E-ISSN:2456-3110

Research Article

Ksheena Shukra

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

To evaluate the efficacy of Ashwattha Churna with and without Virechana Karma in Ksheena Shukra (oligo-zoospermia) - A Comparative Study

Lokesh.1*, Aarti.2, Kusum.3, Kumar Katara P.4
DOI: http://dx.doi.org/10.21760/jaims.7.10.12

1* Lokesh, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, India.

2 Aarti, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, India.

3 Kusum, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, India.

4 Pankaj Kumar Katara, Assistant Professor, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, India.

In present scenario cases of infertility arise abundantly which is a serious problem among the present generation as it affects the person mentally hence can deteriorate life. There are various etiological factors related to male infertility. In Ayurveda the quality of Shukra is mentioned by various Acharya to produce a healthy progeny. But Shukra Dushti can lead to differently abled or no progeny. There are various types of Shukra Dushti mentioned by Acharya Sushrut, Ksheena -Shukra is one of them. Aim: To compare the efficacy of Virechana Karma followed by Ashwattha Churna and Ashwattha Churna alone in Ksheena Shukra (oligozoospermia). Objective: To assess the efficacy of Virechana Karma followed by Ashwattha Churna in Ksheena Shukra and to assess the efficacy of Ashwattha Churna alone in Ksheena Shukra and to detect increase in sperm count. Methods: It is open label, randomized, interventional and comparative study. Group A - In this group Virechana Karma followed by Ashwattha Churna was given. Group B - In this group Ashwattha Churna was given. Result: Group A (Virechana Karma followed by Ashwattha Churna) there was an increase of 55% in sperm count, increase of 11.6% in sperm motility, relief in Maithuna Ashakti is 50%, relief in Medra Vrishna Vedana is 32%, and relief in Chiraat Prashek is 32%. Conclusion: Both group shows statistically significant results in parameters i.e., Maithuna Ashakti, Medra Vrishna Vedana, Chiraat Prashek, sperm count, motility.

Keywords: Ksheena Shukra, Virechana, Shukradhatu, Shukradushti

Corresponding Author How to Cite this Article To Browse
Lokesh, Post Graduate Scholar, Department of Panchkarma, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, , India.
Email: 		Lokesh, Aarti, Kusum, Pankaj Kumar Katara, To evaluate the efficacy of Ashwattha Churna with and without Virechana Karma in Ksheena Shukra (oligo-zoospermia) - A Comparative Study. J Ayu Int Med Sci. 2022;7(10):94-103.
Available From
https://www.jaims.in/jaims/article/view/2123

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-10-01 2022-10-03 2022-10-10 2022-10-17 2022-10-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Lokesh, Aarti, Kusum, Pankaj Kumar Kataraand 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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Introduction

The chief desires of human life are Praneshana, Dhaneshana and Paralokeshana. In Ayurvedic classics there has been mentioned four Purushartha i.e., Dharma, Artha, Kama and Moksha. Kama is related with sexual gratification, which is one of the happiness in the life and to create a healthy progeny. As a result, human existence would be incomplete without fertility. Parenthood is one of the most cherished dreams of any couple, and a failure to conceive may lead to a strained marriage, divorce, or even suicide. Kashyapa explains that 'Aputrasya Gatirnasti' without offspring, the individual would not be able to obtain Moksha. Many people in rural regions of India feel ashamed of their inability to have children because of the stigma attached to infertility. Infertility may have a negative impact on a woman's physical and social well-being, as well as on her male partner's social standing. Ritu (reproductive age and ovulation period), Kshetra (female reproductive system), Ambu (nutritional variables) and Bija (conception) are the most important elements (sperm and ovum). Reproductive health is required for this to occur. Infertility is caused by a malfunction in the system. According to Ayurvedic texts, Shukradhatu is responsible for reproducing the body. A standard classification of Shukradusti names eight distinct varieties. Shukradusti prevents a person from completing their Chaturvidha Purushartha. A form of Shukradusti known as Ksheena Shukra is one of them. The occurrences of Infertility are increasing now days due to change in life style, sociocultural changes and influence of media and other habits like Smoking, Alcohol, Tobacco chewing etc. In this era of fast food, we are taking food, which is adulterated by preservatives and many other chemicals.

Infertility affects one in every six couples, according to statistics gathered in the last several years.[1] Male infertility is one of the most common and serious of these conditions, affecting up to 30-40 percent of men.[2] Oligozoospermia, asthenozoospermia, and azoospermia are all contributing factors.[3] One of the most common causes of infertility is oligospermia. An oligozoospermia diagnosis is made if there are fewer than 20 million sperm per millilitre of blood or 40 million per ejaculate, according to the World Health Organization's Semen analysis criteria.[4]

The sperm count should be at least 40 million/ml and the sperm motility should be at least 60%.[5] Even with a low sperm count (less than 05 million/ml), studies have shown that a woman may become pregnant if her sperm cells have strong Progressive Motility. It is similar to Ksheena Shukra, where Shukra Dhatu is reduced in both quantity and quality.

Ayurveda provides a glimmer of hope since it has a unique way of looking at Ksheena Shukra. Shukra is the seventh Dhatu in Ayurveda. Dhatu Majja Dhatu is the raw material for it.[6] the Oja, which provides the body with nourishment, is made up of the Sapta Dhatus as well as the Saara, which is accountable for the Oja.[7] Shukra should possess such a potency so as to conceive a lady.[8] Shukra being the ultimate Dhatu meant mainly for reproduction,[9] also attribute qualities as Dhairya, Chyavana, Preeti, Dehabala, Harsha etc. to males.[10] Astha Shukra Dusthi and Ksheena Shukra (Oligozoospermia), which are linked to Dourbalya and Mukhashosha and include the key Klaibya, Shukra Kshaya, and Maithuna Ashakti, may result from a variety of abnormalities, including deformities. Ksheena Shukra is a Doshabala Pravrutta, Kruchra-Sadhyaroga of Shukravaha Srotodusti, where Dushita Vata and Pitta are connected.[11] We may conclude that Oligo-asthenozoospermia belongs under the umbrella of Sukraduşţi, which includes a variety of different clinical illnesses that affect the Srotas of the Sukravaha. In the subject of Andrology, the study of herbal fertility agents is a key focus. It would be a huge help to the world's population, which is suffering greatly due to infertility, if the Vajikarana branch of Ayurveda could make a contribution to finding a solution to this issue. In addition to its aphrodisiac qualities, Vajikarana has a significant motto. “Apatya Santankaraha”.[12] It provides progeny to infertile couple, sexual potency to the impotent at the same time therapy assures the excellency of progeny. Avapeedaka Sneha is mainly indicated in Adhonabhigata Vikaras, it alleviates Pitta and Vata & thus gives strength to pelvis and thighs. It is Balya and acts as Vrushya.

According to Vaghbata, Avapeedaka Snehapana is administration of Sneha in large doses both before taking of food and after digestion of food.[13] Sneha Virechana Karma is regarded as Shodhana's preferred method of managing Ksheena Shukra.


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Virechana Karma is one of Pitta's most important therapy methods. The reduction of Vata is another important benefit. Before providing Rasayana and Vajikarana, this is one of the recommended Shodhana Karma.[14] Acharya Kashyapa has glorified the importance of Virechana Karma in the management of Ksheena Shukra. Because it purifies the Beeja (sperm) thus, making it effective in achieving Fertilization. It also improves sexual vigor (Vrishata) and helps in achieving good progeny (Apatya).[15] Ksheena Shukra has been the subject of several investigations; however, an effective and safe formulation is still required to address this issue. For the present clinical study herbal formulation - Aswattha Churna was selected. According to Acharya Susruta Aswattha Churana is Vajikara Dravya. It is due to its Madhur Rasa and Snigdha Guna properties. Keeping the fundamentals of management in mind the current study was conducted which entitled as – “To evaluate the efficacy of Ashwattha Churna with and without Virechana Karma in Ksheena Shukra (oligozoospermia) a comparative Study” with following aims and objective.

Aim

To compare the efficacy of Virechana Karma followed by Ashwattha Churna and Ashwattha Churna alone in Ksheena Shukra (oligozoospermia).

Objectives

To assess the efficacy of Virechana Karma followed by Ashwattha Churna in Ksheena Shukra, to assess the efficacy of Ashwattha Churna alone in Ksheena Shukra, to detect increase in sperm count.

Materials and Methods

This study was done on 60 registered of Ksheena Shukra (oligozoospermia) patients and randomly divided in two groups of 30 each.

Group A: In this group Virechana Karma followed by Ashwattha Churna was given.

Group B: In this group Ashwattha Churna was given.

Consent: Written informed consent was taken on prescribed Performa before the inclusion of patient in trial. They were briefed about merits and demerits of research plan before taking consent.

IEC Certificate No. CBP-IEC/ 2019/PK/MD/04

CTRI No. CTRI/2021/03/031627

Method of evaluation

Clinical screening: A detailed case history Performa was specially prepared for this purpose. All the following mentioned points were recorded in this Performa before initiating the trial.

Pre-trial screening: This was done before the commencement of the clinical trial.

  • Semen Analysis
  • Serum FSH
  • Serum LH

Total 90 patients were screened out of basis of inclusion and exclusion criteria. Out of them 60 patients were fulfilled the clinical trial criteria and these patients were selected for clinical trial.

A. Selection of patient: The study was conducted on 60 clinically diagnosed and confirmed cases of Ksheena Shukra (oligozoospermia) from OPD of Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi.

B. Criteria of diagnosis: The main criteria of diagnosis of patients were based on the cardinal associated sign and symptoms of disease based on the Ayurvedic and modern texts.

C. Criteria of inclusion

1. Sperm count < 15 million/ml.

2. Male patients belonging to 21yr to 45 years of age.

3. Patient suitable for Virechana Karma.

D. Exclusion criteria

1. Patients with azoospermia and aspermia.

2. Genetic defects like Klinefelter’s syndrome.

3. Patients with diseases like Varicocele, Accessory sex gland infection, sexually transmitted diseases, and systemic diseases like DM etc.

4. Patient not suitable for Virechana Karma.

Grouping: Patients were randomly divided and studied under two Groups viz. Group A and Group B irrespective of religion, sex, occupation, cast etc.

Group A: In this group Virechana Karma followed by Ashwattha Churna was given.


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Group B: In this group Ashwattha Churna was given.

Total Duration of trial

45days for each Patient

Table 1: Showing procedure protocol

Procedure Drug dose Duration
Deepan and Pachana Deepan and Pachan with Chitrakadi Vati From 3 days till then achievement of Langhita Lakshanas.
Snehapana Snehapana with Go Ghrita as per Kostha and Agni (in morning with empty stomach 6 am) 3-7 days
Abhyanga and Swedana Abhayang with Mahanarayana Tail (45 mins) Swedana Karma (10-15 days) 3 days
Virechana 2 Karsha Trivrita Churna[16]

Follow-up screening

Initial assessment

0 day, assessment after Virechana Karma and 30th day done to evaluate their clinical status and to observe the effect or adverse effect of treatment.

Criteria of withdrawal

  • During the course of trial if any serious condition or any serious adverse effects of occur which required urgent treatment.
  • Patient himself wants to withdraw from the clinical trial.

Criteria of Assessment

All the patients were assessed for relief in sign and symptoms after the completion of trial. For subjective parameters grading/scoring pattern were adopted which is as follows;

Subjective Parameters

  • Relief in the symptoms of Ksheena Shukra Klaibyam, Sukraavisarga, Medra-Vrshnavedana, Maidhunaashakti

Objective parameters

  • Semen analysis i.e., Total sperm count and Motility.
  • Serum FSH
  • Serum LH Subjective & objective parameters will be assessed before, and after Virechana and Ashwattha Churna intake.


For Statistical Analysis

The level of significance was prescribed in following manner:

  • Non-significant (NS) - p > 0.05
  • Significant (S) - p <0.05
  • Highly significant (HS) - p < 0.001
  • Extremely significant (ES) - p < 0.00

Observations and Results

jaims_2123_01.JPG

Table 2: Comparison of Semen Volume before and after treatment in both the groups

Group Before Treatment After Treatment % Relief Within group comparison
Mean Standard deviation Mean Standard deviation t -value p - value
Virechana Karma + Ashwattha Churna 2.929 0.9100 3.34 0.831 14.03% 2.977 0.006 (*)
Ashwattha Churna 3.161 0.8504 3.13 .919 0.98% 0.311 0.758
Between group comparison  
t-value 0.986 0.900
p-value 0.328 0.372

Within group comparison done using paired sample t-test. Between group comparisons done using independent sample t-test.

(*) p-value is significant at 5% level of significance

Within group comparison revealed a significant difference after treatment in the semen volume (p-value = 0.006) in Virechana Karma + Ashwattha Churna group. Semen volume increased from 2.929 before treatment to 3.34 after treatment in Virechana Karma + Ashwattha Churna group. It was observed that Ashwattha Churna when administered with Virechana Karma showed a better effect on increasing semen volume than Ashwattha Churna given alone (14.03%v/s 0.98%).


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jaims_2123_02.JPG

Table 3: Comparison of Total Sperm Count before and after treatment in both the groups

Group Before Treatment After treatment % Relief Within group comparison
Mean Standard deviation Mean Standard deviation t-value p-value
Virechana Karma + Ashwattha Churna 11.70 2.451 26.35 15.984 125.21% 5.098 <0.001(*)
Ashwattha Churna 11.32 3.026 14.89 8.870 31.5% 2.736 0.011(*)
Between group comparison      
t-value 0.519 3.318
p-value 0.606 0.002 (*)

Within group comparison done using paired sample t-test. Between group comparison done using independent sample t-test.

(*) p-value is significant at 5% level of significance

Within group comparison showed a significant difference after treatment in total sperm count in both the groups (p-value < 0.05). Moreover, between group comparison also revealed a significant difference after treatment (p-value = 0.002). It was evident that total sperm count showed a significant improvement in Virechana Karma + Ashwattha Churna group (% change = 125.21%) as compared to in Ashwattha Churna group (% change = 31.5%)

jaims_2123_03.JPG

Table 4: Comparison of Motility (%) before and after treatment in both the groups

Group Before Treatment After Treatment % Relief Within group comparison
Mean Standard Deviation Mean Standard Deviation t-value p-value
Virechana Karma + Ashwattha Churna 36.54 7.053 41.36 9.109 13.2% 3.840 0.001 (*)
Ashwattha Churna 36.25 5.835 38.32 7.503 5.7% 2.773 0.010 (*)
Between group comparison      
t-value 0.165 1.361
p-value 0.869 0.179

Within group comparison done using paired sample t-test. Between group comparison done using independent sample t-test.

(*) p-value is significant at 5% level of significance

Within group comparison showed a significant difference after treatment in motility in both the groups (p-value < 0.05). However, no significant difference was observed after treatment between both the groups. However, Virechana Karma + Ashwattha Churna group showed better results (% change = 13.2%) as compared to the group in which Ashwattha Churna was given alone (% change = 5.7%)

jaims_2123_04.JPG

Table 5: Comparison of Liquefaction before and after treatment in both the groups

Group Before Treatment After Treatment % Relief Within group comparison
Mean Standard Deviation Mean Standard Deviation t-value p-value
Virechana Karma + Ashwattha Churna 30.64 4.855 30.21 5.350 1.4% .383 0.704
Ashwattha Churna 30.36 7.689 32.61 7.218 7.4% -2.417 0.023(*)
Between group comparison  
t-value 0.166 1.409
p-value 0.869 0.164

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Within group comparison done using paired sample t-test.

Between group comparisons done using independent sample t-test. (*) p-value is significant at 5% level of significance

Significant difference after treatment was observed in liquefaction in Ashwattha Churna group (p-value = 0.023).

However, no significant difference was observed after treatment between both the groups.


jaims_2123_05.JPG


Table 6: Comparison of Total abnormal forms before and after treatment in both the groups

Group Before Treatment After Treatment % Relief Within group comparison
Mean Standard Deviation Mean Standard Deviation t-value p-value
Virechana Karma + Ashwattha Churna 34.46 8.090 33.11 7.932 3.9% 1.520 0.140
Ashwattha Churna 33.93 8.645 36.43 9.315 7.4% 3.000 0.006 (*)
Between group comparison  
t-value 0.239 1.437
p-value 0.812 0.157

Within group comparison done using paired sample t-test.

Between group comparison done using independent sample t-test.

(*) p-value is significant at 5% level of significance

Significant difference after treatment was observed in total abnormal forms in Ashwattha Churna group (p-value = 0.006).

However, no significant difference was observed after treatment between both the groups.

jaims_2123_06.JPG

Table 7: Comparison of Serum LH before and after treatment in both the groups

Group Before Treatment After Treatment % Relief Within group comparison
Mean Standard Deviation Mean Standard Deviation t-value p-value
Virechana Karma + Ashwattha Churna 3.72 1.791 3.75 1.749 0.8% 0.432 0.669
Ashwattha Churna 3.65 1.589 3.78 1.533 3.56% 2.201 0.036 (*)
Between group comparison      
t-value 0.166 0.054
p-value 0.869 0.957

Within group comparison done using paired sample t-test. Between group comparison done using independent sample t-test.

(*) p-value is significant at 5% level of significance

Significant difference after treatment was observed in Serum LH levels in Ashwattha Churna group (p-value = 0.036).

Mean serum level in Ashwattha Churna group before treatment was 3.65 which increased to 3.78 after treatment.

However, no significant difference was observed after treatment between both the groups.

jaims_2123_07.JPG



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Table 8: Comparison of Serum FSH before and after treatment in both the groups

Group Before Treatment After Treatment % Change Within group comparison
Mean Standard Deviation Mean Standard Deviation t-value p-value
Virechana Karma + Ashwattha Churna 5.99 3.122 5.95 3.070 0.66% 0.323 0.749
Ashwattha Churna 7.02 2.214 6.81 2.175 3.0% 1.965 0.060
Between group comparison      
t-value 1.425 1.218
p-value 0.160 0.228

Within group comparison done using paired sample t-test.

Between group comparisons done using independent sample t-test.

No significant difference was observed in the FSH levels after treatment in both the groups. Moreover, between groups analysis also revealed no significant difference in after treatment serum FSH levels in both the groups.

jaims_2123_08.JPG

Table 9: Comparison of Viscosity before and after treatment in both the groups

Viscosity   Virechana Karma + Ashwattha Churna Ashwattha Churna Between Group p-value
Before Treatment Thick 9 (32.1%) 12 (42.9%) 0.408
Thin 19 (67.9%) 16 (57.1%)
After Treatment Thick 16 (57.1%) 16 (57.1%) 1.000
Thin 12 (42.9%) 12 (42.9%)
 Within Group p-value 0.016 (*) 0.125  

Within group p-value compared using mc-nemar test Between group p-value compared using chi-square test

(*) p- value is significant at 5% level of significance

Within group comparison using mc-nemar test revealed a significant difference

(p-value = 0.016) in the viscosity in the Virechana Karma + Ashwattha Churna group

Table 10: Comparison of PH before and after treatment in both the groups

PH   Virechana Karma + Ashwattha Churna Ashwattha Churna Between Group p-value
Before Treatment Acidic 1 (3.6%) 2 (7.2%) 0.601
Alkaline 27 (96.4%) 26 (92.8%)
After Treatment Acidic 0 1 (3.6%) 1.000
Alkaline 28 (100.0%) 27 (96.4%)
Within Group p-value - -  

Within group p-value compared using mc-nemar test

Between group p-value compared using chi-square test.

Discussion

Klaibya / Maithuna Ashakti: In Group A, 23 patients were having Maithuna Ashakti which reduced to 9 after giving Virechana Karma and Ashwattha Churna, While in Group B, 21 patients were having Maithuna Ashakti which reduced to 15 after given only Ashwattha Churna. Hence, it is concluded that in group A, 14 patients got relief and in Group B, 6 patients got relief. So, Virechana Karma and Ashwattha Churna is best to improve Maithuna Shakti. In Virechana Srotoshudhi occur and strength of Indriya increase. So, Group A patient got more relief than Group B.

Medra Vrishan Vedana: In Group A, 13 patients were having Medra Vrishan Vedana which reduced to 4 after giving Virechana Karma and Ashwattha Churna, While in Group B, 12 patients were having Medra Vrishan Vedana which reduced to 9 after given only Ashwattha Churna. Hence, it is concluded that in group A, 9 patients got relief and in Group B, 3 patients got relief. So, Virechana along with Ashwattha Churna is best for treating Medra Vrishan Vedana than only Ashwattha Churna.

Chiraat Prasek: In group A, 10 patients were having Chiraat Praseka which reduced to 1 in group A while in group B it reduced from 12 to 9. Hence, it can be concluded that in Group A 9 patients got relief while in Group B only 3 got relief. So Virechana along with Ashwattha Churna is best for treating Chiraat Praseka than only Ashwattha Churna.



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By Virechana Karma, Apana Vayu comes in its normal state as there is proper evacuation of faeces, micturition on so same with ejaculation of semen.

Semen Volume: In Group A 3.34 mean was reduced to 2.92 which means improvement of 12.5 % while in Group B Mean was 3.13 which reduced to 3.16 which means no significant improvement was present.

Total sperm count: In group A mean was 26.35 which reduced to 11.70 which means improvement of 55.5% while in Group B mean was 14.89 which reduced to 11.32 which means improvement of 23.9%. Medhra , Vrishan, Kati and Vankshan are site of Apana Vayu, when Apana Vayu gets vitiated leads to Ksheena Shukra with this imbalance of Jatharagni and Dhatvagni also results Ksheena Shukra, after Virechana Karma vitiated Apana Vayu gets Anulomana and Pitta Dosha gets balanced which is the main entity of body represents Agni and maintain Jatharagni and Dhatvagni and Acharya Charak has mentioned that Sanshodhana Karma is itself leads Vrishyata and Aswattha Churna have Vajikarna effects hence, Virechana Karma followed by Aswattha Churna results in increased sperm count.

Motility: In group A mean was 41.36 which reduced to 36.54 which means improvement of 11.65% while in Group B mean was 38.32 which reduced to 36.25 which means improvement of 5.4 %. In Ksheena Shukra, Vata and Pitta Doshas gets vitiated, for removing vitiated Pitta, Virechana Karma is applied, it also leads to Srotoshodhana and active transformation of Dhatu through Dhatvagni Vyapara and the most desirable Shuddha Shukra is formed. The whole procedure helps in eliminating the oxidants (Aama) presents in Shukravaha Srotsas, which obstacle function of Shukra by doing so, increase activity of Shukra (sperm).

Liquification: In group A mean was 30.21 which increased to 30.64 while in Group B Mean was 32.61 which was reduced to 30.36 which shows improvement of 6.8%. No significant result seen.

Total abnormal forms: In group A mean was 33.11 which increased to 34.46 while in Group B 36.43 which reduced to 33.93 which shows improvement of 6.8%. No significant result seen.


Conclusion

Both group shows statistically significant results in parameters i.e., Maithuna Ashakti, Medra Vrishna Vedana, Chirat Prashek, sperm count, motility. Group A (Virechana Karma followed by Ashwattha Churna) there was an increase of 55% in sperm count, increase of 11.6% in sperm motility, relief in Maithuna Ashakti is 50%, relief in Medra Vrishna Vedana is 32%, and relief in Chiraatprashek is 32%. Upon comparing both the group, statistically significant difference observed in parameters i.e., Maithuna Ashakti, Medra Vrishna Vedana, Chirat Prashek, sperm count, motility. Group A was found statistically (p-value = 0.011) and is clinically better than group B in management of Ksheena Shukra.

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1. Stedman‟s Medical Dictionary, 25th Edition Illustrated, Page No. 1083.

2. Hawkins& Bourne, Shaw‟s Textbook of Gynecology, 12th Edition, B. I. Churchill Livingstone, New Delhi, Page No. 157.

3. www.drmalpani.com/oligospermia.html as seen on 20/12/2015

4. http://www.fertilityfriends.co.ukforumindex.phptopic=82727.0 03/03/2016

5. Harrison’s Principles of Internal Medicine, Volume-I, edited by Anthony S Fauci & Kasper, Braunwald, Stephen L. Hauser, Loscalzo, 16th edition-2005, Page No.280.

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7. Astanga Hridaya of Vagbhata with Sarvanga Sundari commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri, Edited by Pt.Hari Sadashivashastri paradhakara, Chaukhambha Sanskrit Samsthana, Varanasi, Reprint Edition-2010, Sutrasthana, 11th chapter, Sloka no.37, Page no.189.

8. Charaka Samhita, Ayurveda Dipika’s Ayushi Hindi Commentary, Volume-II Edited by Vd.Harishchandra Singh Kushwaha. Choukambha Orientalia. Varanasi,


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Journal of Ayurveda and Integrated Medical Sciences 2022;7(10)102