvagni always depends on Jatharagni the role of Jatharagni is of utmostimportance. Any impairment in Jatharagni can cause impairment in Shukradhatvagni. Sothe disturbances in Agni disturb the functions of Shukra. Hypofunctioning of Dhatvagniespecially Rasagni occurs due to diminished Jatharagni and results in the production ofimproperly metabolized Rasa Dhatu. This results in depletion of further Dhatu, alongShukra.Ama: Ama is produced in the Koshta due to hypofunctioning of Jatharagni later due tohypofunctioning of Dhatvagni. Ama is the prime factor for the increase of abnormalPicchila Guna of Kapha, which causes the obstruction in the pathway of Shukra. The five Bhutagni are responsible for metabolism at molecular level. Thedeficiency or diminution of this Agni may result into the production of unwanted and Shatavari ghrita Matra basti in the management of Ksheena Shukra 80
  • DISEASE RIVIEWincompatible products of finer metabolism. Free radicals that may be identified as Ama atthe first level considered being responsible for tissue damage. This has been proved factthat the primary suspects in the link between environmental assaults and infertility areoxygen free radicals, also called oxidants. These are unstable particles that are released asa by-product of many natural chemical processes in the body. Infections andenvironmental assaults can produce high level of oxidants. Evidence now stronglyindicates they can also damage sperm.Srotas: The pathogenesis confirms at the level of Srotas in any of the disease and hencealso in Ksheena Shukra. The chief Srotas involved in the pathogenesis of Shukra Dushtiviz., Ksheena Shukra are Rasavaha Srotas, Shukravaha Srotas and Manovaha Srotas. Shukravaha Dhamani145 is categorized under Adhogami Dhamani amongst whichtwo acts for the production of Shukra and other two work to ejaculate the same.Adhogami Dhamani in general is intended to pass/expel the substances viz., Mutra,Shukra, from above downwards. Any of the disturbances at these dhamani due to theirrespective Hetu will land up in disturbances either in Shukra production process orShukra Visarga (ejaculatory) properties. Hence it seems that the production andejaculation of Shukra (Semen and Androgen) is controlled by Neuro-endocrinal-vascularsystem, the intactness of which aids to the proper production and ejaculation of Shukraand any disturbance in the same may lead to the pathological manifestations ofproduction or ejaculation.Pathology of Testicular Function Normal testicular function is the final result of several harmonious factors.Genetic, Hormonal, Biochemical, Anatomical and Environmental variables have been Shatavari ghrita Matra basti in the management of Ksheena Shukra 81
  • DISEASE RIVIEWshown to be the underlying causes for testicular dysfunction, leading to disturbed spermproduction and/or androgen secretion. This impairment is usually termed‘Hypogonadism’ regardless of the exact etiology. However the entire process in the testisis under gonadotrophin control it is common to classify the hypogonadic state intoseveral categories 146.Lakshana of Ksheena Shukra Lakshana of Ksheena Shukra can be divided into two groups viz. related toShukra Vaha Srotas and those symptoms related to Sharira. Lakshana of Ksheena Shukra can manifest due to dysfunction or hypofunctioningof one or other properties of Shukra (Semen and Androgen).The symptoms related to Shukra Vaha Srotas - Shighrapraseka, Chiradvapraseka and Shukra Avisarga: Snigdha, Sara andAnupravana Bhava are the biophysical or physicochemical properties of Shukra asmentioned earlier. The affliction of these properties by any exogenous or endogenousfactor leads to its dysfunction. For example lack of Dravatva, Saratva andAnupravanattva, due to increased Ruksha Guna of Vata leads to delayed ejaculation(Chiradvapraseka).Defect in Madhurata, Avisrata and Madhugandhi means lack ofnutrient substances in ejaculate material and any extra smell is indicative of pathologicalprocess, which may lead to ejaculatory problems such as early ejaculation, delayedejaculatory and anejaculatory. (Shighrapraseka, Chiradvapraseka and Shukra Avisarga). Toda or Vedana of Vrushana and Medra: If Avidahi and Snigdha propertiesare hampered due to Ushnam, Teekshna Guna of Pitta and Ruksha Guna of Vata, the Shatavari ghrita Matra basti in the management of Ksheena Shukra 82
  • DISEASE RIVIEWeffect will be burning sensation (Vrushana and Medrayodhomayateeva), pain in genitalorgans (Ati Toda, Vrushana Medra Vedana). Dalhana, opines that the various Vedanaseen in Ksheena Shukra are caused due to vitiated Vayu. Shonita Alpa Shukra, Mishrita Nissarana: When other Dosha is associated asPitta with Vata, it causes Shoshana of Ap Bhaga of Shukra due to Ruksha property ofVata. According to this the Teekshna and Ushna Guna of Pitta does more Shoshana. TheRuksha and Laghu Guna of Vata cause the reduction of Ghanata of Shukra, so Tanuta isseen. Phenila is the resultant of Vata Dosha. Apart from spermatozoa, semen containspus cells, precursor cells, macrophages, mucus threads, crystals gelatinous bodies,bacterial matter and RBC, which are all considered as Anyadhatu, and the semencontaining excessive above substances may be called Anyadhatu Samsrsta Retas(Mishrita Nissarana). Presence of RBC can be seen in Vataja Retas as well as Raktaja Retas. Todifferentiate, in Vataja Retas, only few RBC will be present which gives Arunavarna andthere may not be any change in volume of ejaculate, where as in case of Raktaja Shukra,hemorrhage will be severe which gives reddish colour and the volume of ejaculate will behigh.The symptoms related to whole Shareera - Dourblya, Mukhashosha, Panduta, Sadana, Shrama, Timiradarshana andBhrama: Ksheena Shukra will be caused due to the Kshaya in preceding Dhatu. Sowhen Kshaya of almost all Dhatus are involved, the symptoms like Dourblya,Mukhashosha, Panduta, Sadana, Sharma, Timiradarshana and Bhrama can be seen. Alsoas Shukra is pervading all over the Sharira, its Kshaya will show the Lakshana all over Shatavari ghrita Matra basti in the management of Ksheena Shukra 83
  • DISEASE RIVIEWthe body. Here we can consider the function of testosterone. Testosterone plays importantrole in protein formation and muscle development also in bone growth and calciumretention. Testosterone increases basal metabolism and it is seen that normal quantities oftestosterone are injected into a castrated adult the number of red cells per cubicmillimeter of blood increases 15 to 20 percent so it can be consider that it is helpful inproduction of RBC. Steroids hormones can increases the reabsorption of sodium in thedistal tubules of the kidneys.Upadrava of Shukra Kshaya No direct Upadrava has been mentioned for Ksheena Shukra . But while dealingwith Shukra Kshayajanya Klaibya, it is said that, as Shukra is the end product of DhatuParinama, it is said to be the essence (Paramadhama) of food. Its wastage leads tonumber of serious diseases or even death147.Sadhya Sadhyata Assessment of the Sadhyasadhyata is mandatory before the commencement oftreatment. It determines whether the disease is curable or not. Ksheena Shukra being Dwidoshaja is said to be Krichra Sadhaya, Pitta PrakrutiPurusha has less Shukra and if he is affected with Shukra Kshaya then the prognosis isstill more Kasthasadhya.Prognosis of Oligospermia It usually depends upon the underlying cause i.e. Oligospermia due to majorsystemic disorders like cirrhosis of liver or renal involvement depends upon the severityof the disease. Shatavari ghrita Matra basti in the management of Ksheena Shukra 84
  • DISEASE RIVIEW1. Oligospermia associated with Varicocele has a very poor prognosis with medicalmanagement. Surgical intervention (Varicocelectomy) is very much necessary.2. Oligospermia due to genetic causes is difficult to manage.3. Severe Oligospermia i.e. <5 million/ml has a very poor prognosis according to modernscience and so they suggest for ART) Assisted Reproductive Technology.4. Stress induced Oligospermia and Oligospermia due to environment hazards andchemicals often have a good prognosis until and unless the cause is avoided148.Chikitsa Charaka, Sushruta, Vagbhata have dealt with the Chikitsa aspect of ShukraDosha. The Samanya Chikitsa for Shukra Dosha are Snehana, Svedana, Vamana,Virechana, Niruha Basti and Anuvasana Basti followed by Uttarabasthi149 which can beadopted for all types of Shukra Dosha including Shukra Kshaya. The Shukra Dosha can be treated with proper diet of Madhura and Tikta Rasa,proper Vyavaya and Vyayama, timely elimination of Dosha in proper quantity150. Coming to the Vishesha Chikitsa of Ksheena Shukra, after Panchakarmaprocedures (Snehana, Vamana, Virechana and Basti) the Shamanoushadhi are to beadministered. Basti is considered as the main line of treatment in KsheenaShukra(Ksheena shukrasya chativa snehabastir balapradah).151 The principle treatment in any Dhatu Kshaya is to administer the Dravya, whichare having the same qualities of that Dhatu Eg. Mamsa in Mamsakshaya, Shukra inShukra Kshaya152. Administration of Shukra such as consuming Nakra Retah153. InSushruta Samhita Vajikara Dravya are particularly recommended for Shukra Kshaya in Shatavari ghrita Matra basti in the management of Ksheena Shukra 85
  • DISEASE RIVIEWKsheena Baleeya chapter some of them are Vajikara Utharika, Amalaka Yoga, MashaYoga, Swayamguptadi Yoga154. Dravya having the properties of Madhura, Sheeta, Snigdha, Picchila such asKshira, Ghrita, Mushali etc. are very good Shukrala Dravya. Charaka has mentionedShukrajanaka Gana, 10 Dravya namely Mashaparni, Meda, Shatavari, Kulinga etc 155.Uttara Basti: Administration of medicine through urethra of males has been emphasizedin the disorders of Shukra. Various Shukra Shodhana as well as Shukra Pravartaka drugsbring about the desired therapeutic effect and helps in palliating the Apana Vata. Shatavari ghrita Matra basti in the management of Ksheena Shukra 86
  • METHODOLOGYDRUG REVIEW The ingredients of Shatavari Ghrita are as follows-SHATAVARI (ASPARAGUS RACEMOSUS): 156Family Name: LILIACEAEBotanical Name : ASPARAGUS RACEMOSUSCommon Name: ASPARAGUS, ASPARAGUS ROOT, SHATAVARI, HUNDREDHUSBANDSPart Used: TUBEROUS ROOTSRasa : Madhura, TiktaGuna: Guru, SnigdhaVeerya: SheetaVipaka: MadhuraPharmacological : Shukra janana, Balya, Vrishya, Stanya janana, Mootra janana,Therapeutic uses: Klaibya, Shukrameha, Netra roga, Atisara, Grahani, Mootrakricchara,Raktapitta, Apasmara,Other Uses : The roots are bitter, sweet, emollient, cooling, nervine, antispasmodic, indigestible,appetizer, alliterative, stomach, tonic, aphrodisiac, galactagogue, astringent, antidiarrhoeal,antidysenteric, laxative properties . They are useful in nervous disorders, dyspepsia, tumours,scalding of urine, throat infections, tuberculosis, diseases of blood and eye, tuberculosis, leprosy,epilepsy, night blindness and kidney disorders and general debility.This herb, used externally, is said to increase breast milk and semen production. It also nurturesmucous membranes, blood cleanser, supplies female hormones, nourishes the ovum, etc.Shatavari means "100 spouses" because of its ability to increase fertility and vitality. Itnourishes and rejuvenates the tissues, promotes vitality and strength, maintains a healthyfemale reproductive system, removes excess pitta and bolsters immunity. 87 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYGodugdha 157Pharmaco dynamics: Rasa – Madhura, Guna – Snigda, Mridu, Slaksna and Picchila Veerya – Sheeta Vipaka - Madhura. Dosha karma – Vata pitta shamaka Karma – Vrishya, Balavardhaka,Bramhana, Madhya, Jeevaniya & Asthisandhanakara Rogaghnata – Pandu, Rakta pitta, Yoni roga, Shukra dosha, Mootra roga, Pradara roga etc & it is pathya in vata pittaja vikara Cows milk promotes long life it is rejuvenator good for those emaciated after injury,increases intelligence, strength & breast milk. It cures shrama, kasa, thrishna, jeernajwara, mootra krichra & rakta pitta.Goghrita 158Synonyms: Grutha, sarpi, ajya,Nomenclature: Sanskruth – grutha, English ghee, Kannada tuppa,Pharmaco dynamics: Rasa – Madhura, Guna – Snigda Virya – Sheeta Vipaka - Madhura.Action of cow’s ghee on different body system: Dosha : Vatapitta nashaka Nadivaha samsthana : Medhya, Insanity Pachana samsthana : snehana, agnideepaka, anaha Swasana samsthana : Rajaksma Raktawaha samsthana : Visarpa 88 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGY Mutravaha samsthana : Mutral Prajanana samsthana : Sukra janana Rogagnata : jwara, Visarpa, Rajayakshma.CLINICAL STUDY The therapeutic measures, drugs and proced+ures of Ayurveda have remained inthe practice since long on the basis of methodology prevalent in ancient times. This is thetime that the rationality of Ayurvedic therapeutic approach is explained on rational lines.Clinical trial is a way of research and its best method to evaluate any drug or line oftreatment. The trial is a carefully designed experiment with the aim of solvingunrewarding problems conducted on scientific lines. Approximately 50% of infertility cases are caused due to decreased and abnormalsperm production in male. Sperm count of 20 millions per millimeter or less is consideredas Oligospermia. The management of Oligospermia is still challenge to modern medicalscience in spite of vast advances in experimental and clinical research in Andrology.Ayurveda offers some hope for this condition in the form of Snehabasti, a science thatdeals with the promotion of reproductive and sexual health. Vitiation of Vata is held responsible for all types of Dhatu Kshaya in whichKsheena Shukra is also included. For Vata, Basti is the best treatment. Further Charakaadvices Basti as a unique therapy in the management of Shukra Dusti i.e. “Prashasthashukradosheshu basti karma visheshathah |”(Ca, Chi. 30). Also Caraka has specified theindication of SnehaBasti in Ksheena Shukra chikitsa i.e. “Ksheenashukrasya chateevasnehabastibalapradah”(Ca. si. 4). But before administration of Basti Sthanika Abhyangaand Svedana are essential. Ingredients of Shatavari ghrita MatraBasti are Shatavari,Godugdha and Goghrita which are Vrisya, Balya and also Vatahara, so by pacifying Vatait may provide improvement in Ksheena Shukra i.e. improvement in the semen volume,sperm count etc. In this view Shatavari Ghrita MatraBasti was selected for the study to evaluate itsrole in the management of KsheenaShukra (Oligospermia). 89 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYResearch Approach Experimentation is the most powerful research approach. In the present study, theobjective is to “EVALUATION OF THE EFFICACY OF MATRABASTI WITHSHATAVARI GHRITA IN KSHEENA SHUKRA”. The efficacy can be determinedby finding out the difference between the results of before and after the treatment.Study Design The study design set for the present study is ‘Single randomized prospectiveclinical trial’. In this only one group is taken i.e. Matra Basti group. Demographic dataand disease-specific data are collected according to the case record from given in theappendix.Source of Data Patients suffering from Kasheena Shukra were selected from the P.G. andResearch Panchakarma OPD and IPD of Shri D G Melmalgi Ayurvedic Medical Collegeand Hospital.Sample Size The sample size for the present study was thirty patients suffering from KsheenaShukra as per the selection criteria. Patients were randomly selected in a single group. Allthe patients received Matra Basti only.Reasons For Selection Of The Study Design The results and conclusions of a clinical trial depend on the study design. The aimof this study was to find out the effect of Matrabasti in the management ofKsheenashukra. Therefore, single randomized group was made for the study.. 90 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGY Selection Criteria The cases were selected strictly as per the pre-set inclusion and exclusion criteria.A) Inclusion Criteria Patients with decreased sperm count (< 40 million) Patients with deranged morphology and motility of sperm. Male patients of fertility age group between 20 -40 years. Patients those are fit for Matrabasti.B) Exclusion Criteria Patients who under concomitant therapy. Patients those are unfit for Matrabasti. Patients who has undergone surgical procedure such as hydrocele, varicocele etc. Patients having congenital disorder of gonads. Patients with hormonal imbalance. Duration of the Study The total study duration was 60 days including 30 days followup with placebo. Data Collection Patients were thoroughly examined both subjectively and objectively. Detailed history pertaining to the mode of onset, previous ailment, previous treatment history, family history, habits, ashtavidhapareeksha and dashavidhapareeksha and physical examination findings were noted. Routine investigations were done to exclude other pathologies. 91 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYSEMEN EXAMINATION: Semen examination was carried out in order to diagnose and to assess the effect oftherapy. As most of the semen parameters are subjective, in order to avoid subjectiveerrors, the semen examination was carried out by scholar himself at recommendedstandards of WHO (1992).Sample Collection: All the patients were given clear oral instructions for propercollection of semen. Abstinence: High fluctuations are common in all semen parameters with duration. In order toavoid such natural fluctuations, sexual abstinence of 3-5 days was strictly followed incollection of sample through out the study period. Method of collection: Masturbation is believed to be the best method of collection, as it facilitates thecomplete collection of ejaculate and the chances for contamination is less. All the patientswere instructed to clean the hands and glans penis thoroughly with tap water beforecollection. Collection was done adjacent to the Laboratory. However, in case of failureto masturbate, ejaculation was induced with penile vibrator. Coitus interrupts wasallowed in case, if patients failed to ejaculate with both of the above methods. Collectionwas done adjacent to the laboratory irrespective of method of collection. Collection time: The different timings of the day is having effect on the quality of semen(Valasamma 1988). In order to avoid such difference in the present study, we have fixedthe collecting time between 9.00 AM to 1.00 PM throughout the study period. Container: Wide mouth containers i.e. 100 ml glass beakers (pre-cleaned,warmed and labeled) were used for semen collection. The semen samples collected in the above said manner were examined at roomtemperature as follows: 92 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYMacroscopic examination:Appearance: Semen is a liquid, which coagulates immediately after ejaculation.Absence of the coagulum indicates vas-aplasia.Liquefication: Semen liquefies spontaneously within 40 min. of time. Abnormalliquefication or non-liquefication indicates prostatic dysfunction. Unliquified samples orpartly liquefied samples were passed repeatedly through syringe containing 20 G needle,and then utilized for further examination.Colour: Colour was noted after liquefication of sample and the presence of mucousstreaks were also recorded.Volume: Hypospermia and Hyperspermia are terms describing semen samples with avolume of less than 1.5 ml and more than 5.5 ml respectively.Viscosity: Viscosity is the theological property of semen.pH: Semen pH was obtained by spreading the semen on calibrated pH paperimmediately after liquefication. The normal pH averages from 7.2 to 7.8Microscopic Examination:Motility: For the process of fertilization, a few motile cells are required. Sperm motility isone of the most important parameter in semen analysis. It should be evaluated understandardized temperature condition. Semen sampling containing more than 50%progressively moving sperm cells is concerned. Asthenospermia is a term, whichdescribes semen samples in which the percentage of motile cells initially is below 50%.One drop of well-mixed semen was taken on pre cleaned, warmed glass slide, coveredwith 20 x 20 mm cover slip and left to stabilize. The slide was studied under microscopewith 40X power. The spermatozoa were scanned systematically and were included in oneof the following 4 types of motility. A total of 200 spermatozoa were counted by usingcounting chamber and the mean values were recorded. 93 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYTypes of Motility:Rapid linear progressive (RLP)Slow linear progressive (SLP)Non-progressive (NP)Immotile (IMM)Sperm count: Rough estimate of the spermatozoa count was made from the wet drop slide seenunder 40X and the dilutions were made accordingly. Samples containing spermatozoaless than 20 per HPF were diluted in 1:10 ratio (0.1 ml of semen + 0.9 ml of dilutingfluid); the samples containing more than 20 and less than 100 spermatozoa per HPF werediluted in 1:20 ratio; and the samples containing more than 100 spermatozoa per HPFwere diluted in 1:50 ratio. The diluted samples were thoroughly mixed on vertex mixerand one drop of the above mixture was filled in pre-cleaned Neubaur chamber and thesperms were counted in RBC counting squares. The number of squares counted wereaccording to number of spermatozoa present per RBC square i.e. if less than 10spermatozoa present per RBC square then 25 squares were counted; if spermatozoanumber was between 10& 40 then 10 squares were counted; and if spermatozoa numberwas more than 40 per RBC square then 5 squares were counted. The total sperm count was obtained in millions / ml after application of thecorrection factor, for example if 100 is the number of spermatozoa counted, in 25 RBCsquares in a sample diluted with 1:20 ratio then the total sperm count is 20 millions/ml(N/5, N=Number of spermatozoa and 5 is the correction factor). Diluting fluid was prepared with sodium bicarbonate formalin and distilled watertaken in the ratio of 5:1:100.Sperm Morphology: After completion of sperm count, each sperm was scanned and counted into headabnormality (doubled head, amorphous head, round head etc.), mid piece abnormality(bent neck thinned out mid-piece, cytoplasmic droplet, only heads), tail abnormality(coiled tail, doubled tail, stumpy tail) and headless. A total of 200 spermatozoa were 94 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYcounted by using counting chamber and the mean values were recorded. Themorphological phenotype of sperm cells presents a historical picture of events occurringduring germ cell production, epididymal sperm cell transport and storage. Evaluation ofthe sperm structure can help the diagnosis of a male factor infertility with its possibleetiology and to predict whether possible recovery to normal sperm production is likely ornot. The percentage of normal forms is used for the assessment of fertility capacity ofthe male. According to W.H.O. the normal percentage of normal spermatozoa is 50%.Treatment scheduleMATRABASTIThe procedure of administration of Matrabasti in general can be divided into three stages Poorva karma The patients were instructed to come after taking light diet (neither too snigdha nor too ruksha) and after elimination of stool and urine. The patients were also advised not to take diet more than 3/4th of routine quantity.the patients were mainly subjected to Sthanika Abhynga and Mridu Swedana prior to the administration or matravasti. Abhynga : The sthanika abhynga over Abdomen, buttock and on thighs for 5-10 minutes was done by lukewarm ksheerabala taila. Swedana : After Snehana the patients were subjected for Sthanika Mridu sweda, by using nadi sweda. Swedana was done on abdomen, buttoks and on thighs for 5-10 minutes. Pradhana karma After this Purva karma the patient was advised to lie down on left lateral position on the Droni with the left lower extremity straight and lower extremity flexed on knee and hip joint. The patient was asked to keep his left hand below the head. First the anus should be anointed with Shatavari ghrita ; then 60ml lukewarm Shatavari ghrita was taken in enema syringe. Rubber catheter oleated with Shatavari ghrita was 95 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGY attached to enema syringe. After removing the air from enema syringe, rubber catheter was administered to the anus of the patient’s up to the length of 4 inches. The patient was asked to take the deep breath and not shake his body while introducing the catheter and the drug. The total Ghee was not administered in order to avoid entrance of Vayu into the Pkwashaya which may produce pain. Paschat karma After administration of vasti, the patient was advised to lie down in supine position with hands and legs freely spread over the table. There after patient’s both legs were raised 3-4 times so as to raise the waist and gently tapped over the hips. Simultaneously taps were given to his soles, over elbow and palms, so that matravasti may spread throughout the body and may be retained for the required period. After sometime patient was advised to get up from the table and take rest in his bed and also not to take day sleep. Basti pratyagamana kala was noticed in each case.Pathyapathya during treatment period The pathyacharana is an important factor which was followed for 30 daysincluding the treatment period. The regimen prescribed for Snehapanavidhi was followedby the patients. Patients were advised to take katu-tiktha-kashaya-rooksha varjitha aharadravyas in light quantity. Rice gruel with little milk was advised as the ideal food. Patientwas advised to drink hot water only. Patient was advised to avoid sexual intercourse,suppression of natural urges, traveling, exercise, excessive speech, uneven sitting andlying postures, exposure to wind, cold, heat and dust, anger and grief.Assessment Consecutive two assessments of patients were carried before and after thecommencement of treatment. Assessment Criteria The assessment of the effect of the therapy was done before and after Basti coursein which semen analysis was done. Improvement in the sexual power of patient, 96 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYimprovement in Shukra Dhatu (quantity and quality of sperm), Shukravaha Srotas (othersexual symptoms) was recorded.Sexual Parameters: Present status and improvement in sexual health i.e., Sexual desire,Erection, Ejaculation, Rigidity and Orgasm were recorded and graded as shown below.Parameters ScoreSEXUAL DESIRENo desire at all 0Lack of desire 1Desire but no activity 2Desire only on demand of partner 3Normal desire 4Excess desire 5ERECTIONNo erection by any method 0Erection only after manipulation 1Erection but unable to penetrate 2Erection, initial difficulty but able to penetrate 3Erection with occasional failure 4Erection whenever desired 5EJACULATIONEjaculation at mere thought / sight / touch of partner 0Ejaculation during foreplay 1Ejaculation just before penetration 2Ejaculation after penetration but early discharge 3Ejaculation with own satisfaction 4Ejaculation with own and partners satisfaction 5 97 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYRIGIDITYUnable to maintain erection 0Some loss in erection but able to act 1Able to continue the act 2Able to continue the act without getting the desire effect 3Able to continue the act till the desire fulfills 4Able to continue the act to get the perfect orgasm 5ORGASMNo enjoyment at all 0Lack of enjoyment in most of the occasions 1Enjoyment in only 25% of sexual encounters 2Enjoyment in 50% of coital opportunities 3Enjoyment in 75% of sexual intima 4Enjoyment in every sexual act 5 (Source: Dr B. L. Mehra, Studies on Klaibya (male sexual dysfunction) and itsmanagement with Vajikaran, G. A. U, Jamnagar. 1996). 98 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • METHODOLOGYOverall Assessment of Clinical ResponseFor the assessment of grades were fixed depending upon the condition. Overallassessment is made taking into consideration both subjective and objective parameters. Considering all the above parameters patients are graded into four groupsdepending upon the response to Shatavarighrita Matrabasti. The overall scored wasconsidered based on subjective and objective parameters. The assessment was donedepending upon the scoring of individual patient and the grading was done as follows Grade Score range Good Response – Above than 75% Moderate Response – 45 – 75% Mild Response – 15 – 45% Poor Response – 8 – 15% 99 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS Table No. 12 1. Observation of patients based on Age Sl. No. Age in No. of Percentage years Patients 1 21-30 9 45% 2 31-40 10 50% 3 41-50 1 5%Among the 20 patients 9 patients were in the age of 21-30 yr(45%), 10 patients were of31 – 40 yr(50 %) , 1 patient was in the age group of 41 – 50 yr (5%). This table showsthat maximum number of patients were found in the age group 31 – 40 Yr. Belowdepicted graph describes the above statement. Observation of patients based on age Graph No. 01 21-30 31-40 10 41-50 41-50 Age 5 31-40 21-30 0 No. of Percentage patients Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 2. Observation of patients based on Religion Table No. 13 Sl.no. Religion No. of Percentage Patients 01 Hindu 17 85 02 Muslim 2 10 03 Christian 1 5Present study explains all the communities are reported with the problem ofoligospermia. The Hindu community was shown more prone to this disorder. This doesnot mean that other communities have less risk towards this problem. In fact the areawhere the study underwent has the dominancy of Hindu community. Out of 20 patientsrecorded 17 (85%) patients belong to Hindu, 2(10%) patients belong to Muslim and only1(5%) patient belongs to Christian community. Below depicted graph describes the abovestatement. Observation of patients based on Religion Graph No. 02 100% 80% 60% Christian 40% Muslim 20% Hindu 0% No. of Percentage patients Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 3. Observation of patients based on Occupation Table No. 14 Sl.no. Occupation No. of Percentage Patients 01 Labor 4 20 02 Sedentary 5 25 03 Active 11 55In this study we considered three categories of occupation for the convenience of study.Out of 20 patients 4 (20%) are labor, 5 (25%) patients do sedentary job and 11 (55%)patients were of active group. The people who are working as long standing, sports men,lecturers, contractors etc. are taken in active group. Below depicted graph describes theabove statement. Observation of patients based on Occupation Graph No. 03 Active Percentage Sedentary Labor No. of Patients 0 10 20 30 40 50 60 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 4. Observation of patients based on Socio-Economic status Table No. 15 Sl.no. Economic status No. of patients Percentage 01 Poor 5 25 02 Middle 7 35 03 Upper middle 4 20 04 Higher 4 20This socio economic status refers to life style of the patient. In this study out of 20patients 5 (25%) patients belong to poor category, 7 (35%) to middle, 4 (20%) patients toeach upper middle and higher category. Below depicted graph describes the abovestatement. Observation of patients based on Socio-Economic status Graph No. 04 35 30 Poor 25 Middle 20 Upper middle 15 Higher 10 5 0 No. of Percentage Patients Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 5. Observation of patients based on Education Table No. 16 Sl. No. Education No. of patients Percentage 01 Under/ Primary education 4 20 02 Secondary education 6 30 03 Graduate/ Post graduate 10 50Even though there is no specific relation to the disease with education, awareness towardsthe Ayurvedic treatment and the faith is observed in this study. In this present studyeducation is categorized into three groups according to the qualification of the patients.Out of 20 patients 4 (20%) patients are under/ primary educated, 6 (30%) patients aresecondary educated, 10 (50%) patients are graduate/ post graduated. Below depictedgraph describes the above statement. Observation of patients based on Education Graph No. 05 50 40 Under/ Primary education 30 Secondary education 20 Graduate/ Post graduate 10 0 No. of Percentage Patients Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 6. Observation of patients based on Diet Table No. 17 Sl .No . Diet No. of patients Percentage 01 Vegetarian 7 35 02 Mixed 13 65Foods always have a direct effect over the somatic body. Out of 20 patients 7 (35%)patients are vegetarian, 13 (65%) patients are mixed. Below depicted graph describes theabove statement. Observation of patients based on Diet Graph No. 06 70 Vegetarian 60 Mixed 50 40 30 20 10 0 No. of Percentage Patients Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 7. Observation of patients based on Habits Table No. 18 Sl .No. Habits No. of patients Percentage 01 Alcohol 3 15 02 Tobacco Chewing 6 30 03 Smoking 3 15 04 Anya Stree sanga 2 10 05 None 6 30Habits also play a major role in the field of manifestation of disease. Here out of 20patients, 3 (15%) patients are alcoholic, 6 (30%) patients are tobacco chewers, 3 (15%)patients are in habit of smoking, 2 (10%) patients habit of going to prostitutes, and 6(30%) patients are not having any habits. Observation of patients based on Habits Graph No 07 30 Alcohol 25 20 Tobacco 15 chewing Smoking 10 Smoking 5 Anya Stree 0 sanga No. of Percentage Patients Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 8. Observation of patients based on Duration of marriage Table No. 19 Sl. No. Duration in No. of patients Percentage 01 01 years 4 20 02 1-5 Years 5 25 03 6-10 Years 8 40 04 >10 Years 3 15In this study out of 20 patients 4 (20%) patients are found 1 year history of marriage, 5(25%) patients are 1- 5 years, 8 (40%) patients are 6 – 10 years, 3 (15%) patients areabove 10 years of duration of marriage. Observation of patients based on Duration of marriage Graph No. 08 40 35 30 01 year 25 1 - 5 years 20 6 - 10 years 15 >10 years 10 5 0 No. of Percentage Patients Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 9. Observation of patients based on Previous illness Table No. 20 Sl . No. Previous illness No. of Percentage patients 01 Typhoid 6 30 02 TB 1 5 03 Thyriod disorders 1 5 04 Epididymo orchitis 2 10 05 Mumps 1 5 06 Crypto-orchidism 1 5 07 Varicocele 1 5 08 Scrotal injury 1 5 09 None 6 30 Out of 20 patients 6 (30%) patients had suffered from typhoid; 2 (10%) patientshad Epididymo orchitis; and only single (5%) case had found from each TB, Thyrioddisorders, Mumps, Crypto orchidism, Varicocele, Scrotal injury; 6 patients did not notifyany previous illness. Below depicted graph describes the above statement. Observation of patients based on Previous illness Typhoid Graph No. 09 TB Thyriod Epididymo orchitis Mumps Percentage Crypto orchadisim No. of patients Varicocele 0% 20% 40% 60% 80% 100% Scrotal injury None Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 10. Observation of patients based on History of masturbation Table No. 21 Masturbation No. of patients Percentage Regularly since adolescence 10 50.00 Occasionally 06 30.00 No history 04 20.00 Out of 20 patients 10 (50%) patients are found with history of doing regularmasturbation since adolescence, 6 (30%) were doing occasionally and 4 (20%) had notdone masturbation at all. Below depicted graph describes the above statement. Observation of patients based on History of masturbation Graph No. 10 Regularly since adolescence Occasionally % No history No. of patients 0% 50% 100% Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 11. Showing sexual relationship with partner Table No. 22 Sexual relationship with partner No. of patients Percentage Satisfactory 9 45 Unsatisfactory 11 55In this study 9 (45%) patients show their satisfaction with the partner where as 11 (55%)patients gave the unsatisfactory history of sexual relationship with the partner. Showing sexual relationship with partner Graph No. 11 Satisfactory Untsatisfactory Patients No. of 0 50 100 150 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 12. Observation of patients based on Psychological History Table No. 23 Sl. No. Psychology No. of patients Percentage 01 Stress 13 65 02 Strain 12 60 03 Anger 7 35 04 Fear 10 50 05 Worries 15 75 The above table shows the involvement of psychological factors in each patient.More than one factor was found in all cases. The observation shows 13 (65%) patientswere suffering from stress, 12 (60%) patients were suffering from Strain, 7 (35%)patients were suffering from Anger, 10 (50%) patients gave the history of fear, and 15(75%) patients had worries. Below depicted graph describes the above statement. O bservation of patients based on Psychological History Graph No. 12 Stress Strain Anger Percentage Fear W orries No.of patients 0% 20% 40% 60% 80% 100% Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 13. Observation of patients based on Ejaculation Table No. 24 Sl. No. Ejaculation No. of patients Percentage 01 Normal 7 35 02 Premature 10 50 03 Retrograde 0 0 04 Delayed 3 15Out of the 20 patients 7 (35%) patients were normal, 10 (50%) patients had prematureejaculation, 3 (15%) patients complained delayed ejaculation and no one had complainedregarding retrograde ejaculation. Below depicted graph describes the above statement. Observation of patients based on Ejaculation Graph No. 13 Normal Premature Percentage Retrograde Delayed No. of Patients 0 20 40 60 80 100 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 14. Observation of patients based on Ksheena Shukra lakshana Table No. 25 Sl . No. Lakshana No. of patients Percentage 01 Alpa Shukra 20 100 02 Medhra vedana 7 35 03 Vrushana vedana 9 45 04 Asakta maithuna 3 15 05 Chirit praseka 3 15 06 Lingadaha 9 45In this present study out of 20 patients, all 20 (100%) patients reported alpashukra, 7(35%) patients complained medhra vedana; 9 (45%) patients complained vrishna vedana;3 (15%) patients reported for each Asakta maithuna and Chirat praseka; 9 (45%) patientscomplained for Linga daha. Below depicted graph describes the above statement. Observation of patients based on Ksheena Shukra lakshana Graph No. 14 Alpa Shukra Medhra vedana Vrushana vedana Percentage Asakta maithuna Chirat Praseka No. of Patients Linga daha 0% 20% 40% 60% 80% 100% Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 15. Observation of patients based on Chief Complaints Impact of Shatavari ghrita Matra basti on Ejaculation Table No. 26 Grade No. of Patients B.T. % A.T. % 00 - - - - 01 - - - - 02 2 10 - - 03 10 50 - - 04 1 5 2 10 05 7 35 18 90This above table shows that 2 (10%) patients having Grade II ejaculation; 10 (50%)patients having Grade III ejaculation; 1 (5%) had Grade IV ejaculation; and 7 (35%)patients were reported Grade V ejaculation before treatment. After receiving treatment 2(10%) patients improved to Grade IV and the rest 18 (90%) patients improved to GradeV. 15. Observation of patients based on Chief Complaints Impact of Shatavari ghrita Matra basti on Ejaculation Graph No. 15 % 00 01 A.T. 02 % 03 04 B.T. 05 0% 20% 40% 60% 80% 100% Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 16. Impact of Shatavari ghrita Matra Basti on Sexual Desire Table No. 27 Grade No. of patients B.T. % A.T. % 00 - - - - 01 4 20 - - 02 2 10 1 5 03 5 25 2 10 04 7 35 9 45 05 2 10 8 40This above table shows that 4 (20%) patients having Grade I in Sexual desire; 2 (10%)patients having Grade II Sexual desire; 5 (25%) patients having Grade III Sexual desire; 7(35%) had Grade IV Sexual desire; and 2 (10%) patients were reported Grade V Sexualdesire before treatment. After receiving treatment 1 (5%) improved to Grade II, 2 (10%)patients improved to Grade III, 9 (45%) patients improved to Grade IV; and the rest 8(40%) patients improved to Grade V. Impact of Shatavari ghrita Matra Basti on Sexual Desire Graph no. 16 100% 05 04 03 50% 02 01 0% 00 B.T. % A.T. % Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 17. Impact of Shatavari ghrita Matra basti on Erection Table No.28 Grade No. of patients B.T. % A.T. % 00 - - - - 01 - - - - 02 1 5 - - 03 3 15 - - 04 5 25 3 15 05 11 55 17 851 (5%) patient having Grade II; 3 (15%) patients having Grade III; 5 (25%) patientshaving Grade IV; 11 (55%) patients Grade V erection. After receiving treatment 3 (15%)patients improved to Grade IV; and the rest of 17 patients improved to Grade V. Impact of Shatavari ghrita Matra basti on Erection Graph No. 17 100% 05 80% 04 60% 03 02 40% 01 20% 00 0% B.T. % A.T. % Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 18. Impact of Shatavari ghrita Matra Basti on Rigidity Table No. 29 Grade No. of patients B.T. % A.T. % 00 1 5 - - 01 1 5 - - 02 1 5 - - 03 9 45 - - 04 7 35 08 40 05 1 5 12 601 (5%)patient shows rigidity for each Grade 0, I, II,V; 9 (45%) patients showed Grade IIIrigidity; 7 (35%) patients showed Grade IV rigidity. After getting treatment 8 (40%)patients improved to Grade IV, and 12 (60%) patients improved to Grade V. Impact of Shatavari ghrita Matra Basti on Rigidity Graph No. 18 60 40 % 12 05 8 A.T. 04 03 5 02 35 % 45 01 5 5 5 00 1 7 B.T. 9 1 1 1 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 19. Impact of Shatavari ghrita Matra Basti on Orgasm Table No. 30 Grade No. of patients B.T. % A.T. % 00 1 5 - - 01 1 5 - - 02 3 15 - - 03 6 30 - - 04 9 45 8 40 05 - - 12 60 Before treatment 1 (5%) patient was having Grade 0 and 1(5%) in Grade I Orgasm; 3(15%) were having Grade II; 6 (60%) were having Grade III; 9 (45%) were having GradeIV orgasm. After getting treatment 8 (40%) patients were improved to Grade IV and restothers 12 (60%) patients improved to Grade V. 19. Impact of Shatavari ghrita Matra Basti on Orgasm Graph No. 19 40 60 % 12 A.T. 8 15 30 45 % 5 5 B.T. 1 3 6 9 0 20 40 60 80 100 120 00 01 02 03 04 05 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 20. Observation of patients based on Alpa Shukra Table No. 31 Grade No. of patients B.T. % A.T. % 00 - - 9 45 01 2 10 4 20 02 8 40 5 25 03 10 50 2 1010 (50%) patients were included in grade III; 8 (40%) patients were included in Grade IIand 2 (10%) patients included in Grade I depending upon their investigation report beforetreatment. After receiving the treatment 9 (45%) patients improved to grade 0; 4 (20%)patients improved to Grade I; 5 (25%) patients improved to Grade II; and 2 (10%)patients showed no improvement. Observation of patients based on Alpa Shukra Graph No. 20 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% B.T. % A.T. % 00 01 02 03 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 21. Observation of patients based on Medhra and Vrishana vedana Table No. 32 Grade No. of patients B.T. % A.T. % 00 5 25 13 65 01 4 20 7 35 02 5 25 - - 03 6 30 - -Out of 20 patients, 6 (30%) patients were included in Grade III; 5 (25%) patients wereincluded in Grade II; 4 (20%) patients were included in Grade I; 5 (25%) patients wereincluded in Grade 0 depending their complaints. After receiving treatment 13 (65%)patients were improved to Grade o and 7 (35%) patients were improved to Grade I. Observation of patients based on Medhra and Vrishana vedana Graph No. 21 B.T. 5 % 25 % 65 A.T. 13 B.T. % A.T. % Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 22. Observation of patients based on Semen volume Table No. 33 Volume B.T. % A.T. % Below 1 ml 2 10 - - 1 – 2 ml 15 75 14 70 Above 2 ml 3 15 6 30Before treatment 2 (10%) patients were reported semen volume below than 1ml; 15(75%) patients were reported semen volume of 1 – 2 ml and rest 3 (15%) patients werereported semen volume of more than 2 ml. After getting treatment 14 (70%) patientswere improved semen volume in-between 1 –2 ml and other 6 (30%) patients wereimproved semen volume more than 2ml. Observation of patients based on Semen volume Graph No. 22 75 70 80 70 60 Semen Volume 50 30 40 30 15 15 14 10 20 6 2 3 10 0 B.T. % A.T. % Below 1 ml 1-2 ml Above 2 ml Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 23. Observation of patients based on Sperm count Table No. 34 Sperm count No. of patients B.T. % A.T. % 0-10 4 40 2 10 11-20 9 60 2 10 21-30 4 1 5 31-40 3 5 25 41-50 - 3 15 51-60 - 4 20 61-70 - 3 15Out of 20 patients 4 (20%) patients were having sperm count below 10 millions/ml; 9(45%) patients were having sperm count 11-20 millions/ml; 4 (20%) patients were havingsperm count of 21-30 millions/ml; 3 (15%) patients were having sperm count of 31-40millions/ml. After getting treatment 3 (15%) patients were improved up to sperm count of61-70 millions/ml; 4 (20%) patients were improved sperm count of 51-60 millions/ml; 3(15%) were improved up to sperm count of 41 – 50 millions/ml; 5(25%) patients wereimproved up to sperm count of 31- 40 millions/ml; 1(5%) patients was improved spermcount up to 21- 30 millions/ml; 2 (10%) patients were improved sperm count up to 11-20millions/ml; and 2 (10%) patients showed no improvement. Observation of patients based on Sperm count Graph No. 23 Percentage 0 - 10 A.T. 11 - 20 Percentage 21 - 30 31 - 40 B.T. 41 - 50 51 - 60 0 20 40 60 80 100 61 - 70 Sperm count Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 24. Observation of patients based on Sperm motility Table No. 35 Sperm motility No. of patients B.T. % A.T. % 0-20 7 35 2 10 21-40 6 30 2 10 41-60 4 20 7 35 61-80 3 15 9 45Before treatment out of 20 patients, 7 (35%) patients were reported Sperm motility of 0-20%; 6 (30%) patients were having sperm motility of 21-40%; 4 (20%) patients werehaving sperm motility of 41-60%; 3 (15%) patients were having sperm motility of 61-80%. After receiving treatment 9 (45%) patients improved up to 61-80%; 7 (35%)patients improved up to 41-60%; 2 (10%) patients improved up to 21-40%; 2 (10%)patients did not any improvement. Observation of patients based on Sperm motility Graph No. 24 45 40 35 Sperm Motility 30 25 20 15 10 B.T. 5 0 A.T. 0 - 20 21 - 40 41 - 60 61 - 80 0 - 20 21 - 40 41 - 60 61 - 80 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS 25. Over all assessment of Shatavari Ghrita Matra Basti Table No. 36 Parameters No. % Relief Good response 3 15 Moderate response 4 20 Mild response 9 45 Poor response 4 20Totally 20 patients had under gone the treatment. Out of them 4 (20%) patients respondedpoorly; 9 (45%) patients responded mildly; 4 (20%) patients responded moderately; and 3(15%) had shown Good response after the treatment. Over all assessment of Shatavari Ghrita Matra Basti Graph No. 25 Percentage No. of Patients 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Good Response Moderate response Mild response Poor response Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTS Table No. 37 Showing the Assessment of each individual on Subjective parameters Sl. OPD No. Alpa shukra Medhra and No. Vrushana Vedana with Linga daha B.T. A.T. B.T. A.T. 01 1497 3 1 0 0 02 2762 2 0 2 1 03 2966 2 0 2 0 04 2604 1 3 1 0 05 2897 3 3 0 0 06 2819 3 0 3 0 07 2969 1 0 2 0 08 2619 3 0 0 0 09 6011 3 1 3 1 10 1493 2 2 1 0 11 1453 3 2 3 0 12 1486 2 3 3 1 13 1489 3 1 2 1 14 1501 2 0 3 1 15 1509 3 0 0 0 16 633 2 1 2 1 17 271 2 2 3 1 18 529 3 2 1 0 19 3015 2 0 1 0 20 3079 3 0 0 0 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTSTable No. 38Showing the Assessment of each individual on Objective parametersSl. OPD Sperm count Sperm Volume Pus cells inNo. No. in motility numbers B.T. A.T. B.T. A.T. B.T. A.T. B.T. A.T.01 1497 16.3 33.8 <10 68 1 2.5 5-6 14-1502 2762 25 46 23 54 1 2 0-1 0-103 2966 20 53 60 78 2 2 0-1 0-104 2604 35 10 70 50 1.5 2.5 1-2 1-205 2897 <10 <10 < 10 <20 2.5 2 0-1 4-806 2819 18 52 36 60 1.5 1.5 0-1 0-107 2969 32 63 74 80 1.5 2 3-5 0-108 2619 10 50 <10 80 1 2 10-20 0-109 6011 <10 35 <10 45 0.5 1.5 0-1 0-110 1493 25 27 65 70 2.5 2 1-2 0-111 1453 <10 25 15 30 <½ 1 1-0 0-112 1486 20.3 16.6 <10 10-20 1.5 2.5 0-1 0-113 1489 16 38 45 70 1.5 2 2-3 1-214 1501 20 68 15 35 2 2.5 2-4 0-115 1509 19 65 25 75 1 2 0-1 0-116 633 24 36 38 54 2.4 2.5 0-1 0-117 271 28 32 24 42 2.0 2.0 2-3 0-118 529 17 38 46 68 1.5 2.0 3-4 0-119 3015 34 53 48 57 1.0 1.0 0-1 0-120 3079 16 46 35 73 2.0 2.5 2-3 1-2 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTSTable No. 39Showing Individual study on Assessment criteriaSl. OPD Ejaculation Sexual desire Erection Rigidity OrgasmNo No. B.T. A.T. B.T. A.T. B.T. A.T. B.T. A.T. B.T. A.T.01 1497 3 5 4 4 5 5 3 5 3 402 2762 3 5 1 3 4 5 4 5 4 503 2966 5 5 5 5 5 5 4 5 4 504 2604 5 5 1 4 3 4 3 4 2 405 2897 2 5 1 2 4 5 3 5 2 406 2819 3 5 2 5 2 4 0 4 1 407 2969 5 5 4 4 5 5 4 5 4 508 2619 5 5 3 4 5 5 3 5 4 509 6011 5 5 4 4 5 5 4 5 4 510 1493 3 5 3 4 4 5 3 4 3 411 1453 3 5 4 5 5 5 1 5 0 512 1486 3 5 4 4 5 5 3 5 2 513 1489 5 5 5 5 5 5 4 5 4 514 1501 2 4 3 5 4 5 3 5 3 415 1509 3 5 3 5 3 4 2 4 3 516 633 3 4 3 4 3 5 3 4 3 417 271 4 5 1 3 5 5 4 4 4 518 529 3 5 4 4 4 5 3 4 3 419 3015 5 5 2 5 5 5 5 5 4 520 3079 3 5 4 5 5 5 4 4 4 5 Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTSTable No. 40Showing Statistical Analysis or the Assessment criteriaParameters Mean S.D. S.E. t -value p -value RemarksEjaculation 1.25 1.019 0.27 5.506 < 0.001 H.S.Sexual desire 1.15 1.1089 0.243 4.75 < 0.001 H.S.Erection 0.55 0.686 0.153 3.594 < 0.001 H.S.Rigidity 1.45 1.099 0.245 5.918 < 0.001 H.S.Orgasm 1.55 1.05 0.234 6.62 < 0.001 H.S.Alpa Shukra 1.65 0.988 0.220 7.5 < 0.001 H.S.Medhra and Vrishana 1.25 0.966 0.216 5.787 < 0.001 H.S.vedana with LingadahaSperm count 22.5 14.00 3.132 7.187 < 0.001 H.S.Sperm motility 25.75 17.911 4.0 6.4375 < 0.001 H.S.Volume 0.58 0.431 0.096 6.04 < 0.001 H.S.Pus cells 2.2 3.679 0.822 2.700 < 0.002 H.S. Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • OBSERVATION & RESULTSCONCLUSION OF RESULTSTo know the effect of drug before and after the treatment, the statistical analysis is doneby using paired t- test, by assuming that the drug is not responsible for change in thereadings before and after treatment. Among the subjective parameters the parameter Erection and in all otherparameters shows highly significant (p<0.005). The parameters Orgasm, Rigidity,Ejaculation, Alpashukra shows more highly significant than other parameters bycomparing t- value. Among objective parameters the pus cells only shows slightly highly significant.But in the parameter Sperm count shows more highly significant than the other objectiveparameters, (By comparing t- test.) Shatavari ghrita Matra basti in the management of Ksheena Shukra
  • DISCUSSION Discussion Ksheena Shukra is a disease in which depletion of Shukra is observed bothQualitatively and quantitatively, the ultimate result of this being loss of parenthood. Theabove picture of the disease holds well even today in Oligospermia, where in there willbe decreased sperm count and which is the major cause for Infertility. Male infertility canarise from factors such as low sperm count and sperm abnormalities including alteredmorphology and low motility. Up to 10% of infertility cannot be explained medically. The term Shukra mentioned in our classics has got a wider concept i.e. it includesboth endocrine and reproductive functions (Androgen and Semen). It is very difficult todiagnose Ksheena Shukra with the help of signs and symptoms mentioned in our classicsbecause it was observed in the study that most of the patients did not have thosesymptoms. So as the technology is so much advanced, Semen analysis is an importantand necessary investigation to diagnose Oligospermia. It is estimated that one of five couples will have difficulty establishing apregnancy and that a male factor will be identified as the sole or contributing cause in 40percent of these cases. As the number of couples seeking assistance rises, malereproductive disorders have become an increasingly important part of the infertilityexamination. Current diagnostic and advanced treatment modalities have significantlyimproved prognosis and created a new era in the treatment of male-factor infertility The treatment of male infertility is mainly aimed to increase sperm count andmotility. So Ksheena Shukra (Oligospermia) was selected as subject for this clinical trial. Shatavari ghrita Matra basti in the management of Ksheena Shukra 129
  • DISCUSSION Science is the only media to observe and analyze the all kinds of events in theuniverse. The systematic arrangement of facts and events, ascertained by observationsand interpretation makes the facts a part of the science. Discussions on the study are made under the following headings: 1. Ksheena Shukra vis-à-vis Oligospermia 2. Probable mode of action of Matrabasti with Shatavari Ghrita in the management of Ksheena shukra 3. Discussion on Semen analysis 4. Clinical study Ksheena Shukra vis-à-vis Oligospermia Ksheena Shukra is the most upcoming disorder arising with greater number of affected population in the world. It comes under the various Shukra dusti explained by Acharya of Ayurveda. It is caused by the vitiated Vata and Pitta dosha in the Anuloma kshaya of Majja and Shukra dhatu and Pratiloma kshaya of Shukra Dhatu. It is characterized by the symptoms pertaining to the Majja and Shukra dhatu like Alpa shukra, Klaibya, Medhra and Vrishana vedana etc. Oligospermia is a disease coming under the Reproductive system of diseases andAndrology described by the modern science, which is almost identical to Ksheena Shukrain etiology, pathology and clinical features. Hence, the discussion is made accordingly. Shatavari ghrita Matra basti in the management of Ksheena Shukra 130
  • DISCUSSIONDiscussion On Shareera The roots of Shukravaha Srotos are the Vrishana (Testicles) and Sopha (Penis).Testicles synthesize the hormone testosterone and also they are the sites ofspermatogenesis. Penis is the copulatory organ of males through which seminal fluid isdeposited in the female reproductive tract. Shukra is present all over the body in the same manner in which the fat in themilk and juice in sugarcane plants are described. All hormones of hypothalamus –pituitary- gonadal – axis can include under the term Shukra. Sneha bhaga (Fatty portions) of ‘Majja Dhatu’ forms Shukra. This Shukra comesout of bones through the pores created by Vayu and Aksha Mahabhuta. So it is known asMajja Rasa, Majja jata Dhatu i.e. Born out of Majja. As if the water oozing out of newmud pot. Shukra oozes out of this pores and circulates all over the body throughShukravaha Srotansi. Now the modern science has proved that the human bone marrowhas been used to create early-stage sperm cells. Scientific steps forward that will helpresearchers understand more about how sperm cells are created. The research publishedFriday, April 13 2007, in the academic journal Reproduction: Gamete Biology, wascarried out in Germany by a team of scientists led by Professor Karim Nayernia, formerlyof the Universitat Gottingen but now of the North-East England Stem Cell Institute(NESCI), based at the Centre for Life in Newcastle upon Tyne. For the experiment, ProfNayernia and his team took bone marrow from male volunteers and isolated themesenchymal stem cells. These cells have previously been found to grow into other bodytissues such as muscle. They cultured these cells in the laboratory and coaxed them intobecoming male reproductive cells, which are scientifically known as germ cells. Genetic Shatavari ghrita Matra basti in the management of Ksheena Shukra 131
  • DISCUSSIONmarkers showed the presence of partly-developed sperm cells called Spermatagonial stemcells, which are an early phase of the male germ cell development. On the other hand Dalhana has commented Mastaka as Majja.Hypothalamus secretes the GnRH and Hypothalamo- hypophysial portal system carriesthis to the anterior pituitary. Anterior pituitary in the response to GnRh secretes FSH andLH into the blood stream. These hormones then circulate all over the body and stimulatetesticles to secrete their hormones. Oozing out of Shukra can be considered here the entryof hormones from the cranial cavity into the general circulation. 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. Shatavari ghrita Matra basti in the management of Ksheena Shukra 132
  • DISCUSSIONDiscussion On NidanaAhara janya: Asatmya ahara sevena, rooksha, tikta, lavana and amla rasa ati sevanaleads to shukra dusti. Excessive intake of lavana and katu rasa leads to Punstva upaghata Excessive intake of teekta rasa leads to Shukrasoshana Excessive intake of Kashaya rasa leads to shukravarodha and srotovibandha. Excessive intake of Alcohol, Smoking, tobacco chewing lowers the plasma testosterone and increase conversion of androgens into estrogens. Thus testicular dysfunction may occur in the patients. Anashana for long time leads to dhatu kshaya which reduces the shukra dhatu.Vihara janya: Vata gets provoked due to atyadhika vyayama, Ati Vyavaya etc. this mayaltimately caused for dhatu kashya. So kshaya of Shukra dhatu will occurred that willleads to ksheena shukra. The contemporary science has proved that excessive exercises,excess coitus will decrease the androgenic hormones. Also environmental factors play agreat role in the spermatogenesis. Excess heat, Sun rays, Pollution, Dust allergy candisturb the spermatogenesis process.Manasa janya: Stress and exercises can interrupt the normal flow of hormones fromhypothalamus and pituitary. The endophrings raised by the brain to minimizew the painand stress may block the normal release of GnRH. This is essential for maintainingspermatogenesis in male. At the Present study psychological factors shows significantvalues as 13 (65%) patients was found under stress category. Shatavari ghrita Matra basti in the management of Ksheena Shukra 133
  • DISCUSSION Wolfram and Perloff pointed to the fact that emotional stress might lead tooligospennia. Steve examined testicular biopsy specimens in men awaiting verdictbecause of rape. He found in all such specimens complete spermatogenic arrest. The factthat the raped women became pregnant attested to the premise that the rappers hadnormal spermatozoa and spermatogenesis at the time of the crime. Steves theory wasbased on the assumption that anxiety and psychic tension brought this organic change. The hypothalamus-hypophyseal axis is responsible for the normal regulation ofgonadotropin excretion. Neurological influences through nerve routes from higher levelsin the brain control normal hypothalamic action. Any factor of hindrance to thisequilibrium might cause insidious changes in gonadotropin excretion and abnormalspermatogenesis. So reduction of stress, strain anger, fear may increase thespermatogenesis.Discussion On SampraptiSpecific samprapti of Ksheenashukra is not mentioned in the classics. From the aboveetiological factors one can establish the process of pathogenesis. Initially Vata and Pittadosha vitiate the body. Later the Kapha dhatu kshaya occurred due to guna like Rooksha,Laghu, Kshara, Sukshma, Ushna, Teekshna and sara. This above said properties are alsothe opposite properties of Shukra. Lack of Jalavargeeya dravya or kapha on account ofwhich Shukra undergoes kshaya due to Ashrya-ashrayee bhava. Shatavari ghrita Matra basti in the management of Ksheena Shukra 134
  • DISCUSSIONDiscussion On ChikitsaPROBABLE MODE OF ACTION OF MATRABASTI Udbhavasthana of Ksheena shukra is Pakwashaya and Vyaktasthana is Shukradhatu. Hence, Matrabasti chikitsa has nectarous effect over it. Matrabasti is a type ofSnehabasti classified on the basis of quantity of Sneha dravya used in it. So this canconquer the vitiated vayu in Ksheena Shukra effectively. Vyanavata and Apanavata invariably play an immense role in pathogenesis ofKsheena Shukra. The sneha of Bastidravya acts over the Vyanavayu and Apanavayupredominantly. So Matrabasti could be the best mode of drug administration so far astaste of drug, dosage and Agni is concerned, in comparison to oral drug administration. Guda is Pradhana marma and the Moola of Siras, that nourishes the whole body.By maintaining the left lateral procedure at the time of Matrabasti procedure, thebastidravya reaches the pakwasaya resides in the left side. Charaka opines that byattaining this posture, gudavalees will be relaxed and the grahani is situated in the leftside. Chakrapani states that agni will be in the natural state in the posture whileGangadhara says agni, grahani and nabhi are present in the left side. Jejjata commentsagni is present left side over the nabhi, guda has got a relation with sthoolantra on leftside. So bastidravya can reach to the large intestine and grahani, as they are present in thesame level. Left lateral position is the best posture for better and effective administration ofMatrabasti. Because – In this posture, anal canal turns to left side to rectum, sigmoidcolon and descending colon. Moreover, medicines stay at these surfaces and gets Shatavari ghrita Matra basti in the management of Ksheena Shukra 135
  • DISCUSSIONabsorbed more and show its effect, especially in Matrabasti. The absorptive area ofmucosa is more on left side and it is easily approachable through anus rather than on theright side and this posture relaxes the ileo-ceacal junction and makes the easy flow ofBastidravya into the sigmoid colon. The drug given through the Matrabasti reaches to the site of the origin of thedisease. As Susruta mentioned that the veerya of the Basti dravya spreads all over thebody just as water poured at the root reaches all parts of the tree through the micro andmacro channels. While Charaka mentions that Matrabasti by reaching up to the umbilicalregion (transverse colon), sacroiliac region (rectum), flanks and hypochondrial regions(ascending and descending colon) and churning of the fecal and morbid matters presentthere in and at the same time by spreading its unctuous effect in whole body, drawn outthe fecal and morbid matter. While dealing with the action of Basti Vagbhata says, the veerya of Basti beingconveyed to Apana to Samana Vata which may regulate the function of agni then toUdana, Vyana and Apana thus providing its efficacy all over the body. At the same timethis effect of Matrabasti by specifying Vata, restores the displaced Kapha and Pitta attheir original seats. The control gained over Vata leads to the Samprapti vighatana ofdisease.The same action of Basti drugs has been described by Charaka. Administered Matrabastienters into Pakwashaya, Nabhi, Katipradesha and Kukshi. It spreads to all over the bodyby its Veerya to drain out the morbid dosha lodged in the entire body from the foot to thehead, just as the sun situated in the sky sucks up the moisture from the earth. Shatavari ghrita Matra basti in the management of Ksheena Shukra 136
  • DISCUSSION Action of Matrabasti is possible by Anupravaranabhava of bastidravya, whichcontains sneha. Sneha easily moves up to Grahani by Anupravanabhava guna similar tothat of dravya, which freely moves in the utensil. Matrabasti also act on the Majjavaha and Shukravaha srotas. Pittadharakala and Majjadharakala and Grahani part takes in the action ofMatrabasti. Bastidravya enters till Grahani (Pittadhara Kala) which is the seat of agni.The nutrients may get absorbed and thereby nourishes the Majjadharakala, which ishaving a strong bond with Pittadharakala and Vata. Matrabasti contains Sneha (i.e. Shatavari Ghrita) with above mentioned propertieswhich are capable to pacify Vata by their potencies. Due to its less quantity, it facilitate tostay longer period in Pakwashaya (9-10 hours which was observed in this study) andmay acts both locally and systemically. Ksheena Shukra possess aggravation of Vata and Pitta which in turn leads toreduction of Snehabhava and Dhatukshaya condition. Its incidence is predominant insenile condition where Matrabasti is indicated. Hence, Matrabasti can be administered inall the ages without any complications. It plays vital role in the management ofKsheenaShukra. It induces Snehabhava and corrects Vata and Pitta in turn checks thepathology of the disease. According to modern science, the rectum has a rich blood and lymph supply.Drugs can readily cross the rectal mucosa like other lipid membrane. As per Basti/Enemaconcerned, in trans-rectal route, the unionized and lipid soluble substances are readilyabsorbed from the rectum. Shatavari ghrita Matra basti in the management of Ksheena Shukra 137
  • DISCUSSION The concentration gradient of Matrabasti dravya is more inside the lumen of intestineas compared to rectal venous plexus, which facilitates the absorption. This rectal venousplexus further divided into internal venous plexus and external venous plexus. Internalvenous plexus, situated in the submocosal layer of anal canal and carries into superiorrectal vein and to external venous plexus. Basti dravya is also absorbed from external venous plexus in three parts, i.e. inlower part through inferior rectal veins and drained into internal pudendal vein, in middlepart through middle rectal vein which is having tributaries, those drains from bladder,prostate and seminal vesicle into internal iliac vein, in upper part through superior rectalvein into inferior mesenteric vein a tributary of portal vein. Matrabasti dravya is also absorbed from the upper rectal mucosa, and is carried bythe Superior mesenteric vein into the portal circulation and enters into Liver. Secondly,the portion absorbed from the lower rectum enters directly into systemic circulation viamiddle and inferior hemorrhoidal veins. This indicates that due to more vascularity in thisarea absorption rate is high. Acharyas also said that “Guda moolam hi shareeram”. The advantage of this route is total gastric irritation is avoided and that by using asuitable solvent the duration of action can be controlled. Moreover, it is often moreconvenient to use drugs rectally in the long time in case of geriatric and terminally illpatients. Matrabasti plays major role in maintaining normal bacterial flora by virtue of itsaction which is supported by some of the studies conducted already. Pakwashaya is supplied with large numbers of nerve plexuses originating fromthe hypo-gastric plexus and lumbosacral plexus, etc. These plexus will receive Shatavari ghrita Matra basti in the management of Ksheena Shukra 138
  • DISCUSSIONnourishment and soothening effect by Matrabasti. Because Matrabasti mainly acts on thePakwashaya, here it nourishes, purifies and expels the unwanted toxins from the bodyand facilitates the normal functions in the body.Regulating the Gut Brain. In 1981, Wood described the Enteric Nervous System (ENS) as ‘The Brain of theGut’ that integrates information received and issues an appropriate response. ENSintegrates sensory information from mucosal receptor and organizes an appropriate motorresponse from a choice of predetermined programmes. So enteric nervous system of gutbrain is an integrative system with structural and functional properties that are similar tothose in CNS and physiological and pharmacological properties of Matrabasti chikitsa aresaid to be the outcome of modification of gut brain up to certain extent. By considering above explanation it is clear that Basti dravya is absorbed throughrectal mucosa either by chemically altered or un-altered state and carried throughout thegeneral circulation gives local and systemic effects by controlling Vata which isbackbone of the disease pathology.Probable Mode of Action of Shatavari ghrita Matra Basti : By the above qualities it may act on Dhatvagni. It does the Srotoshodhana, whichis one of the main aims of Matra Basti. Shatavari are said to be Vrishya. Apart from being Vrishya they are also Balya,Rasayana, useful in palliating Vata and Pitta which are the main culprit Dosha involvedin Ksheena Shukra. They have the same qualities as that of Shukra by which they act asShukrala and Brihmana. Along with Vrishya they also act as Rasayana. Shatavari ghrita Matra basti in the management of Ksheena Shukra 139
  • DISCUSSION Milk is a complex colloidal dispersion of fat globules and protein (casein, whey)in an aqueous solution of lactose, minerals, and other minor constituents. The majorconstituents of milk are made up of 87.4% water and 12.6% milk solids (3.7% fat, 8.9%milk solids-not-fat). The milk solids-not-fat contains protein (3.4%), lactose (4.8%), andminerals (0.7%). Milk fat, the most complex of lipids, exists in microscopic globules in an oil-in-water emulsion in milk. Milks lipids are mainly triacylglycerols (triglycerides) or estersof fatty acids with glycerol (97-98%), 0.2 to 1.0% phospholipids, 0.2 to 0.4% free sterols(cholesterol, waxes, and squalene, an intermediate of cholesterol), traces of free fattyacids, and varying amounts of the fat-soluble vitamins A, D, E, and K. It activates theandrogenic hormones within few minutes after administration. Ghrita nourishes the Shukra Dhatu directly due to the presence of similar qualitiesof Shukra like Madhura Rasa, Snigdha, Pichila, Guru and Sheeta Guna. It is MadhuraVipaka and Vajeekara in effect. The production of Shukra Dhatu takes place isShukravaha Srotas, by the action of Shatavari ghrita Matra Basti due to Deepana andPachana. Hence, this therapy can directly attribute to increasing the quantity and qualityof the Shukra. One of the ingredients Shatavari has aphrodisiac action due to the presence ofShatavarin 4. It boosts the hormones in the body. It stimulates increase in hormoneproduction and also stimulates its effect. It also acts as a diuretic and removes toxiccompounds through kidneys. The aphrodisiac and fertility potentiating action has beentested. Shatavari ghrita Matra basti in the management of Ksheena Shukra 140
  • DISCUSSION All the drugs of Shatavarighrita have Doshahara properties. Like Shatavariremoves Shukra Dusti by acting as Doshahara. It may repair the morphology and increasethe motility of sperms. By correcting Vata and Pitta they may improve the physiologicalaction of the Dosha, there by improving the motility and increasing the actively motilesperms. Honey added with Shatavari ghrita it attain the qualities of Vrishya. The presenceof Madhu in Basti makes it more potent and enhances the formation Shukra. Madhu isTridoshghna. Honey contains some minerals like potassium, calcium, magnesium, zinc, iron,copper, phosphorus, sulphur, chlorides, and traces of chloride, traces of chromin, nickel,tin, silver and gold. Zinc may play an important role in the antibacterial activity ofseminal plasma (Insler and Lunenfeld 1993) and is found to be important for spermmotility. Zinc is related to the morphology of sperm tails. In adolescent boys zincdeficiency results in retardation of growth and hypogonadism. Except in azoospermia, inall pathological groups, the concentration of copper was found high; a decrease orincrease in the concentration of iron may alter the sperm motility. Calcium is essential forthe motility of spermatozoa. Gold was reported 2 to 5 μg/100 ml in seminal plasma. Shatavari ghrita Matra Basti provided improvement in sexual desire, erection,ejaculation, orgasm and msp it may be due to Vrishya and Vatahara properties. It also provided significant improvement in semen volume, Sperm count andmotility of sperm, it may be said that the drug was acting at a particular site, probablysperm-mitochondrial level and thereby improved the motility by correcting the relatedmitochondrial disorders, in proliferating the spermatogenic process and Androgen level Shatavari ghrita Matra basti in the management of Ksheena Shukra 141
  • DISCUSSIONalso which may due to Shukrala and Dhatwagni Vardhaka that to Shukragni Vardhakaproperties of ingredients of it. This Basti also corrects the Apana Vata which is one of the main culprits inKsheena Shukra. The spermatogenesis is a highly complex process involving subtleinteraction between endocrine, paracrine and autocrine regulators acting on different cellpopulation both within and out of testes. These entire factors can very well be regulatedby above said Basti, thus bringing about healthy spermatogenesis.Discussion on Semen Analysis The semen analysis forms the basis of the initial evaluation for assessing male-factor infertility. Prior to establishing a reliable fertility baseline, two to three semenanalyses should be performed. Multiple analyses are necessary because semen findingsnormally fluctuate for a given individual. For each analysis, patients are instructed toabstain from intercourse for 2 to 3 days. Abstinence for a shorter period can decreaseejaculate volume and sperm count whereas prolonged abstinence may impair spermmotility. It is critical that the specimen be collected in a nontoxic container, that there beno inadvertent loss of the specimen, and that the analysis be performed within 2 hours ofcollection.A properly performed semen analysis evaluates several parameters including: • Ejaculate volume - 1.5 to 5.0 ml. • Sperm count - >20 million sperm/ml. • Sperm motility - >50 percent • Forward progression - >2 (scale 0 to 4) Shatavari ghrita Matra basti in the management of Ksheena Shukra 142
  • DISCUSSION • Sperm morphology - >50 percent normal • pH - 7.2 to 7.8 • No significant sperm agglutination • No significant leukospermia • No hyperviscosityInitially, semen is a coagulum that under normal conditions liquefies within 1 hour afterejaculation. The seminal constituents responsible for coagulation originate in the seminalvesicles while the proteolytic enzymes that initiate liquefaction are found in the prostate.Following liquefaction, the quality of the seminal fluid can be evaluated. Viscosity isconsidered normal when the specimen can be gently passed through a 21 G needle.Impaired liquefaction and hyperviscosity in the presence of normal sperm motility and anormal postcoital test is probably of no clinical significance; however, when impairedmotility is noted, trials of sperm processing followed by intrauterine insemination areworthwhile.Ejaculate volume: Normal ejaculate volume range from 1.5 to 5.0 mL and is almost entirely derivedfrom seminal vesicle and prostatic secretions. A low ejaculate volume may indicateendocrine disorders (low testosterone level), retrograde ejaculation, or obstruction oragenesis of the seminal vesicles. Determination of the serum testosterone level, post-ejaculate urine, and seminal fructose concentration may help identify the etiology of alow-volume ejaculate. Men with abnormally low semen volume who also haveoligospermia or azoospermia may have seminal vesicle agenesis, ejaculatory-duct cysts, Shatavari ghrita Matra basti in the management of Ksheena Shukra 143
  • DISCUSSIONor obstruction. These abnormalities can occasionally be detected by transrectalultrasonography (TRUS), which provides an accurate method for evaluating the prostate,seminal vesicles, and ejaculatory ducts. When identified, obstructing cysts or stricturesare amenable to treatment by transurethral resection. In contract, excessive semen volumecan influence fertility by a dilutional effect, resulting in less sperm reaching the cervix. Inthis case, too, sperm processing and artificial intrauterine insemination may be beneficial.Sperm countThe semen parameter most utilized is sperm count; it is important, however, to appreciatethat sterility does not exist until no sperm are present. While the average sperm count innormal fertile males is 70 to 80 million sperm/mL, this value represents the mean and isnot indicative of the minimal requirements for fertilization. It is true that low spermconcentrations are associated with decreased fertility rates, but pregnancy rates declineonly after the sperm density drops below 20 million sperm/mL. In fact, naturalpregnancies have been documented with sperm concentrations as low as 1 millionsperm/mL.Sperm motilitySperm motility is evaluated both quantitatively and qualitatively. Overall quantitativemotility is defined as the percentage of sperm that demonstrate any movement; in asemen analysis, more than 50 percent motile sperm is considered normal. Forwardprogression is a qualitative assessment and defines the characteristic motion of the sperm. Shatavari ghrita Matra basti in the management of Ksheena Shukra 144
  • DISCUSSIONAbnormalities of motility can arise from infection, the presence of antisperm antibodies,partial ejaculatory-duct obstruction, gonadotoxin exposure, and varicoceles.Necrospermia (when none of the sperm are moving) is a misnomer, because in somecases the sperm are alive yet immotile secondary to structural defects in the tail. With thecurrently available assisted reproductive technology techniques, men showing this defectshould not necessarily be considered sterile.Sperm morphologySperm morphology is an important factor in semen analysis because it is a reflection ofspermatogenic development. A normal sperm has an oval configuration with a smoothcontour, an acrosome comprising 40 percent to 70 percent of the distal part of the head,no abnormalities of the neck, midpiece, or tail, and cytoplasmic droplets filling no morethan half the sperm head. Using these strict criteria, a normal semen analysis will containmore than 14 percent normal-appearing sperm. In some studies, classification of spermaccording to the Kruger criteria has correlated well with in vitro fertilization (IVF)outcomes and various sperm-function assays.Some infertile men show numerous round cells in their semen. These round cells may beeither immature sperm or white blood cells, and special staining techniques are needed toaccurately differentiate between the two. Increased numbers of seminal leukocytes(leukospermia) may indicate a potentially treatable subclinical genital-tract infection, andappropriate cultures of both semen and prostate secretions should be performed. Seminalwhite blood cells may adversely affect sperm function either directly, through the releaseof soluble modulators (cytokines), or by production of harmful free oxygen radicals. Shatavari ghrita Matra basti in the management of Ksheena Shukra 145
  • DISCUSSIONPH: The normal seminal pH is 7.2 to 7.8; it is influenced by prostatic secretions,which are slightly acidic. Seminal pH determinations need to be performed immediately,as a delay in testing may result in abnormal values. Alkalinization of the semen mayindicate an infection such as prostatitis.Researches going on Evaluating oxidative stress-induced nuclear DNA damage and its effects on sperm quality. Pathogenesis of DNA Damage in Spermatozoa of Infertile Patients. Enhancement of Sperm Quality by Magnetic Cell Separation. Antioxidant Use to Minimize Human Sperm Apoptosis and DNA Damage During Cryopreservation. Effects of Electromagnetic Waves Exposure From Cell Phones on Semen QualityDiscussion on Effect of therapiesEffect of Therapy on Ejaculation: Shatavarigrita MatraBasti gave upto 90%improvement. In the statistical analysis, the parameter showed highly significant (p-value<0.001) and the corresponding t-value 5.506.Effect of therapy on sexual desire: Shatavarighrita MatraBasti displayed 45% increasein sexual desire. In the statistical analysis, the parameter showed highly significant (p-value <0.001) and the corresponding t-value 4.75.Effect of Therapy on Erection: Shatavarighrita MatraBasti provided 30% improvementin erection. In the statistical analysis, the parameter showed highly significant (p-value<0.001) and the corresponding t-value 3.594. Shatavari ghrita Matra basti in the management of Ksheena Shukra 146
  • DISCUSSIONEffect of the therapy on Rigidity: Shatavarigrita MatraBasti showed 60% improvementin Rigidity. In the statistical analysis, the parameter showed highly significant (p-value<0.001) and the corresponding t-value 5.918.Effect of Therapy on Orgasm: Shatavarigrita MatraBasti showed 60% improvement inorgasm. In the statistical analysis, the parameter showed highly significant (p-value<0.001) and the corresponding t-value 1.55.Effect of therapy on Alpa Shukra: After the treatment the patients suffering alpaShukra has improved up to 45%. Statistically this parameter showed highly significant(p-value < 0.001).and corresponding t- value 7.5Effect of the therapy on Medhra and Vrishana Vedana: After the treatment thepatients suffering Medhra and vrishana vedana had improved up to 65%. Statistically thisparameter showed highly significant (p-value < 0.001).and corresponding t- value 5.787Effect of Therapy on Sperm Count: The sperm count after the treatment showed 50%increased in between 41 – 70 million. Statistically this parameter showed highlysignificant (p-value < 0.001).and corresponding t- value 7.187Effect of therapy on motility: The motility of sperm increased up to 80% from the rangebetween 41 – 80%. Statistically this parameter showed highly significant (p-value <0.001).and corresponding t- value 6.4375Effect of Therapy on Semen Volume: The semen volume increased to 30% in the rangebetween 1 – 2 ml. It may be said that the Statistically Shatavari ghrita Matra Basti iseffective in increasing the semen volume significantly (p-value < 0.001) andcorresponding t- value 6.04Overall Assessment of the Therapy: In this treatment 15 % patients got Good response,20% patients got moderate response, where as 45% patients got mild response. But onstatistical observation each parameter had shown highly significant i.e. p – value <0.001.So all the patients has got improvement after the therapy. Hence this therapy is foundeffective in the management of Ksheena Shukra Shatavari ghrita Matra basti in the management of Ksheena Shukra 147
  • CONCLUSION CONCLUSION Conclusions are the essence of whole study. In ancient research methodology it isdescribed as "Nigamana". In the discussion part of the study, the work is discussed on thebasis of concepts, supported by data and logical reasoning. The conclusions drawn fromthe scientific discussion are as follows : Matrabasti is a type of Anuvasana which is very effective in Ksheena shukra can be practiced safely. Ksheena shukra is disease condition pertains to impairment of Shukra utpatti i.e. Spermatogenesis in the testes. Ksheena shukra is caused due to hormonal imbalance in the body. Ksheena shukra is also caused due to the dietic and psychological interference. Shatavari ghrita Matrabasti prove its efficacy by increasing sperm count and also associated factors of semen. Ksheena shukra lakshana from the classics are compared to the baseline data in the study. It was found that Medhra vrishana vedana, Maithuna asakti, Chirat praseka, klaibya, Dhumayana, Dourbalya, and Mukhasosha, Shrama became normal after the administration of Shatavarighrita Matrabasti. Alpashukra shows significant result, i.e. 17 patients out of 20 got relieved. 13 factors such as Volume, Liquefaction, Count, Motility, Morphology, Colour, pH, Viscisity, Desire, Erection, Ejaculation, Rigidity and orgasm are considered for the overall assessments to declare the results Shatavarighrita matrabasti shows statistically viable with highly significant p- values. Shatavari ghrita Matra basti in the management of Ksheena Shukra 148
  • CONCLUSION Shatavarighrita matrabasti shows overall results of 3 (15%) patients in good response, 4 (20%) patients moderately improved, 9 (45%) patients mildly improved and 4 (20%) patients showed poor response. Ksheena shukra can be managed by the classical treatments mentioned in the Ayurveda. Hence it can be stated that Shatavarighrita matrabasti has significant result in the management of Ksheena Shukra.SUGGESTIONS FOR FUTURE STUDIES The study should be conducted in a large sample. As the spermatogenesis take 74 days so the study should be conducted for a longer duration so as to know the lasting of the clinical effects. As 30% oligospermia case occur due to the abnormality of Y-chromose so study should be taken the effect of Matra basti on Y-chromose. Free radicals such as superoxide anion (O2-·), hydrogen peroxide (H2O2), hydroxyl (OH-), and peroxyl radicals are involved in initiation and progression of oxidative damage to spermatozoa. If the levels of these reactive oxygen species (ROS) exceed the antioxidant capacity of the cell, oxidative stress will be induced, which reflect negatively on the male fertility potential. So the role of Matrabasti on this factor should be studied. Out of Shatavari ghrita matrabasti many other Vrisya basti and Shukravridhikara basti are explained in classical texts they can be used for further research. Shatavari ghrita Matra basti in the management of Ksheena Shukra 149
  • SUMMARY SUMMARY The dissertation work entitled “EVALUATION OF THE EFFICACY OFMATRABASTI IN KSHEENA SHUKRA”.consists of seven parts. They are 1. Introduction 2. Objectives 3. Review of literature 4. Methodology 5. Results 6. Discussion 7. Conclusion.The introduction highlights on the Global incidence report of Infretile Couple i.e 2,000,000 per year. The contribution of male factor alone to this total infertility is reported as 50% Panchakarma Chikitsa (Vamana, Virechana, Basti, Snehapana etc.) Matrabasti - Bastikarma has been doing wonders in the treatments of Ayurveda. Though it has been indicated for almost all the diseases, the prime importance of Bastikarma with Sneha dravy has been specified in the management of Ksheena Shukra. KshenaShukra – In Ksheena Shukra the major doshic involvement are Vata and Pitta. Due to its high incidence rate it is taken for this study. Shatavari ghrita Matra basti in the management of Ksheena Shukra 150
  • SUMMARY The objectives part describes Need for the study Title of the present study Objectives of the present 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. Review of literature part covers The historical view on Basti, and Ksheena Shukra Nirukti and Paribhasha of Basti, Ksheena Shukra Shareera of Guda and Shukra Description of Basti and Matrabasti Description of Ksheena shukra. Methodology part contains Deview of the properties and chemical composition of the drugs Methodology of the clinical study Procedures of Matrabasti Subjective and Objective parameters for assessment. The results part contain Demographic data related to the disease Data related to the overall response to the treatment Statistical analysis of the subjective and objective parameters. Shatavari ghrita Matra basti in the management of Ksheena Shukra 151
  • SUMMARY Discussion part consists of the headings Ksheena Shukra vis-à-vis Oligospermia, Role of Matrabasti in the management of KsheenaShukra, Clinical study Over all response of the therepy Conclusion part contains the conclusions of the present study and further suggestions for future study. Shatavari ghrita Matra basti in the management of Ksheena Shukra 152
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  • 41. Susruta, Susrutasamhitha Sareerasthana chapter 3 sloka 03. Chaukhambha Surabharati Prakashan; 2003; p. 152.42. Agnivesa, Charakasamhitha Vimanasthana chapter 15, sloka 34. 1st ed. Varanasi: Chaukhambha Surabharati Prakashan; 2005. p. 278.43. Agnivesa, Charakasamhitha Vimanasthana chapter 15, sloka 16. 1st ed. Varanasi: Chaukhambha Surabharati Prakashan; 2005. p. 278.44. Agnivesa, Charakasamhitha Vimanasthana chapter 8, sloka 109. 1st ed. Varanasi: Chaukhambha Surabharati Prakashan; 2005. p. 278.45. Agnivesa, Charakasamhitha Chikitsasthana chapter 30, sloka 145. 1st ed. Varanasi: Chaukhambha Surabharati Prakashan; 2005. p. 640..46. Susruta, Susrutasamhitha Sareerasthana chapter 2 sloka 11. Varanasi: Chaukhambha Surabharati Prakashan; 2003; p. 345.47. Vagbhata, Ashtangahridaya Shareerasthana chapter 1 sloka 17. Varanasi: Krishnadas Academy; 1982. p. 365. (Krishnadas academic series 4).48. Bhavamishra, Bhavaprakasha, Garbha prakarana, 199 sloka; vol I, 2nd ed Varanasi: Krishnadas Academy;2001 p. 4549. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 28. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 1046.50. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 28. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 1052.51. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 28. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 103852. Sarangadhara, Sarangadhara samhita Poorva khanda chapter 5 sloka 48 ; 3rd ed Varanasi: Chaukhambha orientalia; 2003. p.40 (Jaikrishnadas Ayurveda series 82). E
  • 53. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sharirasthana, 5th chapter, 37th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.36854. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sharirasthana, 5th chapter, 13th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.36555. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sharirasthana, 5th chapter, 15th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.36856. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sharirasthana, 7th chapter, 7th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.377 .57. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sharirasthana, 9th chapter, 7th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.38458. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 28. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 104559. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 28. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 1046,1047.60. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 28. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 1048.61. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 87. Varanasi: Krishnadas Academy; 1982. p. 286. (Krishnadas academic series 4).62. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 1. Varanasi: Krishnadas Academy; 1982. p. 270. (Krishnadas academic series 4).63. Susruta, Susrutasamhitha Chikitsasthana chapter 35sloka 4. Varanasi: Chaukhambha Surabharati Prakashan; 2003; p. 525.64. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 1. Varanasi: Krishnadas Academy; 1982. p. 270. (Krishnadas academic series 4). F
  • 65. Kasture VG, Ayurvediyapanchakarmavigyan chapter 6. 6th ed. Nagpur: Shree Baidyanath Ayurved Bhavan Ltd.; 1998. p. 373.66. Susruta, Susrutasamhitha Chikitsasthana chapter 35 sloka 18. Varanasi: Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).67. Ashtangasangraha Suthrasthana chapter 28 sloka 4. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 485. (Jaikrishnadas Ayurvedic series 79).68. Susruta, Susrutasamhitha Chikitsasthana chapter 35 sloka 17. Varanasi: Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).69. Susruta, Susrutasamhitha Chikitsasthana chapter 35 sloka 19. Varanasi: Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).70. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 61. Varanasi: Krishnadas Academy; 1982. p. 282. (Krishnadas academic series 4).71. Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5 sloka 19-22. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 323. (Jaikrishnadas Ayu. Granthamala 53).72. Agnivesa, Charakasamhitha Siddhisthana chapter 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 713-715. (Kasi Sanskrit series 228).73. Susruta, Susrutasamhitha Chikitsasthana chapter 37 sloka 77. Varanasi: Krishnadas Academy; 1980. p. 536. (Krishnadas Ayurveda series 51).74. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 47-48. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 684. (Kasi Sanskrit series 228).75. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 7. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154). G
  • 76. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).77. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 9. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).78. Susruta, Susrutasamhitha Chikitsasthana chapter 37 sloka 39. Varanasi: Krishnadas Academy; 1980. p. 533. (Krishnadas Ayurveda series 51).79. Agnivesa, Charakasamhitha Siddhisthana chapter 8 sloka 2-14. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 713. (Kasi Sanskrit series 228).80. Susruta, Susrutasamhitha Chikitsasthana chapter 38 sloka 118. Varanasi: Krishnadas Academy; 1980. p. 548. (Krishnadas Ayurveda series 51).81. Susruta, Susrutasamhitha Chikitsasthana chapter 36 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 528. (Krishnadas Ayurveda series 51).82. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 701. (Kasi Sanskrit series 228).83. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 53. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 701. (Kasi Sanskrit series 228).84. Agnivesa, Charakasamhitha Siddhisthana chapter 12 sloka 15. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 731. (Kasi Sanskrit series 228).85. Susruta, Susrutasamhitha Chikitsasthana chapter 38 sloka 116. Varanasi: Krishnadas Academy; 1980. p. 548. (Krishnadas Ayurveda series 51).86. Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 170. Jain Sankarlalji Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 999. H
  • 87. Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 186-190. Jain Sankarlalji Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 1000.88. Chakrapanidatta, Chakradatta chapter 73 sloka 29-31. 2nd ed. P.V.Sharma editor. Varanasi: Chaukhambha Publishers; 1998. p. 628. (Kasi Ayurveda series 17).89. Chakrapanidatta, Chakradatta chapter 73 sloka 23-26. 2nd ed. P.V.Sharma editor. Varanasi: Chaukhambha Publishers; 1998. p. 627-628. (Kasi Ayurveda series 17).90. Vagbhata, Ashtangahridaya Chikitsasthana chapter 9 sloka 72-76. Varanasi: Krishnadas Academy; 1982. p. 661. (Krishnadas Academic series 4).91. Agnivesa, Charakasamhitha Siddhisthana chapter 6 sloka 83. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 708. (Kasi Sanskrit series 228).92. Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 182-185. Jain Sankarlalji Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 999.93. Agnivesa, Charakasamhitha Siddhisthana chapter 10 sloka 4. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 724. (Kasi Sanskrit series 228).94. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 86. Varanasi: Krishnadas Academy; 1982. p. 285. (Krishnadas academic series 4).95. Agnivesa, Charakasamhitha Siddhisthana chapter 10 sloka 5-6. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 724. (Kasi Sanskrit series 228).96. Susruta, Susrutasamhitha Chikitsasthana chapter 36 sloka 6. Varanasi: Krishnadas Academy; 1980. p. 529. (Krishnadas Ayurveda series 51).97. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 87. Varanasi: Krishnadas Academy; 1982. p. 286. (Krishnadas academic series 4). I
  • 98. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 38-39. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 683. (Kasi Sanskrit series 228).99. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 27-28. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 682. (Kasi Sanskrit series 228).100. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 289. (Kasi Sanskrit series 154).101. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 7. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 691. (Kasi Sanskrit series 228).102. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 10-14. Varanasi: Krishnadas Academy; 1982. p. 273-274. (Krishnadas Academic series 4).103. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 8-9. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 691. (Kasi Sanskrit series 228104. Susruta, Susrutasamhitha Chikitsasthana chapter 35 sloka 7-9. Varanasi: Krishnadas Academy; 1980. p. 525-526. (Krishnadas Ayurveda series 51).105. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 14. Varanasi: Krishnadas Academy; 1982. p. 274. (Krishnadas Academic series 4).106. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 10-12. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 692. (Kasi Sanskrit series 228).107. Agnivesa, Charakasamhitha Siddhisthana chapter 5 sloka 4-6. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 702. (Kasi Sanskrit series 228).108. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 68-69. Varanasi: Krishnadas Academy; 1982. p.283. (Krishnadas Academic series 4). J
  • 109. Ashtangasangraha Suthrasthana chapter 28 sloka 8. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.503, ( Vrajajivan ayurvijnan Granthamala 6 ).110. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 52. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.701. (Kasi Sanskrit series 228).111. Ashtangasangraha Suthrasthana chapter 28 sloka 8. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.503, ( Vrajajivan ayurvijnan Granthamala 6 ).112. Ashtangasangraha Suthrasthana chapter 28 sloka 8. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.503, ( Vrajajivan ayurvijnan Granthamala 6 ).113. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 52-54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.701. (Kasi Sanskrit series 228).114. Ashtangasangraha Suthrasthana chapter 28 sloka 8. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.503, ( Vrajajivan ayurvijnan Granthamala 6 ).115. Hemadri, Ayurvedarasayana teeka on Ashtangahridaya Suthrasthana chapter sloka 69.Varanasi: Krishnadas Academy; 1982. p. 283. (Krishnadas Academic series 4).116. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 53. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.701. (Kasi Sanskrit series 228).169. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 67. Varanasi: Krishnadas Academy; 1982. p.283. (Krishnadas Academic series 4). K
  • 117. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Chikitsasthana chapter 35 sloka 18. Varanasi: Krishnadas Academy; 1980. p. 526-527. (Krishnadas Ayurveda series 51).118. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha Siddhisthana chapter 4 sloka 54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 701. (Kasi Sanskrit series 228).119. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 104-105. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 285. (Kasi Sanskrit series 154).120. Sharangadhara, Sharngadharasamhitha Utharakhanda chapter 5, sloka 5. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p 320. (Jaikrishnadas Ayurveda Granthamala 53).121. Susruta, Susrutasamhitha Chikitsasthana chapter 37 sloka 55-56. Varanasi: Krishnadas Academy; 1980. p. 534. (Krishnadas Ayurveda series 51).122. Ashtangasangraha Suthrasthana chapter 28 sloka 8. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.503, ( Vrajajivan ayurvijnan Granthamala 6 ).123. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 29-30. Varanasi: Krishnadas Academy; 1982. p.276-277. (Krishnadas Academic series 4).124. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 44. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.684. (Kasi Sanskrit series 228).125. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha Chikitsasthana chapter 30 sloka 138 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.640126. www.students.com L
  • 127, Chakrapani, Ayurvedadeepika teeka on Charakasamhitha Chikitsasthana chapter 30 sloka 138 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.143128. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha Chikitsasthana chapter 30 sloka 138 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.143129. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha vimanasthana chapter 5 sloka 19 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.250130. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha chikitsasthana chapter 30 sloka 138 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.640131. http:Mount Sinai - Department of Urology.htm132. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha chikitsasthana chapter 30 sloka 138 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.640133. Susruta, Susrutasamhitha Nidanasthana chapter 2 sloka 15 Varanasi: Chaukhambha Sura bharati prakashana; 2003. p. 534.134. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 24. 4th ed. NewJersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 861135. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha chikitsasthana chapter 30 sloka 177 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.641136. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 28. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 1046. M
  • 137. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sarirasthana, 6th chapter, 25th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.373138. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha sutrasthana chapter 17 sloka 69 4th ed. Varanasi: Chaukhambha Sura bharati prakashana; 2005. p.103139. Susruta, Susrutasamhitha Sutrasthana chapter 15 sloka 09 Varanasi: Chaukhambha Sura bharati prakashana; 2003. p. 69.140. Ashtangasangraha Suthrasthana chapter 19 sloka 6. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.149, ( Vrajajivan ayurvijnan Granthamala 6 ).141. Vagbhata, Ashtangahridaya Suthrasthana chapter 11 sloka 20. Varanasi: Krishnadas Academy; 1982. p.164. (Krishnadas Academic series 4).142. Vaidya Shankarlal jain edited Vangasena, vajikarana adhyaya, chapter 75,sloka 1- 2, edition 1996, Pub:. Shri krishanadas prakashana Mumbai, p. 953143. Sarangadhara, Sarangadhara samhita Poorva khanda chapter 5 sloka 25, 26; 3rd ed Varanasi: Chaukhambha orientalia; 2003. p.40 (Jaikrishnadas Ayurveda series 82).144. Dalhanacharya, Susrutasamhitha Shareerasthana chapter 02, sloka 04, Varanasi: Chaukhambha Surabharati prakashana; 2003. p.344 .(Chaukhamba Ayurvigyan Granthamala 42).145. Dalhanacharya, Susrutasamhitha Sutrasthana chapter 09, sloka 07, Varanasi: Chaukhambha Surabharati prakashana; 2003. p.384 .(Chaukhamba Ayurvigyan Granthamala 42). N
  • 146. C. Guyton & John E. Hall, Texy book of medical physiology, Chapter 80, 9th edition, 1996, Pub: Prism books Pvt. Ltd., p. 1014147. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha chikitsasthana, chapter 30 sloka 181-185, 4th ed., Pub:Varanasi: Chaukhambha Sura bharati prakashana; 2005.p.103148. http:// Reproductive Research Center - Male Infertility Research Projects.htm149. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sharirasthana, 2nd chapter, 12th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.345150. Vaidya Jadavji Trikimji Acharya edited Caraka samhita , Sharirasthana, 6th chapter, 11th sloka, 4th edition reprint 2005, Pub: Choukambha Sanskrit Sansthana Varanasi, p.331151. Vaidya Jadavji Trikimji Acharya edited Caraka samhita , Siddhisthana, 4th chapter, 23rd sloka, 4th edition reprint 2005, Pub: Choukambha Sanskrit Sansthana Varanasi, p.699152. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Sharirasthana, 2nd chapter, 10th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.345153. Vaidya Jadavji Trikimji Acharya edited Caraka samhita , Sutrasthana, 25th chapter, 4th , 5th sloka, 4th edition reprint 2005, Pub: Choukambha Sanskrit Sansthana Varanasi, p.132154. Vaidya Jadavji Trikimji Acharya edited Shusrutu samhita , Chikitsasthana, 26t chapter, 10th sloka, 4th edition1980, Pub: Choukambha Sanskrit Sansthana Varanasi, p.345 O
  • 155. Vaidya Jadavji Trikimji Acharya edited Caraka samhita , Chikitsasthana, 30th chapter, 146th sloka, 4th edition reprint 2005, Pub: Choukambha Sanskrit Sansthana Varanasi, p.640156. Bhavamishra, Bhavaprakash nighantu, Guduchyadi Varga, Sloka No. 186-187, 6th edition 1982, Pub: Choukhambha bharati academy, Varanasi, p. 885157. Kashinath shastri edited Charaka samhita, Sutrasthanachapter 9th ,shloka 108- 113, 17th edition1991,Pub: Chawkhambha Bharati academy Varanasi; pp-46.158. Shrikantha murthi edited Vagabhata Ashtanga hridaya Sutrasthana chapter 5th shloka 21; 3rd edn, 1996; Pub :Shrikrishna das Academy Varanasi; pp-60. P
  • POST GRADUATE STUDIES AND RESEARCH CENTRE (PANCHAKARMA)SHREE D.G.M. AYURVEDIC MEDICAL COLLEGE AND HOSPITAL, GADAG. CASE SHEET PROFORMA EVALUATION OF THE EFFICACY OF MATRA BASTI IN KSHE ENA SUKRA Guide: Dr. P. Shivaramudu P.G. Scholar: Dr. Siba Prasad M.D. (Ayu) Co-Guide: Dr. Santosh N. Belavadi, M.D. (Ayu) Name of the patient: Sl. No Father’s/Husband’s name: OPD NO. Age : ……….Yrs IPD NO. Sex : Male/Female Religion: Hindu Muslim Christian Others Occupation: Sedentary Active Labor Others Economical status: Poor Middle Upper middle Higher Address : …………………………. Phone No: …………………………. E- Mail: …………………………. Pin Date of Schedule of Initiation: Date of Schedule of Completion: Good Moderate Mild Poor Results: Response Response Response ResponseConsent: I here by agree that, I have been fully educated with the disease and the treatment here by satisfied whole heartedly, and accept the medical trial over me.Investigator’s signature Patients signature
  • Main complaints: Lakshanas Duration Alpa sukra Medra vedana Vrushana vedana Asakta maithuna Rakta praseka Chirat praseka Linga daha KlaibyaAssociated complaints: Lakshanas Duration Timira darshanam Agnimandya Chinta Mukha shosha Sadana Shrama Daurbalya Panduta Bhrama And any other -History of past illness: Mumps Sexual transmitted disease . Typhoid Epididymo orchitis TB Prostatis Thyroid disorders Crypto-orchidism Diabetes mellitus Varicocele Hyper tension Scrotal injuries Liver disorders OthersFamily history: H/o delayed conception/ No conception
  • Marital history: Date of marriage Marital life in years Age of wife in yearsH/o of previous conception of wife: Number of conceptionCoital history:MastrubationRegularly since adolescence Occasionally No historyFrequency of coitus per week-SatisfactoryNon satisfactoryEjaculation:Normal Premature Retro grade DelayedOccupational history:Occupation Day/ NightMental exertionPhysical exertionFrequent toursWorking conditions Mental history:Sun light Exposure to stressX-rayChemical Strainenvironment AngerNear furnace FearOther Worries
  • PERSONAL HISTORY:s a. Ahara: Veg Mixed Matra: Alpa Sama Adhika Agni: Manda Teekshna Vishama Sama Koshta: Mrudu Madhyama Krura Nature of Day sleep Night sleep Total hours b. Nidra: sleep Sound Disturbed c. Vyasana: Habits Duration Regular Stopped Smoking Alcohol Tobacco chewing Illicit relation d. Snana: Ushna jala Shitala jalaTreatment history: Oligospermia Yes / No Others a. Ayurvedic medicines: If yes details: b. Modern medicines: If yes details:
  • General Examination:A. Astha sthana pareeksha B. Vital examination1 Nadi /min 1 Temperature /F 2 Res.rate /min2 Mala Frequency- pravriti 3 B.P. Mm of Hg Day Night3 Mootra Frequency- 4 Weight Kgs pravriti Day Night 5 Height ft4 Jihwa5 Sabda6 Sparsha7 Druk8 AkrutiC. Dasha vidha pareeksha1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sanipataja ( )2 Sāra Pravara. ( ) Madhyama. ( ) Avara ( )3 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )4 Pramana Pravara ( ) Madhyama. ( ) Avara ( )5 Sātmya Ekarasa. ( ) Sarva rasa ( ) Rooksha satmya ( ) Snigda satmya ( )6 Satva Pravara ( ) Madhyama ( ) Avara ( )7 Ahara Shakti a) Abhyavaharana shakti P( )M( )A( ) b) Jarana shakti P( )M( )A( )8 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )9 Vaya Bala ( ) Yuva ( ) Vrudda ( )Systemic examination: a) C.V.S. – b) Reproductive System –Sroto pareeksha: Sukra vaha Srotas:
  • Examination of Testes and Penis:1) Penis: Skin Prepuce Glans Urethral miatus Normal Normal Normal Normal Redness Phimosis Balanitis Epispadias Swelling Paraphimosis Balanoposthitis Hypospadias Others - Others - Others - Others - 2) Scrotum: Sac- Normal/ Rt hydrocele/ Lt hydrocele/ Bilateral Pigmentation- Normal/ slight Hernia- Right/ Direct/ Indirect Skin- Normal/ Less folds / Nodules / Ulcerated 3) Scrotal contents- a) Testis Testis Right Left1) Position (Normal/Retracted/Cryptorchidism/ Inverted)2) Surface (Smooth/Nodular)3) Palpitation (Tender/Non tender)4) Consistency (Firm/Soft)5) Size b) EpididymisEpididymis Right Left1) Size related to testis (Small/ Big)2) Palpitation (Normal/ Tender) c) Spermatic cord: Spermatic cord: Right Left1) Size (Normal/thicken/Vericocele Grade)2) Palpitation (Tender/ hard nodular/ Vas impalpable)Other Sroto pariksha if necessary:
  • NIDANA PANCHAKA :a. Nidana:1. Aharaja Ruksha Tikta Kashaya Lavana Katu2.Viharaja3. Manasa Bhaya Chinta Soka Krodha Abhicharanab. Rupa:SL. Chief complaints Before AfterNo. Treatment Treatment1 Klibya2 Medhra and vrushna vedhana3 Ashakta maithuna4 Rakta praseka5 Chirat praseka6 Linga daha7 Sukra avisarga8 Shrama9 Sadana10 Chinta11 Bhrama12 Agnimandya13 Panduta14 DaurbalyaCriteria for assessment of Clinical InvestigationsSl.no. Symptoms Before After Treatment Treatment1 Erection2 Ejaculation3 Semen analysis Liquefaction time Colour Volume PH Viscosity Sperm count/ ml Sperm motility Pus cells4 Morphology5 Fructose test
  • TREATMENT PROTOCOL: Matrabasti: Matra basti with Shatavari Ghrita 60 ml/ day for 30 days. DAY BASTIPRANIDANA BASTIPRATYAGAMANA REMARKS KALA KALADAY 1DAY 2DAY 3DAY 4DAY 5DAY 6DAY 7DAY 8DAY 9DAY 10DAY 11DAY 12DAY 13DAY 14DAY 15DAY 16DAY 17DAY 18DAY 19DAY 20DAY 21DAY 22DAY 23DAY 24DAY 25DAY 26DAY 27DAY 28DAY 29DAY 30Signature of Guide Signature of Co Guide