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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 45-48

Role of Matra basti in polycystic ovary syndrome: A case report


Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India

Date of Submission07-Jun-2021
Date of Acceptance15-Feb-2022
Date of Web Publication20-Apr-2022

Correspondence Address:
Dr. Sarvesh Kumar Singh
Department of Panchakarma, National Institute of Ayurveda, Jaipur - 302 002, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_46_21

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  Abstract 


Polycystic ovary syndrome is a disorder of reproductive women characterized by hyperandrogenism (elevated free testosterone levels and hirsutism), ovulatory dysfunction, and polycystic ovarian morphology. Here, a case of 29-year-old female was presented with complaints of irregular menstrual cycle, only twice during the last six months associated with severe pain in the lower abdomen and back. Acne on the face, facial hair growth, and increase in weight (from 42 kg to 53 kg) were also associated. The diagnosis of Polycystic Ovarian Syndrome (PCOS) was established through Ultrasonography (USG) and blood hormonal profile (prolactin, serum testosterone total, androstenedione value, complete blood count, thyroid profiles, luteinizing hormone, fasting insulin, dehydroepiandrosterone sulfate, follicle-stimulating hormone, sex hormone-binding globulin, progesterone level, and estrogen level). Ayurvedic treatment was planned on the lines of management for Nastaartava (~ceases of menstrual fluid with ovary dysfunction). Matra basti (a form of unctuous enema) was administered in a dose of 75 ml of Phala ghrita regularly for 24 days starting from 6th day of menstruation cycle. The regimen was adopted for two consecutive cycles. Improvement in USG findings showing reduced endometrial thickness from (9 mm to 6 mm) and ovarian size (from 40 mm × 20 mm to 34 mm × 24 mm of right ovary and 39 mm × 18 mm to 36 mm × 22 mm of left ovary), and normal menstrual cycles were noticed after the treatment. The size of follicle also reduced from >12 mm to 3–7 mm in both ovaries. These findings suggest that Ayurvedic management and Matra basti procedures may be beneficial in case of PCOS.

Keywords: Matra basti, Nastaartava, polycystic ovary syndrome


How to cite this article:
Singh SK, Rajoria K, Sharma S, Regar AK, Jangir RK, Gupta K. Role of Matra basti in polycystic ovary syndrome: A case report. J Ayurveda Case Rep 2022;5:45-8

How to cite this URL:
Singh SK, Rajoria K, Sharma S, Regar AK, Jangir RK, Gupta K. Role of Matra basti in polycystic ovary syndrome: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2022 May 28];5:45-8. Available from: http://www.ayucare.org/text.asp?2022/5/1/45/343504




  Introduction Top


Polycystic Ovarian Syndrome (PCOS) is clinically manifested in reproductive age as ovulatory dysfunction, hyperandrogenism, hirsutism, acne, acanthosis nigricans, and polycystic ovaries.[1] As per the Rotterdam diagnostic criteria of PCOS, at least two of the features the hyper-androgenism, oligo-anovulation, or morphological polycystic ovaries should be present.[2] Prevalence of 8%–13% makes it most common endocrinopathy of young age group in females.[3] Depending on the population studied and the criteria used for diagnosis, the prevalence of PCOS in India ranges from 3.7% to 22.5%.[4] Incidence of PCOS is increasing due to sedentary lifestyles and eating habits. In Ayurveda, PCOS is mentioned under the headings of Yonivyapad (~gynecological disorder),[5] Artava dusti (~menstrual blood disorder),[6] Aartavkshaya (~depletion of menstrual fluid with ovary dysfunction),[7] or Nastaartava (~ceases of menstrual fluid with ovary dysfunction).[8] Currently, the suggested treatment for PCOS is lifestyle modification, pharmacological interventions, and elective surgery. These treatments are associated with substantial costs and side effects.[9] The treatment strategies available in the current times have certain limitations, whereas Ayurveda approaches can provide some leads in the management. A case of diagnosed PCOS is managed following Ayurveda approach. The details are presented herewith.


  Patient Information Top


A 29-year-old unmarried female attended the outpatient department at Ayurveda institute on May 17, 2019, with complaints of irregular and painful menstrual cycles. Only two cycles of menstruation were observed in the last six months. Acne on the face, facial hair growth, and increased weight (from 42 kg to 53 kg) were associated. Her height was 155 cm, and her body mass index was 22.1 kg/m2. Family history was negative for PCOS. She was a postgraduate student and fond of junk foods. She had no fixed sleep and eating patterns. The patient did not have any related medication history.


  Clinical Findings Top


On physical examination, the patient had a clear tongue, clear voice, and rough skin. The patient had Vata-pitta Prakriti (~body constitution according to humors) with Avara samhanana (~lowermost body constitution). Sara (~excellence of Dushya or tissue elements), Satmya (~homologation), Satva (~mental strength), Vyayamshakti (~power of performing exercise), Aharshakti, and Jaranshakti (~mid food intake and digestive power) were Madhyama (~middlemost). She had Krura kostha (~irregular nature of bowel). All systemic examinations were normal. Ultrasonography (USG) (dated-October 06, 2018) showed Endometrial Thickness (ET) of 9 mm, ovarian size of 40 mm × 20 mm and 39 mm × 18 mm, respectively, of right and left ovaries. Multiple small follicles of >12 mm size were observed in both ovaries. Estrogen level was 269.0 pg/ml, and progesterone level was 24.40 ng/dl. Sex hormone-binding globulin, dehydroepiandrosterone sulfate, follicle-stimulating hormone, fasting insulin, luteinizing hormone, prolactin, serum testosterone total and androstenedione value, complete blood count, and thyroid profiles were within normal limits.


  Timeline Top


The detailed timeline of the treatment is given in [Table 1].
Table 1: Timeline

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  Diagnostic Focus and Assessment Top


The diagnosis of PCOS was made on the basis of symptoms and USG findings. The examinations and laboratory investigations do not suggest deranged autoimmune status in patient. Hyperprolactinemia, hypothyroidism, and hypothalamic amenorrhea were ruled out through estimation of prolactin level, thyroid profile, and androgen (progesterone) levels that were within the normal limits in the patient. Considering the case of Nastaartava, treatment is planned.


  Therapeutic Intervention Top


Ayurvedic management was directed to ameliorate various symptoms of PCOS. Matra basti (~ a form of unctuous enema) was administered in the dose of 75 ml for 24 days with Phala ghrita from 6th day of menstrual cycle. The date of menstruation was calculated from previous history of menstrual cycle. This regimen was repeated for two consecutive menstruation cycles [Table 2]. No other medication or intervention was given to the patient. She was advised to follow timely fresh light diet, fixed sleeping time, and avoid junk foods such as pizza, burgers, and stale food. The patient was assessed after completion of each Matra basti regimen on parameters as stated under the follow-up and outcome section.
Table 2: Procedures adopted

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  Follow-up and Outcomes Top


The patient was assessed before starting the treatment on May 17, 2019. Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score[10] was 10, the modified Ferriman–Gallwey index[11] for facial hair was 2, global acne grading system score[12] was also 2, and weight was 53 kg. After the two courses of Matra basti, the WaLIDD score decreased to 7, modified Ferriman–Gallwey index reduced to 1, and global acne grading system score reduced to 0, and weight reduced to 47 kg on July 30, 2019. The retention time of Matra basti was varied from 45 to 90 min. There was improvement in digestive power, and bowel movements were regularized. ET reduced to 6 mm from 9 mm. Ovarian size was reduced. The size of other follicles also reduced from to 3 to 7 mm in both ovaries. The estrogen and progesterone levels were observed to be in normal levels after the treatment [Table 3]. The patient was followed for next six months, where no fresh symptoms nor relapses were noticed.
Table 3: Changes in radiological and hormonal parameters after treatment

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  Discussion Top


In Ayurveda, Nastaartava is not mentioned as an independent disease entity, but it is covered under the Yonivyapada and Artavadusthi. Both are responsible and resultant for each other. The prime pathology behind Nastaartava is obstruction of Artavasrotas due to vitiated Vata, which causes cessation of menstruation and ovulation. This vitiation of Vata can be due to excessive use of junk food, disturbed sleep patterns, and lifestyles such as irregular food habits and excessive traveling. This lead to Dhatukshaya (~depletion of tissues) or Avarana (~distortion of normal Vata function) of Vata by Vata itself or Kapha and Pitta doshas. The line of management of Yonivyapada are Snehana (~oleation), Swedana (~sudation), and Basti (~medicated enema).[13] It is also indicated that Vata dosha should be treated first in all types of Yonivyapada.[14] The patient was lean and thin and had dry skin texture and Krura kostha, indicating vitiation of Vata in the body. Specific line of management of Nastaartava is the use of substances with Vata kapha dosha nashaka (~to pacify Vata and Kapha dosha). Thus, foods such as warm Yusha (~soup of vegetables and/or pulses) and drugs such as Phala ghrita were used.[15] Snehana, Swedana followed by Matra basti with Phala ghrita was administered to counter Avarana of Artavasrotas (~fallopian or uterine tubes) and restore normalization of menstrual cycles. Snehana and Swedana are useful to pacify Vata and Vata kapha doshas, respectively. Phala ghrita has the property of Yonidoshahara (greatest ability to treat all diseases related to female reproductive organs).[16] Hence, the Matra basti with Phala ghrita after Snehana and Swedana follows the line of management of Yonivyapada and Nastartava. Good outcome through this management was noticed. This study suggests that PCOS may be managed with Ayurvedic management for satisfactory outcomes. Findings of this study are important as it throw light on the management of PCOS with Ayurveda principles.


  Conclusion Top


Polycystic ovary syndrome is a complex endocrinal dysfunction with high prevalence and early to long-term risks. Restoration of normal menstrual cycles, reduced ET, ovarian follicle size, normalization of hormones, improvement in bowel habits, and digestive functions were observed after treatment. These findings suggest that the line of management for Yonivyapada may be beneficial in the cases of PCOS. The line of management may further be followed in many cases to establish the efficacies.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given her consent for reporting the case along with the images and other clinical information in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Witchel SF, Oberfield SE, Peña AS. Polycystic ovary syndrome: Pathophysiology, presentation, and treatment with emphasis on adolescent girls. J Endocr Soc 2019;3:1545-73.  Back to cited text no. 1
    
2.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490.  Back to cited text no. 2
    
3.
Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2016;2:16057.  Back to cited text no. 3
    
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Ganie MA, Vasudevan V, Wani IA, Baba MS, Arif T, Rashid A. Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India. Indian J Med Res 2019;150:333-44.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Pandey GS, editor. Caraka Samhita of Agnivesha, Chikitsa Sthana. 1st ed., Ch. 30., Ver. 8. Varanasi: Chaukhamba Sanskrit Sansthan; 2006. p. 841.  Back to cited text no. 5
    
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7.
Shastri AD, editor. Sushrut Samhita of Sushruta, Sutra Sthana. 1st ed., Ch. 15., Ver. 16. Varanasi: Chaukhamba Sanskrit Sansthan; 2014. p. 59.  Back to cited text no. 7
    
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Shastri AD, editor. Sushrut Samhita of Sushruta, Shareera Sthana. 1st ed., Ch. 2., Ver. 23. Varanasi: Chaukhamba Sanskrit Sansthan; 2014. p. 13.  Back to cited text no. 8
    
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Teherán AA, Piñeros LG, Pulido F, Mejía Guatibonza MC. WaLIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. Int J Womens Health 2018;10:35-45.  Back to cited text no. 9
    
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Moolenaar LM, Nahuis MJ, Hompes PG, van der Veen F, Mol BW. Cost-effectiveness of treatment strategies in women with PCOS who do not conceive after six cycles of clomiphene citrate. Reprod Biomed Online 2014;28:606-13.  Back to cited text no. 10
    
11.
Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004;18:671-83.  Back to cited text no. 11
    
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Alsulaimani H, Kokandi A, Khawandanh S, Hamad R. Severity of acne vulgaris: Comparison of two assessment methods. Clin Cosmet Investig Dermatol 2020;13:711-6.  Back to cited text no. 12
    
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Pandey GS, editor. Caraka Samhita of Agnivesha. 1st ed., Vol. 2., Chikitsa Sthan; Ch. 30., Ver. 41. Varanasi: Chaukumba Sanskrit Sansthan; 2006. p. 847.  Back to cited text no. 13
    
14.
Pandey G, editor. Pt. Kasinatha Shastri Vidhyotini Hindi Commentator of Charaka sanhita of Agnivesha. 1st ed., Vol. 2., Chikitsa Sthana; Ch. 30., Ver. 114-5. Varanasi: Chaukhamba Sanskrita Sansthana; 2006. p. 847.  Back to cited text no. 14
    
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Acharya YT, editor. Sushrut Samhita of Sushruta. 1st ed., Sharir Sthan; Ch. 2., Ver. 23. Varanasi: Chaukumba Surbharati Prakashan; 2018. p. 13.  Back to cited text no. 15
    
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Tripathi B, editor. Sharangdhar Samhita of Sharangdhara, Madhyam Khanda. 1st ed., Ch. 9., Ver. 87-90. Varanasi: Chaukhamba Surbharati Prakashan; 2019. p. 230-1.  Back to cited text no. 16
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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Introduction
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Follow-up and Ou...
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