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Introduction

Polycystic Ovary Syndrome or PCOS was previously known as the Polycystic Ovarian Disease (PCOD) and Stein-Leventhal Syndrome. Polycystic Ovarian Syndrome (PCOS) is a systemic endocrine dysfunction specifically, androgen production disturbed metabolism, affecting approximately 10% of women of reproductive age with onset manifesting as early as puberty, includes oligo/amenorrhoea, hirsutism, obesity and enlarged ovaries with multiple small cysts and thickened tunica.[1,2] One out of three symptoms are consistent with the diagnosis of PCOS such as  infertility, menstrual irregularity, or hirsutism.[3] Although, the aetiology of PCOS is uncertain according to the modern science, it can be explained as per Ayurvedic principles as one of the Anukta Vyadhi. Due to Mithya Aahara-Vihara (improper dietary habits and lifestyle), Vata Dosha and Kapha Dosha get aggravated which mainly vitiate Rasa Dhatu and Meda Dhatu, leading to Rajodushti and Artavavaha Srotodushti, subsequently resulting in manifestation of group of symptoms (syndrome). Agneya Guna of Artava indicates the involvement of Pitta Dosha.[4] Artavanasha (absence of menstrual flow) occurs because of Avarana (obstruction) in Srotas (body channels). Women with PCOS may present with features of diabetes mellitus because there is insulin resistance leading to excessive androgen production. It has already been mentioned in Ayurveda classics that Prameha is a Medogata Vikara wherein there is Avarana of Medo-Dhatu. As PCOS is a syndrome related to lifestyle & metabolic disorders, diet and lifestyle management have a special importance. Ayurveda system of medicine prescribes diet and lifestyle modifications for management of various diseases which can prove useful in management of PCOS too. Along with medical treatment, diet and lifestyle management are equally important in alleviation of diseases. Ayurveda gives precedence to prevention of diseases over cure of diseases in human beings. Acharya Charaka has mentioned dietetic rules under ‘Ashta Ahara Vidhivisheshaayatana’ as well as Vihara explained under Dinacharya (daily regimen) which can be instrumental in the management of PCOS.This article is aimed to draw role of Pathyapthya in PCOS and list out the Pathya Ahara and Vihara for PCOS as well as Apathya Ahara and Vihara for PCOS.

Materials and Methods: The available literature has been reviewed from ayurvedic texts, modern medicine, and research journals regarding Pathya Ahara (diet) & Vihara (lifestyle) with special reference to PCOS. In this critical review, PCOS in the context of Anukta Vyadhi have also been compiled from Charaka Samhita.

Results:

According to Charaka Samhita, there are innumerable diseases because the same vitiated Dosha causes various disorders according to variations in etiology and location. Hence one should initiate any treatment after acquiring complete knowledge of following: inherent nature of the disease, its pathogenesis, origin or site of lesion and location of presentation and etiological factors.[5] PCOS is one of the Santarpanottha Vyadhi. The inflammatory changes in patients with PCOS can also be linked    to    excessive    weight    gain    which    can    be correlated   with Samavastha (metabolic   toxins) in Ayurveda.  Apathya Aahara Vihara (unwholesome diet and lifestyle) causes    the    formation    of Aama in Rasadhathu which in turn causes Artava Upadathu Dushti. The Aama thus produced, vitiates    the    remaining Dhatu which manifests as excessive weight gain and hair loss. Kapha Dosha and Medo Dushti occur due to excessive intake of fatty diet along with Avyayama (lack of exercise) and Divaswapna (daytime sleep). By taking all these facts into consideration, line of treatment should be decided by the physician. Appropriate Shodhana (elimination therapy), Shamana (alleviation therapy) and Nidana – Parivarjana (avoidance of etiological factors) along with Pathya Ahara Vihara can play significant role in the management of PCOS.[6] Ayurveda is a science which has given importance to diet and regimen as a part of Chikitsa. Pathya – Apathya has a major supportive role in the management of PCOS. It also states that even the best medicines will not be useful if a wholesome diet is not followed.

Concept of Pathyapathya: Acharya Charaka mentioned Pathya as “that which does not adversely affect the Patha (channels) related to body and mind; while Apathya is opposite of that.’’[7] Both Pathya and Apathya as dos and don’ts have been mentioned in the context of treatment of various diseases. The physician desirous of success in treatment should take both (Pathya and Apathya) into consideration. Owing to this, Pathya is also mentioned as one of the synonyms of Chikitsa (treatment), being integral part of medicine. The importance of Pathya (wholesome) and Apathya (unwholesome) in Ayurveda are often deduced from the very fact that Acharya Charaka had detailed Pathya (wholesome) as a synonym for treatment. He stated that when channels of circulation become hard by aggravated and vitiated Dosha, Pathya (wholesome) helps to soften the Srotas (channels of circulation) and Dosha alleviation. He also elaborately described the concept of Pathya (wholesome) and Apathya (unwholesome) giving a general list of Pathya (wholesome) and Apathya Dravya (unwholesome) along with specific Pathya (wholesome) and Apathya Dravya (unwholesome) for patients and Sansarjana Karma (specific food regime) for patients who have undergone Panchakarma Therapy.[8] Acharya Susruta had specifically written a chapter named Hita-Ahitiya Aadhyay in Sutrasthana.

Concept of Ahara Vidhi Vishesha Ayatana:  Ahara Vidhi Vishesha Ayatana means, the factors responsible for the wholesomeness or unwholesomeness of the diet. These factors explore each and every aspect of Aahara.[9] Ahara Vidhi Vishesha Ayatana comprises of Prakriti (Qualities/nature/properties/inherent attributes of the food substances/items), Karana (Processing of food), Samyoga (Combination of items), Rashi (Quantity of food), Desha (Habitat), Kala (Time & seasonal variation), Upayokta (Person consuming the food) and Upayoga Samstha (rules while taking food). These are essential for proper digestion. If these dietetic rules are not observed, then the food will not be properly digested. This may lead to Ama (undigested incompatible food toxins) formation further resulting into diseases.

Concept of Dinacharya: The Sanskrit word Dinacharya means "the daily routine". According to Ayurveda, one should follow Dinacharya in order to lead a healthy and disease free life. Ayurveda gives more stress on prevention of diseases than treatment of a disease. Ayurveda in its literature has given detailed practices (Charya) that one should follow every day to establish the balance of Dosha, Dhatu and Mala in our body, which helps to maintain the healthy status of the person. Dinacharya helps to establish balance in one’s constitution. It also regularizes a person’s biological clock, aids digestion, absorption and assimilation and generates self esteem, discipline, peace, happiness and longevity. [10]

The Charakokta Ahara Vidhi Vishesha Ayatana and Dinacharya have to be taken into consideration in deciding the Pathya Ahara – Vihara as well as Pathya Ahara – Vihara for PCOS patients.

• Pathya Ahara: Chapatti prepared with Yava (barley), millet like Jowara, Ragi; regular use of Laja (puffed rice/ grains), Moong Daal (green gram) with or without husk or sprouted or Tuvar Daal in food. Use of fruits like papaya, orange, sweet lemon, coconut water, salads prepared with cucumber, carrot, radish, spinach etc. Vegetables soups prepared of Patola (Trichosanthes dioica), gourd etc., luke warm water and seasoned honey.
• Pathya Vihara: Waking up early morning, regular exercises, brisk walking, swimming, playing outdoor games, Yoga, Aachara Rasayana, Sadvritta (following code of conduct).
• Apathya Ahara: Heavy fried food, black gram, refined foods, sugar, Amla Dravya, Teekshna Dravys,  Adhyashana/Anashana, Viruddhahara, Abhishyandi Bhojana, Ruksha, Paryushita Ahara, food with high soy supplements, French fries, mashed potatoes, corn flacks, canned food.
• Apathya Vihara: Vegadharana, Prajagarana, Atishrama , Ativyayam and Akalbhojana

Discussion

PCOS is one of the lifestyle disorders prevalent in females. Its Samprapti has to be well understood on the basis of Ayurvedic concepts to decide the line of treatment according to Ayurvedic principles. PCOS involves aggravation of Kapha and Vata Dosha along with Pitta Dosha. Rasvahaa, Medovaha and Artvavaha Srotas are involved in it. Being one of the Santarpanottha Vyadhi, Apatarpana Upakrama would be helpful in the management of PCOS. Along with Shodhana, Shamana and Nidana Parivarjana, Pathya Ahara – Vihara plays significant role in treatment. The Charakokta Ahara Vidhi Vishesha Ayatana and Dinacharya are helpful in deciding Pathya Ahara – Vihara in PCOS patients. Laghu, Ruksha, Ushana Gunatmaka, Katu – Tikta - Kashaya Rasatmaka Ahara and Vyayama (exercise) should be advised in PCOS patients. These types of diet and regime would help in alleviation of Kapha and Vata Dosha along with Pitta Dosha, removing the obstruction of Srotas as well as formation of excellent quality of Rasa, Meda and Artava thus leading proper menstrual cycle and healthy reproductive life in females.

Conclusion

Pathya Ahara-Vihara based on the Charakokta Ahara Vidhi Vishesha Ayatana and Dinacharya can play significant role in the management of PCOS.