Introduction

Ayurveda is the ancient, holistic science of life which heals and treats the human body on the basis of natural, eternal phenomenon. To achieve its main objective i.e. “to maintain health of the healthy persons and to cure the diseases of diseased persons.” [1] It mainly focuses to follow daily routine life style (Dincharya)[2] seasonal life style (Rutucharya),[3] Rules and regulations to take diet (Ashta Aharvidhi Vishesh Ayatanas, Ahar Vidhi Vidhanas),[4] Pathya–Apathya management in each disease and simple herbal medicinal preparations to cure disease ect. These are the some important aspects for what whole world is approaching towards Ayurveda. At present era, sedentary working nature, lack of exercise, day dreams and faulty food habits without following rules and regulations of Ahara become the vulnerable causes for the developing the various metabolic disorders like obesity, type 2 diebetes mellitus, hypothyroidism, hypertension ect.. Among these PCOS (polycystic ovarian syndrome) is one of the increasing metabolic, life style disorders now a days. Globally prevalence of PCOS is estimated to be between 5.5% - 12.6% where as relatively high prevalence in India estimates between 8.2% - 22.5% [5] therefore multiple, different line of treatments and life style management for PCOS should be evaluated and developed. In the Ayurveda, PCOS can be correlated with various Aartav Dusti Vikara. Artava is said Updhatu of Ras dhatu[6] formed in Rasvaha Srotasa due to the action of   Ras Dhatvagni on Ahar Rasa. [7]  Balanced state of Ras Dhatvagni is responsible for the formation of Shuddha Aartav in the body. hence vitiation of Ras Dhatvagni plays major role in the etiopathogenesis of PCOS. As etiopathogenesis of all metabolic disorders (Santarpanjanya Vyadhi) is more or less similar, the sedentary lifestyle and faulty food habits  cause diminition of Digestive fire (Agni) especially diminition of  Ras Dhatvagni, resulting in  the formation of excess of Ama Rasa without nourishing further Raktadi Dhatu and Aartavadi  Updhatu also.[8] So to treat PCOS, provision of certain Pathyakara Ahara and herbal medicines which have opposite qualities (Gunas) of Ama Rasa  causing Ras Dhatvagni Dipan should be done. In the present study review of various Ayurvedic medicinal plants like Vatsak, Patol, Kutki, Sariva, Nimba, Triphala,Mrudvika, Mustha, Guduchi, Vishva, Chandan ect. and Pathyakara Ahara is done which together can cause Dipan of Ras Dhatvagni as a result of this ultimately capable to prove effective in  PCOS.

Aim: To study the critical review of effect of Ayurvedic Diet and Herbal medicines as Dhatvagni Dipan in the management of PCOS.

Objectives:

1. To study the review of Modern concept of PCOS.
2. To study the review of Pathyakara Ahara.

To study the review of different herbal medicines like Vatsak, Patol, Kutki, Sariva, Nimba, Triphala,Mrudvika, Mustha, Guduchi, Vishva, Chandan ect.   

Materials and Mathods:

  A literature review will be taken from :

1. Ayurvedic clssics : From Charak Samhita. Sushrut Samhita., Ashtang hriday., Bhaishajya ratnavali.,Bhavprakash., Sharangdhar Samhita.

2. Modern  Science : Text books of internal medicines.

3. By internet : Information of research database from various search engines.

4. By different journals

Review of literature:

Review of PCOD:

In Ayurveda, gynacological diseases are described under Yonivyavada, types of Aartav Dushti Vikara, Rakta Pradar, Aartav Kshya and Vruddhi ect. The signs and symptoms of PCOS can be correlated with few Yonivyavad Vikara[9] like Vandhya, Arajaska, Vatal Yoni, Vataj or Vat-Kaphaj Aartav Dushti,[10] Nashtartav [11]ect.

• In  Nashtartav, menstrual flow is obstructed by vitiated Vata and Kapha
• In Vandhya Yoni where menstrual flow is normal but anovulatory cycle may present.
• In Avarana pathology where Aartav pravrutti becomes irregular due to Avarodh by Vat and Kapha as like hormone imbalance.

Etiology: Specific etiology is not described in Ayurveda classics but as mentioned above, etiopathogenesis of all the metabolic disorders is more or less similar. So Mithyachara like Adhyashana,Viruddhashan, Kaphakar Ahar Sevan, Avyayam, Divaswapna[12] ect. can be taken as principal causative factors to alter hypothalamo - pitutory axis causing PCOS like changes. Bijdosha, Pradushtaartav, Daiva [13] are also the causative factors for PCOS. 

Etiopathogenesis: The sedentary lifestyle and faulty food habits cause diminition of Digestive fire (Agni) especially diminition of  Ras Dhatvagni, results in  the formation of excessive sweet, Ama Rasa which blocks every Srotasa and forms only very unctuous, vitiated Meda. Due to the obstruction to the channels, nutrition of further Raktadi Dhatu and Aartavadi Updhatu does not takes place.[14] Excess increase of Meda finally turns into obesity, disturbed metabolism, hormone imbalance, hyperinsulinemia, hyperandrogenism thus developing amenorrhea, anovulation, hirsutism etc.

Clinical features of PCOD:

• Amenorrhoea or oligomenorrhoea.
• Increased ovarian volume >10cc.
• Hirsutism.
• Abnormal hair growth.
• Acne or skin manifestation.
• Pelvic pain.

Management:

Management of PCOD is symptomatic. According to symptoms like menstrual disturbances, symptoms of hyperandrogenism and infertility modern allopathic management include:

• Oral contraceptive pills for menstrual irregularities.
• Anti – androgens and other ovulation induction related drugs in infertility.
• Ovarian drilling in infertility.
• Uses of mood elevators to pacify stress and anxiety.
• Certain hypoglycemic drugs for insulin resistance.

Ayurvedic management considers following aspects:

1. Nidanparivarjanam: In the management, Nidanparivarjana is the primary management suggested by   Sushruta. Therefore Apathyakara Ahara and Vihara should be avoided and Pathyakara Ahara should be suggested.
2. Karshan Chikitsa: Charaka suggested Karshan Chikitsa[15] in Santarpanjanya Vyadhi (metabolic disorders). It can be done by Shodhan (Panchakarma) and Shaman (medicinal) treatment also.
3. Dhatvagnidipan : Many herbal drugs are mentioned in the Ayurveda classics to relive Agnimandya especially Dhatvagnimandya due to that Avarodha at Aartva Vaha Srotas gets relived and proper nutrition of Aartva takes place.
4. Aagneyadravya and Swayonivardhana[16] : Aartva is Aagneya in nature so medicines having Laghu, Ushna, Tikshna properties and  ushna virya resulting Vat and Kapha Shaman should be used.  

Review of certain herbal medicines:

Charaka has mentioned different herbal medicinal therapy in the form of Kwath formulation to relieve Dhatvagni Mandya in different Dhatugat Jwara.[18] Similar Kwath formulations can be used in PCOD also to cause Dhatvagni Dipan so that Avarodha at Aartav Vaha Srotasa can be relived and proper nutrition of Aartav Dhatu can takes place correcting PCOS symptoms. The herbal medicines are Vatsak, Patol, Kutki, Sariva, Nimba, Triphala,Mrudvika, Mustha, Guduchi, Vishva, Chandan etc.

Discussion

Sushruta has mentioned Aartav vaha Srotas []just to perform its functions but actual formation of Aartav takes place in the Rasvaha Srotasa only by the action of Ras Dhatvagni. Therefore any pathophysiology of most of the gynaecological disorders start from vitiation of digestive fire (Agni) especially vitiation of Ras Dhatvagni. Therefore management and treatment of PCOS should include Pathyakara Ahara and medicines so that Dhatvagni Dipan can take place and PCOS can be corrected. For the management, Nidanparivarjan Chikitsa, Karshan Chikitsa, Dhatvagni Dipan Chikitsa, Aagneya Dravya Yojana should be done. Taking account of all the above  references, Pathyakara Ahara  and  the medicines mentioned in Dhatugat Jwara to cause Dhatvagni Dipan can be used to treat PCOS. For Nidanparivarjan, the Kaphakar Ahara (Snigdh, Sheet, Madhur, Picchila), Adhyashan, Viruddhashan, Divaswap, Avyayam should be excluded from the daily routine of life. For Karshan chikitsa, the Pathyakar Ahar should be followed. The food substances included in the diet are mentioned above have Laghu (easy to digest), Ruksha (decrease fat from the body), Ushna (hot) etc properties which have exactly opposite properties to that of the vitiated Kapha and Ama Ras  and perform  Dipan, Pachan, Medohar, Kaphaghna, Jwarghna etc actions in the body which direcly decreasing the production of Ama Ras and excess of Meda  thus in turns regulating normal functioning of Aartav. For Dhatvagnimandya, the herbal medicines mentioned for Dhatvagni Dipan are Vatsak, Patol, Kutki, Sariva, Nimba, Triphala,Mrudvika, Mustha, Guduchi, Vishva, Chandan ect. should be used. These have  Katu, Tikta, Kashay Ras, Ushna Virya, Katu Vipaka and Laghu, Ruksha ect  Guna. Due to these properties these medicines can perform Kaphahar, Lekhan, Dipan, Pachan functions  inhibiting formation of Ama Ras and decreasing excess of Meda from the body.  In this way Medas Avrutta channels get cleared as result of this, Dhatvagni Dipan can take place indirectly PCOS can be corrected. According to different animal studies, it is established that various known bioactive metabolites in above herbal plants extract especially phenolic and flavonoid compounds inhibit pancreatic lipase (PL) secreted by the pancreas. Pancreatic lipase is a key enzyme that is responsible for the absorption of free fatty acid and digestion of 50 -70% fat into monoglyceride which results in the reduction of accumulation of fat in adipose tissue thus decreasing obesity.The presence of phenolic compounds demonstrate peroxide decomposition, free radical inhibition, metal inactivation or oxygen scavenging in the biological system and thus reduce the burden of oxidative disease. Morever, it has been reported that natural polyphenols exert lipid lowering effects through several mechanisms including inhibiting pancreatic lipase activity and decreasing absorption of lipids and proteins in the intestine, thus reducing calorie intake, suppressing appetite, imparing adipogenesis, enhancing the activation of AMP-activated protein kinase in the skeletal muscle, liver and adipose tissues and improving systemic inflammation, insulin resistance and hyperglycemia.[20] The meta-analysis including eighteen studies and 300 animals shows that flavonoids efficiently break the pathology of PCOS, especially corrects ovarian histo-morphology and hormonal status. It also analyzed how different types of flavonoids influenced various phenotypes in animal models induced by different drugs. Specifically, the count of atretic follicles, the count of cystic follicles, LH, LH /FSH and FT reduced and the count of corpus luteum increased in the groups where animals were administered with flavonoids.[22]

Conclusion

With all the above references , it is proved that together the  Pathyakar Ahara with natural herbal medicines can be  effective in the management of PCOS.