Effect of Ginseng in male reproductive disorders: Traditional medical practice versus Homoeopathy

Dr Madhusree Dutta
Dr Sabyasachi Mukherjee.

Abstract:
Ginseng which is known to be the king of all herbs which has been used to treat male sexual dysfunction in traditional medical practice and is used for enhancing sexual behavior since the ages. Due to the action of the alkaloid ginsenosides, ginseng is found to improve the sperm quality and count of healthy individuals as well as patients suffering from infertility. In homoeopathy, the sexual sphere of this medicine requires much more clinical exploration and research. Since, there is absence of two many significant symptoms for male reproductive disorders in homoeopathy in the source books and no clinical trials or clinical verifications are conducted till date so this becomes a very important area where some light should be thrown in order to bring out much more facts which are to yet unknown to the society. This article deals with multi-faceted effects of ginseng on male reproductive function, focuses on it’s mechanism of action in traditional medical practice and includes various new research designs in homoeopathy which opens a new sphere of research where the various preparations of this drug can bring up some novel therapeutic strategies for the treatment of male reproductive disease or disorders.

Keywords: Ginseng, Traditional medical practice, male reproductive disorder, mechanism of action, Homoeopathy, clinical exploration and research.

Introduction:
Ginseng,  a popular root being used for various conditions in East Asian countries for two thousand to five thousand years, whose genus name is “Panax” which is given by the Russian Botanist Carl A Meyer in 1843 ⁽¹⁾. The mean of Panax in Greek is “all healing” and contain 9 species and over 20 ginsenosides (steroidal and non-steroidal saponins) and nonginsenosides which are the responsible for the mechanism of action of the drug⁽²⁾. The 9 species named according to their geographical location such as Asian Ginseng (Panax Ginseng), American Ginseng (Panax quinquefollium) and Japanese Ginseng (Panax japonicus) and many more⁽²⁾.

Based on the processing ginseng can be prepared in 3 different ways which are as follows ^(1)(3)(4)(5):-

1. Fresh ginseng (less than 4 years old)
2. White ginseng (four to six years old and sundried after peeling but is not fermented)⁽¹⁾.

• Red ginseng (harvested when 6 years old, steamed and dried)⁽⁵⁾.

The full name if the medicine used in homoeopathy is Ginseng Quinquefolium⁽⁶⁾. In homoeopathy, it is prepared by trituration and tincture of the root is specifically used⁽⁷⁾. It is considered to be specific for rheumatism, lumbago and sciatica but less stress is given on male sexual sphere which requires extensive research to unfold some more new facts⁽⁶⁾⁽⁷⁾. Ginseng can enhance sex performance & satisfaction, it has been employed in traditional herbal medicine confirmed by the clinic based survey reports⁽¹⁾⁽⁸⁾.

Body:
Infertility is a problem which is increasing all over the world and as estimated in the year 2010, 48.5 million couples all over the world were infertile ⁽¹⁾⁽⁹⁾.Besides female, in 40% cases approximately the male is responsible for the infertility or a contributing cause of infertility^(1)(10)(11).

The 2 major causes of infertility are as follows⁽¹⁾:-

1. Related to sexual performance.
2. Related to sperm quality & production (assessed by semen analysis).

The following dysfunction of sex performance may lead to infertility⁽¹⁾:-

1. Erectile dysfunction
2. Loss of libido

Erectile dysfunction:-
It is one of the most common types of sexual dysfunction in men in which there is a persistent inability to obtain or maintain sufficient penile election to allow satisfactory sexual intercourse⁽¹²⁾. This condition is highly correlated with age, the etiology of more than 90% cases are organic and based on Massachusetts Male aging study it can be concluded that it  affects over 50% of men aged between 40 to 70 years^(13)(14)(15). Apart from the age, other risk factors includes smoking, hypertension, Coronary artery or peripheral vascular disease, obesity, sedentary life style, hyperlipidaemia, diabetes mellitus, benign prostratic hypertrophy, depression and lower urinary tract symptom and even traumatic causes including surgery to pelvis or spine⁽¹⁶⁾. The present treatment options available for this condition in modern medicine includes oral medications, alprostadil self-injection, penile implants, penile revascularisation and psychological counseling but 30-35 % of men donot respond to the oral medicines^(12)(17).

Mechanism of action:

1. Ginseng has a potential effect on the risk factors responsible for erectile dysfunction like cardiovascular disorders including HTN and hence, it helps in treating erectile dysfunction^(18)(19)(20).
2. The effect of ginseng might be related to central humoral regulation ginseng ‘s alleged anti-fatigue effect helps to get involved in sexual arousal as well as physical energy enhancement⁽²¹⁾.

Libido: Libido or sex-drive in higher mammals involves a complex co-ordination between the hormones and neuronal components and the most essential one is testosterone, synthesized by leydig cells under the influence of the hormone LH produced by the anterior pituitary⁽²²⁾. Ginseng significantly increases the blood testosterone levels, hence helps in the treatment of males with reduced libido^(23)(24).

Sperm quality and sperm count⁽²⁰⁾:-

Semen quality is taken as a surrogate measure of male fecundity in various assessments including male fertility and reproductive toxicity.

The criteria for semen analysis is described below in a tabular form⁽²⁰⁾:-

Volume	Equal to or more than 1.4 milliliters
Total count	Equal to or more than 39 million
Motility	Equal to or more than 42%
Viability	Equal to or more than 54%
Morphology	Equal to or more than 4%

There are various studies which suggests that both oligoastenospermic patients and age-matches healthy counterpart showed am increase in spermatozoa density and motility after the use of Panax Ginseng and asthenospermic patients treated with ginseng also showed a significant increase in progressive sperm motility⁽¹⁾⁽²⁾. To pinpoint on specific active components for this action, these effects are found to be mediated through induction of nitric oxide synthase (NOS) activities and NO production, which is closely related to sperm function⁽¹⁾. Since, ginsenosides are structurally similar to the steroid hormones which results in the activation of steroid hormones and stimulate sexual functions and spermatogenesis⁽¹⁾.

Homoeopathy : J.H Henry considered it to be specific in lumbago, sciatica and chronic rheumatism, with frequent desire to urinate and sexual excitement⁽⁷⁾. Great excitation of the genital organs with nocturnal erections which are painful while sitting at engrossing business ⁽⁷⁾. Pressure in testicle with vivid, lascivious dreams of which the recollection remains, always after taking the medicine⁽⁷⁾. It is said that it can have a stimulators effect on the secretary glands, especially salivary glands⁽⁶⁾. Rheumatic pains after frequent emissions. Weakness of genital organs ⁽⁶⁾. Voluptuous tickling at the end of urethra. Sexual excitement with pressure in the testicles⁽⁶⁾.

New probable research models
In order to employ this medicine specifically for treating male reproductive disorders and male infertility pre-clinical trials, human pathogenetic trials and randomized control clinical trials should be conducted to authenticate the efficacy of this medicine.

New probable research designs for clinical randomized trials:-

1. A comparative study of ginseng mother tincture vs ginseng 3C in the treatment of erectile dysfunction: A double blinded randomized controlled trial.

Research question : Do ginseng mother tincture and ginseng 3C treat erectile dysfunction in the same way?

Null hypothesis : Ginseng mother tincture and ginseng 3C treat erectile dysfunction in the same way.

Alternative hypothesis : Ginseng mother tincture and ginseng 3C do not treat erectile dysfunction in the same way.

Explanation: It is a double -blind randomized control trial which would be converted in 2 parallel arms. In one arm ginseng mother tincture and in another arm ginseng 3C will be given to the study subjects for a particular duration of time and the results pre and post intervention would be analyzed.

2. A comparative study of ginseng mother tincture vs ginseng 3C in the treatment of male infertility due to low sperm count: A double blinded randomized controlled trial.

Research question : Do ginseng mother tincture and ginseng 3C treat male infertility due to low sperm count in the same way?

Null hypothesis : Ginseng mother tincture and ginseng 3C treat male infertility due to low sperm count in the same way.

Alternative hypothesis : Ginseng mother tincture and ginseng 3C do not treat male infertility due to low sperm count in the same way.

Explanation:- It is a double -blind randomized control trial which would be converted in 2 parallel arms. In one arm ginseng mother tincture and in another arm ginseng 3C will be given to the study subjects for a particular duration of time and the results pre and post intervention would be analyzed.

3. A comparative study of ginseng mother tincture vs ginseng 3C in the treatment of male infertility due to loss of libido: A double blinded randomized controlled trial.

Research question ” Do ginseng mother tincture and ginseng 3C treat male infertility due to loss of libido in the same way?

Null hypothesis : Ginseng mother tincture and ginseng 3C treat male infertility due to loss of libido in the same way.

Alternative hypothesis : Ginseng mother tincture and ginseng 3C do not treat male infertility due to loss of libido in the same way.

Explanation: It is a double -blind randomized control trial which would be converted in 2 parallel arms. In one arm ginseng mother tincture and in another arm ginseng 3C will be given to the study subjects for a particular duration of time and the results pre and post intervention would be analyzed.

Conclusion:
Traditional medicine has been using ginseng in the treatment of various disorders of male reproductive organs since the ages including male infertility. There are various studies which are conducted in the traditional system of medicine and have given positive results. This medicine and have given positive results. This medicine seems to be quite unexplored in the homoeopathic world due to lack of pre-clinical trials, clinical verifications and randomized clinical trials without which the efficacy of the medicine cannot be affirmed. These studies should be encouraged in all the undergraduate as well a post-graduate institutions and multicentric studies should be conducted in huge members to unfold the hidden mysteries of this medicine. This will be extremely help in the present society where male infertility is still an important prevailing cause. Various novel research models are included in this article which may be helpful for the researchers to explore this medicine in various ways which might prove to a boon for the society. So, homoeopathy has a huge scope here.

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1)  Dr. Madhusree Dutta.
PG Scholar (Part II), Mahesh Bhattacharya Homoeopathic Medical College and Hospital, Howrah.West Bengal.
Email – madhusreedutta2811@gmail.com
Mobile no- 8777486871.

2) Dr. Sabyasachi Mukherjee.
BHMS, Homoeopathic medical officer (H.M.O),
Banda BPHC ,Raghunathpur II, Purulia.West Bengal.