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ERECTILE DYSFUNCTION AND AYURVEDA

Authors:
  • Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, India

Abstract and Figures

Erectile dysfunction or impotence is emerging as one of the most serious life style and stress related disease. Over exertion, physiological disturbances, lowered level of hormones and strained relationship with partner are the main causes for this disease. Apart from drug therapy and diet control regime, Ayurveda offers natural drugs with proven efficacy for treatment of erectile dysfunction. Ancient medical literature, especially Ayurveda, mentioned several natural drugs, alone or in combination, under the chapter of 'Rasayana' and 'Vajikaran' to be used in this type of disorders. Garlic is one of them used traditionally to enhance sexual power. Psychotherapy alongwith meditation and self belief may also prove very useful approaches to treat this disease. The latest research in modern medical science yielded several purified compounds to deal with bodily disorders. Sildenafil citrate USP and related compounds are the latest addition in the weaponry of the modern medicinal system used for the treatment of erectile dysfunction. In present article, two alike drugs of different systems and properties-Garlic – a traditional drug and Sildenafil citrate – a synthetic drug are compared. Special emphasis is given to establish the correlation in mechanism of action used for similar therapeutic effect i.e. erectile dysfunction along with a comparison on pharmacological and social basis. The results had shown that garlic has more or less same therapeutic effect and mechanism of action as that of Sildenafil citrate. The only step that differs is that Sildenafil citrate increases blood GMP level by inhibiting its degrading enzyme phosphodiesterase-5 (PDE 5) while garlic acts by activation of guanalyl cyclase enzyme and thus by increasing production of GMP in body. Garlic was observed to have lesser side effects and toxicity, no abuse potential and contraindications in comparison to Viagra. The use of garlic is also justified from social aspect and may be a drug of choice in comparison to Viagra. There is a possibility that an odorless garlic preparation may have potential to treat erectile dysfunction. Therefore further research work in this direction may be worthwhile.
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J. Res. Educ. Indian Med., Oct. - Dec., 2008 pg 15-24 ISSN 0970-7700
ERECTILE DYSFUNCTION AND AYURVEDA
ASHISH BALDI*
Plant Cell Culture Lab., Department of Biochemical Engg. and Biotechnology,
Indian Institute of Technology Delhi, Hauz Khas, New Delhi - 110016 (India)
Abstract : Erectile dysfunction or impotence is emerging as one of the most
serious life style and stress related disease. Over exertion, physiological
disturbances, lowered level of hormones and strained relationship with partner are
the main causes for this disease. Apart from drug therapy and diet control regime,
Ayurveda offers natural drugs with proven efficacy for treatment of erectile
dysfunction. Ancient medical literature, especially Ayurveda, mentioned several
natural drugs, alone or in combination, under the chapter of ‘Rasayana’ and
‘Vajikaran’ to be used in this type of disorders. Garlic is one of them used
traditionally to enhance sexual power. Psychotherapy alongwith meditation and
self belief may also prove very useful approaches to treat this disease. The latest
research in modern medical science yielded several purified compounds to deal
with bodily disorders. Sildenafil citrate USP and related compounds are the latest
addition in the weaponry of the modern medicinal system used for the treatment
of erectile dysfunction. In present article, two alike drugs of different systems and
properties- Garlic – a traditional drug and Sildenafil citrate – a synthetic drug are
compared. Special emphasis is given to establish the correlation in mechanism of
action used for similar therapeutic effect i.e. erectile dysfunction along with a
comparison on pharmacological and social basis. The results had shown that
garlic has more or less same therapeutic effect and mechanism of action as that
of Sildenafil citrate. The only step that differs is that Sildenafil citrate increases
blood GMP level by inhibiting its degrading enzyme phosphodiesterase-5 (PDE 5)
while garlic acts by activation of guanalyl cyclase enzyme and thus by increasing
production of GMP in body. Garlic was observed to have lesser side effects and
toxicity, no abuse potential and contraindications in comparison to Viagra. The use
of garlic is also justified from social aspect and may be a drug of choice in
comparison to Viagra. There is a possibility that an odorless garlic preparation
may have potential to treat erectile dysfunction. Therefore further research work
in this direction may be worthwhile.
Keywords: Ayurveda, Erectile dysfunction, Impotence, Garlic, Allium sativum,
Sildenafil citrate, Herbal medicine, Vajikaran, Rasayan chikitsa.
1. Introduction
Erectile dysfunction affects the lives of
million’s men and their partners. Erectile
dysfunction (ED) or impotence is the inability
of a man to achieve or maintain an erection
sufficient for his sexual needs or the needs of
his partner.
Ayurveda defines erectile dysfunction or
ED as follows:
* National Doctoral Fellow
Sankalpapravano nityam priyaam vashyaamapi sthreeyam ||
na yaathi lingashaithilyaath kadaachidyaathi vaa yadi |
Shwaasaarthaha swinnagaatrshcha moghasankalpacheshtitaha ||
mlaanashishnashcha nirbeejaha syodetat klaibyalaxanam |
(Charaka Chikitsa: 30/155-157)
Ashish Baldi16
This means even though a man has a
strong desire to perform sexual act with a
cooperative partner, he cannot perform sexual
act because of looseness (absence of erection)
of his phallus (penis). Even if he performs sexual
act with his determined efforts he does not get
erection and gets afflicted with tiredness,
perspiration and frustration to perform sex.
2. Physiology of Erection
There is a series of reactions involved in
the erection of muscles, in which nitric oxide
(NO) is utilized. Corpora cavernousa, the
erectile tissue, alongwith Corpus spongiosum
makes up the body of the penis and erection
consists of dilation of arteries of the penis and
blood in turn flows and fills the spaces in the
erectile tissue. NO is the principal vasodilator
in the penis. NO activates Guanylyl Cyclase,
present in the cell membrane, which results in
an increases in the level of Cyclic Guanosine
Mono Phosphate (CGMP) leading to the
relexation of smooth muscles of the Corpora
cavernousa, thus allowing inflow of blood.(1,2)
In Ayurveda, physiology of erection and
ejaculation is described as follows:
The apaana vayu one of the five types
of vayu is located in the testicles, urinary
bladder, phallus, umbilicus, thighs, groin, anus
and colon. Its functions are ejaculation of semen,
voiding of urine and stools. Shushruta explains
the process of erection and ejaculation as
“when a man has desire (ichcha) to have sex,
his response to touch increases. Vayu located
in skin causes flow of signals from skin to
brain, thus causing sensation of touch. This
causes arousal or harsha. Harsha intensifies
actions of vayu and at this moment highly active
vayu liberates the teja or heat of pitta. Thus
tejas and vayu increase body temperature,
heart beat and blood flow causing erection.”
3. Types of Erectile Dysfunction
3.1 Erectile dysfunction (primary and
secondary impotence): Primary impotence
refers to a man who has never been able to
maintain an erection for purposes of intercourse
either with a female or a male, vaginally or
rectally. In secondary impotence, a man cannot
maintain or perhaps even get an erection, but
has succeeded at having either vaginal or rectal
intercourse at least one time in his life. The
occasional failure to get an erection is not to be
confused with secondary impotence. Familial,
societal, and intrapsychic factors contribute to
primary impotence. Some of the more common
influences are(1) performance anxiety,(2) a
seductive relationship with a mother,(3) religious
beliefs in sex as a sin,(4) traumatic initial
failure,(5) anger toward women and
(6) fear of
impregnating a woman.
3.2 Rapid ejaculation: Rapid ejaculation
is the most common dysfunction and it is the
easiest to treat. Premature ejaculation can be
defined as the inability to delay ejaculation long
enough for the woman to orgasm fifty percent
of the time or as the inability to delay ejaculation
for thirty seconds to a minute after the penis
enters the vagina.
3.3 Retarded ejaculation (ejaculatory
incompetence): Ejaculatory incompetence is
the opposite of premature ejaculation and refers
to the inability to ejaculate inside the vagina.
Men with this difficulty may be able to maintain
an erection for 30 minutes to an hour, but
because of psychological concerns about
ejaculating inside a woman, are not able to
achieve orgasm. One of the reasons this
dysfunction goes undetected is because the
male’s partner is satisfied and indeed often is
able to achieve several orgasms. Most of these
men can readily achieve orgasm through
masturbation. Many factors contribute to this
condition, some of which are religious
Vrishunow basthimedram cha naabhyuuru vankshnow gudam |
Apaanasthaanamantrasthaha shukra mootra shakrunti cha ||
(Charak Chikitsa:28/10)
Erectile Dysfunction : An Ayurvedic Perspective 17
4.3 Over exertion - physically and
mentally : Working for long hours in office,
mental stress at office and home, short
temperedness and insufficient sleep cause
erectile dysfunction.
These causes are explained in Ayurveda
as “shoka chintaa, bhaya, traasaat....” which
means that erectile dysfunction occurs due to
grief, fear, anxiety and terror.
4.4 Strained relationship with sexual
partner: Erectile dysfunction also occurs
when there is a disliking towards sexual
partner. Ayurveda describes
this as “naarinaamarasamjnatwaat...........
means disliking for women.
4.5 Diseases that cause erectile
dysfunction: Neurological disorders,
hypothyroidism, Parkinson’s disease, anemia,
depression, arthritis, endocrine disorders,
diabetes, and diseases related to cardiovascular
system also become reasons for erectile
dysfunction.
According to Ayurveda the diseases
which cause erectile dysfunction are
Hritpaandurogatamakakaamalashrama...
Heart diseases, anemia, asthma, liver disorders,
and tiredness. Apart from these the imbalances
in tridoshas also cause erectile dysfunction.
4.6 Consumption of medicines, drugs
and tobacco: Using anti-depressants,
tranquilizers and antihypertensive medicines for
a long time, addiction to tobacco especially
smoking, excessive consumption of alcohol,
addiction to cocaine, heroin and marijuana cause
erectile dysfunction. In Ayurveda texts these
causes have been said in brief as
rukshamannapaanam tathoushadham” -
“dry food, drinks and medicines” cause erectile
dysfunction.
4.7 Trauma to pelvic region:
Accidental injury to pelvic region and
surgeries for the conditions of prostate,
bladder, colon or rectal area may lead to
erectile dysfunction.
restrictions, fear of impregnating, and lack of
physical interest or active dislike for the female
partner. In addition such psychological factors
as ambivalence toward one’s partner,
suppressed anger, fear of abandonment or
obsessional preoccupation also play a significant
role in developing retarded ejaculation.
4. Causes of Erectile Dysfunction
4.1 Physiological problems: Erection
requires a sequence of events. Erectile
dysfunction can occur when any of the events
is disturbed. Nerve impulses in the brain, spinal
column, around the penis and response in
muscles, fibrous tissues, veins, and arteries in
and around the Corpora cavernosa constitute
this sequence of events. Injury to any of these
parts which are part of this sequence
(nerves, arteries, smooth muscles, fibrous tissue)
can cause ED.
4.2 Lowered level of testosterone
hormone: The primary male hormone is
testosterone. After the age of 40 years, a man’s
testosterone level gradually declines. About 5%
of men that doctors see for erectile dysfunction
have low testosterone levels. In many of these
cases, low testosterone causes lower sexual
interest, not erectile dysfunction. The whole
male body responds to testosterone.
Even Sushruta has illustrated about this
response of body to the element shukra. He
has said:
This means The shukra (the element
which helps in reproduction) is present all over
the body. But the cream of shukra (semen)
comes out of the body only during the process
of ejaculation, which needs a joyful union of
mind and body. Decrease in production of
shukra causes erectile dysfunction.
“yatha payasi sarpistu goodashchekshow raso yatha
shareereshu tatha shukram nrinaam vidyaadhbishagwara”
( Sushruta Shareer: 4/20)
Ashish Baldi18
These causes are mentioned as
abhighata (trauma), shastra danta nakha
kshataha (injury from weapons, teeth and nail)
in Ayurveda (Charaka Chikitsa: Chap. 2).
4.8 Other reasons: Obesity, prolonged
bicycle riding, past history of sexual abuse and
old age also cause erectile dysfunction.
Ayurveda describes the cause of impotence or
erectile dysfunction due to old age as diminution
of - tissue elements, strength, energy, span of
life, inability to take nourishing food, physical
and mental fatigue lead to impotence.
5. Treatment of Erectile Dysfunction
5.1 Vajikarana therapy in Ayurveda:
Charaka has mentioned numerous herbal
remedies for erectile dysfunction which
contain natural aphrodisiacs. These
preparations enhance one’s potency by leaps
and bounds by increasing the span of erection,
hardness and prevent premature ejaculation and
rejuvenating the male reproductive system. The
total treatment for impotence is called as
Vajikarana therapy in Ayurveda. A third kind
of tonic herb, closely allied with Rasayanas, is
what is called in Ayurveda - Vajikarana.
A vaji is a horse or stallion.
These are substances that give the power
or vitality of a horse, particularly the horse’s
great capacity for sexual activity. More
commonly, one could call them “aphrodisiacs”.
Vajikaranas reinvigorate the body by
reinvigorating the sexual organs.
The semen or reproductive tissue (the
Ayurvedic concept includes both male and
female reproductive tissues) is the essence of
all the dhatus, the cream of all the tissue
elements in the body. It contains the power to
create life. This means not only the capacity to
bring a new life into existence, to create a
child, but also to renew one’s life, to return our
cells to the vigor of youth.
The same life-creating energy, if directed
inwards, can aid in the renewal of both body
and mind. Vajikarana substances may be used
either to improve sexual vitality and functioning,
or to help direct sexual energy inwards for
regeneration. Vajikaranas can be divided into
tonics and stimulants. Stimulants increase the
functional activity of the reproductive organs,
while tonics increase and improve the tissue-
substance that composes them. Others help
promote the creative transformation of sexual
energy for the benefit of the body-mind. By
starting in the reproductive system, these herbs
invigorate the entire system, just as a tree is
invigorated from the roots. They have a strong
revitalisation action on the nerves and bone
marrow, and increase the energy of the mind.
Semen is the soma of the body, which if
catalyzed in the right way, by Rasayana and
Vajikarana substances, brings about the
renewal of the mind. In a similar way, it helps
strengthen the bones, muscles, ligaments and
blood.
Ayurveda also discriminates those herbs
that enhance spermatogenesis, called shukrala.
These are substances that are nutritive tonics
to the reproductive secretions, like semen and
breast milk. They are mainly those Vajikaranas
which are nutritive. Those aphrodisiacs whose
nature are Sattvic, and are strong in energy,
also enhance Ojas. Such substances include
Ashwagandha, ghee Shatavari and others.
Numerous herbal preparations are
mentioned in Ayurveda to treat ED or
impotence. It has been said that people who
have strong sexual urge, who want to enjoy
sex regularly have to consume these preparations
regularly to replenish the energy, vigor, stamina
and strength. These preparations also supply
the nutrients which are necessary for production
of semen. The major combinations and
preparations described in Ayurveda and
Charaka Samhita for enhancing or maintaining
Erectile Dysfunction : An Ayurvedic Perspective 19
sexual ability includes some of the most
commonly occurring natural drugs of plant origin.
Some of these are Garlic, Bhanga, Orchis
mascula, root extracts of Bombax
malabaricum and Amaranthus adscendens,
Phalagrita, powdered root of Albizzia lebbek,
Saffron, nutmeg extract, pepper, clove and
gandhak. Most of these agents are used in
combinations. Local application of Jaiphal,
Lavanga, Pista and Nirgundi on the penis has
been claimed to increase vascularity and
contractility.
5.2 Drug therapy: As impotence is an
increasing problems world wide due to change
in life style and stress, the pharmaceutical
industry has initiated efforts to tackle the grave
situation and yielded a few important drug
molecules. Sildenafil citrate USP, a drug which
is manufactured by Pfizer Inc. as ‘Viagra’, and
was approved by the Food and Drug
Administration (FDA) in March 1998 for the
treatment of erectile dysfunction or impotence,
became the first oral medication for erectile
dysfunction in the market. Since then, Levitra
(Vardenafil) and Cialis (Tadalafil) have been
approved, providing more options for oral
therapy.
5.3 Psychotherapy: Decreasing anxiety
associated with intercourse, with psychologically
based treatment helps to cure ED. The patient’s
partner can help with the techniques, which
include gradual development of intimacy and
stimulation. Such techniques also can help
relieve anxiety when ED from physical causes
is being treated. Same treatment is illustrated
in Ayurveda. It has been said “A woman who
understands a man and is liked by him, along-
with erotic environment act as best aphrodisiac.”
5.4 Diet and nutrition control:
Nutrition can also have a lot to do with sexual
vitality, which clearly decreases with
malnourishment. The focus of the diet is on
antiaging and a healthy cardiovascular system.
A wholesome diet low in fat and high in fiber
and complex carbohydrates is a good thing to
begin. Any diet (and life style) that maintains
good circulation and normal weight and contains
high-vitality fresh foods will lead to better sexual
function. A good protein intake is important, but
excessive protein may interfere with sexuality.
Likewise, adequate dietary fats and fatty acids
are required for normal hormonal function.
Cholesterol is a precursor of several
sexual hormones, and if it is too low, this may
lead to impaired sexual function and
vitality. Extra vitamin E may be helpful for
sexual vitality and fertility, but this is still hard
to prove in humans. The essential fatty acids
are important to tissue strength and membrane
integrity and fluidity.
Niacin, the flushing form of vitamin B3,
acts as a vasodilator, increasing blood flow to
the skin and many other parts of the body. Some
people also experience sexual stimulation from
this niacin flush. Zinc seems to be especially
related to male fertility and sex drive. Low zinc
levels may lead to impotence, a low sperm
count, and a loss of sexual interest. However,
taking more than 100 mg. daily is not
recommended as this can reduce immune
function and absorption of other minerals, such
as copper and manganese. Prostate health and
testosterone hormone production may also be
influenced by zinc. Vitamin C is associated with
sperm motility, and male infertility has been
related in part to vitamin C deficiency.
Besides vitamin C, the bioflavonoids,
along with vitamins A and E, and the mineral
zinc, are important to healthy mucous
membrane tissue and function. L-arginine, an
amino acid, is also somehow related to sperm
production. Selenium may mildly stimulate sexual
energy; manganese may also be related to sex
drive; and molybdenum may have an as-yet-
undetermined influence on sexual function.
Pantothenic acid provides pituitary and adrenal
support and thus, indirectly improves
testosterone production in men. Folic acid is a
Ashish Baldi20
B vitamin helpful for both ovarian function and
sperm production, and it, alongwith beta-
carotene, vitamin E, and selenium, may reduce
the production of abnormal cells. Iodine supports
the thyroid gland function, which improves both
the desire and capacity for sexual activity.
Sperm contains calcium, zinc, sulfur,
vitamin B12, vitamin C, and inositol, so these
are likely important also. ATP (energy) is an
absolute requirement for sperm motility, so
nucleic acids, especially inosine.
6. Garlic and Sildenafil Citrate: A
Comparative Case Study
In this section, attempts have been made
to compare two alike drugs of different system
and nature, a well known synthetic drug –
Sildenafil citrate and a commonly used natural
drug – Garlic, on the pharmacological basis. A
special emphasis was given to establish
correlation between NO production and
mechanism of erection by these drugs and also
social implications of their use in treatment of
erectile dysfunction. It is summarized that the
mode of action and mechanism are almost
similar, one is useful in case of S.O.S.
requirements, while second may be used as
long term therapy, but free from side effects-
medicinally and socially as well.
6.1 Mechanism of action of sildenafil
citrate: Viagra, Levitra and Cialis work in much
the same way, chemically known as
phosphodiesterase inhibitors. Among these,
Sildenafil citrate is an inhibitor of
phosphodiesterse type 5 (PDE-5) an enzyme
that degrades GMP. Thus it helps to retain high
levels of CGMP during erection. It also inhibits
PDE-6, involved in phototransduction in the
retina. Its effect was found to be 4000 fold
greater than any other PDE-inhibitors. Studies
had shown that the drug causes erection only
in response to sexual stimulation.(3,4)
6.2 Garlic: The garlic or lasan consists
of ripe bulbs of the Allium sativum Linn
belonging to the family Liliaceae and contains
not less than 0.1% allicin.(5) Alongwith several
uses of garlic, its cloves are used as a vegetable
to treat preliminary stages of impotency.
Traditionally Lasun chatni or Lasun dal
alongwith ghee is taken to increase sexual
power. It is reported that garlic can exert some
of its therapeutic properties by increasing NO
production in the body.(6)
6.3 Garlic and nitric oxide production:
At present, two distinct types of enzymes that
catalyse NO production are known i) Ca++
requiring constitutive enzyme or cNOS and ii)
Ca++ independent inducible enzymes or iNOS.
At least two isoforms of cNOS exist- eNOS,
present in endothelial cells and nNOS present
in neuronal cell(7) and garlic has also been
shown to increase the activity of NOS in cell
free system which is probably an effect on
cNOS.(6)
Amino acid analysis of garlic power
showed the presence of most of the commonly
occurring amino acids as well as several related
compounds. Arginine was present at the highest
concentration along with significant amounts of
lysine, alanine glutamic acid, serine and histidine.
Ingestion and complete absorption from 1 gm.
of garlic powder raised the blood arginine
concentration by approximately 16 ìM/L, if the
blood volume is assumed to be 5 Ltr. Normal
serum arginine concentration rangesfrom
59-143 ìM/L. This raises the possibility that
arginine present in garlic may be responsible
for its activation of NOS seen in cell-free
homogenates of platelets.(8,9)
All the NOS-isoenzymes catalyse five
electron oxidation of L-arginine to NO and
citruline using reduced nicotinamide adenine
dinucleotide phosphate (NADPH) as the source
of the electrons and the cofactor
tetrahydrobiopeterin (TBH), flavin adenine
dinucleotide (FAD), flavin mononucleotide
(FMN) and protoprophyrin IX (Heme). The
Erectile Dysfunction : An Ayurvedic Perspective 21
process incorporates molecular oxygen into NO
and cirtuline.(10-12)
The linkage between garlic and L-
arginine-Nitric oxide was reported by Das
et al. (1996). The L-arginine-NO pathway was
originally identified in vascular endothelial
cells.(13-20) The significant relation between NOS
and cellular polyamine was also established by
Soorana et al. (1995). Since NO and
polyamines are both products of L-arginine
metabolism(21) and there is a link between garlic,
L-arginine and NO pathway, there is a
probability of relation of polyamines with the
production of NO by garlic also.
It was reported that garlic increase the
activity of GTP-Cyclohydrolase-I enzyme,
which is responsible for the synthesis of TBH
by GTP.(22-24) The ability of garlic to increase
both Nitric Oxide Synthesis (NOS) and the
production of one of the essential cofactors-
TBH for the enzyme, adds support to the claim
that garlic can exert some of its therapeutic
properties by increasing NO production in the
body.(6,11,12)
The dose dependent increase in NOS
activity by garlic without having effect of arginine
on NOS was reported by Das et al. (1996).
When the effects of perchloric acid extract of
garlic on placental NOS activity were studied
in the presence and absence of equivalent
amount of arginine present in garlic, arginine
by itself did not enhance the NOS activity.
However the garlic extract showed a dose
dependent increase in NOS activity.(8) This
raises the possibility that a substrate other than
arginine is responsible for the NOS activation
by garlic. The beneficial effects of garlic on
vasodilation were reported.(25,26)
Garlic increases in NOS activity
depending on dose. The vascular endothelium
has a primary regulatory role to kept the blood
vessels dilated and NO is continuously released
by vascular endothelial cells and regulates the
blood flow and vasodilaiton.(27) This release of
NO appears to be shear stress and tone
dependent and this constitutes a local vascular
reflex mechanism to sustain regional blood flow
GTPCH-1
TBH
Garlic
Dose de
p
endent increase in NOS activit
y
Nitric oxide synthesis
Free radical
g
eneration Metabolites as NO2
S - Nitrothiols
(
at cell membrane
)
Activation of Guanal
y
l c
y
clase enz
y
me
GTP
into vascular beds in the presence of intense
sympathetic vasoconstriction.(2,10,12) (Figure I)
7. Results and Discussion
7.1 Erectile dysfunction and its
treatment: Erectile dysfunction is emerging
as one of the most serious life style and stress
related disorder. Physiological disorders, over
exertion, lowered level of testosterone and
strained relationship with partner are the main
causes of this disease. Apart from drug therapy
and diet control regime, Ayurveda offers natural
drugs with proven efficacy for treatment of
erectile dysfunction. Psychotherapy alongwith
meditation and self belief may also be very
useful approaches to treat this disease.
7.2 Garlic vs Sildenafil citrate - A case
study: Rasayana and vajikaran are the
important chapters in the Ayurveda. The drugs
Fig. I. Activation of Guanalyl Cyclase Enzyme by Garlic
Ashish Baldi22
mentioned in these chapters are even dispended
to healthy individuals for the improvement of
sexual desire and some times as preventive
medicine to prolong life. Garlic is one of the
most constantly featured natural drugs in these
combinations.
On the other hand, the use of Sildenafil
citrate U.S.P. is associated with several side
effects by increase in concentration of NO, a
signaling molecule, in the body and has effect
on different systems and body mainly
cardiovascular system. Simultaneously there are
several undesired effects socially as well as
free use of this drug may lead to alarming
situation in the society. There is huge difference
in the social norms of the countries of east and
west, mainly because of climate and
environmental conditions. Sildenafil citrate, a
drug of West to enhance the sexual activities
may be responsible for the sexual crimes in the
East, therefore the use of drugs like Sildenafil
citrate should be regulated otherwise a boon
for western countries will prove our to be a
curse of eastern countries.
Comparison between Garlic and Sildenafil
citrate on of the basis of medicinal potential
and social aspects is given as Table 1.
The results had shown that as far as
therapeutic effects of Sildenafil citrate in erectile
dysfunction is concerned; garlic also has more
or less similar effects and mode of action. The
only step that differs is that Sildenafil citrate
increases blood GMP level by inhibiting its
degrading enzyme phsphodiesterase-5 (PDE-5),
while garlic acts by activation of guanalyl
cyclase enzyme and thus by increasing
Table 1. Sildenafil Citrate and Garlic -A Comparison
S. No. Parameter Sildenafil Citrate Garlic
1 Nature Synthetic Herbal
2 Main active
constitutents
Sildenafil Citrate USP Many organo-sulfur and some other
compounds
3 Economy Costly Abundant
4 Onset of action One-hour-Tablet,
15 Minutes-Spray
Dose dependent
5 Degradation By cytochome P-450 Mainly by sulfur detoxication pathway
6 Metabolism Hepatic Hepatic
7 Abuse-potential High No
8 Side-effects Very toxic at high doses,
Visual impairment, Headache, Dyspepsia,
Indigestion, Painful and prolonged
erection, Death.
Not used in woman
Mild and transient,
Contact dermatitis, Inflammation of GIT,
Asthma
Equally effective in women
9 Warning &
contraindica-
tions
Patient’s having cardiac diseases, with
vasodilators, with nitrate containing drug,
with CYP- Inhibitors (sustained erection)
No
10 Dose As directed by the physician Maximum tolerable dose - 25ml. of fresh
aqueous garlic extract,
further research required for therapeutic
level determination
11 Uses For erectile-dysfunction Wide range of therapeutic uses including
use in erectile dysfunction
Erectile Dysfunction : An Ayurvedic Perspective 23
production of GMP in body, and rest of the
steps are common in both the cases. Detailed
mode of action and interactive steps of both
the drugs under study is given as Figure II.
level determination and pharmacological studies
on an odorless garlic based preparation may be
worthwhile.
Acknowledgements
The author gratefully acknowledges all
help and guidance given by Dr. S. Saraf and
Dr. Swarnalata Saraf, Institute of Pharmacy,
Pt. Ravishankar Shukla University, Raipur,
Chhattisgarh (India) during the study.
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Fig. II. Mechanism of Action of Viagra and Sildenafil Citrate
Garlic Sildenafil Citrate
Activation of Guanal
l C
clase Inhibition of CGMP-degrading
enzyme PDE-5
Dose de
p
endent increase in levels of blood GMP
Induction of a sequence of protein
phosphorylation
Smooth muscle relaxation
Sexual stimulation
Arteries su
pp
l
y
in
g
p
enis
More blood in erectile tissue – Cor
p
ora
Ex
p
ansion of these s
p
aces
Compression of veins draining the penis
More blood entrapped
Vascular Changes
Erection
Parasympathetic reflex
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Oxide Synthase (NOS) by garlic.
On the basis of above inferences, it can
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substitute of synthetic drugs for erectile
dysfunction and there is a possibility to treat
this disease with a natural product based
preparation. Therefore further research work
in the direction of standardization, therapeutic
Ashish Baldi24
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Abbreviations: NOS-Nitric Oxide Synthases: GTP-
Guanosine tri Phosphate; GTPCH-I GTP
Cyclohydrolase-I; PDE-5 Phosphodiestrease-5: TBH-
Tetrahydrobiopterin, CGMP-Cyclic Guanosine Mono
Phosphate.
Address for correspondence : Ashish Baldi, National Doctoral Fellow, Plant Cell Culture Lab.,
Department of Biochemical Eng. and Biotechnology, Indian Institute of Technology Delhi, Hauz Khas,
New Delhi - 110016 (India). E-mail: baldiashish@gmail.com
032-2007
... WHO also suggests that it is high time for the countries to include traditional and modern evidence-based medicine (EBM) as a part of their constituent health care system [5]. Author and his co-workers are also contributing significantly towards quality management and regulatory perspectives of herbal and traditional products [6][7][8][9][10]and extensively reviewed and established preliminary clinical evidences for herbal drugs/formulations in treatment of erectile dysfunction, sexual disroders [11][12][13][14][15], diabetes [16][17][18], hepato-toxicity [19,20], cancer [21]and for antioxidant potential [20,22,23] and in cosmetics [24]. Further in depth pharmacological evaluation and mechanistic studies are in progress. ...
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