A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF VANGA BHASMA AND JATHIPALA CHOORNA IN SHUKRAGATA VATA W.S.R. PREMATURE EJACULATION

METHODOLOGY

The study entitled with “A Comparative Clinical Study to evaluate the efficacy of Vanga Bhasma and Jathiphala Choorna in Shukragata Vata w.s.r. to Premature Ejaculation” was carried out in the following methodology.

OBJECTIVES OF THE STUDY

• To evaluate the therapeutic effect of Vanga Bhasma with Jathiphala Choorna and counseling in Shukragata Vata w.s.rz. to Premature ejaculation.
• To evaluate the therapeutic effects of Vanga Bhasma and counseling in Shukragata vata w.s.r. to Premature ejaculation.
• To compare the therapeutic effects of both the groups.

MATERIALS AND METHODS

A. SOURCE OF DATA

1. Literary source

• All classical, Contemporary text books , National and international journals websites pertaining to the study.

2. Drug source

The raw drug required for the preparation of Jathiphala choorna & Prepared Vanga bhasma was prepared in the pharmacy of RSBK of SKAMCH & RC under the guidance of experts

3. Sample source

The patients with clinical features of Shukragata Vata w.s.r premature ejaculation were selected from Kaya chikitsa OPD of SKAMC,H&RC, Bangalore

B. METHOD OF COLLECTION OF DATA

STUDY DESIGN

• It was randomized double arm controlled open label clinical study.

SAMPLING TECHNIQUE

The subjects who fulfilled the inclusion and exclusion criteria and complying with the informed consent (IC) were selected using lottery method of random sampling technique.

SAMPLE SIZE

• A comparative clinical study where in 40 male Patients diagnosed as Shukra gata Vata w.s.r Premature ejaculation were randomly assigned into two groups i.e., Group A, Group B each comprising of 20 patients.
• A case proforma & parameters containing all the necessary details pertaining to the study was prepared.

DIAGNOSTIC CRITERIA¹¹

• Patient presenting with lakshana of Shukragata Vata
• Patient presenting with signs and symptoms of Premature ejaculation.
• Consistent inability to delay or control ejaculation as Patient wishes to.
• Unable to satisfy partner in at least 50% of the coital incidences.

INCLUSION CRITERIA

• Patients with lakshana of Shukragata Vata.
• Patients with signs and symptoms of Premature ejaculation
• Male Patients aged above 21 years.

EXCLUSION CRITERIA

• Any other systemic disorders interfering with the course of the treatment.
• Major psychological disorders.

INTERVENTION

40 male patients with Shukra gata vata, premature ejaculation were selected and Divided randomly into two groups, as Group-A and Group-B. For the purpose of Koshta Shuddhi, 20ml Eranda taila was given with milk after food at bed time for 2 days.

Group-A- Patients were given Jathiphala choorna 1gm and Vanga bhasma 125mg Orally for 30 days, twice daily before food with Sukoshna jala.

Group-B-Patients were given Vanga bhasma 125 mg orally for 30 days twice daily before food with Sukoshna jala.

INVESTIGATION

1. Blood examination. Complete Blood Count & Random Blood Sugar (RBS).

2. Urine. Sugar, albumin and microscopic examination.

GRADINGS¹²

1. ABILITY TO DELAY EJACULATION.

i. Ejaculation during sexual act of at least 5min with more than 17-20 penile thrust, able to delay up to some extent according to wish , with both partners satisfied in almost all counters.---- 7.

ii. Ejaculation within 1-5 minutes of sexual act with 13- 16 penile thrust, with both partners satisfied in almost all encounters but unable to delay according to wish -----6.

iii. Ejaculation during sexual act of at least 50% of encounter and 9-12 penile thirst----- 5.

iv. Ejaculation within one minute to sexual act and5-8 penile thrust--- 4.

v. Ejaculation within 30 seconds of sexual act with 1-4 penile thrust--- 3.

vi. Ejaculation on penetration ---- 2.

vii. Ejaculation during foreplay----1.

viii. Ejaculation at mere touch, sight, hearing of partner-----0.

2. PERFORMANCE ANXIETY

i. No anxiety at all -----5

ii. Slight anxiety that does not disrupt the sexual act --4

iii. Anxiety that hampers sexual act in 25% of encounter 3

iv. Anxiety that hampers sexual act in 50% of encounter-2

v. Anxiety that hampers sexual act in 75% of encounter1

vi. Anxiety that hampers sexual act in all encountered -- -0

3. SEXUAL DESIRE

i. Normal ---3

ii. Lack of desire ---2

iii. Desire only on demand of partner ---1

iv. No desire at all -----0

4. PENILE ERECTION

i. Erection when ever desired----5

ii. Erections in 75% of sexual act -----4

iii. Erections in 50% of sexual act -----3

iv. Erections in 25% of sexual act -----2

v. Erection only after manipulation ----1

vi. No erection at all -------0

5. PENILE RIGIDITY

i. Proper stiffness to maintain erection and continue sexual act till last-4.

ii. Some loss of stiffness but can maintain the erection and continue sexual act till last -3

iii. Some loss of stiffness able to maintain the erection but unable to continue sexual act till last---2.

iv. Loss of stiffness, can initiate sexual act, but unable to maintain the erection -----1.

v. Total loss of stiffness, unable to initiate the sexual act 0.

6. ORGASM

i. Satisfaction in early sexual act ------5

ii Satisfaction in 75% sexual act ----4

iii. Satisfaction in 50% sexual act-----3

iv. Satisfaction in 25% sexual act-------2

v. Lack of enjoyment in most of occasion ----1

vi. No orgasm at all ------0

OBSERVATIONS 

The present study revealed that the maximum of patients

• Demographic -60% were in the age group of 31-40. 80% were married, 60% had studied upto high school, 60% had occupation of both mental and sedentary, 60% patients were addicted to smoking, 60% were following vishamasana,
• Shukragata vata-100% Kshipramunchana, 0% Shukra Badnaati,
• Among Ksheena shukra lakshana – 20% aharshana, 60% daurbalya, 40% sandhishoola, 20% alpacheshtata, 40% vr i s h n aveda n a, alpas h u krapravr i t t i , 2 0% maithunaashakthi, 2 0% atipravrutti.
• Premarital-60% got knowledge from friends and after watching pornography, 100% patients had history of 3-4 times masturbation episodes per week, 80% were exposed to pre-marital coitus with known partner,
• Coital - 80% were indulging in foreplay,60% were getting erection within 1-3 min, 60% were having coital frequency upto 4-5 days/week, 80% practiced MOT position, 40% were anxious 40% were depressed,80% patients don't know that partners were satisfied or not,
• Nidana- 40% were consuming ati ushna aahara 20% used to used to consume ati lavana rasa aahara.

OTHER OBSERVATION DURING STUDY

• In group A, after intervention Deeptagni and vatanulomana was observed in patients who had mandagni before intervention'.
• In group B, patients observed increase in the quantity of semen after ejaculation. ·In group B patients experienced relaxed mind and calmness during their regular work
• 4 patients had no issues, one patient from each group conceived at the end of the study.
• After koshta shuddhi with eranda taila, patients observed increased libido, erections and interest in sexual activity was observed in the patients with mridu koshta
• In Shoditha Vangabhasma group patients started to notice more relaxed mind, and calmness during their daily routine work.
• 4 patients had complaints of no-issues, 1 patient's from each group had conceived at the end of the study.
• In the Eranda taila prayoga for the purpose koshta shuddhi, patients noticed increased libido, erections, interest in sexual activity in the patients of mrudu koshta were obtained

RESULTS

The values obtained were subjected to paired 't' test to compare the mean values within the group and unpaired 't' test to compare the mean values between the groups. The differences in the mean values were considered highly significant at p<0.001 and p<0.01,significant at p<0.05 and insignificant at p>0.05.

Tables Are Attached At The Last Page

(I) ABILITY TO DELAY EJACULATION: (WITHIN THE GROUP)

On Ability to delay ejaculation, before treatment and after treatment p value (<0.001) revealed statistically highly significant in both the groups. But t-value (4.908), in Group A was higher when compared to the t-value, (2.879) in Group B. Hence the result on the effect of treatment on ability to delay ejaculation in Group A was better than Group B.

ABILITY TO DELAY EJACULATION: BETWEEN THE GROUP

• Group A: The mean value on the ability to delay ejaculation before intervention was 4.15 with SD 1.089 which was reduced to 2.2 with SD 1.196 after intervention.
• Group B: The mean value on the ability to delay ejaculation before intervention was 4.35 with SD 1.039 which was reduced to 3.4 with SD 1.046 after intervention.
• Before intervention, the p value revealed statistically highly significant result between the groups, whereas after intervention, the p value revealed statistically non significant result between the groups on the effect of ability to delay ejaculation.

(II) PERFORMANCEA NXIETY: (WITHIN THE GROUP)

On performance anxiety, before treatment and after treatment, the p value (<0.001) revealed statistically highly significant in both the groups. But t-value (10.71) in Group B was higher when compared with the t-value (3.942), in Group A. Hence the result on the effect of treatment on performance anxiety in Group B was better than Group A.

• Group A: The mean value on the Performance anxiety before intervention was 2.8 with SD 0.951 which was reduced to 1.75 with SD 0.716 after intervention.
• Group B: The mean value on the Performance anxiety before intervention was 3.15 with SD 0.988 which was reduced to 2.2 with SD 1.015 after intervention.
• Before and after intervention, the p value revealed statistically non significant result between the groups on the effect of Performance anxiety.

(III) SEXUAL DESIRE: (WITHIN THE GROUP)

On sexual desire, before treatment and after treatment, p value (<0.001) revealed statistically highly significant in both the groups.

But t-value (3.715), in Group A was higher when compared with the t-value (3.715), in Group B. Hence the result on the effect of treatment on sexual desire in Group A was better than Group B.

• Group A: The mean value on the Sexual desire before intervention was 1.75 with SD 0.850 which was reduced to 0.85 with SD 0.670 after intervention.
• Group B: The mean value on the Sexual desire before intervention was 2 with SD 0.973 which was reduced to 1 with SD 0.725 after intervention.
• Before and after intervention, the p value revealed statistically non significant result between the groups on the effect of Sexual desire.

(III ) ERECTION: (WITHIN THE GROUP)

On erection, before treatment and after treatment the p value (<0.001) revealed statistically highly significant in both the groups.

But t-value, (4.438) in Group A was higher when compared with the t-value (3.552), in Group B. Hence the result on the effect of treatment on erection in Group A was better than Group B.

• Group A: The mean value on the Erection before intervention was 3.3 with SD 0.978 which was reduced to 1.95 with SD 0.944 after intervention.
• Group B: The mean value on the Erection before intervention was 3.2 with SD 0.695 which was reduced to 2.35 with SD 0.812 after intervention.
• Before and after intervention, the p value revealed statistically non significant result between the groups on the effect of Erection.

(V). RIGIDITY (WITHIN THE GROUP)

On rigidity, before treatment and after treatment p value (<0.001) revealed statistically highly significant in both the groups.

But t-value (7.007), in Group A was higher when compared to the t-value, (4.580) in Group B.

Hence the result on the effect of treatment on rigidity in Group A was better than Group B

• Group A: The mean value on the Rigidity before intervention was 2.75 with SD 0.550 which was reduced to 1.3 with SD 0.732 after intervention.
• Group B: The mean value on the Rigidity before intervention was 2.85 with SD 0.933 which was reduced to 1.45 with SD 0.998 after intervention.
• Before and after intervention, the p value revealed statistically non significant result between the groups on the effect of Rigidity.

(VI). ORGASM: (WITHIN THE GROUP)

On orgasm, before treatment and after treatment, the p value (<0.001) revealed statistically highly significant in both the groups.

But t-value (5.182) in Group A was higher when compared with the t-value (4.024), in Group B. Hence the result on the effect of treatment on self satisfaction in Group B was better than Group A.

• Group A: The mean value on the Orgasm before intervention was 3.4 with SD 0.940 which was reduced to 1.95 with SD 0.825 after intervention.
• Group B: The mean value on the Orgasm before intervention was 3.65 with SD 0.988 which was ·reduced to 2.3 with SD 1.128 after intervention.
• Before and after intervention, the p value revealed statistically non significant result between the groups on the effect of Orgasm.

DISCUSSION

• The term 'shukra' have multiple identities in its nature, if the physical, functional and pathological characteristics are concerned.
• It is located all over the body, explained as 'tvakstha' and have specific functions, general body functions, psychological functions and functions related to sexual act.
• A critical analysis reveals that shukra have structural and functional identity as androgens, semen or spermatozoa, moreover many explained and unexplained psycho-neurobiological featured of manliness can be attributed to shukra
• Among the psychological and sexual related functions of shukraharsha, dhairya, chyavana and preeti are important to the context. dhairya and chyavana and preeti are interred complimentary and normally characterized by an optimal anxiety.
• Shukragata vata is a distinct pathological entity characterized by early ejaculation, delayed ejaculation, seminal abnormalities or affliction of foetus.
• Early ejaculation is a functional impairment at the different levels of Vata, Manah and Shukra which are having striking functional approximation. The individual components of vata viz. Prana, Udana, Vyana and Apana are having specific functions in the male sexual response cycle, and an imbalance in between control (niyata) and stimulation (pranata) leads to sexual dysfunctions.
• Shukragata vata denotes a group of disorders with different symptomatology which may not necessarily coexist. Under the heading Shukragata vata disease like premature ejaculation, retrograde ejaculation in males.
• Premature ejaculation can be caused due to decreased nerve latency time and physiological orgasm.
• The individual components of vata viz. prana, udana, vyana and apana are having specific functions in the male sexual response cycle, and an imbalance in between control and stimulation leads to sexual dysfunctions.
• Premature ejaculation is caused by a vitiated vata causing over stimulation, and lack of control over physiological and psychological activities.
• Specific etiological factors related to Shukra dourbalyakara ahara viharas, code of conduct of maithuna, manobhighata and vataprakopa are favoring this.
• Sukra is the terminal tissue element and nourishes of the supreme vital essence.
• Shukra has multifunctional identity, out of which Dhairya, Cyavana and Preeti are interdependent and ? related to sexual act.
• The aggravated cala (seeghra) property of vata on psychosexual parlance may be reduced by
• The drugs have vrishya, balya, Medhya and better niyantranaand subsequent controlled prerana.
• Premature Ejaculation in persons who are physiologically predisposed to early ejaculation by short nerve latency time, rapidity of all reflexes or behavioural conditioning. Vata is explained as life and vitality, supporter of the all embodied beings and sustain long life free of disorder.
• Shukrastambhaka properties. As vrishya and balya the drug enhances the quality of Shukradhatu reducing Dourbalya and Riktata in shukravaha srotas thus by pacifies the aggravated gata vata.
• Medhya properties of the drugs act biologically and improve the psychological functioning.
• The shukra stambhaka property by virtue of decreasing saratva (which is making prerana) of shukradhatu and enhancing sthiratva (which is favouring dharana) helps in the retention of semen for longer duration. It also improves the strength of the individual by balya property helps in sexual functioning as harsh shakti depends on dehabala also.
• Magnesium is one of the elements present in human semen, and it is required for enzymes that act on 13 phosphate containing substrates .
• A decrease in magnesium level will result in an increase of thromboxane A2 (TxA2), and this will lead to a rise in endothelial intracellular calcium, and subsequently, a decline in nitric oxide (NO),Since NO is a vascular smooth muscle-relaxing factor, cavernosa smooth muscle contraction, resulting from decreased NO, may be a contributing factor to premature ejaculation.

CONCLUSION

• Shukragata vata comes under Vata vyadhi, Ksheena Shukra and is characterized by the feature of kshipra munchana. The disease can be correlated to premature ejaculation which comes under male sexual dysfunction.
• Anavasthitatva is the characteristic feature of vata manifested on the base of chala property supported by other properties and is directional in nature which termed as gati.
• Gatatva is implicated either to denote the activity or to denote the abode of activity, Gatatva is an essential feature of any vatajasamprapti characterized by aggravation of Vata Gati and diminution of dhatu leading to riktata and dhatu daurbalya.
• Dhairya, chyavana, and preeti are the important functions of shukra related to sexual act and plays vital role in the normal human sexual response