polycystic ovarian syndrome modern and ayurvedic perspective

1. Guided by :-
Dr. Krishan kumar chopra
( HOD )
Dr. Meenu wahi
( Reader )
Submitted by :-
Arvinder kaur
Bams 3rd year
Roll no:-
Batch: 2020-2021

4. 
PCOD is a condition that has multiple ovarian cysts and
lots of hormonal and biochemical aberations. Excess
androgen production by ovary and adrenals interferes with
follicle and ovulation. The clinical features of PCOD are
menstrual abnormalities, increasing obesity, hirsutism and
acanthosis nigricans etc. It is the state of androgen excess
and chronic anovulation. Polycystic ovary syndrome(PCOS)
is a common endocrinopathy found in the females of
reproductive age group characterized by atypical menstrual
cycle pattern, hormonal disarrays and polycystic ovaries. It
may be difficult to diagnose due to Heterogeneous
presentation and varying features with age. In PCOS,
severe hormonal derangements give rise to the clinical
manifestations i.e. amenorrhea or oligomenorrhea, hirsutism,
obesity, Acanthosis nigricans & infertility. Sedentary life-
style, lack of exercise, excessive stress and anxiety
accompanied with junk food worsens the prognosis.

6. 
 Polycystic ovary syndrome (PCOS) was originally
described in 1935 by Stein and Leventhal as a syndrome
manifested by amenorrhea, hirsutism and obesity
associated with enlarged polycystic ovaries. It is the most
common endocrinopathy in female with reproductive age
group with a prevalence of 9.13% in Indian population.
PCOS is a condition characterized by hyperandrogenism
and chronic oligo-anovulation. Hirsutism may be clinically
evident in 25% of the cases.
 PCOS is a common female endocrine disorder affecting
approximately 5-12% of women.

9.  Polycystic ovarian syndrome, also known as
Polycystic ovarian disease or PCOD is a very
common female health complaint. The word
“Syndrome” is used to describe the PCOD
because, it isa complex manifestation involving
many factors and organs such as–obesity,
insulin resistance, irregular menstrual bleeding
(in most cases, excessive menstrual
bleeding),abnormal menstrual periods & cycle,
lack of ovum production (anovulation) etc.
 It is commonly found in reproductive age; also
it is thought to be one of the leading cause of
female infertility.

11. 
MENSTRUAL CYCLE
 The cycle begins with the first day of menstrual bleeding
 A new ovum begins to mature in the ovaries
 The sac around the maturing ovum produces estrogen,
increasing the levels in the body
 Increasing estrogen levels prompt the uterine lining to thicken
 Estrogen levels peak around day 14 and the sac, containing
the mature ovum, splits open releasing it from the ovary
 The empty sac (corpus luteum) left in the ovary begins to
produce both estrogen and progesterone
 Around day 22 the corpus luteum stops producing estrogen
and progesterone and if the egg has not been fertilized, both
levels will drop.
 Blood vessels in the uterine walls contract and spasm due to
the lack of estrogen and progesterone and the uterine lining is
shed.

13. 
Luetizing hormone (LH) and follicle-
stimulating hormone (FSH) are called
gonadotropins because the stimulate the
gonads-in males, the testes, and in females, the
ovaries
Theca cells in the ovary respond to LH
stimulation by secretion of testosterone, which
is converted into estrogen by adjacent granulosa
cells.
Ovulation of mature follicles on the ovary is
induced by a large burst of LH secretion.
FSH stimulates the maturation of ovarian
follicles

14. 
 LH is present in low levels throughout the
woman’s cycle except for 1 ½ days prior to
ovulation.
 Ovulation occurs about 10-12 hours after the
peak LH surge (this is what the ovulation kits
pick up), then returns to its low levels.
 As a result of the ruptured follicle an increase
in the production of progesterone occurs to help
prepare the uterus for implantation.

15.  Most common endocrine disorder in women of
reproductive age
 These women often have elevated androgen and
LH levels, an increased LH:FSH ratio, some
increase in serum estrogens, increases in fasting
or challenged insulin levels, decreased HDL
levels with increased triglycerides, and
occasionally increased prolactin levels.
 Its etiology is not completely understood
 Its treatment is based primarily on signs and
symptoms
 Recent findings demonstrate that PCOS has
significant metabolic sequel including increased
risk for diabetes and CVD, (seven times
increased risk of heart attack and heart disease
than other women)

18.  Menstrual cycle is fundamentally regulated by
the rhythmic release of the neuropeptide
gonadotropin-releasing hormone (GnRH)
 Increased output of GnRH from the
hypothalamus is thought to be responsible for the
hyper-secretion of LH that acts on the theca cells
to augment ovarian androgen production
 CNS stimulates the pituitary gland to secrete LH
which results in cyclical ovarian steroid output
 Women with PCOS have an increased LH
 Androgen production by the theca cells is LH
dependent

21.  Careful survey concludes that the biggest lifestyle
contributor to PCOS is poor diet. Young women with
PCOS tend to eat far too much sugar or carbonized drinks
and highly refined carbohydrates which causes unhealthy
raise in insulin levels. According to world fame Jerilyn
Prior, insulin stimulates androgen receptors outside of
ovary, causing typical PCOS symptoms which also play a
role in blocking release of ovum from follicle. This type of
diet will cause obesity and thus aggravating PCOS.Also,
in stressful women, as they eat more food that are high in
fat, sugar and carbohydrate in response to stress, the more
fat they store, thus, contributing in the development of
obesity-linked PCOS.Thus we can deduce that the modern
stressful lifestyle and food-habits are linked and
contribute or accelerate many diseases, PCOS being one
among them.

23.  Lifestyle diseases also referred to as diseases of
longevity or diseases of civilization,are the ones that
are reported to increase in frequency as countries
become more industrialized and people live longer.
 A new concept of Chronic Diseases of Lifestyle (CDL)
is taking roots in conventional medicine. These are
diseases that share similar risk factors because of
exposure to unhealthy diets, smoking, lack of exercise
and stress.
 These are non-communicable entities but still proving
to be silent killers. These include atherosclerosis,
alzheimer‟s disease, diabetes, chronic renal failure,
asthma, cancer, osteoporosis, the highest on the list
being obesity.

24.  Obesity is a gateway to an arena of metabolic
disorders as it hampers the functions of many
vital systems of our body.
 It further gives rise to hypertension, type 2
diabetes, osteoarthritis, depression. The most
important sequellae of obesity,today,is the
faulty ovulation in females due to Polycystic
Ovarian Syndrome (PCOS) which further leads
to infertility.
 There are reports of incidenceof PCOS in non-
obese and lean women too.But, the prevalence
of obesity alongwith PCOS is higher.

27. Defect associated with PCOS is
unknown, however women with this
syndrome have several interrelated
characteristics
1. Insulin resistance
2. Evidence of androgen excess-for
which there is no other cause
3. Chronic oligo or anovulation (altered
gonadotropin dynamics)
4. An ultrasound appearance of
polycystic ovaries in the absence the
above three characteristics is NOT a
basis for defining PCOS and should
not prompt a full evaluation

29.  Insulin is a hormone that has extensive effects on
metabolism and other body functions, such as vascular
compliance. Insulin causes cells in the liver, muscle, and
fat tissue to take up glucose from the blood, storing it as
glycogen in the liver and muscle, and stopping use of fat
as an energy source. Abnormal insulin creates increased
androgen, but not the reverse. Weight loss will help
correct the symptoms of increased androgen, but
administration of gonadotropins does not result in a
reduction of insulin.
 Insulin stimulates steroidogenesis, (the process wherein
desired forms of steroids are generated by transformation
of other steroids), in the ovarian cells
 Products of steroidogenesis include: androgens,
thestosterone, estrogens, progesterone, corticoids, cortisol
and aldosterone

31.  The condition in which normal amounts
of insulin are inadequate to produce a
normal insulin response from fat, muscle
and liver cells.
 The patients are not technically diabetic
because their glucose levels are normal.
 Although obesity is associated with
insulin resistance, it can not be
explained entirely by obesity.
 Difficult to diagnosis, fasting insulin
levels may be normal. Glucose tolerance
testing where you also measure the
insulin levels may be more accurate.

33. Increased output of GnRH from
the hypothalamus is thought to be
responsible for the hypersecretion of
LH that acts on the theca cells to
augment ovarian androgen
production
Reason unknown
Hyperinsulinism also increases the
levels of bioavailable androgen by
reducing the amount of sex
hormone-binding globulin (SHBG)
produced by the liver.

34.  Hirsutism – presence of terminal hair in
a male like pattern. Androgens directly
transform vellus hair to terminal hair in
androgen sensitive areas. Male pattern
distribution includes hair growth on the
face, chest, upper back, abdomen and
inner thighs.
 Acne –sebaceous glands are strongly
influenced by androgens. The degree and
severity of the acne is directly associated
with circulating androgen
concentrations.

36.  Follicles in the ovaries of women with
PCOS do not mature fully-therefore
estradiol production by these follicles is
limited.
 Follicle Stimulating Hormone (FSH) is
absolutely essential for preovulatory
follicle growth-so impaired FSH signaling
is a reason for anovulation.
 FSH secretion is constrained by negative
feedback inhibition

37.  Cycle duration greater than 35 days in
duration or less than eight cycles per
year
 Usually begins at menarche
 Anovulation bleeding represents
endometrial breakthrough bleeding
resulting from continual estrogen
stimulation unopposed by progesterone.
 Exclusion of other disorders-
hyperprolacticemia, thyroid dysfunction,
androgen-secreting tumors, 21-
hydroxylase deficiency

39. SIGNS AND SYMPTOMS
Clinically PCOS often manifest itself at
menarche with some form of menstrual
irregularity, but not essentially.
The principle signs and symptoms of PCOS are
related to menstrual disturbance and elevated
levels of male hormones (androgens).
 Patient approach the physicians with the
features like menstrual irregularities,
androgenic features such as hirsutism, acne,
alopecia etc ,obesity and infertility caused by
improper ovulation etc.

41.  Patient complains of increasing obesity, menstrual
abnormalities in the form of less menstrual bleeding,
absence of menstruation, or abnormally high and
irregular bleeding and infertility.
 There may be abnormal growth of hair at different
places of the body.
 The patient may not always be obese.In some
patients, due to insulin resistance,a dark coloured
band like skin lesion may be developed at the back
of the neck, inner thighs and axilla,called as
Acanthosis nigricans.
 Internal examination reveals bilateral enlarged
cystic ovaries which however may not be revealed
due to obesity

43. Dyslipidemia
Non-insulin-dependent diabetes
mellitus
Gestational diabetes
Hypertension
Cardiovascular disease
Thrombosis
Endometrial cancer
Ovarian cancer
Breast cancer

44.  INVESTIGATIONS
 SONOGRAPHY transvaginal
sonography
 SERUM VALUES
 Ratio of lh:fsh is 2:1
 Estradiol and estrone level is elevated.
 SHBG level is reduced.
 Androstenedione level is raised.
 Serum testosterone and
dehydroepiandrosterone sulphate may be
marginally elevate.

46. Most important goals
Avoiding over- and under-
diagnosis
Counseling
Prioritize specific aspects
affecting health and quality
of life for each individual
Optimize fertility and
pregnancy (prevention)
Minimize cardiometabolic
sequelae

48. Exercise
Weight loss
Hair removal
Medications

49.  Oral contraceptives are used to both
regulate the menstrual cycle and suppress
the androgens.
 Spironolatone affects the androgen
receptors and will, over a prolonged period
of time, reduce the hirsutism on its own.
 Metformin has been shown to directly
inhibit androgen production in the human
thecal cells and to have a direct effect on
ovarian steroidogenesis. It also lowers
insulin levels.

50. Diet and exercise
Ovulation No Ovulation
Clomiphene citrate use 50-150 mg
Consider metformin at this time
Ovulation
Noovulation
Use of ne citrate with
referral

52.  Loss of at least 5-7% body weight
canrestore ovulation in up to 80% obese
patients possibly by reducing
hyperinsulinaemia and thus
hyperandrogenismwhen BMI is elevated.
 Induction of ovulation (OI) with
Clomiphene citrateis the next step in
management, but it should be limited to
three cycles. This is followed by use of
insulin sensitizer as a single agent.
Subsequently, administration of insulin
sensitizer with Clomiphene is advisable.

53.  Following insulin sensitizing, Gonadotropin
therapy and FSH hormone are the next option.
Pharmacotherapy includes Metformin(Glucophage),
a drug of choice that increases ovulation and
simultaneously reduces the problems caused by
insulin resistance and regulates the excessively
raised levels of the androgens.Apart from these, anti
androgenic therapy is advisable to reduce the
masculine effects of testosterone like alopecia,
hirsutism etc. and Eflornithine as a cream to retard
hirsutism.
 Patients who do not respond to Clomiphene
therapy are further subjected to surgical procedure
namely Laproscopic Ovarian Drilling (LOD).It
destroys the androgen producing tissues, thus
correcting hormonal imbalance and restoring normal
ovarian functioning.

55.  In Ayurveda, PCOS is not described as a separate
heading, but can be portrayed under the headings of
various yonivyapadas (genital pathologies) and
aartavadushti (menstrual pathologies). PCOD can be
correlated with Pushpaghni Jataharini, aartava-
kshaya(hypomenorrhea), nashtartava, arajaska,
ksheenaartava(oligomenorrhea) and granthibhuta
aartava(clotted menses).

56.  The disorder involves Vata and Kapha doshas, Meda-Mamsa-Rakta
dhatus. Therefore Poly Cystic Ovarian Syndrome can also be described
with same involvement of Dosha and Dhatu.
Chikitsa siddhanta aims Agni Deepana and
Aampachana, hence clearing away the Srotorodha (obstacles)of Aartava-
vaha srotas (Channels carrying menstrual blood)and others.
 Srotoshodhana leads to Apana-Vatanulomana resulting in
regularization of menstrual cycle, imbalanced hormones and metabolism.
Reduction in Kapha is helpful in relieving obesity along with the
associated symptoms of hyperandrogenism. Moreover, regular exercise
and balanced diet catalyzes the action of drugs. Hence PCOS can be
managed with Ayurvedic formulations along with Life-style
modifications and restricted diet.

57.  In Ayurveda, the balance state of doshas is mainly
responsible for health and any derangement to this
will lead to disease.This dosha-vaishamya is directly
connected to symptoms and the relation between
doshas and lakshanas are permanent.By the outlook of
the symptoms of PCOS as per modern description, it
becomes clear that even though they are not compiled
as a syndrome in Ayurveda most of them have been
described as features of separate diseases or conditions

58.  One among the 100 lady is suffering from this life style disorder, hence
it is proved that if any lady is getting such symptoms which are
mentioned above should get alert herself to get rid of this problem.if we
summarize this than we can find these symptoms in Ayurveda as:-
1. Menstrual irregularities have been described under artava vyapads
or Yoni rogas(uterine disorders).
2. Anovulation is included under Vandhya(infertility).
3. Obesity is the condition described as Sthoulya.
4. Acne and Baldness have been described as
MukhadooshikaandKhalitya, two independent pathogenesis.
5. Hyperinsulinemia leads to type 2 Diabetes mellitus, and is described
under prameha. It is also manifested as a complication of sthoulya

59.  ETIOLOGY (AYURVEDA)
In the context of yonivyapadas, there are
four basic causative factors i.e. unwholesome
lifestyle, menstrual disarrays (dushti of
antahpushpa i.e. ova and bahipushpa i.e.
menstrual blood), genetic disorders and some
divine factors, responsible for the manifestation
of the syndrome.
It is a disorder involving vata and
kapha doshas along with Meda Dhatu dushti. On
the basis of Ayurvedic interpretation PCOS can
be enumerated as Rasapradoshaja and
Santarpanottha vyadhi.

60.  ORIGIN OF THE DISEASE(AYURVEDA)
When the deranged vata etc. vitiates the
mamsa, shonita and meda mixed up with Kapha; thus they
produce circular, raised and knotted inflammatory swelling
called “Granthi‟. This type of glandular swelling has been
compared with the modern terminology “cyst” which means
an abnormal closed epithelium-lined cavity in the body,
containing liquid or semisolid material.
In PCOS, development of follicles has
been arrested at one or any level and remained as it is. The
cysts are follicles at varying stages of maturation and
atresia. So, these cysts are not destined to ovum. Thus, this
pathology is compared with granthi bhuta artava dushtii.
cyst, as in PCOS, the follicles becomes cysts instead of
developing up to mature ovum Hence, an attempt was
made to correlate modern symptoms of PCOS with
Ayurveda, so, that we can come symptoms of PCOS with
Ayurveda, so, that we can come to one conclusion

61. TREATMENT OF PCOS
ACCORDING TO AYURVEDA
Ayurvedic treatment is by applying a
multi-pronged approach towards:
Correcting the hormonal
imbalance
Treatment to obesity and avoiding
high cholesterol levels
Treatment to insulin resistance

62. 1. Correcting hormonal imbalance :-There are
manyherbs useful in correcting the hormonal
imbalance. Ashoka (saraca asoca),
Dashamoola (a group of ten herbal roots) a
group of herbs useful in preparation of
Sukumara Kashaya like Ashwagandha,
Eranda, Shatavari etc.are useful in
correcting the hormonal imbalance.
2. Treatment to obesity :-Treatment to obesity
and specifically against cholesterol can be
achieved by using Ayurvedic herbal remedy
plus diet and lifestyle changes.
3. Treatment insulin resistance :-Treatment for
insulin resistance involves a time-consuming
approach with effective Ayurvedic treatment
and diet and lifestyle changes including
exercise

63. 1. “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.
2. 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.
3. 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, lifestyle-modification as well as regular exercise is also
emphasized.
4. To remove the Sanga (obstruction)of Aartavavah Srotas, Uttar-Basti,
(douche)is given with Dhanvantari Taila.
5. 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.

64. 6. 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.
7. Kanchanara Guggulu, Sukumara Ghrita for reducing the size of
formed ovarian cysts.
8. Pathadi Kwath mentioned by Acharya Sushruta in
Vatakaphaja Aartava dushti given orally along with the matra-
basti of Shatpushpa taila40after the cessation of menstrual
cycle for seven days is found efficient due to its properties of
Aampachana, agnideepana, Vatanulomana, Srotoshodhana and
Vata-Kaphashamana.
9. Narayana taila.
10. Rasona Kalpa.
11. Pushpadhanva Rasa.
12. Regular practice of Yoga i.e. Uttanapadasana, Sarvangasana,
Halasana, Mayoorasana, Surya-namaskara, Vakrasana and
Sheersasana in amenorrhea and, while Sarvangasana,
Sheersasana, Halasana, Bhastrika and Ujjayi pranayama in
female sterility , are indicated
13. Kumaryasava is indicated in Nashta pushpa

65. 1. Basti(Vasti):Enema of medicated oil or Decoction is given through
Rectum. Vitiated “Vata” can create various health problems. Basti
releases obstructions in the way of Vata dosha and thus regulates the
normal phenomenon of “Vata”. Different types of medicated Oils,
Ghruta, milk or decoctions are used for Basti treatment. It can state
miracles if administered in a proper way with appropriate
medicines.Basti procedure eliminates the doshas from rectum. It balances
the “Vata” Dosha. Apana Vayu is the type of “Vata Dosha”, which
controls on the Shukra Dhatu (Semen) in males & Aartava (Ovum) in
females. “Apan Vayu” controls the reproductive system. The procedure
“Basti” regulates Apan Vayu which improves quality of Semen &
Ovum.In females oil Basti of “Sahachar Tail” improves quality of
ovulation within normal days. In males the Basti procedure improves
quality & quantity of Semen i.e. it improves total sperm count and
motility of Semen.

66. 2. 2.Uttarbasti(Vasti):Uttara basti(Vasti) is the most
effective treatment in gynaecological disorders. It
helps to purification and clears the Aartava Vaha
Srotas, pacifies vitiated Apana Vayu and improve
follicular maturity.
3. 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‟.

67. 4. Vaman:Cleansing procedure intended mainly for the
expulsion of vitiated „Kapha‟. This is a painless, drug
induced emetic procedure, carried out mainly in the
Vasant rhitu i.e. Feb.,Mar.,April Months.Vaman
procedure purifies internal toxins. This balances hormonal
system. Vaman acts on Thyroid gland. It also
stimulatesPancreas to secret insulin in normal level, so
P.C.O.D. decreases accordingly.Useful Herbs in PCOS
TreatmentAloe vera, cinnamon, fenugreek, amalki, honey,
glycosugars, shilajit, shatawari, aswgandha, Kauncha,
Vidarikand, salam, ashoka, are the useful
herbs.Herb"Latakaranj"(Caesalpinia crista) has shown
encouraging results in PCOS cases.

68. YOGA FOR PCOS
1. Sarvagasana
2. Matsyasana
3. Ardhmatsyendrasana
4. Paschimottanasana
5. Surya namaskar
6. Ushtrasana
7. all backward bending asana are
recommended but they should be
try under the supervision of an
expert.

70.  1) Sanshodhan Chikitsa It aims at improving ailments by curbing the
root cause. Here, Sanshodhan chikitsa and that too vamana is stated to
be applied. Vamana karma is basically given shleshma dhikyata. Being
a santarpana vyadhi, there is rasadushti in the patient which leads to
ama formation in obese person. The deranged metabolic process further
continues as a chain reaction disturbing the function of all dhatus. The
mala of Rasa is kapha. Here in, the mala swarupa kapha is increased
and so the nutrition to the upadhatu raja is hampered leading to its
imbalance.
 2) Agneya chikitsa
 Firstly,our body is stated as agnishomiya. Normally, Artava
is stated to be agneya in nature. The shleshmalaa ahara vihara results
in soma guna dhikya thus, influencing artava kshaya. The propertiesof
agneya dravyas-ushna, ruksha, tikshna, vishada, sukshma,dahaka ,
prabha (aura), varna (lustre of skin) , pachana (metabolism).

71. CURATIVE
The chikitsa in artavakshaya by Sushruta
Sanshodhanam agneyanam cha dravyanam
vidhivat upayoga:
Dalhana quotes that Artava is normally
agneya in nature;Vamana therapy decreases
saumya guna and increases the agneya
guna.The examples given are sesame, urad dal,
alcoholic preparations,etc.In Ayurveda,
chikitsa is of two types Sanshodhan and
sanshamana.

72.  Mahabhutagni concept
 Agneya dravyas (sesame, alcoholic preparations,etc have been stated) are agni mahabhuta pradhan. The
rakta dhatu also is agneya. Pitta and rakta have ashrayashrayi sambandh. The mukhya sthana is
yakrit for rakta dhatu. Liver is regarded as a major site of carbohydrate metabolism, fat metabolism
and protein metabolism. Reduced hepatic extractions, impaired suppression of hepatic gluconeogenesis
and abnormalities in insulin receptor signalling causes improper insulin metabolism. In a study, it has
been proved that liver has a significant role in maintaining fertility.The highest activation of oestrogen
receptors was found in liver. This also supports the ayurvedic principle of formation of rakta from rasa
dhatu, thus intermediate upadhatu precursors may be correlated with these oestrogen receptors.
Besides, the major lipid responsible for reproductive steroidogenesis i.e cholesterol is principally found
in liver. Thus, the Agneya chikitsa can be considered in respect of stimulant for bhutagni site i.e liver
in order to correct the SHBG levels i.e steroid hormone binding globulin levels (which are otherwise
normally secreted in liver) as also facilitate normal conversion of cholesterol to and rostenedione,
finally into estrogen.Besides, Agneya dravyas will induce normal restoration of hepatic
gluconeogenesis thereby reducing insulin resistance.
PCOS according to Ayurveda can treated with yet another dimension i.e.avarana
chikitsa.Improper function of Apana can be treated with avritta apana chikitsa given in Charak
Samhita. It includes dipana, grahi dravyas, vatanulomana drugs with sanshodhan of pakvashay. This
is a package treatment of obesity. Dipana and vatanulomana drugs will probably act on the leptin
resistance and ghrelin insensitivity thereby alleviating the symptoms.Pertaining to aushadhi
chikitsa,the pharmacological actions and gunas of drugs from Lekhaniya

73.  AAHARA
 Acharyas have suggested to use those dravyas that are guru
but still apatarpana. This can be correlated with concept of
GI and GL. Now-a days,a great emphasis is laid on
adequate diet prescription for obesity and PCOS.GI-
glycemic index is a major of how quickly blood sugar levels
rise after eating a particular food.A lower glycemic index
suggests slower rates of digestion and absorptionof foods
promoting satiety and delaying hunger and promotes fat
oxidation there bycontrolling weight. This can be correlated
with guru gunatmak anna. This concept matches with that
given in Bhelasamhita, guru ahara can be dravyata: or
matrataha: i.e.the guruta depends on the nature of drug
(probably low glycemic index food stuffs as they delay
process of digestion and absorption) and the quantity of
food stuff. (probably glycemic load.)The Glycemic index
and Glycemic load of some commonly consumed food stuffs
are mentioned in Table

75.  Thus, the concept of guru ahara is justified. In case of
apatarpana, all food stuffs possessing medoghna properties
must be prescribed. e.g. gavedhuka (which has a direct role
on NPY and leptin recptor), yava(barley), priyangu (Setaria
italica), shyamak(Echinochloa frumentacea), cheenak
(Panicum millaceum). Studies are needed in these food
stuffs.Besides these, madhu(honey) and takra (fresh
buttermilk) which is a good source of vitamins and lactic
acid. Fruits can include amla rasa pradhan like oranges,
lemons, sweet lime, also pineapple, papaya that stimulate
digestion.

78. VIHARA
Vyayama nityo jirnanshi yava godhuma bhojana: |Santarpankritai doshai:
sthaulyam muktvavimuchyate
1. Exercise This firstly includes regular exercise. Many studies have reported
improvement in insulin resistance and thereby regularity in menses by regular
exercise
2. Pranayama In a clinical study effect of kapalbhati pranayama was observed in 60
obese doctors in relation to BMI and abdominal skin fold thickness. They were
divided further into two groups. The regimen consisted of asanas (postures),
pranayama (breathing exercises),stress management, discussions, lectures, and
individualized advice for a period of two weeks. There was a significant decrease in
chronic inflammatory markers like plasma cortisol and TNF alpha and increase in
beta endorphins.
3. Asanas effect of a yoga program on glucose metabolism and blood lipid levels in
adolescent girls with polycystic ovary syndrome. Yoga was found to be more
effective than conventional physical exercises in improving glucose, lipid, and insulin
values, includin insulin resistance values, in adolescent girls with PCOS.
4. Proper dietary habits: Jirnashana Isoenergetic 1000 kJ (240 kcal) servings of 38
foods separated into six food categories (fruits, bakery products, snack foods,
carbohydrate-rich foods, protein-rich foods, breakfast cereals)

80. Preventive Management
1. The nidana parivarjana(avoiding of the causative factors)
2. Shleshmala aaharaThis includes consumption of foodstuffs like bakery products e.g
bread, cakes,pastries, puddings in excess, also rice, fast foods, oily foods, canned
foods, processed foods, overuse of cornflakes and breakfast cereals, etc.
3. Adhyashan Dalhana has quoted the meaning to have a habit of overeating without
leaving a considerable amount of time in between two mealsor eating without a
proper hunger trigger. Also „ajirna bhojana abhyasina‟ is stated which means to
have food before the complete digestion of previous meals is ceased. Thus, the habit
of over eating must be strictly avoided.
4. VyayamThe physical activity and dietary habits in PCOS that women with PCOS
do not achieve the necessary physical activity, and mean % energy is more from fat
and the dietary glycemic index is higher in overweight obese women with PCOS as
compared to healthy weight women with PCOS. The total sugar intake was high.
5. DivaswapnaAdequate sleeping habits must be practised as abnormal duration and
timings lead to a disturbed biological clock

82. Intervention
1) Undergo seasonal sanshodhan therapyi.eVamana in Vasant rutu , Virechan in
Sharad rutu and Basti chikitsa in Varsha rutu.
2) Practising Dinacharya and Rutucharya.
3)Nitya vyayama
4) Udvartana –kapha medo vilayana.It is stated to decrease the lipids
5) Utsadana-This is stated specially in females.
6) Aaharkala -one should consume meals in morning when the days are shorter and
nights are longer in the season and in evening when days are longer.(Pratarashe tu
ajirne api sayam aashe na dushyati)
7) Effect of skipping meals is barred. It results in mandagni.
8) Aahar matra -nirdishtam sukham yavat hi jiryati.
9) Water intake dosage -twice the meals.
10) Anupana helps to stimulate digestion prolonged due to intake of guru aahar.
11)Pathya in ahara The Pathya aspect has been well described in
Pathyapathyavibhodhaka Nighantu

83. 83

84.  SUBMITTED BY:-
 ARVINDER KAUR
 BAMS 3RD YEAR
 ROLLNO: 29
 GAC PATIALA
 SUBMITTED TO:-
 DR. K.K. CHOPRA
( HOD STRI ROG DEPTT.)
 DR. MEENU
( LECTURER)
84