E-ISSN:2456-3110

Case Report

Klaibya

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 8 September
Publisherwww.maharshicharaka.in

A case report on the management of Klaibya with special reference to Arterial Insufficiency Erectile Dysfunction

Pramod.1*, Diggavi M.2, Rakesh K.3
DOI:

1* Pramod, Final Year Post Graduate Scholar, Department of PG Studies in Kayachikitsa, Taranath Government Ayurvedic Medical College and Hospital, Bellary, Karnataka, India.

2 Madhava Diggavi, Professor & HOD, Department of PG Studies in Kayachikitsa, Taranath Government Ayurvedic Medical College and Hospital, Bellary, Karnataka, India.

3 K.B Rakesh, MBBS, Specialist in Cross Sectional Imaging Non-Vascular Intervention Radiologist, Clarity Diagnostics, DNB Breach Candy Hospital, Bellary, Karnataka, India.

Klaibya is a Vikara of Karmendriya, with the involvement of Mana and Jnanendriya. Aggravated Vata Dosha, Shukrakshaya, Shukravaha Srotodusti and Mano Dosha are the prime factors involved in the pathogenesis. And it very well co-relates with that of Erectile Dysfunction. It is a multifactorial condition commonly observed in society. According to the survey conducted by “India Today,” the prevalence of the disease is “one in every ten is Impotent in India” Master and Johnson also reported a fear of impotence in all men above 40 years of age. Considering the grave nature of the disease with its higher incidence, it has been selected for the present study to find out a better cure. In the context of Klaibya, treatment with Basti and Vrishya Yoga has been very much highlighted, and it is stated as the best. So, in the present study, Basti is selected in the form of Nirhua Basti, Uttar Basti and Vrishya Yoga with Sishna Lepa. Also, it is easy for the patient to undergo treatment and carry out their daily routine and offers very limited restrictions to follow.

Keywords: Klaibya, Uttar Basti, Vrishya Yoga, Arterial insufficiency dysfunction, Case Report

Corresponding Author How to Cite this Article To Browse
Pramod, Final Year Post Graduate Scholar, Department of PG Studies in Kayachikitsa, Taranath Government Ayurvedic Medical College and Hospital, Bellary, Karnataka, India.
Email: 		Pramod, Madhava Diggavi, K.B Rakesh, A case report on the management of Klaibya with special reference to Arterial Insufficiency Erectile Dysfunction. J Ayu Int Med Sci. 2022;7(8):131-142.
Available From
https://www.jaims.in/jaims/article/view/1918

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-07-25 2022-07-26 2022-08-02 2022-08-09 2022-08-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Pramod, Madhava Diggavi, K.B Rakeshand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)131
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction

Introduction

Sex is a basic instinct, but sexual behavior is learning ability. Dharma, Artha, Kama and Moksha are four objectives (Purusharthas) of life mentioned in Ayurveda. The concept of Kama reveals that the recreational aspects like pleasure are equally important to its procreation aspects. Healthy sexual behavior plays an essential role in maintaining the harmony and happiness of marital life. It provides a media to express love, which is the base for all sorts of creative activities.

Erectile dysfunction[1] represents a major quality of life-related health problem. WHO defined Erectile Dysfunction as the various ways in which an individual is unable to participate in a sexual relationship as he would wish and include all sorts of disturbances. It can be defined as a man’s inability to attain or maintain an erection of sufficient strength to perform the act of intercourse. The basic etiology behind Erectile dysfunction includes psychological, neurological, vascular insufficiency, and diseases like diabetes mellitus and Hypertension etc.

Erectile dysfunction is more prevalent in diabetes mellitus and hypertension patients. Available data indicates that DM and hypertension is a major risk factor for Klaibya in men. Several factors affect the sexual function of the patients such as severity and duration of disease, age, and medicaments. Several mechanisms have been implicated in the pathogenesis of sexual dysfunction.

The pathophysiology of Erectile dysfunction is multifactorial with endothelial, vascular, autonomic, endocrine, and neurogenic factors involves loss of unmyelinated C fibers in the early in the last stage.[2]

The vascular factors are implicated are atherosclerosis and microangiopathy. Small penis vessels show changes like endothelial proliferation, subintimal fibrosis, hypercholesterolemia. There is impaired relaxation of corpous-cavernosal smooth muscle in response to neural and endothelial derived nitric oxide.

Though both, nonsurgical and surgical treatments are in practice for the management of ED, but each of them is having its own limitations and demerits. The nonsurgical treatment is having poor efficacy with systemic and local side effects.

The surgical treatments are associated with complications, change in the shape of the penis and they are unaffordable by the common people. Hence both are having poor acceptance in the society. After knowing the burning nature with higher incidence of the problem and the limitations of the available medications, it is the need of time to find out an effective, safe, and affordable therapy to manage this troublesome problem.

In Ayurveda, we may find a ray of light as it is having unique approach to understand the disease. Further in case of management also it is having unique way to treat the suffering not only by means of palliative treatments, but also by means of purification procedures to treat and check the root cause of the disease and minimize the recurrence of the same. Considering the grave nature of the disease though it does not reduce the life expectancy, it has been selected for the present study to find out a better cure. As Basti, Uttar Basti[3] is very much highlighted and praised in the context of Klaibya to overcome the aggravated Vata, in the present study Basti, Uttar Basti is selected in the form of Niruha Basti, Uttar Basti and Vajeekarana Yoga with Sishna Lepa. Vajikarana has been described specially to improve the sexual health to enhance the status of Sukra and to please the mind.

Case Report

A 50-year-old male patient visited to Pandith Taranth Government Ayurvedic Medical College and Hospital, Bellary on 22/02/2022 with a complaint of Dhwajanuccharya (Lack of erection), Lingashaitilya (Flaccid state of penis), Mlanasishnata (Constriction of penis), Moghasnkalpa Chesta (Futile sexual act), Suratashakta (Incapability to perform sexual act), Svinna Gatrata (Excess perspiration), Lack of sexual desire and absence of morning erection since 6 months. Reg no-C.OPD no:2375, Dept. OP NO: 705

Past history

H/o Type2 Diabetes mellitus since 2 years on Modern medicine.

No H/o of Hypertension/Thyroid dysfunction/surgical history.

Personal history

H/o of smoking since 20 years



Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)132
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction

General Examination

Built: Moderate, Height: 5’10’’, Weight: 75kg, Nourishment: Moderate, Pulse: 78/min, Blood Pressure: 130/80, Temperature: 98.6F, Respiratory rate: 16/min, Tongue: Clear.

Systemic Examination

  • CNS: Well oriented, conscious.
  • CVS: S1 S2 Normal, No added sounds.
  • RS: Vesicular breathing, Mild wheezing sounds.
  • P/A: Umbilicus centrally placed, Soft, non-tenderness, no organomegaly.
  • Uro-genital:
  • Penis: Soft, Non-tender, Glans: Dark pinkish, no ulcer, Urethral meatus: Center, non-discharge, Scrotum: Rugae present, no scar mark, Testis: Bilateral soft, non-tender, Spermatic cord: Soft, movable, non-tender, Femoral region: No swelling, non-tender, Inguinal Region: No swelling, non-tender, and Cremasteric reflex: Present.

Asthavidha Pareeksha

  • Nadi: Vata Kaphaja, Mutra: 8-10 times a day, 2-3 times/night, Mala: 2/day, Jiwha: Alipta, Shabda: Prakruta, Sparsha: Anushana Sheeta, Druk: Prakruta, Akriti: Madhyama

Dashavidha Pareeksha

  • Prakriti- Vata Kaphaja, Vikriti- Kapha, Sara- Meda, Samhana- Madhyama, Satmya- Vyamishra, Satwa- Avara, Pramana- Madhyama, Ahara Shakti- Madhyama, Vyayama Shakti- Madhyama, Vaya- Madhyama

Investigations

Routine investigation such as CBC, ESR, PT-APTT, RBS, HIV, HBsAg along with this Serum testosterone, Serum FSH, Serum LH, Serum prolactin, TSH and Semen analysis.

Sonography investigations are Scrotal doppler and Penile doppler are done.

Materials and Methods

Intervention

a. Deepana Pachana and Kosthashodhana with Hareetakyadi Yoga[4] 4 gm before food thrice a day with Sukhooshnodaka, for 5 days.


Table 1: Observations of Deepana Pachana and Kosthashodhana

Day Date Observations
01 01/03/2022 Vata, Mutra, Pursiha Visarga, Diptaagni
02 02/03/2022 Vata, Mutra, Pursiha Visarga, Diptaagn, Ruchi
03 03/03/2022 Vata, Mutra, Pursiha Visarga, Diptaagn, Ruchi, Angalagavata.
04 04/03/2022 Vata, Mutra, Pursiha Visarga, Diptaagn, Ruchi, Angalagavata, Udgara Shuddi,
05 05/03/2022 Vata, Mutra, Pursiha Visarga Diptaagn, Ruchi, Angalagavata, Udgara Shuddi,

b. Niruha Basti

Table 2: Niruha Basti ingredients and their quantity.

Ingredients of Niruha Basti Pramana
Saindhava Lavana 15gm
Madhu 80ml
Sneha - Ashwagandha Taila[6] 80ml
Kalka - Shatapushpa Churna (15gm) + Madanaphala Churna(3gm) 18gm
Kvatha Dravya - Ashwagandhadi kashyam (Ashwagandha, Shatavari, Kustha, Jatamansi, Brihati) 480ml

 

Date 06/03/2022 07/03/2022 08/03/2022
Basti Pranidana Kala 9:00 am 9:10 am 9:50 am
Basti Pratygamana Kala 9:10 am 9:15 am 10:00 am
Retention time 10 min 05 min 10 min
Observations Angalaghwam, Deeptiagni Anghalagwam, Deeptiagni, Indriya Prasada. Anghalagwam, Deeptiagni, Indriya Prasada

c. Uttar Basti

Uttar Basti given with Murchita Tila Taila[7] 40ml fixed dose for 3 consecutive days.

And repeated the same after the interval of 3 days.

Table 3: 1st Sitting Uttar Basti

Date 09/03/2022 10/03/2022 11/03/2022
Uttar Basti Pranidana Kala 2:32 pm 2:35 pm 2:50 pm
Time taken for Uttar Basti Netra insertion 2 min 10 seconds 1 min 10 seconds 1 min 20 seconds
Time taken for injecting Uttar Basti Dravya 2 min 30 seconds 2 min 10 seconds 2 min
Time taken for Uttar Basti Netra removal 1 min 10 seconds 1 min 1 min 10 seconds

Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)133
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction
Length of Uttar Basti Catheter inserted (in cm) 23 cm 28 cm 28 cm
Basti Pratyagamana Kala 5:10 pm 7:10 pm 5:30 pm
Retention Time 2 hours 38 mins 4 hours 35 mins 2 hours 40 mins
Observations Manoprasada, Indriya Prasada, Smyak Nidra, Mild Erection + Manoprasada, Indriya Prasada, Smyak Nidra, Mild erection+, Sexual desire+ Manoprasada, Indriya Prasada, Smyak Nidra, Morning erection+, Sexual desire+
  Before UB After UB Before UB After UB Before UB After UB
Pulse/min 74 76 72 76 72 72
Blood pressure (mmhg) 120/80 120/80 110/70 120/80 125/78 125/76
Measurement of Penis in cm (In Flaccid state) 1st Day 2nd Day 3rd Day
Length 9 cm 10 cm 10 cm
Circumference 10 cm 10.2 cm 10.2 cm

Table 4: 2nd Sitting Uttar Basti

Date 09/03/2022 10/03/2022 11/03/2022
Uttar Basti Pranidana Kala 2:32 pm 2:35 pm 2:50 pm
Time taken for Uttar Basti Netra insertion 2 min 10 seconds 1 min 10 seconds 1 min 20 seconds
Time taken for injecting Uttar Basti Dravya 2 min 30 seconds 2 min 10 seconds 2 min
Time taken for Uttar Basti Netra removal 1 min 10 seconds 1 min 1 min 10 seconds
Length of Uttar Basti Catheter inserted (in cm) 23 cm 28 cm 28 cm
Basti Pratyagamana Kala 5:10 pm 7:10 pm 5:30 pm
Retention Time 2 hours 38 mins 4 hours 35 mins 2 hours 40 mins
Observations Manoprasada, Indriya Prasada, Smyak Nidra, Mild Erection + Manoprasada, Indriya Prasada, Smyak Nidra, Mild erection+, Sexual desire+ Manoprasada, Indriya Prasada, Smyak Nidra, Morning erection+, Sexual desire+
  Before UB After UB Before UB After UB Before UB After UB
Pulse/min 74 76 72 76 72 72
Blood pressure (mmhg) 120/80 120/80 110/70 120/80 125/78 125/76
Measurement of Penis in cm (In Flaccid state) 1st Day 2nd Day 3rd Day
Length 9 cm 10 cm 10 cm
Circumference 10 cm 10.2 cm 10.2 cm


Table 5: 3rd Sitting Uttar Basti

Date 21/03/2022 22/03/2022 23/03/2022
Uttar Basti Pranidana kala 3:31 pm 3:18 pm 3:15 pm
Time taken for Uttar Basti Netra insertion 1 min 55 sec 1 min 6 seconds 1 min 10 seconds
Time taken for injecting UB Dravya 4 min seconds 2 min 10 seconds 2 min 30 seconds
Time taken for Uttar Basti Netra removal  55 seconds 50 seconds 1 min 10 seconds
Length of Uttar Basti Catheter inserted (in cm) 28.5 cm 30.5 cm 26 cm
Basti Pratyagamana Kala 8:00 pm 8:00 pm 9 pm
Retention Time 4 hours 29 mins 4 hours 42 mins 5 hours 45 mins
Observations Manoprasada, Indriya Prasada, Smyak Nidra, Morning erection +, Penile hardness+. Sexual desire+ Manoprasada, Indriya Prasada, Smyak Nidra, Morning erection+, Sexual desire+ Penile hardness+ Manoprasada, Indriya Prasada, Smyak Nidra, Morning erection+, Sexual desire+, Penile hardness+
  Before UB After UB Before UB After UB Before UB After UB
Pulse/min 100 88 90 84 80 79
Blood pressure mmhg 130/84 137/88 118/73 120/78 130/80 117/78
Measurement of Penis in cm (In Flaccid state) 1st Day 2nd Day 3rd Day
Length 10.5 cm 10.5 cm 11 cm
Circumference 10.5 cm 10.5 cm 10.5 cm

Vrishya Yoga: After completion of Uttar Basti procedure oral Vrishya Yoga is started.

The Vrishya Yoga - Kapikacchu Ghana Vati[8] 500mg with Sukoshna Dugda morning and night before food is administered for 25 days. Along with this Sishna Lepa - Aruskhara Lepa[9] (external application) is advised to apply on penis for 7 days.

jaims_1918_01.PNG


Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)134
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction

jaims_1918_02.PNG

Image 1: Pictorial presentation of preparation of Niruha Basti and Uttar Basti instruments.

jaims_1918_03.PNG

Image 2: Pictorial presentation of procedure of Uttar Basti.

Assessment

Subjective Parameter

1. Lingashaitilya Grading BT DT AT
  No Lingashaitila at all, Normal sexual act CS0     √
  Mild, rare Lingashaitila without disturbance to sexual act CD1   √  
  Moderate and often Lingashaitila Moderate problem to sexual act CD2      
  Severe Lingashaitila always interference with sexual act CD3 √    
2. Mlanasishnata        
  No Mlanasishnata at all, Normal sexual act CS0     √
  Mild and rare Mlanasishnata without disturbance to sexual act CD1   √  
  Moderate and often Mlanasishnata Mild problem to sexual act CD2      
  Severe and always Mlanasishnata, always interference with sexual act CD3 √    
3. Moghasankalpachesta        
  No Moghasankalpachesta at all, Normal sexual act CS0   √ √
  Mild Moghasankalpachesta, mild disturbance to sexual act CD1      
  Moderate Moghasankalpachesta Moderate disturbance to sexual act CD2      
  Severe Moghasankalpachesta Always disturbance sexual act CD3 √    
4. Dhwajanuccharya        
  No Dhwajanuccharya at all, Normal sexual act CS0   √ √
  Mild, rare Dhwajanuccharya without disturbance to sexual act CD1      
  Moderate and often Dhwajanuccharya Moderate problem to sexual act CD2      
  Severe Dhwajanuccharya always interference with sexual act CD3 √    
5. Svinnagatarata        
  No Svinnagatrata at all, Normal sexual act CS0     √
  Mild, rare Svinnagatrata, after sexual act CD1   √  
  Moderate and often Svinnagatrata During and after sexual act CD2      
  Severe Svinnagatrata always interference with sexual act CD3 √    
6. Mukhashosha        
  No Mukhashosha at all, Normal sexual act CS0     √
  Mild, rare Mukhashosha, after sexual act CD1   √  
  Moderate and often Mukhashosha During and after sexual act CD2      
  Severe Mukhashosha always interference with sexual act CD3 √    

 

1. Sexual Desire Grading BT DT1 (27th day) AT
  No sexual desire at all 0 √    
  Lack of Sexual desire 1      
  Sexual Desire but no activity 2      
  Sexual Desire only on demand of partner 3      
  Normal Sexual desire 4   √ √
2. Erection        
  No Erection by any method, always interfere with sexual act 0 √    
  Erection only after manipulation, but unable to penetrate, Severe disturbance in sexual act 1      
  Erection but unable to penetrate, Moderate disturbance in sexual act 2      
  Erection with occasional failure, Mild disturbance in sexual act 3      

Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)135
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction
  Erection whenever desired, Normal sexual act 4   √ √
3. Rigidity        
  Total loss of rigidity unable to maintain erection and initiate the act 0 √    
  Loss of rigidity, unable to maintain erection but can initiate the sexual act 1      
  Loss of rigidity, able to maintain the erection but unable to continue sexual act till last 2      
  Some loss of rigidity but can maintain erection and continue sexual act till last 3      
  Proper rigidity to maintain erection and continue the act till last 4   √ √
4. Ejaculation        
  Anejaculation 0 √    
  Ejaculation during foreplay 1      
  Ejaculation just before penetration 2      
  Ejaculation with own satisfaction 3      
  Ejaculation with own and partner satisfaction 4   √ √
5. Performance Activity        
  No anxiety, Normal performance activity in sexual act 0   √ √
  Anxiety that hampers the Mild performance activity in sexual act 1      
  Anxiety that hampers the Moderate performance activity in sexual act 2      
  Anxiety that hampers the Severe performance activity in sexual act 3      
  Anxiety that hampers the Severe performance activity in sexual act 4 √    

Objective Parameter

Hormone test BT (03/03/2022) DT (24/03/2022) AT (21/04/2022)
Serum Testosterone i. Testosterone Chemiluminescence 276.70 ng/dl 390.0 ng/dl 435.92 ng/dl
ii. Sex Hormone Binding Globulin 20.30 Nmol/L 25.43 Nmol/L 28.74 Nmol/L
iii. Free Testosterone 7.81 ng/dl 8.26 ng/dl 9.83 ng/dl
iv. Bioavailable Testosterone 151.0 ng/dl 207.0 ng/dl 251.0 ng/dl
v. Serum Prolactin 1.97 ng/ml 3.46 ng/ml  6.0 ng/ml

 

Semen Analysis BT DT (24/03/2022) AT (21/04/2022)
Semen Volume Absence of Semen 2.5 ml 1.5 ml
Fructose Present Present
Reaction Alkaline Alkaline
Liquification time 20 minutes 20 minutes
Count 65 millions/ml 60 millions/ml
Motility 50 % Actively Motile 10% Sluggish Motile 50 % Actively Motile 10% Sluggish Motile
Morphology Abnormal Forms 30% Abnormal Forms 30%

Self-Assessment done through as per International Index of Erectile Dysfunction Questionnaire Before and After Treatment

  Score BT AT
Over the past 6 months: 1 2 3 4 5    
How do you rate your confidence that you could get & keep an erection? Very low Low Moderate High Very high 01 05
When you had erection with sexual stimulation, how often was your erection hard enough for penetration? Almost never or never Much less than half the time Almost half the time Much more than half the time Almost always or always 01 05
During sexual intercourse how often able to maintain to erection after you had penetrated your partner? Almost never or never Much less than half the time About half the time Much more than half the time Almost always or always 01 04
During sexual intercourse how difficult was it to maintain your erection to the completion of intercourse? Extremely difficult Very difficult Difficult Slightly difficult Not difficult 01 05
When you attempted sexual intercourse how often was it satisfactory for you? Almost never or never Much less than half the time Almost Half the time Much more than half the time Almost always or always 01 04
Total Score 05 23

IIEF-5, Score is the sum of questions 1 to 5.
Before treatment, the score is 5 and the score after treatment is 23.
jaims_1918_04.PNG
Image 3: Penile Doppler report showing before treatment- Erectile dysfunction due to Arterial insufficiency


Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)136
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction

jaims_1918_05.PNG

Image 4: Penile doppler report showing After treatment - Normal doppler study

jaims_1918_06.PNG

Image 5: During treatment - After Deepana Pachana, Niruha Basti and Uttar Basti.


jaims_1918_07.PNG

Image 6: After Vrishya Yoga - Kapikacchu Ghana Vati

Result

Significant results were found in Dhwajanuccharya, Mlanasishnata, Moghasankalpachesta, Svinnagatrata, and Mukashosa. And observed improvement in sexual desire, Erection, Increased penile rigidity and reduced performance anxiety.

In objective parameter Serum Testosterone and Serum prolactin were increased after the Uttar Basti and Vrishya Yoga. Before treatment, the penile doppler report showed absence of expected normal persistent increase in PSV and reversal of diastolic flow in the bilateral cavernosal arteries with reduced PSV of cavernosal arteries even after 15 min of injection which suggest Erectile dysfunction due to Arterial insufficiency. After intervention significant change in Penile doppler is observed. That is presence of expected normal persistent increase in PSV and reversal of diastolic flow in the bilateral cavernosal arteries with normal PSV of cavernosal arteries after 5 min of injection which means normal doppler study. And observed a significantly increased in Length of the Penis in a flaccid state from 9cm to 11cm, and in circumference from 10cm to 10.5cm.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)137
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction

Discussion

Kayachikitsa is the potential applied practical up to date branch of Ashtanga Ayurveda that deals with the management of complex diseases along with genetic disorders, internal medicine, endocrinology, eugenesis, geriatrics, sexology, and psychiatry. When man started his livelihood concurrently his sexual behaviour and sexual dysfunctions started. Klaibya is an umbrella term classical and explain in detail in Ayurveda literature. The literal meaning of the term Klaibya includes impotence, eunuch, unmanliness, weakness, etc. It is a Karmendriya Vikara along with the involvement of Ubhaya-Indriya Manas. Klaibya is told due to Reto Dusti.

Erectile dysfunction includes all sorts of disturbances during the coital performance. It refers to problems during any phase of the sexual response cycle that prevents the man from experiencing satisfaction from the activity. Erectile dysfunction denoting the inability of a man to achieve an erection or problem with emission, ejaculatory dysfunction. These wide range of disorder pertaining to the male sexual response ultimately converts into male sterility also.

In Arterial insufficiency erectile dysfunction is due to Atherosclerosis, the condition in which a penile artery wall thickness as the result of a build-up fatty materials such as cholesterol affecting the penile arterial blood vessel, a chronic inflammatory response in the walls of arteries. Even with the advent of modern treatment, the success rate for Erectile dysfunction is very low. Atherosclerosis can be taken as Sroto Marga Nirodhana, With Vrushya Yogas, Basti, Uttar Basti etc. are added and can be given in Seminal Disorders like Klaibya. In Klaibya there is a definite derangement of Apana Vayu. The Sroto Dusti is Atipravrutti and Sanga. This Apana Vruddhi in its own Sthana needs a strong treatment to cure it as, Dosha aggravated in its own Sthana is naturally difficult to cure. Hence, Kosthashodhana, Basti, and Uttar Basti is the best way ahead to cure Klaibya.

Hareetakyadi Yoga, Ashwagandhadhi Niruha Basti, Murchita Tila Taila Uttar Basti and Kapikacchu Ghana Vati with Arsuhkara Lepa are used. Intervention has been found to be effective in breaking the chain reaction and proved to have hydroxyl radical scavenging activity.

Thus, helpful in cleansing the vessels and the elimination of doshas corrects the derangement of Apana Vayu. Owing the properties removes the blocks in the penile blood vessels and making the circulation of blood and mitigates the Amadosha which is seen in arterial insufficiency acts as anti-atherosclerotic property. Presence of tannin, phenols, flavonoids and terpenoid helps in the breakdown of the glucose and facilitate the absorption of free glucose by the cells due to its cleansing properties which does Srotoshodhana and Avarnahara. The L-dopa and its metabolite dopamine stimulate the hypothalamus and forebrain to secrete GnRH. Upregulates the anterior pituitary gland to secrete FSH and LH causing increased synthesis of testosterone by the Leydig cells of the testis. Increased level of dopamine in the brain increase in sexual drive, performance activity and accomplishes reduction of psychological stress that is reducing anxiety. Dopamine stimulates the Nitric oxide which does the relaxation of penile smooth muscle and increase the penile blood flow. The Arushkara Lepa owing properties like Tikhsna, Sukshma and Ushna Virya pacify Vata Dosha and acts as Swedana which does the Srotomukha Vishodhana and relaxes the cavernosal muscles and dilation of the penile vessel which increases the blood capacity. Thus, it increases the rigidity. Lepa is a Vrishya,Ggrahi, that increases sex drive, performance activity and improves erection.

Conclusion

Arteriogenic erectile dysfunction caused by the insufficient arterial blood supply to the cavernous bodies regardless of the arterial disease or abnormality responsible for the insufficiency. The subject shows the erectile dysfunction due to arterial insufficiency in penile doppler report. In Contemporary science penile revascularization and penis arterial-venous surgery is done in vascular erectile dysfunction. But in classics there are many treatment modalities which can be practised for Klaibya, but Shodhana, Niruha Basti, and Uttar Basti followed by Vrishya Yoga is proposed in vasculogenic erectile dysfunction. The selected intervention counteracts the aggravated Vata in erectile dysfunction, clears the Shukravaha Sroto Dusti and improves the sexual arousal, thus can be used as good intervention in treating the erectile dysfunction due to Arterial insufficiency.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)138
Pramod et al: Klaibya to Arterial Insufficiency Erectile Dysfunction

Showed a highly significant increase in erectile function, Penile rigidity, Ejaculatory function, and sexual desire. It has also shown a significant increase in total Sperm count, Serum Testosterone, Serum Prolactin, and IIEF score in the patient. And showed the significant result in penile doppler.

Declaration of patient consent: The author certifies that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images, reports, and other clinical information to be reported in the journal.

Reference

1. Peter E Lipsky Harrison’s Principles of internal medicine, vol.1, 16th Edition,Editor Jean D. Wilson et al.., Health Professions Division, Mc.Graw Hill,inc 2002, pp272.

2. Peter E Lipsky Harrison’s Principles of internal medicine, vol.1, 16th Edition,Editor Jean D. Wilson et al.., Health Professions Division, Mc.Graw Hill,inc 2002, pp273.

3. Acharya Agnivesha. Caraka Samhita. Ayurveda Dipika Commentary by Cakrapanidatta, Edited by Siddhi Nandan Mishra Acharya, Varanasi: Chaukamba Orientalia; First Edition 2009, Reprint Edition 2018, Siddhi Sthana, 9th Chapter, Verses 50-57, pp1078.

4. Acharya Agnivesha. Caraka Samhita. Ayurveda Dipika Commentary by Cakrapanidatta, Edited by Siddhi Nandan Mishra Acharya, Varanasi: Chaukamba Orientalia; First Edition 2009, Reprint Edition 2018, Chikitsa Sthana, 1st Chapter, Verses 25-25, pp5.

5. Acharya Agnivesha. Caraka Samhita. Ayurveda Dipika Commentary by Cakrapanidatta, Edited by Siddhi Nandan Mishra Acharya, Varanasi: Chaukamba Orientalia; First Edition 2009, Reprint Edition 2018, Siddhi Sthana, 3rd Chapter, Verses 16-19, pp981.

6. Acharya Govind Dasji Bhisagratna Bhaisajya Ratnavali, Commented upon by Vidya shri ambika datta shastri by Dr. Kanjiv Loachan First Edition 2006, Volume 3rd verses 355-356, pp558.

7. Acharya Govind Dasji Bhisagratna Bhaisajya Ratnavali, Commented upon by Vidya shri ambika datta shastri by Dr. Acharya Kaviraj 10th Edition 2010, 5/1286-1287, pp-1312.

8. Acharya Sarngadhara, Sarngadhara-Smhita, Madhyama Khanda,English Translation, Edited by Prof. K.R.Srikantha Murthy, Chaukhambha Orientalia, Varanasi:Reprint 2009, 7th Chapter, Verses 1-3, pp101.

9. Acharya Kalyanmalla, Ananga-Ranga, By A.F.F & B.F.R. Reprint MDCCCLXXXV, Chapter 6th, 4th prayoga pp47.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(8)139