WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Sharma.

World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 5.210

Volume 4, Issue 11, 768-774

Review Article

ISSN 2278 – 4357

BENIGN PROSTATIC HYPERPLASIA (BPH) AND ITS MANAGEMENT IN AYURVEDA *Dr. Ajay Kumar Sharma Associate Professor, Deptt. of Shalya Tantra, Patanjali Bharteeya Ayurvigyan Avam Anusandhan Sansthan, Haridwar, Uttarakhand.

Article Received on 14 Sept 2015,

ABSTRACT

Revised on 05 Oct 2015, Accepted on 27 Oct 2015

male persons. The enlarged prostate creates pressure on the urethra, to

Benign prostatic hyperplasia (BPH) is very common disease of old

compress like a partial clamp and causing obstructive urinary symptoms eg increased frequency of urination, painful micturition *Correspondence for

(ie.dysuria) etc. In Ayurveda symptoms of Astheela resembles with

Author Dr. Ajay Kumar Sharma

obstructive uropathy ie. benign prostatic hyperplasia (BPH). The term

Associate Professor,

Paurush granthi refers to prostate gland indicates its presence in male

Deptt. of Shalya Tantra,

persons only. The prevalence of histopathology of BPH is age-

Patanjali Bharteeya Ayurvigyan Avam Anusandhan Sansthan, Haridwar, Uttarakhand.

dependent with initial development usually after 40 years of age. More than 50% of men in their 60s and upto 90% of men in their 70s and 80s have some symptoms of BPH.

Keywords: Benign Prostatic Hyperplasia (BPH), Astheela, nocturia, PSA test Vasti karma. INTRODUCTION Benign prostatic hyperplasia (BPH) is very common disease of old male persons. Some recent epidemiological studies have revealed that, to a large extent lifestyle factors associated with metabolism including obesity, blood glucose, exercise, and diet also contribute substantially to the development of these conditions.[1] The prevalence of histopathologic BPH is age-dependent, with initial development usually after 40 years of age [2] and more than 50% of men in their 60s and upto 90% of men in their 70s and 80s have some symptoms of BPH.[3] The disease refers to the adenamotous enlargement of the periurethral tissue of prostate gland, leading to obstruction of the urethral passage and outlet of bladder neck. The prostate gland increases in size as the age advances, making BPH one of the most common age-related conditions in men. The enlarged prostate creates pressure on the urethra causing www.wjpps.com

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obstructive urinary symptoms like increased frequency of urination, painful micturition (ie.dysuria), urinary urgency, excess urination at night (ie.nocturia) and dribbling of urine etc.[4] Infection and inflammation of prostatic tissues may also take place along with BPH. International surveys have found a high prevalence of moderate to severe obstructive symptoms in men over the age of fifty years.[5] The exact mechanism of etiopathogenesis is not very clear but probably occurs due to changes in hormonal activity with age and lifestyle. With the advancement of age, the serum testosterone level gradually decreases and proportionally increase of estrogen level and that leads to enlargement of prostate. Androgens (ie.testosterone) are most likely plays role in prostatic hyperplasia. Conversion of testosterone to dihydrotestosterone (DHT) takes place in prostate. DHT hormone stimulates cell growth in the glandular epithelium of prostate and causes rapid prostate enlargement. Concept of Prostate Gland (ie.Astheela) in Ayurveda: In Ayurvedic literatures, the systematic description of urinary system regarding anatomy and physiology is not described well but availability of scattered knowledge through concepts thrown some light about their structures, relation and function. The anatomical structures related to urinary system are Vasti (ie.urinary bladder), Gavini (ie. ureter), Vrikka (ie.kidney), Mutrapraseka (ie.urethra) etc. Acharyas has mentioned position of prostate in relation to Vasti (ie.urinary badder). Vasti (ie.urinary bladder) is an important vital organ as it is a Sadyopranhar Marma.[6] The prostate is situated at the outlet point of Vasti in relation to Mutrapraseka (ie.urethra). According to Ayurveda embryologicaly glandular part of prostate is basically originated Matrijabhava and fibrous part from Paitrija bhava. The term Paurush granthi refers to prostate gland indicates its presence in male persons only. Acharya Sushruta described the involvement of Doshaj in the origin of different part of body. According to him Rakta and Kapha are responsible for origin of intestine, anal canal and urinary bladder.[7] The glandular part having soft consistency and secretary in nature is due to Kapha and Pitta predominance. The symptoms of benign prostatic hyperplasia (BPH) have some correlations with diseases described in Mutraghata (ie.obstructive uropathy). Mutraghata is obstruction or suppression of urine out flow. Dalhana explained Mutraghata as mutraavarodha.[8] According to Chakrapani it is a condition characterized by drying up or retention of urine is Mutraghata- “Mutraghaten Mutram Shoshyate Pratihanyate va’’. Benign Prostatic Hyperplasia in Ayurveda

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In Ayurvedic literature the bladder outlet obstruction (BOO) mentioned under the heading of Mutraghata. In Ayurveda BPH assumed as Paurush Granthi Vriddhi. Some Ayurvedist, correlated Astheela or Vatashtheeta and Mutragranthi with BPH. The term Ashtheela denotes the consistency of part like very hard and rounded in shape. Vatastheela is a stony hard growth between the anal canal and bladder. According to Sushruta, the Apana vayu resides in the space between rectum and urinary bladder vitiation leads to a hard (like stone), immobile and prominent growth. This growth in turn produces obstruction to the stool, urine and flatus, distention of bladder and pain over suprapubic region. The anatomical changes of prostate gland in BPH may be rubbery in consistency with enlargement. The description of Asthheela is more closely resembles with benign prostatic hypertrophy rather than Mutragranthi. Because in Mutragranthi obstructive uropathy occurs inside the urinary bladder due to calculi etc but in Astheela obstructive uropathy occurs from outside the urinary passage due to enlargement of prostate and leads to compression on urethra. So symptoms of Astheela have more resemblance to BPH rather than Mutragranthi . Etiology of BPH (ie.Nidana)[9] 

Suppression of natural urges.(ie.Vegavarodha)

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Excessive exercise (ie.Ativyayam)

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Excessive sexual intercourse (ie.Ativyavyav)

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Too much intake of astringent, bitter, and pungent foods (ie.Katu and Teekshna rasa ahara).

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Excess use of wine and fleshy meat.

Pathogenesis of Benign Prostatic Hyperplasia: All these factors exaggerate the Vata Dosha mainly involved in the pathogenesis of benign prostatic hyperplasia. In old age there is Vata predominance, which may be the basic causative etiological factor in the genesis of BPH. However single Dosha cannot develop a disease. So involvement of other Doshas should be considered. Presence of vitiated Vata along with Kapha and Pittaja undergoes process of cellular proliferation. The action of vitiated Vata over fibrous part, results into hardening of the layer. Clinical features of Benign Prostatic Hyperplasia: The enlarged prostate obstructs the passage of urine hence related symptoms are: 1) Incomplete evacuation of urine 2)Weak strea m 3)Increased frequency

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4) Straining 5) Intermittency 6) Increased frequency of urination at night (ie. nocturia) 7) Urgency 8) Suprapubic pain 9) Painful micturition (ie. dysuria) etc. The above mentioned symptoms of obstructive uropathy are mainly due to Vata predominance.[10] These Vatika symptoms are increased frequency, urgency, weak stream and nocturia, whereas incomplete evacuation of urine and intermittency due to vitiated Kapha Dosha. The nature of pain in BPH is mild to moderate, heaviness over suprapubic region, which indicates the Kaphaja type of pain. Overall symptoms resemble Vata and Kapha predominance. When there is infection in the urinary tract the Pittaja symptoms may appear like burning micturition etc. Diagnosis (1)Blood examination like CBC, ESR, CT, BT etc, Prostate Acid Phosphatase (PAP), Prostate specific antigen test (PSA) (2) Routine and microscopic examination of urine, (3) Ultrasound (KUB), Trans rectal Ultrasound (TRUS),(4) Radiography –CT, MRI. (5) Histological studies like biopsy, FNAC etc. Prostate specific antigen test -It is a very specific test normal value is up to 4 ng/ml of plasma, more than 10 ng/ml is significant. PSA is in two forms namely major-bound form and minor-free form. Major bound form PSA increases in carcinoma of prostate while minor free form increases in benign conditions (BPH). PSA is used as diagnostic marker and also used as marker of efficacy of therapeutics. Management of BPH in Ayurveda According to Ayuraveda literature, Mutraghata should be treated with Ausadha Chikitsa,Vastikarma and by following lifestyle modification etc. Acharya Sushruta has mentioned general guideline for management of all type of Mutraghata with use of Kashaya, Kalka, Avaleha, Kshar, Madya, Aasava, Snehana, Swedana, Basti and Uttarbasti.[11] 1. Ausadha Chikitsa 2. Vasti Karma therapy 3. Life style modification 1) Ausadha Chikitsa: Treatment principle of BPH is based on pathogenesis described in Ayurveda classics. Ayurvedic formulation having following properties should be used in the treatment of BPH: 

Ayurvedic formulation having analgesic and anti-inflammatory activity like Abhayadi kalka and Draksha kalka etc.[12]

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

World Journal of Pharmacy and Pharmaceutical Sciences

Drugs like Mootra-virechaniya (ie.diuretics) and Mutra-visodhaniya (ie.antiseptics) are useful in benign prostatic hypertrophy like Gokshuradi Guggulu, Punarnavdi Guggulu, Chandraprabha vati etc.



Drugs having Vata and Kapha pacifying properties like Yavakshara, Moolak kshara etc can be prescribed. The dose of all the above mentioned drugs should be adjusted according to severity of disease and strength of patient.

2) Vasti karma therapy: Vata dosha is the main causative factor in the genesis of benign prostatic hyperplasia. To pacify the vitiated Vata Vatanulomana drugs and Vasti karma is the best modality. Vata pacifying Vasti (ie.uttar vasti) is effective in reducing the symptoms of BPH with decoction of Dasmool,Gokshuradi and Varunadi Gana drugs etc. 3) Life style modification: Physical activity and regular exercise have been robustly and consistently linked with decreased risks of BPH and lower urinary tract symptoms.[13] Diet rich in Red meat and fat products have been associated with increased risks of BPH. Pathya(wholesome) Vegetables are associated with decreased risks of BPH and lower urinary tract symptoms.[14] Patients suffering from urinary disorders Takra, Cow’s milk,Guava ,drumstick pods, Pancha Jeeraka, Shali rice, Draksha, coconut water, barley water , Jaggery (ie.purana guda), Khanda (ie. brown sugar), sugarcane juice, Coriander etc are beneficial. Apart from these, substances or drinks which have diuretic property will be helpful in the management of urinary disorders. Apathya(Unwholesome) Guru (ie.difficult to digest), Vidahi (ie.produces burning in the GIT) and Abhisyandi (ie, obstructing fine channels) substances like curd, peas, cauliflower, brinjal, dry mango powder and over exercise etc are not suitable for patients suffering with urinary diseases.

DISCUSSION Benign prostatic hyperplasia is a very common disorder in elderly male persons. It affects the quality of life and physiology of urination. Prolonged BPH may result in bladder calculi, haematuria and retention of urine may leads to hydro-ureter, hydronephrosis and lastly renal insufficiency. Proper evaluation of BPH is mandatory with help of advanced diagnosic

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techniques like PSA test, biopsy, TRUS etc. Ayurveda has plenty of drugs quite helpful by acting on Mootravha srotus (ie.renal system) that are diuretic, anti-inflammatory, analgesic and antiseptic in nature. Ayurvedic medication, suitable dietary pattern and lifestyle modification contributes in the prevention of BPH. REFERENCES 1. Parsons JK. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol., 2007; V1(78): 395–401. 2. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol., 1984; 132(3): 474-9. 3. National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication., June 2006; 07-3012. 4. Pamela D, Reagan, RW,Bhanson RR, J.American family Physician., 2002; 66: 77-84. 5. Fenter TC, Naslund MJ, Shah MB, Eaddy MT, Black L. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care., 2006; 12(4): S90-S98.). 6. Sushrut Samhita, Dr. Anantram Sharma, Sushrutvimarshini hindi commentary, Chaukhamba Surbharati Prakashan, Varanasi 1st edition, 2001 Vol. III, Marma nirdesh sharira, Su.Sha 6/10, page no-89. 7. Sushrut Samhita, Dr. Anantram Sharma, Sushrutvimarshini hindi commentary, Chaukhamba Surbharati Prakashan, Varanasi 1st edition, 2001 Vol. III, Marma nirdesh sharira, Su.Sha 4/26 page no- 54. 8. Sushrut Samhita, Nibandh sangraha commentary Sanskrita

commentary,Acharya

Dalhanacharya, Chaukhamba Surbharati Prakashan, Varanasi edition, 2011, Mutraghata pratishedh adhyaya, Su UT.-Dalhana 58/12 page no-787. 9. Sushrut Samhita, Dr. Anantram Sharma, Sushrut vimarshini hindi commentary, Chaukhamba Surbharati Prakashan, Varanasi 1st edition, 2001

Vol.III, Udavarta

Pratisedha Adhyaya Su.UT.55/9-10,page no-454. 10. Sushrut Samhita, Dr. Anantram Sharma, Sushrutvimarshini hindi commentary, Chaukhamba Surbharati Prakashan, Varanasi 1st edition, 2001 Vol. III, mutraghata pratishedh adhyaya, uttartantra aadhyaya no. 58, sutra no. 5-8; page no- 474. 11. Sushrut Samhita, Dr. Anantram Sharma, Sushrut vimarshini hindi commentary, Chaukhamba Surbharati Prakashan, Varanasi 1st edition, 2001, Vol.II, ashmari chikitsaadhyaya, Su.Chi 7/27, Page No. 237.

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12. Sushrut Samhita, Dr. Anantram Sharma, Sushrut vimarshini hindi commentary, Chaukhamba Surbharati Prakashan, Varanasi 1st edition, 2001

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Pratisedha Adhyaya Su.UT.58/37-38, page no-477. 13. Parsons JK. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol V 178 2007; 395–401. 14. Kristal AR, Arnold KB, Schenk JM, et al. Dietary Patterns, Supplement Use, and the Risk of Symptomatic Benign Prostatic Hyperplasia: Results from the Prostate Cancer Prevention Trial. Am J Epidemiol., 2008; 167: 925–934.

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