E-ISSN:2456-3110

Case Report

Virechana Karma

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER
Publisherwww.maharshicharaka.in

Role of Virechana Karma in Poly Cystic Ovarian Syndrome - A Case Study

Santosh PR1*, Jaiswal D2, Amrutha BS3
DOI:10.21760/jaims.9.11.42

1* Pargaonkar Rasika Santosh, Final Year Post Graduate Scholar, Pg Department of Prasutitantra and Stree Roga, Sri Jayendra Saraswathi Ayurveda College Hospital Nazarathpeth, Chennai, Tamil Nadu, India.

2 Deepali Jaiswal, Final Year Post Graduate Scholar, Pg Department of Prasutitantra and Stree Roga, Sri Jayendra Saraswathi Ayurveda College Hospital Nazarathpeth, Chennai, Tamil Nadu, India.

3 Amrutha BS, Assistant Professor, Department of Ayurveda, Sri Chandrashekharendra Saraswathi Viswa Mahavidyalaya, Ennathur, Kanchipuram, Tamil Nadu, India.

Background: Polycystic Ovarian Syndrome is a prevalent endocrine disorder among women of reproductive age, characterized by hormonal imbalances, irregular menstrual cycles, insulin resistance and presence of ovarian cyst. Conventional treatments for PCOS often focus on symptoms management but ayurvedic medicine offers a holistic approach that aims at addressing the root cause. Virechana Karma is an essential treatment modality in ayurveda for managing hormonal imbalances and detoxifying the body.

Materials and Methods: In the present study a 25 years old female diagnosed with PCOS was treated with Shodhana Karma as Snehapan, Sarwanga Abhyanga, Swedana followed by Virechana Karma and Shamana Chikitsa given after discharge.

Result: After the given treatment patient has got significant relief in her symptoms and showed significant difference in her subsequent USG report.

Conclusion: The role of Virechana Karma in the treatment of PCOS, emphasizing its ability to regulate the Dosha, particularly Kapha and Pitta, which are considered to be imbalanced in PCOS. By eliminating ama from the body and promoting Agni, Virechana helps restore hormonal balance, improve insulin sensitivity and regulate the menstrual cycle. Hence, Virechana Karma represents a promising and integrative therapeutic option in the present study.

Keywords: Poly Cystic Ovarian Syndrome, PCOS, Virechana Karma, Arthavakshaya, Pushpaghni, Jataharini.

Corresponding Author How to Cite this Article To Browse
Pargaonkar Rasika Santosh, Final Year Post Graduate Scholar, Pg Department of Prasutitantra and Stree Roga, Sri Jayendra Saraswathi Ayurveda College Hospital Nazarathpeth, Chennai, Tamil Nadu, India.
Email: 		Santosh PR, Jaiswal D, Amrutha BS, Role of Virechana Karma in Poly Cystic Ovarian Syndrome - A Case Study. J Ayu Int Med Sci. 2024;9(11):295-298.
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https://jaims.in/jaims/article/view/4049

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-10-16 2024-10-26 2024-11-06 2024-11-16 2024-11-27
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© 2024by Santosh PR, Jaiswal D, Amrutha BSand 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].

J Ayu Int Med Sci 2024;9(11)295
Download PDFBack To ArticleIntroductionCase ReportResultDiscussionConclusionReferences
Pargaonkar R S et al. Role of Virechana Karma in Poly Cystic Ovarian Syndrome

Introduction

Polycystic Ovarian Syndrome (PCOS) has become a lifestyle disorder nowadays, affecting 30-40% of young girls in their reproductive age in India. PCOS is the most common endocrine condition in reproductive-aged women. PCOS characterized by a combination of hyperandrogenism (clinical or biochemical), oligo-ovulation and/or anovulation and polycystic ovaries (PCOS).[1] This adversely affects the reproductive system by menstrual disorders like oligomenorrhea or secondary amenorrhea, Acanthosis nigricans, obesity, depression, sleep apnea, insulin resistance and in due course may result in diabetes mellitus (10%) and Infertility.[2,3]

There is no direct reference in Ayurveda for Polycystic ovarian syndrome (PCOS). On the basis of Lakshana and Dosha involvement, this condition can be correlated with Arthavakshaya, Pushpaghni Jataharini, Vata-Kaphaja Artava Dushti, Granthi, Sthoulya and Medoroga. In the present case study 25-year-old, unmarried female patient with a history of irregular menstrual cycle since menarche, diagnosed with PCOS was treated successfully with Virechana Karma.

Case Report

A 25-year-old female patient came to the hospital with the complaints of irregular menstrual cycle since menarche (At age of 15 years) and decreased interval between two cycles since 1 year. The patient has noticed weight gain, increased facial hair, mood swings, irritability, blackish discolouration around nape of neck and elbow and has experienced lower abdominal pain during menses since 1 year. Her LMP was on 5-12-2023, PLMP- 20-11-2023, 10-11-2023, interval between two cycles is of 15-20 days and using 2-3 pads per day, partially soaked. Big sized, dark red coloured clots present. Patient has visited a doctor 4 years ago and has done an USG scan with which she was diagnosed with PCOD. The patient was under the allopathic medications which she stopped taking a year back because of no relief.

The patient is obese in built with BMI of 31.9 kg/cm. Examination revealed, coated tongue, 980 F temperature, 110/80mmhg Blood pressure, 80/min pulse rate, pallor, oedema, clubbing, icterus, cyanosis and lymphadenopathy was absent.

USG Report

Dated on 31-12-2022
Fatty Hepatomegaly Liver - 16.6 cm
Bilateral polycystic ovaries.
Endometrial thickness: 13.2 mm
Right ovary: 3.8 x 2.8 x 3.1 cm, Volume: 17.7 cc
Left Ovary: 4.0 x 2.6 x 2.5cm, Volume: 13cc,
Both ovaries appear enlarged and polycystic,
Minimally complex left Para ovarian cyst 3.8 x 3.2 cm with internal septum
No sign of torsion.

Blood Glucose Level

Fasting: 93.0 gm/dl (31-12-2022)
100 gm/dl (20-12-2023)
Postprandial: 126.0 gm/dl (31-12-2022)
149 gm/dl (20-12-2023)
HbA1C - 5.9 %

Thyroid Function Test

F T3 - 2.97 ng/dl
F T4 - 1.04 ng/dl
TSH - 2.14 uIU/ml

Treatment Plan

SNDate and Number of DaysTreatment
1.19-12-2023 TO 23-12-2023
(5 days)		1.  Udvartana with Kolakulathadi Churna
2.  Takradhara with Mustakamalakadi Siddha Takra
3.  Mahashankh Vati 2 tabs TDS (B/F)
4.  Panchakola Paniya (whenever thirsty)
2.24-12-2023 TO 27-12-2023
(4 days)		Sneha Pana with Kalyanaka Ghrita
D1- 36 ml + 2 gm Saindhava
D2- 72 ml + 3 gm Saindhava
D3- 108 ml + 4 gm Saindhava
D4- 160 ml + 5 gm Saindhava
3.28-12-2023 To 31-12-2023
(4 days)		1.  Sarvanga Abhyanga with Dhanwantaram Taila
2.  Bashpa Swedana
4.31-12-2023Virechana with Trivrutta Lehyam 70 gm + 50 ml of Triphala Kwatha.
Total Vega - 23 (Pravara Shuddhi)

On discharge medication

  1. Ashokarishta & Dashamoolarishta 10 ml each twice a day with 40ml warm water after food.
  2. Dhanwantaram Gulika 1 tablet twice a day along with Arishtam.
  3. Sukumara Ghrita, 1 teaspoon with warm water on empty stomach.

J Ayu Int Med Sci 2024;9(11)296
Pargaonkar R S et al. Role of Virechana Karma in Poly Cystic Ovarian Syndrome

Result

SNBefore TreatmentAfter Treatment
1.Prolonged Bleeding
(10-12 days)		5 days of bleeding
(21-02-2024 TO 25-02-2024)
2.Weight – 100 kgWeight – 94 kg
3.Dysmenorrhea presentDysmenorrhea Absent
4.Big sized clotsClots Reduced
5.Acanthosis nigricans presentAcanthosis nigricans Reduced
6.Mood swings and irritability presentMood swings and irritability reduced
7.USG-
Right ovary- 3.8 x 2.8 x 3.1 cm, Vol- 17.7cc
Left ovary- 4.0 x 2.6 x 2.5cm, Vol- 13cc
Left Para ovarian cyst- 3.8 x 3.2 cm.		USG-
Right Ovary- 4.1 x 4.0 x 1.4 cm, Vol- 12.8cc
Left Ovary- 4.0 x 2.5 x 1.7 cm, Vol- 9.0 cc,
Left Para ovarian cyst- 3.4 x 2.8 cm

Discussion

Virechana Karma, a therapeutic purgation procedure in Ayurveda, is gaining recognition as an effective approach for managing Polycystic Ovary Syndrome (PCOS). Virechana expel out the Aamashayadi Doshas dragging them towards the Adhobhaga through the Guda (anus).This traditional practice aims to detoxify the body, balance hormones, and improve overall reproductive health through a structured regimen of dietary modifications, herbal medications, and therapeutic purgation.[4]

PCOS occurs due to the vitiation of Vata and kapha dosha as they do Margavarodha to Artava Vaha Srotas leading to absence of flow of Artava. It can be understood as the Sannipataja Dosha manifestation with Samprapti of Rasa Dusti, Medodusti, Aavarna of Vata and Aartava Dusti with Beejopaghata as factor. After Shamana Chikitsa Dosha may be aggravate again but in Shodhana chikitsa all dosha are eliminated by root so they can never be reoccurred.[5]

Virechana Karma - Poorva Karma - Deepan & Pachana - Mahashankha Vati - It works as Deepan and Vata-Pitta Doshahar.[6] Udvartan - Kolakulatthadi Churna - It works as Vatahara and it is indicated in all type of Vata Roga.[7] Takra Dhara - Musta and Amalaki Siddha Takra -It relaxes and revitalises the central nervous system, balances the brain and hormonal functions hence releases stress and anxiety and relaxes all the function of the body.

It has to regularize the functions of pituitary gland and hypothalamus and also has soothing effect on endocrine system.[8] Panchakola Paniya - It has the properties like Tikshna, Pacna, Kapha-Vata Har, Shoolaghna, Gulmahara and it said to be Shreshtha Deepana.[9] Sneha Pana - Kalyanaka Ghrita It has the properties like Tridosha Shamak, Vrushya, Yonidoshahara, and Garbhasthapak . As it is Deepan - Pacana, it regulates Jatharagni and corrects metabolism.[10,11] Sarwanga Abhyanga - Dhanwantaram Taila - It act as Gulmahar, Yonirogahar, Vata-Kapha Hara.[12] Pradhana Karma - Virechana - 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.[13] Trivrit Leha - When both digested or indigested Mala are liquefied and evacuated then the process is termed as Rechana and the drug is termed as Rechana Dravya. The example of Rechana Dravya is Trivrita.[14] Triphala Kwatha - It is Vata-Kapha Hara.[15] Paschat Karma - Sansarajan Kram for 5 days.

On discharge medicines - Ashokarishta - It works as Pitta Doshahar, Vata-Kapha Shaman and it is indicated in Raktapitta, Mandagni, Ruja.[16] Dashmoolarishta - Deepan - Pacan, Vatanuloman, Shollahar, Grahi, Balya and it is indicated in Gulm, Mandagni, Vata Vyadhi.[17] Dhanwantaram Gulika - Kapha Vatahar, Vatanulomana.[18] Sukumar Ghrita - Vata-Pitta Har, Rasayan, Agni Deepan, Anila - Artihara and indicated in Gulma, Yoniroga.[19]

Conclusion

Virechana Karma, a prefatory therapy in Ayurveda, plays a significant role in managing polycystic ovarian syndrome by targeting the root cause of the condition, such as imbalance in Doshas (Kapha and Pitta), Viechana helps in detoxifying the body and restoring hormonal balance. It acts in regulating the menstrual cycle, reducing insulin resistance and managing symptoms like acne, hirsutism and weight gain, which are commonly associated with PCOS. By promoting the elimination of Ama and improving digestive and metabolic function, Virechana Karma offers a holistic and natural approach to PCOS management. In the present case study, a significant result of the Virechana Karma is seen in the PCOS.


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References

1. Dutta DC. PCOS In: Konar H, editor. DC Dutta's textbook of gynaecology. 6th ed. 2013. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2014. pp. 384-385.

2. Howkins and Bourne. Shaw’s Textbook of Gynecology edited by VG Padubidri and Daftary, Published by Reed Elsevier India Private Limited; India: 2015. pp. 431.

3. Schorge JO, Schaffer JI, Halvorson Lm,Hiffman BL,Bradshaw KD,cumningham FG, editors. Williams Gynecology. 1st edi. China: McGraw-Hill; 2008 pp.397-400.

4. Prarthana, T, Rao, Veena G. Management of secondary amenorrhea and PCOS by Vamana and Virechana - a case report. Journal of Research in Ayurvedic Sciences 6(1):p 11-16, Jan–Mar 2022. DOI: 10.4103/jras.jras_37_21

5. Vadhya Sarvesh kumar singh, Vadhya Kshipra rajoria. Panchakarma Parigyan. First edition, Varanasi; Chaukhamba Orientalia, 2019 pp.361.

6. Kanjiv lochan , Bhasajya ratnavali of govinda dasji bhisagratna, vol. I, Agnimandya rogadhikar, edition reprint : 2019, chaukhambha sanskrit sansthan varanasi, chapter 10/187, pp 667.

7. stanga Sangraha of Vrddha Vagbhata,Uttara Sthana, Transalated by Prof. Srikantha Murthy K.R, Vol.III, Varanasi, Chowkhambha Orientalia, Reprint Edition 2018,Chapter 23/3, pp 520 .

8. Astanga Hirdayam of Acharya Vagbhata, Sutra Sthana, Translated by Prof. K.R. Srikantha Murthy, Gandushadi vidhi, Vol. I, Varanasi, Chowkhambha Krishna Das Academy, Edition 11th, 2020, Chapter 22/27-31, pp 274.

9. Bhavaprakash of Bhavamisra, Purvakhand, haritakyadi varga, Commentary by Dr. Bulusu Sitaram, Vol. I, Chowkhambha Orientalia, Varanasi, Reprint Edition 2020 Chapter 6 /72-73, pp.142.

10. Prarthana, T.; Rao, Veena G. Management of secondary amenorrhea and PCOS by Vamana and Virechana - a case report. Journal of Research in Ayurvedic Sciences 6(1):p 11-16, Jan–Mar 2022.DOI: 10.4103/jras.jras_37_21

11. Charak samhita of Agnivesa’s ,Chikitsa sthana , By Dr. Ram karan sharma and vaidya bhagwan dash,Vol. III, Varansi, Chowkhambha Sankrit Series Office , Edition Reprint 2018, Chapter 9/35, pp 424.

12. Astanga Hirdayam of Acharya Vagbhata, sharira sthana, Translated by Prof. K.R. Srikantha Murthy, Vol. I, Varanasi, Chowkhambha Krishna Das Academy, Edition 11th, 2020, Chapter 2/47, pp 387.

13. Rajpurohit D, Neelima A. Ayurvedic perspective of Polycystic Ovarian Syndrome. Journal of Ayurveda and Integrated Medical Sciences. 2023 Sep 1;8(7):128-33.

14. Prabhakar rao, Sarngadhara samhita of sarngadharacarya, prathama khanda, first edition 2013 chaukhambha publications new delhi, chapter 4,/6, pp17.

15. Kanjiv lochan , Bhasajya ratnavali of govinda dasji bhisagratna, vol. II, shotharogadhikar, edition reprint: 2019, chaukhambha sanskrit sansthan varanasi, chapter 42/27, pp 648.

16. Kanjiv lochan , Bhasajya ratnavali of govinda dasji bhisagratna, vol. I, Pradararoga chikitsa Prakarana, edition reprint: 2019, chaukhambha sanskrit sansthan varanasi, chapter 66/118, pp 357.

17. Kanjiv lochan, Bhasajya ratnavali of govinda dasji bhisagratna, vol. II, Vajikarana Prakarana, edition reprint: 2019, chaukhambha sanskrit sansthan varanasi, chapter 74/357, pp 730.

18. G Prabhakar Rao, Sahastrayogam,Gutika yoga prakaram, Edition Reprint 2019, Chaukhmbha Publications New Delhi, Chapter 17/41, pp 427.

19. Astanga Hirdayam of Acharya Vagbhata, chikitsa sthana, Translated by Prof. K.R. Srikantha Murthy, Vol. II, Varanasi, Chowkhambha Krishna Das Academy, Edition 11th, 2020, Chapter 13/41, pp 398.

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