Introduction

Procreation is a blessing that aids in transferring the genes from one generation to another, thus aids to evolution.  All  couples  desire procreation  of  progeny  endowed  with  good  health, supreme  intellect  and  excellent  qualities. But, in today’s era due to teenage  pregnancies,  advanced maternal age, inflexible workplace policies, economic or housing uncertainty,  faulty  lifestyle,  unawareness  of  health due  to  hectic  life  schedule  incidences  of  recurrent abortion, still birth, infertility and congenital malformations are the burning issues of present era. Causes of infertility includes anatomical physiological and psychological factors.

Incidence: Infertility in 90% of couples in which male related problems account 30%, female related problems are 30% and 30% both1.

Infertility again comprises –

1. Sterility- It implies that absolute inability to conceive due to congenital anomalies, surgical complications in either male or female or both2 .

2. Infertility- It implies failure to conceive after one year of unprotected coitus. It can be further classified as

A. Primary infertility- never conceived.

B. Secondary infertility- Failure to conceive after having previous conception.

Ayurvedic concepts of Vandhyatva

• Ayurvedic science has its own basic principles (Siddhantas), diagnosis and treatment.

• In Ayurvedic literature, there is huge background of Vandhyatva and its treatment. In Atharvaveda, there is wide exploration about Vandhyatva, its causes and treatment in many sutras.

• According to Ayurveda, infertility is failure to achieve a child rather than pregnancy as a Garbhastraav (repeated abortions) or Mrutavatsa (repeated still births) are also included in types of infertility3.

 • In Sushruta Samhita, Vandhyatva has been included in twenty Yonivyapadas. According to Sushrutacharya, absence of Artava is called as Vandhya. It also includes malformation or congenital deformity of genital organs which leads to infertility. Acharya Sushruta told Garbhotpadak Samagri which is the main factor for Garbhotpatti i.e. Rutu (Fertile period), Kshetra (healthy reproductive system), Ambu (nutrition for the foetus), Beej (ovum). When these factors assemble together, conception occurs4.

1.         Rutu - Rutukal comprises 12-16 days after menstruation. If coitus is done during this period it is fruitful for conception. This Rutu is probably proliferative phase including ovulation5.

2.         Kshetra - It comprises healthy reproductive system which plays important role in fertilization and implantation.

3.         Ambu - It comprises Jal or Ahaar Ras. After fertilization the zygote receives its nourishment for next 3-4 days from the secretions of fallopian tubes. When blastocysts gets embedded in the uterine wall, gets nutrition direct from Rakta and Rasa of mother.

4.         Beej - It represents both Purush and Stree Beej i.e. Shuddha Shukra and Shuddha Artava respectively. When it is vitiated by Doshas, no conception will occur.

• Acharya Charaka and Vaghbata referred Vandhyatva as abnormalities of Beejansha6. Acharya Charaka has a unique drug classification according to its action known as Charakokta Mahakashaya. Prajasthapan Mahakashaya7 is amongst it. The drugs in Prajasthapan Mahakashaya has active principles which acts as fertility modulator. Many conditions can cause disturbance of Garbhotpadak Samagris which are the basic factors in Garbhotpatti that is Rutu (fertile period), Kshetra (healthy reproductive system), Ambu (nutrition for the foetus) and Beej (ovum). Prajasthapan Dravyas acts on all these four factors with their special properties and shows miraculous effects in female infertility.

Types of Vandhyatva According to Charakacharya –

Vandhya - As Beejbhaga of ovum is responsible for formation of uterus, when Beejbhaga is vitiated in ovum of mother, she gave birth to a sterile girl child. It will lead to congenital absolute sterility which is incurable.

Apraja - Acharya Chakrapani used this word for Avandhya, for a childless woman but having capacity to conceive. This concept is still unexplained.

Sapraja - In this, woman does not conceive after giving birth to one or more child in her reproductive age.

• Acharya Harita first time described Vandhyatva in detail8.

1. Garbhakosha Bhanga- Injury to uterus.

2. Kakvandhya- Secondary infertility.

3. Anapatya- Primary infertility.

4. Garbhastraavi- Repeated abortions.

5. Mrutvatsa- Repeated still births.

6. Balakshaya- Loss of strength.

Treatment according to Ayurveda

In Ayurveda specific treatment for Vandhyatva is not mentioned but treatment has been given according to causes i.e. Yonivyapada, Shukra Dushti and Artava Dushti etc. Principle of treatment of Vandhyatva is highlighted by various Garbhsthapak and Prajasthapak Upayas as below-

1. Forsaking of various etiological factors like stress, psychological troubles, diet and lifestyle, coitus before or after Rutukal etc.

2. Brumhana to compensate the loss of Bala and Dhatus.

3. Yonivyapadas should be treated to treat vitiated dominant Vata dosha and corresponding Doshas.

4. Drugs described in Prajasthapana Mahakashaya can be used in various manners.

5. Sharirshuddhi especially, Virechana, Asthapan and Anuvasana Basti are very beneficial.

7. Vandhyatvahar Yogas by Various Acharyas in classics can be used for fruitful results.

9. Ayurvedic preparations like Maharasnadi kwath, Shatavari and Shatpushpa Kalpa, Phalaghrita, Sheeta kalyanak Ghrita, Shatavari Ghrita, Lashunadi Ghrita, Pug paka etc. has good results.

1. Brahmi (Bacopa monnieri):

-It works as Stanyajanan and Stanyashodhana.

-Acharya Charaka has described it as nerve tonic, improves the brain cell functions. And hence used in various mental conditions leading to psychosis. -This drug is also used as tonic and foetus growth promoting drug.

-Antistress, Antioxidants effects of Bacosides of B. monnieri10.

-Active compound includes brahmine, herpestine, saponins, D-mannitol, betulic acid, bacosides A & B. Brahmin can enhance immunofunction by increasing immunoglobulin.

2. Aindri (Centella Asiatica)11:

-It helps in Artavajanan. It works on menstrual diseases thus helps in conception.

- Acharya Charaka enlisted this drug in Balya, Prajasthapana, Vayasthapana, and Shonitasthapana vargas.

-Antidepressant, neuroprotective and antioxidant activity.

3. Shatavari (Asparagus racemosus):

-Acharya Charaka kept this drug in Balya, Shukrajanan, Prajasthapana and Vayasthapana gana of Mahakashayas which are examples of Balyadi Varga and Shonitasthapanadi Vargas. -An oestrogenic effect of Shatavari on the female mammary gland and genital organs12.

-A glycoside, Shatavarin I, isolated from the root of A. racemosus has been found to be responsible for the competitive block of oxytocin-induced contraction.

-It is galactogogue, antioxidant, immune- stimulant, aphrodisiac, diuretic, helps in anorexia, insomnia, antifungal, anti tussive, hypotensive.

-The active compounds are satavarin, asparagamine-An in roots and sarsapogenin, sitosterol, stema sterol in aerial parts.

4. Doorva (Cynodon dactylon):

-It acts as Raktastambhaka.

-Acharya Charaka has mentioned this in Varnya Mahakashaya.

-Acharya Sushruta described Doorva in Pittashaman, Ropan and as Kumar Rasayan.

-The plant extract checks uterine bleeding, strengthens the uterus, averts abortion and augments of foetal growth.

- Ethanol extract of C. dactylon has also marked CNS depressant and antioxidant activities13.

-The active constituents are triticin oil, agropyrene, furfural, arunodin which leads to its stress coping activity, anti-inflammatory, diuretic, immune-modulator, anti-microbial, urogenital activity.

5. Patala (Stereospermum suaveolens):

-According to Charaka it acts as Hridya, Vishada.

-The Root Bark of plant Stereospermum suaveolens was traditionally used for the treatment of pains and inflammations14.

-The active constituents are lapachol, sitosterol, gum, sylscutellarcin dinatin.

6. Guduchi (Tinospora cardifolia):

-Charakacharya has kept this drug in Vayasthapana, Stanyashodhana, Dahaprashaman, Trishnanigrahan and Chhardinigrahan Gana.

-It is Tridosha Nashak, therefore helps in all disorders which causes to infertility.

-It is Rasayana and Ayuvardhak.

-It is Tridosashamak, therefore cures all diseases and make women fertile and prevent diseases

-It is said to be antioxidant, anti-bacterial, antifungal, antiviral, cardio protective immuno modulator. -Antioxidant capacity of Tinospora cordifolia15.

7. Haritaki (Terminalia chebula):

-It works as Rasayana.

-Acharya Charaka has kept it into Prajasthapana, Kushthghna, Arshoghnsa, Kasaghna, Jwarhara Gana, Shonitsthapanadi, Triptighnadi Varga.

-Anti?microbial activity of Terminalia chebula fruit extract against microrgnism. Bacillus substils, Staphylococcus aureus, Staphylococcus epidermis, Escherichia coli, Staphylococcus flexineria and Pseudomonas aeruginosa16.

8. Kutaki (Picrorhiza kurroa)17:

-Charakacharya enlisted this into Lekhaniya, Bhedniya and Stanyashodhana Mahakashaya.

-Picroliv- a standardised fraction from root and rhizome of Picrohiza Kurroa consisting of glycosides and shown to be responsible for its hepato protective activity.

-Picrorhiza kurroa (Kutki) is a potent immunostimulant, anti-inflammatory action18, antioxidant19, modulates liver enzyme level, anti-allergic action and mild laxative.

9. Bala (Sida cordifolia):

-Charakacharya included this drug in Bruhaniya, Balya, Prajasthapana, Jivaniyadi, Balyadi and Shonitsthapanadi Varga.

-Sida cordifolia is Rasayana drug generally possesses strong neuroprotective20 and Antioxidant21 properties.

-It is a Balya tonic and promote reproduction.

-Analgesic and anti-inflammatory effects22.

-It is a good Rasayana herb, as it supplies essential nutrients and strengthen immune system.

10. Priyangu (Callicarpa macrophylla):

-Charakacharya kept this drug in Mutravirajniya, Purishsangrahaniya Varga. 

-Aqueous as well as ethanolic extracts of leaves of C. macrophylla shows anti-inflammatory activity. -It act as anti-inflammatory, astringent and rejuvenating properties23.

Discussion

Acharya Vagbhata says “All the plants have a potential medicinal value, although in practice a plant is referred to as medicinal plant when it is so used by some system of medicine. Hence we are having discussion on ten drugs of Prajasthapan Mahakashaya as described by Acharya Charak. Those drugs who help in conceiving by removing the uterine Doshas /disorders are known as Prajasthapan. The properties of these drugs are Kashaya, Madhura, Sheeta, Snigdha and Balya. In our Ayurvedic classics, a wide exploration about Vandhyatva is given which can be implemented successfully for the society. Keeping all this in view now the analysis of the drugs in light of the literature available in authentic Ayurveda as well as modern text and establishes the fact of the use of these drugs in infertility. The ten drugs of Prajasthapan are which are going to be discussed on the parameter of Vandhyatva on today’s era. Brahmi and Aindri which has Medhya Prabhav, helps in reducing stress, anxiety and depression.

Brahmi: It works as Artavjanana and Hridya. Therefore helps in treating Acharana, Udavarta and in Nashtartava. As it is Vatkaphshamak, it relieves Vata dushti and ultimately Vatakaphaj Yonirogas.

Aindri: C. asiatica is Kapha-pitta Shamak, helps in Asaruja, arajaska, pittala and shlaishmiki Yonivyapadas. Most of properties are alike to B. monnieri and is said Stanyajanana and Stanyashodhan and is vasodilater, therefore keep circulation of blood through uterus good and helps in Prajasthapana, remove depression and stress which are the major factors affecting sexual desire and can cause amenorrhea and hence affect fertility.

Shatavari: Asparagus racemosus is considered as a powerful Rasayana, which improves physical health and strength and maintain youthfulness. It is well known for its effect on the female reproductive system. -Being a Rasayana, and rejuvenating herb its restorative activity beneficial in women complaint. -It is said Vata-pitta Shamak, therefore helps in Udavarta, Putraghni, Acharana, Aticharana, Shandi, Suchimukhi, Vatagi, Prakarna, shushka, Arajaska, Asruja, Pittala, oligomenorrhoea, hypofunctioning ovary. In all Artava Dosha Shatavari is beneficial.

Doorva: Kapha-pitta Shamak, therefore helps in treating Shlaishmiki and Pittala, Arajaska & Asruja Yoni-vyapad Rogas, and helps in Asrugdar, Putipuya, endometritis, chronic pelvic cellulitis diseases which lead to infertility.

Patala: Its bark is used in Karnini, Putraghni, endometriosis, carcinoma of cervix, excessive bleeding, oligomenorrhoea with general weakness whereas flowers are used in Paripluta, and Vamini, Kshinaartava and are said Balya.

Guduchi: The anti-stress and tonic properties was clinically tested and is anti-inflammatory, more effective in acute inflammation, therefore used in Pittala, Sarvaja, Upapluta Yonivyapada.

-As it is already said to be antibacterial, anti-microbial, anti-inflammatory, hepatoprotective, immunostimulant and antioxidant.

Haritaki- -It is Rasayana, prevent ageing, re-establish youth and strengthen life. It is Tridoshashamak, therefore cures all diseases and make women fertile and prevent diseases.

-It is said to be antioxidant, anti-bacterial, antifungal, antiviral, cardio protective immuno modulator.

is Kapha-pitta shamak therefore cures Shlaishmiki, Pittala, Arajaska, Asruja, chronic endometritis diseases.

-The active compound is kutkin, D-mnanitol, apocynin picroside II. It is said hepatoprotective, antiviral, anti cholestatic, and also has analgesic effect.

Bala: It is Vata pitta Shamak, therefore used in Shushka, Udavarta, Acharna, Shandi, Pittala, Asrugadar, Asruja and also in hypo functioning of ovary.

Priyangu: It is Vata pitta Shamak, therefore cures Shushka, Acharana, Asruja, Asrugdar and helps in conceiving. Priyangu is said to be Sheeta Veerya, Sugandhit and is used in bleeding disorders and to purify blood and to eliminate toxins.

- Hence in all the problems of Kshetra, Rutu, Beeja, Ambu, the ten drugs are curing and by removing Doshas, it helps to overcome Vandhyatva.

Conclusion

The objective of present study entitled a literature review of Prajasthapan Mahakashaya for healthy progeny is literature review of all ten drugs of Prajasthapan Mahakashaya to provide safe and better pregnancy and fruitful outcomes on Vandhyatva for society.