Male Infertility and Management (Concept of Sukrawaha Srotas)

Infertility is no longer an urban phenomenon, nor is it confined to women. In a growing and alarming trend, the problem of infertility in men is moving out of purely urban settings and is surfacing in tier II and tier III cities too. The alarming increase in infertility rates on lifestyle changes resulting in stress and obesity caused by lack of physical exercise, changes in eating habits and pollution accompanied by medical disorders like diabetes. Male Infertility is extremely complex to diagnose and cure. Often, we try to find out the fundamental reason by various tests and research. Semen samples are tested in the laboratory to know the sperm count, sperm strength and other factors. Hormonal levels are checked to determine the testosterone levels.

This book is a concise summary of current researches including its Ayurvedic aspects. The book covers the underlying physiological, genetic and environmental components which may contribute towards its pathogenesis and also covers the different aspects of investigations and definitive management according to Ayurvedic concepts. The purpose of this book is to answer the various questions about Infertility so that any one can easily understand various aspect of this disease'.

Dr. Ajay Kumar is distinguished Ayurvedic Clinician and presently working as lecturer in Dept. of Kayachikitsa at Govt. Ayurvedic College, Varanasi. He has completed his B.A.M.S. from Govt. Ayurvedic College, Varanasi in 2006 and M.D. (Kayachikitsa) from Institute of Medical Sciences. B.H.U., Varanasi in 2009. He has also done Ph.D. in Kayachikitsa and Diploma in Yoga from B.H.U., Varanasi. After completing M.D. in Kayachikitsa, he was appointed as Assistant Prof. in Dept. of Kayachikitsa in B.H. U. on contractual basis.

Dr. Ajay Kumar is recipient of several awards and medals. He is the first rank holder in all professional exams of B.A.M.S. in University. He has got 'Ayurmedha Award' from Dabur India Limited for 1st position in B.A.M.S. first prof. Exam and also got 'Jiwak Award' from Himalaya Herbal Healthcare for 1st position in B.A.M.S. third prof. Exam.

He has presented several scientific papers in National and International conferences. He has published almost 20 scientific papers in National and International journals and magazines. He has done too much work on hypertension, diabetes, obesity, impotency and gastro-intestinal diseases. He has chaired many seminars all over India and is member of many National Bodies. He is editor of several National and International journals also.

Dr. Tina Singhal is renowned Ayurveda Scholar and Assistant Professor of Rachana Sharir (Anatomy) at Govt. Ayurveda College and Hospital, Varanasi. She has passed B.A.M.S. from Govt. Ayurveda College and Hospital, Varanasi and M.D. from Institute of Medical Sciences, B.H.U., Varanasi.

She has presented many scientific papers in National and International conferences and seminars. She has also published almost 20 scientific research papers in different journals. She has done too much work on marma and osteology in Ayurveda and published almost 6 papers on clinica1 aspect of marma. She is editor of several National and International journals. She has chaired many seminars all over India. She is member of many associations.

It is a matter of great pleasure to write foreword for the book 'Male Infertility and Management' written by Dr. Ajay Kumar, Lecturer, Kayachikitsa at Govt. Ayurveda College & Hospital, Varanasi. A Scientific treaties of this nature and work of such merit and utility doesn't require any foreword. However, I can never bring myself to deny a request from respectable scholar and teacher. The author is eminently qualified for the task undertaken by him, he has done a distinct service to Ayurveda by writing such a nice book on very important subject i.e. Infertility.

Prevalence of Infertility among male is increasing by leaps and bounds especially in India. Infertility may be the complications of various disorder, physical or psychological. Concept of Srotas is unique contribution of Ayurveda to medical system. Srotsas transport all the Drishya (perceptible) and Adrishya (imperceptible) Bhavasin the body. Shukravaha Srotas is made for the production and transportation of Shukra Dhatu.

The textbook has been divided into several chapters, which deal with prospective subject matters related to general introduction of Shukra, Shukrotpatti, different types of infertility, Ayurvedic and Modern aspect of infertility and management. This book has been written to highlight and to make clear cut understanding of the concept of Shukravaha Srotas regarding its macroscopic and microscopic level and to construct new scientific dimensions to produce ideal and healthy generation for the welfare of family and the society.

Shukravaha Srotas is the channel for the passage of semen and of sperms, starting from testis where the sperms are produced from seminiferous tubules. It extends up to the external urethral sphincters. According to Ayurvedic Acharya, the Vrishana (testes), Shefa (penis), Stana (mammary glands) and Majja are the Mula of Shukravaha Srotas. Acharya Sushruta and Vagbhat suggest Stana as the site origin of Shukra. Shukra Dhatu is defined as seventh Dhatu and formed by Ahar rasa and Majja Dhatu (bone narrow).

Since Shukra is the end product of Dhatu Parinama, it is said to be the quintessence of food. Its wastage leads to a number of serious diseases or even death. Hence, one must protect his Shukradhatu at all costs with self-discipline. Apart from symptoms described above, the Shukra Kshaya further leads to several other diseases like Kanthadhvansa (Hoarseness of the voice), Shirogata Kapha Kshaya (Feeling of hallowness of head), Angamarda (pains all over the body), Aruchi and Avipaka (dyspepsia), Jvara, Kasa, Shvasa (cough and dyspnoea) Pratisyaya (common cold) and the patient may at last go to death by excessive sexual indulgence. The drugs or treatment which increases the sexual vigour and desire on women are known as Vajikarana Dravyas. Vajikarana Chikitsa is one of the Ashtanga (eight branches) of Ayurveda, that can be administered both in health and disease.

Even though there may be many excellent books on infertility or impotency, a paucity of concise book on Male infertility, written in simple easy to understand language was felt by students and scholars. Thus this effort made by author will be very useful and can be applicable in day to day practice. I have no hesitation in saying that this book will serve as text book and reference book of for both undergraduate and postgraduate students and teachers of respective disciplines.

I feel pleasure to present my newest book 'Male Infertility and Management'. I wrote the book with the hope that it would become an indispensable desktop reference for everyone who ever presents to any audience. It will beone of the book that focuses to this level of detail on Male infertility. Infertility has, in the last few years surfaced in society as a significant problem affecting as many as 15% of couples.

Idea behind Book

In day to day practice, we see too much patients of infertility and this number is always increasing. There is no hope other than Ayurveda for this problem. Most of the patients is unaware about the problem. In recent past, very few literature has been written and very few are available till date about infertility. This book contains all the problem and solution for common men as well as researchers. It will be very useful for the students to understand the different dimensions of infertility and management. Impotence, one of the most feared words for men, is classified as either primary (never able to have intercourse), or secondary (had intercourse before dysfunction). Secondary dysfunction is the most common and can occur at any age and results from different causes. Impotence may be caused by a medical condition, such as diabetes, genital infection or physical stress such as fatigue, alcoholism. It can also reflect psychological issues such as performance fears, poor communication, adjusting to a new partner, or other kinds of emotional distress. Each of these can reduce sexual arousal and cause the loss of an erection. Impotency can be caused by lack of proper blood flow or disturbance in neural transmissions to the penis. Other reasons can be infections, injuries, sexually transmitted diseases, ejaculatory disturbances and sexual dysfunctions. This gives an obvious reason for men to go for male fertility tests that can help them treat their infertility problems.

This book has several chapters describing the whole reproductive system from origin of sperm to conception as per both Ayurvedic perspective as well as modern. The chapter 'Concept of Srotas' describes Srotas as the internal transport system or channels of the body. They have selective function to allow only such nutrient materials as are required by one and not others. Therefore Srotas has great importance to maintain the equilibrium, development of the body and in the application of treatment to the patients.

The chapter 'Sukravaha Srotas' tells us Mulas of Sukravaha Srotas, Sukramarga, Medhra Dwara, Causes of Sukravaha Srotas Dushti. Sukravaha Srotas are affected due to sexual act in improper time and non-vaginal tract, suppression of discharge of semen, excessive coitus and application of Shastra, Ksharaand Agni.

The chapter 'Concept of Sukra' describes that sukra is Saumya which has originated from Jala Mahabhuta. Sukra is seventh in order of formation of Sapta Dhatu and essence of all Dhatus. Sukrais produced as a result of successive evaluative metamorphosis of Ahara Rasa. Etymology of word Sukra, Synonyms of Sukra, Pancabhautika Sangathana, Rasa of Sukra, and Quantity of Sukraare also described in this chapter.

In the chapter of management, we have discussed about Vajikaran, which is an important treatment modality as per Ayurveda and proposed benefits are manifold including increased sexual capacity, improving health of future progeny as well as in treatment of many common sexual disorders like infertility, erectile dysfunction and premature ejaculation. Vajikaran medicines can be taken in two forms : Internal usage i.e. oral intake and external usage i.e. application of various preparations like powder, paste, massage of body with various herbal oils through the prescribed procedures. These all are discussed in detail in this chapter.

Acknowledgement

At this very juncture of Launch of my new book 'Male Infertility and Management', I prostrate at the feet of Almighty 'GOD' to infuse me the desire and ability, without his blessings it would not have been possible for me to reach at this destination.

With immense pleasure and gratitude, I regard my deep respect to my learned and reverend teacher Prof. B.N. Upadhyay, Ex. Professor & HOD, Kayachikitsa and Prof. H.H. Awasthi, Ex. HOD, Rachana Sharir, Institute of Medical Sciences, Banaras Hindu University, Varanasi, who gave me scientific searchlight at every stage and has been kind enough to extend their supervision and guidance throughout the journey of this book. I humbly take this opportunity to express my gratefulness to them.

I express my profound gratitude to my respected teachers Prof. R.H. Singh, Emeritus Professor and Ex-Vice Chancellor, Rajasthan Ayurveda University, Jodhpur, Prof. S.P. Mishra, Vice-Chancellor, Uttrakhand Ayurved University, Dehradun.

I also express my gratitude to respected teachers Prof. J.S. Tripathi, Professor & HOD, Kayachikitsa, B.H.U., Prof. O.P. Singh, Dr. K.N. Murthy, Dr. Ajay Pandey, Dr. Rajendra Prasad, Dr. Vijay Srivastava & Dr. J.P. Singh for their encouragement.

It is an excellent opportunity to express the deepest gratitude to Prof. S.N. Singh, Principal & Superintendent, Government Ayurveda College & Hospital, Varanasi, who helped by his constant and valuable guidance, encouragement and suggestions. I am also thankful to our senior teachers and colleagues Prof. A.K. Sonker, Prof. Sanjay Pandey, Dr. K.K. Dwivedi, Dr. Shailendra Srivastava, Dr. P.L. Sankhua, Dr. C.S. Pandey, Dr. Yashwant Chauhan, Dr. Sameer Rathore, Dr. Ashutosh Yadav, Dr. Vijay Kumar Rai, Dr. Prakashraj Singh, Dr. D.N. Singh, Dr. Ashwini Gupta, Dr. Mahesh Narayan Gupta, Dr. Umesh Chandra, Dr. Manish Mishra, Dr. Vinay Mishra, Dr. Anand Vidyarthi, Dr. B.N. Maurya, Dr. Ramesh Gupta, Dr. Parwez, Dr. Sushil Dubey and all teachers of Government Ayurveda College & hospital, Varanasi.

I express my love to my wife Dr. Tina Singhal and my son 'Rishabh' whose little talk refreshed and delighted me, when I had exhausted from my work.

I really feel indebtedness to those all who have not been included here, helped me in one way or other, to bring up this work. I would like to thank to all the authors, scholars, publishers who provided materials and source related to this work.

I would also like to express my special thanks to Mr. Ashok Gupta and Mr. Sunil Gupta from Chaukhambha Vishvabharati. I acknowledge all the team from the core of my heart without whom this couldn't be possible.

In Ayurveda, different Aisna (instinct or sentiment) has been described such as Prana Aisna, Dhan Aisna, Parlok Aisna and Putra Aisna. Among them Putra Aisna or 'A babe in a house' is one of the most important Aisna of human. Ayurveda also believes that male and female instinct of Putra Aisna is fulfilled by the copulation of male and female and they reproduce Supraja (ideal and healthy generation) for the well-being of the family as well as the society. Susruta has scientifically established that Supraja or ideal progeny can only be reproduced by four vital and essential factors. They are Rtu (ovulation or climate and ideal fertility period or healthy menstrual cycle), Ksetra (field for germination or uterus) and Ambu (nutritional status of Garbha) and Bija (germinal cells i.e. healthy sperm and healthy ovum).

Dosha-Dhatu-Mala theory is the basic philosophy of Ayurveda. Diagnosis, treatment, prognosis and drug development of every disease in Ayurveda is based on Tridosha theory which includes Vatta, Pitta and Kapha. The human body consists of seven basic tissues known as 'Sapta Dhatu'. Generally Dhatu gives support to the body or maintains it. The seven Dhatu constitute the anatomy and physiology of the human body. They play a major role in the chain of bodily activities, ultimately ensuring a healthy body and a healthy mind. There are seven Dhatu in all which forms the different organs and different body systems. These are Rasa, Rakta, Mansa, Meda, Asthi, Majja and Shukra. Each human tissue or Dhatu is derived from the previous Dhatu in ascending order of complexity. These Dhatu are composed of the five Mahabhoota i.e., Earth (Prithvi), Water (Aap), Divine Fire (Tej), Air (Vayu) and Universal Space (Akash). These Dhatu remain within the human body in the right proportion so that the body can function properly but any disturbance in their equilibrium causes disease. Disorders in the Dhatu should be immediately taken care of to prevent further degeneration of the body.

The Sukra Dhatu originates from the Majja. According to Ashtanga Ayurveda, Sukra is the most significant of the seven Dhatu because it has the potential to produce new life (offspring) by nourishing the reproductive systems of male and female. In male it is known as Sukra and in female it is known as Sonita. Other associated functions include enabling intimate satisfaction and strengthening the body.

In Ayurvedic literature the terms Sukra and Sonita (Artava) have been used in two separate contexts. At one point the term Sukra means Purusa Bija or spermatozoa. In other sense it has been used as semen in which spermatozoa lives. Thus the term Sukra has been used as a liquefied media for the survival of spermatozoa. Similarly the terms like Sonita or Artava have been used firstly for Stri Bija and secondly it has also been used in the sense of menstrual blood. Therefore it is essential to understand the concept of Sukra and Sukravaha Srotas and its Srotodusti before proceeding further.

The Anatomy of reproductive organ, physiology and the treatment of various conditions which are due to Sukra, Sukra Dosas, Sukravaha Srotas and it's Srotodusti have been described in detail in Ayurveda. A complete chapter of Vajikarna has been devoted on the sexual problems and their treatment. The drugs have been enlisted to promote fertility and virility of mean.

Dosa, Dhatu and Mala are the three pillars and the health of the body depends upon the proper function and development of Dosas, Dhatu and excretion of Malas. Dhatus are the structural substances of the body and Dosas perform their functions through Dhatu. Sukra is the seventh Dhatu which is formed from Rasa at the end of one month following a continuous process of Dhatu Parinama. Thus Sukra is a Dhatu which is a substance whose complete absence is not possible for survival of an individual. But we observe that complete absence of semen does not affect the life. Therefore the word Sukra should not be taken only as the secretion of reproductive organs. More so over Acaryas have described its presence in male and female both. Therefore it should be interpreted as the total internal hormones i.e. Hypothalamic Hypophyseal-gonadal Hormones. Seminal ejaculate or semen is one part of it which can be termed as Vahya Sukra.

In the same context of the Prajanana (reproductive process), Sukravaha Srotas in male, which include testes, seminal vesicles, seminal glands, Sefasa (penis) in male, anatomical study of these structures are the essential topics of study to make a understanding to produce Supraja (ideal and healthy generation) as well as population control for the welfare of family and the society.

Aim and objectives

This book has been written to elucidate the concept of Sukravaha Srotas regarding from its macroscopic to microscopic level and to make a clear-cut understanding and to construct new scientific dimensions to produce Supraja (ideal and healthy generation for the welfare of family and the society). In the present literature author had made full effort to expose all those aspects, which need further clarification. These can be summarized by the following:

a. Exploration of the concerned literature, which is available in Ayurveda and modern text books.

b. Collection of the views of commentators and also of different modern scholars.

c. Analysis of Ayurvedic concepts with recent advances in knowledge.

The entire discussion has been done in terms of anatomical concepts concerning the Sukravaha Srotas. We, researchers' think that the outcome of this systematic literary and experimental study will satisfy and acceptable to the modern (present) group of Ayurvedic scholars, it will also rehabilitate the faith amongst Ayurvedic and modern medical scientist regarding the fundamental principles of Ayurveda.

Contents

1	Introduction	3
2	Concepts of Srotas	7
3	Classification of Srotas	38
4	Sukravaha Srotas	46
5	Concept of Sukra	56
6	Anatomical aspect of Sukravaha Srotas	72
7	Applied aspect of Shukra	93
8	Male Impotency and Infertility	111
9	Management of Male Infertility	124
10	Bibliography	137

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