E-ISSN:2456-3110

Case Report

PCOS

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 8 August
Publisherwww.maharshicharaka.in

Insight into Ayurvedic management of PCOS through Shodhana and Shamana Chikitsa

Bhandwalkar PA1, Veena R2*
DOI:10.21760/jaims.10.8.60

1 Priyanka A Bhandwalkar, Third Year Post Graduate Scholar, Department of PG Studies in Prasuti Tantra and Stree Roga, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

2* Veena R, Assistant Professor, Department of PG Studies in Prasuti Tantra and Stree Roga, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

The female reproductive system is primarily controlled by hypothalamo - pituitary - ovarian (HPO) axis. Alterations in the proper functioning of HPO axis can leads to metabolic and endocrine disorders such as PCOS (polycystic ovary syndrome). It is characterized by menstrual irregularities, hyperandrogenism and polycystic ovarian morphology. As it is a syndrome, to find out an exact ayurvedic co-relation is difficult. The various conditions associated with PCOS shows similarities with Pushpagni Jathaharini, Nashtartava, Artava Kshaya, Granthi, Sthoulya etc. In the present case, a 23-year-old female patient complains of irregular menstrual cycle with the interval of 2-3 months along with heavy bleeding during periods for 7-8 days duration and polycystic ovaries seen in ultrasonography report in the last 5 years associated with sudden weight gain. Both Shodhana and Shamana Chikitsa adopted in this condition. Improvement was noted in both the symptoms as well as in USG report.

Keywords: PCOS, Pushpagni Jathaharini, Nashtartava, Artava Kshaya, Granthi, Sthoulya, Shamana Chikitsa, Shodhana Chikitsa

Corresponding Author How to Cite this Article To Browse
Veena R, Assistant Professor, Department of PG Studies in Prasuti Tantra and Stree Roga, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.
Email: 		Bhandwalkar PA, Veena R, Insight into Ayurvedic management of PCOS through Shodhana and Shamana Chikitsa. J Ayu Int Med Sci. 2025;10(8):359-364.
Available From
https://jaims.in/jaims/article/view/4691/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-06-10 2025-06-26 2025-07-07 2025-07-16 2025-07-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Not required 10.32

© 2025 by Bhandwalkar PA, Veena R and 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 2025;10(8)359
Download PDFBack To ArticleIntroductionAim and ObjectiveMaterials and MethodsCase ReportObservations and ResultsDiscussionConclusionReferences
Priyanka AB et al. Ayurvedic management of PCOS

Introduction

Polycystic ovary syndrome (PCOS) is one of most frequent gynecological endocrine disorders affecting a significant number of females in their reproductive age. Nowadays prevalence of PCOS is approximately one in every 10 women.[1] It is characterized by menstrual irregularities in form of oligomenorrhea, amenorrhea or DUB, accompanied by metabolic abnormalities like obesity and insulin resistance (IR). Chronic low-grade inflammation is a key contributor to pathogenesis of PCOS. Nearly 30% women with PCOS have abdominal adiposity or visceral fat. These Hypertrophic adipocytes sharply increase level of adiponectin, Leptin, IL6 and TNF-a which cumulatively contribute to inflammation of adipose tissue and can cause hyperandrogenism which might contribute to insulin resistance.[2]

This hyperandrogenism impairs follicular maturation and ovulation, thus give rise to multiple cyst in ovaries and also associated with menstrual irregularities like oligomenorrhea or amenorrhea. A gradual rise in level of estrogen with concomitant phase of amenorrhea and endometrium get thickened slowly under influence of this unopposed estrogen due to anovulation. After a variable period, estrogen levels fall which results in shedding of thickened endometrium with heavy bleeding.

In Ayurveda classics, we cannot find an exact correlation of this condition. The various symptoms associated with PCOS shows similarities with Pushpagni Jathaharini, Nashtaartava, Artavakshaya, Granthi, Sthoulya etc. Acharya Kashyapa mentioned Pushpagni Jataharini with Lakshanas like Vrutha Pushpam (fruitless cycles), Sthoola Lomasha Gan-da[4] (corpulent cheeks with excessive hair gro-wth). These can be correlated with hyperandrogenic state resulting in hirsutism, anovulation and menstrual irregularities. According to Acharya Sushruta, Nastartava is a condition in which vitiated Vata and Kapha Dosa causes Avarana to Artavavaha Srotas and results in Artavanasa[5], this can be considered as secondary amenorrhea or anovulation associated with PCOS. Artavakshaya is also menti-oned by Susruta Aacharya with Lakshanas ‘Yatho-chitha Kala Adarshana (irregular menstruation), Alpata (scanty menstruation) and Yonivedana (pain in genital region)[6], so this condition can be considered as abnormal uterine bleeding such as oligomenorrhea and hypomenorrhea.

Granthi mentioned by Acharya Susrutha which is due to vitiated Vatadi Dosas, which vitiates Rakta, Mamsa & Medas results in nodular swelling with Vrutha (round) & Unnatha (raised appearance)[7], so this can be taken as polycystic lesions in ovary. Acharya Charaka mentioned Sthoulya Lakshanas like Chala Sphik Udara Stana(flabbiness of buttocks, abdomen and breasts) due to increased Meda and Mamsa Dhatu[8], these having close resemblance with visceral obesity in women with PCOS. As it is syndrome, PCOS can be considered as Bahudo-savastha, therefore both Shamana and Shodhana Chikitsa having great role in its management.

Aim and Objective

To assess the effect of Ayurvedic management of PCOS with Shodhana and Shamana Chikitsa.

Materials and Methods

Informed written consent was taken from the patient in her own language and case was recorded as per case proforma.

Case Report

A 23 years old female patient complains of irregular menstrual cycle with interval of 2-3 months along with heavy bleeding for 7-8 days & Polycystic ovaries seen in ultrasonography report in last 5 years associated with sudden weight gain. She had undergone HRT therapies, but she didn’t get comp-lete relief so she visited OPD of Prasuti Tantra & Stree Roga, Alva’s Ayurvedic Medical College & Hos-pital, Moodbidri on 21/08/24 for better treatment.

Personal History

Diet - Mixed
Bowel - Normal
Appetite - Good
Micturition - Adequate (4-5 times/day, 1-2 times/night)
Sleep - Sound

Menstrual History

PMP - 10/05/24
LMP - 15/08/24
Cycle - Irregular
Interval - 2-3 months
Duration - 7-8 days
Amount of bleeding - 5-6 pads/ day


J Ayu Int Med Sci 2025;10(8)360
Priyanka AB et al. Ayurvedic management of PCOS

General Examination

Appearance - Bulky
Height - 155cm
Weight - 66kg
BMI - 27.5 kg/m2
BP - 120/80 mmhg
PR - 70 Bpm
RR - 16/min
Pallor - Absent
Icterus - Absent
Edema - Absent
Lymphadenopathy - Absent

Systemic Examination

RS - AEBE clear
CVS - S1S2 normal
CNS - Conscious oriented

Local Examination

Per abdomen - Soft, non-tender
Per speculum - Not done
Per vaginal - Not done

Asthavidha Pariksha

Nadi - Pitta-kapha
Mala - Samanya
Mutra - Anavila
Jivha - Lipta
Shabda - Spashta
Sparsha - Anushnasheeta
Drik - Prakrita
Akruti - Sthoola

Therapeutic Interventions

1) Shodhana Chikitsa

DateTherapeutic approachMedicine with dose
21/8/24- 23 /8/24Deepana & PachanaChitrakadi Vati 1-1-1
(A/F) for 3 days
21/8/24- 23/8/24Udwartana with BashpaswedaKolakulathadi Choorna for 3 days
24/8/24 – 26/8/24SnehapanaMoorchitha Tila Taila
1st day - 30 ml
2nd day - 60 ml
3rd day - 90 ml
27/8/24 – 30/8/24Abhyanga with Bashpa SwedaMoorchita Tila Taila for 4 days
30/8/24VirechanaTrivruth Lehya - 40gm
Drakshadi Phanta Kashaya - 150 ml
31/8/24 - 4/9/24Samsarjana Krama

2) Shamana Chikitsa

Date & durationMedicine with dose
5/9/24 - 19/9/24 (15 days)1. Varunadi Kashaya 15ml Kashaya with 45 ml lukewarm water Bd (B/F)
2. Navaka Guggulu 1-0-1 ( A/F)
3. Pushpadhanwa Rasa 1-1-1( A/F)
4. Shatapushpa Choorna ½tsp-0-½tsp (A/F) with lukewarm water
19/9/24 - 20/12/24 (3 months)1. Varunadi Kashaya 15ml Kashaya with 45 ml lukewarm water Bd (B/F)
2. Navaka Guggulu 1-0-1 (A/F)
3. Shatapushpa Choorna ½tsp-0-½tsp ( A/F) with lukewarm water

Pathyapathya

PathyaApathya
Green leafy vegetables
Vegetable soup, green gram soup
Whole grains like brown rice		Processed food like fast food, soft drinks
Red meat
Excessive stress
Sedentary life style

Observations and Results

Parameters21/8/24
Day 1		23/9/24
Day 35		28/10/24
Day 70		2/12/24
Day 105		6/1/25
Day 140
LMP15/8/2418/9/2420/10/2423/11/2426/12/24
Cycle Interval2-3 months35 days34 days35 days34 days
Amount bleeding5-6 pads/day1-2 pads/day1-2 pads/day1-2 pads/day1-2 pads/day
Clots+++absentabsentabsent
Duration7-8 days4-5 days4-5 days4-5 days4-5 days
weight66kg63.5kg60kg58.2 kg55.6kg
BMI27.5 kg/m226.4 kg/m225 kg/m224.2 kg/m223.1 kg/m2

Investigation Report

USG:

Before treatmentAfter treatment
Date18/10/2331/12/24
UterusAnteverted
Normal size and texture
ET - 6mm		Normal in size measures
6.05×2.46×4.9 cms
ET - 3.6mm
OvariesProminent
Multiple small follicles at the periphery with central echogenic stroma		Normal size and echotexture
RO-3.27×1.47×2.93 cms
(vol - 7.37cc)
LO-3.42×1.23×2.55 cms
( vol- 5.61 cc)
(vol - 5.61cc)
ImpressionPolycystic ovariesNo significant abnormality

J Ayu Int Med Sci 2025;10(8)361
Priyanka AB et al. Ayurvedic management of PCOS

jaims_4691_01.JPG
Figure 1: USG report before treatment

jaims_4691_02.JPG
Figure 2: USG report after treatment

Discussion

The direct correlation of PCOS is not mentioned in Ayurveda classics. It can be considered as Bahudosavastha along with the involvement of all Dooshyas and Agni. So, the treatment is planned accordingly by considering its Dosa Dooshya Sammoorchana. Both Shodhana Chikitsa and Shamana chikitsa having Tridoshahara, Agnideepana, Amapachana, Srotosodhana, Vatanulomana, Lekhana and Artava Janana properties was selected to manage this condition effectively.

The first aim of the treatment is Agni Deepana and Ama Pachana. So Chitrakadi Vati was used initially for 3 days to correct the Agni Mandya, which has Agni Deepana and Ama Pachana properties.[9]

PCOS is associated with chronic low-grade inflammation. Inflamed adipose tissue contributes to the inflammatory load in PCOS. Udvartana with Kolakulathadi Choorna having Rooksha, Usna, Tridoshagna Gunas mainly Kapha Vatahara, Medoghna, Lekhana, Amaharatwa and Srothoshodhana properties. Udwarthana opens the minute channels and improves circulation also helps in reabsorption of fat and inflammatory products. So, it helps in weight reduction in this patient and also helped to reduce the inflammatory load.[10]

Moorchita Tila Taila was used as Shodhananga Snehapana and also for Sarvanga Abhyanga. By it’s Sookshma and Vyavayi Guna it can carry all over the body and can penetrate into minute channels so it helps in Utkleshana of Doshas and facilitate the removal of Doshas through Shodhana Karma. It also helps to reduce weight by it’s Medohara, Sthoulyahara, Lekhana properties.[11]

Some studies suggested that sesame legumes can increase the expression of enzymes involved in the b oxidation of lipids and increase the cellular capacity for fat burning. The chemical constituents such as sesamol and sesamolin exhibits anti-inflammatory property which helps to reduce the inflammatory load in adipose tissue and also in PCOS.[12] Hence these can reduce the weight of the patient. Phytoestrogens and antioxidants in sesame legumes have the potential influence on HPO axis.[13] So it helps to regulate hormonal imbalance in PCOS and also to maintain the regulated hormone level.


J Ayu Int Med Sci 2025;10(8)362
Priyanka AB et al. Ayurvedic management of PCOS

Virechana is the best Shodhana Karma for the regulation of pitta dosha and for restoring hormonal balance. Trivrith Lehya used for Virechana, which is having Rechana Karma & Srothoshodhana Karma , so it helps to eliminate the vitiated Doshas in this condition and also it can improve the metabolism by its Agnideepana property. So, in this case the Virechana Karma plays a crucial role in the management of PCOS.[14]

Varunadi Kashaya is having Katu Tikta Rasa, Laghu Ruksha Guna, Usna Veerya, Katu Vipaka and it is mentioned as ‘Mandagnitwam Niyachathi, so it helps to improve Agni, which is hampered in this condition. It is also having Kaphahara, Lekhaniya, Chedaniya, Medohara and Gulmanashana Karma[15], these helps to reduce the weight of the patient and to remove multiple cysts from the ovaries. It’s anti-adipogenic and antiobesity properties also have an effect on reducing the weight[16] Varunadi kashaya reduces the production of proinflammatory cytokines, TNF-a ,IL-b[17], So it is effectively used to control chronic inflammation in this condition.

PCOS is accompanied by metabolic abnormalities like obesity and insulin resistance (IR). Agnimandya is one of the root causes of metabolic disorders. Katu Rasa, Laghu Rooksha Guna, Usna Veerya, Katu Vipaka, Agnideepana properties of Navaka Guggulu[18] helps to potentiate the weakened Dhatwagni. It’s Medo- Kleda Upashoshana reduce the weight of the patient and also to reduce the size of multiple cysts in the ovaries.

Studies suggested that Pushpadhanwa Rasa having action on both male and female reproductive system. All the Bhasmas in this medicine having Tridoshahara, Deepana & Pachana properties, which helps to correct the Dhatwagnimandya and leading to proper formation of Rasadhatu and its Upadhatu Artava. These helped to correct menstrual irregularities in this case. Along with its Dhatuposhana, Brimhana, Vatanulomana properties, which supports in effective growth, maturation of follicles and ovulation. Hence it helped to maintain regular menstrual cycle.[19]

Shatapushpa Choorna is having Katu Rasa, Laghu Tikshna Guna, Usna Veerya, Katu Vipaka and indicated in Ritupravartini Anartava and Pittavardhaka properties.[20] These facilitate the normal production of Artava (menstrual bleeding), So helped to correct amenorrhea in this case.

It also indicated in Atiprabhoota Artava (heavy bleeding) which helped to correct heavy bleeding from the thickened endometrium due to unopposed estrogen in anovulatory cycles of PCOS. Shatapushpa having phytoestrogenic property which is beneficial to regulate menstrual cycle.[21]

Conclusion

In the present case, both Shodhana and Shamana Chikitsa was adopted to restore Doshic balance and to improve Agni, while addressing hormonal and metabolic dysregulation in PCOS.

The improvement is evident from the restoration of normal menstrual cycle and reduction in other symptoms as well as from the ultrasonography report. Hence this case report shows an insight into effective management of PCOS through Ayurvedic treatment modalities.

References

1. Deswal R, Narwal V, Dang A, Pundir CS, et al. The prevalence of polycystic ovary syndrome: A brief systemic review. Int J Curr Res Rev. 2020 Oct–Dec;13(4):261–71. [Crossref][PubMed][Google Scholar]

2. Dey R, Bhattacharya K, Syamal AK. Inflammatory perspectives of polycystic ovary syndrome: Role of specific mediators and markers. Middle East Fertil Soc J. 2023;28:33. [Crossref][PubMed][Google Scholar]

3. Konar H. Dutta’s textbook of gynecology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers; Chapter 29. p. 378 [Crossref][PubMed][Google Scholar]

4. Sharma HR. Kashyapa Samhita Kalpa Sthana. In: Bhishagacharya SS, editor. Vidyotini Hindi commentary. 9th ed. Varanasi: Chaukhamba Sanskrit Sansthana; 2004. Chapter 6/33. p. 192 [Crossref][PubMed][Google Scholar]

5. Acharya N. Sushruta Samhita Sharira Sthana. In: Dalhanacharya, Nibandhasangraha commentary. Varanasi: Chaukhambha Krishnadas Academy; 2004. Chapter 2/21. p. 346 [Crossref][PubMed][Google Scholar]

6. Murthy KRS. Sushruta Samhita Sutra Sthana. Varanasi: Chaukhambha Orientalia; 2008. Chapter 15/12. p. 101 [Crossref][PubMed][Google Scholar]


J Ayu Int Med Sci 2025;10(8)363
Priyanka AB et al. Ayurvedic management of PCOS

7. Murthy KRS. Sushruta Samhita Nidana Sthana. Varanasi: Chaukhambha Orientalia; 2008. Chapter 11/3. p. 532 [Crossref][PubMed][Google Scholar]

8. Sharma PV. Charaka Samhita Sutra Sthana. In: Sastri K, Vidyotini Hindi commentary. 8th ed. Varanasi: Chaukhamba Sanskrit Sansthana; 2004. Chapter 21/9. p. 179 [Crossref][PubMed][Google Scholar]

9. Sen GD. Bhaishajya Ratnavali. Vol. 1. In: Rao GP, English translation and commentary. Varanasi: Chaukhambha Orientalia; 2014. Chapter 8/26–27. p. 301 [Crossref][PubMed][Google Scholar]

10. Dev N, Kumar SJ, Rai NS. A comparative clinical study on the effectiveness of Udvartana with Siravyadha in the management of Sirajagranthi (varicose vein). Int Ayur Med J. 2020 Nov. doi:10.46607/iamj1108112020 [Crossref][PubMed][Google Scholar]

11. Tripathi B. Astanga Hridaya of Shrimadvagbhata Sutra Sthana. Vol. 1. In: Nirmala, Hindi commentary. Delhi: Chaukhamba Sanskrit Pratishthan; 2011. Chapter 5/55–56. p. 77 [Crossref][PubMed][Google Scholar]

12. Hadipour E, Emami SA, Tayarani-Najaran N, Tayarani Z, et al. Effects of sesame (Sesamum indicum L. ) and bioactive compounds (sesamin and sesamolin) on inflammation and atherosclerosis: A review. Food Sci Nutr. 2023 May 22;11(7):3729–57. doi:10.1002/fsn3407 [Crossref][PubMed][Google Scholar]

13. Haider F, Riaz S, Shakeel R, Hafeez K, et al. Investigation of phytoestrogens found in sesame seeds via computational and translational approaches. BioSci Rev. 2023;5(4):53–68. doi:10.32350/bsr.54.05 [Crossref][PubMed][Google Scholar]

14. Santosh PR, Jaiswal D, Amrutha BS. Role of Virechana Karma in polycystic ovarian syndrome – A case study. J Ayurveda Integr Med Sci. 2024 Nov;9(11). [Crossref][PubMed][Google Scholar]

15. Tripathi B. Astanga Hridaya of Shrimadvagbhata Sutra Sthana. Vol. 1. In: Nirmala, Hindi commentary. Delhi: Chaukhamba Sanskrit Pratishthan; 2011. Chapter 15/21. p. 200 [Crossref][PubMed][Google Scholar]

16. Chinchu JU, Mohan MC, Kumar P. Anti-obesity and lipid-lowering effects of Varanadi Kashayam (decoction) on high-fat diet-induced obese rats. Obes Med. 2020 Mar;17:100170. doi:10.1016/j.obmed.2019.100170 [Crossref][PubMed][Google Scholar]

17. Chinchu JU, Mohan MC, Devi SJR, Kumar BP, et al. Evaluation of anti-inflammatory effect of Varanadi Kashayam (decoction) in THP-1-derived macrophages. Ayu. 2018 Oct–Dec;39(4):243–9. doi:10.4103/ayu.53.18 [Crossref][PubMed][Google Scholar]

18. Sen GD. Bhaishajya Ratnavali. Vol. 2. In: Rao GP, English translation and commentary. Varanasi: Chaukhambha Orientalia; 2014. Chapter 39/43. p. 93 [Crossref][PubMed][Google Scholar]

19. Irfan S, Saxena A, Srivastava S. A review on role of Pushpadhanwa Rasa in ovulation induction for management of anovulatory factor of infertility. Int Res J Ayurveda. 2023;6(6):105–9. doi:10.47223/IRJAY.2023.6616 [Crossref][PubMed][Google Scholar]

20. Sharma HR. Kashyapa Samhita Kalpa Sthana. In: Bhishagacharya SS, editor. Vidyotini Hindi commentary. 9th ed. Varanasi: Chaukhamba Sanskrit Sansthana; 2004. Chapter 5/10–13. p. 186 [Crossref][PubMed][Google Scholar]

21. Shelani N, Tomar P. Effect of Shatpushpa Kalpa in Stree Bandhyatva w. s. r. to anovulatory factor – A review study. Int Ayur Med J. 2019 Apr–May;3(4). Available from: www.iamj.in [Crossref][PubMed][Google Scholar]

Disclaimer / Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.


J Ayu Int Med Sci 2025;10(8)364