Efficacy of Shrungatak Modak and Jatifal Oil in Ksheenshukrata w.s.r. to Oligospermia – A Single Case Study

Sunil Sadashiv More; Ashlesha Suresh Bankar

doi:http://dx.doi.org/10.21760/jaims.8.7.43

Efficacy of Shrungatak Modak and Jatifal Oil in Ksheenshukrata w.s.r. to Oligospermia – A Single Case Study

Sadashiv More S.¹, Suresh Bankar A.^2*

DOI: http://dx.doi.org/10.21760/jaims.8.7.43

¹ Sunil Sadashiv More, Professor and HOD, Department of Streeroga and Prasutitantra, Shree Saptshrungi Ayurved Mahavidyalay, Nashik, Maharashtra, India.

^2* Ashlesha Suresh Bankar, Post Graduate Scholar, Department of Streeroga and Prasutitantra, Shree Saptshrungi Ayurved Mahavidyalay, Nashik, Maharashtra, India.

Infertility is defined as the failure of a couple to achieve a pregnancy with regular unprotected sexual intercourse after 12 months or more. A recent study status on Infertility states that, 50% is related to reproductive anomalies or disorders in the male, in which 90% of male infertility problems are related to Oligospermia and other abnormalities in semen analysis. However, there are number of treatments like hormonal therapies, intrauterine Insemination and test tube baby. Available but it is cost effective and not surety is there. That is the reason today to explore Ayuerveda are mediator to treat this type of condition. As per Ayurveda, Oligospermia can be considered as Ksheenashukra. In Ksheenashukra there is diminished level of Shukra in the infertile couples. In Auervedic texts many herbal preparations mentioned in management of Ksheenashukra. Here a Single case were taken to evaluate the effectiveness of Shrungatak Modak to treat a Ksheenashukra.

Keywords: Shukrakshya, Ksheenshukra, Oligospermia, Shrungatak Modak

Corresponding Author	How to Cite this Article	To Browse
Ashlesha Suresh Bankar, Post Graduate Scholar, Department of Streeroga and Prasutitantra, Shree Saptshrungi Ayurved Mahavidyalay, Nashik, Maharashtra, India. Email:	Sunil Sadashiv More, Ashlesha Suresh Bankar, Efficacy of Shrungatak Modak and Jatifal Oil in Ksheenshukrata w.s.r. to Oligospermia – A Single Case Study. J Ayu Int Med Sci. 2023;8(7):223-228. Available From https://jaims.in/jaims/article/view/2528

Introduction

Infertility is the failure to conceive more than 12 months with regular unprotected intercourse.^[1]Infertility is problem of global proportion affecting an average of 8%-12% of couples worldwide.^[2]Parenthood is one of the most desired goals of every couple. A sexual health is also as important as good physical health as well mental health. We should never feel shy to share our sexual problems. Sometimes these problems may ruin self and social life. There is nothing bad to talk about these problems and relationships because these complications can become the reason of frictions in married couples.

According to Ayurveda, anatomical and physiological variation in Shukra Dhatu leads to infertility there is no direct correlation of oligospermia but we can correlate it with Ksheen Shukra.^[3] There are various herbs and natural compounds in Ayurveda which are quite beneficial to treat this problem. In this case we use combination of Shrungatak Churna with Mishree along with Jatifal Tail Uttarbasti as well as lifestyle modification were added. As Apana Vayu is responsible for proper expulsion of Shukra, so medicines are given at Apanakala.^[4] Shrungatak churn orally said to be Vrishya, hence can be considered as one of the ideal treatments for Shukradosha.^[5] It shows significant improvement in sperm count and motility.

Objectives

1. To evaluate effect of Shrungatak Churna on Ksheenashukra (Oligospermia).

2. To evaluate effect of Jatiphal oil Uttarbasti on Ksheenashukra (Oligospermia).

Materials & Methods

Type of study - It was a single case study

Inclusive criteria

1. Willing for conception

2. Oligospermia more than 10 million count

3. Asthenospermia

Exclusive criteria

1. Azoospermia

2. Oligospermia less than 10 million count

3. Any venereal disease - VDRL positive, HIV positive, HbsAg

4. Endocrine disorder

Drug used - Shrungatak Modak

Dose - 1 Modak (2gm) BD

Route of administration of drug - Orally

Time - Daily BD for 25 days in a month

Duration - For 1 month

Jatiphal oil - Uttarbasti

Dose - 10 ml for 3 continuous days and repeat after 25 days

Route of administration of drug - Uttarbasti

Duration - For 1 month

Follow-up of patients - On every 25^th day of month for 1 month have been taken

Case Report

A 26-year-old male patient belong to lower middle class of the society from urban area Nashik came to SSAM & H Streeroga OPD with complaint of unable to conceive his partner since 5 years of his married life. After taking full history, the patient was advised to investigate for semen analysis. Once report came with 2million/ml sperm count, patient was asked to report for 3 times after 3 days of coital act Absence. After the investigation and proper history, patient was diagnosed with Ksheenashukra (Oligospermia) [Table 1.] The patient was treated with Uttarbasti for 1 month with Jatiphal tail along with Shrungatak Modak. After that patient was investigated again for Semen Analysis and was kept under observation with advice of Pathya-Apathya (diet lifestyle modification) for further period.

Chief Complaints

The patient had 5 years of his married life and active normal coital act without any contraceptive use, unable to conceive her partner since 4 years. The patient’s wife was completely normal at endocrinology and clinical examination. She had failed to conceive inspite of unprotected frequent intercourse even during the 12^th to 18^th day of menstruation since last 4 yrs. The patient had habit of smoking since last 5 years and also a habit of taking alcohol weekly.

By occupation patient was working as sales manager in shifting duty. The patient had not any past medical history of mumps, gonadal trauma, orchitis, hydrocele, tuberculosis, or history of any other long term attenuating diseases, or deathly illness. He did not have any history of previous surgical procedures like vasectomy reconstruction, herniorrhaphy and no history of taking any gonadotoxic agent. No other parameters except sperm count was altered within the male patient. The patient was advised analysis of semen after proper abstinence of 3 days. Before starting the medicine, the semen examination report revealed 45 million/ml sperm count. Smear showed 3-4 pus cells, 1-2 HPFE epithelial cells, no RBC cells.

General Examination: On examination of patient, pallor was absent; tongue was clear, and vegetarian in diet style. The patient appetite was good and usually prefers a salty and spicy diet, also bowel habits were irregular with complain of constipation. Patient had disturbed sleep and frequency of micturition was 6-7 times in day and 1-2 times in night time.

Table 1: Timeline events

Duration	Particular and interventions
March 2018	Married
March 2018-2023	Unable to conceive the partner
February 2023	Repetitive clinical and endocrinological examination of wife was done and found normal.
February 2023	First visit in SSAM & Hospital Streerog OPD
2 March 2023	Investigate for semen analysis and report came with 45million/ml sperm count.
3 March 2023	Treatment starts with Ampachan, Ampachak Vati 2 tab (500mg each) two times a day with Ushnodaka before meal till Niramlakshana appears.
7 March 2023	Koshthashudhhi - Gandharva Haritaki Yoga 2-6 gm dose according to Kostha in stat dose for one night
8 March 2023	Jatiphala Oil Uttarbasti 10 ml, once in a day
9 Mrach 2023	Shrungatak Modak were started to patient orally Matra - 1 Modak 2gm BD.
13 April 2023	Investigate 2nd time for semen analysis and report came with 60million/ml sperm count.
May 2023	Patient’s wife first UPT test was found positive after 10 days of her missed period.

Treatment plan

Details of Uttarbasti procedure in Male

Instruments:

Jathipala oil
Infant feeding tube no. 6
Sterile 10 ml disposable syringe Complete Uttarbasti Procedure done in 3 steps

Purvakarma

Before the procedure patient should passed urine
General examination of patient was done
Supine position
Painting and draping were done

Pradhankarma

Penis skin was retracted Glans penis was cleaned with disinfectant to avoid infection
Medicated oil was applied on tip of feeding tube.
Feeding tube was penetrated into the penile urethra.
Feeding tube was gently passed into the bladder.
Oil was slowly inserted into the bladder.

Paschatkarma

Patient was in supine position for10–15 minutes.
Lower abdomen massage was done for few minutes.
NBM for 2hrs, after 2hr plenty of water, juices are advised.

Drug Posology

1. Ampachak Vati - 500 mg - 2tab, BD with Anupan - Ushnodak

2. Gandharva Haritakyadi Yoga - 2-6 gm according to Kostha in stat dose for one night

3. Jatiphal oil - 10ml, once in a day

Drug review

Chemical Constituents of Shrungatak^[6]

Starch, protein, calcium, carbohydrates, phosphorus

Drug Action: Vrushya, Prajasthapana, Balya, Pittashamak, Daahprashaman, Stambhan, Raktapittashamk, Mutral ^[7]

Drug properties^[8]

Rasa - Madhur, Kashaya;

Guna -Laghu, Ruksha;

Virya - Sheeta;

Vipak - Madhur

Pathya-Apathya advised to patient

Pathya: Patient was advised to take milk and milk products, cowghee, and gruel in routine diet. He was also advised to include red variety of rice, wheat, banana, coconut milk, supernated part of butter milk, Sharkara, castor oil, honey and old jaggery in his diet. Patient was also advised to do massage over body, Surya Namaskara, light exercises, meditation and Yoga on daily basis.

Apathya: Patient was asked to avoid excessive intake of pungent, bitter and salt in routine diet. Patient should ask to avoid stress, worry, excessive exercise, excessive coital activity and suppression of natural urges.

Result

Result of this case report show that after performing Jatiphala Oil Uttarbasti followed by internal medication Kshrungatak Modak, sperm count increased 45 million/ml to 60 million/ml

Investigation	On March 2023	On April 2023
Method	Masturbation	Masturbation
Abstinence	3 days	3 days
Collected at	9:00 am	10:00 am
Examined at	9:20 am	10:20 am
Physical examination
Quantity	1.0 ml	2.0 ml
Colour	Grayish white	Grayish white
Odor	Normal	Normal
Viscosity	Normal	Normal
Liquification	20 min	15min
PH	Alkaline	Alkaline
Fructose	Present	Present
Microscopic Examination
Total sperm count	45 million/ml	60 million/ml
Progressive/ forward motility	Grade 0- 30% Sluggish motile- 40%	Grade 0- 20% Sluggish motile- 30%
Total motility	30%	50%
Pus cells	4-6/ Hpf	2-4 Hpf
RBC Cells	Nil	Nil
Morphology	Normal	Normal

Discussion

Ayurveda is an ancient science that dates back to that times when modern medicine even did not exist. The science aims at improving the overall health of a person as well as solves the infertility problems. Ayurvedic medicines and therapies balance the hormones; improve blood circulation and acts on the nervous system. These results can be attributed to Vrushya effect of Shrungatak Modak for the study. The ultimate aim of treating Oligospermia or may be any case of infertility is to get conception. Though the duration of

the treatment was less in the study, it was very pleasing to hear that couple achieved conception after the treatment in variable period of time.

Effect of Jatiphal Oil Uttarbasti
Ayurveda philosopher had mentioned Shaman and Shodhan Chikitsa for the treatment of infertility. Panchakarma provides best efficacy because it helps in balancing Doshas and Dushyas. Uttarbasti is such type of therapy being indicated for infertility. Cleansing action of Uttarbasti clears the genital passage and restores the functions. The Sneha Basti administered in Uttarbasti will be having a supportive role. They are nutritive in function and will improve the blood circulation, nerve conduction and immunity of the organs. Ayurveda specifically mentioned Uttarbasti for Shukra Doshas. Therefore, drugs that are administered in Basti form are said to enhance the quality and quantity of Shukra. The line of treatment of Ksheenashukra should be based on Vrishya drugs having Shukravriddhikara properties. So, Jatiphala oil is selected which is particularly Vryishyakar. Jatiphala (Myristica fragrance) effectively removes free radicles as assessed by reducing level of various oxidants and improve level of diverse antioxidants. Due to its Primary constituents Elemicin and Myristicin, increases the level of central catecholamine which is mediator for maintain raise in FSH, LH, and Testosterone, which acts on Sertoli cells and Leydig cells and supports the Spermatogenesis.^[9] In China, India, and the middle east it was used to induce sexual arousal, review marriages and help with fertility. It can increase the volume of sperm count, so it acts as Sperm Booster. Also, according to Ayurved Vidnyan, Jatiphala Oil has Samuttejan property.

Effect of Kshrungatak Modak
Kshrungataka (water chestnut or Caltrops) belongds to Amradi Phalavarga according to Bhavaprakash^[10] and Mulakadi Varga according to Rajnighantu. It has a chemical constituent’s starch, calcium, protein, carbohydrates and phosphorous.

According to Bhavprakash, Kshrungatak is Vrushya (Improve the potency) drug. It plays a role of Prajasthapana as well as Balya and Pittashamak.

It has a Madhur and Kashaya Rasa, Laghu Guna, Madhur Vipaka with Sheeta Virya. The fruit of it is used to improve the sexual potency.

The line of treatment of Ksheenashukra should be

based on Vrishya drugs having Shukravriddhikara and Prajasthapan properties. So here we selected Kshrungatak Modak to treat oligospermia. This plays an important role as Prajathapana.

Conclusion

To conclude, this study that Treatment based on Ayurveda principles was found to be effective in male infertility. Patient with Oligospermia in improving sperm count. All the Lakshanas mentioned for Ksheena Shukra such as Sada, Brahma etc, was not found in the patient, so lab investigation like semen analysis plays a vital role in diagnosis and Assessment of prognosis. Are search study concluded that disturbing lifestyle and working stress resulting in changing dietary habits, sleeping habits leads to disturbance in metabolism of body as well as psychological stress and it affects all Dhatus including Shukradhatu. In addition, it results in a hormonal imbalance. Finally, it concerns the male sexual activity, which is one of the major causes of male infertility.

Scope of Study

Before Treatment

After Treatment

It can be a field of research and recommend larger and more rigorous studies such as randomized control trials to get more conclusive results. Vajikaran or Vrishya Chikitsa is one of eight major specialities of the Ashtang Ayurveda. Ayurveda remedies can be helpful for infertile patients to achieve healthy progeny.

Reference

1. Zagers-Hochschild F, Adamson GD,de Mouzon J, Ishihara O, Mansour R, Nygren K ,et al ; International committee for monitoring assisted reproductive technology (ICMART) and world health organization (WHO) revised glossary of ART terminology, 2009.Fertil sterile 2009;92:1520-4.

2. Inhorn MC Global infertility and the globalization of new reproductive technologies. Illustrations from Egypt.Soc Sci Med 2003;56:1837-51.

3. Premavati Tiwari, editor. Ayurvediya Prasutitantra Evam Striroga. Chaukhambha Orientalia, Varanasi, 2: 478-496.

4. Sushrut Samhita Sarirsthanam by Bhaskar Govind Ghanekar, Published by Meharchand Lachhmandas Publication, New Delhi, reprint- March 2006.p23.

5. Acharya Priyavrata Sharma, Dravyagun vigyan, Editors Chaukhambha Bharti academy, Reprint, 2013; 2: 588-590

6. The Ayurvedic Pharmacopoeia of India the controller of publications civil lines delhi, 1(1): 116 – 117.

7. Dravygun vigyan, Dr. A. P. deshpande & Dr. subhash ranade by Proficient publishing house, reprint may, 2011; 838.

8. J. K. Ojha, editor, A Hand Book of Dravyaguna. st. ed. Sanskrit Pratishthan. vanaspatika Dravya Varanasi, Chaukhamba, 2004; 323: 1

9. Collen R; Brown G.M and Vau Loon, G.V. Clinical neuroendocrinology. Black Scientific Publication 1998.Pg no 43

10. Bhavaprakash Nighantu by dr. krushnschandan chunekar, dr. gangasahay pandey, published by chaukhambha Bharti academy Varanasi reprint annadiphalvarga, 1999; 578-579: 92-93

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-05-30	2023-06-01	2023-06-08	2023-06-15	2023-06-22
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	18%

Case Report

Oligospermia

Journal of Ayurveda and Integrated Medical Sciences

Efficacy of Shrungatak Modak and Jatifal Oil in Ksheenshukrata w.s.r. to Oligospermia – A Single Case Study

Sadashiv More S.1, Suresh Bankar A.2*

Introduction

Objectives

Materials & Methods

Case Report

Result

Discussion

Conclusion

Scope of Study

Reference

Sadashiv More S.¹, Suresh Bankar A.^2*