Ayurvedic Approach to PCOS-A Critical Review

[Find the meaning and references behind the names: Sheela, Anjana, Main, Verma, Rupa]

Review Article This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 5 (12),68-72, Dec,2022 ISSN: 2581-785 X; https://irjay.com/ DOI: 10.47223/IRJAY.2022.51211 Ayurvedic Approach to PCOS-A Critical Review Sheela Verma 1 , Anjana Saxena 2 1 PG scholar,Deptt. Of Prasuti Tantra and StriRoga Govt. Ayurvedic P.G. College and Hospital Varanasi. 2 Reader, Deptt. Of PrasutiTantra and Striroga Govt. Ayurvedic P.G. College and Hospital, Varanasi. INTRODUCTION Jataharini has described by Acharya Kashyapa in Revati Kalpaadhyaya of Kalpasthana in Kashyapa Samhita. The word Jataharini comprises of two words: Jata+Harini . ( jata- one who is born) + harini (to enrapture) means jataharini is one which kills or effects the embryo,foetus,neonate ,menses and the child till 16 years of age. Jataharini is a group of disease that affects the women during their different stages of life. It not only affects the women but also their fetus, neonates and children. Pushpaghani Jataharini is one of them which affect the women at their reproductive age. Jataharini destroys beeja-rupa artava, destroys bodies, destroys the foetus, destroys the born children, destroys the being born or to Be born. The woman who had menstruation in time. But it is useless (without fruit). The one whose hair follicles are gross and loamy, that is called Pushpaghani jataharni. AIMS AND OBJECTIVE • To understand the concept of the menstrual cycle according to the Ayurved. • To understand the role of tridosha in the development of follicles in the ovaries. • To understand the etiology & pathogenesis of PCOS, as per Ayurveda theories. MATERIAL AND METHODS The data are collected from the Ayurvedic Samhitas, journals & articles on google & from previous studies. Critical Review PCOS is a lifestyle disorder of females of reproductive age Article Info Article history: Received on: 12-10-2022 Accepted on: 21-12-2022 Available online: 31-12-2022 Corresponding author- Sheela Verma, PG scholar, Deptt. Of Prasuti Tantra and StriRoga Govt. Ayurvedic P.G. College and Hospital Varanasi, Emailms.sheelaverma@gmail.com ABSTRACT: Introduction- Polycystic Ovary Syndrome (PCOS) is a common chronic anovulatory disorder with androgen excess in women of reproductive age. It is a multifactorial, multisystem disorder but, obesity & insulin resistance are often associated. The patient with symptoms of menstrual irregularities, excess androgen (hirsutism, acne alopecia), and USG shreds of evidence of >2-9 mm size arranged in the cortex of the ovary. Aims : To explore and understand ayurvedic theories and practices on PCOS. Material and methods: The Charaka Samhita, a classical Ayurvedic book, was thoroughly examined to compile a list of relevant references together with Sanskrit commentary. Internet searched to locate study papers and related material. Conclusion: According to the Ayurveda PCOS is studied, and its pathogenesis tried to be established. Kapha Vata predominant tridoshaja vikara & agnimandhya is the main reason for pathogenesis. So, it can be effectively treated by tridosha pacifying, agnivardhak chikitsa with uttarvasti. Keywords- PCOS , Pushpaghani jataharini,Aartavakshaya, Anartava

[Find the meaning and references behind the names: Raja, Pushpa, Rasa, Heart, Good, Kalam, Ritu]

Sheela et al “Ayurvedic Approach to PCOS-A Critical Review” : 2022; 5 (12):68-72 69 group & a most common form of chronic anovulation with androgen excess, excluding other causes of hyperandrogenism like non-classical congenital adrenal hyperplasia, androgen secreting adrenal tumors, hyperprolactinemia etc. It is considered as a heterogeneous, multifactorial, multisystem endocrinopathy. Ayurveda And Pcos • Anartava, Nastartava, Artavkshaya, Vandhya yonivyapat, Pushpaghni jataharani, Granthibhoot artvadusthi and Santarpantotha nidana can be compared with PCOS. • Predominantly Kapha Vataj disorder involving Rasa, Rakta, Meda, Asthi, Shukra, Artava (Raja upadhatu ) and Rasavaha, Medovaha, Asthivaha, artavaha Srtotasas. • Kaphadushti Agnimandya(Jatharagni+ Dhatwagni) Vandhyatva, sthaolya , etc. • Vatadusthi - Painful, Scanty, Irregular menses. • Pittadusthi - Acne, hair fall, heart diseases. Hirsutism. In ayurvedic literature, mainly 4 factors are stated essentially for the conception & maintenance of their quality is emphasized for good pregnancy outcomes Ritu - appropriate time (ovulating time) Kstera -field (whole reproductive tract) Ambu - proper nourishment Beeja – ovum, menstrual blood, hormones, Artav Out of all the four factors, artava has great importance, as normal physiology of the other three factors depends on the normal functioning of artava. “streenam garbhoupyogi shyaat artavam Sarva sammtam”. In ayurvedic literature, the artava word is used for Antaha Pushpa – hormones &ovum and Bahaya Pushpa – menstrual blood. Features of bahya Pushpa and rituchakra can help to predict the physiology of antaha Pushpa . When the antaha Pushpa (hormones) is functional physiologically than the bahya Pushpa (menstruation) shows features of shudha artava if there is no anatomical deformity in the genital Although in Ayurveda description of PCOS is as such not present but to some extent few diseases simulated as described by some Scholars- 1 Pushpaghani jataharni - “vrutha pushpam” & “sthula Loma gandasha ”: Menses occurs regularly at the usual time. And the women suffering from this type of infertility have obese cheeks covered with hairs. Description of obese cheeks may indicate central obesity which is found in PCOS as steroid hormones, mainly androgen have increased. Also, there is an indication of hirsutism, which is again due to androgen excess [17]. The name Phuspaghani here indicates, infertility due to anovulation or due to the formation of bad quality of ovum or defective endometrium. 2 Vikuta jataharni : Menses are irregular in terms of duration, color, and amount. In the anovulatory and oligoovulatory cycle menses are either scanty or excessive in terms of amount either there is oligomenorrhoea or amenorrhea. Menses may vary in duration of bleeding and color, according to the interval at which menstrual bleeding starts. It seems to be due to oligo ovulation or anovulation found in PCOS [18]. 3 Artavakshaya “yatho uchita kalam aadarshanam alptaa va yoni vedana cha”: In artava kshya there are features of oligomenorrhea, scanty menses, and painful menses explains PCOS only partially. Since acharyas mainly focused on the description of bahaya atarva Lakshana (menstrual blood) not the other, signs of androgen excess and the presence of cystic ovaries have not been explained [15]. 4 Granthibhut artava dushti: As artava word used for an Ovum, hormone, and menstrual blood. We see in beeja roopi artava /ovum is anovulation cystic ovaries if we consider that the antaha artava/hormones get vitiated by excess Kapha and Vata . And the bahaya artaval menstrual blood will also form clots, either with the scanty or heavy flow depending on dosha predominance. Or there may be hyperplasia of the of the endometrium from polyps. In the nidana of Nasta artava , Acharya Vagbhata has explained that obstruction of channels artava is not evident, the patient remains amenorrheic [18]. Development of PCOS is attributed to combination of ➢ Environmental factors- like lifestyle modifications in form of sedentary life, over eating without proper Gap between meals, work load, mental stress etc. ➢ Genetical factors – it has sometimes family history. ➢ Obesity & Insulin resistance are recognized as important factors. Diagnosis of PCOS is based upon the presence of 2 of following 3 criteria (ASRM/ESHRE) ➢ Oligoovulation or Anovulation – manifest as menstrual abnormalities- Amenorrhea/Oligomenorrhea ➢ Androgen excess- clinically manifest as hirsutism, Acne, Hair fall. -biochemically as testosterone >2 ng/ml

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Sheela et al “Ayurvedic Approach to PCOS-A Critical Review” : 2022; 5 (12):68-72 70 ➢ USG evidences if PCOS- >>12 follicular cyst measuring 2-9 mm ➢ By symptoms and signs of PCOS we can consider it as Vata kapha predominant tridhoshaj artava dushti. As Vata is responsible for division of cells (granulosa, theca cells), rupture of follicle etc. Pitta has paaka karma so is associated with conversion of androgen to estrogen & maturity of follicle. Kapha has nutritive function so along with Vata it helps in proliferation of ovarian follicles. PCOS cannot be completely correlated to any one disease described in Ayurvedic literature but to some extent few diseases can be simulated as described by some Scholars ➢ An unvitiated female genital tract only can lead in to proper sexual function & perfect pregnancy with a healthy & virtuous progeny. Artava represent the healthy state of reproductive system following a rhythm & cyclicity in female genital physiology. Thus, we can consider 3 Physiological concepts unde r Artava. ➢ Dhatu (updhatu) rupa artava – hormones ➢ Beeja rupa artava – ovum ➢ Rajahsrava rupa artava- menstrual flow Samprapati (Pathogenesis) Of Pushpaghni Jataharini Intake of heavy, foods which increases secretion ( Abhishyanda ), sweets, cold, spicy and junk foods in frequent intervals ( Vishamasana ) (Flow Chart 1) Causing to Pushpaghani Jataharini leading to symptoms like anovulatory menstrual cycles, increased facial, body hairs (Menstruation does not appear in its Appropriate time or delayed “Sthula-lomasha-ganda” i.e. cheeks are Corpulent and covered with hairs.” Channels carrying Aartava are obstructed by Vata and Kapha, so not discharged monthly.) Treatment Of Pcos As Per Ayurveda ➢ “Nidana Parivarjana ” (avoid the causative factors) is said to be the very first step towards the management of PCOS. As Agnimandya, Medovriddhi , Apana Vayu and Kapha dushti plays the major role in the pathogenesis of the syndrome, so taking above fact into the consideration, Pathya Ahara- Vihara (dietary regimen & exercise) is to be used ➢ For Agnimandya and Aampachana , use of Trikatu Churna . Chitrakadi Gutika, Shadushana Churna, Haritaki Churna , Hingwashtaka Churna ” is to be done in order to palliate the Srotovarodha and to facilitate the Apana- Vatanulomana. ➢ For Medovriddhi , use of Takrarishta, Madhu like lekhanadravyas (scrapping agents) along with Yava, yavaka, kulattha etc. as aahara (diet) is mentioned by Acharya Charaka in chikitsa of Atistula (obese). Moreover, lifestylemodification as well as regular exercise is also emphasized ➢ To remove the Sanga (obstruction) of Aartavavah Srotas,Uttar -Basti(douche) is given with Dhanvantari Taila ➢ Vamana Karma (emesis) – as it alleviates the Srotovarodha by eliminating vitiated Kapha. As Kapha is soumya in prakriti, decrease in Kapha consequently increases Aartava of Aagneya nature ➢ Shatpushpa and Shatavari Churna (Asparagus recemosus Willd.) are to be used in females with deficiency or loss of Aartava , women getting their menstruation but not conceiving. ➢ Kanchanara Guggulu”, Sukumara Ghrita” for reducing the size of formed ovarian cysts ➢ Pathadi Kwath mentioned by Acharya Sushruta in Vatakaphaja Aartava dushti given orally along with the matrabasti of Shatpushpa taila ” after the cessation of menstrual cycle for seven days is found efficient due to its properties of Aampachana, agnideepana, Vatanulomana, Srotoshodhana and Vata-Kaphashamana. ➢ Narayana taila, Rasona Kalpa, Pushpadhanva Rasa and Kumaryasava is indicated in Nashta pushpa. ➢ Regular practice of Yoga i.e. Uttanapadasana, Sarvangasana, Halasana, Mayoorasana, Suryanamaskara, Vakrasana and Sheersasana in amenorrhea and, while Sarvangasana, Sheersasana, Halasana, Bhastrika and Ujjayi pranayama in female sterility, are indicated DISCUSSION According to Ayurveda, the disorder is caused by vitiated Vata and Kapha doshas and Rasa-Meda-Mamsa-Rakta dhatus dushti . The main objective of the chikitsa is- • To flame the Jathragni and dhatvagni with the use of Deepanapachana dravyas to correct the Agnimandya. • To remove the Sanga of Aartava-vaha srotas and Srotoshodhana through various Samshodhana karmas to balance the imbalanced doshas i.e. reduction of Kapha and Anulomana of Apana Vata ; to nourish the du shta dhatus and to regulate the irregular menstrual cycle • To reduce the weight through Lekhana dravyas, Pathya aaharavihara and regular exercise to regulate the hormonal imbalance • To reduce the size of already formed ovarian cysts through Kanchanara Gugglu & Sukumara Ghrita as Kanchanara is very useful in treating extra growths or tumors¹7

[Find the meaning and references behind the names: Sri, Gupta, Tiwari, Nil, Prakashan]

Sheela et al “Ayurvedic Approach to PCOS-A Critical Review” : 2022; 5 (12):68-72 71 • To enhance the chances of conception with the use of Shatpushpa and Shatavari Churna. As Shatavari (Asparagus recemosus Willd.) is known for its phytoestrogenic 48 properties.” CONCLUSION PCOS is a frustrating experience for women. As the infertility cases increasing recent days mainly caused by PCOS which is the complex of syndromes like Irregular periods, Weight gain, Excess androgen, Polycystic ovaries. From an Ayurvedic perspective this can be considered under the Pushpagni Jataharini in which the Nidana, Lakshana areas that of the cause and PCOS. So Based on the Samprapthi, Dosha Dushya involvement, and Roga Lakshana Samshodhana will be the line of management for the condition. Acknowledgments- Nil Conflicts Of Interest- Nil Source of finance & support – Nil ORCID Sheela Verma , https://orcid.org/ 0000-0002-7298-5502 REFERENCE 1. Shastri K, Charak Samhita, vidhyottini teeka, Chaukambha Sanskrit Samsthan Varanasi, Reprint edition 2013.pp.70 2. Shastri A.D, Sushrut Samhita Ayurveda sandipika teeka. Chaukambha Sanskrit Samsthan Varanasi, Reprint edition 2013.pp.70 3. Acharya J, Astang sangraha Shashilekha teeka Chaukambha Sanskrit Samsthan Varanasi, Reprint edition 2017.pp.89 4. Gupta A, Astang hiradya vidhyottini teeka Chaukambha Sanskrit Samsthan Varanasi, Reprint edition 2013.pp.70 5. Tiwari P.V, Ayurvedic Prasuti Tantra evam Stri Roga Chaukambha Sanskrit Samsthan Varanasi, Reprint edition 2013.pp.70 6. Shaws textbook of gynaecology 16* edition. New central book agency (P) Ltd,Calcutta 2009 7. Dutta.D.C.Textbook of Gynaecology including Contraception, Fourth edi tion,page no .422.,New central book agency (P) Ltd,Calcutta 2009 8. Acharya YT: Charaka samhita of Agnivesha; Suth rasthana; Chaukamba Surbharati Prakashan; 2009.pp.97 9. Acharya YT; Charaka Samhita of Agnivesha; Siddhisthana; Chaukamba Surbharati prakashan: 2009.pp.688 10. Acharya YT, Sushruta samhita of sushruta with Nibandha sangraha commen tary of Sri Dalhanacharya; Suthrasthana; Chaukambha Sanskrit Samsthan Varanasi, Reprint edition 2013.pp.70 11. Gupta A, Sahasrayogam, Chaukambha Sanskrit Samsthan Varanasi, Reprint edition 2013.pp.209 How to cite this article: Verma S, Saxena A “Ayurvedic Approach To PCOS-A Critical Review ” IRJAY.[online]2022;5(12); 68-72 Available from: https://irjay.com DOI linkhttps://doi.org/10.47223/IRJAY.2022.51211

Sheela et al “Ayurvedic Approach to PCOS-A Critical Review” : 2022; 5 (12):68-72 72 (Flow Chart) Samprapati (Pathogenesis) Of Pushpaghni Jataharini Agnimandya Aamotapatti Kaphdushti Kapha Pitta Vriddi(tridosha prakopa) In turn vitiating the Dusya Rasa and Rakta Causing to Pushpaghani Jataharini leading to symptoms

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Agnimandya, Kaphavata, Charakasamhita, Jataharini, Heavy food, Dietary regimen, Reproductive age, Menstrual cycle, Critical review, Environmental factor, Vamana Karma, Menstrual abnormalities, Insulin resistance, Weight gain, Nidana Parivarjana, Menstrual irregularities, Vata-Kapha, Artavakshaya, PCOS, Kanchanara guggulu, Review article, Artava Dushti, Irregular period, Vata-Kapha Predominant, Shatavari churna, Polycystic Ovaries, Pushpadhanva rasa, Pushpaghni Jataharani, Androgen excess, Excess androgen, Ovarian follicle, Pushpaghani Jataharini, Vata-Kaphashamana, Follicular cyst.