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EFFECT OF PUSHPADHANVA RASA IN THE MANAGEMENT OF SUKRA DUSTI W.S.R. TO OLIGOZOOSPERMIA, Magan Singh Shekhawat, 2006-2007, S. D. M. COLLEGE OF AYURVEDA, UDUPI

EFFECT OF PUSHPADHANVA RASA IN THE MANAGEMENT OF SUKRA DUSTI W.S.R. TO OLIGOZOOSPERMIA, Magan Singh Shekhawat, 2006-2007, S. D. M. COLLEGE OF AYURVEDA, UDUPI

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  • 1. EFFECT OF PUSHPADHANVA RASA IN THE MANAGEMENT OF SUKRA DUSTI W.S.R. TO OLIGOZOOSPERMIA By Dr. Magan Singh ShekhawatDissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore . In partial fulfillment of the requirements for the degree of Doctor of Medicine (M.D) In Department of Kayachikitsa Under the guidance of Dr. U.N.PRASAD M.D (AYU) Principal Co-Guide Dr. NIRANJAN RAO. M.D. (Ayu) Assistant Professor S. D. M. COLLEGE OF AYURVEDA, UDUPI 2006-2007
  • 2. Rajiv Gandhi University of Health Sciences DECLARATION BY THE CANDIDATEI hereby declare that this dissertation / thesis entitled “EFFECTPUSHPADHANVA RASA IN THE MANAGEMENT OF SUKRADUSTI W.S.R. TO OLIGOZOOSPERMIA” is a bonafide and genuineresearch work carried out by me under the guidance Dr. U.N.PRASADM.D. (Ayu), Principal, Department of KayachikitsaDate: Signature of the candidatePlace: Udupi Dr. Magan Singh Shekhawat
  • 3. Rajiv Gandhi University of Health Sciences CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “EFFECT OFPUSHPADHANVA RASA IN THE MANAGEMENT OF SUKRADUSTI W.S.R. TO OLIGOZOOSPERMIA” is a bonafide research workdone by Dr. Magan Singh Shekhawat in partial fulfillment of therequirement for the degree of Doctor of Medicine (Ayu)Date: Signature of the GuidePlace: Udupi Dr U.N.PRASAD M.D. (Ayu) Principal Department of Kayachikitsa
  • 4. Rajiv Gandhi University of Health Sciences ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “EFFECT OFPUSHPADHANVA RASA IN THE MANAGEMENT OF SUKRADUSTI W.S.R. TO OLIGOZOOSPERMIA” is a bonafide research workdone by Dr. Magan Singh Shekhawat under the Guidance ofDr. U.N.PRASAD M.D. (Ayu) Principal, Department of Kayachikitsa.Dr. G. Shrinivasa Acharya Dr. U.N.Prasad HOD PrincipalDate: Date:Place: Udupi Place: Udupi
  • 5. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation / thesis in print or electronic format for academic / researchpurpose.Date: Dr. Magan SinghPlace: Udupi Signature of the Candidate © Rajiv Gandhi University of Health Sciences, Karnataka
  • 6. Dedicated toMy Beloved Parents
  • 7. ACKNOWLEDGEMENTSWith a bowed head, to the almighty; I express gratitude beyond words to my guide Dr U.N.Prasad M.D (AYU),Principal, S.D.M. College of Ayurveda for his encouragement, wholehearted supportand helpful suggestion.I am extremely happy to express my deepest sense of gratitude to my beloved andrespected Dr. Niranjan Rao, Asst professor Department of Kayachikitsa whosesympathetic scholarly suggestions and guidance at every step.I am extremely happy to express my deepest sense of gratitude to my beloved andrespected H.O.D. Dr. G. Shrinivasa Acharya, for his valuable support andcooperation through out the thesis work.I express my deep sense of gratitude to Dr Jonah, Dr Shreelatha, Dr Lavanya,and Dr Veera Kumar for their valuable support.I also express my all hearted thanks to my most beloved friendsDr M.S.Thirunavukkarasu, Dr Mahesh patil, Dr Kuldeep patil, Dr Ramesh,Dr Ranjit Patil, Dr Shobha, Dr Deepthi, Dr Harish, Dr Sagar Shah, Dr Asha, andDr Gautam.With lots of love and regards I am again thankful to my parents, Sister and mywife Dr (Mrs.) Santoshi Shekhawat and all my family for rejuvenating support, loveand affection towards me, which kept me always going on.I am grateful to the librarian Mr. Harish Bhat, asst. librarian and to Mr. Kinni,digital library in charge for providing valuable books and internet services in timethroughout my study.Place : UdupiDate : 15/09/2006 Dr. Magan Singh Shekhawat
  • 8. ABBREVIATIONS A.H. Ashtanga Hridaya A.S. Ashtanga Sangraha AJOC American Journal of Obstetrics and GynecologyAm J Ep American Journal of Epidemiology BMJ British Medical Journal Br J Ur British Journal of UrologyBh.Pra.Ni. Bhavaprakasha NighantuBhi. Rat. Bhaishajya Ratnavali Br.U Brahma Upanishada C.S Charaka Samhita Chi. Chikitsa Sthana F St Fertility Sterility JCEM Journal of Clinical Endocrinology & Metabolism J Ur Journal of Urology J Adr Journal of AndrologyJ Ped Surg Journal of Pediatric Surgery Ga.pu Garuda Purana H.S Harita SamhitaHum Rep Human Reproduction Int Med Internal Medicine Kal Kalpasthana M.N. Madhava Nidana Ni. Nidana Sthana N.A. Nighantu Adarsha NEJM New England Journal of Medicine R.V Ruga veda S.S. Sushruta Samhita Sha. Shareera Sthana
  • 9. Sha.S. Sharangadhara Samhita Su. Sutrasthana T.A Taittiraya AranyakaT.B.M.P Text Book of Medical Physiology U Uttaratantra Vi Vimanasthana Y.R Yoga Ratnakara
  • 10. ABSTRACT Male infertility is defined as the inability of a man to father a child after one yearof regular unprotected intercourse. Although male infertility may be associated withimpotence, many infertile men have perfectly normal and happy sexual relationships.About 8% to 10% of couples of reproductive age experience infertility, and inapproximately 40% of these cases male infertility is the major factor. Another 40% ofinfertility problems are caused by abnormalities of the womans reproductive system, andthe remaining 20% involve couples who both suffer reproductive difficulties. Malefactors appear to be increasingly recognized as a cause of infertility .Not all men withabnormal semen tests will have problems conceiving and in fact many men whoserandom tests are abnormal have an entirely normal fertility history. There is enormousvariation from sample to sample and month to month in each of the parametersmentioned in study. What is important is what range the counts are in rather than whatthe absolute number is.For the management of sukradushti W.S.R to oligogozoospermia, pushpadhanva rasawas selected which is having Shukra vridikara and sukra dhatu utpatti properties and thedose fixed is 125mg twice daily with milk for 8 weeks. After 8 weeks of treatment thefollowing results were obtained. It is single blind clinical study with pre test and post testdesign where minimum of 20 patients diagnosed with clinical condition shukrakshyawere selected between age group of 25- 40 years of age. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 11. Though the study was basically on oligozoospermia and observation shows that thesperm count was significantly increased by 54.34%. Other areas of improvement are asfollows:- Volume (25.85% ↑), RLP motility (43.07% ↑), SLP motility (19.14 %↑), liquefactiontime (13.07↓), pus cells (13.39 %↓), Orgasm (48.9 %↑), desire (40 %↑), erection (63.4%↑). All this parameters shows statistically significant results.The study also reveals that it has also significant effect on pus cells, volume etc so it canbe taken for further studies. After the treatment with Pushpadhanva rasa 20% patientsable to impregnate their wives, where as 30% of patients attained normozoospermia. 40%of patients had marked improvement and 10% patients had no change in sperm count.KEY WORDS:-InfertilitySukraSukradustiSperm Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 12. CONTENTSPART - I: INTRODUCTION 1-3PART - II: OBJECTIVES OF THE STUDY 4PART – III: REVIEW OF LITERATURE 5-70 Historical Review 5-7 Disease Review 9-27 Derivation of Sukra 9 Definition 9 Qualities of Sukra 10 Evolution of Sukra 11 Functions of Sukra 12 Sukradusti 14 Nidana 14 Bheda 47 Roopa 20 Samprapti 23 Chikitsa 24 Sadhyasadhyata 27 Upadrava 27 Pathya-Apathya 27 Modern Review 28-58 Drug Review 59-60PART - IV: METHODOLOGY 61-64PART – V: RESULTS 65-103PART –VI: DISCUSSION 104-112PART –VII: CONCLUSION 113-115PART –VIII: SUMMARY 116PART –IX: BIBILIOGRAPHY 117-125PART –X: ANNEXURES 126-134
  • 13. LIST OF TABLESSr.No Titles of Table Page No1 Drug review 602 Incidence of Age Group 653 Incidence of Religion 664 Incidence of Occupation 675 Incidence of Socio-economic status 686 Educational Status of Patients 697 Incidence of habitat 708 Incidence of satva 719 Incidence of sara 7210 Incidence of samhanana 7311 Incidence of satmya 7412 Incidence of pachakagni 7513 Incidence of koshta 7614 Incidence of prakriti 7715 Incidence of nidra 7816 Incidence of diet 7917 Incidence of addictions 8018 Incidence of vyayama 8119 Incidence of vaya 8220 Incidence of main complaint 8321 Incidence of marital life span 8422 Incidence of relation with partner 8523 Incidence of psychological status 8624 Incidence of surgical intervention 8725 Incidence of drug toxicity 8826 Incidence of vericocele 8927 Incidence of sukrakshya lakshana 9028 Effect on sperm count 9129 Effect on volume 9230 Effect on RLP 9331 Effect on SLP 9432 Effect on liquification 9533 Effect on pH 9634 Effect on pus cells 9735 Effect on orgasm 9836 Effect on rigidity 9937 Effect on ejaculation 10038 Effect on desire 10139 Effect on erection 10240 Over all effect of treatment 103
  • 14. LIST OF FIGURESSr.No Titles of Table Page No1 Types of sukradusti 192 Incidence of Age Group 653 Incidence of Religion 664 Incidence of Occupation 675 Incidence of Socio-economic status 686 Educational Status of Patients 697 Incidence of habitat 708 Incidence of satva 719 Incidence of sara 7210 Incidence of samhanana 7311 Incidence of satmya 7412 Incidence of pachakagni 7513 Incidence of koshta 7614 Incidence of prakriti 7715 Incidence of nidra 7816 Incidence of diet 7917 Incidence of addictions 8018 Incidence of vyayama 8119 Incidence of vaya 8220 Incidence of main complaint 8321 Incidence of marital life span 8422 Incidence of relation with partner 8523 Incidence of psychological status 8624 Incidence of surgical intervention 8725 Incidence of drug toxicity 8826 Incidence of vericocele 8927 Incidence of sukrakshya lakshana 9028 Effect on sperm count 9129 Effect on volume 9230 Effect on RLP 9331 Effect on SLP 9432 Effect on liquification 9533 Effect on pH 9634 Effect on pus cells 9735 Effect on orgasm 9836 Effect on rigidity 9937 Effect on ejaculation 10038 Effect on desire 10139 Effect on erection 10240 Over all effect of treatment 103
  • 15. INTRODUCTION 1 INTRODUCTIONInfertility is the failure of a couple to become pregnant after one year of regular,unprotected intercourse. In both men and women the fertility process is complex. Evenunder ideal circumstances, the probability that a woman will get pregnant during a singlemenstrual cycle is only about 30% and when conception does occur, only 50% to 60% ofpregnancies advance beyond week twenty. In many cases, infertility is caused by acombination of problems in both partners that conspire to prevent conception fromoccurring.About 8% to 10% of couples of reproductive age experience infertility, and inapproximately 40% of these cases male infertility is the major factor. Another 40% ofinfertility problems are caused by abnormalities of the womans reproductive system, andthe remaining 20% involve couples who both suffer reproductive difficulties.Infertility affects one in 25 American men. More than 90% of male infertility cases aredue to low sperm counts, poor sperm quality, or both. Oligozoospermia is one suchcondition for the cause of infertility, which is alone, is about 5% in India. Whether spermcounts are declining overall in industrialized countries is a controversial issue1.It has been shown that reproductive potential of human population has a tendency todiminish. Approximately, 20% couples can be threatened by infertility out of those, malepartners can be suspected for a leading reason of this disorder accounting for 40–60%cases. At the same time, modern techniques of assisted reproduction (ART) althoughquite aggressive, cannot exceed 1/3 part of couples who wish to be successful inprocedures of in vitro fertilization. An increased sensitivity of males to spermatogeneticdisorders became one of the hot issues, intensively studied throughout the world.The need for a wider range of methods of fertility regulation for men has been aconsistent recommendation emanating from a number of international for over the pastfew years but still lacking in it for success. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 16. INTRODUCTION 2There is no doubt that modern medicine inspires awe. IVF laboratories and sophisticatedultrasound scanning machines appear very impressive and reassuring when you areinfertile. However, paradoxically, even though the effectiveness of reproductivetechnology has improved dramatically, more infertile patients than ever before havebecome dissatisfied with their medical care today. This situation has resulted in a movetowards “alternative medicine”, which has become increasingly popular all over theworld. Even in the United States of America (the bastion of high-tech scientificmedicine), more than 20 per cent of infertile couples have consulted an alternativemedicine practitioner, mainly because they were unhappy with modern medical care2.In Ayurveda, Vajikarana is the branch which deals with producing healthy progeny forthe creation of a better society. A vaji is a horse or stallion. These are substances that givethe power or vitality of a horse, particularly the horses great capacity for sexual activity.More commonly, one could call them "aphrodisiacs". Though they are much more thansuperstitious love potions. Vajikaranas reinvigorate the body by reinvigorating the sexualorgans.Hence, it deals with various diseases like infertility and conditions relating to weakshukra dhatu or the vital reproductive fluids of the body. Apart from prescribing a lot ofeffective formulations to provide nutrition to enhance the quality of these vital bodyfluids it specifically emphasized to lead a highly disciplined life. Charaka states the useof aphrodisiacs as mentioned in ayurvedic therapies enhance ones potency. Vajikaranameans the medicine or therapy by which the man becomes capable of copulating with thewoman. It also helps in nourishing the body of the person.The shukra dhatu has a direct link with ojas or the immunity of the body. Hence,Vajikarana prescribed the therapeutic use of various aphrodisiacs and tonic preparationsfor enhancing the vigor and reproductive capabilities of men that also strengthens otherbody tissues (dhatus) like muscles, fats, bones and blood. Vajikarana is mainly concerned Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 17. INTRODUCTION 3with therapies concerning specific remedies for male infertility and impotence as well asfemale infertility. They serve as good aphrodisiacs and induce an immediate sense ofpleasurable excitement, along with increased fertile seminal secretions even in an ageingperson3. Vajikarana substances may be used either to improve sexual vitality andfunctioning, or to help direct sexual energy inwards for regeneration. Most of these arenot simple aphrodisiacs - substances exciting sexual activity through irritation of thesexual organs. Many are tonics that actually nurture and give direct sustenance to thereproductive tissues. Others help promote the creative transformation of sexual energy forthe benefit of the body-mind. By starting in the reproductive system, these herbsinvigorate the entire system, just as a tree is invigorated from the roots. They have astrong revitalization action on the nerves and bone marrow, and increase the energy ofthe mind. Semen is the Soma of the body, which if catalyzed in the right way, byRasayana and Vajikarana substances, brings about the renewal of the mind. In a similarway it helps strengthen the bones, muscles, ligaments and blood. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 18. OBJECTIVE OF THE SRUDY 4 OBJECTIVE OF THE STUDY To evaluate therapeutic efficacy of Pushpadhanva Rasa in Oligozoospermia. Conceptual study of sukra dusti & its role in infertilityEffect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 19. REVIEW OF LITERATURE 5 HISTORICAL REVIEWVEDAS AND UPANISHDH:-Vedas ancient treaties of knowledge are having plenty of references about the“SUKRA” .The main contributing factor for male reproduction is considered as SUKRA.It has physical properties such as nirmala4, subhra, sveta and sukla5 .Though many of thesynonyms are used to denote the SUKRA.Putraeshana {desire for the progeny}, is one of the primary desire of the mankind. A verygood description has been mentioned in Upanishad 6. To have a better progeny varioustypes of therapies has been explained and among them which are still followed isvajikarana and vrushya treatments. Same concept for better procreation has beenexplained at the time of Atharva Veda (4th and 8th khanda).To have a healthy baby is desire of every parent, for such many of the concept likegarbhadhana, madhuvidhya, garbhadosh nivarana has been explained. But there are noA direct reference has been quoted about shukradushti and its various varieties. Only theexcellancy of Ashwini kumars has been explained in infertility.7In Taittiriya Aranyaka8 it has typically explained about the formation of the Garbha.In bradaryanyaka Upanishad pregnancy, sexology is disscused.9ITIHAS AND PURANAA description of “Putrakameshti Yajna” is given in Valmiki Ramayana which againindicates that king Dashratha was suffering from one or other illness of sukradushti. FromMahabharata it may be assume that the total clan of the pandu, vidhura, kauravas wassuffering from any of the sukra dushti. Yashodhara in his commentary on Kamasutra10opines that the reproduction is impossible in the absence of sukra.Garudapurana described various recipes having spermatopoetic activity11. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 20. REVIEW OF LITERATURE 6SAMHITACARAKA:-Caraka used the word Retas and sukra as synonyms and he used the word retas insutrasthana and explained 8 varieties of retasdoshas12 where as in chikitsasthana13yonivyapda, the same 8 have been mentioned under title dusta sukra. 2nd chapterof chikitsa sthana is totally related to vajikarana drugs, diet, principle and differentcombinations.SUSHRUTA SAMHITA:-Retas word is used while describing 8 doshas; in the chapter Shukra shonita shuddhi14.Insutra sthana the definition of the vajikarana has been mentioned15.In chikitsa sthananamed ksheena baliya vajikarana chikitsa, causes of shukra kshaya are described16 andsome vajikaran drugs for its management have also been highlighted. He uses the word“Prajotpadane Na Samartha” while describing about sukra doshas.KASHYAPA SAMHITA:-8 types of sukra dusti are mentioned17. He has not given any description about itssymptomology and treatment.ASTANGA SAMGRAHA:-He specifies the word Abeeja which said to be the cause of infertility and further dividedinto 8 types18.SHARANGADHAR SAMHITA:-5 types of punstava roga and 8 types of shukra doshas are also mentioned which are verymuch similar to Sushruta.BHELA SAMITHA:-Bhela mentioned only 7 varieties of sukradusti. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 21. REVIEW OF LITERATURE 7HARITA SAMITHA:-To avoid sukrakshaya various pathyapathya is described19 and 5 varieties of klaibyaexplained.MADHAVA NIDANA:-Sukradosha or retodosha are not dealt in this book, but upadmsa, sukadosha are dealt indetail.SARANGDHARA SAMITHA:-After enumerating 5 types of pumsavatrog, author told 8 types of sukradoshas. The 8variety is called malabha due to the involvement of all three doshas20.CHAKRADATTA:-There is no reference about sukrdosha or retodosa in this book, but categorization ofdrugs into sukravrddhikarana, sukrasurtikara, sukravrdhi srutikara has been explained.BHAVA PRAKASA:-There is no description of sukradushti in this book, but 7 types of klaibya itssymptomology, treatment has been explained. In same context many “Retivarna Yogas”are described.YOGA RATNAKAR:-No specific description about sukradusti has been explained, but a separate chapter ofVajikarana has given. It includes Klaibya lakshanas, its treatment and various Vajikaranadrugs21. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 22. REVIEW OF LITERATURE 8 PREVIOUS WORK DONEInstitute for Post graduate teaching and Research in Ayurveda, Jamnagar.Gujarat Ayurveda university, Jamnagar.1997 Dr. Niranjan Rao A Clinical study on the role of sujrajanaka and sukrasodhana in the management of sukradustiSDM college of Ayurveda, Udupi.RGUHS, Bangalore.2003 Dr.Ajit Kumar A pharmaceutical study of vanarigutika wsr to its therapeutic effect on shukra dusti vis –a-vis oligoasthenospermia2004 Dr. Jeevan G A comprehensive pharmaco - therapeutic study of ksheera vidari in shukra dusti wsr oligoasthenospermia Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 23. REVIEW OF LITERATURE 9 DISEASE REVIEWAYURVEDIC REVIEW:- 22The word sukra is derived from Sanskrit root“suk shocha” it means purity and suc 23kleda which means moistness. The term also suggests the meaning like resplendent,white, shiny, etc. it is the 7th among the metamorphic chain of dhatus.DEFINITION:-The factors which is implanted for the formation of the embryo is known as sukra.It ismainly composed of vayu, agni, prithvi and jala mahabhoot and has their specific role information of garbha24.PARYAYA:-Numerous of synonyms have been explained by various authors like Amarkosh, RajNighantu and Dhanvantri Nighantu. From above such references some of them are asfollows:- Majja samudbhava: - born out of majja dhatu Beeja: - one which has capacity to produce new generation. Punsava {virility}:- Masculinity of the body, Tejas {resplendent}:- which is shiny bright. Retas {ejaculate}:- which is ejaculated at the time of coitus. Veerya {potency}:- by virtue of which an action is manifested. Anand samudbhava: - which is excreted at the time of intense pleasure or Orgasm. Balam: - strength Charama dhatu: - last dhatu. Pourusham-Virility Pumsatva –Fertility Rupa Dravya-Which gives form of chetana Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 24. REVIEW OF LITERATURE 10PHYSICAL QUALITIES OF SUKRA:-ACCORDING TO CARAKA25:- Snigdha Ghana Picchila Madhura Avidhae Shweta varna SphatikaACCCORDING TO SUSHRUTA26:- Drava Snigdha Madhura Madhugandhi like Sphatika like thin consistency of Tail like thick consistency of Madhu ACCORDING TO ASTANGA HRIDYA27:- Shukla Guru Snigdha Madhura Bahala Bahu Like Gritha, Tail or Madhu Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 25. REVIEW OF LITERATURE 11ACCORDING TO ASTANGA SAMGRAHA28:- Shukla Guru Snigdha Madhura Madhugandhi Pichila Bahalam Like Gritha, Tail or MadhuEVOLUTION OF THE SUKRA29:-The evolution of the sukra can be explained in the following ways:-1) Origin according to mahabhuta.2) Produced from majja dhatu3) From aahara rasa1) Origin according to mahabhuta It is considered as soumya and kapha varga, as soma or jala mahabhuta is the one Principle from which kapha derives, it can be said that Sukra belongs to jala mahabhuta.2) Production from Majja Dhatu:- Sukra being 7th in the order and produced through the evaluative metamorphosis of majja dhatu i.e. 6th and preceding one30 Sukra is produced from the essence of majja dhatu, vayu and akasha. Due to the porosity in asthi dhatu sukra ooze out like water from new earthen pitcher31.3) From Aahara Rasa:- Beginning from rasa dhatu upto sukra dhatu all the 7 dhatus are produced in fashion of progressive evaluative metamorphosis i.e. ksheera dadhi nyaya these means that previous dhatu is precursor for the next and higher. 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.32,33 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 26. REVIEW OF LITERATURE 12FUNCTIONS OF SUKRA34:-So garbhoutpatti is considered as one of the important function of the sukra dhatu.Instead of this Acharya Sushruta has given some more other importantfunctions of sukra, these are:- Dhairyam Chyavanam Priti Dehabalam Harsha BijarthamSo from above various important functions explained by acharya sushruta it canbe concluded that sukra not only having important role in fertilization but it helpsin development of physical as well as mental health of the person. So many of thepsychological factors may interfere in proper sukra formation and leads to infertility.DURATION FOR FORMATION OF SUKRA35:-Though the explanation for the formation of sukra varies from author to author.One school of thought opines that it total required 7 days after the food intake,but some says about 15 days.Sushruta opines that this duration may differ fromone month to instant formation of the sukra.He explained if person is only dependenton simple diet it requires near about 30 days for sukra formation but if sameperson consume sadhyo sukrakar, vrushya or vajikaran drug he may achieve at instant.PRAMANA36:-Caraka explained its pramana as ArdhanjaliSUKRA SAARA PURUSHA37:-The person with excellence of sukra is known as sukra sara purusha, he is having soumyanature, having gentle look, eyes appearing as filled with milk, extremely happy, he ispleasant, unctuous, has good complexion and voice. His appearance is dazzling, he is Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 27. REVIEW OF LITERATURE 13loved by women {stree priya} endowed with prosperity, vigor, health, wealth, honor andapatya.STHANA OF SUKRA38:-In classics seven kalas has been explained and the seventh kala is called“SUKRADHARAKALA” and Sushruta explained that it is present all over the body.Similar thoughts are shared by Acharya Caraka and Sushruta. By giving exampleSushruta says that as grutha is there all over the milk, sugarcane juice in sugarcane.Sameway sukra is present all over body. Caraka quote as tiltail is present all over the Tila sameway sukra is present all over the body.SUKRA IN CO-ORELATION TO ANDROGENS:-The first and foremost important function explained by all Acharya’s about sukra isGarbhotpati. In addition to this many of the other functions explained by acharya sushrutalike priti, chyavanam etc can be easily compare with the functions of the Androgens. Theword chyavanam means proper physical development of the body structure either of maleor female.If the functions of androgens are observed it may be opined that the FSH-folliclestimulating hormone and LH-leutinizing hormone helps in secretion of progesterone,oestrogen, and testosterone which helps in giving a proper physical development of thebody structure in either sex. They play an important role by maintaining metabolicactivities, maintaining internal environment or homeostasis of the body and variousaction on other systems.The word meaning of the “BIJA” can be taken for male and female gametes both ofwhich have direct relation in fertilization. A Dalhana commentary on sushruta atsutrasthana 14th chapter gives a synonym arthava as sukra and its function forfertilization. In the 30th chapter of Chikitsha sthana caraka while giving explanation aboutretodushti he uses the word arthava as menstrual bleeding. So from the two differentmeaning of the word suggest that it arthava may consider as a gamete and its role infertilization. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 28. REVIEW OF LITERATURE 14The word “PREETI” is acceptable for both the partners. It is an attraction towardsopposite sex to which may be physical or mental. The cause of all this is the developmentof primary and secondary sex characteristics in both sex and all this is dependent uponthe functions of Androgens.The word “DEHABALAM” means better strength to a person for his/her daily activities.This strengthening is possible by male from testosterone as it helps in anabolism ofprotein and similar function is done by oestrogen in female.Similar manner this entire concept can be explained on the basis of androgenic functionsbut a concept of homosexuality and formation of baby like a mass is not still notunderstood.SUKRADUSTI:-Sukra which is vitiated is called dushta sukra and the condition is sukra dushti.NIDANA OF SUKRADUSTI 3 9 :Even though the descriptions regarding Sukra dusti are available in Sushurta Samhita &Astanga samgraha & Hridaya, the causative factors are not discussed. Description ofNidana is available only in Caraka Samhita and Madhava Nidana parishista. It may bedescribed on the basis of:- AHARA VIHARA MANSIKA VAIDYAKRTA VYADHIKARSANA JANYA KSATA.AHARA:-Asatmya Ahara Sevana (Intake of unsuitable food), excessive intake of ruksa, tikta,kasaya, lavana, amla and usna dravyas Fascination with slimness and dietary controlpervades a large segment of modern American society(including men ) and may have arole in the high incidence of reproductive failure (15%) experienced by American Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 29. REVIEW OF LITERATURE 15couples.(William, Bates 1993)Asatmya Sevana means that which is incompatible to the body. Here, we can put alcoholconsumption etc. excessive consumption of alcohol (more than 60gms/day), tobacco,narcotics, leads to infertility. Alcohol consumption lowers plasma testosterone synthesis.Ethanol increases the metabolic clearance rate of testosterone, concomitant with anincrease in hepatic 5-alphareductase activity and increased conversion of androgens intoestrogen.VIHARA:-Excessive coitus, untimely coitus, coitus in other than vagina, abstinence, intercoursewith an aroused partner, coitus in old age, excessive exercise, suppression of ejaculation.The physical effects of strenuous exercise on hypothalamic pituitary gonadal function inmales have been established. Deceased testicular androgens (testosterone anddihydrotestosterone) and increased adrenal androgen have been noted in the plasma ofhighly trained male athletes compared with a control population. It is not undesirable toexpect reproductive dysfunction in male athletes and under weight men (William, Bates92.)Excessive intercourse , intercourse during improper time, intercourse in other thanvagina/perverted sexual activities are all found in person who are having a very poor willpower or satvabala. These persons will fall prey easily to such things and contact towardsinfection is also easy. These persons are prone to get sexually transmitted disease orsimple genital tract infections. Now it is an established fact that the silent infection ofsemen also leads to male infertility.40MANSIKA:Chinta (anxiety), shoka (grief), avisrambha (suspicion), bhaya (fear), krodha (anger).Low quality semen was found to be positively correlated with work related stress andstress within the family as well as with increased psychosomatic symptoms (Insler andLunenfeld, 1993).The patients with stress reveal azoospermia, but it may be transient(Mary polan 1982). The key word here is emotional stress. The stress that comes fromwork, however, leaves the sperm free to run its reproductive race. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 30. REVIEW OF LITERATURE 16VAIDYAKRTA:Sastra, ksara, Agni vibhrama, leades to sukra dusti.The patients who have had an operation correction of the bladder neck along urethralreimplantation during childhood are highly unlike to be fertile. Because, the bladder necksurgery has ablated the internal sphincter. These individuals often experience retrogradeejaculation. This should be suspected in the patient who has a history of bladder surgeryand ejaculate is less than 1ml in volume, oligospermic and abnormally alkaline. Thediagnosis can be made by finding large numbers of sperm (at least 10 to 15 per HPF.) inthe uncentrifuged, post ejaculation urine.Apart from surgery, many drugs may interfere with spermatogenesis either directly orthrough alteration in the endocrine system. Medication such as sulphasalazine,cimetidine, nitrofurontin, has also been implicated as gonadotoxic agents. The use ofanabolic steroids, usually by athletes may also interfere with normal spermatogenesis.(Hammond and Tablert 92.).41Some drugs are known to interfere with Leydig cell function. Spironolactone inhibitstestosterone synthesis by reducing testicular cytochrome p450 and 17 alpha- hydroxylaseactivity. (Menard et al 78)VYADHIKARSANA JANYA:Atisara (Ma. Ni. Pa) but the review of andrological / urological literature as well as otherliterature pertaining to medicine gives many diseases which will ultimately leads to poorsemen quality.Diabetes mellitus may cause peripheral neuropathy leading to retrograde ejaculation, lossof seminal emission, or erectile dysfunction (Kaplan et al, 1968). The Vas deferens orepididymis may be absent in cystic fibrosis (Kaplan et al 1968) kartagener’s syndrome(Situs inversus, chronic sinusitis and Bronchiectasis) possess ultra structural defects inboth cilia and sperm tails resulting in immotile sperm.(Etiasson R. et al 1977) subnormalsperm densities are found in approximately 50% of testicular cancer patients prior tochemotherapy (Oroecklin H.R. et al 1973) sperm production and motility may betransiently affected by fever, viremia and elevations in environmental Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 31. REVIEW OF LITERATURE 17temperature(Lipshultz and Witt 92). Patients with a history of fibrocystic disease ofpancreas may have congenital absence of vas deference (Lunenfeld, Insler, Glezerman93)42.KSATA. –Ksata or injury is the one cause which leads to the sukradusti. Here injury means topelvic organ. Injury to the testes, testicular torsion may lead to atrophy of the testes andimpaired fertility (Lunenfeld et al 93).TYPES OF SUKRADUSHTI:-ACCORDING TO CARAKA 4 3 :- Phenil –vataja Tanu –vataja Ruksha –vataja Vivarna -pittaja Picchila -kaphaja Puti -pittaja Anyadhatu sanshrita- rudhranvita Avasadi -vatajaACCORDING TO SUSHRUTA 4 4 :- Vataja Pittaja Kaphaja Kunapa- sonitaja Grantibhuta -sleshmaja Putipuya -pittasleshmaja Ksheena -pittavataja Mutragapurisha Gandhi Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 32. REVIEW OF LITERATURE 18ACCORDING TO ASTANGA SANGRAHA 4 5 :- Vataja Pittaja Sleshmaja Kunapgandhi-sonitaja Granthibhuta-sleshmaja Puya -sleshmaja Ksheena -pittavataja Mutrapurisha Gandhi –sannipataja Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 33. REVIEW OF LITERATURE 19 FIGURE 1 PhenilaAC Tanu VatajaCOR Ruksa AD CI Nila / Pitta Pittaja CN Vivarna OG R Vita DT Kaphaja I PicchilaO N GCA Puti + Puya Putipuya (P.K.) TR OAK Rakta Kunapagandhi SA Anyadhatusamsrsta U S Other dhatus H R Avasadi Granthibhuta (K.V) U T A Ksina (P.V) Mutra Purisagandhi (Sannipataja) TYPES OF SUKRA DUSTI ACCORDING TO CARAKA, SUSRUTA AND VAGBHATA Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 34. REVIEW OF LITERATURE 20Sushruta explained in such a manner that’s look similar in number but on the basis ofdoshic vitiation it is totally counted as 8 in number. Both ashtang samgrah and ashtanghridya followed the pattern of sushrutha. Though mild difference of opinion in namingbut totally it looks same. Kashyapa counted it as 8 in number. But he had not giveninvidividual description of the each variety, their characteristic for diagnosis andmanagement.There are difference between school of caraka and school of sushruta while naming thetype of sukradushti even though the total number is same. Even though caraka dealtdoshic vitiations of sukradushti separately, he put stress on abnormal physicalcharacteristics of semen. It mean phenile, tanu etc 8 characters mentioned by caraka areenlisted as 8 different types of sukradushti. Sushruta clubbed phenile tanu, rukshatogether and labeled it vataja sukradushti.Caraka brought all the conditions of discoloration under vivarna where as sushruta dealtit separately under doshic variety .Overall sushruta incorporated all 8 types of caraka’sclassification of sukradushti under 6 heading only.Furture sushruta added ksina andmutrapurishagandhi variety and made the total number 8.It seems that caraka classified on the basis of the characteristics of pathological semen orabnormal physical characteristics of the semen .but sushruta clubbed such factorstogether according to doshic vitiation ,where as caraka has mentioned doshicclassification separately as described the treatment accordingly. Later sharangdharafollowed the path of sushruta .he used the term “MALABHA” for sannipataja variety ofsukrdushti.ROOPA OF SHUKRA DUSTI:-VAATAJA SUKRA DUSTI46:-The sukra which is vitiated by vata dosha posses aruna or krushna varna , appears asphenil, tanu in consistency, rooksha in nature, alpa in quantity, there will be eitherdelayed ejaculation or ejaculation with pain i.e. toda, bheda,. This sukra is having thequality of vicchinata & have no capacity to fertilize. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 35. REVIEW OF LITERATURE 21Vataja sukra dusti can be correlated clinically with hemorrhagic injury, severeoligospermia, and azoospermia, obstruction of the efferent ducts and chronicinflammation of accessory sex glands.PITTAJA SUKRA DUSTI47:-The sukra which is vitiated by pitta dosha posses pita, neela Varna, hot in nature withputigandha, apicchila {not hyper viscous} and patient experiences daha, osha, chosa typeof pain during ejaculation. This can be clinically co related with acute inflammatorycondition of testis where semen may be yellow in colour having fetid smell due topresence of the pus cells.The hot nature of the semen and burning ejaculation indicate theacute state of inflammation acute bacterial prostitis, epididymitis etc.KAPHAJA SUKRA DUSTI48:-It will be having sukla Varna, atipicchla in consistency, prabhuta in quantity, ejaculatedwith kandu mixed with majja dhat. This will be having visra gandha {unpleasant smell},this morbid kapha also obstructs shukravaha srotas. The above mentioned featuresindicate increased viscosity of semen, commonly seen in chronic inflammation, presenceof abnormal form in morphological seminal study. Above features also indicate chronicinflammatory condition.SHONITAJA {KUNAPAGANDHI} SUKRA DUSTI49:-This is caused by excessive coitus, injury and wound and is due to affliction of rakta. Thesemen will posses smell of kunapa, quantity of semen is analpa or more. The patientexperiences osha, chosha this reflects the condition called, haemaspermia along withacute inflammation caused by infection and injury to external genitals i.e. presence ofRBS in semen, which can be seen in both vataja and shonitaja sukra dusti.In vataja sukra dusti few RBCs may be present, which gives aruna Varna, and blood clotsmay present which gives blackish Varna to the semen, but in shonitaja sukra dusti semencolour is rakta Varna and volume is high due to severe hemorrhage.In other words, this may be inferred as in case of vataja sukra dusti, the injury may be oldone where as in raktaja sukra dusti, the injury will be recent origin and fresh blood can beseen. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 36. REVIEW OF LITERATURE 22GRANTHIBHUTA SUKRA DUSTI50:-This is due to vitiation of morbid kapha and vata; hence the feature resembles kaphavataja dusti. Here due to suppression of the urge, the sukravaha srotas will be vitiated andobstructed by vata causing granthibhuta sukradusti, here patient will experience difficultyin ejaculation, the semen will be grathita, i.e. in form of coagulum, and clinically this canbe compared to unliquifiable semen commonly found in prostatic dysfunction. This eitherdoes not contain liquefying enzyme or contains poor quantity causing failure inliquefying seminal coagulum.PUTI PUYA NIBHA SHUKRA DUST51: -This is due to vitiation of pitta and kapha dosha, here the infected semen containing puya.This is commonly seen in the infection of genitor urinary tract. This condition may beseen in where abundance of leucocytes or positive culture findings i.e.pyobacteriospermia, chlamydial infection, this may be seen in urogenital inflammatorydisease {Liunenfield & Mann 1993}KSHEENA SUKRA DUSTI52:-The semen which is in little quantity or with subnormal parameters is called as kshinaretas and is said to be vitiated by pitta and vata. Dalhana while commenting on thismentioned that the features told in ‘Dosa dhatu mala Vijnaniya’ in sutrasthana aboutSukrakshaya should also be considered here in this context.Kshina retas also a variety under classification of sukrakshaya results due to acquiredcauses. Here, this particular variety denotes the same condition, but where the involveddosas are pitta and vata only. So decreased semen parameters resulted due to dosas otherthan pitta and vata should not be considered under this one. No specify features arequoted anywhere in classics, however, the characters explained for pitta and vata shouldbe considered here.MUTRA PURISHA GANDHI SUKRA DUSTI53:-The semen which posses the smell of urine or faeces is said to be vitiated by tridosha,however their is no such modern science explanation where semen is having smell ofurine or fecal matter. It may be thought that recto genital urinary tract fistula may present Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 37. REVIEW OF LITERATURE 23with above said symptoms.ANYADHATU UPASAMSHRITA54:-While enumerating 8 varieties of sukra dusti, Charaka has explained this condition butwhile explaining the treatment for this variety, he emphasized on involvement of dhatusand treatment aimed at treating vitiated doshas and dhatus.SAMPRAPTI 5 5The vitiated dosas singly or collectively having reached the retovahasira, cause defects insukra. Further, sukra pervades in the entire body, so also vyanavayu. So,vyanavayuprakopa may also lead to sukradusti. In addition apanavata prakopa may alsocause sukradusti as ejaculation of sukra is the function of apanavata, so by vaatkaranidanas 3 types of pathology may develop simultaneously.In apanavata dusti if we observe the apanavata function, this is mainly responsible forejaculation of sukra. Because of the above said etiological factors vitiated, apanavatacausing disturbance in sukravahastothas leads to kshina sukra i.e. both qualitatively andquantitatively.In sukravahastrothas apana vayu is undergoing avarna by vyanavayu leading to vitiationof sukradhatu. Due to that the produced sukra will be showing abnormalities like kshinasukra. In kaphaavruta apana this condition apanavayu undergoing avarna by kapha whichleads to Gatisanga (obstruction) may be partially or completely associated with painwhich leads to kshina sukra. In vitiated vata and pitta undergoing sthanasamsrya insukravaha strothas leading to the vitiation of sukradhatu. Due to that produced sukra willbe showing abnormalities.The other factors related to food like excess consumption of Katu, Tikta, Kashaya,Lavana Rasa, Ati Ushna Sevana and Manasika Karanas leads to vitiation of Doshasespecially Vata and Pitta. Dosha Prakopa here can be interpreted as hormone imbalance.The Manasika Karana like Chinta, Bhaya lead to stress, which causes Vata Prakopa.According to modern view emotional stress may interfere with the GnRH Gonadotrophinreleasing hormone, which initiates the release of LH and FSH from anterior Pituitary.FSH – Follicle Stimulating Hormone and LH – Lutinizing Hormone is responsible for Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 38. REVIEW OF LITERATURE 24spermatogenesis. Thus disturbance in GnRH secretion ultimately results in defectivespermatogenesis.Pitta Prakopa can be taken as increased temperature due to thermal exposure, radiation,hot tubs etc., where elevated temperature directly applied to testis can impairspermatogenesis.Khavaigunya Karaka Nidana like Abhigata, Shastra, Kshara, Agni Karma Vibramamentioned in the classics directly affects the Shukra Vaha Srotas especially testis andresults in Shukra Kshaya. Any surgery or drugs (Sulphasalazine, Cimitedin, Alcohol),which are gonadotoxic agents, which affects spermatogenesis, can be considered here.CHIKITSHA56 Chikitsha of sukradusti is divided into 2 categories 1. Samanya Chikitsha 2. Vishesa ChikitshaSamanya Chikitsha comprises of management of the condition with purifactorymodalities [sodhana Chikitsha].In Vishesa Chikitsha certain drugs which are indicated in individual variety of sukradusti.SAMANYA CHIKITSHA:-This constitutes Snehana, Svedana followed by Panchakarmanusara Visodhana i.e.;Vamana, Virecana, Niruha basti, Anuvasana basti especially Uttara basti. Caraka saysthat before administration of any variety of treatment to shukradusti shashodana shouldbe administrated to get a better efficacy in treatment .he quote an example that if a dirtycloth is not properly washed it not possible to give a colour over it, same way without ashashodana management drug efficacy is not so effective57..Though shanshodana has its important role in treatment aspect but still due to somereason if patient is unable to go this procedures the a second method of administration ofshodhana should be accepted where acharaya’s has given importance to mala shudi whichcan be given on the basis of koshta of patient for 3,5, or 7 days58. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 39. REVIEW OF LITERATURE 25VISESA CHIKITSHA:-Here the treatment is aimed at the particular dosa or dosas, which get vitiated. Afterproper administration of shodana a physician can also think its line of management ontwo aspects59:- • Shukrajana drugs • Shukrashodhana drugsThough the acharaya’s has explained various varities of sukradushti but this all can beeasily classified in two types. Example a condition like kshina sukra can be taken as formof sukradushti where proper genesis is affected so in this condition drugs which acts as asukrajanana can be used for fertilization. Similarly conditions like putipuya,anyadhatusamishra where drugs having shukrashodhana effect will be better effective.Vataja Sukra Dusti:The semen affected by Vata, Niruha vasti and Anuvasana vasti should be employed.According toAcharya.60 Sushruta, the first three varieties i.e. in Vataja, Pittaja andKaphaja varieties, the treatment modalities such as Snehana ,Swedana ,Vamana,Virecanaand Anuvasana ,Astapana and especially Uttara vasti should be employed ,and all theother pacifying measures according to doshas.Those vitiated by Vata and others 2 doshas should be treated with appropriate drugs.Ghritapana, Ashtapana, Anuvasana and Uttara vasti should be administered to treat theVataja Sukra dusti.Pittaja Sukra Dusti:-Caraka advocates abhayamalaki rasayana61.Vagbhata advocates ghrita prepared from kandeksu, gokshura, guduchi;Virechana withTrivrut choorna and ghee ;Astapana vasti with Sreeparni and Payasya ; Treatment withksira ;Anuvasana –Uttara vasti with Taila prepared out of Madhuka and Mudgaparni.Kaphaja Sukra Dusti :62In addition to samanya Chikitsa, Specifically Pippali rasayana, Amalaki rasaya areadvisable in Kaphaja type .Treatment as sodhana involve snehana, Svedana, Vamana, Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 40. REVIEW OF LITERATURE 26Virecana, Astapana, Anuvasana and Uttarabasti Gritapana – Patina bheda, Ashmanataka,Amalaki are used for preparation of gritha for abhyantarasnehana, Madanaphala Kwathafor Vamana, Virecana with Danti & Vidanga coorna, Astapana Basti with decoction ofAragwadha, Madanaphala Anuvasana – Uttarabasti with taila of Madhuka and PippaliKaphahara measures should be adopted for pacifying Kapha dosha in Kaphaja Sukradusti.Kunapaganti Sukra DustiGhrita prepared out of Dhataki pushpa, Khadira, Arjuna and Dhadima are claimedbeneficial63. Also sarpi processed with Salasaradi gana or Asanadi gana is useful in thetreatment of the same.Granti bhuta Sukra Dusti:In this condition Ghrita of Pashana bheda and Palasa kshara is advised. Ghrita preparedout of palasa khsara is also beneficial64.Puya Sukra Dusti:Parusakadi gana and Vatadi gana drugs are used in the preparation of Ghrita, is said to beuseful in puya variety of Sukra dusti65.Kshina Sukra Dusti:Sva yoni vardhana dravyas, Sukra Kari karya kriyas are advised by Vagbhata, whileSushruta propounds the treatment in Ksina baliya adhyaya of Chikitsha stana66The retas which got kshina avastha or decreased levels of sukra should be brought tonormal state by means of upachaya.Mutra Purisa Gandhi Sukra Dusti:Ghrita made of Hingu, Useera Citric are claimed to be beneficial by Sushruta67Dalhana concludes that Sodhana procedures are to be employed first accordinglyMedications are started.68 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 41. REVIEW OF LITERATURE 27Acharya Vagbhata expounds the use of Ghrita prepared out of Citric, Vitunnaka,Priyangu, Hingu, Samanga and Mrunala69.Indukara says patients with severe vitiation are to be ignored, as this condition isAsadhya70. Even though this variety is told to be Asadhya, to counteract the bad smellwhich is unbearable to the patients, treatment should be given74. In Dvandvaja variety ofSukra dusti sodhana should be done first and then corresponding Ghrita is given71.In totality Sushruta advised to conduct Shodhana initially and then respective medicationto be employed72. According to Vagbhata Uttara vasti should be given repeatedly73.SAADHYAASADHYATWA74:-Retamsi abijani bhavanti, it means if sukra dusti is left untreated or not treated properly,then it will hamper the fertility aspect of the individual.Vataja pittaja kaphaja sukra dusti are said to be sadhya, kunapagandhi, putipuya andksheen a variety are kruchra sadhya and sannipataja variety i.e. mutra purisha Gandhi isasadhya.UPADRAVA75If the condition is left untreated then it may lead to infertility and sexual inadequacy orklebya.PATHYAGhrita, dugdha, mansarasa, shali satika Sali, avoidance of the etiological factors also canbe considered as Pathya76. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 42. REVIEW OF LITERATURE 28 MODERN REVIEWReproduction is the process by which new individuals of a species are produced andgenetic material is passed from generation to generation. This maintains the constitutionof the species. For the production of better progeny not only sperm have the importantsole but all the anatomy of reproductive organ should have these proper functions. E.g. ifaccessory glands are unable to secrete properly it may effect the motility of the sperm andmay effect the total count. So a proper knowledge of anatomical and physiologicalaspects of reproductive organs should be known77.The reproductive organs can be grouped on their functions:-Gonads – production of sperm and hormonesDucts – helps in transport and storageAccessory glands – support gametesSupporting structure – penisGONADS: -Testis is considered as male gonads which have important functions in the formation ofsperm and to secrete sex hormones. The testis or testicals are paired oval glandsmeasuring about 5cm long and 2.5 cm in diameter. Each testis has a mass of 10 to 15 g. itmainly made up of 2 membranes outer one is called tunica vaginalis and the inner one astunica albugenia a capsule composed of dense irregular tissue. Tunica albugenia extendsinwards forming septa that divide the testis into a series of internal compartments calledlobules. Each of the 200 to 300 lobules contains 1 to 350 coiled seminiferous tubuleswhere sperm is produced the process by which the seminiferous tubules of the testisproduce the sperm is called spermatogenesis.The seminiferous tubules contains 2 types of cells, spermatogenic cells the spermproducing cells and steroli cells which have several functions in supportingspermatogenesis. Steroli cells extend from the basement membrane to the lumen of the Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 43. REVIEW OF LITERATURE 29tubule .Internal to the basement membrane and spermatogonia tight junctios joinneighboring steroli cells to one another.The junction forms an obstruction known as blood testis barrier because substances mustfirstly pass through the steroli cells. Before they can reach the developing sperm.Steroli cells support and protect developing spermatogenic cells in several ways. Theynourish spermatocytes, spermatids and sperm; phagocytize exass spermatid cytoplasm asdevelopment proceeds and control movements of spermatogenesis cells and the release ofsperm into the lumen of somniferous tubules. They also produce fluid for spermtransports secrete androgen binding protein and hormone inhibin and mediate the effectof testosterone and FSH.In the space between adjacent somniferous tubules are clustered of cells called leydigcells or interstitial endocrinocytes. These cells secrete testosterone, the most prevalentandrogen. Although androgens are hormones that promote development of masculinecharacterstics. They also have other functions such as promoting libido (sexual desires) inboth males and females.FUNCTIONS OF TESTOSTERONE78:-PRENATAL DEVELOPMENT:-Before birth testosterone stimulates the male pattern of development of reproductivesystem ducts and the descent of the testes. Testosterone is also converted in the brain toestrogen (feminizing hormones), which may play a role in the development of certainregions of the brain in males.DEVLOPEMENT OF MALE SEXUAL CHARECTORSTICS:-At puberty testosterone is dihydrotestosterone bring about development of the male sexorgans is the development of masculine secondary sexual characteristics. These includesmuscular is skeletal growth that results in wide shoulders &narrow hips, pubic, axillary,facial& chest hairs, thickening of the skin, increased sebaceous gland secretion &enlargement of the voice. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 44. REVIEW OF LITERATURE 30DEVELOPMENT OF SEXUAL FUNCTIONS:-Androgens contributes to male sexual behavior is spermatogenesis is to sex drive in bothmales& females.PROTEIN ANABOLISM:-Androgens are anabolic hormones that is they stimulate protein synthesis. This effect isobvious in the heavier muscles and bone mass of most men as compared to women.SPERMATOGENESIS79:-In humans, spermatogenesis takes 65-75 days. It begins in the spermotogonia, whichcontain the diploid (2n) chromosome number. Spermatogonia are stem cells because afterthey under go into mitosis at last they converted into primary spermatocytes. Primaryspermatocyte, like spermatogonia are diploid that is they have 46 chromosomes. Eachprimary spermatocyte enlarges and then begins mitosis. In mitosis 1st the 2 cells formedis called secondary spermatocyte. Each spermatocyte has 23 chromosomes, the haploidnumber. Each chromosome with in a secondary spermatocyte, how ever is made up oftwo chromatids still attached by a Centro mere. In mitosis 2 few haploid cell resultscalled spermatids. The final stage of spermatogenesis, spermiogenesis is the maturationof haploid spermatids into sperm. Because number of cell division occurs inspermiogenesis each spermatid develops into a single sperm cell.Spermatogenesis produces about 300 million sperm per day. Once ejaculated, must donot survive more than 24 hours with in the female reproductive tract. A sperm cellconsists of 3 structures highly adapted for reaching and penetrating a secondary oocyte: ahead, a mid piece and a tail.It contains an acrosome, a lysosome like vesicle and a nucleus that has the haploidnumber of chromosomes (23). Enzymes within the acrosome include hyaluronidase andprotease, which aid penetration of the sperm into secondary oocyte. In the mid piece aremany mitochondria, which provide ATP for locomotion. The tail a typical flagellumpropels the sperm cell along its way. From head to tip of tail, human sperm about 70micrometer in length. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 45. REVIEW OF LITERATURE 31The above function of testis is possible by supporting structure called scrotum, a sacconsisting of loose skin and superficial fascia that hangs from the root of the penismuscle like Dartos have important role in maintenance of temperature making them 2-3degree Celsius below the core temperature. The cremaster muscle, a small band ofskeletal muscle in the spermatic cord that is the continuation of the internal obliquemuscle, elevates the testis upon exposure to cold (and during sexual arousal). This actionmoves the testis closer to the pelvic cavity, where they can absorb body heat.DUCTS OF THE TESTIS:-The total structure is made from the combination of epididymus, vas deferens, ejaculatoryduct and urethra. The epididymis is a comma-shaped organ about 4 cm long that liesalong the posterior border of each border. it is site where sperm mature that is theyacquire motility and the ability to fertilize an ovum. This occurs over 10-14 days of theperiod. The ductus epididymus also store sperm and helps propel them by peristalticcontraction of its smooth muscle into the ductus deferens. Within the tail of theepididymis, the ductus epididymus becomes less convoluted and its duct is known asductus deferens or vas deferens. This act as storage of the sperm, which remain viablehere for up to several months. The ductus deferens also conveys sperm from theepididymis toward the urethra by the peristaltic contraction of the muscular coat.ACCESORY SEX GLANDS:-This constitutes of seminal vesicles, prostate secretions and coupers gland.SEMINAL VESICLE:-Secretes alkaline, viscous fluid that helps neutralize acid in the female reproductive tract,provides fructose for ATP production by sperm, contributes to sperm motility andviability and helps semen coagulate after ejaculation.PROSTATE:-Secretes a milky, slight acidic fluid that helps semen coagulates after ejaculation andsubsequently breaks down the clot. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 46. REVIEW OF LITERATURE 32BULBOURETHRAL (COWPERS) GLAND:-It secrets alkaline fluid that neutralizes the acidic environment of the urethra and mucusthat lubricates the lining of the urethra and the tip of the penis during sexual intercourse.PENIS:-It acts as a supporting structure for the semen into the vagina. upon sexual stimulation,which may be visual, tactile, auditory, olfactory or imagined the arteries supplying thepenis dilate and large quantities of blood enter the blood sinuses expansion of thesespaces comprises the veins draining the penis, so blood outflow is slowed .this vascularchanges, due to local release of nitric oxide is a parasympathetic reflex, results inerection, the enlargement and stiffing of the penis. The penis returns to in flaccid stagewhen the arteries constrict and the pressure on the vein is relieved.INFERTILITY:-Infertility is the inability of a couple to achieve a pregnancy after repeated intercoursewithout contraception for 1 year.Infertility affects about one of five couples in the United States. It is becomingincreasingly common because people are waiting longer to marry and to have a child.Nevertheless, up to 60% of the couples who have not conceived after a year of trying doconceive eventually, with or without treatment.It is a common problem among young adults. About 15% of all couples are unable toconceive a child after 1 year of regular, unprotected intercourse.Infertility is one of the most difficult experiences that a couple may face together. Thecouple may have a sense of loss and a feeling of uncertainty. It is a time, however, whenthe couple must make certain key decisions. It is important that they work together as ateam and avoid placing blame on one another.It often results from reproductive problems in both partners. Doctors now know that amale factor for infertility may be involved in roughly one half of all infertile couples.In 30-40% of these couples, the infertility involves both male and female factors.In about 20% of infertile couples, the inability to conceive is due entirely to a male factor. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 47. REVIEW OF LITERATURE 33In about 30-40% of infertile couples, the infertility is due to a female factor alone.In about 10% of couples, neither partner has a detectable abnormality.Infertility may be due to problems in one or both of the partners. An evaluation of bothpartners of an infertile couple should be performed at the same time.ETIOLOGY OF MALE INFERTILITY80:- I. EXTERNAL CAUSES • conditions of semen collection • environmental factors • iatrogenic factorsII. ACQUIRED DEFECTS OF THE TESTIS, PROSTATE AND SPERM • infection: prostatitis etc. • immunologic causes : antisperm antibodies • varicocele • testicular tumoursIII. DEVELOPMENTAL AND STRUCTURAL DEFECTS OF THE TESTIS ORSPERM • cryptorchism • genetic causes • `sertoli cell only syndrome • spermatogenetic arrest • anomalies of sperm structureIV. HORMONAL CAUSES AND ANDROGEN RESISTANCE • hypogonadotrophic hypogonadism (hh) • hyperprolactinaemia • congenital adrenal hyperplasia • androgen resistance syndrome Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 48. REVIEW OF LITERATURE 34V. SYSTEMIC DISEASESVI. IMPAIRMENT OF SPERM TRANSPORT: obstructive azoospermiaVII. PROBLEMS OF EJACULATION • retrograde ejaculation • ejaculation failureVIII. SEXUAL DYSFUNCTIONIX. IDIOPATHIC CAUSESEXTERNAL CAUSES :-1. CONDITIONS OF SEMEN COLLECTION:- • incomplete sperm collection • use of condoms (spermicids),vaginal lubricants • duration of sexual abstinence: short – oligospermia, increased motility; long- asthenospermia2. ENVIRONMENTAL FACTORS:-81 • occupational heat exposure • sauna, hot baths, tight underwear 82 • feverish states • Season: oligospermia in September (heat, photoperiodicity?) • toxic products: lead, cadmium83 • dibromochloropopane (DBPC), kepone • boric acid, vinyl chloride • aromatic solvents84 • drugs: heroine, methadone: FSH and LH ( marijuana: T and sperm mobility) • alcohol: inhibition of T synthesis and sperm capacitation, • reduced sperm quality in heavy drinkers85 • Cigarette smoking: in 11 studies the sperm density is 22% lower in smokers, the motility is lower; increased sperm disomy has been found. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 49. REVIEW OF LITERATURE 353. IATROGENIC FACTORS:-Surgery: Hernioraphy in childhood (lesion of vasa), testicular torsion, orchidopexy • Radiotherapy • ChemotherapyDRUGS:-With anti androgenic action: spironolactone, cimetidine, ketoconazole, cyproteroneacetate, tetracycline, phenytoin, carbamazepine86 • gonadotrophins: estrogens, androgens • sulfasalazyne, furodantoines, garamycine. • possible adverse effect: cotrimoxazol, antimalarials, amoebicides, tetracyclines - impotence or ejaculation disorders: neuroleptics, thioridazine, • clomipramine, alpha and beta adrenergic blocking drugs,clonidine, methyldopa, fibrates, anticholinergics etc, SSRI (fluoxetine,citalopram) • drugs without adverse effect on sperm: ranitidine, 5 -aminosalicylique, amitryptiline, enzyme conversion inhibitors (enalapril), AINS (diclofenac), quinolones (ciprofloxacine)II. ACQUIRED DEFECTS OF THE TESTIS, PROSTATE OR SPERM 1. INFECTION:- • Orchitis: mumps, echovirus, B arbovirus. Mumps: 75% of men witunilateral orchitis have a normal sperm within 1 to 2 years but only 30 % with a bilateral orchitis. Treatment with interferon 2B? • Epididymitis: Chlamydia, Gonococci, Tuberculosis: obstruction of epididymis: azoospermia + antisperm antibodies87 • Prostatitis: present in 25 to 30% of infertile compared to 10-15 % of fertile men. Controversial cause of asthenospermia and male infertility. Leukospermia and decreased seminal levels of zinc. Possible role of mycoplasma, chlamydia, capable of attaching to sperm. Induction of auto antibodies. Controversial effect of antibiotics. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 50. REVIEW OF LITERATURE 36 • HIV: present in 10 to 30% of the sperm of seropositive men (in 87% by PCR). The virus is present in semen as cell-free or as cell-associated virus (mononuclear cells) (Kiessling, F St 58:667, 1992). Insemination with processed semen of HIV partners is still experimental and controversial. The virus is still present in seminal cells of patients receiving antiretroviral therapy88. 2. IMMUNOLOGIC CAUSES:- Antisperm antibodies89Antisperm antibodies have been detected in 5 to 10% of infertile men and in 2% of fertilemen. Antibodies against spermatozoa can reduce fertility by decreasing the binding ofsperms to the zona pellucida, by interfering with capacitation or acrosome reaction or byimmobilizing sperms in cervical mucus. Antibodies directed against the sperm head aredeleterious. The presence of antisperm antibodies is determined by the attachment of alabeled antihuman immunoglobulin specific for the class of human Ig to be essayed, tothe sperm-associated antibody. The label can be an erythrocyte (MAR test), a polycramidbead (immunobead essay) an enzyme (ELISA), a fluorescent molecule or a radioisotope.a) Male autoimmunization- Antisperm auto antibodies in semen:-They induce no specific abnormality in sperms but could decrease the mobility and canbe detected by MAR test or immunobead essay (IgG or IgA). The cause is unknown:possible cross reactivity between sperm internal antigens and certain microorganisms?An increased incidence has been found in the case of associated Prostatitis. Antispermantibodies are also present after vaso-vasostomy, inversely related to sperm motility90.Antibodies (Ab) have a high affinity for sperm surface antigens and they cannot beremoved by washing (even 18 times). Ab could be added by exposure to seminal plasmaand ejaculation into buffer can be useful to decrease antibody-bound sperm by dilution91.IVF is possible except in case of antibodies directed against sperm head or acrosine),ICSI is preferred in the latter situation. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 51. REVIEW OF LITERATURE 37b) Circulating antisperm auto antibodiesUnbound antibodies can be measured by the tray agglutination test (serial dilutions ofserum are able to agglutinate donor spermatozoa) or by the indirect immunobead test(antisperm antibodies in the serum will bind to donor sperm free of antibody). Ab can beproduced because of disruption of the blood testis barrier that isolate sperm antigens fromthe males immunological system (testis biopsy, torsion). Leakage of sperm due to spermdegeneration in the epididymis could be responsible for the occurrence of circulatingantibodies in unilateral or bilateral obstruction of the male genital tract (e.g. antibodiesare present in 50 to 80 % of cases after vasectomy) . Genetic factors (HLA A28) couldplay a role. The roles of the circulating ab in infertile couple and in the persistentinfertility after vaso-vasostomy as well as the utility of prednisone treatment arecontroversial 92c) Auto antibodies in the testis:Auto antibodies directed against testicular basement membrane and against steroid cells(Leydig cells) have been described in rare cases of hypogonadic men with multipleendocrine autoimmune diseases933. VARICOCELEThe incidence is 10-15% in the male population and 20 to 30% in infertile patients.Varicoceles are associated with impaired seminal and hormonal parameters. It is aclassical cause of secondary infertility. Adverse effects could result from increasedscrotal temperature, reflux from the adrenal gland or adrenal metabolites (left internalspermatic vein enters the left renal vein). A review of 509 publications comprising 5471patients shows that surgical ligation of the spermatic vein results in an average pregnancyrate94 of 36%. However the benefit of surgery has not been proved in a randomized studycontrolling for female factors (29% pregnancy in the treatment group and 25% in thenon- treatment group (n=125).Practically, varicocelectomy can be recommended in order to prevent a furtherdeterioration of the sperm if the following criteria are fulfilled95: Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 52. REVIEW OF LITERATURE 38 1. infertility for 1 year 2. Valsalva-positive varicocele documented by doppler and US 3. smaller testicular volume on the varicocele side 4. subnormal seminal parameters 5. FSH not elevated 6. normal or treatable female reproductive functions 7. no other causes of male infertility (prostatitis, autoimmunity etc)High surgical ligation (by laparoscopy!) and angiographic embolization give similarresults.4.TESTICULAR TUMORS:-Testicular tumors affect 2-3/100.000 men per year and are responsible for 1% of cancerdeaths. Men with cryptorchidism have a fivefold increased risk (3/4 are seminoma=tumors arising from the germinal epithelium). Tumors of adrenal cell rests dependent onACTH have been described in 21-hydroxylase deficiency and can decrease after corticoidtreatment. About 50% of men with germ cell tumors have initial low sperm count96.III. DEVELOPMENTAL AND STRUCTURAL DEFECTS OF THE TESTIS ORSPERM1. CRYPTORCHISM :-Cryptorchism exists in 0, 7-0, and 8% of adult men and in 2-3% in newborns and ispresent in 6% of infertile patients. Maldescent occurs in more than 40 human congenitaldefects including cases of hypogonadism and lack of androgen synthesis or action. It isassociated with HLA-A11 and A-25. The lack of descent after HCG occurs in 40% ofHLA-A11 and 70% of HLA-DR5. It is not clear whether the testis functions poorlybecause of the maldescent (heat etc.) or it fails to descent because it is initially abnormal.Spermatogenesis is also abnormal in the descended testis. Deleterious changes in the ultrastructure of the cryptorchid testis are observed in the first year of life. Therefore it hasbeen suggested to operate the cryptorchid testis in the first year in case of lack ofresponse to GnRH or HCG. However, operation may not ameliorate the fertility potential Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 53. REVIEW OF LITERATURE 39in cases of bilateral cryptorchism. In case of unilateral cryptorchism surgery in earlypuberty has been advised by some authors.In bilateral cryptorchism 42% of treated patients are azoospermic and 31% areoligospermic. In untreated cases 75% are azoospermic. In unilateral cases 14% of treatedpatients are azoospermic and 31% are oligospermic (the results are not different fortreated cases) 972.GENETIC CAUSES98Karyotype abnormalities have been observed in 15 to 23% of azoospermic and in 5-6%of oligospermic patients99.Klinefelter syndrome (XXY):Frequency: 1 in 500 males. It is the most common form of hypogonadism in men (1,6%of infertile men) and occurs due to meiotic non-dysjunction during gametogenesis.Patients present with small firms testes (2-10 ml), gynecomastia, increased height,azoospermia and elevated levels of gonadotrophins. Due to increased estradiol andincreased TBG, T levels may be normal although the production is reduced. 10% of thecases are mosaic forms 46 XY/ 47 XXY (due to mitotic non- dysjunction afterfertilization of the zygote). Sometimes the mosaicism can be present only in the testes.Azoospermia is present only in 50% and some patients can be fertile.3. SERTOLI CELL ONLY SYNDROMEIt accounts for 1/10 to 1/3 of azoospermic patients. Histological findings arecharacterised by a complete absence of germinal elements occuring in patients with anormal male phenotype and normal caryotype. It can be the result from several etiologies:viral orchitis, cryptorchidism, androgen resistance, familial syndrome. FSH values areusually high, sometimes normal Y microdeletions can be detected in 50% of cases.4. SPERMATOGENETIC ARREST:This is observed in 4 to 30% of azoospermic patients. Interruption of germ celldifferentiation resulting in oligospermia (partial arrest) or azoospermia (complete arrest).It generally occurs in normal patients with normal testicular volume and gonadotropin Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 54. REVIEW OF LITERATURE 40levels. Most cases are due to genetic abnormalities occurring in the prophase of the firstmeiotic division (zygoten and pachyten phase). Acquired cases can be due to hormonal,thermic or toxic factors.5. ANOMALIES OF SPERM STRUCTURE:a) Immotile cilia syndrome:Inherited as an autosomal recessive trait. Results in chronic sinusitis and bronchiectasis.The Kartagener syndrome is associated with situs inversus. Due to missing or very shortdynein arms, missing central tubules or displacement of one of the nine doublets. Innormal subjects 10% of sperms have an incorrect number of microt. Doublets and 7%have fewer than 9 doublets. Asthenospermia can also be due to mid-pieces abnormalitiesof mitochondria and to deficiency in protein carboxyl methylase100. Among 400 patientswith absent sperm motility 3% had dynein arm deficiency and 23% were necrospermic.b) Necrospermia: can be distinguished from immotile sperm. Syndrome by supravitaldyes. Degenerative changes involve all sperm componentsc) Teratospermia: agenesis of the acrosome results in round headed spermatozoa.Familial, polygenic mode of inheritance.Monomorphic round head teratozoospermia isprobably of genetic origin whereas testicular factors could be responsible for theamorphous head. Teratospermia has been associated with autosomal translocations.IV: HORMONAL CAUSES AND ANDROGEN RESISTANCEThe incidence of primary endocrine defects in infertile men is less than 2%1. HYPOGONADOTROPHIC HYPOGONADISM (HH)Patients with HH show decreased levels of gonadotrophins and T. If it occurs beforepuberty, signs of eunuchoidism are present: arm span 5 cm greater than height, decreasedhair and muscular development, infantile genitalia. If anosmia is present: Kallmannsyndrome (frequency: 1/10000 to 1 /60000). Absence of neurons secreting GnRH. Xlinked inheritance or autosomal-dominant or recessive (role of KALIG 1 locus on short Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 55. REVIEW OF LITERATURE 41arm of chromosome X which encodes for a protein that could be responsible for neuronalmigration (GnRH neurons arise in olfactory placode and migrate along the cranial nerve Ito the preoptic area)101.Acquired form of HH occurs in patients with normal pubertal development with a recenthistory of decreased sexual function and fertility. Partial defect in gonadotrophinsecretion (low LH and normal FSH) can lead to fertile eunuch syndrome.Hemochromatose must be ruled out by dosage of ferritine.HH can also be due to pituitary lesions (prolactinoma, Cushing disease) or infiltrativediseases and a IRM of the pituitary is always indicated in case of HH, as well as a dosageof prolactin in case of impotence (cf infra). These conditions can be treated with HCG (3x 2000 U and HMG 3 x 75-150 U /week) or by pulsatile GnRH if fertility is desired.Cryptorchism has a bad prognosis102.2. HYPERPROLACTINAEMIAMicro- or macroadenoma of the pituitary secreting prolactin can induce hypogonadismeither by impairing GnRH release or by destruction of the pituitary. It causes loss oflibido, visual abnormalities and galactorrhea in 15-30% of cases. Fertility and potencycan be recovered after surgical or medical treatment.3. CONGENITAL ADRENAL HYPERPLASIAIn mild forms of 21-hydroxylase deficiency high ACTH levels stimulate the synthesis ofandrogenic steroids by the adrenal cortex (androstenedione and 17 OH P) resulting inprecocious puberty and abnormal phallic enlargement. Gonadotrophins are suppressedresulting in some cases in oligospermia. Fertility can be restored by glucocorticoidtreatment4. ANDROGEN RESISTANCE SYNDROMEQuantitative or qualitative defects of testosterone binding to the androgen receptor due tomutations in the receptor result in a spectrum of disease ranging from complete testicularfeminisation to infertile male syndrome. Androgen receptor deficiency has been observedin 0 to 19% of men with idiopathic oligospermia and normal phenotype. LH levels are Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 56. REVIEW OF LITERATURE 42slightly increased and T levels are normal. The LH (UI) x Testo (ng/ml) product isincreased above 200, but could be normal (100) in some cases. Increased LH x Tproducts have also been reported in coeliac disease and in hyperthyroidism (withincreased estradiol levels in the latter).The androgen receptor has been shown to contain trinucleotid repeat loci. An increasedlength of these repeats has been associated with androgen resistance and defectivespermatogenesis103.V. SYSTEMIC DISEASES:-1. Renal failure:-Renal failure leads to decreased T levels and increased gonadotrophins and prolactin in25% of cases. Improvement of sperm after zinc administration104. Fertility can be restoredby kidney transplantation but not by dialysis105.2. Cirrhosis of the liverGynaecomastia and impotence are present in half of the cases, estradiol and TBG areincreased. Gonadotrophins are slightly increased. Testicular atrophy andhypospermatogenesis are described.3. Sickle cell anaemia:Testicular atrophy occurs in 1/3, maturation arrest of sperms. Hypoxaemia and zincdeficiency might play a role1064. Gastrointestinal diseases:In coeliac disease, a decreased mobility and teratospermy has been observed as well as anincreased T x LH ratio. In Crohns disease oligospermia has been observed in 6/13patients. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 57. REVIEW OF LITERATURE 435. Hodgkin disease:Asthenoteratospermia has been observed in 50% of the cases, oligospermia in 25% (35patients) and low T levels.6. Neurological diseases:a) Myotonic dystrophy: small testes, low T and high gonadotrophinsb) Spinal cord lesions: moderate oligospermia and most of the time asthenospermia isobserved in paraplegics. Multifactorial causes: retrograde ejaculation, urinary tractinfection. Not due to hormonal problem or infrequent ejaculations. Semen collection byrectal probe electrostimulation or vibrator.7. Psychological factors:Infertile men do not present a special psychopathological profile and compared to acontrol group of fertile men they do not present differences in personality profile andcoping strategies. No sperm alteration has been observed in male marathon runners and indepressed patients107. However, the stress due to IVF procedure and the stress due to theloss of a close parent or due to earthquake but not the stress at work could decreaseslightly semen quality.VI. IMPAIRMENT OF SPERM TRANSPORT: OBSTRUCTIVE AZOOSPERMIAGenital duct obstruction is found in 5 to 7% of infertile patients. Obstruction may occurat any level of the genital tract. It can be congenital or acquired, secondary to infection(bilateral epididymitis), stricture or vasectomy. Most of the patients present withazoospermia, normal size testes and normal gonadotrophin levels. In congenital absenceof the vas there is usually an associated absence of the seminal vesicles and ampulla. Thesemen volume is low, acid and fructose negative.Incomplete or unilateral obstruction of the male genital tract can be responsible foroligospermia and is associated with circulating antisperm antibodies. A trial with an anti-inflammatory treatment such as diclofenac could be useful Investigations and treatmentwill be discussed by Dr de Boccard Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 58. REVIEW OF LITERATURE 44VII. PROBLEMS OF EJACULATION1. Retrograde ejaculation:It can be suspected in case of "dry" ejaculation or small volume of the ejaculate. It mayfollow transurethral resection of the prostate, bladder neck surgery, retroperitoneal lymphnode dissection or pelvic surgery (rectum). It occurs in diabetes with peripheralneuropathy, multiple sclerosis, paraplegia and alpha-adrenolytic drugs. Sperm can berecovered in the urine after alkalinisation (650 mg of bicarbonate 4 x /d 48 h prior tocollection). Imipramine (25-50 mg/d) can be tried to re-establish antegrade ejaculation.2. Ejaculation failure:A complete absence of antegrade ejaculation can be due to sympathetic denervation,autonomic medications or psychogenic problems. Retarded ejaculation can be a milderform of this condition. Treatment includes vibratory stimulation, electro ejaculation andpsychotherapy.VIII. SEXUAL DYSFUNCTIONImpotence and premature ejaculations. Discussed by Prof. Ruedi.IX. IDIOPATHIC CAUSESIn 30 to 50% of cases (if we include cases with no sperm improvement after varicocelerepair or prostatitis treatment) no aetiology can be identified to explain abnormal semenor infertility. Abnormalities of all semen parameters are usually observed. Slight increaseof FSH values may result from injury of the testis due to viral, toxic or congenital factor.In 1/3 of the cases of idiopathic infertility with apparently normal sperm, there is adecreased rate or a lack of oocyte fertilisation with IVF. A decreased binding to zonapellucida has been observed in 28% of cases and an absence of sperm hyperactivationinduced by follicular fluid in another 39% (from 18 patients). In these patients (withidiopathic infertility), reactive oxygen species generation was not different from thecontrol group (semen samples producing high rate of free oxygen radicals arecharacterized by a loss of sperm function) 107. Ultrastructural defects of sperm head or tailor defects of acrosine reaction could also be responsible for some cases of lack of IVF.Immunological factors could be responsible for another 10% of cases (by decreasing Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 59. REVIEW OF LITERATURE 45sperm binding to the zona pellucida). Androgen receptor deficiency is under diagnosedalthough the prevalence rate is much lower than the 40% rate observed by Aiman.Genetic diseases are also under diagnosed in case of chromosomal anomalies presentexclusively in germ cells.Reduced LH pulse frequency has been observed in oligospermic patients with high FSHlevels, which were decreased by GnRH pulsatile administration. However, there is nosperm improvement after GnRH treatment. Aromatase inhibitors could improve thesperm count.EXAMINATION OF THE INFERTILE MALE:Ideally the patient should be naked, so that the physician can obtain a general impressionof possible endocrine stigmata. The presence of Cushing’s disease, hypogonadism orhypothyroidism may become obvious by observing the body habits, the amount anddistribution of body hair, the presence or absence of gynaecomastia and the pattern of fatdistribution. Height, weight, blood pressure, any unusual length of extremities andgeneral nutritional status are noted. A test for anosmia is important in patients withhypogonadism in order to rule out Kallamans syndrome. If hyperprolactinemia is presenta space occupying lesion in the fossa turcica should be ruled out (visual fields, CT scan).The thyroid gland is carefully palpated and the breasts are carefully examined forgynaecomastia. Abdominal palpation may reveal liver enlargement. Operative scars inthe inguino genital areas are noted.The examination room should be warm so that the scrotal dartos reflex will be relaxedfacilitating the examination of the genitalia. Urogenital examination includes inspectionof the penis and the location of the urethral opening. Any abnormality concerning theprepuce should be noted. Palpation of the scrotal content provides information aboutlocalization, consistency and possible tenderness of the testes. The size of the testesshould be measured with orchidometer. Men who have small and firm testes (volumeless than 6 ml) may have Klinefelter’s syndrome. Testes volume more than 15 ml isconsidered as normal.The epididymis and vas deferens are carefully palpated in search of cystic formations,tenderness or thickening which could confirm past, present or chronic inflammatory Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 60. REVIEW OF LITERATURE 46disease resulting in infertility. The presence of scrotal swelling due to hernia orhydroceleis noted, with the patient standing upright, occurrence of varicocele or of spermaticvenous reflex during valsalva manoeuver is investigated and graded as follows:Grade-I: No varicocele on inspection and palpatation but palpable filling of thepampiniform plexus during valsalva manoeuver.Grade-II: No varicocele on inspection but detectable varicocele by palpation.Grade-III: Varicocele clearly visible.Other means for diagnosis of a varicocele are scrotal thermography, Doppler echography,venous scintigraphy and retrograde venography.Then the groins are examined for lymphadenopathy, surgical or other scars. Finally,prostate and seminal vesicles are examined. The prostate should be symmetrical, of firmconsistency, normal in size and non tender to palpation. A prostate gland that is enlargedand boggy in consistency is often congested, infected or both.ENDOCRINE EVALUATION:Testosterone levels should be determined in patients with history or signs of deficientdevelopment of the secondary sex characteristics and in men with sexual impotency.Some times the only sign of androgen deficiency may be deficient sperm motility orabnormal sperm output as a consequence of impaired epididymal sperm maturation. Todetermine the functional quality of the Leydig cells, the HCG stimulation test should beperformed: An increase in plasma testosterone without an increase in the concentrationsof the physiological markers in the ejaculate indicates a mechanical block, dysfunction oragenesis of the respective secondary sex gland.FSH determination is indicated in patients with a sperm concentration of less than 5million per ml. Elevated levels indicate germinal cell insufficiency. In azoospermic men,high FSH levels indicate primary germinal cell failure, only Sertolicell syndrome, orgenetic conditions such as Klinefelter’s syndrome. If elevated FSH levels areaccompanied by elevated LH levels and subnormal testosterone, this indicates primarytesticular failure or andropause (Lunenfeld et al 1982) Elevated levels of LH in thepresence of relative low values of testosterone is sign of Leydig cell insufficiency. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 61. REVIEW OF LITERATURE 47An elevated prolactin levels may be a symptom of hypothalamic inability to secrete theprolactin inhibiting factor or may be an early sign of pituitary adenoma.SEMEN ANALYSIS:-108Spermatozoa were first described by Leeuwenhoek in the 17th century but it was not until1928 that the sperm count was found to be associated with fertility potential. Since thattime a variety of sperm tests and semen parameters have been developed with the hope ofclarifying whether or not a man could impregnate his partner.MacLeod (1942), MacLeod and Gold (1953), Eliasson (1971) and Hellinga (1949, 1976)have led the scientific basis of conventional analysis of spermatozoa and the techniquesrecommended by them are still considered the reference for more advanced methods.Semen analysis comprises a set of descriptive measurements of spermatozoa and seminalfluid parameters that help to estimate semen quality.Conventional semen analysis includes measurement of particular aspects of spermatozoasuch as concentration, motility and morphology and of seminal plasma. Quantificationand identification of non-spermatozoidal cells and detection of antisperm antibodies arealso part of basic semen analysis.Normal values of semen parameters issued by the World Health Organization (WHO) in1992 are generally used as reference values.Ideally, each laboratory should set its own normal values, reflecting the specificpopulation analyzed.SAMPLE COLLECTION AND DELIVERY:-The following instructions for sample collection and delivery are based on WHOrecommendations. The subject should be provided with clearly written or oralinstructions concerning the collection and, if required, transport of the semen sample.The sample should be collected after a minimum of 48 hours and no longer than 7 days ofsexual abstinence. The name of the man, period of abstinence, date and time of collectionshould be recorded. The time interval between the last ejaculation and sample collectionshould be well defined and preferentially as constant as possible in order to allow areliable interpretation of the results of, in particular, sperm concentration and motility. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 62. REVIEW OF LITERATURE 48When the duration of abstinence is more than 7 days, sperm motility, i.e. the proportionof spermatozoa with rapid progressive motility, may decline. If the duration of abstinenceis <48h, sperm concentration may be reduced, but motility will probably not be affected .Two semen samples should be collected for initial evaluation. The interval of timebetween the collections will depend on local circumstances but should not be less than 7days or more than 3 months apart. If the results of these assessments are remarkablydifferent, additional semen samples should be tested because marked variations in spermoutput may occur within the same individual. Analysis of multiple semen specimensprovides a reliable screen in the evaluation of male factor infertility. Information andsupport are important since semen analysis cause a moderate amount of stress.Ideally the sample should be collected in the privacy of a room near the laboratory. If not,it should be delivered to the laboratory within 1h after collection.The sample should be obtained by masturbation and ejaculated into a clean, wide-mouthed glass or plastic container. If plastic is used, it should be checked for lack oftoxic effects on spermatozoa. The container should be warm to minimize the risk of coldshock.Ordinary condoms must not be used for semen collection because they may interfere withthe viability of spermatozoa. In cases in which masturbation is not possible or against anindividual’s values, the specimen can be collected in a non-spermicidal condomfollowing intercourse. It has been shown that semen samples collected during intercourseusing a special plastic condom or a silastic collection device tend to have betterparameters. Other authors, referring to their experience, hold the view that the quality ofthe specimen when collected in this way is generally compromised. This way ofcollection should be considered for a second sample if the first one shows a relatively lowvolume. Coitus interrupts is not acceptable as a means of collection because it is possiblethat the first portion of the ejaculate, which contains the highest concentration ofspermatozoa, will be lost. Moreover, there will be cellular and bacteriologicalcontamination of the sample and the acid pH of the vaginal fluid will adversely affectsperm motility.Incomplete samples should be not analyzed, particularly if the first portion of theejaculate is lost. The sample should be protected from extremes of temperature (not less Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 63. REVIEW OF LITERATURE 49than 20°c and not more than 40°c) during transport to the laboratory. The sample shouldbe examined immediately after liquefaction and certainly within 1h of ejaculation.Laboratory technicians should be aware that semen samples may contain harmful viruses(e.g., HIV and viruses causing hepatitis and herpes) and should therefore be handled withdue care.MACROSCOPIC EVALUATION:-AppearanceThe semen sample is first evaluated by simple inspection. A normal sample has a grey-opalescent appearance, is homogenous and liquefies within 60min at room temperatureunder the influence of enzymes of prostatic origin. In some cases, liquefaction does notoccur within the normal time period and this fact should be recorded, as it may suggestfunctional disturbance of the prostate. Normal semen samples may contain jelly-likegrains which do not liquefy.The sample may appear clear if the sperm concentration is too low. It may also appearbrown when red blood cells are present in the ejaculate (haematospermia).The presence of mucous streaks may interfere with the counting procedure and suggestsinflammation or abnormal liquefaction.Samples which do not liquefy need additional treatment such as exposure to bromelin, tomake the sample amenable to analysis.The sample should be well mixed in the original container. Incomplete mixing isprobably a major contributor to errors in determining sperm concentration.ConsistencyThe consistency, also called viscosity, of the liquefied sample can be estimated by gentleaspiration into a 5-ml pipette and then allowing the semen to drop by gravity andobserving the length of the thread formed. A normal sample leaves the needle as smalldiscrete drops, while in cases of abnormal consistency the drop will form a thread of >2cm (6, 25). Another method to estimate consistency does not use needles and isperformed by introducing a glass rod into the sample and observing the thread that formson withdrawal of the rod. Again the thread should not exceed 2 cm. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 64. REVIEW OF LITERATURE 50Increased consistency has the same clinical meaning as abnormal liquefaction, and maybe related to prostate dysfunction resulting from chronic inflammation.Very viscousspecimens can impair the availability of fertile sperm at the site of fertilization.VolumeThe major component of the ejaculate volume is made up of secretions from theaccessory glands. The bulk of the volume is secreted by the seminal vesicles and between0.5 and 1 ml originates from the prostate. The volume of the ejaculate should bemeasured either with a graduated cylinder or by aspirating the whole sample into a wide-mouthed pipette by means of a mechanical device. The sample volume can also bedetermined directly in the collection tube by weighing, assuming 1ml equals 1g..Thereby, loss of volume associated with transfer from the collection tube to eitheranother tube or a pipette can be avoided.A low ejaculate volume can reflect abnormalities in accessory sex gland fluid synthesisor secretion. It can also be indicative of a physical obstruction somewhere in thereproductive tract, or may occur in cases of incomplete or (partially) retrogradeejaculation.Large volumes are sometimes found in association with varicocele or after relatively longperiods of sexual abstinence.pHThe pH is determined by acidic secretions of the prostate and alkaline secretions of theseminal vesicles. It should normally be in the range of 7.2-8.0.Recently, one author has shown that the mean pH values are consistently well above 8.0regardless of the method of analysis and the time of examination and has suggested thatthe range of normal values needs to be revised further.To test pH, pH paper range 6.1 to 10.0 is used. Whatever type of pH paper is used for thisanalysis, its accuracy should be checked against known standards before the use inroutine semen analysis.If the pH exceeds 8.0, infection should be suspected with decreased secretion of acidicproducts by the prostate, such as citric acid. Abnormal pH may also be recorded in cases Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 65. REVIEW OF LITERATURE 51of incomplete ejaculation. Extremely acidic pH (<6.5) is found in cases of agenesis (orocclusion) of the seminal vesicles.Initial microscopic investigationDuring the initial microscopic investigation of the sample, estimation of motility andconcentration of spermatozoa is performed. The presence of cells other than spermatozoaand of agglutination of spermatozoa is determined.MotilityIn recent years, a number of techniques for objective assessment of movementcharacteristics of human spermatozoa have been introduced by using computer-assistedsemen analysis (CASA) systems. For the purpose of conventional analysis, a simpleclassification system which provides the best possible assessment of sperm motilitywithout resorting to complex equipment is recommended.A fixed volume of semen (not more than 10 m l ) is delivered onto a clean glass slide andcovered with a 22x22 mm cover slip. It is important that the volume of semen and thedimension of the cover slip are standardized so that the analyses are always carried out ina preparation with fixed depth (i.e., 20m l). This depth allows full expression of therotating movement of normal spermatozoa. The preparation is then examined at amagnification of x400-600. An ordinary light microscope can be used for unstainedpreparations, particularly if the condenser is lowered to disperse the light. However, aphase-contrast microscope is preferable.The weight of the cover slip spreads the sample for optimal viewing. The freshly made,wet preparation is left to stabilize for approximately one minute. Motility estimation canconveniently be carried out at a room temperature between 18 and 24°c. At temperaturesoutside this range, some alteration in sperm motility will occur and this must bestandardized in the laboratory. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 66. REVIEW OF LITERATURE 52The microscopic field is scanned systematically and the motility of each spermatozoonencountered is graded a, b ,c or d according to whether it shows:- (a) Rapid progressive motility. (b) slow or sluggish progressive motility (c) Non-progressive motility. (d) Immotility.Spermatozoa graded (a) are supposed to display rapid progressive motility along a lineartrack, covering a distance of at least 20 mm (half the length of a spermatozoon) persecond..At least 100 spermatozoa are classified in this way. Visual field close to theborder of the cover slip should be avoided.It is advisable to repeat the procedure on a second drop of semen processed in the sameway.Estimation of sperm concentrationThe concentration can be estimated roughly during the initial examination in order todetermine the dilution procedure to be used and to indicate whether centrifugation maybe required to prepare an adequate smear for morphologic analysis.Cells other than spermatozoaThe ejaculate usually contains cells other than spermatozoa. These include polygonalcells from the urethral tract. If many of these are present, and they are covered withbacteria then it is probably that the sample was obtained by coitus interruptus and thecells originate from the vagina . Spermatogenic cells and white blood cells (WBC), whichare often referred to as "round cells", are present in almost every semen sample. Byconventional light microscopy or sperm staining techniques it is not possible to reliablydifferentiate WBC from immature germ cells in semen. In contrast, the cytochemicalperoxidase method reliably identifies granulocytes, the most prevalent WBC type insemen. The method is cheap, fast and easy to perform. The gold standard for thedetection of all WBC populations in semen is immuno-cytology using monoclonalantibodies. However, it is expensive and time-consuming, thus remaining a research tool Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 67. REVIEW OF LITERATURE 53at present. For clinical purposes, the peroxidase method is ideally suited to detectgranulocytes.The method aims at the counting of peroxidase-positive round cells in a haemocytometer.The working solution is prepared by combining 1ml of saturated NH4Cl solution, 1ml of5% of Na2 EDTA solution, 9ml of orthotoluidine solution and 1 drop of H2O2. Thissolution is mixed before use and can be conserved for 24h after preparation. Theprocedure consists of mixing 0.1ml of semen with 0.9ml of the working solution toachieve a total volume of 1ml. This mixture is shaken for 2 min. It is then left for 20-30min at room temperature and mixed again by shaking. The mixture is now transferredonto a haemocytometer chamber for leukocytes and the number of peroxidase-positivecells which stain brown is counted. Peroxidase-negative cells remain unstained and arecounted in the haemocytometer chamber. The differentiation of round cells into eitherperoxidase-positive polymorphonuclear granulocytes or peroxidase-negativespermatogenic cells or lymphocytes is of clinical relevance. The presence of an excessivenumber of peroxidase-negative mostly spermatogenic cells suggests pathology at thelevel of the seminiferous epithelium with inadequate spermatogenesis and prematurerelease of spermatids spermatocytes or, rarely, spermatogonia. The pathological meaningof the presence of an elevated number of WBC is still a matter of dispute. Some reportshave demonstrated that leukocytospermia appears to be of no diagnostic value to identifymen with actual microbial infections. Also, measurement of seminal leukocytes in routinesemen analysis appears to be of little prognostic value with regard to male fertilizingpotential.Others hold the view that the presence of an elevated number of WBC may be associatedwith infection or inflammation of the accessory glands and that the unfavorable effect onspermatozoa of hydrogen peroxide secreted by peroxidase-positive WBC has clearly beenproven .A comprehensive approach that considers other clinical and laboratory findings seems tobe more reliable in detecting male accessory gland infection.AgglutinationAgglutination of spermatozoa means that motile spermatozoa stick to each other, head tohead, mid piece to mid piece, tail to tail, or mixed, e.g. mid piece to tail. The adherence Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 68. REVIEW OF LITERATURE 54of either immotile or motile spermatozoa to mucus threads, to cells other thanspermatozoa, or to debris is not considered agglutination and should not be recorded assuch..The presence of agglutination is suggestive of, but not sufficient evidence to provethe existence of an immunological factor of fertility. The extent of agglutination may beimportant but even the presence of only a few groups of small numbers of agglutinatedspermatozoa should be recorded. In case of agglutination, sperm culture must beperformed in order to exclude infection with e.g. Escheria coli. Sperm agglutinationcould be used also as indication for antisperm antibody testing of infertile men.Further microscopic examinationSperm viabilityVital staining of the spermatozoa allows quantification of the fraction of living cellsindependently of their motility. Live and dead sperm are distinguished by adding onedrop of eosin y stain to one drop of semen at room temperature (one to two minutes) andsmearing the mixture on a microscopic slide. 100 spermatozoa are classified as eithercolored orange-red, if the stain has passed through the membrane and therefore the cell isconsidered dead, or non-stained, the cell than being considered alive .This staining technique makes it possible to differentiate spermatozoa that are immotilebut alive from those that are dead.. Reduced percentage of motility with a highpercentage of viable sperm may reflect structural or metabolic abnormalities of spermthat are derived from abnormalities in testicular function or antimotility factors in theseminal plasma .This technique also provides a check on the accuracy of the motilityevaluation, since the percentage of dead cells should not exceed the percentage ofimmotile spermatozoa.Hypo-osmotic swelling (HOS) testThe hypo-osmotic swelling (HOS) test measures sperm membrane integrity by examiningits ability to swell when exposed to hypo-osmotic media, and has been claimed to berelevant to fertilizing ability. The rationale of the test is based on the assumption that anundamaged sperm tail membrane permits passage of fluid into the cytoplasmic spacecausing swelling and the pressure generated leads to curling of tail fibers, while thedamaged or chemically inactive membrane allows fluid to pass across the membrane Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 69. REVIEW OF LITERATURE 55without any accumulation and accordingly no cytoplasmic swelling and curling of the tailoccur.The HOS test should not be used as a sperm function test but may be used as an optional,additional vitality test. It is simple to perform and easy to score and gives additionalinformation on the integrity and the compliance of the cell membrane of the sperm tail.Counting the spermatozoaThe concentration of spermatozoa should be determined using the haemocytometermethod.In this procedure a 1:20 dilution from each well-mixed sample is prepared by diluting 50m l of liquefied semen with 950 m l diluents. The latter is prepared by adding 50 g ofsodium carbonate (NaHCO3), 10ml of 35% (v/v) formalin and, optionally, 0.25 g oftrypan blue or 5ml of saturated aqueous gentian violet to distilled water and making upthe solution to a final volume of 1000ml. The stain needs not to be included if a phase-contrast microscopy is used. If the preliminary examination of the semen indicates thatthe concentration of spermatozoa present is either excessively high or low, then the extentto which the sample is diluted should be adjusted accordingly. For samples containingless than 20x10 6 spermatozoa/ml, a 1:10 dilution should be used; for samples containingmore than 100x10 6 spermatozoa/ml, a 1:50 dilution may be appropriate. Both chambersof the haematocytometer are scored and the average count is calculated, provided that thedifference between the two counts does not exceed 1/20 of their sum (i.e., less than 10%difference). If the two counts are not within 10%, they are discarded, the sample dilutionre-mixed and another haemocytometer prepared and counted.An optional procedure for determining sperm concentration employs specialized countingchambers, e.g. Makler chamber.The total number of spermatozoa per ejaculate reflects spermatogenesis and is related tothe duration of sexual abstinencePerhaps the most widely utilized semen parameter is sperm count. Men with <20x10 6spermatozoa per ml are typically deemed sub-fertile, and men with counts <5x10 6spermatozoa/ml are often considered infertile. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 70. REVIEW OF LITERATURE 56Other authors have confirmed that in patients with sperm counts <20x10 6/ml the fertilitypotential is significantly impaired. However, it must be emphasized that patients withsperm counts <20x10 6 are not infertile. It simply takes them a substantially longerperiod of time to achieve pregnancies.Analysis of the morphological characteristics of spermatozoaSperm cells represent a unique population in which up to 50% (up to 70% according toWHO criteria 1992 and up to 86% according to strict criteria) of the cells can havemorphological defects in normal fertile individuals (4). Although the morphologicalvariability of the human spermatozoon makes differential sperm morphology evaluationvery difficult, observations on the selection of spermatozoa recovered from the femalereproductive tract (especially in post coital cervical mucus) helped to define theappearance of a normal spermatozoon. The normal head should be oval in shape.Allowing for the slight shrinkage that fixation and staining induce; the length of the headshould be 4.0-5.5 mm, and the width 2.5-3.5 mm. The length-to-width ratio should be1.50 to 1.75. There should be a well-defined acrosomal region comprising 40-70% of thehead area. There must be no neck, mid piece or tail defects and no cytoplasmic dropletmore than one-third the size of a normal sperm head. This classification scheme requiresthat all borderline forms be considered abnormal.The following categories of defects should be scored. • Head shape/size defects, including large, small, tapering, pyriform, amorphous, vacuolated (>20% of the head area occupied by unstained vacuolar areas), or double heads, or any combination of these. • Neck and mid piece defects, including absent tail, non inserted or bent tail (the tail forms an angle of about 90° to the long axis of the head), distended / irregular / bent mid piece, abnormally thin mid piece or any combination of these. • Tail defects, including short, multiple, hairpin, broken, irregular width, or coiled tails, tails with terminal droplets, or any combination of these. • Cytoplasmic droplets greater than one-third of the area of a normal sperm head. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 71. REVIEW OF LITERATURE 57The traditional feathering technique (whereby the edge of a second slide is used to drag adrop of semen along the surface of the cleaned slide) may be used to make thin smears ofspermatozoa. The Papanicolaou smear for staining of spermatozoa is the method mostwidely used in andrology laboratories. In our practice we have tried simpler methods:Meyer’s haematoxiline, Harris haematoxiline and Giemsa. We have reported that thismethod are not as elegant as the Papanicolaou method but allows the classification of thespermatozoa in the main groups with the same accuracy.Sperm morphology gives information for the function of the reproductive tract and is apredictor of man’s fertility potential.Physical sperm aberrations may occur during the production of sperm or during storagein the epididymus. In cases of teratozoospermia, one should start first by excluding thepresence of monomorphic genetic syndromes such as globozoospermia, microcephalyand short tail spermatozoa. The increased number of immature spermatozoa may be dueto epididymal dysfunction or is a consequence of frequent ejaculations. The increasednumbers of spermatozoa with tapering heads are found in association with varicocele. Ina recent study we have reported that the percentage of tapered spermatozoa, spermatozoacontaining cytoplasmic droplets and spermatozoa with bent tail are significantlyincreased in varicocele patients compared to controls.The usefulness of sperm morphology assessment as a predictor of a man’s fertilizingpotential has often been challenged due to different classification systems, various slidepreparation techniques and problems with reproducibility because of observer variations.According to the literature the importance of sperm morphology as a single andindependent predictor of in-vivo and in-vitro fertilization seems to be proven.Testing for antibody coating of spermatozoaThe presence of anti-sperm antibodies in semen can alter the fertilizing ability of thespermatozoa. Being haploid, sperm cells are immunogenic and display different surfaceantigens from their diploid counterparts. Under normal circumstances, they are protectedfrom the man’s immune system by a basal membrane constituting the blood-testis barrier.When this barrier is ruptured, sperm cells induce the synthesis of anti-sperm antibodies.The presence of sperm antibodies coating the spermatozoa is typical of and is considered Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 72. REVIEW OF LITERATURE 58to be specific for immunologic infertility. Sperm antibodies in semen belong to theimmunoglobulin classes IgG, IgA or rarely IgM. There are some data suggesting that IgAantibodies may have greater clinical importance than IgG antibodies. The screening testfor antibodies is performed on the fresh semen sample and makes use of either theImmunobead method or the mixed antiglobulin reaction test (MAR test).Immunobead testImmunobeads are polyacrylamide spheres with co-valent bound rabbit anti-humanimmunoglobulins. The presence of IgG, IgA and IgM antibodies can be assessedsimultaneously with this test. Spermatozoa are washed of seminal fluid by repeatedcentrifugation and resuspended in buffer. The sperm suspension is mixed with asuspension of Immunobeads. The test is considered positive when 25% or more of motilespermatozoa have Immunobead binding.MAR testThe IgG MAR test is performed by mixing fresh, untreated semen with latex particles orsheep blood cells coated with human IgG. A monospecific antihuman-IgG antiserum isadded to this mixture. The formation of mixed agglutinates between particles and motilespermatozoa proves the presence of IgG antibodies on the spermatozoa. The diagnosis ofimmunologic infertility is probable when 50% or more of the motile spermatozoa haveparticles adherent. Immunologic infertility is suspected when 10%-50% of the motilespermatozoa have adherent particles.Sperm antibodies could influence sperm function in a variety of ways. For example,sperm agglutination and immobilizing antibodies might limit the number of fertile spermcells at the site of fertilization. Antibody production against sperm surfacemacromolecules could interfere with critical physiologic fertilization precursor events,such as capacitation and the acrosome reaction. It is also possible that antibodiesproduced against essential intraacrosomal enzyme systems, such as proacrosin-acrosincould impair sperm penetration through egg investment. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 73. REVIEW OF LITERATURE 59 DRUG REVIEWWhile explaining about different modalities of the treatment for sukradushti Acharya’sdivides it into 2 types on the basis of the pathogenesis ie either a shukrashodhana orsurarajanana. The concept of oligozoospermia when it is compared on an ayurvedicperspective it’s treatment can be comparable to ksheensukra where a spermatogenesis hasimportant role for fertility. Here the drug pushpadhanva rasa have a spermatopoetic andin addition to it has role of vajikarana and vrushya effect to achieve a propermanagement. PUSHPADHANAVA RASA:-109Contents:-RSASINDOOR - 1 TOLANAGABHASMA - 1 TOLALOHABHASMA - 1 TOLAABHRAKBHASMA - 1 TOLAVANGABHASMA - 1 TOLABhavana drugs:-DHATURAPATRA SWARASABHANGA KWATHAYASHTIMADHU KWATHAROOT OF SHALMALINAGVELLI PATRA SWARASA Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 74. REVIEW OF LITERATURE 60Table 1 Drug Latin Rasa Guna Virya Vipaka Prabhava Name Name Loha Ferrum Tikta, Ruksha Sheeta Madhura Vrushya,109 balya Kashaya Vanga Stannum Tikta, Laghu, Ushna Katu Vrushya, Kashaya Sara, Kamavivardhanama110 Sheeta, Ruksha Naga Plumbum Madhura, Guru, Ushna Katu Vrushya, Vagikaran, Tikta Sara, Balya111 Snigdha Abhraka Mica Madhura, Snigdha Sheeta Madhura Vrushya, shukrala112 Kashaya Yashti Glycyrrhi Madhura Guru, Sheeta Madhura Shukrala113 madhu za Snigdha GlabbraShalmali Salmalia Madhura Laghu, Sheeta Madhura Vrushya114 malabaric Snigdha,p ichila Dhattura Dhattura Kashya, Guru, Ushna Katu Shukrala115 metal Madhura, vyavayi, Tikta VikasiNagavalli Piper Tikta, Katu Laghu, Ushna Katu Kamagni betle Ruksha, sandipanam116 Tikshna Bhanga Cannabis Tikta Laghu, Ushna Katu Shukrala indica Tikshna lamm. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 75. REVIEW OF LITERATURE 61 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 76. METHODOLOGY 61 CLINICAL STUDYMethod of collection of the data:-It is single blind clinical study with pre test and post test design where minimum of 20patients diagnosed with clinical condition shukrakshya were selected between age groupof 25- 40 years of age.Patients were examined clinically and detailed history regarding disease and relevant labinvestigations will be recorded in specially prepared Proforma.The semen analyses were carried out for diagnosis at Higher Biochemical,Microbiological Laboratory centers of Udupi and Mangalore.Kosta shodhana were done to all patients prior to the treatment for 3 to 7 days, this werefollowed by Pushpadhanva Rasa 1bid with milk for 8 weeks. The patients were assessedclinically and with semenogram, before and after treatment.Source of data:-Male patients were selected from OPD section of S.D.M Ayurveda Hospital, Udupi,irrespective of their caste, community end social status.Inclusion criteria:-Male patients aged between 25-40 years.Male Patient suffering from Primary and Secondary infertility.Oligozoospermia (by semenogram)Exclusion criteria:-Patients aged below 25 years and above 45 years were excluded.AzoospermiaPyospermiaAsthenospermia Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 77. METHODOLOGY 62Investigations:-Semen analysis.Other investigations if required would be conducted.Materials used for clinical study:-Swadistha virechana choorna (Rasa Tantrasara page no. 691)This Swadistha virechana choorna was prepared in SDM Ayurveda Pharmacy, Udupi.Pushpadhanva Rasa with the dose of 125mg bid with milk.Intervention:-Patients were given Swadistha virechana choorna one teaspoon at night for 3 to 7 dayswith water for Kostha Shodhana.After Kostha shodhana, Pushpadhanva Rasa 125mgs bid with milk was given before food for 8 weeks.After the completion of treatment also the patients were kept under follow up to observedevelopment further for 2 months, so that the total overall effect of treatment could beassessed.Assessment criteria:-Improvement in sexual health i.e. desire, erection, rigidity, ejaculation, orgasm wasrecorded and graded (Mehra &Singh, 1994)SEXUAL FUNCTIONAL PARAMETERS:-SEXUAL DESIRE:-No desire at all: - 0Lack of the desire: - 1Desire but no activity: - 2Desire only on demand of partner: - 3Normal desire: -4Excess desire:-5 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 78. METHODOLOGY 63ORGASM:-No enjoyment: - 0Lack of enjoyment: - 1Enjoyment in 25% of sexual intercourse:-2Enjoyment in 50% of coital opportunities:-3Enjoyment in 75% of sexual intima: - 4Enjoyment in every act: - 5RIGIDITY:-Unable to maintain erection or continue sexual act -0Some loss in erection but able to continue sexual act: 1Able to maintain erection and continue sexual act: 2ERECTION:-No erection by any method-0Erection by artificial methods-1Erection but unable to penetrate-2Initially difficult but able to penetrate-3Erection with occasional failure-4Erection whenever desireEJACULATION:-No ejaculation at all-0Delayed ejaculation without orgasm-1Ejaculation before penetration -2Ejaculation with penetration-3Ejaculation with own satisfaction -4Ejaculation with own and partners satisfaction-5 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 79. METHODOLOGY 64ASSESMENT OF PUBERTAL DEVELOPMENTPUBIC HAIRS:- 1) No pubic hair 2) Sparse growth of straight light hair. 3) Spreads over pubes, darker coarser, curlier. 4) Adult in character but smaller area. 5) Extends on to thighs and towards umbilicus in men.SEMEN EXAMINATION:-VolumeLiquéfaction timePHTotal sperm countMotilityNUMBERS OF PATIENT REGISTERED FOR STUDY:-Total numbers of patients – 20Numbers of patients completed – 20Numbers of patient drop out -0OVERALL EFFECT OF THE TREATMENT:-The overall effect of the treatment could be graded into:Conceived: the partner’s wife otherwise normal, conceived after male partner wastreated.Complete Remission: Patient attains normal range of sperm count, active motility.Markedly improved: Marked increase in sperm count, active motility.Improved: Relative increase sperm count, active motility.Unchanged: No improvement. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 80. OBSERVATION AND RESULTS 65 OBSERVATIONS AND RESULTSTable No. 2.Incidence of 20 patients According to Age:-Age in years No. of patients %25-30 4 2031-35 12 6036-40 4 20Figure 2 60 50 40 25-30 30 31-35 20 36-40 10 0 %The maximum numbers of patients in this study were reported from 31 to35 yrs of agegroup having 60%. 20% patients were in the age group 36-40yrs and 25-30 groups each. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 81. OBSERVATION AND RESULTS 66Table No.3Incidence of 20 patients According to Religion:-Religion No. of patients %Hindu 17 85Muslim 2 10Christian 1 5Figure 3 90 80 70 60 50 H 40 M 30 C 20 10 0 %Among the 20 patients of this series maximum patients (85%) were belonged to theHindu community, whereas remaining (10%) patients were belonged to Muslim and 5%were Christian. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 82. OBSERVATION AND RESULTS 67Table No.4Incidence of Occupation:-Occupation No. of patients %Physically exertional 10 50sedentary 6 30service 4 20Figure 4 50 40 30 P.E. S 20 S 10 0 %In this study majority of patients (50%) were having physical exertional workers, such asagriculture. 30% were doing sedentary nature of work, and it is followed (20%) byservice men. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 83. OBSERVATION AND RESULTS 68Table No.5Distribution of 20 patients on the basis of socio economic status:- So.Eco.St No. of patients % Poor 10 50 LowerMiddle 5 25 Upper Middle 5 25 Rich 0 0Figure 5 50 40 30 LM M 20 UM R 10 0 %Poor classes were more with 50%. Lower Middle, Upper Middle, each of 25%. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 84. OBSERVATION AND RESULTS 69Table No.6Incidence of Educational StatusEducational Status No. of patients %High school 8 40Higher Secondary 8 40Graduate 4 20Post Graduate 0 00Figure 6 40 35 30 High Sch 25 H Sec 20 Grad 15 PG 10 5 040% of patients each had higher secondary, High school level education, and 20% ofpatients had graduation. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 85. OBSERVATION AND RESULTS 70Table No.7Shows Habitat:- Habitat No. of Patients Percentage Urban 4 20 Rural 16 80Figure 7 80% 70% 60% 50% 40% U 30% R 20% 10% 0% %Maximum numbers (80%) of patients reported in this study were residing in rural areaand remaining 20% patients were belonged to urban habitat. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 86. OBSERVATION AND RESULTS 71Table No 8Incidence of SatvaSatva No. of patients %Pravara 2 10Madhya 6 30Avara 12 60Figure 8 60 50 40 P 30 M 20 A 10 0 %Above table shows that the maximum numbers of patients (60%) were belonged to avarasatva, followed by madhyam (30%) satva patients and only 10% were pravara satva. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 87. OBSERVATION AND RESULTS 72Table No.9Incidence of SaraSara No. of patients %Tvak 4 20Rakta 0 00Mamsa 6 30Meda 6 30Asthi 4 20majja 0 00Figure 9 30 25 T 20 R 15 Ma Me 10 A 5 Ma 0 %The above said table shows maximum number of patients (30%) were belonged toMamsa and meda sara, which is closely followed by 20% patients of asthi and tvak saraeach. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 88. OBSERVATION AND RESULTS 73Table No.10Incidence of SamhananaSamhanana No. of patients %Pravara 2 10Madhyama 14 70Avara 4 20Figure 10 70 60 50 40 P 30 M A 20 10 0 %Maximum numbers of patients (70%) in this study were belonged to madhyamaSamhanana, followed by Pravara (20%) Samhanana and only 10% were avara satva. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 89. OBSERVATION AND RESULTS 74Table No.11Incidence of SatmyaSatmya No. of patients %Amla , tiktta 10 50Lavana ,katu ,kashya 10 50Figure 11 50 40 30 A,T. 20 L,K,K. 10 0 %The above figure shows that 50% ech were having Amla and tiktta rasa satmyata. andlavana, katu, kashya rasa Satmya. instead of katu & kashya rasa more people are prone tolavana rasa. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 90. OBSERVATION AND RESULTS 75Table No.12Status of PachakagniStatus of Pacakagni No. of patients %Mandagni 2 10Samagni 14 70Visamagni 4 20Figure 12 70 60 50 40 M 30 S V 20 10 0 %Maximum of 70% of patients were with samagni, .20% of patients with visamagni andonly 10% of patients with mandagni. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 91. OBSERVATION AND RESULTS 76Table No.13Status of KosthaKostha No. of patients %Mrdu 2 10Madhya 14 70krura 4 20Figure 13 70 60 50 40 m 30 m k 20 10 0 %70% of patients had madhyama Kosta, 20% patients were of Krura Kosta and 10% ofMrdu Kosta catogeroy. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 92. OBSERVATION AND RESULTS 77Table No. 14Incidence of PrakritiPrakriti No. of patients %V 0 00P 0 0K 2 10VP 10 50VK 2 10PK 6 30VPK 0 0Figure14 50 40 V P 30 K VP 20 VK 10 PK vpk 0 %Majority were of Vatapitta Prakriti with 50%. Kaphapitta Prakriti was 30% and kapha,Vatakapha were 10% each. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 93. OBSERVATION AND RESULTS 78Table No.15Incidence of NidraNidra No. of patients %Sound 4 20Disturbed 16 80Figure 15 80 70 60 50 40 S 30 D 20 10 0 %20% had sound sleep and 80% had disturbed sleep. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 94. OBSERVATION AND RESULTS 79Table No.16Incidence of type of DietDietary habit No. of patients %Veg 6 30Mixed 14 70Figure 16 70 60 50 40 V 30 MIX 20 10 0 % Maximum 70% of patients were mixed diet, 30% patients were vegetarians. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 95. OBSERVATION AND RESULTS 80Table No.17Incidence of AddictionsAddictions No. of patients %Smoking 2 10Tobacco 4 20Pan 2 10Alcohol 2 10No Addiction 10 50Figure 17 50 40 S 30 T P 20 A 10 NO 0 %50% of the patients are not addicted to health harming habits. Tobacco chewers were20%, rest 10%each of patients had the habit of regular alcohol consumption, smoking andpan chewing habits. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 96. OBSERVATION AND RESULTS 81Table No.18Incidence of VyayamaVyayama No. of patients %Heavy 10 50Moderate 6 30less 4 20Figure 18 50 40 30 H M 20 L 10 0 %50% are heavy workers, 30% moderate and remaining 20% are doing less vyayam. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 97. OBSERVATION AND RESULTS 82Table No.19Incidence of VayaVaya No. of patients %Baala 0 0Madhya 20 100Vridha 0 0Figure 19 100 80 60 B M 40 V 20 0 % All patients are Madhyam Vaya Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 98. OBSERVATION AND RESULTS 83Table No.20Main complaintsMain complaints No. of patients %Primary infertility 8 40Secondary infertility 12 60Figure 20 60 50 40 30 P. I. S. I 20 10 0 %The above said table depicts that maximum number 40% of patients were complained ofprimary infertility, whereas remaining 60% patients complained of secondary infertility. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 99. OBSERVATION AND RESULTS 84Table No. 21Marital life spanMarital life span No. of patients %01-05 12 6006-10 6 3011-15 2 10Figure 21 60 50 40 1-5Y 30 05-10Y 20 10-15Y 10 0 %Above table clearly depicts that maximum number (60%) of patients were in the group of1-5 years of married life span. About (30%) of patients belonged to the span of 6-10years. Remaining 10% patients belonged to the life span of 11-15 years. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 100. OBSERVATION AND RESULTS 85Table No. 22Relationship with partnerRelation with partner No. of patients %Satisfactory 12 60Unsatisfactory 8 40Figure 22 60 50 40 30 S UnS 20 10 0 % 60% of patients are satisfied with partners and 40% are unsatisfied. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 101. OBSERVATION AND RESULTS 86Table No.23Psychological statePsychological state No. of patients %Normal 8 40Elevated 00 00Depressed 12 60Figure 23 60 50 40 N 30 E 20 D 10 0 %40% of patients had normal psychological status and 60% are depressed by various stressfactors. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 102. OBSERVATION AND RESULTS 87Table No. 24Previous Surgical interventionPrevious surgical No. of patients %interventionHerniorrhaphy 0 0Hydrocele 0 0No Surgical 0 0interventionFigure 24 1 0.8 0.6 H HY 0.4 N. S. I. 0.2 0 % No patient has such history. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 103. OBSERVATION AND RESULTS 88Table No.25History of exposure to Gonadotoxic agentsGonadotoxic agents No. of patients %Ranitidine / Cemetidine 6 30No medication 14 70Figure 25 70 60 50 40 R/C 30 N. M. 20 10 0 %The above figure indicates that maximum of 70% patients were not exposed to anymedicine. Ranitidine or cemetidine was consumed by 30% patient. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 104. OBSERVATION AND RESULTS 89Table No.26 Incidence of Varicocele in 20 patients:-.Incidence of Varicocele No. of patients %Present 2 10%Absent 18 90%Figure 26 100% 80% 60% P 40% A 20% 0% %The study reveals that 10% patients were possessing Varicocele whereas out of that oneis having 2nd degree and another one is having 3rd degree Varicocele whereas 90%patients were not having it. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 105. OBSERVATION AND RESULTS 90Table No.27Sukra kshaya lakshana:-Sukra skaya laksanaha No. of patients %Daurbalya 12 60Srama 12 60Mukhasosa 10 50Svarabhanga 0 00Angamarda 10 50Aruchi 0 00Avipaka 0 00Alpa praseka 0 0Garbhapata 6 30(female partner)Dumayana 0 00Figure 27 60 D S 50 M 40 S 30 A A 20 A 10 A 0 G % DSukrakshaya lakshanas: - in 60% patients Daurbalaya and srama was found.50% patienthave mukhsosha and angamarda.Only 20% patients Garbhapata were found by thehistory of female partner. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 106. OBSERVATION AND RESULTS 91Table No. 28Effect on Sperm CountNo. of Means D % S.D P tPatients BT AT20 9.200 14.200 5.000 54.34% 1.892 < 0.001 1.820 ±0. 694 ±0.618Figure No 28 16 14 12 10 BT 8 AT 6 4 2 0The table shows that there was significant increase in sperm count with the difference of5.00. The average percentage increased by 54.34%. The change that occurred with thetreatment is greater than would be expected by chance; there is a statistically significantchange (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 107. OBSERVATION AND RESULTS 92Table No 29Effect on VolumeNo. of Means D % S.D P tPatients BT AT20 2.050 2.58 0.53 25.85% 0.394 < 0.001 4.32 ±0.125 ±0.818Figure No 29 3 3 2 2 BT AT 1 1 0The patients of Sukra dusti got increased in volume by the difference of 0.380 and by25.85% .The values are statistically significant at the level P<0.001 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 108. OBSERVATION AND RESULTS 93Table No 30Effect on Rapid Progressive MotilityNo. of Means D % S.D D tPatients BT AT20 27.850 39.846 11.996 43.07% 2.957 < 0.001 14.53 ±0.406 ±0.659Figure No 30 40 35 30 25 20 BT 15 AT 10 5 0The above table shows that the difference is only 11.996 and by 43.07%. The change thatoccurred with the treatment is greater than would be expected by chance; there is astatistically significant change (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 109. OBSERVATION AND RESULTS 94Table No 31Effect on Slow linear Progressive Motility Spermatozoa.No. of Means D % S.D D tPatients BT AT20 25.600 30.500 4.900 19.14% 2.553 P=<0.001 8.385 ±0.358 ±0.663Figure No 31 31 30 29 28 BT 27 AT 26 25 24 23SLP motility showed increase 4.900 units by the treatment and average percentage ofincrease was 19.14%. The change that occurred with treatment is greater than would beexpected by chance, there is statistically significant change (p<0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 110. OBSERVATION AND RESULTS 95Table No 32Effect on LiquificationNo. of Means D % S.D P tPatients BT AT20 26.05 22.65 3.40 13.07% 1.66 < 0.001 9.21 ±0.531 ±0.443Figure No. 32 27 26 25 24 BT 23 AT 22 21 20The value has been decreased in the study which shows clinical improvement in theliquefaction. The change that occurred with the treatment is greater than would beexpected by chance; there is a statistically significant change (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 111. OBSERVATION AND RESULTS 96Table No. 33Effect on pHNo. of Means D % S.D P tPatients BT AT20 7.807 7.400 0.407 5.21% 0.480 0.005 3.27 ±0.134 ±0.097Figure No 33 7.9 7.8 7.7 7.6 7.5 BT 7.4 AT 7.3 7.2 7.1The value of pH were decreased after treatment. The average decreased was 0.407 unitshaving 5.21%. The change that occurred with the treatment is greater than would beexpected by chance; there is a statistically significant change (P = 0.005) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 112. OBSERVATION AND RESULTS 97Table No. 34Effect on Pus cellsNo. of Means D % S.D P tPatients BT AT20 2.840 2.465 0.015 13.39% 0.091 <0.001 18.4 ±0.037 ±0.386Figure No 34 2.9 2.8 2.7 2.6 BT 2.5 AT 2.4 2.3 2.2The values were decreased to 0.015 and by 13.39%. The value has been reduced in thestudy which shows clinical improvement in the pus cells. The change that occurred withthe treatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 113. OBSERVATION AND RESULTS 98Table No 35Effect on OrgasmNo. of Means D % S.D P tPatients BT AT20 2.350 3.500 1.150 48.9% 1.150 < 0.001 5.759 ±0.167 ±0.115Figure No.35 3.5 3 2.5 2 BT 1.5 AT 1 0.5 0The grading of orgasm increased by the difference of 1.150 and by 48.9%.The changethat occurred with the treatment is greater than would be expected by chance; there is astatistically significant change (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 114. OBSERVATION AND RESULTS 99Table No 36Effect on RigidityNo. of Means D % S.D P tPatients BT AT20 1.70 2.00 0.300 17.6% 0.470 < 0.010 2.854 ±0.105 ±0.00Figure No 36 2 1.9 1.8 BT 1.7 AT 1.6 1.5The values of rigidity has been increased of difference by 0.300 and by 17.6%.Thechange that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P =<0.010) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 115. OBSERVATION AND RESULTS 100Table No 37Effect on Ejaculation:-No. of Means D % S.D P tPatients BT AT20 2.50 3.55 1.05 42 % 0.510 < 0.001 9.200 ±0.154 ±0.114Figure No 37 4 3.5 3 2.5 2 BT 1.5 AT 1 0.5 0The difference of grading was increased by 1.05 and by 42%. The change that occurredwith the treatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 116. OBSERVATION AND RESULTS 101Table No 38Effect on DesireNo. of Means D % S.D P tPatients BT AT20 2.50 3.50 1.00 40% 0.459 < 0.001 9.747 ±0.136 ±0.115Figure No 38 3.5 3 2.5 2 East 1.5 West 1 0.5 0Desire has been increased by a difference of 1.00 and by 40%.The change that occurredwith the treatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 117. OBSERVATION AND RESULTS 102Table No 39Effect on ErectionNo. of Means D % S.D P tPatients BT AT20 2.050 3.350 1.30 63.4% 0.571 < 0.001 10.17 ±0.170 ±0.131Figure No 39 3.5 3 2.5 2 BT 1.5 AT 1 0.5 0The values of erection were increased by difference of 1.30 and by 63.4%.The change that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P = <0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 118. OBSERVATION AND RESULTS 103Table no 40Overall effect of the TreatmentOverall effect of the No. of patients %treatmentConceived 4 20Complete Remission 6 30Marked improvement 8 40No change 2 10Figure 40 40 35 30 25 C. 20 C.R. 15 M.I. 10 N.C. 5 0 %After the treatment with Pushpadhanvarasa 20% patents able to impregnate their wives,where as 30% of patients attained Normozoospermia. 40% of patients had markedimprovement and 10% patients had no change. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 119. DISCUSSION 104 DISCUSSIONReproduction is the process by which new individuals of a species are produced andgenetic material is passed from generation to generation. This maintains the constitutionof the species and procreation of living beings. But when this process is hampered by anyof the reasons a person is considered infertile. Infertility is the failure of a male toimpregnate his wife after one year of regular, unprotected intercourse. In both men andwomen the infertility process is complex. In many cases, infertility is caused by acombination of problems in both partners that conspire to prevent conception fromoccurring.Aphrodisiacs are mainly preferred as a treatment for an infertility couple. The line ofmanagement is also dependent on the etiological factors too. Andrology is a branchwhich recently arisen in modern medicine but in Ayurveda it is considered as one ofbranch of Astanga Ayurveda. It mainly deals with producing healthy progeny for thecreation of a better society. As Sukra has direct relation with immunity, so line ofmanagement given for Vajikarana act as to give power or vitality by reinvigorating thesexual organs as well as by increasing the body immunity and revitalizing the othersystems too. As this study is confined to male factor responsible for infertility, onlysukradusti is diagnosed.Caraka says that factors which is implanted for the formation of the embryo is known assukra and when it get vitiated it is called sukradusti. Susruta explained in such a mannerthat’s look similar in number but on the basis of doshic vitiation it is totally counted as 8in number. Both Astanga Samgraha and Astanga Hridya followed the pattern of Susruta.Though mild difference of opinion in naming but totally it looks same. Kashyapa countedit as eight in number. But he had not given individual description of the each variety,their characteristic for diagnosis and management. There are difference between schoolof caraka and school of Susruta while naming the type of sukradushti even though thetotal number is same. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 120. DISCUSSION 105Even though caraka dealth doshic vitiations of sukradushti separately, he put stress onabnormal physical characteristics of sukra. Caraka brought all the conditions ofdiscoloration under vivarna where as Susruta dealt it separately under doshic variety.Overall Susruta incorporated all eight types of Caraka’s classification of sukradushtiunder six heading only. Further Susruta added kshina and mutrapurishagandhi variety andmade the total number eight.The different sukradusti can be compared with present andrological concept. As vatajacan be compare with severe oligozoospermia, azoospermia, hemorrhagic injuries etc.Pittaja with acute inflammatory conditions of testis, kaphaja with increased viscosity ofsemen in case of chronic infections, higher percentage of morphological abnormal forms.Kunapgandhi with haemospermia, granthibhuta with prostatic dysfunction which leads tounliquified semen, puttipuya with pyospermia or bacteriospermia, micoplasma, kshinasukra can be correlated with subnormal parameters of semen and mutrapurishagandhi byrecto-genito-urinary tract fistula.Similarly the various functions explained by sushruta can be easily explained on the basisof androgens and their functions in the body for development of various reproductiveorgans for procreation.E.g PREETI” is acceptable for both the partners. It is an attractiontowards opposite sex to which may be physical or mental. The cause of all this is thedevelopment of primary and secondary sex characteristics in both sex and all this isdependent upon the functions of Androgens.Discussion about clinical study:-Patients were given Swadistha virechana choorna one teaspoon at night for 3 to 7 dayswith water for Kostha Shodhana. After Kostha shodhana, pushpadhanva rasa 125mgs bidwith milk was given before food for 8 weeks. After the completion of treatment also thepatients were kept under follow up to observe development further for 2 months, so thatthe total overall effect of treatment could be assessed. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 121. DISCUSSION 106Total number of patients registered for the complaint of infertility:-Total number of patient’s registered for study– 20Total number of patients Completed – 20Total number of patients Drop out-0OBSERVATIONS:-Age:-Due to industrialized world the average age for marriage is increased and as perAyurvedic context there is direct relation between age and fertilization has beenexplained. So in this study maximum (60%) numbers of patients were reported from 31to35 yrs of age group. Only 20% each patient was in the age group 36-40yrs and 25-30groups each. The age group of 36-40 less may be due to lose of confident after severalyear of treatment failureReligion:-The demographical study shows more population of Hindus as compared to Muslim andChristians. So among the 20 patients of this series maximum patients (85%) werebelonged to the Hindu community, whereas remaining (10%) patients were belonged toMuslim and 5% were Christian.Occupation:-In Nidana it has been explained that excessive work leads to infertility. So in this studymajority of patients (50%) were having physical exertional workers, such as agriculture.30% were doing sedentary nature of work, and it is followed (20%) by service men.Socio economic status:-As economic status indicates the things a person can afford for easy living. Lower classfamilies are unable to afford their nutritional diet in particular values which may leads toinfertility. So in this study lower class were more with 50% and lower middle, uppermiddle each of 25% were there. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 122. DISCUSSION 107Educational status:-40% of patients each had higher secondary, high school level education, and 20% ofpatients had graduation. So it is inconclusive to say the relation between education andinfertility.Habitat:-The habitat effects the living way of human being, so it will also effect its sexual andpsychological behavior with his partner and as compared to urban people rural are lessaware of reproductive periods, proper hygiene etc .So in this study maximum numbers(80%) of patients reported were residing in rural area and remaining 20% patients werebelonged to urban habitat.Satva:-In this study it is found that the maximum numbers of patients (60%) were belonged toAvara Satva, followed by Madhyama (30%) Satva patients and only 10% of PravaraSatva.Sara:-Maximum number of patients (30%) were belonged to Mamsa and meda sara, which isclosely followed by 20% patients of asthi and tvak sara each.Samhanana:-Maximum numbers of patients (70%) in this study were belonged to madhyamaSamhanana, followed by Pravara (20%) Samhanana and only 10% was AvaraSamhanana. There no such direct relation between Samhanana and infertility.Satmya:-Though the sukra having madhura ,snigdha qualities and opposite to it leads to infertility.So in this study the maximum numbers of patients (50%) were having amla and tikta rasasatmyata.and lavana, katu, kashya rasa Satmya was reported in 30% patients. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 123. DISCUSSION 108Pacakagni and Kostha:-Maximum of 70% of patients were with samagni ,.20% of patients with visamagni andonly 10% of patients with mandagni. 70% of patients had madhyama Kosta, 20%patients were of Krura Kosta and 10% of Mrdu Kosta catogeroy.So above both it can’tbe concluded that there is direct relation between koshta and pachakagni or it take longterm study to prove.PrakritiMajority were of Vatapitta Prakriti with 50%. Kaphapitta Prakriti was 30% and kapha,vatakapha were 10% each. So on the basis of observation it not easily possible to say thatvatapitta prakriti is more prone to infertility.Nidra:-Stress due to unable to conceive or heavy routine activity affects the sleep. So in thisstudy only 20% had sound sleep and 80% had disturbed sleep.Diet:-Maximum 70% of patients had mixed diet, 30% patients were vegetarians. So it isinconclusive to say the relation of diet with infertility.Addictions:-In modern medicine there is direct relation between addiction and infertility has beenexplained. But this study reveals 50% of the patients are not addicted to health harminghabits. Tobacco chewers were 20%, rest 10%each of patients had the habit of regularalcohol consumption, smoking and pan chewing habits. So it is inconclusive to say theeffect of addiction on infertility.Vyayama:-In Nidana it has been explained that excessive work leads to infertility. Here 50% areheavy workers, 30% moderate and remaining 20% are doing less vyayama. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 124. DISCUSSION 109Vaya:-All patients are Madhyam Vaya.Main complaints:-Infertility is divided into 2 types primary & secondary. In above study maximumnumbers (40%) of patients were complained of primary infertility whereas remaining60% patients complained of secondary infertility.Marital life span:-Newly married couples are more anxious to get child, observation says that maximumnumber (60%) of patients were in the group of 1-5 years of married life span. About(30%) of patients belonged to the span of 6-10 years. Remaining 10% patients belongedto the life span of 11-15 years. Patients of above 35 age lose hope for conception soprobably there numbers are less.Relationship with partner:-Due to various etiologies 60% of patients are satisfied with partners and 40% areunsatisfied.Psychological state:-40% of patients had normal psychological status and 60% are depressed by various stressfactors which is considered a Nidana for infertility.Previous surgical intervention:-Various surgical interventions like Hydrocele, Hernia had direct role in infertility but inthis study it is found out that no patients has such history of surgical intervention.Exposure to gonadotoxic agents:-The chronic use of various modern medicines effects the fertility of the person mainlylike H2 receptor blockers. The observation study indicates that maximum of 70% patients Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 125. DISCUSSION 110were not exposed to any medicine and ranitidine or cemetidine was consumed by 30%patient.Varicocele:-This is responsible for 40-50% cases of primary or secondary infertility. The studyreveals that 10% patients were possessing varicocele out of that one is having 2nd degreeand another one is having 3rd degree varicocele whereas 90% patients were not havingsuch complaint.Sukra kshaya lakshanas:-Sukrakshaya lakshanas: - in 60% patients Daurbalaya and srama was found.50% patienthave mukhsosha and angamarda. Only 20% patients Garbhapata were found when apartner history was taken out. So a symptomology compared with sukrakshaya andmodern investigations in cases of oligozoospermia were matching.Sperm count:-The observation of the study states that significant sperm count has been increasedwith the difference of 5.00. The average percentage increased by 54.34%. The changethat occurred with the treatment is greater than would be expected by chance; there is astatistically significant change (P = <0.001)Volume:-A significant increase in volume was found in the patients of Sukra dusti in volumei.e.25.85% .The values are statistically significant at the level P<0.001Rapid Progressive Motility and Effect on Slow linear Progressive Motility:-Though the study is only concern about count of sperm but still it is found thatPushpadhanva rasa has significant effect on motility. The above table shows that thedifference is only 11.996 and by 43.02%. The change that occurred with the treatment isgreater than would be expected by chance; there is a statistically significant change (P =<0.001). SLP motility showed an increase by 4.900 units by the treatment the average Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 126. DISCUSSION 111percentage of increase was 19.14%. The treatment shows statistical significance at thelevel of P=<0.001.Liquification:-The value has been decreased in the study which shows clinical improvement in theliquefaction. The change that occurred with the treatment is greater than would beexpected by chance; there is a statistically significant change (P = <0.001)pH:- The average decreased was 0.407 units having 5.21%. The change that occurred withthe greater than would be expected by chance; there is a statistically significant change (P= 0.005)Pus cells:-The values were decreased to 0.015 and by 13.39% and which shows the clinicalimprovement. The change that occurred with the treatment is greater than would beexpected by chance; there is a statistically significant change (P = <0.001). So fromobservation it can be concluded that it is showing significant effect on pus cells so it canbe helpful in Pyospermia cases.Orgasm:-The grading of orgasm increased by the difference of 1.150 and by 48.9%.The changethat occurred with the treatment is greater than would be expected by chance; there is astatistically significant change(P = <0.001).Rigidity:-The values of rigidity has been increased of difference by 0.300 and by 17.6%.Thechange that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P =<0.010) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 127. DISCUSSION 112Ejaculation:-The difference of grading was increased by 1.05 and by 42%. The change that occurredwith the treatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001)Desire:-Desire has been increased by a difference of 1.00 and by 40%.The change that occurredwith the treatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001)Erection:-The values of erection were increased by difference of 1.30 and by 63.4%.The changethat occurred with the treatment is greater than would be expected by chance; there is astatistically significant change (P = <0.001)Overall effect of the treatment:-The study was conducted for effect of “Pushpadhanva rasa in sukradusti W.S.R tooligozoospermia” and from various observation it is found that it is highly significant byincreasing the sperm count .The study also reveals that it has also significant effect onpus cells, volume etc so it can be taken for further studies. After the treatment withPushpadhanvarasa 20% patients able to impregnate their wives, where as 30% of patientsattained Normozoospermia. 40% of patients had marked improvement and 10% patientshad no change in sperm count. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 128. CONCLUSION 113 CONCLUSIONThe thesis entitled “effect of Pushpadhanva Rasa in the management of sukradushti wsrto oligozoospermia” mainly comprises introduction, review of literature, methodology,results, discussion, conclusion and summary.In introduction a definition of infertility according to modern and Ayurveda has beenexplained. Similarly the incidence of male infertility and its specific to oligozoospermiahas explained.Historical review deals with historical aspect related to sukra, sukradusti. It revels withinformation about infertility from Vedic period to samhita kala which indicate that sincethousands of years ago the knowledge of infertility was there in this world. The differenttext book of different ages, pertaining to Ayurveda reviewed for specific mentioning ofsukradusti.Conceptual study deals with sukra at first its derivation and its synonyms with meaningof each. Then the detail description about its physical characteristics ,production of sukra,function of sukra , comparison of sukra with the function of androgen, types ofsukradusti, pramana , various causes of sukradusti and its treatment. Though it is dividedinto different manner by acharyas but still they can be compared with modern withdifferent types of condition leads to infertility.Vataja sukra dusti can be correlated clinically with hemorrhagic injury, severeoligospermia, and azoospermia, obstruction of the efferent ducts and chronicinflammation of accessory sex glands.Pittaj sukradusti can be correlated to acute inflammatory conditions of testes.Shonitaja sukra dusti semen colour is rakta Varna and volume is high due to severehemorrhage.Kunapgandhi- HaemospermiaGranthibhuta sukradusti - Prostatic dysfunction which leads to liquefied semen.Putipuyabhuta sukradusti- Pyobacteriosemia , mycoplasma etc. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 129. CONCLUSION 114Ksina sukradusti –subnormal level of androgen, semen and spermatozoa.Mutrapurishagnadhi sukradusti – recto-genito urinary tract fistulaSamanya and vishes chikitsa is explained of sukradusti.Drug review explained about the action of content of drug on sukradusti by givingAyurvedic references.Methodology: - It is single blind clinical study with pre test and post test design whereminimum of 20 patients diagnosed with clinical condition shukrakshya were selectedbetween age group of 25- 40 years of age. An observation in relation to age, religion,Occupation, socio economical status, educational status, habitat, Satwa, Sara, samhanana,Satmya, koshta, prakriti, nidra, diet, addictions vaya was taken for the study.Results:Sperm count: - there is significant increase in sperm count with the difference of 5.00.The average percentage increased by 54.34%. The change that occurred with thetreatment is greater than would be expected by chance; there is a statistically significantchange (P = <0.001).Volume :-The patients of Sukra dusti got increased in volume by the difference of 0.380and by 25.85% .The values are statistically significant at the level P<0.001RLP:-The difference is only 11.996 and by 43.07%. The change that occurred with thetreatment is greater than would be expected by chance; there is a statistically significantchange (P = <0.001)SLP:- It shows increase 4.900 units by the treatment and average percentage of increasewas 19.14%.The change that occurred with treatment is greater than would be expectedby chance, there is statistically significant change (p<0.001) Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 130. CONCLUSION 115Liquefaction:-The value has been reduced in the study which shows clinical improvementin the liquefaction. The change that occurred with the treatment is greater than would beexpected by chance; there is a statistically significant change (P = <0.001)Pus cells:-The values were reduced to 0.015 and by 13.39%. The value has been reducedin the study which shows clinical improvement in the pus cells. The change that occurredwith the treatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001)Ejaculation:-The difference of grading was increased by 1.05 and by 42%. The changethat occurred with the treatment is greater than would be expected by chance; there is astatistically significant change (P = <0.001)Desire has been increased by a difference of 1.00 and by 40%.The change that occurredwith the treatment is greater than would be expected by chance; there is a statisticallysignificant change (P = <0.001)Erection :-The values were increased by difference of 1.30 and by 63.4%.The changethat occurred with the treatment is greater than would be expected by chance; there is astatistically significant change (P = <0.001)Overall effect of treatment: - After the treatment with Pushpadhanvarasa 20% patentsable to impregnate their wives, where as 30% of patients attained Normozoospermia.40% of patients had marked improvement and 10% patients had no change.Summary and conclusion: summarizes the whole thesis and the conclusions drawn arepresented. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 131. SUMMARY 116 SUMMARYThe dissertation entitled “A Critical study on effect of Pushpadhanva Rasa in themanagement of sukradusti wsr to oligozoospermia consist of 8 chapters namelyintroduction, objectives, review of literature, methodology, observation and results,disscusion, conclusion and summary.Chapter 1: A brief introduction about infertility and its incidence on either sex.Incidenceof oligozoospermia and importance of Ayurveda in its management.Chapter 2: Gives an idea about aims and objective of the studyChapter 3:- Deals with the historical aspects related to Shukra, Shukra dusti. SinceVedic period the availability of references about Shukra dusti were mentioned.Derivations of Shukra, its technical usages, synonyms, definition are dealt in detail.Physical characters of Shukra, production of Shukra, various etiologies for sukradustiVarious functions of Sukra explained by acharya Sushruta were compared withAndrogens.Shukra dusti is divided into 8 types. Charaka described 8 types on the basis of physicalcharacters of the semen while Sushruta and Vagbhata mentioned types on the basis ofdoshas. Sukrakshaya explained by Sushruta and Vagbhata can be compared witholigozoospermia. From the various assessment criteria it is concluded thatoligozoospermia can be comparable to sukrakshya .In this detail explanation of samanyaand vishesha chikitsa of shukradusthi has been explained. Various etiologes leading toinfertility. In drug review explaination on the basis of Ayurvedic context by giving ofeach and every content of Pushpadhanva Rasa with references.Chapter 4:- Methodology deals with the materials and methods including selection ofthe patient for the study and criteria for assessment of results.Chapter 5:-All the results obtained were analzed by statistical methods and aremethodically presented in the chapter observation and results of therapy.Chapter 6:-This section of disscusion deals with patient in relation to age, religion etcand effect of Pushpadhanva Rasa on oligozoospermia i.e. sperm count.Chapter 7:-. Conclusion drawn from various sections of work is given here.Chapter 8:- Summarizes the entire work here. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
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  • 137. BIBILIOGRAPHY 122 Varanasi, PP 956 Sharira sthana 1/13, Pg 36763.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi, PP 824 Sharira sthana 2/8 Dal Commentry, Pg 34564.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1998 Varanasi, PP 824 Sharira sthana 2/9, Pg34565.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi, PP 824 Sharira sthana 2/9,Pg34566.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi. PP 824 Sharira sthana 2/10,Pg 34567.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi. PP 824 Dalhan Commentry Sharira sthana ,Pg 34568.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi. PP 824 Dalhan Commentry Sharira sthana ,Pg 34569.Vagbhata’s,Astanga Samgraha Kaviraj Atridev Gupta,Krishna Acadmy,Varanasi, PP 408 Sharira sthana 1/27 Pg 22470.Vagbhata’s, Astanga Samgraha Kaviraj Atridev Gupta,Krishna Acadmy,Varanasi, PP 408 Indu Commentry Sharira sthana71.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi. PP 824 Dal Comm Sharira sthana 2/10,Pg 34572.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi. PP 824 Sharira sthana 2/10, Pg 34573.Vagbhata’s,Astanga Samgraha Kaviraj Atridev Gupta,Krishna Acadmy,Varanasi, PP408 Sharira sthana 1/28 Pg 22674.Sushruta, Sushruta Samhita Yadavji Tikramji, Choukambha Publication 1997 Varanasi. PP 824 Sharira sthana 2/4,pg 34475.Agnivesa, Caraka Samhita, Acharya Yadavji Tikramji, Choukambha Publication 2001 Varanasi. PP738 Chikitsha sthana 30/153,pg641 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 138. BIBILIOGRAPHY 12376.Agnivesa, Caraka Samhita, Acharya Yadavji Tikramji, Choukambha Publication 2001 Varanasi. PP738 Chikitshasthana 30/152, Pg 64177.Principal of Anatomy & Physiology, Tortora &Grabowski, PP 986, Pg 101478.Principal of Anatomy & Physiology, Tortora &Grabowski, PP 986 Pg 102279.Text book of medical physiology, Guyton & Hall, PP114680.Human Reproduction 14:1028 199981.Human Reproduction 8:1251,199382.Journal of Andrology 20:18;199983.American Journal of Epidemiology 135:1208,199284.Fertility Sterility 71:690,199985.Andrologia 3:43,199986.British Medical Journal 284:844, 198287.Hendry, British Journal of Urology 146:54,198388.New England Journal of Medicine 339:1803,199889.Mazumdar, Fertility Sterility 70:799,199890.Broderick, Journal of Urology 142:752,198991.Alexander, Fertility Sterility 53:602,199092.Human Reproduction 13:3363,199893.Murthy, Journal of Clinical Endocrinology & Metabolism, 42:637,1986 and 52:1137,198194.Mordel, Journal of Reproductive Medicine 35:123,199095.Nieschlag, Clinical Endocrinology 38:123,199396.Journal of urology126:141, 1981 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 139. BIBILIOGRAPHY 12497.Chilvers, Journal of Pediatric Surgery, 21:691,198698.Johnson Fertility Sterility 70:397,199899.Bourroullon, Human Genetics 71:336,1985100. Gagnon, New England Journal of Medicine 306:821,1982101. Bick, New England Journal of Medicine 326 :1752,1992102. Finkel, New England Journal of Medicine 313:651,1985103. New England Journal of Medicine 82:3777,1997104. Mahajan, An Internal Medicine 97:357,1982105. Handelsman, Endocrinology Revised 6:151,1985106. Prasad, American Journal of Hematology 10:119,1981107. Amsterdam Psychosomatic Medicine 43:183,1981,108. World Health Organizing community, 1992109. Bhaisayajyaratnavali Vidhotini hindi vyakhya ayurvedacharya kaviraj shri ambikadattshastri 16th edition,PP781,vajikarana chapter, Pg 781110. Rasatarangini –pranacharya shri sadananda sharma virachita ayurvedacharya shri haridatt shastri kritya prasadniya vyakhya,11th edition PP 772 , Pg 507111. Rasatarangini –pranacharya shri sadananda sharma virachita ayurvedacharya shri haridatt shastri kritya prasadniya vyakhya,11th edition PP 772 , Pg443112. Ayurveda prakasa of acharya sri madhava edited with the atrhavidyotini and arthaprakasini Sanskrit & hindicommentries by vaidya vachaspati shri Gururaj mishra, 4th edition, PP 504113. Rasratnasamuchaya of shri vagbhatacharya edited with suratnojvala hindi commentry 9th edition 1995,PP646,Pg39114. Bhavaprakasha of shri bhavamishra including Nighantu portion edited with vidyotini hindi commentary by shri bhavashankar maishra,11th edition,PP 959,Pg65115. Bhavaprakasha of shri bhavamishra including Nighantu portion edited with Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 140. BIBILIOGRAPHY 125 vidyotini hindi commentary by shri bhavashankar maishra,11th edition,PP 959 ,Pg537116. Bhavaprakasha of shri bhavamishra including Nighantu portion edited with vidyotini hindi commentary by shri bhavashankar maishra,11th edition, PP 959, Pg 317 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 141. ANNEXURE 126 DEPARTMENT OF KAYACHIKITSA S.D.M.COLLEGE OF AYURVEDA.UDUPICASE PROFORMA FOR THE EFFECT OF PUSHPADHANVA RASA IN THE MANAGEMENT OF SHUKRA DUSTI W.S.R OLIGOZOOSPERMIAName: - Case no:-Age: - OPD/IPD:- D O Commencement of Treatment :-Religion:-H/M/C/J/S D O Completion of Treatment:-Education:-UE/PR/H/HS/G/PG. Occupation:-Marital Status:-M Diagnosis:-Social Status: - L/M/U Result:-Place of Birth: - Jangala / Aanupa / Sadharana.Address:-Main Complaints:-No issues since………..years. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 142. ANNEXURE 127 Concern about oligo-zoospermiaAssociated complaints: - ED/PE/OD *Neela/Peeta/Vivarna/sarakta/Asweta Sukra. *Puti/KunapaGandhi/Visra SukraPravritti. *Mutra/PurishaGandhi SukraPravritti *KsheenaSukra/AlpaSukra/VishushkaSukraPravritti. *Bahu/Bahala/Analpa SukraPravritti. *Tanu/Ruksha SukraPravritti. *Pichchila/Granthibhuta/MajjasamsristaSukraPravrittiSUKRA PRAVRITTI:- *Krichchrena/Chirat/Sheeghra. *Avega/Badhnati/Ativegayukta. *Saruk/Chosha/Osha/Kandu/Lingamdahateeva. *Mutrakrichchra/Dahayukta/Peetamutrata.H/o Present illness:-Past History:-Jwara/Rajayakshma/Vyavayashosha/Grahani/Sahaja arshas/ Kaphaja arshas/Lingarsha/Kamala/Haleemaka/Vitapa Marmabhighata/Mutrakrichchra / Mutraghata /Ashmari / Phiranga/ Upadmsha/ S.T.D’s/Hydrocele/ Vericocele/ Haematocele / Inguinal Hernia /Mumps/Orchitis/ Tuberculosis/ Filariasis/ChickenPox/Pancreatitis/ Prostatitis/Cystitis/EpididymoOrchitis /Febrile/ Viral infection/Typhoid/Hypertension/ DiabetesMellitus / MultipleSclerosis / Thyroid related disease/TesticularTorsion/ Bladder Neck Surgery / Herniorraphy /Herniotomy. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 143. ANNEXURE 128Drug History:- Cyclophosphamide-Sulphasalazine-Femotidine- Ranitidine-cimetidine-Omiprazole-Nitrofurantoin- Androgenic steroids/Chemotherapeutic agents/Others………………...Family History:-Personal History:- Appetite : - Good/Moderate/Impaired. Diet : - Veg / Mixed. Sleep : - Sound/Disturbed/Delayed. Micturation : - Regular/Scanty/Burning/Dysuria/Feeling of Retention Frequency - Day. ………times & Night…………times. Bowels : - Regular/Constipated/…………… Habits : - Tobacco/pan/pan with Tobacco /Smoking / Alcoholic/ Drugs / Others ……………Since ………years. Exercise : - Heavy/Moderate/Less.Marital Life:- Duration…………years. Frequency of coitus-………/week.Sexual life: - Satisfactory/unsatisfactory/ED/PE/ODAttainment of Puberty:-…………….of age.Sexual behavior:- a) H/o. Masturbation since………..years. Frequency………../wk. b) H/o Nocturnal emissions since………years. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 144. ANNEXURE 129 Frequency…………../wk. c) H/o Homosexuality Akalayonigamana / Ayonigamana/ Dustayonigamana / Rogopasristayonigamana/RajaswalagamanaGeneral Examination:- Built:- well / moderate / poor. Nourishment:-Good/Moderate/ under nourished. Psychological state:-Normal/Elevated/Depressed. Conjunctive:- Temp:- Height:- Pulse:- Wt:- RR:- BMI:- BP:-Dashavidha parikshaPrkritata:- V/P/K/VP/VK/PK/SVikritita:-Sarata:- twak/ rasa/ masa/ meda/ asthi:Samhanana:-uttama/ madhyama/ HeenaPrmanata:- pravara/ madhyam /HeenaSaatmyata:- madhur/amla/lavana/katu/tiktta/kashaya.Satwata:- pravara/ madhyam /HeenaAaharashaktiabhyavarana shakthi pravara/ madhyam /HeenaJaranashakthi:- pravara/ madhyam /HeenaVyama shakthi pravara/ madhyam /HeenaVayata:-madhyamaSROTOPARIKSHA:-Shukravaha srotas.:-klaybya- aharashana- rogi or kliba or aplayee orvirupi shishu janana-garbha na jayate- patati- prasravati – ciratpraseka- Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 145. ANNEXURE 130rakta praseka.SHUKRAVRITTA VATA LAKSHNAM:- avega ativega of shukra-nisphalatwa.SHUKRAGATA VATA LAKSHANA:- kshipram munchati / badnati-garbhana kshripam munchati or bhadnati viritim janayati( garbha /shukra).SHURKA KSHAYA LAKSHNAM:-Daourbalya-shrama-mukhashosa- swarabhanga- angamarda-avayava pida- avipaaka aruchi jwara kasa shawasa praishyaya panduchirata praseda rakta praseda , raktayukta shukra darshana, klebya, medravrushanayoho vedana, aaharshana, maithuna asaktata, garbhapataSystemic ExaminationExamination of Genital System:-Local examination:-Pubic hair distribution(PHD)Inguinal lymphnodes:-Palpable / Nonpalpable.Examination of Penis Texture of skin:-Normal/Ulcers/Scars/Other skin lesions . Body/Shaft:-Curved/Shrunken/Evidence of wound. Prepuse:-Normal/phimosis/ParaPhimosis/Circumcessed. Glans:-Normal/Ulcers/scars/Balanitis/Balanoasthitis. Ext Urethral Meatus:-Normal/Hypospadias/Epispadias/Discharge. Length of Penis:- Circumference of Penis:- Palpation:-Tenderness/Induration etc. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 146. ANNEXURE 131Examination of Scrotum:- Right Left Pigmentation Temperature Rugae Scars Swellings CryptorchitismExamination of Testes:- Right Left Position Normal Antiverted Retroverted Size Surface:- Smooth Nodular Consistency Hard Soft Firm TendernessBorders Regular Irregular Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 147. ANNEXURE 132Examination of Epididymus:- Palpable/ Unpalpable / with swelling.Examination of Vas Deference:- Palpable / Unpalpable / with nodules.Examination of Spermatic Cord:- Tender / Non tender / Thickened. (Gread-1/2)Examination of Prostate:- Normal / Tender / Enlarged.Cardio Vascular System:-Respiratory System:-GIT:-Central Nervous System:- Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 148. ANNEXURE 133Assessment criteria:- Parameters BT AT Desire Orgasm Rigidity Erection Ejaculation SEXUAL FUNCTIONAL PARAMETERSDESIRE:-No desire at all:- 0Lack of the desire: - 1Desire but no activity: - 2Desire only on demand of partner:- 3Normal desire: -4Excess desire:-5ORGASM:-No enjoyment: - 0Lack of enjoyment: - 1Enjoyment in 25% of sexual intercourse:-2Enjoyment in 50% of coital opportunities:-3Enjoyment in 75% of sexual intima: - 4Enjoyment in every act: - 5RIGIDITY:Unable to maintain erection or continue sexual act -0Some loss in erection but able to continue sexual act:1Able to maintain erection and continue sexual act:2 Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia
  • 149. ANNEXURE 134ERECTION:No erection by any method-0Erection by artificial methods-1Erection but unable to penetrate-2Initially difficult but able to penetrate-3Erection with occasional failure-4Erection whenever desireEJACULATION:No ejaculation at all-0Delayed ejaculation without orgasm-1Ejaculation before penetration -2Ejaculation with penetration-3Ejaculation with own satisfaction -4Ejaculation with own and partners satisfaction-5ASSESMENT OF PUBERTAL DEVELOPMENTPubic hairs:- PH 1 ) no pubic hair PH 2) sparse growth of straight light hair. PH 3) Spreades over pubes, darker coarser, curlier. PH 4) Adult in character but smaller area. PH 5) Extends on to thighs and towards umbilicus in men. Effect Of Pushpadhanva Rasa In The Management Of Shukra Dusti WSR To Oligozoospermia