Brief Answer:
Condition is more of psychological than physical

Detailed Answer:
Hello Dear.
Welcome to HCM.
Thanks for contacting Ayurveda with your health concern and after reviewing your history and suggestions given by other eminent members on the board I have come up with following symptomwise approach

1. Is problem with ejaculation or erection?
2. Are you in a relationship? any performance anxiety, feeling of guilt or fear of rejection?
3. Any associated psychological/physiological symptoms apart from physical symptoms described?
4. Are you taking any drugs which suppress libido ( bloop pressure medicines, gastric medicine, hormonal preparation, alcohol, opiates?
5. Since all blood parameters are normal thus hopefully it could be a psychological disease for which CBT (cognitive behavior therapy) is needed.

Do revert back with your clarification so that I can advice you on the said issue on the basis of 'Shukra gat Vata' or DHAT syndrome.

Dr. Munish Sood
Consultant & Physician
Naimittika

---

Brief Answer:
symptomwise approach and management

Detailed Answer:
Dear
Thanks for reverting back and start incorporating following dietary & lifestyle management:

A.
Ejaculation and Orgasm can be voluntarily controlled. You have to learn to recognize the sensations prior to orgasm and stop.

Stage I: Man is advised to masturbate himself, and when ejaculation is near, stop. Allow the erection to subside. Start again. Repeat this number of times before allowing ejaculation. Practice for 2-4 weeks.

Stage II: Learn the same with your partner.She will masturbate you near orgasm, stop when you indicate, wait for erection to subside, then start again.Repeat this a few times & then allow ejaculation. Practice for 2-4 weeks

Stage III: Follow the same method for intercourse, initially with female superior position and then with male superior position. The principle is to stop before ejaculation, wait for the erection to subside & then start again. Practice for 3-4 months, or more till perfect control is achieved.

PS. You may consult an Ayurveda Physician for " Tantric Vajroli" which is a very easy, very effective method to have a full control over ejaculation

. Belly breathing: Lie comfortably on a bed, on your back. Loosen [if any] tight clothing. Place one hand on your abdomen and the other on your heart. Now take a deep slow breath that you can feel all the way down to your abdomen. Breathe as if you are drawing breath down through your body, into your legs and toes. This time tested exercise will help allay anxiety, increase the ability to relax and activate the benevolent energies of the parasympathetic nervous system. [duration: 10 minutes]

. In my Clinical Practice I usually treat the patient on line of ": Shukragat Vata" which is characterized by a group of clinical presentations either with the impairment of ejaculation or with seminal abnormalities.

i. The line of treatment should be based on 'vrishya', 'medhya', 'shukrastambhaka', and 'vatahara' properties. You may Consult a good Ayurveda Physician or Hospital in and around your place.

B
Take: banana, coconut, water melon, pomegranate, raisins,dates, almonds, apple, pears, walnut, urad dal, carrots, apricots, amla, musk melon, bottle gourd, brinjal, potato, milk, milk cream, fresh curd, butter, onion
. Avoid: mainly 'clove' in any form

C
. CBT [cognitive behavioral therapy] is an essential part of treatment
. take trifla churan at bed time
. Akarakkarabhadi yoga: 500 mg [two capsules each twice a day]
. Lemon juice mixed with sugar in a glass of water helps release stress removing hormones from the body and bring mind at peace/rest
. Apple, almond, banana, broccoli, cantaloupe, melon, carrot, cashew nut, corn, cauliflower, grapes, guava, lemon, XXXXXXX orange, pineapple, soybean, spinach have anti oxidant and detoxifying properties so take them in plenty.

Dr. Munish
Naimittika

---

Brief Answer:
Management

Detailed Answer:
Dear
Thanks for reverting back.

1. Management of POIS/DHAT Syndrome includes a detailed evaluation of the patient due to the following reasons:

i. Patient(s) with this syndrome are usually in their teens
ii. No organic cause can be found to explain the anxiety related symptoms and other features
iii. The laboratory and other investigations are usually normal and since all these 3 points are present in you thus once diagnosis is established the treatment is done in two ways:

a) Drug therapy: prescription drugs which one can ask is/are: smritisagar ras,trifla churan,brihat vata chintamani ras,ghritkumari, ashwagandha, brahmi,jatamansi, stresscom.

. You can practice: bhujangasana,halasana, paschimottasana, sarvangasana, shalabhasana, shavasana and vakrasana and pranayamas like bhastrika and kapalbhati

b) Psychotherapy: or Counselling [CBT] plays a very important role which aims at removing the anxiety about sex,vitality and married life in future. It also helps the patient to clear myths and misconceptions about POIS.

Dr. Munish
Naimittika

---

Brief Answer:
some proven herbs in clinical practice

Detailed Answer:
Dear
Thanks for reverting back.

1. In Ayurveda, we have treatment based on three aspects through which it can be controlled & treated effectively:

. Ras Shastra Chikitsa
. Rasayan & Vajeekaran Chikitsa because of the influence of these three on sexual performance in man by inducing changes in the level of NT (Neurotransmitter) mainly SEROTONIN.

2. I have not prescribed Ras Shastra medicine since more comfortable with Rasayan/Vajeekaran herbs and some of the result oriented herbs are:

. Safed musli, Gokshura,Ashwagandha, valeriana welchii, Saffron, Nutmeg, Clove, Date palm,Ginseng.

3. You may contact with your doctor or consult a qualified Ayurveda practitioner there for the best herb(s) suitable for you and if interested I may recommend you the best combination suitable for people of your age group(s) with dosage and duration


Dr. Munish
Naimittika

---

Brief Answer:
further information

Detailed Answer:
Dear
Thanks for reverting back and following os further necessary information:

1. Leakage of semen while urinating/defecation is completely normal (secretion from Prostate) and shouldn't be of much concern but you may consult an Urologist to allay your anxiety.

2. I usually approach the disease in connection with the Endocrine system i.e. I usually prescribe the drugs which decreases Cortisol/Adrenaline and increases Melatonin and my choice of herbs are Ashwagandha root and Tulsi leaves.

3. Since main pathology in POIS is increase in Adrenaline & Cortisol & Melatonin oppose the action of both thus following things should be kept in mind:

I. Since melatonin is produced in dark thus make sure your room is devoid of light (dark curtains and keep away mobile/laptops away from you)

ii. Practice Belly breathing exercise immediately after orgasm which helps decreasing adrenaline/cortisol

iii. Take: Ashwagandha root (from a reputed Pharmacy) and take twice daily with lukewarm water and avoid STRESS as much as possible (since any stress will lead to release of Adrenaline^Cortisol.) You can take Tablet STRESSAN ( herbal tranquiliser) 1 tablet thrice daily.

iv. In people with POIS one must check with level of mercury-aluminum-zinc.

Dr. Munish
Naimittika

---

Brief Answer:
Clinical trials/review

Detailed Answer:
Dear
Thanks for reverting back

1. As Ashwagandha is a classic example of "adaptopgen" (which helps the body adapt to stress), and also has antioxidant & Immunodulator properties thus:

i. If a person is tense, anxious and hyperalert then take the capsule of Ashwagandha during day, otherwise take at evening.
ii. Avoid high doses in evening because in some people it lead to stimulation before leading to sedation.
iii. The drug is better absorbed on empty stomach.
iv. It is better to give a gap between the use of the drug (3-4 times /week as against daily)
v. Since numerous reports have been written about the prolonged use of Ashwagandha with rise in TSH (thyroid stimulating hormone) resulting in thyrotoxicosis/ hyperthyroidism thus regularly check with thyroid levels.

Dr. Munish Sood
Naimittika

---