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 Table of Contents  
EXPERT REVIEW
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 5-13

Algorithm of ancient Ayurveda method of semen analysis and integrative approach toward male infertility


1 Department of Panchakarma, KLEU's Shri BMK Ayurveda Mahavidyalaya, Belgaum, Karnataka, India
2 Department of Dravyaguna, KLEU's Shri BMK Ayurveda Mahavidyalaya, Belgaum, Karnataka, India

Date of Web Publication8-Jun-2016

Correspondence Address:
Prof. Sreenivasa Prasad Buduru
KLEU's Shri BMK Ayurveda Mahavidyalaya, Belgaum - 590 003, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.183681

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  Abstract 

Ayurveda scientifically described as andrology (Vajikarana) incorporates semen morphology in normal and pathological conditions, as 8-fold pathological condition and therapy are based on them. Morphological and physicochemical evaluation methods of semen are useful in better diagnosis of clinical manifestation of underlying etiopathology. Based on the standard publications on andrology, an attempt is made to integrate the clinical and laboratory diagnostics of semen physiology and pathology, which help in understanding the abnormalities in conventional Ayurveda as well as modern medicine to plan appropriate pharmacotherapy. Integrative approach would open up new arena in andrology and widen the scope of therapeutic benefits to more infertile males.

Keywords: Andrology, integrative management, retopariksha, shukra dusti, vajikarana


How to cite this article:
Buduru SP, Vedantam G. Algorithm of ancient Ayurveda method of semen analysis and integrative approach toward male infertility. Indian J Health Sci Biomed Res 2016;9:5-13

How to cite this URL:
Buduru SP, Vedantam G. Algorithm of ancient Ayurveda method of semen analysis and integrative approach toward male infertility. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2019 Aug 24];9:5-13. Available from: http://www.ijournalhs.org/text.asp?2016/9/1/5/183681


  Introduction Top


Since time immemorial, male infertility is one of the issues, man is constantly trying to define, explain, diagnose, and manage. Semen is the prime factor for evaluation of male in the diagnosis and management of infertility. Microscopic demonstration of spermatozoa [1] revolutionized the semen examination and since then, there is a sea change in semen parameters, evaluation methods, as well as reference values.

Ayurveda, the first codified medical system, defined male infertility at different contexts with different words such as vandhya, kleeba, anapathya. Similarly, retas (the ejaculate), virya (the factor that provides virility), and shukra (which is white) are the words used for semen. Among them, retas (the ejaculate) is the most suitable and appropriate term for semen. Specialty practice was well in place during ancient times. Ayurveda was being practiced under eight specialties, namely kayachikitsa (internal medicine), shalya tantra (surgery), shalakya tantra (ENT, ophthalmology, and oro-dentistry), kaumarabhritya (obstetrics and pediatrics), graha chikitsa (demnology/microbiology), damstra chikitsa (toxicology), rasayana (rejuvenation), and vajikarana (andrology and eugenics).[2] It is interesting to note that andrology was given equal importance with other subjects and a separate specialty was developed which is not the case with contemporary medical science even now. During course of time, we lost most of the literature pertaining to Ayurveda including literature on vajikarana (andrology and eugenics). At present, the introductory description in various Ayurveda classics (Charaka Samhita, Sushruta Samhita, Ashtanga Sangraha, etc.)[3],[4],[5],[6] is the only source for practice of andrology through Ayurveda.

Contemporary medical science identified and described several tissues whereas Ayurveda described only seven dhatus, namely rasadhatu, rakthadhatu, mamsadhatu, medodhatu, asthidhatu, majjadhatu, and shukradhatu.[7] It seems many tissues are grouped under one dhatu. Probably, stem cell origin as well as tissue response to treatment may be the reason for grouping [Figure 1].[8] Shukradhatu (reproductive tissue) - Ayurveda has elucidated its wide scope and included not only testicular and ovarian tissue but also the stem cells present throughout the body, with a capability to renew and replenish. However, in the context of male infertility, the term shukradhatu refers to testicular tissue. Vivid description is available in Ayurveda literature regarding formation, characteristic features and functions of normal shukra/retas, etiopathogenesis along with examination factors, and various abnormal clinical conditions including diagnosis and management.
Figure 1: Comparison of characteristics of retodusti as per Caraka and Sushruta

Click here to view



  Methodology Top


Literature pertaining to retas, shukra, and other relevant aspects from Ayurveda classics as well as recent publications and also the advances taken place in the analysis of semen in contemporary medical science from various print and electronic media such as PubMed are collected and reviewed.


  Results Top


From the descriptions of Ayurveda, characteristic features of fertile shukra/retas are said to be Dravata (liquidity), Bahalam (thick), Guru (heavy), Madhura (sweet), Snigdha (unctuous), Avisra (without any putrid smell), Picchila (viscous), Spatikabha (grayish white like alum), and Taila kshoudra nibha (consistency between sesame oil and honey).[9],[10],[11]

Ayurveda has also described various pathological conditions of semen, characteristic features, and their management. Almost all the authors of Ayurveda described eight pathological conditions of retas (semen), but differed in nomenclature or conditions.[6],[10],[11] The following is the list of summarized pathological conditions of retas (semen):

  • Phenila (frothy)
  • Tanu (thin)
  • Ruksha (dry)
  • Vivarna (discolored)
  • Ati-Picchila (hyper-viscous)
  • Putipuya (pyospermia)
  • Anyadhatusamsrista (associated with tissue components)
  • Kunapagandhi (smell that of dead body)
  • Avasadi (sedimentation)
  • Grandhibhuta (nonliquefaction)
  • Kshina (low volume)
  • Sannipata (smell like that of urine/feces).


After describing the method of examination and diagnosing various pathological conditions of retas/shukra, Ayurveda also mentioned the line of management specific to each clinical condition.

  • Vataja Shukradusti is to be treated by Basti (transrectal drug administration)[10]
  • Pittaja Shukradusti by Brahma rasayana, Chyavanaprasha, Amalaki rasayana, Haritakyadi rasayana, etc., formulations and drugs such as Amalaki (Phyllanthus emblica Linn.), Haritaki (Terminalia chebula Retz.), Draksha (Vitis vinifera Linn. ), Usheera (Vetiveria zizaniodes [Linn.] Nash.), Candana (Santalum album Linn.), Mudgaparni (Vigna trilobata [Linn.] Verdc.), Kapikacchu (Mucuna prurita Hook.), Madhuyasthi (Glycyrrhiza glabra Linn.), Vidari (Pueraria tuberosa DC), and Ikshu (Saccharum officinarum Linn.)[10],[12]
  • Kaphaja Shukradusti is to be managed by drugs such as Pippali (Piper longum Linn.), Amrata (Spondias pinnata [Linn.f.] Kurz.), Loha (iron), Triphala: Amalaki (P. emblica Linn.), Haritaki (T. chebula Retz.), Vibhitaki (Terminalia belerica Roxb.); and Bhallataki (Semecarpus anacardium Linn.)[10]
  • Anyatha Samsrusta is a nonspecific condition and hence to be treated as per involved dhatu by adopting appropriate principles [13]
  • Kunapagandhi is to be treated by administering Ghrita (ghee) prepared out of Dhataki pushpa (flowers of Woodfordia fruiticosa [Linn] Kurz), Khadira (Acacia catechu), Dadima (Punica granatum), Arjuna (Terminalia arjuna), or ghee prepared out of Salasaradi gana: (Sala sara [Shorea robusta Gaertn.], Ajakarna [Vateria indica Linn./Diplocarpus turbinatus Gaertn.], Khadira [Acacia catechu Willd.], Kadara [Acacia suma Buch. Ham.], Kalaskandha [Diospyros melanoxylon Roxb.], Kramuka [Areca catechu Linn.], Bhurja [Betula utilis D. Don.], Meshashringa [Dolichandrone falcata Seem./Gymnema sylvestre R. Br.], Tinisha [Ougeinia dalbergioides Benth.], Candana [S. album Linn.], Kucandana [Caesalpinia sappan Linn.], Shimshapa [Dalbergia sissoo Roxb.], Shirisha [Albizia lebbeck Benth.], Asana [Pterocarpus marsupium Roxb.], Dhava [Anogeissus latifolia Wall.], Arjuna [T. arjuna W. and A.], Tala [Borassus flabellifer Linn.], Shaka [Tectona grandis Linn.f.], Naktamala [Pongamia pinnata (Linn.) Merr.], Putika [Holoptelea integrifolia Planch.], Ashvakarna [Dipterocarpus alatus Roxb.], Aguru [Aquilaria agallocha Roxb.], Kaliyaka [Coscinium fenestratum (Gaertn.) Colebr.])[11],[14]
  • Grandhibhuta/Avasadi may be managed by ghee prepared out of Shati (Hedychium spicatum Ham. Ex. Smith) or Palasha kshara (alkali made from Butea monosperma [Linn.] Kuntze.)[11]
  • Putipuya may be treated with ghee processed with Parushakadi gana or Vatadi gana [11]
    • Parushakadi gana [15] – (Parushaka [Grewia asiatica Linn.], Draksha [V. vinifera Linn.], Katphala [Myrica nagi Thunb.], Dadima [Punica granatum Linn.], Rajadana [Mimusops hexandra Roxb.], Kataka phala [Strychnos potatorum Linn.], Shakaphala [T. grandis Linn.], Triphala [Amalaki (P. emblica Linn.)], Haritaki [T. chebula Retz.], Bibhitaka [Terminalia bellirica Roxb.])
    • Vatadi gana [16] (Vata/Nyagrodha [Ficus benghalensis Linn.], Udumbara [Ficus racemosa Linn.], Ashvattha [Ficus religiosa Linn.], Plaksha [Ficus lacor Buch. –Ham.], Madhuka [G. glabra Linn.], Kapitana [Thespesia populnea Soland ex Correa], Kakubha [T. arjuna W. and A.], Amra [Mangifera indica Linn.], Koshamra [Schleichera oleosa (Lour.) Merr.], Coraka patra [Laportea crenulata/Ficus altissima Blume. Leaves], Jambu dvaya [Syzygium cumini Linn. Skeels. and Eugenia operculata Roxb.], Priyala [Buchanania lanzan Spreng.], Madhooka [Madhuca indica J.F. Gmel.], Rohini [Myrica nagi Thunb.], Vanjula [Salix tetrasperma Roxb.], Kadamba [Anthocephalus indicus A. Rich.], Badari [Ziziphus jujuba Lam.], Tinduki [Diospyros melanoxylon Roxb.], Sallaki [Boswellia serrata Roxb.], Rodhra [Symplocos racemosa Roxb.], Savara-rodhra [Symplocos crataegoides Buch. –Ham.], Bhallataka [S. anacardium Linn. f.], Palasha [B. monosperma (Linn.) Kuntze.], Nandi vruksha [Ficus rumphii Blume.])
  • Sannipata condition is to be managed by the administration of ghee processed with Chitraka (Plumbago zeylanica Linn.), Ushira (V. zizaniodes [Linn.] Nash.), and Hingu (Ferula foetida Regel.).[11]



  Review of Research Works Top


Here, three studies conducted by the first author's supervision are described which are tried to explore the benefits of integrative approach. Further studies are needed to establish the utility of traditional concepts and complimenting recent clinical diagnostics with them.

Dr. B. S. Prasad (PhD Thesis) - Gujarat Ayurveda University, Jamnagar, 1998

A clinical study conducted with 92 patients in three separate groups, namely Svarna-bhasma (gold) group (33 patients), Musali (Asparagus adscendens) group (35 patients), and Ashwagandha (Withania somnifera) group (24 patients – control group) treated for 4 months. By understanding the role of Svarna-bhasma in Vajikarana, the gold content of semen was measured by using sophisticated technology (ICP-AES/ICP-MS). Survey study was also conducted in goldmine area and nongoldmine area to find the role of gold in spermatogenesis, the quantitative and qualitative difference between semen samples of both these areas.In vitro study with Svarna-bhasma was also carried out to see its effect on sperm motility.

The results of the study showed that Svarna-bhasma significantly improved both RLP (335.9%) and SLP (72.1%) motility and caused correspondingly significant decrease in the immotile spermatozoal count (21.59%) and abnormal forms (16.2%) of spermatozoa. Musali showed better overall effect in converting severe oligozoospermic (37.5%) and severe asthenozoospermic (33.3%) patients to normal state.

The results of the study also indicate that Svarna-bhasma is acting on mitochondria and also proliferating the spermatogenesis, especially at earlier stages. Whereas Musali hastens the maturation process and proliferates the spermatogenesis at later stages. Hence, Svarna- bhasma may be recommended for the treatment of Ksina sukra and in cases of Asthenozoospermia, Musali for the treatment of visuska retas (severe grade oligozoospermia); and in cases of oligo-asthenozoospermia, Ashwagandha for picchila sukra-dusti (hyperviscosity of semen).

The examination of the semen of the subjects of the study revealed that 8.8% of the patients had alparetas, 11.8% of the patients had ksina retas, and 24.5% of the patients had visuska retas. Considering sperm count and motility, it showed that 39.2% of the patients had asthenozoospermia and 60.80% of the patients had oligo-asthenozoospermia.[17]

Effect on viscosity

In Ashwagandha treatment (control group), there was a decrease in the viscosity by 20% in the 1st, by 40% in the 2nd, by 20% in the 3rd, and by 60% in the 4th months, respectively. These changes were insignificant. Control therapy provided statistically insignificant reduction in semen viscosity score, i.e. by 20%, 40%, 20%, and 60% during 1st, 2nd, 3rd, and 4th months of study, respectively. In Svarna–bhasma-treated group, the viscosity score of semen showed gradual reduction by 2.58%, 4.06%, 7.75%, and 32.1% during the 1st, 2nd, 3rd, and 4th months of study. These effects were statistically insignificant during the course of the study. On the other hand, in Musali-treated group, the viscosity score of semen was found to be elevated by 69.96%, 48.15%, 23.46%, and 11.93% in the 1st, 2nd, 3rd, and 4th months of the study, respectively. However, all these effects were statistically insignificant.

It was evident from the study that both control and Svarna-bhasma therapy have reduced the viscosity score of semen with a peak in the 4th month. However, Ashwagandha was found to be more effective in comparison to Svarna-bhasma in reducing semen viscosity. On the contrary, Musali has exerted adverse effect in respect to viscosity. Hence, Musali must not be used in kaphaja sukradushti where picchilata (viscosity) is found to be increased.

Semen viscosity versus asthenozoospermia

In control group, 25% reduction was noticed in asthenozoospermic cases where status of semen viscosity remain increased, in Musali group, the reduction was 75% in such cases and in Svarna-bhasma group, it was 54.54%. Obviously, Musali provided a remarkable increase in active motility even though viscosity remains increased. Among the cases where semen hyperviscosity reduced to normal, 66.6% reduction in asthenozoospermic cases was noticed in Musali group and 33.3% in Svarna-bhasma group, but no improvement was noticed in control group.[17]

V. G. Huddar and B. S. Prasad 2015 (PhD Thesis)

In an open single group clinical study with Shatavari ghrita on fifty subjects having hypo-osmotic swelling of sperms for 4 weeks, it was observed that the mean score of hypo-osmotic swelling test, semen quantity, and sperm count was increased, which is statistically significant (P < 0.05). Mean pH value was also increased, but it is not statistically significant. Mean score of immotile sperms and agglutination was decreased, which is statistically significant (P < 0.05) [Figure 2].[18]
Figure 2: (a and b) Semen analysis (Retopareeksha) report - Page 1 and 2

Click here to view


Dr. Pradeep Grampurohit and Dr. B. S. Prasad (PhD Thesis study) 2014

Thirty subjects with Anyadhatu Samsrushta having semen samples with the presence of immature cells, leukocytes, epithelial cells, and amorphous matter in a single open group clinical trial were recruited in the study. Treatment was Virechana with Trivrit Churna 20–40 g, following the due prior procedure of Agni Deepana for 2 days, Snehapana maximum for the 7 days, VishramaKaala for 3 days, and postprocedure of Samsarjana karma for 3–5 days. Assessment was done on the day 0 and 15 days after Samsarjana Karma. Results revealed that liquefaction time, SLP, agglutination abnormalities, macrophages epithelial cell, and amorphous matter were significantly decreased after the treatment.[19]

To enable uniform documentation for the effective integrative approach in diagnosis, thus management, format for “semen analysis (Retopareeksha) report” is designed and practiced regularly at the institute's fertility center.


  Review of Drug Research on Semen Parameters Top


Many drugs showed efficacy on various seminal parameters. Following studies show variable action of different drugs on different seminal parameters such as count, quantity, motility, viscosity, weight of testis, and hormone levels.

  • Guruprasad et al., 2010, have observed marginal increase in sperm count in experiment on rats treated with Brahma Rasayana[20]
  • Gauthaman et al., 2002, observed that Tribulus terrestris (Gokshura) contains dioscin, protodioscin, and diosgenin. Protodioscin is a potent natural precursor of the testosterone enhancer, which also increases the production of testosterone in another natural way. Tribulus leads to the production of the luteinizing hormone (LH) and when the LH levels are increased, the natural production of testosterone also increases [21]
  • Thirunavukkarasu et al., 2012, observed in their randomized placebo-controlled double-blind clinical trial on 63 patients of ksheena shukra (Oligozoospermia) that Gokshura (Tribulus terrestris Linn.) granules group has showed increased levels of testosterone hormone and sperm count, but difference is statistically insignificant when compared with placebo [22]
  • Ghanashyam et al., 2012, have observed that treatment with herbal composition containing the mixture (powder form) of the medicinal plants, namely Mucuna pruriens (Linn), Chlorophytum borivilianum (Sant and Fernand), and Eulophia campestris (Wall) for 40 days showed a significant increase in the body weight, testis, and epididymis weight in rats. Concomitantly, the sperm motility and the sperm density were significantly increased. After 90 days of treatment with the herbal composition, sperm density vis-a-vis motility was increased in oligozoospermic patients as a result of elevation in serum testosterone levels [23]
  • Pandya et al., 2011, have suggested that Gokshura (Tribulus terrestris) can increase the testosterone by increasing the LH and the gonadotropin-releasing hormone. This hormone is active in stimulating spermatogenesis and sertoli cell activity in rats [24]
  • Seyyed et al., 2015, in their study indicated that the Ferula asafoetida (Hingu) significantly increased the number and viability of sperms (P < 0.05). Histological study showed that spermatogenesis process and numbers of Leydig cells were increased with increasing the dose, but the Leydig cells become vacuolated [25]
  • Sudipta and Asit in 2013 found that Shweta Musali (Chlorophytum borivilianum) water extract showed highly significant improvement in the semen parameters (volume, liquefaction time, sperm count, and sperm motility) and nonsignificant improvement in serum testosterone levels, in comparison to placebo in a randomized, double-blind, placebo-controlled trial upon healthy volunteers of 20–40 years age for 12 weeks in two divided doses of 500 mg per day [26]
  • Ahmad et al. in 2010 observed that Ashwagandha (Withania somnifera) significantly increased serum testosterone and LH, reduced the levels of FSH and PRL, inhibited lipid peroxidation and protein carbonyl content, and improved sperm count and motility [27]
  • Kamla Kant Shukla et al. in 2010 found that the treatment with Mucuna pruriens (Atmagupta) significantly ameliorated psychological stress and seminal plasma lipid peroxide levels along with improved sperm count and motility, restored the levels of SOD, catalase, GSH, and ascorbic acid in seminal plasma of infertile men [28]
  • Falgun et al. in 2015 observed that Asparagus adscendens Roxb. (Shatavari) root extract caused a significant increase in body and testes weights, significant increase in testicular tubular diameter, and the number of round/elongated spermatids [29]
  • Chauhan et al. in 2008 observed pronounced anabolic and spermatogenic effect of Krishna Musali – Curculigo orchioides Gaertn. by weight gains of reproductive organs [30]
  • Pandit et al. in 2015 in a clinical study of treatment with Shilajit on 35 healthy male volunteer for 90 days significantly increased total testosterone, free testosterone, and dehydroepiandrosterone (dehydroepiandrosterone sulfate) compared with placebo. Gonadotropic hormone (LH and FSH) levels were also well maintained and it was predicted that it acts via hypothalamus–pituitary–testicular axis [31]
  • Raghav et al. in 2013 found that the treatment with lower dose (15 mg) of Lavanga - Syzygium aromaticum flower buds increased the motility of sperm, stimulated the secretory activities of epididymis and seminal vesicle, while higher doses (30 and 60 mg) had adverse effects on sperm dynamics of cauda epididymidis and on the secretory activities of epididymis and seminal vesicle [32]
  • Sumanta et al. in 2013 observed in their study that in young rats, methanolic extract of Butea frondosa (MEBF) (Palasha) and sildenafil treatment increased total sperm count as well as live sperm count, while there was a decrease in defective sperm count. However, the statistical significance (P< 0.05) was observed only in MEBF-treated group [33]
  • Mohammed et al. have found that Coriandrum sativum (Dhanyaka) significantly (P > 0.05) increased sperm concentration, motility, and viability, when compared with control. Histology results showed that sperm numbers significantly (P< 0.05) increased in the luminal spermatozoa in both concentrations of coriander compared with control [34]
  • Bhutani et al. in 2004 observed that Lodhra (Symplocos racemose) increases LH/FSH and was effective in treating a murine model analogous to secondary infertility. In males, LH is known to stimulate testosterone production while FSH nourishes developing sperm [35]
  • Khawaja et al. in 2012 have reported the reclamation of spermatogonia and the interstitial tissue after Jambu (S. cumini) fruit pulp extract treatment for 5 days in mice following losses from NaF exposure, indicated revival of germ plasm and a gradual rehabilitation of micrometric dimensions of spermatozoa [36]
  • Saad et al. in 2013 reported that G. glabra in addition to the sperm activation media causes a significant increase in sperm concentration, sperm motility, and grade activity of progressive forward movement of mice epididymal sperms.[37]


These studies by different scientists show that they are more focused on semen parameters such as count and quantity, whereas the parameters such as viscosity were not give importance. Hence, there is a need to incorporate parameters mentioned in Ayurveda also for better understanding pathogenesis and clinical management through integrative approach.


  Discussion Top


From the above description, it is evident that Ayurveda considered physico-chemical features for the analysis of semen. For example, color, consistency, viscosity, density, smell, liquefaction time, etc. Explanation of possible mechanism or the scientific basis/background for each condition mentioned in Ayurveda has been elaborated here.

Phenila (frothy)

Presence of surfactants may be considered in this regard. It has been reported that surface-acting agents cause irreversible changes in sperm surface and interact with membrane lipoproteins by which cell permeability increases and leakage of vital intracellular constituents ensues.[38] Aquarium bubbler has been used to produce foam in semen samples (after liquefaction) and to study the phenomenon. It is noticed that semen samples forming bigger bubbles (approximately more than 0.5 cm size) may be considered as phenila-positive.[39]

Tanu (thin)

Thin and translucent semen samples are seen in case of azoospermia or severe oligozoospermia. Sperm count and translucency are inversely proportional. Hence, sperm count may be taken as a parameter for tanu.

Ruksha (dryness)

As semen is in liquid form, dryness cannot be demonstrated. Considering similar examples in Ayurveda, i.e., buttermilk as ruksha, it may be understood that the material need not be physically dry rather it must exert dryness on administration. From these lines, it may be stated that increased pH (>8.5) of seminal plasma may be considered as ruksha as at this pH, seminal plasma exerts reverse osmotic pressure on sperms and thus hampers normal function of spermatozoa. Interestingly administration of drugs possessing snigda (unctousness) property antagonistic to ruksha, showed the decline of increased pH.[40]

Vivarna (discolored)

Other than grayish white, i.e. Sveta (milky white), Pita (yellowish white), Aruna (reddish), Krishna (blackish), and Nila (bluish) are described as abnormal colors of semen. Among the abnormal colors, Aruna and Krishna Varna falls under Vata category, Pita and Nila are of Pitta category, while Sveta is included under Kapha category.

Ati-Picchila(hyperviscosity)

Increased viscosity, i.e., tantubaddha (thread-like formation) is to be considered as ati-picchila retodusti. The mean of sperm parameters including count, motility, and normal morphology in patients with hyperviscosity was significantly lower than those in nonhyperviscosity patients.[41] Reduced levels of fructose in hyperviscosity semen samples has been attributed to defective functioning of the seminal vesicles.[42] Kokilaksha (Asteracantha longifolia) found to increase the viscosity of seminal plasma.[43]

Puti-Puya (putrid and pyospermia)

Puti means putrid smell and puya means pus and hence, this condition is indicative of pyospermia. This condition is predominant of Pitta and Kapha doshas.[44] Chronic suppurative infections of semen, where semen showing increased pus cells (>5 pus cells/HPF), are all included under puti-puya retodusti. Proper stain is essential to differentiate pus cells from precursor cells.

Anyadhatu Samsristha (association of other than reproductive tissue components)

Apart from spermatozoa, semen contains precursor cells, macrophages, mucus threads, crystals, gelatinous bodies, bacterial matter, and red blood cell, which are all considered as anyadhatu, and the semen present with any of these substances may be labeled as anyadhatu samsrsta retas.

Kunapagandhi (smell like dead body)

In case of injury or wound or due to excessive coitus,[10],[45] semen is ejaculated along with blood. In such conditions, there will be high volume and the semen may be reddish or blackish and smell like that of dead body.[44] This condition may be considered as hemospermia.

Granthibhuta retas (non/in-complete liquefaction)

In general, the semen liquefies within 40 min after ejaculation. The semen which is not liquefied or incompletely liquefied is said to be vitiated by Kapha and Vata.[44],[46] The sperm do not attain their full motility until liquefaction of the coagulum occurs.[47] Men whose semen fails to liquefy spontaneously are likely to be subfertile; their semen remains highly viscous and sperm movements in such semen are very sluggish. A high prevalence of hyperviscosity in semen samples is associated with hypofunction of the seminal vesicles.[48]

Avasadi (sedimentation)

Normal semen disperses when added to water. The semen sample which is not dispersed in water and the drop of semen either suspended or settled to bottom without dispersion may be considered as avasadi retodusti.

Kshina (low volume)

Decreased ejaculate volume is considered as Kshina. Sufficient volume of semen is essential to provide transport media across the vaginal milieu of acidic pH as well as to diagnose obstructive azoospermia.[49]

Sannipata

The condition where all the three doshas (Vata, Pitta, and Kapha) are affected. This condition is characterized with semen smelling like urine or feces.


  Conclusion Top


It is interesting to note that Ayurveda indicated the management specific to each clinical condition. This clearly indicates that unless and until the semen is examined by following the Ayurveda descriptions or the semen evaluation reports are studied in terms of these reodusti, one cannot plan Ayurveda management. Present laboratory reports containing sperm count, spermatozoal motility, etc., with impressions such as oligozoospermia and asthenozoospermia are directly of no use in the selection of drugs as well as treatment modalities as per Ayurveda. However, these semen parameters are useful as assessment tools. Hence, there is a need for integrative approach, i.e., establishing Retodusti through advanced scientific methods [50] so that selection of right drug as per Ayurveda is possible. This approach may definitely enhance the fertility rate through medical management as well as reproductive technologies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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