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Abstract
To create a healthy progeny is one of the foremost Dharma of an individual, so fertility is an
existential necessity since the time immemorial. Impaired sperm parameters especially
decreased sperm count, motility and abnormal morphology leads to male infertility. Hence the
current study was conducted with aim to evaluate the efficacy and safety of oral
administration of Tb. Chandraprabha vati, Tb. Makardhwaj Vati, Amalakyadi Churna in
oligoasthenoteratospermia. The results of the study showed that given drug significantly
improved the sperm count and motility moderately and total abnormal sperms reduced.
Hence it is concluded that the given drug can be of great help in managing the sperm count,
motility and abnormalities in infertile males.
Keywords: Male infertility, oligoasthenoteratospermia, sperm count, sperm motility, sperm
morphology.
Corresponding author: Dr.Vipul Kanani
Article Info: Published on : 15/01/2025
P
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Issue : 02
Publisher
ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION
FOR PATHOLOGY AND RADIODIGNOSIS
DOI
: 1 0 . 5 2 8 1 / z e n o d o . 1 4 6 5 0 0 4 6
Reg. No. : MAHA-703/16(NAG)
Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
An Ayurvedic Management of Oligoasthenoteratospermia: A Case Study
Dr.Vipul Kanani
1
, Dr.Pooja Chikhlondhe
2
, Dr.Rajiv Mundane
3
1
Professor and Head of Rognidan Aum Vikruti Vigyan Department , RTM Ayurved College , Akola.
2
PG Scholar , Rognidan Aum Vikruti Vigyan Department , RTM Ayurved College , Akola.
3
Professor and Head of Rognidan Department, DMM Ayurved Mahavidylaya, Yawatmal.
Cite this article as: - Dr.Vipul Kanani (2025) ; An Ayurvedic Management of Oligoasthenoteratospermia: A Case Study;
Inter.J.Dignostics and Research 2 (2) 10-18, DOI: 1 0 . 5 2 8 1 / ze no d o . 1 4 6 5 0 0 4 6
Introduction:
Ayurveda asserts four objectives of life that is
Dharma, Artha, Kaam and Moksha.
[1]
Amongst it the
first three objectives has great importance during the
life period attained which should be harmonious and
productive. Ayurveda states that righteousness,
wealth, affection and good repute are dependent on
begetting a son.
[2]
This is possible only with
reproduction. Reproduction is an important
phenomenon for the continuation of species. Since the
beginning of recorded history, the human race has
placed a great emphasis on fertility. Fertility or being
fertile itself is a necessity for existence. Being infertile
or unable to bring forth a progeny itself is a worrying
situation for a couple which makes them approach for
a medical advice. Reproductive Medicine is a branch
G
A
R
V
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of medical science which deals with infertility cases
in males and females and associated disorders.
Infertility is a disease of reproductive system defined
by failure to achieve the clinical pregnancy after 12
months or more of regular unprotected sexual
intercourse. Infertility is a global problem in the field
of reproductive health. It is considered as a social
stigma in India which ultimately affects the
psychological harmony of the family, disturbed sexual
and social life. “The incidence of infertility varies in
different regions nearly 8–12% of couples worldwide.
Of all infertility cases, approximately 40– 50% is due
to “male factor” infertility and as many as 2% of all
men will exhibit suboptimal sperm parameters. It may
be one or a combination of low sperm concentration,
poor sperm motility, or abnormal morphology.”
[3]
Shukradushti is the complex pathological conditions
were, low sperm count, poor sperm motility, or
abnormal morphology like clinical presentation seen.
Where low sperm concentration (Kshina Shukra) plays
a major role to develop Oligoasthenoteratospermia and
become major cause for Male infertility. Kshina
Shukra or Shukrakshaya
[4]
is the type of Shukradusti
resulting in infertility in which Oligospermia is one of
the presentations. ‘The diagnosis of Oligospermia is
based on one low count in a semen analysis performed
on two occasions. For many decades sperm
concentrations of less than 20 million sperm/ml were
considered low or oligospermic, recently, however the
WHO
[5]
reassessed sperm criteria and established a
lower reference point, less than 15 million sperm/ml,
consistent with the 5th percentile for fertile men.’
Sperm concentrations fluctuate and oligospermia may
be temporary or permanent. Out of these some cases
remain unexplained whereas rest of the cases are
caused due to malnutrition, genetic abnormalities, side
effects of some medicines, hormones and chemicals
play the major role. The problem of oligospermia is
observed quite common in male infertility cases.
Hence it is important to find a remedy which is
effective, affordable and having less complications.
Nevertheless to say nature has answers for all. Many
herbal plants are used since ages for infertility issues.
Vajikaran Chikitsa highlights many such herbal
medicinal plants, their decoctions, Ghrita, food
preparations etc. for improving the Veerya of those
deficient, correcting the vitiation of Shukra Dhatu,
replenishing it on reduction due to various causes,
guarding it in old age as well as increasing pleasure
during coitus.
Materials And Methods:
Study Design: Randomized Open Labelled clinical
study with Pre- test and Post-test design.
●Conceptual Study: Ayurvedic and Modern literary
review of Kshina Shukra (Oligospermia) and
Shukradushti was done.
●Clinical Study: Detailed history taking along with
physical and systemic examinations and assessment
of the treatment was done.
Case Study:
The case of this study is 32 years old married, non-
smoking, non-alcoholic male patient with primary
infertility since 2 years of married life. Laboratory
investigations of seminal parameters on comparing
with normal revealed oligoasthenoteratospermia. The
clinical symptoms identified in the present case report
correlate to Kshina Shukra or Shukradushti
comprehended in Ayurvedic classics. In the present
case Report Explains The Role Of Shamana Chikitsa
With Tb. Chandraprabha Vati, Tb. Makardhwaja
Vati, Amalakyadi Churna in the management of
Oligoasthenoteratospermia.
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Patient Information :
The patient got married before 2 years. She was
unable to conceive even after two years of
unprotected sex, they decided to consult a doctor
and husband was diagnosed with
oligoasthenoteratospermia. They visited our
outpatient department (OPD) on dated 23/9/2023
OPD number 15438. He had nothing specific in
history of previous illness. Family history was
negative for any major illness.
Table 1: Personal History of Patient :
Table 2: Ashtavidha Pariksha (Eight
fold examination):
Nadi (Pulse)
68/min
Mutra (Urine)
7-8 times in
daytime, 2-3
times in night-
time
Mala (Stool)
1-2 times per day
Jivha (Tongue)
Alpa Sama
Shabda
(Speech)
Spashta
Sparsh
(Touch)
Rukshata
Drik (Eyes)
Prakruta
(Normal)
Akriti (Built)
Madhyama
Clinical Findings:
The physical and external genital organ examination
did not reveal any abnormal findings. Patients was
basically Vatapradhana Vata-Pitta Prakruti. Patient
was used to take spicy, ruksha, sheetapradhana ahara
and also have some stressful life. Latest report of
semen analysis is showed 15% motility in total of 10
million/ml count.
Diagnostic Assessment: - Based on the signs and
symptoms the present case was diagnosed as Kshina
Shukra (Oligoasthenoteratospermia). The assessment
was done by comparing baseline parameters with
repeated evaluation after 1 months of administration
of Shamana Chikitsa.
Baseline seminal parameters includes: Initial
investigation prior to treatment and investigation after
treatment comparative table described in result
section.
Therapeutic Intervention:
Therapeutic plan was begin with administration of
Shaman Chikitsa.
Table 3: Therapeutic intervention :
Sr.
No.
Drugs
Dose
Anupana
Duratio
n
1.
Tb. Chandrabha
Vati
2BD
Lukewarm/
Normal water
1
month
2.
Tb. Makardhwaj
Vati
2BD
Lukewarm/
Normal water
1
month
3.
i) Amalaki
Churna 2gm
ii) Rasayana
churna 1 gm
iii) Ashwagandha
churna 1 gm
iv) Satavari
churna 1gm
v) Safed musli
churna 500mg
vi) Akkalkara
churna
500mg
½
tsf
BD
Lukewarm/
Normal water
1
month
Diet
Mixed
Micturition
7-8 times in
daytime, 2-3 times
in night-time
Bowel
Regular
Appetite
Moderate
Sleep
Normal
Addiction
Nil
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Sadhyasadhyata of Ksheena Shukra (Prognosis):
Determination of Sadhya Asadhya is important before
the commencement of treatment. It will help to find
out whether the disease is curable or not. Ksheena
Shukra is a Dwidoshaja vyadhi with involvement of
Vata and Pitta Dosha, and is recognized as Krichra
Sadhaya.
[6]
Pitta Prakruti Purusha has less Shukra,
and if he has Shukra Kshaya, his prognosis will be
more Kashtasadhya.
Pathya-Apathya:
Patient was asked to take Madhura,Guru, Brumhana,
Snigdhapradhana Bhojana
[7]
including Dugdh, Shali,
Rotti, etc Rukshaannapan, Ratrijagarana, spicy foods,
sex was prohibited and also advised to avoid excessive
travelling.
Result:
Follow up and outcomes:
After 30 days, the patient was advised to have a follow
up on the OPD with reassessment of Semenogram.
After treatment there was a good improvement in the
seminal parameters.
Figure 1: Follow up and outcomes
Figure 2: Follow up and outcomes
Table 4 : Improvement in Parameters before and
after treatment.
Sr.
No.
Seminal
Parameters
Before
Treatment
After 30
days of
Treatment
1.
Volume
2 ml
2 ml
2.
Color
Grey white
Milky
white
3.
Viscocity
Normal
Normal
4.
Reaction Ph
7
Alkaline
5.
Liquefaction
time
Not
completed
till 1 hr
40 minutes
6.
Total count
10
millions/ml
38
millions/ml
7.
Motility
15%
70%
8.
Normal
morphologies
%
16%
70%
Samprapti Of Kshina Shukra: Samprapti of Kshina
Shukra can be explained as below.
There are different causes for Kshina Shukra to occur,
as explained under the heading Nidana. It includes
both Samanya and Vishistha Nidana when an
individual continuously comes to the contact with the
specified causes of Kshina Shukra first of all they
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vitiate both Vata and Pitta Dosha and they undergo
Prakopa. This is a common happening and from this
stage the Samprapti can be compiled in two different
ways.
A) Vata and Pitta which has undergone Prakopa
vitiate Jatharagni which in turn ends in the production
of Ama Dosha. The Ama Dosha, which is the
improperly digested Annarasa enters Dhatuvaha
Srotas. As a result of the entrance of sama dosha into
the Rasavaha Srotas, It gets obstructed. When a Srotas
is obstructed, it affects the Dhatu Parinaman
(transformation of body tissues) since there is
obstruction, transformation of Rasa Dhatu to the next
higher Rakta Dhatu is hindered. The result is Rakta
Kshaya. As a result of this progressive Metamorphosis
of Dhatu is hampered. The ultimate Srotas that is
Majjavaha Srotas obstruction leads to poor
nourishment of Shukradhatu which in turn produces
Shukra Dhatu of low quantity and quality, i.e
manifestitation of Kshina Shukra.
B) The Nidanas of Kshina Shukra makes Khavaigunya
in the Shukravha Srotas directly. The Vata and Pitta
which are the connected Doshas are still in the stage
of Prakopa, it gets localized in the region where
Khavaigunya occur in the Shukra Vaha Srotas.Srotas
itself is made-up of Dushyas and when the vitiated
Doshas localise in the Srotas, it is really Doshadushya
Sammurchana.
C) The Prakupita Doshas i.e Vata and Pitta with a
potential of creating pathology in body interact with
Shukra Dhatu, thus producing Kshina Shukra.
D) Samprapti Ghatakas:
Table 5 : Samprapti Ghatakas
Dosha
Vata And Pitta
Dushya
Shukra
Adhisthan
Vrushan, Shepha
Ama
Jatharagnimandhya
janya
Srotas
Shukravaha Srotas
Srotodusthi
Lakshana
Sanga
Rogamarga
Madhyam
Sadyasadhyata
Kruchra Sadhya
Chikitsa Of Kshina Shukra:
Charakacharya in seventh chapter of Vimana Sthana
explains three particular steps of treatment and
mentioned that the physician should follow these
principle treatment modalities they are:
1. Nidan parivarajana .
[8]
2. Samshaman chikitsa
3. Samshodhan Chikitsa
1. Nidana Parivarjana
To rule out the Roga one has to avoid the etiological
factors, earlier mentioned Nidanas, Aunupashya are to
be strictly avoided by the patient; To create Dhatu
Samya it is unavoidable to keep distance from the
Nidanas.
2. Samshaman Chikitsa
Dalhana comments as Upachaya is the primary line of
treatment in Ksheena Shukra. So while treating
Ksheena Shukra the physician should select the
combination of drugs which boost the Shukra Dhatu.
Properties of Vrishya Dravyas are Madhura Rasa,
Snighdha Guru Guna with function of Jivanan and
Brimhana and which create Harshana of Mana.
Shukrakar Aushadhis : They can be effectively
selected according to the condition from the following.
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1. Those mentioned in Vajikar Yogas.
2. Those mentioned in Shukradusthi Chikitsa.
3. Raktapittahara Yogas.
4. Yonivyapadhara Yogas
Shukrakara Aharas: Aharas which, includes Ghee,
milk, Madhura, Snighdha, Sheeta Dravyas, Shali
Yava, Godhuma etc can be used effectively as
Shukrakara Aharas
Shukrakara Viharas: Stree is explained as best
among Vajeekaranas and Ritucharya mentioned by
our classic which augment Shukra in body
3. Samshodhan Chikitsa:
In Kshina Shukra The main line of treatment in
Kshina Shukra has been given as “Kshine Shukrakari
Kriya” .
[9]
Before the administration of the drugs,
which are having Vrushya karma, it is a general factor
to prepare the body in order to get maximum benefit.
These Shodhana procedures are sufficient enough to
create Srotoshuddhi and a body devoid of Malas.
Ayurveda includes Vamana Karma and Virechana
Karma in these Shodhana procedures .
[10]
. In Shukra
Dosha i. e in Kshina Shukra the choice of treatment is
Basti (Anuvasana & Niruha) Which Is Made Out Of
Shukravardhaka Dravyas in Ghrita, Taila etc. is
given. .
[11]
The classics like Charaka samhita, Susruta
Samhita etc. explain various recipes of Vrushya Basti
which can be effectively used in the condition. .
[12,13]
Discussion:
Kshina Shukra is a Vyadhi in which Shukra dhatu is
qualitatively and quantitatively vitiated. Also, certain
degree of quantitative reduction in Shukra Dhatu is
indicated by three conditions namely Alpa-Kshina-
Vishushka Retas. Acharya Sushruta has also
mentioned the word Kshina Retas, while elaborating
definition of Vajikarana Tantra.
[14]
. While Dalhana
opines Kshina Retas is moderately low level of Shukra
occurring in middle age group due to some
etiopathology. Fertility potential of Shukra Dhatu is
also affected by disease Ksheena Shukra. These
Lakshnas can be included under qualitative vitiation of
Shukra Dhatu.
Hence it can be concluded that in Kshina Shukra due
to consumption of various etiological factors and
Dushti of Shukravaha Srotas, Shukra Dhatu
production is not up to its mark and ejaculated in low
volume. In short, which indicate towards quantitative
and qualitative changes of Shukra Dhatu. The Doshik
involvement in this condition is Vata and Pitta
Doshas.
Table 6 : Oral medication & Mode of action
Oral
medication
Mode of action
1. Chandraprabha
Vati
Balance Vata and Pitta
Doshas, enhancing all seven
Dhatus specially Shukra
Dhatu, enhancing overall
vitality and rejuvenating the
reproductive system,
improving genitourinary
health. Though its adaptogenic
and calming properties, aids in
reducing mental stress. Having
Deepan and Pachana,
Diuretic, antimicrobial, anti-
inflammatory and analgesic
properties.
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Oral medication
Mode of action
2. Makardhwaj
Vati
Powerful Rasayana,
balancing Tridoshas,
enhancing Shukra Dhatu, and
supporting physical, mental
and sexual health.
Aphrodisiac, enhance vitality,
rejuvenates tissues.
3. Amalakyadi
Churna
Balancing Tridoshas,
enhancing Shukra Dhatu and
improve sperm count. Having
Rasayana, antioxidant,
rejuvenating properties.
Improving blood circulation,
adaptogenic in nature,
reducing stress, mild
aphrodisiac, promoting
fertility and sexual vitality.
Deepana and Pachana in
nature.
Conclusion:
This Ayurvedic treatment therapies were helping in
improving the seminal parameters to a satisfactory
level. Hence this approach can be considered in
patients with low sperm count and motility..
Reference:
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dipika commentary by Chakrapanidutta ,
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17
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