Professional Documents
Culture Documents
By
Dr. GEETHA. P, B.A.M.S.
Co-Guide
Dr. V. RAJENDRA. M.D. (Ayu)
Assistant Professor,
Department of Post-Graduate Studies in Ayurveda Siddhanta
G.A.M.C., Mysore
I bow to the sacred feet of Almighty, without the blessings of whom this study would
not have been completed.
I owe my deep sense of gratitude to all my teachers Dr. T.D. Ksheera Sagar,
Dr.T.R.Shantala Priyadarshini, Dr.Shreevathsa, Dr.V.A.Chate, Dr. Ananda
Katti for their support and guidance.
vii
I personally thank Dr. Gajanana Hegde and Dr. Jyothi Hegde for their kind support.
I thank Dr.Lancy Dsouza for his valuable help and guidance in the statistical
analysis and interpretations.
I personally thank Mr.Amith, KCDC and all the staff of the Laboratory for their kind
support.
I thank my younger colleagues, Dr. Athika jan, Dr Arhanth, Dr.Rekha, Dr. Preetha,
Dr. Arun, Dr. Atul , Dr. Divyarani and Dr. Sapna for their help.
I thank Dr.Ananta shayana, Dr. Sameena, Dr. Shreedhar murthy, Dr. Vyasraj, Dr.
Ranjini, Dr. Parveen, Dr. Kiran, Dr.palavi and Dr. Aditya for their support in my
dissertation.
I thank Dr. Prasad, Principal SDM, Udupi and Dr Niranjan, Assistant professor,
SDM, Udupi for their support in my dissertation.
I also owe my heart felt gratitude to my teachers of under graduation who initiated
and instilled in me the knowledge of this holy science.
viii
ix
LIST OF ABBREVIATIONS
B.P:Bhava Prakasha
x
ABSTRACT
Background of the study
Obesity has increased at an alarming rate in recent years & has become one of the
obesity which is not greatly emphasized by the medical practitioners and researchers
as well. Almost 8 out of every 10 men who suffer from erectile dysfunction are
overweight. Studies show that obese males have a 30% higher chance of developing
the condition than the people of normal weight. In recent years several informations
are available with regard to obesity related sexual dysfunction. It is also noteworthy
regarding the relationship between obesity and sexual act. Obesity is described as
Charaka Samhita establishes the relationship between these through the statement
margatva.
The present study was conducted to compile the available information regarding the
and to validate the statement of Charaka Samhita. The present work also intends to
xi
Objectives of the Study
Method
Intervention
33 obese individuals between age group 30 to 60 years were assigned into a single
group. They were assessed for sexual function and semen analysis.
Results
erectile functions of obese individuals. In rest of the components of IIEF like sexual
The parameters like liquefaction time, viscosity, sperm count, were at statistically
significant levels suggesting that there is no much change seen in the semen
xii
There was no statistically significant difference in semen volume, motility (class a
and b) and overall impression. Correlation studies suggest the fact that the extent of
suggesting that there was mild dysfunction observed in these two parameters.
suggesting that there is no erectile dysfunction seen in obese individuals. But the
In rest of the components of IIEF there was no significant findings observed. But
some amount of dysfunction from severe to mild was observed in these two
components also.
It is observed from the study that the relationship between BMI and erectile
dysfunction was not significant statistically. However the study suggests that the
erectile dysfunction increases proportionately with waist hip ratio. There is no direct
relation between BMI and erectile dysfunction but Correlation studies suggest the fact
that the extent of erectile dysfunction varies directly with the hip waist ratio.
Even though there are no significant changes in all the semen parameters, 60%
individuals had the semen volume less than 2 ml indicating that some amount of
abnormality observed in semen volume suggest that the probability of a lesser volume
It was concluded that there is a relation between Sthoulya and krucchra vyavaya.
xiii
Keywords
Sthoulya
vyavaya
krucchra vyavaya
shukra abahutva
medasaavruta marga
obesity
Erectile dysfunction.
xiv
CONTENTS
Particulars Page no
Introduction 1
Objectives 4
Review of literature 5
Review on Sthoulya 5
Review on obesity 23
Review on vyavaya 38
Discussion 101
Conclusion 145
Summary 146
Annexure I- XXII
xv
LIST OF TABLES
xvi
14. Showing the distribution of Nature of work in the individuals of 71
Sthoulya
22. Showing the distribution of sleep during night time in the individuals 74
of Sthoulya
xvii
29. Showing the distribution of jarana Shakti in the individuals of Sthoulya 77
34. Showing the Scores of IIEF related to Sexual Desire in the individuals 79
of Sthoulya
42. Showing the Motility of Sperms ( class a & class b ) in the individuals 82
of Sthoulya
xviii
44. Showing the Impression of Semen Analysis in the individuals of 83
Sthoulya
47. Showing the Correlations of waist hip ratio with Erectile Functions in 84
the individuals of Sthoulya
48. Showing the Correlations of waist hip ratio with Semen Analysis in the 85
individuals of Sthoulya
List of Illustrations
xix
7. Showing the incidence of Nature of work 89
xx
25. Showing Liquefaction time of Semen 98
Sl No Particulars Page no
xxi
xxi
Ma: madhyama
Pr: Pravara
Av: Avara
K: Kroora
1
INTRODUCTION
medas in the body, especially in the areas of buttocks (sphik), breasts (stana) and
abdomen (udara).
Over weight and obesity are the two medical conditions described in Western
With the increasing prevalence of obesity, it is viewed as one of the serious health
Both Ayurveda and Western Medical science agree with the fact that obesity
has many adverse effects on health and increases the risk for various diseases,
particularly heart diseases, type2 diabetes mellitus and osteoarthritis.2, 3.Lot of clinical
and research studies are being conducted over the past 2-3 decades to understand the
understudied subject despite the fact that sexuality is one of the important areas of
normal health. It is hypothysed that obesity has a negative effect on sexual abilities.
However the relationship between obesity and sexual dysfunction has not been
completely clarified.The studies that are conducted in this direction are seldom,
Interestingly the link between obesity and sexual dysfunction has been
emphasized in charaka Samhita. Not only the relation between the two but also the
greatly understudied, despite the great attention that has been focused on Sthoulya
In the above situation to explore and validate the time old statement of
vyavayata may play an important role in establishing the relationship between the
two.
Samhita.The current study was undertaken to analyse the statement conceptually and
The study consisted of two parts. Firstly, a detail conceptual analysis of the
The second part of the study was an observational study. The study was conducted in
analysis of all individuals of the above group except three in whom semen analysis
could not be carried out because of Erectile dysfunction and low volume of semen.
The results of the study were observed and statistically analysed using
descriptive statistics, frequencies and percentages, Chi- Square test, Pearsons product
In the study it was observed and recorded that the relationship between
also revealed that varying degree of sexual dysfunction was observed in all the 5
Eventhough the conclusions drawn from the study for the metabolic syndrome
the probable link between the two may be a useful motivation for men to improve
their health related life style choices advocated by Ayurveda, which can reduce the
STHOULYA
in Ayurvedic literature since the period of Charaka Samhita. It has been considered as
Madhava nidana discussed this condition in an independent chapter. The later authors
also have paid lot of attention to this disease. Sthoulya in terms of obesity has also
been considered as a great health problem in the present era drawing lot of attention
Derivation
Sthoulya is a term which is A karanta napumsaka linga.It is derived from the mula
dhatu xj with Ac and wrg pratyaya as suffixes. The vyutpatti of the term
Sthoulya is as follows.
By the derivation the meaning of the term Sthoola is the one which is bulky, big or
thick
Definition
deposited in areas like sphik, udara and stana causing pendulous movement in
activities.
Synonyms
Sthoolam(big)
Classification
literature of Ayurveda, an attempt can be made to classify the same based on the
Classical literature of Ayurveda lists out various etiological factors for the
process starting from genetic disorder to the dietary factor. These etiological factors
atisevana of guru, madhura sheeta and Snigdha aharas.In this context Atisampoorana
In Sushruta Samhita, the nidanas like Adhyashana (consumption of food before the
proper digestion of previous meal) and Shleshmala ahara sevana can be considered as
Divaswapna (day time sleep) are mentioned as the etiological factors.13, 14, 15
may be induced characters of either mother or father. Only in Charaka Samhita, the
treatments such as Snehana, Snehabasti, Snana, Utsadana and swapna are considered
Sl Nidana Cha Su A.S A.H M.Ni B.P Y.R G.Ni Sha V.sena B.Raj
no
A Aharatmaka
Nidana
1 Atisampoorana + - - - - - - - - - -
2 Adhyashana - + - - - - - - - - -
3 Guru ahara + - + - - - - - - - -
4 Madhura + - - - - - - - - - -
ahara
5 Sheetala ahara + - - - - - - - - - -
6 Snigdha + - - - - - - - - - -
aharas
7 Shleshmala - + - - + + + + + + +
ahara
B Viharatmaka
Nidana
Avyayama + + - - + + + + + + +
Avyavaya + - - - - - - - - - -
Divasvapna + + - - + + + + + + +
C Manasika
Nidana
Achintyam + - - - - - - - - - -
Harsha + - - - - - - - - - -
Nityatvam
D Beeja Doshaja
Beeja + - - - - - - - - - -
Svabhava
E Anya Karana
Ati Bruhmana + - - + - - - - - - -
chikitsa
Ama - - + - - - - - - - -
RasaNimittaja - + - - - - - - - - -
Samprapti
The samprapti of Sthoulya has been briefly dealt in all the three major
highlighting the process medasavruta vata20. It states that the set of nidanas increase
medas alone at the cost of other dhatus in vulnerable people. Due to the avarana of
digestion. This causes the habit of over eating and repeated intake of food. The major
portion of the food thus consumed is ultimately converted into medas resulting in
sthoulya.
The samprapti of all the eight major lakshanas of sthoulya such as Ayushohrasa,
differs slightly from that of Charaka Samhita. It states that, due to the indulgence of
madhura in nature. The annarasa thus produced circulates all over the body in the
throws some more light on this process of pathogenesis. The commentary tries to
critically analyze how ama is produced in people who are predominant of medas,
though they have teekshnagni. The reasons attributed for amotpatti are
Aq Circri).
avastha itself in the dhatu poshana krama, still medodhatu upachaya takes place at
the cost of rakta and mamsa. There are three reasons attributed for this23.
medodhatu.
Due to the intake of nidana such as guru ahara, the anna rasa produced is
Indu teeka on Astanga Sangraha adds that the increase of medo dhatu is
because of the specific reasons which are favourable for medo vriddhi25.
Madhava nidana tries to integrate the views of both Charaka Samhita and
anna rasa which has the predominance of madhura rasa as a result of which there is
an increase of sneha guna and medo dhatu in the body. The medo dhatus thus
depleted causing symptoms such as inability to perform all the activities, kshudra
untimely food as the cause of the formation of ama in people who are obese. In
that annavaha srotas predominantly contains madhura anna rasa irrespective of rasa
Poorva roopa
Ayurveda do not enumerate any of the poorva roopas. Hence, roopa expressed in
Roopa
Charaka Samhita has described ashta doshas inherent to the Ati sthoola persons
and can be taken as the primary clinical features of sthoulya28. They are as follows:
4. Dourbalya- weakness
The individual causes of all these eight doshas have been mentioned separately.
gurutva of medas.
Dourgandhya is caused by the inherent defect and the nature of the medas and
sweating.
The last two doshas namely atikshudha and ati pipasa are caused as an effect
The other cardinal features of sthoulya described in classical text books are as
follows: 30, 31
Ayathopachaya
Ayatha utsaha
The other features of sthoulya described in different classical text books can be listed
as follows.
weakness in the body), Gadgadatva (stammering/ slurred speech) and Alpa prana
Sushruta samhita with some minor differences. It has included jadya and alpa ayu
bala and at the same time has excluded alpa vyavaya mentioned in Sushruta
samhita33.
Madhava nidana adds one more lakshana Moha to the above mentioned
lakshanas34. Other text books such as Bhava Prakasha, Yoga Ratnakara, Gada
S.No Laskanas Cha Su A.S M.Ni B.P Y.R G.Ni Sha V.Sena B.raj
1 Ayushohrasa + - - - - - - - - -
2 Javoparodha + - - - - - - - - -
3 Krucchra + - - - - - - - - -
vyavaya
4 Dourbalya + - - - - - - - - -
5 Dourgandhya + + + + + + + + + +
6 Swedabadha + + + + + + + + + +
7 Kshutatimatra + + + + + + + + + +
8 Pipasatiyoga + + + + + + + + + +
9 Chala Sphik + - + + + + + + + +
10 Chala udara + - + + + + + + + +
11 Chalastana + - + + + + + + + +
12 Ayathopachaya + - + + + + + + + +
utsaha
13 Kshudra - + - + + + + + + +
Shwasa
14 Swapna - + - + + + + + + +
15 Kratana - + - + + + + + + +
16 Gatra sada - + - + + + + + + +
17 Gadgadatva - + + - - - - - - -
18 Sarvakriyasu - + - + + + + + + +
asamartha
19 Alpa vyavaya/ - + - + + + + + + +
maithuna
20 Shwasa - - + - - - - - - -
21 Atinidrata - - + - - - - - - -
22 Ayasakshamata - - + - - - - - - -
23 Jadya - - + - - - - - - -
24 Alpa ayu bala - - + - - - - - - -
25 Moha - - - + + + + + + +
26 Alpa Prana - - - + + + + + + +
Upashaya
literature of Ayurveda.
Upadravas
Visarpa, Bhagandara, Jwara, Atisara, Moha, Arsha, Shleepada, Apachi and Jantava
destroying a forest. Impaired vata & Agni associated with the disproportionate
fatal also40.
Madhava nidana and Gada nigraha also endorses the view of Charaka Samhita in
texts.
Sadhyaasadhyata
involved in the management. The treatment procedures like santarpana & apatarpana
cannot be adopted. The main difficulty with the Sthoola persons is that if they are
given santarpana measures they will grow more corpulent, they even cannot
Sthoulya which occurs due to beeja dosha is asadhya since all sahaja vyadhis
upadravas of sthoulya are mainly due to vata & Agni vaishamya. These upadravas
Treatment
Samhita while describing the chikitsa of sthoulya and karshya. It is considered that
the treatment of karshya which is the opposite condition of sthoulya is simple and
straight forward. All treatment modalities which cause bruhmana will alleviate
karshya. On the other hand the treatment of sthoulya is relatively difficult because
neither bruhmana nor karshana can be carried out easily. Bruhmana increases the
body mass while karshana even though is supposed to reduce the body mass is
difficult to carry out because of the strong digestive power which normally
mainly aimed at the correction of Vata, kapha & medas45, 46. This can be achieved by
of all the diseases and Sthoulya in particular. Sthoulya is a condition caused by the
intake of brumhana ahara & vihara in excess. The management of the condition is
invariably dependent on all such factors which results in bruhmana. This includes
Langhana chikitsa should be carried out both as shamana & shodhana therapy. The
latter is carried out by the procedures which include Virechana, Basti &
48
Raktamokshana . Charaka Samhita advocated teekshna, ushna & ruksha bastis49.
Shamana
sthoulya should be guru & atarpana. By the virtue of guru guna the ahara &
oushadhas minimize the aggravated vata & also reduces the teekshnagni. The
Atarpana guna of ahara & oushadhas will help in the reduction of medho dhatu.
According to Charaka Samhitha in this context the term guru indicates the qualitative
Shamana chikitsa includes deepana, pachana, kshut and trushna nigraha, vyayama,
atapa and maruta sevana54. For the management of sthoulya, the drugs which reduce
vata, kapha and medas should be used55. One of the ways of achieving this objective
articles can be used for management of Sthoulya56. Katu and Kashaya Rasa are having
Medoupashoshana Karma .Hence, Katu, Tikta and Kashaya Rasa dominant drugs can
Bilvadipanchmula with Madhu and Shilajatu with Agnimantha Svarasa are advised
Apart from this the Drugs and formulations mentioned for sthoulya are:
Lekhaniya Mahakashaya60,
Bibhitaka61,
Venuyava62 and
especially Shilajatu, Guggulu, Gomutra, Triphala, Loha Raja, Rasanjana and Madhu
are advised. In this context, Dalhana has explained that Virukshana property helps to
reduce Meda and Chedaneeya property helps to remove obstruction from body
Churna Yogas
Triphala
Shilajatu
Guggulu Yogas
Navaka guggulu
Trayushanadi guggulu
Amrutadya guggulu
Rasayanas
Taila Yoga
Pathya-Apathya
The various types of ahara which are to be used in Sthoulya are listed below:
mudga, kulattha, chakramudgaka, adhaki beeja, patola and amalaka as food followed
by honey diluted in water.Arishtas which are meda, mamsa and kaphahara are used
management of Sthoulya66.
Pathyas advocated in Sushruta Samhita for sthoulya are yava, mudga, koradushaka,
shyamaka, uddalaka and other dravyas which promote rukshata and reduces medas67.
In Ashtanga Sangraha, the pathyas mentioned for Sthoulya are similar to that
of Charaka Samhita with the addition of Mastu and Takra which are indicated as
pana68.
masura, mudga, tuvara, madhu, laja, takra, sura, pingala matsya, dagda vartaka
phala, triphala, guggulu, palasha, katutraya, sarshapa taila, ela kshara, aksha taila,
pratapta neera, shilajatu, patrotha shakagaru and other dravyas which are deepana
The activities which are indicated for the management of Sthoulya are
(excercise), and chinta72. Sushruta Samhita has mentioned vyayama as the only
the activities such as chinta(to think about), shrama(be tired of doing anything)
jagarana(Being awake late night), vyavaya (sexual act), udvartana, langhana ,atapa
For the management of sthoulya the following food articles are said to be
apathya. They are most of the rasayanas, shali, godhuma, masha, matsya mamsa,
The activities which are said to be apathya for the management of sthoulya are
OBESITY
within the last 20 years and continues to rise. Obesity has its influence on both
mortality and morbidity. The only medical benefit of obesity is seen in osteoporosis,
where bone density increases in response to increased mechanical stress. Obesity may
supplies are intermittent, the ability to store energy in excess of what is required for
immediate use is essential for survival. Fat cells, residing within widely distributed
adipose tissue depots, are adapted to store excess energy efficiently as triglyceride
and, when needed, to release stored energy as free fatty acids for use at other sites.
permits humans to survive starvation for as long as several months. In the presence of
endowment, this system increases adipose energy stores and produces adverse health
Definition
effects.78
of both80.
Obesity refers to an increase in total body fat. When body weight is 20%
above ideal body weight, for age, sex and height the condition is termed as
Obesity has been more precisely defined by the National Institutes of Health
Prevalence of Obesity
Obesity has reached epidemic proportions globally, with more than 1 billion adults
overweight - at least 300 million of them clinically obese - and is a major contributor
to the global burden of chronic disease and disability. Obesity is more common
among women and in the poor; the Prevalence in children is also rising at a
worrisome rate. India is following a trend of other developing countries that are
steadily becoming more obese and it has reached epidemic proportions in India in the
Epidemiological factors
Age
Obesity is most prevalent in middle-age, but can occur at any stage of life.
Sex
Normally, women are more prone to be obese than men. The young women contain
fat approximately 15% of body weight and it is about more than young man. In the
phase of puberty and adolescence fat accumulates in body due to hormonal changes.
Occupation
businessmen.
Socioeconomic Status
There is clear inverse relationship between socioeconomic status and obesity. Within
some affluent countries however, obesity has been found to be more common in the
lower socio- economic groups. In developing countries it can occur only in the
prosperous elite. After so many surveys, it is observed that the increased prevalence
of obesity is seen in middle, lower and upper socioeconomic classes respectively. The
prevalence of obesity is not related with quantum of money but it depends upon faulty
The National Institute for Health and Clinical Excellence (NICE) systematic review
identified a body of evidence from cohort studies that pregnancy is associated with
postpartum weight gain. One good quality systematic review of a range of cohort and
other observational studies found that women lose weight after birth, and that those
NICE systematically assessed five cohort studies which examined the association of a
number of variables with weight change during menopause. The findings suggest that
weight gain during menopause transition is itself inconsistent and may indicate
change.
'obesogenic' environment84
Synonyms of Obesity:
Etiology of Obesity
The etiology of obesity arises from a complex interplay of behavioral and genetic
factors.
Specific causes of weight gain can be explained under the following headings.
Genetic Factors
Behavioral Factors
Endocrinal Factors
Drugs
Genetic Factors:
A few rare single gene disorders have been identified which lead to a system complex
that accounts for approximately 5% of severe early onset obesity, the Prader-Willi
Dietary factors,
Smoking cessation,
Alcohol consumption
a. Dietary factors
High fat diets do not switch off appetite; also fat consumption induces very little
energy expenditure as most is stored. Consumption of energy dense foods and drinks,
often high in fat and sugar but low in bulk. This increases energy intake substantially.
statements on the associations between dietary components and obesity. Low energy-
probably protect against weight gain, overweight, and obesity. High energy-dense
foods (marked by intake of animal fats) are probably a cause of weight gain,
overweight, and obesity, particularly when large portion sizes are consumed regularly.
Sugary drinks probably cause weight gain, overweight, and obesity. Fast foods
b. Smoking cessation
Giving up smoking which induces a fall in energy expenditure and leads to an average
Studies show that those who quit smoking for at least a year experience greater weight
gain than their peers who continue to smoke. The amount of weight gained with
cessation may differ with age, social status and behaviors. A follow-up study of a
weight gain and increased waist circumference in those who quit compared to those
c. Alcohol consumption
Studies have shown that the relationship between exposure to work stress and
A high quality cohort study assessed whether work stress was linked to development
of obesity during mid-life. The study involved 6,895 men and 3,413 women taken
from the Whitehall II cohort and followed them for 19 years. This study considered
adult, mostly
Caucasian / European ethnicity British civil servants and found there is a very likely
causal, dose-response relationship between exposure to work stress and the risk of
and obesity
A large, good quality prospective cohort study considered female, middle-aged nurses
and the relationship between self-reported sleep duration at baseline with self-reported
weight gain and risk of incident obesity after a median follow-up of around 12 years;
although the accuracy of exposure and outcome measurement is unclear and reverse
causation and bias cannot be excluded, it found that less than seven hours reported
sleep showed a dose response relationship with increased weight gain, compared to
those reporting seven hours of sleep and that weight gain was greater in those with a
BMI<25 at baseline88.
Endocrinal Factors
Hypothyroidism
Cushing's syndrome
Insulinoma
Drug
Tricyclic antidepressants
Corticosteroids
Sulphonylureas
Anti-seizure medicines
-blockers
Lithium
Antacids
Mood stabilizers
Migraine medicines
Antipsychotics
Among all the etiological factors, Endocrinal Factors & Drugs are potentially
Classification
Based on BMI
Based on BMI
The World Health Organization (WHO) and International Obesity Task Force have
modifications.
Exogenous
Endogenous
Idiopathic
Cushings syndrome
Hypothyroidism
Hypothalamic tumours
Hyperinsulinism
Pathogenesis
exceeds energy expenditure, the excess calories are stored as triglycerides in adipose
tissue. The energy equation consisting of intake and expenditure, are regulated by
neural and hormonal mechanisms and therefore influence the body weight. This
1. The afferent system, which generates humoral signals from the adipose tissue
3. The effector system, which carries out orders from the hypothalamic nuclei
In the afferent system, Ghrelin is a short term mediator produced in the stomach. The
level of ghrelin rise sharply before every meal and fall when the stomach is filled.
Whereas the insulin and leptin exert long term control over the energy cycle by
activating catabolic circuits and inhibiting the anabolic pathways. Leptin has more
important role than insulin in the central nervous system control of energy
homeostasis.
The adipocytes communicate with the hypothalamic centers that control appetite and
It inhibits anabolic circuits that normally promote food intake and inhibit
energy expenditure.
The net effect of leptin is to reduce food intake and promote energy expenditure.
Hence over a period of time, energy stores are reduced and weight is lost. This in turn
reduces the circulating levels of leptin, and a new equilibrium is reached. This cycle is
reversed when adipose tissue is lost and leptin levels are reduced below a threshold.
Equilibrium is again reached, since with low leptin levels, the anabolic circuits are
relieved of inhibition and catabolic circuits are not activated, resulting in net gain of
weight89.
Treatment91
1. Goal
Reduce weight at a rate of about -1Kg per week for six months.
2. Dietary Therapy
Encourage low calorie diet with low fat. The reduction is usually to
Low fat diets have a lower energy density than high fat diets and as
Low fat diets also have higher fiber content and this may also
enhance satiety.
fat diet.
Physical exercise
Moderate exercise should be done for 30-45 minutes per day, 3-5
days a week.
Behaviour modification
3. Pharmacotherapy
Drugs are used when BMI is more than or equal to 30kg/m2 .Currently
diethypropion.
4. Surgery: Known as Bariatric surgery. Useful in patients with BMI more than
or equal to 35-40kg/m2 when other methods have failed and patients have
Liposuction
KRUCCHRA VYAVAYA
essential to examine the two components of the term viz. Krucchra and Vyavaya.
Vyavaya
The term vyavaya represents sexual intercourse. It is the physical act through which
Kama, one among the four pursuits of life is achieved. Ayurveda attaches a lot of
importance to the method of copulation. The details of which are discussed under
under stree sevana vidhi. This Vidhi includes explanation about the sexual intercourse
and also about the eligible people, erogenous zones, the code and conduct during the
Men who copulate following all these norms of ratricharya obtain longevity of life
and their aging process is delayed. They are also endowed with Varna, bala and
sthiropacitamamsa92.
Derivation
u+Au+Ch+bg urur
It is derived from the mula dhatu Ch with two prefixes namely u & Au and a
suffix bg. By the derivation the meaning of the term vyavaya is copulation93.
Synonyms
Sexual Physiology
Normal sexual act is dependent upon the excitement which is proportional to the
strength of body and mind97. Male sexual act comprises of the following phases:
Sankalpa
Cheshta
Nishpeedana and
Shukra chyuti
Sankalpa
Sankalpa means the mental preparation for the sexual act. Charaka Samhita has
highlighted the mental preparation for the sexual act as an important prerequisite.
Appropriate psychic stimulus can greatly enhance the ability of a person to get
cheerful/ joyful state of mind, due to actions such as ramana, vasana98 etc where as
anuraga99.
Simple imaging or sexual fantasy can cause erection. This has been emphasized in
senses and happy disposition of mind as a necessary prerequisite for good arousal. In
this context, the term suprasanna refers to the state of mind which is devoid of
irshyadi bhavas100.
Sushruta Samhita has compared the process of ejaculation with that of lactation in
females, as both are deeply associated with psychological factors. It also considers
touching, seeing, remembering sexual objects and constant affection towards the
Charaka Samhita. A pleasing environment which induces happiness of mind frees the
mind from anxiety & thus excites the man sexually by elevating the mood. Even a
good aroma, sounds of ornaments of women, a pleasant state of sensory faculties and
musical melodies enhance the sexual drive. Intoxicating beverages also add to sexual
excitement102.
Cheshta
parispandana ie. the response of the body or vibrations of the body. The main object
and means of sexual arousal is tactile stimulation. The sense of touch pervades all
the senses and shukra which is present all over the body is sensitive to tactile
stimulation104.
Sushruta Samhita has mentioned samharsha as one of the cause for shukra chyuti.
Specific part of the body is required to be stimulated to get maximum arousal and
potentiating sexual act. These are known as Kama sthanas (erotic zones). The
specific zones in the body are Seemanta (parting of the hair), netra (eyes), adhara (the
lip), kapola (the cheek), gala (neck), kukshi (belly), kucha (breast), urasthala (chest
region), nabhi (the navel), shroni (the hip & loins), bhaga (perineum), janu (the
knee), gulpha (the ankle), pada (the foot) and angushta (the finger). During shukla
paksha, zones on the left side of the body, starting from seemanta towards
To get optimum level of arousal, specific acts are mentioned. The act of scratching
with nails should be done in seemanta, kukshi and kanta pradesha. Chumbana
(kissing) on netra and kapola, biting with dantagra is to be carried out in adhara.
Mild patting in vaksha (chest) Firm massaging in kucha and shroni (the hip & loins),
Chapetika (a slap with the open hand) in nabhi pradesha are mentioned in
Yogaratnakara107.
Nishpeedana.
genital parts especially in the upastha causes ejaculation. The process of physical
Among these uttana is the best position to get healthy progeny. Rest of them are said
Shukra chyuti
Nishpeedana results in shukra chyuti. Shukra is present in the entire body and
responds to the stimulation of skin. The process is similar to that of water coming out
sankalpa and nishpeeda. Even though shukra is sarva shareera vyapi, it is due to the
Charaka Samhita has given three comparisons for the pervasion of shukra in
individuals into three groups according to the duration of sexual act and the effort
needed to express out the shukra. When shukra is ejaculated without much effort,
then it is compared with the extraction of juice from sugarcane. If it is ejaculated with
moderate effort and time, then it is like extracting ghee from curds and if it is
ejaculated with much effort and time, then it is like extracting oil from the sesame
seeds113.
They are,
unstable
Paicchilya: sliminess. Because of this guna shukra flows out without any
friction
Anu bhava and Pravana bhava: The shukra is able to come out from the
has a very fast action. Apana vayu controls and stimulate the sex organs
especially the sites of shukra, exerts force during the sexual act. As a result of
which shukra comes out of its place and is ejaculated through the genital
organ.
Bhavaprakasha explains the act vyavaya in a slightly different way. It states that,
rubbing between medhra and yoni, the shareera ushma of men, excited by vata,
liquifies the retas present all over the body, then vayu brings it through the urinary
After vyavaya, one has to follow specific diet and regimen in order to restore strength.
They are snana, lepana of chandanadi dravyas (anointing the body with chandana
etc.) exposure to breeze (himaanila) use of sweets prepared out of sugar and
sugarcane, plain milk or milk with sugar, cold water (sheetamu), Mamsa rasas, yusha,
sura and prasanna. (A variety of fermented drink). Thereafter one should have
Krucchra
Derivation
The term Krucchra is a Napumsakalinga pada and is derived from the root Mi
difficulty or pain.
Mi +UM McN
Synonyms
urj- Uneasyness,Pain
M-Difficult, troublesome
The different terminologies which represent Krucchra are causing trouble or pain,
Krucchra Vyavaya
After analyzing the terms Krucchra and Vyavaya, the KrucchraVyavaya is defined
as follows:
Desire for sexual intercourse is the prerequisite one. This is explained under the
heading Sankalpa. Loss of desire towards sexual act is the foremost cause for
krucchra vyavaya.
Chesta is the second phase in sexual intercourse. As tactile stimulation is the main
object of sexual arousal. Without chesta proper arousal is not possible though the
Nishpeedana is the third phase in the act of vyavaya,it is the sexual intercourse. (lU
mwr mUxmU xqNl). Vyavaya depends on the position of purusha and stree during
the act. Improper position leads to difficulty in sexual intercourse which is also
Shukra chyuti is the fourth phase in the act of vyavaya. Proper chesta, Sankalpa, and
vyavaya.
Regarding Shukra chyuti there are eight specific factors influencing that in the form of
Harsha, Tarsha, Saratva, Paicchilya, Gaurava, Anu bhava, Pravana bhava and
Drutatva of maruta. Among them the former two factors viz Harsha and Tarsha
Tarsha: It is nothing but vanitabhilasha. Loss of desire towards female partner is one
The latter six factors namely Saratva, Paicchilya, Gaurava, Anu bhava, Pravana
bhava, depend on the quality of the shukra formed. If the shukra produced does not
possess shuddha shukra lakshanas, then it lacks in above mentioned factors which
invariably becomes a cause for krucchra vyavaya. Apart from these, normalcy of
apana vata is necessary for shukra chyuti. Any abnormality in the function of apana
Appetitive Phase
Excitement phase
Plateau phase
Resolution phase
The term was coined by William H. Masters and Virginia E. Johnson in their 1966
Appetitive Phase
of this phase is the motivation and drive of the individual for sexual interaction. This
is the phase which occurs before the actual sexual response cycle. This phase is
Excitement phase
This is the first true phase of the sexual response cycle, which starts with physical
stimulation and or by appetite phase. The duration of this phase is highly variable and
The excitement phase (also known as the arousal phase or initial excitement
phase) is the second stage of the human sexual response cycle. It occurs as the result
of any erotic physical or mental stimulation, such as kissing, patting or viewing erotic
A study on shukra abahutvat medasaavruta margatvat cha krucchra vyavayata in sthoulya.
49
images, that lead to sexual arousal. During the excitement stage, the body prepares
for coitus or sexual intercourse. The major changes during this phase are listed below.
The excitement phase results in an increase in heart rate, an increase in breathing rate
and a rise in blood pressure. The sex flush tends to occur more often under warmer
conditions and may not appear at all under cooler temperatures. It has also been
commonly observed that the marked degree of the sex flush can predict the intensity
of orgasm to follow.
Plateau phase
This is an intermediate phase just before actual orgasm, at the height of excitement. It
is often difficult to differentiate the plateau phase from the excitement phase. The
duration of this phase may last from half to several minutes127. Further increases in
circulation, muscle tension and heart rate occur in both sexes. Sexual pleasure
Dew drops on glans penis (2-3 drops of mucoid fluid with spermatozoa).
prevent urine from mixing with semen, and guard against retrograde
ejaculation) and muscles at the base of the penis begin a steady rhythmic
Orgasmic phase
tension and rhythmic contractions of pelvic reproductive organs. The duration of this
phase may last from 3-15 seconds. The important changes are as follows:
Orgasms are often associated with other involuntary actions, including vocalizations
and muscular spasms in other areas of the body, and a generally euphoric sensation.
In men, orgasm is usually associated with ejaculation. Each ejection is associated with
a wave of sexual pleasure, especially in the penis and loins. Orgasm generally
During the first phase, called the emission phase, seminal fluid builds up in the
urethral bulb of the prostate gland. As the fluid accumulates, the male senses he is
During the second phase, there will be contractions of urethra and penis along with
prostrate so that semen spurts out of the penis. The first and second convulsions are
usually the most intense in sensation and produce the greatest quantity of semen.
Resolution phase
The resolution phase occurs after orgasm and allows the muscles to relax, blood
pressure to drop and the body to slow down from its excited state.
A General sense of relaxation and well being, after the slight clouding of
body.
Refractory period for further orgasm in males varies from few minutes to
many hours, some being immediate (no refractory) and some being as
long as 12 to 24 hours.
The resolution phase is marked by a general sense of well being and enhanced
The difficulty experienced during the sexual response cycle is considered as difficulty
cycle.
In appetite phase disorders manifest in amotivation, disinterest and lack of desire for
sexual activity130.
orgasm either does not occur or is considerably delayed. Premature ejaculation occurs
when there is an inability to control ejaculation sufficiently for both partners to enjoy
sexual stimulation. In the absence of orgasm the resolution takes longer in both men
and women. There is a sense of heaviness in the pelvic region, throbbing ache because
of congestion132.
VYAVAYA
emphasized the disease Sthoulya and its consequence. One problem related to obesity
that may cause concern and constitute a major problem for the individual, is the
possible link between obesity and sexual function. This relationship is often
dysfunction.
Ayurvedic literature starting from the time of Charaka Samhita stresses the
Charaka Samhita has considered vyavaya as one of physical activity the lack of which
is also a causative factor for Sthoulya. While the non indulgence in sexual activity
debilitating disorders133.
Sushruta Samhita has also explained about the relationship that exists between
sthoulya and vyavaya. Where as the later authours like Madhvakara134, Bhava
The relationship between Sthoulya and krucchra vyavaya has been very clearly
ie. Shukra abahutva (Alpa shukra) and medasavruta marga are the causes for
Krucchra vyavaya.
Yogendranath sen opines that Shukra abahutvat is nothing but shukra alpatvat and
Sushruta Samhita has mentioned that alpa vyavaya in sthoulya occurs due to the
Alpa shukra
sthoulya only medodhatu upachaya takes place, at the cost of other dathus. As a result
of this the rest of the dhatus including shukradhatu are deprived of their nutrients.
Charaka Samhita explains the nourishment of all the dhatus takes place
The various nyayas which are proposed to understand the dhatuposhana can be
1. Rasa which is formed after ahara paka circulates throughout the body
continuously.
2. The rasa thus formed circulates in different channels of the body to nourish
3. The specific amsha of this rasa is absorbed by the respective dhatus for their
4. After absorption, the particular amsha is converted into specific form which is
In Sthoulya, the pathogenesis may occur at any of these stages resulting in Alpa
2. The annarasa thus produced circulates all over the body in the state of
amavastha itself.
medodhatu.
4. The madhura anna rasa thus absorbed is converted into medodhatu only
In Sthoulya there will be improper formation of medas which in turn obstruct the
This ama is circulated in the body resulting in excessive production of sneha and
meda. Thus produced meda along with kapha causes obstruction to the marga
In Sthoulya, there will be alpa shukra and margavarana by medas causing kruchra
vyavaya. The ashta doshas of sthoulya mentioned in Charaka Samhita are considered
and over production of medodhatu. This results in the under nutrition or under
gurutva of medas. In vyavaya the role of cheshta is very important. The sluggish
movement of the body affects the cheshta, which results in krucchra vyavaya.
Dourbalya, Dourgandhya and Swedabadha will disturb the routine of the person
which will in turn affect desire for sex ie. Sankalpa leading to krucchra vyavaya.
Ati Kshut and Ati Pipasa are not tolerated by an obese person and when he indulges in
the sexual act, in this situation the performance will not be up to the mark.
Apart from the ashta doshas, the other cardinal features of Sthoulya described in
classical text books are Chala spik udara stana, Ayathopachaya and Ayatha utsaha.
Chala spik udara stana may cause discomfort during the act, thus affecting cheshta,
to krucchra vyavaya. Ayatha utsaha is the lack of desire for doing any activity which
will include sexual act also. This affects the sankalpa stage of vyavaya leading to
krucchra vyavaya
In a nutshell, the symptoms manifested in sthoulya will hinder each and every stage of
Stages of Vyvaya
2 Javoparodha -
3 Dourbalya
4 Dourgandhya - - -
5 Swedabadha - -
6 Ati Kshut - - -
7 Ati Pipasa - - -
10 Ayata utsaha - - -
The efficacy of the sexual act is determined by the quantum of shukra and its easy
of shukra and obstruction of the marga by medas which hinders its easy flow and
DYSFUNCTION
The relationship between obesity and sexual dysfunction was not considered with
great importance in contemporary medical science. Since last decade lot of research
work are being done to understand the relationship between obesity and sexual
Katherine Esposito, MD; Francesco Giugliano, MD; Carmen Di Palo, MD; Giovanni
Giugliano, MD; Raffaele Marfella, MD, PhD; Francesco D'Andrea, MD; Massimo
D'Armiento, MD; Dario Giugliano, MD, PhD , published in JAMA. 2004; 291:2978-
2984.
Randomized, single-blind trial of 110 obese men (body mass index 30) aged 35 to 55
Erectile Function (IIEF).This study shows that Lifestyle changes are associated with
improvement in sexual function in about one third of obese men with erectile
dysfunction at baseline.
Gress,** and Ted D. Adams** Kolotkin, Ronette L., Martin Binks, Ross D. Crosby,
Truls Stbye, Richard E. Gress, And Ted D. Adams. Obesity andsexual quality of
quality of life and BMI class, sex, and obesity treatmentseeking status.
Results: Higher BMI was associated with greater impairments in sexual quality of
life.
This study suggests that one-third of obese men with ED can regain their sexual
activity after 2 yr of adopting health behaviors, mainly regular exercise and reducing
weight.
9: 712.The study revealed that obesity has a detrimental effect on semen quality and
Caroline Laborde, research assistant, Caroline Moreau, research fellow for the CSF
Group .The study was conducted to analyse the association between body mass index
(BMI) and sexual activity, sexual satisfaction, unintended pregnancies, and abortions
in obese people and to discuss the implications for public health practices, taking into
Obese men were less likely than normal weight men to report more than one sexual
partner in the same period (0.31, 0.17 to 0.57, P<0.001) and more likely to report
Irwin Goldstein, M.D. is Director of Sexual Medicine, Alvarado Hospital, San Diego
and Clinical Professor of Surgery at University of California, San Diego. Dr. Mario
Maggi The study was published in The Journal of Sexual Medicine, the official
The results showed that obesity was significantly associated with a higher physical
psychological determinants.
1. Literary sources
2. Assessment tools(Instruments)
Collection of Material
1. Literary
For the present study the primary sources of literature were different classical
texts books of Ayurveda. Along with that related information are compiled from
other sources such as Vedic and Upanishad scripts, the literature on different
Indian philosophies. Information are also gathered from the texts books of
2. Assessment tools
a) Weighing Machine
b) Measuring Tape
d) Vernier calipers
f) Semen analysis
1997 Jun; 49(6):822-30. Relevant domains of sexual function across various cultures
questionnaire, the International Index of Erectile Function (IIEF), was examined for
In the beginning of the questionnaire instructions are given as to how the questions
are to be answered, and the terminologies used in the questionnaire are defined. IIEF
Methodology
1. Measurement of Weight
Patient was asked to remove the slippers and was asked to stand on the
weighing machine devoid of any accessories (like hand bag, mobiles). The
2. Measurement of Circumferences
3. Skin fold thickness of triceps were taken using vernier calipers skin fold at
the triceps region was held between the fingers and the thickness was measured
using calipers.
4. Measurement of Height
Heights were taken by asking the patient to stand bare foot with their heel,
back and head touching the wall. In that position a metal scale was placed over the
head perpendicular to the wall and the corresponding reading on the wall was
recorded in centimeters.
Methodology:
index of erectile function (IIEF) was used to assess erectile function. The
question was carefully translated and care was taken to convey the same meaning of
the original questionnaire. The individuals were informed about the questionnaire and
the purpose of administering it to them. A written consent was also obtained. They
were informed about the 15 questions and instructions were given to mark whichever
appropriately suits them among the 5 options of answers. It was also suggested to
answer all the questions compulsorily. No time limit was fixed to complete the
questionnaire. However they were informed not to indulge in an undue delay. In some
under educated persons each question was read and explained and was scored on the
Scoring was done based on the standardized methods of the scale which consists of
scoring of different factors such as erectile function, orgasmic function, sexual desire,
Investigation:
Semen Analysis was done in all the patients after administering the questionnaire.
Methods
Aim: To validate the statement of Charaka Samhita Shukra abahutvat medasaavruta
Source of Data:
Sample: For the 3rd objective a minimum of 33 patients whose BMI is >30,
Mysore and also from other available sources was selected for the study.
Inclusion Criteria:
Male Patients between age group of 30-60, who have primary obesity and who
Exclusion Criteria:
Patients with other systemic disorders that interfere with the study and
Patients who have undergone other surgical interventions which interfere with
Diagnostic Criteria:
Patients with BMI more than 30, along with the below said criteria are
considered.
Sampling Method
The study was conducted on obese individuals, from O.P.D. and I.P.D. of
Government Ayurveda Medical College and Hospital, Mysore and other available
sources.
Research Design
After screening, the selected individuals were assigned to one group. This is an
observational study. The readings were recorded to assess various parameters of this
study.
Statistical Analysis
Statistical Analysis to assess Individual and comparative effects of the data, was done
using descriptive statistics, frequencies and percentages , Chi- Square test, Pearsons
product moment correlation. All the statistical methods were carried out through the
Criteria of Assessment
Clinical Interpretation
Score Interpretation
0-2 Severe dysfunction
3-4 Moderate dysfunction
5-6 Mild to moderate dysfunction
7-8 Mild dysfunction
9-10 No dysfunction
Score Interpretation
0-2 Severe dysfunction
3-4 Moderate dysfunction
5-6 Mild to moderate dysfunction
7-8 Mild dysfunction
9-10 No dysfunction
Score Interpretation
0-3 Severe dysfunction
4-6 Moderate dysfunction
7-9 Mild to moderate dysfunction
10-12 Mild dysfunction
13-15 No dysfunction
Score Interpretation
0-2 Severe dysfunction
3-4 Moderate dysfunction
5-6 Mild to moderate dysfunction
7-8 Mild dysfunction
9-10 No dysfunction
OBSERVATIONS
In the present study 37 individuals were registered out of which there were 4 drop-
outs. Among these 33 individuals semen analysis could not be done in 3 patients as 2
individuals had a very low sample volume of semen and the other one had the severe
that was given for the study. The study was concluded in a sample size consisting of
33 individuals
Out of 33 individuals, 17 individuals (51.5%) were in the age group of 30-35, 6 were
in (18.2%) the age group of 36-40, 5 were in (15.2%) the 41-45 age group , 3 were in
46-50 age group, 1(3.0%) in 51-55 age group and 1(3.0%) in 56-60 age group.
Sthoulya.
Out of 33 individuals, 32 individuals (97%) were married and 1 individual (3%) was
unmarried.
Table No. 10. Showing the distribution of Religion in the individuals of Sthoulya.
were Muslims.
Sthoulya.
Out of 33 individuals, 1 patient had studied till Primary (3.0%), 1 patient had
studied till Middle School (3.0%), 15 patients had studied till High School (45.5%),
13 patients were Graduates (39.4%) and 3 patients were Post graduates (9.1%).
of Sthoulya.
Upper middle class (15.2%) and one individual belonging to Rich ( 3.0%).
Sthoulya.
Out of 33 individuals, the symptom Chala Spik udara stana was present in all
individuals were suffering from atipipasa and atikshuda ( 12.1%),15 individuals were
Sthoulya.
individuals were doing Mild work (12.1%), 17 individuals were doing Moderate
manual work (51.5%) and 1 individual was doing Hard Manual work (3.1%).
Sthoulya.
Sthoulya.
P
Frequency Percentage value
Intake of heavy food 9 27.3 0.009
Normal food with 2 6.1 0.000
increased frequency
Nature of Small quantity with 21 63.6 0.117
diet regular interval
Use of snacks between 8 24.2 0.003
the meals
Excessive dieting 0 0 -
Out of 33 individuals, regarding the nature of food, intake of heavy food was noticed
increased frequency, 21 individuals (63.6%) were having the habit of taking Small
quantity with regular interval, 8 individuals (24.2%) were having the habit of taking
snacks between the meals and none of the individuals were excessive diet.
individuals of Sthoulya.
(21.2%) were having moderate appetite 22 individuals (60.7%) were having good
Table No. 21. Showing the distribution of sleep during daytime in the individuals
of Sthoulya.
individual (3.0%) sleeps for 30minutes, 8 individuals(24.2%) sleep for 1hour and 2
individuals (6.1%) sleep for 2hours and 22 individuals (66.7%) were not having the
Table No. 22. Showing the distribution of sleep during night time in the
individuals of Sthoulya.
(27.3%) slept for 7 hrs at night, 13 individuals ( 39.4%) slept for 8hrs at night, 4
individuals ( 12.1%) slept for 9hrs at night and 5 individuals( 15.2%) slept for 10hrs
at night.
Table No. 23. Showing the distribution of Habits in the individuals of Sthoulya.
(15.2%) had the habit of taking alcohol and all the individuals had the habit of taking
Sthoulya.
P
Frequency Percentage value
Madhyama 30 90.9
Samhanana Pravara 3 9.1 0.000
Total 33 100.0
individuals of Sthoulya.
P
Frequency Percentage value
Avara 1 3.0
Abhyavaharana Madhyama 32 97 0.000
Shakti Total 33 100.0
(87.9%) had madhyama jarana Shakti and 3 individuals (9.1%) had pravara jarana
Shakti.
RESULTS
Table No .32. Showing the scores of IIEF related to Erectile Functions in the
individuals of Sthoulya.
Table No. 33. Showing the scores of IIEF related to Orgasmic Functions in the
individuals of Sthoulya.
Table No .34. Showing the scores of IIEF related to Sexual Desire in the
individuals of Sthoulya.
Out of 33 individuals, none of the individuals had Severe sexual desire Dysfunction.5
Table No. 35. Showing the scores of IIEF related to Intercourse Satisfaction in
Table No .36. Showing the scores of IIEF related to Overall Satisfaction in the
individuals of Sthoulya.
Sthoulya.
Out of 33 individuals, the viscosity of semen was normal in 27 individuals (90%) and
Out of 33 individuals, the normal Sperm count was noticed in 24 individuals (85.7%),
Table No.42. Showing the Motility of Sperms (class a & class b) in the
individuals of Sthoulya.
Sthoulya.
Table No .45. Showing the Correlations of BMI with Erectile Functions in the
individuals of Sthoulya
V1 V2 Correlation Sig
co-efficient
BMI Erectile function -.025 .891
BMI Orgasmic Function .031 .862
BMI Sexual Desire -.042 .815
BMI Intercourse .056 757
Satisfaction
BMI Overall Satisfaction .105 .560
Table No .46. Showing the Correlations of BMI with Semen Analysis in the
individuals of Sthoulya
V1 V2 Correlation Sig
co-efficient
BMI Semen volume 0.124 0.514
BMI Sperm count 0.278 0.137
BMI Motility 0.234 0.213
BMI Morphology 0.001 0.994
Table No .47. Showing the Correlations of waist hip ratio with Erectile Functions
V1 V2 Correlation Sig
co-efficient
Waist Hip ratio Erectile function -.413 0.017
Waist Hip ratio Orgasmic Function -.203 0.256
Waist Hip ratio Sexual Desire -.290 0.102
Waist Hip ratio Intercourse .-.305 0.084
Satisfaction
Waist Hip ratio Overall -.225 0.207
Satisfaction
There is significant relation observed between Waist Hip ratio and erectile function
Hip ratio and Orgasmic Function, Sexual Desire, Intercourse Satisfaction and Overall
Satisfaction.
Table No .48. Showing the Correlations of waist hip ratio with Semen Analysis in
V1 V2 Correlation Sig
co-efficient
Waist Hip ratio Semen volume -.148 0.436
Waist Hip ratio Sperm count -.199 0.291
Waist Hip ratio Motility -.147 0.437
Waist Hip ratio Morphology -.308 0.098
There is no significant relation observed between Waist Hip ratio and semen
parameters.
DISCUSSION
any conclusion. In this part the conceptual and observational studies are discussed.
Discussion on title
Obesity has been a health problem since the inception of the civilization.
However, the present era has seen a drastic increase in the rate and severity of the
problem. Changing lifestyle with regards to food habits and lack of physical activities
are considered as the important causes for this. As a result of this obesity is
considered as the most important lifestyle disorder of the modern age. WHO has
shown the severe concern about the growing rate of puberty onset obesity in
metropolitan Population. It is estimated that every year 3 lakh people die of the
complications of obesity.
growth in economy and technology. These factors have changed the lifestyle of
Indians considerably. Now a days more people are addicted to the complex high
calorie food habits, television and computer, private mode of transportations and other
such comforts which leads to reduced physical activity and sedentary lifestyle.
people is the difficulty experienced during their sexual act. Even though the western
science is yet to recognize the exact mechanism and the impact of obesity on the
quality of sexual life, researchers and clinicians have taken a keen interest in this
regard. Presently a good number of studies are being conducted focusing on the
subject.
recognized this problem long ago. Krucchra vyavayata was recognized as one of
the limitations of Sthoulya144. Not only the relationship between obesity and the
quality of sexual life but also the pathophysiology for the same was also hypothesized
The current study is conducted to understand, analyze and validate the hypothesis
Discussion on Sthoulya:
science. Obesity is defined as state of increased body weight due to adipose tissue
also implies the same meaning. By definition in obesity there is abnormal growth of
adipose tissue due to an enlargement in fat cell size or an increase in fat cell number
or combination of both which is similar to the cardinal feature of Sthoulya i.e., ayatha
Charaka Samhita has considered Sthoulya as a complicated health condition and has
among the eight undesirable physical status (Ashta nindita purusha), but also the most
severe and untreatable form of them. The other classical text books of Ayurveda have
also recognized Sthoulya and its health consequences. Sushruta Samhita has
lucid description in the classical text book of Ayurveda. Madhava nidana is the first
text book which has dedicated a separate chapter for the discussion of obesity under
the label Medoroga. Bhavaprakasha and other later text books of Ayurveda have
condition has changed over years from the time of Charaka Samhita to the later
authors. This may be due to the prevalence of the disease which gradually increased
in the course of time. Understanding this disease from Ayurvedic perspective is the
most important need of the present era as it is reaching pandemic levels and has a
Not only the definition but also the classification of Sthoulya has a good similarity
The etiological factors mentioned for Sthoulya and obesity are also strikingly similar.
Beejaswabhava or hereditary factor has been emphasized as the intrinsic factor. The
Ahara rasa plays a major role for the increase of medodhatu. Sushruta Samhita
describes both Sthoulya and karshya as two opposite conditions which mainly
depends on the quality and quantity of the ahara rasa146, which is again
The role of diet in the manifestation of Sthoulya can be better understood with the
help of Samanya Vishesha Siddhanta. Foods that have madhura rasa, guru, sheeta
and snigdha guna increase medodhatu and kapha dosha which have similar qualities.
Similarly, food habits like adhyashana and atisampoorana acts as the causative
In the process of dhatu poshana krama, it is anticipated that the food consumed
should invariably result in the increase of subsequent dhatus i.e. from rasa to rakta,
rakta to mamsa, mamsa to medas and so on . But the process of nutrition of dhatus is
also selective causing the increase of an isolated dhatu. The reason for this is well
articles which act as causative factors for the increase in medas are specific to that
particular dhatu and not to other dhatus because of the similarity and dissimilarity in
Samhita endorses the same by quoting vishishta ahara (uz AWU) as one of the
Contemporary science also highlights the role of dietary factors in causing obesity.
Fats and sugars are considered as energy dense food but low in bulk which increase
energy intake substantially. It can be interpreted that, these food items are of guru,
regular physical activity (vyayama), regular sexual activities and proper sleep
schedule promotes good health and controls the probability of developing Sthoulya.
consequence of this there is accumulation of calories in the body in the form of medas
energy expenditure during the sexual act. On the other hand divaswapna leads to
Sthoulya which is mediated through the quantitative and qualitative increase of kapha.
general and medovaha srotas in particular. All these factors collectively promote
Sthoulya. The reduced metabolic rate during the increased sleeping period also acts as
factors which are responsible for Sthoulya. These factors enhance tamas at the
A recent study reveals that stress induces obesity. This may be due to the fact that a
person under stress tends to eat more to tide over that situation. One who frequently
gets stressed gets accustomed to take frequent food which is nothing but Adhyashana,
Charaka Samhita has mentioned Beejadosha as one of the cause for Sthoulya147.
Defect of Beejabhaga avayava i.e. part of Beeja, may lead to defective development
stout (stoola, snigdha and supushta shareera) and bala heena148.This hypothesis is
also supported by the contemporary medical science. It stresses the role of genetic
intake of Madhura Rasa during pregnancy is considered as a causative factor for birth
of obese child, which indicates that the maternal dietary factors influence the child in
Smoking cessation increases appetite, which inturn results in excessive intake of food
activities and habits. Most of the times it is due to the combination of more than one
Samprapti
Discussion on Samprapti Ghatakas
Dosha - Tridosha, Samanavayu, Apanavayu, Vyanvayu, Pachaka pitta,
Kledaka kapha.
Dushya - Rasa and Meda( primary ),
Agni - Medodhatvagnimandya, Jatharagnimandya
Ama-Jataragnimandyjanya ama in initial phases, Medodhatvagnimandyajanya
ama in later phase
Srotas - Annavaha, Rasavaha, , Medovaha
Udabhavasthana - Amashaya
Sanchara - Rasayani
Vyakta - Whole body specifically udara, sphika, stana
Adhisthana Medo dhatu
Srotodushti - Sanga, Vimargagamana
Swabhava Chirakalina
A study on shukra abahutvat medasaavruta margatvat cha krucchra vyavayata in sthoulya.
107
Sthoulya involves all the three doshas in its manifestation at various levels. However
Abhishyandi Ahara and Vihara like Divaswapna, Achintana are more favourable for
vitiation of kapha rather than any other. Most of the symptoms of Sthoulya come
The role of pitta in Sthoulya can be understood by the state of teekshnagni which is
pitta which is present in the koshta. Pitta acts as an important cause in maintaining
Sthoulya.
The involvement of vata dosha can be well appreciated at two levels. First is the state
of Avruta Vata which stimulates Agni and ultimately increases the demand for the
Sanga in Medovaha srotas the nutrients cannot be carried by Vyana vayu to their
respective dhatus resulting in the undernourishment of all the dhatus other than
medas.
involvement of medas in the form of its overproduction is the most important step in
Sthoulya.
Agni
Jatharagni
In Sthoulya the Agni is teekshna. This is the result of avarana of vayu by medas
which confines vayu in the koshta, resulting in the exaggerated speed of digesion.
Dhatvagni
quantitative increase and decrease of a particular dhatu depends on the kshaya and
Ama
The cause for the formation of ama in Sthoulya is dhatvagnimanya and adhyashana
respectively. Even though obese people have strong digestive strength, the
adhyashana is the other cause for the formation of ama in people who are obese.
The three important srotas that are involved in Sthoulya are annavaha, rasavaha and
medovaha srotas.
Formation of ama which is in the form of apakva anna rasa (amarasa) and
predominantly madhura rasa is the initial step in the samprapti involving annavaha
srotas. The resultant apakva anna rasa impairs the nourishment of rasa dhatu
Discussion on Samprapti
key factors avarana of vayu by medas, the state of agni or koshta and the formation of
The samprapti that is explained in different classical text books of Ayurveda can be
following stages.
Formation of Ama
Formation of ama which is in the form of apakva anna rasa (amarasa) and
nidanas such as guru, Madura sheeta ahara which are kapha and medo vardhaka
Medovruddhi
The next stage of pathogenesis is the actual increase of the bulk of medas. The apakva
annarasa formed during the previous stages of pathogenesis circulates all over the
body in its apakva stage itself. The jataragnimandya and the subsequent
there is a unilateral increase of medo dhatu at the cost of other dhatus. This is a result
particular dhatu. Secondly the continued intake of nidanas which have more affinity
towards medodhatu. Thus the resultant medodhatu which is over produced circulates
all over the body and gets deposited in places such as udara,stana, and spik resulting
in Sthoulya.
Srotorodha by medas
medodhatu, it starts obstructing the channels all over the body resulting in vata
consumption of higher quantity of food. The major part of which is again converted
quickly. Added to this, there will be upalepa of annavaha srotas by madhura rasa, as
a result of which whatever food is consumed it ultimately attains the madhura bhava
which promotes the formation of medas and kapha which are the two important
Nidana sevana
Jataragnimandya
Amotpatti
Ama annarasa
Medodhatvagnimandya
Medovruddhi
Sthoulya
Medasavrutamarga Madhuropalipta
annavaha srotas
Vata is confined to koshta
Conversion of ahara into
madhura rasa irrespective of
Increases Agni rasa consumed
Ayurveda, the general rule of considering the subtle form of rupa itself as the
and other factors in the initial and milder form are to be considered as the purvarupa
of Sthoulya.
Discussion on Roopa
Sthoulya.
Physical activity clearly modulates overall calorie balance and obese individuals tend
to be less active. This can be a contributory factor in the causation and maintainance
of excess weight. Obesity induces inactivity and inactivity further promotes weight
gain. This vicious cycle leads to symptoms such as javoparodha, jadya, ayatha
thermogenesis and dietary thermogenesis, all of which are impaired in obese people.
This leads to decreased calorie expenditure and over efficient calorie utilization.
Which inturn leads to excess thirst and hunger (pipasa and kshut atimatra).
In obese people the sweat glands work overtime to dispose off the excess minerals
from the body. Hence there will be excessive sweating (Swedabhada), which inturn
Obesity has a great impact on the quality of life. It can also lead to many
others. Hence the morbidity and mortality rate of obese individuals is higher than non
obese individuals. For this reason Ayushohrasa, Alpaayu, Alpabala and Alpa prana
Excessive sleep and daytime sleep is associated with Sthoulya is due to involvement
that people who are overweight have thicker necks. When they gain weight they also
gain it in the neck area and that extra bulkiness in the throat constricts the air way and
makes it more difficult to breathe. At night the constriction increases the likelihood of
snoring. Another reason is that overweight people tend to lose muscle tone, even in
their neck. At night these loose muscles are likely to sag and cause airway obstruction
Chala sphik udara stana is one of the cardinal features of Sthoulya. Adipose tissue is
found in specific locations, which are referred to as 'adipose depots and Udara,
sphik, stana are one among the adipose depots. Fat in the lower body, as in thighs and
buttocks, is subcutaneous, whereas fat in the abdomen is mostly visceral. Visceral fat
adipose tissue (EWAT) and perirenal depots. This is the reason for fat accumulation
Upadravas
Shleepada, Apachi, Kamala and Jantava (krimi). These upadravas can be classified
Upadrvas namely Prameha and Prameha pidika, may result due to Abaddha
Meda. Due to the similarities in the causative factor and the involvement of
individuals. For the same reason Prameha can also be considered as the most
individual152.
of vata by meda.
Complications such as krimi and Kushtha may occur due to swedabadha and
vitiated Medas.
Kamala and Udara are the complications of Sthoulya which are similar to
fatty liver, cirrhosis caused in obesity due to the excessive accumulation of fat
The western literature on obesity lists out the possibility of recurrent skin
infection especially in the groin and sub mammary areas. Ayurvedic literature
Sadhyasadhyata
Sthoulya as the krucchra sadhya condition. This view can be understood and justified
Chikitsa
Foods which are guru but apatarpana should be prescribed. Guru ahara refers to the
food which are heavy and takes longer duration for digestion. At the same time
apatarpana refers to the quality contained in the food which reduces medas. Similarly
the management of obesity involves low calorie diet with lower levels of fat,
With regards to physical activities, both Ayurveda and the contemporary medical
science stress the importance of increased physical activities in the form of exercise
sibutramine, orlistat, rimonabant and others which reduces appetite and induce
anorexia thereby helps in reducing calorie intake and hence used in obesity. There are
many side effects associated with the use of these medications which limits the use of
such drugs in routine management of obesity. Some of the side effects include
increase in heart rate, blood pressure with the use of sibutramine, oily stools,
flatulence, and diarrhoea with the use of orlistat and nausea, diarrhoea, anxiety,
are also indicated. Many drug formulations which probably have lesser side effects
The literal meaning of the term krucchra vyavaya is difficulty in sexual intercourse.
The term broadly represents different difficulties experienced during the various
Vyavaya and brahmacharya; indulgence in sex and its regulation are considered to be
the key factors for the maintenance of health. Sex with a proper regulation (vyavaya
with samyama) will result in the enhancement of longevity and also retards ageing. It
will also help to improve the complexion, strength, firm and healthy musculature153.
sexual physiology includes four distinct phases namely Sankalpa, Cheshta, Nishpeeda
and Shukra chyuti. The descriptions of the various physical and emotional changes
that occur during each stage of these four phases have a good correlation with the
purusharthas including kama , which represents desire in general and sexual desire
and performance in particular154. Sexual act is both a physical act and a mental
phenomenon. The role of mind in sexual act has been emphasized in Charaka samhita
by the statement that anything that causes harsha of mind will act as vrushya155.
This statement has been further analyzed by Chakrapanidatta by stating that the
Charaka Samhita has explained in detail about the measures which help to keep the
mind in cheerful state which enhances pleasure and ability of sexual act. It includes
environment plays an important role in keeping the mind in a pleased state i.e., the
environment which is pleasing removes stress and anxiety and induces happiness of
mind which in turn acts as sexual enhancer. So sexual excitement depends on the
prerequisite for the act. Suprasannata of manas with respect to sexual act includes the
visual, the auditory and tactile stimulations. The stimulii can also occur through the
rehearsal of sexual activities with a desired partner. Along with these positive stimuli
the absence of negative emotional stimuli in the form of anger (krodha), envy (Irshya)
are also factors, which has an impact on the quality of sexual act. These factors can
act as the blocking forces both in the psychological level and physiological level. In
the psychological level they retard the sankalpa and in the physiological level they
The state of mind has no doubt has an impact on all the stages of sexual act but it has
Among the eight contributing factors of ejaculation Harsha and Tarsha are the
kriya nivrutti. Among these most of them viz smarana, keertana, prekshana, guhya
Deha bala is the other important factor for the sexual act. Lack of physical strength
which can occur because of various reasons which includes diseases, composition of
the body and hereditary factors158 results in the abhava of Harsha (excitement) which
The sankalpa stage described in Ayurvedic literature has similarities with the appetite
Cheshta is the second phase which includes the activities carried out during vyavaya.
During this phase sparshanendriya has a significant role since shukra pervades
throughout the body and is sensitive to sparshanendriya which also exists throughout
the body. Touching and being touched are physical expressions of love. So by cheshta
the stimulations are carried through sparshanendriya which in turn helps in shukra
chyuti.
There are some specific parts of the body, by the stimulation of these parts, one can
get optimum arousal. Also specific actions in specific parts of the body are mentioned
to get maximum arousal. The response to the stimulus in particular parts is due to the
high sensitivity of the parts for the particular action. For ex. the act of scratching with
nails is advocated in specific areas such as seemanta, kukshi and kanta pradesha.
Hence specific action in particular parts result in optimum arousal and thereby
The phase of Cheshta and Excitement are similar as both highlight foreplay during the
stage.
Nishpeedana, the third phase refers to union of male and female. Also it refers to the
peedana of yoni, shepha and upastha. Twacha is the sthana of vata160. Hence during
the process of copulation, by the sangharsha of medra and yoni, there is stimulation
(uttejana) of vayu. This stimulation is both local i.e. genital stimulation and systemic
i.e. central stimulation. This stage is known as tejodeerana, wherein there will be
udeerna of teja which is experienced throughout the body. Similarly this type of
During this phase the position of male and female plays an important role. Vatsyayana
Kamasutra and Nafzavis162 The perfumed garden have described and illustrated
many positions that are used for intercourse. There are dozens of positions, with a
profound symbolism attached to each in popular mythology. But all these can be
boiled down to four basic positions and each can be varied infinitely. The four basic
positions are:
Many positions are interchangeable. Charaka Samhita also explains four different
positions. The couple may indulge in any of the position for sexual pleasure as each
position varying opportunities for physical and emotional expression. But uttana
The Nishpeedana phase is the stage in sexual act wherein the actual copulation takes
place. This phase is followed by orgasm and ejaculation which is represented by the
The shukra which is present in the entire body is just like ghee present in milk and
manas the shukra which is present in the entire body comes out through mutra marga.
Though the sthana of shukra is sarvadehika, medhra and vrushana are considered as
and physiological experiences. The excitation stimuli, the experiences and the peak
Krucchra Vyavaya
vyavaya. The disorders which manifest in the appetite phase /sankalpa are
amotivation, disinterest and lack of desire for sexual activity. The most important
cause for difficulty in sexual act is loss of desire towards the sexual act. The lack of
desire towards sexual activity may be total or partial. It may also be primary or
prospect of sexual activity is associated with strong negative feeling and produces fear
and anxiety.
The disorders which manifest in the excitement phase are erectile disorders. Erectile
dhwajocchraya to occur sankalpa and harsha are needed invariably. This suggests that
process results in erectile disorders. To conclude, erectile disorders may occur due to
The difficulty which occurs in the Nishpeedana phase is due to the improper positions
of male and female during the act. Because, in some positions the partners will have
greater freedom to initiate and control the tempo, angle or style of movement to create
arousing stimulations. Both verbal and non verbal communication about preferences
of position, tempo and movement can enhance the pleasure and arousal for both
partners. The desirability of a particular position may change with ones mood at the
moment, alteration in health, age, weight, pregnancy or partner may create different
situations.
Nishpeedana results in Shukra chyuti. The difficulty that occurs during orgasmic
Among the eight contributing factors, six factors namely Saratva, Paicchilya,
Gaurava, Anu bhava, Pravana bhava and Drutatva of maruta can be considered as
the physical factors. They play an important role in shukra chyuti. If the shukra
produced does not possess shuddha shukra lakshanas, then it lacks in above
mentioned factors which invariably becomes a cause for krucchra vyavaya. In this
context, saratva represents the fluid nature of shukra i.e. the consistency of which is
like madhu, taila or ghruta. Paicchilya represents the sliminess of Shukra. Gurutva
indicates parthivatatva and anu bhava represents the subtleness of Shukra. Because of
these qualities the pravana bhava i.e. downward movement of shukra takes place.
Hence these qualities enable easy flow of shukra. If the shukra produced does not
possess these qualities, then it affects the flow of shukra resulting in krucchra
Vyavaya.
During sexual act, vata plays an important role because vata controls the functions of
senses, regulates the mind, initiates and regulates various movements in the body.
Hence impairment in the functioning of vata in general and Apana vata in particular
will invariably result in krucchra Vyavaya, as apana vata is responsible for shukra
nishkramana.
Any obstruction in shukra marga affects the flow of shukra resulting in krucchra
Vyavaya, as for the easy movement of shukra the marga has to be clear.
VYAVAYA
Charaka Samhita gives a clear cut statement regarding the relationship that exists
between the difficulty experienced during sexual intercourse and the weight of the
body. Two specific causes have been attributed for the said difficulty. First one is
reduction of Shukra (Shukra Abahutvat) and the second one is the obstruction for the
Sushruta Samhita opines that the obstruction to the marga by both kapha and medas
is the cause for difficulty experienced by the obese people during the intercourse.
The relationship between Shukra abahutva which is also called as Alpa Shukra165 and
In obese people the upachaya of medodhatu takes place, at the cost of other dhathus.
Among all the other dhatus probably shukra dhatu is the most affected one. The
In dhatu poshana krama the possibility of impairment of the uttara dhatu is higher
than that of purva dhatus. Hence the possibility of impairment of the dhatus which are
nourished after medas is higher than that of rasa, rakta and mamsa. Again among
three uttara dhatus nourished after medas, shukra is the most affected as it has a
qualitative resemblance with medo dhatu. Qualities such as guru, snigdha, madhura,
are similar in both dhatus. Hence the poshakamsha of both medodhatu and shukra
dhatu are similar. As shukra dhatu upachaya takes place after medo dhatu upachaya,
majority of poshakamshas are utilized by medo dhatu itself causing the depletion in
Formation of Shukra
Quality of Shukra
Function of Shukra
There are certain factors which lead to shukra kshaya among which roga (diseases) is
one which leads to shukra alpata166. Sthoulya is a disease entity which in turn leads to
alpa shukra. Also in Sthoulya the nourishment of shukra dhatu is impaired resulting
The normal quality of shukra is bahala, madhura, snigdha, avisra, guru, picchila,
shukla varna, resembles ghruta, makshika, taila167,168. Among these qualities guru,
sara, paicchilya, anu bhava, pravana bhava are considered as the contributing factors
for shukra chyuti. Any deviations from the normal quality result in early ejaculation/
delayed/ difficult ejaculation which can be considered as the cause for krucchra
Vyavaya.
The normal functions of shukra include dhairya, chyavana, preeti, harsha, deha bala
and garbhotpadana. Among these dhairya, preeti, harsha represent the psychological
factors. Dhairya is a factor which is essential for chyavana and maithuna. Preeti is
affection towards opposite sex and harsha is the stage of excitement. All these
In Sthoulya, alpa shukrata may result in the diminished function of shukra dhatu.
This may be one of the causes for difficulty in sexual act. The functions of shukra
such as dhairya, preeti, harsha may be diminished resulting in loss of sexual desire
which is considered as the major cause for krucchra Vyavaya. If deha bala is
diminished, the individual finds difficulty in performing the sexual act itself which is
medas which is abaddha in nature. This abaddha medas obstructs different channels
of the body including shukra vaha srotas. The obstruction to the channels may also
cause vata vruddhi particularly the apana vata which is situated in shroni and
Vyavaya.
Sthoulya
Alpa Shukra
Atikshudha
Krucchra Vyavaya
Sankalpa
It is the stage of mental preparation for sexual act. The cardinal features of Sthoulya
dourgandhya, sveda badha, ati kshut, and ati pipasa will hamper the routine of the
disturbances. These disturbances may cause apprehension about the sexual act and
Cheshta
These are the activities which are carried out during Vyavaya. In Sthoulya there will
Erectile disorders manifest during this phase. Even the recent studies suggest that one
third of obese men with Erectile Dysfunction (ED) regain their sexual activity after
occur. Also in Sthoulya there will be medasavruta marga because of this dilatation of
shukra vaha srotas is improper as dilatation is invariably needed for erection resulting
The difficulties experienced by obese individuals during the stage of Nishpeedana and
Shukra chyuti may be in the form of premature ejaculation, delayed ejaculation and
painful orgasm. All these difficulties are again the impact of either decreased volume
or obstruction to the passage. The position of male and female is one of the important
key factors for sexual pleasure. In obese people the sexual pleasure may be decreased
the body acts as a blocking factor for a comfortable sexual act. Premature ejaculation
and delayed ejaculation are also the difficulties faced during orgasmic phase, as a
result of apana vata vikruti caused by margavarodha. Pain and other discomforts
experienced during Vyavaya in obese people may be because of the decreased volume
From the above analysis, it can be inferred that the people who are obese are more
The present study was conducted on a single group. All the subjects were given a
individuals.
erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall
satisfaction.
Semen analysis was done to find out the qualitative and quantitative changes in the
semen as alpa shukrata is considered as one of the causes for Krucchra Vyavaya in
Sthoulya.
Inclusion criteria
The individuals selected for the study belong to the age group of 30-60 years. The
people of this age group represent youvana avastha in which any sexual problems
Exclusion criteria
primary obesity.
Patients with other systemic disorders that interfere with the study and
semen analysis.
Diagnostic criteria
The primary diagnostic criteria for Sthoulya are BMI and Waist Hip ratio. BMI was
taken as diagnostic criteria as it takes into account both height and weight of an
individual. Waist to hip ratio is also considered as the BMI does not account for
weight distribution.
Semen analysis
Semen was collected after 48 hours of abstinence and was subjected to analysis. The
following parameters were assessed.
Volume
Liquefaction time
Viscosity
Alkalinity
Sperm count
Motility
Morphology
Statistical methods
Descriptive statistics
The descriptive procedure displays univariate summary statistics for several variables
Frequencies
The Frequency procedure provides statistics and graphical displays that are useful for
describing many types of variables. The Frequency procedure is a good place to start
looking at data.
Chi-square test: This test is used so as to quantify the qualitative data and find out
two variables X and Y, giving a value between +1 and 1 inclusive. It is widely used
variables.
Observations
Among the 33 individuals who have completed the study, semen analysis could not be
individuals it was not possible because of low sample volume. In another individual
Age
In the present study, 17 individuals (51.5%) were in the age group of 30-35, 6 were in
(18.2%) the age group of 36-40, 5 were in (15.2%) the 41-45 age group , 3 were in
46-50 age group, 1(3.0%) in 51-55 age group and 1(3.0%) in 56-60 age group.
The statistical value is highly significant (p value .000). In the present study 51.5% of
the individuals are in the age group of 30-35 years which suggests the fact that the
Marital status
In the present study out of 33 individuals, 32 individuals (97%) were married and 1
individual (3%) was unmarried. As majority of the individuals are married the
Religion
In the present study, 29 individuals (87.9%) were Hindus and 4 individuals (12.1%)
were Muslims. The statistical value is highly significant (p value .000) as the majority
Education
In the present study, 1 individual had studied till Primary (3.0%), 1 individual had
studied till Middle School (3.0%), 15 individuals had studied till High School
graduates (9.1%). The statistical values are highly significant (p value .000) as most
middle class (15.2%) and one individual belonged to Rich ( 3.0%). The statistical
values are highly significant (p value .000) as the prevalence of obesity is more in
middle class. It is evident from the study that the incidence is due to faulty habits and
Cardinal symptoms
In the present study, the symptom Chala Sphik udara stana was present in all
with dourgandhya and snigdhangata (0.024) and 4 individuals (12.1%) with atipipasa
that the distribution is similar. This can also be interpreted that most of the individuals
Nature of work
In the present study, 11 individuals were doing Sedentary work (33.3%), 4 individuals
were doing Mild work (12.1%), 17 individuals were doing Moderate manual work
(51.5%) and 1 individual was doing Hard Manual work (3.1%), with statistically
significant p value 0.000. This suggests that the incidence of Sthoulya was found to be
more in individuals involved in Moderate manual work (51.5%). The incidence was
Duration of exercise
In the present study, 23 individuals did not involve in Exercise (69.7%) and 10
are not involved in any kind of exercise (P value .000) which is statistically highly
significant; supporting the fact that avyayama is one of the causative factors for the
development of Sthoulya.
Diet
In the present study, Diet of 25 individuals (75.8%) was mixed type and is statistically
significant with p value 0.003 suggesting that the prevalence of obesity in individuals
Nature of Diet
Regarding the nature of food, intake of heavy food was noticed in 9 individuals
(27.3%), 2 individuals (6.1%) were taking Normal food with increased frequency, 21
individuals (63.6%) were having the habit of taking Small quantity with regular
interval, 8 individuals (24.2%) were having the habit of taking snacks between the
Deviation from regular dietary pattern was noticed in all the individuals (33). Though
the incidence of obesity is more in individuals who consume small quantity with
obesity in individuals who consume heavy food (p.009), normal food with increased
frequency (p .000), use of snacks between the meals (p .003) comparatively less but
statistically it is significant.
untimely and heavy food which is evident from the classical reference.
Predominant rasa
It was found that 20 individuals (60.6%) preferred all the 6 rasas which is statistically
significant (p .003). Though it may imply from the above results that the incidence of
obesity is independent of the rasa consumed, it is evident from the classics that once
the disease is manifested, irrespective of the rasa consumed it will attain madhua
Appetite
In the present study, 3individuals (9.1%) were having poor appetite, 7 individuals
(21.2%) were having moderate appetite, 22 individuals (60.7%) were having good
appetite and 1 individual (3.0%) was having severe appetite, which is statistically
significant (p .000).
In Sthoulya the Agni will be good which is evident from the present study as
Nature of sleep
Prasannata of manas, harsha nityatva ensure sound sleep which is evident from the
significant (p .000).
Day sleep
In the present study 11 individuals were in the habit of Day sleep of which 1
individual (3.0%) sleeps for 30minutes, 8 individuals(24.2%) sleep for 1hour and 2
individuals (6.1%) sleep for 2hours and 22 individuals (66.7%) were not having the
Habits
In the present study, out of 33 individuals, 2 individuals (6.1%) had the habit of
smoking, 5 individuals (15.2%) had the habit of taking alcohol and all the individuals
had the habit of taking tea and coffee indicating statistical insignificance in relation to
sthoulya.
Prakruti
In the present study out of 33 individuals, 1 individual is of vata- pitta prakruti, 22
statistically significant p value 0.000. This suggests that the Incidence of Sthoulya is
Sara
Samhanana
Saatmya
In the present study, 5 individuals (15.2%) were of avara satmya, 1 individual (3.0 %)
that the incidence of Sthoulya was more in persons with pravara saatmya which is
Sattva
In the present study, 2individuals (6.1%) were of avara sattva, 24 individual (72.7 %)
Most of the individuals in the present study had madhyama sattva (p .000) which is
statistically significant indicating that the incidence is frequent with the people of
madhyama sattva.
Abhyavaharana Shakti
In the present study, 1 individual (3.0%) had avara abhyavaharana Shakti and 32
the present study had madhyama Abhyavaharana shakti (p .000) which is statistically
significant.
Jarana Shakti
In the present study, 1 individual (3.0%) had avara jarana Shakti , 29 individuals
(87.9%) had madhyama jarana Shakti and 3 individuals (9.1%)had pravara jarana
Shakti. Most of the individuals in the present study had madhyama jarana Shakti (p
Vyayama Shakti
In the present study, 13 individuals (39.40%) had avara vyayama Shakti and 20
with p value 0.223, as the distribution of the data is similar. Most of the individuals in
the present study had madhyama Vyayama Shakti suggesting that incidence of
Koshta
In the present study 1 individual (3.0%) had kroora koshtha and 32 individuals (97%)
had madhyama koshtha. Most of the individuals in the present study had madhyama
factors including dietary factors and level of physical activity. By this study it is
evident that chala sphik udara stana is the cardinal symptom as it is present in almost
all the individuals. Rest of the lakshanas depends on the pathogenesis and the srotas
involved.
Erectile Functions
In the present study, Out of 33 individuals, 4 individuals (12.1%) had Severe Erectile
had Mild Moderate Dysfunction, 5 individuals (15.2%) had Mild Dysfunction and
From the data it is evident that 57.6% of individuals had some degree of erectile
dysfunction ranging from severe to mild, though statistically insignificant i.e. among
individuals had some amount of erectile dysfunction though only 4 individuals had
severe dysfunction. This suggests that in obese individuals there will be some amount
Orgasmic function
value .029, as 12 individuals had Mild Dysfunction. This Suggest that in obesity,
Sexual desire
Out of 33 individuals, none of the individuals had Severe sexual desire Dysfunction. 5
problems with sexual desire which includes variation from severe to mild degrees.
15.2% of the individuals did not have any problem with sexual desire. This suggests
that in obese individual there will be some amount of dysfunction seen in Sexual
Intercourse satisfaction
had Mild Moderate Dysfunction, 11 individuals (33.3%) had Mild Dysfunction and
problems with intercourse satisfaction which includes variation from severe to mild
degree and 15.2% of the individuals do not have any problem with intercourse
satisfaction. This suggests that in obese individual there will be some amount of
Overall satisfaction
significant with p value .000 as 17 individuals had Mild Dysfunction related with
overall satisfaction, indicating that in obesity there will be Mild Dysfunction related
Semen analysis
Semen volume
Out of 33 individuals, 7 individuals (23.3%) had semen volume <1.5ml/ejaculate, 11
But when the results are observed, 7 individuals had semen volume less than 1.5ml/
eja, 11 individuals had semen volume between 1.5ml/eja to 2ml/eja and 12 individuals
had semen volume more than 2ml/ eja. In total, 18 individuals had semen volume less
than 2ml/eja.i.e. In 60% individuals the semen volume is less than 2 ml suggests that
0.000, suggesting that there is no much change in the Liquefaction time of Semen in
obese individuals.
Viscosity
Out of 33 individuals, the viscosity of semen was normal in 27 individuals (90%) and
individuals.
Sperm count
Out of 33 individuals, the normal Sperm count was noticed in 24 individuals (85.7%),
statistically significant p value 0.000, suggesting that there is no much change in the
suggesting that there is no much change in the sperm count in obese individuals.
insignificant p value 0.144, suggesting that the distribution of the data is equal.
Morphology of Sperms
insignificant p value 0.144, suggesting that the distribution of the data is equal.
Even though the semen analysis results have statistically non significant values,
when seen from the medical point of view near to 50% of abnormality in semen
parameters like liquefaction time, viscosity, sperm count and Motility of Sperms
qualitative changes in the semen. This may be due to the low sample size of the study.
There is significant relation observed between Waist Hip ratio and erectile function
Waist Hip ratio and Orgasmic Function, Sexual Desire, Intercourse Satisfaction and
Overall Satisfaction.
Correlation studies suggest the fact that the extent of erectile dysfunction varies
directly with the hip waist ratio (p value .017). Rest of the erectile functions like
parameters has no statistically significant variation with hip waist ratio. There is no
with BMI.
The study can be undertaken involving larger sample size and multiple
centers.
sexual act.
CONCLUSION
stages of vyavaya.
physical causes.
The cause for the difficulty in sexual act may be due to apla shukrata and
medasavruta marga.
From the results of the present study the statement of charaka samhita
be substantiated.
SUMMARY
relationship between Sthoulya and krucchra vyavaya. To assess this, parameters like
IIEF and semen analysis were used and results were analysed.
The study had two components. The first was a conceptual study which
included various aspects of the subject such as Sthoulya, vyavaya, krucchra vyavaya,
obesity and relationship between obesity and sexual dysfunction. The second
obese individuals. The relation between obesity and the sexual function was observed
in these individuals with the help of IIEF questionnaire and semen analysis. All the
individuals were assigneed in a single group. The results were analyzed statistically
based on the scores obtained from the questionnaire and semen analysis results.
function, sexual desire, intercourse satisfaction and overall satisfaction were assessed.
suggesting that there was mild dysfunction observed in these two parameters.
suggesting that there is no dysfunction seen in obese individuals. But the degree of
the components of IIEF there was no significant findings observed. But some amount
of dysfunction from severe to mild was observed in these two components also.
Statistical results suggest that there were no changes observed in the semen analysis
results. But 60% of the individuals had semen volume less than 2ml suggesting that
Correlation studies suggest that there was no relation of BMI with either erectile
functions or semen analysis. However the studies suggest that Erecile dysfunction
increases proportionately with waist hip ratio. The rest of the components in IIEF and
By the results it was observed that there is a definite relation between Sthoulya and
krucchra vyavaya
The conclusion derived on the basis of detailed observation & deep study is submitted
Bibliographic references
10. Wasudev Laxman Shastri Panshikar, Amara Kosha with short commentary,
7th Ed: Bombay, Panduranga Jawaj, 1934,PP: 209
11. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
12. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
13. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
14. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
16. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
17. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
18. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 121
19. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP 225
20. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
21. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
22. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
23. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73, 74
28. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
29. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
30. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
32. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
35. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
39. Indradeva Tripati & Dr.Daya Shankar Tripati , Yoga Ratnakara, 1st Ed,
Krishnadas Academy, 1998, PP:522
40. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
41. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
42. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 449
43. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 116
44. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
45. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP :226
47. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 121
49. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
50. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
51. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 687
52. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
53. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
54. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP 223
55. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
56. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 138
57. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 144
58. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
59. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 26
60. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 32
61. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 161
62. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 154
63. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 172
64. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
65. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:164 - 170
66. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
67. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
72. Acharya YT, Charaka Samhita of Agnivesha. 5th Ed, Varanasi: Choukhambha
Prakashana, 2007, PP: 117
73. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP:73
74. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP 228
78. Kumar, Abbas, Fausto, Robbins and cortan- pathologic basis of disease,
7thedition, Elsevier India private limited, 2005, page no 303.
80. M S Bhatia, Essentials of psychiatry, 4th Ed, New Delhi, CBS Publishers,
2004, PP: 22.1, 22.3.
81. M S Bhatia, Essentials of psychiatry, 4th Ed, New Delhi, CBS Publishers,
2004, PP: 22.1.
82. "India facing obesity epidemic: experts". The Hindu. 2007, 10-12.
83. www.obeseliving.com
87. Brunner EJ, Chandola T, Marmot MG. Prospective effect of job strain on
general and central obesity in the Whitehall II Study. American Journal of
Epidemiology 2007;165(7):828-37
88. Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB. Association between
reduced sleep and weight gain in women. American Journal of Epidemiology
2006; 164(10):947-54.
89. Kumar, Abbas, Fausto, Robbins and cortan- pathologic basis of disease,
7thedition, Elsevier India private limited, 2005, PP: 462.
91. K. George Matthew, praveen aggarwal, Medicine, 3rd Ed. (prep. Manual for
undergraduates), Elsevier India private limited, 2008, PP: 587 589.
94. Wasudev Laxman Shastri Panshikar, Amara Kosha with short commentary,
7th Ed: Panduranga Jawaj, Bombay, 1934, PP: 147.
97. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397.
99. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 374.
100. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 309.
101. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 309.
104. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397.
105. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 310.
106. Indradeva Tripati & Dr.Daya Shankar Tripati , Yoga Ratnakara, 1st Ed,
Krishnadas Academy, 1998, PP:68
107. Indradeva Tripati & Dr.Daya Shankar Tripati , Yoga Ratnakara, 1st Ed,
Krishnadas Academy, 1998, PP:69
108. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397.
110. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 340, 341.
112. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397.
113. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397.
114. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397.
117. Indradeva Tripati & Dr.Daya Shankar Tripati , Yoga Ratnakara, 1st Ed,
Krishnadas Academy, 1998, PP:70
119. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 494.
121. Wasudev Laxman Shastri Panshikar, Amara Kosha with short commentary,
7th Ed: Panduranga Jawaj, Bombay, 1934, PP: 53
123. M S Bhatia, Essentials of psychiatry, 4th Ed, New Delhi CBS Publishers,
2004,PP: 18.10.,18.11
124. Schiavi RC, segraves RT. The biology of sexual function. Psychiatric clinics
of North America 1995; 18, 1,7-23.
125. M S Bhatia, Essentials of psychiatry, 4th Ed, New Delhi CBS Publishers,
2004, PP: 18.10.
126. M S Bhatia, Essentials of psychiatry, 4th Ed, New Delhi, CBS Publishers,
2004, PP: 18.10.
127. M S Bhatia, Essentials of psychiatry, 4th edition, New Delhi, CBS Publishers,
2004, PP: 18.10.
129. M S Bhatia, Essentials of psychiatry, 4th Ed, New Delhi, CBS Publishers,
2004, PP: 18.8, 18.11.
130. World health organisation. The ICD 10, classification of mental and
behavioural disorders. Clinical descriptions and diagnostic guidelines. World
health organisation, Geneva, 1992.
131. World health organisation. The ICD 10, classification of mental and
behavioural disorders. Clinical descriptions and diagnostic guidelines. World
health organisation, Geneva, 1992.
132. World health organisation. The ICD 10, classification of mental and
behavioural disorders. Clinical descriptions and diagnostic guidelines. World
health organisation, Geneva, 1992.
133. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP: 144
137. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 174.
138. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 516.
139. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP :397
140. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 116.
141. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 73, 74.
142. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 116.
143. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 116.
144. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 116
145. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP 224
146. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 73
147. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 116
149. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP:344
150. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 516
151. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 251
152. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 451
153. Indradeva Tripati & Dr.Daya Shankar Tripati , Yoga Ratnakara, 1st Ed,
Krishnadas Academy, 1998, PP:67
154. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 6
155. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397
156. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 308
157. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 349.
159. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397
160. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 42
163. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 357.
164. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed., Varanasi:
Chowkamba Orientalia, 2003, PP: 69.
166. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397
167. Acharya YT, Charaka Samhita of Agnivesha, 5th Ed, Varanasi, Choukhambha
Prakashana, 2007, PP: 397
168. Anna Moreshwar Kunte .Ashtanga hrudaya of Vagbhata. 7th Ed, Varanasi:
Chowkamba Samskrit Adhishtan, 2002, PP :365
ANNEXURE -01
HEAD OF THE DEPARTMEN : Dr. Anjaneya Murthy M.D., (Ayu) /Dr.Shakunthala.G.N M.D., (Ayu)
Sl.No:
I. ATURA VIVARANA:
Name: Date:
Age: yrs.
Marital Status: M / UM / W / D.
Religion: H / M / C / Others.
Education: UE / PS / MS / HS / G / PG.
Socio-Economic Status: VP / P / LM / M / UM / R.
Address:
Phone No :
B M I:
V. PERSONAL HISTORY
A. Nature of work: Hard manual work / Moderate manual work / Mild Work/ Sedentary
work
B. Duration of exercise:
Nature of exercise:
D. Nature of food:
Intake of Heavy food regularly : Yes / No
Normal quantity with increased frequency: Yes / No
Small quantity with regular frequency: Yes / No
Use of snacks between meals: Yes / No
Excessive dieting : Yes / No
Predominant taste Prefered /cosumed :
E. Appetite: Poor / Moderate / Good / Severe
iii
F. Sleep
Nature: Satisfactory/ Unsatisfactory/ Excess
Duration: Day:
Night:
H. Sexual History:
A. Secondary Sexual Characters :
B. Psychosexual Disorders:
C.
VI. TREATMENT HISTORY:
Nadi:
Mutra:
Mala:
Jihva:
Shabda:
Sparsha:
Druk:
Akruti:
Prakriti:
Vikriti:
Satmya:
Aharashakti:
a. Abhyavaharana : Avara / Madhyama / Pravara
ANNEXURE -02
PATIENT QUESTIONNAIRE
These questions ask about the effects that your erection problems have had on your
sex life over the last four weeks. Please try to answer the questions as honestly and as
clearly as you are able. Your answers will help your doctor to choose the most
effective treatment suited to your condition. In answering the questions, the following
definitions apply:
-Ejaculation is the ejection of semen from the penis (or the feeling of this)
Q1. How often were you able to get an erection during sexual activity?
0- No sexual activity
Q2. When you had erections with sexual stimulation, how often were your erections
hard enough for penetration?
Q3. When you attempted intercourse, how often were you able to penetrate (enter)
your partner?
Q4. During sexual intercourse, how often were you able to maintain your erection
after you had penetrated (entered) your partner?
Q5. During sexual intercourse, how difficult was it to maintain your erection to
completion of intercourse?
1 -Extremely difficult
2 -Very difficult
3 -Difficult
4 -Slightly difficult
5 -Not difficult
vii
0 -No attempts
Q7. When you attempted sexual intercourse, how often was it satisfactory for you?
0- No intercourse
3 -Fairly enjoyable
4 -Highly enjoyable
Q9. When you had sexual stimulation or intercourse, how often did you ejaculate?
Q10. When you had sexual stimulation or intercourse, how often did you have the
feeling of orgasm or climax?
2 -Low
3- Moderate
4 -High
5 -Very high
Q13. How satisfied have you been with your overall sex life?
1 -Very dissatisfied
2 -Moderately dissatisfied
ix
4 -Moderately satisfied
5 -Very satisfied
Q14. How satisfied have you been with your sexual relationship with your partner?
1 -Very dissatisfied
2- Moderately dissatisfied
4- Moderately satisfied
5 -Very satisfied
Q15. How do you rate your confidence that you could get and keep an erection?
1 -Very low
2 -Low
3 -Moderate
4- High
5- Very high
ANNEXURE -03
SHLOKAS
Sthoulya
lSl
3. auSukSxslzszqqe Ux ||
xmmi
2. qSxuiqaiur M uzwi |
15/32
6. auSukSxslzszqqe Ux ||
9. qSxuiqaiuimwrlirlr l kiu |
pxuUerq 18/
sh
,Sosrq Axqiui kil , Salkr qSSwl qSx xupui xuSliu ,qSx zswq
Arxqi eqsmrosuai |
6. SxiwqWxumljl xSl|
EmSu
xkrxkri
cMix
2. rer i qimWq |
x.x.15/32
sbuMUh || c. x. 26/11
uQ laU U MssWUe qk |
mjr
1. aQcpSqxil mraTsxij |
uQ laU U MssWUe qk |
McN urur
AWUUxrliuSu xilrqm xr ||
xilr zui xmuii | Amir xxmzS MUh cirm xlW qsMUhqi iSu
SzrW xlW CirS mxu xilr xuh | Am ciuLA Wiu mUq ruixjl
r U.....31
r.U.....32
xvi
lmQli | aakU
c.c.2/4/46
qRrlrpxwcNUUwqlsWi ||
mx xuzUUxj Ui Surij ii ||
urqWlqah mirirlpa ||
xvii
xjsr - McNurur
31. zxr Asmiui qSxui qaiui c McNh urur qjl rxr ixr pu
McNururi ||ealSlj xl on c.x,21/3
Master Chart
Sl No Age M.Sta Reli Ed. SES BMI W.H.R C.S.U. K.S A.uh Doub Nidr.A Dour snig Ati.Pip Ati.Ks Alp.Vya G.S Swed
1 38 M H G MC 31 1.01 P Ab Ab Ab Ab Ab P Ab Ab Ab Ab P
2 48 M H G UM 30.46 1.01 P P Ab P Ab Ab P P Ab P P P
3 40 M H MS MC 33 1.08 P P Ab Ab Ab Ab Ab Ab Ab P Ab Ab
4 38 M H PG Rich 30.44 1.01 P P Ab Ab Ab Ab Ab Ab Ab Ab Ab Ab
5 34 M Mu HS MC 32.69 1.01 P Ab P Ab P P P Ab Ab P P P
6 31 M H HS MC 33.53 1.05 P P Ab Ab Ab P P Ab Ab P Ab P
7 60 M H G MC 30.85 1.02 P P P Ab P Ab Ab Ab Ab P P Ab
8 32 M H HS MC 31 1.02 P P P Ab Ab Ab Ab Ab P Ab P P
9 42 M H HS MC 30.24 1.05 P Ab Ab Ab P Ab Ab Ab P P Ab Ab
10 31 M H PG MC 30.22 1.02 P P Ab Ab P Ab Ab Ab Ab Ab Ab P
11 37 M H G UM 31 1.02 P Ab Ab P P Ab Ab Ab Ab P P Ab
12 32 M H G MC 30.1 1.01 P Ab Ab Ab Ab Ab P Ab Ab Ab Ab P
13 52 M H G UM 31.94 1.01 P Ab Ab Ab Ab Ab Ab Ab Ab P Ab Ab
14 42 M H HS LM 31.22 1.04 P P P Ab Ab Ab Ab Ab Ab Ab Ab Ab
15 46 M H PG MC 30.24 1.02 P P Ab Ab P Ab Ab Ab Ab P P Ab
16 33 M H HS MC 32.14 1.03 P P Ab P Ab P Ab Ab Ab P Ab P
17 31 M H HS MC 30.69 1.01 P Ab P P Ab P Ab Ab Ab Ab P Ab
18 45 M H G MC 30.24 1.03 P P Ab Ab P Ab Ab Ab Ab Ab P Ab
19 43 M H PS MC 32.19 1.03 P P Ab P Ab Ab Ab Ab Ab Ab Ab P
20 48 M H G MC 31.22 1.03 P P Ab P Ab P Ab Ab Ab P Ab P
21 35 M H HS MC 31.58 1.03 P P P P P P Ab Ab Ab Ab P P
22 33 U.M H HS LM 32.19 1.03 P P P Ab Ab Ab P P Ab Ab P P
23 30 M H HS MC 30.68 1.08 P Ab Ab Ab P P Ab Ab P P Ab P
24 44 M Mu G UM 34 1.02 P P Ab Ab P Ab Ab Ab Ab P Ab P
25 31 M H HS MC 30.22 1.03 P P Ab Ab P Ab Ab Ab Ab P Ab P
26 36 M H HS LM 30.22 1.01 P Ab Ab Ab Ab P P Ab Ab Ab Ab P
27 32 M H HS LM 30.3 1.01 P Ab Ab Ab P P P Ab Ab Ab Ab P
28 30 M H G MC 30.45 1.01 P P Ab Ab P Ab Ab Ab P P Ab Ab
29 32 M Mu HS MC 30.81 1.03 P P Ab Ab Ab Ab Ab Ab Ab Ab Ab P
30 37 M Mu HS MC 38.06 1.01 P P P P Ab Ab P P Ab Ab Ab Ab
31 32 M H G MC 30.85 1.01 P Ab Ab Ab P P Ab Ab Ab Ab Ab P
32 31 M H G MC 30.1 1.01 P P P Ab Ab Ab Ab Ab Ab Ab P P
33 35 M H G UM 30.48 1.02 P Ab Ab Ab P Ab P P Ab Ab Ab P
xix
Sl No Nat.W Dt In.H.F N.I.F S.R.F U.S.M Ex.Dt Pre.Tast Appetite Sl.Nat Prakruti Samhana satmya sattva Abh.Sha Ja.Sha Vya.Sha Koshta
1 Mod. M.W mix N N Y N N All good satis KP Ma Pr Ma Ma Ma Ma Ma
2 Mod. M.W veg N N Y N N Katu poor unsat KP Ma Ma Pr Ma Ma Ma Ma
3 Mod. M.W mix Y N N Y N All mod satis KP Ma Pr Pr Ma Ma Ma Ma
4 Mod. M.W mix N N Y N N All good satis KV Ma Pr Pr Ma Ma Ma Ma
5 Mod. M.W mix N N Y Y N Sweet good satis KP Ma Av Ma Ma Ma Ma Ma
6 Mild.W mix Y N N N N Katu good satis KP Ma Av Ma Ma Ma Av Ma
7 Sed.W veg N N Y N N All good satis KP Ma Pr Ma Ma Ma Ma Ma
8 Mild.W veg N Y N N N Katu good unsat KV Ma Av Pr Ma Ma Av K
9 Mod. M.W veg N N N Y N Sweet good satis KP Ma Pr Pr Ma Pr Av Ma
10 Mod. M.W mix N N Y N N Sweet Mod satis KV Ma Pr Ma Ma Ma Ma Ma
11 Sed.W mix N N Y N N Katu poor satis KV Pr Pr Ma Ma Ma Ma Ma
12 Mod. M.W mix N N Y N N Sweet mod satis KV Ma Av Pr Ma Pr Ma Ma
13 Mod. M.W mix N N Y N N Katu good satis KV Pr Pr Pr Ma Ma Ma Ma
14 Sed.W mix N N Y N N All good unsat KP Ma Pr Ma Ma Ma Av Ma
15 Sed.W mix N N Y N N All Mod satis VP Ma Pr Ma Ma Ma Av Ma
16 Mod. M.W mix Y N N N N All Mod unsat KP Ma Pr Ma Ma Ma Ma Ma
17 Sed.W mix N N Y N N Katu Mod satis KP Ma Pr Ma Ma Ma Av Ma
18 Mod. M.W mix N N Y N N All good satis KP Ma Pr Ma Ma Ma Av Ma
19 Sed.W mix N N Y N N All poor satis KP Ma Pr Ma Av Av Av Ma
20 Sed.W mix Y N N N N All good satis KP Ma Pr Ma Ma Ma Av Ma
21 Mild.W veg N N Y N N Katu good satis KV Ma Pr Ma Ma Ma Av Ma
22 Sed.W veg N N Y N N Sweet good unsat KP Ma Av Av Ma Ma Av Ma
23 Mild.W mix N N Y N N All good satis KP Ma Pr Ma Ma Ma Ma Ma
24 Sed.W mix Y N N Y N All good satis KP Pr Pr Ma Ma Ma Ma Ma
25 Mod. M.W mix N N Y N N All good satis KV Ma Pr Ma Ma Ma Ma Ma
26 H.manual mix Y N N N N All good satis KP Ma Pr Av Ma Ma Ma Ma
27 Mod. M.W mix N N Y N N All good satis KP Ma Pr Ma Ma Ma Ma Ma
28 Sed.W mix Y N N Y N All sev satis KP Ma Pr Ma Ma Pr Ma Ma
29 Mod. M.W mix N N Y Y N All good satis KV Ma Pr Ma Ma Ma Ma Ma
30 Mod. M.W veg Y N N Y N All good satis KP Ma Pr Ma Ma Ma Ma Ma
31 Mod. M.W mix Y N N N N All good satis KV Ma Pr Ma Ma Ma Ma Ma
32 Mod. M.W mix N N Y N N All good satis KP Ma Pr Ma Ma Ma Av Ma
33 Sed.W veg N Y N Y N Katu Mod satis KP M P M M M A M
xx
S.No E.F Org.F SexD I.Sat OvSat E.F Org.F Sex.D I. Sat Ov.Sat Semvol Liqu Vis Count Mot.a Mot.ab Morp Imp
1 27 10 9 15 10 no dys no dys no dys no dys no dys <1.5 N N N N N N N
2 19 7 6 9 7 mild mild md to mod mid to mod mild <0.5 . . . . . . .
3 6 4 5 4 6 severe mod md to mod mod md to mod <1.5 N N Abn Abn Abn Abn Abn
4 30 10 9 14 10 no dys no dys no dys no dys no dys 1.51-2 N N N N N N N
5 22 7 7 10 8 mild mild mild mild mild 1.51-2 N N N N N N N
6 24 8 10 11 10 mild mild no dys mild no dys <1.5 Abn N N N N N N
7 11 4 4 5 6 mod mod mod mod md to mod 1.51-2 N N . Abn Abn Abn Abn
8 26 8 7 12 8 no dys mild mild mild mild 1.51-2 N N N N N N N
9 16 5 4 5 7 md to mod md to mod mod mod mild . . . . . . . .
10 29 10 8 13 8 no dys no dys mild no dys mild 1.51-2 N N N N N N Abn
11 17 8 5 11 7 md to mod mild md to mod mild mild abv 2 Abn Abn . Abn Abn Abn Abn
12 4 0 5 0 7 severe severe md to mod severe mild 1.51-2 N N N N Abn N N
13 30 10 8 14 10 no dys no dys mild no dys no dys abv 2 Abn N N Abn Abn N Abn
14 27 10 9 13 9 no dys no dys no dys no dys no dys abv 2 N N N N N N N
15 17 10 7 5 4 md to mod no dys mild mod mod 1.51-2 N N N Abn Abn N N
16 11 4 5 3 8 mod mod md to mod severe mild . . . . . . .
17 27 9 9 10 9 no dys no dys no dys mild no dys 1.51-2 N N N N N N N
18 24 8 8 10 8 mild mild mild mild mild 1.51-2 N N N N N N N
19 15 4 6 7 8 md to mod mod md to mod md to mod mild abv 2 N N N Abn Abn N N
20 18 6 5 7 6 md to mod md to mod md to mod md to mod md to mod abv 2 N N N N N N N
21 12 6 4 7 6 mod md to mod mod md to mod md to mod abv 2 N N N N N N N
22 2 0 4 0 4 severe severe mod severe mod abv 2 Abn Abn N N N N N
23 15 8 6 7 6 md to mod mild md to mod md to mod md to mod <1.5 N N N N N N N
24 14 7 6 7 6 md to mod mild md to mod md to mod md to mod abv 2 N N N N N N N
25 5 4 4 3 2 severe mod mod severe severe abv 2 N N N N N N N
26 24 8 8 8 8 mild mild mild md to mod mild <1.5 N N N N N Abn Abn
27 28 9 8 12 8 no dys no dys mild mild mild <1.5 N N N Abn Abn N Abn
28 26 5 8 7 5 no dys md to mod mild md to mod md to mod 1.51-2 N N N N N N Abn
29 27 8 8 11 8 no dys mild mild mild mild abv 2 N N Abn Abn Abn Abn Abn
30 29 10 7 12 8 no dys no dys mild mild mild abv 2 N N N N N N N
31 27 9 8 11 8 no dys no dys mild mild mild <1.5 N N B.line N Abn N Abn
32 29 8 8 11 8 no dys mild mild mild mild 1.51-2 N Abn N N N N N
33 26 8 8 9 8 no dys mild mild md to mod mild abv 2 Abn N B.line Abn Abn N Abn
xxi