E-ISSN:2456-3110

Case Report

Managing PCOD

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

An Ayurvedic methodology for managing PCOD - A Case Report

Sokiya G1, Vandana2*, Painuly P3, Sharma G4
DOI:10.21760/jaims.9.4.51

1 Gracy Sokiya, Assistant Professor, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

2* Vandana, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

3 Paridhi Painuly, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

4 Gaurav Sharma, Assistant Professor, Department of Rachana Sharir, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.

Polycystic ovarian disease (PCOD) is a heterogenous endocrine disorder characterized by ovarian cysts, anovulation, and hormonal fluctuations, impacting women’s health in various ways. PCOD has transformed into a lifestyle disorder due to sedentary habits, excessive consumption of fast food, and an unhealthy lifestyle. Predisposing risk factors such as genetics, neuroendocrine factors, lifestyle and environmental influences, as well as obesity, play significant roles in the development of PCOD. In Ayurveda, PCOD cannot be correlated to any one particular disease; it can be related to certain diseases like Vandhya, Nasthartava, Aratava Kshaya, Pushpaghni Jataharini, etc. and must be controlled according to the Dosha Dushya vitiation. In this present case study, a 21 year old female patient came with symptoms of scanty menses, acne over face and weight gain in the OPD of Kayachikitsa. The USG report reveals PCOD changes in both ovaries as both ovaries are bulky in size right ovary, vol = 18cc and left ovary, vol = 13.2cc with multiple peripherally arranged follicles with central echogenic stroma. The result was determined based on the relief of clinical symptoms and the findings from the ultrasound report. Therefore, in this case study, drugs such as Dashmool Kwath, Narikanti, Cystogrit diamond etc. was given which have Lekhaniya properties results into reducing the size of ovary and effectively alleviate Kapha Dosha and Ama, facilitating the treatment of Sroto-Dusti and removing obstructions caused by Apana Vayu, ultimately enhancing menstrual flow.

Keywords: PCOD, Aratava Kshaya, Sroto-Dusti, Anovulation

Corresponding Author How to Cite this Article To Browse
Vandana, Post Graduate Scholar, Department of Kayachikitsa, Patanjali Ayurveda College, Haridwar, Uttarakhand, India.
Email: 		Sokiya G, Vandana, Painuly P, Sharma G, An Ayurvedic methodology for managing PCOD - A Case Report. J Ayu Int Med Sci. 2024;9(4):304-309.
Available From
https://jaims.in/jaims/article/view/3144

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-08 2024-02-18 2024-02-28 2024-06-10 2024-03-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 23.89

© 2024by Sokiya G, Vandana, Painuly P, Sharma Gand 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

Women play a crucial role in every nation, serving as the foundation for happiness and fostering healthy families. As highlighted in a United Nations report, women constitute half of the world’s human resources, ranking them as the second most valuable resource after men. Contemporary women are increasingly rushing to advance their careers and achieve financial independence. However, this pursuit often comes at a cost to their health. Changes in lifestyle, dietary habits, and sleep patterns are contributing to poor health. Moreover, advanced lifestyle has led to the prevalence of conditions such as Polycystic ovarian disease (PCOD).

PCOD is most common endocrine disorder in women reproductive age group, affecting 5 to 10% of women.[1] It is first described in 1935 by Stein and Leventhal, giving rise to the term Stien-Leventhal Syndrome. Polycystic ovarian disease (PCOD) is a heterogenous endocrine disorder characterized by chronic anovulation and androgen excess with clinical manifestations of irregular cycles, hirsutism, acne and obesity.[2] According to the World Health Organization (WHO) estimation revealed over 116 million women (3.4%) are affected by PCOS worldwide.[3] The exact cause of PCOD remains uncertain, accumulating evidence indicates that is a complex condition influenced by multiple genes and impacted by significant epigenetic, high levels of insulin, hyper androgen, LH and environmental factors, such as nutrition and lifestyle choices. [4] The most frequently observed symptoms of PCOD include menstrual irregularities and reproductive issues, often resulting in female infertility. PCOD frequently remains unnoticed and undiagnosed, as irregular periods during adolescence are commonly considered normal. [5] Many women tend to recognize the significance of PCOD primarily when it impacts their fertility. The Polycystic ovary is considered as a sign, not as a disease entity.

In Ayurvedic texts, there is no direct correlation PCOD rather, symptoms are described under various disease conditions in references such as Aartavavaha Strotas Dushti, Nastaartava, Granthi, Santarponnth Vyadhi, Yonivyapad. PCOD arises from the blockage of Vata and Pitta by Kapha, disrupting movement and inhibiting the transformation process. Following dietary

habits and activities that elevate Kapha leads to Kapha dominance in the body. Characteristics of Kapha such as Sheeta, Manda, Sthira, Guru,[6] diminish the Jatharagni[7] (digestive fire), and starts impacting the metabolic function of the body’s seven tissues i.e., Dhatu Agni. [8] The Kapha and Ama resulting from Agnimandya cause blockages in Artavavaha Strotas (Artavaha Sroto Dushti). This stagnation of Apana Vayu in the Artavavaha Strotas obstructs the flow of Vata in the ovarian cycle, leading to menstrual disturbances like oligomenorrhea and amenorrhea in PCOD.

Menstrual irregularities primarily manifests from the aggravation of all three Doshas but notably Apana Vayu. The main quality of the Artava Dhatu is Agneyatva.[9] When the Artava Dhatu is obstructed, it exacerbates Pitta Dosha. The aggravation of Pitta, particularly Bhrajaka Pitta and Ranjaka Pitta, manifests as symptoms like acne and increased body hair observed in PCOD.[10]

The accumulation of excess Kledak Kapha and Ama in the body also results Dhatu Agni Mandya.[11] As per the Saamanya Vishesh Siddhant,[12] The presence of Kledak Kapha and Ama impacts the Meda Dhatu Agni. This impaired metabolism of the fat tissue leads to a contradictory state of fat metabolism (Meda Viruddha), ultimately contributing to obesity.

In modern medicine, the primary line of treatment for PCOD often involves hormonal therapy. In Ayurveda, treatment is based on the predominance of Doshas, focusing on treating Ama, Vatakaphahara, Strotoshodhaka, and Anulomana therapies.

Case Report

A 21 years old female patient hailing from Sriganganagar, Rajasthan approached Kayachikitsa OPD of Patanjali Ayurvedic Hospital, Haridwar in 12/09/2023 with complaints of:

Table 1: Chief complaints

SNComplaintsDuration
1.Acne over face1 year
2.Weight Gain1 year
3.Scanty Bleeding2 months

Then, she was advised for USG and it was found that presence of PCOD changes in both ovaries. Now, she approached our hospital for Ayurvedic management.


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Table 2: General Examination

1. BuiltObese
2.  Weight93 kg
3.  Height5’4 ft.in
4.  BMI35.2 kg/m2
5.  Blood Pressure120/80 mmHg

Materials and Methods

Patient was given oral Ayurvedic medications and therapeutic procedures such as Snehapana, Sarvanga Abhyanaga followed by Swedana and Virechana as mentioned below:

Table 3: Shamana Aushadi

SNShamana AushadiMatra and Sevan Kala
1.Sarvakalp Kwath + Dashmool Kwath100 ml twice daily empty stomach
2.Narikanti2 tab twice daily before meal
3.Cystogrit Diamond1 tab twice daily before meal
4.Medohar Vati2 tab twice daily before meal
5.Punarnavadi Mandoor2 tab twice daily after meal
6.Haritaki Churna1tsf at bed time with lukewarm water

Table 4: Shodhana Treatment

SNDaysTreatment procedureDrug used
1.Day 1 - Day 3Deepana PachanaPanchkol Churna 1/2 tsf twice daily before meal.
Chitrakadi Vati 2 tab twice daily after meal.
2.Day 4 - Day 8SnehapanaPanchatikta Ghrita
Day 4 - 50 ml
Day 5 - 100 ml
Day 6 - 125 ml
Day 7 - 150ml
Day 8 - 200ml
3. Day 9 - Day 12Sarvanga Abhyanga + Saranaga SwedaMahanarayana Taila + Dashmool Kwath
4.Day 12VirechanaTriphala Kwath 120ml + Trivrit Avleha 40gm

Result

Within 3 months, the patient experienced significant alleviation of symptoms, accompanied by a notable result in USG, as illustrated below:

Before Treatment

USG findings (07-09-2023): Mild hepatomegaly with grade 1 fatty liver.

Changes of PCOD in both ovaries - Both ovaries

are bulky in size right ovary, vol = 18cc and left ovary, vol = 13.2cc with multiple peripherally arranged follicles with central echogenic stroma.

After Treatment

USG findings (05-01-2024): No significant abnormality. Both the ovaries are normal in size (Rt- 2.6x1.4 cm, Lt- 3.2x1.9cm) and appearance.

Fig. 1: USG report before treatment.
jaims_3144_01.JPG

Fig. 2: USG report after treatment.
jaims_3144_02.JPG

Discussion

Polycystic ovarian disease (PCOD) is a diverse endocrine disorder characterized


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by the presence of ovarian cysts, anovulation, and hormonal fluctuations, significantly affecting a woman’s life. Imbalances in reproductive hormones such as LH, FSH, oestrogen, and testosterone disrupt the regular menstrual cycle, resulting in irregularities such as oligomenorrhea and amenorrhea.[13] According to Ayurveda, In PCOD mainly affected Srotas are Artavaha Srotas, Rasavaha Strotas and Medavaha Strotas. It involves an imbalance of all three Doshas, three Dhatus such as Rasa, Medha and Artava along with Updhatu of Rasa i.e., Artava. Kapha Dosha and Ama is responsible for Stroto Dushti in the Artavavaha Strotas.[14] The Sanga of Apana Vayu impeding the flow of Vata in the ovarian cycle results into disturbances in the outflow of menstrual fluid.[15] So, to alleviate the Ama, Deepana Pachana drugs were chosen such as Chitrakadi Vati and Panchkol Churna. Cystogrit Diamond, and Medhohar Vati include ingredients with Lekhana properties and possess Vatakaphara properties which helps in clearance of obstruction. Drugs which have rejuvenating properties were chosen.

Shaman Ausadhi given during the treatment is

Sarvakalp Kwath: Punarnava (Boerhaavia diffusa), Bhumiamla (Phyllanthus niruri), and Makoy (Solanum nigrum) collectively exhibit hepatoprotective properties, aiding in the reduction of liver inflammation. Punarnava and Bhumiamla possess rejuvenating effects on the liver and act as blood purifiers, thus alleviating splenomegaly. [16]

Dashmool Kwath: It contains roots of ten drugs i.e., Bilva, Gambhari, Agnimantha, Patala, Shyonaka, Brahati, Gokharu, Kantakari, Prishniparni, Shalaparni specifically possess Kaphavata Shamak properties and Tridosha Shamak Guna along with Deepana Pachana properties[17] which effectively alleviate Kapha Dosha and Ama, facilitating the treatment of Sroto-Dusti and removing obstructions caused by Apana Vayu, ultimately enhancing menstrual flow.

Narikanti: Shatavar, Shisham, Jaljamini, Nagkesar, Gokhru, Ashoka, Supari are the key ingredients. Shatavar is the main component with its rejuvenating properties, enhancing strength. Ashoka, Supari and Nagkesar alleviates menstrual disorders and abnormal bleeding along with strengthening the uterine muscles property.[18]

Cystogrit Diamond: Kanchnar Bark, Haldi, Shila Sindoor, Muktashukti Pishti, Moti Pishti,

Tamra Bhasma, Heeraka Bhasma as key ingredients exhibit Lekhana (scraping) properties facilitating the reduction in the size of the ovary.

Shilasindoor is particularly effective in alleviating vitiated Raktadhatu and treating infectious diseases such as fever (Jwara, Sannipataja Jwara).[19]

B.variegata shows antitumour, antiulcer, immunomodulatory, haematinic, antimicrobial, hepatoprotective, antioxidant properties, [20] due to the presence of chemical constituents such as lupeol, kaempferol-3-glucosides, 5, 7 dimethoxy flavanone-4-o-L etc. in stem bark.[21] Heeraka Bhasma is also best used as Lekhandravya.[22]

Medohar Vati: It is composed of herbal component includes Amla, Baheda, Harad, Guggul shuddha, Shilajeet Shuddha, Kutki, Nisoth, and Vayavidnga exhibits Rechaniya (a form of osmotic laxative), Deepaniya (promotes digestive and metabolism capacity) along with Vatakapha Shamaka (pacifying vatadosha) properties which corrects Medha Dhatu (fat tissue), Ama dosha (indigested substance), Dhatwagni (metabolic factors located in Dhatu) and Jatharagni resulted into Srotoshudhi (purification of channels) and Laghutava in the body.[23] Guggulu, a key component, possess Tikta (bitter taste), Katu Rasa (pungent taste), Laghu (light to digest), Ruksha (dryness inducing), Vishada (clears channels), Sukshma (minute), Sara (instability), Katu Vipaka (pungent bio transformed) and Ushna Veerya (hot potency) properties .[24] It is best drug for obesity. [25]

Punarnavadi Mandoor: Punarnava Mandoor having anti-obesity properties as it possess Kaphavata Shamaka (pacifying Kapha and Vatadosha), Deepaniya (enhancing metabolic fire), Pachana (enhancing digestion) and Lekhana (therapeutic scrapping) properties. It is known to be effective in reducing belly and hip fat through reducing the basal metabolic rate and increases lipid metabolism in the body. It also acts as Anulomana (mild purgative action), Mutrala (diuretic) and hepatoprotective.[26]

Haritaki Churna: Haritaki Churna possesses the Anulomana property, which aids in balancing Apana Vayu, thereby alleviating symptom of disturbances in the outflow of menstrual fluid. Its use, particularly as a Mridu Virechana Dravya, is suggested in conditions dominated by Vata and disorders associated with central locations of Vata Dosha.[27]


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Conclusion

PCOD cannot be correlated to any one particular disease in Ayurveda, it can be related to certain diseases like Vandhya, Nasthartava, Aratava Kshaya, Pushpaghni Jataharini, etc. and must be controlled according to the Dosha Dushya vitiation. Deepana and Pachana medicines play a crucial role in alleviating Ama, thereby enhancing the patient’s digestive capacity, which forms the initial step in PCOD management. The Vata- Kaphahara and Medohara properties of certain herbs aids in controlling the Apanavata and preventing imbalances in Medodhatu, thereby controlling conditions like Granthi (cysts), Prameha (urinary disorders), and Sthoulya (obesity). Therefore, considering the particular disturbances in Sroto Dushti, Avarodha, Agni, Ama, etc., we can choose the appropriate Shodhana and Shamana Chikitsa.

Acknowledgement

I am immensely grateful to my institution and hospital management for providing me with the opportunity to undertake and complete this project. Also, I take this opportunity to express my heartfelt appreciation to my guide and co-guide whose invaluable guidance has been instrumental in the successful execution of this project.

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