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AYURVEDIC APPROACH FOR MANAGEMENT OF OVARIAN CYST: A CASE

REPORT

Article in International Journal of Research in Ayurveda and Pharmacy · April 2020

DOI: 10.7897/2277-4343.110221

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Case Report
www.ijrap.net (ISSN:2229–3566)

AYURVEDIC APPROACH FOR MANAGEMENT OF OVARIAN CYST: A CASE REPORT

Neha Rawat 1, Manjry Anshumala Barla 2, Rakesh Roushan 3*
1
P.G Scholar, P.G Department of Kriya Sharir, CBPACS, New Delhi, India
2
Senior Medical Officer (Ayu.), Government of NCT of Delhi, India
3
Assistant Professor, P.G Department of Kriya Sharir, CBPACS, New Delhi, India
Received on: 31/12/19 Accepted on: 06/02/20

*Corresponding author
E-mail: rakesh.roushan45@gov.in

DOI: 10.7897/2277-4343.110221

ABSTRACT

In this present case study, an18 years old woman patient consulted to the ayurvedic outpatient department (OPD) of polyclinic, Govt. of NCT of Delhi,
New Delhi, India with the complain of pain in lower abdomen and epigastric region, burning micturition and constipation. She was advised for
ultrasonography (USG) and finding suggested a right ovarian cyst measuring 3.32 X 2.75 cm. She was intended to treat with traditional ayurvedic
formulations; the case was treated for 03 months with the combination of different traditional Ayurvedic drugs, with the aim to alleviating symptoms
and dissolves the ovarian cyst. This patient was treated with traditional Ayurvedic formulations like tablet Antaf, syrup Dealka, Gokshuradi guggulu,
Khadir arishta, Punarnavadi guggulu, Kanchnar guggulu, shankh vati, Ashok arishta, Amlapitta mishran and sphatik bhasma. Only traditional
Ayurvedic drugs were used during the treatment. Patient’s condition was assessed through USG after three months of treatment for ovarian cyst which
was completely relieved. This indicates the ovarian cyst can be completely and successfully cured with Ayurvedic treatment.

Keywords: Gokshuradi guggulu, Granthi, Khadir arishta, ovarian cyst and Shankh vati

INTRODUCTION Here we present a case of ovarian cyst that was successfully

treated on the line of Ayurvedic management of Granthi. Ethical
Ovarian cyst is one of the prevalent reasons for ovarian standards were followed as per as per International conference of
dysfunction, which directly affects the fertility. Any ovarian Harmonization-Good Clinical Practices Guidelines (ICH-GCP)
follicle larger than two centimetres in diameter is termed as or as per Declaration of Helsinki guidelines.
ovarian cyst. Ovarian cysts are closed; sac structures within the
ovary filled with a liquid or semisolid substance. Ovarian cysts Presenting complains
affect women of all ages and most often occur during young and
child bearing years. Most ovarian cysts are functional in nature An eighteen-year-old Indian, non-smoker, non-alcoholic
and harmless (benign). Common symptoms of an ovarian cyst are unmarried woman consulted in Out-Patient Department (OPD) of
irregular periods, abnormal uterine bleeding, pain in the abdomen Aam Admi Polyclinic, Rohini sector 18, New Delhi.
or pelvis, fatigue, headaches and nausea. Ovarian cysts are (Government of NCT of Delhi) on 07.09.2018 with complaint of
diagnosed by ultrasound, MRI and CT scan. pain in lower abdomen and epigastric region along with burning
micturition and constipation for about six months. On
In modern system of medicine, the treatment of an ovarian cystis examination, the patient was found anxious with disturbed sleep,
mainly done by hormonal treatment (combined oral contraceptive moderate appetite, constipation and burning micturition. The
pills) or by surgical treatment such as pelvic laparoscopy. This is tongue was coated, voice was vibrant and roughness of the skin
the only management of ovarian cyst present in modern system was present. Patient had Madhyam Sara, Madhyam Samhanana
of medicine to meet urgent need of the patient and challenges are (proper body built), Sama Pramana (normal body proportion),
remain to establish a satisfactory conservatory medical treatment Madhyam Satmya (proper homologation), Madhyam Satva
till date; unavailability of conservative and satisfactory treatment (Balanced Mental strength), Madyayam Vyayamshakti (moderate
in bio-medicine need to search for conservative and satisfactory capability to carry on physical activities), Madhyamaharshakti
treatment available in other medical system. In Ayurveda ovarian and Madhyam Jaranshakti. Vata and Kaphadoshas were mainly
cyst is similar to granthi. It develops due to localization of morbid affected in the patient. Chest expansion was normal with normal
body humours in body tissue1. There are nine different types of respiratory sounds. Heart rate was 72 bpm with normal heart
Granthi have been mentioned in ayurvedic texts depending upon sounds. No organomegaly was seen. Last menstrual Period
the pathological factor and the body tissue involved2-4. (LMP) was on 23.08.2018 for 3 days. Her menstrual cycle was
Pathogenesis of Granthi is explained as when Rakta (blood), regular i.e., after 28 days. Woman had sedentary mode of life and
Mamsa (fleshy/muscles), and Meda (fat/adipose tissue) are was on self-medication for long time and took analgesic for pain
vitiated by Tridoshas that are admixed with Kapha produce relieving. She was advised for ultrasonography (USG) to know
rounded glandular, protuberant, knotty and firm swelling known the cause of complain. USG was done on 12.09.2018 and report
as Granthi5. Such clinical entity can be correlated today as showed cyst in right ovary measuring 3.32 X 2.75 cm. Left ovary
ovarian cyst where vata Dosha (humor) is the predominant was normal in size, shape and echotexture. Ayurvedic drugs were
pathological factor being the natural site of its location (Basti advised for management of cyst.
Pradesh) in the body. The principle of Samprapti Vighatana (i.e.,
to break the pathogenesis) is used for the management of granthi.

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 Neha Rawat et al / Int. J. Res. Ayurveda Pharm. 11 (2), 2020

Treatment schedule are required whereas involved Dushyas are Rakta, Mamsa and
Meda hence the medications should possess vatahara and
Ovarian cystcan be compared to Granthi roga and in the Lekhana (scrapping or dissolving) properties. The treatment
pathogenesis of the Granthi Roga Vata, Kapha dominating schedule given to the patient was as per given below Table 1:
Tridoshas are involved and hence Vata‑Kaphahara medications

Table 1: Timeline of case

Date and Year Clinical events and Intervention

07 September 2018 Patient came to OPD with the complains of-
• Pain in lower abdomen and epigastric region
• Burning micturition and
• Constipation
- Whole abdomen USG was advised to the patient.
Following ayurvedic medicines were advised for oral intake to the patient
1. Tab. Antaf 2 Tablet TDS
2. Syrup Dealka 2 Teaspoonful BD
3. Gokshuradi guggulu 2 Tablet BD
12th September 2018 Whole abdomen USG was done.
USG findings showed- right ovary showing cyst measuring 3.32 X 2.75 cm. Left ovary is normal in size,
shape and echotexture.
17th September 2018 On the basis on USG finding some drugs were withdrawn and a revised drug was advised to continue as
below-
Continued drugs Withdrawn drugs
1. Tab. Antaf 2 Tablet TDS 1) Syrup Dealka
2. Khadir arishta 2tsf BD with equal water after meal 2) Gokshuradi guggulu
3. Punarnavadi guggulu 2 Tablet TDS
12th October 2018 Patient came for follow up. Some drugs were withdrawn and below mentioned drug were advised to continue.
Continued drugs Withdrawn drugs
1) Punarnavadi guggulu 2 Tablet TDS 1. Tab. Antaf
2) Kanchnar guggulu 2 Tablet TDS 2. Khadira rishta
3) Shankh vati 1 Tablet TDS
22th October 2018 Patient came for follow up. Sankhvati was withdrawn and below mentioned drug was advised to continue.
Continued drugs Withdrawn drugs
1. Punarnavadi guggulu 2 Tablet TDS 1. Shankh vati
2. Kanchnar guggulu 2 Tablet TDS
3. Ashoka rishta 2tsf BD with equal water after meal.
29th October 2018 Patient came for follow up and same treatment continued.
20th November 2018 Patient came for follow up and same treatment continued.
28th November 2018 Patient came for follow up and complained for vaginal discharge. Sphatik bhasma was added and advised for
vaginal wash.
Whole abdomen USG was advised.
Continued drugs
1. Punarnavadiguggulu2Tablet TDS
2. Kanchnarguggulu2Tablet TDS
3. Ashoka rishta 2tsf BD with equal water after meal
4. Sphatik bhasma was added for vaginal wash
18th December 2018 Whole abdomen USG findings showed- Both the adnexa normal.
19th December 2018 Patient got complete relief from ovarian cyst.
Patient complained epigastric pain and heartburn.
Continued drugs Withdrawn drugs
1. Tab. Antaf 2 Tablet early in morning empty 1. Punarnavadi guggulu 2 Tablet TDS
stomach. 2. Kanchnar guggulu 2 Tablet TDS
2. Shankh vati 2 Tablet BD 3. Ashoka rishta 2tsf BD with equal water after meal
4. Sphatik bhasma was added for vaginal wash
28th December 2018 During the regular follow up
Continued drugs
1. Tab. Antaf 2 Tablet early in morning empty stomach.
2. Shankh vati 2 Tablet BD
3. Amlapitta mishran 2 Teaspoonful BD
11th January 2019 Relieved of all the complains for which patient came to OPD
No further treatment advised.
Patient was called for follow up and was completely fine.
Withdrawn drugs
1. Tab. Antaf 2 Tablet early in morning empty stomach.
2. Shankh vati 2 Tablet BD
3. Amlapitta mishran 2 Teaspoonful BD

Diet and lifestyle modifications many diseases. Over cooking of vegetables should be avoided; it
loses most of the nutrients. Onion, cabbage, beans, garlic, carrots,
Patient was advised to avoid junk, oily, spicy and refrigerated beets were asked to avoid because it forms excess of gases and
food. Fibres and vegetables were also advised to the patient. Junk plenty of water was recommended for drinking. She was advised
foods are deficient in nutrients and one of the main causes of to increase physical activity.

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 Neha Rawat et al / Int. J. Res. Ayurveda Pharm. 11 (2), 2020

Follow up and outcomes withdrawal during the course of treatment. On 18th December
2018 USG finding suggested both the adnexa normal. Both
Patient’s treatment was started on 7th September 2018. Her ovaries appeared normal in size. There was no evidence of
treatment was continued with oral ayurvedic drugs for three ovarian cyst. The patient got complete relief from ovarian cyst
months. Some other oral ayurvedic drugs were added and (Table 2).

Table 2: Chronological USG report date wise

Before treatment After treatment

12th September 2018 18th December 2018
USG findings- right ovary showing cyst measuring 3.32 X 2.75 cm. Left ovary is normal in USG findings- Both the adnexa normal.
size, shape and echotexture.

Action of Ayurvedic drugs The case was treated on the line of management of Granthi roga.
Mainly Vata and Kapha Doshahara drugs were prescribed
Gokshuradi guggulu mainly acts on Vata and has a great role in because of predominance of Vata and Kapha Dosha in Granthi.
Shukra Dosha. Gokshuradi guggulu is recommend as it helps in These drugs help to cures female disorders. It gives strength to
the treatment of artvadushti as well as helps in the management uterus and ovary. It relieves epigastric pain. Vata and Kapha are
of pain. Vata is responsible for pain and goksuradi guggulu helps the main Doshas involved in Granthi. Generally, poor digestive
in the management of vata “vatasramvataroganshsh power (mandagni) causes production of Ama (partial digested
shukradoshamtatha ashmarim”6. Khadira rishta is food) in the body, which ultimately cause a variety of disorders.
“gulmamgranthikrimenkasamshvasamplehhoudramjayeta.” Constipation occurs due to Vata Vriddhi and is also a root cause
This drug has a direct effect on granthi roga7. Kanchanara of many diseases. These drugs work on both ovarian cyst as well
Guggulu was prescribed due to its Vata‑Kaphahara properties as constipation. It improves absorption and metabolic activities in
i.e., which alleviates the aggravated Vata and Kapha Doshas and the body as well as cures constipation and prevents diseases.
due to its Raktashodhana (purification of blood), Lekhana
(bio‑scraping) and Shothahara (anti-inflammatory) properties it On 17th September 2018 Tab. Antaf along with Khadir arishta
shows significant effect in Granthi8. two teaspoonful twice a day with equal water and Punarnavadi
guggulu two tablets thrice a day were advised and Syrup Dealka
Kanchnar guggulu is one of the preferred drugs for the treatment and Gokshuradi guggulu were withdrawn. On 12th October 2018
of granthi and a lot of effects are observed in several studies for all the drugs were withdrawn only Punarnavadi guggulu two
the management of ovarian cyst. “Grantheenvranach Tablet thrice a day, Kanchnar guggulu two Tablet thrice a day
gulmanschkusthani cha bhaganderm”9 Ashokarishta is effective and Shankh vati one tablet thrice a day were added. On 22th
in scanty menstruation and menorrhagia. It is useful in Yoni roga October 2018 Shankh vati was withdrawn and Ashoka rishta 2
i.e., Asrgdararuja, Yoniruja and Shwetapradara10. Tab Antaf t.s.f. twice a day with equal water was added. These drugs
manufactured by Karnataka antibiotics and pharmaceuticals continued for one month with the regular follow up on 29th
limited contains Glycyrrhiza glabra, Embelica officinalis, October 2018 and 20th November 2018. On 28th November 2018
Narikela Lavana and Shankha Bhasma. It acts an antacid and patient complained of vaginal discharges so; Sphatika bhasma
Anti-flatulent. These medicines were advised to treat epigastric was added for vaginal wash and USG was advised. On 18th
pain. Amlapitta mishran is also indicated for the same. Later on, December 2018 USG was done and the findings showed both the
patient had a complaint of vaginal discharge so; sphatika bhasma adnexa normal. On 19th December 2018 as the patient got
was advised for vaginal wash to the patient. Sphatika bhasma is complete relief from ovarian cyst but burning sensation was still
useful in vaginal discharges as well as low backache as it balances there in epigastric region and pain in abdomen. So, all the above-
vata and pitta. Fibres and vegetables were also advised to the mentioned drugs are withdrawn and Tab. Antaf 2 Tablet early in
patient. Ovarian cyst was completely cured as no sign of ovarian morning empty stomach and Shankh vati two tablets BD were
cyst seen in ultrasonography. There is no recurrence of any advised. On 28th December 2018 same treatment is continued and
symptoms and sign till now. Amlapitta mishran two teaspoonful BD was added. On 11th
January 2019 patient got relieved from all the complaint for which
RESULT AND DISCUSSION patient came to OPD. No further treatment was advised. Patient
was called for follow up and was completely fine. Tab Antaf,
Aetiology of ovarian cyst remains poorly understood. It often Syrup Dealka, Gokshuradi guggulu, Khadira rishta,
affects several family members and is aggravated by obesity. Punarnavadi guggulu, Kanchnar guggulu, shankh vati, Ashoka
Ovarian cyst often leads to pituitary dysfunction, anovulatory rishta, Amlapitta mishran and sphatik bhasma were found
menstrual cycles, androgen excess, obesity, insulin resistance. effective in the treatment of ovarian cyst.
Patients with ovarian cyst may have amenorrhea. Though patients
vary in the severity of each feature. Patient came to OPD with the CONCLUSION
complain of pain in lower abdomen and epigastric region along
with burning micturition and constipation. USG was advised to This Ayurvedic treatment is helpful in treating the patient of
the patient for proper diagnosis. Oral ayurvedic drugs Antaf two ovarian cyst. This approach of treatment should be taken into
tablets thrice a day, Syrup Dealka manufactured by Karnataka consideration for further treatment and research work for ovarian
antibiotics and pharmaceuticals limited 2 Teaspoonful twice a cyst.
day and Gokshuradi guggulu 2 Tablets twice a day were advised
to the patient. USG was done on 12th September 2018. USG Patient perspective
findings suggested right ovary showing cyst measuring 3.32 X
2.75 cm. Left ovary was normal in size, shape and echo texture. The patient was satisfied with the improvement. Her ultrasound
Ovarian cyst requires the demonstration of cyst in the ovary reports showed no evidence of ovarian cyst along with symptoms.
which are most readily detected by transvaginal USD. Her pain was also reduced, and she was completely cured with
Ayurvedic management.

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 Neha Rawat et al / Int. J. Res. Ayurveda Pharm. 11 (2), 2020

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Vijananiya Adhyaya. In: Tripathy BN, editors. Astanga
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