Introduction

PCOS is also known as infertility queen as it is the leading cause of infertility. Exact cause of PCOS is not known but it is believed that it is a combination of genetic environmental and hormonal factors. One in every 10 women in India has PCOS. The incidences vary between 0.5- 4% and it is prevalent in young reproductive age group (20- 30%).^[2]

Low grade inflammation often seen in PCOS which contributes to insulin resistance and metabolic dysfunction. Insulin resistance leads to hyperandrogenic and ovulatory dysfunction. Presence of multiple cysts in the ovaries in USG is the hallmark of PCOS. Also imbalance between oxidative stress and anti oxidant defense may damage ovarian tissue and disrupt hormone production. Altered oestrogen also disrupt ovulation.

The high oestrogen production is due to conversion of androgen to oestrogen in ovaries and peripherically. It increases LH level, decreases FSH level, causes thecal hyperplasia and increased androgen in ovaries. High androgen leads to increase in SHBG which causes increased free androgens. The hyperthecosis is related to an over producing androgens which decreases granulosa cell proliferation and maturation, as well as stimulating fibrosis of stroma and capsules which inturn leads to anovulation and infertility.

Free androgens also lead to acne, hirusitism, male pattern baldness and converted to oestrogen. Also, these days genetic involvement in PCOS is a routine find. The gene involved are CYP11a, CYP17 and CYP21 which are sterroidogenetic. PCOS patients also have risk of developing infertility, HTN, type-2 DM, cancer of uterus and cardiac issues. As per Ayurved, imbalance of Kapha Dosha leads to improper development of follicles because upchaya i.e., to develop is the Karma of Kapha.

Vata Dosha causes rupture of follicles which manages ovulation. And Pitta Dosha is responsible for aromatization i.e., conversion of excess androgen to oestrogen. Hence, all 3 Doshas when vitiates, collectively leads to hormonal imbalance, anovulation and irregular menstrual cycle. Besides this, causes of PCOS involves both Aharaj and Mansika Nidaan. Any factor which vitiates Kapha, Vata and Meda Dhatu are responsible for PCOS. Some of the Nidaan are Pramitahara, Vishamahar,

Allergic history: No allergy from any drug or food items.

Family history: Her father is hypertensive since 2 years. Other family members are healthy.

Personal history:

Diet - Pure vegetarian.
Sleep - 7-8 hours in night, only half an hour rest in day time.
Bowel - Constipated (on and off)
Micturition - 4-5 times a day.
Appetite - Adequate
Addiction - Tea once a day
Allergy - Nil

Menstrual history

Age of menarche - 12 years
LMP - 12/4/2024
LOC - Irregular (40-70 days)
DOC - 1-2 days (2 pads per day - half soaked)
Pain - Nil
Clots - Nil
Smell - Nil
Picchilta - Nil

Astavidha Pareeksha

Nadi - 74/min, Kaph-Pitta
Mala - Samanya Mala, frequency - once a day.
Mutra - Samyak, frequency - 6/7 times a day.
Jihva - Lipta
Shabd - Samyak
Sparsh - Sheetoshna
Aakruti - Madhyam
Drika - Samanya

Dasvidha Pareeksha

Prakruti - Vata Kapha
Vikruti - Kapha Vata
Sara - Madhyam
Sanhanana - Madhyama
Satva - Avar
Satmaya - Pravar
Aahar Shakti - Madhyam
Vyayam Shakti - Avar
Vaya - Yuva
Pramana - Madhyam

Systemic Examination

Respiratory system - S1S2 Normal, no murmurs.
CVS - Normal air entry B/L, No other added sounds present.

After Treatment

Investigations:

Serum prolactin - 15.47ng/ml
Serum LH - 8.76 mIU/ml
Serum FSH - 7.25 mIU/ml
Serum TSH - 3.78 um/ml
Serum testosterone - 18 ng/dl
RBS - 112 mg/dl
Hb - 11.6 gm/dl
USG findings - B/L Ovaries bulky (Right ovary - 11.6 cc, left ovary - 12.9 cc) with multiple small peripherally placed follicles with increased stromal echogenicity.

Treatment Plan

1. Virechan Karma

Virechan Karma with Madhyama Sudhi was done (16 Vegas). After that Sansarjana Karma was foll. by patient as advised. Then internal medications were started from 27/9/2024 for 3 months.

Probable mode of action of drugs

1. Gorakhmundi Churna - Gorakhmundi helps in balancing the hormones as it has anti-androgenic properties that reduce testosterone levels, restoring the balance between FSH and LH. Additionally, it balances Kapha-Pitta Doshas in the body hence help in PCOD.

2. Chaturbeej Churna - It is the combination of seeds of Methika, Chandrashur, Kalajaji and Yavanika in equal Chaturbeeja Churna has predominantly Katu Rasa, Snigdha Guna and Ushna Virya with Vata-Hara Dosha-Karma. It has Garbhashudhikar and Shoolhar properties. Due to the Garbhashaya Shodhaka^[5] and Sankochaka (ecbolic) action of the Kalajaji it cures Margavrodha i.e., Sanga thus alleviating the Vata Dosha.

3. Kanchnar Guggulu - It has Vata-Kaphasamana, Lekhana (scrapping) and Shodhohara (anti- inflammatory) properties. It is found to be effective in balancing Kapha by boosting metabolism and the bitter and pungent taste of Guggulu helps in burning fat and enhances digestion. Anti-inflammatory, anti-diabetic properties of Kanchanar helps in the reducing insulin resistance often associated with PCOS.

4. Gandharvahasthadi Kashaya^[6] - It normalizes Vata-Kapha Doshas and its Anulomana property helps in relieving constipation. Majority of contents possess anti-inflammatory action and some of them mainly Punarnava (Boerhaviva diffusa) and Gandharvahastha (Ricinus communis), Chirivilwa (Holoptele integrifolia), Viswa (Zingiber officianlis) and Hutaasa (Plumbago zeylanica) reduces Aamavastha via their Deepana (carminative) and Pachana

Conclusion

Ayurvedic treatment of PCOS focuses on restoring balance to the Doshas, Dhatus, Agni, and Ojas. This can be achieved through a combination of dietary changes, herbal remedies, Yoga, and lifestyle modifications. PCOS can also lead to a depletion of Ojas (vital energy), resulting in symptoms such as fatigue, stress, and mood swings. Artava Dhatu imbalance leads to irregular menstrual cycles, ovulation disorders, and infertility. An imbalance of the Rasa Dhatu (plasma tissue) can contribute to symptoms such as weight gain, insulin resistance, and skin problems.