A Holistic Approach for Oligospermia (Kshirn Shukra) - A Review
Article

Kumar P; Upreti D and Chavan SG

doi:10.23880/jonam-16000425

Journal of Natural & Ayurvedic Medicine Research Article 8 min read

A Holistic Approach for Oligospermia (Kshirn Shukra) - A Review Article

Kumar P^*, Upreti D and Chavan SG

^* Corresponding author

ISSN: 2578-4986 10.23880/jonam-16000425 Received: September 12, 2023 Published: November 27, 2023

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Keywords

Kshina Retasa Sperm Andrology Vajeekarana

Abstract

Infertility is still a major issue in our society because of change in natural habits, food habits and living style. Infertility means inability to produce offspring after 12 months of unprotected intercourse. Where societies do not respect an infertile person, it causes major loss of self confidence and other mental and physical problem to the concerned person. Almost 15% of world population is suffering from infertility where male infertility contributes to half of the reasons. Here we had thrown light on Male infertility specifically Oligospermia due to increased number of cases in past years. Oligospermia is called as Ksheena Retas or Ksheena Shukra in Ayurveda, which means low sperm counts or sperm counts less than 15millions sperm/ml of sperm. In this article we have discussed about the cause, symptoms and management of ksheena shukra as per Ayurveda context. The main objective is to rule out the causes, dig into Ayurvedic prospective and affordable Ayurvedic treatment of Ksheena Shukra. Numerous treatment is available in allopathic medicine field but no such desirable results have been achieved as most treatment is hormonal based which do not treat disorder from its roots. Classical Ayurvedic texts like Charak samhita, Shushruta samhita, Ashtang Hridyam etc, modern textbooks, journals and different websites have been taken for studying about literature aspect. After analyzing looking into all aspects, it was concluded that Ayurvedic herbs with properties like sheeta, balya, vrishya, madhura, sheet virya, brihana and pacifies vata and also therapies which pacifies vata like basti have great effect in treating Ksheena shukra which are easily available and affordable for all divisions of society.

Introduction

Failure to produce a clinical pregnancy after 12 months or longer of regular, unprotected sexual activity is a sign of infertility, a disorder of the reproductive system. It affects public health over the world. Oligospermia is characterized by a low sperm count of less than 15 mil sperm/ml of semen [1]. An estimated 15% of couples worldwide struggle with infertility [2]. Infertility in men may be brought on by poor sperm quality (lower motility/fewer sperm) [3]. The condition of Kshina Retasa, according to Acharya Sushruta, is Vata-Pitta predominance [4]. Shukradoshas is given the highest importance in the old Ayurvedic writings as the main cause of male infertility.

The Ayurvedic classics provide a thorough explanation of the Retasa test. Charaka categorized the analysis of Dusta Retasa into eight categories: Phenila, Tanu, Ruksha, Vivarna, Puti, Picchila, Anya Dhatusamsrata, and Avsasadi [5]. According to Acharya Sushruta, the Shukra that has been vitiated by Vata, Pitta, Kapha, or Kudapagandhi (the stench of a dead body) or Granthiyukta or Durgandhayukta or Puyamisrit, Kshina, or Alpamatrayukta (the smell of urine and stool) is unable or unfit to reproduce naturally [6]. Low sperm count (Oligospermia) is a major cause of male infertility and is linked to Kshina Retasa in Ayurveda. Kshina Retasa denotes that, although being in Madhyam Aayu, the Retasa count will be lower than typical due to a variety of causes [7].

Need for the Study

Infertility is a social stigma that has an impact on psychological well-being, sexual life, and social function. The infertile couple’s existence revolves on doctors and laboratory for regular check-ups. According to Acharya Charaka, a person without a child is like a single tree with branches devoid of fruits, shadows, and any nice odor. He is also thought to be an artificially painted light, a dried-up lake, or a faux metal with the look of a precious metal. He is identified as Apratishtha (not well established), Nagna (naked), Shunya (empty), has only one sense organ, and has lived a purposeless life [8].

Materials and Methods

Classical texts in Ayurvedic and modern literature are reviewed.
Various articles and databases in platform like PubMed, Medline, Scopus are reviewed.

Retas?

The term Retasa is derived from the Sanskrit root ‘Ri Ksrane Riyate Ksarate Iti’, which means to flow. ‘Re Gati Recanyoh Riyate Gacchati SariratVahati Maithunkale Iti’ means “the substance that flows out of the body during sexual intercourse.” It is normal practice to use the terms ‘Retas,’ ‘Sukra,’ and ‘Virya’ interchangeably. However, these terms were coined for a specific purpose; Shukra refers to the entire testicular and accessory gland secretion, i.e., semen and androgens. It is the seventh Dhatu of the body, representing the essence of all Dhatu, whereas ‘Retas’ represents the ejaculate (Semen) and ‘Virya’ represents the potency. According to Acharya Sushruta, a flower bud emits scent only when it blossoms; yet, this does not imply that the bud is devoid of fragrance. Similarly, Shukra does not appear in childhood, but as one grows older, it appears, and this does not imply that Shukra is absent in childhood. Shukra is present in both male and female and is manifested in male by the appearance of hairs on the face and genital organs (secondary sexual characteristics) and in female by the appearance of menstruation. The term ‘Veerya’ is used to describe potency, strength, or masculinity in general.

Differentiate B/W Healthy & Unhealthy Retasa

Quality of Shudha Retas

In nature, the best pure Retasas are Snighda (unctuous), Ghana (viscous), Pichila (slimy), Madhura (sweet), Avidahi (nonblazing), Sweta, and Sphatika Sannibham, according to Acharya Charaka [9]. Similarly, the properties of pure Retasa, according to Acharya Sushruta, are Sphatikabham, Dravam, Snighdham, Madhuram, Madhugandhi, Taila Nibham, and Ksoudra Nibham [10].

Unhealthy Retasa/Astadosha of Retasa

According to Acharya Charaka, the eight Doshas of Shukra are Phenilam (frothy), Tanu (slender), Ruksha (arid), Vivarnam (discolored), Puti (putrid), Picchilam (slimy), Anya Dhatu Samsrata (afflicted with other Dhatu), and Avasadi. Vata (dominance) is responsible for frothy, thin, arid, sparse, and uncomfortable ejaculation. As a result, damaged sperm is incapable of fertilization (Garbha). Pittaa affects purple or yellow discolored sperm with a putrid odor and ejaculation with a scorching feeling. Kapha-affected sperm is highly sticky and obstructs the sperm channel (ejaculatory duct) [11].

Inidan of Kshina Shukra

Consumption of unsuitable food, Excess exercise, untimely ejaculation, consumption of dry, bitter, astringent, salty, sour, hot food, injury, morbidity producing vitiation of Dhatu, anxiety, distress, distrust, apprehension, rage, exorcism, Dosha individually or collectively reaching to Retovahasrotas lead to acute disorders of the Shukra (semen) [12].
Any type of physical or emotional stress might result in Oligospermia.
As there is an Ayurvedic fundamental concept for Sapta- dhatu, if the first Rasadhatu is not generated properly or in the correct amount, the successive Dhatus will likewise be formed inappropriately [13].
Due to Shukravaha srotadusti, i.e., sexual actions at unsuitable hours and through non-vaginal tract, suppression of sperm discharge, excessive coitus, unawareness of female desire, senility, and improper surgical treatments, or if Kshara and Agni karma cauterization operations are provided.

Causes of Oligospermia (Modern View)

Following factors which may be responsible for Oligospermia are –

Genetic abnormalities that cause faulty spermatogenesis include Klinefelter’s syndrome and XX male syndrome.
Addiction- Alcohol, tobacco.
low testosterone, and high prolactin levels (Hormonal imbalance).
Oligospermia is caused by occupational and environmental risks such as chemical nematocides, lead, microwaves, and ultrasound.
Ejaculation backward into the bladder (Retrograde ejaculation).
Infections that impair sperm production or health, such as Syphilis, Non-specific urethritis, Mumps, or Orchitis.
Cryptorchidism or undescended testis.
Varicocele [14]

Investigations

General physical examination and medical history.
Semen Analysis
Routine examination of blood.
Serum Testosterone, Serum FSH, Serum LH.
USG Scrotum.
Transrectal ultrasound.
Genetic tests can be done [15]

Management of Oligospermia through Modern Medicines

Anti-sperm antibody- Immune suppression by cyclic steroid
Artificial insemination (A.I), In vitro fertilization. (IVF)
Intra cytoplasm sperm injection [16]
Varicocele- Varicocelectomy.
TURED (Transurethral resection of ejaculatory duct)- In obstruction of ejaculatory duct.

Management of Ologospermia by Ayurveda

Ayurveda Mentioned Vajikaranatantra for the treatment of oligospermia, which included the use of Rasayana and Vajikarana dravyas (aphrodisiac medications) along with Panchkarma. Diet and lifestyle changes aid in conception and the production of healthy offspring. Shodhana has been prioritized as a prerequisite for Vajikarana. In case of disease of Shukra, treatment with Vajikarana (aphrodisiac) and formulations that are Raktapitta Nashaka in nature is effective. Many traditional literature describe drugs for Kshina Retasa, and the basic principle is Upachaya (spermatogenesis) Chikitsa, which delivers Viryavardhaka effect, such as Kapikacchuhu [17, 18, 19, 20].

Chikitsa According to Dosha

If Shukra affected by Vata the Niruha Basti with Anuvasana Basti are advisable.
If Shukra affected by Pitta the Rasayana is used such as Abhayamalakeeyam.
If Shukra affected by Kapha Dosha then it will be treated with Amrita, triphala, Loha, pippali and bhllatak rasayana.

Shamana and Shodhana chikitsa

Following Herbs Most commonly used in ayurveda-

Ashawgandha (Withania somnifera), which improves spermatogenesis through a testosterone-like action [20].
Yashtimadhu (Glycyrrhiza glabra), it is Shukarala in Nature it improves Semen quality.
Gokshura (Tribulus terrestris), It stimulates testosterone production by increasing luteinizing hormone and gonadotropin-releasing hormone [21].
In Ayurvedic classics, Shukrajanan, Shukrashodhaka Shukrapravartaka, Sukrasthambhaka are also mentioned [21].

Ahara and Vihara

Ahara- Godhum, Shalidhanya, Ghrita, Amalaki, Pippali, Mamsarasa, Saindhava all these are shukrala, vrishya in nature.
Vihara- Snana, Nidra, Vyayama, Abhyanga.

Shodhana chikitsa

Before administering the Vajikarana drugs, the Sodhana procedures must be followed. It should only be utilized after Sroto suddhi and after confirming Shareera is free of Malas. Generally, Virechana and Basti are recommended for Shukradoshas management.

Conclusion

According to the literature, medicines with Snighdha guna, Balya, Vrishya, and Vatasthapana characteristics have a positive impact on Kshina Retasa. Similarly, several medications’ Madhura rasa, Sheetavirya, Vrishya, Brimhana, and Vatapittahara characteristics help with Kshina Retasa. As a result, we may infer that the traditional Ayurvedic

method is a preferable therapy option for Kshina Retasa in the current environment

References

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