Polycystic Ovarian Disease (PCOD)

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Table of Contents
Casestudies of Contents

Brief Medical History

Presenting Complaints with severity and episode duration

1. Complaints of rough coarse hair over chin
2. Scanty menstruation with spotting for the first two days associated with pain and clots, the menstrual cycle is for 4-5/50 days cycle , with blackish discoloration on Menstrual blood
3. Passing of hard stools once in 3 days

Family History:

Patient’s mother also has the same complaint of PCOD since her Menarche, later after hysterectomy the clinical symptoms have subsided.

Integrated Summary

Allopathy Ayurveda
Vital Parameters

BP - 90/60 mm Hg
Pulse - 62/min
Weight - 59.8 Kg
BMI - 23.5
Ht – 165 cms
Asta Sthana Pariksha

Nadi - Vata Kapha Pradhana
Malam - Once in three days/ Vibadha, relieved by taking hot water in morning
Mutra - 5-6 (D)/1 (N), Samyak
Shabda - Prakruta
Sparsha - Prakruta
Drik - Prakruta
Akruti - Madhyama
Examinations

GC - moderate built
PA- On Inspection-No flabby abdomen,
Umbilicus – central
O/ palpation-tenderness over Bilateral iliac regions
O/percussion-normal tympanic abdomen
O/Auscultation – Normal
CVS- clinically NAD
CNS- clinically NAD
RS- clinically NAD
Dasa Vidha Pariksha

Prakriti- Vata kapha
Vikriti- vata kapha
Sara- madhyama
Samhanana- madhyama
Pramana- 59.8 kg, madhyama
Satmya- avara
Satva- pravara
Aharashakti- avara
Vyayam Shakti- madhyama
Vaya- madhyama
Desha- jangala
Kala- sharad
RogiBala- Madhyama
Roga Bala- Balwan
DSQ findings Rating
1. ADRS
low
2. ADSS
Med
NidanaPanchaka

Nidana -Kapha Vriddikara Aharas
like more oily foods, cheese, pizza
Purvaroopa - Chronic constipation
Roopa -pain in left side of the abdomen
while lying, Pain during menstruation,
Scanty menstruation with spotting for
first 2 days, Hirsutism
Updrava: NIL
Arishta Lakshana: NIL
Samprapti:
Dosha: Kapha Vata
Dushya: Rasa, Rakta, Meda
Agni - Manda
Ama - Rasa, Rakta & Medo
dhatwagnimandyajanya Ama
Srotas - Rasa, Rakta, Medo
Artava vaha and Purisha vaha
Sroto Dushti Prakara - Sanga ,
Vimarga Gamana
Differential Diagnosis with reasoning

1. Cushing syndrome
2. Androgen secreting tumor
3. Thyroid disorders
PCOD (polycystic ovarian disease)
Symptoms like
Menstrual Irregularity
Infertility
Hirsutisn acne etc

Obesity
Symptoms present with Hirsutism, acne, obesity, Ovarian enlargement and Acantosis Nigricans confirms the PCOD which is supported by USG also.
Differential Diagnosis with reasoning

1. Vataja Artava dushti
2. Anartava
3. Udavartini Yoni Vyapat

Medavruta vata leading to arthava dusti

1. Arthava Kshaya
2. Shoola yukta arthava pravritti
3. Sthoulya
4. Vandhyatva

All the bold marked above symptoms are present in the patient, so its diagnosed as Medavruta Vata leading to Arthava Dushti.
Evidence Based Diagnosis:
- PCOD
- Current medication
Evidence Based Diagnosis:

Medavruta Vata leading to Artava Dushti
Chikitsa Vivechana:
Type – OPT/IPT
Duration – 8 days

Primary Treatments:
Deepana and Pachana: Panchakola Choorna 1tsp twice a day for 3 days

Main Treatments:
Snehapana: Guggulu Tiktaka Ghrita for 3 days in Arohana Karma, with 30ml on day 1 of Snehapana, 60ml, 90ml and 110ml on the consecutive days.
Swedana: Sarvanga Abhyanga by Dhanwantara Taila and Bashpa Sweda for the next three days
Virechana: On the third day of Swedana, Virechana Aushada with Mishraka Sneha 40 ml followed by Triphala Kashaya 150ml was given and advised patient to observe for the Vegas.
Vegas: Pittanta virechana with 10 vegas.

Post Treatments:
- Lightness of body was observed
- Apppettie was stabilized
- Sukha prabhodana – patient used to feel enthusiastic once after waking up
Samyak pravartana of vid mootra
Weight was reduced after treatment to 57.8 kg i.e., around 2 kgs after virechana

Chikitsa Paddhati with details of dose of medicine: After virechana
- Kalyanaka kshara 2 pinch twice a day
- Saptasara kashaya 15ml twice a day before food
- Satavari gulum 1tsp, once at bed time
- Guggulu tiktaka grita 10ml in empty stomach in morning followed by hot water.
The above medicines were continued for a period of one month followed by virechana Later a rescan was adviced, the reports of which are attached.
Arthava pravritti after treatment showed normal colour of arthava with no pain during menstruation , malabaddata was totally recovered with passing of stools once a day
But no improvement in hirsutism was observed.

Referral Opinion Sought if any: Patient after the rescan after one month was advised to take the opinion of the surgeon for the persisting endometrial cyst. For the same patient was advised to undergo laparoscopic excision of the same. The same was advised to be followed as the cyst was large enough.

Integrated View: PCOD is a disease which is said to be manifested as the result of medavruta vata leading to artava dushti manifested as a result of altered vata kapha and rasa rakta, artava and medovaha sroto dushti.

 

Outcome

  • Specific Outcome scale used-

USG outcome before and after treatment:

USG : BEFORE TREATMENT AFTER TREATMENT
- Before treatment USG report: The uterus is normal in size and echo pattern The uterus, measures 59.4 *27.5* 38.1 mm
- The endometrium thickness is 5.9 mm hyperechoic
- Both ovaries have polycystic ovarian pattern
- Right ovary is bulky with hypoechoic, poorly vascular cyst approximate 54.18*40.9*51.3 mm and 59.4 cm3 vol
- The right ovary measures 63.5* 51.4*59.0 mm and 100.8 cm 3vol
- The left ovary measures 52.2*26.2*20.2 mm and 14.5cm3 vol
- No free fluid is seen in the pelvis
- The uterus is normal in size and echo pattern
- The uterus, measures 62.8 *24.7* 41.6 mm
- The endometrium thickness is 4.4 mm trilaminar
- Both ovaries have a polycystic ovarian pattern
- Right ovary is bulky with large poorly vascular hypoechoic cyst? Endometriotic heamorrhagic corpus luteum?
- Nature : measures approximate 78.5*58.3*78.2 mm and 187 cm3 vol Occupy entire ovary right side
- The left ovary measures 26.8* 17.1*25.4 mm and 6.1 cm 3vol, has multifollicular pattern and is normal in size
- No free fluid or mass is seen in the pelvis Inference:

Specific Outcome scale used- USG outcome before and after treatment:

# Outcome Parameters / / Date-Time: TSD 19/10/2014 TED 24/10/2014 R 8/11/2014
1.
Sleep (Nidra)
Disturbed
Sound
Sound
2.
Appetite (Agni)
Manda
Sama
Sama
3.
Bowels (Mala)
Constipated
Samyak
Samyak
4.
Urination (Mutra)
Samyak
Samyak
Samyak
5.
Stress (Manas)
Low
Low
Low
8.
BP
90/60
110/70
120/80
9.
Pulse
62/min
70/min
75/min
10.
Weight, Kg
59.8
57.8
57.5

Patient’s Outcome Scale

# Presenting Complaint Status_TSD Status_TED Status_2 Month
1.
Hirsutism
present
present
present
2.
Scanty menstruation
Present for 4-5 days with spotting for first 2 days.
present
Absent
3.
Painful menstruation
present
present
Absent
4.
Colour of the menstrual blood
Black
Dark red
Normal
5.
Hard stool
Once in 3 days
Regular, once daily
Regular, once daily
5.
Menstrual cycle
4-5/50 days cylce
-
4-5/35 days cycle
Attachments
Lab Reports At the start of Treatment 24/09/14 Post treatment 24/11/14
Lab Reports

Other reports Ca 125 ovarian cancer marker serum
Nil

Conclusion

At the end of the classical Ayurveda treatments complete improvement in left ovary with multifollicular pattern and normal size restoration of the ovary was achieved. Clinically it was evident from the fact that the menstrual period was regular and normal – without pain, and normal in colour and amount. There was an improvement in meda dhatwagani which is evident from the fact that patient has lost 2kgs of weight during the course of treatment.

Patient’s testimonials

* Outcomes may vary from person to person

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