Vajikarana: Treatment of sexual dysfunctions based on Indian concepts

Integrative Yoga and Ayurvedic Approach to Oligoasthenozoospermia: A Holistic Case Study on Fertility Enhancement

Infertility is the failure to conceive after one or more years of regular, unprotected life for a fertile female. Around 45% of males are responsible for infertility worldwide. Research shows that nearly 50% of infertility in India is related to male reproductive factors or diseases. The male-carrying pathology in semen production includes low sperm count, volume, motility, abnormal forms, and sperm functional tests. This case presents a 31-year-old male with complaints of wanting issues after a complete year of regular, unprotected intercourse. He had undergone all the routine diagnostic investigations on his wife, which reported no issues and recorded regular ovulatory cycles with patent tubes. Then, progressing in the diagnosis, a semen analysis revealed a semen volume of 2 mL, a sperm concentration of 4 million/mL, progressive motility of 8%, non-progressive motility of 3%, and immotile sperm of 89%, with normal sperm morphology. Based on clinical examination, semen analysis, and investigation, the case was diagnosed as oligoasthenozoospermia. Oligozoospermia means low sperm count, and asthenozoospermia means low sperm motility. Oligoasthenozoospermia can be correlated to the Shukra Kshaya Lakshanas mentioned in Ashta Shukra Dushti. There is no satisfactory treatment in modern medicine for these conditions. Yoga and Ayurvedic intervention are the better options for these conditions. This case report focuses on the management of oligoasthenozoospermia through yoga and Ayurvedic medicines, Youvanamrit Vati and Shilajitrasayan Vati, given to the patient for four months.

Conserving traditional wisdom in a commodified landscape: Unpacking brand Ayurveda

As Ayurveda continues to gain global recognition as a sanctioned system of health care, the essence of Ayurveda's identity has become prey to commoditization and commodification for commercial undertakings in the holistic health milieu of India, but also in emerging markets such as Europe. This paper critically assesses the commodification of Ayurveda as a cultural signifier within Europe that separates the indigenous artefact from its Vedic origins. Often presented as an elite commodity in Western settings, Ayurveda has become embedded as a cultural artifact within consumer society as the epitome of holistic care with an emphasis on its spiritual attributes, yet simultaneously isolating it from the customary elements that motivated its inception. The paper argues that Ayurveda's discursive detachment from its ontological tenets facilitates its rearticulation as a malleable experience as it crosses national boundaries, and in this process fosters the misinterpretation of the ancient healing tradition. This process may provide Ayurvedic treatments and principles with increased visibility in Europe's health sector. However, brands are exploiting this niche with push-marketing strategies to capitalize on the budding Ayurveda industry, turning traditional medicines into emblematic commodities. To advance this argument, we examine product diversions in the commodification of classical Ayurvedic medicines in the Netherlands and Germany, focusing on the over-the-counter (OTC) segment. We present an interpretive analysis of the processes that are (de)constructing traditional practices and principles as Ayurveda travels beyond India, and how this complicates issues of authenticity and expertise as herbal medicines diverge from the indications ratified in Ayurveda's classical compendiums.

Oxidative Stress and Male Infertility: Role of Herbal Drugs

Infertility is a universal health problem affecting 15% of couples, out of which 20-30% cases are due to male infertility. The leading causes of male infertility include hormonal defects, physical reasons, sexual problems, hazardous environment, stressful lifestyle, genetic factors, epigenetic factors, and oxidative stress. Various physiological functions involve reactive oxygen species (ROS) and nitrogen species at appropriate levels for proper smooth functioning. ROS control critical reproductive processes such as capacitation, acrosomal reaction, hyperactivation, egg penetration, and sperm head decondensation. The excessive free radicals or imbalance between ROS and endogenous antioxidant enzymes damages sperm membrane by inducing lipid peroxidation causing mitochondrial dysfunction and DNA damage that eventually lead to male infertility. Numerous synthetic products are available in the market to treat infertility problems, largely ending in side effects and repressing symptoms. Ayurveda contains a particular group of Rasayana herbs, called vajikarana, that deals with nourishment and stimulation of sexual tissues, improves male reproductive vitality, and deals with oxidative stress via antioxidant mechanism. The present study aims to describe oxidative stress and the role of herbal drugs in treating male infertility.

Medicinal plants as a potential source of Phosphodiesterase-5 inhibitors: A review

ETHNOPHARMACOLOGICAL RELEVANCE

The prevalence and distress caused by erectile dysfunction (ED) to both male and female partners are increasing at a steady rate. ED has now become the most treated sexual disorder for men among young and old age groups due to varying physical and psychological factors. The treatment with synthetic Phosphodiesterase-5 (PDE5) inhibitors are cost-effective but due to adverse effects such as priapism, loss of vision, heart attack and syncope, the daily life patterns of these patients are distressed and hence the need for alternative medicaments or sources are of utmost important. Therefore, the exploration of medicinal plants as PDE5 inhibitors will be worthwhile in tackling the problems as many plant extracts and fractions have been long used as aphrodisiacs and sexual stimulants which may be found to be active against PDE5 enzyme.

AIM OF THE STUDY

To provide a review on the different medicinal herbs traditionally used as natural aphrodisiacs, libido or sexual enhancers which are proven for their PDE5 inhibitory effect.

MATERIALS AND METHODS

Ethnobotanical and scientific information was procured, reviewed and compiled from the literature search of electronic databases and search engines.

RESULTS

A total of 97 medicinal plants exhibiting PDE5 inhibitory effect are reviewed in this paper which is supported by preclinical experimental evidence. Among them, 77 plants have been selected according to their traditional and ethnobotanical uses as aphrodisiacs and the rest are screened according to their effectiveness against predisposing factors responsible for ED and sexual dysfunction such as diabetes and hypertension or due to the presence of phytochemicals having structural similarity towards the identified natural PDE5 inhibitors. In addition, sixteen alkaloids, sixty-one phenolics and eight polycyclic aromatic hydrocarbons have been isolated or identified from active extracts or fractions that are exhibiting PDE5 inhibitory activity. Among them, isoflavones and biflavones are the major active constituents responsible for action, where the presence of prenyl group for isoflavones; and the methoxy group at C-5 position of flavones are considered essential for the inhibitory effect. However, the prenylated flavonol glycoside, Icariin and Icariside II isolated from Epimedium brevicornum Maxim (hory goat weed) are the most effective inhibitor, till date from natural sources. Traditional medicines or formulations containing extracts of Ginkgo biloba L., Kaempferia parviflora Wall. ex Baker, Clerodendrum colebrookianum Walp., Eurycoma longifolia Jack and Vitis vinifera L. are also found to be inhibitors of PDE5 enzyme.

CONCLUSION

The review suggests and supports the rational use of traditional medicines that can be further studied for the development of potential PDE5 inhibitors. Many traditional medicines are still used in various regions of Africa, Asia and South America that are poorly characterized and experimented. Despite the availability of a vast majority of traditional formulations as aphrodisiacs or sexual stimulants, there exists a need for systemic evaluation on the efficacy as well as the mechanism of action of the herbal constituents for the identification of novel chemical moieties that can be further developed for maximum efficacy.

Pueraria tuberosa: A Review on Traditional Uses, Pharmacology, and Phytochemistry

Pueraria tuberosa (Roxb. ex Willd.) DC. (Fabaceae), also known as Indian Kudzu (vidari kand), is a perennial herb distributed throughout India and other Asian countries. Traditionally, tuber and leaves of this plant have extensively been reported for nutritional and medicinal properties in Ayurveda as well as in Chinese traditional practices. The objective of the present review is to compile and update the published data on traditional uses, pharmacological potential, and phytochemistry of compounds isolated from the plant Pueraria tuberosa. P. tuberosa extracts and its purified compounds possess multiple activities such as anticancer, anticonvulsant, antidiabetic, antifertility, anti-inflammatory, antioxidant, anti-stress, antiulcerogenic, cardioprotective, hypolipidemic, hepatoprotective, immunomodulatory, nephroprotective, nootropic, neuroprotective, and wound healing. Tuber and leaf extracts of P. tuberosa contain several bioactive constituents such as puerarin, daidzein, genistein, quercetin, irisolidone, biochanin A, biochanin B, isoorientin, and mangiferin, which possess an extensive range of pharmacological activities. The extensive range of pharmacological properties of P. tuberosa provides opportunities for further investigation and presents a new approach for the treatment of ailments. Many phytochemicals have been identified and characterized from P. tuberosa; however, some of them are still unexplored, and there is no supporting data for their activities and exact mechanisms of action. Therefore, further investigations are warranted to unravel the mechanisms of action of individual constituents of this plant.

Development and evaluation of aphrodisiac potential of a classical ayurvedic formulation, 'Kaamdev ghrita' in rat model

BACKGROUND

Ghee is widely considered as the Indian name for clarified butterfat and processing of ghee with therapeutic herbs i.e. ghrita is renowned for augmenting their medicinal properties. Kaamdev ghrita (also known as 'VajikaranaRasayana') is cow ghee based classical Ayurvedic formulation from the aphrodisiac category, which is used to ameliorate and potentiate sexual performance and also in the treatment of sexual dysfunctions, infertility, and premature ejaculation.

OBJECTIVE

Present research work deals with the organoleptic, physicochemical, and biological assessment of Kaamdev ghrita for its aphrodisiac activity using in-vivo animal models.

MATERIAL AND METHODS

Kaamdev ghrita was prepared using Indian cow's ghee as per standard Ayurvedic classical texts and subjected to organoleptic (color, odor, taste, texture, touch), physicochemical (acid value, peroxide value, iodine value, saponification value, unsaponifiable matter, extractive values, refractive index, and specific gravity) analyses as per the standard pharmacopeial procedures. The aphrodisiac potential of ghrita in rat model was evaluated by monitoring sexual behavioral performance using different parameters (mount frequency and latency, intromission frequency and latency, anogenital grooming and sniffing) at the dose of 150 and 300 mg/kg body weight.

RESULTS

The physicochemical evaluation of Kaamdev ghrita showed higher acid value, iodine value, refractive index, and specific gravity whereas the lower saponification and peroxide value than the plain ghee. Kaamdev ghrita revealed the presence of flavonoids, alkaloids, saponins, sterols, terpenoids, coumarins, tannins, and showed remarkable antioxidant activity by in-vitro assays. It augmented the sexual performance in a dose-dependent manner as indicated by significant improvement (P < 0.05) in mount frequency and latency, intromission frequency and latency, anogenital grooming, and sniffing as compared to plain ghee treated control group. The present investigation has corroborated the ethnopharmacological claim of Kaamdevghrita for its aphrodisiac potential.

CONCLUSION

Kaamdev ghrita exhibited aphrodisiac activity which may be attributed to the presence of antioxidant herbs present in it. It is the first scientific report on validation of the traditional claim of Kaamdev ghrita for its aphrodisiac potential.

Medicinal plants/herbal supplements as female aphrodisiacs: Does any evidence exist to support their inclusion or potential in the treatment of FSD?

ETHNOPHARMACOLOGICAL RELEVANCE

Female Sexual Dysfunction is a complex condition with biopsychosocial origins. Plants traditionally used as aphrodisiacs may be promising as routes to develop therapeutic options which are lacking.

AIM

To distinguish the plants commonly used in (AP) on the market in the United States, and to evaluate their ethnobotanical and clinical evidence as a basis for their inclusion.

METHODS

This study is a narrative review of 53 species commonly found in AP on the market in the United States. Most species listed have anecdotal use as aphrodisiacs throughout history; therefore, a systematic search was done for clinical evidence. The primary outcome assessed is the clinical efficacy of plants in the treatment of libido desire disorders.

RESULTS

There is little to no evidence from the literature to substantiate claims of plants currently on the market as AP for female libido desire disorders.

CONCLUSIONS

The biggest problem in the literature is the lack of botanical verification and consistency in material across studies. Any botanical, commercial or otherwise must be tested for chemical markers exhibited by individual species; however, if no markers exist, work must first be done to determine these. Appropriate analytical techniques for this would include high pressure liquid chromatography, and mass spectroscopy. It would also be sufficient to taxonomically authenticate species provided the plant material. Further research should aim to standardize plant material and extraction methods utilized in order to compare studies effectively and allow for reproducibility to draw conclusions. While clear interest into investigation the aphrodisiac potential of plants exists, a translatable in vivo animal model does not. Clinical trials rely on patient reported outcomes to determine efficacy but cost and length of such trials deem a necessity for development of an animal model to first screen botanicals. We suggest development of screening tools utilizing the evident neurobiological underpinnings of FSD as the first step. In general, studies of plants currently used as ingredients for AP are severely lacking, and even so the evidence that exists is weak.

Ethnomedicobotanical study of indigenous knowledge on medicinal plants used for the treatment of reproductive problems in Nalbari district, Assam, India

ETHNOPHARMACOLOGICAL RELEVANCE

Reproductive problems are becoming the most predominant health care problems in many countries. World Health Organization (WHO), in 2012, also exemplified maternal illnesses, for instance, birth asphyxia and post birth difficulties are rising at an alarming rate. In addition, not all abnormalities of the human reproductive system have the same origin; the effects of reproductive problems would likely been affected by both male and female. For easy accessibility and affordability, medicinal plants are playing crucial role in primary healthcare services in India and their use is moreover, an integral part of the cultural heritage. However, our growing understanding of the human reproductive problems are segregated and scanty for herbal medications.

AIM OF THE STUDY

To document the local name of the medicinal plants used by both male and female from indigenous knowledge for the treatment of reproductive ailments and to explore their biological and pharmacological confirmation and to address the class of secondary metabolites present therein.

MATERIALS AND METHODS

The results stem in September 2015-April 2016 from an array of informations that were collected by direct interviews of the traditional medicinal practitioners in three villages, viz. Jaha, Niz-Bahjani and Madhupur of the southern Nalbari district, Assam. Both semi-structured and open-ended interview schedule was carried out with purposively selected individuals and focus group discussion (FGD) in the three selected sites for this study. Systematic analysis of fidelity level percentage (FL %), preference ranking percentage (PR %) and formulation scoring (FS) were calculated. Electronic databases such as Google, Google Scholar, and ScienceDirect were also been used to search existing pharmacological citations. Finally, qualitative chemical profiling were executed for the plants whose PR % scores ≥ 65.

RESULTS

A total of 71 plant species belonging to 48 families and 64 genera are reported to be used for the treatment of several reproductive problems such as, infertility in male, impotence, erectile dysfunctioning, retrograde ejaculation and sexual potency in men and in women, aphrodisiac, metrorrhagia, infertility, dysmenorrhea and/or post birth difficulties under mono (57), di (17) and poly (8) herbal formulations. Herbs (40.85%) were reported as the most common lifeform, whereas leaves (22.54%) and the roots (22.54%) were the commonly used plant parts against different ailments. Extracts of Abroma augusta L. (stem) (FL: 66.67%, PR: IM-77.33%, L-65.33, FS: 2), Morinda angustifolia Roxb. (bark) (FL: 64.29%, PR: L-68%, FS: 1), Hodgsonia heteroclita Roxb. (fruit) (FL: 63.64%, PR: IF-65.33, FS: 0.25) and Hibiscus mutabilis L. (stem) (FL: 40%, PR: IM-68%, IIM: 65.33%, IML-68%, FS: 2) were than selected for further phytochemical analysis.

CONCLUSIONS

Of the 71 plants used for reproductive management system, the highest number of plants were used for the treatment of irregular menstruation (22) followed by infertility (in both men and women) (19), vaginal disorder and leucorrhoea (9) and sexual potency (8). The qualitative chemical profiling have demonstrated the presence of alkaloids, carbohydrates, phenolic compounds, flavonoids and phytosterols, in maximum concentrations. Additionally, these data may be the most important resource for the new discovery of many bioactive principles.

Tradition in treating taboo: Folkloric medicinal wisdom of the aboriginals of Purulia district, West Bengal, India against sexual, gynaecological and related disorders

ETHNOPHARMACOLOGICAL RELEVANCE

In order to explore the traditional medicine practised by the ethnic communities residing in the topographically and climatically challenged Purulia, an underprivileged district of West Bengal, India, a quantitative ethnobiological approach was adopted to document the folkloric use of ethnomedicinals against different sexual, gynaecological and related ailments.

MATERIALS AND METHODS

Ethnobiological surveys were conducted during 2012-2015 by interviewing 82 informants or traditional healers with the help of a semi-structured questionnaire. The survey included questions on botanical and non-botanical ingredients and additives mixed with monoherbal and polyherbal formulations, vernacular names of the plants and animals, methods of preparation and administration and restrictions during medications. Additional quantitative indices such as use value, informant׳s consensus factor and fidelity level were used for data analysis.

RESULTS

Twenty eight sexual and gynaecological disorders were found to be treated with 18 monoherbal and 31 polyherbal formulations consisting of a total number of 96 plant species from 86 genera and 47 families and four animal species. A variety of additives, either botanicals or non-botanicals were used with the formulations for higher efficacy and taste enhancement. Fabaceae (16 species) was found to be the most common family of medicinal plants whereas herbs (42.7%) and roots (32%) were the most common habit type and plant part used respectively. Use value, informant׳s consensus factor and fidelity level indicate frequency and coherence of citations.

CONCLUSION

Age old belief on traditional medicine prevails in the studied area due to its efficacy, inexpensive price and the remoteness of tribal villages from conventional medical centres. Traditional healers had detailed knowledge of preparations, doses, methods of administration, restrictions during medications, safety and efficacy of using folkloric therapeutics against sexual and gynaecological disorders. Possible synergistic interactions among phytochemicals and additives were indicated to explain enhanced therapeutic efficacy of mixed herbal formulations.

Effect of Cinnamomum cassia methanol extract and sildenafil on arginase and sexual function of young male Wistar rats

INTRODUCTION

Herbs have been used as an aphrodisiac since ages. Cinnamomum cassia is an important ingredient of many Ayurvedic formulations to treat male sexual disorder including erectile dysfunction (ED).

AIM

The objective of the present study was to evaluate erectogenic and aphrodisiac activity of methanol extract of C. cassia bark in young male rats.

METHODS

Methanol extract of C. cassia was screened in vitro for arginase inhibition potential and IC50 was determined. Effect of the extract was observed in vitro on phenylephrine pre-contracted isolated rat corpus cavernosum smooth muscle (CCSM) at 0.1, 1, 10, and 100 μg/mL. Young male Wistar rats were dosed with extract at 100 mg/kg body weight for 28 days and its effects on sexual behavior and penile smooth muscle : collagen level were observed.

MAIN OUTCOME MEASURE

Effect of C. cassia was studied on arginase activity in vitro and sexual behavior of young male rats.

RESULTS

C. cassia inhibited arginase activity in vitro with an IC50 of 61.72 ± 2.20 μg/mL. The extract relaxed phenylephrine pre-contracted isolated rat CCSM up to 43% and significantly increased (P < 0.05) sexual function of young male rats. Treatment with the extract also increased smooth muscle level and decreased collagen level in rat penile tissue.

CONCLUSION

The study proves usefulness of methanol extract of C. cassia bark for increasing sexual function.