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Polycystic ovarian syndrome

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Polycystic ovarian syndrome

  1. 1. Guided by :- Dr. Krishan kumar chopra ( HOD ) Dr. Meenu wahi ( Reader ) Submitted by :- Arvinder kaur Bams 3rd year Roll no:- Batch: 2020-2021
  2. 2.  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.
  3. 3.   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.
  4. 4.  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.
  5. 5.  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.
  6. 6.  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
  7. 7.   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.
  8. 8.  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)
  9. 9.  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
  10. 10.  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.
  11. 11.  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.
  12. 12.  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.
  13. 13. 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
  14. 14.  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
  15. 15.  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.
  16. 16. 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.
  17. 17.  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.
  18. 18.  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
  19. 19.  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
  20. 20. 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.
  21. 21.  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
  22. 22. Dyslipidemia Non-insulin-dependent diabetes mellitus Gestational diabetes Hypertension Cardiovascular disease Thrombosis Endometrial cancer Ovarian cancer Breast cancer
  23. 23.  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.
  24. 24. 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
  25. 25. Exercise Weight loss Hair removal Medications
  26. 26.  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.
  27. 27. 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
  28. 28.  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.
  29. 29.  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.
  30. 30.  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).
  31. 31.  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.
  32. 32.  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
  33. 33.  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
  34. 34.  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.
  35. 35.  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
  36. 36. 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
  37. 37. 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
  38. 38. 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.
  39. 39. 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
  40. 40. 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.
  41. 41. 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‟.
  42. 42. 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.
  43. 43. 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.
  44. 44.  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).
  45. 45. 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.
  46. 46.  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
  47. 47.  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
  48. 48.  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.
  49. 49. 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)
  50. 50. 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
  51. 51. 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
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