Ashwagandha vs. Madhuyashti in Ksheena Shukra (Oligozoospermia): A Comparative Study

Abstract
Sperm is a vital component of the body because it is used for reproduction, the process of creation of the next generation. Male infertility can cause the inability to reach conception, it can be due to a defect in semen parameters, anatomical defects in the reproductive tract, hormonal issues, etc. A sperm count below 15 million sperm/mL is considered a state of oligozoospermia. Ksheenashukra is the situation in which both the quantity and quality of shukra dhatu are reduced. Oligozoospermia is synonymous with Ksheenashukra, one of the eight varieties of shukradushti described in the classics and it is due to the vitiation of Vata-pitta. In light of this, efforts were made to treat Ksheenashukra (Oligozoospermia) at the OPD level. This study was made to assess the efficacy and compare the role of Madhuyashti churna (3gm BD) and Ashwagandha churna (3gm BD) on seminal parameters with anupana of milk and after kostha shodhana with Haritakyadi churna (one-time dose of 10gm on day 1 only). The trial of these drugs was done on 60 subjects (30 in each group) and assessment of the subjects on the selected criteria was analyzed. The pre-treatment total sperm count levels were 10.08 and
11.21 mil/mL which rises to 17.14 and 20.53 mil/mL post-treatment in Group A and B respectively. The outcome of the study shows that both drugs are effective in the management of Ksheenshukra. But in certain aspects, Ashwagandha churna has outperformed Madhuyashti churna.
Keywords – Ksheenshukra, Shukra Kshaya, Shukrakshaya, Ksheenretas, Oligozoospermia, Vajikarana.

How to cite this article
Tiwari SK, Trivedi AB, A randomised controlled study to evaluate the comparative efficacy of Ashwagandha (Withania somnifera) and Madhuyashti (Glycyrrhiza glabra) in the management of Ksheena shukra (Oligozoospermia), Annals Ayurvedic Med. 2025;14(1) 18-29, DOI.10.5455/AAM.153596

Introduction
Ayurveda is a life science focused on two main goals: maintaining and promoting positive health and managing disease.1 Most of the diseases have strong dietary and lifestyle components towards their development. Ayurveda literature has described in detail how to exercise dinacharya, ritucharya, sadavritta, and aachar rasayana in order to live a healthy, disease-free life. The majority of dietary practices, such as virudhahara, adyashana, samshana, dagdahara, and sedentary lifestyles, where individuals tend to have more faulty dietary behavior due

to hectic work schedules, sedentary lifestyles have left people more susceptible to diseases today than ever before.
Just like a strong tree with a huge trunk that shows enormous growth with multiple branching, vajikarana therapy in Ayurveda aims to achieve similar accelerated growth in healthy human progeny.2 And that progeny need not be enormous in quantity only, the quality of progeny also matters.
Male infertility is the cause of the inability to reach conception, it can be due to a defect in semen parameters,

anatomical defects in the reproductive tract, hormonal issues etc.3 Men with abnormal semen report can have low sperm count, low sperm volume, less or no fructose levels, low sperm motility and abnormal sperm forms.
The main cause of infertility is oligozoospermia.4 A sperm count below 15 million sperm/mL is considered a state of oligozoospermia,5 but this lower limit, or the reference limit set by WHO, is considered too low to be a lower reference limit. Linear decline in the chances of conception with sperm concentration goes below 40 million sperm/ml.6
Oligozoospermia is synonymous with Ksheenashukra, one of the eight varieties of shukradushti7 described in the classics. Ksheenashukra is a condition in which shukra dhatu is decreased in quantity and quality as well. Acharya Sushruta has mentioned the definition of vajikarana tantra as the one which deals with the condition of alpa (less), dushta (vitiated), ksheena (decreased) and vishushka (dried up) retas.8 Dalahana has quoted that the ksheena retas (condition of oligozoospermia) occurs in the middle age group due to some etiopathology.9 Vata and Pitta are the main doshas responsible for the condition of Ksheenashukra.10 The channels that convey shukra (shukravaha srotas) experience dushti as a result of the vitiation of Pitta and Vata doshas, which further inhibits the ability of the person to conceive his life partner and results in infertility.
Additionally, despite being in good health, many persons

are not prepared for shodhana procedures in the modern period because of the change in lifestyle, strenuous activities, busy schedules, lack of time etc. Hence attempts were undertaken to treat Ksheenashukra (Oligozoospermia) subjects at the OPD level in light of this. As the drugs under trial is having balya, shukrala, vrishaya, vajikarana and rasayana properties.11,12 These drugs were used along with the anupana of milk which is again ojovardhaka and rasayana in the property.13 The trial of these drugs was done on 60 subjects (30 subjects in each group) and assessment of the subjects on the selected subjective and objective criteria was continuously analysed.
Aims & Objectives
Aim – To compare the efficacy of Mudhuyashti churna and Ashwagandha churna in the management of Ksheenshukra (Oligozoospermia).
Objective – To evaluate the effect of Mudhuyashti churna and Ashwagandha churna in the management of Ksheenshukra (Oligozoospermia).
Materials and Methods Sample
Selection of the subject: the study was conducted in 2 groups clinically and subclinically diagnosed subjects were selected. Details of intervention is given in the table no. 1.

Sampling
Using the lottery method randomization was done, irrespective of age, caste, social economic status, and religion. 85 Subjects were assessed for eligibility, out of which 71 subjects were found suitable for study and

divided into 2 groups having 36 subjects in group a (6 dropouts) and 35 subjects in group b (5 dropouts) and 71 subjects in total including 11 dropouts (Figure no. 1). Data were collected before treatment, after treatment and after follow up.

Figure 1 : Showing consort ? ow diagram

Groups
Koshtha shodhana karma with Haritakyadi yoga (10 gm single dose) on day 1 and then drug of choice was given in both the groups. (Table No. 1)
Inclusion Criteria

1. Age- 21-45 years of male
2. Sperm count <15 million/ml (according to WHO-2010) (ICD code – N46.1)
   Exclusion Criteria
3. Subjects of azoospermia and aspermia.
4. Subjects of various diseases (documented) like varicocele, accessory sex gland infection, sexually transmitted diseases, severe systemic diseases etc.
5. Genetic disorders like Klinfelter’s syndrome.
6. Subjects taking treatment for major psychiatric problem.
7. History of previous medications and trauma leading to oligozoospermia.
8. Subjects suffering from Tuberculosis, Diabetes mellitus, Hypertension and Inflammatory bowel disease.
   IEC code – CBP-IEC/2019/KC/MD/02 CTRI No. – CTRI/2021/02/031114 CLINICAL ASSESSMENT
   Subjective Parameters
   • Relief in the symptoms of Ksheenashukra based on the symptoms given in the Sushruta samhita.16
   Objective Parameters

• Semen analysis especially total sperm count, motility and normal form.
Statistical analysis

1. Chi Square Test & Student T Test – used in observation.
2. Wilcoxon Signed Rank test – Used to analyse ordinal data for in the group comparisons.
3. Mann – Whitney U test – Used to analyse ordinal data for across the group comparisons.
4. Paired Sample T-test – Used to analyse continuous and discrete data for in the group comparisons.
5. Independent sample T-test – Used to analyse continuous and discrete data for actross the group comparisons.
   Note – The semenogram was performed following standard protocols. The semen sample was collected after a recommended period of 3-5 days of abstinence to ensure consistency. The sample was then evaluated within one hour of collection at a certified laboratory, adhering to WHO guidelines for semen analysis, which includes assessing parameters such as sperm count, motility, and morphology. All procedures were conducted in a controlled environment to ensure the accuracy and reliability of the results.
6. Result
7. Objective criteria
8. Total sperm count In this study, the mean rise in total sperm count was 70.072 % and 83.164 % in group A and group B respectively and this was statistically highly significant (both P value <0.001). But after discontinuation of the drugs, there was a fall of 4.983% and 10.458 % respectively which was statistically highly significant (both P value <0.001). When the difference of before treatment and after treatment was compared across the group the results were statistically significantly better in group B (P value 0.039). Also, when compared the total sperm count value of before treatment in both the groups, the P value came out to be 0.119 which is non-significant, and this shows the homogeneity of the sample (Table no. 2).

Volume
In this study, the mean rise in volume was 11.330 % and 17.222 % in group A and group B respectively and this was statistically highly significant (both P value <0.001). But after discontinuation of the drugs, there was a fall of 3.273% and 5.466 % respectively which was statistically significant (P value 0.006 and 0.007 respectively). When the difference between before treatment and after

treatment was compared across the group the results were statistically non-significant (P value 0.062). Also, when compared the volume of before treatment in both the groups, the P value came out to be 0.027 which was statistically significant (group B> group A), and this shows a slightly higher baseline of volume in group B (Table no. 3).

Active Motility
In this study, the mean rise in active motility was 13.122 % and 20.935 % in group A and group B respectively and this was statistically highly significant (both P value <0.001). But after discontinuation of the drugs, there was a fall of 3.216% and 3.960 % respectively which was statistically significant (P value 0.043 and 0.023 respectively). When the difference between before treatment and after treatment was compared across the group the results were statistically non-significant (P value 0.126). Also, when comparing the volume of before treatment in both the groups, the P value came out to be 0.742 which was statistically non-significant, and this shows the homogeneity of the sample (Table no. 4).

Normal Form
In this study, the mean rise in active motility was 4.536 % and 6.086 % in group A and group B respectively and this was statistically highly significant (both P value <0.001). But after discontinuation of the drugs, there was a fall of 0.807% and 0.880 % respectively which was statistically non-significant (P value 0.217 and 0.188 respectively). When the difference between before treatment and after treatment was compared across the group the results were statistically non-significant (P value 0.359). Also, when comparing the volume of before treatment in both the groups, the P value came out to be 0.544 which was statistically non-significant, and this shows the homogeneity of the sample (Table no. 5).

Subjective Criteria

1. Medhra vishana vedana
   In this study, the betterment in the medhra vishana vedana (MVV) was found to be statistically significant in both groups, with P values of 0.003 and 0.014 and standard errors of 7.500 and 4.287 in group A and group B respectively. But after discontinuation of the drugs, there was a fall in the betterment of MVV, but this fall was statistically non-significant in both the groups (P value of 1.00 and 0.564 respectively). When the value of after treatment was compared across the group results were

statistically non-significant (P value 0.317), which means both the drugs are equally effective to subside MVV. Also, when comparing the value of before treatment in both the groups, the P value came out to be 0.102 which was statistically non-significant, and this shows the homogeneity of the sample (Table no. 6).
2. Ashakti maithuna
In this study, the betterment in the ashakti maithuna (AM) was found to be statistically highly significant in group A and significant in group B with P values of <0.001 and 0.003 and standard error of 13.00 and

7.500 in group A and group B respectively. And after discontinuation of the drugs, there was a slight fall in the betterment of AM, but this fall was statistically non-significant in both the groups (P value of 0.414 and 0.317 respectively). When the value of after treatment was compared across the group results was

statistically non-significant (P value 0.238), which means both the drugs are equally effective to subside AM. Also, when compared the value of before treatment in both the groups, the P value came out to be 0.915 which was statistically non-significant, and this shows the homogeneity of the sample (Table no. 6).

3. Praseka cha alpa
   In this study, the betterment in the praseka cha alpa (PCA) was found to be statistically significant in group A and highly significant in group B, with P values of 0.002 and
   <0.001 and standard error of 8.696 and 21.794 in group A and group B respectively. But after discontinuation of the drugs, there was a fall in the betterment of PCA, and this fall was statistically significant in group A and non-significant in group B (P value of 0.014 and 0.739

respectively). When the value of after treatment was compared across the group results were statistically significant (P value 0.004), which means Ashwagandha churna is more effective to subside PCA than Madhuyashti churna. Also, when compared the value of before treatment in both the groups, the P value came out to be 0.336 which was statistically non-significant, and this shows the homogeneity of the sample (Table no. 6).
4. Chirata praseka

In this study, the betterment in the chirata praseka (CP) was found to be statistically non-significant in both groups, with P value of 1.000 and a standard error of 0.00 in both groups. So, there was no change in CP due to both drugs because very few subjects were having CP as their symptom.
5. Rakta shukra darshana
In this study, there was no subject having rakta shukra darshana as their symptom in the before treatment, after treatment, or even after follow-up times in both the groups.
Discussion
Madhuyashti17,18 has madhura rasa, sheeta virya, madhura vipaka, guru and snigdha guna, shukrala, rasayana and vajikaran karma, it has vata pitta har action as well. As it is madhura in rasa, it works for brihana and dhatu poshan19; also, as shukra possesses madhura ras as well, it is shukrakaraka by samanya siddhant.20 Also, the madhura vipaka dravyas have the property of increasing the shukra.21 It is sheeta in virya, guru, and snigdha in guna, so it increases the shukra again by samanya siddhant. By action on doshas, it is Vata Pitta shamak, and Ksheenshukra is a condition caused by Vata and Pitta dosha, so again, it works on the basic dosha pacification.
Ashwagandha22,23 has ushna virya, madhura vipaka, laghu and snigdha guna, vata kapha shamak doshaghnta and atishukrala, rasayana and vajikaran action. Again, it is madhura vipaka, hence increasing shukra.24 Since it is ushna virya and laghu guna, it is easy to digest, as its digestion happens in less time, it works does the dhatu poshana karma timely and properly. Also, it is snigdha in guna as well, so by samanya siddhanta it increases the amount of shukra.25 It is atishukrala, rasayana, and vajikaran in karma as well, by that it works in increment of the shukra dhatu as well.
Madhuyashti also possesses antioxidant activity as proven in some studies as well and by virtue of that it was proven

that it helps in the betterment of the semen parameters.26,27
Catecholamines and serotonin are biogenic amines that are created in response to stress and may have a direct influence on the hypothalamus, causing hypothalamic-releasing hormones to be released. Because these hormones are known to cause vasoconstriction in other target tissues, epinephrine and norepinephrine produced from the adrenal medulla may impact the testis via modifying local blood flow. Psychological stress can disrupt the hypothalamo-pituitary control of hormone production by affecting brain function and the biological clock. This disruption in the hypothalamus-pituitary-gonadal axis could have a negative impact on spermatogenesis.28 Male infertility has been linked to stress in multiple studies.29 Cortisol is a hormone that is created in reaction to stress,30 and a rise in cortisol levels can impair LH’s functional activity, lowering testosterone levels.31 Due to a decrease in LH pulse frequency caused by psychological stress, low testosterone levels develop.
Reduced testosterone levels contribute to a decrease in libido and oligospermatogenesis.32 There is direct evidence that Ashwagandha works in stress reduction and improved male factor fertility. Finally, Ashwagandha has the ability to combat stress-related infertility. The effect could be attributable to the presence of ergostane steroids, alkaloids, and amino acids in the roots of this herb, such as GABA agonists, and serotonin agonists.33 Ashwagandha is said to be high in neurotransmitters, as well as various other alkaloids and flavonoids.34 Flavonoids in Ashwagandha have been shown to have high antioxidant action and treatment with Ashwagandha may help infertile men avoid the production of reactive oxygen species (ROS).35 Treatment with Ashwagandha provided concrete proof of anti-stress property.36
An important limitation of the present study is the lack of assessment of key sex hormones such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone, which play a crucial role in male reproductive health. Future studies should incorporate these hormonal parameters to provide a more

comprehensive understanding of the effects of Ashwagandha and Madhuyasthi on oligospermia.
Conclusion
The outcome of the study shows that both drugs are effective in the management of Ksheenshukra. But in certain aspects, like total sperm count and praseka cha alpa the Ashwagandha churna has outperformed the Madhuyashti churna. There was no consideration of the sex hormones like LH, FSH, and testosterone, which can be considered in future studies.
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