AYURVEDIC AND YOGIC MANAGEMENT OF POLY CYSTIC OVARIAN DISEASE (PCOD)
INTRODUCTION
Poly Cystic Ovarian Disease is a relatively common endocrine disorder in women of reproductive age group. It is found in around 70% of women who have ovulation difficulties leading to subfertility. Poly Cystic Ovarian Disease is a condition that has cysts on the ovaries that prevent the ovaries from performing normally. Symptoms of Poly Cystic Ovarian Disease include Amenorrhea or infrequent menstruation, irregular bleeding, infrequent or no ovulation, multiple immature follicles, increased levels of male hormones, male pattern baldness or thinning hair, excess facial and body hair growth, acne, oily skin or dandruff, dark coloured patches of skin specially on neck, groin, underarms, chronic pelvic pain, increased weight or obesity, diabetes, lipid abnormalities and high blood pressure. Fertility problems experienced by women with Poly Cystic Ovarian Disease may be related to the elevated hormone, insulin or glucose levels, all of which can interfere with implantation as well as development of the embryo1. Increased Leutenizing hormone reduces the chance of conception and increase miscarriage. Additionally abnormal insulin levels may also contribute to poor egg quality, making conception more difficult1 .
In Ayurveda few diseases in group of yoni vyapad and jatiharini have some similarities with this entity but pushpaghni jatiharini described by Acharya Kashyap has got much resemblance. Early recognition and intervention such as the development of further complications, medical and surgical treatment are advised according to need and severity of disease. Ayurveda advocate prevention of disease by following dincharya and ritucharya, by use of pathya aahar, vihar, aushadh and also by avoiding apathya aahar, vihar, prajnaparadha, mandagni, eating excessive sweet and kaph vardhak aahar and lack of love and other etiological factors. Therefore kapha reducing, insulin rebalancing, obstruction clearing aushadh aahar and vihar can helps to prevent / treat PCOS. This disorder involves pitta, kapha, medas with ambuvahasrotas and artavdhatu, these should be considered during treatment. (Ref 2)
The aim of this article is to communicate ayurvedic and yogic management of poly cystic ovarian disease. The focus here is to convey the symptoms , causes, ayurvedic treatment for PCOD. The emphasis is also given to relevant diet and yogic exercises for females suffering from PCOD and also for healthy females to avoid PCOD.
ETIOPATHOGENESIS
The cause of the PCOS remain unknown, insulin resistance and hyperandrogenism play an important role. There is no defect in Hypothalamo-Pituitary Ovarian axis but normal function is masked by inhibition of ovarian follicular development and inappropriate feedback to pituitary. The high oestrogen production is largely due to conversion of androgen to estrogen in the ovary and peripherally. It causes increase in luteinizing hormone (LH) and decrease in follicle stimulating hormone (FSH). A vicious circle is established for the increase in luteinizing hormone induces thecal hyperplasia and increased androgen synthesis in the ovary. High level of androgen results in increase in the peripheral production of the sex hormone binding globulin (SHBG). This leads to increased level of free androgens to produce hirsutism and to be converted to oestrogen. The hyperthecosis is related to an over production of androgens which reduces granulosa cell proliferation and maturation, as well as stimulating fibrosis of surrounding stroma and capsule resulting in anovulation and infertility (Jeffcoate’s Principal of Gynaecology). Burghen et al. (1980) first described the association between hyperinsulinemia and hyperandrogenism and stated that in addition to hirsutism and infertility PCOS has associated metabolic risks (Burghen et al., 1980). Another consequence of the raised estrogen level is the target organ effect on adipose tissue formation and endometrial hyperplasia, may result in endometrial cancer. Now a days Genetic involvement in PCOS cases is emerging. The main sterroidogenetic genes that were reported to play a role in the pathogenesis of PCOS are CYPlla, CYP17 and CYP21 (Aldo, 2005) and follistatin gene (Urbank et al., 1999). According to Ayurveda - It occurs due to prajnaparadha, mandagni, eating excessive sweet and kapha alleviating foods and lack of love. Sign and Symptoms Oligo/ Amerorrhoea, Anovulation and Infertility: These are due to increased level of endometrial and follicular activity, approximately 100% of patients with PCOS are considered to be oligo or anovulatory although not all the patients present with an overt abnormalily in their cyclic menstrual bleeding pattern (Ricardo et al., 2005). A prospective study conducted on 400 unselected women of general population nearly 60% had menstrual dysfunction (Azziz et al., 2004). Hyperthecosis is related to overproduction of androgen which reduce granulosa cell proliferation and maturation and stimulate fibrosis of surrounding stoma and capsule. Ovulation may occur intermittently. The elevated LH levels, deficient progesterone secretion, abnormal embryo from atritic oocytes and abnormal endometrium could be some of the reasons attributed to pregnancy loss (Enrico and Rogerio, 1999). Obesity: It is one of the features of the original description of the syndrome by Stein and Leventhal, is seen in 35-60% of women with PCOS (Balen et al., 1995). Typically this obesity is centripetal, related to truncal abdomen for distraction demonstrated by an increased waist to hip ratio (Evans et al., 1988; Pasquali et al., 1993).
Obesity is a cause of PCOS or it is result of PCOS is unclear, but it seem that later is more likely (Samuels Thatcher). Woman with central fat have high level of LH androsteindione, estrone, insulin, triglycerides, very low density lipoproteins (VLDL and lower level of high density lipoproteins (HDL) (Pettigrew et al., 1997). Mitchell and Rogers reported that obesity was present at four times higher than woman with normal cycles (Mitchell, 1953). Hirsute: Excess terminal body has in a male distribution pattern commonly seen in upper lip, chin and along with linea alba of lower abdomen, may have acne, male pattern balding, hirsute effects psychological life of woman. The treatment of hirsutism embraces both cosmetic and hormonal therapies. Androgenic Alopecia: Loss of scalp terminal hair that is common with baldness, it is seen in PCOS woman (Futterweit et al., 1988).
Differential Diagnosis: Any process capable of producing acyclical estrogen production will produce clinical and endocrine features resembling the PCOS like.
i). Cushing Syndrome.
ii). Androgen producing tumor of the adrenal gland or ovary. iii. Congenital adrenal hyperplasia. But for the diagnosis of PCOS, minimum three criteria has to be fulfilled. 1. Menstrual irregularity. 2. Hyperandrogenism: Shown clinically by hirsutism, acne, male pattern baldness, bio chemically by elevated serum androgen level.
3. Hyperinsulinemia (developed due to insulin resistance) elevated fasting blood insulin level.
PCOS IN AYURVEDA
i. Shandi Yoni Vyapad ( C.S. )
“Bijdoshattu garbha sthmarutophatshya. Nradweshinyastani chaiv shandi syadanupkramah” (C.S.Ch. 30/34-35) .
> A congential disorder (bijadosha).
> Absence or slight development of breasts.
> Dislike coitus.
> Incurable Disease.
ii. Shandi Yoni Vyapad ( S.S. )
“Anartavstna shandi kharsparsha cha maithune. Chasrashvapi chadhyasu sarvlingochhitirbhavet” (S.S.Ut. 38/18-20).
> Primary amenorrhoea (anartava).
> No breast development (astana).
> Capable of coitus but vaginal canal is rough.
iii. Bandhya
“Yada hyasyah shonite garbha shyabeejbhagah pradoshmapadyate. Tada bandhyam janyati” (C.S.Sh. 4/30).
Bijamsa dushti (chromosomal /genetic abnormalities); if part of bija responsible for the development of uterus is defective then born girl child would be bandhya (infertile)
iv. Bandhya Yoni Vyapad
“Bandhyam nashtartvam vidhyat chashrastpichadyasu bhavantyanilvednah” (S.S.Ut. 38/10-11).
> Breast developed (only differentiating point with shandi).
> Has amenorrhoea (nastratava considered as destruction of artava of female foetus).
v. Vikuta Jatiharini
“Kalvarnapramanerya vishmam pushpamrichhati. Animittbalglanirvikuta nam sa smrita” (Ka.S.K. 6/34-35).
> Oligomanorrhoea and scanty menses or excessive menses.
> General weakness (metabolic manifestation).
vi. Pushpaghni Jatiharini
“Vritha pushpam tu yo nri yathakal prapashyati. Sthulalomashganda vpushpaghni sa api revati” (Ka S.K.6/32-33).
> It is curable.
> woman menstruate in time but it is useless (vyathpushpa i.e anovulatory cycle).
> Has corpulent and hairy cheeks – hirsutism; may be due to hyperandrogenism. Thus Pushpaghni jatiharini seems to be nearer to polycystic ovary syndrome.
> Sthula purusha (obese person ) in ashtanindiya (censurable person) described by Acharya Charak have discribed 8 faults which include polyuria, polydipsia and short life. This condition may simulate with hyper insulinemia condition.
> Atiloma person with excessive hair growth is also a censurable person. Above two conditions may indicate female afflicted with PCOS.
TREATMENT
Vaaman followed by nashtpushpantak ras and shatpushpa churna orally is effective.3
Five common Ayurvedic medicines that help in the management of PCOS:
Shatavari (Asparagus racemosus)
Shatavari helps in promoting normal development of ovarian follicles, regulates menstrual cycle and revitalizes the female reproductive system.Shatavari also helps in combating the hyperinsulinemia- i.e. high levels of insulin, mainly due to its phytoestrogen (natural plant based estrogen).1
Guduchi (Tinospora Cordifolia)
Guduchi is a powerful anti- inflammatory herb. Chronic inflammation in tissues is the root cause for insulin imbalance and ovarian cysts.Guduchi helps in revitalizing all the body tissues and boosts metabolism naturally. It also helps in lowering insulin resistance.
Shatapushpa (Foeniculum vulgare)
Fennel seeds also known as shatapushpain Sanskrit are a good supplement for PCOS. They are rich source of phytoestrogens. Phytoestrogens in fennel, helps in reducing insulin resistance and in bringing down the inflammation in PCOS. Phytoestrogens are also believed to help reduce the cellular imbalance which leads to metabolic disturbances in PCOS.2
Triphala
A mixture of three fruits- Amalaki (Emblica officinalis), Haritaki (Terminalia chebula) and Bibhitaki (Terminalia bellerica) blended in it;Triphala is one of the most popular Ayurvedic classical formulations! It is a rich source of vitamin C- a powerful natural antioxidant that helps in reducing inflammation by scavenging free radicals.Triphala helps in cleansing and detoxifying your system and hence is best taken prior to taking any other Ayurvedic medicines.
Aloe Vera- Kumari (Aloe barbadensis)
Aloe vera is yet another Ayurvedic herb that is extremely beneficial in treating PCOS. It helps in regularizing the menstrual cycles, promotes normal mestruation and normalizes ovarian hormonal imbalance.
Patajali yogpeeth prescribes the following medicines:
Shilasindur. 2g
Giloy sat. 10g
Prawal pishti. 10g
Mukta pishti. 4g
Kahrwa pishti. 5g
Punarnawadi mandoor. 20g
Vridhivadhika vati. 20g.
The above medicines are to be mixed and 60 doses are prepared.
One BD before meal morning evening
After meal
Kachnar guggul. 60g
Istrirasayan vati. 60g
1 bd after meal.
The above medicines are have been prescribed to 40 patients and it have been observed that in 50% cases, the patients got relief in a period of 6 months.
YOGA POSES FOR PCOS (http://www.gyanunlimited.com/health/15-yoga-poses-for-polycystic-ovarian-syndrome-pcos-treatment/9195/)
Yoga helps to regulate the endocrine glands in the body thereby beneficial in balancing of hormones. Yoga is effective in keeping your ovary and uterus healthy along with solve the issues such as infertility, weight gain and psychological problems. There are many yoga postures, which are good for PCOD. Some of the important Yoga postures are given below.
1. Nadisodhan Pranayama: Nadisodhan Pranayama is also called Anulom Vilom, which helps to soothe your mind refresh your brain nerves thereby helpful in de-stressing the body. It brings peace and comfort to your body thus cure PCOS naturally.
2. Bhramri Pranayama: It is the only pranayamas which control all the negative domains such as stress, strain, anxiety, tension, depression, etc. So, it is helpful in contending your mood swings.
3. Meditation will help to stabilizing your mind and acts like as mood elevator and facilitates calming effect. Meditation brings harmony within the body, mind and emotions to control PCOD naturally.
4. Bhadrasana (Butterfly pose): This is an effective asana for those who are experiencing PCOD. Butterfly should be practiced coolly and calmly. It helps to open up the pelvic area and promote relaxation. It beats stress and relieve menstrual discomfort.
5. Sun Salutation (Surya Namaskar): The twelve Yoga poses in the Sun Salutation is good to enhance flexibility in the body as well as effective in controlling hormonal imbalance. Surya Namaskar is also helpful in controlling of weight. Sun Salutation helps to de-toxify and de-stress the entire system.
6. Bhujangasana (Cobra pose): Cobra pose exerts pressure on the stomach and helps to stimulate ovarian function. It has many advantages like improves digestion, bust stress, good for chest, lungs, and shoulder.
7. Naukasana (Boat pose): Naukasana is good in case of PCOS as the boat pose put excess pressure on the abdominal region.
8. Dhanurasana (Bow pose)
9. Warrior pose (Superman pose)
10. Supta Badhakonasana (Reclining Butterfly Pose)
11. Bharadvajasana (Bharadvaja’s Twist)
12. Chakki Chalanasana (moving the grinding wheel) helps to modify the endocrine glandular function thus enhances the efficiency of hormonal secretion.
13. Shavasana (Corpse pose)
14. Padmasana helps to stretch the pelvic region and good to control hormonal imbalance.
15. Kapalbhati
DIET FOR PCOS
· Focus on protein and fresh vegetables
· Eat low GI and GL foods.
· Eat natural based foods like egg, fresh fruits.
· Eat the good fats.
· Take balanced and healthy diet
· Eat foods, which are having enough fiber and roughage
· Avoid more sugary and carbohydrate foods.
· Low glycemic foods should be preferred.
· Low saturated foods should be given importance.
· More weightage should be given fresh fruits and fresh vegetables.
· Vitamin B6 helps to maintain hormone balance and good to control PCOD.
· Vitamins B2, B3, B5 and B6 are good in controlling weight.
· Foods such as lentils and chickpeas should be taken as it reduces estrogen levels.
· Foods such as nuts, seeds and olive oil should be encouraged as they contain essential fatty acid
· Use apple cider vinegar.
A low glycaemic index foods such as cauliflower, tomatoes, onions, peaches, apples and grapefruit are also recommended.
Eating at regular intervals is advised. Restriction of food is another aspect.
PROHIBITED AHAR AND VIHAR
· Junk Foods like chowmein, pizza, burger
· Stale foods
· Excessive sweet foods like sweets
· Higher quantity of dairy products like cheese
· Refined Foods like maida products
· Deep fried Oily foods like malpura
· Total absence of fruits and vegetables in diet
· Brinjal
· Broccoli
Prohibited Vihar
Laziness in life
Inactivity
Sleeping for long duration in day time
CONCLUSIONS
In this article the management of PCOD has been extensively explained with ayurvedic medicines, ahar, vihar and yog aasans.
References Aldo E Caloegero. Genetics of Polycytic ovarian syndrome. Reprod Biormed Online 10 (6) :71320 (2005). Ashtanga Sangraha. Translated by Atridev Gupta, Published by Nirnaya Sagar Press, Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES and Vildiz BD. The Balen A.H., Conway G.S., Kaltsas G., Techatrasak K., Manning P.J., West C. and Bombay, first edition, (1951). Burghen C.A., Givens J.R. and Kitabchi A.E. Correlation of hyper and regenism with hyperinsulinamia in Polycystic ovarian disease. Journal of Clinical Endocrinology and Metabolism 50, 113-116 (1980). C Swathi, M. Suchetha Kumari, Rajlaxmi, Chaturvedi Ashutosh, An open randomized control study to evaluate the combined effect of shodhana followed by shamana chikitsa over polycystic ovarian syndrome, International Journal Res. Ayurveda Pharm. 6(5), Sep-Oct2015. Charak Samhita (Text with english translation and critical exposition based on Chakrapani Datt’s Ayurved Dipika) by R.K Sharma, Bhagwan Das, Published by Chowkhamba Sanskrit Series office, Varanasi (1995).
