1. Management of PCOS:Ayurvedic perspective
Dr.shailesh s phalle M.D.(K.C)
Ayusanjivani ayurveda ,kharadi

2. Introduction : 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. INCIDENCE : Among the total female population 6%
About 50% cases seen within the age of to 30 years
60 % presents with anovulation
90 % presents with hirsutism
80 % with Obesity.
30 % with infertility

6. ETIOLOGY : 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. Pathophysiology :
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

9. Hyperinsulinaemia arising from receptor dysfunction

11. 3) Hyperandrogenemia : ( adrenal/Ovarian)
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. 4) Genetic inheritance :
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. CLINICAL FEATURES : 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)

15. INVESTIGATIONS : 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. AYURVEDIC CONSIDERATION :
“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. Kala i.e.ovulation period. – (Su. Sha 3/6 Dalhana Commentary)
ध्रुवं चतुर्णाम् सन्निध्यात् गर्भः स्यात् विधिपूर्वकः ऋतुक्षेत्राम्बुबीजानां सामग्र्याङ्कुशे यधा (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. VANDHYATVA W.S.R. TO ABIJOTSARGA (ANOVULATION)
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. Ayurveda perspective :
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. Frame of samprapti : 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. Treatment protocol : Sthoulya chikitsa : Dhatwagni deepan
Kapha medo dusti chikitsa

27. Role of panchakarma : 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. Basti For minimising kapha related granthis in overy
Erandamuladi shodhan basti-
Lekhan basti –
Uttarbasti –
Falghrutam,kasisadi tailam,sahachar tailam,bala tailam.

29. Lekhan basti –1 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. Shaman chikitsa :
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
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.
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

34. CASE STUDY
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
Progesterone
Testesterone
Before
treatment
7.8 32 35 11
Not done 78
After
tretment
3.2
10.76 16
10.6
0.18 36