Varicocele: Ayurvedic Understanding, Treatment Principles

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
We can’t find references of any particular disease which resembles the clinical picture of ‘varicocele’ explained in Ayurvedic treatises. But looking at the pathology, clinical features and presentation of varicocele, we can make an inference and derive at some conditions which can be compared to varicocele with an Ayurvedic way of understanding. This will help us to draw some conclusions regarding the ‘treatment plan-up’ for varicocele if it has to be dealt in an Ayurvedic way. 

This article is an attempt to correlate varicocele to some pathological conditions mentioned in Ayurveda and also to enlist the strategies through which treatment of varicocele could be made on Ayurvedic lines.

Sira Granthi

Sira Granthi type of deformity
Granthi means a cyst or cystic swelling. Cyst or cystic swelling can occur anywhere in the body but when they happen to occur in the Siras (veins or blood vessels), they are called Sira Granthi (cystic swelling or congested swelling of veins).

(Note: Cysts are sac-like structures that can be filled with fluid, pus or other gaseous material. It is noncancerous. They are often caused by infection, clogging of sebaceous glands or around earrings)

Varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum (sac which holds testicles). This plexus of veins drains the testicles. Since in the varicocele (though not a cyst) the enlargement looks like fluid filled sac (like a cyst), we can consider it as cystic form of swelling (not as a rule or by definition though, only by appearance) and thus can be correlated to Sira-Granthi type of deformity as explained by Ayurveda.
Read related: Varicocele: Causes, Symptoms, Differential diagnosis, Treatment

Granthi Chikitsa

Treating Varicocele on the lines of Granthi Chikitsa (treatment lineup of Granthi, Sira Granthi)

Granthi is generally treated on the lines of Shotha Chikitsa. If the Granthi or Sira Granthi is ama (unripe), it should be treated on the lines of shotha chikitsa (explained later) and if it is pakwa (ripe), it should be cut open drained and applied with vrana ropaka medicines (wound healing medicines). Treatment of Pakwa granthi cannot be carried over in case of varicocele, the modern medicine explains the surgical methods for varicocele though.
Read related: Granthi: Cystic Swelling, Types, Features, Ayurvedic Treatment

Vayu Vikruti Chikitsa

Treating Varicocele on the lines of treating Vayu Vikriti, Apana Vayu Vikriti
In the pathogenesis of Sira Granthi we have seen that the condition is caused by vitiated Vayu. Therefore it is important that we handle the morbid Vayu to get rid of Sira Granthi. Also it is clearly evident that the sira granthi form of deformity which has occurred in the pampiniform plexus of veins in the scrotum, which is a Vayu sthana (lower parts of the body belong to the territory of Vayu), especially Apana Vata. Thus in Sira Granthi of Mushka or Vrushana kosha (varicocele of scrotum, testes), the chief culprit is Vayu, more specifically Apana Vayu.

The main strategies of treating Vikrita Vayu (morbid Vayu) are:

• Snehana – use of medicated oils and ghee
• Swedana – medicated fomentation or steaming (sudation therapy)
• Kashaya Vasti or Asthapana Vasti – medicated decoction enemas
• Anuvasana or Sneha Vasti – enema with medicated oil / ghee
• Madhura, Amla, Lavana rasa yukta ushna snigdha ahara – Hot, fresh and unctuous foods rich in sweet, sour and salt tastes
• Na vegan dhaarayet and udeerana – not forcibly avoiding the natural urges of the body, mainly those of urge for defecation, to pass fart and urination and also not forcing the urges which are not impending
• Avoiding Ati vyaayama (excessive exercise), sheeta (exposure to cold breeze), Vyavaya (sex), Jagarana (awakening at nights) etc
• Vatanulomana – medicines which regularly keep expelling the morbid vayu like Gandharvahastadi Kashayam, Gandharvahastadi Eranda Tailam, Narayana Tailam, Ksheerabala tailam, Maharasnadi Kashayam, Rasnadi Ghritam etc

Arshas Chikitsa

Treating Varicocele on the lines of treatment of Arshas (piles, haemorrhoids), mainly shushka arshas (Vata and Kapha types)
Arshas or Piles (haemorrhoids) is also a condition which is similar to Sira granthi type of deformity. There is congestion in haemorrhoidal blood vessels (veins) due to incompetence of valves, as in varicocele. Therefore Varicocele can be treated on lines of Arsha Chikitsa or treatment lineup of Piles.

Varicocele shall be treated on the lines of Shushka Arshas because the pathology of varicocele is also similar to that of vata-kaphaja arshas, though rakta and pitta are involved as secondary doshas. Granthi rupa vikriti is predominantly caused by kapha and the location in which varicocele occurs belongs to vata, apana vata in particular. It is also said in the pathogenesis of sira granthi that it is chiefly caused by vitiated vata.

Treatment line-up of varicocele on the lines of Shushka (Vata, Kapha and Vata-Kaphaja) Arshas chikitsa:
Swedana – Mild fomentation (excess heat is to be avoided).
Avagaha Sweda (tub bath sudation) – is the best form of swedana in varicocele. This can be given in presence of pain. Firstly the afflicted part should be smeared with pain relieving oil and the patient is made to sit in the tub filled with one of the below said liquids, the liquids being tolerably hot.

• Mulakadi kwatha – Decoction prepared using Mulaka (radish), Arka patra (leaves of Calotropis gigantea), Triphala (3 fruits, those of Terminalia chebula, Terminalia bellirica and Emblica officinalis), Vamsha patra (leaves of bamboo) etc
• Badara patra kwatha – Decoction of leaves of Jujube
• Kanji – Hot fermented liquid prepared from fermentation of herbs, grains etc
• Bilwa kwatha – Hot decoction of Aelge marmelos
• Takra – hot buttermilk

Shotha Chikitsa

Treating Varicocele on the lines of Shota Chikitsa (treatment of swelling, edema)
Varicocele can be treated on the lines of Vataja, Kaphaja Kapha-vataja and abhighataja shotha. If there is excessive inflammation, it indicates the avarana of vata (obstruction to the free functions of vata) by pitta. In such conditions pittaja shotha treatment can be followed.

Blending Shotha chikitsa (general principles of treatment of shotha) in the treatment of varicocele (siragranthi of mushka) –
The treatment of shotha antagonistic to the causes and causative dosha should be planned.
When the shotha is ama (unripened), langhana (fasting) and pachana (ripening medicines) should be given.

When the shotha is matured, it should be subjected to Shodhana, Vamana (therapeutic emesis) and Virechana (therapeutic purgation) are the best options to expel the morbid doshas.

Panchakarma in Varicocele

The role of Panchakarma has been highlighted in the context of discussing various strategies of dealing with varicocele in the first part of the article. To sum up Virechana is the best treatment for Varicocele. Virechana is good for both vata (pain), pitta (inflammation), kapha (accumulation and stagnation) and rakta (blood related issues). Though vamana is an ideal treatment for kapha related problems, since varicocele is a problem developed in vata zone, virechana will be one shot remedy for all the problems and pathology associated with varicocele. Virechana can be administered in the form of krama virechana (classical purgation wherein snehana or oleation, swedana or fomentation and virechana i.e. purgation are given in that order) or nitya virechana (daily purgation). Krama virechana shall be preferred in long standing and stubborn cases and nitya virechan shall be preferred in mild to moderate cases. After the varicocele has resolved, enemas (vasti) can be given to take control of Vayu and to avoid the recurrence of the disease.

Limitations

Limitations of Ayureda in tackling Varicocele –
Varicoceles respond variously to different strategies of treatment approaches. They are big issue when they interfere with the fertility. Mild to moderate cases of varicocele can be strategically well dealt through Ayurvedic approach with highly effective combinations of treatment, medicines, and effective diet and lifestyle changes. Even in cases where fertility is at stake, Ayurveda can give good relief because of availability of good medicines which promote fertility. Availability of Panchakarma measures like Virechana is a bonus. Severe, chronic and compromised conditions may be referred for surgery or to be addressed with the help of other effective strategies.

Clinical experience

My clinical experience in treating Varicocele
I should admit that I have not got too many cases of varicocele to deal with in my lengthy career as Ayurveda practitioner. It is also because (as I have tried to figure out) many people either ignore varicocele if it is mild or moderate condition presenting with feeble symptoms or ‘google people’ try with home remedies or take to super-specialization like seeking help from a surgeon or sex specialist.

But in whatever cases I happened to get I was successful to a higher extent to give good relief to the patients. I generally follow the Arsha and Shotha Chikitsa line of treatment and prescribe the medications advised in those contexts with permutations and combinations after having analyzed the Prakriti (basic constitution of the patient) and Vikriti (morbidity) thoroughly.

Ayurvedic medicines

Ayurvedic Medicines for Varicocele (Sira granthi of Vrushana kosha)
Classic formulations:

• Dusparshakadi Kashayam
• Chiruvilwadi Kashayam
• Sukumaram Kashayam
• Gandharvahastadi Kashayam
• Punarnavadi Kashayam
• Varanadi Kashayam
• Abhayarishta
• Mridwikarishta
• Dantyarishta
• Vidangarishta
• Bahushala guda
• Kalyanaka guda
• Manibhadra guda
• Suranavaleha
• Hingutriguna Leham
• Vyaghryadi leham
• Saptavimshati Guggulu
• Triphala Guggulu
• Kanchanara Guggulu
• Changeri Ghrita
• Avipattikara Churna
• Triphala Churna
• Arshoghna vati
• Kankayana Gutika Arsha
• Arshakutara Rasa etc

Proprietary products:

• Cap Arsol (BAN)
• Tab Arshonyt (Charak)
• Cap Balvac (BAL Vedics)
• Tab Kultab (Vasu)
• Tab Pilex (Himalaya)
• Tab Pilocure (Alopa)
• Tab Pilorid (Nagarjuna)
• Tab Pirrhoids (Baidyanath)
• Cap Pylapy (Capro)
• Tab Rectocare (Bacfo)
• Cap Sukhada (Ayulabs)
• Cap Sunarin (Phyto pharma) etc

Pathya

Pathya (wholesome food and activities) in Varicocele (Sira granthi of Vrushana kosha)

• Takra – buttermilk
• Rakta shali – red rice
• Mulaka – radish
• Kulattha – horse gram
• Bilwa –Aegle marmelos
• Kutaja – Holarrhena antidysenterica
• Indrayava – seeds of Holarrhena antidysenterica
• Avagahana – tub bath
• Kshara – alkalis
• Yava kshara – alkali made by burning the full plant of barley
• Shunti – ginger
• Pippali – long pepper
• Dadima – pomegranate
• Amla phala – sour fruits
• Guda – jaggery
• Karanja – Pongamia pinnata
• Ghrita – ghee
• Mamsa rasa – meat soup
• Trivrit patra – leaves of Operculina turpethum, Danti patra – leaves of Baliospermum montanum, Palasha patra – leaves of Butea monosperma, Chitraka patra – leaves of Plumbago zeylanica fried in ghee and oil and mixed with curds
• Ushna jala – hot warer
• Kantakari jala – water processed with Solanum xanthocarpum
• Shunti-dhanyaka jala – water processed with ginger and coriander
• Yavagu – gruel
• Yusha – soups
• Dugdha – milk etc.

Apathya

Apathya (unwholesome foods and activities) in Varicocele (Sira granthi of Vrushana kosha) –

• Kashaya rasa ati sevana – excessive intake of astringent foods
• Katu rasa / ahara – foods which are spicy or pungent in nature
• Lavana- excessive consumption of salt or salty foods
• Ruksha – dry foods
• Atisheeta-atiushna ahara – excessive hot or cold foods
• Vidahi anna – corrosive foods
• Amla – excessive consumption of sour foods
• Abhishyanda ahara – food which increases kapha, cause blocks and congestion in the body
• Viruddha ahara – mutually incompatible foods
• Ajeerna bhojana – foods which cause indigestion
• Pramita ahara – restricted diet
• Asatmya bhojana – incompatible on non-suitable foods
• Mamsa – flesh of cow, fish, pig, buffalo, sheep, goat etc in excess
• Puti mamsa – consumption of putrified meat
• Guru ahara – hard to digest foods
• Paishtika ahara – excessive consumption of foods made out of flour
• Shushka shaaka – dry vegetables
• Harita – lot of green and fresh vegetables
• Vasa – muscle fat
• Paryushita, puti, sheeta, sankeerna ahara – contaminated, putrid, cold and stored foods
• Vikruta jala – contaminated water
• Adhika sneha – excessive consumption of fats
• Sukha shayya asana – comfortable bed and seats (always)
• Diwaswapna – day sleep
• Kathora asana – hard seating
• Ushtra ashwadi gamana – always riding horses and camels
• Kshata – injury to the anal region
• Pravahana – straining at defecation and urination (practise)
• Vega dharana – forcibly holding the reflexes of defecation and urination, farting
• Teekshna Madhya – strong alcohol
• Maithuna – indulgence in sexual activities
• Avyayama – lack of exercise
• Shoka – grief
• Vata – excessive exposure to breeze
• Atapa – excessive exposure to heat of sun

Single herbs

Single herbs which are beneficial in in Varicocele (Sira granthi of Vrushana kosha) –

• Kutaja – Holarrhena antidysenterica
• Indrayava – seeds of Holarrhena antidysenterica
• Dadima – pomegranate
• Daruharidra – Berberis aristata
• Haridra – turmeric
• Nimba – neem
• Patha – Cyclea peltata
• Danti – Baliospermum montanum
• Trivrit – Operculina turpethum
• Yavani – Bishops weed
• Shunti – ginger
• Pippali – long pepper
• Chitraka – Plumbago zeylanica
• Haritaki – Terminalia Chebula
• Bibhitaki – Terminalia bellirica
• Amalaki – Emblica officinalis
• Bilwa – Aegle marmelos
• Rasanjana – extract of Berberis aristata
• Yavasa – Alhagi camelorum
• Kapikachchu – Mucuna Pruriens
• Samanga – Biophytum
• Kantakari – Solanum xanthocarpum
• Takra – buttermilk
• Saindhava lavana – rock salt
• Palandu – onion
• Tila – sesame
• Nagakeshara – Mesua ferrea
• Yashtimadhu – Liquorice
• Kamala – lotus and its variants
• Rakta chandana – red sandal wood etc

Just Before Finishing –

Though there are no direct descriptions of diseases or conditions resembling varicocele in the Ayurvedic texts, the clues for its treatments are obtained from thoroughly learning and analyzing the pathological changes happening in the disease with the help of Ayurvedic basics available in various contexts, scattered in the treatises. Once the nature of the disease is understood in Ayurvedic language, it is easy to translate the available treatment options and compile them. This article is focused towards sharing the knowledge of ‘strategically approaching towards effective healing of varicocele through Ayurveda’ with our readers.
Click to Consult Dr Raghuram Y.S. MD (Ayu)