Shukravaha srotas-Role of panchakarma -Dr Kishore Mahindraker

3/17/2014DR KISHORE MAHINDRAKER

DR.KISHORE MAHINDRAKER
2ND YR PG SCHOLAR ,DEPT. OF PANCHAKARMA
GAMC, BANGALORE-09

Introduction
Panchakarma as detoxification
Understanding Human Body-Conceptual
Understanding shukra & Shukra vaha srotas
Panchakarma in Shukra vaha sroto vikara –
Klaibya(Erectile Dysfunction)
Shukragata vata(Premature ejaculation)
Na jayete garbha(Infertility)
Conclusion

In the present scenario of medicine ,
manifestation of many non communicable
diseases which are categorised under the
Idiopathic aeitiology have become difficult to
treat radically in Western system of medicine.
After lot of research work done till date
,Doctors & Scientist have failed to come out
with fruitfull results in managing such non
communicable disease.
Male sexual dysfunction being one of the
burning issue……….

Ayurveda –The Science enriched with its unique
modality of treatment i.e. PANCHAKARMA provides
lot of hopes & near radical management in NCD ,
Specially in management of Male sexual dysfunct
Considering one of the burning issue in society & its
radical treatment by panchakarma , this topic is
selected for the presentation & dissussion

What is Panchakarma or Detoxification
Therapy?????

CAN BE DEFINED AS………………
“Controlled disturbance in the homeostasis of the
body to activate some defence system which is
beneficial to host ”

 Modern view
 Ancient view

Panchamahabhuta
Dosha
Dhatu
Mala
Avayava
Srotas

Understanding
shukra & shukra vaha srotas

 It is seventh dhatu present in both sexes.
 Shuklayati Tyajayati shuklam rajatam shuklam viryam
(Amarkosha)
A whitish or silvery discharge ejaculated
during sexual act

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Shukravaha srotas= Reproductive system
 Srotas- shukravaha
 Avayava- Vrashna, shepha, stana and majja
 Dhatu- Shukra
 Dosha- Sleshma pradhana ,
 Panchamabhuta- except Akasha
 Shukra prasada bhaga- Garbha,Oja

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 Total of around 200 Thesis have been carried
out on vajikarana so far . (M S Baghel, 2005)
 Male Infertility : 32
 Shukradushti: 24
 Oligozoospermia: 56
 On Male Sexual Dysfunction : 34
 Shukragatavata: 7

 Globally decreasing semen quality and
increasing infertility is the matter of
concern.
 Panchakarma before Vajikarana is essential.
Panchakarma can definitely help infertile
couples in fullfiling their wishes.
 Thorough understanding of use of
panchakarma therapy & vajikarna in
shukravaha srotas is in high demand.

 Erectile dysfunction (Klaibya)
 Premature ejaculation (Shukragata vata)
 Infertility (Vandhya)
 Lack of libido (Apraharsha)
 Performance anxiety (Bhaya)
 Night emission (Svapna skalana)
 Spermatorrhea (Mutra shukra)
 Failure to reach orgasm
 Dhat syndrome

Panchakarma in
shukravaha sroto
vikara- Klaibya
w.r.s.t ED

 Klaibya is a vikara of Karmendriya, with
the involvement of Mana and
Jnanendriya.
 Erectile Dysfunction to which klaibya is co
related is a multifactorial condition
commonly observed in society.
 Survery by India Today – One in every ten
is impotent
 Aggrevated vata dosha, sukraksaya,
sukravahasrotodusti & Manodosha are
prime factors involved in pathogenesis.

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General examintion-
 Pt.. general appearance may suggest depression,anxiety,&
other mental health problem
 Question about illnesses or disabilities and surgeries
 Previous medications
 Sexual development as a boy
Systemic examination-
CVS,- Check BP & palpate peripheral pulse ,evidence of atrial
disease ,such as absence of foot pulse ,suggests that ED might be
because of arterial insufficiancy.
CNS,- commonly lumbosacral system is assessed,
the condition of perineal reflex may provide evidence of spinal
cord dysfuction

Testing of reflex
 1.bulbocavernosus reflex (S2,S3)
 Provokes contraction of the bulbocavernosus
muscle located b/w scrotum & anal canal

 2.Bulbo anal reflex (S3,S4)
 Provokes contraction of anal spinchter

Examination of genitals
Testes-
Vas deferens
Epididymis

Peyronies disease;

Investigation in Klaibya;
Blood & Urine –To R/o DM
Hormone assasy-
Sex hormone binding globulin(SHGP)
Testosteron
FSH
LH
Prolactine
Penile doppler
Nocturnal penile tumescence

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Medicines used-
Snehapana- amritaprasha ghrita,
swadamstradi(gokshura) ghrita, jeevaniya
ghrita
Virechana-GH oil, Sukumara erandam,mishraka
sneha
Asthapana- Erandamooladi, Karma
Mustadi yapana basti Basti
Anuvasana-Same as for snehapana

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Medicine Used ;
Pradeha-(Chakradatta)Kanaka rasa bhavit Ashwaganda
Pradeha, Bhallatakadi lepa,
Parisheka- Ashwagandha taila, Bhallatakadi taila
Raktamokshana-
Snehapana- Amritaprasha ghrita,
Swadamstradi(gokshura) ghrita,
Jeevaniya ghrita,
Snigdha Virechana- GH oil,
Sukumara erandam,
Mishraka sneha
Anuvasana- Same used for snehapana
Asthapana Basti-Erandamooladi, Karma
Mustadi yapana basti Basti

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Medicine Used
Rasayana- Abhayamalaki, pippali, guduchi,
Loha rasayana ,shilajithu, triphala.
Vrishya yoga- Ksheera sarpi, shastika,yava
godhuma, ashwagandha, shatavari, mushli,
kapikacchu, vidari,

Panchakarma in
shukravaha sroto vikara-
Shukragata vata w.s.r.t.
premature Ejaculation

Premature ejaculation is a Psychosexual
disorder charecterized by persistent or
recurrent ejaculation by minimal sexual
stimulation . In ayurveda this clinical condition
is described under SHUKRA GATA VATA .
Understanding Relation of shukra with vata and
manas is very much essential in samprapti
vighatana by means of ayurvedic
management

Treatment is ;
Harsho annapana-
Vrashya
Balya
Vatahara
Shukra Sthambaka
Medhya dravyas
Yapana basti

Panchakarma in
shukravaha sroto vikara-
Vandyatva w.s.r.t. Male
infertility

पुरुषस्य यदा बीजे बीजभागः, प्रदोषमापद्यते, तदा
वन्ध्यं जनयतत II Cha.sha 4/31
Infertility is defined as a failure to
concieve within one or more year of regular
unprotected coitus.

 Sperm count has fallen 50% lesser over last
50 years .
 @ 2% every year.
 Acc. To WHO In 1950 -over 113 million/ml
 2012 -over 15 million/ml
 "At this rate, there would be no fertile men
left in the next 40-50 years“?
courtesy: TOI

 W.H.O estimates 8-10%
 Worldwide incidence is 50-80 million
 Incidence vary from region to region

 Pre testicular causes
 Testicular factors
 Post testicular causes
 Idiopathic

 Hypogonadism due to various causes
 Drugs, alcohol, smoking
 Strenuous riding (bicycle riding, horseback
riding)
 Medications, including androgens.

 Age
 Genetic defects on the Y chromosome
 Y chromosome microdeletions
 Abnormal set of chromosomes
 Klinefelter syndrome
 Neoplasm

 Cryptorchidism
 Varicocele(upto14%)
 Trauma
 Hydrocele
 Mumps
 Malaria

 Vas deferens obstruction
 Lack of Vas deferens, often related to
genetic markers for Cystic Fibrosis
 Infection, e.g. prostatitis
 Ejaculatory duct obstruction

 Soumanasya Garbha Dharana !!
-R/o it by proper Counselling
 Shukra Garbham Prajayate!!
-Further insvestigate into the Shukra
dusti samprapti

 Samanya karana- Cha.chi. 30/138
Maintuna Na cha Gachati
Avisrambha = Avishwasat
 Vishesha karana
Shukra vaha sroto dusti nidana cha. vi. 5
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History-
Duration of marriage –
Previous marriage and proven fertility
Medical h/o- Mumps orchities STD
DM Recurrent chest infection
Surgical h/o- herniorrhaphy
Operation on testes
Operation in genital area
Occupational h/o- Exposure to heat, radiation.

 Sexual history- frequency
Full Penatration
Position of male partner
Social Habits- Particularly Alcohol, Smoking

 General physical examination
 Semen analysis
 Hormonal assay
 Scrotal ultrasound
 Assess Shukra Kshaya Laxana-
 Assessment of Rupa Dravya shukra –
-Doshik Involvement in it, and treat accordingly or
Use the semen Analysis to Infer Doshik Involment.

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SL.
NO.
STANDARD TEST NORMAL VALUES
1 Colour Greyish white
2 Liquefaction time < 60 min
3 Volume 2 ml or more
4 pH 7.2- 8.0
5 Sperm concentration 20 million/ml
6 Total sperm count 40 million/per ejaculate or more
7 Sperm motility >25% - Rapid motility
> 50% - Slow motility
8 Sperm morphology > 30 % normal
9 Sperm vitality > 75% or more live.i.e. excluding dye
10 WBC < 1 million /ml
11 Agglutination > 20% agglutinated
12 HOS test > 60% spermatozoa with tail coiling3/17/2014DR KISHORE MAHINDRAKER

SL. NO. STANDARD TEST NORMAL VALUES
13 Acrosome intactness 50% of spermatozoa with halos having
mean diameter of > 30micro meter
14 Seminal fructose .>1200 microgram/ml
15 Zinc > 75 microgram/ml
ENDOCRINE EVALUATION
1 Testosterone Plasma concentration- 2.5- 10mg/dl
2 Serum FSH 5- 20 IU/litre
3 Serum LH 5- 20 IU/litre

Vataja shukra dushti:
Phenila- Frothy & Sperm Functional Integrity
assessment.
*Flagellar Integrity-hypo osmotic Swelling.
- (Normal,>55% spermatozoa with tail coiling)
- Decrease in HOS positive reaction indicates loss
of viability, indicative of degenaration.
*ARIC test(Acrosome reaction after ionopher
challenge)
-(Normal,>15% of spermatozoa with halos diamtr of
10mm)
Decrease in ARIC +VE reaction indicates low/no
fertilisation

Vataja shukra dushti:
Tanu- low count < 15million/ml
Rooksha- Ph >8.5
Alpa- vol <1.5ml

Pittaja shukra dushti:
Puti- >8 pus cell/hpf
Vivarna- yellowish Discoloured
(normal is Greyish White)
---------------------------------------------
Kaphaja Shukra Dushti:
Picchilla-Increased viscosity

Raktaja shukra dushti:
Increased Rbc’s in Semen Sample,
Foul Smelling
Vata-kaphaja:
Granthi Bhuta - Reduced Motility
Avasadi (normal >25% RLP,>50%SLP
>50% RLP+ SLP
DNA fragment index
(Good-<30% ,Fair- 30-45%,poor->45%)

Vata-pittaja shukra dushti:
Ksheena- Reduced Count + Low vol
---------------------------------------
Pitta-kaphaja shukra dushti:
Puti puya- >5 pus cells + Rbc Casts
--------------------------------------
Anya dhatu samsrusta Shukra dusti:
Presence of Macrophages,Mucus threads
Epithelial cells, Amorphous matt.

Acc. To cha.chi.28/146-152
 Adopt the Shodana Chikitsa
 Use of Vajikarna Yogas
 Use of yogas mentioned in Raktapitta chikitsa
 Use of yogas mentioned in yonivyapat chikitsa
 Jeevaniya gana aushada siddha
Ghrita,Chavanaprash,Girija as Rasayana
 Sarpi,paya, shali, Godhuma
 Follow respective treatment for each shukra
dushti
 “prashasta shukra dosheshu basti karma
viheshata”

Acc. To Shu.Sha.2/10
1.“Snigdha vaantam viriktam cha
nirudamanuvasitam I
Yojayet shukram doshat
samyakuttarbastinaamII”
2.Follow the individual reto dushti chikitsa
Shu.Sha.2/8-10

SL.NO SHUKRA
DUSTI
PRAKARA
PANCHAKARMA ADOPTED Ast.Sam. Sha.1/24-34
1 Vata Snehana- Vasuka,Saindava, Amla phala Siddha Ghrita
(vasuka-romaka, Amla phala- Dadimadi Phala)
Anuvasana- Madhuka, bhadradaru sidda taila
Asthapana-Bilwa vidari siddam, Ksheera yuktam
Uttarabasti- Ksheera,Kullira rasa sidda taila
(kullira- Jalaja Prani vishesha)
2 Pitta Snehapana- Kandikshu, Swadamshtra,Guduchi sidda Ghrita
(murva,maduka as prativapa)
Virechana-Trivrit churna with Ghrita
Asthapana-Sriparni sidda ksheera yukta
Anuvasana & Uttar basti- Madhuka ,Mudgaparni siddam
taila 3/17/2014DR KISHORE MAHINDRAKER

3 Kapha Snehapana- Pashanabheda,Ashmantaka,Amalaka
kwatha sidda ghrita (pippali, Madhuka churna –
Avapa)
Vamana-Madana phala kashaya
Asthapana-Rajavriksha,madanaphala kashaya
Pragadam
Anuvasana & Uttara basti- Madhuka,pippali sidda
taila
4 Rakta Snehapana- Dhataki pushpa ,Khadira,Arjuna,Dadima
Sidda Ghrita
5 Vata-pitta Treat on the principle Nunya dhatu purayet,
6 Vata-kapha Snehapana-Pashana bheda, Palasha bhasma sidda
ghrita
7 Pitta-kapha Snehapana- Parushakadi Nyagrodadi sidda ghrita
8 Anyadhatu Snehapana-
Yava,Chitraka,Vittunaka,Priyangu,samanga, sidda
ghrita (Ela,Mocha churna prativapa)3/17/2014DR KISHORE MAHINDRAKER

 Guda, Ghrita, Ikshu, Kharjura, Kshira,
Mamsa, Madhu, Majja, Mamsarasa, Shati,
Taila, Vilepi, Vasa
 Certain Drugs Like Amalaki, Bala, Atmagupta,
Amratakaphala, Amraphala,, Jivanti,
Kushmanda, Lashuna, Meda, Narikela,
Patola, Palandu, Shrngataka, Saliparni, Vidari

 Katurasa, Ati-Amlarasa,Matsya, Mastu, Shaka,
Tiktarasa, Takra
 Drugs like Atasi, Akshota, Canaka, Gandhaka,
Guggulu, Kalinda, Kuluttha, Katabhi, Marica,
Moksha, ParasikaYavani

 Abhyanga, Udavartana, Snana,
PadaPrakshalana.
 Streeis explained as best among Vajikaranas
which augments Shukra in body
(Ca Ci2: 1: 4-7).

 Shukra Janaka – indicated in Vishushka Reto
Dushti,oligospermia where there is need of
proliferation of germ cells. Eg:
Sharkara,Shatavari,Mamsa,Ghritha.
 Shukra Pravartaka (Shukra srutikarana)
Stimulates the production of androgens or
modifies the action of androgens. Indicated in
sthira shukra ( Androgen insensitivity) eg
Sankalpa, Stri vichara mano balakarana which
causes ejaculation of semen. Eg Uchchata,
Brihati, Milk, Sugarcane juice.

 Shukra janaka / pravartaka- Increases both
mano and dehabala eg ksheera, ghrita,
masha, bhallataka phala majja.
 Shukra stambhaka – Drugs are meant to
prolong the sexual act. Indicated in early
ejaculation. Eg Akarakarabha, Jatiphala,
Ahiphena, Bhanga, Puga, Dhattura.
 Shukrashoshaka – Indicated in excessive
secretion from bulbo urethral glands. Eg
Hareetaki, Purana Guggulu, Suchi.

 Shukra shodhaka – Katphala, Kushtha,
Samudraphena.

MADHURA OLIGOSPRMIA,
MATURATION ARREST
VIDARI
SHATAVARI
AMLA VISCOSITY DADIMA,
AMALAKI
LAVANA LIQUEFACTION SAINDHAVA
KATU OLIGO-ASTHENOSPERMIA PIPPALI,
SHUNTHI
TIKTA ASA, IMMUNOLOGIC GUDUCHI
KASHAYA PREMATURE EJACULATION JATIPHALA

The Knowledge of the tradition (Shastra) & The
technology (tantra) is required to pin point the
diagnosis of shukra vaha sroto vikara.
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Shukravaha srotas-Role of panchakarma -Dr Kishore Mahindraker

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