Gynaecological Understanding Specific Examination

“A PERFECT NIDAANA IS MANDATORY TO APPLY PERFECT CHIKITSA SUTRA

AFTER KNOWING THE PERFECT SAMPRAAPTI IN EACH PATIENT”

SHWETA PRADARA --

DEFINITION -

SHWET PRADARA (white vaginal discharge/Leucorrhoea), the unusual vaginal discharge -

is a common problem now-a-days in gynaecological practice. It may be physiological but
when turn into pathological condition, produce associated problems like itching vulva,
backache and anxiety to a female suffering from this. It is also a symptom in multiple
gynaecological problems.

CLINICAL PRESENTATIONS --

 In AYURVEDIC literature, no separate chapter is allotted concerning SHWETA

PRADARA. Commentator CHAKRAPAANI has explained the word PANDURA -
ASRIGDHARA (Pale vaginal discharge) as SHWETA PRADARA (leucorrhoea) in
his commentary.
 SUSHRUTA has described a physiological discharge of women secreted during
sexual act as SHWETA PRADRA.
 MADHAVA NIDANA has described a type of ASRIGDARA named KAPHAJA
ASRIGDARA and its symptoms are similar to SHWETA PRADARA.
आमम सपिच्छा अप्रतिमम्सपाण्डु पुलाकतोय अप्रतिमम कफात तु – माधव निदान
 KAPHAJA YONI – Many of the KAPHAJA YONI patients may be considered as
SHWETA PRADRA patients and can be treated on the lines of treatment of
KAPHAJA YONI.
कफो अभिष्यन्दि अभिवृ द्धौ योनिम च दूष्ये त स्त्रियाः
स कुर्यात पिच्छिलाम शीताम कण्डू गर् स्त अल्प वे दनाम
पाण्डुवर्णा तथा पाण्डुपिच्छिलार्तव वाहिनाम – चरक चिकित्सा स्थान ३०/१३-१४
-it happens when all the KAPHA KARAKA AHAARA VIHAARA increases
KAPHA in the body
-then the secretions may be slimy and cold in nature
-there is itching in the YONI
-there can be mild pain in the YONI
-the secretions of the YONI may also be yellowish pale and slimy in nature

CAUSES OF SHWETA PRADARA -

1. VIRUDDHA AHAARA - incompatible foods
2. MADYAPAANA - alcohol intake
3. ADHYASHANA - repeated food intake causing indigestion
4. Ajeerna - undigested food
5. Garbhapaata - repeated abortion
6. Yaana - riding the vehicles
7. Adhwa - long walk
8. Shoka - grief, stress
9. Atikarshana - emaciation due to certain disorders
10. Bhaaravahana - weight lifting
11. Abhighaata - injury
12. Divaa nidra - day sleep/sedentary lifestyle
13. Ashuchi - Unhygienic activities, infection

SAMPRAAPTI -

Due to the above said HETUS (reasons)

>>>>>>

the DOSHAS are vitiated (the normal physiological functions of DOSHAS are disturbed)

>>>>>>

Disturbed DOSHAS get lodged in/affect the sites of APAANA VAATA, namely SHRONI
(hip), BASTI (bladder/around bladder area), URU (thighs), GARBHAASHYA (uterus),
YONI (vagina) and surroundings

>>>>>>

Due to imbalanced DOSHAS, body cannot withstand the vital strength in these organs

>>>>>>

And RASA DHAATU secretion/formation and its functions in this area get disturbed

>>>>>>

and hence it is lost through vaginal route in the form of SHWETA PRADARA.

RAKTA PRADARA –

DEFINITION OF ASRIGDARA (RAKTA PRADARA) – SUSHRUTA SHARIRA

STHAANA - 2
तदे वातिप्रसङ्गे न प्रवृ त्तमनृ तावपि |
असृ ग्दरं विजानीयादतोऽन्यद्रक्तलक्षणात् ||१८||
-important feature is ANYATA RAKTA LAXANAATA
-there is excessive bleeding but the main feature is the character and appearance of the blood
will be altered from the normal features of the blood. This can be asked from the patient.

SYMPTOMS -
असृ ग्दरं भवे त् सर्वं साङ्गमर्दं सवे दनम् |२|
तस्यातिवृ त्तौ दौर्बल्यं भ्रमो मूर्छा मदस्तृ षा |
दाहः प्रलापः पाण्डुत्वं तन्द्रा रोगाश्च वातजाः ||२|| - (सु . शा. अ. २) |
-there can be body pains and a feeling of stiffness and lethargy in the body
-when this is in excess, there manifests extreme weakness, giddiness, syncope like conditions,
feeling like unconsciousness, excessive thirst, burning sensations, delirium and feelings of
sleepiness and many other VAATA PRADHAANA ROGAS can be present in the later
stages.

CLINICAL PRESENTATIONS HAVING EXCESSIVE BLEEDING -

RAKTAJAA YONI – 5TH YONI ROGA BY CHARAK

ू तम
रक्तपित्तकरै ः नार्या रक्तम पित्ते न दषि
अतिपरवर्तते योन्याम लब्धे गर्भे अपि सासृ जा – चरक चिकित्सा स्थान ३०/१६
When a female keeps on indulging in PITTA and RAKTA VARDHAKA AAHAARA
VIHAARA in excess then this condition may result in excessive bleeding in non-pregnant
females as well as in the situations like miscarriage or bleeding per vagina when she becomes
pregnant

PARIPLUTAA – 11TH YONI ROGI BY CHARAK

When a female already having PITTA PRAKOPE and she tries to hold the natural urges like
sneezing etc, then there is vitiation of VAATA along with PITTA then the symptoms
produced are –
-pain in the lower abdomen
-pain in the lower back
-SHOONA – there is swelling in the YONI
-SPARSHA AKSHAMA – tenderness in the YONI
-Pain in the YONI
-bleeding with bluish or yellowish tinged blood
ASHTAANGA HRIDAYA adds – heaviness in abdomen, diarrhea, loss of appetite, pain in
the pelvis and groins, pricking pain sensations and fever could also be present
SUSHRUTA says – there is pain during intercourse in this condition

All of these symptoms can be seen in various different patients having complaints of
excessive bleeding.

PRASRANSINI – by SUSHRUTA
-excess menstrual bleeding with pain and difficulty

RAKTAYONI---excessive bleeding

PRADARA - ASRIGDARA - दु ष्टार्तवप्रवृ त्तिस्वरूपं प्रदरमाह- VIJAYRAKSHIT –

PRADARA is that condition in which there is menstrual flow in the DUSHTA manner and
flow.

ENDOMETRIAL HYPERPLASIA
  Vaginal bleeding between menstrual periods or after menopause
 Heavy menstrual bleeding
 Periods that last longer than usual
 Pain during sexual intercourse
 Anovulatory periods (menstrual cycles without ovulation)

ENDOMETRIOSIS –

This condition can also present as heavy bleeding with many other symptoms as well.

METRORHAGIA - Uterine bleeding at irregular intervals, particularly between the expected

menstrual periods. Metrorrhagia may be a sign of an underlying disorder, such as hormone
imbalance, endometriosis, and uterine fibroids or, less commonly, cancer of the uterus.

MENORHAGIA - Menorrhagia is defined as menstruation at regular cycle intervals but with

excessive flow and duration and is one of the most common gynecologic complaints in
contemporary gynecology.

HETU –
विरुद्धमद्याध्यशनादजीर्णाद्गर्भप्रपातादतिमै थुनाच्च |
यानाध्वशोकादतिकर्षणाच्च भाराभिघाताच्छयनाद्दिवा च | - MADHAVA NIDAANA
All above causes have been explained above in the context of SHWETA PRADRA.

SAMPRAAPTI --
याऽत्यर्थं से वते नारी लवणाम्लगु रूणि च|
कटू न्यथ विदाहीनि स्निग्धानि पिशितानि च||२०५||
ग्राम्यौदकानि मे द्यानि कृशरां पायसं दधि |
शु क्तमस्तु सुरादीनि भजन्त्याः कुपितोऽनिलः||२०६||
रक्तं प्रमाणमु त्क् रम्य गर्भाशयगताः सिराः|
रजोवहाः समाश्रित्य रक्तमादाय तद्रजः||२०७||
यस्माद्विवर्धयत्याशु रसभावाद्विमानता |
तस्मादसृ ग्दरं प्राहुरे तत्तन्त्रविशारदाः||२०८||
रजः प्रदीर्यते  यस्मात् प्रदरस्ते न स स्मृ तः| - CHARAK CHIKITSAA 30/205-208

Excessive intake of the foods having LAVANA, AMLA, KATU and GURU GUNAS and
those foods which are more acid producing systemically in the body as well as the foods
which are more oily and heavy to digest, the meats of various animals in excess, more fatty
things, excess KRISHARAA (rice gruel), milk and curds, excess sour drinks, excess alcohol
>>>>>>
there is vitiation of the functions of the VAATA and RAKTA as well as there is quantitative
increase in the blood in the blood vessels of the uterus
>>>>>>
And when the blood increases in amount, it also causes an increase in the RAJA DHAATU
>>>>>>
And the RAJA DHAATU is expelled out with the RAKTA and this is called ASRIGDARA
OR RAKTA PRADARA

TYPES -
तं श्ले ष्मपित्तानिलसन्निपातै श्चतु ष्प्रकारं प्रदरं वदन्ति ||१||
Four types have been described as varieties of the RAKTA PRADRA but clinically usually
we can diagnose all such cases under RAKTA PRADRA and treat as per the HETUS. In
some cases we may need to make a differential diagnosis as per the following –

VAATAJA PRADARA –
-the secretions can be frothy, thin, blackish or brownish in color
-secretions are generally of the consistency of water
-it may or may not be associated with pain

PITTAJA PRADARA –
-the secretions may be bluish, blackish or reddish
-the patient feels heat or hotness in the secretions
-there can be burning, redness, excess thirst, feverish feelings, and giddiness

KAPHAJA PRADARA –
-the secretions are thick, slimy and yellowish red in color
-the patient feels coldness in secretions
-there is very less pain during secretions
-there can be symptoms like vomiting, nausea, anorexia, cough or breathlessness

TRIDOSHAJA –
-due to all types of HETUS there can be various types of the secretions based on which
DOSHA is more prevalent at a particular type

PELVIC INFLAMMATORY DISEASE

DEFINITION -

Pelvic inflammatory disease, or PID, is an infection of the organs of a women’s reproductive

system. They include the uterus, ovaries, fallopian tubes, and cervix. It’s usually caused by a
sexually transmitted infection (STI), like chlamydia or gonorrhea, but can also be caused by
some other infections also.

SYMPTOMS -

 Pain in lower abdomen and pelvis

 Heavy vaginal discharge with an unpleasant odor

 Abnormal uterine bleeding, especially during or after intercourse, or between

menstrual cycles

 Pain or bleeding during intercourse

 Fever, sometimes with chills

 Painful or difficult urination

PID might cause only mild signs and symptoms or none at all. When severe, PID might cause
fever, chills, severe lower abdominal or pelvic pain — especially during a pelvic exam —
and bowel discomfort.

CAUSES -

Chlamydia trachomatis and Neisseria gonorrhoeae are usually the main cause of PID. Data
suggest that PID is often polymicrobial. Isolated anaerobes and facultative microorganisms
have been obtained from the upper genital tract. N. gonorrhoeae has been isolated from
fallopian tubes, facultative and anaerobic organisms were recovered from endometrial tissues.

ALMOST ALL TYPES OF CASES OF PIDs CAN BE GROUPED UNDER THE

YONIVYAAPADA PARIPLUTAA AS DESCRIBED BELOW -

PARIPLUTAA –
CHARAK SAYS -
पित्तलाया नृ संवासे क्षवथूदग ् ारधारणात्|
पित्तसम्मूर्च्छि तो वायु र्योनिं दषू यति स्त्रियाः||२३||
शूना स्पर्शाक्षमा सार्तिर्नीलपीतमसृ क् स्रवे त्|
श्रोणिवङ्क्षणपृ ष्ठार्तिज्वरार्तायाः परिप्लु ता||२४||-CHARAK CHIKITSA 30
When a female who is already afflicted with PITTA PRAKOPE and she tries to hold the
natural urges like sneezing etc then there is vitiation/disturbances in the functions of VAATA
with PITTA ALSO then the symptoms produced are –
-pain in the lower abdomen
-pain in the lower back
-SHOONA – there is swelling in the YONI
-SPARSHA AKSHAMA – tenderness in the YONI
-Pain in the YONI
-bleeding with bluish or yellowish colored blood

ASHTAANGA HRIDYA adds – heaviness in abdomen, diarrhea, loss of appetite, pain in the
pelvis and groins, pricking pain sensations and fever could also be present

SUSHRUTA says – there is pain during intercourse in this condition

SOME CASES OF PID MAY FALL UNDER THE HEADING OF TRIDOSHAJA YONI
ROGA –

SAANNIPAATIKA YONIVYAAPADA---
All the three DOSHAAS are aggravated by consumption of food having all the six tastes.
They vitiate YONI AND GARBHAASHAYA (Uterus).
This YONIVYAAPADA manifests with burning sensation (DAAHA), pain (SHOOLA). The
menstrual blood becomes whitish and sticky (PICHCHHILA).
(C. Chi. 30/14-15; A. H. U. 33/51)
This is called as SARVAJAA YONIVYAAPADA BY SUSHRUTA. IN SANNIPAATAJAA
YONIVYAAPADA, there is manifestation of symptoms due to all the DOSHAS. This is
incurable. (S. U. 38/19, 20)

DIAGNOSIS –
  Upon a pelvic examination, cervix, uterine, or adnexal tenderness will be experienced.
 Muco-purulent cervicitis and or urethritis may be observed.
 In severe cases more testing may be required such as laparoscopy, intra-abdominal
bacteria sampling and culturing, or tissue biopsy.
 Other imaging methods, such as ultrasonography, computed tomography (CT), and
magnetic imaging (MRI), can aid in diagnosis.
 Blood tests can also help identify the presence of infection: the erythrocyte
sedimentation rate (ESR), the C-reactive protein (CRP) level, and chlamydial and
gonococcal DNA probes.

CERVICITIS

DEFINTION -

Cervicitis is infectious or noninfectious inflammation of the cervix.

Findings may include vaginal discharge, vaginal bleeding, and cervical erythema and
friability (prone to bleeding).

HETUS -

Cervicitis is inflammation of the cervix, which can be due to:

 Irritation of the cervix

 Infection in the cervix

 Injury of cells that line the cervix

These irritated or infected tissues may become red, swollen, and ooze mucus and pus. They
may also bleed easily when touched.

The two categories of the cervicitis are as follows --

NON INFECTIOUS CERVICITIS -

Non-infectious cervicitis can be caused by --

 Local trauma - eg, cervical irritation caused by tampons, a cervical cap, the string
from an intrauterine contraceptive device, a pessary, or a diaphragm

 Radiation – when some treatment like radiotherapy is used

 Chemical irritation - eg, vaginal douches, latex exposure, or contraceptive creams

 Systemic inflammation - eg, Behçet syndrome (Behçet's disease (BD) is a type of

inflammatory disorder which affects multiple parts of the body. The most common
symptoms include painful mouth sores, genital sores, inflammation of parts of the
eye, and arthritis.)
  Malignancy

INFECTIOUS CERVICITIS -

The infectious etiologies of cervicitis, all of which are sexually transmitted infections (STIs),
are significantly more common than the noninfectious causes.

Infectious cervicitis may be caused by Chlamydia trachomatis, Neisseria gonorrhoeae, or

herpes simplex virus (HSV). In most cases of cervicitis, however, lab tests fail to isolate an
organism; this is particularly true in women with low risk factors.

SAMPRAAPTI –

Traumatic affliction of the cervix due to multiple causes

>>>>>>
KHAVIGUNYA at the site of this affliction
>>>>>>
DOSHA PRAKOPE at the local site
>>>>>>
VAATA or KAPHA KARMA DUSHTI
>>>>>>
DAAHA, KANDU, SHOOLA, SRAAVA based on the dominance of the DOSHA

LAXANAS –

 Large amounts of vaginal discharge that's green, brown, pale or yellow and pus-like
and that sometimes has an unpleasant odor
 Frequent, painful urination
 Pain during intercourse
 Vaginal bleeding after intercourse, not associated with a menstrual period
 Pelvic or abdominal pain

MOST OF THE CASES OF CERVICITIS MAY FALL UNDER PITTALA YONI –

PITTALAA YONI -
व्यापद कतु अम्ल लवणाक्षारादयै ः पित्तजा भवे त
दाह पाक ज्वर उष्ण आर्ता नील पीत असित आर्तवा
भृ श उष्ण कुणप स्रावा योनिः स्यात पित्त दषि ू ता – चरक चिकित्सा स्थान ३०/११-१२
-PITTALAA YONI occurs due to the intake of the PITTA VARDHAKAA AAHAARA and
VIHAARA
-there is burning sensations
-there can be suppuration due to increased inflammation
-fever can also be present
-patient feels increased heat in the body
-secretions of the vagina are bluish, blackish or yellowish
-patient feels that secretions are quite hot with the smell like that of a dead body

FIBROID UTERUS
WHAT ARE FIBROIDS -

 Uterine fibroids are benign tumors that originate in the uterus (womb).
 It is not known exactly why women develop uterine fibroids.
 Most women with uterine fibroids have no symptoms. However, fibroids can cause a
number of symptoms depending on their size, location within the uterus, and how
close they are to adjacent pelvic organs. These are most commonly abnormal
bleeding, pain and pressure.

Uterine fibroids are considered mostly a KAPHA-accumulation disorder, but often involve
PITTA AND VAATA displacements/VAIGUNYA also, in which case the patient may be
considered as precancerous.

NIDANA (CAUSATIVE FACTORS) -

All Causes of KAPHA accumulation
--sleeping between sunrise and sunset
--eating KAPHA provoking foods and eating after 7pm
--having sex during the menses
--unresolved concerns about abortion
--exposure to cold especially on menses
--suppression of urination, defecation or flatulence
--history of scarring from ‘dilatation and curettage’, and many more
--Insufficient exercise, excess food intake
--low thyroid function
--a hidden sense of grief and sadness associated with issues of maternity and conception.
--Retrograde APANA VAAYU
--chronic incomplete evacuation, can lead to accumulation of AMA and later to DOSHIC
changes.

SAMPRAPTI (PATHOGENESIS) -

The psycho-biological KAPHA qualities of cold, slow, heavy, etc. begin to accumulate in the
generalized circulation

>>>>

and eventually into the ARTAVA VAHA SROTAS

>>>>

onset of the menses may become sluggish, pre-menstrual bloating of the breasts, fingers and
abdomen

>>>>

if this gradual accumulation continues, cystic changes may begin to come and go. The patient
may report more lethargy or fatigue. She may report beginning signs of clotting and/or
prolonged menses.

>>>>
endometrial thickening becomes a clinical manifestation of unprocessed, long-standing
KAPHA deposits.

>>>>

This may hamper the normal functions of the VAATA

>>>>

Fibrotic changes represent the manifested stage of disease

Fibroids may grow as much as to displace digestive, respiratory and eliminative organs and
disrupt their functions.

Fibroids may manifest as intra-mural, inter-mural, extra-mural or any combination of these,

depending upon the duration of deposition and degree of trauma.

TYPES OF FIBROIDS -

Different fibroids develop in different locations in and on the uterus.

Intramural Fibroids

Intramural fibroids are the most common type of fibroid. These types appear within the
muscular wall of the uterus. Intramural fibroids may grow larger and can stretch the womb.

Subserosal Fibroids

Subserosal fibroids form on the outside of the uterus, which is called the serosa. They may
grow large enough to make the womb appear bigger on one side.

Pedunculated Fibroids

When subserosal tumors develop a stem (a slender base that supports the tumor), they are
called pedunculated fibroids.

Submucosal Fibroids

These types of tumors develop in the middle muscle layer (myometrium) of the uterus.
Submucosal tumors are not as common as other types, but when they do develop, they may
cause heavy menstrual bleeding and trouble conceiving.

SYMPTOMS -

Many women who have fibroids don't have any symptoms. In those that do have, symptoms
can be influenced by the location, size and number of fibroids. In women who have
symptoms, the most common symptoms of uterine fibroids include --

 Heavy menstrual bleeding

 Menstrual periods lasting more than a week

  Pelvic pressure or pain

 Frequent urination

 Difficulty emptying the bladder

 Constipation

 Backache or leg pains

Uterine fibroids are diagnosed and confirmed by pelvic exam and by ultrasound.

POLYCYSTIC OVARIAN SYNDROME

WHAT IS POLYCYSTIC OVARIAN DISEASE (PCOS)?

Polycystic ovary syndrome is a problem in which a woman’s hormones are out of balance. It
can cause problems with their periods and make it difficult to get pregnant. If it is not treated,
over time it can lead to serious health problems, such as diabetes and heart disease.

ALLTHOUGH IT IS CALLED PCOS, BUT NOT ALL CASES OF PCOS HAVE THE
CYSTS IN THE OVARIES AND NOT ALL OVARIAN CYSTS ARE DUE TO THE
PCOS.

WHAT HAPPENS IN POLYCYSTIC OVARY DISEASE??

This is a complex disorder of the females and generally has all or few of the following signs
and symptoms---

MENSTRUAL DISTURBANCES – oligomenorhoea (less bleeding during the menstrual

period) or amenorrhoea (absence of menstrual periods), sometime there may be
hypermenorhoea (very frequent menstrual periods), sometimes irregular periods.

MUSCULINE CHARACTERS – because of the increased levels of androgenic or

masculinizing hormones in this syndrome, females develop acne and hirsutism (male pattern
hair growth, in the areas where females don’t usually have hair)

METABOLIC SYNDROME -- this appears as a tendency towards central obesity and other
symptoms associated with insulin resistance (insulin becomes unable to work due to some
reasons). Serum insulin and homocysteine levels are higher in women with PCOS.

INFERTILTY – because of the disturbances in the female hormones there is almost

anovulation or the non-maturation of the eggs or the decreased ovulation which is the main
cause of the infertility in these cases.

SYMPTOMS OF PCOD –
  Dull aching, or severe, sudden, and sharp pain or discomfort in the lower abdomen
(one or both sides), pelvis, vagina, lower back, or thighs; pain may be constant or
intermittent—this is the most common symptom
 Fullness, heaviness, pressure, swelling, or bloating in the abdomen
 Breast tenderness
 Pain during or shortly after beginning or end of menstrual period.
 Irregular periods, or abnormal uterine bleeding or spotting
 Change in frequency or ease of urination (such as inability to fully empty the
bladder), or difficulty with bowel movements due to pressure on adjacent pelvic
organs
 Weight gain
 Nausea or vomiting
 Fatigue
 Infertility
 Increased level of hair growth
 Increased facial hair or body hair
 Headaches
 Strange pains in ribs, which feel muscular
 Bloating
 Strange nodules that feel like bruises under the layer of skin

HETU AND SAMPRAAPTI -

The main cause in the development of the PCOS is the development of the INSULIN
RESISTANCE which causes an increased level of the INSULIN in the blood which has
multiple effects on various parts of the body which in turn alter the production of hormones
by the ovary and produce PCOS.

CAUSES OF PRODUCTION OF INSULIN RESISTANCE—

 high dietary intake of triglycerides and fatty acids (excess MEDAYUKTA

AAHAARA)
 high dietary intake of sugars (ATI MADHURA RASA AAHAARA)---- excess
carbohydrates get converted into triglycerides
 then there is LEPTIN INHIBITION --- Leptin is secreted in response to high fat in the
body – which produces inhibition of appetite --- when it detects that fats have
increased in the body
 overeating due to any reason (ADHYASHANA and ATISHANA) – leads to obesity
--- insulin resistance and vice a versa
 fast food --- they are a rich source of calories – inhibit the fats in the body to be used
 animal proteins – cause high levels of cortisol --- which in turn causes insulin
resistance
 sedentary life style
 some diseases like HCV
 OBESITY (STHAULAYA) --- causes change in Insulin receptors in adipose cells ---
insulin cannot work on them --- Insulin is increased in the blood – insulin resistance
 Many other causes like stress, high bacterial load in the body, and IRRGUALR AND
BAD DIET HABITS (MITHYAA AAHAARA VIHAARA) --- cause change in the
insulin receptors --- cause insulin resistance --- which cause OBESITY
EFFECTS OF INSULIN RESISTANCE---

 INSULIN doesn’t bind to insulin receptors -- gets accumulated in blood -

hyperinsulinemia
 High Insulin acts on pituitary and alters the functions of GnRH
o increased LH secretion ---- causes anovulation
o decreased FSH secretion ---- causes non maturity of follicles in ovary
 High INSULIN acts on liver --- cause a decrease in sex hormone binding proteins
(SHBP) --- less binding of androgen --- increased free androgens in the blood – act on
pituitary ---increased LH

 Hyperinsulinemia --- directly affect the theca cells of the ovary --- produce more
androgens
 Hyperinsulinemia --- increases the sympathetic stimulation --- affect the pituitary to
increase the LH production

WHAT AYURVEDA SAYS ABOUT THIS?

Any disease related to female reproductive organs lead to the damage to the progeny or
infertility.
This condition is not explained as a single disease in AYURVEDA but it can be considered
under the heading of YONI VYAAPADA (various utero vaginal disorders).

Also, PUSHPAGHNI REWATI, mentioned by ACHARYA KASHYAPA bears some

similarity with the symptoms of PCOS.

The symptoms commonly found in these conditions can be summarized as below-

1. Menstrual irregularities have been described under ARTAVA VYAPADS

OR YONIROGAS (uterine disorders).

2. Anovulation is included under VANDHYA (infertility).

3. Obesity is the condition described as STHOULYA, A SANTANPANAJANYA

VIKAARA.

4. Acne and Baldness have been described as MUKHADOOSHIKA and KHAALITYA,

two independent pathologies.

5. Hyperinsulinemia leads to type 2 Diabetes mellitus, and is described

under PRAMEHA. It is also manifested as a complication of STHOULYA.

6. Since menstrual irregularities including anovulation and obesity are the commonly

seen symptoms these two has to be taken care with due attention.

SAMPRAAPTI -
When the deranged VAATAADI DOSHA vitiate/disturb the MAANSA, RAKTA and
MEDA and mixed up with disturbed KAPHA thus  they produce circular, raised and knotted
inflammatory swelling called ‘GRANTHI’.
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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.

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In PCOS, developments of follicles have been arrested at one or any level and remain 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 GRANTHIBHUTA ARTAVA
DUSHTI  i.e. cyst, as in PCOS, the follicles becomes cysts instead of developing up to mature
ovum.