ROLE OF PANCHKARAMA IN MANAGEMENT OF

MALE INFERTILITY

Fertility is affected by many different cultural, environmental and socioeconomic factors,

especially in developing countries where poverty and infections are common place. Infertility
is the inability of a sexually active, noncontracepting couple to achieve spontaneous
pregnancy in 1 year. Shodhana (biopurificatory) procedures are indicated before the
administration of Vajikarana (aphrodisiac) drugs, especially Virechana Karma (therapeutic
purgation) is indicated in the cases of vitiation of Shukra (seminal parameters). Nature is
always doing better for all living being; but due to the present lifestyle, there has been a
drastic change in day-to-day activities including lifestyle, food habits, sexual life,
environmental pollution, industrial and occupational hazards and these changes have adverse
effect on Shukra Dhatu which leads to infertility.

Understanding Shukra Dhatu (Sperm tissue in Ayurveda)

Shukra is the term used to denote male gamete It is the male factor responsible for the
formation of embryo When the sperm gets united with the ovum in which soul descends and
gets implanted in the uterus, embryo is formed. It is the last and seventh tissue, hence
constitutes the essence of all the previous sot tissues. It is located at the Basti Dvara or
opening of the unnary bladder and gets ejaculated through the Mutravaha Srotas or urethra

Physical properties of Shukra (Sperm tissue) in Ayurveda

बहलं मधुरं स्निग्धमवित्रं गुरु पिच्छिलम्। क्लं बहु च यच्छुक्रं फलवत्तदसंयम्॥५०॥
(C.S.Ch.S 2/50)

Physical properties of Shukra are liquidity, abundant, sweet, unctuous, heavy, viscous, white
like rock crystal and without any putrid smell.It gets ejaculated during coitus because of the
fluidity, sliminess, heaviness, atomicity and tendency to flow out.
Shukra Dhatu is ejaculated into the vagina during coitus because of the function of Vata
Dosha, mainly Apana Vata in association with Tejas or heat generated during the sexual act.
Passionate attachment, excitement, desire and physical pressure are also responsible for
ejaculation of semen.

Role of Shukra (Sperm) in Fertilization

Two main functions of paternal factor, that is male partner for the process of fertilization are-

1. Production of healthy sperms

2 Deposition of sperm in the female genital tract through the act of coitus.
MALE INFERTILITY :-
Males’ infertility constitutes about 40% of infertility case and females’ infertility constitutes
about 40% of infertility. Infertility is the not getting pregnant, despite of having carefully
timed, unprotected sex for one year.Various environmental and biological factors affect the
sperm count in males. Infertility is the worldwide problem and it affects 15% of married
couples worldwide. The prevalence of infertility in general population is 15-20%, and of this,
the male factor is responsible for 20-40% and in India, the prevalence is around 23% . In a
preliminary study by the WHO multi-centre study, 45% of infertile men were found to be
affected by Oligozoospermia or Azoospermia . Oligozoospermia means the sperm count is
less than 20 million /ml and Asthenozoospermia means the motility of spermatozoa is lower
than 50% of active motile sperm (WHO 1992). In Oligoasthenozoospermiaboth less number
of sperm and low motility are found.
In Ayurveda, Shukra Dosha (pathological disorders of
sperm/semen) is mentioned as of eight types. They
are Vataja, Pittaja, Kaphaja, Kunapa, Granthi, Puti, Puya and Ksheena
In the male reproductive system, infertility may be caused by:

 obstruction of the reproductive tract causing dysfunctionalities in the ejection of

semen. This blockage can occur in the tubes that carry semen (such as ejaculatory
ducts and seminal vesicles). Blockages are commonly due to injuries or infections of
the genital tract.
 hormonal disorders leading to abnormalities in hormones produced by the pituitary
gland, hypothalamus and testicles. Hormones such as testosterone regulate sperm
production. Example of disorders that result in hormonal imbalance include pituitary
or testicular cancers.
 testicular failure to produce sperm, for example due to varicoceles or medical
treatments that impair sperm-producing cells (such as chemotherapy).
 abnormal sperm function and quality. Conditions or situations that cause abnormal
shape (morphology) and movement (motility) of the sperm negatively affect fertility.
For example, the use of anabolic steroids can cause abnormal semen parameters such
sperm count and shape .

Lifestyle factors such as smoking, excessive alcohol intake and obesity can affect fertility. In
addition, exposure to environmental pollutants and toxins can be directly toxic to gametes
(eggs and sperm), resulting in their decreased numbers and poor quality.

Defects in either of these functions may lead to male infertility

Ayurveda explains two pathological conditions, namely Shukrakshaya (deficiency in sperm)

and Shukradushti (defect in sperm).
 Shukra Kshaya (deficiency in sperm)Shukra means Sperm and Kshaya means
deficiency Thus, Shukrakshaya means, deficiency of one or more functions of the
testes which are synthesis of testosterone and spermatogenesis. It may cause male
inhealthas well as sexual dysfunction too
 Acharya Susrutha has classified Shukrakshaya into three types - Alpa Retas, Kshina
Retas and Visushka Retas
Alpa Retas means low levels of sperm from birth or below the age of 25 years resulting from
chromosomal or congenital defects like in Klinefelter's syndrome Although low levels of
sperm are from birth, diagnosis can be made only during or after puberty
Kshina Retas indicated moderately low level of sperm in middle age There is proper growth
and development and normal level of sperm, however deficiency occurs later during life
because of indulgence in causative factors such as unhealthy diet and lifestyle or affliction
with chronic debilitating illness or infections, side effects of treatment such as chemotherapy

Visushka Retas is extremely low level of sperm during old age, that is after 70 years of age.
There is proper growth and development and normal levels of sperm, however sperm levels
become greatly decreased in old age

Shukra Dosha (Sperm malfuntioning):-

There are several causes, which may cause Shukra dosas. For the sake of easy explanation, all
these causes can be broadly classified under four main headings

1. Defective Spermatogenesis
2. Disorders in efferent duct system
3. Flaccid penis leading to non-deposition of sperm high in the vagina .
4. Errors in seminal fluid

1 Defective Spermatogenesis

Different causes which interfere with spermatogenesis are as below

Bija Dosha - Chromosomal defects caused due to the defects in sperm or ovum of the parents
results in production of offspring with defective genital organs

Dvireta are the disorders of sexual development resulting from disordered sex chromosomes
due to vitiation of the sperm and ovum of the parents responsible for creation of sexual
characters in the foetus

Janmabala Pravrtta - Congenital disorders such as hypospadias, epispadias, etc where there
are developmental defects of the male genitalia

Kalabala Pravrtta - Metabolic or Pubertal defects &

Sanghatabala Pravrtta - Accidental trauma to the testes If the testes of the foetus are affected
by vitiated Vata Dosha and Agni (Pitta Dosha) then there is eviration in the offspring and the
person will have problems with ejaculation

2 Shukravaha Srotodushti
Any defect in efferent duct system (Shukravaha srotas) either, structural or functional may
lead to infertility.
Structural Defects of Shukravaha Srotas Anomalies such as congenital absen of one or more
parts of Shukravaha srotas such as total absence of cauda epididymis, the loop of the vas, and
the vas deferens itse, also known as vas aplasia, although the caput epididymis is kept intact.

Functional Defects of Shukravaha Srotas. Functional defects in Shukravaha srotas is caused

by Srotodushti, that is the patency of Shukravaha srotas (channels/ efferent duct system) is
affected by various unhealthy life practices or by injury.

Causes of Shukravaha Srotodushti

1 Untimely coitus: intercourse under stressful conditions and with a lady having vaginal
infectious diseases

2 Celibacy Forced abstinence due to traditional problems or prolonged abstinence due to

relationship problems with partner or due to occupational problems etc

3 Injury to Shukravaha srotas or its mula (testes) may be caused by sastra (sharp
instrument), ksara (alkali) and agni (fire). Injuries with the above said factors may lead to
haemorrhage, neurological deficits, inflammations and wounds Further the wounds may get
infected and affect the normal function of efferent duct system

4 Errors in seminal fluid (Shukra Dushti)Provoked Dosas due to their respective causate
factors vitiate Shukra and produce several types of Shukra Dushti,Shukra Dushti (Sperm
vitiation)Shukra means Sperm and Dushti means vitiation, thus Shukradushti refers to
vitiation of seminal fluid The sexual function is not necessarily affected in Shukradushti
Causative factors of Shukra Dushti
The three fold causative factors for the vitiation of semen are improper diet, unhealthy
lifestyle and psychological factors.
Ahara (Dietetic factors):
Excess consumption of unsuitable food,At Ruksha Anna: Excess intake of dry food items
such as crackers.
Tikta Kashaya Lavana Amla Rasa Atisevana Use of bitter, astringent, salty and sour tastes
excessively in diet.
Ati Ushna Ahara Consumption of excess hot food and drinks

Vihara (Lifestyle factors)

Excessive coitus
Untimely coitus
Improper abstinence
Intercourse with unaroused partner
Coitus in old age
Excessive exercise
Suppression of ejaculation and other natural urges such as urination, defaecation, flatus, etc.

Manasika (Psychological factors)

Chinta Anxiety
Shoka Grief
Avisrambha Suspicion
Bhaya Fear
Krodha Anger
Family & Work Related stress

Pathophysiology of Shukra Dushti

One or more Doshas get vitiated and reach the Shukravaha Srotas (Efferent ducts) causing
defects in semen. In addition aggravation of Apana Vata may also cause Shukra Dushti as
ejaculation of Shukra is the function of Apana Vata

Significance and Types of Shukradushti:-

Doshas vitiate the semen leading to infertility In case conception occurs, either miscarriage or
abortion occurs or the progeny will be sick, sterile, short-lived and disfigured. Vitiated semen
shows changes in physical characters based on the Dosha vitiation. There are eight types of
vitiation of semen

1 Vataja Retas Semen vitiated by Vata Dosha will have the following features
Colour:-Aruna/Isad Rakta Varna (Bright red or light red colour) or Krisna varna
(black colour)

Characteristics:-
Phenila (frothy)
Tanu (thin in consistency)
Ruksa (less unctuous)
Satoda Bheda Ejaculated in a little quantity with pain has no potency for
fertilization.
Different haemorrhagic injuries, oligospermia, azoospermia, obstruction in
efferent ducts come under Vataja Retas

2 Pittaja Retas Semen which is vitiated by Pitta Dosha will have the following features

Colour:-Pita (Yellowish),Nila (Blue) in colour

Characteristics:-
Acute inflammatory conditions of the testes fall under this type of Shukra Dushti Foetid smell
Ati Ushna: Very hot
Sadaha. Ejaculated with burning sensation of presence of pus cells whereas hotness and
burning sensation could be because of acute inflammation

3 Kaphaja Retas:-Vitiated Kapha Dosha obstructs the normal flow of semen

and causes the following features

Colour:-Shukla (Whitish)
Characteristics:-
Ati Picchila Slimy in consistency
Sakandu: Ejaculated with mild itching
In this type of vitiation, there is increased viscosity of semen which is mostly
seen in chronic infections and is associated with increased morphologically
abnormal forms.

4 Anya Dhatu Samsrsta: Anya Dhatu means other materials apart from
spermatozoa such as pus cells, mucus, bacteria, RBC, etc Thus a semen
containing these substances may be callo Anya Dhatu Samsrsta: Due to injury
to the Shukravaha Srotas, blood mixed with semen can be seen.

Colour:-Rakta Varna (Reddish in colour)

Characteristics:-
Bahalam Bulk in quantity
Kunapa Gandhi: Smell of dead body

5 Kapha Vataja Retas (Granthibhuta/Avasadi):-Semen being vitiated by Kapha

and Vata Doshas looks coagulated because of non- liquefaction as seen in prostate
dysfunctions. The normal time for liquefication of semen is within 40 minutes after
ejaculation. When the semen fails to liquify spontaneously it may result in sub-fertility.
Characteristics:-
Sandra Highly viscous
Manda Sluggish

6. Pitta Kaphaja Retas (Putipuyanibha) When the semen is vitiated by Pitta and
Kapha, it becomes infected and contains pus cells (Puya) When semen contains excess pus
cells it is known as pyospermia which a chronic suppurative infection of semen

7. Pitta Vataja Retas (Ksina Retas) When the semen is vitiated by Pitta and Vaid, it is
scanty or less in quantity or with subnormal parameters. It is also a variety under main
classification of Shukra Kshaya resulting from specific causes as explained above In this
context, the semen parameters decreased due to vitiated Vata and Pitta are only considered.

8 Sannipataja Retas (Mutra Purisha Gandhi) Semen which is vitiated by all the
three Doshas will have the smell of urine or faeces and is known as Sannipataja Retas
Ayurveda Treatment Approach of male infertility

 A healthy lifestyle and healthy diet promote health and prevent disease.
In this context Ayurveda provides better solution for Male infertility in the form of-
Proper Dietary Management (Pathya-Apathya)
 Pathya - ( SnigdhaPradhanBhojana) Masha, Godhuma,Tandula, Dugdha, Ghrita,
Madhu, Kukkutanda,Matsyaetc.
 Apathya- RukshaAnnapana
 Life Style Advice:-
(Dinacharya,Rutucharya,Ratricharya,Trayopstambha, Sadvritta,Achara Rasayana,
Ashtanga Yoga),
 Panchakarma (Detoxification)-Snehana (Oleation),Swedana (Sudation).
 Yoga –Improve blood circulation and body toning, Yoga helps in reducing stress,
because stress is considered the primary psychological cause of infertility. Some
poses in yoga can help not just improve blood circulation but balance your body’s
chemicals which in turn produce more sperm

Chikitsa is mainly of two types, Shodhana and Shamana.Acharyas always emphasize on

Shodhana Karma prior to Shamana drugs. Shodhana Karma (Virechana Karma) in
Ksheena Shukra is done only to eliminate Vata and Pitta vitiated Dosha from the body
followed by Shamana therapy with Vrishya drugs. Acharya Charaka while explaining
Chikitsa of Klaibya stated that after proper Snehan Swedan Karma, Sneha Virecharna
should be administered to the patient.( (Chikitsa Sthana) chapter 30,verse 196.)

PANCHKARAMA IN MANAGEMNET OF MALE

INFERTILITY
Chikitsa is mainly of two types, Shodhana and Shamana.Acharyas always emphasize on
Shodhana Karma prior to Shamana drugs. Shodhana Karma (Virechana Karma) in
Ksheena Shukra is done only to eliminate Vata and Pitta vitiated Dosha from the body
followed by Shamana therapy with Vrishya drugs. Acharya Charaka while explaining
Chikitsa of Klaibya stated that after proper Snehan Swedan Karma, Sneha Virecharna
should be administered to the patient.( (Chikitsa Sthana) chapter 30,verse 196.)
Shodhana procedures are to be performed before administration of Vajikarana drugs,
especially Virechana Karma has been indicated in the cases of vitiated Shukra.

To produce healthy progeny four things is necessary i.e. Ritu,Kshetra, Ambu and Beeja11 and
presence of any Dushti in the above factors will lead into Shukradushti which is the prime cause of
infertility. Oligozoospermia that is shukrakshaya is one of the most prevalent reasons for male
infertility. In most of the cases, functional deformity in spermatogenesis is the major reason for
oligoasthenozooapermia, which involves either defective mechanism of testosterone or excess
production of reactive oxygen specimen or both.
 Acharya Sushruta has included Shukrakshaya (oligozoospermia) under Shukradusti.[ Sharira sthana
Chapter 2/3; 344] Here Vata Dosha along with Pitta undergo vitiation and does disturbance in the
normal qualities and quantity of Shukra Dhatu.[ Sutra sthana, Chapter 4/13;85] As a result of this,
Shukravaha Strotas undergoes Dushti, which debilitate one normal individual from impregnating his
life partner, ending in infertility. Shodhan and shaman might have effect as Vyadhiviparita Chikitsa .
Deepana, Pachana and Shodhana should be given systematically and can get better outcome in the
management of Shukradushti (Asthenecroteratozoospermia).
 Role of Purvakarma:-
Before proceeding to main Karma i.e.,Samshodhan Karma, Purva Karma needs to be
done. Purva Karma includes Prakritip Pareeksha, Kostha Pareeksha, Depan, Pachan,
Snehana and Swedana.

1. Deepan Karma-
Deepan drugs composed of Agneya and Vata Mahabhoot. Due to this, they help in ignition
of digestive fire. They also help in separation of Leena Dosha from Dhatu.

2. Pachan Karma-
Pachan Karma is helpful in Ama Awastha. If Snehana Karma is done in Amaj condition, it
can further enhance Ama Dosha in the body and lead to destruction of sensory perception and
even death. If Sanshodhan therapy is used in Ajeerna Awastha symptoms like
Vibhandh (Constipation) and Glani (exhaustion/fatigue) appear.
Therefore, Deepan and Pachan Karmaare mandatory prior to Snehana and
Sanshodhan Karma.

3. Snehana Karma-
Snehana Karmais done in two form-Internal and External application. Internal Snehana is
also of two types Sodhana Snehana and Shamana Snehana. Sodhana Snehana is done for
minimum three days and maximum for seven days.
Days for Internal application (Snehapaan) depends upon the patient's Kostha, Agni and
appearance of proper Snehana symptoms. Snehana enhances the Drava Guna of
Doshaswhich is needed for the eviction of vitiated Doshas. Snehana Dravya with its
Sukshma property, reaches to the minute channels and performs its action.

Sarvang Abhyang:-
which comes under external application.Main purpose of Snehana Karma before Pradhan
Karma is alleviation of Vata Dosha, softness of
Doshas(DoshaMriduta) and lubrication of channels (Strotasas) which ease the expulsion
of Doshas from the body without any discomfort.

4. Swedana Karma –
Sarvang Swedana (fomentation)results in Dosha Dravta (liquefaction of Doshas) and helps
to move Doshas from Shakha (extremities) to Koshtha from where Doshas are expelled out
from the body through the nearest route.

 Role of Virechana Karma-

Virechana Karma /purgative therapy is a procedure for removal of vitiated Pitta andVata
Doshas through anal route. Mainly indicated in Pitta predominant condition. Virechana
Karma are of two types: Snigdha and Ruksh Virechana.
Ayurveda has crystal clear treatment protocol in case of Ksheena Shukra Dosha. The unique
Shodhana therapy (Virechana) specifically hits on the target that is Shukravaha Srotas
Acharya Charaka mentions Snehan Virechana in Klaibya Chikitsa. Due to peculiar properties
ofVirechana drugs (Ushna, Teekshan, Sukshma,Vyavayiand Vikasi Guna) it will reach up to
Dhatulevel and helps in expulsion of Doshas from minute channels of the body. After
SmayakaVirechana symptoms like feeling of purification, feeling of lightness along with
feeling of generalized weakness were there. Therefore, the process of Virechana Karma
helps in removal of vitiated Vata and Pitta Doshas and simultaneously clear the Sroto-
Avrodha of Shukra Vaha Srotas.So, execution of VirechanaKarma is helpful in the
management of Ksheena Shukra Dosha.
Shukra is Saumya i.e. Jala Mahabhuta Pradhana. In the pathogenesis of Kshina Shukra, there
is involvement of Pitta and Vata. Pitta is Agneya Mahabhuta Pradhana, while Shukra is Jala
Mahabhuta Pradhana, so in order to increase the Saumyata one has to decrease the Agni
Tatva, which can be achieved through rhashahetuvisheshasya principle.In order to remove the
vitiated Pitta Dosha, Virechana is administered. The active principles of Virechaka Dravya
are believed to be Soma and Pruthvi dominant, as described earlier Shukra is Saumya
Pradhana. It also eliminates the Srotorodha and active transformation of Dhatu through
Dhatvagni Vyapara and the most desirable Shuddha Shukra is procured. The whole process
helps in removing the free radicals (oxidants) present in the micro circulatory channels of
Shukra Vaha Srotasa, which interferes with the function of Shukra and by doing so, increases
the activity of Shukra (motility) as well as Shukra Vaha Srotasa and the respective Dhatwagni
thereby facilitating the production of more Shukra Dhatu. (Volume, Count). Virechana may
be responsible for rectifying the Pitta Dhara Kala, as it is the main procedure for Pitta
Shodhana. According to Acharya Dalhana, Pitta Dhara Kala and Majja Dhara Kala are
considered to be same. Hence Majja Dhara Kala may also be rectified through Virechana,
which will lead to the formation of pure Majja and hence Shuddha Shukra. There may also be
some relation between Pitta Dhara Kala and Shukra Dhara Kala.
*The Shodhana therapy(Virechana)specifically hits on the target that is Shukravaha Srotas .
Virechana Karma helps in both removal of Srotorodha as well as estimulation of
Shukragni. Because of this, Virechana Karma gears up the metabolism of the body
which boosts the quantity and quality of semen. Shodhantherapy detoxifies the body
and improves physical as well as psychological health.

Acharya Kashyapa has emphasized on the role of Virechana Karma (purgation)

for the purification of the Beeja (sperm), as it make Beeja (sperm) effective in
achieving fertilization. It also improves sexual vigor and helps in achieving
healthy progeny.

Koshtha-Shuddhi (purgation) with Eranda Taila (castor oil) was given for
detoxification and to pacify Vata which is the main cause for vitiation
of Shukra (sperm).
Probable mode of action of Virechana karma

Vajikarana drugs (Aphrodisiac recipes) should be administered after purifying the body i.e.
proper Shodhana (cleansing procedures) either by Vamana or Virechana. Shodhana
(cleansing procedures) therapy not only increases the bio-availability of the drug, but
also cures the ailments. The role of Shodhana (cleansing procedures) procedures as
preoperative regimens before the administration of medicine is adequately substantiated.
By these therapies not the occluded channels in the body are cleared off and this
enhance the quality and quantity of Shukra. These therapies have been kept in supreme
veneration by the classical authorities ameliorating different verities of Shukra Dushti.
Statistically significant increase in sperm count was found after the completion of
Virechana Karma and hence, it is clear from the generated data that Virechana
enhance the level of Shukra definitely.
  ROLE OF Basti (Herbal enema) KARAMA
Medicated enema is administered in men Basti is a Panchakarma which performs
detoxification, strength promoting, Dosha pacification actions and possess superior qualities
by virtue of the herbs used in treatment As Basti is the best treatment to pacify Vata Dosha
Uttara Basti normalizes the functions of Vata Dosha, mainly Apana Vata the viliation of
which causes inhealthissues. The detoxifying action of basti in the genital passages helps to
restore the normal sexual functions. Also, inflammation, irritation, discomfort will be reduced
The oil or ghee used in treatment has nutritive functions and will improve blood circulation,
nerve conduction and nourish the genital organs
Anuvasana Basti (Oil enema), NiruhaBasti (Decoction enema), YapanaBasti (Rejuvenating enema
which can be used for a long time without any adverse effect.) Uttar Basti (enema given throughthe
urethral orifice) AcharyaSushruta explained that there wasvitiation of Apana Vayu and Vyana Vayu in
the Shukradoshabecause site of Shukrais the whole bodyand Apana Vayu is responsible for the
proper expulsion of ShukraDhatuvitiation of Apana Vayu can impair the function of Shukra. Basti
therapy is specifically designated to treat Vata Vikaras.Basti by expelling out Vit, Shleshma, Pitta,
Anila, Mutra offers firmness of the body and enriches ShukraAcharya Charakaalso specifically
mentioned Basti Karma for ShukraDoshas.Therefore drugs which are administered in Basti form are
said to enhance the quality and quantity of Shukra. The line of treatment of KshinaShukrashould be
based on Brimhana Chikitsa and Vrishyadrugs having ShukraVriddhikaraproperties. Yapana Basti is
said to possess best Brimhanaand Rasayanaeffect which magnifies the quality of Rasa Dhatu and
Dhatwagni. As a result formation of better Dhatu takes place. As a whole all the Dhatus get
nourished by Yapana Basti to maintain Dhatu samya and to improve the resistance of the body
towards the invasion of the disease

Treatment according to cause :-

AlpaRetasa- Apyayana means nourishment. According to SamanyaVisheshaSiddhanta
(Principle),two substances having same properties increases quantity and quality both so
here Gunas of Goghruta, milk product like Navneeta,Dadhietc.Mamsa resembles with gunas
of Shukra. So it nourishes ShukraDhatu by quality and quantity both.

Dushta Retasa- Prasadana. Prasadana means cleansing or detoxification and

which can be done by shodhana karma. Due to shodhana cleansing of dhatu
takes place after that we give drugs which can do nourishment of shukradhatu.
KsheenaRetasa- Upachayaspermatognesis e.g.Kapikachchhu
hasVeeryavardhaka effect
VishushkaRetasa- Janana- regeneration. Drugs having regeneration properties
have Rasayana (Rejuvenation)and Vrishya (Aphrodisiac) effect. e.g.
Yashtimadhu, Musali.