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Line 1,321: − Vidhi vimarsha: + − Rasayana and vajikarana therapies have a common aim - to provide positive health and prevention of diseases by increasing vigor of a healthy person. And so, vajikarana is described just after Rasayana chapter. Health scientists are showing great interest in screening classical Rasayana drugs for their antioxidant activity, and research reveals good results. Studies on Amalaki Rasayana[ ] shows increased longevity and on Drosophila melanogaster[ ] there is reduced oxidative damage to extend lifespan. Many drugs are described as Rasayana and Vajikara both. Reactive oxygen species (ROS) has a deteriorating effect on sperm . ROS has been increasing due to changing lifestyle and exposure to environmental pollution . Spermatozoa normally produce ROS in a normal physiological process. The amount of ROS produced is to be carefully controlled. The imbalance between the generation and scavenging of ROS may lead to damage to DNA or other important structures. Spermatozoa lack cytoplasmic defensive enzymes, such as catalase, glutathione peroxidase, which are involved in the protection of most cell types from ROS induced peroxidative damage. Large amounts of unsaturated fatty acids are observed in plasma membranes of spermatozoa, those are particularly vulnerable to free radical attack. [ ] The subfertile men have higher concentrations of ROS in seminal plasma, whereas an inverse correlation exists between ROS concentration and motility. [ ] Many Rasayanas act as antioxidants, so they can also be used to enhance sperm quality and quantity. Thus, mutual correlation and common mode of action justify the description of vajikarana just after Rasayana therapy. − For many years, the decline in human semen quality and fertility rates is a concern.[ ] Environmental and occupational pollutants, changes in lifestyles, exposure to toxic agents, and changes in dietary habits are observed among the most commonly cited factors associated with these declines.[ ] The environmental and lifestyle factors causing subfertility shall be targeted for curative or preventive measures. Environmental stress causes an increase in the number of free radicals (i.e., hydrogen peroxide [H2O2] and reactive oxygen species [ROS] that cause apoptosis in the spermatogenic cell.[ ] Chronic or severe stress leads to anovulation and amenorrhea in women[ ] and to decrease in sperm count, motility, and morphology[ ] in men. Smoking, [ ] alcohol, [ ] caffeine, [ ] pesticides, air pollution,[ ] bisphenol A,[ ] diseases like hypertension, diabetes mellitus, obesity, cardiovascular disease are related to deterioration of reproductive health[ ] by affecting sperm quality. − The role of diet in vajikarana: − Nutrition status is also a major cause of sub-fertility. Sexual dysfunction due to malnutrition can be easily overcome. Nutrition is important for DNA synthesis leading to the development of spermatozoa and oocytes. Diet also provides exogenous antioxidants (vitamins C and E). Dietary formulations mentioned are a perfect amalgamation of energy and nutrients required for production and maturation of sperm. − In Ayurveda, ahara or diet has been considered to be a form of medicine (bhaishajya), and the role of diet is not limited to nutrition only. Properly planned diet can be used for prevention as well as treatment of the diseases. Shukra is one of the seven dhatus and is formed by successive evolution of dhatus starting from rasa dhatu, and diet forms the substrate (Cha. Chi. 15/16). So, ahara is one important factor on which quality of dhatu depends. − Various simple dietary preparations which can increase the quantity, as well as the quality of sperm, are mentioned. The substance acts in various modes in the body, one of those is the principle of dravya samanya (similarity in substance) i.e. consumption of food item similar to body tissues increase them due to the similar constitution. Keeping this fact in mind semen of different animals has been used with fat. Snigdha dravya (unctuous substances) increase semen by similar properties. However, this mode of therapy may not have individual acceptance or practical in current period so the principle of gun samanya (dravya with similar properties) may be used. − The role of milk and dairy products: − Milk is integral to Ayurvedic diet regime. In the list of best factors for sustaining life, milk is considered best among all substances providing life (Cha.Su.25/40). Milk has a nutrition value as it provides essential amino acids, vitamins, minerals and fatty acids, and affects absorption of nutrients. Milk fat has a wide-ranging spectrum of fatty acids and lipids. Milk protein is rich in amino acids leading to stimulation of muscle synthesis, positive health effects on blood pressure, inflammation, oxidation and tissue development. − In Ayurveda, milk has been said to have a beneficial effect on semen quality. However, in present era due to change in feeding regime of dairy animals, the composition of milk might have been changed. This change has resulted in an increase in estrogens, fat content, etc. which are attributed to causing adverse effect on semen quality. Few types of research have claimed that milk and dairy products have a negative effect on semen as observed in male mice . − Feeding of the animal affects the quality of milk: − Milk composition can be altered by the feeding regimen of the cow. The content of several fatty acids such as c9, t11-CLA and the ratio between omega-6 and omega-3 fatty acids are affected by the amount of grass and supplemental feeds (concentrate) in the diet. Milk content of several vitamins and minerals are also influenced by the cow's diet. In a study it was found that concentrations of micro-components like CLA, and to a lesser extent EPA and DHA, can be significantly enhanced through the use of diet formulation and nutritional management of dairy cows.[ ] In another study effect of diet and cooling interactions on milk composition were studied in cows. So, it can be said that diet affects milk composition and in turn, effects are also modulated. If a cow is fed with masha, then the qualities of milk will increase and thus such milk is said to be a good aphrodisiac that has more beneficial effects on sperm quality. Masha itself has properties of increasing Shukra as it has Snigdha and madhura qualities. − According to Ayurveda, cow milk is better than other milk. The beneficial role of cow’s milk has been established by some recent researches. A study unambiguously clarified at the cellular level that cow's milk increased the activities of human PPARalpha, PPARdelta, and RXRalpha . − Milk is itself regarded as ‘Sadyo Shukrakara’ (means instant aphrodisiac) in Ayurveda as it increases sperm quality soon after the consumption. − Rice and its preparation with milk: − Shashitika rice is Snigdha, madhura, and sheeta and so by the Ayurvedic principle of guna samanya (similar properties), it helps in improving semen quality. Balya and brimhaniya drugs are added to rice for increasing strength of the patient. Masha, shali, shashtika, godhuma provide a combination of both carbohydrate and protein. It can be taken with milk and meat juice which again adds nutritive value. As digestive power varies with persons, dose fixation should be done individually after assessment of agni. − Payasa is dietary preparation which is popular as a sweet dish in India. It is prepared from a combination of milk and rice. It has property to increase sperm quality. If made from various aphrodisiac drugs its effect is much more. Payasa is included in normal diet regime so it can be easy aphrodisiac formulation by changing contents of Payasa. − Ghee: − Clarified butter (ghrita or ghee) is used as an aphrodisiac because it is considered good for rasa, Shukra, and ojas, Charaka Sutra 13/14. Intake of regular ghrita and milk is said to be best Rasayana in Agrya Prakrana by Charaka. Ghee is used as processing media that carries the therapeutic properties of herbs to all the body's tissues. Proper metabolism of the drug is crucial in obtaining the maximum benefit. The lipophilic action of ghee facilitates transportation to a target organ and final delivery inside the cell since the cell membrane also contains lipid. The effect of herb increases when it is used with ghee as compared to powder or tablet form.[ ] − Rasala has been said to be balya and shukrala (Bhavaprakasha Purva Khanda-12/124-127). − Pupalika is a dietary preparation which increases strength and sexual power. When prepared with potent aphrodisiac drugs as mentioned above its efficacy increases many folds. Such preparation can be easily prepared and can be used as food supplement. − Animal proteins and fats for virility: − Egg increases virility as they provide indispensable nutrients needed for sperm formation. Pork and chicken meat has been used in some formulations. For vegetarians, a diet rich in protein with high nutritive value can be used. − Fish has Snigdha, madhura, vrimhaniya, balya and vrishya properties. Shaphari is a kind of small fish. Rohita is best among different varieties of fish. By Guna, fish helps in improving sperm quality. Fish has various important constituents that are not synthesized naturally by human beings and, therefore, serve as effective supplements for enhancing virility, among other health benefits. any of these are required for proper functioning of the reproductive system of a human. So, fish may help in improving sperm quality. − Nonmedicinal agents and mental factors for vajikarana: − Mental factors play a prime role in sexual behavior and on this fact. Sankalpa (determination) is the best aphrodisiac. Soumansaya (pleasant mental disposition) is the most important factor in garbha dharana or conception. While mentioning factors having a beneficial role in sperm quality and quantity, mental factors have also been given importance. Harsha is termed as stimulating pleasure to initiate the sexual act by psychological means (Gangadhar commentary on 1-4/48). ‘Harsha’ can be explained as the desire produced from Sankalpa (fantasy) leading to erection and ejaculation (Chakrapani commentary). − Mental status and surroundings of the patient plays a crucial role in determining virility of a person. Several studies show that psychosocial distress contributes significantly to the etiology of some forms of infertility .Stress is one among important factor of increasing infertility in men, reducing semen quality by increasing plasma ROS generation while decreasing antioxidant protections, per studies. − Eight factors which are involved in ejaculation process are mentioned. Harsha, as discussed earlier, is stimulating pleasure to initiate the sexual act by psychological means. ‘Harsha’ is the desire produced from Sankalpa (determination) leading to erection and ejaculation. Chakrapani described Tarsha as vanitanamabhilasha i.e. desire of female partner. The word Tarsha is also used to denote Trisha so it can be described as strong desire to have a female partner. Both the Harsha and Tarsha are psychological entities. According to Hemadri, the substance which is having the potency of prerana (inspiration) is called sara. So, sara is the natural quality of Shukra, and so it flows without retention. Picchilata refers to sliminess, and so it helps in smooth ejaculation. Gurutva helps in falling of semen. Anu refers to small so due to anu-bhava semen comes out quickly. Chakrapani comments that due to anu-bhava Shukra has a tendency to come out. The factors sara, paicchilya, guru, anu-bhava, and pravanabhava are the physical properties of shukra which helps in ejaculation. − There is an immense need that we should change lifestyle to have a content mind. Meditation, Yoga and Ayurvedic spiritual principles can contribute a lot in this field. − Explanation of Shukra: − From the different descriptions given regarding Shukra, its structure and functional identity can be understood in a broader sense. The term Shukra represents androgens, semen, and sperm itself according to the suitability of the contexts. In above context, the seat of Shukra has been told as whole body so it can be taken as a hormone. It has been clarified that semen exists in the whole and it comes out after sexual arousal. The main object and means of sexual arousal is tactile stimulation. Shukra pervades all over the body seated on the sparshanendriya (tactile sensorium). The mind has inseparable union with tvak. According to Gangadhara the shukra present in the tvak (Tvaggatam Shukram) by continuous erotic stimulation gets ejaculated. Sushruta compares the ejaculatory physiology with that of lactation since both are deeply associated with psychological factors in Nidana Sthana 10th chapter. Sushruta explains the physiology of ejaculation as a combined activity of vata which is heightened by the heat generated in the act of copulation as a result of the rubbing of female and male genital organs which dispels the Shukra. − Ther are various parameters for normal Shukra. Beside physical parameters, the main criteria of normal Shukra are that it should be able to procreate progeny. − Factors affecting virility: − − The virility of a person may vary from person to person. Normal variations are described in here. Two parameters are given by which virility of a person can differ. In the first example, the sparrow is mentioned to indicate the frequency of sexual activity whereas in second example elephant is mentioned to indicate a large amount of semen ejaculation. With the help of two examples, Sparrow and elephant variation in frequency and amount of semen ejaculation has been mentioned. These two parameters are important for determining fertility rate. − 1. Frequency: − Statistical estimates suggest that fecund ability rises sharply with the frequency of intercourse. It is observed in a study that 94% of women aged 35 years and 77% women aged 38 years are conceived with regular intercourse for three years. [ ] The risk of erectile dysfunction in males aged among 30 to 75 years can be reduced by maintaining a regular frequency of intercourse. [ ] Coital frequency is directly related to conception. Research shows that best sperm motility is found in semen emission every three to four days on average.[ ] Intercourse every two to three days can maximize the overall chance of natural conception because spermatozoa can survive for up to seven days after insemination in the female reproductive tract.[ ] So, regular coitus with 3-4 days gap should be regarded as optimum coital frequency. − 2. Volume: − With the example of an elephant, the second parameter of semen volume is mentioned. According to WHO guidelines, the normal semen volume is 2.0–5.0 mL. An adequate volume of semen is required to carry male gametes into the female reproductive tract. Therefore, ejaculate volume is an important component of a semen analysis done to investigate male factor infertility. [ ] − 3. Season: − Effect of seasonal and individual variation on virility of a person has been mentioned. A particular code of conduct based on the season has been told for coitus frequency. Such regime helps to preserve the strength of the person. According to Chakrapani, in Hemant (early winter) and Shishir Ritu (winter) virility of a person is more. So one can have coitus regularly as per their strength in these seasons. In Vasant Ritu (spring) coitus on every third day, and in Varsha Ritu (rainy season) in a fortnight is advocated. − Human conception follows a seasonal rhythm.[ ] Seasonal modifications of reproductive functions[ ] and semen parameters[ ] are documented in human males. Recent trends noted a decline in the relation of seasonal variation and human conception rhythm. The increased industrialization leading to increasing in people being shielded from both photoperiod (by indoor work) and temperature (by heating and air conditioning) might be the reason behind this. [ ] − 4. The cause of infertility: − In the present era, even with the availability of sophisticated diagnostics in approximately 15% to 30% of couples we are unable to find out the exact cause of infertility. [ ] Ayurvedic Scholars included all conditions in which no evident cause of infertility was seen under broad term ‘Prakritya.' The second important cause of infertility which is observed was an affliction of diseases. A person who is afflicted with diseases gets debilitated and this result in a decrease in fertility/virility. This is another important principle, and it shows a scientific vision of ancient Ayurvedic scholars. − The adverse impact of infertility: − Infertility is one of the major stress factor [ ] similar to the intensity of a life-threatening illness. [ ] [ ] This distress and its treatment can affect various aspects of personal and family life. [ ] It also adversely affects the relationship regarding support, satisfaction, and communication [ ], increases anxiety, guilt, somatization, and depression. [ ] It challenges one’s own beliefs and about the world. [ ] The social network is affected as well.[ ] As the purpose of life is terribly shattered person goes into depression and considers himself as useless. − Selected vajikarana herbs and formulations currently in use: − Shatavari, Vidari, Jivanti, Twakshiri, Sita, Godhuma, Masha are referred to have aphrodisiac properties in recent nighantu(glossaries of herbs). This is due to their inherent properties similar to Shukra. − Ikshu: Ikshu or sugar cane has aphrodisiac properties and when a cow is fed with sugarcane stalks than the milk will be more beneficial and rich in its aphrodisiac qualities. − Pippali: Pippali is said to be vrishya or drug having property to increase sperm. − Pippali has above-mentioned properties only when it is used in proper dose and for a short time. − Yashtimadhu: Madhuka is a guru, madhura, Snigdha in properties. So, by guna samanya, it acts as good aphrodisiac. When given with ghee, honey, and milk it forms good aphrodisiac formulation. − Researches on herbs: − 1. Kapikachchu (Mucuna pruriens): − Atmagupta or Mucuna pruriens has been established as a potent aphrodisiac. M. pruriens efficiently recovers the spermatogenic loss induced due to Ethinyl estradiol administration by a reduction in ROS, restoration of mitochondrial membrane potential (MMP), regulation of apoptosis and increase in the number of germ cells. L-DOPA largely accounts for pro-spermatogenic properties of M. pruriens.[ ] In another study, seminal plasma of infertile patients, the levels of lipids, antioxidant vitamins, and corrected fructose were recovered after a decrease in lipid peroxides after treatment.[ ] Another study has demonstrated the potency of M. pruriens to reduce the diabetic induced sperm damage induced by oxidative stress (OS).[ ] In a study, the oral administration of M. pruriens to infertile men for three months not only resulted in general improvement in sperm count and motility, but it also led to significant reduction in the level of psychological stress.[ ] Similar research studies of other drugs mentioned should be done to explore their aphrodisiac properties. − 2. Arjuna (Terminalia arjuna): − Extract of T. arjuna could be used as a natural antioxidant and enhances the phytosterol content in clarified butter. Antioxidant supplementation drastically improves sperm count and sperm motility. [ ] Some tribal communities of Assam, India use Arjuna in cases of infertility as observed in an ethnobotanical survey. [ ] Arjuna bark is widely used to decrease the level of serum triglycerides and cholesterol, recover the level of high-density lipoprotein (HDL). As an anti-ischemic agent, it relieves myocardial necrosis, modulates platelet aggregation. It is an effective antioxidant. [ ] So, antioxidant properties of Arjuna can be used to increase virility of a person. − All five Gana (Shukrajanana, Jeevaniya, Brumhaniya, Balya and Kshira Samjanana) as mentioned in sutra sthana 4th chapter is used in vajikarana. The drugs mentioned in these Gana are mainly madhura, sheeta, mridu in nature and so by the similarity in properties, they increase sperm quality. For example, meda is included in jeevaniya & shukrajanana gana; payasya in brumahaniya & balya; Jivanti in jeevaniya; shali & shashtika in stanyajanana. These drugs may act on the higher center of the brain, i.e. the hypothalamus and limbic system. This may have antistress, adaptogenic actions, which helps to alleviate anxiety associated with sexual desire and performance. Administration of vajikarana Rasayana viz. C. orchioides, A. longifolia and M. pruriens ethanolic extracts modulates the level of the pituitary hormones FSH and LH. [ ] − Current vajikarna formulations: − Experienced Ayurvedic physicians create vagikarna formulations based on the properties of individual dravya and needs of the individual. Identification of some drugs mentioned in the text is controversial. Some drugs are endangered species. So, practically it is not possible to prepare some formulations with same ingredients, but Pratinidhi or Abhava drugs can be used in place of such drugs. − Further scope: − Ayurvedic formulations for vajikarana lack research as per current scientific standards. Lack of standardization of formulations and difficulty in getting unadulterated herbs are real obstacles in the utility of vajikarana preparations. Randomized controlled trials of these formulations can be helpful in understanding efficacy, possible side effects and other treatment related parameters. Glossary:
→Characteristics of good woman best for virilification
• Sexual act should not be done before age16 and after age 70.
• Sexual act should not be done before age16 and after age 70.
=== Glossary ===
1. Alpaśukra (alpashukra, अल्पशुक्र) Oligozoospermia, Oligospermia : The term signifies decrease of the seminal fluid or decrease of the sperms than the normal.
1. Alpaśukra (alpashukra, अल्पशुक्र) Oligozoospermia, Oligospermia : The term signifies decrease of the seminal fluid or decrease of the sperms than the normal.
2. ānūpā (anUpA, आनूप) -marshy lands.
2. ānūpā (anUpA, आनूप) -marshy lands.