Understanding & Management of PCOS/PCOD through Ayurved

Dr. Rani Khandelwal* Dr. Harish Kumar Singhal**

MD Scholar* HOD & Associate Professor**

Post Graduate Institute of Ayurveda, Jodhpur

Abstract

Amenorrhoea, hirsuitism, and obesity are symptoms of polycystic ovarian syndrome, which is
characterised by enlarged polycystic ovaries. When it comes to women of reproductive age, it
is the most prevalent endocrine condition. In addition, it manifests as infertility, irregular
bleeding, a rise in miscarriages, and problems associated with pregnancy. The majority of
patients have high levels of prolactin, oestrogen, testosterone, and luteinizing hormone (LH)
when they first arrive. Genetic and environmental variables combine to form a multifactorial
aetiology. Some etio-pathogenesis-related hypotheses are yet unproven. A key diagnostic
technique for identifying the existence of numerous ovarian cysts ranging in size from 2 to 9
mm is pelvic ultrasonography. In current science, the only treatments available are hormonal
therapy and LOD (laproscopic ovarian drilling), but Ayurvedic management, with its holistic
approach, includes lifestyle modifications and drugs with qualities like Tridoshahara,
Srotoshodhaka, and Anulomaka. In Ayurveda, PCOD is diagnosed based on the various ways
it manifests itself, including its hetu, lakshana, dosha-dushya, and samprapti. In line with
Ayurveda Rasa, Rakta, and Medas are examples of Dhatus, or the three Doshas, which are
involved in PCOD. The Rasa, Rakta, and Arthava vaha srothas are responsible for this illness.
They exhibit symptoms like Anarthava (amenorrhoea), Bandhyathwa (infertility), Pushpagni,
and Abeeja rtuchakra (anovulat haemorrhage).

Introduction

A heterogeneous ailment known as polycystic ovarian disease (PCOD) is typified by increased

testosterone levels, irregular menstruation, and tiny cysts on one or both ovaries. According to
research, it affects between 20–30% of Indian women who are between the ages of 18 and 45
[1]. PCOD diagnosis should be taken into consideration when the following conditions are met:

 Rare or nonexistent ovulation

 Hyperandrogenism's biochemical or clinical manifestations, include increased
testosterone, acne, and hair growth.
  Morphological alterations: several follicular cysts, typically ranging in diameter from
2 to 9 mm, and bilateral ovaries enlargement.

The following are characteristics of polycystic ovarian disease seen on an ultrasound scan:

A "string of pearls" pattern is noted, consisting of around 12 follicles ranging in size from 2 to
9 mm, positioned peripherally. Enhanced ovarian stroma echogenity and/or ovarian volume
exceeding 10 millilitres [2]. Fertility is typically caused by chronic anovulation. A disrupted
hypothalamo-pituitary-ovarian axis, leading to thyroid or adrenal illness, is frequently
associated with ovarian dysfunction. In these situations, improving metabolic syndrome is
crucial [2]. Restoring fertility may be one of the main objectives of PCOS treatment.

 Acne or hirsuitism treatment

 Endocrine function restoration

Multiple ovarian cysts are a defining feature of PCOS (Poly Cystic Ovarian Syndrome). The
most typical symptoms are irregular menstruation, weight gain and trouble reducing it, oily
skin, dandruff, acne, excessive facial, chest, and back hair growth, hair thinning, infertility,
miscarriage, high blood pressure, diabetes, and high cholesterol. On the other hand, 30% of
women have regular menstruation, 85%–90% of women with oligomenorrhea have PCOS, and
30%–40% of women with amenorrhoea have PCOS. A frequent clinical manifestation of
hyperandrogenism, hirsutism affects up to 70% of PCOS-affected women [3]. Although the
exact origin of PCOS is unknown, research points to a significant genetic component that may
be influenced by lifestyle factors, the environment during pregnancy, or both. Heart attacks,
high levels of low-density lipoprotein, low levels of high-density lipoprotein, endometrial
cancer, diabetes and pre-diabetes, hypertension, and cardiovascular disease are among the
conditions that women with PCOS are more likely to experience [4]. Medications include

 Birth control pills to regulate menstruation

 Insulin sensitizing medications

 Ovulation induction to treat infertility

 Androgen blocking medications

 Other excess hair treatment

 Treatment for hair loss

 Acne treatment

 Treatment for other skin problems

Irregular menstruation can be corelated with Rajakshaya; Pushpaghni Jataharini mentioned in

Kashyapa Samhita, Revati Kalpadhyaya bears similitude to the symptom of
hyperandrogenism; however, features of metabolic dysfunction and polycystic ovarian
morphology are not evident from any description. Ayurvedic classics do not directly mention
this disease; instead, symptoms are found under various diseased conditions at various
references.

Aim & Objectives

To study Ayurvedic approach of PCOD according to its presentation in so many ways

depending upon its hetu, lakshana and dosh-dushya and various aspects of its treatment.

Objective

 To study hetu (causative factors) of PCOD according to Ayurvedic aspect.

 To study lakshana (symptoms) of PCOD according to Ayurvedic aspect.
 To study nidan(differential diagnosis) of PCOD according to Ayurvedic aspect.
 To study chikitsa (treatment) of PCOD according to Ayurvedic aspect.

Material & Methods

Review of the literature: For this study, all Ayurvedic texts pertaining to strereiroga and
prasutitantra, such as Bhrutrayee and Laghutrayee, were used.

Methods: Every element in the nidanpanchaka of PCOD is correlated with Ayurvedic

references to produce an Ayurvedic perspective on PCOD and its suitable Ayurvedic therapy.

Nidana

1) Santarpaniya – guru, abhishyandi, snigdha, sheetaannasevana, eg. Fast food, bakery, aerated
cold drinks, excessive nonvegetc

2) Vatprakopakhetu– ruksha, laghu, sheeta, khara, vishada, ahar-vihar

3) Manashetu– atichinta, aalasya, mana:santapa

4) Raja: swalaaparicharya
5) Yonivyapadhetu

6) Rasavahasrotasadushtihetu

7) Agni dushtihetu

8) Vegavarodh – visheshata: apanvayu

9) Artavadushtikaran

Roopa

1) Rajovikruti – irregular menses

 Quantity- less / excessive

 Varnavikruti(colour changes)

 Gandha vikruti(odour changes)

 With or without pain

 With or without clots

Depending upon these factors rajovikruti further classifies in one of the ‘ashtourajovikruti’

2) Sthoulya – excess weight gain without responding to strict diet control

3) Atikesha – asthane, atimatrena

4) Kshutasahatwa

5) Twakdushti – mukhadushika, pidaka, karshnya,keshamala

6) Vandhyatwa – failure to conceive

Ayurvedic Pathophysiology

The cause of PCOS is kapha obstructing pitta and vata, which impedes mobility and
suppresses the transformation process. In the body, Kapha dominates when eating patterns
and behaviours that raise Kapha are followed. Due to its qualities like sheet, manda, sthir,
guru, etc [5]. , kapha dosha reduces digestive fire (jathara agni) [6] and begins to influence
the seven tissues' metabolic component, known as dhatu agni [7]. The dhatus that are
affected are –
  rasa dhatu – lymph and plasma

 meda dhatu – adipose tissue and

 artava dhatu – the female reproductive system

Kapha vardhak aahar and vihar

Kledak kapha dominance

atharagni mandya

Amasanchit

Decrease in AGNI causes incorrect Dhatus digestion and absorption, which in turn causes
an overabundance of Kelda to develop (Kledak kapha). As Kledak kapha enters the first
tissue rasa vaha strotas channel, it starts to exit the GI tract. This has an impact on the body's
metabolism of lymph and plasma, or rasa dhatu agni. The menstrual fluid, or rajah [8], is a
consequence of rasa dhatu. The menstrual fluid will acquire kapha qualities due to the
body's predominance of the kapha dosha, which will then start to obstruct apana vayu in
the rajahvaha and artavavaha strotas—the channels that facilitate the menstrual fluid's
functional action.

This Pathogenesis of PCOD can be explained in different way according to Ayurveda:

Dhatu agni mandya is also brought on by an increase in the body's levels of Kledak kapha and
ama. The meda dhatu Agni is affected by the Kledak kapha and ama, as per the saamanya
Vishesh siddhant [9]. Obesity is caused by the meda dhatu Agni mandya, which leads to the
meda Viruddha. At the meda dhatu level, the free androgens that are circulated throughout the
body are metabolised. Here, it adopts the guru and the meda dhatu sheet qualities. Oestrogen
is another way to convey this. Consequently, we see that PCOD patients have higher oestrogen
levels.

Kledak kapha + ama + dhatu agni maandya

 Affects meda dhatu (saamanya Vishesh Siddhant)

Meda Viruddha, causing obesity.

Free androgens moving throughout the body are processed at the level of meda dhatu where it
takes on the heavy cool quality of meda expressed as estrogen.

In the artavavaha strotas, stroto dushti is also brought on by the kapha dosha and ama that
Agnimandya generated. The sanga of apana vayu in artavavaha strotas gets stagnant,
obstructing the channel and preventing vata from flowing throughout the ovarian cycle. The
outflow of menstruation fluid is disturbed when the apana vayu channels are blocked. As a
result, the patient experiences irregular menstruation, such as oligomenorrhea and amenorrhoea
in PCOD.

Menstrual disorders arise from the imbalance of the three doshas, with apana vayu being the
most affected. Agneyatva is the primary characteristic of artava dhatu [10]. Agravation of Pitta
dosha results from obstructed artava dhatu. Acne and increased body hair are signs of Pitta
aggravation at the level of Bhrajaka pitta and Ranjaka pitta, which are found in PCOD.

Management of PCOD according to Ayurveda

1) Ayurvedic Panchakarma
2) Ayurvedic Medications
3) Diet Modifications ( pathyaahar )
4) Lifestyle Modifications (dinacharya and rutucharya)

Management

Ayurvedic ideas for managing PCOD encompass the following therapeutic modalities:

 Agni deepan: Since Agni mandya is the underlying factor causing PCOD, Agni deepan
treatment is crucial to the condition's management. Chitrak, Trikatu, and so on.
 A significant contributing element to PCOD is ama pachan. As a result, ama pachan
provides greater therapeutic outcomes. Such as Aarogyavardhini vati
 Kaphanashan, such as guggul kalpa
 Lekhan: therapy for lekhan should be administered as ama causes strotorodha and
kapha dosha predominates. Like Kuberakha vati [11] and so forth.
 Shodhan: To eradicate the prakupit doshas, shodhan therapy can be administered based
on the doshas avastha and kala.
  Shaman –
 Dravya: sariva, manjishtha, patha, deodar, kirattikta, pimpalmool, indrayava,
erandmoola etc.
 Yoga: rasapachak, medopachak, chandraprabha, koutajashilajatu, hinguvachadi
choorna, ajamodadi choorna etc.
 Kalpa – pushpadhanwa, all vasantkalpa, phalaghruta, mahakalyanaka ghruta,
dashamoolkadha, purnachandra-rasa etc
 Vyayam– exerciseis the most important part of the treatment due to which medicinal
treatment is much more helpful than singly done.
 Yoga and Pranayam - kapalbhati, bhasrika, bhramari, anulom vilom, ujjayi
 Basti: Since vata dosha is best treated with basti, and apana vayu is the cause of
menstruation abnormalities, basti therapy is crucial in managing PCOD. For instance,
yoga and lekhan bastis
 Udvartan: aids in the treatment of skin conditions

Some herbal preparation and herbomineral preparartion as effective management in PCOD:

1. Sukumara Kashaya: Punarnava, Yashti Madhu, Ashwagandha, Shatavari, Dashamula,

Draksha, Eranda, Ikshumula, Dwidarbha, etc. are the key ingredients of Sukumara
Kashaya, which gives the greatest results for vaginal and menstruation problems
(Yonirogahara) [12]. It is also discovered to be a superb Sarvakalopayogi,
Pushtidayaka, Vajikara, and Vrishya. Treatment options for various gynaecological
problems include conditions affecting the uterus, ovaries, and reproductive system. It
corrects the unbalanced hormonal function and is a great treatment for infertility and
menstruation issues. It has been discovered that medications with antibacterial, anti-
inflammatory, immunomodulatory, anti-stress, and estrogenic qualities are highly
helpful in the current situation and, when taken consistently, encourage conception
[13].
2. Kanchnar Guggulu is a traditional, classic polyherbal remedy used to heal ulcers,
PCOS, tumours, and cystic swelling. [14] It does this by dehydrating the body of extra
fluid and Kapha, which lowers swelling and lumps. It has components that support the
body's normal functioning by having anti-inflammatory, anti-tumor, diuretic, and
decongestant qualities. [15]. An extensive usage of kanchnar guggulu is recommended
by Ayurvedic practitioners to restore thyroid function. Guggulu's and Kanchnar's
 cleaning and detoxifying qualities work together to promote the thyroid's normal
functioning. Additionally, it aids in the lymphatic system's cleansing—a network of
organs and tissues that aids in the body's removal of waste products, toxins, and other
undesirable substances.
3. Gulmakalanal Rasa: Bhaishajya Ratnavali suggests using Gulmakalanal Rasa to cure
heartburn, bloating, dry cough, dark and black faeces, dysphasia, and a sour taste in the
mouth. It is very effective in treating Gulmarogadhikar gaseous tumours and cysts. [16]
Additionally helpful for loose, watery stools, fever, blood in the stool, and relief from
cramps and pain in the abdomen are these.
4. Yavakshar: Ayurvedic medication called yavakshar is used to balance the vata and
kapha doshas. Yavakshar is a common component in Ayurvedic medications. It may
also be used as a poultice to wounds and burns. It functions as a urinary cooler and
effectively treats blood in the urine.Yavakshar is also recommended for heart disease,
anaemia, malabsorption, enlarged spleen, blockage of the throat, piles, and
haemorrhoids. Yavakshar also helps expand prostates that are not malignant.
5. Abhyarishta: Strong ayurvedic mixture abhayarishta treats a wide range of conditions,
such as piles, constipation, dysuria, flatulence, anuria, gas, and abdominal distension
[17]
6. Agnitundi vati: Because of its primary constituent, Kuchila (Strychnos Nux-vomica
Linn), which has the qualities of Deepan, Pachan, and Vednasthapan, Agnitundi vati
enhances Mandagni and relieves pain [18].
7. Vati Aaroghyavardhini: Serving rasa and rakta dhatu, Aaroghyavardhini Vati aids in
"prasadbhuta raja nirmitee"—the creation of excellent follicles. It increases "kayagi"
and "dhatwagni," or the secretions of sex hormone binding globulin by the liver, which
results in a reduction in the synthesis of androgens. This is accomplished by stimulating
the liver's activities. One of the main ingredients of Arogyavardhini vati is kutaki
(Picrorhiza kurroa Royle ex Benth), which is pitta virechak. Rakata suddhi follows. In
the end, Artavavaha srotas Suddhi happens [19].
8. Dashamularishta: Dashmularishta is a traditional Ayurvedic polyherbal composition
made from powdered herbs and a natural fermentation process of the decoction. It
includes the 10 herb roots known as Dashamula in addition to more than fifty herbs. Its
therapeutic use are documented in Vatasaman. Vata is believed by Ayurveda to be
crucial in the vitiation of all illnesses connected to women. Therefore, Dashamularishta
 is important for vata suppression. It has been mentioned in the Sharangadhar Samhita
regarding infertility [20].
9. Sadavindu taila: Sadavindu taila, which was utilised as nasya, travels via the nasal canal
to Shringataka Marma (Siro Antarmadhyam). It covers the whole Urdhwajatrugata
region. That gets rid of the morbid Doshas. Gonadotropin Releasing Hormone (GnRH)
neurons are stimulated by it. As a result, it controls gonadotropin-releasing hormone's
pulsatile release. Eventually, it triggers ovulation, which resolves the polycystic ovarian
syndrome symptoms [21].
10. Maha Narayana Taila: With the help of MahaNarayana Taila and its Katu, Tikta Rasa;
Laghu, Ruksha Guna; Ushna Veerya and Katu Vipaka and Vata Kapha shamaka, Matra
vasti and Sarvanga snehan were completed. In the end, Doshaghnata causes Karmas
like Deepana, Pachana, Vilayana, Anulomana, and Sodhana, which result in
Amapachana and Vatakaphashamana. These Karmas can also eliminate Sanga and
Avarana, allowing Vayu to properly regulate Beejagranthi Karma, which in turn causes
Beejotsarga (ovulation). By normalising Apana Vayu and promoting Vatanulomana
and physiological functioning of Vata, Matra Basti administered through the Guda
(rectal channel) may facilitate the extrusion of ovum from the follicle and ovulation.
Consequently, by aiding in the fertilisation process [22].
11. Shatavari Churna: Asparagus racemosus (Willd.), (Asparagaceae) is traditionally used
in Indian medicine (Ayurveda). It facilitates in selling ordinary improvement of ovarian
follicles, regulates menstrual cycle and revitalizes the girl reproductive gadget
particularly because of its phytoestrogen (herbal plant primarily based totally
estrogen).. It also helps in combating the hyperinsulinemia [23].
12. Satapuushpa Churna: Seeds from the Satapushpa plant (Foeniculum vulgare Mill) are
a useful dietary supplement for PCOS control. They contain high amounts of
phytoestrogens. The phytoestrogens in fennel contribute to lowering PCOS
inflammation and insulin resistance. It's also thought to aid in lessening the cellular
imbalance that causes PCOS metabolic problems [24].

Discussion

Patients with PCOS always exhibit elevated levels of inflammatory alterations. According to
Ayurveda, inflammation is also connected to excessive weight gain, which is associated with
Samavastha, or metabolic poisons. PCOD is a metabolic condition as well as a reproductive
endocrinopathy. Every day, more and more people with PCOD are becoming diagnosed and
coming to ayurvedic practitioners for therapy. Scholars must thoroughly research the
Ayurvedic texts in order to comprehend PCOD from an Ayurvedic perspective. Prior to using
Ayurvedic methods to treat PCOD, it is important to understand the correct etiopathology
(samprapti) and keep in mind all of the sporadic references. Only then can the appropriate
Ayurvedic diagnosis be established, and only then will one have the optimal PCOD outcomes.
PCOD is a condition that is heterogeneous and has various factors contributing to its
presentation. According to Ayurveda, these are the causes of PCOD. Dominance of Kapha
Ama Agnimandya (both dhatvagni and Jatharagni) Rasadhathu forms Aama due to Apathya
Aahara Viharas (unhealthy food and lifestyle), which leads to Arthava Upadathu Dushti. This
vitiated state results in inappropriate ovum maturation and selection. Hence, the Aama
generated vitiates the residual Dhathus, resulting in excessive weight gain and hair loss. Asthi
Dhathu Dushti (bone tissue degeneration) is associated with undesired hair and hair loss, as
hair is the Mala Roopa of Asthi. Together with Avyayama and Divaswapna (day sleep), an
excessive intake of Mamsahara causes Kapha and Medho Dushti. The ovary is affected by
these vitiated Dosha and Dhathus, which impairs its morphology. Drugs with the activity of
Agni deepana (carminative), Pachana (digestive), Vatanulomana, Lekhana, and Artava janana
(ovulation induction) should be taken to normalise this situation.

Chiefly Affected strotas: Rasavaha strotas, artavavaha strotas, medavaha strotas are mainly
affected in the manifestation of PCOD.

Conclusion

PCOD is a condition that is heterogeneous and has various factors contributing to its
presentation. According to Ayurveda, these are the causes of PCOD.Dominance of Kapha Ama
Agnimandya (both dhatvagni and Jatharagni)While therapy approaches have evolved, science
is also progressing. So, Ayurvedic medicine expects the best possible therapy with the fewest
possible adverse effects. Several Ayurvedic medications are effective treatments for PCOD-
related infertility, with good outcomes. Furthermore, the therapy corrected the hormonal
imbalance by regulating the menstrual cycle and endocrine dysfunction. In addition to
medicine, alterations in lifestyle and increased physical activity can also improve immunity
and general health. As a result, it is discovered that Ayurvedic care is more dependable and
well-liked than current technology, which only uses intrusive procedures and hormone therapy.

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