PCOS Ayurveda Traditional Treatment and Management

PCOS Ayurveda Traditonal Treatment and Management in Melbourne

 

 

 

 

PCOS or the Poly Cystic Ovarian Syndrome is an hormonal disorder which is one of the leading causes of infertility in female. PCOS generally begins with menstrual irregularities during adolescence. Thus mostly it is diagnosed during menarche or adolescence period because of the irregularity in menstrual cycle, however sometimes woman come to know that they have PCOS when they struggle to conceive.

 

Ayurveda disseminates holistic care for PCOS, the fundamental knowledge and sensitivity towards which need to be fostered. In Ayurveda, PCOS is explained under ‘Yoni Vyapat’ (Utero vaginal disorder). According to Kashyapa, ‘Pushpaghni Jataharini’ is a condition where the woman menstruates in regular intervals but is useless because of no ovulation resulting in failure to conceive. Other symptoms include corpulence and excess facial hairs. Pushpa means ovum, Ghni means destruction, Jata means birth of baby and Harini means destruction. Thus in Pushpaghni Jataharini, there is destruction of ovum which in turn destroy the chance of forming a foetus by preventing conception.

 

रौक्ष्याद्वायुर्यदा गर्भ जातं जातं विनाशयेत् ।।२८।।

दुष्टशोणितजं नार्याः पुत्रघ्नी नाम सा मता ।।२९।।

(च० सं० चि० ३०)

 

 

स्थितं स्थितं हन्ति गर्भ पुत्रजी रक्तसंस्रवात् ।।१३।।

चतसृष्वपि चाद्यासु पित्तलिङ्गोच्छ्यो भवेत् ।।१४।। (सु० सं० उ० ३८)

 

 

………जातघ्नी तु यदानिलः । जातं जातं सुतं हन्ति रौक्ष्यादृष्टार्तवोद्भवम् ।।

(अ० सं० उ० ३८/३७ एवं अ० ह० उ०३३/३४)

 

 

 

According to Ayurveda, three Doshas, the vitiation of adipose and lymph tissue and menstrual irregularities are involved in the pathogenesis of PCOS. Ovary, adrenal glands, pancreas and pituitary gland are involved in the PCOS. It is more common in present day period because of increased stress there is intake of more quantity food which are high in sugar, carbohydrates and fats in response to stress. Modern day food habits and unhealthy sedentary lifestyle with lack of exercise are the accelerating factors of PCOS and many other diseases. Stress occurs because of Vata Dosha and intake of sugary / fatty food aggravates Kapha Dosha in the body. Hence there is increased fat storage in the body leading to the development of insulin resistance or obesity-linked PCOS.

 

 

Equilibrium of the three Doshas is responsible for health. Although there is no direct reference  or names for all the modern day diseases in Ayurveda, the Ayurveda Acharyas have clearly mentioned in the text that it is impossible and unwise to name every disease, as everyone’s experience in unique. Ayurveda suggests that the proper understanding of the Dosha involvement, tissue, status of digestive and metabolic fire, channels involved in pathogenesis and the symptoms will help in understanding disease pathogenesis. Symptoms observed in PCOS is due to over functioning of one or more Doshas, envelopment of Dosha by other Doshas or Tissues or endotoxin formation. Thus in PCOS, ovarian dysfunction occurs and there is multifactorial involvement at the level of Doshas and tissues.

 

 

 

Understanding the functions of the three Doshas & the reproductive tissue

 

• Vata Dosha, mainly the subtype of Vata - Apana Vata is responsible for the movement of follicle, release of ovum and movement of ovum into the fallopian tube and uterus. Vata Dosha is also responsible for the discharge of menstrual fluid during menstruation and for the downward movement of the baby during labor.

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• Pitta Dosha is the hormonal aspect, the energy responsible for transformation. Hormones play an important role in the female reproductive cycle. Menstrual and ovarian cycle are influenced by the hormones.

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• Kapha Dosha being anabolic in nature nourishes the reproductive tissue, ovum. It helps in growth of the ovarian follicle and is responsible for the protective unctuous mucosal layer of the fallopian tubes and uterus that prevents the dryness quality of Vata Dosha from affecting the reproductive organs. At the digestive level, Kapha Dosha is the mucosal lining that protects the tissues from the digestive enzymes.
• Artava Dhatu is the Ovum which is responsible for reproduction. Artavavaha Srotas are the channels carrying menstrual fluid as well as ovum.

 

 

Ayurvedic Causative Factors of PCOS

 

 

Ayurveda explains 4-fold causative factors in the formation of PCOS.

 

विंशतिळपदो योनेनिदिष्टा रोगसंग्रहे ।।७।।

मिथ्याचारेण ताः स्त्रीणां प्रदुष्टेनातवेन च । जायन्ते बीजदोषाच्च दैवाच्च शृणु ताः पृथक् ।।८।।

(च० सं० चि०३०/७, ८)

 

प्रवृद्धलिङ्ग पुरुषं याऽत्यर्थमुपसेवते । रुक्षदुर्बलबाला या तस्या वायुः प्रकुप्यति ।।३।।

स दुष्टो योनिमासाद्य योनिरोगाय कल्पते । त्रयाणामपि दोषाणां यथास्वं लक्षणेन तु ।।४।।

विंशतिया 'T' याः" ।।५।।" पृथक् ।।६।।

 

(चरक सं० सदृश ही) (सु० सं० उ० ३८/३ से ६)

 

 

विंशतिळपदो योनेर्जायन्ते दुष्टभोजनात्। विषमस्थाङ्गशयनभृशमैथुनसेवनैः ।

दुष्टार्तवादपद्रव्यैर्बीजदोषेण दैवतः ।।

(अ० सं० उ० ३८/३२ एवं अ० ह० उ० ३३/२७,२८)

 

 

 

Ahita Ahara: Faulty Diet

Excess intake of heavy to digest food items, unctuous, oily, fatty food, cold food and drinks, high calorie diet, excess consumption of sweet & salty tastes, milk and other dairy products like yoghurt, cheese, ice cream, milkshakes; white rice, processed food, refined sugar, molasses, sweet yoghurt, milk pudding, wheat, black gram, mangoes, fast food, increased intake of oils, ghee & sweets made from ghee, non-vegetarian food especially red meat, over eating, binge eating, drinking liquids in excess, voracious eating, eating food before digestion of previous meal lead to increase of Kapha Dosha in the body and PCOS.

 

 

Ahita Vihara: Improper Lifestyle

Kapha Dosha is aggravated by regular indulgence in day sleep, lack of exercise, sedentary lifestyle, laziness, excessive sleeping, excess indulgence in sexual intercourse thereby causing PCOS. Also, mental factors like ego, hatred, jealous, selfish, negative emotions also cause PCOS.

 

Bija Dosha: Genetic Defects

 

Artava Dushti: Menstrual Disturbances

 

 

 

What happens due to the indulgence in above causative factors?

 

Katu Ahara Sevana: Over intake of pungent food items

Excess intake of spicy food leads to increase of Vata & Pitta Dosha.

 

Madhura Ahara: Sweet taste in excess

The heaviness and coldness property of sweet food items (sugary food and simple carbohydrates) increases Kapha Dosha leading to vitiation in the passage of channels carrying lymph and adipose tissue, thus causing obesity in PCOS.

 

Vidhahi Anna: Foods that are excessively hot & spicy

Food that cause burning sensation, that is fast food, deep fried spicy food and foods with preservatives and artificial colors envelops the Kapha Dosha in the gastro intestinal tract. Also, the high sugar and carbs of these food leads to imbalance in glucose level.

 

Chinta: Stress / Worries

Stress leads to hormonal imbalance (Pitta & Vata vitiation) which affects the menstrual cycle.

 

Avyayama: Lack of exercise

Lack of Physical activity or exercise, having a sedentary lifestyle, that is sitting or lying down most times increases Kapha Dosha which in turn aggravates the lymph tissue and adipose tissue and hampers the normal functioning of digestive & metabolic fire. Thus, three Doshas are vitiated leading to PCOS.

 

Divaswapna: Day Nap

Regular day sleep increases unctuousness in the body and vitiates the adipose tissue, channels carrying lymph tissue, muscle and adipose tissue leading to obesity.

 

Atinidra: Excess sleep

Sleeping in excess, more than 9 hours and waking up late in the morning will lead to aggravation of Kapha, because Kapha Dosha becomes predominant in the atmosphere after 7 pm. Thus, waking up late regularly will increase Kapha Dosha and along with Tamas it will block the circulatory channels leading to endocrine dysfunction.

 

Ratri Jagarana: Staying awake at night

Staying awake late at night, that is going to bed after midnight regularly or working in night shifts will increase Vata Dosha. Particularly the dryness nature of Vata Dosha increases leading to scanty menstruation.

 

Abhojana: Fasting

Fasting or long gap between meals, taking food in less quantity increase Vata Dosha and this can lead to nutritional deficiency thereby causing amenorrhea or oligomenorrhoea.

 

Mutra Vegadharana: Suppression of the natural urge to urinate

As the subtype of Vata, Apana Vata controls the micturition, suppression of urge to urinate vitiates the Vata Dosha, mainly Apana Vata. Also, Apana Vata is responsible for the flow of menstrual blood and because of its vitiation, the flow of menstrual blood is also affected. Thus, menstrual cycles are irregular in PCOS.

 

 

Because of the indulgence in above mentioned causative factors, the three Doshas get aggravated with predominance of Vata & Kapha mainly. They in turn vitiate the channels carrying menses leading to obstruction in the channels and causing reverse flow in the channels, hence amenorrhea or oligomenorrhoea and anovulation occurs.

 

 

Pathogenesis of PCOS as Per Ayurveda

 

In PCOS, the aggravated Kapha Dosha obstructs the normal movement of Vata and Pitta Dosha.

 

Diminution of Digestive & Metabolic Fire: Excessive intake of foods which are sweet in taste (sugar, white rice, white flour, potato) when there is low digestive fire causes increase of Kapha Dosha in the body. Because of the cold, sticky, heavy and dull properties of Kapha the digestive fire is diminished. Impairment in digestive fire affects the metabolic fire as well.

 

Increase of Kapha Dosha: As the digestive fire is hampered and excess Kapha aggravating food is consumed, there is improper digestion, which in turn leads to increase of Kledaka Kapha, the subtype of Kapha in the Gastro intestinal tract.

 

Formation of Ama (Endotoxins): The heaviness and coldness property of Kapha Dosha suppress the digestive fire further leading to endotoxin formation due to hampered digestion. The increased Kapha Dosha mixed with the endotoxins starts moving into the channels of circulation thereby reaching the different tissues including the reproductive tissue.

 

Blockage of Vata Dosha in its normal pathway: The increase in Kapha Dosha and endotoxins will lead to obstruction in the channels carrying menstrual fluid because of the heaviness, coldness and sticky / unctuous qualities thus obstructing Vata Dosha moving in its normal pathway in the circulatory channels carrying menstrual fluid or ovum. Blockage in the movement of Apana Vata, the subtype of Vata located in the pelvis disturbs the flow of menstruation hence leads to amenorrhoea or oligomenorrhoea. As Vata Dosha is the controller of Pitta and Kapha Dosha in the body, when Vata Dosha gets affected, it hampers the functioning of Pitta and Kapha Dosha. The vitiated Pitta Dosha causes hormonal imbalance and the vitiated Kapha forms cyst in the ovary.

 

Developing insulin resistance: The endotoxin and increased Kapha Dosha begins to affect the metabolic fire at the cellular level which is responsible for the permeability of the cell membrane and hence Kapha Dosha and endotoxins lodges or coats the cell membrane affecting the functioning of the cells thus causing insulin receptors on the cells unable to recognise the chemical structures that make use of insulin. Thus, insulin unable to be used up and the cellular receptors begin to build up in the blood stream moving towards reproductive tissue contributing to the formation of PCOS.

 

Developing Obesity: As adipose tissue also has similar properties as that of Kapha Dosha and endotoxins, adipose tissue increases in quantity because of increased Kapha Dosha and endotoxins thereby leading to weight gain. Adipose tissue is expressed as oestrogen in the body. With the increase of adipose tissue, oestrogen is also increased.

 

Excess hair growth & Acne formation: Menstrual fluid is heating in property. As the channels carrying menstruation are blocked, it leads to aggravation of Pitta Dosha, because of increased heat accumulation leading to increase in the subtypes of Pitta Dosha namely, Bhrajaka Pitta located in skin and Ranjaka Pitta which imparts red colour to the blood thus increasing the growth of body hairs and acne formation.

 

Impaired quality of Reproductive Tissue: The metabolic fire related to the formation of reproductive tissue is affected by the increased Kapha Dosha and endotoxins thereby the quality of reproductive tissue is affected at the cellular level causing inhibition of death of defective cells.

 

How is PCOS formed?

 

Ovary, Adrenal glands, Pancreas (produces insulin) and Pituitary gland (controls hormones) are involved in PCOS. In PCOS, ovaries are enlarged and has many cysts within it. Biggest contributor of PCOS is poor diet. Too much sugar, carbonated drinks, highly refined carbs causes unhealthy raise in insulin levels. The aggravated Vata Dosha vitiates the adipose, muscular and blood tissue and mixed with already aggravated Kapha Dosha produces cyst known as ‘Granthi’ in Ayurveda. Follicular development is stopped and follicles become cysts instead of developing into mature ovum. Cysts are nothing but the follicles at different stages of maturation and atresia.

 

 

 

Factors involved in the Pathogenesis of PCOS

 

Dosha involved: Three Doshas mainly Vata & Kapha

Tissues involved: Lymph, Blood and Reproductive Tissue

Status of Digestive & Metabolic Fire: Low

Channels of circulation: Channels carrying menstrual fluid / ovum

Type of vitiation of channels: Obstruction and Reverse Flow

Pathway of Disease: External

 

 

 

Symptoms of PCOS

 

Menstruation is delayed or irregular or there is decreased quantity of menses because of obstruction in the passage of channels carrying menstruation and increase of Vata in the passage which dries up the menstrual fluid. Due to increased androgens because of the enveloping of Vata Dosha by the Kapha Dosha and endotoxins, menstrual fluid is not expelled timely as its flow is obstructed resulting in oligomenorrhoea. The reproductive tissue is not nourished properly and there is depletion of reproductive tissue leading to reduction in menstrual blood. Thus amenorrhoea or oligomenorrhoea occurs. In PCOS, there is anovulatory cycles due to vitiated Vata Dosha thus leading to infertility. Obesity and Hyperinsulinemia occur due to improper adipose tissue metabolism & pancreas dysfunction caused due to over nourishing diet. This also leads to infertility because of the under nourished or defective reproductive tissues. There is enveloping of Vata by Kapha Dosha which causes faulty neuro endocrine system feedback, that is negative feedback mechanism of hormones.

 

 

All three Doshas control the menstrual and ovarian cycle. PCOS involves all three Doshas, fat tissue, water carrying channels in the body and channels carrying menstrual fluid. The symptoms of PCOS varies from person to person and clinical features manifest based on the predominance of Doshas which is different for different people, involvement of the different tissues and vitiation of channels carrying menstruation. The clinical manifestation of mentioned in Ayurveda text books are -

 

• Vata predominance manifests with dysmenorrhea (painful menses), menstrual irregularity (either delayed or early cycles), feeling of coldness before and during menses and low body weight.
• Pitta Dosha dominance causes acne, skin problems, menorrhagia (increased menstrual bleeding), hair fall.
• Kapha Dosha predominance manifests as weight gain, infertility, insulin resistance, metabolic disturbances and hirsutism.
• Yatha Kalam Na Pushyati: Non-nourishment at appropriate time
• Kukshi Shoola: Pain in the abdomen
• Nirutsaha: Lack of enthusiasm
• Brisha Satva: Mental instability
• Apriyarupa: Not pleasing appearance
• Roga Upadruta: Occurrence of various diseases
• Vruta Pushpam: Destruction of ovum
• Yathalakam Prapashyati: Regular menstruation
• Symptoms occurring due to specific vitiation of channels of circulation are listed in the below table

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Vitiation of Channels	Symptoms
Rasavaha Srotas (Lymph carrying channels)	Srotorodha: Obstruction in channels carrying menstruation and ovum Artava Vyapad: Menstrual irregularities, variation in menses – delayed menses or prolonged menses with scanty or heavy flow with clots
Raktavaha Srotas (Blood carrying channels)	Ati Artava: Menorrhagia Mukhadushika: Acne Vivarnata: Hyperpigmentation of skin especially in neck, breasts, thighs and axilla
Mamsavaha Srotas (Channels that nourish muscle tissue)	Granti: Cyst
Medovaha Srotas (Channels that nourish adipose tissue)	Sthoulya: Obesity Prameha: Hyperinsulinemia Granti: Cyst

 

• Symptoms occurring due to obstruction in the channels carrying menstruation and ovum are listed below.

• Alpartava – Oligomenorrhoea
• Kashtarthava: Painful menstruation
• Vandhyatva: Infertility
• Anartava: Amenorrhea
• Maithunasahsnutvam: Dyspareunia
• Grantibhuta Artava: Clots in menses

 

 

Ayurvedic Treatment Approach to PCOS

 

As PCOS is a multifactorial disease, the treatment should be strong and different types. Along with correcting the root cause, the treatments should also give symptomatic relief by regulating the menstrual and ovulatory cycle, helping treat insulin resistance and healthy weight management. Ayurvedic therapies aim at a radical approach for a natural and healthy reversal of PCOS. Ayurveda treatment approach aims at treating low digestive fire, removing obstruction in the channels carrying menstrual fluid / ovum and regulating the Vata Dosha. Aim of Ayurveda treatment in PCOS is as follows -

 

• Detoxification or Panchakarma procedures to cleanse the body
• Clear obstruction in the circulatory channels of menstruation and ovulation.
• Normalise metabolism
• Correct hormonal imbalance
• Regulate menstruation
• Strengthen the female reproductive system
• Normalise the vitiated Kapha Dosha, help in downward movement of Vata Dosha and increase the heating quality of Pitta Dosha

 

Line of treatment of PCOS is as follows -

 

1. Nidana Parivarjana (Avoidance of Causative Factor)

 

One should avoid indulgence in Kapha and Vata aggravating diet and lifestyle.

Wholesome Diet – Barley, Asparagus, Bitter gourd, Fenugreek, Turmeric, Black pepper, balanced diet, timely meals.

Wholesome Lifestyle – Regular exercise, maintaining healthy weight, following daily and seasonal regimen, timely sleep.

Unwholesome Diet - Junk food, heavy to digest food items like black lentil, kidney bean; dairy products like cheese, yoghurt, full fat milk, milk cream; sweet potatoes, sugar, chocolates, cold food and drinks.

Unwholesome lifestyle – Day sleep, lack of exercise, excess sleep, inactivity of the mind.

 

2. Ama Pachana (Eliminates endotoxins) and Agni Deepana (Improving the digestive fire) – It is important to increase the digestive and metabolic fire to help eliminate the obstruction caused due to endotoxins at the digestive and cellular level thus regularizing the Vata Dosha. This is achieved by the administration of herbal powders like Avipathikar churna, Trikatu churna, Chitrakadi vati, etc.

 

 

3. Shodhana Chikitsa / Panchakarma (Detoxification)

 

Panchakarma treatments will help to eliminate the endotoxins and bring back Kapha Dosha to normalcy. Because of this, the Soumya (Cooling property) nature is decreased in the body which increases the Agneya (Heating property) in the body thereby increasing or regulating the menstrual cycle and improving the quality of ovum. In PCOS, Saumya nature is increased and Agneya nature is reduced.

 

• Basti (Therapeutic enema) improves the quality of ovum. As Apana Vata, the subtype of Vata is increased in PCOS, Basti is effective. Anuvasana Basti is administered with medicated oils like Shatavari taila, Bala taila, etc. when there is amenorrhea, oligomenorrhoea, non-ovulation and previous history of miscarriages. Yapana Basti is a special type of Basti prepared from herbal concoctions like decoction, paste of herbs, honey, etc. which lubricates and cleanses the reproductive system hence beneficial in infertility.

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• Uttarbasti helps in all gynecological problems. It clears the obstruction in the channels of menstruation and ovulation, balances Vata Dosha and improves follicular maturity and helps in conception. Uttarabasti is administered for 3 consecutive days after cessation of menstrual flow between 4^th to 10^th day of menstrual cycle. It is repeated for 3 months.

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• Virechana (Therapeutic Purgation) removes obstruction thereby improving quality of reproductive tissue and helps to balance Pitta & Kapha Doshas. To remove endotoxins from the body and in scanty mensuration, Virechana is suggested.

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• Vamana (Therapeutic emesis) helps to balance Kapha Dosha and regulates the function of thyroid gland and pancreas as well. It regularizes fat metabolism too. So, when Kapha Dosha is predominant in the pathogenesis of PCOS, Vamana is recommended.

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• Nasya (Nasal medication) during ovulation period helps in rupture of ovarian follicle. The heating and penetrating property of the herbs used in Nasya irritate the nasal mucosa, thereby increasing local secretions and helping to eliminate the vitiated Doshas from the head. It stimulates the CNS and GnRH.

 

4. Shamana Chikitsa (Pacification treatment)

 

Administration of suitable herbs and therapies along with modifications in diet and lifestyle will help in PCOS. Use of hot potency herbs helps to restore hormone function as it is increases Pitta Dosha. Also, the hot and penetrating property of hot potency herbs reduces Vata and Kapha Dosha, restores equilibrium of adipose tissue, removes obstruction in the passage of channels of menstruation, improves tissue metabolism and removes endotoxins. Herbs having uterine cleansing properties like fenugreek and cumin will help to shed the endometrium resulting in menstruation. Use of hot potency, dry and scrapping quality herbs like dry ginger, black pepper, long pepper, guggulu will help to normalize the vitiated Kapha Dosha.

 

Traditional Ayurveda Herbs and herbal formulations used in conditions similar to PCOS

 

 

• Single herbs - Ashoka, Varuna, Shatavari, Lodhra, Guduchi, Methika, Maricha, Karela, Gokhura, Triphala, Aswagandha, Arjuna, Nimbi, Triphala, Satapushpa, Tejapatra, Bilwa, Tulsi, Gurmar, Vijayasar

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• Compound Powders - Pushyanuga Churna

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• Herbal Decoctions - Varunadi Kashayam, Sahacharadi Kashaya, Lekhaniya Kwath, Dashmool Kwath

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• Fermented preparations - Lakshmanarishta, Kumaryasava, Ashokarishta, Pushyanuga Churna

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• Medicated Ghee - Phala Ghrita

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• Herbal Linctus - Kadalikalpa Rasayana

 

 

• Shatavari is good to correct hormonal imbalance and enhance follicular maturity.
• Guduchi helps to enhance immunity.
• Shatapushpa helps to improve follicular maturity and helps regulate menstruation.
• Atibala is beneficial in correcting hormonal disturbances, helps to conceive and to prevent miscarriage.
• Sahachara is effective in removing unwanted follicles.
• Herbs like Dashmoola, Ashoka, Eranda help in correcting hormonal imbalance.
• Varunadi Kashayam and Dashmool kwath help in proper follicular genesis and ovulation.
• Methika, Maricha and Karela helps to regulate blood sugar levels and improve tissue sensitivity to insulin.
• Ashwagandha helps to reduce mental stress caused due to infertility and amenorrhea.

 

Traditional Ayurvedic therapies useful in conditions similar to PCOS - Udwartana (Herbal Powder Massage), Swedana (Steam bath) and Yonipichu (Vaginal tampon) using cotton dipped in medicated oils like Shatavari taila, Bala taila, Eranda taila are beneficial.

 

Specific Yoga for helping in PCOS - Yogasanas specifically Sarvangasana (Shoulder stand), Shavasana (Corpse pose), Matsyasana (Fish pose), Ushtrasana (Camel pose), Paschimottanasana (Seated forward bend) and breathing techniques like Kapalabhati (Skull-Shining Breath), Anuloma-Viloma (Alternate nostril breathing), Ujjayi (Ocean breath or Breath regulating technique) are beneficial.