Contribution of Ayurveda in the Management of Ksheena Shukra Vikara with Special Reference to Asthenozoospermia: A Case Report

Background: Male Infertility is one of the burning issues now a day’s nevertheless disregarded reproductive health problems in India. Incidences of this issue expands day by day because of the disturbing lifestyle pattern. Almost 30-40-% of infertility cases found to be related to male factor. Asthenozoospermia is the most common identifiable anomaly related to male infertility found in semen analysis having reduced motility of sperm. Aim and Objectives: To assess the efficacy of Ayurvedic management (Shodhana and Shamana Chikitsa) in the management of Ksheena Shukra Vikara w.s.r. to Asthenozoospermia. Methods: It is a single case study. A 33-year-old male patient who was already diagnosed with Asthenozoospermia for three years approached to Pancharkarma OPD. Sperm motility was only 12%. The patient was treated with Shodhana Chikitsa (Vamana and Virechana with Mahatiktaka Ghritapana and Dashmooladi Niruha Vasti and Uttarvasti with Vidaryadi Ghrita followed by Shamana Chikitsa (Tab Neo Charak Pharmacy, Tab Addyzoa, Chandraprabha Vati, Paripathadi Case Study Mohan et al.; JPRI, 33(36B): 140-149, 2021; Article no.JPRI.71104 141 Kashaya, Ashwagandhadi Yamaka, Avipattikar Churna) approximately 3 months. After 3 months, patient-reported improvement. Results: Assessment of the patient with clinical symptoms and sperm analysis report was done following 3 months. Sperm motility increased up to 40% with increment in sperm count. Conclusion: This case report provides us a guideline that infertility associated with Asthenozoospermia can be treated successfully by adopting basic Ayurveda Siddhanta's.


INTRODUCTION
Infertility is characterized as failure of a couple to conceive following a year of regular intercourse without utilizing any contraception. Male infertility implies inability to cause a pregnancy in a very fertile female [1].Male infertility is one among the burning problems currently nevertheless disregarded reproductive health problems in India. Incidences of this issue expands day by day in light of the disturbing lifestyle pattern.
Nearly 30-40% of infertility cases found to be identified with male factor [2].Infertility influences nearly 8-12% of couples normally [3].Infertility is caused either by male factor, male factors, or nay unexplained causes. Infertility influences 2.5& to 12% of men and male issue globally contribute around 40-50% in cases failing to conceive a child [4]. In India, couple seeking treatment for male infertility is that the cause is approximately 23% [5].
Asthenozoospermia is the most common identifiable anomaly related to male infertility found in semen analysis implies the motility of spermatozoa is lower than 50% of active motile sperms [2]. In Ayurveda, eight types of Shukra Dushti are mentioned viz Vataja, Pittaja, Kaphaja, Granthibhuta, Putipuyanibham, Mutrapurishagandhi and Ksheena [6]. Acharya Sushruta clearly characterizes the condition of Ksheena Shukra Vikara as diminution of semen quality along with reduced motility. It is enclosed in one among the varieties of AsthavidhaShukra Dushti having vitiation of Vata and Pitta Dosha which may prompt to male infertility [7].
In conventional medication, numerous choices for primary infertility are accessible ranging from drugs to IVF with their own limitation [8]. While Ayurveda has extended horizons o management for infertility that works as fast heal for complex infertility issues. Ayurveda had depicted Shamana and Shodhana Chikitsa for the management of ShukraDushti. Amongst them Apyayana (nourishment of Dhatus), Prasadana (Detoxification process), Upachaya (drugs that aids spermatogenesis) and Janana (regenerative drugs) are essential standard methodologies for its management [9]. This line of management give emphasis on Dhatu Vriddhikara, Balakara, Shukrajanaka and Shukrapravartaka perspective regarding expanding the sperm count and motility by utilizing Vajikarana Dravya.
The concept of Vajikarana, as represented within the texts of Ayurveda, is a special category of treatment modalities which improve the reproductive system and upgrade sexual functions, it offers an answer to attenuate Shukra defects and to guarantee a healthy progeny. Before administration of Vajikarana medication, Shodhana Karma ought to be done as to get desired result of treatment [10]. Thus, Shodhana Karma have been kept in preeminent veneration by Ayurveda in enhancing various assortments of Shukra Dushti. According to these principles, it is advocated to utilize Shamana therapy after performing Shodhana Karma counting on the state of the patient.

Aim and Objective
To assess the efficacy of Ayurvedic management (Shodhana and Shamana Chikitsa) in the management of Ksheena Shukra Vikara w.s.r. to Asthenozoospermia.

MATERIALS AND METHODS
A single case study

Case History
A 33-year-old male resident of Hinghanghat, Wardha district, Maharashtra, social worker by occupation, moderately build, married for 4 years, was apparently healthy before 2015, then he started complaining of failure to conceive even after active married life, his 29-year-old wife had regular menstruation cycles. She had no significant past or family history of reproductive tract disorders and pelvic infections and had not undergone any surgical procedures since birth. But there was issue to conceive. So, they approached to Gynecologist, in the routine checkup, report if wife was normal but he was diagnosed as Asthenozoospermia. Simultaneously, he as suffering from generalized weakness for 1 year. Patient is having history of Grade I fatty liver for the last 1 year. Patient had also taken allopathic medicine for failure to conceive from different private practitioners, didn't got satisfactory relief. So, he approached to Panchakarma OPD, Mahatma Gandhi Ayurved College Hospital & Research Centre, Wardha, Maharashtra (OPD No. -1912180006) for ayurvedic treatment and he was advised for admission and appropriate Panchakarma treatment were prescribed to him. Patient was not taking any medication for any systemic disorders like hypertension, diabetes mellitus etc.

Past History
There was history of Mumps at the age of 5 year. No history of sexually transmitted infections (STI), Tuberculosis, Filariasis. No history of trauma/ exposure to any chemical/ surgical procedures involving the inguinal and scrotal areas.

Sleep: Sound sleep
Addiction: No any addiction

Clinical Examination
Vitals examination of the patient within normal limit and Asthavidha Parikshawasmentioned in Table 1. The physical examination of the genitalia in the male partner reveled no any anatomical abnormalities and there was no signs of inflammation, ulceration or rashes of testes or penis. Temperature was found normal. The position and size of the testes was normal.

OBSERVATIONS AND RESULTS
After completion of 3months of total Ayurvedic therapy (Shodhana and Shamana Chikitsa). Patient was assessed based on semen analysis before and three months after the treatment. After the treatment, total sperm count was increased to 70 million/ml and there was also increase in sperm motility. It is observed that 40% were actively progressive, 20% were slowly progressive and 40% were non motile. Details of the investigations carried out before and after the treatment were mentioned in Table 4 and shown in Fig. 1.

Before Treatment
After Treatment    for the ShukravahaSrotoshodhana, purification of the Beeja (sperm), as it makes Beeja effective in achieving fertilization. It additionally improves sexual vigor and aides in accomplishing sound progeny [14]. Virechana also facilitates Dhatvagni Deepana and helps in improving the liver function which plays a significant role in controlling the plasma testosterone concentration in the body [15].

 Yogavasti:Yogavasti
induces Vatanulomana in body and maintain the harmony of Tridosha which are disturbed due to causative factors. With the assistance of various medicated decoction and oil it additionally provides strength to Katisthana which is the vital site of reproductive organs.

 Uttarvasti with Vidaryadi Ghrita:
Uttarvasti is a method of introducing medicine into genitourinary tract by prescribed technique. Vidaryadi Ghrita is having properties of Madhura Rasa and Madhura Vipaka which pacifies Vata and Pita Dosha, provides Brimhana and Balya effect and is indicated in Sosha (emaciation), Dhatu Kshaya [16]. The pharmacokinetics of Uttarvasti can be described as in two ways: First by local action, after the administration of Uttarvasti, it softens and loosen the genital muscle and membrane, acts as lubrication, which helps to increase motility. Second by systemic action, it releases endogenous opioids in ENS which is richly supplied by parasympathetic nerve and gives signal to CNS which release Gonadotropin releasing hormone (GnRH1) from hypothalamus and Follicle stimulating hormone (FSH) and Luteinizing hormone (LH) from Pituitary gland and helps to stimulates sperm production. Uttarvasti also relaxes spongy tissues and increase blood flow to penis which acts as regulatory factor for libido an erection [17].

Shamana Chikitsa  Tablet Neo:
Tablet Neo is a proprietary Ayurvedic medicine manufactured by Charak Pharmaceuticals. Kapikachhu, Bhringaraja, Shatavari and Yashtimadhu are the main ingredients having adaptogenic property. It helps in pacifying nervine impulses, promotes decongestion of genitalia and prostrate and diminishes sexual irritability [18].

 Tablet Addyzoa:
Tablet Addyzoa is a proprietary Ayurvedic medicine manufactured by Charak Pharmaceuticals.
Addyzoa is a herbomineral spermatogenic antioxidant. Addyzoa tablet has varied free radical scavenging action and hence, Addyzoa limits successfully the damage to the sperm cells because of reactive oxygen species (ROS). Withania somnifera, Tinospora cordifolia and Emblica officanalis are potent antioxidants in Addyzoa, which acts by lessening the excessive oxidative stress, which is answerable for sperm damage. Shuddha Shilajit, Mucuna pruriens and Withania somnifera improves sperm count. Asparagus racemosus recovers seminiferous tubules and builds spermatogenesis. In this way, Addyzoa improves sperm count, motility and morphology and furthermore increases semen density [19].

 Chandraprabha Vati:
ChandraprabhaVati is a herbomineral compound preparation, which is choice of drug for urinary tract infections and furthermore improves the functioning of male reproductive organs [20] [23] and overall motility and a number of other studies urged it inverts semen quality even in barren men [24].
By taking all the above discussion into consideration that the overall effect of all treatment regime planned in this patient instigates Srotoshuddhikar, Vatapittaghna, Amanashaka, Vajikarana, Brimhana and Balya effects, that improves the nature of semen, increasing its motility along with increment in sperm cell count. [32][33][34][35][36]

CONCLUSION
After the completion of treatment, patient had got satisfactory outcome. Srotoshuddhi, Dhatvagni Deepana, development of new Shukra Dhatu are accomplished by Shodhana Karma. Because of improved status of Dhatus and further because the action of ingredients demonstrated increased sexual desire, erectile and ejaculatory function, duration of coitus, sexual satisfaction. This case report provides us a guideline that infertility related with Asthenozoospermia can be dealt effectively by embracing basic Ayurveda Siddhanta's. the current study is about the presentation of the single case only. Further study in large sample size must be recommended for establishing good and standard outcome.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline patients consent and ethical approval has been collected and preserved by the authors.