Department of Post Graduate Studies in Kayachikitsa

Ayurveda Mahavidyalaya, Hubballi.

Title of Dissertation:
"A COMPARATIVE CLINICAL STUDY ON THE MANAGEMENT OF
SHUKRAGATA VATA W.S.R. TO PREMATURE EJACULATION THROUGH
SHODHANA AND SHAMANA"
Scholar: Co-Guide: Guide/HOD
Dr.SHRINIVASRADDI.G.V. Dr.S.G.CHAVAN Dr.PRASHANTH.A.S.
PG Scholar MD (AYU) MD(AYU),Ph.D,PGMH,MHA

Special Case Sheet

Name of Patient: SL NO. ………..
OPD NO:
Age: IPD NO:

Occupation: D.O.A:
Sex: Male D.O.D:
Religion: Hindu Muslim Christian Others
Socio Economic Status: Poor class Middle class
Higher middle class Higher class
Address: Education:
Email: Phone. No:
Results: Responded Not responded
Group: A B
CONSENT:
My self ………………………………. ……………………………………I have been informed
about my problem to my satisfaction. I am convinced by the doctor about treatments to best of
my knowledge. I am also ready to undergo necessary Laboratory Investigations to monitor and
safeguard my body functions. I am also aware of my right to opt or quit the treatment at any time
during the course.
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gÉÆÃVAiÀÄ ºÀ¸ÁÛPÀëgÀ/Patient's Signature

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COMPLAINTS
CHIEF COMPLAINTS: DURATION
Early or Rapid Ejaculation
Loss of Rigidity/Erection
Lack of Sexual Desire
General weakness
ASSOCIATED COMPLAINTS DURATION
Lack of Satisfaction
Performance Anxiety
Less satisfaction of partner
Night Emission
H/O Present Illness

H/O Past Illness

Disease: Acute/Chronic Infection:

Operation:
TREATMENT HISTORY:
Ayurveda:

Modern Medicine:

Any other:
FAMILY HISTORY:
H/O - HTN/DM-II/IHD/TB/Thyroid dysfunction
Father/Brother/Siblings (Any History of Gonadal defects: Cryptorchidism /Vericocele )

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PERSONAL HISTORY:

Ahara: Samisha( ) Niramisha( )

Dietary Habits: Regular( ) Irregular( )
Ahara Vidhi: Samashana( ) Adhyashana( ) Vishamasana( ) Viruddhashana( )
Guna Guru( ) Laghu( ) Sheeta( ) Ushna( )
pradhanata:
Snigdha( ) Ruksha( ) Tikshna( ) Mrudu( )
Rasa pradhanata: Madhura( ) Amla( ) Lavana( ) Katu( ) Tikta( ) Kashaya( )
Pramana : Heena( ) Madhyama( ) Atimatra( )
Agni : Sama( ) Vishama( ) Tikshna( ) Manda( )
Kostha : Mridu( ) Madhyama( ) Krura( )
Defecation : Regular( ) Irregular( ) Loose stool( ) Constipation( )
Frequency..…..times/day ……times/night
Micturition : Frequency...…..times/day...…..times/night
Quantity: Alpa( ) Madhyama( ) Bahu( )
Any Other Symptoms :
Bath : Regular( ) Irregular( ) Cold water( ) Hot water( ) Mixed( )
Sleep : Sound( ) Disturbed( ) Insomnia( )
Duration …..hours in day .…..hours in night

Night Emission : Yes( ) No( ) & if yes frequency…….

Emotional Status: Anxiety( ) Tension( ) Depression( ) Sentimental( ) Normal( )
Addiction: Tea/Coffee( ) Smoking( ) Tobacco( ) Supari( )
Alcohol( ) Sleeping pills( ) Analgesics( ) Purgatives( )
Vyayama : No( ) Light( ) Heavy( )
Regular( ) Irregular( ) Occasional( )

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OCCUPATIONAL HISTORY:
Nature of Stress Mentally( ) Physically( ) Both( )

Nature of work : Sitting/Sedentary( ) Standing( ) Heavy( ) Travelling/Driver( )

Working near high temperature zone( ) X-ray units( )
Heavy metals( ) Pesticides( ) Night duty( ) Others( )

Total hours:

SEXUAL HISTORY :
Attainment of Puberty: At the age of ..….years
Masturbation : Yes( ) Never( ) Rare( ) Before marriage( ) Continuing( )
Frequency of Daily( ) 3-4 per week( ) 1-2per week( ) 1per fortnight( )
Masturbation :

Night emission : Yes( ) Stopped after marriage( ) On Abstinence( )

Foreplay: YES( ) NO( ) <5min( ) 5-10min( )
Any coital difficulties
……………………………………
MARITAL LIFE :
Age of 18-22yr( ) 23-28yr( ) 29-33yr( ) 34-38( )
Marriage :
Duration .……years
Duration of
unprotected sex
…..months/years
Sexual life: Satisfactory( ) Unsatisfied( ) PME( ) ED( )
Contraception None( ) Condoms:…….dates of use
Diaphragm:……. dates of use
IUD:……..dates of use
Undergarment: Type: Cotton( ) Synthetic( )
Wearing pattern: Tight( ) Loose( )

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SAMANYA PAREEKSHA :

1 Shareeroshmata (Temp) ……… oF

2 Shwasa Gati (RR) ………/min

3 Raktachapa (BP) …….mm of Hg

4 Shareera Bhara (Weight) ……….kgs.

5 Shareera Dhairgya(Height) ………….cms

ASTHA VIDHA PAREEKSHA :

1. Nadi Gati …./min Dosha Pradhana: Vata( ) Pitta( ) Kapha( )
2. Malapravritti ………./Day
3. Mutrapravritti Frequency:………/Day ……./Night
4. Jiwha Liptata( ) Aliptata( ) Ardrata( ) Shushkata( )
5. Shabdha Sakampa( ) Ksheenaswara( ) Any( )
6. Sparsha Snigdha( ) Ruksha( ) Ushna( ) Sheeta( )
7. Drik Prakruta ( ) Drustimandya( ) Anya( )
8. Akriti Krisha( ) Madhyama( ) Sthoola( )

DASHAVIDHA PAREEKSHA :
1 Prakruti V( ) P( ) K( ) VP( ) VK( ) PK( ) Tridoshaja( )
2 Vikruti Dosha
Doshavastha
Dushya Dhatu Dusti
Upadhatu Dusti
Mala Dusti
Adhisthana
Rogamarga
3 Sāra Pravara( ) Madhyama( ) Avara( )
4 Samhanana Pravara( ) Madhyama( ) Avara( )
5 Pramana Pravara( ) Madhyama( ) Avara( )
6 Sātmya Ekarasa( ) Sarva rasa( ) Vyamishra( )
Rooksha satmya( ) Snigda satmya( )

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7 Satva Pravara( ) Madhyama( ) Avara( )
8 Ahara Shakti a) Abhyavaharana shakti P( ) M( ) A( )
b) Jarana shakti P( ) M( ) A( )
9 Vyayama Shakti Pravara( ) Madhyama( ) Avara( )
10 Vaya Bala( ) Yuva( ) Vrudda( )

NIDANA :
Aharaja :

Viharaja :

Manasika :

Anya :

SAMPRAPTI GHATAKA :
Dosha:
Dushya:
Ama:
Agni:
Srotas:
Srotodushti prakara:
Udbhavasthana:
Sancharavastha:
Adhistana :
Vyaktasthana:
Rogamarga:
Vyadhi swabhava:
Sadhyaasadhyata

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SYSTEMIC EXAMINATION :
Respiratory system:

Cardiovascular system:

Gastro intestinal system:

Central Nervous System:

Urogenital Examination: Secondary Sexual Characters: Well developed ( )

Poorly developed( )

LOCAL EXAMINATION:
Penis
Lymph nodes
Skin texture N( ) Vesicle( ) Scabies( ) Eczema( ) Herpes( ) Lice( ) Scar( ) Ulcer( )
Shaft Curved( ) Shrunken( ) Erected( ) Scar( ) Plaque( ) Partially erected( )
Prepuce N( ) Phimosis( ) Paraphimosis( ) Smegma( ) Circumcised( )
Glans N( ) Balanitis( ) Balano-posthitis( ) Ulcers( ) Scars( )
Ext.ure.meatus N( ) Hypospadiasis( ) Epispadiasis( ) Discharge( ) Ulcers( )
Scrotum N ( ) Rugae( ) Pigmentation( ) Swelling( ) Scar or lesion( )
Testes Right Normal( ) Ante or Retroverted( ) Small( ) Nodular( ) Soft or firm( )
Left Normal( ) Ante or Retroverted( ) Small( ) Nodular( ) Soft or firm( )
Epididymis Palpable or Indurated/Vas deferens
Spermatic cord Tender( ) Non-tender( ) Hernia( ) Vericocele( )

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INVESTIGATION:
SEMEN ANALYSIS: B.T. A.T.
Date:
Volume
Liquefaction
Colour
Consistency
Viscosity
pH
Sperm count (million/ml)
Sperm motility (%)
Dosha dushita shukra lakshana

URINE ROUTINE & MICRO : B.T. A.T.

Albumin
Sugar
Pus cells
R.B.C.
Cast
Crystals
Epithelial cells

BLOOD PICTURE B.T. A.T.

Hb%
TC
DC Neutrophils
Lymphocytes

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 Monocytes
Eosinophils
Basophils

CHIKITSA KARMA-

GROUP A:
Aama Pachana- Hareetakyadi Churna
Dose: 5gms of Churna with warm water before food.(Till nirama laxana)
Abhyanga Murchita Tila Taila followed by Swedana.
Basti TRITIYA BALADI YAPANA BASTI, in Yoga Basti schedule.
Shamanoushadi Vanari Yoga Dose : 5gms of Granules with warm milk (Twice a day)
OBSERVATIONS

Yoga Time of Basti Time of Basti Mala Temperature

Basti Administra Dravya Retention pratyagamana Vega of Basti
tion Pramana kala Dravya
1st day AM
ml mins
2nd day AM ml
mins
3rd day AM ml
mins
4th day AM ml
mins
5th day AM ml
mins
6th day AM ml
mins
7th day AM ml
mins
8th day AM ml
mins

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Yapana basti vyapath

Shopha
Agninasha
Panduta
Udarashula
Arsha
Parikartika
Jwara
Atisara

GROUP B:

Ama Pachana Hareetakyadi Churna

Dose: 5gms of Churna with warm water before food.(Till nirama laxana)
Abhyantara Sadhyo Snehapana with Shalmali Ghrita
Snehana Dose –Madhyama Matra (As per Agni,Kostha of patient).
Vishrama kala Abhyanga with Moorchita Tila Taila followed by Swedana.
Sneha Virechana Eranda Taila Dose – As per Kostha of patient.
Paschat karma Samsarjana Krama depending on Vega/Shuddhi.
Shamanoushadi Vanari Yoga Dose : 5gms of Granules with warm milk (Twice a day)
Chikitsa Kala 60days (45+15 F/U)

POORVA KARMA :

PROCEDURE DRAVYA MATRA

SNEHAPANA SHALMALI GHRITA

VIDANA

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JEERYAMANA LAKSHANA: SNEHA JEERNA LAKSHANA :
Shiroruja Jeeryamana lakshanas
Bhrama prashamana
Lalasrava shiroguruta
Murcha vatanuloma
Klama Kshuda pravrutti
Trushna Trushna pravrutti
Daha Udgara shuddi
Arathi

VIRECHANA KARMA OBSERVATION:

OBSERVATION RESULT
Dose of ERANDA TAILA
Anupana
Time of Administration
Time taken for the beginning of First Vega
Vegiki
Antiki
Laingiki Indriya Prasada
Laghuta
Vatanulomana
Daurbalya
Aruchi
Nature of Shuddhi: P( ) M( ) A( )
Complication if any
Samsarjana krama Given for ...........Annakala

FOLLOW UP :
1st: After 15days
2nd: After 30days
3rd: After 45days
4th: After 60days

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ASSESSMENT CRITERIA:

SUBJECTIVE PARAMETER SCORING B.T. A.T

EJACULATION :
Ejaculation with own and partner's satisfaction 0
Ejaculation with own satisfaction 1
Ejaculation after penetration but early discharge 2
Ejaculation just before penetration 3
Ejaculation during foreplay 4
Ejaculation at mere thought / sight / touch of partner 5

ERECTION :
Erection whenever desired 0
Erection with occasional failure 1
Erection, Initial difficulty but able to penetrate 2
Erection but unable to penetrate 3
Erection only after physical manipulation 4
No Erection by any method 5

PENILE RIGIDITY :
Proper stiffness to maintain erection and continue sexual act till last. 0
Able to maintain Erection but, unable to continue sexual act till last 1

Some loss of stiffness and able to maintain Erection and initiate sex 2

Some loss of stiffness but can able to continue sexual act till last 3

loss of stiffness but can able to continue sexual act 4

Total loss of stiffness or unable to initiate the sexual act 5

PERFORMANCE ANXIETY :
No anxiety at all 0
Slight anxiety which doesn't hamper the sexual act 1
Anxiety that hampers the sexual act in 25% occasions 2
Anxiety that hampers sexual act in 50% occasions 3

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 Anxiety that hampers the sexual act in 75% occasions 4
Anxiety hampering the sexual act in all encounters 5

SEXUAL DESIRE :
Excessive Desire 0
Normal Desire 1
Desire only on demand of partner 2
Desire in sex but no sexual act 3
Lack of Desire 4
No Desire at all 5

RESULT:
OVERALL ASSESSMENT GRADE OF IMPROVEMENT
OF RESULTS
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

Signature of the Scholar Signature of the Co- Guide Signature of the Guide/HOD

Dr.SHRINIVASRADDI.G.V. Dr.S.G.CHAVAN Dr.PRASHANTH.A.S.

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