Scientific Basis for Ayurvedic Therapies -32

Scientific Basis for

Ayurvedic Therapies 

edited by

Brahmasree Lakshmi Chandra Mishra

27.4.1.7 Vanda tessellata

Screening of orchids for aphrodisiac activity in male mice resulted in the identification of

remarkable aphrodisiac activity in Vanda tessellata. The flower and, to some extent, the

root (but not the leaf) were found to stimulate the mounting behavior of male mice. This

activity was found in the alcoholic extract of the flower. The flower extract (50 or 200 mg/

kg) increased mating performance in mice. The pups fathered by the extract-treated mice

were found to be normal with an increasing trend in the male/female ratio of the pups.

Preliminary toxicity studies have shown no conspicuous toxicity in mice.40,41 No citable

clinical studies for this plant showing curative effects for male sexual dysfunction were

found.

27.4.1.8 Withania somnifera

Recent studies have shown that the aqueous extract of Withania somnifera (ashwagandha)

increased the testicular weight, the diameter of seminiferous tubules, and the number of

seminiferous tubular cell layers in the immature rats. Further, the extract of the plant

elicited notable spermatogenesis in the rat. However, serum testosterone and FSH levels

were lower, whereas the luteinizing hormome (LH) level was higher in the treated animals.

It was concluded that the extract has a direct spermatogenic influence on the seminiferous

tubules of immature rats, presumably by exerting a testosterone-like effect.24 An investigation

was conducted to test the curative property of W. somnifera root powder in the

context of derangements in spermatogenesis caused by treatment of the fungicide carbendazim

(methyl 2–benzimidazole carbomate) in Wistar rats. It was found that when the

root powder was suspended in milk and fed through oral route to the affected rats,

spermatogenesis was restored to the full status (Akbarsha and Kadalmani, unpublished

observation). No citable clinical studies for this plant showing curative effect for male

sexual dysfunction were found.

27.4.1.9 Shilajit, the Black Asphaltum

Shilajit, a popular incredient in several Ayurvedic preparations, is considered an aphrodisiac.

It has been suggested that it be taken with Withania somnifera in order to combat

sexual weakness.23

27.4.1.10 Zingiber officinale

Studies on experimental animals indicate that Z. officinalis (ginger) significantly increases

sperm counts and motility.42

27.4.2 Non-Ayurvedic Herbs

The following herbs are not cited in Ayurveda but are used in other countries, such as the

U.S., to treat male sexual dysfunction.

27.4.2.1 Ginseng

Ginseng is one of the plants subjected to a fairly extensive scientific investigation for

application in male sexual dysfunction. The studies have concerned three ginseng plants,

Panax ginseng (Asian ginseng), P. quinquefolium (American ginseng), and Ganoderma japonicum

(Korean red ginseng). Ginsenosides, which are glycosidic compounds, in the ginseng

plant, are the active compounds under consideration. These compounds are, by and large,

antioxidants and enhance nitric oxide (NO) synthesis in the endothelium of many organs,

including the corpus cavernosum, which is the erectile tissue of the penis. Ginsenosides

also enhance acetylcholine-induced and transmural nerve stimulation-activated relaxation

associated with increased tissue cyclic guanosinemonophosphate. Both these properties

appear to qualify ginsenosides as male aphrodisiacs.43 However, it is important to test the

efficacy of ginseng in humans by means of appropriately designed double-blind, placebocontrolled

clinical studies in a large scale and under the various causative conditions of

infertility and erectile dysfunction.44

27.4.2.1.1 Animal Studies

Under the influence of ginseng, male mice began ejaculation earlier and repeated the

action more often in a 45-min observation period and deposited more copulation plugs

in 10 days.45 Male rats that were administered American ginseng were stimulated in

copulatory behavior,46 unaccompanied by any change in the circulating levels of testosterone

and LH. The prolactin level was reduced, suggesting that ginsenosides affect the

pituitary gland directly.47 In a different approach, it was shown that daily treatment of

mice with an extract of Asian ginseng (2.5 to 100 mg/kg intraperitoneally [i.p.]) or ginsenoside

Rg1 (2.5 to 10 mg/kg i.p.) produced a dose-related increase in the number of mice

displaying copulatory behavior; ginsenosides Rb1, Rb2, and Ro did not have any effect.48

In vivo and in vitro studies on the corpus cavernosal endothelium of rabbit showed that

ginsenosides enhanced the release of NO.49,50 Ginsenosides also enhance acetylcholineinduced

and transmural nerve stimulation-elicited relaxation in the rabbit corpus cavernosum.

49 These results suggest that the effects of ginseng extract on corpus caverenosum

tissue are mediated by the release of NO from the endothelial cells and perivisceral

nerves.47

There is at least one animal study that does not recommend the use of ginseng in male

sexual dysfunction.51 In this study, feeding male rats with a diet supplemented with the

ginseng extract G115 produced little change in the sexual performance.

27.4.2.1.2 Clinical Studies

There are two reports of clinical studies testing the efficacy of Korean red ginseng in

treating erectile dysfunction. The first study52 consisted of a total of 90 patients in 3 groups

of 30 each (ginseng-treated, placebo-controlled, and trazodone [a proerectile drug treated]).

It was reported that in the ginseng-treated patients, changes in early detumescence and

erectile parameters, such as penile rigidity and girth, libido, and patient satisfaction, were

significantly higher than in the other groups, and the overall therapeutic efficiencies on

erectile dysfunction were 60% for ginseng group and 30% for placebo- and trazodonetreated

groups. The second investigation53 was a double-blind, placebo-controlled, crossover

study in which a total of 45 patients with clinically diagnosed erectile dysfunction

were enrolled. The treatment dosage was 900 mg of Korean ginseng or placebo, 3 times/

day for first 8 weeks; this was followed by a 2-week wash-out period where the patients

received crossover treatment. It was shown that ginseng treatment increased penetration,

maintenance, and Rigiscan test outcome.

27.4.2.2 Yohimbe

The bark of yohimbe (Pausinistalia yohimbe), an African tree, is the source of yohimbine

hydrochloride; in short, yohimbine is an indolequinolonic alkaloid. It has been used

historically for several years as a treatment for male and female sexual dysfunction.54

Yohimbine is an established alpha 2-adrenoceptor antagonist.55 Its action at the CNS and

the central endocrine mechanisms is believed to increase sexual arousal.56,57

27.4.2.2.1 Animal Studies

In an early study of the male rat, it was shown that yohimbine increased mounting

performance, the percentage of male rats ejaculating in their first heterosexual encounter,

and induction of copulatory behavior in sexually inactive male rats.56 It was later shown

that yohimbine treatment caused a decrease in the ejaculatory latency, postejaculatory

interval, and intercopulatory interval.58 In a more recent study, male golden hamsters were

administered i.p. with yohimbine at a single dose of 2 mg/kg body weight 30 min prior

to a number of sexual behavior tests. It was found in the treated animals, when compared

with the saline-injected controls, that aspects of male sexual behavior, including ejaculatory

frequency, were increased.59

27.4.2.2.2 Clinical Studies

There are a few clinical reports encouraging the use of yohimbine in erectile dysfunction.

60–69 A few authors have opined that these studies are poorly designed trials, that

yohimbine does not appear to have any modest therapeutic benefit over placebo,54,70 and

that the drug has not yet been subjected to scientifically rigorous clinical trials.71 In the

most recent clinical studys of 18 men between the ages 40 to 80 years, who were not active

smokers,72 were given doses of 5.4 mg of yohimbine three times/day for 4 weeks; the

doses were then increased to 10.8 mg three times/day for another 4 weeks. Results showed

that 50% of patients had a positive effect, an improvement over the already reported

success histories.60,61,64,65 An earlier clinical study69 also supports the view that yohimbine

could be therapeutic in the case of nonorganismic impotence. Another study73 in Brazil

examined 22 patients with organismic impotence, all serving as placebo control for 1

month, who were later treated with 100 mg of yohimbine once a day for 1 month. Results

did not encourage the use of yohimbine in male sexual dysfunction, supporting the view

of Danjou et al.74

27.4.2.3 Lepedium meyenii (Maca)

Lepedium meyenii is a domesticated crop of the Andean Mountains of Central Peru, cultivated

at an altitude of 3000 m and above. Its subterranean part (hypocotyle) is edible and

highly valued for its nutritive value. For several hundred years it has been used by the

Andean Indians as food and folk medicine and used to increase the fertility and sexual

performance of men and women. There have been a few attempts of scientific investigation

on the application of this plant as a male aphrodisiac and as a curative of sexual dysfunction.

27.4.2.3.1 Animal Studies

Purified lipidic fraction of the alcoholic extract of dried maca roots was produced into

two formulae, namely, M-01 and M-02, differing in the concentration of macaene and

macamide. Along with a few additional and new compounds, both formulae were administered

to male mice for 22 days, and the mice were allowed to mate with virgin female

mice. The sexual performance of the treated male mice almost doubled. In the same report,

a test on the latent period of erection (LPE) in the rats with erectile dysfunction revealed

that the purified maca products at 180 and 1800 mg/kg body weight were improving the

erectile function in the testis-removed rats, as demonstrated by the decrease in LPE. The

study revealed, for the first time, an aphrodisiac activity of L. meyenii.75 In a parallel

study,76,77 L. meyenii pulverized root (standardized to 0.6% macamides and macaenes),

prepared in saline, was administered to male rats through a gastric tube at a daily dose

of 15 and 75 mg/kg (acute and chronic doses, respectively) for 15 days. It was shown that

the treatment significantly improved the sexual performance parameters of the treated rats.

A third study78 was concerned with the spermatogenesis in adult male rats. Male rats

receiving aqueous extract of maca root (66.7 mg/ml) twice/day for 14 consecutive days

showed increased weight of the testes and epididymis and in the length and frequency

of stages IX–XIV seminiferous tubules and a decrease in the stages I–VI. Results indicate

that L. meyenii root invigorates spermatogenesis acting on its initial stages.

27.4.2.3.2 Clinical Studies

In the only clinical study,79 a 4-month oral treatment was conducted on 9 men 24 to 44

years old with L. meyenii tablets (1500 or 3000 mg of maca). Results showed increased

seminal volume, sperm count per ejaculation, motile sperm count, and sperm motility;

the response was not related with any alteration in the serum hormones. The study has

limitation in respect of sample size and lack of placebo control.

27.5 Future Perspectives

From the foregoing review it is evident that Ayurveda/phytotherapy has the potential to

become into effective therapy for male sexual dysfunction. Additional research is required

in order to make it acceptable to health-care providers as an alternative to conventional

medicine. It is likely that because sex, infertility, and impotence are highly personal and

embarrassing issues, several commercial establishments sought to profit from these problems

with cheap advertisements to lure the suffering men. The question of heavy metal

concentration in some of these preparations and the likely consequence on the general

health are also of concern.80,81

The application of the various therapeutic modalities in the abrogation of male sexual

dysfunction needs to be related to the various etiological categories of male sexual dysfunction.

Most of the scientific studies, among those conducted so far, have been concerned

with impotence and aphrodisiacs. There is an urgent need to conduct scientific studies on

the phytochemical therapy for male infertility such as the aspects connected with sperm

and the mechanism of action at the cellular and molecular levels.

Acknowledgments

The authors place on record the authoritative contribution of Dr. T.V. Narayanan and

Shri Sasi Varier, Ashtanga Ayurveda Sala, Tiruchirappalli, India, in the preparation of the

Ayurvedic portion of the manuscript. The help rendered by S. Anandhi, R. Girija, Sr.,

Jancy M. George, and B. Kadalmani, doctoral students of M.A. Akbarsha, in the compilation

and verification of the data, are heartily acknowledged. The financial assistance

from the Department of Science and Technology, Government of India, to M.A. Akbarsha,

to study the male reproductive effects of phytotherapeutics (Grant No. SP/SC/C-31/98)

is also acknowledged. A. Subramoniam thanks Dr. G.M. Nair, Director, TGBRI, and V.M.

Madhavachandran thanks Shri Devadas Namboodiripad, Managing Director, Nagarjuna

Herbal Concentrates Ltd., respectively, for the permission to participate in the review

and their support. The technical support of S. Sudhakar is heartily acknowledged.

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28

Raktaja Krimis (Dermatophytes)

Mahendra K. Rai, Nandkishore J. Chikhale, Manjusha J. Choukhande, and

Milind N. Dudhane

28.1 Introduction

Raktaja krimis

have been described as very minute (invisible with naked eyes) on the

basis of the description available in Ayurvedic texts. Their corelation can be made with

the dermatophytic fungi, causing superficial infections in man and animals. In Ayurveda,

krimis

of a particular group are responsible for hair loss from the head, face, and other

parts of the body; the distortion of nails (

kesha, shamarshu, nakha, loma dhwansa

), hairraising

sensation of a person after a horrific situation (

roma harsha

); itching and pain in

the wounds (

vranna, kandu, toda

); a creeping sensation (

sansarpa

); and the eating away

of the skin, vessels, ligaments, muscles, and cartilage (

twak, shirasnayu, mansa, tarunasthi

bhakshanana

).

The word

krimi

originated from Dhatu

kramu pad vikccep

(

kramyati sarpati

), meaning that

which moves with legs. But this derivation of

krimi

does not include all the

krimis

because

there are several

krimis

described in

vedas

and Ayurvedic texts that are without legs. Therefore,

they cannot be included in the group of

krimi

according to above definition. However,

yaskacharya

has defined

krimi

as

kravyamedati

, which means the organisms that eat and grow

on raw flesh.

28.2 Historical Background

Krimi

has been classified as external (

bahya

) and internal (

abhyantra

) in most of the

Ayurvedic texts, except

Sushrutra Samhita

and

Bhela Samhita

.

As compared with other texts,

a detailed classification of

krimi

is found in

Charak Samhita

. The classification of

sahaja krimi

is given in

Charak Samhita

. Bhela, who was a prudent student of maharishi Attreya, did

not give any account of external

krimi

. It seems that external krimis

are probably a personal

contribution of

Agnivesha

, which was universally accepted by later scholars. The classification

of

krimi

by

Kashyap Samhita

is found only in the treatment chapter.

In

Charak Samhita

,

raktaja krimis

have been explained up to a certain extent. On the

contrary, Sushrutra did not pay any attention to the health problems. Sharma et al.

3

proposed close similarity of

raktaja krimis

with microbes and parasites. Some

raktaja krimis

can be compared with dermatophytes (etymologically the plants of skin) of the fungal

kingdom.

This chapter will focus on the scientific basis of

raktaja krimis

as described in Ayurveda.

28.3 Etiology of

Raktaj Krimis

According to Sushruta, the

kapha

and

pitta

of the body are aggravated by several factors.

Examples include eating before the digesting the previous meal; excessively using any

indigestible, uncongenial, incompatible, or filthy articles of fare sedentary habits; eating

cold, heavy, or fatty meals; sleeping during the day; and excessively using

masha

(meat).

In modern system of diagnosis, the minute

krimis

are supposed to be the following species:

Epidermophyton

(1 species),

Microsporum

(14 species), and

Trichophyton

(20 species).

28.4 Clinical Description

28.4.1 Symptoms of

Dadrukustha

The

dadrukustha

(ringworm caused by dermatophytes) have coloration of linseed flowers

or copper. They are also serpigerous and full of eruptions.

The general features of this disease are elevated, spherical, itching, and slowly growing

patches. Other types of

kustha

may be considered as tuberculoid leprosy, piodermas,

psoriasis, melanodermas, and erysepales. These types are incurable or difficult to treat

according to Ayurveda.

28.5 Classification of

Krami Roga

Acharya Charak and Sushrut mentioned a special chapter on diseases caused by

krimis

,

and classified them into seven types of

purisaj

, six types of

kaphaj

, and seven types of

raktaja

.

Raktaja krimis

circulates in the blood and eventually produce disease symptoms in

skin. In Ayurveda, Sushrutra has focused more elaborately on

krimi

. According to him,

raktaja

krimi

cannot be seen with the naked eye. He has mentioned seven types of

kustha

(skin disease):

1.

Arunkustha

(due to

vata

)

2.

Udumbarkustha

3.

Krishyajivhakustha

4.

Kapalkustha

5.

Kakanakakustha

(due to

pitta

)

6.

Pandarika

7.

Padrukustha

(due to

kapha

)

Out of these seven types,

dadrukustha

is curable with Ayurvedic treatment.

Nomenclature given by Sharma et al.

3

is given below.

Mycological Types and Species

28.5.1 Dermatophytes

Dermatophytes (

derma

= skin,

phyton

= plant) are a highly specialized group of keratinophilic

fungi that utilizes keratin of the skin. They are also known as ring-worm fungi and tinea

Ayurvedic Nomenclature Mycological Nomenclature Term

Keshad Trichophyton

sp. Dermatophyte

Lomada Microsporum

sp. Dermatophyte

Nakhada Epidermophyton

sp.

Trichophyton

sp.

Dermatophyte

Raktaja

Krimi

(Dermatophyte) Selected Species

Epidermophyton E. stockdale

,

E. floccosum

Microsporum M. audouinii

,

M. canis

,

M. gypseum

,

M. fulvum

,

M. nanum

Trichophyton T. tonsurans

,

T. mentagrophytes

,

T. rubrum

,

T.

schoenleimii

,

T. soudanes

infections. More than 40 dermatophyte species are known to exist.

1,2,4

The three types of

dermatophytes (ringworm) — geophilic, zoophilic, and anthropophilic — are shown below:

Dermatophytes have also been isolated from air, public swimming pools, and barbershops.

28.5.1.1 Clinical Types

The infection caused by dermatophytes is clinically known as tinea infections. These can

be categorized as follows:

28.5.1.1.1 Tinea pedis

This type of infection is also known as athlete’s foot or ringworm of the foot. The causal

organism involved in

Tinea pedis

are

Trichophyton rubrum

and

T. mentagrophytes.

28.5.1.1.2 Tinea unguinum

The ringworm of the nails is referred to as

Tinea unguinum

or onychomycosis. Such

infections generally occur in nails that are deformed due to the pressure of tight shoes.

The species usually responsible for onychomycosis are

T. rubrum

and

T. mentagrophytes

.

28.5.1.1.3 Tinea corporis

The ringworm of the glabrous skin is called

Tinea corporis

or

Tinea circinata

. It is characterized

by a circular lesion exhibiting varying degrees of inflammation. The infection is

usually caused by

T. rubrum, M. canis,

and

T. mentagrophytes.

28.5.1.1.4 Tinea imbricata

Tinea imbricata

(

dadru

) is a common infection in tropical areas. It is characterized by lesions

that are originally circinate but which become irregular and coalescent and do not heal at

the center. The causal organism is usually

T. concentricum.

28.5.1.1.5 Tinea barbae

It is also called ringworm of the beard, barber’s itch, or sycosis.

Tinea barbae is a foliculitis

of the beard and rarely infects the face and neck. T. verrucosum of Tinea barbae is transmitted

from cattle, whereas T. mentagrophytes is transmitted from horse or dog.

28.5.1.1.6 Tinea favosa

It is commonly known as favus and is a severe type of chronic ringworm. The causal

organisms of favus are T. schoenieinii, T. violaceum, and M. gypseum.

28.5.1.1.7 Tinea cruris

This infection is also known as Dhobi’s itch, ringworm of the groin, jock itch, or eczema

marginatum. Tinea cruris is an acute or chronic infection usually severely pruritic

Geophilic Zoophilic Anthropophilic

Soil as a substrate Parasitizes on animals and may

also cause infections in man

Parasitizes on man

Microsporum gypseum, Trichophyton

ajelloi, T. terrestre

Microsporum canis, Trichophyton

verrucosum, T. mentagrophytes

Microsporum audouinii, E.

floccosum, T. rubrum, T. tonsurans,

T. violaceum

dermatophytosis of the groin. The lesions are generally caused by Epidermophyton

floccosum and various species of Trichophyton with special reference to T. rubrum.

28.5.1.1.8 Tinea capitis

This infection is usually known as ringworm of the scalp. Tinea capitis includes dry, diffuse,

and scaly lesions of the scalp. Generally, it is caused by T. tonsurans, T. violaceum, T. schoeninileinii,

T. mentagrophytes, T. audouinii, and M. canis.

28.5.1.1.9 Mycological Types

There are three main genera or mycological types: Epidermophyton, Microsporum, and

Trichophyton. These genera have been classified purely on the basis of mycology.

28.5.1.1.9.1 Epidermophyton — The genus Epidermophyton includes only one valid species,

E. floccosum, which is a good example of anthropophilic dermatophyte. Another

species named E. stockdale is yet to be recognized. It was reported from only one soil

sample. It produces club-shaped macroaleuriospores that are 59.5–2 ¥ 12.9–3.0 mm with

two to nine cells. E. floccosum rarely parasitizes lower animals. It lives in human and is

transmitted from man to man by direct and indirect contact. E. floccosum is a cosmopolitan

fungus in distribution and invades only human nails and skin. It is not capable of invading

human hair. The teleomorphic state of E. floccosum is unknown.

The genus Epidermophyton is characterized by large, fusiform that obovate and smooth,

multiseptate asexual spores known as macroaleuriospores. They are produced in bunches

of two or three. They measure 20–40 ¥ 6–3 mm with two to four cells. The microaleuriospores

are not formed.

28.5.1.1.9.2 Microsporum — There are 15 species of Microsporum, which can be categorized

on the basis of natural habitat into three broad groups. Eight of them live

saprophytically in soil (geophilic). M. boulardi is reported only from the African republic

of Guinea. There is only one report of M. boulardi. The majority of the species of

dermatophtes produce two types of conidia in culture. The smaller, pyriform to obovate

conidia are known as microaleuriospores; the larger conidia are called macroaleuriospores

which are multiseptate, echinulate, variable in size and shape (fusiform to

obovate), and thin or thick walled. They are born singly or in hyphae. The length of

conidia are 5 to 100 mm and width 3 to 8 mm, with two to five cells. The type species of

Microsporum is M. audouinii. The important species include M. audouinii, M. canis, M.

gypseum, M. fulvum, and M. nanum.

28.5.1.1.9.3 Trichophyton — Macroaleuriospores are smooth and either thin or thickwalled

and range from clavate to fusiform in shape. They are born singly or in clusters.

Microaleuriospores are spherical either pyriform or clavate and are borne singly or in

chains (in grapelike bunches). The genus Trichophyton has 25 valid species. The type species

is T. tonsurans.

Some important species are T. equinum (teleomorph unknown), T. mentagrophytes (teleomorph

Arthoderma benhamiae, A. vanbreuseghemii), T. rubrum (teleomorph unknown),

T. schoenleimii (teleomorph unknown), T. soudanes (teleomorph unknown), T. verrucosum

(teleomorph unknown), and T. violaceum (teleomorph-unknown). The common names

of fungal diseases are listed in Table 28.1.

28.6 Diagnostic Methods

The method of diagnosis in the ancient period was according to sign and symptoms of

the disease, because pathological investigations were not possible. Generally round, bluish,

or reddish spots are formed on the skin. Sometimes boils or eruptions may also be

produced. The spots generally spread and sometimes coalesce with other spots to form

irregular bigger spots.

In conventional medicine, krami rogas are diagnosed by the following laboratory test

methods: potassium hydroxide (KOH) squash tests, culture techniques, agar blocks technique.

Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)