E-ISSN:2456-3110

Review Article

Polycystic Ovarian Syndrome

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 7 July
Publisherwww.maharshicharaka.in

Ayurvedic perspective of Polycystic Ovarian Syndrome

Rajpurohit D.1*, Neelima A.2
DOI: http://dx.doi.org/10.21760/jaims.8.7.24

1* Divya Rajpurohit, Post Graduate Scholar, Department of Prasuti Tantra evam Stri Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

2 A Neelima, Head of department, Department of Prasuti Tantra evam Stri Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.

Women health remains a staggering challenge, particularly in the developing world. Around 5-15% of women in the reproductive age group suffer from hormonal imbalances that lead to menstrual irregularities.[1] A wide range of factors affect menstruation among all factors polycystic ovarian syndrome (PCOS) is the foremost factor. At least 70% of women with PCOS remain undiagnosed in primary care due to lack of knowledge and not giving attention to commonly occur menstrual irregularities. Incidence rate of PCOS is increasing day by day due to sedentary lifestyle and faulty daily routine, high consumption of unhealthy foods.

Keywords: Polycystic Ovarian Syndrome, PCOS, Ayurveda, Women Health

Corresponding Author How to Cite this Article To Browse
Divya Rajpurohit, Post Graduate Scholar, Department of Prasuti Tantra evam Stri Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur, Rajasthan, India.
Email: 		Divya Rajpurohit, A Neelima, Ayurvedic perspective of Polycystic Ovarian Syndrome. J Ayu Int Med Sci. 2023;8(7):128-133.
Available From
https://jaims.in/jaims/article/view/2612

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-01 2023-06-03 2023-06-10 2023-06-17 2023-06-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Divya Rajpurohit, A Neelimaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrinological disorder with a heterogeneous spectrum of ovulation dysfunction, polycystic ovary morphology, and hyperandrogenism. The global prevalence rate based on different diagnostic criteria used for PCOS diagnosis varies between 2 - 21 percent.[2] 85-90% of women with oligomenorrhoea have PCOS while 30-40% of women with amenorrhea will have PCOS.[3] PCOS is the most common endocrinal as well as metabolic disorder in the female population among adolescence and reproductive age group. It is the multifaceted disease with various etiologic factors characterised by chronic anovulation, hyperandrogenism, and polycystic ovaries with the existence of insulin resistance, hypertension, obesity, and dyslipidaemia are responsible for long term serious outcomes such as endometrial hyperplasia, type 2 DM, and coronary artery diseases.

Clinical features[4]

  • Obesity (abdominal-50%)
  • Menstrual abnormalities (70%) in the form of oligomenorrhea, amenorrhea or dysfunctional uterine bleeding (DUB) and infertility, Classical symptom of anovulation - oligomenorrhea with heavy bleeding,
  • Presence of hirsutism and acne are the important features (70%). Virilism is rare,
  • Acanthosis - nigricans is characterized by specific skin changes due to insulin resistance (thickened and pigmented (grey brown) skin) commonly affected sites are nape of the neck, inner thighs, groin and axilla.
  • HAIR-AN syndrome in patients with PCOS is characterized by hyperandrogenism, insulin resistance and acanthosis nigricans, Ferriman – gallwey score for hirsutism score >8 considered as hirsutism.

Diagnosis[5]

Rotterdam criteria (2003) (based upon the presence of any two of the following three criteria (ASRM)

1. Oligo and/or anovulation

2. Hyperandrogenism (clinical and/or biochemical)

3. Polycystic ovaries in USG (antral follicle count ≥12 measuring about 2-9mm and /or ovarian volume >10 cm)

Ayurveda perspective of follicle development and ovulation

  • The process of development and enlargement follicles is said to be due to Kapha, as one of the functions of Kapha is Upachaya which means development. Differentiation or separation and then expulsion are the functions of Vata. So, here Vata is responsible for the rupture of follicle and proper outcome of menstrual cycle and ovulation. These are the normal functioning of
  • In PCOS due to vitiation of Kapha, there is no proper development of follicles and due to vitiated Vata premature luteinisation of follicles occurs and thus causes anovulation. Here, the function of Pitta is somewhat suppressed by Vata and Kapha, so there is reduced rate of aromatization (Pitta being not enough to convert increased androgens into oestrogens causing androgen excess) and no maturation of follicles occurs. Hormonal imbalance first disturbs ovarian cycle which later on reflects by irregular menstrual cycle.

Hetu (Aetiology)[6]

Mithyachara: Mithya Ahara - it includes Unhealthy lifestyle, altered food habits excess use of Madhur, Amla, Lavana Rasa Ahara, Snigdha, Guru, Abhishyandi, Sheeta, Snighdha Guna Ahara, Eating habits like Adhyasana (Taking food before digesting previous food), Vishmasana (Taking food in irregular quantity and at irregular time), Atyashanam (Taking excessive amount of diet without knowing their Agni), Samasana (wholesome and unwholesome diet together) causes the vitiation of Dosha, Pramitabhojana (Less quantity of food irrespective of need).

Mithya Vihara (abnormal mode of living) - It includes faulty modes of Dincharya, Ratricharya, Divaswapna, Ratrijagarana, Vegadharana, Avyayama, Shoka (grief), Chinta (worry), Bhaya (fear).

  • Pradushtartava - Hormonal imbalance, endometrium and ovarian pathology
  • Beejadosha - X linked, autosomal genes, genetic tendency
  • Deva - Idiopathic

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Rasavaha Strotas Dushti Hetu - “Gurusheeetam Atisnigdham Atimatram Samashnataam, Rasavahini Dushyanti Chintyanaamapi Chintanaat.” - excessive intake of heavy diet like cheese, fast food, Chinese, bakery products, excessive intake of cold food or products, eating too oily, unctuous food, taking wholesome and unwholesome diet together, Chinta (stress/worry).[7]

Medovaha Strotas Dushti Hetu - “Avayayama Diwaswapanama Medhyanacha Atibhakshanata Medovahani Dushyanti Varunyashchatisevanata” - lack of exercise, day sleeping, eating fatty foods, excess intake of alcohol.

Purvarupa and Rupa

  • Menstrual irregularities have been described under Artava Vyapads[8] or Yonirogas[9] (uterine disorders).
  • Anovulation is included under Vandhya[10] (infertility).
  • Obesity is the condition described as Sthoulya,[11] a Santanpanajanya Vikara.
  • Acne and Baldness have been described as Mukhadooshika[12] and Khalitya, the two independent pathogenesis.
  • Hyperinsulinemia leads to type 2 Diabetes mellitus, and is described under Prameha. It is also manifested as a complication of Sthoulya.

Different references in Ayurvedic Classics

Anartava - amenorrhoea; Yonivyapad - physiological and anatomical disorder of the reproductive system; Arjaska-Anartava due to vitiation of Pitta and Rakta Dosha; Lohitakshaya - Anartava due to vitiation of Vata-Pitta Dosha; Pushpaghni[13] - anovulatory menstruation, hirsutism and obesity; Vandhya - Infertility; Viphalumbeeja / Abeejata / Akarmya Artava- anovulation; Ashtartava Dushti- menstrual disorder due to vitiation of Dosha; Granthibhut Artava - due to Vata-Kapha cystic accumulation at periphery of ovary; Ashtanindniya[14] - Atiloma (excessive hairs on body); Atisthula (obesity).

Samprapti Ghataka of Pushpaghni

  • Dosha: Kapha & Vata (Kapha-Vridhi, Vata-Vaigunya)
  • Dushya: Rasa, Rakta, Mamsa, Meda

Lakshan of Dushya Dushti - Rasa - Aruchi, Gouravam, Tandraagninasa, Angamarda,

Srotorodha, Klaibya; Rakta - Kushta, Pidaka, Asrigdar; Mamsa - Granthi; Meda - Prameha, Poorvaroopa; Asthi - Keshaloma; Majja - Gaurava; Shukra - Klaibya, Garbhasrava.

  • Upadhatu: Artava (Rasa)
  • Agni: Jatharangi, Dhatvagni
  • Srotas: Rasavaha, Raktavaha, Mamsavaha, Medovaha, Swedvaha, Artavavaha.

Rasa & Meda involvement as Insulin Resistance & Obesity, Avarana of Vata for Faulty Negative Feedback Mechanism of hormones or Improper functioning of HPO axis & Hyper Androgenism, Artavadushti as Irregular Cycles / Anovulatory Cycles, Beeja-Upaghata for Hereditary factor

  • Srotodushti: Sanga, Atipravarti, Granthi
    • Sanga - Amenorrhoea, oligomenorrhoea, Kaphaavaranam to Vata & Pitta Kashaya
    • Atipravarthi - Abnormal uterine bleeding - Pitta Vridhi
    • Granthi - PCOD

Samprapti: Kapha Vriddhikara Nidana Sevan causes:

1. Jatharagni Mandhya

  • It increases Snehansha of body which affect Agneya property of Diminish Pitta causes Prabha and Varna Nasha Karshyam (acanthosis nigricans)
  • Due to this Dhatu diminishes and Mala It results in Kesha (Asthi Mala) overproduction (hirsutism), Sweda (Majja Mala), increased sebum production and Mukha Dushika (acne)
  • Jatharagni Mandhya causes accumulation of Ama Dosha. It does Vata-Vaigunya. Vitiated Vata-Kapha Avruta Artavaha-Srotas Causes Artava Nasha (oligo-amenorrhea)

2. Sthula

  • Medovaha Sroto Moola (Kati) Dushti and Sthan Samshrya at Kati Pradesh causing Apana Vaigunya. It impairs Artava Nirgaman.

3. Vitiated Kapha

  • Affect Medodhatu and cause Santarpana Janya Vyadhi Prameha (hyperinsulinemia)

Chikitsa Sidhanta of PCOS

1. Nidana Parivarjana (Eradication of causative factor) - Swasthayarakshana principle


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- Dincharya (daily regimen), Ritucharya (seasonal regimen), Sadvritta, Achara-Rasayana, Hit-Ahara, Samyakanidra (proper sleep of 6-8 hours in night), Vyayama (physical activity) for prevention of disease, Avoidance of high calorie diet like junk food, bakery items, cold drinks, etc., Results in greater weight loss; low glycemic diets decreased insulin resistance, fibrinogen, total and high lipoprotein density, improved menstrual irregularities.

Shodhana (Purification of the Body)

  • Vamana Karma (emesis) - Intended mainly for the expulsion of vitiated ‘Kapha’, Purifies internal toxins, Balances hormonal system, stimulates pancreas to secrete insulin in normal level, helps to increase metabolism of body therefore reduce weight and specifically act on liver metabolism which is the main site of hormone formation. For Vamana Madhanphala Ikshwaku, Jimutak can be used.
  • Virechana (Purgation) - it removes Aavarana, Vata Anulomana and catering the normal functioning of dosha, increases the bio availability of drugs by opening channels & improve the assimilation of drug. For Virechana Danti Avaleha, Abhyadi Modaka can be used.
  • Basti (Anuvasana Basti, Niruha Basti) - it releases obstructions in the way of Vata Dosha and thus regulates the normal phenomenon of “Vata” (Apana vata). Apana Vayu which controls on the Shukra Dhatu (Semen) in males & Aartava (Ovum) in females. As per Kashyapa, Anuvasana Basti is the choice of treatment in oligomenorrhoea, amenorrhoea. Matrabasti of Shatpushpa Taila, Sahachara Taila,, Niruha Basti of Dashmoola Kwatha, Sahachara Kwatha can be used.
  • Nasya - It stimulate olfactory nerves and limbic system, hypothalamus, GnRh neurons, regularizing GnRh pulsatile secretion and regularize normal menstrual cycle. For Nasya Narayana Taila, Shatapushpa, Shatavari Taila can be used.
  • Uttar-Basti - it Purify and clears the Aartava Vaha Srotas, pacifies vitiated Apana Vayu and Improve follicular maturity. For Uttar Basti Dhanvantara Taila, Bala Taila, Phala Ghrita can be used

3. Shamana (Use of Artavajanana, Vatakaphashamaka, Agneya Dravyas)

  • Agnimandya & Aampachana drugs - Trikatu Churna, Shadushana Churna, Haritaki Churna, Hingwashtaka Churna, Chitrakadi Gutika
  • Medonashaka drugs - Madhu like Lekhana Dravyas (scrapping agents), Takrarishta, along with Yava, Yavaka, Kulattha as Aahara (diet) is mentioned by Acharya Charaka in Chikitsa of Atistula.
  • Nashtartava/Alappushpa (Artavajanana) - Shatpushpa and Shatavari Churna
  • Anya Yoga - Lasona Kalpa, Pushpadhanva Rasa, Kumaryasava, Varunadi Kasaya, Kulatthadi Kasaya, Saptasara Kashaya, Tila Kwath, Kanchnara Guggul, Dashmoola Haritaki, Kuberaksha Vati, Shadadharan Churna, Sukumara Kashaya, Nasta-Pushpantaka Rasa

4. Yoga and Pranayam - Uttanapadasana, Sarvangasana, Paschimottanasana, Halasana, Surya- Namaskara, Sarvangasana, Shirshasana, Halasana, Bhastrika and Ujjayi Pranayama.

Previous researches on PCOS

In earlier research Shatapushpadi Ghan Vati(250mg BD),[15] Krishna Tila Kalka(5gm BD),[16] Rajahpravritini Vati (250mg BD), Varunadi Kashaya (20ml BD), Kanchnar Guggulu (1Gm BD),[17] Lasuna Rasayan, Palashkshara & Palashkashaya,[18] Asanabilwadidi Kwatha (20ml BD),[19] Sowbhagya Shunthi,[20] Sharavni, Ghritkumari ,Pathadi Kwath(20ml),[21] Chandraprabha Vati[21] were given.

Alternative therapy was also used in which for Shodhan Chikitsa like Vamana by Ikshwaku Beeja (5-7gm),[22] Virechana by Dantiavleha (10gm),[23] Basti (Madhutailik Basti, Shatpushpa Taila Matra Basti,[24] Yogabasti), Uttar Basti (Panchagavya Ghrit)[25] given.

All max. used drug for the treatment having Ushna Virya, Vata-Kaphahara, Medonashan, Gulmahara, Vidradhinasha, Pittavardhaka, Bhedana, Granthiharaguna property which regulates menstrual cycle & decrease cyst size.

Shodhan Chikitsa by Vamana, Virechana or Basti showing highly significant (p<0.0001) result on regularizing menstruation, reduction in body weight & BMI, lowering FBS level.[2,8] & also showing highly significant (p<0.0001) result on reduction in cyst no. and cyst size, significant reduction in LH level, significant reduction in FSH:LH ratio.[8]


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Virechana by Kashaya (Trivrit, Aragwadha Phalamajja, Eranda) has shown significant decrease in SBP & DBP along with FBS & PPBS, Cholestrol, Triglycerides & increase in HDL level[26] and provided better relief in pt. of Madhumeha[27] means it works on insulin resistance which are root cause of PCOS. No adverse effect seen in trial all mentioned drugs are safe & effective.

Discussion

PCOS is a condition involving disorder of ovary associated with deranged metabolism of lipids and carbohydrates and multiple hormonal involvement. Changing lifestyle and eating habits of the modern era along with genetic factors contribute significantly to the development of PCOS in obese women. PCOS now regarded as a metabolic syndrome can be managed to a large extent by following proper Ahara and Vihara. Equilibrium of doshas is attained by indulging in Hitakar-Aahara and Vihara This, in turn, results in the proper functioning of Agni. Which is essential for the adequate formation of Rasadhathu, Artava being the Upadhatu of Rasa will be then formed unvitiated and does Samprapti Vighatana of PCOS.

Conclusion

Various researches and reviews have been done on PCOS despite this, some controversies are still there related to its diagnosis, pathophysiology, treatment. Researches are required for understanding the correct pathophysiology of PCOS in Ayurveda. There is a great need to analyses the previously researched drugs on the basis of Ayurvedic pharmacological principles to find the promising remedy for PCOS.

Reference

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13. Pandit Hemaraja Sharma, Vriddha Jivaka, Kashyapa Samhita Or (Vriddha Jivakiyam Tantram), The Vidyotini hindi commentary, Chaukhamba Sanskrit Samsthan, Varanasi, 6th edition, 1998, Ka.rewati kalpa. 33

14. Kasinath Shastri & Dr. Gorakha Natha Chaturvedi Charak Samhita, Vidyotini Hindi commentary, publisher Choukambha Sanskrit Sansthan, Varansi, Sutra Sthana, chapter 21



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5. Kamini Balasaheb Bhingardive, Dattatray Durgadas Sarvade, Santosh kumar Bhatted, Clinical efficacy of Vamana Karma with Ikshwaaku Beeja Yoga followed by Shatapushpadi Ghanavati in the management of Artava Kshaya w. s. r to polycystic ovarian syndrome. AYU 2018

16. Sridevi. M, B.S.Savadi, A randomised single blind comparative clinical study on the efficacy of Anjani-a folklore herb and Krishna Tila Kalka in the management of PCOS w.s.r to oligomenorrhoea, feb.2021, vol 9

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18. Jyoti PK, Clinical Trial to evaluate the efficacy of Palasksharam with Palasakashayam in management of PCOD, submitted to IPGTRA-Jamnagar, 2008

19. Swetha Suvarna. A clinical study of PCOD in Ayurveda perspective and role of Shatpushpa Churna and Asanadi kwatha in PCOS, submitted to IPGTRA-Jamnagar, 2009

20. Pushkala. Clinical effect of Sowbhagya Shunti-Dwiteeya on Pradushtartava w.s.r to PCOD- A.R 2008

21. Krupa D Patel. A clinical study on polycystic ovarian disease and its management by Shatpushpa tail Matrabasti and Pathadikwath, submitted to IPGTRA-Jamnagar, (2011)

22. Kamini Balasaheb Bhingardive, Dattatray Durgadas Sarvade, Santosh kumar Bhatted, Clinical efficacy of Vamana Karma with Ikshwaaku Beeja Yoga followed by Shatapushpadi Ghanavati in the management of Artava Kshaya w. s. r to polycystic ovarian syndrome. AYU 2018

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25. Nikki Bulani. Study on Ayurvedic pathogenesis of PCOD and evaluate the effect of Ayurvedic compound and Panchgavya Ghrit Uttarbasti- submitted to NIA-Jaipur,2010

26. Gyanendra Shukla, Santosh K. Bhatted. Efficacy of Virechana and Basti Karma with Shamana therapy In the management of essential hypertension: A comparative Study; AYU jan 2013, vol 34 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764884/

27. Jyoti kumari, Charmi S.Mehta, V.D.Shukla. A comparative clinical study of Nyagrodhadi Ghanavati and Virechana Karma in the management of Madhumeha. AYU july 2010 vol 31 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221062/

 


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