management of pcos in unani system of medicine by dr. shaikh nikhat

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MANAGEMENT OF PCOS IN UNANI SYSTEM OF MEDICINE DR.SHAIKH NIKHAT RESEARCH OFFICER (U) CCRUM, NEW DELHI, MINISTRY OF AYUSH, GOVT. OF INDIA 9820399433 [email protected]

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Page 1: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

MANAGEMENT OF PCOS IN UNANI SYSTEM OF MEDICINE

DR.SHAIKH NIKHATRESEARCH OFFICER (U)

CCRUM, NEW DELHI, MINISTRY OF AYUSH, GOVT. OF INDIA 9820399433

[email protected]

Page 2: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat
Page 3: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

• What is Polycystic Ovary Syndrome (PCOS) & Polycystic Ovarian Diseases?• Why is PCOS important?• What causes PCOS?• Can PCOS be cured?• Will I be able to have children?

Questions

Page 4: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

PCOD vs PCOS

• Ovaries are very important parts of female reproductive system.

• every normal female has two ovaries

• Both ovaries release ova into uterus, every month.

• Ovaries also produce many hormones, Estrogen (female hormone) and Androgens or testosterone (male hormones).

• PCOD and PCOS are the diseases associated with ovaries.

Page 5: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

PCOD• an enlarged ovary and small follicular cysts or immature follicles

(0.5—1.0 cm diameter). • It is hormonal imbalance• Its lead to collection of mature eggs in the ovary, as they cannot be

discharged. • some cysts leads to more cysts and this cycle goes on. • Although reasons vary from person to person, but insulin, diet,

hormonal disturbances and stress are some cause, which leads to PCOD.

• Sing and symptoms:• irregular periods, hair pattern (male patterns), central obesity and

infertility. • FSH and LH levels are important for the diagnosis of disease • PCOD does not exactly mean infertility, many women can bear

child even with this disease.

Page 6: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

PCOS• PCOS is another condition of ovaries. • In this condition, more than twelve follicles are produced

every month, but as they all are, immature• so no ovum is releases and resultantly, ovaries start

producing higher level of testosterones, which leads to hormonal imbalance.

• One forth population of women are having multiple follicles in ovaries, but only 10% women suffer from PCOS.

• Symptoms for this syndrome are irregular periods, weight gain, Acne; difficulties in pregnancy and thinning of hair etc.

Page 7: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Differences and Similarities

• Both (PCOD and PCOS) are associated with malfunctioning of ovaries.

• Both are caused by hormonal imbalance • Symptoms like irregular periods are common in both

cases.• PCOS leads to thinning of hair• While in PCOD a female develop hair pattern like

males. • PCOD is not very serious if we compare it with PCOS,

which is more severe form of this syndrome.

Page 8: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Single cysts on ultrasound or follicles Loss of periods due to stress, rapid weight

loss or excessive exercise Loss of periods due to premature menopause

D/D or What is not PCOS?

Page 9: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat
Page 10: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

MenstrualIrregularities

Androgens Ultrasound

PCOS

PCOS PCOS

PCOS

PCOS Types

Page 11: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

• Cycles consistently more than 35 days

• Less than 10 periods per year

Irregular periods

Page 12: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Hypothalamus

Pituitary

Ovaries

Uterus

GnRH

FSHLH

OestrogenProgesterone

Page 13: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

• Androgens= ‘male-type’ hormone

• Sometimes increased hair growth on face, chest, back (hirsutism)

• Sometimes loss of hair on the scalp (alopecia)• Sometimes acne• Can be seen on a blood test

Increased androgens

Page 14: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

• Trans-vaginal (internal)ultrasound

is best

Ultrasound appearance

Page 15: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

PCOS Presentation• Two of the following symptoms:

–Polycystic ovaries (PCO)–Hyperandrogenism–AnovulationNo single criteria is sufficient for clinical diagnosis.

• Additional features may include:

Abnormal bleedingObesityAcneInfertility

Azziz R, Obstetrics and Gynecology, 2003.

Page 16: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat
Page 17: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat
Page 18: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

What causes PCOS?GENETICS LIFESTYLE

Hormonal Changes

↑ Insulin

OVARIESAnovulation

Irregular Periods

CARDIO- VASCULAR RISK

↑ Androgens

Hair GrowthAcne

Page 19: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

CONSEQUENCE (COMPLICATIONS)

• PCOS: Short term effects

• Irregular periods

• Hair growth

• Acne

• Infertility

• Psychological

Page 20: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

PCOS: Long term effects

• Insulin Resistance– High association with PCOS– 10% have Type 2 Diabetes– 30%-35% have Impaired Glucose Tolerance

(IGT)• Obesity

– 50% of PCOD patients are obese

Page 21: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

• Not all women with PCOS are overweight• Being overweight increases the signs and

symptoms of PCOS• Weight loss has been shown to reduce the

signs and symptoms of PCOS and reduce the risk of long-term consequences

Weight and PCOS

Page 22: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

PCOS: Metabolic Disorder• Endometrial Cancer

– Long-term follow-up of 786 PCOS women found an increased risk of endometrial cancer

• Cardiovascular Disease– Increased risk of myocardial infarction in PCOS

women• Sleep Apnea

– Increased Sleep Disordered Breathing (SDB) and daytime sleepiness in PCOS vs. controls

• Depression– Higher prevalence in PCOS patients, associated with higher body mass index

(BMI, P=0.05) and greater insulin resistance (P=0.02)

Wild S et al, Human Fertility, 2000.

Pillay OC et al, Human Reproduction, 2006.

Paradisi G et al, Circulation, 2001.

Page 23: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

PCOS - Pregnancy Complications• Spontaneous Abortions

– Increased in high BMI/PCOS patients• Gestational Diabetes• Pregnancy Induced Hypertension• Infertility >75% of women with anovulation infertility•Follicular arrest

– Impaired selection of dominant follicle–Risk of multiple pregnancy with treatment

.

Page 24: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Most of the time not diagnosed (we missed the early diagnosis)

• PATIENT COMES TO THE DOCTOR WITH C/O• Primary infertility / after married if pt is not

conceived • Amenorrhea / irregular menses • Acne / pimples• Hair loss• Obesity

Page 25: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

INVESTIAGTIONS TESTING

• Serum HCG• Serum prolactin• Thyroid function test• FSH: r/o ovarian failure • Serum luteinizing hormone (LH)—

elevated• Serum estradiol—normal• Serum estrone—elevated

Page 26: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

TESTING

• Fasting glucose: elevated • 2 hour OGTT: elevated • Fasting insulin: elevated • Free testosterone: elevated• DHEA-S: normal• 17-hydroxyprogesterone: normal• Pelvic USG

Page 27: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

•Gynecologist• Fertility Specialist• Endocrinologist• Dermatologist•Allied health professionals• Dietician/ Jim

Page 28: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

TREATMENT MODALITIES

• OBESITY: Weight loss• HIRSUTISM: Mechanical hair removal• SUPPRESS OVARIAN ANDROGEN &

REGULATE THE MENSES: Combination estrogen-progestin pill first line when fertility is not desired.

• OCP plus antiandrogen (spironolactone)• INSULIN-SENSITIZING AGENTS:METFORMIN

Page 29: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

METFORMIN

• Decreases hepatic glucose production• Reduces need for insulin secretion• Improves insulin sensitivity (increases

peripheral glucose uptake and utilization)

• Antilipolytic effect—reduces fatty acid concentrations and reduces gluconeogenesis

Page 30: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

FINAL OUTCOMES / RESULTS????

Page 31: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

When PCOD come to us • With complaints of amenorrhea /

oligomenorrhea• Dysmenorrhea• Some time with all investigation and

confirmed diagnosis by USG report

Page 32: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Being a Unani Hakim

• History about• Menstrual cycle• Diet• Sleep• Bowel • Physical exercise • Mental / emotional

status • Medication (OCP/HRT)• Addiction

Page 33: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Very important to understand the concept of PCOS/PCOD In Unani System

of medicine

• The disease has not been defined under the term of PCOS / PCOD

• Unani physicians described the PCOS under the headings of qillate tams, ehtebase tams, and uqr.

• uqr (infertility) is an advanced stage

Page 34: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

• symptoms like obesity and hirsutism associated with Amenorrhea or oligomenorrhea are clearly described in classical texts.

• Further Jalinoos says women become amenorrheic if her mizaj transformed towards masculinity and develops the features like male pattern hair growth, hoarseness of voice etc.

Page 35: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

The major causes

within the uterus• impairment of humors

(Akhlat).• sue mizaj barid of rehm• sue mizaj barid causes

increase in the viscosity of the Khilte balgham

• sudda (obstruction),• waram, and • trauma or due to the spasm of

the blood vessels

outside the uterus• due to Sue Mizaj of Jigar or

Zoafe Jigar• malnutrition• Anemia • Over eating • lack of exercise• Depression• Late marriages • Stress, lack of sleeping• Obesity

Page 36: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

As a curative measures…. by following Golden Unani principles

• Elimination of the existing causes (Correction of Metabolism) / Islahe Jigar • Correction of the Sue Mizaj Barid • Following Asbab Sitta Zarooriyah • Ilaj Bil Tadbeer

Page 37: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Ilaj Bil Ghiza (Diet therapy) for the management of Obesity

Page 38: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

May increase in Kamiyat (quantity/ Volume)

Food should be decreased in terms of Kaifiyat (quality / Calories)

Kamiyat wa Kaifiyat (Quantity & Quality)

Page 39: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat
Page 40: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Ilaj Bil Tadbeer (Regimenal therapies): • Increase the physical activity to produce fatigue. • Body massage with hot oils. • Exercise before meals • Proper sleep (depend on person..5-7 hrs) • Avoid late night sleep• Early morning wakeup• Bathing before meal • Stay for long time in hammam causes excessive

sweating

Page 41: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

U may adopt out door games like

• Swimming • Brisk walking• jogging,• running, • jumping rope• Playing tennis• Skipping• Foot ball• Basket ball• kabaddi & Cricket

Page 42: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Ilaj Bil Dawa (Pharmaco therapy)

Page 43: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

• Liver correctives: corrects the Sue Mizaje Kabid and ultimately correcting the qillat tams due to anemia

• Mudir haiz drugs (emmenagogue): Due to its mudirr and mulattif properties liquefying the blood and removes the sudda there by it clears the passage for menstrual blood.

• The mizaj of such drugs are haar and lateef, which stimulate the flow of blood towards uterus and its blood vessels and dilate them.

Page 44: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Ilaj Bil Dawa (pharmaco therapy):• Munzij wa Mushil Therapy (MMT) Regimen: • Form of Drugs: Joshanda for 21 days• Along with Sharbat Deenar 20 ml BD• Majoon Dabedulward 5 gm OD after Breakfast • From 22nd Day: Habbe Mudirr & Wet Cupping

Therapy on both calf and thighs (4 cups)

Page 45: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Chief ingredients of MMT are

• badiyan, • Beekhe badiyan, • mako khushk, • gule surkh, • anjeer zard,• parsiyaoshan, • chiraeta shirin

• Emmenagogue,• deobstruent, • Dessicant • anti inflammatory• liver correctives,• antihyperlipidemic, • anti obesity,

Antidiabetic Activity as well.

Page 46: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Al Hijama (Wet Cupping therapy) for Qillat wa Ahetebas Tams

• It is an effective method for Istafrague-e-Akhlat-e-Fasida (Evacuation of diseases matter) from the body.

• It is a minor surgical eliminatory procedure where negative pressure (suction force) is applied to the skin surface using cups.

• Scarifications of the skin uplifting opens skin barrier for the evacuation of fluids admixed with pathogenesis causing substances.

• Wet cupping therapy is considered as a mode of treatment where humoral imbalance is involved8.

• For qillat tams multiple incisions (25to30) are applied over both the calf muscles and the blood is sucked through application of cups.

Page 47: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Anisoon (Pimpinella anisum) Kamoon (Zeera)

HOT SPICES

Page 48: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Filfil siyah (Piper nigrum) Kishneez (Coriandrum sativum)

Page 49: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Lehsun (Allium sativum) Zanjabeel (Ginger)

Page 50: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Nankhwah (Ptychotis ajowan) Saunf (Foeniculm vulgare)

Page 51: Management of PCOS in Unani System of Medicine by Dr. Shaikh Nikhat

Compound Formulation

• Nuskha-1:• Majoon Saras + majoon muqil hamwazan 10

gm TDS• Nuskha-2:• Majoon Dabedulward 10gm + Arq Badiyan +

Arq Zeera 25 ml TDS