A clinical evaluation of Kanchanara Guggulu and Bala Taila Matra Basti in the management of Mutraghata with special reference to benign prostatic hyperplasia.

BACKGROUND: Mutraghata a disease of Mutravaha Srotasa (urinary system) described in Ayurveda, closely resembles with benign prostatic hyperplasia (BPH) of the modern medicine. It affects man above the age of 40 years. Conservative management with hormonal therapy, open prostatectomy and TURP are the options available in modern medicine. In Ayurveda, the drugs having Vata Kapha pacifying action, Shothahara (anti-inflammatory) and Mutrala (diuretic) are recommended for its management. AIM: The aim of this study was to evaluate the clinical efficacy of Kanchanara Guggulu orally and Bala Taila Matra Basti in the management of Mutraghata (BPH).
MATERIALS AND METHODS: A total of 32 selected patients were divided into two groups. In group A, Bala Taila 60 ml, Matra Basti, once a day, was administered just before breakfast for 21 days. In group B, Bala Taila (60 ml), Matra Basti, once a day, was administered just before breakfast for 21 days and Kanchanara Guggulu Vati 1g (2 tab, 500mg each) three times a day, orally with lukewarm water was administered for 21 days. Findings were recorded in research proforma at weekly interval and patients were followed up till 1 month.
RESULTS: In group A, the maximum improvement was seen in 3 patients (25.00%), moderate improvement was seen in 8 patients (66.67%) and mild improvement was observed in 1 patient (8.34%). Similarly, in group B, the maximum improvement was found in 10 patients (55.56%), moderate improvement in 7 patients (38.89%) and mild improvement in 1 patient (5.56%) only. None of the patients got complete remission or remained unchanged in either of the groups. Significant reduction was observed in postvoidal residual urine volume and the size of the prostate in both the groups.
CONCLUSION: It was concluded that Matra Basti along with Kanchanara Guggulu orally showed Mutraghata comparatively better symptomatic relief as compared to Matra Basti alone in cases of Mutraghata (BPH).

Introduction

In Ayurveda, Mutraghata has been defined as a syndrome of obstructive urinary pathology due to deranged function of Vata Dosha, particularly Apana Vata (a type of Vata responsible for excretory function). Twelve types of Mutraghata[1] are mentioned in Sushruta Samhita Uttaratantra. The symptoms such as retention of urine, incomplete voiding, dribbling, hesitancy and incontinence of urine are found in Mutraghata; these features probably reflect lower urinary tract symptoms. Based on these features, Mutraghata bears a close resemblance with benign prostatic hyperplasia (BPH). BPH is a nonmalignant enlargement of the prostate gland caused by excessive growth of the prostatic tissue and is the most common benign neoplasm of aging men mainly above 40 years.[2] The overall incidence rate of BPH is 15/1000 men/year. The prevalence of histologically diagnosed prostatic hyperplasia increases from 8% in men aged 31–40 years, to 40–50% in men aged 51–60 years and to >80% in men elder than 80 years.[3] The management of BPH is either through a surgical approach (e.g. open prostatectomy, transurethral resection of the prostate, cryotherapy etc.) or by conservative treatment using drugs (e.g. hormonal therapy) in the modern medicine. In case of hormonal therapy, though there are some advantages, the complications such as loss of libido, impotence and gynecomastia are unwanted effects encountered in clinical practice. In a surgical procedure, prostatectomy is choice, but it also has many complications like postoperative morbidity, impotence, retrograde ejaculation etc. The other procedure is Transurethral Resection of the Prostate (TURP), which is also not free from complications and recurrence rate is around 15% in 5–8 years after TURP.[4] In Ayurveda, Sushruta has given regimen consisting of Kashaya (decoction), Kalka (paste), Ghrita (medicated ghee), Kshara (alkalizers), etc. to combat this condition.[5] The formulations having property of pacification of Vata, Vatanulomana, anti-inflammatory, scraping and diuretic effect and therapeutic procedures such as Matra Basti and Uttara Basti are recommended to normalize the function of urinary system by reducing the size of the prostate, clearing the bladder outlet obstruction and to enhance the tone of urinary bladder. Matra Basti is treatment for vitiated Vata where no strict restrictions are required. Hence, this research work was planned to assess the efficacy of Kanchanara Guggulu, which has Vata-Kapha pacifying, anti-inflammatory, cyst dissolving properties and Bala Taila Matra Basti in the management of Mutraghata (BPH).

Aims and objectives

The aim of this study was to evaluate the clinical efficacy of Kanchanara Guggulu (KG) orally and Bala Taila Matra Basti in the management of Mutraghata with special reference to BPH.

Materials and Methods

The patients having signs and symptoms of Mutraghata (BPH) were selected from the outpatient department and inpatient department of Shalya Tantra. The trial formulations Bala Taila and Kanchanara Guggulu (KG) were prepared and supplied by Pharmacy, Gujarat Ayurved University, Jamnagar. Before registering the patients in clinical trial, clearance from the Institutional Ethics Committee was obtained, vide letter no. PGT/7-A/Ethics/2013-14/1767 Dated 10/09/2013. The trial has been registered in CTRI with registration No. CTRI/2015/07/006010, date of first enrolment was February 19, 2014 and date of completion of the trial was January 20, 2015.

Inclusion criteria

Age between 40 and 70 years

Patients having classical signs and symptoms of Mutraghata (BPH).

Exclusion criteria

Age below 40 years and above 70 years

Patients of malignancy, congenital deformities of the urogenital tract or any abdomino-pelvic pathology other than BPH

Systemic diseases such as uncontrolled systemic arterial hypertension and diabetes mellitus, tuberculosis, paralysis and parkinsonism known cases of heart disease were excluded from the study

Diagnostic criteria

Patients having signs as enlarged prostate size and decreased urinary flow rate and symptoms like retention, incomplete voiding, dribbling, hesitancy and incontinence of urine were diagnosed as a case of Mutraghata (BPH)

International Prostate Symptom Score (IPSS) (based on the guidelines of American Urological Association) was used to evaluate subjective complaints of patients before and after the administration of the therapy, average urine flow rate (AUFR) measurement (manually), ultrasonography (USG) findings of the prostate gland and post voidal residual urine (PVRU) volume and per rectal digital examination for the prostate was also done.

Investigations

In all patients, the following laboratory and radiological investigations were carried out before and after treatment

Routine hematological examination: Hb%, complete blood count, erythrocyte sedimentation rate

Biochemical examination of fasting blood sugar, postprandial blood sugar, serum creatinine, serum alkaline phosphatase and blood urea

Routine and microscopic examination of urine and stool

USG abdomen and prostate

X-ray kidney, ureter, and bladder.

Trial drugs

Bala Taila (BT): The contents of Bala Taila are Atibala (Abutilon indicum (L.) Sweet)[6] and Tila Taila (Sesamum indicum L.)[7] which were prepared as per the Snehapaka Kalpana (clssical procedure to prepare medicated oil) and procured from Pharmacy Gujarat Ayurved University, Jamnagar

Kanchanara Guggulu (KG): It was prepared as per the reference given in Sharangdhara Samhita.[8]

Clinical study design

Registered patients by coin-toss method were divided into two groups, group A (Bala Taila Matra Basti) and group B (Bala Taila Matra Basti and Kanchanara Guggulu). All the patients were followed up till 1 month.

Group A: Bala Taila Matra Basti 60 ml once a day, administered to selected 12 patients before breakfast for 21 days

Group B: Bala Taila Matra Basti 60 ml was given once a day, administered to selected 18 patients, before breakfast for 21 days along with Kanchanara Guggulu orally 1g (2 tab., 500mg each) three times a day after food with lukewarm water for 21 days.

Assessment criteria

Subjective criteria

Improvement in the symptoms as per the IPSS.[9]

Objective criteria

Changes in residual urine volume. [Table 1]

Table 1

Gradation of residual urine volume

Post viodal residual urine volume (PVRU)	Gradation
Nil (up to 30 cc)	0
30–60 cc	1
60–90 cc	2
90–120 cc	3
>120 cc	4

Changes in urine flow rate. [Table 2]

Table 2

Gradation of urine flow rate

Urine flow rate (UFR)	Gradation
Normal or more (≥15 ml/s)	0
11–15 ml/s	1
7–11 ml/s	2
3–7 ml/s	3
0–3 ml/s	4

Changes in prostatic size as assessed by per rectal digital examination and USG study. [Table 3]

Table 3

Gradation of prostate size (volume)

Prostate size as per USG (volume)	Gradation
Up to normal (14–26 cc)	0
26–36 cc	1
36–46 cc	2
46–56 cc	3
>56 cc	4

Overall assessment criteria

Complete remission: 100% relief in subjective, objective findings and IPSS parameters

Maximum improvement: 76%–99% relief in subjective, objective findings and IPSS parameters

Moderate improvement: 51%–75% relief in subjective, objective findings and IPSS parameters

Mild improvement: 26%–50% relief in subjective, objective findings and IPSS parameters

Unchanged: Up to 25% relief in subjective, objective findings and IPSS parameter.

General observations

All patients were vegetarian and consuming Madhura Rasa (sweet taste) and Snigdha Guna (oily) food articles, 46.87% of patients were having irregular bowel habit and 37.5% patients had habit of passing hard stool. Maximum 59.37% patients had chronicity of disease up to 1 year [Table 4].

Table 4

General observations (n=32)

Observation		No. of Patients (%)
Age group	61-70	50%
Religion	Hindu	96.87%
Socio -economic status	Lower Middle Class	75.00%
Nature of work	Physical Labor	53.13%
Marital status	Married	100%
Education (primary level)		84.37%
Dietetic habit	Samashana	81.25%
Koshtha (bowel habit)	Madhyama	84.37%
Agni (digestion state)	Manda	71.87%
Dominancy of Rasa in diet	Madhura Rasa	100%
	Sigdha Guna	93.75
Vaya (age)	Madhyama	53.13%

In the present study, nocturia and increased frequency of micturition was found in 87.50% patients. Similarly, other symptoms such as weak stream, dribbling, incomplete voiding, burning micturition and urgency was observed in 81.25%, 75%, 68.75%, 65.63% and 62.50% of the patients respectively. None of the patients suffered from hematuria or dysuria [Table 5].

Table 5

Symptoms wise distribution as per IPSS

Symptoms	Group A		Group B		Total
	n	%	n	%	n	%
Nocturia	10	83.33	18	100.00	28	87.50
Increased frequency	10	83.33	18	100.00	28	87.50
Dribbling	11	91.67	13	72.22	24	75.00
Heamaturia	0	00.00	0	00.00	0	00.00
Burning micturation	7	58.33	14	77.78	21	65.63
Dysuria	4	33.33	4	22.22	8	25.00
Incomplete voiding	6	50.00	16	88.89	22	68.75
Weak stream	11	91.67	15	88.33	26	81.25
Urgency	7	58.33	13	72.22	20	62.50

*IPSS: International Prostate Symptom Score

As per per-rectal examination, maximum patients (53.13%) were noted having prostate enlargement of both lobes, oval shaped (84.37%) with smooth surface (100%). The upper border of the prostate was not approachable in 53.13% patients, median groove of the prostate was palpable in 87.50% and free rectal mucosa and firm consistency of prostate were noted in 100% cases. The size of the prostate gland was mildly enlarged in 59.37% of patients [Table 6].

Table 6

Per rectal digital examination findings (n=32)

P/R Digital Findings		Group A		Group B		Total
		n	%	n	%	n	%
Enlargement of lobes	Bilateral	6	50.00	11	55.00	17	53.13
Shape	Oval	10	83.33	17	85.00	27	84.37
Surface	Smooth	12	100.00	20	100.00	32	100.00
Upper border of gland	Unreached	5	41.67	12	60.00	17	53.13
Median groove	Palpable	10	83.33	18	90.00	28	87.50
Mobility	Fixed	12	100.00	20	100.00	32	100.00
Rectal mucosa	Fixed	0	00.00	0	00.00	0	00.00
Consistency	Firm	12	100.00	20	100.00	32	100.00
Tenderness	Absent	12	100.00	20	100.00	32	100.00
Enlargement of gland	Mild	8	66.67	11	55.00	19	59.37

Results

Laboratory investigations

In both of the groups in significant changes ere found in most of haematological and biochemical parameters.[10] [Table 7]

Table 7

Effect of therapy on investigations in Group B: (n=18)

Parameters	Mean Score		%Relief	SD	SE	T	P
	BT	AT
Hemoglobin (%)	13.42	13.67	1.90	0.371	0.087	-2.92	0.010
Total WBC ( /cumm)	6916.66	7183.33	3.86	1038.09	244.68	-1.09	0.291
ESR (mm/hr)	25.78	19.33	25.00	13.06	3.08	2.09	0.052
FBS (mg/dl)	103.94	103.0	-0.91	13.36	3.15	0.3	0.768
PPBS (mg/dl)	139.1	132.6	4.63	18.63	4.39	1.47	0.160
Sr. Alkaline Phosphatase (IU/L)	52.05	46.83	10	12.55	2.96	1.765	0.096
Blood Urea (mg/dl)	30.44	27.22	10.58	7.24	1.71	1.89	0.086
Sr. Creatinine (mg/dl)	1.15	1.16	-0.97	0.178	0.042	-0.265	0.794
Urine Albumin (gm/dl)	1.43	1.43	0.0	0.816	0.309	0.0	1.00
Urine Sugar (mmol/L)	1.25	1.50	-20.0	0.957	0.479	-0.52	0.638
Urine Pus Cells ( /HPF)	9.36	9.86	-5.34	13.35	3.57	-0.14	0.891

** BT- before treatment, AT- after treatment, SD- standard deviation, SE- standard error

Result on International Prostate Symptom Score

Statistically highly significant relief (P < 0.001) was recorded in chief complaints like nocturia, increased frequency of micturition, incomplete voiding, dribbling and weak stream, while significant relief (P < 0.01) was noted in burning micturition and urgency in group A [Table 8]. Statistically highly significant (P < 0.001) result was noted on almost all symptoms in patients of group B [Table 9].

Table 8

Effect of therapy on IPSS in Group-A (n=12)

International Prostate Symptoms Score (IPSS)	Mean Score		n	%Relief	SD(±)	SE(±)	t	P
	BT	AT
Incomplete emptying	1.4	0.2	12	84.24	0.866	0.25	5.0	<0.001
Frequency	2.5	0.5	12	77.42	0.603	0.174	11.48	<0.001
Intermittency	1.2	0.2	7	77.78	0.577	0.218	4.58	0.004
Urgency	2.1	0.2	9	89.47	1.054	0.351	5.376	<0.001
Weak stream	1.8	0.3	11	80.00	0.522	0.157	9.24	<0.001
Straining	1.6	0.2	8	84.62	0.744	0.263	5.23	0.001
Nocturia	2.0	0.6	11	69.57	0.934	0.282	5.164	<0.001
Quality of life	3.2	1.4	12	58.33	0.577	0.167	11.00	<0.001

** BT- before treatment, AT- after treatment, SD- standard deviation, SE- standard error

Table 9

Effect of therapy on IPSS in Group-B (n=18)

International Prostate Symptoms Score (IPSS)	Mean Score		n	%Relief	SD(±)	SE(±)	t	P
	BT	AT
Incomplete emptying	2.71	0.76	17	71.74	0.966	0.234	8.282	<0.001
Frequency	3.11	0.79	18	75.00	0.97	0.23	10.20	<0.001
Intermittency	1.85	0.34	13	79.17	0.967	0.268	5.447	<0.001
Urgency	2.21	0.43	14	80.65	0.80	0.21	8.33	<0.001
Weak stream	2.5	0.43	14	82.86	1.33	0.35	5.84	<0.001
Straining	1.54	0.23	13	85.00	1.032	0.286	4.57	<0.001
Nocturia	3.0	0.61	18	79.63	0.916	0.216	11.06	<0.001
Quality of life	3.39	1.56	18	54.10	0.618	0.146	1258	<0.001

** BT- before treatment, AT- after treatment, SD- standard deviation, SE- standard error

Result on objective parameters

Statistically highly significant (P < 0.001) increase was noted in AUFR and significant (P < 0.01) reduction was recorded in prostate size as well as PVRU in group A [Table 10]. Statistically highly significant (P < 0.001) effect in reducing PVRU and increasing AUFR and significant (P < 0.05) decrease in the size of enlarged prostate gland was noted in patients of group B [Table 11].

Table 10

Effect of therapy on objective parameters in Group-A: (n=12)

Objective parameters	Mean Score		%Relief	SD(±)	SE(±)	t	P
	BT	AT
Prostate size & volume	1.75	1.17	33.34	0.515	0.149	3.924	0.002
Post-voidal residual urine volume	1.8	0.45	88.89	0.894	0.4	4.0	0.016
Average urine flow rate	1.2	0.3	75.00	0.568	0.18	5.014	<0.001

** BT- before treatment, AT- after treatment, SD- standard deviation, SE- standard error

Table 11

Effect of therapy on objective parameters in Group-B (n=18)

Objective parameters	Mean Score		%Relief	SD(±)	SE(±)	t	P
	BT	AT
Prostate size & volume	2.8	2.35	16.67	0.717	0.174	2.704	0.016
Post - voidal residual urine volume	1.11	0.11	90.00	0.5	0.167	6.0	<0.001
Average urine flow rate	1.69	0.41	74.07	0.577	0.144	8.66	<0.001

** BT- before treatment, AT- after treatment, SD- standard deviation, SE- standard error

Overall result of therapy (group wise)

In group A, maximum improvement was seen in 3 patients (25.00%), moderate improvement was seen in 8 patients (66.67%), and mild improvement was observed in 1 patient (8.34%) [Table 12]. Similarly, in group B, maximum improvement was found in 10 patients (55.56%), moderate improvement in 7 patients (38.89%) and mild improvement in 1 patient (5.56%) only. None of the patients had complete remission or remained unchanged in either of the groups [Table 13].

Table 12

Overall Effect of therapy in Group A: (n=12)

Overall effect of therapy	Effect on IPSS		Effect on objective parameter		Overall effect of therapy
	n	%	n	%	n	%
Complete remission	0	00.00	0	00.00	0	00.00
Maximum improvement	10	83.34	2	16.67	3	25.00
Moderate improvement	1	8.34	3	25.00	8	66.67
Mild improvement	1	8.34	7	58.34	1	8.34
Unchanged	0	00.00	0	00.00	0	00.00

Table 13

Overall effect of therapy in Group B (n=18)

Overall effect of therapy	Effect on IPSS		Effect on objective parameter		Overall effect of therapy
	n	%	n	%	n	%
Complete remission	1	5.56	0	00.00	0	00.00
Maximum improvement	13	72.23	2	11.12	10	55.56
Moderate improvement	2	11.12	8	44.45	7	38.89
Mild improvement	2	11.12	5	27.78	1	5.56
Unchanged	0	00.00	3	16.67	0	00.00

Overall effect of therapy

Maximum improvement i.e. 76.67 % was found in the symptoms like retention of urine, incomplete voiding, dribbling, hesitancy and incontinence of urine. While mild improvement (40.00%) was observed in average urine flow rate (AUFR), post voidal residual urine (PVRU) volume and size of the prostate. [Table 14]

Table 14

Overall effect of therapy on different parameters (n=30)

Overall effect of therapy	Effect on IPSS		Effect on objective parameter
	n	%	n	%
Complete remission	1	3.34	0	0
Maximum Improvement	23	76.67	4	13.33
Moderate Improvement	3	10.00	11	36.67
Mild Improvement	3	10.00	12	40.00
Unchanged	0	00.00	3	10.00

Discussion

In Ayurveda, Mutraghata is a broad term as it covers most of the pathological entities of the urinary system. Total, 12 types of Mutraghata are mentioned by Acharya Sushruta[11] and 13 types by Acharya Charaka. Mutraghata comprises of two different words, that is, “Mutra” means urine and “Aghata” means obstructive pathology. The features of Mutraghata such as retention of urine (Mutrasanga) and pain in suprapubic region are observed due to obstructive pathology and can be correlated with BPH on the basis of its symptoms and signs. In old age, there is deranged function of Vata Dosha, particularly Apana Vata which is the prime causative factor and it also disturbs with Kapha Dosha. Consequently, vitiated Vata and Kapha Dosha affect to Mutravaha Srotasa and derangments occurs in Basti (urinary system) and results in Mutraghata. Hence, the drugs having Vata-Kapha pacifying property, Srotoshodhana (cleaning the channels), Lekhana (scraping), Shophahara (anti-inflammatory), Mutrala (diuretic) and along with digestive properties are helpful to break the Samprapti of Mutraghata (BPH).

Kanchanara Guggulu is an Ayurvedic formulation having properties of Vata-Kapha Dosha pacification, Lekhana and Shothahara (anti-inflammatory).[12] Because of these properties, Kanchanara Guggulu may check the changes of prostatic tissues and regulates the urinary function.[13] Matra Basti is the procedure to control Vata Dosha, especially Apana Vata.[14] All Acharya have recommended Matra Basti as a line of management of Mutraghata to improve urinary function and to remove the obstruction.

Most of the patients in this study (50%) were from the age group of 61–70 years. This age group favors the vitiation of Vata Dosha and might be a cause for the development of Mutraghata, especially hyperplasia of the prostate gland. Modern science has also reported that benign changes in the prostate gland are more prevalent in sixth and seventh decades of life. Most of the patients had chronicity up to 1 year. In the initial stage, the symptoms of BPH are not severe; hence, the patients ignore the complaints till the condition becomes chronic. Samashana (mixing of wholesome food with unwholesome food) was found in the majority of the patients. Ama (undigested food) is the causative factor for the manifestation of Mutraghata as described by Charaka and more formation of Ama is seen in the person habitual of Samashana. Disturbed sleep was found in maximum number of patients, which might be due to increased frequency of micturition at night. Constipation was found in 37.5% of the patients, which might be due to faulty dietary habits such as Samashana and deranged Apana Vayu.

In group A, Bala Taila Matra Basti provided 84.24% relief in incomplete voiding of urine, 77.42% relief in increased frequency, 77.78% relief in intermittency, 89.47% relief in urgency, 80% relief in weak stream, 84.62% in straining and 69.57% in nocturia. The quality of life was improved in 58.33% of patients. These results were highly significant (P < 0.001) in all of the above mentioned symptoms except intermittency, which was statistically significant (P < 0.01), whereas in objective findings, the size of the prostate was reduced up to 33.34%. Reduction of 88.89% was found in PVRU and AUFR was improved up to 75%. This encouraging result was found because Matra Basti has the potency to pacify vitiated Apana Vata, which is the prime factor for the manifestation of Mutraghata. The properties of Bala Taila such as muscle tone building, rejuvination and anti-inflammatory activities help to improve the function of the detrusor muscle. Atibala is an important ingredient of Bala Taila which contains saponin as a chemical component. It has diuretic and anti-inflammatory actions.[15] Hence, it is obvious that Bala Taila might have contributed in improvement of bladder function by increasing the bladder tone as well as reducing the size of the prostate. Ultimately the bladder outflow obstruction was improved and overall quality of life was improved with Matra Basti.

In group B, Kanchanara Guggulu and Bala Taila Matra Basti provided 71.74% rellief in incomplete voiding, 75% in increased frequency, 79.17% in intermittency, 80.65% in urgency, 82.86% in weak stream, 85.00% in straining and 79.63% in nocturia. The quality of life was improved up to 54.10%. These obtained results were statistically highly significant (P < 0.001), whereas in objective findings, the size of the prostate was reduced up to 16.67%, PVRU was improved up to 90.00% and 74.07% increase was observed in AUFR.

The drug Kanchanara Guggulu having the properties of Vata-Kapha Shamana, Pachana, Basti Shodhana and Mootrala etc., might have helped to enhance the function of the bladder. The drug Varuna (Crateva nurvala Buch.-Ham.) is one of the ingredients of this formulation containing Kampferol and quercetin flavonoids. These chemical constituents act as inhibitor of estrogenic receptor.[13] Hence, Kanchanara Guggulu was helpful in reducing the size of the prostate. Ingredients of Kanchanara Guggulu like, Triphala and Trikatu contains ascorbic acid which helps to relax the smooth muscle of the prostate and bladder neck to relieve pressure and improve urine flow rate.[16]

On comparison to the effect of therapy as per the IPSS pattern, group A has shown better result as compared to group B (79.15%). There was no statistically significant difference (P = 0.296) within two groups in the subjective parameters. It is suggested that changes that occurred with the treatment were not enough to exclude the possibility that the difference was due to chance. Hence, both groups had given parallel effect on symptoms/IPSS score of disease as per the statistical analysis.

According to all objective parameters such as prostate size, PVRU volume and average UFR, group A had shown better effect, that is, 65.74% relief as compared to group B (60.25%). But in both groups A- UFR was found increased statistically highly significant, whereas insignificant reduction (P > 0.05) were observed in prostate size and PVRU as per statistics.

During the entire period of therapy, there was no any untoward effect or adverse drug reaction observed in any of the patients of the group.

Conclusion

This study concluded that 60 ml Bala Taila Matra Basti is effective and tolerable in the patients of Mutraghata (Benign Prostatic Hyperplasia). As the Benign Prostatic Hyperplasia is progressive degenerative disorder long term treatment may be needed to provide maximum relief in such patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.