Physiological Effects of Mustadi Yapana Basti on reproductive biomarkers in infertile males – an open-labeled clinical trial

1. Physiological Effects of Mustadi
Yapana Basti on reproductive
biomarkers in infertile males – an
open-labeled clinical trial
Vaidya Ankur Kumar Tanwar
Ph.D.Scholar,
Dept. of Kriya Sharir
All India Institute of Ayureda

2. INTRODUCTION
प्रीतिर्बलं सुखं वृतितवबस्तारो तवपुलं क
ु लम् |
यशो लोकााः सुखोदकाबस्तुतिश्चापत्यसंतििााः| (Ch.Chi.2.1/21)
• Acharya Charaka described the virtues of man
who have many children’s in Chikitsa Sthana.
He told that pleasure, strength, happiness,
livelihood, expansion, large family size, fame,
worldly attainments, happiness at the end of life
and contentment depend on the progeny.

3. • Our Upanishada describe “Putra-Eshana” as
chief desire of life.
• Acharya Chakrapani mentioned new term called
as Kama-eshana.
• It means Kama is related to sexual indulgence
which has procreation aspects like pleasure and
recreation aspect like to fulfill the desire of Child
(Putra-eshana) or Healthy Progeny.
So Fertility is always the essential
necessity from the time immemorial.

4. INFERTILITY
• Infertility is “a disease of the reproductive system
defined by the failure to achieve a clinical pregnancy
after 12 months or more of regular unprotected
sexual intercourse.”
• According to WHO, One in every four couples
in developing countries had been found to be
affected by infertility. A WHO evaluation of
Demographic and Health Surveys (DHS) data
(2004), estimated that more than 186 million ever-
married women of reproductive age in developing
countries were maintaining a "child wish”.

5. INFERTILTY STATISTICS
• Estimated 70 million people globally affected by the
Infertility.
• Infertility is the main issue of concern worldwide and
its incidence varies from area to area with average
5%.
• The World Health Organization estimates that 9% of
couples worldwide struggle with Fertility issues
and that male factor contribute to 50% of the issues.
• According to WHO, the overall prevalence of Primary
Infertility in India is between 3.9% to 16.8%.

6. WHO SURVEY DATA
• WHO conducted 47 surveys in developing
countries under the Demographic and Health
Surveys (DHS) program 1994-2000 .
• Total 5 lakh approx female worldwide
participate in the survey out of which 90
thousands from India.
• In India, Infertility percentage in age 40-44 is
2.0% and in 25 -49 is 2.5 %.
• India is on No.19 in terms of % of infertility (age
25-49 year) out of 47 countries.
• In Central Asia, India is on No.03 out of 11
countries.

8. FACTORS RESPONSIBLE FOR INFERTILTY
FACTORS
FAULTY FOOD HABITS
SEDENTARY LIFE STYLE CHANGING SEXUAL LIFE
JOB PRESSURE OR STRESS
POSTPONING PARENTHOOD
VEHICULAR POLLUTION
ENVIRONMENT
POLLUTION

9. IMPACT OF INFERTILITY
• Infertility obscures the most intimate relationship physically
and mentally.
IMPACT

10. MALE INFERTILTY
• In about half the cases, Male factor is involved.
• But due to social stigma male partner is consider as
secondary in infertility and most often untreated
and undiagnosed.
30 -40 % 40 – 50 % 10 %

11. CAUSES OF MALE INFERTILTY
ACCORDING TO AYURVEDA
Acharya Charaka Defined 4 causes:
• Bijoupghata Janya: Anatomical abnormality of
sperm due to genetic factor.
• Shukrakshaya Janya: Deficiency of seminal fluid
or sperm production.
• Dhawajoupghata Janya : Defective penile
function.
• Jara Janya: Due to age.

12. CAUSES OF MALE INFERTILITY
CAUSES
IMPAIRED SPERM
PRODUCTION OR
FUNCTION
LIFESTYLE
ENVIRONMENT EXPOSURE
IMPAIRED SPERM
DELIVERY

13. SIGN OF MALE INFERTILITY:
• The main sign of Male Infertility is inability for
couples to get pregnant.
• Other symptoms or signs are:
• Difficulty in ejaculation
• Volume of ejaculated fluid being less.
• Erectile dysfunction or premature ejaculation.
• No or very less sexual desire.
• Minimal Growth of hair of body and face.

14. TEST FOR MALE INFERTILITY
• The method of evaluation of Male Infertility starts
from semen analysis which evaluates sperm count,
motility and sperm morphology specially.
• Low sperm count (Oligozoospermia) and poor
sperm quality is responsible for approx. 90% cases
of Male Infertility. Oligozoospermia is one of the
main factors responsible for Male Infertility.
• Oligozoospermia, a pathological term describing a
sperm density below the fifth centile in fertile men,
recently reduced Sperm count from 20 to 15
million/ml.
• Decrease sperm count lead to decrease chance of
conception and hampers fertility

15. NEED OF STUDY
• In present era, due to increase cases of infertility
new IVF center and technique are developed day by
day.
• Modern medical science has reached to its peak in
the field of infertility. New technology like MART
(Medically Assisted Reproductive Technology),
artificial insemination, invitro- fertilization, and
intra-cytoplasmic sperm injection are started to
combat infertility by modern science.
• These are considered as advanced technologies, but
are very costly and not reachable for poor people. So
it is Unable to provide service to all class of people
in society, also have low success rate.

16. HOPE IS AYURVEDA
• Ayurveda has described several drugs and special
therapeutic procedures to treat the problem of
Infertility.
• Basti Karma was specifically recommended by
Acharya Charaka for the strengthening of Shukra
Dhatu and the management of Shukra-Doşha.
• According to the Classics, correctly administered
Basti improves an individual's virility, vitality, and
life span by increasing the low level of Shukra.

17. MUSTADI YAPANA BASTI
• Acharya Charaka mentioned Mustadi Yapana
Basti for “शुक्रमांसर्लजननाः ” and “ सद्यो र्लजननो
रसायनश्चेति ” in Sidhi Sthana.
• Acharya Sushruta mentioned it as Raja Yapana
Basti “ यापनानामयं राजा र्स्तस्तमुबस्तातदको मिाः ”and
described its qualities as “ र्ल्याः सञ्जीवनो वृष्य ”.
• It is superior to all Yapana Basti.

18. INGRIDIENTS OF MUSTADI YAPANA BASTI
S.No Drug Latin Name Karma
KwathDravya
01. Nagarmotha Cyperus rotundus Pachana,Shukrashodana
02. Patha CissampelosPareira Shukra shodana
03. Giloy Tinospora cordifolia Rasayana
04. Kutki Picrorhiza kurroa Shukra Shodan
05. Bala Sidacordifolia Balya,BrihanOjovardhan
06. Rasna Pluchea Lanceolata Bala vardhan
07. Purnnava Boerhavia diffusa vrishya
08. Manjistha Rubiacordifolia Shukra shodan
09. Amaltasa Cassia fistula Shukra janan
10. Khas Vetiveria Zizanioidis Shukra janana

19. 11. Trayamana Gentiana kurro Shukra shodan
12. Gokhru Tribulus Terrestilis Vrishya ,pushtiprada
13. Laghu panchmula Balya,Brihana
14. Madanphal Randia spinosa Shukra shodan
Kalka Dravya
15. Sauf Foenieulumvulgare Vrishya
16. Priyangu Callicarpa macrophylla Praja sthapana
17. Mulethi Glycyrrhiza glabra Balya,Shukra vardhana
18. Inderyava Holarrhena antidysentrica Shukra shodan
19. Rasot Berberisaristata Rasayana,Yakritutejaka
20. Saindhavlavana Sodium Chloride Vrishya,Deepana, Rochana,

20. Conventional Drug
21. Kshira(Cow) Milk Vŗişya, Śukrala,Rasāyana
22. Madhu(Organic India) Honey Vriya vardhka, Medhya, Srotoshodhana
23. Cow Ghee(Organic India) Vŗişya, Śukrala,
Rasāyana
24. Mansa rasa(Aja) Balaya,vriya vardhak
The Dose of Mustadi Yapana Basti is 600
ml administered in the morning, empty
stomach before food for 15 days with follow
up 15 days after completion of the trial
period.

21. Objective
• To evaluate the clinical effectiveness of Mustadi
Yapana Basti on reproductive Biomarkers
(Serum FSH, Serum LH, Serum Inhibin-B,
Serum Testosterone) and semen parameters.

22. Material and Method
• Study type/Research design: Interventional
• Sub-type: Comparative ,Pre and Post Test Design
• Timing : Prospective
• Masking : Open Clinical
• Sampling Method : Simple Random
• Sample Size :22
• Sample Population : Delhi /NCR
• Study Intervention: Mustadi Yapana Bati
• Duration of Yapana basti : 15 days
• Outcome measures: Sperm Count and Serum biomarkers of
reproduction(Sr.FSH, Sr.LH, Sr.Inhibin-B and Sr. Testosterone)
• Data Analysis: Paired T-Test, Total means score and %
improvement from baseline to the end were assessed.
• CTRI No.: CTRI/2019/08/020538

23. • Selection of Patient: The clinical study was
carried out on the patients, attending OPD of
Panchkarma of A. & U. Tibbia College Hospital,
Karol Bagh, New Delhi, irrespective of caste,
occupation and religion. The Informed consent
was also taken before registering patients in the
study.

24. INCLUSION CRITERIA:
• Infertile Male patients age between 20 to 40 yrs.
• No history of serious illness or disease.
• Not under any type of medical treatment since
last six months.
• Subjects who are able to come for follow up on
fixed visits and are well aware about the
treatment plans.
• Subjects willing to participate and able to give
written informed consent.

25. EXCLUSION CRITERIA:
• Subject having age below 20 years and more than 40 year
• Patients suffering from congenital anomalies
• Subject of Type-I DM or Type-II DM on insulin
• Hereditary Disease
• The patients having varicocele, testicular maldescent,
previous reproductive surgery, STD were excluded.
• Patient of azoospermia and aspermia.
• Taking treatment for major psychiatric problem.
• Illness necessitating long term drug treatment (Rheumatoid
arthritis ,Diabetes Mellitus , Psychoneuroendocrinal disorder
,TB,AIDS)
• Uncontrolled hypertensive patients (BP with or without
medication greater than 140/90mm Hg after 5 min of rest)
• Subjects with any unstable heart disease or known case of MI
,Unstable angina.
• Subjects who have a recent history or who are currently
known to abuse of alcohol or drugs.
• Subjects on systemic or oral steroids.

26. Investigation for assessment :
• Serum FSH
• Serum Testosterone
• Serum Inhibin B
• Serum LH
• Semen analysis

27. RESULT (Serum Biomarkers)
6.22
4.82
7.93
6.05
0
1
2
3
4
5
6
7
8
9
Sr. FSH Sr.LH
86.01 96.92
138.19
453.81
0
50
100
150
200
250
300
350
400
450
500
Baseline
Endpoint

28. Parameters N
Mean Score %Improv
ement
S.D S.E.
t-
value
“p”
BT AT
Sr.FSH 22
6.22 7.93 27.5% 1.56 0.33 5.09 <0.01
Sr.LH
22 4.82 6.05 25.5% 2.30 0.49 2.51 <0.05
Sr.Inhibin-B
22 101 140 38.6% 36.43 7.75 5.05 <0.01
Sr.Testosterone
22 248 470 89% 123.4 26.3 8.43 <0.001
The drug showed statistically significant results in the improvement of serum
biomarkers of spermatogenesis (Serum FSH, Serum LH, Serum Inhibin-B,
and Serum Testosterone) without showing any side effects. Mustadi Yapana
Basti produced a significant increase in Serum Testosterone
(p < 0.001).

29. RESULT (Semen Analysis)
20.5
1.52
29.7
70.3
39.9
22.7
46.5
2.3
52.7
46.8
57.54
38.5
0
20
40
60
80
100
120
140
Sperm
count
Semen
Volume
Normal
Sperm
Abnormal
Sperm
Total
motility
Active
motility
P<0.05

30. Parameters N
Mean Score %Improve
ment S.D
S.E.
t-
value
“p”
BT AT
Total Sperm
count
22 20.5 46.5 126% 24.3 5.17 5.03 <0.01
Semen volume 22 1.52 2.30 51.3% 0.52 0.11 7.14 <0.001
Normal
Sperm%
22 29.7 52.7 77.4% 11.36 2.42 9.53 <0.001
Abnormal
Sperm%
22 70.3 46.8 33.4% 11.84 2.52 9.32 <0.001
Total Sperm
Motility
22 39.9 57.54 44.2% 9.86 2.09 8.40 <0.001
Active motility 22 22.7 38.5 69.6% 9.24 1.96 7.99 <0.001
Sluggish Motility 22 17.2 19.3 12.2% 12.57 2.67 0.79 >0.05
Non- Motile 22 60.1 42.5 29.28% 9.86 2.09 8.40 <0.001
There was marked improvement in sperm count as well as sperm motility after
the intervention significant at p value<0.05.

31. DISCUSSION
How the mustadi yapana basti acts?
Route of
administration
Action of
individuals herbs
Specialized mode
of preparation of
basti dravya

32. Effect of Route of administration
• It is a method of
administering enemas
with medicated
decoctions, oils, ghee or
milk through the anal,
urinary or vaginal route.
• In present study we
administered through anal
route.

33. Role of rectal route of administration
Reach the colon but doesn’t cross
the ileoceacal valve
Change the micro biota which
stimulated the gut brain axis
Basti dravya stay for some time in
Colon which enhance the
absorption of ingredients herbs and
enhances their actions

34. Action of Basti due to its unique
preparation procedure
Preparation of
Kshirapaka
Mixing of
Saidhava+
Madhu+Goghrita
Addition of Kalka+
Mansa rasa
Mix well
Basti Drvaya

35. • This unique mixture
made solid lipid
emulsion which ease
the absorption of
ingredients through gut
wall water insoluble
ingridents
Solid lipid
emulsion
• Lavana part of the
emulsion is stimulated
the sodium gated
channel which also ease
the absorption of water
soluble ingredients
along with water
Sodium gated
channel • The mixture stimulated
may stimulate the
growth and
development of some
specific bacteria which
help in activation of gut
brain axis
Gut Micro-
biota

36. Action of Basti due to drug used in
process of preparation
Boerhavia
diffusa
Tinospora
Cordifolia
Vetiveria
Zizanioidis
Sida
cordifolia
Glycyrrhiza
glabra
Tribulus
Terrestilis
Hepatoprotective effects, the
herb is also useful for the male
reproductive system
V. zizanioidis, is a
popular cooling and
nutritional tonic
Beneficial effect on
sexual health, enhance
plasma testosterone and
spermatogenesis
Nourishment and strengthens
the body's tissues
Aphrodisiac, it can
treat a variety of
sexual diseases
Ameliorating effects on
the sperm parameters

37. Mustadi Yapana Basti
Anal Route
Reach the colon and stay for certain time
Absorb through gut Change the gut micro- biota
Reach the blood stream
and act systematically
•Stimulate Gut Brain Axis
•Enhance absorption and
degradation of herb into useful
and absorbable component
•Increase vasodilatation
•Increase androgen receptors
•Increase nitric oxide production
•Inhibit lipid peroxidation
•Effect Gut Brain Axis
Stimulate Hypothalamus to
release GnRH
Increase Production of FSH,LH
Increase Testosterone level
Enhance sperm maturation and
production
Improves penile erection

38. DISCUSSION
• Mustadi Yapana Basti is a form of Yapana Basti that is
used to increase Strength, and provide nutrition to
muscles, and gonads. It has the properties of both
Sneha Basti and Niruha Basti. It is useful for people
who excessively indulge in sex and effective against all
ailments related to Shukra or semen.
• It contains a total of 27 ingredients, all of which
possess multimodal function and use individually in
various ailments. The ingredients of MYB have Balya
(Provides strength), Shukrala(enhances semen),
Shukra Shodaka (purify the semen), Vrishya
(enhances virility and vigor),
Rasayana(rejuvenating), and Agni Vardhaka
(improves digestive power)effects. It helps in
enhancing the quality and quantity of sperms.

39. • The dominancy of Tikta Rasa in the formulation opens the
channels of the body i.e. Srotoshodhana, increases
digestive power, and clears Ama from the systems. Vata
Shamaka ingredients like Pluchea lanceolata, Laghu
Panchmoola, and Sida cordifolia are helpful in the normal
movement of Vata Dosha, open the blockage, and are
effective in normal delivery of sperms.
• Basti dravya not only acts locally but also systematically
to the target tissue in various disorder that why basti is
called as Ardha chikitsa.
• Basti Karma mentioned in Ayurvedic classics is having
broader therapeutic action on almost all the tissues of the
body and have rejuventive , curative, preventive and
health promotive actions.

40. CONCLUSION
• Mustadi Yapana basti gave significant
improvement on the serum biomarkers specially
on serum testosterone.
• Mustadi Yapana Basti has a positive impact on
the reproductive profile along with semen
parameters.

41. THANK YOU