E-ISSN:2456-3110

Case Report

Benign Prostate Hyperplasia

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 7 August
Publisherwww.maharshicharaka.in

A case study to evaluate the effect of Dashamoola Basti in Asthila w.s.r. to Benign Prostate Hyperplasia

Hemant.1*, Shreyas D.2, M Goud K.3
DOI:

1* Hemant, Post Graduate Scholar, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Vijayanagar, Bengaluru, Karnataka, India.

2 DM Shreyas, Assistant Professor, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Vijayanagar, Bengaluru, Karnataka, India.

3 Kiran M Goud, Professor, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Vijayanagar, Bengaluru, Karnataka, India.

BPH (Benign Prostate Hyperplasia) is a histological diagnosis that states the proliferation of smooth muscle and epithelial cells within the transient zone of prostate gland. The incidence and severity of lower urinary tract symptoms (LUTS) are increasing day by day and more likely to occur in old ages. Due to the resemblance of clinical feature, it is correlated to Asthila which is one of the types of Mutraghata according to all the Acharyas. In this case study a male patient came to OPD of SKAMCH&RC and was diagnosed for Asthila w.s.r. to BPH. He was given management like Sarvanga Abhyanga, Sarvanga Bashpa Swedana and Dashamoola Niruha Basti adopted in Kala Basti Pattern followed by oral medication in follow-up period. The patient showed marked improvement in the symptomatology. It was conclusive study to show the effect of Dashamoola Basti in the management of Asthila w.s.r. to benign prostate hyperplasia (BPH)

Keywords: Asthila, Benign Prostate Hyperplasia, BPH, Dashamoola Basti, Basti Amyantika Ghrita, Panchakarma

Corresponding Author How to Cite this Article To Browse
Hemant, Post Graduate Scholar, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Vijayanagar, Bengaluru, Karnataka, India.
Email: 		Hemant, DM Shreyas, Kiran M Goud, A case study to evaluate the effect of Dashamoola Basti in Asthila w.s.r. to Benign Prostate Hyperplasia. J Ayu Int Med Sci. 2022;7(7):168-172.
Available From
https://www.jaims.in/jaims/article/view/1997

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-06-28 2022-06-30 2022-07-07 2022-07-14 2022-07-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Hemant, DM Shreyas, Kiran M Goudand 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].

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Hemant et al: Dashamoola Basti in Asthila w.s.r. to Benign Prostate Hyperplasia

Introduction

Benign prostatic hyperplasia and lower urinary tract symptoms contributes to a major part as a diseases in ageing men. The pathophysiology involves the role of androgen, estrogen and growth factor in manifestation of BPH.[1] The symptomatology is defined in easy manner as a questionnaire form known as international prostate symptom score (IPSS) comprising eight written screening tool used to screen for rapid diagnosis and track the symptoms of BPH.[2] BPH is found mostly in elderly people involving growth in the transient zone (commonly) of prostate gland which further compress the urethra causing partial or complete obstruction of the urine output. When BPH starts from transient zone the glandular and stromal components of peripheral zone compresses suggesting lateral lobe enlargement. Out of Mutraghata mentioned by Acharyas, Astheela is considered to be close relation to BPH on the basis of clinical features and histology. It is mainly caused when the Vayu cause obstruction in the bladder and rectum which produces mobile and elevated tumour leading to obstruction of the passage. The treatment modality includes wait period followed by medical and surgical interventions. As Basti is told as one among the major treatment modalities for Mutraghata, it provides patients a hope to avoid or postpone the surgical interventions along with significant relief in the symptomatology.

Case Report

A 58 years old male patient who belongs to upper middle class family working as Executive Officer in Government sector came to OPD of SKAMCH&RC with the complaints of Repeated urge to Urinate, Urge to urinate at night, Difficulty to hold the urine urge, Sensation of incomplete evacuation of Urine, Dribbling of urine at the end of stream, Weak urine stream, Difficulty in initiating the urine, stopping and starting again the flow of urine wile urination since 3 years. On enquiry almost always the patient had a sensation of not emptying his bladder. There was also an increase in the frequency of the urine, almost every 2-3 hours patient has the sensation to pass the urine. Patient usually found difficulty to hold the urination urge. The stream of urine was weak and he founds difficulty in maintaining the stream of the urine. The patient has to strain often to initiate the urination.

All the symptoms arise gradually with moderate severity and patient finds irritability from the repeated urge to urine, urination urge at night and difficulty to hold the urine urge.

The symptoms were hampering the day-to-day activities and night sleep. The urge to urinate in night increases if the patient drinks water at night, therefore the patient was avoiding drinking any fluids past 8 o’clock which means the symptoms aggravates on high fluid diet and relived a little on low fluid diet. The patient also complaints of disturbed sleep with markedly delayed sleep induction along with considerable problem with awakening during night time. Patient final awakening is little earlier than desired. The total sleep duration is markedly insufficient. Patient told about markedly unsatisfactory overall sleep which also was impacting on well being during the day and causing day sleep since 6 years which appeared gradually. The work profile of patient was stressful and often without breaks involving sometimes to hold the urine for hours.

From past 3 years the quality of sleep have been diminished to a greater extend. Patient had consulted in a private hospital where he underwent USG stating prostatomegaly with significant postvoid residual urine volume and PSA value of 0.80 ng/ml stating no malignancy suggestive of the diagnosis as BPH and asked to opt for surgery but patient denied for surgical intervention.

The patient was prescribed with Tablet Silodosin 8 mg O.D. and Tab. Trazodone- 50 mg B.D. for the same. He found relief in the symptomatology and stopped the medicine after 4 to 5 months. Patient had reoccurrence of same sort of symptoms again which was affecting his day-to-day life activities since 3 months. He doesn’t want to undergo the surgical intervention suggested by the contemporary doctors and therefore came here for further management after he got to know about the ayurveda line of managements from his friend.

Intervention Given to the Patient

From 24/02/2022 to 11/04/2022

1. Sarvanga Abhyanga with Moorchita Taila

2. Sarvanga Bashpa Swedana

3. Dashamoola Niruha Basti in Kala Basti Pattern as shown in Table: 1



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From 12/04/2022 to 12/05/2022

1. Tablet Bangshil - 1 BD

2. Tablet Fortege - 1 TID

3. Vastyamayantaka Ghrita - 1 Tsf B.D.

Table 1: Showing Dashamoola Niruha Basti in Kala Basti Pattern

Niruha Basti Auvasana Basti
Honey - 40 ml Saindhava Lavana - 6 gm Vastyamayantaka Ghrita - 100 ml Shatapushpa Kalka - 30 gm Dashamoola Kwatha - 500 ml Vastyamayantaka Ghrita - 80 ml
Kala Basti Pattern Followed
Days 1 2 3 4 5 6 7 8
Basti A N A N A N A N
 
Days 9 10 11 12 13 14 15 16
Basti A N A N A A A A

Observations and Results

The patient condition improved gradually with treatment. After the commencement of the treatment there was a significant reduction in the symptoms like Repeated urge to Urinate, urge to urinate at night, Difficulty to hold the urine urge, Sensation of incomplete evacuation of Urine, dribbling of urine at the end of stream, Weak urine stream, Difficulty in initiating the urine, Stopping and starting again the flow of urine wile urination and Disturbed sleep which again got improved after follow up period. Assessment parameters Before Treatment, After Treatment and After Follow-up was recorded by using IPSS and Athens Insomnia Scale as shown in Table: 2. The reduction in symptomatology is depicted graphically in figure: 1 and figure: 2.

Table 2: Showing IPSS & Athens Insomnia Scale

In the Past Month BT AT AF
Incomplete Emptying 5 2 1
Frequency 3 1 1
Intermittency 1 0 0
Urgency 3 1 0
Weak Stream 5 3 2
Straining 3 2 1
Nocturia 2 1 0
Total Score 22 10 5
Quality of Life 5 3 2
Athens insomnia Scale 13 9 6

jaims_1997_01.JPGFigure 1: Showing IPSS Total Score and Athens Insomnia Scale

jaims_1997_02.JPGFigure 2: Showing IPSS Sub Scores

Discussion

The term Mutraghata on splitting stands for Mutra and Aghata meaning low urine output either by retention or any other cause. Acharyas have not mentioned general causative factors for Mutraghata but the Nidanas mentioned for Mutrakricchra[3] and Mutravaha Sroto Dusti[4] can be considered among them. Among Nidanas patient was having Mutravega Dharana as of his occupation, Ruksha Padarth Sevana, Ratijagrana, Chinta, Adhyashana, Nityadrutaprishta Yaanat


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which can now be considered as excess travelling on bike. Abhyanga, Swedana[5] and Basti are among the treatment protocols told by Acharyas for the treatment of Mutraghata which were opted here as intervention and all the measures adopted for Mutrakrichchhra can be administered in all the varieties of Mootraghata.[6] Here the ingredients of Dashamoola are well known for their Vatahara and Shothahara action along with Dashamoola imparting potential anti-inflammatory with analgesic effect as par reviewed of studies done which has been well documented by Acharya Charaka.[7] The Sneha used here which is Vastyamayantaka Ghrita has a reference in Sahasrayoga Ghrita Prakarana which is indicated in all types of Mutraghata by providing Vata Pittahara Karma by the virtue of combination of ingredients present in it. Basti is a treatment modality having supreme combinations of ingredients as per disease condition which also can be given in young as well as elders.[8] Here the condition is Vata Pradhana where Pakvashaya is the specific place of Vata, the specific place of action of Basti is on Pakvashaya and Vata Dosha resulting in Vata Shamana and Samprapti Vighatana which can be seen as reduced symptomatology. In Trimarmiya Siddhi Sthana of Charaka Samhita, it is told to protect the Trimarmas from aggravated Vayu. If afflicted by the Vata Dosha, they should be treated with the help of Basti Karma as the first choice for the safeguard of the Trimarma because the Marmaparipalanam can be done by the action of Basti Karma.[9] The main basis of adopting the Kala Basti pattern is purely based on the Yukti of assessing the extent of vitiation of Vata and its capability to disturb the haemostatic balance of other two Doshas. This pattern of Basti is adopted after the consideration of strength of individual for the procedure commencement, extent of vitiated Dosha and Kala[10] along with the Sukshma Vichara about Dosha, Bheshaja, Desha, Kala, Bala, Sharira, Ahara, Satmaya, Satva, Prakriti and Vaya. Taking these in mind the Basti ingredients along with Kala Basti Pattern have been selected as the intervention. Also when the aggravated Vata is localized in the Gulma Sthana causing Shotha and Shoola together resulting in the formation of Gulma[11] through which Gulma Chikitsa is applied enumerating Abhyanga, Swedana and Basti as mentioned.[12] The selection of Sarvanaga Abhyaga and Bashpa Swedana is based on the criteria that they are one among the treatment modalities told by Acharyas for Mutraghata

and also serves as Poorvakarma to Basti Karma. As Apana Vata is the Pradhana culprit for the Samprapti, the treatment provided help in regaining the correct function of Apana Vata along with the achievement of Vatanulomana action.

As the clinical features have more priority than the investigations to diagnose any illness, the IPSS found to be the great tool for the screening and tracking the symptomatology of BPH. Because of the corrected nocturia and the action of Abhyanga served as Kshramahara, Vatahara and promotes proper sleep, the patient finds much relieve in the disturbance of sleep and there is an improvement in overall quality of sleep which is recorded on Athens Insomnia Scale. For the follow up Vastyamayantaka Ghrita is given as a Shamanaga Snehapana in the dosage of Alpa Matra[13] along with Tablet Bhangshil and Tablet Fortege which were found to be very responsive by helping in toning up the functions of genitor urinary system and decongestion of prostate.

The use of Shilajatu preparations playing a role as inhibiting prostatic stromal proliferation and possible advert the reoccurrence of disease due to immunomodulatory action and multipurpose therapeutic usage.

Conclusion

Panchakarma modalities along with oral medications are found to be profitable in improving quality of life of the patient and reducing the symptomatology of the disease. The management can be a bright spot which helped the patient to avoid and postpone the surgical intervention. The simple treatment protocol giving significant results in a patient who was told to undergo surgical intervention gives a boost to the confidence in the concepts dealt by the Acharyas.

The results were encouraging and giving a further scope of research on large sample to generalize above management protocol for Asthila (BPH).

Declaration of Patient Consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for the reporting of the case and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.


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Reference

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2. Taneja, Yogesh & Ram, Priyatama & Kumar, Satish & Raj, Kishan & Singh, Charan & Dhaked, Santosh & Jaipuria, Jiten. (2017). Comparison of Visual Prostate Symptom Score and International Prostate Symptom Score in the evaluation of men with Benign Prostatic Hyperplasia: A prospective study from Indian population. Prostate International. 5. 158-161.

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6. Agnivesha, Charaka Samhita with Ayurveda Deepika Commentary, Sidhi Sthana 9:49-50, Reprint edition, Chaukhambha Publications 2015. p. 720.

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9. Agnivesha, Charaka Samhita with Ayurveda Deepika Commentary, Sidhi Sthana 9:7, Reprint edition, Chaukhambha Publications 2015. p. 717.

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13. Pandit Kashirama. Uttara Khanda 5:5. Sharangdhar Samhita Reprint Edition, 2012: Varanasi: Chaukhambha Orientalia; p. 320.


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