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Dr.shailesh s phalle M.D.(K.C)
Ayusanjivani ayurveda ,kharadi
www.ayusanjivani.com
PCOS – Poly Cystic Ovarian Syndrome.
Poly - denotes multiplicity, several or more
Cystic - an abnormal sac containing gas, fluid
or semi solid material, containing cysts.
Ovary - one of the two reproductive glands in the
female containing germ cells or ova.
Syndrome - a set of symptoms
It was first described in 1935 by Stein and
Leventhal and called as Stein - Leventhal Syndrome
for many years.
It is heterogenous disorder characterised by
-amenorrhoea,
-hirsutism
-obesity
- associated with enlarged polycystic ovaries
 Among the total female population 6%
 About 50% cases seen within the age of 20
to 30 years
 60 % presents with anovulation
 90 % presents with hirsutism
 80 % with Obesity.
 30 % with infertility
According to modern science :
 Uncertain
 Hypothalamic pituitary gonadal disturbance,
associated with elevated follicular phase LH
levels causes PCOS.
 Abnormal Ovarian Steroidogenesis
 Genetic and Affected families.
 Stress ,sedentery lifestyle,improper diet,lack
of workout
Not clearly understood, can be discussed under
the following headings:
1) Abnormality of HPO axis
2) Hyperinsulinaemia arising from
receptor dysfunction
3) Hyperandrogenemia (Adrenal/Ovarian)
4) Genetic inheritance
ABNORMALITY OF HPO AXIS
Hypothalamus
Increased frequency of GnRH
Increase pulse frequency of LH compared to FSH
Increased pituitary sensitivity of GnRH
LH : FSH
Reduced
shbg
Insulin receptor
dysfunction
Hypothalamus
Pituitary
Follicle
Pancreas
Hyperinsulinemia
AdrenalLiver Stroma
 Abnormal regulation of the androgen forming
enzyme (P450C17) is thought to be the main
cause for excess production of androgens
from the ovaries and adrenals.
 Sources of Androgens –
1) Ovary
2) Adrenal
3) Systemic Metabolism Alteration
 A genetic basis that is both multi-factorial
and polygenic is suspected, as there is well
documented aggregation of the syndrome
within families.
 Specifically, prevalence has been noted
between affected individuals and their sisters
and mothers.
 Familial condition possibly autosomal
dominant, however PCO gene as such has not
been identified.
 Menstrual irregularities
 Anovulation
 Hirsutism
 Acne
 Obesity
 Acanthosis Nigricans –thickend and
pigmented skin –insulin resistance
 HAIR-AN Syndrome: (HA-hyperandrogenism
 IR_insulin resistance ,AN- Acanthosis
Nigricans)
Sonography :
Trans vaginal sonography in obese patients shows
enlarged overies in volume and increase no of
peripheraly arranged cyst.
Polycystic
ovary
Normal
Ovary
 LH – Elevated or LH:FSH is 3:1
 Oestrogen – Elevated
 Testosterone – Raised (>150ng/dl)
 DHEAS – Elevated (>3400 ng/dl)
 Fasting Insulin – Raised (>25µ IU/ml)
 Fasting Glucose – Raised (>119 mg/dl)
 Insulin response at 2 hrs postglucose (75gm) load – 300µ
IU/ml (suggests IR)
 Total Cholesterol - >200 mg/dl
 HDL Cholesterol - <50 mg/dl
 LDL Cholesterol - >130 mg/dl
 Trigycerides - >150 mg/dl
 Prolactin >1000 IU/l indicates pituitary adenoma;
needs repeating
 “PCOS” though a syndrome can not be
correlated to a particular disease.
 An exact correlation is not possible.
 No specific Yonivyapad with the above said
features is noted.
 Conditions like Vandya, Arajaska,
Nashtartava, Artavakshaya and Puspaghni
Jataharini to some extent can be related.
 According to Acharya Sushruta the four
essential factors for the conception are
similar as the germination of a seed.
ध्रुवं चतुर्णाम ् सन्निध्यणत् गर्ाः स्यणत् ववधिपूवाकः ऋतुक्षेत्रामणबुबुबानणिणं सणमर्यायणककु शे यिण
(सु. सु.२/३३)
1. Rutu:
 Fertile period is more explained by Acharya Dalhana that Rutu means Rajaha
Kala i.e.ovulation period. – (Su. Sha 3/6 Dalhana Commentary)
 Deposition of the spermatozoa in the upper vagina should be in appropriate time
of the female cycle.
2. Kshetra:
 Anatomically and physiologically adequate reproductive organs.
 Vagina must be healthy.
 Cervix and its secretion are also permitted to pass spermatozoa.
 The oviduct must be patent and sufficient cilliary movement is present.
 The uterus must be capable of supporting implantation and foetal growth
throughout pregnancy.
3. Ambu:
 Proper nourishment to the body, adequate hormonal level and proper nutrition is
required for genital organs.
4. Beeja:
 The adequate ovum & spermatozoa and the female‟s ovulatory mechanisms must
be normal. The male must produce an adequate number of normal spermatozoa.
So in the concept of PCOS adequate beeja is not available.
 PUSHPAGNI JATAHARINI :
 Vrutha Pushpam –
Anovulation,Fruitless/without conception
 Yathakalam prapashyayti – Mentruating
regularly
 Sthula- obesity
 Lomasha ganda – Hairy chin/ Hirsutism
1.Aartava dushti:
Acharya have mentioned that Ashtartava dushti if
remains untreated or not properly treated then it causes
Abeejata i.e. unable for prajotpadana (Su. Sha. 2/3).
Acharyas have not described any specific etiology of these
eight menstrual disorders.
Vata get aggravated and causes „Dhatu- Kshaya‟.
Because of this Dhatu Kshaya Rasa Dhatu decreases and
that ultimately causes the Kshaya of its Upadhatu i.e.
Artava Kshaya (Anovulation).
2) Avarana:
In the concept of artavanasha, Sushruta and Vagbhatta
has described that both vata and kapha when aggravated,
obstruct the path, thus artava is destroyed (A.S. Su.1/13).
Here artava can be taken as Antapushpa. Here we can
take as anovulation. The Artava Vaha Srotas is obstructed
by the Kapha and Vata due to which Artava is not visible
(Ovulation does not occur). It is also a Sanga Pradhana
Vikara.
(3) Asrikdosha: (Ch. Sha.2/7) :
Word Asrik refers to Ovum and menstrual blood.
abnormalities of ovum and ovarian
hormones produce infertility.
(4) Dietetic habit (Ka. Sa.) :
Besides all these reasons dietetic habits also causes
anovulation as mentioned in Kashyapa Samhita
Kalpa Sthana. Due to ati Ushana veerya annapana
artava, beeja becomes upchita or vitiated.
 Pcos is basically a disease of artav vah shrotas.
 Aavarana is the main pathogenesis in PCOS.
 Kapha Medo related dosha dushyasamurchana is
seen here.
 Sthoulya samprapti and kaphaja prameha
samprapties are the key areas to be explored.
 In pcos kapha dominant granthis are seen in
overy.
 Granthis devloped when there is the sangha in
srotas due to snigdha and guru guna of kapha.
 Thease granthis with strong kapha platform
inhibits the aartav leading to artav rodha.
 Dosha: kapha- (guru,snigdha,manda guna)
 Dooshya –Medodhatu,rasa,rakta
 Strotus :artavvahashrotas,medovahastrotas
 Strotodusti -sangha
 Agni -manda at kostha and dhatu level.
Pcos ayurveda co relation :
 Kaphaja prameha
 Sthoulya
 Medoavrutha vata
 Kaphavrittha vata
 Kaphaj granthi-granthi aartav dosha.
 Sthoulya chikitsa :
 Dhatwagni deepan
 Kapha medo dusti chikitsa
1.Vaman:-for kapha chedan and aavaran
chikitsa
2.virechan-for kapha pitta nissaran,vat
anuloman,
 Virechan with erandam tailam 25 ml with milk
 Virechan with 50 gm trivrutha lehyam
 Virechan with kalyana gulam 25 gm
 For minimising kapha related granthis in
overy
 Erandamuladi shodhan basti-
 Lekhan basti –
 Uttarbasti –
Falghrutam,kasisadi tailam,sahachar
tailam,bala tailam.
Lekhan basti –1 Lekhan basti 2
Makshika -200 ml,
saindhav -15 gm,
morchit tailam -200 ml,
yavanyadi kalkam-30
gm,
triphala kashay-300 ml,
dhanyamla-200 ml,
yavakshara-10 gms
triphala kashay-150 ml
Kulatha kashay -150 ml
Makshika -150 ml
Snehan -100 ml
Kalkam-hinguvachadi-
30 gm
Lavan-10 gm
Yavakshar -10 gm
Bahiparimarjan chikitsa :
 Udwartan – kapha medoshamana by
kolkulathyadi choornam
 avagahasweda-pakwashyavata shaman
 shirodhara
 shiropichu
Adviced as per patient prakruti
Lasun erandadi kashay :lasuna ,erand,punarnava
Removes avarana and useful for reduction in circulating
androgens
Sukumar kashay : acts on pakwashay,corrects apan vaigunya
Varanadi kashay : varun ,saireyak,shatawari,chitrak-removes
avaran,useful in insulin resistance.
Rajaha pravarthini vati -kumari ,kasis,hingu-aartavpravrthak
Kanchanar guggulu –indicated in granthi
Kuberaksha vati - lasuna,latakaranj -indicated in granthi
Phal ghruta – corrects harmonal imbalance,regularies arthav
CONCLUSION
 It is inaccurate to state that PCOS is the most common
cause of anovulation, because PCOS does not cause
anovulation; rather, PCOS is the consequence of chronic
anovulation, which can result from a wide variety of
causes.
 PCOS is now firmly established in our scientific and clinical
lexicon, it is important to emphasize that PCOS is not a
discrete or specific endocrine disorder having a unique
cause or pathophysiology.
 PCOS is a condition involving disorder of ovary associated
with deranged metabolism of lipids and carbohydrates and
multiple harmonal involvment.
 Researches are required for understanding the correct
pathophysiology of PCOS in Ayurveda causing infertility.
 By proper investigations, diagnosis and management we
can fight against PCOS and can bring new glow to
women’s life.
 Extensive studies needed.
PCOD PCOS
 Overies are reeling under pressure
and filling the burnt of the
disturbences in your body and
generally not functioning at that
pick efficiency.
 Hyper androgenic obese
anovulation .
 High lh to fsh ratio.
 Ovaries large with evidance of
homogenous polyfollicular
enlargement with thickal
hyperplasia.
 Necklace pattern on usg
 Thease disturbences are now no
longer just in the overies but are also
manifestating in other parts of the
body as acne,body hair,irrguler
periods,obesity,insulin ensitivity,high
ammount of male
harmones,irritability,oily kin,thinning
of hairs.
 Normoandrogenic,normoestrogenic
lean,Anovulation
 No significant alteration in
harmones.
 Bilateral active overies with no
evidance of follicular dominancy or
ovulation.
 An 31 yrs female patient with primary infertility with h/o pcos since
12 yrs.
 Patient having irreguler periods since menarche.
 Newly diagnosed with hypothyrodism since 2 yrs.
 Acne,hirsutism and lean lady.
Improper Diet and life style,lack of exercise
Investigation report :
tsh lh amh Prolactine Progeste
rone
Testeste
rone
Before
treatme
nt
7.8 32 35 11 Not
done
78
After
tretment
3.2 10.76 16 10.6 0.18 36
Management of PCOS : ayurvedic perspective

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Management of PCOS : ayurvedic perspective

  • 1. Dr.shailesh s phalle M.D.(K.C) Ayusanjivani ayurveda ,kharadi www.ayusanjivani.com
  • 2. PCOS – Poly Cystic Ovarian Syndrome. Poly - denotes multiplicity, several or more Cystic - an abnormal sac containing gas, fluid or semi solid material, containing cysts. Ovary - one of the two reproductive glands in the female containing germ cells or ova. Syndrome - a set of symptoms It was first described in 1935 by Stein and Leventhal and called as Stein - Leventhal Syndrome for many years. It is heterogenous disorder characterised by -amenorrhoea, -hirsutism -obesity - associated with enlarged polycystic ovaries
  • 3.  Among the total female population 6%  About 50% cases seen within the age of 20 to 30 years  60 % presents with anovulation  90 % presents with hirsutism  80 % with Obesity.  30 % with infertility
  • 4.
  • 5.
  • 6. According to modern science :  Uncertain  Hypothalamic pituitary gonadal disturbance, associated with elevated follicular phase LH levels causes PCOS.  Abnormal Ovarian Steroidogenesis  Genetic and Affected families.  Stress ,sedentery lifestyle,improper diet,lack of workout
  • 7. Not clearly understood, can be discussed under the following headings: 1) Abnormality of HPO axis 2) Hyperinsulinaemia arising from receptor dysfunction 3) Hyperandrogenemia (Adrenal/Ovarian) 4) Genetic inheritance
  • 8. ABNORMALITY OF HPO AXIS Hypothalamus Increased frequency of GnRH Increase pulse frequency of LH compared to FSH Increased pituitary sensitivity of GnRH LH : FSH
  • 9.
  • 11.  Abnormal regulation of the androgen forming enzyme (P450C17) is thought to be the main cause for excess production of androgens from the ovaries and adrenals.  Sources of Androgens – 1) Ovary 2) Adrenal 3) Systemic Metabolism Alteration
  • 12.  A genetic basis that is both multi-factorial and polygenic is suspected, as there is well documented aggregation of the syndrome within families.  Specifically, prevalence has been noted between affected individuals and their sisters and mothers.  Familial condition possibly autosomal dominant, however PCO gene as such has not been identified.
  • 13.  Menstrual irregularities  Anovulation  Hirsutism  Acne  Obesity  Acanthosis Nigricans –thickend and pigmented skin –insulin resistance  HAIR-AN Syndrome: (HA-hyperandrogenism  IR_insulin resistance ,AN- Acanthosis Nigricans)
  • 14.
  • 15. Sonography : Trans vaginal sonography in obese patients shows enlarged overies in volume and increase no of peripheraly arranged cyst.
  • 17.  LH – Elevated or LH:FSH is 3:1  Oestrogen – Elevated  Testosterone – Raised (>150ng/dl)  DHEAS – Elevated (>3400 ng/dl)  Fasting Insulin – Raised (>25µ IU/ml)  Fasting Glucose – Raised (>119 mg/dl)  Insulin response at 2 hrs postglucose (75gm) load – 300µ IU/ml (suggests IR)  Total Cholesterol - >200 mg/dl  HDL Cholesterol - <50 mg/dl  LDL Cholesterol - >130 mg/dl  Trigycerides - >150 mg/dl  Prolactin >1000 IU/l indicates pituitary adenoma; needs repeating
  • 18.  “PCOS” though a syndrome can not be correlated to a particular disease.  An exact correlation is not possible.  No specific Yonivyapad with the above said features is noted.  Conditions like Vandya, Arajaska, Nashtartava, Artavakshaya and Puspaghni Jataharini to some extent can be related.  According to Acharya Sushruta the four essential factors for the conception are similar as the germination of a seed.
  • 19. ध्रुवं चतुर्णाम ् सन्निध्यणत् गर्ाः स्यणत् ववधिपूवाकः ऋतुक्षेत्रामणबुबुबानणिणं सणमर्यायणककु शे यिण (सु. सु.२/३३) 1. Rutu:  Fertile period is more explained by Acharya Dalhana that Rutu means Rajaha Kala i.e.ovulation period. – (Su. Sha 3/6 Dalhana Commentary)  Deposition of the spermatozoa in the upper vagina should be in appropriate time of the female cycle. 2. Kshetra:  Anatomically and physiologically adequate reproductive organs.  Vagina must be healthy.  Cervix and its secretion are also permitted to pass spermatozoa.  The oviduct must be patent and sufficient cilliary movement is present.  The uterus must be capable of supporting implantation and foetal growth throughout pregnancy. 3. Ambu:  Proper nourishment to the body, adequate hormonal level and proper nutrition is required for genital organs. 4. Beeja:  The adequate ovum & spermatozoa and the female‟s ovulatory mechanisms must be normal. The male must produce an adequate number of normal spermatozoa. So in the concept of PCOS adequate beeja is not available.
  • 20.  PUSHPAGNI JATAHARINI :  Vrutha Pushpam – Anovulation,Fruitless/without conception  Yathakalam prapashyayti – Mentruating regularly  Sthula- obesity  Lomasha ganda – Hairy chin/ Hirsutism
  • 21. 1.Aartava dushti: Acharya have mentioned that Ashtartava dushti if remains untreated or not properly treated then it causes Abeejata i.e. unable for prajotpadana (Su. Sha. 2/3). Acharyas have not described any specific etiology of these eight menstrual disorders. Vata get aggravated and causes „Dhatu- Kshaya‟. Because of this Dhatu Kshaya Rasa Dhatu decreases and that ultimately causes the Kshaya of its Upadhatu i.e. Artava Kshaya (Anovulation). 2) Avarana: In the concept of artavanasha, Sushruta and Vagbhatta has described that both vata and kapha when aggravated, obstruct the path, thus artava is destroyed (A.S. Su.1/13). Here artava can be taken as Antapushpa. Here we can take as anovulation. The Artava Vaha Srotas is obstructed by the Kapha and Vata due to which Artava is not visible (Ovulation does not occur). It is also a Sanga Pradhana Vikara.
  • 22. (3) Asrikdosha: (Ch. Sha.2/7) : Word Asrik refers to Ovum and menstrual blood. abnormalities of ovum and ovarian hormones produce infertility. (4) Dietetic habit (Ka. Sa.) : Besides all these reasons dietetic habits also causes anovulation as mentioned in Kashyapa Samhita Kalpa Sthana. Due to ati Ushana veerya annapana artava, beeja becomes upchita or vitiated.
  • 23.  Pcos is basically a disease of artav vah shrotas.  Aavarana is the main pathogenesis in PCOS.  Kapha Medo related dosha dushyasamurchana is seen here.  Sthoulya samprapti and kaphaja prameha samprapties are the key areas to be explored.  In pcos kapha dominant granthis are seen in overy.  Granthis devloped when there is the sangha in srotas due to snigdha and guru guna of kapha.  Thease granthis with strong kapha platform inhibits the aartav leading to artav rodha.
  • 24.  Dosha: kapha- (guru,snigdha,manda guna)  Dooshya –Medodhatu,rasa,rakta  Strotus :artavvahashrotas,medovahastrotas  Strotodusti -sangha  Agni -manda at kostha and dhatu level.
  • 25. Pcos ayurveda co relation :  Kaphaja prameha  Sthoulya  Medoavrutha vata  Kaphavrittha vata  Kaphaj granthi-granthi aartav dosha.
  • 26.  Sthoulya chikitsa :  Dhatwagni deepan  Kapha medo dusti chikitsa
  • 27. 1.Vaman:-for kapha chedan and aavaran chikitsa 2.virechan-for kapha pitta nissaran,vat anuloman,  Virechan with erandam tailam 25 ml with milk  Virechan with 50 gm trivrutha lehyam  Virechan with kalyana gulam 25 gm
  • 28.  For minimising kapha related granthis in overy  Erandamuladi shodhan basti-  Lekhan basti –  Uttarbasti – Falghrutam,kasisadi tailam,sahachar tailam,bala tailam.
  • 29. Lekhan basti –1 Lekhan basti 2 Makshika -200 ml, saindhav -15 gm, morchit tailam -200 ml, yavanyadi kalkam-30 gm, triphala kashay-300 ml, dhanyamla-200 ml, yavakshara-10 gms triphala kashay-150 ml Kulatha kashay -150 ml Makshika -150 ml Snehan -100 ml Kalkam-hinguvachadi- 30 gm Lavan-10 gm Yavakshar -10 gm
  • 30. Bahiparimarjan chikitsa :  Udwartan – kapha medoshamana by kolkulathyadi choornam  avagahasweda-pakwashyavata shaman  shirodhara  shiropichu Adviced as per patient prakruti
  • 31. Lasun erandadi kashay :lasuna ,erand,punarnava Removes avarana and useful for reduction in circulating androgens Sukumar kashay : acts on pakwashay,corrects apan vaigunya Varanadi kashay : varun ,saireyak,shatawari,chitrak-removes avaran,useful in insulin resistance. Rajaha pravarthini vati -kumari ,kasis,hingu-aartavpravrthak Kanchanar guggulu –indicated in granthi Kuberaksha vati - lasuna,latakaranj -indicated in granthi Phal ghruta – corrects harmonal imbalance,regularies arthav
  • 32. CONCLUSION  It is inaccurate to state that PCOS is the most common cause of anovulation, because PCOS does not cause anovulation; rather, PCOS is the consequence of chronic anovulation, which can result from a wide variety of causes.  PCOS is now firmly established in our scientific and clinical lexicon, it is important to emphasize that PCOS is not a discrete or specific endocrine disorder having a unique cause or pathophysiology.  PCOS is a condition involving disorder of ovary associated with deranged metabolism of lipids and carbohydrates and multiple harmonal involvment.  Researches are required for understanding the correct pathophysiology of PCOS in Ayurveda causing infertility.  By proper investigations, diagnosis and management we can fight against PCOS and can bring new glow to women’s life.  Extensive studies needed.
  • 33. PCOD PCOS  Overies are reeling under pressure and filling the burnt of the disturbences in your body and generally not functioning at that pick efficiency.  Hyper androgenic obese anovulation .  High lh to fsh ratio.  Ovaries large with evidance of homogenous polyfollicular enlargement with thickal hyperplasia.  Necklace pattern on usg  Thease disturbences are now no longer just in the overies but are also manifestating in other parts of the body as acne,body hair,irrguler periods,obesity,insulin ensitivity,high ammount of male harmones,irritability,oily kin,thinning of hairs.  Normoandrogenic,normoestrogenic lean,Anovulation  No significant alteration in harmones.  Bilateral active overies with no evidance of follicular dominancy or ovulation.
  • 34.  An 31 yrs female patient with primary infertility with h/o pcos since 12 yrs.  Patient having irreguler periods since menarche.  Newly diagnosed with hypothyrodism since 2 yrs.  Acne,hirsutism and lean lady. Improper Diet and life style,lack of exercise Investigation report : tsh lh amh Prolactine Progeste rone Testeste rone Before treatme nt 7.8 32 35 11 Not done 78 After tretment 3.2 10.76 16 10.6 0.18 36