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. Nalini sofia 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 Garpa vaayu which is mentioned in the text Pararasasekaram as asathiyam. The symptoms of Garpa vaayu can be correlated with PCOD
3 POLYCYSTIC OVARIAN DISEASEPolycystic 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 LITERATUREகெர்ப்ப வாயுவின் குணம் பொருமு முதரந் தனையடைத்துப் போத மிகவும் வலியுண்டாய்க் குருதிகழியில் வலிதீருங் கொள்ளுங் கெர்ப்ப முறவலிக்கும் வருடி யிடுப்புத் துடையுளையு மயக்கு மலத்தை மிகவிறுக்கும் பெருகப் பணைக்கும் முதரத்திற் பேசும் கெர்ப்ப வாயுவிதே. GARPA VAAYU PCOD உதரந்தனையடைத்து – Amenorrhoea மிகவும் வலியுண்டாம் - Dysmenorrhoea மலத்தை மிகவிறுக்கும் - Constipation பெருகப் பணைக்கும் – Obesity
5 CASE 1 OPD. No: D D.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 -14/07/13No 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 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 Malaivembathy thylam - 30 ml, 20 ml, 15 ml (early morning with neeragaram for 3 days) Cap. Rasaganthi mezhugu 250 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 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. FOLLICULAR STUDY – 22/10/13 Rt adnexa cyst (2.1 ×2 𝑐𝑚), B/L PCO DATE DAY Rt.ovary Lt.ovary E.T 22/10/13 12 1.3×1.6 NDF 9mm 23/10/13 13 0.8×0.7 24/10/13 14 1.4×1.8 10mm 26/10/13 16 1.0×0.8 11mm
11 HORMONE PROFILE- Case 1 22/10/13 FT3 3.28pg/ml FT4 1.05ng/dlTSH mIU/ml 14/11/13 E2(estradiol) – 32.8pg/ml LH mIU/ml FSH mIU/ml Prolactin 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 BEFORE TREATMENT AFTER TREATMENT USG abdomen 23/4/2013 11/1/2014 Polycystic morphology in both ovaries Bulky cervix, Rt. small simple ovarian cyst Single live intrauterine gestation corresponding to 7 wks. 3 days with Rt. ovarian cyst Rt ovary 3.7× 1.4cms Lt ovary 3.3×1.7 cms Rt ovary 5.2×4.2cms showed a cyst 3.6×3.0 cms Weight – 88.5 kg 89 kg
13 case 2 : During the treatment patient get menstrual cycle on 01/10/13, 07/11/13 and 18/01/13BEFORE TREATMENT AFTER TREATMENT USG abdomen 9/6/2013 4/1/2014 Polycystic morphology in both ovaries Normal study Rt ovary 3.7× 1.4cms Lt ovary 3.3×1.7 cms Rt ovary 2.6× 1.3cms Lt ovary 2.2×1.6 cms Weight – 55 kg Weight – 54 kg
14 HORMONE PROFILE- case 2 Date : 30/12/13 E2(estradiol) – 32.2pg/ml ( ) LH mIU/ml (2.30 – 11.0) FSH mIU/ml (1.06 – 9.50) Prolactin ng /ml (7.80 – 33.0) Testosterone – 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 Malaivembathy thylam – malattu noikal, malattu puzhu 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. KI 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 Pediatr Adolesc Gynecol. 2011 Aug;24(4):223-7. Gynaecology- Robert W Shaw, David luesley, Ash monga , 4th edition. Toxicity Studies of Sidha Medicine - Rasagandhi Mezhugu Sheeja T. Tharakan, Girija Kuttan, Ramadasan Kuttan*, M. Kesavan, Sr. Austin and K. Rajagopalan The Open Toxicology Journal, 2010, 4, 43-50 Siddha vaidhya thirattu – Dr. Kuppusamy mudhaliyar Pararasasekaram garpa roga nithanam
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