Shukravaha srotas-Role of panchakarma -Dr Kishore Mahindraker

04/10/2023DR KISHORE MAHINDRAKER

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PANCHAKARMA IN SHUKRAVAHA SROTO

VIKARA

DR.KISHORE MAHINDRAKER2ND YR PG SCHOLAR ,DEPT. OF

PANCHAKARMAGAMC, BANGALORE-09


CONTENTSIntroductionPanchakarma as detoxificationUnderstanding Human Body-ConceptualUnderstanding shukra & Shukra vaha srotasPanchakarma in Shukra vaha sroto vikara –

Klaibya(Erectile Dysfunction) Shukragata vata(Premature ejaculation) Na jayete garbha(Infertility)

Conclusion


INTRODUCTION In the present scenario of medicine , manifestation of many non communicable diseases which are categorised under the Idiopathic aeitiology have become difficult to treat radically in Western system of medicine.

After lot of research work done till date ,Doctors & Scientist have failed to come out with fruitfull results in managing such non communicable disease.

Male sexual dysfunction being one of the burning issue……….


.

Ayurveda –The Science enriched with its

unique modality of treatment i.e.

PANCHAKARMA provides lot of hopes & near

radical management in NCD , Specially in

management of Male sexual dysfunct

Considering one of the burning issue in society

& its radical treatment by panchakarma , this

topic is selected for the presentation &

dissussion


PANCHAKARMA AS DETOXIFICATION THERAPY--

What is Panchakarma or Detoxification Therapy?????


PROBABLE CHANCE OF TOXIFICATION


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CAN BE DEFINED AS………………

“Controlled disturbance in the homeostasis of the body to activate some defence system which is beneficial to host ”


UNDERSTANDING HUMAN BODY

Modern view

Ancient view


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MODERN VIEW



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REPRODUCTIVE SYSTEM-


ANCIENT APPROACH Panchamahabhuta

Dosha

Dhatu Mala

Avayava

Srotas



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Understanding shukra & shukra vaha srotas


CONCEPT OF SHUKRA It is seventh dhatu present in both

sexes.

Shuklayati Tyajayati shuklam rajatam shuklam viryam

(Amarkosha) A whitish or silvery discharge ejaculated during sexual act


.


. SWAROOPA OF SHUKRA;

oÉWûsÉÇ qÉkÉÑUÇ ÎxlÉakÉqÉç AÌuÉxÉëÇ aÉÑÂ ÌmÉÍ¶ÉsÉqÉç |

zÉÑYsÉÇ oÉWÒûŠ rÉczÉÑ¢Çü TüsÉuÉiÉç iÉSè AxÉÇzÉrÉqÉç || cÉç.ÍcÉ.2/4/50 ÎxlÉakÉÇ bÉlÉÇ ÌmÉÍ¶ÉsÉÇ cÉ qÉkÉÑUÇ

cÉÉÌuÉSÌWû cÉ | UåiÉ: zÉÑ®Ç ÌuÉeÉlÉÏrÉÉiÉ µÉåiÉÇ xTüÌiÉMü xÉÍ³ÉpÉqÉç || cÉç.ÍcÉ.30/145 xTüÌOûMüÉpÉÇ SìuÉÇ ÎxlÉakÉÇ qÉkÉÑUÇ

qÉkÉÑaÉÎlkÉ cÉ | zÉÑ¢üÍqÉ¶ÉÎliÉ MåüÍcÉiÉç iÉæsÉ¤ÉÉæSìÌlÉpÉÇ iÉjÉÉ || xÉÑ.zÉÉ.2/13


SHUKRA KARMA ÌmÉëlÉlÉÇ eÉÏuÉlÉÇ-----------------| aÉpÉÉåïimÉÉSczÉ kÉÉiÉÑlÉÉÇ ´Éå¸ MüqÉïÇ ¢üqÉÉiÉ xqÉ×iÉqÉç|| A.¾èû.xÉÑ.11/4

zÉÑ¢Çü kÉærÉïqÉç crÉuÉlÉÇ mÉëÏÌiÉÇ SåWûoÉsÉÇ WûwÉïoÉÏeÉÉjÉïqÉç cÉ ||

xÉÑ.xÉÔ.15/5


SHUKRA PRAMANA cÉUMü-1/2 AÇeÉÍsÉ pÉåsÉ- 1 AÇeÉÍsÉ


SHUKRA VIKRUTHI (VRIDDHI & KSHAYA) AÌiÉx§ÉÏMüqÉiÉÉÇ uÉ×®Ç zÉÑ¢Çü zÉÑ

¢üzqÉUÏqÉç AÌmÉ | A.¾Òû.xÉÑ.11/12 SÉæoÉïsrÉÇ qÉÑZÉzÉÉåwÉ¶É

mÉlQÒûiuÉÇ xÉSlÉÇ ´ÉqÉ: | YsÉæorÉÇ zÉÑ¢üÉÌuÉxÉaÉï¶Éç ¤ÉÏhÉzÉÑ¢üxrÉ sÉ¤ÉhÉqÉç || cÉ.xÉÑ.17/69


SHUKRA VAHA SROTAS Shukravaha srotas= Reproductive system

Srotas- shukravaha Avayava- Vrashna, shepha, stana and

majja Dhatu- Shukra Dosha- Sleshma pradhana , Panchamabhuta- except Akasha Shukra prasada bhaga- Garbha,Oja


SHUKRA VAHA SROTO zÉÑ¢üuÉWûlÉÉÇ x§ÉÉåiÉxÉÉÇ

uÉ×wÉhÉÉæ qÉÔsÉÇ zÉåTü¶Éç | cÉ.ÌuÉ.5

zÉÑ¢üuÉWåû ²å iÉrÉÉåqÉÔïsÉÇ xiÉlÉÉæ uÉ×wÉhÉÉæ cÉ | iÉ§É ÌuÉkSxrÉ ÎYsÉoÉiÉÉ ÍcÉUÉimÉëxÉåMüÉå U£üzÉÑ¢üiÉÉ cÉ || xÉÑ.zÉÉ.9


SHUKRA VAHA SROTO VIKARA AMüÉsÉrÉÉåÌlÉaÉqÉlÉÉiÉç ÌlÉaÉëWûÉiÉç

AÌiÉqÉæjÉÑlÉÉiÉç | zÉÑ¢üuÉÉÌWûÌlÉ SÒzrÉÎliÉ zÉx§É¤ÉUÉÎalÉÍpÉxiÉjÉÉ || cÉ.ÌuÉ.5

zÉÑ¢üxrÉ SÉåwÉÉiÉç YsÉåorÉqÉç AWûzÉïhÉqÉç |

UÉåÌaÉ uÉÉ YsÉÏoÉqÉsmÉÉrÉÑÌuÉïÂmÉqÉç uÉÉ mÉëeÉÉrÉiÉå || lÉ cÉÉxrÉ eÉÉrÉiÉå aÉpÉïÈ mÉiÉÌiÉ mÉëx§ÉuÉirÉÌmÉ | zÉÑ¢Çü ÌWû SÒ¹Ç xÉÉmÉirÉÇ xÉSÉUÇ oÉÉkÉiÉå lÉUqÉç || cÉ.xÉÑ.28


RESEARCH WORKS..

Total of around 200 Thesis have been carried out on vajikarana so far . (M S Baghel, 2005)

Male Infertility : 32 Shukradushti: 24 Oligozoospermia: 56 On Male Sexual Dysfunction : 34 Shukragatavata: 7


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Globally decreasing semen quality and increasing infertility is the matter of concern.

Panchakarma before Vajikarana is essential. Panchakarma can definitely help infertile couples in fullfiling their wishes.

Thorough understanding of use of panchakarma therapy & vajikarna in shukravaha srotas is in high demand.


THE MOST COMMON CONDITIONS Erectile dysfunction (Klaibya) Premature ejaculation (Shukragata

vata) Infertility (Vandhya) Lack of libido (Apraharsha) Performance anxiety (Bhaya) Night emission (Svapna skalana) Spermatorrhea (Mutra shukra) Failure to reach orgasm Dhat syndrome


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Panchakarma in shukravaha sroto vikara- Klaibya w.r.s.t ED


KLAIBYA / ERECTILE DYSFUNCTION Klaibya is a vikara of Karmendriya,

with the involvement of Mana and Jnanendriya.

Erectile Dysfunction to which klaibya is co related is a multifactorial condition commonly observed in society.

Survery by India Today – One in every ten is impotent

Aggrevated vata dosha, sukraksaya, sukravahasrotodusti & Manodosha are prime factors involved in pathogenesis.


KLAIBYA BHEDA

1)oÉÏeÉÉåmÉbÉÉiÉeÉ ; 2)kuÉeÉÉåmÉbÉÉiÉeÉ;

3)eÉUÉeÉlrÉ ; 4)zÉÑ¢ü¤ÉrÉeÉlrÉ ;


KLAIBYA SAMANYA LAXANA xÉÉqÉÉlrÉ sÉ¤ÉhÉ:

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cÉ.ÍcÉ.30/155


HISTORY AND EXAMINATION OF PATIENTGeneral examintion- Pt.. general appearance may suggest

depression,anxiety,& other mental health problem

Question about illnesses or disabilities and surgeries

Previous medications Sexual development as a boy

Systemic examination-CVS,- Check BP & palpate peripheral pulse ,evidence of atrial disease ,such as absence of foot pulse ,suggests that ED might be because of arterial insufficiancy.

CNS,- commonly lumbosacral system is assessed, the condition of perineal reflex may provide evidence of spinal cord dysfuction


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Testing of reflex 1.bulbocavernosus reflex (S2,S3)

Provokes contraction of the bulbocavernosus muscle located b/w scrotum & anal canal


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2.Bulbo anal reflex (S3,S4)

Provokes contraction of anal spinchter


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Examination of genitals Testes- Vas deferens Epididymis


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Peyronies disease;


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Investigation in Klaibya;

Blood & Urine –To R/o DM Hormone assasy- Sex hormone binding globulin(SHGP) Testosteron FSH LH ProlactinePenile dopplerNocturnal penile tumescence


PANCHAKARMA IN KLAIBYA oÉÏeÉÉåmÉbÉÉiÉeÉ YsÉæorÉ ÍcÉÌMüixÉÉ:

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Medicines used- Snehapana- amritaprasha ghrita, swadamstradi(gokshura) ghrita, jeevaniya ghrita

Virechana-GH oil, Sukumara erandam,mishraka sneha

Asthapana- Erandamooladi, Karma Mustadi yapana basti BastiAnuvasana-Same as for snehapana


.

kuÉeÉÉåmÉbÉÉiÉeÉ YsÉæorÉ ÍcÉÌMüixÉÉ

mÉëSåWûÉlÉç mÉËUwÉåMüÉÇczÉ MÑürÉÉïSè uÉÉ U£üqÉÉå¤ÉhÉqÉç | xlÉåWûmÉÉlÉÇ cÉ MÑüÌuÉïiÉç xÉxlÉåWÇû cÉ ÌuÉUåcÉlÉqÉç || AlÉÑuÉÉxÉlÉqÉç iÉiÉç MÑürÉÉïSjÉuÉÉÅÅxjÉÉmÉlÉqÉç mÉÑlÉÈ | uÉëhÉuÉŠ Ì¢ürÉÉ xÉuÉÉïxiÉ§É MÑürÉÉïÌ²cÉ¤ÉhÉÈ || cÉ.ÍcÉ.30/201


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Medicine Used ;

Pradeha-(Chakradatta)Kanaka rasa bhavit Ashwaganda Pradeha, Bhallatakadi lepa,Parisheka- Ashwagandha taila, Bhallatakadi tailaRaktamokshana-Snehapana- Amritaprasha ghrita, Swadamstradi(gokshura) ghrita, Jeevaniya ghrita,

Snigdha Virechana- GH oil, Sukumara erandam, Mishraka sneha

Anuvasana- Same used for snehapanaAsthapana Basti-Erandamooladi, Karma Mustadi yapana basti Basti


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eÉUÉeÉlrÉ-zÉÑ¢ü¤ÉrÉeÉlrÉ YsÉæorÉ ÍcÉÌMüixÉÉ

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Medicine Used

Rasayana- Abhayamalaki, pippali, guduchi,Loha rasayana ,shilajithu, triphala.

Vrishya yoga- Ksheera sarpi, shastika,yava godhuma, ashwagandha, shatavari, mushli, kapikacchu, vidari,


.

Panchakarma in shukravaha sroto vikara- Shukragata vata w.s.r.t. premature Ejaculation


PREMATURE EJACULATIONPremature ejaculation is a Psychosexual disorder charecterized by persistent or recurrent ejaculation by minimal sexual stimulation . In ayurveda this clinical condition is described under SHUKRA GATA VATA .

Understanding Relation of shukra with vata and manas is very much essential in samprapti vighatana by means of ayurvedic management


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Treatment is ; Harsho annapana- Vrashya Balya Vatahara Shukra Sthambaka Medhya dravyas Yapana basti


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Panchakarma in shukravaha sroto vikara- Vandyatva w.s.r.t. Male infertility


VANDYATVA-MALE INFERTILITY पु�रुषस्य यदा बी�जे बी�जेभागः�, प्रदा�षमापुद्यते , तेदा वन्ध्य� जेनयतिते II Cha.sha 4/31 Infertility is defined as a failure to concieve within one or more year of regular unprotected coitus.


INCIDENCE AND SURVEYS Sperm count has fallen 50% lesser over

last 50 years . @ 2% every year. Acc. To WHO In 1950 -over 113

million/ml 2012 -over 15 million/ml "At this rate, there would be no fertile

men left in the next 40-50 years“?

courtesy: TOI


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W.H.O estimates 8-10%

Worldwide incidence is 50-80 million Incidence vary from region to region


CAUSES

Pre testicular causes

Testicular factors

Post testicular causes

Idiopathic


PRE-TESTICULAR CAUSES

Hypogonadism due to various causes

Drugs, alcohol, smoking

Strenuous riding (bicycle riding, horseback riding)

Medications, including androgens.


TESTICULAR FACTORS

Age Genetic defects on the Y chromosome Y chromosome microdeletions Abnormal set of chromosomes Klinefelter syndrome Neoplasm


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Cryptorchidism Varicocele(upto14%) Trauma Hydrocele Mumps Malaria


POST-TESTICULAR CAUSES

Vas deferens obstruction

Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis

Infection, e.g. prostatitis

Ejaculatory duct obstruction


AYURVEDIC APPROACH IN MALE INFERTILITY Soumanasya Garbha Dharana !!

-R/o it by proper Counselling Shukra Garbham Prajayate!!

-Further insvestigate into the Shukra dusti samprapti


SHUKRA DUSHTI KARANA- Samanya karana- Cha.chi. 30/138

Maintuna Na cha Gachati Avisrambha = Avishwasat

Vishesha karana Shukra vaha sroto dusti nidana cha. vi. 5

AMüÉsÉrÉÉåÌlÉaÉqÉlÉÉiÉç ÌlÉaÉëWûÉiÉç AÌiÉqÉæjÉÑlÉÉiÉç | zÉÑ¢üuÉÉÌWûÌlÉ SÒzrÉÎliÉ zÉx§É¤ÉUÉÎalÉÍpÉxiÉjÉÉ




CLINICAL APPROACH TO INVESTIGATE MALE INFERTILITY

History- Duration of marriage – Previous marriage and proven fertility Medical h/o- Mumps orchities STD DM Recurrent chest infection Surgical h/o- herniorrhaphy Operation on testes Operation in genital areaOccupational h/o- Exposure to heat, radiation.


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Sexual history- frequency Full Penatration Position of male partner

Social Habits- Particularly Alcohol, Smoking


EXAMINATION OF PATIENT-

General physical examination Semen analysis Hormonal assay Scrotal ultrasound

Assess Shukra Kshaya Laxana-

Assessment of Rupa Dravya shukra – -Doshik Involvement in it, and treat accordingly or Use the semen Analysis to Infer Doshik Involment.


SEMEN ANALYSIS

oÉWûsÉÇ qÉkÉÑUÇ ÎxlÉakÉqÉç AÌuÉxÉëÇ aÉÑÂ ÌmÉÍ¶ÉsÉqÉç |

zÉÑYsÉÇ oÉWÒûŠ rÉczÉÑ¢Çü TüsÉuÉiÉç iÉSè AxÉÇzÉrÉqÉç || cÉç.ÍcÉ.2/4/50


SL. NO.

STANDARD TEST NORMAL VALUES

1 Colour Greyish white

2 Liquefaction time < 60 min

3 Volume 2 ml or more

4 pH 7.2- 8.0

5 Sperm concentration

20 million/ml

6 Total sperm count 40 million/per ejaculate or more

7 Sperm motility >25% - Rapid motility > 50% - Slow motility

8 Sperm morphology > 30 % normal

9 Sperm vitality > 75% or more live.i.e. excluding dye

10 WBC < 1 million /ml

11 Agglutination > 20% agglutinated

12 HOS test > 60% spermatozoa with tail coiling


SL. NO.

STANDARD TEST NORMAL VALUES

13 Acrosome intactness

50% of spermatozoa with halos having mean diameter of > 30micro meter

14 Seminal fructose .>1200 microgram/ml

15 Zinc > 75 microgram/ml

ENDOCRINE EVALUATION

1 Testosterone Plasma concentration- 2.5- 10mg/dl

2 Serum FSH 5- 20 IU/litre

3 Serum LH 5- 20 IU/litre


USING SEMEN ANALYSIS AND ASSESSING DOSHA

Vataja shukra dushti:Phenila- Frothy & Sperm Functional Integrity assessment.*Flagellar Integrity-hypo osmotic Swelling.- (Normal,>55% spermatozoa with tail coiling) - Decrease in HOS positive reaction indicates

loss of viability, indicative of degenaration.*ARIC test(Acrosome reaction after ionopher challenge) -(Normal,>15% of spermatozoa with halos diamtr of 10mm) Decrease in ARIC +VE reaction indicates low/no fertilisation


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Vataja shukra dushti:

Tanu- low count < 15million/ml

Rooksha- Ph >8.5

Alpa- vol <1.5ml


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Pittaja shukra dushti: Puti- >8 pus cell/hpf

Vivarna- yellowish Discoloured (normal is Greyish White) --------------------------------------------- Kaphaja Shukra Dushti: Picchilla-Increased viscosity


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Raktaja shukra dushti: Increased Rbc’s in Semen Sample, Foul Smelling

Vata-kaphaja: Granthi Bhuta - Reduced MotilityAvasadi (normal >25% RLP,>50%SLP >50% RLP+ SLP DNA fragment index (Good-<30% ,Fair- 30-45%,poor->45%)


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Vata-pittaja shukra dushti:

Ksheena- Reduced Count + Low vol --------------------------------------- Pitta-kaphaja shukra dushti:

Puti puya- >5 pus cells + Rbc Casts --------------------------------------

Anya dhatu samsrusta Shukra dusti:

Presence of Macrophages,Mucus threads

Epithelial cells, Amorphous matt.


PRINCIPLES IN MANAGEMENT OF VANDHYATVA Acc. To cha.chi.28/146-152 Adopt the Shodana Chikitsa Use of Vajikarna Yogas Use of yogas mentioned in Raktapitta chikitsa Use of yogas mentioned in yonivyapat chikitsa Jeevaniya gana aushada siddha

Ghrita,Chavanaprash,Girija as Rasayana Sarpi,paya, shali, Godhuma Follow respective treatment for each shukra

dushti “prashasta shukra dosheshu basti karma viheshata”


PRINCIPLES IN MANAGEMENT OF VANDHYATVA Acc. To Shu.Sha.2/101.“Snigdha vaantam viriktam cha nirudamanuvasitam IYojayet shukram doshat samyakuttarbastinaamII”

2.Follow the individual reto dushti chikitsa Shu.Sha.2/8-10


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SL.NO

SHUKRA DUSTI PRAKARA

PANCHAKARMA ADOPTED Ast.Sam. Sha.1/24-34

1 Vata Snehana- Vasuka,Saindava, Amla phala Siddha Ghrita (vasuka-romaka, Amla phala- Dadimadi Phala)

Anuvasana- Madhuka, bhadradaru sidda taila

Asthapana-Bilwa vidari siddam, Ksheera yuktam

Uttarabasti- Ksheera,Kullira rasa sidda taila(kullira- Jalaja Prani vishesha)

2 Pitta Snehapana- Kandikshu, Swadamshtra,Guduchi sidda Ghrita (murva,maduka as prativapa)

Virechana-Trivrit churna with Ghrita

Asthapana-Sriparni sidda ksheera yukta

Anuvasana & Uttar basti- Madhuka ,Mudgaparni siddam taila


.3 Kapha Snehapana-

Pashanabheda,Ashmantaka,Amalaka kwatha sidda ghrita (pippali, Madhuka churna –Avapa)Vamana-Madana phala kashayaAsthapana-Rajavriksha,madanaphala kashaya PragadamAnuvasana & Uttara basti- Madhuka,pippali sidda taila

4 Rakta Snehapana- Dhataki pushpa ,Khadira,Arjuna,Dadima Sidda Ghrita

5 Vata-pitta Treat on the principle Nunya dhatu purayet,

6 Vata-kapha Snehapana-Pashana bheda, Palasha bhasma sidda ghrita

7 Pitta-kapha Snehapana- Parushakadi Nyagrodadi sidda ghrita

8 Anyadhatu Snehapana-Yava,Chitraka,Vittunaka,Priyangu,samanga, sidda ghrita (Ela,Mocha churna prativapa)


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. PATHYA

Guda, Ghrita, Ikshu, Kharjura, Kshira, Mamsa, Madhu, Majja, Mamsarasa, Shati, Taila, Vilepi, Vasa

Certain Drugs Like Amalaki, Bala, Atmagupta,

Amratakaphala, Amraphala,, Jivanti, Kushmanda, Lashuna, Meda, Narikela, Patola, Palandu, Shrngataka, Saliparni, Vidari


APATHYA

Katurasa, Ati-Amlarasa,Matsya, Mastu, Shaka,

Tiktarasa, Takra

Drugs like Atasi, Akshota, Canaka, Gandhaka,

Guggulu, Kalinda, Kuluttha, Katabhi, Marica, Moksha, ParasikaYavani


VIHARA Abhyanga, Udavartana, Snana, PadaPrakshalana. Streeis explained as best among

Vajikaranas which augments Shukra in body (Ca Ci2: 1: 4-7).


UNDERSTANDING VAJIKARNA DRAVYAS Shukra Janaka – indicated in Vishushka Reto Dushti,oligospermia where there is need of proliferation of germ cells. Eg: Sharkara,Shatavari,Mamsa,Ghritha. Shukra Pravartaka (Shukra srutikarana) Stimulates the production of androgens or modifies the action of androgens. Indicated in sthira shukra ( Androgen insensitivity) eg Sankalpa, Stri vichara mano balakarana which causes ejaculation of semen. Eg Uchchata, Brihati, Milk, Sugarcane juice.


.

Shukra janaka / pravartaka- Increases both mano and dehabala eg ksheera, ghrita, masha, bhallataka phala majja.

Shukra stambhaka – Drugs are meant to prolong the sexual act. Indicated in early ejaculation. Eg Akarakarabha, Jatiphala, Ahiphena, Bhanga, Puga, Dhattura.

Shukrashoshaka – Indicated in excessive secretion from bulbo urethral glands. Eg Hareetaki, Purana Guggulu, Suchi.


.

Shukra shodhaka – Katphala, Kushtha, Samudraphena.


ROLE OF RASAMADHUR

AOLIGOSPRMIA,

MATURATION ARRESTVIDARI

SHATAVARI

AMLA VISCOSITY DADIMA, AMALAKI

LAVANA LIQUEFACTION SAINDHAVA

KATU OLIGO-ASTHENOSPERMIA

PIPPALI, SHUNTHI

TIKTA ASA, IMMUNOLOGIC GUDUCHI

KASHAYA PREMATURE EJACULATION

JATIPHALA


CONCLUSIONThe Knowledge of the tradition (Shastra) & The technology (tantra) is required to pin point the diagnosis of shukra vaha sroto vikara.

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SHUKRIYA……

Health & Medicine

Shukravaha srotas-Role of panchakarma -Dr Kishore Mahindraker