Is there any science for Ayurvedic herbs to help heal PCOS


PCOS or Polycystic Ovarian Syndrome is a hormonal disorder. It is primarily seen in women of reproductive age. Do you know why the term ‘syndrome’ has been used to represent this disease. It’s because this disease presents itself with a complex manifestation there by showing so many symptoms and affecting different target organs. 

A 19 years girl presented with oligomenorrhea (infrequent menses 5 or 6 per year) and complained of weight gain associated with facial hair growth. Facial hair is the result of Hyperandrogenism which can be assessed by reliable assays. Her main concern of weight gain and irregular menses was addressed first. 

How can Ayurveda successfully treat PCOS with the use of herbs. This article addresses how the use of herbs, diet and exercises can cure the symptoms of PCOS.



PCOS is characterized by the following symptoms/ factors. 

  • Obesity

  • Insulin Resistance

  • Abnormal Menstrual cycle

  • Anovulation

  • Elevated levels of male hormones/androgen resulting in hirsutism i.e. excess face and body hair

  • Complications can result in infertility, Miscarriage/Premature birth, Type 2 diabetes, depression and Anxiety etc. 

We cannot give a typical correlation for PCOS in Ayurveda. But, it can be considered under ‘Yoni Vyapat’ or utero-vaginal disorders. 

Another popular correlation of PCOS among the Ayurveda community is Pushpagni Revati (by Scholar Kashyapa in Kashyapa Samhita).

Ayurveda approach to PCOS 

It is an interesting fact that the symptoms of PCOS are not compiled as a syndrome in Ayurveda, but it is mentioned as different symptoms of different diseases affecting the uterus or Vagina. 

Disease mentioned in Ayurveda 

Classical symptoms found in PCOS

Artava Vyapad/ Yoni Roga 

Menstrual Irregularities

Vandhyatwa or Infertility

Anovulation

Sthoulya

Obesity

Mukhadooshika

Acne

Prameha as a complication of Sthoulya

Hyperinsulinemia leading to Type 2 Diabetes


As per Ayurveda, a fluctuation or variation of any of the three doshas say Vata, Pitta and Kapha can lead to a disease condition. In PCOS, the deranged or been vitiated dosha is Vata. When Vata gets vitiated, the following tissues gets affected – Mamsa or Muscle tissue, Rakta or blood tissue, and Meda or Fat tissue. These affected tissue gets combined with Kapha dosha and granthi or swelling is formed. This swelling can be compared to cyst in modern perspective which develops in the Ovaries. 

Treatment approach to PCOS

Primarily correcting the vitiated doshas and tissues are given importance. 

  • Deepana Pachana – Regulating Agni Mandhya or weakened digestive fire

  • Panchakarma therapies based on the vitiated dhathus or grade of vitiation of doshas

  • Medicines which pacify Vata & Kapha

So, for this girl we advised the following herbs and preparations as internal medication. 

Internal Medications advised – 

  1. Varanadi Kashayam for obesity management and reducing the size of cyst

  2. Panchakola choorna for improving metabolism

  3. Arogyavardhini Vati 

  4. Ashwagandha Ksheerakashaya 

Varanadi Kashayam is an Ayurvedic herbal preparation used for treating diseases associated with an imbalanced Kapha like faulty digestion and metabolism, obesity, internal abscesses, abdominal lump etc. Among the 16 herbas in the Varanadi Kashaya, the 3 main ingredients are Varana (Crataeva nurvala, Shathavari (Asparagus racemosus) and Chitraka (Plumbago zeylanica).  

Herbs for PCOS 

The action of herbs in PCOS is to clear the obstruction in Pelvis, regulates metabolism and maintaining the proper menstrual cycle. The herbs we chose should be Kapha reducing and hormone balancing. 1    

The herbs commonly used in practice are the following -                                                   

  • Triphala and Guggulu (the bitter principles help in breaking the pathophysiology) helps in weight reduction 2

  • Chitraka (Plumbago zeylanica) and Ginger helps in improving the digestion and assimilation and helps in correcting the Ama dosha. 

  • Varuna (Crataeva nurvala) helps to clear the channel and reduce the size of cyst. 

  • Shathavari (Asparagus racemosus) and Aswagandha (Withania somnifera) are two powerful herbs which are used for successful management of PCOS. 

Let us check out the action of each of these herbs in PCOS.

Effect of Triphala in PCOS

The recent data on pharmacological action of this formula has found to be potentially effective for various clinical uses like appetite stimulation, anti-inflammatory, immunomodulating, hypoglycemic etc.7

In PCOS, Triphala acts effectively for managing insulin resistance and obesity. 

Effect of Chitraka in PCOS 

A study on Chitraka antihyperlipidemic effect of the aqueous extract. It is evidenced that the use of aqueous extract significantly reduces cholesterol and triglyceride levels thereby reducing obesity and improving metabolism in PCOS.6 


Effect of Guggulu in PCOS 

The phytoconstituents of Guggulu (Commiphora mukul) include Guggulusterone which has hypolipidemic & hypoglycemic activity. In addition, the Cembranoids Control the gastrointestinal absorption of fat and cholesterol. 8


Effect of Shathavari in PCOS 

The balance and strength of the Menstrual system is regulated by the intake of Asparagus powder. A clinical study was conducted for studying the effect of Satapushpa Shatavari powder (SSP) with or without Satapushpa Shatavari Grita (SSG) enema in managing the menstrual disturbances due to PCOS. 

After one month of administration the participants were assessed on the PCOS appearance of the ovary and endometrial thickness by ultrasound scan. Also, ./volume of menstrual flow, intermenstrual period and hirsutism was assessed by standard scoring system.

The study found out that the participants reduced their ovarian volumes when compared with pretreated stages. Endometrial thickness and Hirsutism ratings were significantly improved and there was a significant reduction and signs and symptoms of PCOS. 3

So, let us have a quick look at the benefits of intake of Shathavari –

  • Promotes normal development of Ovarian follicles

  • Regulates Menstrual cycle

  • Revitalizes the female reproductive system due to presence of phytoestrogen

  • Also helps in combating hyperinsulinemia

Another major source of phytoestrogen is seen in Shathapushpa (Foenicum vulgarae). It helps in reducing insulin resistance and brings down the inflammation in PCOS. 

Effect of Ashwagandha (Withania somnifera) in managing PCOS 

Ashwagandha possess antioxidant properties and has hypoglycemic activity. It is very useful in treating Diabetes and in relieving dysmenorrhea. It has Katu (Acrid), Tikta (Bitter) and Kashaya (Astringent) tastes and undergoes pungent taste post digestion. It balances Tridoshas especially Vata and Kapha. 

To effectively treat obesity which is a primary symptom of PCOS, it can be used internally along with milk or water. Ashwagandha is also administered in capsule forms.

Ashwagandha can be used for women who are planning for conception but must be avoided during pregnancy.  

The phytochemical investigations on Ashwagandha has shown the presence of phytoestrogens such as phytosterol, saponins, phenols, and flavonoids. 4

A clinical study on Ashwagandha showed emmenagogue properties useful in improving the amenorrhea present in PCOS. It also exhibited significant recovery of FSH, LH, estradiole, and testosterone levels in serum of Rats. 5

In addition to medicines strict advice on diet was given. The patient was asked to avoid carbohydrates and asked to take food with low glycemic index. 

Diet for PCOS

  • Include Sweet potato, corn, yam, lima/butter beans, peas, legumes and lentils

  • Most fruits, non-starchy vegetables and carrots.

  • Breakfast - Porridge made with rolled oats, bircher muesli and All-Bran

  • Lunch – Basmati rice, Veggies like carrots, broccoli, cauliflower, celery, tomatoes and zucchini 

  • Dinner - Grains: Quinoa, barley, pearl couscous, buckwheat and a serving of fruit like apples, strawberries, apricots, peaches, plums, pears and kiwi

  • Snacks can be nuts or baked beans, boiled chickpeas etc. 



    Favor

    Avoid

    Ghee, Fruits, Green leafy Vegetables, Nuts like almonds, walnuts, pecans, flax seeds, sunflower seeds and pumpkin seeds, Fatless buttermilk, Avocado, Beets, lentils, fish and meat in moderate quantity

    White sugar, white rice, Potato, Muffins and cakes, Full fat milk, Soya products, Paneer or Tofu, Cheese, Ice cream 


    In addition, the patient was also asked to regularly exercise and practice yoga for controlling weight and improving her metabolism. 

    Yoga and Exercise – 

    • Alternate Nose breathing or Nadi shodhana

    • Child pose 

    • Badha Konasana

    • Cobra Poses

    • Walking for daily 30 minutes in the morning and 30 minutes in the evening

    • Sun salutations 


    After 3 months of internal medication and Diet and exercise her BMI was significantly reduced and metabolism was improved. She came for follow up and was asked to continue with medication for 3 more months. 



    Home Remedies for PCOS

    I often advise my patients that for any medicines to work properly the body metabolism should be fine. There should not be any toxins or Ama dosha in the body, so that the medicines can work effectively. 

    Managing obesity in PCOS patients is very important. You can successfully manage your weight with proper diet, regular exercise and simple home remedies. 

    1. In the morning, 1tsp. of honey + 1 tsp. lemon juice in a cup of warm water is advised. Though honey contains large quantities of sugar, consuming in moderate quantities can help in internal cleansing and can help maintain weight. 

    2. 1 tsp. of Triphala powder along with 1 cup of warm water at bedtime. This also helps in managing the weight effectively. 

    3. To regulate blood sugar levels and insulin secretion, consume 1 tsp. virgin coconut oil on a daily basis. 

    4. Fenugreek seeds commonly known as Methi is an excellent home remedy for PCOS. Soak 3 tsp. of methi seeds in water overnight. In the morning, grind well with a pinch of turmeric and consume in the morning ½ an hour before breakfast. 

    5. Ksheera Kashaya or Milk decoction with the powder of Ashwagandha at bedtime is advised. Add 1 tbsp. of Ashwagandha powder to 4 cups of water and reduce it to 1 cup by boiling. Without filtering add 1 cup of Milk to it. Continue heating this solution until it becomes 1 cup. Filter it and take along with 1 tbsp. of ghee. Do not take during pregnancy. 

    Remember to consult your physician before administering any self-medication. 

    Another popular Ayurveda procedure prevalent for PCOS is Uttarabasti. The medicated oil or decoction is administered to the patient through the vaginal route in Uttarabasti. This type of enema with Sahacharadi thaila in patients with PCOS has shown great results. 


    Early detection of PCOS can help in reducing and curing the symptoms of the disease and prevent further complications like infertility. 



    References – 

    1. Dayani Siriwardene, S. A., Karunathilaka, L. P., Kodituwakku, N. D., & Karunarathne, Y. A. (2010). Clinical efficacy of Ayurveda treatment regimen on Subfertility with Poly Cystic Ovarian Syndrome (PCOS). Ayu, 31(1), 24–27. doi:10.4103/0974-8520.68203

    2. Ayurveda Pharmacopoeia Vol I part I. Department of Ayurveda. 1985:173.

    3. Kumarapeli M, Karunagoda K and Perera PK: A randomized clinical trial to evaluate the efficacy of satapushpa-shatavari powdered drug with satapushpa-shatavari grita for the management of polycystic ovary syndrome (PCOS). Int J Pharm Sci Res 2018; 9(6): 2494-99. doi: 10.13040/IJPSR.0975-8232.9(6).2494-99.

    4. The Wealth of India, Vol. II, New Delhi, National Institute of Science Communication and resources; 2003:283-284,581-585.

    5. Saiyed, A., Jahan, N., Makbul, S., Ansari, M., Bano, H., & Habib, S. H. (2016). Effect of combination of Withania somnifera Dunal and Tribulus terrestris Linn on letrozole induced polycystic ovarian syndrome in rats. Integrative medicine research, 5(4), 293–300. doi: 10.1016/j.imr.2016.10.002

    6. Sudha R. Pendurkar & Sushma A. Mengi (2009) Antihyperlipidemic effect of aqueous extract of Plumbago zeylanica roots in diet-induced hyperlipidemic rat, Pharmaceutical Biology, 47:10, 1004-1010, DOI: 10.1080/13880200902973779

    7. Peterson, C. T., Denniston, K., & Chopra, D. (2017). Therapeutic Uses of Triphala in Ayurvedic Medicine. Journal of alternative and complementary medicine (New York, N.Y.), 23(8), 607–614. doi:10.1089/acm.2017.0083

    8. Hazra, Alok & Sur, Tapas & Chakraborty, Banti & Seal, Tapan. (2018). HPLC ANALYSIS OF PHENOLIC ACIDS AND ANTIOXIDANT ACTIVITY OF SOME CLASSICAL AYURVEDIC GUGGULU FORMULATIONS. International Journal of Research in Ayurved & Pharmacy. 9. 112-117. 10.7897/2277-4343.09122.



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