AN OBSERVATIONAL CLINICAL STUDY FOR THE MANAGEMENT OF GARPA VAAYU (POLYCYSTIC OVARIAN DISEASE)

1. AN OBSERVATIONAL CLINICAL STUDY FOR THE MANAGEMENT OF GARPA VAAYU (POLYCYSTIC OVARIAN DISEASE) Author Dr.C.Pratheepa, P.G.Scholar Co-author :Lecturers Dr. H. Nalinisofia Dr.H.Vetha Merlin Kumari Dept of Maruthuvam, National Institute of Siddha, Chennai.

2. INTRODUCTION Siddha system of medicine is a complete holistic medical system that has been practiced especially in south India for 2000 years and above. Siddha system deals with the combination of herbs, minerals, metals, animal and marine products. Various chronic ailments are treated very well in siddha medicines with out causing desirable side effects. One of such disease is Garpavaayu which is mentioned in the text Pararasasekaram as asathiyam. The symptoms of Garpavaayu can be correlated with PCOD

3. POLYCYSTIC OVARIAN DISEASE Polycystic ovarian disease - gynaecological endocrinopathy with metabolic disturbances1. Prevalence - 2.2% to 26% with age ranged from 18 to 45 years2. Predominant clinical features are irregular menstruation, obesity, chronic non ovulation, insulin resistances, excess of androgenic hormones1 etc. Risk factors are infertility, Type II DM, CVD, Dyslipidemia etc4.

4. REVIEW OF SIDDHA LITERATURE கெர்ப்பவாயுவின்குணம் பொருமுமுதரந்தனையடைத்துப்போதமிகவும்வலியுண்டாய்க் குருதிகழியில்வலிதீருங்கொள்ளுங்கெர்ப்பமுறவலிக்கும் வருடியிடுப்புத்துடையுளையுமயக்குமலத்தைமிகவிறுக்கும் பெருகப்பணைக்கும்முதரத்திற்பேசும்கெர்ப்பவாயுவிதே. GARPA VAAYUPCOD உதரந்தனையடைத்து – Amenorrhoea மிகவும்வலியுண்டாம் - Dysmenorrhoea மலத்தைமிகவிறுக்கும் - Constipation பெருகப்பணைக்கும் – Obesity

5. CASE 1 OPD. No: D 079078D.O.A 5/08/13 • An 20 yrs. old female with the complaints of anxious to have a child since 1 year • Irregular menstruation – 6/60 days cycle • H/O PCOS since 8 months and underwent hormonal treatment for 6 months after that she had taken USG abdomen and the report which revealed the findings of (23/04/13) Polycystic morphology in both ovaries Bulky uterus Rt. small simple ovarian cyst

6. Menstrual date before coming to NIS OPD -14/07/13 • No H/O of DM, HT and thyroidism • Her spouse report shows normal semen analysis • General examination Body weight – 88.5 kg Height – 161 cm Blood pressure- 130/80 mmHg • Systemic examination revealed no abnormality • Routine laboratory investigations of haematological, bio chemical and urine analysis were with in normal.

7. CASE 2 OPD. No: D 075553 DOA : 07/07/13 An 18 yrs. old female with the presenting complaints of irregular periods and weight gain since menarche Patient visit our OPD with the USG report (09/06/13) showing polycystic morphology in both ovaries and a calculus measuring 4mm noted in the upper ureter of lt kidney. Age of menarche – 11yrs M.H : 6/90 days cycle H/O PCOS Menstrual date before coming to NIS OPD – 20/05/13

8. CASE 2 • No H/O of DM, HT and thyroidism • General examination Body weight – 55 kg Height – 140 cm Blood pressure- 120/80 mmHg • Systemic examination reveals no abnormality • Routine laboratory investigations of haematological, bio chemical and urine analysis were with in normal.

9. TREATMENT PROFILE Malaivembathythylam- 30 ml, 20 ml, 15 ml (early morning with neeragaram for 3 days) Cap. Rasaganthimezhugu250 mg - 2 (bid) Tab. Kukil 200 mgs - 2 (bid) for 20 days following it drug holiday given for one week. The same treatment continued each month.

10. Case 1 During the treatment menstruation occurs on 14/08/13, 10/10/13 and 20/11/13. She was advised for follicular study on october (19/10/13) and hormonal assay.

11. HORMONE PROFILE- Case 1 22/10/13 FT3 3.28pg/ml FT4 1.05ng/dl TSH 3.11 mIU/ml 14/11/13 E2(estradiol) – 32.8pg/ml LH - 2.71mIU/ml FSH - 5.97mIU/ml Prolactin - 5.81 ng /ml

12. Case 1:In the next month patient reported for absence of menstruation for 50days and the urine test shows positive result. After that USG was also repeated

13. case 2: During the treatment patient get menstrual cycle on 01/10/13, 07/11/13 and 18/01/13

14. HORMONE PROFILE- case 2 Date : 30/12/13 E2(estradiol) – 32.2pg/ml (27 - 246) LH - 9.56mIU/ml (2.30 – 11.0) FSH - 4.92mIU/ml (1.06 – 9.50) Prolactin - 14.5 ng /ml (7.80 – 33.0) Testosterone – 43.44 ng/dl (5.00 – 73.0)

15. RESULT • Both the cases get regular menstrual cycle. • No significant changes in their body weight. • The most troublesome problem of PCOS i.e., infertility in first case get conceived. • No adverse effect was observed during treatment period.

16. DISCUSSION • “Toxicity studies of siddha medicine - RGM” in wistar rats did not show any signs of toxicity. • Literature evidence - reveals many relative therapeutic property like anti fertility, hypoglycaemic, hypolipidemic, anti tumour and anti oxidant • Malaivembathythylam – malattunoikal, malattupuzhu • Unlike hormonal therapy the siddha formulations not only treat this disease but also strengthen the uterus, ovaries and correct the hormonal imbalance without any undesirable effects.

17. CONCLUSION From the above case studies we could find that the siddha medicines correct the defect in follicular formation which in turn correct infertility. i.e., the cost effective treatment Further studies with more number of cases holds out a tall promise in the successful management on treatment modalities

18. I express my sincere thanks to Prof.Dr.K.Manickavasagam – Director NIS Prof.Dr.S.Mohan- Dean NIS Lecturers, Dept of Maruthuvam

19. BIBILIOGRAPHY • Howkins and Bourne, Shaw’s Text book of Gynaecology,14th edition, Elsevier publication. • Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents.J PediatrAdolesc Gynecol. 2011 Aug;24(4):223-7. • Gynaecology- Robert W Shaw, David luesley, Ash monga , 4th edition. • Toxicity Studies of Sidha Medicine - RasagandhiMezhuguSheejaT. Tharakan, GirijaKuttan, RamadasanKuttan*, M. Kesavan, Sr. Austin and K. RajagopalanThe Open Toxicology Journal, 2010, 4, 43-50 • Siddha vaidhyathirattu – Dr.Kuppusamymudhaliyar • Pararasasekaramgarparoganithanam

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