E-ISSN:2456-3110

Case Report

Infertility

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

Role of Panchakarma in Male Infertility w.s.r to High Altitude Induced Asthenozoospermia: A Case Report

Kumari P.1*, Bhardwaj A.2, Kapil S.3
DOI: http://dx.doi.org/10.21760/jaims.8.5.42

1* Priyanka Kumari, Post Graduate Scholar, PG Department of Panchkarm, RGGPG Ayu. College, Paprola, Himachal Pradesh, India.

2 Anil Bhardwaj, Associate Professor, PG Department of Panchkarm, RGGPG Ayu. College, Paprola, Himachal Pradesh, India.

3 Soni Kapil, Associate Professor, PG Department of Prasuti Tantra evum Stree Roga, RGGPG Ayu. College, Paprola, Himachal Pradesh, India.

Background of the Study: Infertility is a diseased condition of the reproductive system which can be defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected intercourse. It is a major health issue affecting 8%-12% of couples worldwide. Male factor contributes to 20-30%, in India the contribution rate is 23%. Asthenozoospermia is a common cause of male infertility defined as reduced sperm motility, lower than 40%. Present study is looking at the impact of chronic exposure of high altitude (environmental hypoxia) on male infertility. Hypoxia acts directly on testicular seminiferous tubules resulting in impaired quantity and quality of sperm cells. Ayurveda explains male oriented infertility under the wide classification of Ashtshukradosha and asthenozoospermia which can be correlated with Ksheena Shukra. In case of Ksheenshukrta there is predominance of vitiated Vata and Pitta. Ayurvedic literature clearly mentioned Virechan Karma in Ksheena Shukra. Aim & Objectives: The main aim of this study was to evaluate the effect of high-altitude exposure on seminal parameters along with its successful management with Virechana Karma. Result: The current case study of a 29 years old male visiting the OPD section with 20% active sperm motility treated with Virechana Karma after Snehana and Swedana which resulted in the positive effect and the female partner conceived the very next month after Virechana Karma. Conclusion: The case study established the positive impact of Virechan karma in male infertility due to asthenozoospermia.

Keywords: Asanas, Obesity, Sthaulya, Shaileyadi Churna, Udvartana

Corresponding Author How to Cite this Article To Browse
Priyanka Kumari, Post Graduate Scholar, PG Department of Panchkarm, RGGPG Ayu. College, Paprola, Himachal Pradesh, India.
Email: 		Priyanka Kumari, Anil Bhardwaj, Soni Kapil, Role of Panchakarma in Male Infertility w.s.r to High Altitude Induced Asthenozoospermia: A Case Report. J Ayu Int Med Sci. 2023;8(5):245-249.
Available From
https://jaims.in/jaims/article/view/2379

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-03-25 2023-03-27 2023-04-03 2023-04-10 2023-04-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Priyanka Kumari, Anil Bhardwaj, Soni Kapiland 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

Infertility is a big health burden nowadays and makes couples unable to produce their offspring. It can affect both males and females irrespective of their gender. Males’ infertility constitutes about 40% of infertility case and females’ infertility constitutes about 40% of infertility cases.[1] Under various causes of male infertility obesity, psychological stress and hypoxia are predominant causes.[2] Hypoxia can be defined as a transient or sustained decrease in arterial oxygen partial pressure that is less than 90%.[3,4] Exposure to extraordinary conditions like living in high altitude has a significant impact on the reproductive system of males. Chronic exposure to high altitude leads to hypoxia which causes damage to fundamental cellular components s uch as carbohydrates, proteins, lipids and DNA (deoxyribose nucleic acid) which result in increased apoptosis at the germ cell level.[5,6] Hypoxia also shows direct negative effects on testicular seminiferous tubules, leading to disorders of seminiferous tubules.[7] Because of this, hypoxia at high altitude causes adverse effects on both quantity, quality of semen.

Acharya Charaka in the Ayurvedic text book Charaka Samhita states that man without progeny is just like a solitary tree.[8] Asthenozoospermia can be considered similar to Ksheena Shukra in Ayurveda. Acharya Sushruta clearly defines that ksheena Shukrta occurs as result of Vata and Pitta Doshas and Upchaya is stated as treatment of choice in this particular type of Shukra Dosha.[9] Chikitsa is mainly of two types, Shodhana and Shamana. Acharyas always emphasize on Shodhana Karma prior to Shamana drugs. Shodhana Karma (Virechana Karma) in Ksheena Shukra is done only to eliminate Vata and Pitta vitiated Dosha from the body followed by Shamana therapy with Vrishya drugs. Acharya Charaka while explaining Chikitsa of Klaibya stated that after proper Snehan Swedan Karma, Sneha Virecharna should be administered to the patient.[10] On the other hand, Acharya Kashyap also describes the significant role of Virechana Karma and clearly states that the effect of Virechana boosts the structural and functional capabilities of germ cells. With all the above considerations and analysis, a case study was carried out to know the impact of Virechana Karma on male infertility.


Case Repor

A 29 years old male, a soldier who came to the OPD of Ayurvedic hospital along with his wife. The couple was trying to conceive for the past 4 years but was unsuccessful. The female patient had regular menstrual cycles and no signs of hirsutism were detected, but the semen analysis report of male patient carried out one month ago showed that the sperm count of the patient was 30 million per ml along with 20% active motility. Patient did not complain about any other problem related to sexual intercourse. On further enquiry, the patient gave the history of working in very high altitude approximately at the height of 21000 feet (Indo Tibetan Border Post) for 3 years. Stress became a part of his life due to the nature of his profession. Inability to reproduce in 4 years of married life further added to existing stress. The couple had stayed together for the last one year but were still unsuccessful to conceive, even after regular unprotected intercourse. The couple tried various treatments for the last 4 years and the female underwent various diagnostic tests like hormonal profile, USG, graffian follicular study, and sonosalpingography. All tests of the female were normal, but despite it she was unable to conceive. With this complaint the couple came to Ayurvedic hospital for treatment.

History of Past illness: No History of sexually transmitted disease, mumps, urogenital infection or any other chronic illness/surgical intervention.

Family history: No relevant family history was found.

General Examination of Patient

Temperature : 98oF
Respiratory : 22/min
Pulse Rate : 84/min
Blood Pressure : 128/78 mm of Hg
Weight : 72 kg

Ashtvidha Pariksha

Nadi - Vata Pradhan
Mala - Samanya
Mutra - Nirmal
Jihva - Anavrutta
Shabda - Spasht
Sparsh - Ruksha
Druka - Samanya
Akriti - Madhyam

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Kumari P et al: Panchakarma in Male Infertility w.s.r to High Altitude Asthenozoospermia

Personal History: There is no history of smoking, alcohol intake or any other addition.

Appetite : Decreased
Thirst : Normal
Koshtha : Madhyam Kostha
Sleep : Disturbed
Prakriti : Vatopittaja

Semen Analysis Reports (13/11/2022)

jaims_2379_01.JPGFigure 1: Male Semen Report

Semen Physical Examination
Volume : 2 ml
Ph : Alkaline
Colour : Normal
Liquification : 20 minutes
Microscopic Examination
Sperm Count : 30 million/ml
Leuco Cycles (Pus Cells) : 2-3 /h.p.f
Red Blood Cells : Nil /h.p.f
Sperm Motility
Active Motility : 20 %
Sluggish Motility : 80 %

Diagnosis: Asthenozoospermia~ Ksheena Shukra Dosha~ Vata and Pitta predominance.

Treatment plan: According to Ayurveda, the patient was diagnosed as Ksheenshukra Dosha, with investigation showing evidence of Asthenozoospermia. Ksheena Shukra is a type of Shukra Dosha which shows Vata and Pitta predominance. So, Virechana Karma was planned. At the very first, Prakriti and Kostha Pareeksha were done. After their careful assessment Deepana Pachana with Chitrakadi Vati (250 mg) 2 tablets

twice a day with lukewarm water as Anupan before meal was given for 3 days just prior to Snehpana.

Protocol For Virechana Karma has been shown below.

Table 1: Protocol carried out for Virechana Karma

SN Type of intervention Drug of choice Dose Days Route of Administration
1. Deepan - Pachan Chitrakadi Vati 250 mg 3 days Oral
2. Snehapaan Ashwagandha Ghrita 40ml – 240ml 5 days in incremental dose Oral
3. Sarvang Abhyang Bala Ashwagandha Tail Till appearance of proper symptoms 3 days (6th-8th day) External Application
4. Nadi Swedana Dashmool Kwath Till appearance proper symptoms 3 days (6th -8th day External Application
5. Virechana Karma Erand Tail with Triphala Kwath 80 ml + 150 ml 9th day Oral

Madhyam type Shuddhi seen as a patient had a total 18 Vegas. Therefore, Samsarjana Karma was advised for 5 days. After Samsarjana Karma, the patient was asked to take Ojovardhak Dravya like Dugdh, Navneeta, Ghrita etc. and also to follow Viharas like proper Nidra, Vega Adharana etc.

Result

The couple was successfully able to conceive just after a month of Virechana Karma. Refer to Figure 2.

jaims_2379_02.JPGFigure 2: Female Pregnancy Report


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Discussion

Role of Purvakarma

Before proceeding to main Karma i.e., Samshodhan Karma, Purva Karma needs to be done. Purva Karma includes Prakritip Pareeksha, Kostha Pareeksha, Depan, Pachan, Snehana and Swedana.

Deepan Karma: Deepan drugs composed of Agneya and Vata Mahabhoot. Due to this, they help in ignition of digestive fire. They also help in separation of Leena Dosha from Dhatu.

Pachan Karma: Pachan Karma is helpful in Ama Awastha. If Snehana Karma is done in Amaj condition, it can further enhance Ama Dosha in the body and lead to destruction of sensory perception and even death. If Sanshodhan therapy is used in Ajeerna Awastha symptoms like Vibhandh (Constipation) and Glani (exhaustion/fatigue) appear.[14]

Therefore, Deepan and Pachan Karma are mandatory prior to Snehana and Sanshodhan Karma.

Snehana Karma: Snehana Karma is done in two forms - Internal and External application. Internal Snehana is also of two types Sodhana Snehana and Shamana Snehana. Sodhana Snehana is done for minimum three days and maximum for seven days. Days for Internal application (Snehapaan) depends upon the patient's Kostha, Agni and appearance of proper Snehana symptoms. Snehana enhances the Drava Guna of Doshas which is needed for the eviction of vitiated Doshas. Snehana Dravya with its Sukshma property, reaches to the minute channels and performs its action.

Next is Sarvang Abhyang which comes under external application. Main purpose of Snehana Karma before Pradhan Karma is alleviation of Vata Dosha, softness of Doshas (Dosha Mriduta) and lubrication of channels (Strotasas) which ease the expulsion of Doshas from the body without any discomfort.

Swedana Karma

Sarvang Swedana (fomentation) results in Dosha Dravta (liquefaction of Doshas) and helps to move Doshas from Shakha (extremities) to Koshtha from where Doshas are expelled out from the body through the nearest route.


Role of Virechana Karma: Virechana Karma /purgative therapy is a procedure for removal of vitiated Pitta and Vata Doshas through anal route. Mainly indicated in Pitta predominant condition. Virechana Karma are of two types: Snigdha and Ruksh Virechana. Sneha type of Virechana was selected for current study as Acharya Charaka mentions Snehan Virechana in Klaibya Chikitsa. Due to peculiar properties of Virechana drugs (Ushna, Teekshan, Sukshma, Vyavayi and Vikasi Guna) it will reach up to Dhatu level and helps in expulsion of Doshas from minute channels of the body. After Smayaka Virechana symptoms like feeling of purification, feeling of lightness along with feeling of generalized weakness were there. Therefore, the process of Virechana Karma helps in removal of vitiated Vata and Pitta Doshas and simultaneously clear the Sroto-Avrodha of Shukra Vaha Srotas. So, execution of Virechana Karma is helpful in the management of Ksheena Shukra Dosha.

Conclusion

Ayurveda has crystal clear treatment protocol in case of Ksheena Shukra Dosha. The unique Shodhana therapy (Virechana) specifically hits on the target that is Shukravaha Srotas and this is what we actually want in case of Ksheena Shukra Dosha. Virechana Karma helps in both removal of Srotorodha as well as stimulation of Shukragni. Because of this, Virechana Karma gears up the metabolism of the body which boosts the quantity and quality of semen. Shodhan therapy detoxifies the body and improves physical as well as psychological health. Treatment given to the patient was found effective and no complication was found during the treatment. Also, treatment is very cost effective. So, the further study should be conducted on a large number of patients.

Reference

1. Sadock BJ. Kaplan & Sadock's synopsis of psychiatry. Behavioral science/clinical psychiatry. 2003.

2. Gat Y, Gornish M, Navon U, Chakraborty J, Bachar GN, Ben-Shlomo I. Right varicocele and hypoxia, crucial factors in male infertility: fluid mechanics analysis of the impaired testicular drainage system. Reproductive biomedicine online. 2006 Jan 1;13(4):510-5.


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3. Reyes JG, Farias JG, Henríquez-Olavarrieta S, Madrid E, Parraga M, Zepeda AB, Moreno RD. The hypoxic testicle: physiology and pathophysiology. Oxidative Medicine and Cellular Longevity. 2012 Sep 27;2012.

4. Bomhard EM, Gelbke HP. Hypoxaemia affects male reproduction: a case study of how to differentiate between primary and secondary hypoxic testicular toxicity due to chemical exposure. Archives of toxicology. 2013 Jul;87(7):1201-18.

5. Zepeda AB, Figueroa CA, Calaf GM, Farias JG. Male reproductive system and antioxidants in oxidative stress induced by hypobaric hypoxia. Andrologia. 2014 Feb;46(1):1-8.

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7. Li Z, Wang S, Gong C, Hu Y, Liu J, Wang W, et al. Effects of environmental and pathological hypoxia on male fertility. Front Cell Dev Biol [Internet]. 2021;9:725933. Available from: http://dx.doi.org/10.3389/fcell.2021.725933.

8. Pdt. Kashinath Shashtri and Gorakh Nath Chaturvedi Charaka Samhita Vol. II (Chikitsa Sthana) chapter 2-1, verse 16, Varanasi:Chaukhambha Vidyotani Hindi Vyakhya ;2015. p.68.

9. Sushrut Samhita, with Nibandhasangraha of Dalhanacharya and Nyaychandrika Panjika of Gayadasacharya edited by Vaidya Yadavji Trikamji Acharya, shareersthana, chapter 2, shloka 3, Chaukhamba Surbharti Prakashan.

10. Kashinath Shashtri and Gorakh Nath Chaturvedi Charaka Samhita Vol. II (Chikitsa Sthana) chapter 30, verse 196, Varanasi:Chaukhambha Vidyotani Hindi Vyakhya ;2015. p.867.


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