ABSTRACT:

„A woman's health is her capital‟. Today's woman are multitasking experts, nurturing personal and professional dedications and dreams. Though, being a multitasker she pays the heavy price of self- neglect. Withering and waning in her constant endeavors to excel. And due to this she goes through a barrage of changes beginning from the time she attains puberty to the time she goes through menopause. Owing to this, women are subject to large number of complaints in relation to the reproductive system. Among those complaints, polycystic ovarian syndrome is one of the major issue which reflects various abnormal changes in her system. PCOS is a common endocrine disorder characterized by Hyper-androgenism ,Chronic anovulation(Irregular Menses), Insulin resistance, Obesity Ayurvedic medicine has been proven to be efficient to treat PCOS. 

INTRODUCTION:

Present era is advanced and competitive. In this competitive world, women are trying equally to withstand. To achieve her goals, she should be in perfect, healthy conditions. But such as a leading and fast lifestyle has increased the chances of abnormality specially contributing to the female reproductive system, one of them being Polycystic Ovarian Syndrome(PCOS). PCOS is a multifactorial disorder, which includes:• Disturbance in the Menstrual pattern• Hyperandrogenism• Small cysts in one or both the ovaries PCOS can be described as an oligogenic disorder in which the interaction of number of genetic and environmental factors determine heterogenous, clinical and biochemical phenotype. Environmental factors implicated in PCOS can be exacerbated by unhealthy dietary choices and physical inactivity. Ayurveda has proved a boon to such disorders. As the doshas involved in PCOS are basically the Vata and Kapha, the Shodhan and Shaman chikitsa serves efficiently in treating the disease.

 In ayurvedic classics, all of the gynecological disorders are mentioned under Yonivyapadas. Ayurveda understands this on the basis of Dosha and Dushyas relationship. To combat this situation, Shaman and Shodhan is found to be very effective. • 

ACCORDING TO MODERN SCIENCE

 Clinical Features• Prevalence rate is 8-10 %.[3]• It is one of the leading cause of infertility in females.• It is one of the leading endocrine, reproductive and metabolic disorder in the world characterized by:• Hyperandrogenism• Hirsutism• Acne• Chronic anovulation (irregular menses)• Infertility• Endocrine Dysfunction  • Obesity• Insulin resistance• Acanthosis Nigricans• Impaired Glucose Tolerance and Type 2 Diabetes Mellitus• Dyslipidemia• Metabolic Syndrome and Cardiovascular Disease• Polycystic ovaries• 

It was first time described by Stein and Leventhal in 1935 so called Stein and Leventhal syndrome.• Poly means many/ multiple, cystic- abnormal sac containing fluid, Ovary- female gonads, Syndrome- group of multiple symptoms. 

DIAGNOSTIC CRITERIA• Menstrual irregularity due to anovulation oligo-ovulation• Evidence of clinical or biochemical hyperandrogenism• 12 or more follicles measuring 2-9 mm in diameter• Increased ovarian volume (>10 cc )• Exclusion of other causes (tumors, hyperprolactinemia) 

 MANAGING PCOS• Hormonal and Surgical Intervention is carried out (Laparoscopic ovarian diathermy LOD)• Insulin level is lowered• Fertility restoration• Treat for Hirsutism and acne• Restoration of regular menstruation• Prevention of endometrial hyperplasia

 Samprapti- Pathophysiology 

Santarpanotha nidana sevan leads to Agnimandya which leads to → Agnimandya leading to ama rasa formation → Dhatvagnimandya takes place → dushit Rasa dhatu is formed → madhurata and ati snigdha property of rasa dhatu, having close affinity to medadhatu→which leads to ati sthoulya and avarana on various strotas caused by kapha dosha →which results into improper formation of dhatu.   

Samprapti Ghatakas

• Dooshya –Medodhatu, rasa, rakta

• Dosha-vata -Apana,vyana vata, pitta -ranjaka (converts one dhatu to another) kapha-Sleshaka Kapha • Strotus: Artavvahashrotas, medovahastrotas

• Strotodusti -sangha

• Agni -manda at kostha and dhatu level.Above lakshana have relevance with the symptoms of PCOS Role of Tridosha in Ovulation and Menstruation• Vata (Apana vayu, Vyana vayu)Uterine relaxation and contractions are under the influence of apana responsible for normal mensturation  and vyan vayu.function -distribute blood and nutrition all over the body through blood circulation , Vata is also responsible for the movement of follicles, rupture of follicles, release of ovum and movement forwarding to the fimbrial end. • Pitta (Ranjaka pitta) it concerned for production of blood  The action of various hormones which results into various stages of menstrual cyclei.e. ovarian cycle and endometrial cycle.  • Kapha• Sleshaka Kapha is present in all joints, connective , fatty tissue, ligaments It is responsible for the nourishment of the tissues that support the reproductive system including the growth of the follicles during ovarian cycles.  

Nidan

Purvaroopa- Irregular menses, gain in weight, cystic appearance of ovaries. Lakshana of PCOS from an Ayurvedic PerspectiveIt includes Santarpanotha Nidan, Strotodushti lakshan and Beeja Dosh• Keshloma smashru dosha• Prameha purvaroopa-• Strotasam lepa-.• Atyartava• Neelika• Akala Khalitya• Keshlomasmashru dosha- Ayurvedic Approach of TreatmentThe treatment as per modern science is hormonal therapy and other drugs which may affect day to day life of a woman. Henceforth, Ayurveda plays a major role serving safety and efficacy of the treatment. Tridoshas represents the basis of the vital functions of the body, classified under the headingsi.e. vata, pitta and kapha. Nidana Parivarjana” (avoid the causative factors) is said to be the very first step towards the management of PCOD. PCOS, the term itself indicates more than one symptoms and hence possibility for multisystem involvement with ovarian dysfunction. Bahudosha avastha is evident in PCOS with multiple symptoms, so treatment include more than one as shodhan followed by shaman.

 • Shaman Chikitsa:-It Includes*Deepan - It includes the drug which strengthens the jatharaagni but do not digest ama. Deepan drugs are agneya in nature, laghu, tikshna gunatmaka, ushnaviryatmaka, katu amla rasa Pradhan.

*Pachan– It includes the drugs which digest the ama by their ushna virya but do not stimulate jatharaagni. i.e. Mishreya, shatpushpa, Nagkeshar, Hingvashtak churna.  

*Vatanuloman – It includes the drugs which correct vitiated vatta dosha, facilitates evacuation of mala through anal canal. i.e. Aragwadha, Haritaki, chavya, Gandharvaharitaki, etc.

 *Use of Agneya dravya includes:- Katu tikta rasa, ushna virya ushna ruksha tikshna guna, katu vipaka enhances Agni by clearing Ama dosha that is caused by kapha. Hence by initiating the proper action of Ahar rasa and updhatu artava, clears the Apanavayu aavarana and strotoshodhan, thus chala guna of apanavayu is triggered that helps in inhibition of artava and menstrual regularization. Vatahar draya Erandmool,Kantakari, Shatavari Reduces vidambhatwa,laghutwa and shetalatwa Kaphaghna dravya Vasa, Sahachar,Dhanvayas, Musta Decreases the picchilta and guruta Shothahar Erand, Punarnava, Devdaru, Rasna Reduced obesity and BMI Lekhaniya or Medohar Erand, Guggul, Dhanvayas Reduces overweight n subsides the size of granthi Kushthaghna Haritaki, Guduchi,Pippali, Vasa Acanthosis nigricans and acne can be controlled Pramehaghna Guduchi, Devdaru,Haritaki, Guggul Reduces obesity and hyperinsulinaemia Artavjanan/Vrushya Shatavari,Ashwagandha, Bala, Gokshur Enhances the quantity and quality of Shukra and aartav Rasayana Shatvari, Ashwagandha,Guduchi, Haritaki Rejuvinates cells and tissues of the body  

• Samshodhan Chikitsa• Vaman- for kapha chedan and aavaran chikitsa. As kapha is the main dominating dosh. Vaman procedure purifies internal toxins. It balances hormonal system. Vaman acts on Thyroid gland. It also stimulates Pancreas to secret insulin in level, so P.C.O.S is decreased to a certain level, PCOS may be considered as Agni Vaishamyajanya Vikara, Rasagni, Medodhatvagni Mandya, as far as Dosha is concerned it is Kapha‑ Vataja disorder. PCOS is said to be a metabolic disorder and Vamana helps to increase metabolism of body, thereby reducing weight and acts on liver metabolism where hormone formation mainly takes place. • Virechan: It eliminates body toxins like vitiated „Pitta‟. The process of cleansing is carried out in the small intestine & other Pitta zones. Here drugs that stimulate bowel movement are increased for the expulsion of doshas through rectum. It acts on hormones system like „Vaman Karma‟. Vamana and Virechana also work on liver metabolism thus correcting the disturbed lipid levels. Virechana normalises the functions of Pita and Agni. 

• UTTAR BASTI: Uttara basti is the most effective treatment in gynaecological disorders. Due to its local action on uterus and ovaries, it Dissolves the cyst in ovaries more effectively then oral medicines. It also helps to purification and clears the Aartava Vaha Srotas, pacifies vitiated Apana Vayu and improve follicular maturity.  

• Basti: . Basti procedure eliminates the doshas from the anal canal.It balances the “Vata” Dosha. Apana Vayu is one of the Vata Dosha. Basti stimulate the parasympathetic nerve supply which in helps for the maintenance of normal cycle.As per Kashyapa in oligo/hypomenorrhoea, amenorrhoea, Anuvasana Basti is the choice of treatment

.• Nasya: Nasya may also stimulate olfactory nerves and limbic system, which in turn stimulates hypothalamus leading to stimulation of Gonadotropin Releasing Hormone (GnRH) neurons, regularizing GnRH pulsatile secretion, leading to regular and normal menstrual cycle. 

 Conclusion :The Ayurveda treatment principle for PCOS is to clear obstruction in the pelvis, normalize metabolism and regulate the menstrual system (Aartava Dhatu). Kapha reducing, insulin enhancing and hormone re-balancing drugs help to the relieve symptoms of Poly Cystic Ovarian Syndrome. The best medicine for PCOS are herbal medicines like Triphala, Kanchanar, Trikatu, Guggul, Dashamool etc which are effective in PCOS Ayurvedic treatment. Many Ayurvedic herbs like Shatavari, Shatapushpa also helps to grow egg naturally and also helps to rupture follicle naturally. 

By: Dr. Nitin Kumar

Md In Medicines, Bams, Pgdems, Dihm,Ccpt .