2. Wakkumbura H.P., Deepthica S.H.K., Weerasingha W.A.R.P.

!
Alrrrveda
for poly cystic o,varian syndrome
T*T:1.
a randomized clinical trial
ttP. \ttkkuhhttr t. . jt.
lt. ,.{ ,t. /, l1,'.cnsilq//, H
De.pthikx!,
D. R. Sr,,jyanl
Abstract
'y!,,,yi:ri,ir:_,:t;3?ff ii,i"i'il:xl?f ::,T"":*"#a.:::sr:il
;'ikfu *i,H*iit*'*i{ift qit$$:ilffi
fr
e$i$;n"6l.r#il1g3itii_4li$jffi
;6ir$t'.,':ii#nfi*r*:ifrT*:i:'f;.i{;:ii,,ffi
.,i:r:ffi
i:?:,Tfi
m:n*:*"ir_,x*r,
$liiiliirp;lfi
$!;:il;r.ffi rlf i*qli:a"f ff t:ldjli-,i*:ffi
iil,lii;?ii]?;#',i#*.1tnff
Kevwords
:
!:!"1;'::"t;;;t:Jy
aopxhr \i.rk.rtuadr.hi Arured.
\1i.ti'anxr(lrti AJnjn{&
Crrnpnlu
l]mril: [email protected]
;t:,ru;iil*{l*i:n:::*
nd ro m e' Avnfv e dic ntedicine, himutism,
rnsinure lhtv€Ftrv d |'elarila. yakkdx,
sd llnka
Telching Hospna/. txkkrtj Sri Llnka.
Introd.uction
omei
Ovafy Disease. PCOS is thc mosl
cls t ic ov a r ia n s.t, n dro ne
(PCIOS) is believed ro bc onc of
P o I :'
the most colnmon hormonal
abnofmalities found in wonten.
Depending on the cr-iteria uscd to
definc thc syndrome, pCOS may
atlect between 59,," l0% of worren
of |eprorluctir c agc Thc prcsence
oI fotvc)\ttc o\anes Jlonc is nol
enough to achieve a diagnosis of
PCO.S. This is becarLsc multiplc
ova an cysts are detected in as
nany as 20 25% ofnormal uornen
on ultrasound examination. lrving
Stein and Michael Leventhal firsl
identilied this disorder in 1935.
PCOS is generally considered a
syndro,ne rather than a disease
(though it is somctimcs called
)mmon
)sgarch
hamuli
ycystic
aerence
ch was
ears of
)nnaire
en DC
dbacks
rports.
to test
given
arison.
can be
)atrelrts
Ltment.
nstrual
'ment.
jutism,
Polycystic O\ arian Diseasc) because
it-manifcsts itself througli a group
oI stgns and symptonts that can
common cause
of
menstrual
irregularitics in wornan in aqc groun
of l5 to 45 )'ears.ln thc qomei who
a.e srLffering eithcr froln infertilit,,).
recurrent miscarriagc, or we ighl
gain. PCOS is rcsponsible for 54,11,
of the problems. It is characterized
by multiple slnall cvsts on rhe
ovarlcs, lltenstLual irregularities
and features ol_ excess androgen
productton such as rlrurtls.rT (cxcess
facral or body hair). rnale or fcmale
pattcm balding, d.rart ha.t is igrens
and acne.r Not all womcn affccted
with PCOS havc all thrce feetures
but to make a diagnosis of pCOS.
at lcast tu,o of these thrce
characteristics must bc present.
ln lerms of menstrual ifiegularity,
rnenses may be irregular; there
may be oligamenorrhoea (rcduced
I req uency of menstruation)
or
anrenorrhoea (periods of six months
or morc wrthout menstruatior). As
wcll as these diagnostic leatures
PCIOS is associatid with obesitv.
particularly central obcsity, iusulin
occur in any combinttion. rathcf
than having one known cause or
prescntation. k is typicallv defined as
thc association of hyperandrogenisln
with chronic ano!ulation in ivornen
\,,rthoUt sp(cifi c uIdet Iyrng drseil\r
resr
stancc! hypertension. raiscd
blood lipids and ntetabolic syndrome.
ul ihc ddrenill o| prtuitarl glrnds
According to Ayurveda pCf)S is
a disofdcl involving pitta, kdlh(r,
A wonan rvith PCOS may entcr
her cldca years \\.ith an incrcased
.1sk of type Il diabctes and hcarl
clisease.r The cause of pCOS is
m(
d,:1.r, d n b h u,", a h.r_rr.o1dj. and
hu krcr/arthdrctdh ctlr, and it is
stmilef to kaphaldGt dnthi. GranIhi
ret'ers to knotty elcvation.: It refers
poorlv understood. A gene tic
(inherited) link is Iikely. but has
s
not yct been identified. One key
lactor 1n the dcvelopment of pCOS
rs thought to be insulin rcsistance.
The cells ol the bodv become
rcsistant to insulin, fiiling to rcspond
normally. The body compensates
for this by increasing in suli n
to nodular or glandular srvelling
\a.ith ha.d. knotty and rou-qh
appcarence. i other names for
P o /y t.v.t t it Ovary Svndrone
arc Ste in - Leven th e I Syndrome.
h yp eran d roge n i c c h ro n ic
anovulation. functional ova rian
production.
hypcr androgen ism. arld pol),cystic
ieading to
h],perinsulinacmia (excess insulin
81
in the blood). fhis in turn is thought
to be lcad to the othcr probierns of
PCOS: excess ardrogcn production
and abnormai production of lhe sex
horrnoncs responsible for feguLating
the mcnstrual cycle.
Invcstigations for polycystic oval ian
syndrome may include: Clucose
tcsting \&ith a glucose tolcrancc
te st. Blood lipld (cholesterol)
levels,llormone tests,\.vhich nlay
include thyroid honnone, prolachn,
lots of problens. Girls with PCOS
arc more likely to ha,',e infet tilit!,
exccssive hair gtou'th. acne- obesity.
diabctcs, heart diseasc, high blood
prcssure, abnolmal bleeding from
thc utcrus and cancer. The problcm
ofthis rcsear'ch is to sce whether the
f)C Panta, acronym for "Dhashanuli
Clh in n aru ha", a widcly sed
medicjnc in tradition al s),stem.
could be used as an eft'ective drug
in the ma agcmcnt ofPCOS-
testosteaone and sex n ormone
binding globulin, Tr-ans Vaginal
ultrasound examination looking at
the ulerLts and ovarics ls inportant
to exclude thickening ol lhe litting
of the womb, and to look lbr the
classic'polycystic' dppearance of
Materials and. Methods
Aim of thc study
Aim of lhc study was io identif)
the elficacy ol DC tfeatmcnt in
P.)lycy.ttic Ordriati Syndrome by
testing follicular maturation and
decrencnt oI ofter symptoms of
disease by conducting a clinical
the ovarics.
In Westcrn rnedicine, therc is no
definitive treatlncnt for PCOS.
Management is largely symplolllatlc.
The managemeit of PCOS is
study.
complex and life long.
Stud) design
lt
invohes
addressing both acute rssues
(irregular menstruation, in/ertiIity
This is a raidomiy sclected cljnical
study.50married i'emale patients
were randomly selected from the
gynaecology clinic ol the Gan:rpaha
rirs&lisfi), and the chronic issuc
of insulin r'esistance. Ayurrveda can
nakc a signilicant conttibution to
the \rellbcing o1'woinen $ith PCOS
by ollering fdlrrd soothing diet,
lifestyle, and lr.4rld soothing hcrbs.
and
W-ickrarnarachchi Ayurveda
tcaching hospital, Yakkala. Formuia $as introduced to above group
\\'ithin duration of three rnonths.
Diagnostic criteria
Research Problem
Pol1t7y911s
ovdrr tlndrane ls
Three rccognized criterja were rLsod
to select the study samplc including:
( 1) \\"hether the patient r'" as suft'edng
a
cornmon hcalth problem that cen
alfect teenagc girls and wonen.
Although no one really knows
\\'hat causcs PCOS, lt see s to bc
related to an imbelance in a gir-l's
hofi'noncs. tf PCOS is nol treated
properly; it can put a girl at risk tbr
lrom o/igamenorthea andiot
LlnarLtldlion, (2) clinical
a nd/o r b io chem ic al signs of
hyperandrogcnism. and
(l)
positive
polycystic ovaries through Trans
VaginaL ultrasound scan."
a2
'',
:.:r'::!,i11TS,{
_________-_!'|rl!
Inclusiou Criteria
Marricd uunren abo\c lE
or a_ge \\,ho \\crc diagnoscd\ears
and
conllrlned as Pob) Clstic. Ovdrian
J,1 nLtn, nte after
unrlcrrrk jng the
aoove procedure.
,10
out rLttormation regardrng polv
I t \tt.
Ut drton Sntdrome ind Dt
ranra. prepantiofl ofDC panta
*as
oone irccording to the not.ms
anrl
methods oI panta p3r iba s ha
at
rn(,phrrrnac) of
Exclusion Criteria
Women ahove
and internet $,ere refened
to find
vears, previousiv
rnou n eardior ascular diseeses'
tn' rotd discrs(s. ne,rplaqms.
e n d o m e t r io s is,
a iib. t"..
n)fcr1ctrs jou ( blood pressure
vU t+ornm Hg t. renal
irr]pairment
(serum creatinrnc> 120 pmol/l)
ano \{omen uerr on cn\ long
terlr
Inedtcatr!'ns ft,r at Ieasl O
mnnths
pnor to the study rere excluded
rrom the study.
Nlethodology
Both Ayurveda ancl westem text
Gampaba
wrc.rramarachchi At uri eda
r ns rrru
te rcwAI). Subiectud to
select,on crirena. 50 patients
uerc
!]rvcn the que{tionnrjre to
tind out
rnetr s.ttLlrlion bcfore the ttecrment
procedurc was conducted.
Clinical
rrlal was done with the aanclom
setectton procedu res at GalnDaha
rcKratrarachch Ay,lrrr eda terihille
,v\
nosprlrl. fhe prer Jousli
questtonnatre
group res giren the
u.r^ rantt [o be used or
er a perioJ
or J moLrths and feedbacl
$ as taken
inrough questionnaire, laboratorv
11\esttgatton and scan rcpotts
Thc
sratrstrc0 | softu Jj.e. MINiTAB
\aJs
tuSed tor analvsis.
M€thodolo€y
fG--!.'f;
:" ',,';,i;i:,':;r -i,i* t,.,,,.,',:,'
l!+u&li!a !ll!!!l,!q!!
epJrrrion nr DL
I ord/f! r. jhl r.
:il(il
r",r I
]
J5 ,lone
nr\ .,n! merhon\
rr the ph'Jrm
'' ''l
L-
,=
,.
u
_l
]
'{l
r^rorlrrh"r
ri t In' 2r r..tqa\ d
l
ne i rh tund.rr
pfocc(lui. at CNAr h.spilal
]
{ -]
f-ua1{c-!U!!!j!Lt1
n. fk r.' rl., / tr
I \en rh! D' fhra ,, U.,*a.,*
per od !r t,nUih.JrLl
Dr.n rh urrhq!*r!nni
i
Da!!,a!at$rr4r!r!!!l1!
" i*
t..i,',t
",
( .,b. r.lLr^
,n\csrg!tLon nnd scrn rcp.(s
i
83
D Lrr J
s,- tr3s.lo,re
'rl\tMtNtf\H) tr\rns
p ,,8 Jm
\Lal\r,.,l
l'
ti''
Results and Discussion
Table
l:
ADDearance
ol each characteristic belbre thc trcatment
Appearancc of characlcrislic
%
840
IJ
t5.0
50
00.0
!
16 0
,11
8.1 0
50
Obesitv
12
810
s
50
000
000
HifsutLsm
l8
i0
00.0
Ac.nLosls nrgncans
l(l
50
00.0
Cystic O!ary
2I
:12
50
000
Small f(nlicles
50
100 0
50
00.0
42
lrregular \'1.C
ll
0
t9
2.+
0
58.0
0
1aa.|L
F
sar"
6
6
krrlluLar Aaenorhoea
f.,r
Obesiv Htrllish
i
l:
ay i .)v../ Smallb
f:1.:
iltr.ins
C
Figure
A.rntos.
haracterist,c
No
I
lB'.
Appearance ofcach charactcristic belbre lhc treatment
Table 1 indicated that out of 50
patients who partjcipate.l iirr the
study, all ofthcm were having snrall
f'ollic1cs. Considering thc enlire
syndtorre. dntenorrhoetl has been
recorded as ieast indicaied one
among ali lhe patients.
According to the figure 1, more than
80 perccnl ofiadics nere suffering
from Irregular N{enstrual CYclc.
obcsity lntl snall follicles
Table
2: Appcarance ofcach charactedstic after
app."*n..
or.t,rr,.t"ri"ti.-No.
t00
lll
0.0
00
0.t)
0.0
0.0
Acrrlhosjs nigrjcilns
l
ReguJar N4.C
Clstic Ovary
\4alu.c Fotliclcs
5
80.0
6.0
!0
50
t00.0
50
i00.0
50
100.0
6A
1l
tii t)
,10
50
320
100.0
l'1
6ti.0
50
r00.0
8.0
t6
|
2.0
50
r00.0
Jll.0
50
r00.0
2
l
the taeatment
62.0
00
Dar9/o
':.1J9a
a%
HCG+ 'r.&rgh|r.s f rs tish qaftl,Irs
rr,]r.i.-!
;.dwlar [4
| rjysli. Olaij]
r,r'tature
Fotic e5
T
Ye,
ligure 2: Appearance ofeach characterjstic
after the treatment
Considcr ing the table 2. appearance
Figure 2 deprcts tlte appearance
or characteristic s hirsutisnT.
ol
cac h chiraere ctic;fter thc
treatlrent. According to the figure.
rngrgjntll\, less than n0 perceit of
rrdrcs hJ\ e indicated u eight loss.
ocun/ho.r i,\
)
than
rlqrla?r., wete tecoi_deaJ
rn very low amounfs aftcr the
trcalmcnts
cnng
ycle,
s5
7
,-:;.'\
3:
Table
HCC
ADDearance of each characte stic before and after treatment
F
lrrcgula! M C
0
0.0
20.0
4l
81 0
42
8:r.0
680
l:1
l8
t2.{l
Acanros's n'gncans
3l
62.0
Cysiic O!ary
tl
,11.0
0
00
l
2t.0
l1
62.0
htdl nunbar ol Pnrient' i0
*o
oo.r"
g
4a./"
reEua' M
I
Oresily
Hjsltsm
Ata.t.es ()3[ O,3ry
tn:a.s
- 6iro.e ir,"iim.nl
ChaDcteristics
Figurc
l:
Mah] e
rnl.les
n
6 AterT.*rr.rr
Appeamnce ofeach chnracrcristic before and a1lef treahne.t
Having altcrcd the variables in lcl
salne manncr. table 3 was collslructed
to compare the features of belore
and afier treafunents with respcct to
givcn characteristics,{ccording to
the tirble nulnber of paticnts shown
h i rsutism a]nd .ra.rrto-rl.! nigricans
havc bcen remarkably low after the
lrcatmcnL
Hypothesis Testing
ln order to tcst the trcatlnent
e ffic ac y, number of paticnts
indicated thc given charactcristics
befbre According to the figure 3.
numbers of patients indicated the
characteristics, irregular Menstrual
Cl,cle. obesity, ,4ir!& titm. dcdntoti.l
-{
1
ii :
j
tenl
l
nigricans and cystic ovary weae
lower after the treatment_ lt can
be clearly seen that the presence
or patrents shtrwing positive HCC
ancl maturc follicles after gjving lhe
20.0
treatment
6E.0
and after treatmcnt was considered
for comparison. Thc appropriate
srgnrrlcance test ts two sample
44.1)
l2.0
6.0
28.0
Proporhon test stncc the data are
in categorical fonr. The statistical
software, MIN]TAB was uscd for
aoalysis. Series ol.onc-tail test were
Table,l:
:
tt.)
rt, t,)1./ r , |,,)i.t | \tt j.
l r| ],.!\,i|: ''i.
caried out for each characteristic.
Hypothesis
Ho: There is iro difference in
proporti on s of indicating the
relevant characteristic between
before and after treatment.
Hr : There is a difference in
proportion s of indicating the
relevant characteristic between
before and after treatment.
Results oftwo sample proporlion test for each charactedstic.
appearance of each
characteristjc (%)
No.
Before
iatment
atients
torlshcs
igure 3,
aled the
enstrual
Z statisiic
p -vahe
(BT)
(AT)
0.1)
20.0
20.0
r.54
0.000*
84.0
68.0
16.0
- 1.91
Obesity
0.028*
84.0
4.1.0
-40.0
,1.17
1
Hifsutisnl
0.000+
76.0
r2.0
64.0
5
Acanlosis nigricans
6).0
60
J6.0
C!\t;c Ovrry
12.0
18.0
l,l
0.0
62.0
62.0
I
HCC+
2
lrregular M.C
l
J
a
Difference
(,{T BT)
0
0.000*
5.91
0.000*
1.4 8
0.069
9.03
0.000*
:;AtiliLont dt 5% lewl
Table
5. Somc.tatislical
mea.urentenr. ol the palienl5 dge \\ilh re.pect to
parient. shou ing In.lLle tollrclc\ after rhe treaimenL -""'- "
Ptesence of mature
lollicles
Statistical measuremeot
l:
li
i'81)i
li'.1 ltr'lllj
llri'.1.i,J :ttrr t,t,tt,rr.r1rt,tii.t,
rr,r.t\t 1it t".'it ).i:.i,tj, li )if1\r
According to the table 5, it cannot
be seen consideaable differences of
mean and mcdian age of patients
with respect to showing mature
fbllicles.
References
1.
Tewari,P (2000), Ayurveda
PraSuti-taotra Evam Stri-Roga,
Chaukhambha orienttaiia,
Golghag Maidagin, India.
Conclusion
Examining the sign of each Z
statistic, following conclusions
can be made at 5% level ol
significance. Significantly large
nunber of patients has shown
positive HCG (20%) and mature
lbllicles (62%) after the treatment.
The numbers of patients, shown
2.
India.
3. Monga, A. Ed. (2006),
,+.
the characteristics irregular
Gynecology by Ten Teaches,
I8'r' Edition, Book Power with
Hodder Arnold, London.
Rotterdam ESHRE/ASRMSponsored PCOS Consensus
Workshop Group. (2004).
Rcvised 2003 consensus on
diaglostic criteria and long-
Menstrual Cycle, ob esity, hirsutisn
and acdntosis nigricdns aftet lhe
treatment a{e significantly lower
than thosc of before treatment.
There is no sufficient statistical
evidcnce to conclude that decreasing
trend ofcystic ovary after treatment
at 5% significaot level.
Usha, V.N.K (2010), Stree
Roga Vijnan (A texl book of
Gynecology), Chakhambha
Sanskrit Pratishthan, Delhi,
5.
term health risks related to the
polycystic ovary syndrome.
Fertility & Sterility, 81(1), 1925.
Trivax, B., &Azziz, R. (200'7 ).
Dragnosis of polycystic ovary
syndrome. Clinical Obstetrics
and Gynecology, 50(1), 168
l'7'7.