Polycystic ovarian syndrome in Ayurveda

ACCORDING TO AYURVEDA

The disorder involves Vata and Kapha doshas, Meda-Mamsa-Rakta dhatus.Therefore Poly Cystic Ovarian Syndrome can also be described with same involvement of Dosha and Dhatu.Chikitsa siddhanta aims Agni Deepana and Aampachana, hence clearing away the Srotorodha (obstacles)of Aartava-vaha srotas (Channels carrying menstrual blood)and others.Srotoshodhana leads to Apana-Vatanulomana resulting in regularization of menstrual cycle, imbalanced hormones and metabolism. 

Reduction in Kapha is helpful in relieving obesity along with the associated symptoms of hyperandrogenism. Moreover, regular exercise and balanced diet catalyzes the action of drugs. Hence PCOS can be managed with Ayurvedic formulations along with Life-style modifications and restricted diet.

 In Ayurveda, PCOS is not described as a separate heading, but can be portrayed under the headings of various yonivyapadas (genitaln regularization of menstrual cycle, imbalanced hormones and metabolism. Reduction in Kapha is helpful in relieving obesity along with the associated symptoms of hyperandrogenism. Moreover, regular exercise and balanced diet catalyzes the action of drugs. Hence PCOS can be managed with Ayurvedic formulations along with Life-style modifications and restricted diet.

 In Ayurveda, PCOS is not described as a separate heading, but can be portrayed under the headings of various yonivyapadas (genital pathologies) and aartavadushti (menstrual pathologies). PCOD can be correlated with Pushpaghni Jataharini, aartava-(hypomenorrhea), nashtartava,arajaska,ksheenaartava(oligomenorrhea) and granthibhuta aartava(clotted menses).

 In Ayurveda, the balance state of doshas is mainly responsible for health and any derangement to this will lead to disease.This dosha-vaishamya is directly connected to symptoms and the relation between doshas and lakshanas are permanent.By the outlook of the symptoms of PCOS as per modern description, it becomes clear that even though they are not compiled as a syndrome in Ayurveda most of them have been described as features of separate diseases or conditions.

One among the 100 lady is suffering from this life style disorder, hence it is proved that if any lady is getting such symptoms which are mentioned above should get alert herself to get rid of this problem.if we summarize this than we can find these symptoms in Ayurveda as:-

1.Menstrual irregularities have been described under artava vyapads or Yoni rogas(uterine disorders).

2.Anovulation is included under Vandhya(infertility).

3.Obesityis the condition described as Sthoulya.

4.Acne and Baldness have been described as MukhadooshikaandKhalitya,two independent pathogenesis.

5.Hyperinsulinemia leads to type 2 Diabetes mellitus, and is described under prameha. It is also manifested as a complication of sthoulya

 Since menstrual irregularities including anovulation and obesity are the commonly seen symptoms these two has to be taken care with due attention. 

 Modern management of PCOS is primarily targeted to correct the biochemical abnormalities. Weight reduction in obese patients is the first line of treatment.Conservative management mainly involves frequent use of hormonal pills, which results in numerous adverse effects. 

Therefore Ayurvedic formulations from various Ayurvedic texts can be a better option for the definitive cure of PCOS. 

ETIOLOGY (AYURVEDA)

 In the context of yonivyapadas, there are four basic causative factors i.e. unwholesome lifestyle, menstrual disarrays (dushti of antahpushpa i.e. ova and bahipushpa i.e. menstrual blood), genetic disorders and some divine factors, responsible for the manifestation of the syndrome.

 It is a disorder involving vata and kapha doshas along with Meda Dhatu dushti. On the basis of Ayurvedic interpretation PCOS can be enumerated as Rasapradoshaja and Santarpanottha vyadhi. 

ORIGIN OF THE DISEASE(AYURVEDA) 

When the deranged vata etc. vitiates the mamsa, shonita and meda mixed up with Kapha; thus they produce circular, raised and knotted inflammatory swelling called “Granthi‟. This type of glandular swelling has been compared with the modern terminology “cyst” which means an abnormal closed epithelium-lined cavity in the body, containing liquid or semisolid material. 

 In PCOS, development of follicles has been arrested at one or any level and remained as it is. The cysts are follicles at varying stages of maturation and atresia. So, these cysts are not destined to ovum. Thus, this pathology is compared with granthi bhuta artava dushtii. cyst, as in PCOS,the follicles becomes cysts instead of developing up to mature ovum Hence,an attempt was made to correlate modern symptoms of PCOS with Ayurveda, so, that we can come symptoms of PCOS with Ayurveda, so, that we can come to one conclusion

TREATMENT OF PCOS ACCORDING TO AYURVEDA

Ayurvedic treatment is by applying a multi-pronged approach towards:

Correcting the hormonal imbalance

Treatment to obesity and avoiding high cholesterol levels

Treatment to insulin resistance

 A. Correcting hormonal imbalance :-There are manyherbs useful in correcting the hormonal imbalance. Ashoka (saraca asoca), Dashamoola (a group of ten herbal roots) a group of herbs useful in preparation of Sukumara Kashaya like Ashwagandha, Eranda, Shatavari etc.are useful in correcting the hormonal imbalance.

B. Treatment to obesity :-Treatment to obesity and specifically against cholesterol can be achieved by using Ayurvedic herbal remedy plus diet and lifestyle changes.

C. Treatment insulin resistance :-Treatment for insulin resistance involves a time-consuming approach with effective Ayurvedic treatment and diet and lifestyle changes including exercise.

1. “Nidana Parivarjana”(avoid the causative factors)is said to be the very first step towards the management of PCOS. As Agnimandya, Medovriddhi, Apana Vayu and Kapha dushti plays the major role in the pathogenesis of the syndrome, so taking above fact into the consideration, Pathya Ahara-Vihara (dietary regimen & exercise)is to be used.

2. For Agnimandya and Aampachana, use of Trikatu Churna, Chitrakadi Gutika, Shadushana Churna, Haritaki Churna, Hingwashtaka Churna is to be done in order to palliate the Srotovarodha and to facilitate the Apana-Vatanulomana. 

3. For Medovriddhi, use of Takrarishta, Madhu like lekhanadravyas (scrapping agents)along with Yava, yavaka, kulattha etc. as aahara (diet)is mentioned by Acharya Charaka in chikitsa of Atistula(obese). Moreover, lifestyle-modification as well as regular exercise is also emphasized.

4. To remove the Sanga (obstruction)of Aartavavah Srotas, UttarBasti, (douche)is given with Dhanvantari Taila.

5. Vamana Karma(emesis) -as it alleviates the Srotovarodha by eliminating vitiated Kapha. As Kapha is soumya in prakriti, decrease in Kapha consequently increases Aartava of Aagneya nature.

6. Shatpushpa and Shatavari Churna (Asparagus recemosus Willd.) are to be used in females with deficiency or loss of Aartava, women getting their menstruation but not conceiving

7. Kanchanara Guggulu, Sukumara Ghrita for reducing the size of formed ovarian cysts.

8. Pathadi Kwath mentioned by Acharya Sushruta in Vatakaphaja Aartava dushti given orally along with the matra-basti of Shatpushpa taila40after the cessation of menstrual cycle for seven days is found efficient due to its properties of Aampachana, agnideepana, Vatanulomana, Srotoshodhana and Vata￾Kaphashamana.

9. Narayana taila.

10.Rasona Kalpa. 

11. Pushpadhanva Rasa. 

12. Regular practice of Yoga i.e. Uttanapadasana, Sarvangasana, Halasana, Mayoorasana, Surya-namaskara, Vakrasana and Sheersasana in amenorrhea and, while Sarvangasana, Sheersasana, Halasana, Bhastrika and Ujjayi pranayama in female sterility , are indicated

13. Kumaryasavais indicated in Nashta pushpa

TREATMENT BY PANCHKARMA (DETOXIFICATION ) 

1. Basti(Vasti):Enema of medicated oil or Decoction is given through Rectum. Vitiated “Vata” can create various health problems. Basti releases obstructions in the way of Vata dosha and thus regulates the normal phenomenon of “Vata”. Different types of medicated Oils, Ghruta, milk or decoctions are used for Basti treatment. It can state miracles if administered in a proper way with appropriate medicines.Basti procedure eliminates the doshas from rectum. It balances the “Vata” Dosha. Apana Vayu is the type of “Vata Dosha”, which controls on the Shukra Dhatu (Semen) in males & Aartava (Ovum) in females. “Apan Vayu” controls the reproductive system. The procedure “Basti” regulates Apan Vayu which improves quality of Semen & Ovum.In females oil Basti of “Sahachar Tail” improves quality of ovulation within normal days. In males the Basti procedure improves quality & quantity of Semen i.e. it improves total sperm count and motility of Semen.

Female Infertility = Irregular Menses, Dysmenorrhea,P.C.O.D. Fallopian Tubal Block.

 Male Infertility = Erectile Dysfunction, Libido, Decreased Motility etc.

2. Uttarbasti(Vasti):Uttara basti(Vasti) is the most effective treatment in gynaecological disorders. It helps to purification and clears the Aartava Vaha Srotas, pacifies vitiated Apana Vayu and improve follicular maturity.

3. Virechan:It eliminates body toxins like vitiated „Pitta‟. The process of cleansing is carried out in the small intestine & other Pitta zones. Here drugs that stimulate bowel movement are increased for the expulsion of doshas through rectum. It acts on hormones system like „Vaman Karma‟.

4. Vaman:Cleansing procedure intended mainly for the expulsion of vitiated „Kapha‟. This is a painless, drug induced emetic procedure, carried out mainly in the Vasant rhitu i.e. Feb.,Mar.,April Months.Vaman procedure purifies internal toxins. This balances hormonal system. Vaman acts on Thyroid gland. It also stimulates Pancreas to secret insulin in normal level, so P.C.O.D. decreases accordingly.Useful Herbs in PCOS TreatmentAloe vera, cinnamon, fenugreek, amalki, honey, glycosugars, shilajit, shatawariaswgandha, Kauncha, Vidarikand, salam, ashoka, are the useful herbs.Herb"Latakaranj"(Caesalpinia crista) has shown encouraging results in PCOS cases.

YOGA FOR PCOS 

Sarvagasana

Matsyasana

Ardhmatsyendrasana

Paschimottanasana

Surya namaskar

Ushtrasana

all backward bending asana are recommended but they should be try under the supervision of an expert.

CURATIVE 

The chikitsa in artavakshaya by SushrutaSanshodhanam agneyanam cha dravyanam vidhivat upayoga:Dalhana quotes that Artava is normally agneya in nature;Vamanatherapy decreases saumya guna and increases the agneya guna.The examples given are sesame, urad dal, alcoholic preparations,etc.In 

Ayurveda, chikitsa is of two types –Sanshodhan and sanshamana

1) Sanshodhan Chikitsa It aims at improving ailments by curbing the root cause. Here, Sanshodhan chikitsa and that too vamana is stated to be applied. Vamana karma is basically given shleshma dhikyata. Being a santarpana vyadhi, there is rasadushti in the patient which leads to ama formation in obese person. The deranged metabolic process further continues as a chain reaction disturbing the function of all dhatus. The mala of Rasa is kapha. Here in, the mala swarupa kapha is increased and so the nutrition to the upadhatu raja is hampered leading to its imbalance. 

2) Agneya chikitsa

 Firstly,our body is stated as agnishomiya. Normally, Artava is stated to be agneya in nature. The shleshmalaa ahara vihara results in soma guna dhikya thus, influencing artava kshaya. The propertiesof agneya dravyas-ushna, ruksha, tikshna, vishada, sukshma,dahaka , prabha (aura), varna (lustre of skin) , pachana (metabolism).

Mahabhutagni concept 

Agneya dravyas (sesame, alcoholic preparations,etc have been stated) are agni mahabhuta pradhan. The rakta dhatu also is agneya. Pitta and rakta have ashrayashrayi sambandh. The mukhya sthana is yakrit for rakta dhatu. Liver is regarded as a major site of carbohydrate metabolism, fat metabolism and protein metabolism. Reduced hepatic extractions, impaired suppression of hepatic gluconeogenesis and abnormalities in insulin receptor signalling causes improper insulin metabolism. In a study, it has been proved that liver has a significant role in maintaining fertility.The highest activation of oestrogen receptors was found in liver. This also supports the ayurvedic principle of formation of rakta from rasa dhatu, thus intermediate upadhatu precursors may be correlated with these oestrogen receptors. Besides, the major lipid responsible for reproductive steroidogenesis i.e cholesterol is principally found in liver. Thus, the Agneya chikitsa can be considered in respect of stimulant for bhutagni site i.e liver in order to correct the SHBG levels i.e steroid hormone binding globulin levels (which are otherwise normally secreted in liver) as also facilitate normal conversion ofcholesterol to and rostenedione, finally into estrogen.Besides, Agneya dravyas will induce normal restoration of hepatic gluconeogenesis thereby reducing insulin resistance. 

 PCOS according to Ayurveda can treated with yet another dimension i.e.avarana chikitsa.Improper function of Apana can be treated with avritta apana chikitsa given in Charak Samhita. It includes dipana, grahi dravyas, vatanulomana drugs with sanshodhan of pakvashay. This is a package treatment of obesity. Dipana and vatanulomana drugs will probably act on the leptin resistance and ghrelin insensitivity thereby alleviating the symptoms.Pertaining to aushadhi chikitsa,the pharmacological actions and gunas of drugs from Lekhaniya

AAHARA 

Acharyas have suggested to use those dravyas that are guru but still apatarpana. This can be correlated with concept of GI and GL. Now-a days,a great emphasis is laid on adequate diet prescription for obesity and PCOS.GI-glycemic index is a major of how quickly blood sugar levels rise after eating a particular food.A lower glycemic index suggests slower rates of digestion and absorptionof foods promoting satiety and delaying hunger and promotes fat oxidation thereby controlling weight. This can be correlated with guru gunatmak anna. This concept matches with that given in Bhelasamhita, guru ahara can be dravyata: or matrataha: i.e.the guruta depends on the nature of drug (probably low glycemic index food stuffs as they delay process of digestion and absorption) and the quantity of food stuff. (probably glycemic load.)The Glycemic index and Glycemic load of some commonly consumed food stuffs are mentioned in Table

Thus, the concept of guru ahara is justified. In case of apatarpana, all food stuffs possessing medoghna properties must be prescribed. e.g. gavedhuka (which has a direct role on NPY and leptin recptor), yava(barley), priyangu (Setaria italica), shyamak(Echinochloa frumentacea), cheenak (Panicum millaceum). Studies are needed in these food stuffs.Besides these, madhu(honey) and takra (fresh buttermilk) which is a good source of vitamins and lactic acid. Fruits can include amla rasa pradhan like oranges, lemons, sweet lime, also pineapple, papaya that stimulate digestion.

VIHARA 

Vyayama nityo jirnanshi yava godhuma bhojana: |Santarpankritai doshai: sthaulyam muktvavimuchyate 

1. Exercise 

This firstly includes regular exercise. Many studies have reported improvement in insulin resistance and thereby regularity in menses by regular exercise

2.Pranayama 

In a clinical study effect of kapalbhati pranayama was observed in 60 obese doctors in relation to BMI and abdominal skin fold thickness. They were divided further into two groups. The regimen consisted of asanas (postures), pranayama (breathing exercises),stress management discussions, lectures, and individualized advice for a period of two weeks. There was a significant decrease in chronic inflammatory markers like plasma cortisol and TNF alpha and increase in beta endorphins.

3.Asanas  effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. Yoga was found to be more effective than conventional physical exercises in improving glucose, lipid, and insulin values, includin insulin resistance values, in adolescent girls with PCOS.

4.Proper dietary habits: Jirnashana Isoenergetic 1000 kJ (240 kcal) servings of 38 foods separated into six food categories (fruits, bakery products, snack foods, carbohydrate-rich foods, protein-rich foods, breakfast cereals) 

PREVENTIVE MANAGEMENT 

The nidana parivarjana(avoiding of the causative factors)

1) Shleshmala aahara 

This includes consumption of foodstuffs like bakery products e.g bread, cakes,pastries, puddings in excess, also rice, fast foods, oily foods, canned foods, processed foods, overuse of cornflakes and breakfast cereals, etc. 

2) Adhyashan Dalhana has quoted the meaning to have a habit of overeating without leaving a considerable amount of time in between two mealsor eating without a proper hunger trigger. Also „ajirna bhojana abhyasina‟ is stated which means to have food before the complete digestion of previous meals is ceased. Thus, the habit of over eating must be strictly avoided.

3) Vyayam 

The physical activity and dietary habits in PCOS that women with PCOS do not achieve the necessary physical activity, and mean % energy is more from fat and the dietary glycemic index is higher in overweight obese women with PCOS as compared to healthy weight women with PCOS. The total sugar intake was high.

4) Divaswapna 

Adequate sleeping habits must be practised as abnormal duration and timings lead to a disturbed biological clock

INTERVENTION 

1) Undergo seasonal sanshodhan therapyi.eVamana in Vasant rutu , Virechan in Sharad rutu and Basti chikitsa in Varsha rutu.

2) Practising Dinacharya and Rutucharya.

3)Nitya vyayama

4) Udvartana –kapha medovilayana.It is stated to decrease the lipids

5) Utsadana-This is stated specially in females.

6) Aaharkala -one should consume meals in morning when the days are shorter and nights are longer in the season and in evening when days are longer.(Pratarashe tu ajirne api sayam aashe na dushyati) 

7) Effect of skipping meals is barred. It results in mandagni.

8) Aahar matra -nirdishtam sukham yavat hi jiryati.

9) Water intake dosage -twice the meals.

10) Anupana helps to stimulate digestion prolonged due to intake of guru aahar.

11)Pathya in ahara The Pathya aspect has been well described in Pathyapathyavibhodhaka Nighantu

Written by:-

ARVINDER KAUR

Student of BAMS 3rd year

Government Ayurvedic College

City-Patiala

State -Punjab