A double arm clinical study to access the role of Basti and Virechana Karma...

[Full title: A double arm clinical study to access the role of Basti and Virechana Karma along with Vanari Yoga in Premature Ejaculation]

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[Find the meaning and references behind the names: Dharma, Deep, Sneha, Prashanth, Reddy]

ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 108 A double arm clinical study to access the role of Basti and Virechana Karma along with Vanari Yoga in Premature Ejaculation Dr. Shrinivasraddi G. Venkaraddiyavar 1 , Dr. Prashanth A.S. 2 , Dr. S.G.Chavan 3 1 Post Graduate Scholar, 2 Professor & Head, 3 Professor, P. G. Dept. of Kayachikitsa, Ayurveda Mahavidyalaya, Hubballi, Karnataka, INDIA. I NTRODUCTION Ayurveda is one of the most reliable novel and ancient medical science which have proved for more than 5000 years. Even though the modern science is changing from time to time, Ayurveda has maintained existence till date. Ayurveda was developed to safe guard the Arogya and also which is considered to be Address for correspondence: Dr. Shrinivasraddi G. Venkaraddiyavar Post Graduate Scholar, P. G. Dept. of Kayachikitsa, Ayurveda Mahavidyalaya, Hubballi, Karnataka, INDIA. E-mail: shrinivas.reddy 620@gmail.com Submission Date: 12/07/2019 Accepted Date: 23/08/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.4.4.15 essential for the achievements of the life called Chaturvidha Purushartha like Dharma, Artha, Kama and Moksha. [1] Now a days getting the Satisfaction during intercourse and fertility agents from herbal source is of top priority in the field of research in Andrology. If special branch of Ayurveda called Vajeekarana, can contribute something to solve this problem then it would be a great boon to global population, who are in deep depression due to dissatisfaction and infertility. Ayurveda has described several drugs and special therapeutic procedures to treat the problem of Shukra Dusti Shukra is considered as the Saara of all other Dhatu, it gives Happiness, Strength to the body. Shukra plays more important role in the formation of Garbha , Shukra under the influence of Vayu and Pitta is ejaculated from male genital organ, enters into Garbhashaya and combines with Arthava to form the Garbha. [2] A B S T R A C T Satisfaction is a pleasant or positive emotion. It can also be a feeling. If a Satisfaction during intercourse and fertility agents are intact then the whole intension will be lost. Ayurvedic medicine plays important role in the patients who are in deep depression due to dissatisfaction and infertility in the field of Andrology. Gati is the core characteristic concerned with any disorder of Vata. If Shukra Dhatu gets vitiated by Vata Dosha causes Shukragata Vata. Here 40 subjects diagnosed with Shukragata Vata w.s.r to Premature Ejaculation fulfilling the Inclusion criteria were selected for study and randomly categorized into two groups as Group A and Group B each consisting of 20 subjects. Group A received Amapachana with Hareetakyadi Churna, Tritiya Baladi Yapana Basti was administered in Yoga Basti schedule, later Vanari Yoga granules given as a Shamanoushadi. Group B received Amapachana with Hareetakyadi Churna, Sadhyosnehapana with Shalmali Ghrita. Sarvanga Abhyanga with Murchitatila Taila followed by Sarvanga Swedana and Sneha Virechana was administered with Eranda Taila . After Samsarjana Krama, Vanari Yoga granules was given as a Shamanoushadi . So the objective of the study is to establish such a treatment modality which can be helpful in treating the Shukragata Vata Key words: Shukragata Vata, Premature Ejaculation, Tritiya Baladi Yapana Basti, Vanari Yoga.

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[Find the meaning and references behind the names: Man, Guna, Main, Rasa]

Dr. Shrinivasraddi G. Venkaraddiyavar et al. A double arm clinical study on Premature Ejaculation. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 109 Vata can be described as a self-generating and selfpropagating force that is responsible for the conduction, regulation and integration of all vital functions and structures of the body. If Vata is adopting an abnormal route and get occupied in other areas, it will cause derangement in its functions. This condition is termed as Anyasthanagata Vata . Even though the Vata is in equilibrium state and occupied at its own habitat nothing can be interfered with the Gati of Vata. Whenever there is a Dusti in the Gati of Vata it may cause vitiation and/or adopt abnormal Gati . Hence the Gati is the core characteristic concerned with any disorder of Vata. [3] If Shukra Dhatu gets vitiated by Vata Dosha causes Shukragata Vata. Shukragata Vata is a distinct pathological entity characterized by a group of clinical presentation either related with the impairment of Ejaculation or with the impairment of seminal property. One of the symptoms of Shukragata Vata is Kshipram Munchana [4] that is Premature Ejaculation. Premature ejaculation (PME) in Ayurvedic terms are as follows, Kshipram Munchana, Shukrasya Shighram Utsargam, Atishighra Pravritti. Premature ejaculation (PME) is a common sexual problem in males affecting 25-40% of men and characterized by a lack of voluntary control over Ejaculation . A man suffers from PME if he ejaculates before his sex partner achieves orgasm in more than 50% of their sexual encounters. According to W.H.O. Second International Consultation on Sexual Health defined it as Persistent or recurrent ejaculation with minimal stimulation before, during or shortly after penetration and before the person wishes it, over which the sufferer has little or no voluntary control which causes the sufferer and/or his partner distress. An increased susceptibility to PME in men from the Indian Subcontinent has been reported. Most Modern research uses the Intravaginal Ejaculatory Latency Time (IELT) as measured by a stopwatch. This technique was originally used by a Psychoanalyst in 1973. In the present study, the subjects were randomly selected according to the inclusion and exclusion criteria and were placed into two Groups namely Group A and Group B containing 20 subjects each. In Shukradusti Basti, (Prashasta Shukradosheshu Basti Karma Visheshtah ) [5] is most beneficial which is made out of Shukravardhaka Dravya. In classics like Charaka Samhita, Sushruta Samhita etc. explain various Vrishya Basti [6] among them Tritiya Baladi Yapana Basti [7] can be effectively used in this condition. Snehana provides Snigdhatva to the body, liquefies Dosha and increases Kledata in the body. Like this it manages Dosha and helps in bringing them from Shakha to Koshta. [8] Shalmali being Madhura in Rasa, Snigdha in Guna, Sheeta Veerya, Madhura Vipaka which are opposite to the qualities of Vataja Shukradusti like Phenilatva, Tanutva and Rukshatva. [9] Hence Shalmali Ghrita [10] for Snehapana can be helpful in Shukragata Vata condition . Sneha- Virechana is considered as choice of Shodhana in the management of Shukragata Vata. [11] Virechana Karma is one of the prime treatment modality for Pitta. [12] It also has a significant role in mitigation of Vata . Eranda Taila acts as Sneha Virechaka , Vrushya, Vata Kaphahara, Adhobhaga Doshahara, Yonishukra Vishodhaka. [13] Vanari Yoga [14],[15] is a best Vrushya Dravya, in which Kapikacchu Beeja is the main ingredient with Shukrala in action. Hence it directly acts on Shukra Dhatu . The other ingredients such as Dugdha, Ghrita and Sharkara are Brimhana Dravya which helps in Dhatu Vruddhi. Dugdha is considered as Sadhya Shukrakara Dravya . In the present study, 40 subjects were selected incidentally and placed randomly into two groups, Group A and Group B, with 20 subjects in each group. Classical signs and symptoms form the main diagnostic criteria and were also studied for assessment criteria. Group A received Amapachana with Hareetakyadi Churna till the Nirama Lakshana , followed by Tritiya Baladi Yapana Basti in Yoga Basti schedule. Group B received Amapachana with Hareetakyadi Churna till the Nirama Lakshana , followed by Sadhyo-

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[Find the meaning and references behind the names: Singh, Ama]

Dr. Shrinivasraddi G. Venkaraddiyavar et al. A double arm clinical study on Premature Ejaculation. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 110 Snehapana with Shalmali Ghrita and Sneha Virechana with Eranda Taila. In both the groups Vanari Yoga was given as a Shamanoushadi. Follow-up was done for 2 months in both the groups and they were advised to attend the OPD every 15 days for general checkup and for recording changes observed in them. O BJECTIVES OF THE STUDY 1 To study the Effect of Tritiya Baladi Yapana Basti in the management of Shukragata Vata (PME) . 2 To study the effect of Virechana Karma in the management of Shukragata Vata (PME). 3 To study the effect of Vanari Yoga in subjects of Shukragata Vata . 4 To study the concept of Shukra & Nidana Panchaka of Shukragata Vata & Modern view of Premature Ejaculation. Inclusion Criteria 1 Married male subjects presenting with complaints of early ejaculation during sexual intercourse atleast from 6 months. 2 Unable to delay ejaculation till the person wishes it. 3 Male subjects of age group of 25 to 45 years were included. Exclusion Criteria 1 Subjects with Systemic diseases like Uncontrolled DM & HTN, structural deformity like Cryptorchidism, Varicocele, Hydrocele etc. 2 Subjects suffering from STD, HIV, HCV and HBsAg. Parameters of Study Improvement in Sexual Health Parameters will be recorded . The Scoring System developed by Mehra and Singh, IPGT & RA Jamnagar (1995) will be adopted for the purpose. The details of Scoring pattern is: A Subjective Parameters (Sexual Parameters) 1. Erection 2. Penile Rigidity 3. Performance Anxiety 4. Ejaculation 5. Sexual Desire B Objective Parameters (Seminal Parameters) 1. Volume 2. Liquefaction 3. Colour 4. Consistency 5. Viscosity 6. pH 7. Sperm count & Motility 8. Doshadushita Shukra Lakshana Study Design It was a Comparative Clinical Study where minimum of 40 subjects diagnosed with Shukragata Vata were incidentally selected and randomly categorized into two groups as Group A and Group B each consisting of 20 subjects Group A Ama Pachana Hareetakyadi Churna Dose: 5 gms of Churna with warm water before food. (Till Nirama Laxana ) Abhyanga MurchitaTilaTaila followed by Swedana. Basti Tritiya Baladi Yapana Basti , in Yoga Basti schedule. Shamana Yoga Vanari Yoga Dose : 5 gms of Churna with warm milk (Twice a day) Group B Ama Pachana Hareetakyadi Churna Dose: 5 gms of Churna with warm water before food. (Till Nirama Laxana ) Abhyantara Bahya Snehana Sadhyo Snehapana with Shalmali Ghrita Dose - Madhyama Matra (As per Agni, Kostha of subjects). Abhyanga with Moorchita Tila Taila followed by Swedana . Sneha Eranda Taila

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[Find the meaning and references behind the names: Vega]

Dr. Shrinivasraddi G. Venkaraddiyavar et al. A double arm clinical study on Premature Ejaculation. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 111 Virechana Dose : As per Kostha of patient. Paschat Karma SamsarjanaKrama depending on Vega/Shuddhi. Shamana Yoga Vanari Yoga Dose : 5 gms of Churna with warm milk (Twice a day) Overall assessment of results Grade of improvement Complete Relief 100 % Improvement or Conceived. Marked Relief 75 to 99 % Improvement Moderate Relief 50 to 74 % Improvement Mild Relief 26 to 49 % Improvement Unchanged <25 % or No Improvement O BSERVATIONS AND R ESULTS Table 1: Showing symptoms wise distribution of Shukragata Vata subjects in both Groups. Chief Complaints Group A % Group B % Total % Premature Ejaculation 20 100% 20 100% 40 100% Loss of Rigidity 00 00% 00 00 00 00% Lack of sexual desire 00 00% 00 00 00 00% Table 2: Distribution of subjects according to Sperm count. Sperm count Group A % Group B % Total % 0 to 15 million/ml 12 60% 06 30% 18 45% 16 to 30 million/ml 05 25% 00 00% 05 12.5% 31 to 45 million/ml 00 00% 01 05% 01 2.5% 46 to 60 million/ml 00 00% 04 20% 04 10% 61 to 75 million/ml 03 15% 07 35% 10 25% 76 & above 00 00% 02 10% 02 05% Group A ( Basti Karma ) Table 3: Effect of therapy on Subjective Parameters and Objective Parameters Paramet er Mean Me an diff % improve ment S. D. S. E. “t” P BT AT Ejaculati on 4 2 1 25 2.9 5 70.24 0 80 0 18 16 03 0.00 01 Erection 3 75 1 25 2.5 66.67 0 67 0 14 16 22 0.00 01 Penile Rigidity 3 75 1 25 2.5 66.67 0 74 0 16 14 52 0.00 01 Perform ance Anxiety 3 25 1 75 1.5 0 46.16 0 86 0 19 7.5 8 0.00 01 Sexual Desire 3 4 1 95 1.4 5 42.65 0 91 0 20 6.9 3 0.00 01 Sperm Count 4 15 3 15 1 25 1 37 0 30 3.1 7 0.00 5 0.0001 = Highly Significant, 0.005 = Significant Group B ( Virechana Karma ) Table 4: Effect of therapy on Subjective Parameters and Objective Parameters Paramet er Mean Me an diff % improve ment S. D. S. E. “t” P valu e BT AT Ejaculati on 4 1 1 3 2.8 68.30 0 81 0 18 15 03 0.00 01 Erection 3 6 1 25 2.3 5 65.25 0 56 0 12 18 25 0.00 01 Penile Rigidity 3 75 1 2 2.5 5 68 0 58 0 12 19 12 0.00 01 Perform ance Anxiety 3 4 1 6 1.8 52.95 1 16 0 25 6.7 5 0.00 01 Sexual Desire 3 45 1 75 1.7 49.28 1 05 0 23 7.0 3 0.00 01 Sperm Count 2 4 1 8 0.6 25 1 2 0 26 2.1 7 0.05 0.0001 = Highly Significant, 0.005 = Significant

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[Find the meaning and references behind the names: Sara, Tota, Rajo, Asta]

Dr. Shrinivasraddi G. Venkaraddiyavar et al. A double arm clinical study on Premature Ejaculation. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 112 Table 5: Showing comparative efficacy of therapies on subjective and objective parameters in Group A and Group B Assessme nt Paramete rs (N=40,D. F=38) Group A Group B Unpaired t test (Group-A vs Group-B) Me an S. D. S. E. Me an S. D. S. E. S. D. t cal P Ejaculatio n 2.9 5 0 80 0 18 2.8 0 0 81 0 1 0 68 0 75 0.5 00 Erection 2.5 0 67 0 14 2.3 5 0 56 0 12 0 40 1 50 0.2 00 Penile Rigidity 2.5 0 74 0 16 2.5 5 0 58 0 12 0 46 0 35 0.5 00 Performa nce Anxiety 1.5 0 0 86 0 19 1.8 0 1 16 0 25 1 09 0 90 0.5 00 Sexual Desire 1.4 5 0 91 0 20 1.7 0 1 05 0 23 1 06 0 80 0.5 00 Sperm Count 1 1 37 0 30 0.6 1 2 0 26 1 74 0 74 0.5 00 0.200 = Significant, 0.500 = Non Significant Table 6: Overall effect of study on both Group A & Group B Remarks Group A % Group B % Tota l (%) Fertility 04 20 % 02 10 % 06 15% Marked Improvemen t 75% & above 02 10 % 01 05 % 03 07.50 % Moderate Improvemen t 50 to 74% 12 60 % 13 65 % 25 62.50 % Mild Improvemen t 25 to 49% 06 30 % 06 30 % 12 30.00 % No Improvemen t Below 25% 00 00 % 00 00 % 00 00% DISCUSSION Discussion is the most essential part of Research work which helps to explain the interpretation on findings and judgment on the clinical study. In the present study, various aspects of Shukragata Vata (PME) from Ayurveda and Modern perspective have been explored. Ayurveda put attention on healthy living and considers the physical union of Stree and Purusha for the purpose of the creation of offspring. In Shukragata Vata (PME) sexually satisfaction is not possible due to early ejaculation, so in present study an attempt was made to solve the issues of dissatisfaction and infertility agents through herbal sources as dealt in Ayurvedic science Those who not follow the Asta Vidha Ahara Visheshatana will disturb the process of digestion and proper nourishment of Dhatus and also Shukra which is called Parama Sara of Dhatu also not properly nourishes which leads to Dusti in Shukra Dhatu. Viharaja Nidana like Shukra Vega Dharana, etc. and Manasika Nidanas like Chinta, etc. causes Vata Dusti as a result it leads to Shukragata Vata due to Prana, Samana, Vyana and Apana Vayu Dusti and Rajo Dosha Dusti. In this study Basti and Virechana therapy is taken as Shodhana Karma because prior to administering Rasayana and Vajeekarana Yogas, Shodhana Karma is advocated . If Shodhana Karma is not administered priorly, its like dyeing in dirty cloth. Basti Karma is the best choice of treatment for Vata Dosha. Basti which prolongs the life and restores the health is called Yapana Basti and it enhances the quality of Shukra Dhatu, reduces Daurbalya and Riktata in Shukravaha Srotas , there by pacifying of Shukragata Vata. Virechana Karma is one of the prime treatment modality for Pitta and also in mitigation of Vata . Shalmali Ghrita is advised here for Snehapana prior to Virechana Karma because it is indicated in Shukrameha, Klaibhya Dhatu, etc. and Eranda Taila

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[Find the meaning and references behind the names: Bala, Deepika, Low, Guru]

Dr. Shrinivasraddi G. Venkaraddiyavar et al. A double arm clinical study on Premature Ejaculation. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 113 for Virechanartha, which acts as Sneha Virechaka , Vrushya, Vata Kaphahara, Adhobhaga Doshahara, Yonishukra Vishodhaka. After Shodhana Karma Vanari Gutika is administered here in both the groups as Shamanoushadi with Ksheera as Anupana which is explained in Yogaratnakara and Bhavaprakash as Vanari Vati. Both the authors explain it in Sheegra Draavi ( PME ) and Dwajabhanga ( ED ) conditions. Instead of Gutika we prepared the granular form because it absorbs faster than Gutika . Kapikacchu is the main ingredient of Vanari Yoga whichis famous for its powerful Vajeekarana action and also well known to increase the sperm count and testosterone level in the body. In this study Tritiya Baladi Yapana Basti with Vanari Yoga shows more effective in improving the duration of Ejaculation process due to Madhura Rasa and Madhura Vipaka, Guru Snigdha in Guna, Sheeta Veerya properties of its ingredients like Bala, Atibala, Kapikacchu and Yava which helps in subsiding the Vata. Yapana Basti also improve Shukra quality and Mamsa Dhatu which helps in the erectile dysfunction compared to Eranda Taila Virechana. Kapikacchu consisting Dopamine as chemical composition helps to increase sexual activity and thereby helps in improving the duration of Ejaculation process. Eranda Taila Virechana with Vanari Yoga showed more effect in improving the Penile Rigidity . Virechana is indicated in Pitta Vikara (Rakta Dusti), Eranda Taila is Vatashamaka so it corrects the Vyana and Apana Vayu Dusti with respect to improve the blood circulation to penile parts. Also Vrushya, Medho Vardhaka, Smrithikaraka properties of Eranda Taila might act on Manovaha Srotus in controlling the PME . This shows it is more effective in improving the Performance Anxiety and Sexual Desire compared to Tritiya Baladi Yapana Basti. Both the groups showed the same result in Sperm Count, but in Group A, 05 subjects had PME along with Azoospermia and same 02 subjects noted in Group B. Fertility wise 04 Subjects in Group A and 02 subjects in Group B could able to conceive their wives. Based on Fertility aspects Tritiya Baladi Yapana Basti with Vanari Yoga was more effective than Eranda Taila Virechana with Vanari Yoga. CONCLUSION We can conclude that, as compare to modern view, the holistic approach of Ayurvedic system of medicine is effective without any complications and side effects because Ayurveda focuses on rebalancing individuals and not just treating diseases, its treatments are having low potential for iatrogenesis or side effects. In addition, they tend to promote the systemic health and well-being of the individual. This being the case, it makes sense to first attempt to correct sexual dysfunctions through Ayurvedic treatment Gatatva is an essential factor in Vataja Samprapti characterized by Dhatudaurbalya, Srtotoriktata, Vata Prokopa and increased Gati of Vata . Shukragata Vata is a diseased condition, which consists of various clinical symptoms. Such as Kshipram Munchati , Badhnati , Garbha Vikruti. This study shows both the treatments like Tritiya Baladi Yapana Basti with Vanari Yoga and Eranda Taila Virechana with Vanari Yoga shows effectiveness in Shukragata Vata w.s.r to PME. Both Groups shows result in the reduction of subjective parameters. Among all subjective parameters, Group A shows more improvement in Ejaculation and Erection. Group B shows improvement in subjective parameters like Penile Rigidity, Performance Anxiety and Sexual Desire. In objective parameter both the Groups shows same result in Sperm Count. In total out of 40 subjects of Shukragata Vata (PME), after treatment 04 Subjects in Group A and 02 subjects in Group B could able to conceive their wives. 2 subjects in Group A and 01 subject in Group B had marked relief, 12 subjects in Group A, 13 subjects in Group B had moderate relief. Remaining 06 Subjects in Group A and 06 subjects in Group B got mild relief REFERENCES 1 Charaka Samhita of Agnivesha, By Vaidya H.C. Kushwaha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 1 st Volume, Chaukhamba Orientalia, Varanasi. 2012, Sutrasthana, 1 st Chapter, Sloka No - 15, Page No - 9.

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[Find the meaning and references behind the names: Shri, Suresh, Sharma, Ram, Govind, Gupta, Babu, Nil, Med, Mishra]

Dr. Shrinivasraddi G. Venkaraddiyavar et al. A double arm clinical study on Premature Ejaculation. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 114 2 Sushruta Samhita, Dr. Anant Ram Sharma, Susruta Vimarsini Hindi Commentary Varanasi Chaukhamba Surbharati Prakashana 2 nd Volume, Shareerasthana, 3 rd Chapter, Sloka No - 4, Page No - 29-30. 3 Charaka Samhita of Agnivesha, By Vaidya H.C.Kushwaha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 2 nd Volume, Chaukhamba Orientalia, Varanasi. 2012, Chikitsasthana, 28 th Chapter, Sloka No - 4, 11, Page No - 729-731. 4 Charaka Samhita of Agnivesha, By Vaidya H.C.Kushwaha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 2 nd Volume, Chaukhamba Orientalia, Varanasi. 2012, Chikitsasthana, 28 th Chapter, Sloka No - 34, Page No - 734. 5 Charaka Samhita of Agnivesha, By Vaidya H.C.Kushwaha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 2 nd Volume, Chaukhamba Orientalia, Varanasi. 2012, Chikitsasthana, 30 th Chapter, Sloka No - 152, Page No - 821. 6 Charaka Samhita of Agnivesha, By Vaidya H.C.Kushwaha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 2 nd Volume, Chaukhamba Orientalia, Varanasi. 2012, Siddisthana, 12 th Chapter, Sloka No - 18 (1), Page No - 1125. 7 Charaka Samhita of Agnivesha, By Vaidya H.C.Kushw aha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 2 nd Volume, Chaukhamba Orientalia, Varanasi. 2012, Siddisthana, 12 th Chapter, Sloka No - 9, Page No - 1125. 8 Charaka Samhita of Agnivesha, By Vaidya H.C.Kushwaha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 1 st Volume, Chaukhamba Orientalia, Varanasi. 2012, Sutrasthana, 28 th Chapter, Sloka No - 33, Page No - 479. 9 Charaka Samhita of Agnivesha, By Vaidya H.C.Kushwaha Edited with ‘Ayurveda Deepika’ Hindi Commentary, 2 nd Volume, Chaukhamba Orientalia, Varanasi. 2012, Chikitsasthana, 30 th Chapter, Sloka No - 140, Page No - 820. 10 Bhaisajya Ratnavali of Shri Govind Das edited by Bhisagratna Shri Brahmashanakar Mishra, Vidyotini hindi Commentary by Shri Kaviraj Ambikadatta Shastri Ayurvedacharya, Chaukhamba Prakashana, Varanasi, 37 th Chapter, Sloka No - 192-194, Page No - 737-738. 11 Charaka Samhita of Agnivesha , By Vaidya H.C.Kushwaha Edited with ‘ Ayurveda Deepika’ Hindi Commentary, 2 nd Volume, Chaukhamba Orientalia, Varanasi. 2012, Chikitsasthana, 28 th Chapter, Sloka No - 14, Page No - 748. 12 Astanga Hrudaya, Vidyotini Hindi Commentary by Kaviraja Atrideva Gupta, Chaukhambha Prakashana 2016 edition, Sutrasthana, 13 th Chapter, Sloka No 9 , Page No 130. 13 Sushruta Samhita, Dr Anant Ram Sharma, Susruta Vimarsini Hindi Commentary Varanasi Chaukhamba Surbharati Prakashana 1 st Volume, Sutrasthana, 45 th Chapter, Sloka No - 114, Page No - 369. 14 Yoga Ratnakar, by Madham Shetty Suresh Babu, Volume 2 Choukhamba Sanskrit Series Office,Varanasi, Vajikarana Chapter, Sloka No - 27-31, Page No - 1230. 15 Bhava Prakasha of Bhavamisra, by Prof. K.R. Srikantha Murthy, 2 nd Volume, Choukhamba Krisnadas Academy Varanasi, Uttarkhanda 1 st Chapter, Sloka No - 71-75, Page No - 834-835. ******************************* How to cite this article: Dr. Shrinivasraddi G. Venkaraddiyavar, Dr. Prashanth A.S., Dr. S.G.Chavan. A double arm clinical study to access the role of Basti and Virechana Karma along with Vanari Yoga in Premature Ejaculation. J Ayurveda Integr Med Sci 2019;4:108-114. http://dx.doi.org/10.21760/jaims.4.4.15 Source of Support: Nil, Conflict of Interest: None declared.

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Vipaka, Shodhana, Yava, Bala, Rasa, Agni, Guna, Ayurveda, Shukra, Sushruta-samhita, Kapikacchu, Sutrasthana, Snehana, Paschat-karma, Garbha, Rasayana, Atibala, Varanasi, Daurbalya, Koshtha, Basti, Mamsadhatu, Shukrameha, Chikitsasthana, Charakasamhita, Bhavaprakasha, Shukrala, Agnivesha, Madhuravipaka, Madhurarasa, Yogaratnakara, Erandataila, Bhaishajyaratnavali, Vatadosha, Pittavikara, Badhnati, Discussion, Sexual desire, Medical science, Holistic approach, Modern science, Group A, Follow-up, Fertility, Inclusion criteria, Shodhana Karma, Virechana Karma, Hindi commentary, Comparative clinical study, Inclusion and exclusion criteria, Amapachana, Ama Pachana, Nirama Lakshana, Study design, Viharaja Nidana, Manasika Nidana, Rakta-dusti, Sperm count, Group A and group B, Vajeekarana, Samsarjana Krama, Subjective parameter, Shamanoushadi, Marked relief, Objective parameter, Sarvanga Abhyanga, Performance anxiety, Vatashamaka, Premature ejaculation, Moderate relief, Mild relief, Madhyama Matra, Shukragata Vata, Sarvanga Swedana, Overall assessment, Veerya, Azoospermia, Dopamine, Shukravaha Srotas, Astanga Hrudaya, Garbha vikruti, Yoga Ratnakar, Dhatu Vruddhi, Shukra Dusti, Vata Prokopa, Scoring system, Global population, Brimhana Dravya, Bhavaprakash, Sneha virechana, Chaturvidha Purushartha, Herbal source, OPD, Sexual problem, Chaukhamba orientalia, Group B, Seminal parameter.