Hydrocele: Ayurvedic Treatment Strategies For Effective Management

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
Hydrocele can be treated on the lines of Vruddhi (scrotal swelling, inguino-scrotal swelling) Chikitsa. To be precise it shall be treated on the lines of ‘Mutraja Vruddhi Chikitsa’, one among the 7 types of Vruddhi, a condition which closely resembles Hydrocele. 

Related Reading – Hydrocele, Ayurvedic explanation

Treatment (Chikitsa) of Mutraja Vruddhi
Swedana

Swedana (Fomentation, sudation, sweating treatment, steaming) should be given with decoction prepared from Shirovirechana dravyas (herbs used for nasal medication and head cleansing) mixed with Gomutra (urine of cow). After the administration of swedana, the scrotum should be tied (bandaged) with a sterile cloth.

Vedhana karma
The vruddhi should be punctured little below and to the side of the raphae (suture or fold running at the centre of the scrotum, looking like a dividing line seen to divide the scrotum into left and right parts).

Vedhana or puncture of the Mutraja Vruddhi should be done using Vrihimukha shastra. It is an instrument similar to trocar and cannula (modern day instruments used for draining the fluid from the hydrocele vis-à-vis mutraja Vruddhi or Jalodara vis-à-vis ascites, the method is called tapping of fluid or paracentesis).

This allows draining of the fluid which has collected in the mushka (scrotum) and gives relief from the symptoms of mutraja vruddhi.

Bandhana (bandaging) – After removal of the instrument Sthagika bandhana (stump bandage) should be done over the scrotum. The bandage should be regularly changed and recurrent bandaging for the stump should be done.

Ropana – After the wounds get cleansed (after the bandaging) Ropana dravyas (wound healing medicines) should be used.

Treatment (Chikitsa) of Mutraja Vruddhi
Treatment of Vata Vruddhi –
In Vata Vruddhi, snigdha virechana (purgation with medicated oils or ghee) should be administered.
For this milk mixed with Eranda Taila (castor oil) should be consumed daily for at least 1 month.

Eranda taila (castor oil) mixed with Guggulu (Commiphora mukul) and go mutra (urine of cow) is also beneficial in Vataja Vriddhi.

According to Sushruta:
Initially Traivrut sneha should be administered for snehana (oleation). Later Swedana (steaming treatment) should be given followed by Virechana (therapeutic purgation). After the Virechana and after a gap of 8 days, Niruha Vasti (herbal decoction enemas) prepared with kwatha (decoction) and kalka (paste) of Vatahara dravyas (herbs which are anti-vata or antagonistic to morbid vata) should be administered. Later Anuvasana Vasti (oil enemas) is administered with Yashtimadhu taila (oil)

External treatments:
Later application using sneha (medicated oils), upanaha (poultices) and Vatahara pralepa (paste prepared from herbs having anti-vata properties) is done over the afflicted area. After this Pachana or treatments (medicines) to ripen the immature Vruddhi is given followed by Bhedana (incision on the scrotum below and to the side of the midline of scrotum.

Classical formulations for Mutra Vruddhi
Vachadi Kalka – Paste of Vacha (Acorus calamus) and Sarshapa (mustard seeds) should be applied over the scrotum (useful in any type of swelling formed over the scrotum)

Shigru-sarshapa kalka – Paste of Shigru (drumstick) and Sarshapa (mustard seeds) when applied destroys shotha (swelling), kapha (morbid kapha) and vayu (vitiated vayu)

Narayana Taila – Medicated oil in the name of Narayana Taila should be used in the form of pana (internal, oral consumption), abhyanga (massage) and vasti (enema) helps in Anda vruddhi (inguino-scrotal swelling)

Daruharidra – Powder or Daruharidra (Berberis aristata) mixed in gomutra (urine of cow)
Ardraka swarasa – Juice of ardraka (ginger) mixed with honey

Other remedies:
Haritaki Yoga – Cook 1 Haritaki (Terminalia chebula) fruit in eranda taila (castor oil). Remove its seed. Crush the pulp and mix it with Saindhava Lavana (Rock salt). It should be given on empty stomach every day to cure mutra vruddhi.

Devadarvadi Kashayam – Decoction prepared using Devadaru (Cedrus deodara) and Daruharidra (Berberis aristata) is beneficial in Mutra Vriddhi.

Haritakyadi Yoga – Paste of equal quantities of powders of Haritaki (Terminalia chebula), Pippali (long pepper) and Saindhava Lavana (Rock salt) should be taken in the size of small pea sized globules.

Pathya (beneficial and wholesome things) in Mutra Vruddhi

  • Samshodhana – cleansing treatments mainly Virechana (therapeutic purgation) and Vasti (therapeutic enemas)
  • Vasti karma – therapeutic enemas
  • Vamana – therapeutic emesis
  • Raktamokshana – bloodletting
  • Sweda karma – fomentation, sweating or steaming therapy
  • Lepa –application of medicinal pastes
  • Vankshana daha –cauterization using heated ardhachandrakara loha (iron instrument in half moon shape) over inguinal region
  • Bahu sira vyadha – bloodletting should be done through vein-section i.e. cutting the veins in the shoulder in vyatyasa krama i.e. if the right part of scrotum is swollen, the sira in the left shoulder should be cut and if the left scrotum is swollen, the sira in the right shoulder should be cut
  • Shastra vidhi – surgical process
  • Aruna shali – red variety of rice
  • Eranda taila – castor oil
  • Dhanwa amisha – flesh of animals living in desert areas
  • Ushna jala – hot water
  • Takra – buttermilk

Single herbs useful in Vriddhi, which are also mentioned under pathya

  • Eranda – Ricinus communis, castor plant
  • Surabhi jala or go mutra – urine of cow
  • Shigru phala – drumstick
  • Patolam – pointed gourd
  • Punarnava – Boerhavia diffusa
  • Gokshura – Tribulus terrestris
  • Agnimantha – Premna integrifolia
  • Tambula – betel leaves
  • Haritaki – Terminalia chebula
  • Rasna – Pluchea lanceolata
  • Rasona – garlic
  • Priyangu – Callicarpa macrophylla
  • Grunjanaka – carrot
  • Madhu – honey
  • Kaumbha ghrita – 100 years old ghee

Apathya (unwholesome, non-beneficial thins)

  • Aanupa mamsa – flesh of animals living in marshy areas
  • Dadhi – curds, preparations made in large quantities of curds
  • Masha – black gram
  • Pishta – flour, flour preparations
  • Dushta anna – contaminated food
  • Upodika – Basella alba
  • Guru dravya – food which is heavy to digest
  • Shukra vega dharana – forcibly controlling the ejaculation reflex during sex or urge (reflex) to ejaculate semen or sexual desire
  • Vega dharana – forcibly controlling the natural body urges or reflexes Example, the urge for defecation, urination, hunger etc
  • Prushta yana – travelling on animal backs
  • Vyayama – excessive exercises
  • Maithuna – excessive indulgence in sex
  • Ati ashana – excessive consumption of foods (over-eating)
  • Adhwa – excessive walking
  • Upavasa – fasting in excess

Useful Classical formulations for Vruddhi

  • Punarnavadi Kashayam
  • Dashamulam Kashayam
  • Gandharvahastadi Kashayam
  • Dashamulapanchakoladi Kashayam
  • Punarnavadi Mandura
  • Kanchanara Guggulu
  • Punarnavadi Guggulu
  • Shilajatu
  • Vanga Bhasma
  • Trivang Bhasm
  • Punarnavasavam
  • Triphala Churna
  • Haritaki Churna
  • Shotari Mandura
  • Vruddhivadhika Vati
  • Arogyavardhini Vati
  • Chandraprabha vati
  • Dashanga Lepa (external)

Other strategies in treating Hydrocele (Ayurvedic approach)
Vata-Kaphahara Chikitsa

Looking at the location of the disease (mutra vruddhi or varicocele), the site belongs to the Vata (lower portion of the body), mainly Apana Vata sthana.

At the same time, looking at the pathology, the collection of fluid (mutra) in the scrotum we can infer that Kapha (water body, liquid compartment) of the body is involved. Therefore Hydrocele should be looked to as Kapha morbidity occurring in the site of Vata.

Therefore measures to combat morbid Vata and Kapha should be taken in treating Mutraja Vruddhi vis-à-vis hydrocele.

Kapha lodged in Vata places – The vitiated Vata tends to pull down the kapha from its place. The Kapha drips down into the Vata sthana (lower places of the body which belongs to vata). Kapha is basically the water body in our system. The lower portion of the body including scrotum belongs to Vata (below navel) and it should be light and spacious for Vata to render its normal functions. When kapha or water drips into the vata zone, the lighter ‘vata area’ gets heavy due to gravitation of water components. Wherever this water gets accumulated, it causes the morbidity in those places. Example, if the water accumulates in the abdomen it causes ascites, if it accumulates in the ovaries it causes PCOS (polycystic ovarian syndrome), if it accumulates in urinary bladder it causes stones, urinary obstruction, excessive urination and diabetes and if it accumulates in the scrotum it causes hydrocele or mutra vruddhi.

The stagnation of water in the air space (vata=air,kapha=water), will block the Vayu. The vayu further gets disturbed and disturbs the whole body. The vata in turn causes pain and related symptoms.

Thus the strategy in dealing kapha and vata will be twofold:
– To eliminate the kapha (water)
– To control the vitiated vata

Kapha will be considered as agantu dosha (visitor, unwanted in this case), the alien. It is contaminating the Vayu zone. Therefore the first and foremost thing to address this issue is to free the Vayu zone by flushing out or expelling the accumulated kapha.

Vamana (therapeutic emesis or medicine induced vomiting), Kaphaghna aushadha-ahara-vihara (medicines – oral and external, food and activities which are antagonistic to kapha) and Virechana (therapeutic purgation) are ideal choices to expel the morbid kapha.

Medicines like Punarnava Mandura, Punarnavadi Kashayam, Shilajatu, Trivanga Bhasma, Shotari Mandura, Jalodarari Rasa, Dashamulapanchakoladi Kashayam, Varanadi Kashayam, Varadi Kashayam, Chandraprabha Vati, Gokshuradi Guggulu etc will be helpful in this condition.

Once the Kapha has been expelled, the vitiated Vata should be taken under control. Virechana (therapeutic purgation) and Vasti (herbal enema with medicated decoction or oil) will help to control the morbid vata. The diet, medicines and lifestyle practices which are antagonistic to Vata should be followed.

Medicines like Gandharvahastadi Kashayam,  Rasnaerandadi Kashayam, Maharasnadi Kashayam, Gandharvahastadi Eranda Tailam, Nimbamritadi Eranda Tailam, Mahavata Vidhwamsini Rasa, Vatagajankusha Ras, etc will help in mitigating the residual (vitiated) vata.

Once the morbid Kapha and Vata have been taken into control strategically the pathology and root of pathology of the problem (hydrocele in this instance) will be dealt with effectively.

Vata controlling treatment should be continued in the follow up phase to prevent recurrence. They should be continued at least for 2-3 months. At the same time, the status of Vata should be monitored by thorough examination of the patient in subsequent follow-ups. Simultaneously it is wise to look for recurrence of symptoms or collection of fluid and address them till the morbidity is rooted out.

Vataja Vruddhi Chikitsa
Mutraja Vriddhi is a variant of Vataja Vruddhi, the symptoms of Vataja Vruddhi are also evident in Mutraja Vruddhi.

Vataja Vruddhi Symptoms:
– Vata purna dhruti sparsha – the scrotum looks like an air filled sac or bag (or balloon)
– Ruksha – scrotum looks dry
– Ahetu ruk – pain without any reason

Treatment of Vata Vruddhi –
In Vata Vruddhi, snigdha virechana (purgation with medicated oils or ghee) should be administered.
For this milk mixed with Eranda Taila (castor oil) should be consumed daily for at least 1 month.

Eranda taila (castor oil) mixed with Guggulu (Commiphora mukul) and go mutra (urine of cow) is also beneficial in Vataja Vriddhi.

According to Sushruta:
Initially Traivrut sneha should be administered for snehana (oleation). Later Swedana (steaming treatment) should be given followed by Virechana (therapeutic purgation). After the Virechana and after a gap of 8 days, Niruha Vasti (herbal decoction enemas) prepared with kwatha (decoction) and kalka (paste) of Vatahara dravyas (herbs which are anti-vata or antagonistic to morbid vata) should be administered. Later Anuvasana Vasti (oil enemas) is administered with Yashtimadhu taila (oil)

External treatments:
Later application using sneha (medicated oils), upanaha (poultices) and Vatahara pralepa (paste prepared from herbs having anti-vata properties) is done over the afflicted area. After this Pachana or treatments (medicines) to ripen the immature Vruddhi is given followed by Bhedana (incision on the scrotum below and to the side of the midline of scrotum.

Kaphaja Shotha Chikitsa
Hydrocele can be treated on the lines of Shota or Shopha Chikitsa (line of treatment of swelling, inflammation, and edema). To be precise, it should be handled on the lines of Kaphaja Shotha (SHotha caused by morbid kapha) treatment. Read related: Kaphaja Shotha – Edema Due To Kapha: Symptoms, Treatment

Jalodara Chikitsa – Vruddhi treatment based on treatment lines of Jalodara

Kaphaja Granthi Chikitsa
Granthi means cyst or cystic swelling. They are glandular swelling with encapsulated fluid within them. Mutra Vruddhi also looks and appears like a granthi, especially Kaphaja Granthi.

Symptoms of Kaphaja Granthi –

  • Sheeta – cold to touch
  • Vivarna – disocloured
  • Alpa ruk – associated with mild pain
  • Ati pandu – pale appearance
  • Paashaanavat – stone hard on touch
  • Chira abhivruddham – develops slowly and gradually
  • Bhinnaha sravet shukla ghanam cha pooyam – on opening thick, white, viscid pus gets discharged

Treatment of Kaphaja Granthi can be adapted in treating Mutraja Vriddhi
If the Granthi is ama (unripe), shotha chikitsa (treatment on the lines of shotha or swelling) should be done and the granthi should be allowed to ripe. In pakwa granthi (ripe cysts), patana (excision, cut open) should be done by shodana (cleansing of wound). Following this, Vrana Ropana should be done (wound healing by application of wound healing medicines).

Principles of treating Kaphaja Granthi –
Shodhana – Body cleansing through Vamana (therapeutic emesis) and Virechana (therapeutic purgation)
Madhookadi Lepa – wound cleansing and healing (after patana) should be done by applying the paste prepared using Madhooka (Madhuca longifolia), Jambu (Syzygium cumini), Arjuna (Terminalia arjuna), and vetasa twak (bark of bamboo)
Formulations like Kanchanara Guggulu, Punarnava Kashaya, Triphala Guggulu etc are useful.

Treatment of pitta imbalance
As already discussed, Mutraja Vruddhi is a kapha-vata related problem we have seen that the kapha drips into the vata area and causes accumulation of fluids in the scrotum. While the Kapha from the upper portion of the body drips down due to gravitation, it passes through the pitta zone (middle part of the body related to digestive activities and core metabolism). The water body (kapha) passing through fire body (pitta) depletes or dilutes or diminishes the pitta or the core fire of the body. This will lead to agnimandhya (sluggish digestive fire) and ajeerna (indigestion). This further leads to accumulation of ama (unripe digestive juices) or kleda (fluids, unwanted) or kapha or jala (water) in various tissues leading to swelling and edema. The Pitta also flows down along with kapha into the vata sites. If pitta is stronger than kapha, it can cause inflammation of the structures below the navel, including the scrotum, testes, spermatic cord, groin etc and cause inflammatory fluid to accumulate in the scrotum.

In these conditions, apart from taking control over kapha and vayu, the pitta also should be tackled. If kapha is taken into control, the dripping of kapha stops and pitta will eventually be restored at its place.

After kapha has been eliminated and vayu has been taken under control, Deepana (fire kindling medicines and diet) and pachana (ama destroying medicines) should be administered so as to re-kindle and reestablish the pitta. This will also help in preventing the recurrence of the hydrocele.

Herbs like Pippali (long pepper), Shunti (ginger), Maricha (black pepper) etc and formulations like Chitrakadi Vati, Arogyavardhini, Trikatu churna, Panchakola churna, Ajamodadi churna, etc will be useful.

Just before concluding –
Ayurveda has clearly explained the treatment principles of all the diseases, hydrocele or mutra vruddhi in this instance. At the same time, Ayurveda also has mentioned and concealed the medications and treatment options of these conditions in some other context, due to the similarity of presentation of those diseases. Example, the treatment of Vrushana vruddhi (orchitis or hydrocele) has been mentioned in the chapter dealing with Shotha chikitsa. It might just be the best treatment for hydrocele. Therefore we have a lot of treatment options for a given disorder, but their explanation is scattered over different chapters, in contexts of diseases having similar presentation. It is left out for the skill and wisdom of the physician to adopt those treatments and medicines for better success.

This article is written with an intention of highlighting the different treatment options available for Hydrocele in Ayurveda. Along with that my intention is also to tell that the references for treatment and medicines for a given disease might not be available only in the related chapter but may also be available in a distant related chapter. This shows the importance of comprehensive theoretical and practical knowledge a physician should possess!!
Click to Consult Dr Raghuram Y.S. MD (Ayu)

 


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