The Sushruta Samhita, one of the prime texts among Brihatrayee, describes 12 types of Mutraghata.[¹] Vatastheela[²] is one of them and, in its signs and symptoms as well as in anatomical considerations, it bears a close resemblance to benign prostatic hyperplasia (BPH).

BPH is a nonmalignant enlargement of the prostate gland caused by excessive growth of prostatic tissue and is the most common benign neoplasm of aging men.[³] It affects mainly those individuals over the age of 40 years. In modern medicine the management of BPH is either through a surgical approach (e.g., open prostatectomy, transurethral resection of prostate, cryotherapy, etc.) or by conservative treatment using drugs (e.g., chemotherapy, hormonal therapy, etc.). Among the many approaches, prostatectomy is the best, but it is associated with many problems and complications, e.g., postoperative morbidity, impotence, retrograde ejaculation, etc. The second most acceptable procedure is TURP which is also not free from complications, with the cumulative probability of re-operation estimated to be around 15% at 5–8 years after TURP.[⁴] In case of hormonal therapy, although there are some advantages, there are many complications like loss of libido, impotence, gynecomastia, etc. Generally, the conservative treatments mentioned above have to be continued indefinitely and, therefore, treatment can be expensive. The surgical approach has provided a great deal of relief for many people but, as mentioned earlier, there are many associated problems.

In this situation, it is possible that Ayurveda will be able to provide a treatment that is natural and free from any adverse effects. Acharya Sushruta has mentioned successful treatment of Mutraghata with Kasaya, Kalka, Ghrita, Kshara, etc. preparations of different drugs.[⁵] This research work was carried out with the ultimate aim of finding the best treatment available in Ayurveda for BPH.

To compare the effects of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in the management of Vatastheela, with special reference to BPH.

The general observations are shown in Table 1–3. The effect of therapy on various parameters is shown in Table 4–14.

The disease Vatastheela, one of the 13 Mutraghata disorders, can be correlated with BPH on the basis of its Sthana (place), which is between Guda and Basti, and also on the basis of the correspondence of the symptoms and signs. Most of the features of Vatastheela described by Sushruta, such as retention of urine (Mutrasanga), pain in suprapubic region, etc., are similar to the symptoms of BPH. To make it more scientific for treatment as well as assessment point of views certain features like age above 40 years, increased frequency of urine, nocturia, reduced urine flow rate, intermittency which are not described by Acharya Sushruta, are necessary.

Most of the patients in our study (75%) were from the age-group of 61–70 years, which is to be expected since BPH is a disease related to aging. Maximum individuals were of the Hindu religion, which is due to the predominance of Hindus in this area. Most of the patients reported agriculture as their occupation, which is not surprising in this rural region. Most of the patients had had symptoms for 1–2 years. One reason for this long duration is that patients often neglect to seek treatment in the early phase of disease; also, many patients may have tried other forms of treatment before seeking Ayurvedic treatment.

Vishamashana was found in the majority of the patients. Ama is the chief causative factor in the pathogenesis of Vatastheela as described by Charaka, and Vishamashana is responsible for Ama formation which leads to making the firm background for disease. Disturbed sleep was found in almost all the patients, which might be due to the increased frequency of micturition at night. Constipation was found in 91.66% of the patients, which might be due to faulty dietary habits such as Vishamashana. In group A, i.e., the Mahayavanal Roma Kshara group, highly significant relief was found in frequency of micturition, hesitancy, and dysuria, while significantly result was observed in the symptoms of urgency and nocturia. Kshara made from Roma of Mahayavanala contains properties like Tridoshghna, Pachana, Vilayana, and Lekhana[¹⁰] and it is by the virtue of these Gunas that it causes decrease in prostate size and increase in urine flow rate. Kshara also has the capacity to change the pH of urine from acidic to alkaline and by virtue of this it helps reduce the symptoms due to irritation of the lower urinary tract (e.g., dysuria, frequency).

Another probable reason for such relief may be the anti-testosteronic effect of the Kshara. As mentioned by the Acharyas, Kshara can cause impotency and the impotency is certainly due to decrease in the testosterone level. Thus, it is likely that the anti-testosteronic properties of Kshara helps to reduce the size of the prostate gland and give symptomatic relief. This hypothesis requires further evaluation.

Treatment with Dhanyaka Gokshura Ghrita provided highly significant relief in incomplete voiding, intermittency, hesitancy, and nocturia. There was also significant relief of symptoms like frequency of micturition, urgency, and weak urine stream.

Dhanyaka Gokshura Ghrita contains only two drugs, i.e., Dhanyaka and Gokshura. Dhanyaka is Tridoshahara, Dipana, Pachana, and Strotovishodhana,[¹¹] while Gokshura has properties like Vatahara, Mutrala, Anulomana, Basti Shodhaka, Dipana, and Pachana,[¹²] etc. Both drugs were processed with Ghrita which carried all the properties of above drugs, as Ghrita is Yogavahi. Thus, the actions of Dhanyaka Gokshura Ghrita were by virtue of the properties mentioned above.

In this study we compared two Ayurvedic treatments for BHP, i.e., Mahayavanal Roma Kshara and Dhanyaka Gokshura Ghrita. It was found that Mahayavanal Roma Kshara had better effect on the objective parameters, whereas Dhanyaka Gokshura Ghrita showed better effect on the subjective parameters.