Matrabasti vatastila pk007-gdg

By

VIJAYAMAHANTESH. M. HUGAR

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D. (PANCHAKARMA)

In

PANCHAKARMA

Under the guidance of

Dr. P. Shivaramudu,M.D. (Ayu)

And co-guidance of

Dr. Shashidhar. H. Doddamani,M.D. (Ayu)

Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College,

Gadag – 582103.

2006.

“A COMPARARATIVE EFFECT OF MATRABASTI AND

SNEHAPANA (SHAMANA SNEHAPANA) WITHSUKUMARAKUMARAKA GHRITA IN THE MANAGEMENTOF VATASHTILA (BENIGN PROSTATE HYPERPLASIA).”

Ayurmitra

TAyComprehended

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

hereby declare that this dissertation / thesis entitled

“A Compararative Effect of Matrabasti And Snehapana (Shamana“A Compararative Effect of Matrabasti And Snehapana (Shamana“A Compararative Effect of Matrabasti And Snehapana (Shamana“A Compararative Effect of Matrabasti And Snehapana (Shamana“A Compararative Effect of Matrabasti And Snehapana (Shamana

Snehapana) with Sukumarakumaraka Ghrita In the Management ofSnehapana) with Sukumarakumaraka Ghrita In the Management ofSnehapana) with Sukumarakumaraka Ghrita In the Management ofSnehapana) with Sukumarakumaraka Ghrita In the Management ofSnehapana) with Sukumarakumaraka Ghrita In the Management of

Vatashtila (Benign Prostate Hyperplasia).”Vatashtila (Benign Prostate Hyperplasia).”Vatashtila (Benign Prostate Hyperplasia).”Vatashtila (Benign Prostate Hyperplasia).”Vatashtila (Benign Prostate Hyperplasia).” is a bonafide and genuine

research work carried out by me under the guidance of

Dr.P.Shivaramudu, M.D. (Ayu), Professor, Post-graduate department of

Panchakarma and co-guidance of Dr. Shashidhar. H. Doddamani, M.D.(Ayu),

Assistant Professor, Post graduate department of Panchakarma.

Date:Place:

I


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entit led


Snehapana) with Sukumarakumaraka Ghrita In the ManagementSnehapana) with Sukumarakumaraka Ghrita In the ManagementSnehapana) with Sukumarakumaraka Ghrita In the ManagementSnehapana) with Sukumarakumaraka Ghrita In the ManagementSnehapana) with Sukumarakumaraka Ghrita In the Management

of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).” is a bonafide research

work done by VIJAYAMAHANTESH. M. HUGAR in partial fulfillment

of the requirement for the degree of Ayurveda Vachaspathi. M.D.

(Panchakarma).

Date:

Place: Dr. P. Shivaramudu, M.D. (Ayu).

Professor

Post graduate department of Panchakarma.

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION

This is to certify that the dissertation entitled



of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).” is a bonafide re-

search work done by VIJAYAMAHANTESH. M. HUGAR under the

guidance of Dr.P. Shivaramudu, M.D. (Ayu), Professor, Postgraduate depart-

ment of Panchakarma and co-guidance of Dr. Shashidhar.H. Doddamani,

M.D. (Ayu), Assistant Professor, Post graduate department of Panchakarma.

Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil.

Professor & H.O.D, Principal.

Post graduate department of Panchakarma.

CERTIFICATE BY THE CO- GUIDE

This is to cert i fy that the dissertat ion enti t led



of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).”of Vatashtila (Benign Prostate Hyperplasia).” is a bonafide re-

search work done by VIJAYAMAHANTESH. M. HUGAR in partial

fulfillment of the requirement for the degree of Ayurveda Vachaspathi.

M.D. (Panchakarma).

Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).

Place: Assistant Professor,

Post graduate Department of Panchakarma.

COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and

disseminate this dissertation / thesis in print or electronic format

for academic / research purpose.

Date:

Place:

© Rajiv Gandhi University of Health Sciences, Karnataka.


i

ACKNOWLEDGEMENT “Many hands make light work”. I take this opportunity to mention my deep

gratitude to several personalities who have helped me in the successful completion of this

work.

I express my obligation to my honorable H.O.D, Dr. G. Purushothamacharyulu

M.D. (Ayu), H.O.D., P.G. Department of Panchakarma, P.G.S&R, D.G.M.A.M.C, Gadag

for his critical suggestions and expert guidance for the completion of this work.

I express my obligation to my honorable guide Dr. P. Shivaramudu M.D (Ayu),

Assistant Professor, for his critical suggestions and expert guidance for the completion of

this work.

I am extremely grateful and obliged to my co-guide Dr. Shashidhar.H.

Doddamani, Asst. Professor, P.G.S.&R, D.G.M.A.M.C, Gadag for his guidance and

encouragement at every step of this work.

I express my deep gratitude to Dr .G.B Patil, Principal, D.G.M.A.M.C, Gadag,

for his encouragement as well as providing all necessary facilities for this research work.

I express my sincere gratitude to Lecturer Dr. Santhosh. N. Belavadi MD (Ayu),

Lecturer for their sincere advices and assistance.

I express my sincere gratitude to Dr. V. Varadacharyulu M.D (Ayu), Dr.M.C.Patil

M.D (Ayu), Dr. Dilip Kumar M.D. (Ayu), Dr. Mulgund M.D (Ayu), Dr. K.S.R.Prasad

M.D. (Ayu) (Osm), M.A. (Jyotish), Dr. R.Y.Shettar M.D. (Ayu), Dr. Kuner Sankh M.D.

(Ayu), Dr. Girish Danappagoudar Dr. Jagadish Mitti M.D. (Ayu), Dr. Shashidhar

Nidagundi M.D. (Ayu) and other PG staff for their constant encouragement.

I express my sincere gratitude to Dr. Venkatesh S. Karanth M.D. (Patho) D.N.B.

Lecturer Shri. Nandakumar (Statistician), for their sincere advices and assistance.

I also express my sincere gratitude to Shri. V.M. Mundinamani (Librarian), Dr. S.

D. Yerageri, Dr. D. M. Patil, Dr. S. A. Patil, Dr. P.C. Chappanamath, Dr. M. V. Aiholi,

Dr. B. S. Patil, Dr. S. B. Govindappanavar, Dr. B. G. Swamy, Shri. C.S. Bhatt, Dr. U. V.

Purad, Dr. Mallagoudar, Dr. R.K. Gachhinmath, Dr. G.S. Hiremath, Dr. Avvani, Dr. S.

H. Radder, Dr. C. S. Hiremath, Dr. Juktihiremath, Dr. Kudarikannur, Dr. R.R. Joshi, Dr.

K.S. Paraddi, Dr. V. M. Sajjan for their support in the clinical work.

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Shri. B.S. Tippanagoudar (lab technician), Shri. Basavaraj (X-ray technician), Mr.

Shavi, Mr. Nabhi, Mr. Kulkarni, Mr. Hatti and other hospital and office staff for their

kind support in my study.

I express my sincere thanks to my colleagues and friends Dr. Ratna Kumar, Dr.

Uday Kumar, Dr. Jayaraj Basarigidad, Dr.P.Chandramouleeswaran, Dr. Kendadamath

Dr. Shaila. B, Dr. Santhosh.L.Y, Dr. Subin Vaidyamadham, Dr. Febin .K. Anto, Dr,

Satheesha.R, Dr., Dr. K. Krishnakumar, Dr. Ashwini Dev, Dr. Suresh Hakkandi, Dr.

Vijay Hiremath, Dr. Manjunath Akki, Dr. L. R.Biradar, Varsha.S. Kulkarni, Dr.

Hadimani, Dr. C. S.Hanumanta Gouda, Dr.Shankargouda, and other post graduate

scholars for their support.

I also express my obligations to my friends Dr. B.L. Kalamath, Dr. Venkareddy,

Dr. Basavaraj Ghanti, Dr. Pradip, Dr. Sajjan, Dr. Ashok Bhingi, Dr. Umesh Kumbar, Dr.

Devendrappa Budi, Dr. Shubu Prasad, Dr. Ashok M.G., Dr. Payappagouda, Dr.

Madhushri, Praveen. Dr. hemanta. Manju. Kushi. Kittu. etc.

I acknowledge my patients for their wholehearted consent to participate in this

clinical trial. I express my thanks to all the persons who have helped me directly and

indirectly with apologies for my inability to identify them individually.

I am highly thankful to my parents Shri. Mahadevappa D. Hugar & Smt.

Sarojadevi M. Hugar for her constant help and encouragement throughout the work. I am

also thankful to my beloved brother Mr. Vasanth Mrs. Geetha for their constant support

and encouragement.

Date : VIJAYAMAHANTESH. M. HUGAR.

Place : Gadag.

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List of Abbreviations Used

⇒ A. Hr.. – Ashtanga hridaya.

⇒ A. S. – Ashtanga samgraha.

⇒ B. P. – Bhavaprakasha.

⇒ B. R. – Bhaishajya ratnavali.

⇒ Ch. – Charaka.

⇒ C. S. – Charaka samhitha.

⇒ G. N. – Gada nigraha.

⇒ H. S. – Hareetha samhitha.

⇒ M. N. – Madhava nidana.

⇒ No. – Number.

⇒ Pt.’s – Patients.

⇒ Sl. – Serial number.

⇒ S. S. – Sushruta samhitha.

⇒ Su. – Sutrasthana.

⇒ V. S. – Vangasena samhitha.

⇒ Y. R. – Yogaratnakara.

⇒ Sk. D. – Shabdakalpadruma.

⇒ SKKG – Sukumaraka Kumaraka Ghrita.

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ABSTRACT

Obstruction at different levels in the urinary tract produces different effects.

Ayurveda too deals with the chapter of urinary obstruction under Mutraghata and also

principles of its managements. Here a sincere attempt is made to asses the efficacy of

Ayurvedic formulations in the conservative management of Vatashtila (BPH.)

Research begins with doubts and ends with facts, that serve as new data to be

verified again. Thus the process of research never ends, but at the end of it the researcher

would have become wiser with plans to counter newer challenges.

The present study is “A Comparative effect of Matrabasti and as Shamana

Snehapana with Sukumara Kumarak Ghrita in the management of Vatashtila

(BPH)”

MatraBasti is one the most important among the Panchakarmas. It has already

been proved that the “Basti” is the choice of treatment Vata pradanavyadisas the

Vatashtila is one of the Vata pradanana vyadi. And Shamana Snehapana is indicated in

mutrakrachar, it is having importance to alleviates disease quickly.

Sukumara Kumaraka Ghrita is the name itself indicates, it is recommended for

Sukumaras viz old age persons without any hesitation .The ingredients viz- Dashamula,

Laghupanchamoola, Punarnava etc are having properties like Rasayana, Balya,

Shoolahara and Vatahara.etc which helps in correcting the pathology of Vatashtila

(BPH). Hence this study has under taken.

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Objectives Of The Study:-

1) To evaluate the effect of Sukumara kumaraka ghrita Matrabasti in the

management of Vataashtila (BPH).

2) To evaluate the effect of Sukumara kumaraka ghrita as Shamana snehapana in

the management of Vatashtila (BPH).

3) To compare the effect of Sukumsr kumaraka ghrita Matrabasti and as shamana

snehapana in the management of Vatashtila (BPH).

Clinically this study deals with the management of patients of Vatashtila (Benign

Prostatic Hyperplasia.). It is a common problem in who is men over 50years of age;

Approximately one half of 50 years, by the age of 60 years 50 % of men have histological

evidence of BPH, and an estimated three fourths of all men over the age of 60

experiences such symptoms as difficulty in initiating urinations, Nocturia, and frequency.

As life expectancy increases, primary care physicians will likely see significantly more

male patients with this disorder.

Vatashtila (BPH) is characterized by both Obstructive and Irritative symptoms.

The main severity of symptom is not correlated with the size of the prostate. Many men

with enlarged prostate have no symptoms whereas others, some times with lesser

enlarged, experience severe symptoms. The management of BPH is divided into Non-

operative treatment, Conventional operative treatment and Minimally invasive treatment.

All these considerations provided a firm launch pad to make excursion into the

therapeutic alternatives, which could be provided by Ayurveda, the Mantra of

“NIRAMAYA” Therefore a set of therapeutic procedures was designed to assess its

efficacy on symptomatology of BPH.

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In this present work the schedule of treatment was as follows –

30 patients are selected and are randomly categorized into two groups.

Group 'A' – 15 patients with Matrabasti with Sukumara Kumarak Ghrita, 8 days

Matrabasti with 70ml of Ghrita, 16 days for pariharakala total study duration was 24

days.

Group 'B' – 15 patients with Shaman Snehapana with Sukumara Kumarak

Ghrita, 16 days Shaman Snehapana with 30ml Ghrita, divided dose twice Daly up to 16

days and 8 days for pariharakala total study duration was 24 days.

Subjective parameters:

Cardinal symptoms of Vatashtila (BPH).viz – Ashtila vatha Ghanam Ghranthi,

Mala, Mutra, Anila Sanga, Adhmana, Sashula yukta mutratyaga. And American

Urological Association Symptoms Index & (I-PSS).

Objective parameters:

Digital Rectal Examination and Ultrasonography.

Response of the treatment:

Subjective complaints were relieved significantly in the range of 38.88% patents from

good respond after the completion of Matrabasti in Group A, and 22.22% of patients are

from moderate respond, where as 22.22% of patients are from poor respond.

In the objective parameter 6.66% good respond, 26.66% poor respond. Comparing the

subjective and objective parameter, subjective parameter is having better effect.

In Group B the range of relief was observed from subjective parameter 55.55% is

poor respond, 11.11%is moderate respond. Where as objective parameter among 15

patients there is no any respond has seen. Comparing the subjective and objective

parameter, group-A and group-B, group-A (Matrabasti) is having better effect.

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TABLE OF CONTENTS

Chapters Page No.

1. Introduction 1-4

2. Objectives 5-9

3. Review of literature 10-81

4. Methodology 82-104

5. Results 105-137

6. Discussion 138-168

7. Conclusion 169-171

8. Summary 172-173

9. Bibliography 1-16

10. Annexure 17-31

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LIST OF TABLES

Table No.

Showing the Page No.

01. Indications for Bastikarma are as follows – 26 02 Sneha guna, Panchabhoutika sanghatana & Karmukata of Sneha dravyas. 29 03 Source of Sthavara sneha according to Charaka 32 04 Sushruta’s classification of Sthavara sneha. 32 05 Sneha Bhedha based on the Paka. 33 06 Opinion about Sneha Matra 35 07 Sneha Matra according to Sushruta. 35 08 Indications of Sneha Matra. 35 09 Indications of Shamanasneha. 39 10 General Contraindications of Snehana. 40 11 Sneha Jeeryamana and Jeerna Lakshana. 44 12 Nidanas as explained classics. 61 13 Symptomatology Of BPH. 66 14 Pathya-Apathya In Vatashtila (BPH). 79 15 Combination of this ghrita are like as mentioned 83-86 16 Chief Complaints. 92 17 Digital Rectal Examination Chart. 100 18 Grade for U.S.G findings 103 19 Distribution of patients by age groups. 105 20 Distribution of patients by religion. 106 21 Distribution of patients by occupation. 106 22 Distribution of patients by socio-economical status. 107 23 Distribution of patients by dietary habits. 107 24 Distribution of patients by Vyasana. (Addiction). 108 25 Distribution of patients by Viaharaja Nidana. 108 26 Distribution of patients by Nidra. (Sleeping Habits). 109 27 Distribution of patients by Jatharagni. (Status ofJatharagni). 109 28 Distribution of patients by nature of Koshta. 110 29 Distribution of patients by nature of Mala pravritti. 110 30 Distribution of patients by Mutra pareekshya bhavas. 111 31 Distribution of patients by type of Desha. (Nature of Habitat). 111 32 Distribution of patients by dosha pradhanata in Prakriti. 112 33 Distribution of patients by Nidana. 113 34 Distribution of patients by Chief complaints. 115 35 Prostate findings by Digital Rectal Examination. (DRE) 116 36 Residual Urine in cubic centimeter. 118 37 Subjective parameters before and after treatment in Group-A as 119 38 Subjective parameters before and after treatment in Group-A as per AUA

(I-PSS) symptom score index. 120

39 Subjective parameters before and after treatment in Group B. 121 40 Subjective parameters before and after treatment in Group B as per AUA 122

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(I-PSS) symptom score index. 41 Changes (DRE) findings in Group A 123 42 Changes in Prostate size in Group A. 123 43 Changes in weight of the Prostate in Group A. 124 44 Residual Urine values in Group A. 124 45 Changes (DRE) findings in Group B 124 46 Change in Prostate size in Group B. 125 47 Change in weight of the Prostate in Group B. 126 48 Residual Urine values in Group B. 126 49 Over all effect of I-PSS Index of Vatashtila ( BPH ). 127 50 Over all effect of Malasanga. 127 51 Over all effect of Mutrasanga. 128 52 Over all effect of Anilasanga. 128 53 Over all effect of Ruja /Sashoolyukta Mutra tyaga. 129 54 Over all effect of Ruja /Sashoolyukta mutra tyaga. 129 55 Over all effect of size of the prostate. 130 56 Over all effect of upper border of the prostate. 130 57 Over all effect of mobility, of the prostate. 131 58 Over all effect of Residual Urine. 131 59 Over all effect of Weight of prostate. 131 60 Overall results of Subjective and Objective parameters in Group A. 132 61 Over all effect of Subjective and objective parameters in Group B. 132 62 Individual study of Group A. 133 63 Individual study of Group B. 133 64 Inter group comparison. (A.U.A) Symptom score index. Comparative

effect of Group A and Group B 134

65 Individual study of (Mala, Mutra, Anilasanga ,Adhmana, Ruja/ Sashool ukta Mutra tyaga.) group-A

134

66 Individual study of (Mala, Mutra, Anilasanga, Adhmana, Ruja/ Sashool ukta Mutra tyaga.) Group B.

135

67 Inter group Comparative effect of (Mala, Mutra, Anilasanga, Adhmana, Ruja/ Sashool ukta Mutra tyaga.)Group A and Group B.

135

68 Individual study of (Weight of Prostate, Residual Urine) Group A. 136 69 Individual study of (Weight of Prostate,Residual Urine) group-B 136 70 Inter group comparison Weight of Prostate,Residual Urine. Comparative

effect of Group A and Group B 136

71 Composition of the Phytotherapy extracts 160 72 Components of Plant Extracts: 161

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LIST OF FLOW CHART Chart No.


01 Samprapti of Vatashtila. 71-72 02 Pathogenesis of Benign Prostate Hyperplesia 73 03 Discussion to treat BPH. 81-82 04 Probable mode of action for local effect of Matrabasti on Vatashtila

(BPH). 165

05 Probable mode of action of Matrabasti therapy. 165 06 Showing probable mode of action of Matrabasti therapy on Basti,

(urinary bladder). 165

LEAST OF FIGURE

Figure No.


01 Anatomy of Prostate and Bladder. 56 02 Vertical section of the pelvis showing the prostate in relation with

surrounding structures. 59

03 Ingredients of SKK Ghrita, Procedure and instruments for Matrabasti 86-87 04 Digital Rectal Examination (DRE). 93

Least of Graphs. 01 Showing distribution of patients by age groups in both groups. 118-119 02 Showing distribution of patients by religions in both groups. 118-119 03 Showing distribution of patients by occupation in both groups. 118-119 04 Showing distribution of patients by socio-economic status in both groups. 118-119 05 Showing distribution of patients by food habits in both groups. 118-119 06 Showing distribution of patients by vyasana in both groups. 118-119 07 Showing distribution of patients by Viharaja nidana in both groups. 118-119 08 Showing distributions of patients by sleep habits in both groups. 118-119 09 Showing distribution of patients by Jatharagni in both groups. 118-119 10 Showing distribution of patients by the nature of koshta in both groups. 118-119 11 Showing distribution of patients by nature of bowel habits in both groups. 118-119 12 Showing distribution of patients by age groups in both groups. 118-119 13 Showing distribution of patients by age groups in both groups. 118-119 14 Showing distribution of patients by prakrit in both groups 118-119 15 Showing distribution of patients by nidana in both groups. 118-119 16 Showing distribution of patients by chief complaints in both groups. 118-119 17 Showing distribution of patients by residual urine in both groups. 118-119 18 Showing overall response in Group A.. 118-119 19 Showing overall response in Group B. 118-119

hen the hair becomes gray and scanty when speaks of earthy matter begin

to be deposited in the tunica of the artery and when white zone is formed at the margins

of cornea, at this same period the prostrate gland usually. I might perhaps say invariably

becomes increased in size. it is the statement of “SIR BENJAMIN BODIE”.

W

In Ayurveda, there are two main treatment principles explained i.e. (1) Shamana

(2) Shodhana. The Panchakarma comes under the Shodhana, because of their nature, i.e.

elimination or purification methods. It has been mentioned, the diseases which have been

treated with shodhana therapy, will alleviate the disease from its root cause Na-tesham

Punarudbhavaha. The panchakarma techniques have the prime importance in the

treatment, as well as in the two goals of Ayurveda i.e. Swasthasysa Oorjaskara and

Aturasya Roganut.

Ayurveda considered Jara chikitsa i.e. science of geriatrics as one of the eight

divisions of Asthanga Ayurveda. Ayurveda perceives ageing as a special entity and laid

down its own multidimensional treatment approach towards it, which stresses on Vata

pacification along with the nourishment of depleted Dhatus, by means of Rasayana and

Vajikarana. The phenomena of ageing is considered in an entirely new angle, by this

eternal science. Total life span is considered as hundred years by our Aacharys in their

classics.

Different stages of ayu are –

Balya avastha (before 16 years)

Madhyama avastha (16-60 years)

Vridha avastha (after 60 years)

Introduction 1

Last phase of life span is considered as jara, which is natural and inevitable

process as the age advances and is associated with its own disorders. During this period

naturally depletion in Dhatu, Indriya, Veerya, Bala And Ojus occurs, gradually. As age

advances loss of hairs, wrinkling on skin of whole body, senile cough, and short breath

appears.

As per Ayurveda Jaravastha is associated with vitiation of vatadosha and is more

prone to Vatavyadi’s. Vatashtila is one of the vata predominant disease, which succeeds

with old age. Acharyas susrhutha explained Vatashtila under vata vyadi nidana in first

chapter.

Ageing is defined as the “Sense of a progressive generalized impairment of function

resulting in a loss of adaptive response to stress and growing risk of age related diseases” is

expected that with the present rate, in early part of next century, we will be having around

25% of population in a geriatric group. Among the geriatric problems major systems

involved are central nervous system, cardio vascular system and third major is urinary

system. Common urinary diseases which affects elderly men is Benign Prostatic

Hyperplasia. (BPH)

Vatashtila is one of the Mutraghata which explained by all Brahatries and

Laghutries. Acharya Charaka has explained it in Siddhisthana 9th chapter of

“Thrimarmeeyasiddhi” and considered as one of the Bastigata vikara, but not as a type of

Mutraghata. Acharya Sushruta and others explained regarding Vatashtila, in the context of

Mutraghata. The diseases like Vatashtila, and Mutragranthi, which are having similar signs

and symptoms to that of BPH. Out of the two, the signs and symptoms of Vatashtila are in

resemblance to BPH. Vatashtila manifests mainly due to the derangement of Apanavata,

which is responsible for normal voiding of function. There by produces stone like swelling

“Ashteelavath Ghanam Granthi” which is firm, Sthira and Unnatha. Manifesting between the

Guda and basti pradesha, it leads to bahirmrga avarodini means obstruction of Mutra, Anila,

Purisha and Adhmana.

Introduction 2

NEED FOR STUDY

The long-term exposure to drug induced adverse events and the prohibitive costs are

the primary limitations of prevention therapy of BPH. In addition, effective medical and

surgical therapy exists when BPH ultimately does becomes clinically evident. Because there

is no clinically evidence, biochemical, or genetic predictors of BPH development or

progression. So every male is at risk. The ability to identify those individuals who are

predisposed to develop clinical BPH refractory to medical therapy would provide a more

compelling rational for prophylaxis. There is evidence that men with very large prostates are

at greater risk for developing urinary retention. (Jacobsen et al, 1997)

As the high incidence of disease Vatashtila (BPH) in elderly men, at the beginning of

the 4th decade of life, 8% of men have histopathological Benign Prostatic Hyperplasia. 50%

of men aged 51 to 60 yrs, and 90% of the men over the age of 80 yrs. Have histological

evidence of benign prostatic hyperplasia. Approximately 23 million men world wide suffer

from moderate to severe BPH.

In the management of Vatashtila (BPH), which is the out come of vitiated vata,

Acharyas gave importance to the Sneha as the choice of treatment. because Sneha is having

antagonistic properties to that of Vata. The Basti and Sneha are indicated in Mutrakricchra

and Mutraghata. In general Matrabasti is the major and effective treatment modality which is

easy to administer and can be given to old age persons without any complications. Shamana

snehapana is having the capacity to do the Shamana of the Vikaras, “Shigram”

Doshanukarshani, Sarvamarga i.e. Koshta, Sandi, Marma, Shaka, Sancharini and is

Balya, Punarnavikari, Sharira, Indriyachetasam, which is widely indicated in gulma,

Mutrakrichra, Gadhavarchas, etc. (Ch. Su. 13., Uttama Matra) (A. Hr. Su. 16/19) There

by these two remedies i.e. Matrabasti and Shamana snehapana are considered as the best

treatment options to treat Vatashtila (BPH).

Introduction 3

In contemporary system of medicine various surgical approaches have been practiced

to relieve this embarrassing disorder of BPH. because medicines are practically of no avail.

Even surgery is not supposed to be an ideal treatment owing to various complications

associated with operative problems, hemorrhage etc. Incontinence of urine is noted in several

of cases post-operatively, which is more frustrating than the disease itself. The patient

doesn’t want to be treated surgically in the first instance, rather he prefers non-invasive

therapy. Acharyas elaborated the different kinds of treatment modalities regarding the

treatment of various types of Mutravaha Srotovikaras, Mutravikaras. In the management

of Vatashtila Acharya Susrhuta mentioned, Swedana, Abhyanga, Basti Uttara basti, and

Kashaya, Kalka, and Sarpi. Susrhuta specifies treatment for Vatashtila in 5th chapter of

Chikitsa Sthana and he emphasizes to that of Gulma and Abhyantara Vidradivat Chikitsa

(5th Cha. Chi.) to be carried out with regards to Vatashtila.

Sukumara kumaraka ghrita is indicated in Mutrakricchra Chikitsa in the textbook

of Chakradutta and Bhaishajyaratnavali which is best Vatahara, Balya, Rasayana and

Vedana shyamaka. With regard to this Sukumara Kumaraka ghrita was considered for

this present clinical study as Matrabasthi and shamana Snehapaana in Vatasthila (BPH).

Introduction 4

To evaluate the effect of Sukumarakumaraka ghrita Matrabasti in the management of

Vatashtila (BPH).

To evaluate the effect of Sukumarakumaraka ghrita as Shamana snehapana in the

management of Vatashtila (BPH).

To compare the effect of Sukumsrkumaraka ghrita Matrabasti and as shamana

snehapana in the management of Vatashtila (BPH).

The goals of treatment for Vatashtila (BPH) include relieving – LUTS,

Decreasing BOO (Bladder Outflow Obstruction). (Mutra sanga)

Improving bladder emptying. (Mutra sanga)

Ameliorating destrusor instability.(Mutra sanga)

Reversing renal insufficiency.

Preventing future episodes of gross hematuria.

Urinary tract infection and Urinary retention. (Mutraghata)

Preventing future episodes of gross hematuria, (Raktha mutrata)

In our classics there is no explanation about anatomical structure of Vatashtila as

well as BPH but acharya Sushruta has mentioned the term Pourusha which can be

compared with Prostate gland.

In Ayurveda Vatashtila is closely resembles to the BPH according to its location

and signs and symptoms. Vatashtila is one of the Vata pradhna vyadhi, incidence

of both are in old age persons, obstruction induced changes in detrusor muscle

function, compounded by age related changes in both bladder and nervous system

function, lead to urinary frequency, urgency and nocturia. Old age which is

inevitable stage of life also acts as Nidana for Vatashtila which is one among

Vatavyadhi. (A. Hr. Su 1/8).

Objectives of the Study 5

In the classics there is no explanation about Sadhasadhyata for Vatashtila.

But by considering, in general Mutraghata are difficult to cure due to involvement

of Basti marma.

Where as in contemporary system of medicine, there is no satisfactory treatment

modalities in controlling the symptoms and preventing the complications of the

BPH. They include α blockers, androgen suppressants, aromatase inhibitors and

phytotheraphy, i.e. the plant extracts.

However surgical intervention is Prostectomy, even today it is the ultimate choice

of treatment, then also not recommendable. Because most of the patients in late

sixties and seventies, the risk for cardiovascular diseases, hypertension, diabetes

mellitus are high, serious post operative complications like hemorrhage, infective

processes such as Cystitis, and also delayed complications like urge or stress

urinary incontinence. Therefore by considering the contraindications of surgery,

risk of surgery and very less satisfactory results by the hormonal treatment. On

the aim of one should get rid of age related disorders like Vatashtila (BPH), here

an attempt has made with Panchakarma modalities to find a better solution to

maintain the normal life in old age also.

1) “To evaluate the effect of Sukumarakumaraka ghrita Matrabasti in the

management of Vatashtila (BPH)”.

Matrabasti is best treatment for old age persons, because of its less dose and

minimum complication. The drug of Matrabasti is sneha, as it is perfectly

antagonistic to the Vata and the disease Vatashtila is vatadosha pradhana vyadhi

(Apanavata).


Matrabasti is selected, as the Apanavata is prime cause for the disease and the seat

of Apanavata is “Apano apanaga shroni basti medhrorugocharaha.” The

administered Basti dravya stays in Pakvashaya and it will reach to the affected

area quickly by the Anupravaranabhava of Sneha and the properties of ingredients

like Dashamoola, Laghupanchamoola, Punarnava, Ashwagandha etc, as the

affected area is near to the Pakvashaya.

Hypothetically the Matrabasti can bring vitiated doshas to balanced state, severity

of the signs and symptoms of the Vatashtila (BPH) may reduce.

2) To evaluate the effect of Sukumara kumaraka ghrita as Shamana

snehapana in the Management of Vatashtila (BPH).

Shamana snehapana, is having the capacity to (Ch. Su. 13 cha. Uttama

Matrasneha ) spared all over the body immediately and it can restore the normal

health.

Shamana snehapana is indicated in Gulma, Mutrakricchra etc, as the Sneha is the

best vatahara, it can be used for the treatment of Vatashtila (BPH).

By the virtue of active principles of Sukumara kumaraka ghrita it can spread all

over the body and reach the affected area, does the shamana of the disease.

3) To compare the effect of Sukumara kumaraka ghrita Matrabasti and as

Shamana snehapana in the management of Vatashtila (BPH).

Sukumara Kumaraka Ghrita is the name itself indicates, it is recommended for

Sukumaras viz old age persons without any hesitation. The ingredients viz.-

Dashamooula, Laghupanchamoola, Punarnava etc are having properties like

Rasayana, Balya, Shoolahara and Vatahara, etc., which helps in correcting the

pathology of Vatashtila. (BPH).


As Basti is the prime treatment for the Vatavyadhies and Vatavyadhies are

generally correlated with Neurological disorders, by correcting the Apanavata

inturn it acts on the nervous system related to the prostate because normal

function of the Apanavata is the normal function of voiding.

This study has undertaken with the hypothesis that the Matrabasti is having better

results than the Shamana snehapana because as already mentioned the affected

area is near to the Pakvashaya.

This study has under taken to compare the effect of Sukumara kumaraka ghrita

Matrabasti and as Shamana Snehapana in the management of Vatashtila (BPH).

To evaluate the effect of two groups, among two which is best treatment by

assessing the before and after treatment datas of the study.

Ayurvedic preparations, which are having minimal side effects and no

complications, even in aged persons also can be given.

Acharya Susrhuta mentioned, Gulma and Abhyantara Vidradivat Chikitsa for

Vatashtila (BPH).

The main aim of the present study is not only reveals the symptoms of the

Vatashtila (BPH) but also induce reduction in size and weight of the prostate and

decreases the residual urine.

LIST OF FEW STUDIES CONDUCTED

The research papers published by Rashatriya Ayurveda Vidyapeetha in March, 2003.

1) Ashtila Vyadhi ka (Prostate enlargement) ayurvediya upachara. By Dr.

Prakashshraj Singh, Dr. Dayanandan Mana and Ach. Jyotirmita, Varanasi

2) Management of Benign Prostatic Hyperplasia (Vatashtila) in Panchakarma

theatre with reference to Vasti, By - Dr. Anand, Belgaum.


3) Ayurvedic therapy in the management of Benign Prostatic Hyperplasia

By Dr. Shivji Gupta, Dr. Ramesha Bhat, and Dr. M. Sahu, Varanasi.

4) Role of Varunadi Kashaya in the management of Benign Prostatic Hyperplasia.

By Dr. Praveen Kumar, and Dr. K. K. Sijoria, Delhi.

5) Poursh granthi vriddhi ki Ayurvedic chikitsa - Ek aturia adhyayan.

By:- Dr. B. P. Gupta, Delhi.

6) A clinical study on Yavnalkshaya and Chandraprabhavati in Mutrasanga

(Retention of urine w.s.r.t. B.P.H. - Pundir R.K. (1984).

7) A clinical study on Mutraghata (Relation of urine w.s.r. to Mutraghata (B.P.H.) -

Raut S.Y. (1987)

8) Role of Punarnavadi compound in the management of Mutraghata w.s.r. to B.P.H.

Jagruti Joshi (1995)

9) Clinical evaluation of Kshara and Uttar Basti in the management of Mutraghata -

Akasha Kembhavi (1998)

10) Role of Mustadi Kalpa in the management of Mutraghata w.s.r. to B.P.H. - Dr.

Ashish B. Soni (1999)

11) A Clinical study on the role of Devdarayadi Kshaya and Dashmool Siddha Taila

Uttar basti in the management of Mutraghata w.s.r. to B.P.H. - Dr. N.H. Kulkarni

(2002).

12) Some of scholars in Contemporary system of medicine they tried Phytotherapy

(plant extracts) in BPH/LUTS. They have gained widespread usage since about

1990 among them (Plosker and Brogden, 1996), (Gormley et al, 1992),

(Disilverio et al, 1998), (Lowe and Fagelman1999).


HISTORICAL REVIEW

Historical view is an essential part of the literature in which review is done about

the past events. Ayurveda starts since ancient period, before going to write any treatises

in Ayurveda. It would be a judicious to review the references of Vedas and Samhitas.

The Vedas are the first written documents of human civilization. Therefore the

available information can be formulated as follows –

A. Vedic Kala – 2500 B.C. – 1000 B.C.

B. Samhita Kala – 1000 B.C. – 100 A.D.

C. Sangrahakala – 100 A.D. – 800 A.D.

D. Aadhunika Kala – 17 A.D. – onwards.

Veda kala

There is so many reference we can get in Vedas especially Atharva Vada

explanation Basti, (1/3/7Ater) “Vishitam te Vastibilam . . . . . . this type of explanation

are available but there is no explanation regarding Vasti Karma in Vadas.1

Samhitas kala:-

All classical treatises of Ayurveda have emphasized the importance of Bastikarma

and Matrabasti as the most effective therapeutic measure than any other such methods

prescribed for various ailments especially in the diseases occurring due to Vatadosha.

Acharya Charaka has described the Bastikarma, its usage, dosage, advantages,

complications, and indications with different yogas, in Charaka samhitha Siddhisthana

(1stchap. 4,5,7,8,10,12.).2 Sushruta has elaborately described the Bastikarma procedures,

about Bastiyantra, types of Bastis, complications, management, in different chapters of

kalpasthana3 and Chkistasthana- (35,36,37chapters) Acharya Vagbhata has explained the

bastikarma in Ashtangasangraha and Ashtangahridaya like Avastha Anusrutabastis,

Prasrutikabastis and Vyapaths.4, 5, 6.

Historical Review 10

Madhyama kala

Sarngadharasamhita also has given much importance to Bastikarma with the

Brihatriyee’s methods of explanations in Uttarakhanda (5 to 7 chapters) including

Uttarabasti. Yogaratnakara, Bhavaparakasha dealt the bastikarma, and added newer

combinations to the Ayurvedic world for a better practice.7 Acharya Kashyapa equated

the Bastikarma as Amrutam in first chapter of Siddhisthana, because of its wide

applications even in both infants and old age.8

Later, modern authors in Ayurveda has also elaborately explained the Bastikarma,

modifications of Bastiyantra, converted the older measurements to the present day

measurements and made the things easier for the practitioners.

SNEHA

Veda Kala

In Rigveda description of many herbal plants and qualities of Tila Pinji Tilataila,

Sarshapa, are available. The Atharvana veda, gives plenty of references regarding the use

of Sneha therapeutically.9

Samhita Kala

In Charaka samhita references regarding the therapeutically use of Sneha in

various disorders. The author has devoted an entire chapter in the Sutra Sthana on

“Shadvidopakramas.”10 (Ch. Su. 22nd) Snehana as Pradhana karma is the most significant

therapeutic procedure. Among them Charaka has extensively dealt with the subject

“Snehana” and its Qualities, doses, time sedulous, advantages, complications, and

indications, separately in 13th chapter of Sutrasthana,11 and about Shodhananga snehana

in Charaka siddhisthana.12 Here he has described in detail the properties of Sneha

dravyas, basic sources of Sneha dravya, indication and contraindications of Snehana etc.


Acharya Sushruta has contributed separate chapter on “Sneha” in 31st chapter of

Chikitsasthana. Here he has classified Snehana on the basis of its Karmukata as

Shodhana, Shamana and Brumhana and explained the preparation of “Sneha” i.e. Ghrita

and Taila.13 Also we found that number of references regarding the uses of sneha in the

Shodhana and Shamana or alleviation of different diseases. Types and qualities of Ghrita

and Tailas, method of preparations of Aushadhisiddha ghritas and method of

administration have been mentioned in Sutrasthana and Chikitsasthana of Astanga

Hridaya.14

Kasyapa an eminent personality in Koumarabhritya has dealt in detail regarding

Snehana in 22nd chapter of his Sutrasthana and added use of different ghrita and taila in

managing various Balarogas.15 Bhela one of the six celebrated disciples of Atreya has

mentioned the use of different Sneha in treating different disorders.16 Qualities of each

taila their specific indications have been mentioned in 14th chapter in Harita samhita.17

Later others like Yogaratnakara18, Bhavamishraa19, Sharangadhara20, Vangasena

and Chakrapani they explained Paryayas, Swaroopa, Utpattisthana, Gunas of Ghrita and

Taila and their indications.

Adhunika Kala

Detailed explanation about uses of both animal product ghee and plant products

oils, in materia medica and added classification of fats, oils, properties and sources of oil

expression of oils, have been mentioned. Textbook of pharmacognocy, Teiz’s text book

of clinical Biochemistry, etc are the textbooks where literary review regarding the use of

sneha can be obtained clinically.21


VATASHTILA

Vedic period

In vedic period there is no explanation about Vatashtila, but we can get references

of Mutraghata. A comprehensive description regarding Mutraghata, and its treatment

with the use of “Loha Shalaka” this kind of references give as account of the knowledge

that our ancestors had with regards to the anatomical, physiological, pathological and

therapeutic aspects of the human body. (A.V.1-3-1 to 4 & 6 to 9).

Another one important references in treating the Mutraghata in Atharvaveda is

explained as “Mutramoochana.” Atharvana veda22 is treasure house of mantras and they

can be linked to nuclear energy, among the innumerable mantras. This type of

explanation we can get in Ayurveda also. i.e. Acharya Sushruta declares that student

desires of studying Ayurveda should be initiated into the regular practice of “Gayatri

Mantra” and Acharya Charaka also mentioned chanting of “Vishnusahasranama” in

Sannipataja jwara.

Samhita kala

This was the golden period of ayurveda and the two great works viz. Charaka

samhita and Sushruta samhita were written in this period. Acharya Charaka in 9th chapter

of Siddhisthana in the name of Trimarmeeyasiddhi adhyaya explained 13 types of Basti

sambhandi vyadhis among those Vatashtila is one of the mutravarodha janya vyadhi.23

Where as Sushrut explained 12 types of Mutraghata, Nidanapanchaka laxanas and

Chikitsa eloberately,24 particularly for Vatashtila in the 1st chapter of Vatavyadhi

Nidadana25 and also 5th chapter of Chikitsasthana.26 Ashtanga sangrahakara, Ashtanga

hridayakara including Kashyapa fallowed the same view of Charaka and Sushruta.27


Madhyama kala

The important work has been done in the text book of Chakradutta28 and

Bhishajyaratnavali29 have given more concentration over Chikitsa with different Yogas in

the context of Mutrakricchra and Mutraghata chikitsa. Other Acharyas Vangasena,

Yogaratnakara contributed over Mutraghata. The commentators of Chakrapani,

Gangadhara and Dalhana have fulfilled their commentary for the better understanding of

the Samhitas.


Yutpatti and Nirukti of Basti

The word Basti is derived form ‘vas + tich’ and is masculine gender.

“Vasu nivase”30 - Means residence.

“Vas-aachadane” - That which gives covering.

“Vas vasane surabhikarane” - That which gives fragrance.

“Vasti vaste aavrunothi muthram” - That which covers the urine.

“Nabheradhobhage mutradhare” - The position of Basti is just below nabhi

(umbilicus) and is the collecting organ of

urine in the body i.e. urinary bladder.

Paribhasha

In the context of Panchakarma the term Basti is used in different sense.

“Vastina deeyate iti vasti”31

“Vastibhir deeyate yasmat tasmat vastiriti smritha”32

“Vastina deeyate vastini va Purvamanyattavasto vasti” 33

The term Basti means bladder. It is used as a device for Bastikarma. Hence, the

term Basti is used as a name in Panchakarma therapy to designate the process. The

medicated decoctions, milk, oil, ghee, mamsarasa of prescribed quantities are taken in

Basti and introduced into Gudamarga by means of a device Bastinetra after proper

pretreatment procedures.

SNEHA NIRUKTI

The word ‘sneha’ is derived from the root “sniha” with “Lute” pratyaya

Vachaspathyam.34 In general speaking the process in which “Snigdhata” of the body is

brought about is called as Snehana.

Vyutpatti & Paribhasha 15

.

The word Sneha is masculine gender and is derived from “Snih” Dhatu by suffix

“Lyut” Pratyaya

The verb root “Snih” has two implications –

• Snih – Preetau. to render affection.

• Snih – Snehane. to render lubrication.

The term Sneha implies that a substance that brings oiliness or unctuousness.

Sneha literally means oiliness, unctuousness, fattiness, greasiness, lubricity, viscidity,

affection, love, kindness and tenderness.35

PARIBHASHA

“Snehanam - sneha vishyandha mardhava kledakarakam”.36

Achrya Charaka defines, the Sneha indicates Snighata, Vishadana reffers to

vilayana, or fluidit. Vishyando Vilayana Chakrapani. Mardavata indicates softness, and

Kleda is moistness, which signifies the increase in apya guna of body. It means the

Snehana is the process by which Snigdhata, Vishyandana, Mardavata and Kledana are

produced in the body. These measures are adopted to bring about snigdhata in the body is

known as snehana.

The word Sneha is used to describe application of Sneha dravyas in Ayurvedic

text. It is refers to internal administration as well as external use of Sneha. There are such

specific nomenclature used for external application of sneha i.e. Abhyanga, Lepa, etc for

internal administration Shodhana poorva snehapana, Shamansneha and Brimhana sneha

such are used.

Hence which does the Shaman or normalizes the aggravated doshas all over the

body is Shamanasneha.37


NIRUKTI OF VATASHTILA

ASHTILA :- Ashtila Uttarapathe Deergha Vartula Pashana Vishesha.38

Ashtila means it is situated in just above the Guda pradesha and below the Basti.

It is elongated, round, apple and stony like structure.

It is a feminine gender.

Meaning of Ashtila

It is a round bulk, stone, ball or globe like structure.

It is a globular swelling. 39

Ashtila is a type of Mutraghata vyadhi.

Mutra + Aghata = Mutraghata

Enn + Dhanya + Add = Aghata 40

PARIBHASHA

Astilavat Ghanam Granti Urdhwa Ayata Unnatam 41- means Ashtila is the hard,

round, stone like structure which is situated in between Vasti and Guda and its structure

resemblance to Urdhwa, Ayata,Unnata.

01. Yen mootra kricchre mootram kricchrena vahit |

Mootraghate mootram shoshyate partihanyate va ||

(Cha. Chi. 26\43-44 Chakrapani)

Means which is cause for the difficulty in micturation, which will dries up the

mutra and leads to its obstruction is known a Mutraghata.42

2) Mutraghate Tu Vibhandho Balavan Kricchratva | (Vijayrakshita)

The one which causes the obstruction of mutra and leads to difficult in

micturation.


Paryaya and Bheda of Basti

• On the basis of Adhisthana - Pakwashayagata, Grabhashayagata,

Vranagata, Mutrashayagata.

• On the basis of Dravya - Nirooha, Anuvasana, Sneha, Matra.

• On the basis of Karmukata - Shodhana, Lekhana, Snehana, etc.

• On the basis of Samkhya - Kala, Karma, Yoga.

• On the basis of Anushangi - Yapanabasti, Sidhabasti etc.

But Charaka has used the term Basti exclusively for Nirooha as per the

commentary of Chakrapani.43 Similarly the term Basti has also been referred to the

method of Shirobasti, Urobasti, Janubasti, etc.

Synonyms of Sneha

The synonyms mentioned for Snehana are Sneha, Snigdhata, Mritkshana,

Abhyanga and Abhyanjana.44

Bheda of Vatashtila “Ashtila and prathya ashtila”45


IMPORTANCE OF BASTIKARMA

Different Acharyas appreciated this form of treatment considering the efficacy it

generates. No other elimination therapy is equal to Basti because it expels the vitiated

doshas rapidly and easily from the body and also reducing as well as nourishing the body

very fastly. Though emesis and purgation eliminate the vitiated doshas form the body,

the drugs used in these therapies contain Katurasa, Ushnaguna and Teekhsna gunas,

which cannot be taken easily by children or older people. But Basti can be given in all

age groups without any hesitation.46

Bastikarma is the best method of treatment in dealing with Vatavikaras and Vata

dominating other Vikaras as Vata being the chief controller among the causative forces of

disease.47 As per the fundamental principles of Ayurveda; vata is responsible for every

movements and activities in the body whether it is of constructive or of destructive

nature. On the other hand Vata is functionally required to co-ordinate with Pitta and

Kapha in order to accomplish various duties assigned to them in the organization of life.48

Pakwasaya is considered to the seat of Vata. Direct application of this kind of

treatment to Pakwasaya helps for the proper regulation and co-ordination of the functions

of Vatadosha not only in its own site but also control the related doshas which are

involved in the pathogenesis of disease.49 Hence, it is considered as one of the appropriate

treatment for Vata predominant disease and also called it as Ardhachikitsa by Vagbhata.50

Apart form this, Basti is considered as superior to the other therapeutic measures on

account of its varied actions like Samshodhana, Samshamana and Samgrahana of doshas

on this basis of drugs used in it.51

Review of Bastikarma 19

Basti is indicated for providing rejuvenation, happiness, longitivity, strength,

improving memory, voice, digestive power and complexion. It removes noxious matters

form the tissues, pacifies the doshas and rectifies the process of excretion. Consequently,

it affords stability and thus indirectly strengthens the reproductive capacity in man.52

Kashyapa equated the bastikarma as ‘Amrutam’, because of its wide application even in

both infants and in old age.53

Classification of Basti

Basti is an important method of therapy in Ayurveda. For better understanding it

can be classified in various ways. We cannot find uniformity in classification of basti

among the authors of classical texts. Generally, the term Basti has been used for all types

of Bastikarma, which includes Nirooha, Anuvasana, Uttarabasti etc. But Charaka has

used this term Basti exclusively for Nirooha as per the commentary of Chakrapani.54

Similarly the term Basti has also been referred to the method of Shirobasti, Urobasti,

Vrina basti etc. So a rational thinking on various aspects of Bastikarma has brought about

the following classification.55

Adhishtana bheda – The site of application.

Dravya bheda – The medicinal preparations used.

Karma bheda – The action it does.

Sankhya bheda – The number of bastis given.

Anushangika bheda – Always associated

Matra bheda – Based on amount used.

1. Adhishtana bheda

According to the site of application of basti it is classified into two types –

a. Internal b. External


a. Internal

i) Pakwasayagata basti – The administration of medicine via ano-rectal route to

Pakwasaya.

ii) Garbhasayagata basti – The administration of medicine via vaginal route to

Garbhasaya.

iii) Mutrasayagata basti – The administration of medicine via urethral route to

Mutrasaya.

iv) Vrinagata basti – The medicine administered through the Vrinamukha by

the process of Bastikarma.

b. External

In certain diseases the medicated oil is kept over the part of the body using a cap

or with flour paste for prescribed period of time and named after the site of application of

oil such as – Shirobasti, Katibasti, Urobasti, etc.

2. Dravya bheda

It is based on the major ingredients of Bastidravya - kwatha or sneha and

so classified into two types: -

i) Nirooha basti – The main ingredient is Kwatha and it is the important type of

Bastikarma having varied therapeutic effects. The Basti is able to eliminate doshas form

the body and so called Nirooha. Also called Asthapana, as it is Vaya and Aayusthapaka

the Vikalpa of Nirooha basti are synonyms.56 The effect of Nirooha will spread all over

the body even in the cellular level and helps to eliminate the vitiated doshas adhered in

Srotases and its action in the body is beyond the perception of physician.57


ii) Anuvasana basti – Sneha is the chief ingredient of Anuvasana. The term

Anuvasana is coined due to the unharmful effect of the Bastidravya even if it is retained

inside the Koshta. More over this type of Basti can be practiced daily without any serious

precautionary measure, as it is less complications than nirooha.58

3. Karma bheda

Sushruta and Vagbhata have made the following classification according to their

actions.59,60

Shodhana basti – Contains shodhana dravyas and removes doshas and

malas from the body. malas from the body.

Lekhana basti – Reduces medodhatu and produces lekhana in the body.

Sneha basti – Contains more of sneha and produces snehana in the

body. body. body. body.

Brumhana basti – Increases the rasadi dhathus and indirectly it helps in the

growth of the body. growth of the body.

Utkleshana basti – Causes utklesha of malas and doshas by increasing its

Pramana and causes dra Pramana and causes dravabhootha.

Doshahara basti – Purificatory or eliminating type.

Shamana basti – Produces shamana of doshas.

Sharangadhara added, shodhana basti to it also he has added lekhana, brimhana,

deepana and pachana types of bastis.61 Vataghna basti, Balavarnakrita basti, Snehaneeya

basti, Sukrakrit basti, Krimighna basti, Vrushatvakrit basti has been explained in various

contexts by Charaka.62


4. Sankhya bheda

It is stated that neither snehabasti nor niroohabasti can be applied alone63 So,

Charaka has made this classification based on the number of snehabastis and

niroohabastis in a treatment.64

a) Karma basti – There are 30 numbers of bastis in this group out of which

snehabastis and niroohabastis are 18 and 12 respectively. Prescribed in chronic diseases

of prolonged nature and particularly of vata predominant.65 First 1 snehabasti then

alternate sneha and kashaya- each 12 and 5 snehabastis in the end.

b) Kala basti – There are 16 numbers of bastis. First basti is anuvasana,

then 6 nirooha and 6 anuvasana must be given alternately and in the end 3 anuvasana.

Indicated in patients of madhyamabala and vatapitta predominant conditions.66 However,

a difference of opinion regarding the number of nirooha is also prevailing.

c) Yoga basti – There are 8 numbers of bastis. 5 snehabastis and 3

niroohabastis. First basti is anuvasana, then 3 nirooha and 3 anuvasana and last 1

snehabasti. Indicated in diseases where involvement of vata dosha is found less.67

5. Matra bheda

This classification of basti is based on the quantity of bastidravya prescribed. The

quantity may vary according to the age, strength of the patient and severity of the

disease.68

a) Dvadashaprasruta basti – In nirooha, the maximum dose or quantity of

bastidravya prescribed is dvadashaprasruta i.e. 24 palas.

b) Prasritayogika basti – Charaka has prescribed various types of nirooha

in different doses like 4,5,6,7,8,9, and 10 prasrutas, considering the strength of the patient

and condition of the disease.69


c) Padaheena basti – In this type of basti, 3 prasrutas i.e. ¼ of

dvadashaprasruta is less form from the total quantity of nirooha used i.e. 9 prasruthis.

Anuvasana is also classified into 3 according to the difference in the quantity of

sneha70used.

Sneha basti – 6 palas (¼of total quantity of nirooha)71

Matra basti – The sneha that will be digested in 6 hrs if taken orally.72

Anuvasana basti – ½ of the quantity of sneha basti.73

6. Anushangika bheda

01. Yapana basti – Enhances bala, shukra and mamsa. Mostly employed in treating

the vyapats produced by excessive coitus. It can be given during all the seasons of the

years. It increases life span. Charaka has explained 26 bastis of this type. Kukkutamamsa,

ksheera, eggs, kwatha, madhu, ghrita, mamsarasa are should be added to prepare this.74

02. Siddha basti – The basti creates bala, varna, prasanata and it purifies more than

100 diseases.75

03. Yuktaratha basti – Mainly indicated for travelers on horse, different types of

vehicles etc.76

04. Vaitarana basti – It is explained by both Vangasena and Chakradutta. It is mainly

concentrating on the elimination of doshas. It has got wide applications.77

05. Ksheera basti – Explained for shoolam, vitsangam, anaha, murakrirchha.78

06. Ardhamatrika nirooha basti – No need for sneha sweda pratikriya. Sarvaroga

nivarana in nature, mainly rajayakhsma, shoola krimi, vatarakta. It improves sukha and

ojus and has the nature of pumsavana.79


07. Pichha basti – It is given with a drug called as Shalmaliniryasa. It produces

sthamba (stoppage) of pichasrava and jeevashonita. It is also called as Sangrahibasti.80

08. Mutra basti – Gomutra is the main ingredient and it has the qualities of mridu

in nature, pacifies all doshas and it is harmless.81

09. Rakta basti – When there is severe blood loss from the body, acharya has

advised to perform raktabasti that which stops the further blood loss and initiates the

production.82

Importance of Matrabasti

Matra + Basti = Matrabasti. The word meaning of matra.

Arunadutta, states for the word meaning of matra, “Matra Shabdasthara

Pramanarthaha”. (A. Hr. Su 16/25).83

The term Matra conveys many meanings such as measurement, quantity, size,

duration, number, degree, unit of time and moment, but here in this context Matra refers

to measure i.e. quantity of Basti dravya as Ashtanga Hridaya states that Hhrusva matra it

means Alpamatra of sneha, which is given in the name of Matra basti.84

Sushruta states that Matrabasti is Vikalpa of Anuvasana basti it means it is the

type of Anuvasana vasti.85

As per Ashtanga hrudaya “Hrusvaya Sneha Panasya Matrayam” from the above

statement it is clearly understand that it can be given at any age viz. Bala, Vridha, etc

even for Alpagni person also. It is not having any complications due to its less quantity

of Sneha. Hemadri used the term Sukha which gives meaning of easy to handle.86

According to Charaka “Yethashta Ahara Chestashya Sarva Kalam Nirathaiyah”

this quotation gives more importance to Matrabasti. Because during the administration of

Matrabasti it does not require any regimen like ahara chesta.. There is no any particular

time schedule for it.87


Ashtanga Hridaya gives the terms like Nishparihara. Arunadutta added the word

Aniyantrana means, there is no any restriction for the day today activities and no Parihara

kala also as explained for other Bastis. No restrictions of time to follow other procedures

after the administration of Matrabasti.88

Ashtanga sangrahakar states that “Sevyaha Sada Cha Madutailikavat”, it can be

restored to always just as Madhutailika basti.89

Properties of Matrabasti

Acharya Charaka explained benefits of Matrabasti as, it increases strength of the

body (Balya), easily administrable (Sukhopacharya) and no much restrictions after

administration, makes easy evacuation of bowel (Shrishta purishakrita), best for

Vatavyadhies.90

Vagbhata opines the same as Charaka and added it can be given regularly, which

is indicated for Bala, Vriddha, and Alpagni person also it as Varnya, Doshaghna etc.91

Hemadri commenting on the term “Sukho-Vyapad Rahitha”, it is devoid of

complications.92

Indications And Contraindications Of Matrabasti

As Matrabasti is variety of Anuvasan basti so the persons who are fit for

Anuvasan they are also fit for Matrabasti.93,94,95.

Table No. 01. Showing the indications for Bastikarma are as follows –

Sl. Indications C.A A.S H.S Sl. Indications C.A A.S H.S

1 Karma karsita + _ _ 8 Vriddha _ + +

2 Vyayam karsita + + + 9 Bala + + +

3 Bhara karsita + _ + 10 Chinta _ + +

4 Yana karsita + + _ 11 Stree _ + +

5 Durbala + + + 12 Sukumar _ + +

6 Vataroga + + _ 13 Alpagni _ + +

7 Bhagna + + +


Contraindications for Matrabasti

No such particular contraindications for Matrabasti but Ashtanga sangrahakar

stated it should not be administered in case of Ajeerna and Diwaswapna.96

Matrabasti sevana kala and sevana vidhi

Acharya Charaka stated that it can be given regularly at any time and in all

seasons.97

Dosage of Matrabasti

Matrabasti, the term is popular because of its dose. Because Sneha is

administered in the Hriswa matra.

“Hraswaya snehapanasya matrayaha yojita samaha |” 98

So the dose of Matrabasti is equal to the quantity of Sneha which can digest

within 6 hours when taken orally. Acharya Dalhana mentioned the quantity of this as 11/2

phala i.e. 6 tola.99 Where as Kashyapa prescribed the quantity of Matrabasti as 2 palas as

Uttamamatra, 11\2 pala as Madhyama matra and 1 Prakuncha as Hriswa matra. He stated

that even half pala of Sneha can be given in Kaumara. (K. Khi. 8\104-105).100

Chakrapani stated pramana of Matrabasti as 11\2 pala. But whereas

Sharangandhara101 mentioned matra of Matrbasti as 2 palas. (i.e.8 tolas) (Su. U.5\5)102

Matrabasti Procedures

Poorvakarma (Pre-treatment procedure)

The mridu abyangha and swedana administered prior the pradhana karma. Then

advised to have alpha ahara a short walk. Patient must have passed natural urges. Then

made the patient laid on a cot comfortably, which is not very high and the head must be

at little lower level. Pillows should not be used. The patient should be in left lateral side

drawing up the right leg and straightening the left leg.103,104,105.


Pradhana karma (Treatment procedure)

The sneha prescribed for Matrabasti taken in the Bastiputaka and tied well placing

the Bastinetra in position. The entrapped air in Bastiyantra is expelled by gently pressing

the Bastiputaka. Then the anal region and the Netra should be smeared with oil. Gently

probe the anal orifice with the index finger of the left hand and introduce the Bastinetra

through it into the rectum up to first Karnika. Keeping in the same position press the

Bastiputaka with right hand with adequate and uniform force. Bastinetra should be

released carefully when a little quantity of sneha remained inside the Bastiputaka.106

Paschyata karma (Post-treatment procedures)

The patient is kept lying on his back as long as it would take to count up to

hundred. The patient should be gently struck three times on each of the soles and over the

buttocks by Vaidhya’s own hand. The distal part of the cot should be lifted thrice. Allow

him to lie for sometime in the same position. If he gets the urge for defecation he may do

it. But in the event of sneha passed immediately another Anuvasana basti should be

administered. After passing the motion with sneha in proper time the patient is allowed to

take light food if he feels hungry.107,108 There is no specific duration of retention of matra

basti so we can consider duration of sneha basti. i.e. 3 yamas it means 9 hours.


SNEHA

SNEHA GUNAS 109,110,111.

Gunas in the drugs are responsible for the different functions of drug. The

properties of Sneha dravya’s are Snigdha, Sara, Drava, Picchila, Guru, Sheeta, Manda

and Mrdu, which are having opposite properties to Rukshana dravyas. Though drug

having these qualities but always it may not produce Snigdhata in the body. There are

few exceptions to this general rules like Yava, possesses Guru, Sheeta, Sara gunas

produces Rukshata. Rajamasha in spite of having Guru guna produces rukshata. Tila taila

is having Tikshna and Ushna it acts like Snehana. That may be the reason why Acharyas

have used the term Prayo, while explaining Sneha dravya.

Table No.02 : Showing the Sneha guna, Panchabhoutika sanghatana & Karmukata

of Sneha dravyas.112

Dominant Mahabhoota Guna Prathvi Ap Teja Vayu Akasha

Karmukata

Picchila - ++++ - - - Lepana, Jivana, Samghata, Sandhana, Balya, Gouravata

Sukshma - - ++ ++ +++ Sroto Vishodhana, Vivarana, Soushiryakara

Sara - ++ - + - Anulomana, Vyaptisheela, Preranasheela

Snigdha + ++++ - - Snehana, Mardavata, Kledana Bandhana, Vishyandana,

Drava - ++++ - - - Prakledana, Vilodhana, Prasari.

Guru ++++ ++ - - - Brumhana, Malavriddhikara, Tarpana, Angaglani, Balakara,

Sheeta - +++ - ++ - Sthambhaka, Hladana Manda ++ + - - - Shamana Mrudu - ++ - - +++ Shaithilya of Avayava,

Mardavata. By seeing above table it can be justified that Sneha Dravyas are of

apyamahabhuta predominant.

Review of Sneha 29

PROPERTIES OF CHATURVIDHA SNEHAS

1. Ghrita

Rasa – Madhura.

Guna – Snigdha, Mrdu, Guru, Manda.

Veerya – Sheeta.

Vipaka – Madhura.

Prabhava – Agnideepaka.

Karma – Pitta-vatahara, Svara Lavanyab and Tejobalakara,

Chakshushya, Medhya, Increases Rasa, Shukra and Ojas, Vayasthapaka,

Dahashamaka, Alpaabhishyandi, Vrishya, Rasayana, and best agnideepaka.

Seasonal indication – Sharad Ritu.

Suitable condition for Ghrita application

Following are the conditions in whcih the ghrit can be used efficiently –

Vata-pitta Prakrti persons, Vata-pitta pradhana Vikratis, those desirer of longevity, Bala,

Varna, Swara, Pushti, Smriti, Medha, Dhee, and the some oft the conditions like

Dahapeedita, Shastra peedita,Visha Pidita.etc 113,114,115,116

2: Properties of Taila

Rasa – Madhura.

Anu rasa – Tikta, Kashaya.

Guna – Snigdha, Guru, Teekshna, Vikasi, Sara gunas.

Veerya – Sheeta

Vipaka – Madhura.

Review of Sneha 30

Karma – Vata-kaphahara, Pittakara, Balakara, Varnya, Twacha

mardavakara, Krimighna, Garbhashaya Shodhaka, Bhagna Sandhanakara ,

Subsides Yoni shoola and Yoni vyapats.

Seasonal indication – Pravrita (Sheeta Kala)

Suitable condition for Tilataila Snehana

Vata Prakriti, Shleshma pradhana vyadhis, Taila Satmya, Vatavyadhi, Nadivrina,

Bhagandara, Krura Koshta, and along with those desires of Bala, Tanutva, Laghuta,

Drdhata and Sthiragatrata. 113,114,115,116

3. Vasa

Properties – These are similar with the Mamsa of animals from which they are obtained.

Seasonal indication – Madhava Kala.

Suitable Condition for Vasa Prayoga 113,114,115,116

Due to vast origin and qualities of Vasa, it is indicated for the Mahat agnibala

persons along with those who are capable of bearing klantata of ruksha Vayu and Atapa,

karshatwa due to carrying of excess weights and it is found much beneficial in the vikritis

found in Asthi-Sandhi-Marma-Koshta ruja and Avarana like conditions.

4. Majja

Properties – Properties should be understood based on its source.

Seasonal Indication – Madhava Ritu.

Suitable condition for Majja Prayoga

This is the most heaviest sneha dravya. Hence, indicated in persons having

Diptagni, able to bear Klesha, having Krura Koshta and habituated to Sneha. 113,114,115,116

So Majja prayoga is indicated in those who desire of Bala-Shukra-Majja-Asthi Vardhana

and Snehana quickly.

Review of Sneha 31

CLASSIFICATION OF SNEHA

I Based on Yoni (Source)117,118

There are two sources of Dravys viz., Sthavara and Jangama

Based On Yoni (Source)

Sthavara Jangama

A) Sthavara sneha (Vegetable Origin)

Sthavara sneha is extracted from plant source. Phala, Sara, Mula, Tvak, Patra &

Pushpa are the main sources of Sthavara sneha. Charaka has told eighteen Ashayas of

Sthavara sneha.

Table No.03 Source of Sthavara sneha according to Charaka 119

Tila Sarshapa Eranda Bibhitaki Priyala Abhishuka

Bilva Moolaka Chitra Atasi Madhuka Kusumbha

Akshodha Abhaya Karanja Shigru Nikothaka Haritaki

Classification of Sthavara sneha according Sushruta by their action.

Table No. 04. Showing Sushruta’s classification of Sthavara sneha.120

Action

Virechanopayogi Pittasamsrusta Vayu Upayogi

Vamanopayogi Krshnikarana Upayogi

Shiro Virechanopayogi Pandukarana Upayogi

Dushta Vranopayogi Dadru, Kushta, Kitibha Upayogi

Maha Vyadhi Upayogi Ashmari Upayogi

Mutra Sangopayogi Prameha Upayogi

Review of Sneha 32

B) Jangama Sneha (Animal Origin)

Jangama Sneha is derived from animal sources. eg. Ksheera, Dadhi, Ghrita,

Mamsa, Vasa, Majja, etc.

II. PAKA BHEDA

Opinion of different authors regarding varieties of Sneha paka and its indications

are as summarized in following table –

Table No. 05. Showing Sneha Bhedha based on the Paka. 121,122,123.

Snehana Caraka Sushruta Sharangdhara

Abhyanga Khara Madhyama Madhyama

Pana Madhyama Mrdu Madhyama

Nasya Mrdu Madhyama Mrdu

Basti Madhyama Khara Madhyama

Karnapurana - Khara Madhyama

III. SAMYOGA BHEDA:124

Samyoga Bheda

Yamaka Sneha Trivrit Sneha Maha Sneha

(Taila + vasa) (Taila+ Vasa + Majja) (Sarpi +Taila +Vasa+ Majja)

IV. UPAYOGA BHEDA:125,126,127.

Based on the route of administration, Snehana is classified as –

Upayoga Bheda

Abhyantara Snehana Bahya Snehana

(Pana, Basti, Nasya, Bhojana) (Abhyanga, Lepa, Udvartana, etc.,)

Review of Sneha 33

V. PRAYOGA BHEDA 128,129

Based on the method of administration Snehana is of 2 types viz,

Prayoga Bheda

Accha Peya Vicharana Snehana. (Sneha with various preparations

like Vilepi and Yavagu etc.) (Sneha without mixing with

any other Dravya)

VI. ACCORDING TO VISHISTHA SAGNA 130,131,132.

Vishistha sagna

Sadyo Snehana Pancha Prasrta Peya Acchapeya

VII. MATRA BHEDA133,134.

The following dosage schedule is advocated in the classics based on the time

required for digestion of sneha taken.

Hrasva Matra – The dose of Sneha that is digested within 6 hours.

Madhyama Matra – The dose of Sneha that is digested within 12 hours.

Uttama Matra – The dose of Sneha that is digested within 24 hours

Vagbhata has mentioned about Hrasiyasi Matra the quantity of Sneha, which

digests within three hours, is known as Hrasiyasi Matra. This is used when the Koshta of

the person has not been properly diagnosed.135

Fixing the Dosage of Sneha in numerical value is not possible with the reason

that, dose will vary from person to person based on Dosha, Kostha and Agni level. Hence

dosage of the Sneha is explained based on the time required for the digestion of Sneha

viz,

01. Hrasiyasi Matra. 02. Hrasva Matra.

03. Madhyama Matra. 04. Uttama Matra.

Review of Sneha 34

Table No. 06. Showing Opinion about Sneha Matra 135,136,137.

Author Hrisiyasi M. Hraswa Matra Madhyama M. Uttama matra

Hemadri 1 Pala, 2 Pala, 4

Pala, 6 Pala

- - -

Sharangadhara - 2 Tola 3 Tola 4 Tola

Table No. 07. Shows Sneha Matra according to Sushruta.138

Dose Time required for digestion

Action Indication

Sadharana Matra (1/4th day) 3 Hrs. Agnideepti Alpa Dosha Atur

Bruhmana Matra (1/2 day) 6 Hrs. Brimhana, Vrishya

Madya Dosha Atur

Prabhala Dosha Matra (3/4th day)

9 Hrs. - Bahu Dosha Atur

Shrestha Matra (Full day) 12 Hrs. - Glani, Moorcha, Mada

Uttama Matra (Day & Night) 24 Hrs. - Kushta, Visha, Unmada, Graha, Apasmara

Table No. 08 Showing Indications of Sneha Matra.139,140.

Criteria for selection of Dose Person Disease

Action

Uttama Matra

Prabhuta sneha, Nitya kshut–pipasasaha uttama Agnibala, Sharira bala, Manasa Bala, etc

Gulma Sarpa-Damshtra Visarpa Unmatta Mutrakricchra Gadhavarchasa

Shighravikara Shamana, Doshanukarshini, Pervades through all marga Balya, Rejuvenates body, sense organs and mind

Madhyama Matra

Madhyama Sharira bala, Manasa bala, Agnibala, Mridu koshta, etc

Arushka Sphota Pidaka Kandu Pama Kushta Vatarakta

No much complications. Does not effect strength much. Brings Snehana comfortably. Used as Shodhanartha snehanapana

Hrisva Matra

Vriddha, Bala, Sukumara / Sukhocita, Mandagni Durbala/Avara bala Person not able to withstand hunger.

Chronic disease like Jvara, Atisara, Kasa, etc.

Brimhaneeya, Snehaneeya Vrishya, Balya and giving long lasting benefits. Doesnot cause any Complication.

Review of Sneha 35

Hrasiyasi Matra is a trail dose, which is administered on the first day of

Snehapana.

Shamana sneha in Hrisva matra acts as Brimhana. Chakrapani mentions that,

Uttama matra should be used for Shamana and not for Shodhana poorva snehana. So

doubt may arise regarding usage of Uttama and Hrisva matra as Shodhana poorva

snehapana.

VIII. Karmukata Bheda

Based on the Karmukata of Sneha it has been divided into 3 types viz.

(i) Shamana Snehana

(ii) Brumhana Snehana

(iii) Shodhana Snehana

(i) Shamana sneha

Shamana sneha is a procedure of administration of Madhyama matra of Accha

sneha during Annakala when one feels hungry without taking the meal.141,142. Hemadri

defines Shamana snehana is one which normalizes the aggravated doshas without

expelling them and disturbing the normal doshas 143.

(ii) Brimhana sneha

The sneha used for Brimhana is called as ‘Bhrimhana sneha’. The administration

of Sneha along with Mamsa rasa, Madya, Ksheera etc., are known as Brimhana

snehana.144 If, Brimhana sneha is given before food, it will cures Adhobhaga rogas, if

given in the middle of food cures Madhyamabhaga rogas and if given after food cures

Urdhwabhaga rogas and strengthens the body.145 But, here the dose of Sneha should be

Alpa or even less than quantity of Hrisiyasi Matra.146

Review of Sneha 36

(iii) Shodhana sneha

The Uttama matra of Accha Sneha is administered in morning hours when

preceding evening food has been digested but individual have shown less hunger is called

as Shodhana sneha.147,148,149.

Shodhana snehana is carried out through Matranusara or Arohana or

Pravicharana. Matranusara and Pravicharana snehapana were already explained.

IMPORTANCE OF SHAMANA SNEHA PANA

Though the Acharyas explained about Shamana sneha but they did not defined it

clearly. But Arunadutta, the commentator of Ashtanga Hridaya stated that “Rogascha

Shamana Yopa Yuchyate Sneha” which normalizes the aggravated doshas all over the

body is called Shamana sneha.150

Charaka has explained Uttama matra of sneha for the person who is having

Uttama koshtaagni and bala, who can withstand thirst, hunger and fatigue (kshut,

pipasa). If we administered properly, it can does the shamana of the sarva shareeravyapi

doshas immediately, “Vikaran Shamayati Tesham, Shigram, Dhoshanukarshani,

Sarvamarga-Koshta, Sandi, Marma, ShakaSancharini. Balya, Punarnavikari, Shareera,

Indriyachetasam. (Ch. Su. 13 Uttama Matrasneha) and (A. Hr. Su. 16/19) and it has the

capacity to spread in to sarva shareera like entering into Marma, Asthi and Sandhi. It

cures the vyadhis like Gulma, Sarpadamshtra, Visrpa, Mutrakricchra, and it evacuates the

bowel easily. It enhances the Bala, Indriya and Manaprasannata. Arunadatta states that it

should administered when doshas are in relay to kupitavastha.151

Brihatrayee’s explained after Shamasneha, Peyadi krama should be followed

“Sneha Viriktavat” after the digestion of sneha. (Ah. S. 16/19, Ch. Su. 13/81) Because

Chkrapani said that after Dhoomapana is cotra-indication.152,153,154.

Review of Sneha 37

MATRA OF SHAMANA SNEHA

Regarding the posology of Shamana snehapana there is quite controversy between

Acharya Charaka and Vagbata. Charaka while describing the dose schedule for sneha,

says that Uttamamatra or optimum dose of sneha which gets digested with in 24 hours is

the more suitable dose for Shamana sneha.155 Vagbhat opines that the Madhyama matra

sneha which gets digest within 12 hours is the more suitable dose for Shamana sneha.

Where as Ashtanga Hridya added that for Shodana purpose Matra should Bahu, but for

Shamana purpose Madhyama matra should be used,156 It seems to be the time which is

taken for the digestion of Sneha dravya is one and same, but there is no contradictory

explanation by Charaka. Because Uttamamathra sneha will digest within 24 hours

Madyama matra will digest within 12 hours and Hrisvamatra will digest within 6

hours.157 , 157 (a)

Shrangadhara relatively more recent author has determined the dose depending

upon the digestive capacity of a person. Sneha for person of good digestive capacity is

one phala, for the person of medium digestive capacity is 3 karsha, and person of poor

capacity will be 2 karsha, which are considered as pradhana, madhyama, and hrisva matra

respectively.158 A close and critical analysis of the edition of the samhitas would appear

that, there is a gradual decreases in the dose of shamana sneha with the evidence of age.

This may be due to the decrease in the strength and power of digestion of the people with

advancement of age.159,160

The validity and applicability of Uttama and Madyama matra are Shamanasneha

matra according to Charaka and Vagbhat respectively. In the present day the person can

not withstand such a high dose of sneha. Hence it is favor to adopt the principal of

Sharangadhara that the dose of sneha should be decided as Heena, Madhyama, or Uttama

matra depending on the condition of Dosha, Kala, Agni, and Vyadhi of the patient. Even

the Chakrapani while commenting on Charaka opines that there is no fixed dosage of

drugs, but the dose is to be prescribed by considering the state of Doshas, Agni balabala

and nature of disease.

Review of Sneha 38

The author of the Ayurvediya Panchakarma Vigynana Dr. H. S. Kasture has

written the administration of Sneha as 6 tolas in 3 divided doses in a day for Shamana

purpose.161

KALA PRAKARSHA IN SHAMANA SNEHA

There is no standard duration for Shamana sneha advocated by Acharyas

regarding duration of administration. But, Kasyapa while describing the effects of the

snehana considers the vyadi shamana laxanas like “Karnakshi Pranabalam”, “Smriti

Kesha Ojasam”, “Shaanteesta Vyadhinam” as the prime factor. This observation of

Kashyapa suggests that Shamansneha should be continued till the alleviation of the

disease irrespective of any time limitations.162

Table No. 09 Showing indications of Shamanasneha. 163,164,165.

Sl. Indications Ch. Su. A.S.

1 Gulma + - +

2 Sarpadamshtra + - +

3 Visarpa + - +

4 Unmatta + - +

5 Mutrakricchra + - +

6 Gudavarcha + - -

7 Kuushta - + -

8 Visha - + -

9 Unmada - + -

10 Graha - + -

11 Apasmara - + -

12 Udavartta - - +

13 Shabi peeditah - - +

Review of Sneha 39

Table No.10 This table shows General Contraindications of Snehana.166,167,168,169,170.

Sl. Asnehya C.S. S.S. A.H. K.S. Sh.S. 1 Rukshana, Samshodhanadrute + - - - - 2 Utsanna Kapha Medasa + - - - - 3 Kapha prakopa, Dagdha - - - + - 4 Abhishyanna anana guda + - - - - 5 Nitya Mandagni + - + - - 6 Shleshma Pittopahata antaragni - - - + - 7 Tikshnagni - - + - - 8 Durbala + + + - + 9 Pratanta (Klamayukta) + - - - - 10 Shranta - + - - - 11 Shramanvita, Akala Prasuta - - - - + 12 Garbhini + - - + - 13 Prasuta - - - + - 14 Apaprasuta, Urustambha, Udara - - + - - 15 Kshirapa, Ativriddha, Jadya, Glani - - - + - 16 Madatura, Murcha, Trishna + - - - - 17 Talu Shoshi + - - - - 18 Sneha Glani + - - - - 19 Garardita + - - - - 20 Amajahara + - - - - 21 Annadvesha + - + - - 22 Arochaka - + - + - 23 Ajirna - + - - + 24 Chardi + + + + + 25 Atisara - - + - - 26 Vit Prakopa - - - + - 27 Taruna Jvara - + - + + 28 Sthula - + + - - 29 Gala roga - - + + - 30 Akala datta Vireka, - + + - - 31 Akala Datta Basti + + + + - 32 Akala Datta Nasya + - + + - 33 Durdina - + - - +

Review of Sneha 40

SUITABLE RITUS FOR SNEHA

Oil is to be used in Pravrut (First rainy season)

Ghee at the end of Varsha (Season of heavy rain)

Vasa and majja during maadhava (Vasant , spring )

These are when the doshas are in the normal state (in a healthy person) 171

ACCORDING TO DOSHA

When there is Kapha associated with Vata or Kapha alone Sneha has to be

administered in day time.

When the aggravation of Pitta and Vata, Pitta associated with Vata or Pitta

associated with Kapha sneha should be given at night.172

SHAMANA SNEHA PANA VIDHI

The administration of sneha in three different stages (1) Poorvakarma (2)

Pradhana karma and (3) Pachyat karma

Poorvakarma

Athura siddatata

For Shamananga snehapana is no specific preparatory regimens are needed. But

care should to be taken about Sama and Niramavastha of the patient before giving

Shamana sneha. In Samavastha Snehapana is contraindicated. Doshas have permeated

through out the dhatus of the body such an attempt seldom gives the desired effect.

Shamana sneha should be administered when the doshas are in Paripakwa avastha

“Paripakweshu, Dhosheshu, Sarpihi, Panam Yataambrutum.”173Ch. Su. 13/72) Ashtanga

samgraha and Hridayakara advised mridu bhojana prior night of Shamana snehapana.

Because his previous food should digest completely and should feel hunger (bubbukshita)

then only he is fits for Shamana snehapana. When the patient is not having proper

appetite the administered sneha will not be able do its desired effect and may leads to

doshotklesha. So one must be very particular about the appetite while administering

Shamana sneha.174,175

Review of Sneha 41

Pradhanakarma

“Pibet Samshamanam Sneham Anna Kale Prakakshitaha |”176

The Shamana sneha should be administered during the anna kala, when the

patient feels hungry, advise to take Snehapana by praying the God and devoting respect

to the elders.177

Pashatkarma

The physician should take care of three things in Paschyata karma viz.

i. Anupana.

ii. Peyadi krama. (Sneha viriktavat)

iii. Pathya pathyha.

Anupana 178,179,180.

Particular Anupana should selected and given along with the Snehadravya.

Because it helps in breakdown, softening, digestion, proper assimilation and instant

diffusion. It energies the patient and gives sense of pleasure.

Charaka has mentioned particular type of Anuapna dravyas in respect with sneha

dravyas viz.

Ushna jala – For Ghrita

Yusha – For Taila

Manda – For Vasa and Majja,

Sheetala Jala – For Bhallataka and Tuvaraka Taila

In the non availability of particular Anupana dravya Ushnajala can be used except

in case of Tuvaraka and Bhallataka Taila. The dosage of the Anupana should be decided

on the basis of Agnibalabala or according to the pharmaceutical process involved.

Review of Sneha 42

Peyadi Krama (Sneha viriktavat)

After the digestion of sneha patient should follow sequence of regimens as a part

of post-operative care –

Ushna yavagu, Saklinna alpatandula, Krita yavagu, Krita vilepi with alpa ghrita.

Arunadatta has commented over (A.Hr.16/19) Upacharsthu Shamanae Karyah

Snehae Virikthava.181,182,183

Pathya Pathyha

Pathya 184,185,186,187.

Ushna Jalapana – Ushna Jala is having Balya, Deepana-pachana and

Vatanulomana properties. Hence helps in Snehapachana process.

Bramhacharya – Helps in Sneha process.

Kaphashaya – As day sleep and Ratri jagarana aggravates Kapha and

Vata dosha respectively. Hence, only night sleep is advised.

Apathya

Vyayama – Exercise

Uccha Vacana – Loud speech

Vega Samrodha – Suppression of Urges

Shoka, Krodha – Anger, anxiety.

Hima, Atapa – Mist, Sunlight.

Pravata – Open breeze

Atyasana – Sitting at a place for long time.

Nicha/Uccha Upadhana – Usage of too low or too high pillows.

Pathya-apathya is to be followed strictly during the course of therapy.

Review of Sneha 43

Table No. 11. Showing Sneha Jeeryamana and Jeerna Lakshana.188

Jiryamana Lakshana Jirna Lakshana

Shiroruja Shirorujadi Jiryamana Lakshana Prashamana

Bhrama Vatanulomana

Nishtiva(Lalasrava) Kshudha pravrtti

Murcha Trishna pravrtti

Sada Udgarashudhi

Arati Laghuta

Klama

Trishna

Daha

Review of Sneha 44

SHARRERA OF ASHTILA Ashtila is the hard, round, stony like structure . Acharya sushruta explained very

clearly about structure and its location in the body.189 It is located in Shakrunmarga i.e.

it lies in between the Basti and guda Pradesha.190

STRUCTURE OF ASHTILA

01. Deerghavartula pashana visheshaha191 – It means elongated, round, apple and

stony like structure.192

02. Charmakarinam – Means it is very hard mass which feels like metallic one i.e.

(loha, bhandi).

03. Ayata – Means to arrive, to adhere. Here Ayata means Granthi, which is like

Ayatakara. It can be compare with prostate when it enlarges with right and left lateral

lobes.193

04. Urdhwa – It means perhaps raised, tending upwards or raised elevated. It can be

compared with upper border of prostate.194

05. Ghana – Means solid material, hard, thick.195

It can’t be compared with hyperplesia of the prostate, because it composed of

smooth muscle cells and granular epithelial tissue, but it can be compared with prostatic

cancer.

06. Unnata – It means bent, turned upwards, elevated little up or prominent

projective. It can be compared with anterior lobe of the prostate.196

07. Achala \ Eshacchala – Means fixed or partial movable. In case of prostatic

hyperplasia there will be partial movement, where as in prostatic cancer it will be fixed

one.197

Shareera 45

RECTUM / GUDA

Sushruta has explained about the anatomical structure of Guda while describing

Arsharoga. Guda is a part, which is the extension of sthoolantra with 4½ angula in length.

It has got 3 valis (parts) named as Gudavalitrayam.200

Pravahini – That which does pravahana.

Visarjini – That which does viasrajana.

Samvarani – That which does samvarana.

There is another structure called as Gudostha, which is about a distance of 1½

yavapramana. The first vali samvarani starts at a distance of 1 angula from gudostha. The

width of each vali will be 1 angula and resembles the colour of elephant’s palate.201

Charaka when described about the Koshatagni has considered Uttaraguda and

Adharaguda. The modern commentators consider them as rectum and anus

respectively.202

All Acharyas have considered Guda as one among the Dashajeevita dhamanis and

also one among the Bahyasrotas. 203,204,205.

The rectum forms the last 15 cm of digestive tract and is an expandable organ for

the temporary storage of fecal material. Movement of fecal material into the rectum

triggers the urge to defecate.

The last portion of the rectum, the ano-rectal canal, contains small longitudinal

folds, the rectal columns. The distal margins of rectal columns are joined by transverse

folds that marks the boundary between columnar epithelium of the proximal rectum and a

stratified squamous epithelium like that in the oral cavity. Very close to the anus or anal

orifice, the epidermis becomes keratinized and identical to the surface of the skin.

Shareera 46

There is a network of veins in the lamina propria and submucosa of the ano-rectal

canal. The circular muscle layer of the muscular is extern in the region forms the internal

sphincter and are not under voluntary control. The external anal sphincter guards the anus

and is under voluntary control. Pudental nerves carry the motor commands.206

BASTI

Nirukti - The term Basti is derived from the root ‘Vas nivase’ which is suffixed

by ‘Tich' or ‘Ktin' gives the meaning of reservoir or hoarded or covered. In addition, it

has been told as ‘Vas acchadane'.

According to Shabdastomamahanidhi -

‘Baste Avrunoti Mutram’

‘Nabheradho bhage Mutradhare Sthane’,

It means, the organ, which acts as receptacle or lodges or hoarded or covers the

urine, which is situated in the lower part of Nabhi.

According to Medini commentator of Namalinganushasana “Vasati mutramatra”

the organ where Mutra stays or resides or in other words Basti acts as a reservoir of urine.

Synonyms - The terms such as Mutrabasti (Su. Sha.9), Mutradhara (Ch.Si.9),

Mutrashaya (Su. Ni.3), Basti (Su. Ni.3), and Basti puta (Vijayarakshita on Ma. Ni.31).207

Uthpatti - The essence part of the Rakta and Kapha after being digested by Pitta

along with Vayu forms the Basti, Antra and Guda (Su. Sha.4).208 Further in this context

Sushruta explains that the hollow shape is formed when the essence parts are inflated by

the repeated action of Vayu (Su. Sha.4).208 Charaka has not explained about the

embryological origin but has encounters it in Matruja Avayava (Ca. Sha.3).

Shareera 47

Number, Location, Relations - Basti is only one and is one of the Koshthanga

(Ch. Sha.7, Su. Sha.5, Su. Chi.2, A. Hr. Sha.3), Saptashaya (Su. Sha.5) and Dasha

pranayatana (A. S. Sha.5).

Regarding the location, Sushruta and Vagbhata opines that the Basti lies between

the Nabhi, Prushtha, Kati, Vrishana (Mushka), Guda, Vankshana and Shepha

(Medhra/Linga). The Basti, Bastishira, Pourusha, Kati, Vrishana and Guda are all related

to one another and situated within Gudasthivivara (Cavity of rectal bone/Pelvic cavity).

Further in the chapter of Ashmari Nidana,209 Sushruta and also Vagbhata states that in

females the Urinary bladder is situated very near and side to the Uterus (Su. Chi.7, A. S.

Chi. 13, A. Hr.Chi.11).

Acharya Charaka mentions that Basti is located in the midest of Sthula Guda,

Mushka, Sevani, Shukravaha and Mutravaha Nadi, is the receptacle of urine into which

all the channels of the body carrying liquid elements converge as all the rivers on the

earth flow into the ocean (Ch. Si. 9). Further Chakrapani commenting on the same verse

explains that Basti is the resort (Ashraya) of all the surrounding organs and it is the

resting place of Ambuvaha srotas. The channels connected to their moola which are

Marma and which provide nourishment to them because of which even these channels are

called as Marma. Bhavamishra and Sharangadhara have mentioned that the Basti is

located below the Malashaya (Sha. Pu. Kha.5). Amarasimha mentions it to be situated

below the Nabhi.

Size - Acharya Sushruta mentioned that the size or pramana of Basti marma is

equal to the pit of one’s own palm (Su.Sha.6).

Shareera 48

Shape - The shape of the Basti is similar to Alabu (Gourd) (Su. Ni.3), whereas

Acharya Vagbhata says that it has a shape of Dhanurvakra - a bent bow - (A. H. Sha.4).

Adhamalla commenting on Sha. Pu. Kha.5 mentions that it is having resemblance (with

the shape) of a bag of leather.

Structure - It is hollow viscera (Ashaya) (Su. Sha.5), having thin walled (Tanu

Twak) and a single outlet directed downwards, which is fixed on all sides by the Sira and

Snayu (Su. Ni.3, Su. Sha.5, Su. Sha.5). Here Snayu are of Sushira variety. Structurally it

is composed of very less Mamsa and Rakta dhatu (A. H. Sha.4, A. S. Sha.7). Basti is

devoid of Mamsa and Meda dhatu (Dal. on Su.Ni.9) Basti is counted under Sadya

Pranahara marma and Snayu marma having vital area of about 4 Angulas (Su. Sha.6) and

it also consists of Dhamani according to Vriddha Vagbhata (A.S.Sha.6).

Synonyms - Mutra Praseka (Su. Chi.7), Mutra patha (Ch. Chi.26), Mutra vahi

Srotas (Dal - Su. Ut.58), Mutra Seka (Su. Chi.7), Mutra Marga (Ch. Si.9, Su. Chi.7, Su.

Ut. 58), Mutra Srota (Su. Ni.13, A. Hr. Ni.9), Mutrayanam (Madhukosha - Ma. Ni.27).

Mutrapraseka -

There are no direct references available regarding the size, shape and other

specific anatomical details of Mutra Praseka but some relevant and cross references in

Uttara Basti chapter gives a superficial idea about the length of Mutra praseka. Wherein

the Uttara Basti (Pushpa) netra pramana is said to be of 12 or 14 angula in male and 10

angula in female (Ch. Si.9, Su. Chi.37) Further it has been explained that in males it

should be administered up to half of its length i.e. 6 to 7 angula or up to Madhya karnika.

Therefore the length of Mutra praseka in male is about 6 to 7 angula. In female it has to

be introduced up to 2 angula, hence the length of Mutra praseka in female is about 2

angula. Acharyas opinion about Mutra praseka is identical to that of "Urethra".

Shareera 49

Applied aspect - While explaining the surgical approach to Ashmari Sushruta has

said to prevent Mutra praseka from any injury, otherwise dribbling of urine will become

continuously (Su. Chi.7). Sushruta describes that below the opening of the urinary

bladder (Bastidwarasya chapyadhah - internal urinary meatus) and two fingers on the

right side (Dwayangule Dakshine parshwe), the Shukra enters and flows out through the

urinary passage (urethra) of the man (Su. Sha.4, A. S. Sha.5). It also opens from left side

at the same level, which can be practically appreciable (Pratyaksha Shareera).

Suppression of urge of urine during sexual intercourse leads to Shopha and Ruja of the

Mutrashaya, Guda, Mushka and leads to retention of urine. Urologists are also of same

opinion that due to aforesaid cause retrograde ejaculation occurs in consequence to the

relaxation of bladder internal sphincter. It is also related to testes. This is further

substantiated by the lakshana mentioned in Shukrashmari (Ca.Chi.26).

Prakrita Mutra Pramana -

4 Anjali. (Ch. Sha.7) 1 Anjali is nearly about 4 ounces. So 4 Anjali is nearly about

16 ounces, (480 ml) which clearly indicates that Acharyas considered 4 Anjali only

because of the storage capacity of Basti. In 24 hours 1500 ml of urine is excreted out

which can be considered. 1500 ml cannot be stored in bladder at normal physiological

instances.

The urinary bladder performs the function of Dharana (storage) and poshana

(release) of urine. The example of a ''taut bow" in relation to Basti signifies the

functioning of the urinary bladder in the light of modem physiology.

Applied aspect - When Mutravaha srotas is vitiated it manifests the lakshanas

like Atisrushta (Increased Quantity or Frequency), Atibaddha (Obstructed or Retention of

Urine), Prakupita (Provoked), Alpalpam (Scanty), Abhikshnam (Dribbling), Bahalam

(Thick urine or abundant urine) and Sashoolam (With pain or Dysuria) (Ch. Vi.5).

Shareera 50

Any injury to Mutravaha srotas leads to the Anaddha basti (Distention of urinary

bladder), Mutranirodha (Retention of urine) and Stabdha Medhra (Stiffness of the penis)

(Su. Sha.9).

ANATOMY OF PROSTATE

Fundamental to a complete understanding of the pathophysiology and therefore

the symptoms of BPH is a through comprehension of the normal and pathologic anatomy

of the structures involved.

Graphically the prostrate gland can be conceived of as an apple with the core

entirely removed. The hole thus produced through the center of the apple is the prostatic

urethra, which is contiguous with the bladder neck superiorly and the membranous

urethra inferiorly. This analogy with the apple can be carried further by thinking of the

skin of the apple representing the gland itself, which consists of fibrous, muscular and

glandular elements. The entire prostrate gland in a young, healthy adult man weighs

about 20gm is about the size of a large chestnut. Stephen N, Rous Textbook of Urology.)

The Prostate is located in the pelvis and is surrounded by the rectum, bladder,

dorsal and periprostatic venous complexes, musculature of the pelvic sidewall, the

urethral sphincter (responsible for passive urinary control), the pelvic plexus, and

cavernous nerves (which innervate the pelvic organs and corpora cavernosa). Sushruta

and Charaka explained the Sthana of Basti in the similar fashion.

The Prostate is a firm, partly glandular, partly fibro muscular body, surrounding

the beginning of the male urethra. Being somewhat conical, it presents: above - a base or

vesicle aspect, below - an apex and also posterior, an anterior and two inferolateral

surfaces.

Shareera 51

The base is largely contiguous with the neck of the bladder above it; the urethra

enters here, nearer its anterior border. The apex is inferior and in contact with the fascia

on the superior aspects of the sphincter urethra and transversi perinei profundi. The

posterior surface, transversely flat and vertically convex, is separated from the rectum by

the Prostatic sheath and loose connective tissue external to the sheath. Near its superior

(Juxta vesical) border is a depression where the ejaculatory ducts penetrate the gland,

dividing this surface into a superior and an inferior, larger part. The superior part is

variable in size and usually regarded as the external aspect of the median lobe; the

inferior part shows a shallow, median sulcus, usually considered to mark a partial

separation into right and left lateral lobes, forming the main Prostatic mass and

continuous behind the urethra. A band of fibro muscular tissue, ventral to the urethra,

joins these lobes together and is often referred to as the anterior lobe; it contains less

glandular tissue than the rest of the gland. The anterior surface, transversely narrow and

convex, extends from the apex to the base, about 2 cm behind the pubic symphisis from

which it is separated by a venous plexus and loose adipose tissue. Near its superior limit

it is connected to the pubic bones by the puboprostatic ligaments. The urethra emerges

from this surface anterosuperior to the apex of the gland. The inferolateral surfaces are

related to the anterior parts of the lavatories ani, which are separated from them by a

plexus of veins embedded in the fibrous Prostatic sheath.

The Prostatic base measures about 4 cm transversely, the gland being about 2 cm

in anteroposterior and 3 cm in its vertical diameters. It weighs about 20 gms. It has a

fibrous sheath, partly vascular; on each side this consists fibrous tissue containing the

prostatic venous plexus; anteriorly it blends with the puboprostatic ligaments and

inferiorly with fascia on the deep surfaces of the sphincter urethra, the deep transverse

Shareera 52

perineal muscles and with the perineal body. Posteriorly the sheath has a different origin

and is a vascular. In male fetuses, at the forth month, the rectovesical peritoneal pouch

descends to the pelvic floor, separating prostate from rectum; its lower part is obliterated

and the fused peritoneal layers here form the posterior prostatic sheath, sometimes termed

the rectovesical fascia. Traces of its separate layers persist as a plane cleavage. Above, it

descends over the posterior aspects of the seminal vesicles and deferent ducts and is

connected to the floor of the rectovesical pouch; on each side, it joins with the posterior

vesicle ligament. Below, adherent to the prostate, it joins with the perineal body. The

anterior parts of the lavatories ani pass back from the pubis around the prostate as

levatores prostatae.

The prostate is traversed by the urethra and ejaculatory ducts, and contains the

prostatic utricle. The urethra usually passes between its anterior and middle thirds. The

ejaculatory ducts pass antero-inferiorly through its posterior region to open into the

prostatic urethra.

It is divided into a peripheral zone, a central zone, and a transition zone. The

anterior surface is covered by the fibro muscular stroma. Most cancers develop in the

peripheral zone, while nonmalignant proliferation occurs predominantly in the transition

zone. The functional unit is the glandular acinus, which consists of an epithelial

compartment including epithelial, basal - neuroendocrine cells - and a stromal

compartment including fibroblasts and smooth muscle cells.

These compartments are separated by a basement membrane. PSA and prostate

specific acid phosphatase are produced in the epithelial cells. Both stromal and epithelial

cells express androgen receptors and depend on androgens for growth. Additional growth

regulatory signals occur via paracrine signaling between the two compartments. In

cancer, the relationship between stromal and epithelial elements contributes to growth

Shareera 53

both in the primary and metastatic sites. The major circulating androgens in the blood are

Testosterone, which is converted to dihydrotestosterone (DHT), the active form, by 5-α

reductase. Changes in prostate size occur during two distinct periods –

01. Diffuse enlargement during puberty

02. In focal regions in the periurethral area after the age of 55. (Harrison's-I )210

The contemporary classification of the prostate into different zones was based on

the work of Mc Neal. He showed that it is divided into: the peripheral zone which lies

mainly posteriorly and from which many carcinomas arise, and a central zone which lies

posterior to the urethral lumen and above the ejaculatory ducts as they pass through the

Prostate; the two zones are rather like an egg in its egg cup. There is also a periurethral

transitional zone from which most Benign Prostatic Hyperplasia (BPH) arises. Smooth

muscle cells are found through the prostate, but in the upper part of the Prostate and

bladder neck (the internal sphincter) these sub serve a sexual function, closing during

ejaculation. Resection of this tissue during Prostatectomy is responsible for retrograde

ejaculation.

Sushruta explained the condition like Mutra shukra, which resembles to above

said explanation. The distal striated urethral sphincter muscle is found at the junction of

the prostate and the membranous urethra, it is horseshoe shaped with the bulk lying

anteriorly; it is quite distinct from the muscle of the pelvic floor.

The glands of the peripheral zone, lined by columnar epithelium, lie in the fibro

muscular stroma and their ducts, which are long and branched, open into posterolateral

grooves on either side of the verumontanum. The glands of the transitional zones are

shorter and unbranched. All these ducts, the common ejaculatory ducts and the prostatic

ducts, open into the Prostatic urethra. No wonder that infection of the prostatic urethra is

difficult to eradicate.

Shareera 54

Benign Prostatic Hyperplasia starts in the periurethral transitional zone and, as it

increases in size, it compresses the outer peripheral zone of the Prostate, which becomes

the false capsule. There is also the outer true fibrous anatomical capsule, and external to

this lie condensations of endopelvic fascia known as the periprostatic sheath of

endopelvic fascia. Between the anatomical capsule and the prostatic sheath lays the

abundant prostatic venous plexus. The prostatic sheath is contiguous with the strong

fascia of Denonvilliers' that separate the prostate and its coverings from the rectum. The

neurovascular bundles supplying anatomic innervations to the corpora of the penis are in

very close relationship to the posterolateral aspect of the prostatic capsule and are at risk

of damage during radical cystoprostatectomy and radical Prostatectomy; inadvertent

diathermy to these nerves may be the cause of erectile impotence after Transurethral

Prostatectomy. (Bailey and love) 211 Vagbhata and Sushruta had considered this as Abhighata to

Shukravaha srotas that leads to Klaibya or Marana as explained during the operative

procedure of Ashmari.

The peripheral and central zone of the prostate are divided according to newer

anatomical studies.

A dorsocranially located central zone with wide lumina and a high cylindrical

epithelium. The glands show papillary folding. The cellular cytoplasm is light and

granular. The stroma is loose. A transition zone, located mediolateral of the urethra.

Narrow glands and a very tight stroma characterize this zone. A peripheral zone with

loose stroma and glands such as are seen in the transition zone. In all three zones

glandular acini and ducts with basal and secretary cells are found.

Shareera 55

Prostatic Hyperplasia develops in the transition zone, while prostatic carcinoma

develops in 70 % of cases in the peripheral zone. Only 20 % of all carcinoma are found in

the transition zone, and these are usually highly differentiated incidental carcinoma.

Carcinoma is also found in 10 % of the cases in the central zone.

Vessels and Nerves

Arteries - These are rami of the internal pudendal, inferior vesical and middle

rectal arteries.

Veins - They form a plexus around the prostatic sides and base, receiving in front

the deep dorsal penile vein and draining to the internal iliac veins.

Nerves - They come from the inferior hypogastric (pelvic) plexus. The prostatic

nerve supply is very abundant, the periurethral zone being innervated by nerves arising

peripherally. Numerous nerve fibres and ganglia, forming a periprostatic nerve plexus,

cover the Prostatic capsule. (Gray’s Anatomy) 212

Figure No. 01. Showing the Anatomy op Prostate and Bladder.

Shareera 56

PHYSIOLOGY OF PROSTATE

The prostate has a purely sexual function and in animals that have a seasonal

sexual life, it is rudimentary except during the rutting season. The normal adult Prostate

undergoes atrophy after castration.

The glands of the Prostate consist of many follicle-like spaces leading into ducts.

The epithelium of the follicles secretes the prostatic fluid, which is thin and opalescent

and gives the semen its characteristic odor.

Prostatic Fluid – The seminal vesicles produce their own seminal fluid, which

nourishes and gives volume to the sperm. During sexual excitement the seminal vesicles

empty their contents into the prostate, which, in turn, adds its own prostatic fluid to this

mixture. Some prostatic fluid precedes ejaculation, but most of the released fluid is added

to the sperm and seminal fluid to constitute the semen. Only about 5% of the final

mixture comprising the ejaculate is composed of actual sperm. Prostatic fluid is both a

lubricant and a carrier of sperm and constitutes about 20% of the volume of the semen.

The muscles of the prostate are very active in the expulsion of semen from the body at

sexual climax. The stimulation of the prostate that activates ejaculation is responsible for

much of the intense pleasure that immediately precedes ejaculation. This fluid in man is

slightly acid in reaction (pH = 6.4). It is rich in calcium (30 mEq/ltr) and citrate (150

mEq/ltr) and in the enzyme fibrinolysin (Plasmin) and Acid Phosphatase. The low zinc

status of most men who suffer from BPH abets chronic low-level infection because free

zinc is the most active antibacterial agent found in prostatic fluids.

Shareera 57

Systemic hormonal influence (endocrine) and local growth factors (paracrine and

autocrine) were seen on prostate. Many local and systemic hormones whose exact

functions are not yet known govern the growth of the Prostate. The main hormone acting

on the Prostate is testosterone, which is secreted by the Leydig cells of the testes under

the control of luteinising hormone (LH), which is secreted from the anterior pituitary

under the control of hypothalamic luteinising hormone releasing hormone (LHRH).

Testosterone is converted to 5 di-hydrotestosterone (DHT) by the enzyme 5-α-reductase

that is found in high concentrations in the prostate and the perigenital skin. Other

androgens are secreted by the adrenal cortex but their effects are minimal. Estrogenic

steroids are also secreted by the adrenal cortex and, in the ageing male, may play part in

disrupting the delicate balance between DHT and local peptide growth factors and hence

increase the risk of BPH. Increased levels of serum estrogens, by acting on the

hypothalamus, decrease the secretion of LRHR (and hence LH) and thereby decrease

serum testosterone levels. Therefore, pharmacological doses of estrogens cause atrophy

of the testes and Prostate by means of reduction in testosterone.

The prostatic epithelium and mesenchymal stromal cells in response to steroid

hormones secrete other locally acting peptides. These include epidermal growth factor,

insulin-like growth factor, basic fibroblast growth factor, and transforming growth factors

alpha and beta. These undoubtedly play a part in normal and abnormal Prostatic growth

but, as yet, their functions are unclear.

Shareera 58

PSA is a glycoprotien, which is a serine protease. Its function may be to facilitate

liquefaction of semen, but it is a marker for prostatic diseases. It is measured by an

immunoassay and the normal upper limit is about 4 υmol/ml. Its level in men with

metastatic Prostate cancer is usually increased to more than 30 υmol/ml and falls to low

levels after successful androgen ablation. Men with locally confined cancer have serum

PSA levels of about 15 υmol/ml or lower. Although PSA is a reliable marker for the

progress of advanced disease, it is neither specific nor sensitive in the differential

diagnosis of early Prostate cancer and BPH, as both diseases are compatible with PSA in

the range of 4 -12 υmol/ml. PSA measurement has superseded measurement of serum

acid phosphatase. (Bialy & loves)213

Figure No. 02. Showing the vertical section of the pelvis showing the prostate in relation

with surrounding structures.

Shareera 59

NIDANA SEVANA

Dhatu kshaya

Vyadhi kshamatwa heena

Ojah vikriti

Improper formation of successive dhatus

Vriddhavastha

Aharaj

Viharaj

SAMPRAPTI OF VATASHTILA

Vata prakopa in Vriddhavastha

Vataprakopa

Vishamagni

Dosha dushti

Prasara in shareera

Apanavata vikriti

Kha Vaigunya

Particularly in shakrinmarga

Bahirmargavarodhini

Mala, Mutra, Anila sanga

Adhmana, Sashoolayukta mutratyagaVATASHTILA

BHEDA

UPADRAVA

VYAKTAVASTHA

STHANASAMSHRAYA

PRASARA

PRAKOPA

SANCHAYA

Flow chart No. 01. Shoing the Samprapti of Vatshtila (BPH).

Table No.15 Showing Combination of this ghrita are like as mentioned. 255,256.

DASHAMOOLA Drug Name Rasa Guna Veerya Vipaka Doshaghna Karma

Bilwa (Aegle marmelos) Kashaya, Tikta Laghu, Ruksha Ushna Katu Kapha Vata Shamaka

Grahi, Pacaka Agnivardhaka

Agnimantha (Premna integrifolia)

Tikta, Katu, Kashaya, Madhura

Ruksha, Laghu Ushna Katu Kapha Vata Shamaka

Shothahara, Pramehahara

Shyonaka (Oroxylum indicum) Madhura, Tikta, Kashaya

Laghu, Ruksha Ushna Katu Kapha Vata Shamaka

Shothahara, Mutrala,

Patala (Stereospermum suaveolens)

Tikta, Kashaya Laghu, Ruksha Ushna Katu Tridoshahara Kapha Vatahara

Shothahara, Mutrala, Ashmarihara

Kashmarya (Gmelina arbora) Tikta, Kashaya, Madhura

Guru Ushna Katu Tridoshahara Kapha Vatahara

Shothahara, Mutrala

Shalaparni (Desmodium gangeticum)

Madhura Tikta, Guru, Snigdha Ushna Madhura

Tridoshahara Kapha Vatahara

Shothahara Mutrala Mehahara

Prishnaparni Utaria picta Madhura Tikta, Laghu, Snigdha Ushna Madhura

Tridoshahara Shothahara Mutrala

Brihati Solanum indicum Katu, Tikta, Laghu, Ruksha, Teekshna

Ushna Katu Vata Kapha hara

Shothahara Hikka, Shwasahara

Kantakari Solanum xanthocarpum

Tikta, Katu, Laghu, Ruksha, Teekshna

Ushna Katu Kapha Vata Shamaka

Shotha, Kasa, Mutrala

Gokshuru Tribulus- terestris Madhura Guru, Snigdha Sheeta Madhura

Vata Pitta hara Mutrala,Vrushya Bastishodhana Shothahara

Laghupanchamoola Drug Name Rasa Guna Veerya Vipaka Doshaghna Karma Kusha. Desmost- achyabipi- nnta stap

Madhura, Kashaya.

Laghu, snigdha Sheeta. Madhura. Thridhosha- hara

Mutrakrcchra asmrighna.

Kasha. Saccharum- Spontaneum Linn.

Madura, Kashaya.

Laghu, snigdha.

Sheeta. Madhura. Vata pittahara. Mutrala,mutra- Krcchra, Asmari Bedaniya.

Nala. Arundo,donax Linna.

Madhura, Tikta, Kashaya.

Laghu, Snigdha. Sheeta. Madhura. Kapha,pitta Hara.

Vrsya,mutrala. Asmari,mutra- Krcchra,hara.

Darba.

Madura,

Laghu, Snigdha. Sheeta. Madura. Kapha, pittahara. Mutrala,mutra- Krcchra,

Kandekshu. Saccharum- Officinarum Linn.

Madhura.

Snighda, Ghuru. Sheeta Madura Vatapitta Shamaka.

Mutrala ,bhalya. Vrushya.

Drug Name Rasa Guna Veerya Vipaka Doshaghna Karma Punarnava. Boerharia Diffuse linn.

Madhura, Kashaya, Katu,tikta.

Laghu, Ruksha, Ushna.

Ushna. Madhura. Thridhosha Hara.

Anuvasanopaga. Swdopaga. Mutrajanana.

Shatavari. Asparagus Recemosis- Willd

Madhura, Tikta.

Guru, Snigha.

Sheeta. Madhura. Vata pitta Hara.

Vrushya Rasayana.

Bala. Sida cordifolia linn.

Madhura. Laghu, Snigdha, Picchila.

Sheeta. Madhura. Vata pitta Shamaka.

Rasayani, Brimhani, Vataanulomana,

Nagabala. Ghewia- Hirsute.

Madhura, Kashaya.

Ghuru, Snigdha, Picchila.

Sheeta. Madhura. Vata pitta Hara.

Mutrala, Rasayana, Mutrakracchra Hara.

Atibala. Abutilon Indicumlinn.

Madhura,

Laghu, Snigdha, Picchila.

Sheeta Madhura. Vata pitta Hara.

Mutrala, Kracchra hara.

Ashwa- ghandha. Withania somnifera.

Tikta, Katu, Madhura.

Laghu. Snigdha.

Ushana. Madhura.

Kaphs vata Shamaka.

Balya, Rasayana. Hrudhoapi, Mutrala.

Vidari Kandha. Pueraria- Tuberosa dc

Madura. Guru, Snigdha.

Sheeta. Madura. Vata pittahara. Mutrla,balya, Vrushaya. Mutrakricchra- Hara.

Prakshepaka Dravyas :

Drug Name Rasa Guna Veerya Vipaka Doshaghna Karma Guda. (Eragrostiscynosuroides.

Madura, Kashaya.

Guru, snigha Sheeta. Madura. Tridhosha Shamaka.

Ruchikara, mutrala, paniya.

Maduka. Madhuca Longifalia.

Madhura, Kashaya,

Guru, snigha Sheeta. Madhura. Vata pitta Hara.

Balya, Shukrala. Mutrala,krcchra- Hara,

Guduchi. Tinospora, cardipolia

Tikta, Kashaya. Guru. Snighda. Ushna. Madura Thridhosha Ghna. Vatahara.

Balya,agni Deepana.etc.

Shunti. Zingibera- officinale rose.

Katu, Laghu, Snigdha, Guru,etc

Ushna. Madura. Kapha,vata Shamaka.

Vrushya, deepana.

Ajamoda, Apium- graveolans,

Katu,tikta. . Laghu ,Ruksha, Teekshna

Ushna. Katu. Kapha, Vatahara.

Deepana,Hrdya, Vrushya.

Draksha Vitis- vinifera linn.

Madura. Snigha, Guru, Mrudu.

Sheeta Madhura. Vata pittahara.

Vrsya,brmhanana, Virechanopaga.

Pippali Piper longum Katu Laghu, Ruksha. Teekshna

Ushna Katu Kapha Vata Hara Pittakara

Rasayana, Vatanulomana

Yavani Trachispe- mum ammi

Katu, Tikta, Laghu, Ruksha, Teekshna

Ushna Katu Kapha Vata Shamaka, Pitta vardhaka

Shulahara, Mutrala, Deepaka

Saindhava Sodium chloride

Lavana Snigdha, Laghu Sheeta Madhura Tridosha hara

Kapha Vilayana - Chedana, Vatanulomana

Ghrita. Madhura. Snigdha, Mrudu, Guru, manda

Sheeta. Madhura. Vata pittahara.

Balya,rasayana,

Eranda taila . Kashaya. Laghu, Snigdha. Sheeta. Madura Vata pitta Hara.

Gulma,shopa.

VATASHTILA CHIKITSA

Chikitsa means, a combined operation of all the four factors, viz. the Physician

and the other three factors of commendable qualities, with the object of engendering the

concordance of dhatu when pathological changes have occurred in them due to different

Nidana. (Ch. Su.9)238

There is no specific treatment mentioned in classics for Vatashtila (BPH). But,

Mutraghata and Mutrashmari chikista can be used as it is a type of Mutraghata. Sushruta

has mentioneda special treatment i.e. “Gulma Abyantara Vidradivat”239 for Vatashtila

(BPH). But in Mutraghata chikitsa the chikitsoprakamas are depending upon the extend

of vitiation and direction of movement of vayu.240,241(Ch.Chi.28). Basti is one among the

Trividha sadyopranahara marma, so Basti marma paripalana must be kept in mind while

treating.242 To Precautions to be taken to prevent damage to Marma and to maintain the

hygienic measures routinly (Nityam Svasth vrutta auvartanam) (Ch.Si.9)243 Treatment

should be aimed at establishing proper nutrients to Basti marma. So those structures of

Basti receives nourishment only when the nutrient supplying channels are cleared and

Apanavayu made its sanchalana. Basti karma is well appreciated in Charaka samhita

siddhisthana. (ChSi.9/49).244

Avagaha Swedana that alleviate Apana Vata from its main place and removes

obstruction of Mutravaha Srotas and leads to normal voiding of Mutra. Abhyanga due to

its Mardava, Snigdha, Manda, and Guru quality alleviate Vata Dosha. All three types of

Basti are indicated i.e. Niruha, Anuvasana and Uttara Basti (Ch.Su.7, Ch.Chi.28). These

directly act on Vyadhi Udbhava and Adhishthana pradesha (Pakwashaya and Basti) and

disintegrate the Vatashtila pathology. Mutra Virechaneeya medicines and Uttara Basti

can be administered (Ch.Chi.28). Charaka also suggests the utility of Avapeedaka

Sneha.245

Chikitsa 75

Hence at a outstretch the aim of treatment is -

Nidana Parivarjana.

Apanavata Anulomana246

Increasing the stability of Mutravaha Srotas and particularly of Basti.

Removing the Sanga (Obstruction).

Reducing the Ghanatwa of Granthi.

Protecting the Basti marma.

Making proper flow of Urine with Mutrala and Basti Shodhaka drugs.

Following Proper Diet And Regimen

A concise outline can be drawn to manage the problem of Vatashtila (Mutraghata)

according to classics. i.e.

Nidana Parivarjana.

Shodhana.

Shamana.

Shastra Pranidhana.

Rasayana.

Pathya-Apathya.

1. Nidana Parivarjana – It may be further classified as under -

Ahara – Excessive use of Ruksha, Madya, Teekshna ahara and to avoid fasting for

long time.

Vihara – Suppressing the natural urge particularly of Mutra. Performing sexual

intercourse while under the urge of micturition. Excessive exercise, speedy

walking, sitting under the direct sun light continuously etc.

Anya – Avoiding the Teekshna oushadha and psychological depression etc.

Chikitsa 76

2. Shodhana – When Doshas are increased extremely Shodhana Chikitsa become

necessary. While describing the Mutraghata chikitsasutra Sushruta says that in case of

Mutraghata snigdha virechana, Basti and Uttarabasti should be administered according to

the condition of Dosha. Further more he advised to undertake Poorvakarma such as

Snehapana, Snehana/Abhyanga and Swedana followed by Virechana till the Dosha are

eliminated out of the body and then Uttarabasti is advocated. (Su.Ut.58).247 In addition to

this he suggests the Prayoga of Asthapanabasti too. (Su.Chi.35).

Charaka suggests the usage of Trividha basti Karma in Mutra Roga (Ch.Su.7,

Ch.Si.9).248 He also suggests Mutrala drugs, Swedana - especially Avagaha swedana,

Abhyanga, Sarpipana and Uttara Basti (Ch.Chi.28), (Ch.Chi.28/99) & (Ch.Su.7).

Avapeedaka sneha prayoga is a special type of Sneha administered as

Jeernantikamatra.249 After the digestion of Sneha food is given and followed by Sneha

once again. Here giving excessive dosage of Sneha makes Peedana of Dosha and there by

palliate the aggravated Dosha. Acharya Vagbhata advises Tailvaka ghrita for

Virechanartha, Basti karma and especially for Uttarabasti. (A.H.Chi.11, A.S.Chi.13).

3. Shamana – While describing the Mutraghata Chikitsa Acharya Sushruta says

to administer various types of Kashaya, Kalka, Ghrita, Modaka, Avaleha, Dugdha,

Kshara, Asava etc. (Su. Ut.58). Further he says to administer Ashmari hara and Mutra

Udavartahara yogas (Su.Ut.58). Whereas Acharya Charaka states that after diagnosing

the predominance of morbid Dosha, these conditions should be prepared by the measures

curative of Mutrakricchra hara (ChSi.9/49). Acharya Vagbhata has devoted one full

chapter namely Mutraghata chikitsa adhyaya (A. Hr.Chi.11).

Chikitsa 77

4. Shastra Pranidhana Chikitsa – It is further classified into two groups as

under Shalya chikitsa. On going through all the classics it seems to be that no operative

procedures were mentioned for the treatment of Mutraghata.

5. Anu Shalya Chikitsa – Reference of Para-surgical intervention, in the form of

urethral catheterization to drain the bladder in retention of urine, can be traced back to the

Vedic period (A.V.1/1-3). Acharya Sushruta has included Mutra vishodhani Shalaka.

About its function, he has said that it does Marga vishodhana (Su. Su.7). In this context

Dalhana says that Margavishodhana is to be performed during the conditions of Mutra

Sanga and Pureesha sanga (Dal - Su.Su.7).

6. Rasayana – Acharya Vagbhata said to prepare Shilajatu by giving the bhavana

of Veerataradi gana dravya and then it should be given to the patients of Mutraghata.

(A.H.Chi.11/39). It is mainly used for Rasayana purpose. Rasayana chikitsa plays very

important role in Vatashtila / BPH as it is seen in elderly patients where Vata dosha is

predominant and it is also a stage of degeneration of the body.

PATHYA-APATHYA

The entire Ayurvedic system of healing is based on two major principles that is

"Maintaining The Health Of Healthy Persons And Curing The Ailments Of The Patients".

Healthy living is the most important aspect of Ayurveda but unfortunately this has been

the most neglected part. This can be achieved only by the Pathya ahara, which can

nourish both body and mind. Importance of Pathya is to increase the digestive power

there by proper production of optimum quality of Ahara Rasa that nourishes the Dhatu

through these Srotas.

Chikitsa 78

“Food is the factor which sustains and supports the Dhatu, Oja, Shareera Bala,

Varna etc. This food depends upon Agni to contribute the nourishment of the body. It is

obvious that the Shareera dhatu cannot be nourished and developed when food is not

properly digested by Agni."(Ch. Chi.15).

"No structure in the body can grow or develop or waste or atrophy, independent

of Srotas that transport dhatu." Hence every cell in the body requires nourishment thereby

necessitates the spread of Srotas up to cells or all over the body (Ch.Vi.5).

From the above explanation it is clear that these Srotas carry both Pathya and

Apathya ahara. Hence, Charaka defined Pathya, as "that one which is wholesome to

Srotas and Apathya is unwholesome to Srotas".

Table No. 14. Showing Pathya-Apathya In Vatashtila (BPH).

PATHYA APATHYA Ahara Vihara Oushadha Ahara Vihara Oushadha

Shali, Yava, Madya, Takra, Dugdha,

Avoid excess Vyayama Vyavaya, dharana-deerana of natural Vegas.

Abhyanga, Snehana, Virechana, Basti Avagahasweda UttaraBasti

Viruddha ahara in relation to Desha, Kala and Satmyaetc. Ingestion of Ruksha, katu,tikta and Kashaya .

Excessive exercise, Sleeping, sitting or wandering in cold weather Suppression of natural urges. Not to travel continuously on vehicles.

Vamana, Teekshna Oushada.

Chikitsa 79

MANAGEMENT OF BPH

1. Non operative treatment –

The treatment of any disease depends on the magnitude of the clinical effect and

the incidence and severity of treatment related morbidity, assessing the effectiveness of

treatment related morbidity, assessing the effectiveness of medical therapies for BPH.

A. Conservative – 'watchful waiting' - general advice about fluid intake i.e. less intake of

fluid after evening, avoiding caffeinated and alcoholic beverages, and smoking.250

B. Pharmacological treatment – α-blockers, Terazosin, Prazosin, Phenoxybenzymine,

Alfuzosin, Indoramine etc.251

C. Testosterone Ablation Agents – Diethyle stilbestrol, Flutamide, GnRh Analogues,

Progesterone derivatives etc.

D. 5-α reductase inhibitors – Finasteride, Epristeride, Combined agents, Hormonal

manipulation with Antiandrogens. In addition aromatase inhibitors are also used.252

2. Conventional operative treatment –

Trans Urethral Resection of Prostate (TURP)

Bladder neck incision for the small prostate (under 20 gm)

Open Prostatectomy for the big gland (around 80 -100 or more)

Suprapubic Transvesical Prostatectomy.

Simple Retropubic Prostatectomy.

Perineal Prostatectomy.

Trans Urethral Incision of the Prostate (TUIP).

Chikitsa 80

3. Minimally invasive methods –

Intraprostatic Stents.

Contact Laser of the Prostate.

Trans Urethral Microwave Therapy.

Trans Urethral Laser Ablation of the Prostate (TULAP).

Trans Urethral Vaporization of Prostate (TUVP).

Trans Urethral Needle Ablation of the Prostate (TUNA).

Diode Laser.

4. Clinical Endpoints –

The clinical consequences of BPH include LUTS; detrusor dysfunction

characterized by detrusor acontractility, detrusor instability, and detrusor fibrosis;

incomplete bladder emptying; acute and chronic renal retention; urinary tract infection;

renal insufficiency; and haematuria.

The goals of treatment for BPH include -

Relieving LUTS,

Decreasing BOO,

Improving bladder emptying,

Ameliorating detrusor instability,

Reversing renal insufficiency,

Preventing future episodes of gross haematuria,

Urinary tract infection, Urinary retention.

The treatment of any disease depends on the magnitude of the clinical effect and

the incidence and severity of treatment related morbidity, assessing the effectiveness of

treatment related morbidity, assessing the effectiveness of medical therapies for BPH.

Chikitsa 81

DRUG REVIEW

The main motto of this study is to assess the comparative effect of Matrabasti and

as Shamana snehapana with sukumarakumara ghrita. 253

In Ayurveda the success of Chikitsa depends totally upon Chikitsa Chatushpadas.

Among these four basic factors of treatment, Dravya has been awarded the second place.

The selection of a proper drug in the management of disease is very important. Therefore

sufficient attention should be given for selecting the drug. Ghrita, Taila, Vasa, Majja are

the best Sneha dravyas among all snehas. Out of these four, Ghrita is the best Sneha

Dravya for par excellence because of its power to assimilate the properties of the

substance.

Sukumara Kumaraka Ghrita is mentioned by textbook of Chakradutta253 and

Bhaishajyaratnavali in Mutrakricchra chikitsa.254 They have mentioned number of Yogas,

pertaining to Mutrakricchra and Mutraghata. Sukumara Kumaraka Ghrita, the name itself

indicates it is recommended for Sukumaras i.e. old aged persons without any hesitation.

The ingredients viz- Dashamula, Laghupanchamoola, Punarnava etc are having

properties like Balya, Rasayana, sheetam and sukumarakam. This is Indicated in

mootrakricchra, gulma, vataroga, etc. which helps in correcting the pathology of

Vatashtila (BPH).

Methodology 82

01. Initial EvaluationHistoryPhysical examination &DRE.Urine analysisPSAFlow rate

02. Presence ofRefractory retention.Any of the following, clearly secondary to BPH :Recurrent urinary tract infectionRecurrent or persistent gross haematuria.Bladder stones.Renal insufficiency.

03. Quantitive symptomsassessement and quality of life

04. Mild

05. Moderate to Severe 06. Optional diagnostic tests basedon Physician and patient preference.

07. Offer treatmet alternatives.

Watchful waiting

Residual UrinePressure flow

Compatible with Obstruction?

Identify the Non-BPH problems andtreat accordingly.

Surgery

No

Surgery, TUIP, TURP, Open, Laser.

Medical Therapy

Decision diagram to treat BPH

Flow chart No. 03. Shoing the decision diagram to treat Vatshtila (BPH).

CLINICAL STUDY

Methodological approach is the backbone of research. Utmost care is taken in

designing a methodology for conducting this research. Clinical trial is a way of research

and it is the best method to evaluate any drug or line of treatment. It involves the

experimentation of a drug or therapy on a population and recording the feedback based

on which postulations are made regarding the usefulness of the drug or therapy in the

disease. Hence, this trial is a carefully designed experiment with the aim of solving

problems conducted on scientific lines.

Research Approach

The present clinical study is powerful research, with an objective to evaluate

comparative effect of Matrabasti and as Shamana snehapana with Sukumara kumaraka

ghrita in the management of Vatashtila (BPH). The effect is to be determined by finding

out the difference between the base line data before and after treatment.

Study Design

The study design selected for the present study was prospective comparative

clinical trial. Here, Matrabasti, group of patients are compared with the Shamana sneha

group of patients. Demographic data and disease-specific data are collected according to

the case record proforma given in the appendix.

Reasons For Selection Of The Study Design

The results and conclusions of a clinical trial depends on the study design. The

aim of this study was to find out the effect of Matrabasti, and Shamana sneha, in the

management of Vatashtila (BPH). Therefore, two groups were made and the results

obtained in both the individual groups were compared.

Methodology 87

Source of Data

Patients suffering from Vatashtila (BPH) were selected from the P.G.R.S & R

(Panchakarma) OPD & IPD of Shri. D. G. Melmalagi Ayurvedic Medical College

Hospital, Gadag.

Sample Size and Grouping

The sample size for the present study was 30, patients suffering from Vatashtila as

per the selection criteria. Patients were randomly distributed to both the groups of equal

size. In group A, 15 patients received Matrabasti and in group B, 15 patients received

Shamanasneha.

Selection Criteria

The cases were selected strictly as per the preset inclusion and exclusion criteria.

A) Inclusion Criteria

1 Patients who were aged above50years and below 70years.

2 Patients fit for Matrabasti and Shamana sneha.

3 Patients with the clinical features of Vatashtila (BPH) (I-PSS Index)

4 Digital rectal examination findings i.e. (enlargement of prostate) Vatashtila (BPH)

5 Ultrasonography findings suggestive of Vatashtila (BPH).

B) Exclusion Criteria

1 Patients below 50 years and above 70 years of the age.

2 Patients with other systemic and metabolic disorders viz:- urethral stricture,

calculus, prostatitis carcinoma of the prostate and bladder instability.

Duration of The Study

The total study duration was 24 days i.e.

Group A -(8 days Matrabasti, and 16 days Parihara kala.

Group B -(16 days Shamana sneha, and 8 days parihara kala.

Methodology 88

Data Collection

Patients were thoroughly examined both subjectively and objectively. Detailed

history pertaining to the mode of onset, previous ailment, previous treatment history,

family history, habits, Ashtavidhapareeksha and Dashavidhapareeksha and physical

examination findings were noted. Routine investigations were done to exclude other

pathologies.

Examination of the patient

History – History taking of patient is very important to diagnose the diseases

specially benign prostate hyperplasia. When medical history focusing on the urinary tract,

specific things to discussed when taking the history of a man with BPH symptoms

include a history of hematuria, UTI, tuberculosis, diabetes, etc.

Inspection – In case of BPH, the abdomen and genitalia should be examined by

inspection. We can observe the abnormalities in genital organs, etc. if residual urine in

excess of 500 ml, usually produces a visibly distended bladder.

Palpation – Should be accurate to identify any organomegaly, asymmetry,

tenderness, or Mass in the area of abdomen and pelvic reign.

Percussion – It is to understand the gas, watery or any mass. The bladder must

contain at least 150 ml of fluid to allow its detection by percussion. It can be used to

identify the Adhmana and Anilasanga.

Auscultation – It is helpful to elicit the Adhmana and Anilasanga by hearing the

sound like (gudu gudu).

Methodology 89

TREATMENT SCHEDULE

Group A - Matrabasti

Poorvakarma – Patient was given the Sthanika mridu abhyanga and swedana

prior to the pradhanakarma. The abhyanga was done with Murcchita Tila taila. Then

advised to have alpa ahara and made to take a short walk. Encourage to pass his natural

urges previously, and asked the patient to lay down on table of suitable to his height, in

left lateral position.

Pradhanakarma – Matrabasti was administered to using sterilized 100 ml of

glicerine syringe. A quantity of 70 ml Ghrita was injected through the rectum in a luke

warm temperature, after the proper preparation of Dravya as per the classical method

discussed in drug review. The method of administration of bastidravya was strictly

followed as per classics. After the basti, the patient was made to lie on supine posture just

after (5 to 10 min) and gentle tapping was made on his buttocks, legs were lifted up, hips

were tapped thrice and made pressure over abdomen. Asked to wet for 10min in supine

posture, the same procedure was repeated for 8 days and it was conducted in a time

between 9.30 to 10.30 am. The time of administration, the time of retention and any

complications present were `recorded in case sheet proforma.

Pariharakala of 16 days was advised and reported asked the patient to report on

24th day counting from the day of initiation of treatment protocol and observation done

on 24th day.

Methodology 90

Group B – Shamana snehapana

Poorvakarma – Patients were advised to take mridu bhojana at night prior to

shamana Snehapana. Because on the day of Snehapana, the food of the previous day must

have to undergo digestion and patient must feel hunger (i.e. Bubhukshita). Then only the

patient is prepared for shamana snehapana.

Pradanakarma – Next day morning i.e. on the day of Shamana snehapana after

elimination of routine urges, jeerna ahara lakshana should be assessed. Then the 15 ml of

Sukumaraka kumaraka ghrita should be taken with a fresh mind, enthusiasm, courage, by

praying God. Same procedure should be follow twice daily for 16 days.

Paschat karma – Ushnajala should be given as Anupana. The patient is kept

under keen observation till the “Sneha jeerna lakshanas” appears. The patients were

advised to follow strictly the rules and regulations of Pathyapathya as explained in

Snehapana vidhi adhyaya. Followed with Pariharakala of 8 days, patients is asked to

report on 24th day from the day of commencing the treatment protocol.

Diagnostic Criteria

The diagnosis of Vatashtila (BPH) was made according to the signs and

symptoms of the classics and modern science explantion, also with objective parameters.

Signs and symptomatology of Vatashtila (BPH) are mentioned for its diagnosis, but those

may not be sufficient for the diagnose of this disease. Hence, for better understanding of

the diseases, and purpose of the adaptation of resent advancement of for the appropriate

diagnosing the disease, laboratory investigations are essential.

Methodology 91

Table No. 16. Showing Chief Complaints.

Sl. Signs and symptoms Sl. Signs and Symptoms

Ashtilavatghana granthi 05 Adhmana

Urdhwa I-PSS (AUA) Symptoms

Ayata 06 Incomplete emptying

Unnata 07 Increased frequency

Dheerga vartulakara 08 Intermittency

01

Chala/ Ishatchala 09 Urgency

02 Bahirmargavarodhini (Purisha, Mootra

Anilasanga)

10 Weak stream

03 Ruja 11 Staring

04 Achala ,Ishachala 12 Nocturia

The American Urological Association (AUA) developed a new symptom score

that correlates strongly with the overall score (high internal consistency reliability), and

the resultant score gives similar answers when administered again after a short period of

time (high test-retest reliability). The score correlates strongly with both previously used

indices and a response to global questions of degree of both from urinary symptoms

(construct validity) and discriminates between patients with and without BPH (criterion-

validity). It is now believed that the single most important criteria for therapy is the

symptom score.257

Physical examination and laboratory investigetion

The standard evaluation for prostatic diseases includes the digital rectal

examination (DRE). It should be performed with careful attention to the size and

consistency of the gland, the presence of lesions of lesions within the gland, or evidence

of extension beyond its confines. Its importance can not be overemphasized. The

posterior surfaces of the lateral lobes, where carcinoma characteristically is hard, nodular,

and irregular, but indurations may also be due to fibrous areas in a benign hyperplastic

background or calculi.

Methodology 92

Figure No. 03. Showing the Digital Rectal Examination (DRE).

The DRE examination isdone to detect prostate or rectal malignancy, to evaluate

anal sphincter tone, and to rule out any neurologiic problems that may cause the

presenting symptoms. It establishes the approximate size of the prostate gland.in patients

who choose or require invasive therapy such as surgery, estimation of prostate size is

important to select the most appropriate technical approach. It provids a sufficiently

accurate mesurement in most of the cases. This is having most importance in diagnose. It

should be done very gently with a well-lubricated glove and 360 degree digital

exploration. At first, any pathogenesis in the lower anal canal should be ruled out. Before

performing DRE, the physician should place the palm of his other hand against the

patient's lower abdomen. The gloved, lubricated index finger is then inserted gently into

the anus. Only one phalanx should be inserted initially to give the anus time to relax and

to easily accommodate the finger. Thereafter, the prostate should be palpated giving due

attention to its size, consistency, shape, rectal mucosa, median groove, mobility, surfaces,

upper border of the prostate etc. Hyperplasia usually produces a smooth, firm or elastic

enlargement on bimanual examination, intravesical lobes may be felt sometimes and

occasionally the presence of residual urine may be found. 257,258

Methodology 93

Ultrasonography

A detailed USG of both abdomen and pelvis was carried out before and after the

treatment in relation to the bladder wall thickness, trabacular pattern, residual urine,

prostate volume, prostate size and kidneys in general.

The most common method is ultrasound to determination of the size (i.e.height,

width, length) and approximate weight of the prostate, and further important is post voide

residual urine volume measurement, i.e. PVR urine is the volume of fluid remaining in

the bladder immediately after the completion of miturition. The studies indicate that

residual urine normally ranges from 0.09 to 2.24 ml, with the men being 0.53ml (Hinman

and Cox, 1967). 78% of normal men have PVR’s of less then 5ml, and 100% have

volumes of less than 12ml by (Di mare et al, 1963). Ultrasound is the standard diagnostic

instrument for the BPH. The size of prostate is estimated approximately by the

Ultrasonography and made 1 to 4 grading for diagnose the severity of BPH.

Score chart for size of prostate.

Grade 1 – 20 to 25 gms.



Grade 4 – above 75 gms.

Methodology 94

Criteria for assessment of Results

The assessment of result were made based on data collected as per subjective and

objective in all patients before and after treatment. Separate grading has been given far

the assessment of parameters.

Subjective grading

Being on the observation of Vatashtila (BPH), classical texts under keeping in

view of the (“AUA”) symptom score index, the following shown index has been prepare

according to the patient’s condition and associated with help of the Matrabasti and

Shamana snehapana therapy before and after treatment.

Score chart for Malasanga

No. of Pt.’s Less than Less than About half More than Almost

At all 1tim in 5 Half the time the time Half the time Always

Over the past month,

how often you had the 0 1 2 3 4 5

sensation after

defecation of mala

Gradings for Malasanga

Grade 0 – Normal.

Grade 1 – Mild. (Means, after defecation of mala, if he is having the sensation

less than 1time in 5, in routine defecation).

Grade 2 – Moderate. (Means, after defecation of mala, if he is having the

sensation Less than Half the time, and About half the time routine defecation).

Grade 3 – Severe. (Means after defecation of mala, if he is having the sensation

more than half of the time, and almost always of his routine defecation.

Methodology 95

Overall Response Assessment Criteria for Malasanga

Poor response – Means, if severity is reduced by grade 1, then it is considered as

poor response to the treatment.

Moderately response – Means, if severity is reduced by grade 2, then it is

considered as Moderate response of treatment.

Good response – Means, if severity is reduced to grade 0, then it is considered as

Good response of treatment. If the bowel habit returns to grade 0, then that will

be considered as Good response.

Not responded – Means, if severity is not reduced or increase, then it is

considered as Not respond from the treatment.

Score chart for Mutra sanga

Grade- 0 - 500-2500ml. Per day.

Grade -1 - 400-500ml. Per day.



Overall Response Assessment Criteria for Mutrasanga

Poor response – Means, (If there is increase in micturation by 100ml and severity

is reduced by grade 1, then it is considered as poor response of treatment.

Moderately response – Means, (If there is increase in micturation by 200ml to

300ml severity is reduced by grade 2, then it is considered as Moderate response

of treatment.

Good response – Means (If there is increase in micturation by 400ml to 500ml

severity is reduced to grade 0, then it is considered as Good response of

treatment. If the severity is reduced from any other to grade 0, then it is

considered as Good response.

Not respond – Means (If severity is neither reduced nor increased, then it is

considered as No response to the treatment.

Methodology 96

Score chart for Anilasanga (By percussion and auscultation)

Sounds heard Grade 1 + Means – Mild

Sounds heard Grade 2 ++ Means – Moderate

Sounds heard Grade 3 +++ Means – Sever

All sounds Absent Grade 0 Means – Normal

Overall Response Assessment Criteria for Anilasanga

Poor response – Means if Severity is reduced by grade 1, then it is considered as

poor response to the treatment.

Moderately response – Means if Severity is reduced by grade 2, then it is

considered as Moderate response to the treatment.

Good response – Means if Severity is reduced to grade 0, then it is considered as

Good response to the treatment. If the Severity is reduced from any other to grade

0, that is considered as Good response to the treatment.

Not respond – Means if Severity is neither reduced nor increased, then it is


Score chart for Adhmana (By percussion and auscultation)

Sounds heard Grade 1 + Means – Mild

Sounds heard Grade 2 ++ Means – Moderate

Sounds heard Grade 3 +++ Means – Sever

All sounds Absent Grade 0 Means – Normal

Overall Response Assessment Criteria for Adhmana

Poor response – Means, if Saatopa (Gudaguda sound in abdomen) is reduced by

grade 1, then it is considered as poor response to the treatment.

Methodology 97

Moderately response – Means, if Saatopa (Bearable Ruja in Pakvashaya) is

reduced by grade 2, then it is considered as Moderate response to the treatment.

Good response – Means, if Atyugra ruja, and complete distinction in abdomen is

reduced to grade 0, and If the Severity is reduced from any other grade to 0, then

it is considered as Good response to the treatment.

Not respond – Means, if Severity is neither reduced nor increased, then it is


Score chart for Ruja/ Sasholaukta Mootratyaga

No symptoms Grade 0 – Normal.

Bearable Grade 1 – Mild.

Unbearable Grade 2 – Severe.

Overall Response Assessment Criteria for Ruja / Sashoolayukta mutratyaga.

Poor response – Means, if Ruja / Sasholaukta Mootratyaga is reduced up to

bearable stage i.e. grade 1, then it is as poor response to the treatment.

Good response – Means if Ruja/ Sasholaukta Mootratyaga is reduced to Normal

stage i.e. grade 0, and If the Severity is reduced from any other grade to grade 0,

then it is considered as Good response.

Not respond – Means, if Severity is neither reduced nor increased, then it is


Effect over (AUA) I-PSS Index for Vatashtila (BPH)

The international prostate symptom score (I-PSS) which is identical to the AUA

symptom index, is recommended as the symptom scoring instrument, and it was to

provide a universally accepted instrument to quantify the impact of BPH therapies

(Cockettet al, 19992). The I-PSS was developed by the Measurement Committee of the

AUA. This is an integral part of virtually every epidemiologic study as treatment studies

in the field.

Methodology 98

AMERICAN UROLOGICAL ASSOCIATION SYMPTOMS INDEX & (I-PSS)

(Questionary for patients) No. of Pt.’s Less than Less than About half More than Almost


1. Over the past month, how often you had a 0 1 2 3 4 5 sensation of not emptying your bladder completely after you finished urination? 2. Over the past month, how often you have 0 1 2 3 4 5 had to urinate again less than 2 hours after you finished urination? 3. Over the past month, how often have you 0 1 2 3 4 5 stopped and started again several times when you urinated? 4. Over the past month,

how often have you 0 1 2 3 4 5

found it difficult to

postponed urination?

5. Over the past month,

how often have you had 0 1 2 3 4 5

a weak urinary stream?


how often have you had 0 1 2 3 4 5

to push or strain to

begin urination?

7. Over the past month, how many times you did most typically get up to urinate form the

time you went to bed at night until the time you got up in the morning?

0 None 1 1Time 2 2Times 3 3 Times 4 4 Times 5 5Times

Methodology 99

Gradings for I-PSS Index

Grade 1 – Patients scoring 0 to 7 points, classified in mildly symptomatic.

Grade 2 – Those scoring from 8 to 19 points as moderately symptomatic.

Grade 3 – Those scoring 20 to 35 points as severely symptomatic.

Overall Response Assessment Criteria for Ruja / Sashoolayukta mutratyaga.

Poor response – Means, if the severity including all 7symptoms reduced by 1

grade, then it is considered as poor response to the treatment.

Moderately response – Means, if severity including all 7symptoms reduced by 2

grades, then it is considered as Moderate response to the treatment.

Good response – Means, if severity including all 7 symptoms reduced to grade

0, and if the severity is reduced from any other grade 0, then it is considered as

Good response to the treatment.

Not respond – Means, if severity is neither reduced nor increased, then it is


Objective gradings

Table No. 17. Showing Digital Rectal Examination Chart.

Enlargement of lobe

Posterior Left lateral

Right lateral

Median Bilateral

Size of prostate

Normal Mild enlarged Moderately Sever enlarged

Upper border

Not Reached

With difficulty reached

Reached

Consistency Smooth Firm to hard Hard Surface Smooth

& irregular

Hard & irregular

Smooth & regular

Hard & regular

Mobility Fixed Mobile Slightly mobile.

Rectal mucosa

Free Adherent

Tenderness Absent Present

Methodology 100

The DRE findings assessed by a above chart made score chart, and most of the

findings assessed by putting present and absent according before and after treatment.

Score chart for size of prostate.

Grade 0 – Normal.

Grade 1 – Mild enlargement

Grade 2 – Moderate enlargement

Grade 3 – Sever enlargement

Overall Response Assessment Criteria for size of Prostate.

Poor response – Means, if the size of prostate is reduced by grade 1, then it is

considered poor response to the treatment.

Moderately response – Means, if the size of prostate is reduced by grade 2, then

it is considered poor response to the treatment.

Good response – Means, if the size of prostate is reduced to grade 0, and if the

Severity is reduced from any other grade to grade 0, then it is considered as Good

response to the treatment.

No response – Means, if there is neither increase nor decrease in the size of

prostate, then it is called as No response to the treatment.

Score chart for upper border of the prostate.

Grade 0 – Not reached

Grade 1 – With difficulty reached.

Grade 2– Reached.

Overall Response Assessment Criteria for upper border of Prostate.

Methodology 101

Overall Response Assessment Criteria for Upper border of Prostate.

Poor response – Means if by feeling the Upper border of prostate is turns by

grade 1, and, then it is considered as poor response to the treatment.

Good response – Means if by feeling the Upper border of prostate is turns by

grade 0, If the Severity is reduced from any other grade to 0, it is considered it is

as Good response.

No response – Means, if there is neither increase nor decrease in the upper border

of prostate, then it is called as No response to the treatment.

Score chart for of mobility prostate.

Grade 1 – Fixed.

Grade 2 – Slightly mobile.

Grade 3 – Mobile

Overall Response Assessment Criteria for mobility of Prostate

Moderately response – Means if by feeling the mobility of prostate is terns to by

grade 1, and , then it is considered as Moderate response to the treatment.

Good response – Means if by feeling the mobility of prostate is terns to Grade 0,

If the Severity is reduced from any other grade to 0, it is considered it is as Good

response.

Not response --. Means, if there is neither increase nor decrease in the mobility

of prostate, then it is called as No response to the treatment.

Methodology 102

Table No.18 Showing Grade for U.S.G findings.

U.S.G. - Report Before treatment fter treatment Bladder - Trabacular Normal Coarse Normal Coarse Wall thickness Normal Thickned Normal Thickned Residual Urine Prostate Size Antero - Posterior Width Height Prostate Volume Kidney Right Left Right Left Hydronephrosis Caculi Gradings for weight of the Prostate

Grade 0 – means normal.

Grade 1— Means (1gms to 2gms ) increasing from the normal weight of the

prostate.

Grade 2— Means (3gms to 5gms) increasing from the normal weight of the

prostate.

Grade 3— Means ( 6gms to 7gms) increasing from the normal weight of the

prostate.

Overall Response Assessment Criteria for weight of Prostate.

Poor response- Means if weight of the prostate is reduced by grade 1 , and , then

it is considered as poor response to the treatment.

Moderately response- Means if weight of the prostate is reduced by grade 2 then

it is considered as moderate response to the treatment.

Methodology 103

Good response- Means if weight of the prostate is reduced to grade 0. and If the

weight of the prostate is reduced from any other grade to 0, it is considered it is as

Good response.

Not respond-. Means, if there is neither increase nor decrease in the weight of

prostate, then it is called as no response to the treatment.

Score chart for residual urine flow

Grade 0 – Below 10cc normal

Grade 1 – 10 to 50cc.

Grade 2 – 51 to 100cc.

Grade 3 – 101 to 200cc.

Grade 4 – 201 and above.

Overall Response Assessment Criteria for Residual urine flow.

Poor response- Means if residual urine volume is reduced by grade 1, and then

it is considered as poor response to the treatment.

Moderately response- Means if residual urine volume is reduced by grade 2,

(51cc to100cc) as and then is considered as moderate response to the treatment.

Good response- Means if residual urine volume is reduced to grade 0. and If the

is residual urine volume is reduced from any other grade to 0, it is considered as

Good response.

Not respond-. Means, if there is neither increase nor decrease in the residual

urine volume then it is called as No response to the treatment.

Methodology 104

Observations & Results 105

In the present clinical study subjective and objective changes were considered for

the assessment of Ayurvedic management of Vatashtila (BPH) with Matrabasti and as

Shamana snehapana with Sukumara Kumaraka Ghrita. Thirty patients were selected after

fulfilling the criteria for diagnosis and were treated in the following two groups –

Group A – Matrabasti (SKKG) – 15 patients.

Group B – Shamana snehapana (SKKG) – 15 patients.

All the patients were examined before and after the treatment according to the

case sheet format given in the appendix. Both the subjective and objective changes were

recorded and are presented under the following heading –

Demographic data.

Data related to the disease.

Data related to subjective and objective parameters before and after treatment.

Statistical analysis and assessment of results.

DEMOGRAPHIC DATA

Table No. 19. Showing distribution of patients by age groups.

Group A Group B Age in

Years No. of Pt.’s % No. of Pt.’s %

50-55 2 13.33 0 0

56-60 4 26.66 2 13.33

61-65 3 20 4 26.66

66-70 6 40 9 60

In Group A – Out of 15 (i.e.50%) patients, 6 patients (i.e.40%) were in the age

group of 66-70 years, 4 patients (i.e.26.66%) were in the age group of 56-60 years, 3

patients (i.e.20%) were in 61-65 years age groups and 2 patients (i.e.13.33%) were in 50-

55 years of age group.


In Group B – Among 15 (i.e.50%) patients, 9 patients (i.e.60%) were in 66-70

years age group, 4 patients (i.e.26.66%) were in 61-65 years age group and 2 patients

were (i.e.13.33%) were in 56-60 age groups and where as no patients were reported in

50-55 years age group.

Table No. 20. Showing distribution of patients by religion.

Group A Group B Religion

No. of Pt.’s % No. of Pt.’s %

Hindu 13 86 14 93

Muslim 2 13.33 1 6.66

Christian 0 0 0 0

Others 0 0 0 0

In Group A – Among 15 patients, 13 patients (i.e.86%) were of Hindu religion, 2

patients (i.e.13.33%) were in Muslim community and none of the patient observed in

Christian and other religion.

In Group B – Among 15 patients, 14 patients (i.e.93%) were of Hindu religion,

only 1 patient (i.e.6.66%) was of Muslim community and none of the patient observed in

Christian and other religion.

Table No. 21– Showing distribution of patients by occupation.

Group A Group B Occupation


Sedentary 9 60 1 6.66

Active 3 20 7 46.66

Labor 3 20 7 46.66

Others 0 0 0 0


In Group A – Out of 15 patients, 9 patients (i.e.60%) were in Sedentary

occupation, 3 patients each (i.e.20%) were in active and labor groups. No patient was

observed from occupations.

In Group B – Out of 15 patients, 7 patients each (i.e.46.66%) were in active and

labor occupation group, 1 patient (i.e.6.66%) was in sedentary occupation group. No

patient was observed from other occupation.

Table No. 22. Showing distribution of patients by socio-economical status.

Group A Group B Socio-Economic

Status No. of Pt.’s % No. of Pt.’s %

Poor 4 26.66 6 40

Middle Class 6 40 7 46.66

Higher class 5 33.33 2 13.33

In Group A – Out of 15 patients, 6 patients (i.e.40%) were in middle class socio-

economic group, 5 patients (i.e.33.33%) were in to high class socio-economic group and

4 patients (i.e.26.66%) were in poor socio-economical status group.

In Group B – Out of 15 patients, 7 patients (i.e.46.66%) were in middle class

socio-economic group, 6 patients (i.e.40%) were in poor class socio-economic group and

2 patients (i.e.13.33%) were in high class socio-economical status group.

Table No. 23. Showing distribution of patients by dietary habits.

Group A Group B Dietary

habits No. of Pt.’s % No. of Pt.’s %

Vegetarian 10 66.66 7 46.66

Mixed 5 33.33 8 53.33

In Group A – Out of 15 patients, 10 patients (i.e.66.66%) were vegetarian and 5

patients (i.e.33.33%) were mixed diet habit.


In Group B – Out of 15 patients, 8 patients (i.e.53.33%) were vegetarian and 7

(i.e.46.66%) patients were mixed diet habit.

Table No. 24. Showing distribution of patients by Vyasana. (Addiction).

Group A Group B Vyasana


Smoking 2 13.33 10 66.66

Tobacco 4 26.66 4 26.66

Alcohol 3 20 6 40

Tea or coffee 12 80 4 26.66

In Group A – Out of 15 patients, 12 patients (i.e.80%) were habituated to either tea

or coffee, 4 patients (i.e.26.66%) were habituated to tobacco chewing, 3 patients (i.e.20%)

were alcohol abusers and 2 patients (i.e.13.33%) were smokers.

In Group B – Out of 15 patients, 10 patients (i.e.66.66%) were smokers, 6 patients

(i.e.40%) were alcohol abusers and 4 patients each (i.e.26.66%) were habituated to tobacco

chewing.

Table No. 25. Showing distribution of patients by Viaharaja Nidana.

Group A Group B Viahraja

Nidana No. of Pt.’s % No. of Pt.’s %

Vyayama 9 60 13 86.66

Vyavaya 3 20 1 6.66

Nitya Drita

Prishtayana

8 53.33 5 33.33

Mutra Nigrahana

13 86.66 4 26.66

In Group A – Out of 15 patients, 13 patients (i.e.86.66%) were habituated to

Mutra nigraha, 9 patients (i.e. 60%) were indulging in ativyayama, 8 patients

(i.e.53.33%) were indulging in Nitya drita Prishtayana and 3 patients (i.e.20%) were

indulging in ativyavaya.


In Group B – Out of 15 patients, 13 patients (i.e. 86.66%) were indulging in

Ativyayama, 5 patients (i.e.33.33%) were indulging in Nitya drita Prishtayana, 4 patients

(i.e.26.66%) were habituated to Mutra nigraha and only 1 patient was indulging in

ativyavaya.

Table No. 26. Showing distribution of patients by Nidra. (Sleeping Habits).

Group A Group B Nidra


Day 0 0 0 0

Night 5 33.33 4 26.66

Sound 4 26.66 6 40

Disturbed 6 40 5 33.33

In Group A – Out of 15 patients, 6 patients (i.e.40%) were having Disturbed

sleep, 5 patients (i.e.33.33%) were having sleep only in night hours, 4 patients

(i.e.26.66%) were having sound sleep and no patient was reported with the habit of

Divaswapna. (Day sleep)

In Group B – Out of 15 patients, 6 patients (i.e.40%) were having sound sleep

habit, 5 patients (i.e.33.33%) were having disturbed sleep, 4 patients (i.e.26.66%) were

habituated to sleep only in night hours and no patient was reported from Divaswapna.

(Day sleep)

Table No. 27. Showing distribution of patients by Jatharagni. (Status of Jatharagni).

Group A Group B Jatharagni


Manda 6 40 7 46.66

Vishama 3 20 2 13.33

Teekshnagni, 0 0 1 6.66

Samagni 6 40 5 33.33


In Group A – Out of 15 patients, 6 patients each (i.e.40%) were having manda

and Samagni, 3 patients (i.e.20%) were having mandagni and no patient was reported

with teekshnagni.

In Group B – Out of 15 patients, 7 patients (i.e.46.66%) were having Mandagni,

5 patients (i.e.33.33%) were having Samagni, 2 patients (i.e.13.33%) were reported with

Vishamagni and only 1 patient was with Teekshnagni status.

Table No. 28. Showing distribution of patients by nature of Koshta.

Group A Group B Kostha


Mridu 6 40 6 40

Madhyama 3 20 4 26.66

Krura 3 20 3 20

Sama 3 20 2 13.33

In Group A – Out of 15 patients, 6 patients (i.e.40%) were having Mridu koshta

and 3 patients each (i.e.20%) were reported with Madhyama, Krura and Sama koshta.

In Group B – Out of 15 patients, 6 patients (i.e.40%) were having Mridu koshta,

4 patients (i.e.26.66%) has Madhyama koshta, 3 patients (i.e.20%) were of Krura koshta

and 2 patients (i.e.13.33%) has Sama koshta.

Table No. 29. Showing distribution of patients by nature of Mala pravritti.

Group A Group B Mala

Pravritti No. of Pt.’s % No. of Pt.’s %

Regular 1 6.66 4 26.66

Irregular 1 6.66 0 0

Constipation 7 46.66 4 26.66

Frequently 6 40 7 46.66


In Group A – Out of 15 patients, 7 patients (i.e.46.66%) were constipated, 6

patients (i.e.40%) were having frequent mala pravritti and only 1 patients (i.e.6.66%) was

having irregular bowel habit.

In Group B – Out of 15 patients, 7 patients (i.e.46.66%) has frequent mala

pravritti, 4 patients (i.e.26.66%) were constipated and no patient was reported with

irregular type of bowel habit.

Table No. 30. Showing distribution of patients by Mutra pareekshya bhavas.

Group A Group B Mutra

pareeksha No. of Pt.’s % No. of Pt.’s %

Colour 0 0 0 0

Odour 0 0 0 0

Frequency 15 100 15 100

Quantity 0 0 0 0

Frequency of Urine was the one of the inclusion criteria for the patients. So all 30

patients reported with frequency of micturation.

Table No. 31. Showing distribution of patients by type of Desha. (Nature of Habitat).

Group A Group B Type of

Desha No. of Pt.’s % No. of Pt.’s %

Anupa 0 0 0 0

Sadharana 0 0 0 0

Jhangala 15 100 15 100

The place where this study was conducted is in Jangala pradesh. So all the

patients were in Jangala desha habitat.


Table No.32. Showing distribution of patients by dosha pradhanata in Prakriti.

Group A Group B Prakruti


Vata 0 0 0 0

Pitta 0 0 0 0

Kapha 0 0 0 0

Vata pitta 7 46.66 8 53.33

Vata Kapha 8 53.33 7 46.66

Pitta kapha 0 0 0 0

Sama 0 0 0 0

In Group A – Out of 15 patients, 8 patients (i.e.53.33%) were of Vata-kapha

dosha pradhanata, 7 patients (i.e.46.66%) were having Vata-pitta dosha pradhanata in

their constitution and no patient was reported with other doshik constitution.

In Group B – Out of 15 patients, 8 patients (i.e.53.33%) were of Vata-pitta dosha

pradhanata in prakriti, 7 patients (i.e.46.66%) were having Vata-kapha predominance in

natural constitution of deha.


DATA RELATED TO DISEASE

Table No. 33. Showing distribution of patients by Nidana.

Group A Group B Nidana

No. of Patients % No. of

Patients

%

AHARAJA NIDANA

Rooksha ahara sevana 10 66.66 11 73.33

Rooksha madya sevana 3 20 6 40

Anupa matsya sevana 5 33.33 8 53.33

Adhyashayana 3 20 3 20

Ajeerna 3 20 3 20

Teekshna oushadha sevana 0 0 0 0

Katu, Amla, Kashaya rasa

sevana, Kharjura, Shaluka,

Kapittha, Jambuphala, etc.

5 33.33 7 46.66

VIHARAJA NIDANA

Vyayama 9 60 13 86.66

Nitya dhrit pristayana 8 53.33 5 33.33

Ati stree prasanga 3 20 1 6.66

Ati bharavana 9 60 13 86.66

Vegha sandarana. 13 86.66 4 26.66

ANYA

Poorva janma papakarma 0 0 0 0


In Group A – Aharaj Nidana – Among 15 patients, 10 patients (i.e.66.66%) were

habituated to Rooksha ahara sevana. 5 patients each (i.e.33.33%) were accustomed to

Anupa matsya sevana and Katu amla, Kashaya rasa pradhana ahara sevana. 3 patients

each (i.e.20%) were indulging in Rooksha Madhya sevana, Adhyasana, Ajeerna,

Kharjura, Shaluka, Kapitha, Jambu phala.

Viharaja Nidana – Among 15 patients, 13 patients (i.e. 86.66%) were habituated

to Vega sandhara. 9 patients each (i.e.60%) were indulging in Ativayama and

Atibharavahana. 8 patients (i.e.53.33%) was indulging in Nitya dhrita pristayana and 3

patients (i.e.20%) has Ati stree prasanga.

Anya – No patient was reported with purvajanma papakarma.

In Group B – Aharaj Nidana – Among 15 patients, 11 patients (i.e.73.33%) were

indulging in Rooksha ahara sevana, 8 patients (53.33%) were indulging in Anupa matsya

sevana, 7 patients (i.e.46.66%) were habituated to Katu, Amla, Kashaya rasa pradhana

ahara sevana and Kharjura, Shaluka, Kapitha, Jambu phala, 6 patients (i.e.40%) were

habituated to Rooksha Madhya sevana and 3 patients each (i.e.20%) were indulging in

Adhyashana and Ajeerna.

Viharaja Nidana – Among 15 patients, 13 patients each (i.e.86.66%) were

indulging in Ativyayama and Atibharavahana. 5 patients (i.e.33.33%) were indulging in

Nitya dhrita pristayana, 4 patients (i.e.26.66%) were habituated to Vega sandharana and

only 1 patient (i.e.6.66%) was having Ati stree sevana.

Anya – No patient was reported with purvajanma papakarma.


Table No. 34. Showing distribution of patients by Chief complaints.

Group A Group B Sl Chief Complaints No. of Patients % No. of Patients %

Asthtilavat granthi 15 100 % 15 100 % a. Urdhwaaa - - - - b. Ayata - - - - c. Unnata - - - - d. Deergha Vartulakara

- - - -

e. Ghana - - - -

01

f. Chala/Eshat chala/Achala

- - - -

02 Mala sanga 15 100 % 15 100 % 03 Anila sanga 15 100 % 14 93.33 % 04 Adhmana 15 100 % 14 93.33 % 05 Ruja/Sashoolyukta

mutratyaga. 11 73.33 10 66.66 %

06 Mutra sanga 8 53.33 % 6 40 % 07 Incomplete

Emptying 15 100 % 15 100 %

08 Increased Frequency

15 100 % 15 100 %

09 Intermittency 11 73.33 % 10 66.66 % 10 Urgency 13 86.66 % 13 86.66 % 11 Weak Stream 11 73.33 % 11 73.33 % 12 Straining 12 80 % 11 73.33% 13 Nocturia 15 100 % 15 100 %

In Group A – All the patients complained of Ashtilavat Ghana granthi,

Malasanga, Anilasanga, Incomplete emptying, Increased Frequency, and Nocturia; 8

patients (53.33%) complained of Mutra sanga. 11patients (73.33%) complained of

Intermittency, 13 patients (86.66%) complained of Urgency, 11(73.33%) patients

complained of Weak Stream, 12 patients (80%) complained of Straing.


In Group B – All the patients (100%) complained of Ashtilavat Ghana granhti,

Malasanga, Mutrasanga, Anilasanga, Incomplete emptying, Increased Frequency, and 6

patients (40%)complained of Mutra sanga. Nocturia, 10 patients (66.66%) complained of

Intermittency, 13 patients (86.66%) complained of Urgency, 11 (73.33%) patients

complained of Weak Stream, 11 patients (73.33%) complained of straining.

Table No. 35. Showing the Prostate findings by Digital Rectal Examination. (DRE)

Group A Group B Prostatic findings by DRE No. of Pt.’s % No. of Pt.’s %

ENLARGEMENT OF LOBE Right lateral - - - - Left lateral - - - - Anterior - - - - Median 11 73.33 10 66.66 Posterior - - - - Border line enlargement 4 26.66 5 33.33 SIZE OF PROSTATE Mild enlarged 9 60 10 66.66 Modarate enlarged 6 40 5 33.33 UPPER BORDER Not reached 0 0 0 0 With difficulty reached 10 66.66 7 46.66 Reached 5 33.33 8 53.33 CONSISTANCY Smooth 6 40 9 60 Firm to hard 9 60 6 40 Hard 0 0 0 0 SURFACE Regular 15 100 15 100 Irregular 0 0 MOBILTY Fixed 10 66.66 9 60 Mobile 5 33.33 6 40 RECTAL MUCOSA Free 15 100 15 100 Adherent 0 0 0 0 TENDERNESS Absent 15 100 15 100 Present 0 0 0 0


In Group A – Enlargement of lobe – Among 15 patients, 11 patients

(i.e.73.33%) were noticed with median lobe enlargement, 4 patients (i.e.26.66%) were

noticed with border line enlargement.

Size of prostate – Among 15 patients, 9 patients (i.e.60%) were noticed with

mild enlargement and 6 patients (i.e.40%) were noticed with moderate enlargement of

prostate.

Upper border – Among 15 patient, in 10 patients (i.e.66.66%) the upper border of

prostate was reached with difficulty, 5 patients (i.e.33.33%) were noticed with the easy

palpation of upper border of the prostate and no patient was reported with palpation of

upper border of prostate.

Consistency – Among 15 patients, 9 patients (i.e.60%) were noticed with smooth

consistency, 9 patients (i.e.40%) were noticed firm to hard consistency of prostate and no

patient was observed with hard consistency of prostate.

Surface – All patients were observed with regular surface of prostate.

Mobility – Among 15 patients, in 10 patients (i.e.66.66%) the prostate was fixed

and in 5 patients (i.e.33.33%) the prostate was mobile.

Rectal mucosa – All patients the prostate was found free of rectal mucosa.

Tenderness – No patient was noticed with tender prostate.

In Group B – Enlargement of lobe – Among 15 patients, 10 patients

(i.e.66.66%) were noticed with median lobe enlargement, 5 (33.33%) noticed with border

line enlargement of prostate.

Size of prostate – Among 15 patients, 10 patients (i.e.66.66%) were noticed with

mild enlargement of prostate and 5 patients (i.e.33.33%) were noticed with moderate

enlargement.


Upper border – Among 15 patients, in 8 patients (i.e.53.33%) the upper border of

prostate was reached easily. In 7 patients (46.66%) the upper border of prostate was

reached with difficulty. No patient was reported with palpation of upper border of

prostate.

Consistency – Among 15 patients, on palpation 9 patients (i.e.60%) were noticed

smooth consistency, 6 patients (i.e.40%) were noticed firm to hard consistence and no

patients was observed hard consistency.

Surface – All patients were observed with regular surface of Prostate.

Mobility – Among 15 patients, 9 patients (i.e.60%) were observed with fixed, 6

patients (i..e.40%) the mobile prostate was observed.

Rectal mucosa – In all patients prostate was observed with free of rectal mucosa.

Tenderness – No patient was noticed with tender prostate.

Table No. 36. Showing Residual Urine in cubic centimeter.

Group A Group B Residual Urine

(cc) No. of Patients % No. of Patients %

10 to 50 5 33.33 7 46.66

51 to 100 6 40 6 40

101 to 200 4 26.66 2 13.33

201 & above 0 0 0 0

In Group A – Among 15 patients, 6 patients (i.e.40%) were observed with 51-100

cc of Residual urine, 5 patients (i.e.33.33%) were observed with 10-50 cc of Residual

urine, 4 patients (i.e.26.66%) were observed with 101-200 cc Residual urine and no

patients was observed above 201 cc of Residual urine.

In Group B – Among 15 patients, 7 patients (i.e.46.66%) were observed with 10-

50 cc of Residual urine, 6 patients (i.e.40%) were observed with 51-100 cc of Residual

urine, 2 patients (i.e.13.33%) were observed with 101-200 cc residual urine and no

patient was observed above 201 cc of residual urine.


DATA RELATED TO SUBJECTIVE AND OBJECTIVE PARAMETERS

BEFORE AND AFTER TREATMENT

All the assessment of subjective and objective parameters was made on the basis

of the grading given for each parameter dealt in methodology.

Subjective Parameters

Table No.37. Showing Subjective parameters before and after treatment in Group-A

Subjective parameters

Malasanga Mutrasanga Anilasanga Adhmana Sashulavat

mutratyaga

Sl.

No.

OPD

No.

BT AT BT AT BT AT BT AT BT AT

01 5403 4 1 1 0 3 1 2 1 1 0

02 5429 5 0 1 0 3 1 3 1 1 0

03 5426 4 1 1 0 2 1 2 1 1 0

04 5603 3 1 0 0 3 1 2 1 0 0

05 5697 5 0 0 0 1 0 1 0 0 0

06 0752 4 1 0 0 1 0 1 0 0 0

07 2403 5 0 1 0 2 1 2 1 2 0

08 5862 4 2 0 0 1 0 1 0 0 0

09 5901 3 2 0 0 1 0 1 0 1 0

10 3440 4 0 1 0 3 1 3 2 1 1

11 3615 4 1 0 0 2 1 2 1 1 0

12 5467 3 0 0 0 1 1 1 1 1 0

13 5467 3 0 1 0 1 0 1 0 1 0

14 3764 5 2 1 1 3 1 3 1 1 1

15 3728 5 2 1 0 3 1 3 1 2 1


Table No. 38. Showing Subjective parameters before and after treatment in Group-A as

per AUA (I-PSS) symptom score index.

Group A (BT) Group A (AT)

Sl.No. 1 2 3 4 5 6 7

Total

1 2 3 4 5 6 7

Total

01 4 3 2 2 0 0 1 12 2 1 1 0 0 0 0 04

02 5 5 4 5 2 3 3 27 2 2 1 2 1 1 1 10

03 5 4 2 3 2 3 2 21 2 2 1 2 0 1 0 08

04 5 5 2 5 3 3 3 26 2 2 0 1 0 0 1 06

05 4 4 0 1 0 0 2 12 1 2 0 0 0 0 1 03

06 5 5 2 2 2 2 3 21 2 2 0 1 1 1 1 08

07 4 5 5 5 3 1 2 25 2 3 2 2 2 1 2 14

08 4 3 4 0 0 1 2 14 1 1 2 0 1 1 1 09

09 5 3 0 2 2 2 1 15 2 1 0 2 1 1 1 06

10 5 4 4 2 2 1 1 19 2 1 1 1 1 0 1 07

11 3 4 1 0 0 0 1 16 1 2 0 1 0 1 1 6

12 4 3 1 0 0 0 1 09 1 2 1 0 0 0 1 5

13 3 4 0 3 1 1 1 13 1 2 0 2 1 1 1 8

14 5 3 3 2 2 2 2 19 2 2 1 2 1 1 2 11

15 5 4 4 3 3 2 2 24 2 2 1 1 1 2 2 11

Total 66 59 32 38 24 23 28 25 27 11 17 10 11 16

Note : - 1 – Incomplete Emptying, 2 – Increased frequency, 3 – Intermittency, 4 –

Urgency, 5 – Weak Stream, 6 – Straining, 7 – Nocturia.


Table No.39. Showing subjective parameters before and after treatment in Group B.

Subjective Parameters

Malasanga Mutrasanga Anilasanga Adhmana Sashulavat

mutratyaga

Sl.

No.

OPD

No.

BT AT BT AT BT AT BT AT BT AT

16 5498 5 3 1 0 3 2 3 2 1 1

17 0987 4 2 0 1 3 2 3 2 2 1

18 5331 3 2 0 0 1 0 1 0 0 0

19 5350 4 1 1 0 2 1 2 1 1 1

20 5424 4 2 0 0 0 0 0 0 0 0

21 0225 4 1 0 0 3 2 3 1 1 1

22 5306 3 2 0 0 2 1 2 1 1 0

23 3128 3 2 0 0 2 2 2 1 1 0

24 3631 5 2 1 1 3 2 3 2 1 1

25 3035 3 1 1 1 2 1 2 1 0 0

26 3641 2 1 0 0 1 1 1 1 0 0

27 3674 3 3 1 1 2 1 1 1 0 0

28 3692 4 3 0 0 1 0 1 1 1 0

29 0702 5 4 1 1 3 2 2 1 1 1

30 0704 4 2 0 0 2 1 2 1 1 1


Table No. 40. Showing subjective parameters before and after treatment in Group B as

per AUA (I-PSS) symptom score index.

Group B (BT) Group B (AT)

Sl.No. 1 2 3 4 5 6 7

Total

1 2 3 4 5 6 7

Total

16 4 3 3 2 2 2 2 18 2 2 2 2 2 1 2 13

17 5 5 4 5 2 3 3 27 2 2 2 3 1 2 2 14

18 5 5 0 2 0 0 3 15 3 4 0 1 0 0 1 09

19 5 4 0 2 2 2 2 17 3 2 0 1 0 1 1 08

20 5 4 0 0 0 1 2 12 4 3 0 0 0 1 2 08

21 4 5 3 2 2 2 2 20 3 2 3 2 2 2 2 16

22 5 5 0 2 3 3 3 21 3 3 0 2 2 2 2 14

23 5 4 3 3 3 2 2 22 3 3 1 1 2 2 2 14

24 4 4 4 3 3 2 2 22 2 2 1 3 3 1 2 14

25 4 2 3 2 1 1 1 14 2 1 2 1 1 1 1 09

26 3 3 0 0 0 0 1 07 1 2 0 0 0 0 1 04

27 5 4 3 1 1 1 1 16 3 2 2 1 1 1 1 11

28 4 4 3 2 1 1 1 16 3 3 2 1 1 1 1 13

29 5 3 3 4 3 3 2 23 2 1 2 2 3 3 2 15

30 4 4 3 2 0 1 1 15 3 2 2 1 0 0 1 9

Total 67 59 32 26 23 24 28 39 34 19 21 18 18 23

Note : - 1 – Incomplete Emptying, 2 – Increased frequency, 3 – Intermittency, 4 –

Urgency, 5 – Weak Stream, 6 – Straining, 7 – Nocturia.


Objective Parameters of the before and after treatment.

Table No. 41. Showing changes (DRE) findings in Group A

Objective parameters Size of prostate Upper border Mobility

Sl. No.

OPD No.

BT AT BT AT BT AT 01 5403 2 2 2 2 2 2

02 5429 1 1 1 1 2 2

03 5426 1 1 1 1 2 2

04 5603 2 2 2 2 2 2

05 5697 1 1 1 1 2 2

06 752 1 0 1 0 2 2

07 2403 1 1 1 1 2 2

08 5862 1 1 1 1 2 2

09 5901 1 1 1 1 2 2

10 3440 1 1 1 1 2 2

11 3615 1 1 1 1 2 2

12 5467 1 1 1 1 2 2

13 5467 1 1 1 1 2 2

14 3764 1 1 1 1 2 2

15 3728 2 2 2 2 2 2

Table No. 42. Showing the change in Prostate size in Group A.

Prostate Size in Group –A Prostate Size in Group –A Sl. No. B.T. (mm) A.T. (mm)

Sl. No. B.T. (mm) A.T. (mm)

01 39 x 36 x 45 37 x 35 x 45 09 31 x 30 x 39 31 x 30 x 39 02 28 x 32 x 40 30 x 32 x 40 10 35 x 40 x 43 32 x 35 x 42 03 34 x 31 x 43 33 x 31 x 43 11 32 x 29 x 37 30 x 29 x 34 04 45 x 41 x 47 43 x 40 x 47 12 31 x 29 x 42 30 x 29 x 41 05 31 x 32 x 41 29 x 31 x 41 13 33 x 28 x 45 30 x 29 x 41 06 30 x 29 x 42 29 x 28 x 38 14 33 x 42 x 45 33 x 42 x 45 07 33 x 31 x 41 31 x 30 x 41 15 39 x 42 x 51 38 x 41 x 50 08 31 x 31 x 41 29 x 30 x 41

From the above table it is quite evident that size of the prostate was reduced irrespective of dimensions.


Table No. 43. Showing the change in weight of the Prostate in Group A.

Group – A Group – A Sl.

No. B.T. (Gms) A.T. (Gms)

Sl. No.

B.T. (Gms) A.T. (Gms)

01 33 32 09 19 19

02 18 20 10 27 24

03 27 26 11 25 24

04 44 42 12 21 20

05 22 20 13 23 20

06 20 16 14 29 29

07 21 20 15 42 40

08 21 20

Table No. 44. Showing Residual Urine values in Group A.

Group – A Group – A Sl.

No. B.T (cc) A.T (cc)

Sl. No.

B.T (cc) A.T (cc)

01 3 1 09 1 0

02 1 0 10 2 1

03 3 3 11 2 1

04 3 2 12 2 1

05 1 1 13 2 1

06 1 0 14 2 2

07 2 1 15 2 1

08 1 0


Table No. 45. Showing changes (DRE) findings in Group B

Objective parameters

Size of prostate Upper border Mobility

Sl. No.

OPD No.

BT AT BT AT BT AT

16 5498 2 2 2 2 2 2

17 987 2 2 2 2 2 2

18 5331 1 1 1 1 2 2

19 5350 1 1 1 1 2 2

20 5424 1 1 1 1 2 2

21 225 1 1 1 1 2 2

22 5306 1 1 1 1 2 2

23 3128 1 1 1 1 2 2

24 3631 2 2 2 2 2 2

25 3035 1 1 1 1 2 2

26 3641 2 1 1 1 2 2

27 3674 1 1 1 1 2 2

28 3692 1 1 1 1 2 2

29 702 2 2 2 2 2 2

30 704 1 1 1 1 2 2

Table No. 46. Showing the change in Prostate size in Group B.

Group – B Group – B Sl. No. B.T. (mm) B.T. (mm)

Sl. No.

B.T. (mm) B.T. (mm)

16 38 x 36 x 46 38 x 38 x 50 24 39 x 33 x 46 40 x 33 x 46

17 39 x 33 x 48 39 x 42 x 51 25 31 x 31 x 44 31 x 30 x 43

18 32 x 27 x 41 30 x 29 x 43 26 28 x 29 x 40 29 x 30 x 40

19 33 x 31 x 42 33 x 31 x 42 27 34 x 29 x 43 34 x 29 x 43

20 31 x 33 x 37 31 x 35 x 37 28 28 x 32 x 40 29 x 32 x 41

21 30 x 37 x 40 31 x 37 x 41 29 43 x 44 x 50 43 x 45 x 50

22 33 x 31 x 41 33 x 32 x 41 30 29 x 31 x 41 29 x 31 x 40

23 29 x 33 x 41 29 x 33 x 41

From the above table it is quite evident that size of the prostate was reduced irrespective of dimensions.


Table No. 47. Showing the change in weight of the Prostate in Group B.

Group – B Group – B Sl.

No. B.T. (Gms) A.T. (Gms)

Sl. No.

B.T. (Gms) A.T. (Gms)

16 37 37 24 32 32

17 33 44 25 21 22

18 20 22 26 18 19

19 23 23 27 23 23

20 20 20 28 19 20

21 25 25 29 49 49

22 21 22 30 21 20

23 22 22

Table No.48. Showing Residual Urine values in Group B.

Group – B Group – B Sl.

No. B.T (cc) A.T (cc)

Sl. No.

B.T (cc) A.T (cc)

16 2 1 24 2 2

17 2 2 25 1 1

18 2 1 26 1 1

19 1 1 27 2 1

20 1 1 28 1 1

21 2 1 29 2 2

22 1 1 30 2 1

23 1 1


D1ata Related To Declaring The Result And The Effect Of Treatment

Subjective parameter

The overall effect of the therapy on the basis of subjective parameters was

assessed according to 0 to 3 cumulative scoring. If score is 1, indicates poor response, 2

indicates moderate response, 3 indicates good respond, and 0 indicates no response. The

percentage made by the base of total or maximum cumulative score i.e. 18. (3 scorings

into 6 symptoms). For objective parameters the maximum cumulative score is 15. (3

scorings into 5 parameters).

Table No . 49. Showing over all effect of I-PSS Index of Vatashtila ( BPH ).

Response No. of Pt.’s in Group A % No. of Pt.’s in Group B %

Good 00 00 00 00

Moderate 01 5.55 00 00

Poor 11 61.11 06 33.33

Not response 03 16.66 09 50.44

In Group A – Among 15 patients, none of the patient has shown Good response,

1 patient (i.e.5.55%) reported with moderate response, 11 patients (i.e.61.11%) has

shown Poor response and 3 patients (i.e.16.66%) were not responded.

In Group B – Among 15 patients, 6 patients (i.e.33.33%) responded poorly and 9

patients (i.e.50.44%) were not responded.

EFFECT ON MALASANGA

Table No.-50. Showing over all effect of Malasanga.


Good 12 66.66 3 16.66

Moderate 02 11.11 06 33.33

Poor 01 5.55 05 27.55

Not response 00 00 01 5.55


In Group A – Among 15 patients, 12 patients (i.e.66.66%) has shown Good

response, 2 patients (i.e.11.11%) reported with moderate response, 1 patient (i.e.5.55%)

has shown Poor response.

In Group B – Among 15 patients, 3 patients (i.e.16.66%) has shown good

response, 6 patients (i.e.33.33%) has responded moderately, 5 patients (i.e.50.44%) has

shown poor response and only 1 patient (5.55%) not responded.

Table No. 51. Showing over all effect of Mutrasanga.


Good 00 00 00 00

Moderate 00 00 00 00

Poor 07 38.88 02 11.11

Not response 01 5.55 04 22.22

Note : - In Group A, 8 patients were having this symptoms and in Group B, 6 patients

were having this symptoms.

In Group A – Among 8 patients, 7 patients (i.e.38.88%) has shown Poor

response and only 1 patient (i.e.5.55%) reported with no response.

In Group B – Among 6 patients, 2 patients (i.e.11.11%) has shown Poor

response, 4 patients (i.e.22.22%) reported with no response.

EFFECT ON ANILASANGA

Table No-52. Showing over all effect of Anilasanga.


Good 05 27.77 02 11.11

Moderate 06 33.33 00 00

Poor 03 16.66 10 55.55

Not response 01 5.55 02 11.11

Note : - In Group B, 14 patients were having this symptoms.



response, 6 patients (i.e.33.33%) were responded moderately, 3 patients (i.e.16.66%) has

shown Poor response and only 1 patient (i.e.5.55%) reported with no response.

In Group B – Among 14 patients, 2 patients (i.e.11.11%) has shown Good

response, 10 patients (i.e.55.55%) has shown Poor response and 2 patients (i.e.11.11%)

reported with no response.

EFFECT ON ADHMANA

Table No. 53. Showing over all effect of Ruja /Sashoolyukta Mutra tyaga.


Good 05 27.77 01 5.55

Moderate 03 16.66 01 5.55

Poor 06 33.33 09 50.44

Not response 01 5.55 03 16.66

Note : - In Group B, among 15 patients 14 patients In Group A – Among 15 patients, 5 patients (i.e.27.77%) has shown Good


reported with no response and 1 patient (i.e.5.55%) was not responded.

In Group B – Among 15 patients, 1 patient each (i.e.5.55%) has shown good and

moderate, 9 patients (i.e.50.44%) has shown poor response and 3 patients (i.e.16.66%)

were not responded.

Table No. 54. Showing over all effect of Ruja /Sashoolyukta mutra tyaga.


Good 04 22.22 03 16.66


Poor 05 27.77 01 5.55

Not response 02 11.11 06 33.33

Note : - In Group A, 11 patients were having this symptoms and in Group B, 10 patients were having this symptoms.




reported with no response.


response, 1 patient (i.e.5.55%) has shown poor response and 6 patients (i.e.33.33%) were

not responded.

SIZE OF PROSTATE

Table No. 55. Showing over all effect of size of the prostate.

Response No. Of Pt.’s in Group A % No. Of Pt.’s in Group B %

Good 00 00 00 00


Poor 01 6.66 00 00

Not response 14 93.33 15 100

In Group A – Among 15 patients, 1 patient (i.e.6.66%) has shown Poor response,

and rest of 14 patients (i.e.93.33%) were not responded.

In Group B – No case was reported with any significant response.

UPPER BORDER

Table No. 56. Showing over all effect of upper border of the prostate.

Response No. of Pt.’s in Group A % No. Of Pt.’s in Group B %

Good 00 00 00 00


Poor 01 6.66 00 00

Not response 14 93.33 15 100

In Group A – Among 15 patients, 1 patient (i.e.6.66%) has shown Poor response,

and rest of 14 patients (i.e.93.33%) were not responded.

In Group B – No case was reported with any significant response.


MOBILITY

Table No-57. Showing over all effect of mobility, of the prostate.

Response No. Of Pt.’s in Group A % No. of Pt.’s in Group B %

Good 00 00 00 00


Poor 00 00 00 00

Not response 15 100 15 100

There is no any response observed in both groups.

RESIDUAL URINE

Table No. 58. Showing over all effect of Residual Urine.


Good 04 26.66 00 00

Moderate 01 6.66 00 00

Poor 07 46.66 04 26.66

Not response 03 20 11 73.33


response, 1 patient (i.e.6.66%) has shown Moderate response, 7 patients (i.e.46.66%)

were poorly responded and 3 patients (i.e.20%) reported with no response.


response, 1 patient (i.e.5.55%) has shown poor response and 6 patients (i.e.33.33%) were

not responded.

Table No. 59. Showing over all effect of Weight of prostate.


Good 03 20 00 00


Poor 06 40 00 00



In Group A – Among 15 patients, 3 patients each (i.e.20%) has shown Good,

Moderate and no response, 6 patients (i.e.40%) has shown Moderate response.

In Group B – No patient has shown response.

OVERALL RESULTS

The over all assessment is based on i.e. of cumulative values. Above 60% of the

cumulative score is considered as good response. Above 40% of the cumulative score is

considered as moderate response. Above 20% of the cumulative score is considered as

poor response. Below 20% of the cumulative score is considered as not responded.

Table No. 60. Showing overall results of Subjective and Objective parameters in Group A.

Response No. of Pt.’s in

Subjective Parameter

% No. of Pt.’s in Objective

parameters

%

Good 07 38.88 01 6.66

Moderate 04 22.22 00 00

Poor 04 22.22 08 53.33


In Group A – Out of 15 patients, under took for the present study shows good-7

(38.88%), moderate-4(22.22%), poor-4 ( 22.22%), not responded-0, in Response to the

treatment Matrabasti.

Table No. 61. Showing over all effect of Subjective and objective parameters in Group B.

Response No. of Pt.’s in Subjective

Parameter

% No. of Pt.’s in

Objective Parameter

%

Good 00 00 00 00

Moderate 02 11.11 00 00

Poor 10 55.55 00 00

Not response 03 16.66 15 100


Where as in Group-B the response to the treatment Shamana snehapana is out of

15 patients under took for this study has shown good-00, moderate-2 (11.11%), poor-10

(55.55%), not responded-3 (16.66%) in response.

STATISTICAL ANALYSIS AND ASSESSMENT OF RESULTS

Statistical analysis of the Clinical and Functional Parameters and Inter group

Table No. 62. Showing the individual study of Group A.

Mean score Sl. Symptoms B.T. A.T. Net

eff.

Mean%

Relief

S.D. S.E. t value

p value R

01 Incomplete

emptying

4.4 1.666 2.733 62.13 0.4576 0.118 23.16 <0.001 HS

02 Increased

frequency

3.933 1.8 2.133 53.23 0.639 1.165 12.486 <0.001 HS

03 Intermittency 2.133 0.733 1.466 65.63 1.2459 0.321 4.559 <0.001 HS

04 Urgency 2.533 1.133 1.466 55.27 1.2459 0.321 4.559 <0.001 HS

05 week stream 1.6 0.666 1.066 58.37 0.883 0.228 4.674 <0.001 HS

06 Straining 1.533 0.733 0.8 52.18 0.941 0.242 3.292 <0.001 HS

07 Nocturia 1.866 1.066 0.733 42.87 0.883 0.228 3.214 <0.002 HS

Table No. 63. Showing the individual study of Group B.

Mean Score Sl. Symptoms B.T. A.T. Net

eff.

Mean%Relief

S.D. S.E. t value

p value

R

01 Incomplete

emptying

4.46 2.6 1.933 41.7% 0.703 0.182 10.62 <0.001 HS

02 Increased

frequency

3.93 2.26 1.666 42.49% 0.723 0.186 8.956 <0.001 HS

03 Intermittency 2.133 1.266 0.866 40.64% 0.915 0.236 3.666 <0.01 HS

04 Urgency 1.733 1.4 0.733 19.21% 0.798 0.206 3.555 <0.01 HS

05 week stream 1.533 1.2 0.333 21.72% 0.617 0.159 2.091 >0.05 NS

06 Straining 1.6 1.2 0.4 25.00% 0.507 0.130 3.055 <0.01 HS

07 Nocturia 1.933 1.466 0.466 24.15% 0.639 0.165 2.82 <0.05 HS


Comparative effect of group A and B over effect of I-PSS Index of BPH.

Table No. 64. Showing the inter group comparison. (A.U.A) Symptom score index.

Comparative effect of Group A and Group B

Sl Parameters Gr. Mean S.D. S.E. P.S.E t

value

p

value

R

A 1.666 0.487 0.125 01 Incomplete

emptying B 2.6 0.736 0.190

0.227 4.11 <0.05 HS

A 1.8 0.506 0.144 02 Increased

frequency B 2.26 0.798 0.206

0.251 1.83 >0.05 NS

A 0.733 0.703 0.181 03 Intermittency B 1.266 1.032 0.266

0.322 1.655 >0.05 NS

A 1.133 0.833 0.215 04 Urgency B 1.4 0.910 0.235

0.318 0.839 >0.05 NS

A 0.666 0.617 0.159 05 Week stream B 1.2 1.082 0.279

0.321 1.663 >0.05 NS

A 0.733 0.593 0.153 06 Straining B 1.2 0.861 0.222

0.27 1.72 >0.05 NS

A 1.066 0.593 0.153 07 Nocturia B 1.466 0.516 0.133

0.202 1.980 >0.05 NS

Table No. 65 Showing the individual study of (Mala, Mutra, Anilasanga ,Adhmana,

Ruja/ Sashool ukta Mutra tyaga.) group-A

Parameters Mean S.D S.E. t value p value Remark

Malasanga 3.2 1.146 0.296 10.81 <0.001 HS

Mutrasanga 0.4 0.507 0.130 3.076 <0.02 HS

Anilasanga 1.333 0.617 0.159 8.383 <0.001 HS

Adhmana 1.133 0.516 0.133 8.518 <0.001 HS

Ruja/Sashoolayukta

Mutratyaga

0.6 0.632 0.163 3.68 <0.01 HS


Table No. 66. Showing the individual study of (Mala, Mutra, Anilasanga, Adhmana,

Ruja/ Sashool ukta Mutra tyaga.) Group B.

Parameters Mean S.D. S.E. t value p value Remarks

Malasanga 1.666 0.899 0.232 7.181 <0.001 HS

Mutrasanga 0.2 0.414 0.106 1.886 <0.05 HS

Anilasanga 0.733 0.457 0.118 6.211 <0.001 HS

Adhmana 0.8 0.5606 0.144 5.55 <0.001 HS

Ruja / Sashoolayukta

Mutratyaga.

0.266 0.457 0.118 2.254 <0.05 HS

Table No-67 Showing the inter group Comparative effect of (Mala, Mutra,

Anilasanga, Adhmana, Ruja/ Sashool ukta Mutra tyaga.)Group A and Group B.

Parameters Gr Mean S.D. S.E. P.S.E. t-

value

p-

value

Rem

arks

A 0.866 0.833 0.215 Malasanga

B 2.066 0.883 0.228

0.313 3.833 <0.05 HS

A 0.066 0.258 0.066 Mutrasanga

B 0.333 0.487 0.125

0.141 1.89 >0.05 N.S

A 0.666 0.487 0.125 Anilasanga

B 1.2 0.774 0.2

0.235 2.272 <0.05 H.S

A 0.733 0.593 0.153 Adhmana

B 1.066 0.593 0.153

0.216 1.541 >0.05 N.S

A 0.2 0.414 0.106 Ruja/Sashoolyu

kta mutratyaga B 0.466 0.516 0.133

0.17 1.564 >0.05 N.S


Table No. 68 Showing the individual study of (Weight of Prostate,Residual Urine)

Group A.


Weight of prostate 1.6 1.121 0.289 5.536 <0.001 HS

Residual urine 38.4 19.412 5.012 7.66 <0.02 HS

Table No.69. Showing the individual study of (Weight of Prostate,Residual Urine)

group-B


Weight of prostate 1.133 2.799 0.722 1.569 <0.05 NS

Residual urine 21.13 11.94 3.084 6.851 <0.05 HS

Table No.70 . Showing the inter group comparison Weight of Prostate,Residual

Urine. Comparative effect of Group A and Group B

Parameters Gr Mean S.D. S.E. P.S.E t value p value Remarks

A 24.66 7.48 1.931 Weight of

Prostate B 26.66 9.423 2.43

3.103 0.642 >0.05 NS

A 40.4 42.23 10.9 Residual

Urine B 45.00 37.93 9.79

14.65 0.313 >0.05 NS


STATISTICAL CONCLUSION

When the two groups are compared, except in the parameter incomplete emptying

rest of the parameters shows non-significant i.e. the mean effect incomplete emptying is

not same in the two groups after the treatment (p<0.05 ). But individually the

performance of Group A is more effective in the all the parameters (by comparing p

value). The parameter incomplete emptying, urgency, straining, and nocturia, shows

more significant in Group A than in Group B (by comparing t value). The parameter

weak stream shows non-significant in Group B (p>0.05). In Group B, the mean effect

after the treatment is more than Group A, but the in Group A the variation of the S.D is

very less in the parameter. There is uniform effect in all the parameter on the patient. We

can also observe the mean net effect of Group A is more than Group B before and after

the treatment. Hence, Group A is more effective (by comparing mean, variance, and co-

efficient of variation.)

In the parameter except Malasanga and Anilasanga Adhmana, Sashulayukta mutra

tyaga, shows not-significant. When the mean effect of the two groups. But, the individual

groups shows significance in the above said parameters. The but the objective parameters

weight of the prostate and residual urine shows non-significant in the mean effect of the

two groups after the treatment individually the Group A shows more significant than

Group B in the parameter of weight of the prostate and residual urine, but the parameter

weight of the prostate is not-significant in Group B.

Human beings have developed two characteristics since the ages – the urge to

impart his knowledge to other members and the desire to record the life and needs.

Because of these characteristics, lots of inventions have been enlightened in the field of

scientific explanation. Ayurveda is a simple, practical science of life, whose principles

are universally applicable to each individual’s daily existence. Ayurveda speaks of every

element and facet of human life, offering guidance that who seeks greater harmony,

peace and longevity.

Discussion part is divided into five sections.

1. Discussion on Vatashtila (BPH).

2. Discussion on clinical study.

3. Discussion on role of Sukumara Kumaraka Ghrita in Vatashtila (BPH).

4. Discussion on probable mode of action of Matrabasti and Shamana Snehapana

with Sukumara Kumaraka Ghrita in Vatashtila (BPH).

DISCUSSION ON VATASHTILA (BPH)

Ashtila is the hard, round, stony structure. Acharya Sushruta explained very

clearly about its structure and location in the body. It is located in Shakrunmarga i.e. in

between Guda and Basti pradesha. Acharya has explained different types of anatomical

structures with lot of similes for the Ashtila which are elaborated in literary part.

Vatashtila is the condition where in complete or partial obstruction due to

“Ashtilavat Ghana Granthi”, which leads to Mala, Mutra, Aanilasanga and Adhmana, etc

is seen.

Discussion 138

VATASHTILA vis-à-vis PROSTATE

It is one of the great job being an Ayurvedist, with regards to find the description

of prostate gland and the interpretation of its related explantion in Ayurveda. There is no

direct reference regarding this entity in the existent Ayurvedic literature. There by it is

our prime duty to give an appropriate conclusion related to prostate gland in Ayurvedic

terms.

But some scholars concluded that Basti shiras as prostate gland. Where as

Dalhanas comments on Su. Ni. 3\5 and emphasis as “Basti Shiraha Mutrashayopari

Tanobagaha”. It means basti shiras lies in the upper part of the bladder.

As our Acharyas dealt even about the minute structures of the body, no doubt they

may have mentioned about the prostate. Acharya Sushruta mentioned about the organs,

which lies around the Basti, while explaining Mutra utpatti, he emphasized on location of

the Basti, and mentioned the terms like Pourusham, Vrishanou and Guda. (Su. Ni 3\19).

Here, Pourusha can be safely concluded as prostate because, many scholars and

authors have followed the same view. Following are the some of the references –

Pourusha Granthi Vriddhi Ki Ayurveda Chikitsa – By – Dr. P. B. Gupta (New

Delhi)

Shareera Rachanatmaka Ve Kriyatmaka Drishtise Vasti, Vankshana,

Mutrashaya Ve Vrikka Aadi Ka Vivechanatamaka Adhyayana – By Dr. Suman

Rawat & Dr. Umashankar (New Delhi).

A Text Book of Sachitra Hindi Pratyakshika Shareera – By – Kaviraj Gananath

Sena.

Discussion 139

Acharya Sushruta while explaining the location of Vatashtila, mentioned the

terms like “Shakrun Marga” on this regard Dalhana comments that Guda and Basti as

“Shakrun Marga” and in this place Vatashtila is situated which is “Deergha Varthula

Akara,”. within this area there is no other organ which is “Deergha Varthula Akara,”

other than prostate. By this we can concluded that Vatashtila is none other than prostate

which is situated in the inferior aspect of the bladder. (Located at the point at which the

bladder gives rise to the urethra) (Ref-Bailey & Love’s)

Mutra praseka

There is no direct reference regarding the length of Mutra praseka but with the

help of Uttara Basti netra pramana it can be summed that, the length of Mutra praseka in

males is 6 - 7 angula.

Pourusha

Prostate being purely a reproductive gland and if we consider "Pourusha" as

Shukravaha Nadi which extends from Vrushana and opens in Mutra praseka just 2 angula

below Bastidwara then we can infer that probably Acharyas were included such an organ

in between Medhra mula pradesha and Basti dwara, which resembles that of Prostate

gland but. Pourusha Granthi the term already considered as a prostate gland by some

experts. I too agree with that “Pourusha” can be correlated with prostate, but when it

turns to Benign Prostate Hyperplasia it can be correlate with Vatashtila on the basis of

structure, location, signs and symptoms as already explained.

Discussion 140

Prostate

The function of prostate and its vulnerabilities arise from its place in male

anatomy. The prostate is a walnut sized chestnut shaped gland which is strategically

located at the point at which the bladder gives rise to the urethra, the outlet for urine. In

an adult male, the prostate usually weighs about 20 grams. Almost all of this mass

develops during puberty in response to hormonal changes associated with maturation.

The prostate literally doubles in size during puberty. In some of the men prostate

never changes in size. But, unfortunately 60% of elder population (i.e. age group of 50-60

years) is in progressive stage of BPH. Usually this remains asymptomatic till the age of

50, by the age of 80, however 90% of men suffer from one or more symptoms of BPH.

Female Prostate

The term some times applied to the periurethral glands in the upper part of urethra

in the female. This is from “Stadman’s Dictionary” But it cannot be taken into

consideration because we cannot found appropriate literature about it.

NIDANA

In our classics Vardhakyajanita rogas are mentioned along with their preventive

measures viz. Vatavyadi, Vriddhakyajanya klibya, etc. Arunadutta states that,

Vriddhavastha is Vata prokopakala. (A.Hr.Su.1/8) Creation, maintenance and destruction

of our body is under the control of Vata and it is responsible for Arogya and Anarogyata

of our body. In Vriddhavastha Ojovikriti occurs and leads to Vyadhikshamatwa heenata

intern causes Dhatukshaya. Persistent nidana sevana makes the Prakupita vata to attain

Prasaradi avasthas.

Vatasthila is one of the Vatadosha pradana vyadhi. Vriddhavastha may be the one

of Anubandi karana for Vatashtila. Frequency of micturition, difficulty in micturition,

partial or complete obstruction of urine and constipation, etc generally follows with old

age.

Discussion 141

AHARAJA NIDANA

Teekshnoushadhi, Ruksha madya sevana causes vitiation of Mutrvaha Shrotas,

Most of the pharmacological agents like higher antibiotics, α–sympathomimetic,

Antidepressants, Bronchodilators, Anticholinergic agents, α-andrenergic agents and

psychotropic drugs causes LUTS and BPH. In one or the other aspect they disturb the

functional as well as structural integrity of Mutravaha srotas by their Teekshna, Ushna

guna.

Anupa matsya sevana, Adhyashayana and Ajeerna

Anupadesha matsya is having the qualities like Snigdha, Bahudoshakara, Guru,

Madhura, Pavana nashaka. It is responsible for excessive Kledatva in Dosha, Dhatu, Mala

and Srotas. Thus, producing favorable conditions in the body for various diseases

(Ch.Su.27, Su.Su.46). Excessive Kledatva is imparted to Mutra, there by allowing the

vitiated Dosha to be lodged in it and results in various conditions of Mutraghata where

Kleda or Kapha is predominant compared to Vata dosha.

Consuming foodstuffs before ingested food gets digested is known as

Adhyashana. Due to this Ajeerna and Agnimandya takes place and ultimately resulting

into Ama formation. Further it can result into the formation of unmetabolized end

products and reaches to Mutravaha srotas, where they cause different Mutra rogas

including Vatashtila.

Discussion 142

VIHARAJA NIDANA

Mutravega sandarana

It is mentioned as one of the most important causative factor in Vatasthila (BPH).

Because Apanavayu is responsible for normal evacuation of urine, is deranged by

voluntary suppression of the urge of micturition if a person indulges for a long period of

time. This brings about vitiation of Vata to the extent that it results in Vatashtila. The

concept of Vata is analogus to that of nervous system in its functional aspect and is

presented in the study with respect to reflex mechanisms and functioning of the bladder.

The bladder is influenced by conditions that alter the membrane threshold and can

predispose it to either hypoactivity or hyperactivity, and it is tempting to speculate that

the propensity for spontaneous activity contributes in part to detrusor muscle instability

or Hyperreflexia. Suppression of urges routinely disturbs normal biochemical and

biophysical properties of body cells. Aggravated vata due to its suppression infiltrates

inside the Sushira Snayu, Sira and Dhamani of Basti and make them loose so that they

cannot contract during the urge of Mutra and thus urine cannot be voided out.

Nitya druta Prushtha yana, Ati Stree sevana

Continuously sitting over vehicles or continuously traveling over the vehicles

induces the mechanical pressure over the prostate and bladder and moreover those

persons tend to suppress the urge of urine there by vitiate Mutravaha Srotas. During the

urge of urine if a person involves in intake of food or drink or indulging in sexual

intercourse (Mutritasya Udaka, Bhakshya) it may loosen the bladder sphincter and

leads to production of Irritative symptoms. It will produce retrograde ejaculation (Mutra

Shukra), which indicates the Karmatah Viparyaya of Apana Vata.

Discussion 143

Ati vyayama , chankramana, and baravahana

Excessive Vyayamadi leads Datu, Ojah khsaya, because one should have do half

of his body strength other voice it will Vataprakopa result of Datu-kshaya etc.

Poorva janma papas

This is by Astrological if horoscope shows Shani (Saturn) and Rahu in seventh

house, the person is likely to suffer from dysuria, it is very difficult to correlate this

nidana in the manifestation of disease as such there are no psychological reasons

observed for the development of the disease.

Etiological Factor For BPH

Excessive increase of body weight by the accumulation of adipose tissue. This

adipose tissue is the main source of aromatization of testosterone to estrogen and this

estrogen is abundantly found in hyperplastic prostatic cells. Hence obese persons are

more risky to develop BPH. Beef, higher milk consumption and lower consumption of

green and yellow vegetables, NIDDM, Hypertension, Tallness, Obesity, and high insulin

and low HDL cholesterol levels are risk factors for BPH. The etiological factors of BPH

are uncertain even though intense research on various histological, hormonal and age

related changes were going on. Androgens, Estrogens, stromal-epithelial interactions,

growth factors and neurotransmitters may play a role, either singly or in combination, in

the etiology of the hyperplastic process.

Testosterone, the male hormone, is at its peak during adolescence. It decreases

thereafter, and the rate of decrease sharpens by about age 50. This in some ways is the

male equivalent of menopause. The decline in testosterone production typically calls into

play the compensatory release of other hormones, which are stimulants to testosterone

Discussion 144

production. These cannot prevent the decline in testosterone levels, but they can lead to

an elevated rate of transformation of testosterone into di-hydrotestosterone (DHT) and/or

to the increased binding and/or to the decreased clearance of DHT from prostate

cells. This reminds us about the Acharya's view about the depletion in the Shukra dhatu

(Androgens) of aged individuals. Ayurvedic virtuoso have explained completely about

the etiological factors but it is need of the hour to explore these factors with justifiable

and correct reasoning.

In this clinical trial most of the patients had given the history of Mutravega

dharana, Constipation, Teekshna ahara, Nitya Druta Prushta Yana. Some patients have

given the history of Ati Vyayama, Ajeerna, and Alcohol-Tobacco-Tea/Coffee intake.

Samprapti and Etiopathogenesis of Vatashtila (BPH)

Age factor and Nidana are the causes for the deformity (i.e.Khavaigunya) and

restrain Shaithilya in the structures of Basti i.e. Sira, Snayu and Mansa and at another

facet it aggravates Vata dosha. This aggravated Vayu i.e. Apanavayu settles in vitiated

structures of Guda and Basti and interacts with them. Finally the obstruction occurs by

Deergha varthulakara granthi, which causes the Bahirmargavarodha and it leads to

manifestation of lakshanas.

In case of Ashthila, manifestation of an enlarged mass is seen in between the

bladder and the rectum, giving rise to obstruction to urine, feces, and flatus. It is

important to note that, a stony hard mass is found in the carcinoma of prostate. As per my

hypothesis Vatashtila is not having hard consistency. But, in early stage it soft in future

when it becomes hard in consistency may leads to carcinoma of prostate.

Discussion 145

SYMPTOMS

Ashtilavat ghana granthi, Malasanga, Mutrasanga, Anilasanga, Adhmana.

Sashulayoukti Mutratyaga, Incomplete emptying, Increased frequency, Intermittency,

Urgency, Weak stream, Staring Nocturia are the symptoms found in Vatashtila.

BPH mainly consists with the symptoms like incomplete emptying, increased

frequency, intermittency, weak stream, staining, and Nocturia. Hence, there is much

similarity in symptomatology of BPH & Vatashtila. The other symptoms like Adhmana,

(Distention of abdomen) Malasanga, (Constipation) Anilsanga (Obstruction to the Flatus)

are because of Margavarodha by Ashtilavath Ghana granti.

The obstruction induced changes in detrusor function, compounded by age related

changes in both bladder function and nervous system function, lead to urinary frequency,

urgency and nocturia, the most bothersome BPH related complaints.

AYURVEDIC LINE OF MANAGEMENT

Treatments modalities mentioned for Mutrakricchra, Udavarta, Ashmari can be

used to treat Mutraghata. Avapeedaka sneha prayoga, Snigdha virechana, Trividha basti,

Avagaha Swedana, etc are explained. Rasayana and Vajeekara treatments are indicated.

Especially Vrishya drugs have to be advised in the management of BPH as because of

Prostate belongs to reproductive system. There is decrease in androgen level leads to the

proliferation of stromal and epithelial cells of the prostate. Shatavari, Gokshuru, Shilajatu

are some of the drugs which are extensively explained in the management of Mutraghata

that suggests the role of Vrishya and Rasayana drugs. Trivanga is also very useful. Food

is the main cause for both 'ease' and 'disease'. These foodstuffs need proper conversion

(Agni) to their elemental form for nourishment of dhatus for which a media is required

which is called as Srotas. Pathya is that one which is wholesome to body and Apathya is

unwholesome to Srotas. Hence detailed Pathyapathya is explained.

Discussion 146

MODERN LINE OF MANAGEMENT

Treatment should be always concentrating on relieving LUTS, Decreasing BOO,

Improving bladder emptying, Ameliorating detrusor instability, Reversing renal

insufficiency, Preventing future episodes of gross haematuria, Urinary tract infection, and

Urinary retention.

Medical therapies investigated for BPH include α−adrenergic blockers, androgen

suppression, aromatase inhibitors, and plant extracts, which are also reviewed. Because

these agents are widely used in some parts of the world despite the lack of properly

designed clinical trials. Because plant extracts are not classified as drugs, the marketing

and claims are not critically scrutinized by regulatory agencies.

The enthusiasm for medical therapy has been supported in part by the limitations

of Prostectomy, which include the morbidity of the surgical procedure, failure to

consistently achieve a successful outcome, necessity for re-treatment, and the suggestion

that prostatectomy increase the risk of delayed life-threatening cardiac events (Lepor,

1993). Because the indication for intervention in the overwhelming majority of patients

with BPH is to improve quality of life by reliving symptoms (Mebust et al, 1989), the

lower morbidity of medical therapy is of paramount importance in patient driven

treatment decisions.

Acharyas suggested to Avoid the causative factors, increasing the power of

digestion and metabolism, Apanavata anulomana, increasing the stability of Mutravaha

Srotas and particularly of Basti, removes the Sanga (Obstruction), Reducing the Vriddhi,

Protects the Basti marma and makes proper flow of Urine, following proper diet and

regimens may be the 10 principle to manage the Vatashtila (BPH). These principles

supersedes in the management of BPH more than modern medical science.

Discussion 147

DISCUSSION ON CLINICAL STUDY

The patients were selected from the medical camps conducted in the premises of

Shri. D. G. Melmalagi Ayurvedic Medical College and Hospital Gadag. Vatashtila

patients were diagnosed and selected for the clinical study between the age groups 50 to

70 years for the purpose of administration of Matrabasti and shamana Snehapana.

All the patients for the study are randomly selected and categorized in to two

groups. In Group A Matrabasti and Shamana Snehapana in Group B the yoga selected is

Sukumara Kumara Ghrita i.e. for both groups. Matrabasti with 70 ml of Sukumara

Kumara Ghrita was given for 8 days and 16 days was for follow up, where as for

Shamana Snehapana 16 days with same Ghrita was given and 8 days follow up. Total 24

days was the study duration.

DISCUSSION ON OBSERVATIONS

Age – Higher incidence of BPH was found in the age group of 66–70 years (15

patients i.e.50%) followed by 7 patients (i.e.23.33) in 61-65 years of age, 6 patients

(i.e.20%) were belonging to the 56-60 years of age group and remaining 2 patients

(i.e.6.66%) were in to age group of 50-55 years.

This reveals that the disease, which afflicts the aged males, supports the view of

an increasing agglomeration of 5-α−reductase due to an age related shift in Prostatic

androgen metabolism. Age play an important role in the manifestation of BPH and

according to Ayurveda, Vata dominates in this period and hence elders are more likely to

suffer from Vatashtila (BPH).

Religion – In this study maximum number of patients (27 patients i.e.90%)

belonged to Hindu religion an remaining 3 patients (i.e.10%) were in Muslim

community.

Discussion 148

This reflects the geographical preponderance of this particular region rather than

any specific affinity of the disease with religion.

Occupation – The equal incidence of occupation observed during this study. This

shows that the Vatashtila (BPH) patients are obtained from those vicinity of works where

they tend to suppress the urge of micturition or continuously sitting in one place as well.

Dietetic habit – Maximum number of 17 patients (i.e.56.66%) were vegetarian

and 13 patients (i.e.43.33%) were with mixed diet habit.

Chyou and associates 1993 examined 33 food items in relationship to

Prostectomy associated. Araki and Coworkers (1983) reported increased clinical

diagnosis of BPH in men with higher milk consumption and lower consumption of green

and yellow vegetables. Overall, there is no convincing evidence for any dietic factors to

play a major role in the development of LUTS /BPH.

Vyasana – More incidence of the disease was found in the patients with Tea or

Coffee addiction (12 patients i.e.80%). Followed with smokers (12 patients i.e.40%). 9

patients (i.e.30%) were alcohol abusers and 6 patients (i.e.26.66%) were habituated to

Tobacco chewing.

Caffine present in Tea-coffee and Nicotin present in cigarettes appears to increase

both testosterone and estrogen levels. Alcohol is also the causative factors for BPH by

increasing the plasma testosterone level (Chopra et al, 1973). However in this study all

most all patients were found with habituated to some of habits. Because of small sample

size and stipulated nature of study definite relation of habits can not be taken out.

Viharaja nidanas – 22 patients (i.e.73.33%) were exposed to Ativyayama, 17

patients (i.e.56.66%) were indulging in Mutra nigrahana, 13 patients (i.e.43.33%) were

habituated in Nitya drita pristayana and 4 patients (i.e.20%) were indulging Ativyavaya.

Discussion 149

Vata is the nearest cause for Vatashtila and the present study supports the view.

Because of most of the patients were indulging in Ashukari vata vridhhikara bhavas like

Vegavidharana, etc. Because, suppression of urges routinely disturbs normal biochemical

and biophysical properties of body cells. Nitya Drutaprushta Yana (Continuously sitting

and traveling over vehicles and horses, etc) leads to fatigue and exertion thus vitiates

Vata. Indulging in Ativyayama and Ativyavaya leads to dhatu kshaya and extreme

vitiation of Vata. Ekman suggested that the increase in the fibromuscular stroma is a

result of sexual activity (Ekman,1989). The decrease in sexual ability and frequency of

sexual activity with advancing age, exactly when the prevalence of BPH increases, in fact

might suggest a reverse relationship, namely, a causative effect of BPH on sexual

function (Altwein and Keuler, 1992). These are all the favorable conditions for the

Vatashtila. (BPH)

Nidra – 11 patients (i.e.36.66%) were having disturbed sleep, 10 patients

(i.e.33.33%) were having sound sleep, 9 patients (i.e.30%) patients were habituated to

sleep only at night hours and no patient was accustomed to day sleep.

Nidra Ardha Rogahari, Kshudha Sarva Roga Hari | This famous quotation was

well appreciated in this study. Disturbed sleep habits hampers the metabolic processes

and intern causes dhatukshaya and ultimately results in Vatavriddhi. Apart form this the

majority of the patients were of old age group, hence because of this the sleep habitat is

already affected.

Jataragni – Maximum number of the patients 13 (i.e.43.33%) were having

Mandagni, 11 patients (i.e.36.66%) were having Samagni, 5 patients (i.e.16.66%) were

afflicted with Vishamagni and no patients was observed with Teekshnagni.

Discussion 150

Sarve Roga Api Mandagni Eva Karanam | The famous quotation form Charaka

has been well appreciated in present clinical study. Decreased and disturbed nature of

Jathargni indicates that the patients are having pre-existed state of vikrita doshas and

further it hampers the Bhutagni, Dhatwagni vyapara and altimately results in

malformation of dhatus. Dhatu kshaya strongly reflects in terms of Vata dosha vriddhi.

Vriddhavastha and vikrita avastha of Jathargni makes the more favorable place for

Vatashtila.

Mala Mutra pravritti (Bowel movement) – 13 patients (i.e.43.33%) were

having frequent mala pravritti, 11 patients (i.e.36.66%) were constipated, 5 patients

(i.e.16.66%) patients were having normal bowel movements and only 1 patient

(i.e.3.33%) was having irregular bowel habits. Frequency of Mutra is the criteria for

diagnosis which was present in all patients.

Due to disturbed pattern of mala pravritti shows the pre-existence of vikrit vayu

and it may be due to more enlarged prostate, which causes obstruction to feces.

Prakruti – Equal incidence of Vata-pitta and Vata-kapha prakriti was observed.

This suggests that incidence of BPH may be high in these Prakruti purushas and which

also confirms the predominance of Vatadosha in natural constitution of prakriti itself.

DISCUSSION ON DATA RELATED TO DISEASE

Chief Complaints

The maximum symptoms were present in the age group of 66 to 70 age group and

60 to 65 age group. It seams to be as per incidence of BPH, common problem in who is

men over 50 years of age. Approximately the incidence of BPH is more in fifth decade of

men’s life.

Discussion 151

Prostatic findings – The present clinical study assessed through DRE. Most of

the patients were having median lobe enlargement and border line enlargement and free

from rectal mucosa and tenderness was absent.

Residual Urine – 12 patients each (i.e. 40%) were reported in 10 to 50 cc and 51

to 100 cc of residual urine. 2 patients (i.e.20%) were having 101-200 cc of residual urine.

Whereas, no patient was observed with residual urine above 201 cc.

This is due to fatigue of the altered detrusor during prolonged voiding at higher

than normal pressures and reduced flow. Towards the end of the urination, the detrusor

can no longer maintain sufficient contraction to force the urine, to keep the bladder neck

and prostatic urethra open. Due to the contraction and leaving residual urine in the

bladder. This again dependent upon the Chronicity of the disease.

Size and weight of the prostate

In the present clinical study it was observed that, size and weight of the prostate is

first and second degree.

DISCUSSION ON RESULTS

The results were assessed on the basis of subjective and objective parameters with

individual gradings and discussed as follows –

Subjective Parameter

Effect on I-PSS Index of Vatashtila ( BPH)

Group A – The AUA or I-PSS is having 7 symptoms, all the seven symptoms

were given according to age interval. In the age interval of 50 to 55, among two patients

in one patient observed good response and one patient was poor respond. Where as 56 to

60 age interval among 4 patients, all three patient were observed poor respond. And age

61 to 65 among 3 patients, one patient was not responded, where in rest of two patients

responded poorly. As the age interval of 66 to 70, among 6 patients in only 2 patients has

seen poor respond remaining 4 patients were not responded.

Discussion 152

Group B – In the age interval of 50 to 55, there was no any patients were

reported. Where as 56 to 60 age interval among 2 patients, only one patient was observed

good response and another 1 was patient not responded. And age 61 to 65 among 4

patients one patient was not responded, where in rest of 3 patients responded poorly. Age

interval of 66 to 70, among 6 patients in 3 patients has seen poor respond remaining 3

patients were not responded.

EFFECT ON MALASANGA

Group A – Malasanga was found 2 patients in the age interval of 50 to 55, and

shown good response. 4 patients were in age interval of 56 to 60 years. Among these, 3

patients shown good response and 1 patient was not responded. 3 patients were observed

in the age group of 61 to 65 years. All has shown good response. 4 patients were in the

age interval of 66 to 70 years. Among 6 these 4 patients has shown good response,

remaining 2 patients has shown moderate and poorly response respectively.

Group B – No patient was reported in the age interval of 50 to 55 years. 2

patients were in age interval of 56 to 60 years. Among these 1 patient has shown good

response and another patient was not responded. 4 patients were in the age interval of 61

to 65 years. Among these 2 patients responded good and remaining patients were

responded moderately and poorly respectively. 6 patients were in the age interval of 66 to

70 years. Among these 3 patients each has shown moderate and poor response

respectively.

Discussion 153

EFFECT ON MUTRASANGA


Group A – The symptom Mutrasanga in the age interval of 50 to 55, one patient

observed and shown good response. In the age interval of 56 to 60, among 2 patients both

patients shown good respond. In age interval 61 to 65 in among 2 patients one patient

was observed very good response and 1, patient was not responded. As interval of 66 to

70, among 3 patients, 2 patients has seen good responded, one was not responded.

Group B – In the age interval of 50 to 55, there was no any patients are reported.

In the age interval of 56 to 60, among 2 patients, only one patient shown good response,

and another patient was not responded. In the age interval of 61 to 65, among 4 patients 1

patient was responded poorly, and rest of the patients were not responded. In rest other

age interval patients were not reported.

EFFECT ON ANILA SANGA

Note : - In Group B, 14 patients were having this symptoms.

Group A – Symptom Anilasanga in the age interval of 50 to 55, among 2 patients

one patient was responded good, and another one was moderately responded. In the age

interval of 56 to 60, among 4 patients, 3 patients shown good response and 1 patient was

not responded. In the age interval of 61 to 65 in 2 patients 1 was moderately and 1 was

poorly responded. In the age interval of 66 to 70, among 6 patients in 3 patients has seen

good respond, 2 patients were moderately responded and 1 patient was not responded.

Group B – In the age interval of 50 to 55, there is no patients were reported. In

the age interval of 56 to 60 interval among 2 patients, both patient has shown poor

response. In the age interval of 61 to 65, among 4 patients all patients responded poorly.

In the age interval of 66 to 70, among 8 patients in 1 patients has seen good respond, 5

patients responded poorly and 2 patients were not responded.

Discussion 154

EFFECT ON ADHMANA

Note : - In Group B, among 15 patients 14 patients In Group A – Symptom Adhmana in the age interval of 50 to 55, among 2

patients each patient has shown good and poorly response. In the age interval of 56 to 60,

among 4 patients, 2 patients has shown good response and 2 patients are poorly

responded and in the age interval of 61 to 65, 2 patients responded poorly. In the age

interval of 66 to 70, among 6 patients 2 patients has shown good response and 1 patients

has seen moderate respond and 2 patients were poorly responded and only 1 patient was

not responded.

Group B – In the age interval of 50 to 55, there was no any patients are reported.

In the age interval of 56 to 60, among 2 patients each patient has shown poor and

moderate response. In the age interval of 61 to 65, among 4 patients 3 patients were

poorly responded, 1 patient has shown good response. In the age interval of 66 to 70,

among 8 patients in 5 patients are poorly responded and 3 patients were not responded.

EFFECT ON RUJA/SASHOOLYUKTA MUTRA TYAGA


Group A – The Symptom Ruja / Sashoolyukta mutra tyaga, in the age interval of 50

to 55, 1 patient observed and shown good response. In the age interval of 56 to 60, among

3 patients 2 were patients observed good response and 1 was poorly responded. In the age

interval of 61 to 65, among 2 patients 1 patient was observed good response and 1 patient

was poorly responded. As interval of 66 to 70, among 5 patients in 3 patient has shown

poor response and other 2 patients were not responded.

Group B – In the age interval of 50 to 55, there is no any patients are reported. In

the age interval of 56 to 60, among 2 patients, both are not responded. Where age 61 to

65, among 2 patients no one has responded, In the age interval of 66 to 70, among 6

patients 3 patients were good responded and 1 is poorly responded rest of other 2 patients

were not responded.

Discussion 155

OBJECTIVE PARAMETER

SIZE OF PROSTATE

Group A – There was no response observed except age interval of 66 to 70, only

1 patient was observed and responded good.

Group B – There was no response observed in Group B.

UPPER BORDER

Group A – There is no response observed except age interval of 66 to 70, only 1

patient was observed and responded good.

Group B – There was no response observed in Group B.

MOBILITY

There was no response observed in Group A and B.

RESIDUAL URINE

In Group A – In the age interval of 50 to 55, among 3 patients only 1 patient was

responded moderately and 2 patients were not responded. In the age interval of 56 to 60,

among 4 patients, 1 patient has responded good, 2 patients were poorly respond and 1

patient was not responded. In the age interval of 61to 65, among 3 patient 1 patient was

responded good, 2 patients were poorly responded. In the age interval of 66 to 70, among

5 patients only 2 patient good respond, 3 patients were poorly responded.

In Group B – In the age interval of 50 to 55 there was no patients reported. 56 to

60, among 3 patients 1 patient was responded good. In the age interval of 61to 65 among

5 patients 2 patient were responded and 2 patients were not responded. In the age interval

of 66 to 70, among 7 patients only 1 patient poorly responded, remaining all patients

were not responded.

Discussion 156

WEIGHT OF PROSTATE

In Group A – In the age interval of 50 to 55, among 2 patients only 1 patient was

responded moderately and 1 patients was not responded. In the age interval of 56 to 60,

among 4 patients 1 patient responded good, 3 patients were poorly respond. In the age

interval of 61 to 6, among 3 patient, 1 patient was responded good, 2 patients were

moderately responded. In the age interval of 66 to 70, among 4 patients, 2 patients each

responded good and poor.

In Group B – No patient was responded.

STATISTICAL DISCUSSION

In statistical analysis by comparing the two groups, only incomplete emptying of

bladder was significant i.e. the mean effect of incomplete emptying is not same in the two

groups after the treatment (i.e. p value is <0.05). But individually the performance of

Group A is more effective in the all the parameters (by comparing p values). The

parameters incomplete emptying, urgency, straining, and nocturia, were more significant

in Group A then Group B (by comparing t value). The parameter weak stream was not

significant in Group B (i.e. p value is >0.05). In Group B, the mean effect after the

treatment is more than Group A, but in the Group A the variation or the S.D. is very less

in all the parameters. There is no uniform effect in the all the parameter of both Groups.

We can also observe the mean net effect of Group A is more than Group B before and

after the treatment. Hence, Group A is more effective, (by comparing mean, variance, and

co-efficient of variation).

Discussion 157

In the subjective parameter except Malasanga and Anilasanga shows not-

significant. When the mean effect of the two groups, but the objective parameters weight

of the prostate and residual urine shows non-significant in the mean effect of the two

groups after the treatment individually the Group A shows more significant then Group B

in the parameter of weight of the prostate and residual urine, but the parameter weight of

the prostate is not-significant in Group B.

Overall Response to the treatment

Assessment of response was done on the basis of subjective and objective

parameters after recording the baseline pre and post treatment data of Mala, Mutra,

Anilasanga, Adhmana, Sashoolayukta mutratyaga and AUA symptom score index in

gradings. (Mentioned in methodology). The statistical analyses of the subjective and

objective parameters were made for overall result assessment.

The role of Sukumara Kumaraka Ghrita, in Vatashtila (BPH)

Sukumara Kumaraka Ghrita has been selected for the clinical study because of the

direct indication of the yoga towards Mutrakricchra in the textbook of Chakradutta and

Bhaishajya ratnavali.

It contains Dashamoola, Trinapanchamoola, Punarnava, Vidarikanda, Nagabala

and Atibala are having properties like Mutrala, Mutrakricchrahara, Ashmari bhedana,

Shothahara, Shoolahara and Vata-kaphahara.

Dashamoola is having Ushna veerya and hence Vata-kapha shamaka. It is very

good Vedana sthapaka, normalizes the obstructed Gati of Vata dosha by other Dosha or

by Mala. It is used in Shwayathu. It is more beneficial in Apanavata vaigunya.

Discussion 158

Shatavari, Bala, Ashwagandha, and Ghrita are having properties like Mutrala,

Vata-pittahara, Vatanulomana, mainly Vrushya, Balya, Rasayana, Vatanulomana.

Ashwagandha is specially indicated in Vridda. (Aged person)

Pippali, Ajamoda, Shunti, Yavani are having Agnideepana, Vatanulomana

Shoolahara.

Saindhavalavana increases the Vishyandana property of Bastidravya there by

enhances the absorption rate and alleviates Vatadosha. Eranda taila is Mridu virechaka

and Vatanulomaka. The name itself indicates, it is recommended for Sukumaras viz. old

age persons without any hesitation.

Gokshura is having the 5-α reductase inhibitory, α−andrenergic, antagonistic

activity and reduction in the weight of the testosterone induced prostate. It is also noticed

that it inhibits the stromal proliferation and controls the epithelial height. (Sundaram. R,

and Co; R&D Centre; The Himalaya Drug Co. Bangalore, 1999). It is one of the safe and

famous mutrala dravyas mentioned in classical texts.

Shatavari is known for inhibitory activity of 5-α reductase enzyme, there by

checks the proliferation of prostatic cells. It is Mutrala hence reduces residual urine. Its

Rasayana property increases the stability of Basti and Mutravaha srotas. Madhura rasa

and Vipaka, Sheeta veerya alleviates Pittadosha hence useful in burning micturition.

Sukumara Kumaraka Ghrita indicated in various disease Gulma, Mutrakricchra,

and Shoola etc. It is the best vatahara. (i.e. Apanavata) It can be claimed that it helps in

correcting the pathology of Vatashtila (BPH).

Discussion 159

The role of Phytotherapy in BPH

Some of the research scholars did their works with Phytotherapy in which they

tried extracts of medicinal herbs in the management of BPH.

Phytotherapeutic agents for LUTS/BPH have gained widespread usage since

about 1990. (Lowe and Fagelman,1990) Previously, these agents were popular in Europe,

particularly in France and Germany where they are often prescribed and their costs

reimbursed. (Dreikorn et. al 1998)

Composition of the Phytotherapy extracts

The composition of plant extracts is very complex. They contain a wide variety of

chemical compounds, which include phytostosterols, plant oils, fatty acids, and

phytoestrogens, which of these is the exact “active” component is not definitely known.

Both the free fatty acids and the sitosterols have been thought to be the active

components.

Table No-71. Showing Composition of the Phytotherapy extracts

S.l Species Common name

1 Serenoa repens, Sabal

serrulata

Saw palmetto berr/American

Dwarf palm

2 Hypoxis roopi pyrum

africanum

South African star grass

3 Pygeum africanum African plum tree

4 Urtica dioica Stinging nettle

5 Secale cereale Rye pollen

6 Cucurbita pepo Pumpkin seed

7 Opuntia Cactus flower

8 Pinus Pine flower

9 Picea Spruce

Discussion 160

Table No.-72. Showing Components of Plant Extracts:

l. Phytosterols Phytostrogens Terpenoids

1 β--Sitosterol Coumestrol Lectins

2 δ-5-Sterol Genistein 9isoflsvone) Polysaccharides

3 δ-7-Sterol Flavonoids Aliphatic alcohols

4 Stigmasterol Fatty acids Plant oils

5 Campesterol Free Esterified -

Mechanisms of action

The phytotherapeutic agents are generally unknown. (Dreikorn et al, 1998) Many

in vitro experimental studies have been undertaken to elucidate this. Thus, there are

numerous proposed mechanisms of action. The three mechanisms of action that have

received the greatest attention are anti-inflammatory effects, 5α-reductase inhibition, and

growth factor alteration.

Anti-inflammatory effects – These are modulated by effects on prostaglandin

synthesis. Plant flavonoids are inhibitors of both cyclooxygenase and lipoxygenase

enzymes (Bach, 1982: Buck, 1996). Flavone, a phytoestrogen commonly found in plants

and herbs.

5α-reductase inhibitor – The most widely suggested mechanism of action of S

repens is as an 5α-reductase inhibitor. (Losker and Brogden, 1996) The human prostate

contains both type 1and predominantly type 2 isoforms of the 5alpha-reductase enzyme,

which catalyzes the conversion of testosterone to DHT (Rhodes et al, 1993: Span et al,

1999) DHT is important for the development of BPH. Decreasing DHT with the use of

a5alpha-reductase inhibitor, such as finasteride, leads to reduction of prostate volume

(Gormley etal, 1992).

Discussion 161

Growth factor alteration – These are also thought to act by altering growth

factor-induced growth and proliferation. Although experimental data have suggested

numerous possible mechanisms of actions for the phytotherapeutic agents, it is uncertain

which, if any, of these proposed mechanisms is uncertain which, if any, of these

proposed mechanisms is responsible for the clinical responses.

Observations of Matrabasti Procedure

The treatment given to Group A i.e. Matrabasti patients with Sthanika mridu

abhyanga with Murcchita Tila taila and Sthanika swedana was done prior to Matrabasti.

Patient was advised to take alpa ahara before Matrabasti karma. The procedure is

followed consecutively for 8 days.

In severely constipated patients Tab Anuloma DS was given for 2 to 3 days. No

complications were observed in all the patients during and after the Matrabasti procedure.

Basti was administered in between 9 to 10.30am. In 13 patients retention of bastidravya

was up to 5 to 9 hours and in 2 patients it was retained for 2 to3 hours. Basti pranidhana

and Pratyagamana kala were recorded properly. During the course of therapy some

patients showed improvement in both obstructive and irritative symptoms i.e. incomplete

emptying of the bladder, increased frequency and urgency. Some patients showed marked

improvement during and after the treatment which was recorded in proforma of I-PSS

Index. Other symptoms like Constipation, were relieved in most of the patients. Addition

to that patients were relived from Durbalata and body aches, attained Indriya prasannata,

Chaitannya, even.

Discussion 162

Mode of Action Matrabasti

Vatashtila, a clinical entity wherein there is extreme vitiation of Vata

especially the Apanavata, which being sheltered in the Basti and Medhra leads to

obstruction to the outflow of urine due to its Vimargagamana and Margavarodha.

Therefore, the main principle of management should be Margashodhana and

Vatanulomana in order to restore the normal functioning of Apanavata. The ingredients

of Sukumarakumar Ghrita are well known for their Kapha-vatahara, Vatanulomana,

Shothahara, Bastishodhana, Balya and Rasayana effects.

Matrabasti is best treatment for old age persons, because of its less dose and

minimum complications. The drug of Matrabasti is sneha, it is perfectly antagonistic to

the Vata, as the disease Vatashtila is vata pradana vyadhi (Apanavata). Apanavata is

prime cause for the disease, as Moola of Vata is Pakvashaya (apanavata) the Sanchara

Sthana of Apanavata is Apano apanaga shroni basti medhrorugocharaha. The

administered Basti dravya stays in pakvashaya and it will reach to the affected area

quickly by the Anupravaranabhava. In the disease Vatashtila, structurally Affected area

is Guda and Basti pradesha which is near to the Pakvashaya.

The Srotases of a Ruksha and Klanta persons (old aged Vatapradhana person) are

emaciated therefore there will be natural obstructio and n to the movement of Vata to

bring about normal functions. As explained earlier, the Sneha brings about

Srotomardavatwa and Vatashamana actions thereby causes Srotoprasadana and helps for

proper movement of Vata.

Discussion 163

From the foregoing description it may be inferred that on per-rectal

administration, the medicaments are absorbed through the villi of the rectal mucosa and

then come into the vein and then into circulation after proper metabolism. This rectal

route is also mentioned in allopathic system of medicine as the important systemic route

of administration for some drug in the form of retention enema. Drugs, absorbed into

external haemorrhoidal veins (about 50%), bypass the liver, while the drugs, absorbed

into internal haemorrhoidal veins come into portal circulation.

As the Matrabasti quantity is less, it can stay 5 to 9 hours in Pakvashaya, and

may acts locally or systemically after absorption of active principles from Basti dravya.

Guda is pradhana marma and the moola of Siras, that nourishes the body.

The rectum has rich blood supply and drugs can cross the rectal mucosa like other

lipid membranes. Thus unionized and lipid soluble substances are readily absorbed from

the rectum and from rectal venous plexus. The concentration gradient of Basti dravya is

more inside the lumen of intestine as compared to rectal venous plexus, which facilitates

the absorption. This rectal venous plexus further divided into internal venous plexus and

external venous plexus. Internal venous plexus, situated in the submocosal layer of anal

canal and carries into superior rectal vein and to external venous plexus.

Basti dravya is also absorbed from external venous plexus in three parts, i.e. in

lower part through inferior rectal veins and drained into internal pudendal vein, in middle

part through middle rectal vein which is having tributaries, those drains from bladder,

prostate and seminal vesicle into internal iliac vein, in upper part through superior rectal

vein into inferior mesenteric vein a tributary of portal vein.

Discussion 164

Basti dravya is also absorbed from the upper rectal mucosa, and is carried by the

Superior mesenteric vein into the portal circulation and enters into Liver. Secondly, the

portion absorbed from the lower rectum enters directly into systemic circulation via

middle and inferior hemorrhoidal veins. This indicates that due to more vascularity in this

area absorption rate is high. Acharyas also said that Guda (Uttara Guda) is the moola of

Sira.

From above it is clear that Basti dravya is absorbed through rectal mucosa either

by chemically altered or un-altered and carried throughout the general circulation and

gives systemic effect along with local effects like Vatanulomana, Mutravirajaneeya and

Shoolahara, etc. The ingredients of Sukumara Kumaraka Ghrita acts on Rakta dhatu

and helps to provide proper nourishment to Sira, Snayu as they are its Upadhatu. Ushna

veerya and Madhura rasa alleviate Apanavayu.

Basti mainly acts on Pakvashaya the Mula sthana of Vata, it subsides vitiated

Vata, By means of its Katu vipaka, Ushna veerya it reduces the size and volume of the

prostate there by decreases the obstruction to flow of urine.

Basti dravya posses Basti vishodhana drugs, it improves the stability and also

compliance of detrusor muscle of the bladder. When Basti dravya reaches in general

circulation it may act on androgens (testosterone) directly or through pituitary there by

controlling leutenising hormone to stimulate Leydig’s cells present in testes and may

reduce the more production or more conversion of testosterone into DHT by inhibiting 5-

alpha reductase enzyme.

Discussion 165

By these factors Basti is responsible for the relief in the signs and symptoms of

the disease. So these observations suggests that this therapy not only attains symptomatic

relief but can also control it quite effectively.

Vatavyadhies are generally correlated with Neurological disorders. Basti acts on

nervous system related to the prostate (Apanavayu) and brings the normal function of the

Apanavata i.e. voiding of urine (micturation process).

By looking in to pathology of BPH, obstruction induced changes in neck of the

bladder function, compounded by age related changes in both bladder and nervous

system, leads to urinary frequency, urgency, and nocturia, which are the most bothersome

BPH related complaints. Matrabasti may act on nervous system (Apanavayu related), and

restores the normal function of the Apanavata i.e. voiding of urine.

It can be Hypothetically concluded that Matrabasti is an effective management for

Vatashtila (BPH) as the present clinical work reveals not only symptomatic relief but

there is also reduction in size and weight of prostate and decrease in the residual urine

and there is decrease in the level of free serum testosterone.

Discussion 166

Observations of Shamana Snehapana Procedure

Group-B was taken for Shamana Snehapana. Patients were advised to take, mridu

bhojana, before night prior to Shamana snehapana. Which is to be taken when the patient

gets hunger i.e. “Anannaha” (morning Tiffin time). Patients were advised to take 15ml of

Sukumarakumara ghrita with Ushnajala as Anupana twice daily for 16th day followed by

Mridu ahara and other Pathyapathya as explained in Snehapana vidhi adhyaya. A

pariharakala of 8 days was given.

The patients asked to report on 24th day counting from the day of commencement

of the treatment. In some of the patients marked improvement observed in chief

complaints during and after the course of therapy, which was recorded as per proforma of

I-PSS Index. Other symptoms like Constipation were relieved in most of the patients. In

addition to that, patients were relived from Agnimandya, Durbalata, body aches and

attained Indriya prasannata, Chaitannya, even.

MODE OF ACTION OF SHAMAN SNEHAPANA

Shamana snehapana, is capable of effective pacification of vikaras, mitigation of

vitiated doshas, balya, revitalizing tendency of shareera and indriya by reaching to

Koshta, Shakha, Sandhi, Marmas quickly. (Ch. Su 13., A.Hr.Su.16/19) Its effect depends

upon the basis of method of administration and ingredients of the dravya being used.

By method of administration - As we are giving Shamana Snehanapana in the

“Anannaha” means without food, when patient is having hunger. In this condition Shrotas

will not be enveloped with kapha, and Sneha will get digested completely, as the

digestive enzymes are strong when the person is in hunger. And spreads all over the body

Immediately. Acts locally or systemically after absorption, by the virtue of active

principles of Sukumara kumaraka ghrita..

Discussion 167

The ingredients of the ghrita.-viz Dashamoola, Laghupanchamoola, Punarnava,

and Shatavari etc, are having Snigdha Guna it alleviates Vata Dosha. Gokshuru is

Shreshtha Mutrakricchra hara dravya and it makes Anulomana of Apanavata. By

considering above properties of ingredients it makes Anulomana of Apanavayu, remove

the Sanga, makes to facilitate to void the urine and stool properly, gives relief in burning

micturition, and emptying the residual urine in bladder. It also makes Basti Shodhana

hence stability of Snayu and Sira of Basti were maintained or reverses the pathology of

Vatashtila BPH. Rasayana property of these drugs generally enhances the normal

integrity of Mutravaha Srotas in particularly of Basti Gata – Sira and Snayu. It is having

5-alpha reductase enzyme inhibitory properties. It healps to reduce the weight or volume

of the Prostate. Snigdha Guna alleviates Vata Dosha. Ushna veerya alleviates both Vata

and Kapha. Laghu and Sara Guna increases Sara Guna of Mutra there by facilitate easy

voiding. Deepana-Pachana property improves Agni and digests Ama at Koshtha level.

and at Mutravaha Srotas level. Shodhana properties cleanse the Srotas and make it clear

for the proper movement of Apanavayu and leads to normal evacuation of bladder.

Shamana snehapana is indicated in Gulma, Mutrakrichra, Ghadavachras, etc, as the

Ghrita is the best Rasayana Agnideepana, vatahara, etc it helps in correcting the

pathology of Vatashtila (BPH).

Besides the above the Shamana ghrita, used in this study, also possess their

effects on smooth muscle contraction. Prasad et al (1966), reported that Varuna extract

increase the tonicity of smooth muscle of ileum, trachea and uterus in experimental

models. They concluded that the tonic effect of drug may be due to action on the

cholenergic receptors in the smooth muscles. So, a likely probability is that the drug may

be effective in increasing the contractility of detrusor muscle. Chopra et al (1970) also

reported that Varuna is efficacious in neuro-muscular hypotonic and atonic condition of

the urinary bladder.

As seen in the modern texts, the estrogens- metabolized (conjugated) in the liver

reaches the intestines where they are broken down by microorganisms and reabsorbed as

active hormones through entero hepatic circulation. The disturbance of liver function or

intestinal flora can thus alter this mechanism.

Discussion 168

Graph No. 01. Showing distribution of patients by age groups in both groups.

Distribution of Pt.'s by Age in both Groups

24

3

6

02

4

9

02468

10

50-55 56-60 61-65 66-70Age Groups

No.

of P

t.'s

Group A Group B

Graph No. 02. Showing distribution of patients by religions in both groups. Distrubution of Pt.'s by Religion in both Groups

13

20 0

14

1 0 00

5

10

15

Hindu Muslim Christian Others

Religions

No.

of P

t.'s

Group A Group B

Graph No. 03. Showing distribution of patients by occupation in both groups. Distribution of Pt.'s by Occupation in both groups

9

3 3

01

7 7

002468

10

Sedentary Active Labor OthersOccupation

No.

of P

t.'s

Group A Group B

Graph No. 04. Showing distribution of patients by socio-economic status in both groups.

Distribution of Pt.'s by Socio-economic status in both Groups

46

56

7

2

02468

Poor Middle Class Higher class

Socio-economic Status

No.

of P

t.'s

Group A Group B

Graph No. 05. Showing distribution of patients by food habits in both groups. Distribution of Pt.'s by Food habits in both Groups

10

57

8

02468

1012

Vegetarian Mixed

Food Habits

No.

of P

t.'s

Group A Group B

Graph No. 06. Showing distribution of patients by vyasana in both groups.

Distribution of Pt.'s by Vyasana in both Groups

24 3

1210

46

4

0

5

10

15

Smk Tbc Alc T/C

Vyasana

No.

of P

t.'s

Group A Group B

Graph No. 07. Showing distribution of patients by Viharaja nidana in both groups. Distribution of Pt.'s by Viharaja Nidana in both Groups

9

3

8

1313

1

54

0

2

4

6

8

10

12

14

Vy a y Vy a v Dr i t P M u N i

Viharaja Nidana

No.

of P

t.'s

Group A Group B

Graph No. 08. Showing distribution of patients by sleep habits in both groups. Distribution of Pt.'s by Sleep Habits in both Groups

0

54

6

0

4

65

0

2

4

6

8

Day Night Sound Disturbed

Sleep Habits

No.

of P

t.'s

Group A Group B

Graph No. 09. Showing distribution of patients by Jatharagni in both groups.

Distribution of pt.'s by Nature of Jatharagni in both Groups

6

3

0

67

21

5

012345678

M.A. V.A. Tk.A. S.A.

Nature of Jatharagni

No.

of P

t.'s

Group A Group B

Graph No. 10. Showing distribution of patients by the nature of koshta in both groups. Distribution of Pt.'s by Nature of Koshta in both Groups

6

3 3 3

6

43

2

01234567

Mr Ma Kr Sa

Nature of Kostha

No.

of P

t.'s

Group A Group B

Graph No. 11. Showing distribution of patients by nature of bowel habits in both groups.

Distribution of Pt.'s by Nature of Bowel habits in both Groups

1 1

76

4

0

4

7

02468

Re Ir Co Fr

Nature of Bowel Habits

No.

of P

t.'s

Group A Group B

Graph No. 12. Showing distribution of patients by age groups in both groups. Distribution of Pt.'s by Nature of Mutra in both Groups

0 0

15

00 0

15

002468

10121416

Cl Od Fr Qu

Nature of Mutra

No.

of P

t.'s

Group A Group B

Graph No. 13. Showing distribution of patients by age groups in both groups.

Distribution of Pt.'s by Incidence of Desha in both Groups

0 0

15

0 0

15

0

24

6

8

1012

14

16

Anupa Sadhar ana Jhangal a

Nature of Habitat

No.

of P

t.s'

Group A Group B

Graph No. 14. Showing distribution of patients by prakrit in both groups.

Distribution of Pt.'s by Prakriti in both Groups

0 0 0

78

0 00 0 0

87

0 00

2

4

6

8

10

V P K VP VK PK S

Prakriti

No.

of P

t.'s

Group A Group B

Graph No. 15. Showing distribution of patients by nidana in both groups. Distribution of Pt.'s by Nidana in both

Groups

10

35

3 3

0

5

98

3

9

13

0

11

68

3 3

0

7

13

5

1

13

4

002468

101214

A B C D E F G H I J K L M N P

Nidana

No.

of P

t.'s

Group A Group B

Graph No. 16. Showing distribution of patients by chief complaints in both groups. Distribution of Pt.'s by Chief Complaints in both Groups

15 15 15 15

11

8

15 15

1113

1112

1515 1514 14

10

6

15 15

10

1311 11

15

02468

10121416

A B C D E F G H I J K L M

Chief complaints

No.

of P

t.'s

Group A Group B

Graph No. 17. Showing distribution of patients by residual urine in both groups.

Distribution of Pt.'s by Residual Urine in both Groups

56

4

0

76

2

0012345678

10 to 50 cc 51 to 100 cc 101to 200 cc 201 & Above

Residual Urine in cc

No.

of P

t.'s

Group A Group B

Graph No. 18. Showing overall response in Group A..

Overall result in Group A

7

1

4

0

4

8

0

6

0123456789

Sub. P Obj. P.

Overall Response

No.

of P

t.'s

GR MR PR NR

Graph No. 19. Showing overall response in Group B.

Overall Result in Group B

0 02

0

10

0

3

15

02468

10121416

Sub. P Obj. P.

Overall Response

No.

of P

t.'s

GR MR PR NR

CONCLUSION

The long-term exposure to drug induced adverse events and the prohibitive costs

are the primary limitations of prevention therapy.

As there are no clinical, biochemical, or genetic predictors of Vatashtila (BPH)

development or progression, every male is at risk.

A potential role of medical therapy is to prevent the development of Vatashtila

(BPH) or its progression.

The ability to identify those individuals who are predisposed to develop clinical

Vatashtila (BPH) refractory to medical therapy would provide a more compelling

rationale for prophylaxis.

Acute urinary retention is often considered as an absolute indication for medical

intervention, which is related to age, severity of symptoms, and size of prostate

gland. Because urinary retention is a relatively uncommon event, a study designed

to determine whether medical therapy prevents urinary retention would require

large number of patients followed for a long interval of time.

Aim of this therapy is to prevent a relapse of a second episode of urinary retention

after a successful voiding trial. To test the efficacy of the drug therapy for this

indication, patients successfully completing a voiding trial after an episode of

urinary retention would be randomized to active treatment.

The role of treatment for any disease process depends on the magnitude of the

clinical effect and the incidence and severity of treatment related morbidity.

As evident from the present clinical study Vatashtila (BPH) is an ailment of the

ageing male, and is with multifaceted etiology i.e. Vatakara- ahara, vihara, Nithya

Druta Prusta Yana (excess riding /traveling) Mutranigraha, Teekshna oushada and

habits are alcohol consuming, smoking, etc.

The digital rectal examination and neurological examination are done to detect

prostate or rectal malignancy, to evaluate anal sphincter tone, and to rule out any

neurological problems that may cause the presenting symptoms.

I PSS is an ideal instrument to grade baseline symptom severity, and is helpful to

assess the response to the therapy adopted. Which, as a parameter is useful to

Conclusion 168

detect symptom progression in those men managed by watchful waiting. It is not

only meant for the diagnosis of Vatashtila (BPH), but also helpful for the

assessment of a variety of lower urinary tract disorders (e.g. Infection, tumor,

neurogenic bladder disease) in both men and women.

The basic principles of Ayurveda affirms that, the humor Vata dominates with

age by its un unctuousness ( Rukshaguna ), manifestation of Vatashtila (BPH)

will be more. Vata pitta prakruti, Vata kapha prakruti persons are more

susceptible to Vatashtila (BPH) as per the observation of the present study, and

Muslim community is least effected, as these people are with mixed food habits

and when compared with Hindus the extent of dhatu kshaya is not so severe.

After the main treatment (Basti) the follow up the patients are asked to take

Varunnadi kashaya, Shilajatu vati.

It is interesting to detect a reference in “Stadmans Dictionary” regarding female

prostate, and explanation about Para urethral glands in female. asthis reference

makes us to think if any vitiation or derangement of the urethral glands by either

structurally or functionally, it can leads to diseases like urethritis, bulbo urethritis,

where as it is interesting to have thought then “Ashtila or pourusha granthi”

(prostate ) afflictation will take place in female too. In Ayurvedic classics there

is no explanation about female prostate as well as “Ashtila” it needs further

exploration by the scholars of the Ayurveda.

Phytotherapeutic products are also used in modern science’s those are plant

extracts, derived from either the roots, the seeds, the bark, or the fruits of various

plants used. The composition of plant extracts is very complex. They contain a

wide variety of chemical compounds, which include phytostosterols, plant oils,

fatty scids, and phyto-estrogens. which of these is the exact “active” component is

not definitely known. Both the free fatty acids and the sitosterols have been

thought to be the active components.

Statistical enumerations has shown, among all the parameters except incomplete

emptying, are non significant, i.e. comparative effect ( P= <0.05 ). Where as the

objective parameters i.e. weight of prostate, residual urine volume are non

significant, in the comparative effect of two groups. Over all observation of the

Conclusion 169

subjective and objective parameters before and after the treatment, It is evident

even though group-A (Matrabasti) is more significant comparing to group –B

(Shamana.), a satisfactory evaluation of the treatment is possible, if research is

designed with both Shodana and Shamana therapy combined together. And over

all the results observed during the study is encouraging but it needs further

adaptations, diagnostic techniques viz –Prostate specific antigen test, Transrectal

ultra sound, biopsy (to know benign or malignant changes so as to rule out the

malignancy) and hormonal ease, are the standard parameters for the diagnosis as

well as the assessment of Vatashtila (BPH). The taken samples, study duration

and selected criteria for present clinical study may not be sufficient enough for the

better evaluation and treatment of Vatashtila (BPH).

It is observed from this study that, Sukumarakumaraka Ghrita by virtue of its

Balya, Rasayana, Vatahara, Vedanashamaka properties is having a definite role in

the management of Vatashtila (BPH).

I believe that several factors such as aging, the hormonal milieu, nonurologic

diseases, and prostatic growth milieu, nonurologic diseases, and prostatic growth

affect bladder morphometry, neurologic innervations, BOO, and renal function,

and that these factors collectively contribute to clinical BPH. Our present

understanding of the pathophysicalogy of clinical BPH is rudimentary. It is,

therefore, imperative to develop a more comprehensive understanding of the

pathophysiology of symptoms. This knowledge will result in more effective use

of existing therapies and will provide the rationale for the next generation of

therapeutic modalities.

Conclusion 170

SUMMARY

“A Comparative effect of Matrabasti and as Shamana Snehapana with

Sukumara Kumarak Ghrita in the management of Vatashtila (BPH)”

1) Introduction.

2) Review of literature.

3) Methodology.

4) Results.

5) Discussion.

6) Conclusion.

Interest in diseases of Vatashtila (BPH) has always been considerable. In the last

two decades of the 20th century, the interest reached such levels that many important and

valuable studies into this field were carried out, but it was without question the changes

that took place in the treatment of Vatashtila (BPH) that made this work to proceed with

ideal interventional treatment for BPH. The very fact that in the name of “Ashtila or

Pourusha granthi (prostate gland)” has been dealt in such details, in our texts proves

the importance and antiquity of this study. Various measurements for its management

have been advised which only highlights the extent to which this condition was recorded.

Introduction: It has been highlights on panchakarmas, Matrabasti, Shamana

Snehapana, disease of Vatashtila (BPH), Shukumara Kumaraka Ghrita which trial drug of

the study. and incidence, need for study, role of age factor in Vatashtila (BPH).

Objectives of the study: This has explained purpose of the study and objectives

of the study.

Summary 171

Review of literature: This part is described historical review, vyutpatti and

nirukthi of both bastikarma and Sneha, Vatashtila (BPH) The shareera part deals with

both anatomy and physiology related to the Vatashtila (BPH). In the review Basti, the

procedure, types indications and contraindications etc of nirooha, anuvasana etc are

elaborated.

Methodology: This part deals with the administration of Matrabasti and Shamana

Snehapana, ingredients of Shukumara Kumaraka Ghrita and its properties. The study

design, subjective and objective parameters with their gradings and diagnostic criteria,

and criteria for assessment of the parameters are explained.

Observations and Results: This part is dealt in the result section. The

demographic data, response to treatment and overall response are also dealt. Results are

given in the form of tables along with a short description. The improvements in selected

parameters are statistically analyzed and presented in the form of tables and graphs.

Discussion: This part is divided into five sections. Four section entitled- The first

sections discussion on Sharira comparison with prostate gland and disease of Vatashtila

(BPH).The second section discuss about the discussion on analysis of clinical response to

the treatment with logical interpretation study. The third section deals discussion on role

of Sukumara Kumaraka Ghrita in Vatashtila (BPH). Forth section discuss about the

probable mode of action and probable mechanism of Matrabasti and Shamana Snehapana

with Sukumara Kumaraka Ghrita in Vatashtila (BPH).

Summary 172

i

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96) Shrimad Vriddha Vagbhata, Astanga Sangraha, Sutrasthana, Chapter 28, Shloka 8,9. Edited by Ravidatta Tripathi, 10th edn. Varanasi : Choukambha Sanskrit Pratisansthana ; 1996. p.no- 487-488. 97) Agnivesa, Charakasamhitha Shiddisthana chapter 4th sloka 53. Edition ; reprint,2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 701. 98) Vagbhata, Astanga Hridaya, Sutrasthana, “Hemadri Commentary,” Chapter 19, sloka 67, Edited by Bhishagacharya Harishasashtri ParadakaraVaidya 7th edn. 1982. Varanasi : Choukambha Sanskrit Sansthan ; p. no- 283. 99) Sushrutha, Sushruthasamhitha chikishtasthana chapter 35th, sloka 18, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 527. 100) Vriddha Jeevaka, Kashyapa Samhita, Khilasthana, 8th chapter, shloka 104-105, Edited by Pandita Hemaraj Sharma, Varanasi: Chaukhamaba Sanskrit Samsthana, 4th Editon 1988.p.285. 101) Agnivesa, Charakasamhitha Shiddisthana chapter 4th sloka 52-54. Edition ; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no.285. 102) Pandita Sharangadhara Acharya, Sharangadhara Samhita, Uttara khanda, chapter 5, shloks 5, Edited By Pandita Parashuram Shastei Vidyasagar, 3rd Edition, 1983.p.320. 103) Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 22-23. Varanasi: Krishnadas Academy; 1982. p. 275. (Krishnadas Academic series 4). 104) Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 27. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 694. (Kasi Sanskrit series 228). 105) Sushrutha, Sushruthasamhitha Chikitsasthana chapter 38 sloka 1-6. Varanasi: Krishnadas Academy; 1980. p. 539-540. (Krishnadas Ayurveda series 51). 106) Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 24-26. Varanasi: Krishnadas Academy; 1982. p. 276. (Krishnadas Academic series 4). 107) Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 26-30. Varanasi: Krishnadas Academy; 1982. p. 276-277. (Krishnadas Academic series 4). 108) Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 28-29. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 694. (Kasi Sanskrit series 228).

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112) Sushruta, Sushruta samhita, Sutrasthana, Chapter 41, Shloka 14-15. Edited by Kaviraj Ambikadatta Shastry, 6th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. P No.155. 113) Vagbhata, Astanga Hridaya, Sutrasthana, Chapter 16, sloka 25, Edited by Bhishagacharya Harishasashtri ParadakaraVaidya 7th edn. 1982. Varanasi : Choukambha Sanskrit Sansthan ; p. no- 243,to245..

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128) Agnivesha, Charaka samhita, Sutrasthana, Chapter 13. Shloka 23-28. Edited by Rajeshwaradatta Shastry, 4th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1994. p. 185.

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152) Vagbhata, Astanga Hridaya, Sutrasthana, Chapter 16, sloka 19, Edited by Bhishagacharya Harishasashtri ParadakaraVaidya 7th edn. 1982. Varanasi : Choukambha Sanskrit Sansthan ; p. no- 246 to 248. 153) Agnivesa, Charakasamhitha Sutrasthana chapter 13th sloka 81, edition ; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 86. 154) Sushrutha, Sushruthasamhitha chikishtasthana chapter 31th, sloka 34, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 511. 155) Agnivesa, Charakasamhitha Sutrasthana chapter 13th sloka 29-40, edition ; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 83. 156) Vagbhata, Astanga Hridaya, Sutrasthana, Arunadatta, Chapter 16, sloka 19, Edited by Bhishagacharya Harishasashtri ParadakaraVaidya 7th edn. 1982. Varanasi : Choukambha Sanskrit Sansthan ; p. no- 247. 157) Agnivesa, Charakasamhitha Sutrasthana “Chakrapani”chapter 13th sloka 29-40, edition ; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 83.

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222) Sushrutha, Sushruthasamhitha Uttaratantra, “Dhalhana” chapter 59th, shloka 8 to 9, fourth edition; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no-792. 223) Bhavamishra, Bhavaprakasha Poorvakhanda chapter 5 sloka 123. 5th ed. Varanasi: Chaukhambha Orientalia; 1988. (Chaukhambha Sanskrit series 130).

224) Sri Vaidya Shodala, Gada nigraha edited by Indradeva tripathi 1st edition, delhi; Chaukhambha Sanskrit Sansthan; 1969, chapter 27, shloka 1-2, P, no-625

225) Sushrutha, Sushruthasamhitha Sharirasthana, “Dhalhana” chapter 6th, shloka 25, fourth edition; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no-373. 226) Agnivesa, Charakasamhitha Chikisthasthana chapter 25th shloka 15, edition; reprint,2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 592. 227) Nigantu Ratnakara, Bastisharira and kriyavijnyana. By Vasant Balaji Athavale, Mutrakrachra prakarna, P,no-1029.

xv

228) Sushrutha, Sushruthasamhitha Uttaratantra, chapter 58th, shloka 7 to 8, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 787 229) Agnivesa, Charakasamhitha Siddisthana “Chkrapani” chapter 9th shloka 36, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 719 230) John D, et.al. Epidemiology, etiology, pathophysiology and diagnosis of Benign Prostatic Hyperplasia in Campbells, Urology by Patrick C, Walsh, et al, 7th edition, 1998, Vol 2, section 8, chapter 39, P.no- 1340. 231) Vagbhata, Astanga Hridaya, Sutrasthana, Chapter 1, sloka 8, Edited by Bhishagacharya Harishasashtri ParadakaraVaidya 7th edn. 1982. Varanasi : Choukambha Sanskrit Sansthan ; p. no- 07. 232) Sushrutha, Sushruthasamhitha Uttaratantra, chapter 58th, shloka 7 to 8, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 787 233) Sushrutha, Sushruthasamhitha Sutrasthana, chapter 21th, shloka 33, fourth edition;1980. Edited by vaidya jaadavaji trikamji acharya, Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 105,106. 234) Sushrutha, Sushruthasamhitha Sutrasthana, chapter 21th, shloka 30, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 105. 235) Sushrutha, Sushruthasamhitha Uttaratantra, chapter 58th, shloka 7 to 8, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 787 236) Bailey and love, Short practice of surgery. Chapter 66, Edited by- R. c. c. Russell, Norman .s. Williams. 23ed edition, P no 1238. 237) John D, et.al. Epidemiology, etiology, pathophysiology and diagnosis of Benign Prostatic Hyperplasia in Campbells, Urology by Patrick C, Walsh, et al, 7th edition, 1998, Vol, 2, section 8, chapter 39, P.no- 1348. 238) Agnivesa, Charakasamhitha Siddisthana “Chkrapani” chapter 9th shloka 49, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 720. 239) Sushrutha, Sushruthasamhitha, Chikisthasthana chapter 5th, shloka 27, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 429. 240) Agnivesa, Charakasamhitha Chikisthasthana chapter 28th shloka 212, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no, 625,. 241) Agnivesa, Charakasamhitha Chikisthasthana “Chakrapani,” chapter 28th shloka 85, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no, 620. 242)Agnivesa, Charakasamhitha Siddisthana “Chkrapani” chapter 9th shloka 11, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 719.

xvi

243) Agnivesa, Charakasamhitha Siddisthana “Chkrapani” chapter 9th shloka 49, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 720. 244) Sushrutha, Sushruthasamhitha Uttaratantra, chapter 58th, shloka 27, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 789. 245) Agnivesa, Charakasamhitha Sutrasthana with “Chkrapani” chapter 7th shloka 8, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 49. 246) Agnivesa, Charakasamhitha Sutrasthana with “Chkrapani” chapter 7th shloka 13, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 49,50. 247) Sushrutha, Sushruthasamhitha Uttaratantra, chapter 58th, shloka 27, fourth edition ; 1980. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 789. 248)Agnivesa, Charakasamhitha Siddisthana “Chkrapani” chapter 9th shloka 49, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 720. 249) Agnivesa, Charakasamhitha Sutrasthana with “Chkrapani” chapter 7th shloka 8, edition; reprint, 2004. edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; p.no. 49. 250) John D, et.al. Epidemiology, etiology, pathophysiology and diagnosis of Benign Prostatic Hyperplasia in Campbells, Urology by Patrick C, Walsh, et al, 7th edition, 1998, Vol, 2, section 8, chapter 38, P.no- 1312. 251) John D, et.al. Epidemiology, etiology, pathophysiology and diagnosis of Benign Prostatic Hyperplasia in Campbells, Urology by Patrick C, Walsh, et al, 7th edition, 1998, Vol, 2, section 8, chapter 39, P.no- 1347. 252) I-PSS (AUA) Guidelines on benign prostatic Hyperplasia, P,no-250, (pub med, or googul.)

253) Chakrapanidatta, Chakradatta chapter 32, sloka 29-33 2nd ed. EditorBhishagratna Shibrahama Shankara mishra. Varanasi: Chaukhambha Publishers; 1998. p. 279. (Kasi Ayurveda series 17).

254) Govindadasa, Bhaishajya Ratnavali edited by Ambikadatta Shastri, chapter 34, shloka 59-65, 2ed edition ; Publishers; Chaukhambha Sanskrit Sansthan; p no-497. 255) J ,L ,N Shastri ,Drvyaguna Vijnana Vol,- 2, edition;2004, Publishers; Chaukhambha Sanskrit Sansthan; P no-1040,1042,1044,673,266,524. 256) P. V .Sharma , ,Drvyaguna Vijnana Vol,- 2, edition 12th -1989, Publishers; Chaukhambha Sanskrit Sansthan; P no-630, 761, 763, 332, 813,634,636, 638,736. 257) John D, et.al. Epidemiology, etiology, pathophysiology and diagnosis of Benign Prostatic Hyperplasia in Campbells, Urology by Patrick C, Walsh, et al, 7th edition, 1998, Vol, 2, section 8, chapter 39, P.no- 1340. 258) T.R. Harrisons. Harrison.s; Principles of Internal Medicine, Editor-T.R. Harrisons, Chapter 95, International edition-2003, 15th edition.p.-609.

xvii

CASE SHEET FOR VATASHTILA (BPH) Post Graduate Research and Studies Center (Panchakarma)

Shri. D.G.M. Ayurvedic Medical College, Gadag Guide : Dr. P. Shivaramudu M.D. (Ayu) Co-Guide : Dr. Shashidar H. Doddamani M.D. (Ayu) P.G. Scholar : Dr. Vijaymahantesh M. Hugar. 1. Name of the patient : Sl. No. 2. Father’s/ Husband’s Name : OPD. No. 3. Age : Years IPD No. 4. Sex Bed No. M F 5. Religion : Hindu Muslim Christian Others 6. Occupation : Sedentary Active Labour Others 7. Economical Status : Poor Middle class Higher class 8. Address :………………………………………….Phone No. ………………………………………… ………………………………………… E-mail : Pin : 9. Date of Schedule Initiation : 10. Date of Schedule Completion : 11. Result :

Well respond

Moderate response

Mild response

No response

12. Consent : I hereby agree that, I have been fully educated with the disease and treatment. Hereby satisfied whole heartedly, and accept the medical trial

over me.

Investigator’s Signature. Patient’s Signature.

xviii

I. COMPLAINTS WITH DURATION :

Sl. No. Chief complaints Duration

01. Ashtilavat granthi a. Urdhwa b. Ayata c. Unnata d. Deergha vartulakara e. Ghana f. Chala – Ishat chala – Achala –

02. Mala sanga 03. Anila sanga 04. Adhmana 05. Ruja / Sashoolayukta mutratyaga

(Difficulty in micturition)

06. Mutra sanga

07. Incomplete emptying of bladder

08. Muhurmuhur Mutra pravritti (Increased urine frequency)

09. Alpa-alpa mutra pravritti (Intermittency)

10. Urgency

11. Atibadhha mutra pravritti (Weak stream)

12. Staring

13. Naocturia

II. ANUBANDHI VEDANA (Associated Complaints)

Hematuria

Burning micturition

III. HISTORY OF PRESENT ILLNESS :

Mode of onset Acute Gradual

Mutradhara Continuous Intermittent

xix

History of recurrent attack

Yes No

If, Yes –

Frequency of attacks

Intermittent time between attacks

- 3 months

- 6 months

- 9 months

- 12 months

IV. HISTORY OF PAST ILLNESS :

Teekshnaushadha sevana -

Yes No

If yes, then mention the details –

Prostate cancer Prostatitis

Urinary bladder carcinoma Bladder calculi

Urethral stricture Stricture of the neck of the bladder

Hemituria UTI

Tuberculosis Diabetes

Neurologic and spinal cord

V. FAMILY HISTORY :

Specify the relation No

xx

VI. PERSONAL HISTORY :

1 Ahara Vegeterin Dominent rasa

in food

Non

vege

I

table

M xed

2 Vihara Vyayama Vyavaya Drita

prishtayana

Mootra

ir

n gamana

Tobacco Tea Coff Alc ee ohol 3 Vyasana

ka Othe Smoking Guta rs

Day Night Soun Disturbed d 4 Nidra

f hours s p ay Interrupted No. o le t in a d

5 Jatharagni Sam Manda Vishama agni

6 Koshta Mridu Madhyama Krur a

7 Mala Frequency Irreg Constipation Regular ular

Consistency

Mootra dour Frequency Quantity Colour O8

Intake of wa xima l (l rter appro te y

liters per day

Out put ite s per

day)

9 a Sadhrana Jangala Type of desha Anup

10 pational history Occu

I Work involving any p ysical strain/Vega dharana . special h Yes /No

II Exposure to more sunlight during working rs. Yes /No. H

III YeWhether symptoms produced during working hours s /No.

VII A. ROGI SAMANYA PAREEKSHA

We Temperature in

degree Celsius

ight in kgs. Height in cms.

Pulse rate per

Minute Minute

n Heart rate per Blood pressure i

mm Hg

Respiration per

Minute

xxi

B. ASTAST

1. N

HANA PAREEKSHA

adee :

Dosha

Gati

Poornata

Spandana

Kathinya

2. Mutra :

VIII. DASHAVIDHAPAREEKSHA

PK SAMA

3. Mala :

4. Jihwa :

5. Shabda :

6. Sparsha :

7. Druk :

8. Aakruthi :

A. PRAKRITI

V P K VP VK

B. VIKRITI

Dosha Desa

Dushya Kaala

Bala Linga

xxii

C. SAARA Pravara Madhyama Avara

D. SAMHANANA mhatha Madhyama samhatha Asamhatha Susa

E. PRAMANA Sama Heena Adhika

F. SATMYEkarasa

A Sarvarasa

Rookshasaatmya Snigdhasaatmya

G. SATVA Pravara Madhya Avara

H. AHARASHAKAbhyavahaara Pravara Madhyama Avara

THI

Jaranasak ra a a Avara thi P v ra M dhyama I. VYAYAMASHAKTHI

a h a raPravar Mad y ma Ava J. VAYAHA

Madhya Vrudha

IX. SROTOPAREEKObserved laxana Yes No

SHA Srotas

Atisrishta Atibaddha - Alpaalpa - Bahala - Sashoolayukta

Stabdha medhrata

a srotas

Mootravah

Mutra nirodha Krichhra and alpa-alpata Sashabda Shoolayukta Atidrava Atighrathita Atibahu

Durgandhata

Purishavaha srotas

xxiii

Anya srotas pariksha

Srotas Observed Lakshana

Pranavaha

Annavaha

Udakavaha

Rasavaha

Rakthavaha

Mamsavaha

Medovaha

Asthivaha

Majjavaha

Sukravaha

Swedovaha

X. SYSTEMIC EXAMINATION

A. Urinary system –

s lar system –

Yes No

B. Cardiova cu

C. Respiratory system –

D. Per-abdominal examination –

E. Central nervous system –

F. Musculoskleletal system –

X1. NIDANAPAREEKSHA

Sl. Nidana

Aharaja nidana

1. Rooksha ahara atisevana

2. Rooksha madya atisevana

3. Anupamamsa atisevana

4. Matsya atisevana

5. Adhyashana

6. Ajeerna

xxiv

7. Katu amla, kashaya rasa atisevana

Viharaja nidana

8. Vyayama

9. Nitya dhrit pristayana

10. Ati stree prasanga

11. Ati bharava hana

12. Mutranigraha

Anya

13. Teekshna aushadha sevana

XII. PARAM EET RS

A. Subjective parameters

ATMEN

OGICAL ASSOCIATION SYMPTOMS INDEX & (I-PSS)

(Questionary for patients) an Less than About half More than Almost

At all time Half the time Always

1. Over the past

how often 5

sensation of not

emptying your bladder

onth,

0 1 2 3 4 5

ou

0 1 2 3 4 5

BEFORE TRE T

AMERICAN UROL

No. of Pt.’s Less th

1tim in 5 Half the time the

month,

you had a 0 1 2 3 4

completely after you

finished urination?

2. Over the past m

how often you have

had to urinate again less

than 2 hours after y

finished urination?


how often have you

stopped and started

again several times

when you urinated?

xxv





h,

0 1 2 3 4 5

?

th,

d 0 1 2 3 4 5

ow many times you did most typically get up to urinate form the time

until the time you got up in the morning?

Time 2 2Times 3 3 Times 4 4 Times 5 5Times

GICAL ASSOCIATION SYMPTOMS INDEX & (I-PSS)

No. of Pt.’s out half More than Almost


how often you had a 0 3 4 5

sensation of not

emptying your bladder

ompletely after you

,

e 0 1 2 3 4 5

5. Over the past mont

how often have you had

a weak urinary stream

6. Over the past mon

how often have you ha


begin urination?

7. Over the past month, h

you went to bed at night

0 None 1 1

AFTER TREATMENT

AMERICAN UROLO

(Questionary for patients)

Less than Less than Ab


1 2

c

finished urination?

2. Over the past month

how often you hav

had to urinate again less

than 2 hours after you

finished urination?

xxvi



stopped and started

again several times

when you urinated?

h,

2 3 4 5

?

th,

d 3 4 5

ow many times you did most typically get up to urinate form the time

until the time you got up in the morning?

Time 2 Tim 4 4 Time 5 5Times





5. Over the past mont

how often have you had 0 1

a weak urinary stream

6. Over the past mon

how often have you ha 0 1 2


begin urination?

7. Over the past month, h

you went to bed at night

0 None 1 1 2Times 3 3 es s

Score chart for Malasanga No. of Pt.’s Less than Less than About half More than Almost


ow often you had 2 3 4 5

defecation of mala.

a sanga

1. Over the past month

h 0 1

the sensation after

Score chart for Mootr

00 ay. 00 ml. Per day

00 ml. Per day.

Grade 3 – 200 ml to 300 ml. Per day.

Grade 0 – 500 – 25 ml. Per d

Grade 1 – 400 – 5

Grade 2 – 300 – 4

xxvii

Score chart for Anala (Subjective & examiners)

On percussion On auscultation

Score chart for Adhmana (Subjective & examiners)

On percussion

core chart for Ruja / Sasholayukta mootratyaga

On auscultation

S

miners Assessment gradings

Objective Parameters

Subjective gradings Exa

B.

ECTAL EXAMINATION CHART

f lobe Posterior Median ft

lateral

BEFORE TREATMENT DIGITAL R Enlargement o

Anterior` Right lateral Le

Size of Normal prostate

Mild enlarged Moderately ed

enlarg

Upper Not With difficulty Reached border Reached reached

Consistency Smooth t hFirm o ard Hard

Surface Regular Irregular

Mobility obile Fixed M

Rectal mucosa

Free Adherent

Tenderness Present Absent

Present Absent

Present Absent

Present

bsent A

Present Absent

Grade 0 – Normal. Bearable Unbearable

Grade – Bearable 1 Grade 2 – Unbearable. .

xxviii

AFTER T EATME

RE XAMINATION CHART

ent Median Anterior`

lateral

Left

lateral

R NT DIGITAL CTAL E Enlargem

of lobe

Posterior Right

Size of

prostate

Mild enlarged oderately

Normal M

enlarged

Upper Not With difficulty Reached

border Reached reached

Consistency Smooth h HFirm to ard ard

Surface reguRegular Ir lar

Mobility Fixed Mobil e

Rectal

mucosa

dherFree A ent

Tenderness Absent Present

nt of e of Vataastila (BPH)

ling t & le t lobe indicates the Ayatatakara astila granthi.

eeling of upper border indicates the Urdhwa astila granthi.

ng ior lobe indicates the Unnata astila granthi.

Feeling of firm to hard or hard consistency indicates the Ghana astila granthi.

Feelings of mobility or firmness indicates the Chala / Ishad chala / Achalatwa of

astila granthi.

Assessme the shap

Fee of righ f

F

Feeli of anter

xxix

SCORE CHART FOR DIGITAL RECTAL EXAMINATION Score chart for size of prostate Score chart for Upper border

Grade 0 Normal Grade 0 Not reached

Grade 1 Mild enlargement Grade 1 With difficulty reached

Grade 2 Moderate enlargement Grade 2 Reached

USG findings –

U.S.G. - Report Before treatment fter treatment

Score chart for Mobility

Grade 1 = Fixed

Grade 2 = Slightly mobile.

Grade 3 = Mobile.

Bladder - Trabacular Normal Coarse Normal Coarse Wall thickness Normal Thickned Normal Thickned Residual Urine Prostate Size Antero - Posterior Width Height Prostate Volume Kidney Right Left Right Left Hydronephrosis Caculi Size of prostate

Score chart for Weight of prostate




Grade 4 – 75 & above.

xxx

Residual urine flow –

1 2 3 4 Score ch esidual urine flow –

ad

Grade 3 – 100 to 200 cc.

Grade 4 – 200 & abo

III. LAB IN

Urine exa

Serum creatinine dl

art for r

Gr e 1 – 10 to 50 cc.

Grade 2 – 50 to 100 cc.

ve.

X VESTIGATIONS :

mination –

Dsf df skasdflk asmg/

Urine albumin

Urine sugar

Blood investigations –

Sl.No Name of the Test Values

01. Blood urea Mg/dl

02. ESR /1st Hr.

03. Hb% Gm%

3. Total Count

PWBC er cm

RBC Per cm

4. Differential Coun

N E B M L

t

5. Random blood sugar

S Mg/dl RB

xxxi

XIV. CHIKITSA PATRIKA

Local application of Tila taila all over the body and mridu abhyanga is to be done

Sukumarakumaraka ghrita.

unt

ced

Pratyagamana

kala

No. of times

motion passed

Upadrava if

any

Nadi sweda.

Matrabasti - 70 ml. of

Day Time of Amo

performance introdu

01. am. ml. min.

02. am. ml. min.

03. am. ml. min.

04. am. ml. min.

05. am ml. min. .

06. am. ml. min.

07. am. ml. min.

08. am. ml. min.

B. Sha Sukumarakumaraka ghrita – For 16 days

.D.)

(J before

Observations – XV. ASSESSMENT OF R S

XV1. INVES

Signature of Co-Guide Signature of Guide

managa snehapana with

(15 ml B

ust one hour meals.)

ESULT

TIGATORS NOTE :

Flow Chart No. 04. PROBABLE MODE OF ACTION FOR LOCAL

EFFECT OF MATRABASTI ON VATASHTILA (BPH)

BASTI

Local Hyperthermia

↑ Osmolarity of Extra- cellular compartment

Desiccation of prostate

↓ Cell size of Prostate by Osmosis

↓ Size of Prostate

↓ Size of Prostate

PROSTATE NORMAL

ANATOMICALLY

Flow Chart No. 05.

PROBABLE MODE OF ACTION OF MATRABASTI THERAPY (Ayurvedic Concept : Su.S.Chi. 35/24-28)

BASTI

Absorption and Circulation with the help of Apana, Udana

and Vyana Vayu

Normalisation of Vitiated Apana Vata

Dosha in equilibrium stage

Remission of complaints

Flow chart No. 06. DIAGRAMMATIC REPRESENTATION OF

PROBABLE MODE OF ACTION OF MATRABASTI THERAPY ON (BASTI) URINRY BLADDER

BASTI

Absorbed through rectal mucosa

Stimulus Transmitted

Resetting of Micturition Strech Reflex

Stimulation of Postganglionic

parasympathetic nerve endings

Release of Acetylcholine

Contraction of detrusor muscles of urinary bladder

&

Relexation of Trigonal

sphincter

Decreased Residual urine

Documents

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