E-ISSN:2456-3110

Case Report

Polycystic Ovarian Syndrome

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 1 January
Publisherwww.maharshicharaka.in

Ayurvedic approach to manage Polycystic Ovarian Syndrome with Yoga Basti - A Case Study

Lalita1*, Tanwar S2, Kumar Panda J3, Rani T4
DOI:10.21760/jaims.9.1.47

1* Lalita, Post Graduate Scholar, Dept of Prasuti Tantra Evam Stree Roga, Institute for Ayurved Studies and Research, Kurukshetra, Haryana, India.

2 Suniti Tanwar, Associate Professor, Dept of Prasuti Tantra Evam Stree Roga, Institute for Ayurved Studies and Research, Kurukshetra, Haryana, India.

3 Jitesh Kumar Panda, Professor HOD, Dept of Prasuti Tantra Evam Stree Roga, Institute for Ayurved Studies and Research, Kurukshetra, Haryana, India.

4 Tinkle Rani, MD Panchkarma, Chaudhary Brahm Prakash Ayurvedic Charak Sansthan, New Delhi, India.

A 31year old unmarried woman came to OPD of PTSR department of IAS&R, Kurukshetra with clinical features such as irregular menses, weight gain and excessive hair growth over face, abdomen and thighs, mood swings, insomnia, acne on face, bloating etc. Patient was a diagnosed case of PCOD as she had already visited allopathic hospitals. Her USG report shows multiple small follicles in Necklace pattern in bilateral ovaries. Hormone test shows LH-FSH ratio value >2.50. Lipid profile shows derangement of Triglycerides (187.00 mg/dl), HDL (26.70mg/dl), VLDL cholesterol (37.40mg/dl). She has undergone hormonal therapy for 3 months and later discontinued the treatment this case was managed by tablet Sukumar Kashaya, Kanchnar Guggul, Dashmoolarishta and Kaumaryasava along with Yoga Basti with the Sahacharadi Taila mixed with Murchhit Til Tail and Erandamooladi Niruha Basti and Matra Basti with Sahacharadi Taila mixed with Murchhit Til Tail. This treatment gave very promising results with improvement of overall health of the patient.

Keywords: PCOS, Pushpaghni Jataharini, Sukumar Kashaya, Kanchnar Guggul, Dashmoolarishta, Sahacharadi Taila

Corresponding Author How to Cite this Article To Browse
Lalita, Post Graduate Scholar, Dept of Prasuti Tantra Evam Stree Roga, Institute for Ayurved Studies and Research, Kurukshetra, Haryana, India.
Email: 		Lalita, Tanwar S, Kumar Panda J, Rani T, Ayurvedic approach to manage Polycystic Ovarian Syndrome with Yoga Basti - A Case Study. J Ayu Int Med Sci. 2024;9(1):298-303.
Available From
https://jaims.in/jaims/article/view/3043

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-11-14 2023-11-24 2023-12-04 2023-12-14 2023-12-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 19.69

© 2024by Lalita, Tanwar S, Kumar Panda J, Rani Tand 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

Stein leventhal syndrome commonly known as polycystic ovarian syndrome (PCOS). PCOS is a complex disorder where numerous genetic and environmental factors act and contribute to its pathophysiology. Owing to sedentary life style and unhealthy eating habits PCOS has become very common now a days. PCOS is commonest endocrinopathy of reproductive aged women. PCOS is mainly typified by presence of oligo/anovulation, excess androgen production and multiple small cysts in ovary. Presence of hyperandrogenism may vary among the ethnicities as PCOS is heterogenous, multifactorial and polygenic condition.[1] These sign and symptoms varies widely and unfavourably affects metabolism, reproductive health, psychological and social health of the female. Reproductive system disorder includes Menstrual dysfunction, Infertility and Hyperandrogenism typically manifested by hirsutism also causes Endocrine dysfunction like insulin resistance, acanthosis nigricans, dyslipidemia, Acne, Alopecia and metabolic syndrome, cardiovascular disease, obstructive sleep apnoea, obesity etc.

As per Ayurveda perspective symptoms of PCOS simulates Pushpaghani Jataharini[2], Artavkshaya and Bandhayatva because there is involvement of Tridosha along with Rasa, Rakta and Meda Dhatu so Rasavaha, Raktavaha and Artav-Vaahi Srotas are affected due to which above Lakshana are found.

The global prevalence of PCOS is estimated between 9% to 20%. The WHO data suggests that approximately 116 million or 3.4 % women are affected by PCOS globally.[3]

Polycystic Ovarian Syndrome (PCOS) affects 5-10% of women of reproductive age, making it the most common endocrine disorder of women in this age group. It is characterized by amenorrhea, hirsutism and infertility predominantly. It mainly occurs due to the complex interaction of abnormalities in gonadotropins, androgens & estrogens. Insulin resistance and hyperinsulinemia contributes crucially to its pathophysiology. Although PCOS is associated with hyperandrogenism & infertility early in life, it is a harbinger of a lifelong condition that can lead to serious sequelae such as Endometrial or Ovarian cancer, Diabetes mellitus and Coronary arteries disease. Thus, it is essential to diagnose PCOS early in its course not only to recognize but also to delay or arrest its metabolic sequelae.

PCOS is mainly diagnosed by Rotterderm Criteria.[4]

European society of Human reproductive medicine and American society for reproductive medicine (ESHRE / ASRM) purposed definition of PCOS as the presence of any two out of following:

1) Oligo or anovulation
2) Clinical &/or biochemical signs of hyperandrogenism
3) Polycystic ovaries (with exclusion of related disorders)

Ratio of LH to FSH > 2.5 indicates the presence of PCOS

AMH concentration > 3.5ng / mL is predictive of PCOS

TSH levels are subject to circadian variation, reaching peak levels between 2-4 am & at a minimum between 6-10 pm. The variation is of the order of 50%. Hence time of the day has influence on the measured serum TSH concentrations. TSH values < 0.03ulU / mL need to be clinically correlated due to presence of a rare TSH variant in some individuals.

Pathophysiology

Alteration in GnRH release leads to relative increase in LH AND FSH biosynthesis and secretion. LH stimulates the production of ovarian androgen while FSH prevents adequate stimulation of aromatase activity in granulosa cells. So decreases androgen conversion into estrogen and estradiol.[5] Follicular atresia occurs as a result of increased intrafollicular androgen levels circulating androgens also causes abnormality in patient lipid profiles and manifest as hirsutism and facial acne.

Increased adipose tissue and genetic abnormalities cause insulin resistance, which in turn causes follicular atresia in the ovaries and acanthosis nigricans in the skin. The absence of follicular development ultimately leads to anovulation, which in turn causes oligomenorrhea or amenorrhea.

Materials and Methods

Patient Information

A diagnosed case of 31 years old unmarried female came in OPD of Stree Roga Evam Prasuti Tantra Department of IAS&R with following complaints as:


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Chief Complaints

Present with irregular menstruation for 5 years

She also complained of Pimples, Weight gain, Facial hair growth, Mood swings, insomnia and Constipation.

History of past illness

No significant medical, surgical, gynaecological and psychiatric diseases found.

Family History: Her father is hypertensive.

No any significant medical, surgical, gynaecological and psychiatric diseases in her family members.

Personal History: She has good appetite. She drinks 10-12 glass of water daily. Tongue was mildly coated and dry. She experiences constipation quite frequently. Her bladder habit is normal and she is vegetarian. There is no any significant addiction.

Demographic history

She is living in US for 5-6 years. Since she is working and living in US so her dietary habits changed completely. The main dietary trend after migration she followed was substantial increase in energy and fat intake like pizzas, cold drinks etc. and reduction in carbohydrates and a switch from whole grains and pulses to more refined sources of carbohydrates, resulting in a low intake of fiber.

Treatment History

For the present illness, patient went to private allopathic Hospital for treatment and got Hormonal therapy but her symptoms didn’t subside. So, she visited OPD of Streeroga Evam Prasuti Tantra Department of IAS&R, Kurukshetra.

Menstrual History: Her age at the time of Menarche was 13 years; she had regular menses but is irregular since last 5 years. Menstruation only used to occur with progesterone challenge test. Presently it is irregular (once in every 2-3 months), bleeding occurs just for 1 day. It is associated with foul odour, clots and dysmenorrhoea is also present. She uses 1 pad per day during menstruation which is partially soaked.

Mental State Examination

She was Normal and cooperative.

Clinical Examination:

Height - 160 cms

Weight - 75kg

BMI-29.3 (overweight)

Pulse - 70/minute

B.P. - 130/80 mm of Hg

Systemic Examination:

Gastro-Intestinal System - No abnormality detected

Cardiovascular System - No abnormality detected

Nervous System - No any abnormality detected

Respiratory System - No abnormality detected

Diagnosis

Diagnosis was done clinically by following symptoms as per Rotterdam criteria.

  • Scanty menstrual bleeding.
  • Abnormal menstrual cycles.
  • Oligo menorrhea.
  • Weight gain.
  • Poly cystic ovary morphology on USG.

According to Ayurveda Samprapti Ghatakas are as follows:

Hetu: Diwaswapna, Avyayam, Ruksha Ahar Vihar, Abhishyandi Ahar Vihar.

Dosha: Kapha, Vata.

Dushya: Rasa, Meda

Strotasa: Rasavaha, Medovaha, Artavaha Strotasa

Strotodushti: Strotosanga, Vimarg-Gamana.

Pratyatma Lakshana: Artavkshaya, Sthaulya.

Investigations

  • Hb% - 10gm
  • Triglycerides - 187.00mg/dl
  • HDL cholesterol - 26.70 mg/dl
  • VLDL cholesterol - 37.40 mg/dl
  • Anti-mullerian hormone (AMH) - 9.72 ng/mL
  • TSH - 2.860 muIU /mL
  • USG (ABDO PELVIS) - Multiple small follicles in Necklace pattern in bilateral ovaries.

Ashtavidha Pareeksha

Nadi: 72/min


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Mootra: Prakrita

Mala: Niram, Aatop

Jihwa: Kinchit Saam

Shabda: Spashta, Prakrita

Sparsha: Samsheetoshna, Snigdha

Drik: Vikrita

Akriti: Sthool

Treatment

1) Nidan Parivarjana

Pathya[5] - Purana Ghrita, Purana Shaali, Yava, Godhuma, Mudga, Patola, Raktashigru, Asparagus sticks, garlic, black sesame, fish, brisk exercise for 10 min everyday

Apathya - Chillies, poultry products, red meat, pizza, burger, chowmein, curd, pickles, chole bhaturey, rajma, refined wheat flour, cold drinks etc.

2) First 15 days

Table 1: Ayurveda medication for first 15 days

SNAyurveda medicationMode of administration
1.Kanchnar Guggul2 tablet BD orally
2.Sukumar Kashaya2 tablet BD orally
3.Dashmoolarishta2 tsf BD with equal water orally
4.Kaumaryasava2tsf BD with equal amount of water after food

3) After 15 days

Table 2: Ayurveda medication and Panchakarma after 15 days

SNMedication & PanchakarmaMode of administration
1.Sukumar Kashaya2 tablet BD orally
2.Kanchnar Guggul2 tablet BD orally
3.Dashmoolarishta2 tsf with equal water orally
4.Kaumaryasava2 tsf with equal water orally
5.Dhanwantari TailSthanika Snehana before Basti
6.Dashmool KwathaSthanika swedana before Basti
7.Sahacharadi Tail + Til TailAnuvasan Basti
8.Erandamooladi KwathaNiruha Basti

4) After 30 days

Table 3: Ayurveda medication after 30 days

SNAyurveda medication & PanchakarmaMode of administration
1.Sukumar Kashaya2 tablet BD orally
2.Kanchnar Guggul2 tablet BD orally
3.Dashmoolarishta2 tsf with equal water orally
4.Kaumaryasava2 tsf with equal water orally
5.Ajmodadi Churna3gm HS

5) After 45 days

Table 4: Ayurveda medication after 45 days

SNAyurvedic medication and procedureMode of administration
1.Kanchnaar Guggul2BD
2.Sukumar Kashaya2 tablet BD orally
3.Dashmoolarishta2 tsf with equal water orally
4.Kaumaryasava2 tsf with equal water orally
5.Dhanwantari TailSthanika Snehana before Basti
6.Dashmool KwathaSthanika Swedana before Basti
7.Sahacharaadi + Til TailaMatra Basti for 7 days
8.Dashmool KwathaNiruha Basti for 1 day

Results

After 30 days of treatment her menses comes on regular interval, with normal blood flow and no pain. Assessment was done on the basis of following points:

After 1 month

Table 5: Improvement before and after the treatment

SNSign and SymptomDay 1Day 30
1.Amount of bleeding1 pads/day1-2 pads/day
2.Interval between two cycles3 months28-30 days
3.Duration of menses2-3 days3-4 days
4.Pain during menstruation+++-
5.Weight75kg70.5kg
6.Facial hair++++
7.Mood swings++++-
8.Dark patches on neck++-

Discussion

PCOS is mainly Vatakapha Pradhana Vyadhi so Chikitsa mainly focus on Vatakapha Dosha Prashamana including both Shamana and Shodhana Chikitsa.

Shamana treatment involves Aahara i.e. intake of Pathya Aahara and avoiding Apathaya Aahara, Vihara i.e., Alpa Vyayama and Aushadh i.e., prescribed medication. Shodhana Chikitsa involves Basti which is best treatment modality of Vata Dosha and Kapha-Anubandhi Vata, Pitta-Anubandhi Vata. Basti is easy to perform and Acharya Vagbhata considered it as Ardha Chikitsa. The main objective of treatment is to regulate the menstrual cycle and proper flow of Aartava during each menstrual cycle.

Kanchanara Guggulu has Vata-Kaphasamana, Lekhana (scrapping) and Shotha-Hara (anti- inflammatory) properties. Kanchanara Guggulu exhibits cytotoxic effect by inhibiting cell division


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and reducing cell proliferation.[6] Guggulu being warm, pacify the Vata. It is Medohara because of being Ruksha and Vishada and due to Tikshna and Ushna Guna, it pacifies the Kapha. It has anti-inflammatory action along with Rasayana and Artavajanaka properties.

Anti-inflammatory, anti-diabetic properties of Kanchanara (Bauhinia variegate) helps in the reducing insulin resistance often associated with PCOS.[7]

Dashmularishta is a classical polyherbal Ayurvedic formulation prepared by natural fermentation process of the decoction and powdered various herbs. It contains more than 50 herbs along with the group of ten herb roots known as Dashamula. Therapeutic uses of which is noted in Vatasaman. According to Ayurveda, Vata plays important role in vitiation of any female related disorders. So for the suppression of Vata, Dashamularishta plays a major role. In Sharangadhar Samhita, it has been indicated in infertility.

Kumaryasavam helps balance Vata and Kapha in the body improves digestion and increases appetite. It also has the property of promoting ovulation, which is beneficial in treating PCOS.

Ajmodadi Churnais a polyherbal medicine used as a carminative, antispasmodic, anti-inflammatory. it contains six ingredients,Trachyspermum ammi, Cedrus deodara, Piper longum, Terminalia chebula, Argyreia nervosa, andZingiber officinale.

Sukumara Kashayam is made of 27 medicinal plants.it contains antioxidant potential. It was observed that the 3 antioxidants namely, DPPH, FRAP and Hydrogen peroxide scavenging activity, have shown very good activities. This could be one of the mechanisms of action of this medicine.[8] Sukumaram Kashayam is useful in treating severe pain during and severe back pain during menstruation.

Garbhashya is Moola of Aartavaha Srotas and Aartava Vahini Dhamani which is the main seat of Apanvayu. In PCOS mainly Apanvayudushti is there and Basti is the most effective treatment for Apanavayudushti. So, for this patient we choose Basti treatment as Vatahar Chikitsa. If we do only Lekhan and Bhedan (reducing and disintegrating) treatment it may lead to Vatavruddhi so for that purpose treatment using Sneha

is more effective. So, we give Sahacharadi Taila Anuvasana Basti in patient.

Sahachara, Devadaru, Nagara, and Tila Taila are all present in Sahacharadi Taila. Cedrus deodara, also known as Devadaru and Sahachara (Barleria prionitis) are Kapha-Vatashamaka with properties similar to those of Vedana Sthapana, Shothahara, Kusthaghna, Kaphanisaraka, and Vranashodhana. Vranaropana. Additionally helpful in Shothahara and Shulahara circumstances is nagara (Zingiber officinalis), which is a Kapha-Vatashamaka and digestive in nature.[9]

Conclusion

Therefore, in this instance, we can draw the conclusion that the pathogenesis of polycystic ovarian disease is greatly disintegrated by Chikitsa in combination with Sukumar Kashaya, Kanchnar Guggul, Dashmoolarishta, and Kaumaryasava, as well as Yoga Basti with the Sahacharadi Taila + Murchhit Til Tail, Erandamooladi Niruha Basti, and Matra Basti with Sahacharadi Taila and Murchhit Til Tail. Throughout the course of this treatment, no side effects or complications were discovered. The study's findings are promising. It suggests that Ayurvedic treatment can control the menstrual cycle, help with weight loss, and relieve PCOS symptoms.

References

1. Cunningham F, Halvorson L, Dashe J, Hoffman B, Schorge J, Schaffer J. Williams Gynecology. 3rd ed. New York: McGraw-Hill Education; 2016. p. 387.

2. Sharma H. Kashyap Samhita: Kashi sanskrit maala. Varanasi: Chaukhamba Sanskrit Pratishthan. Kalpa Sthana Revati Kalpa, Shloka 33.

3. Jabeen A, Yamini V, Amberina AR, Dinesh Eshwar M, Vadakedath S, Begum GS, Kandi V. Polycystic Ovarian Syndrome: Prevalence, Predisposing Factors, and Awareness Among Adolescent and Young Girls of South India. Cureus. 2022 Aug 12. doi: 10.7759/cureus.27943. PMID: 36120281; PMCID: PMC9464521.

4. Dutta DC, Hiralal K. DC Dutta’s Textbook of Gynecology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers; 2016. Chapter 29.

5. Shastri K, Chaturvedi


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G. Charaka Samhita. Varanasi: Chaukambha Prakashan; 2018. Part I Sutra sthana, Chapter 5, Verses 13-14.

6. Tomar P, Dey YN, Sharma D, Wanjari MM, Gaidhani S, Jadhav A. Cytotoxic and antiproliferative activity of Kanchnar guggulu, an Ayurvedic formulation. J Integr Med. 2018 Nov;16(6):411-417.

7. Nariyal V, Sharma P. Kanchnar (Bauhinia Variegata) As a Medicinal Herb: A Systematic Review. Int J Adv Res. 2017;5:587-591.

8. Mudiganti N, Rao RK, Prabhu K, Kaliaselvi VS. Antioxidant Study of One Ayurvedic Medicine “Sukumara Kashayam”. Published on 2017.

9. Sakhare S, Raut R, Dole V, Dongare K. Clinical Efficacy of Sahacharadi Tail Basti in Management of PCOS - A Single Case Study. Ayushdhara. 2022;9(2):128-132.


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