PCOD is a burning problem now days. Its incidence is rising day by day because of mithya aahara-vihara. It is one of the leading cause of female sub-fertility with prevalence rate of 25-30% in the young reproductive age group, the full blown syndrome of hyper-androgenism (clinical or biochemical), chronic anovulation and poly cystic ovaries with the exclusion of other etiologies. Obesity is found in over 50% of patients with PCOS. And there is increased risk of type 2 diabetes mellitus and cardiovascular disease in later life. It may be correlated with artava-kshaya in which vata and kapha doshas are vitiated. In the present study we are trying to see the efficacy of nasya procedure in treating this disease. PCOD is a result of hormonal imbalance initiating from hypothalamic-pituitary department. As per ayurveda, it is said that “nasa hi shiraso dwaaram”, so nasya would be the appropriate shodhana procedure to deal with endocrine disorders, where hypothalamus or pituitary gland is involved. Panchakarma therapy is considered to abolish the vitiated doshas through the nearby route and to maintain a state of its equilibrium.

Keywords: PCOD, Nasya karma, Panchakarma, Vata, Kapha

INTRODUCTION

Polycystic ovarian 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 a multifactorial and polygenic condition. It is characterized by excessive androgen production by the ovaries mainly. Its incidence is rising day by day because of mithya aahara-vihara. It is one of the leading cause of female sub-fertility with prevalence rate of 20-30% in the young reproductive age group, the full blown syndrome of hyperandrogenism (clinical and/or biochemical), chronic anovulation and poly-cystic ovaries with the exclusion of other etiologies. At a recent joint European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM) consensus meeting (Rotterdam criteria), a refined definition of PCOS was agreed- namely the presence of two out of the following three criteria [1,2]:

·         Oligomenorrhea or anovulation

·         Hyperandrogenism (clinical or biochemical)

·         Polycystic ovaries, with the exclusion of other etiologies

Any defect in H-P-O axis will cause hormonal or chemical imbalance which may alter the ovarian function leading to PCOS. Despite of accumulated literature and remarkable advance in understanding PCOS, etiology and primary mechanism remains unclear thus posing a burning problem. Underlying cause of PCOS is unknown. PCOS has genetic and familial tendency and may be autosomal dominant inherited. Hyperandrogenism and anovulation may be caused by abnormalities in four endocrinologically active compartments [3]:

1.       Hypothalamic-pituitary compartment

2.       Ovaries

3.       Adrenal glands

1.       Peripheral compartment (fat)

Pathophysiology

a)       Hypothalamic-Pituitary compartment-Increased pulse frequency of GnRH leads to increased pulse frequency of LH. The LH:FSH ratio is increased.

b)       Androgen excess-Abnormal regulation of the androgen forming enzyme is thought to be the main cause for excess production of androgens from the ovaries and adrenals.

c)       Anovulation-Because of low FSH level, follicular growth is arrested at different phases of maturation.

d)       Obesity and insulin resistance-Apart from excess production of androgens, obesity is also associated with reduced SHBG. It also induces insulin resistance and hyperinsulinemia which in turn increases the gonadal androgen production.

e)       Long term consequences-Endometrial hyperplasia, risk of developing DM, risk of developing endometrial carcinoma, risk of HTN and cardiovascular disease.

·         Ovaries enlarged 2-5 times the normal size.

·         Capsule is thickened and pearly white in color.

·         Ovarian volume increased >10 cm³ and stroma is increased.

·         Multiple >12 follicular cysts measuring 2-9 mm in diameter crowded around the cortex.

·         There is thickening of tunica albuginea.

Clinical features

u  Menstrual dysfunction in the form of oligomenorrhea, amenorrhea or DUB

u  Increasing obesity (abdominal)

u  Infertility

u  Hirsutism

u  Acne

u  Acanthosis nigricans

Of the various lines of treatment available for PCOS, hormonal therapy is the main choice. Hormonal therapy may offer exceptional results for a shorter period. But over time it can lead to permanent metabolic damage. It further depletes the already taxed endocrinal system and pulls it to sleep.

AYURVEDIC REVIEW

PCOD may be correlated with Pushpghni jatharini; o`Fkk iq’ia rq; k ukjh; Fkkdkya izi”; frA LFkwyykse”kx.Mk ok iq’i?uh lk·fi jsofrAA (K.S.Ka.6).

·         o`Fkk iq’i & Anovulation

·         LFkwyx.M & indirectly denotes obesity

·         ykse”kx.M - Hirsutism

Etiology

feF; kpkjs.k rk% L=h.kka iznq’VsukrZosu p A tk;Urs chtnks’kkPp nSokPp J`.kq rk% i`Fkd~ AA (C.S.Chi.30:7-8).

·         feF;kpkj & Abnormal lifestyle and diet

·         nq’V vkrZo - Hormonal imbalance

·         chtnks’k & Genetic and Familial tendency

·         nSo & Idiopathic

Aartavkshaya

vkrZo {k; s; Fkksfprdkykn” kZueYirk ok; ksfuosnuk pAA (S.S.Su.15:12)

;Fkksfprdkyks ekfl ekfl «; gL=o.ke~A A (S.S.Su.15:12;Dalhana)

vkrZo {k; bR; knkS; ksfuosnuk rn~ns” kkfHkiwjdkrZo {k; dqfirsu ok; qukA (S.S.Su.15:12;Chakra)

In the event of deficiency or loss of artava, the menses does not appear in its appropriate time or is delayed, is scanty and does not last for three days. There is also pain in vagina. Chakrapani opines that this pain is due to aggravation of vata caused by loss of artava which fills this region.

TREATMENT

l  r= la”kks/kuekXus;kuka p nzO;k.kka fof/konqi;ksx%AA    (S.S.Su.15:12)     

l  …… *la”kks/kufeg lkekU;e~* bfr dsfpr~*] ^la”kks/kufeg oeua u fojsd% bR;ijs*] dqrk%\ fojspusu fg fiÙk{k;knkrZoL; {k; ,o L;kfnfr] oeusu rq lkSE;/kkrkS fuârs vkXus;/kkrkS o`)s vkrZoekI;k;rsA     (S.S.Su.15:12;Dalhana)

l  r= “kks/kufeR;usu L=ksr%”kq);FkZa “kks/kua] rPp oeua fojspua pks/okZ/k%L=ksr%”kqf)djr;k……A      (S.S.Su.15:12;Chakra

The artavakshaya should be treated by the use of purifying measures and agneya substances. Dalhana says that for purification, only emetics should be used, not the purgatives, because purgation reduces pitta which in turn decreases artava, while emesis removes saumaya substances, resulting into relative increase in agneya constituents of the body. Chakrapani says that by the use of purifying measures srotasas (channels) are cleared. Samshodhna chikitsa include 5 modalities like vamana, virechna, anuvasana basti, niruha basti and nasya karma. Acharya Kashyapa has explained the role and importance of Shatapushpa Taila in menstrual irregularities when used in the form of nasya, snehapaana, abhyanga and basti. GnRH is the main regulator of H-P-O axis and the cells of GnRH originate in the olfactory area and migrate into the brain. Keeping this view in mind, Nasya karma can be adopted to stimulate the hypothalamus and pituitary gland through its nearest route [4].

DISCUSSION

In Ayurveda, many therapies are used for the maintenance of health and eradication of diseases. Nasya karma is an important therapy among them. In this therapy, the medicine is administered through nose either in the form of ghrita, oil, powder, liquid or smoke. It is particularly useful in the treatment of diseases occurring in the organs situated above the clavicle but indirectly it works on the whole body by improving the functioning of the endocrine glands and nervous system. According to all Acharyas, nasa is said to be the main doorway to shiras and medicine introduced through nasa occupies shrungatak marma and all channels of eye, ear, nose, throat and removes the morbid doshas From modern view, nose is connected pharmacodynamically through vascular system and nerve plexus of olfactory nerve and branches of trigeminal nerve to brain. The olfactory nerves are connected with the higher centers of brain, i.e., limbic system, consisting mainly of amygdaloidal complex, hypothalamus, epithalamus, anterior thalamic nuclei, parts of basal ganglia, etc. So the drugs administrated here stimulate the higher centers of brain which shows action on regulation of endocrine and nervous system functions [5].

CONCLUSION

Keeping view on the above said facts it can be concluded that either the essence of nasya or nasya dravya is reaching the brain and thus controlling different endocrinal functions. On this basis, nasya therapy can be supposed an effective option in the management of PCOD. Therefore this conceptual hypothesis should be applied over a sample to see the effectiveness of nasya karma on PCOS.

1.       Dutta DC (2013) Textbook of Gynecology including contraception. 6^th Edn, Revised reprint: 2013, edited by Hiralal Konar. New Central Book Agency (P) Ltd. P.N., pp: 440-443.

2.       Acharya VJT (2012) Sushruta Samhita with Nibandhasangraha commentary of Shri Dalhanacharya. Published by Chaukhamba Subharati Prakashan, Varanasi. Su.15/12, p: 70.

3.       Vatsya (2012) Vrddha Jivaka. Kashyapa Samhita. Ka.5/23-25, p: 187.

4.       Malhotra N (2013) Jeffcoate’s Principles of Gynecology. 8^th International Edn. Published by Jaypee Brothers, pp: 360-368.

5.       Tewari P (2007) Ayurvediya Prasuti Tantra Evam Striroga. Part II, pp: 163-167.