Ayurvedic Management of Ovarian Cyst: A Case Report

Ovarian cysts are fluid-filled sacs that develop either on or within a woman’s ovaries, which are part of the female reproductive system. They are frequently encountered and can form at any stage of life, but they are most often detected in women during their reproductive years. According to Ayurveda, ovarian cysts can be correlated to Kaphaja Granthi Roga. A 49-year-old female patient came to the Outpatient Department (OPD), with complaints of pain in the pelvic region, bloating, heaviness in the lower abdomen, and changes in menstrual patterns in the last six months. Her ultrasonography report suggested an ovarian cyst measuring 66.2×44.2 mm. The condition was addressed with a combination of various traditional ayurvedic medicines like Kanchnar guggulu 2 tab twice a day, Chandraprabha vati 2 tab twice a day, Bruhat panchmula kwath 20 mL twice a day, Ajmodadi churna 1 tsf at night, Varunadi kashyam 10 mL twice a day, all medicine were given for six months. The patient was satisfied with the outcomes. According to her Ultrasound (USG) reports, after six months of treatment there was no evidence of an ovarian cyst, and her symptoms also demonstrated improvement. The current case underscores the effectiveness of Ayurvedic treatment in achieving positive outcomes for managing ovarian cysts.

Artavavaha shrotas,Granthi,Kanchnar guggulu

A 49-year-old female patient came to the OPD, with chief complaints of severe and sharp pain in the pelvic region, bloating, heaviness in the lower abdomen, and irregular menstrual cycle lasting between 5 to 7 days with interval varying from 20 to 25 days since last six months. The patient was asymptomatic six months ago, but gradually began to experience the aforementioned symptoms. She visited the allopathic hospital where a complete blood count, cancer antigen 125, and Ultrasonography were done and she was diagnosed with a right ovarian cyst (66.2×44.2 mm) and was advised surgery. Patient did not take any allopathic medication for ovarian cyst. Then, she came to our OPD for further management. The patient had a known history of hypothyroidism for the past five years and is currently on a daily dose of Thyrox 50 mcg (Thyroxine Sodium). There was no known history of Diabetes Mellitus (DM) or Hypertension (HTN).

The patient had no significant past surgical or medical history, indicating a lack of major medical conditions or surgical interventions. Additionally, the family history was unremarkable, with no significant medical conditions reported, suggesting no notable hereditary health concerns. Her obstetric history was G₀P₃A₀L₃D₀. The patient followed a vegetarian diet (Ahara) and led a generally normal lifestyle (Vihara). Bowel habits were regular, with one movement per day. The patient had an addiction to tea and reported having sound sleep. Urine output was 4-5 times during the day and 0-1 time at night. The patient’s blood group was B+. The patient stated that her menstrual cycles lasted between five to seven days and occurred irregularly, with intervals varying from 20 to 25 days. She experienced increased bleeding accompanied by lower abdominal pain. The patient had a normal built with a height of 158 cm and a weight of 69 kg. Vital signs were within normal ranges, including a pulse rate of 78 beats per minute, blood pressure of 130/80 mmHg, respiration rate of 16 breaths per minute, and a body temperature of 98.6°F. The patient’s gait was also normal, indicating no apparent issues with mobility or balance.

Ashtavidha Pariksha: The patient’s Nadi was identified as Vata-Kapha with a rate of 78 beats per minute. Bowel movements (Mala) were regular, occurring once daily and urinary frequency (Mutra pravritti) was normal at 4-5 times per day. The tongue (Jihva) was coated (Saam), indicating possible Ama (toxins). Speech (Sabda) was clear (Spasta), and touch sensation (Sparsha), vision (Drika), and overall physical appearance (Akruti) were normal, reflecting balanced physiological functions. Dasavidha Pariksha- The patient’s Prakriti was identified as Vata-Kaphaja, while the current imbalance (Vikriti) was of Kaphaja nature. The assessments of strength (Saar, Sahanana), mental resilience (Satva), adaptability to diet and lifestyle (Satmya), body constitution (Pramana), digestive capacity (Aaharshakti), and physical activity capacity (Vyayamashakti) were all classified as moderate. The patient’s age was also in the Madhya stage, indicating middle age. This overall evaluation reflected a balanced yet moderately built constitution with potential areas for improvement in maintaining equilibrium.

On per-abdominal examination, the abdomen was soft with mild tenderness in the lower region, while the per-vaginal examination revealed No Abnormalities Detected (NAD). The results showed haemoglobin at 11.2 g/dL, platelet count at 1.60 lac cells/cumm, fasting blood sugar at 102 mg/dL, and cancer antigen-125 at 21 U/mL. A recent USG examination revealed the presence of a right ovarian cyst measuring 66.2 mm by 44.2 mm. The pharmacological type of therapuetic intervention was given to the patient.

The treatment involved using the specified medications for a duration of three months mentioned in [Table/Fig-1]. After continuation of medicine for three months, patient got symptomatic relief and also improvement in USG findings. Then for other three months, treatment was given to the patient mentioned in [Table/Fig-2]. Follow-up was taken every month. Previously, the patient was pleased with the results. Based on her USG findings, the ovarian cyst was gradually decreased and no longer detected after six months, and her symptoms had also shown improvement. An initial USG showed a right ovarian cyst measuring 66.2×44.2 mm. After three months, a follow-up USG revealed a reduction in size to 34.8×26.4 mm. Another three months later, the cyst had further decreased to 26.5×21 mm. This steady reduction in size over time suggested that the cyst might be gradually resolving by medications. Her pain diminished significantly, and she experienced complete recovery through Ayurvedic treatment. There have been no recurring symptoms or signs since then.

Diagnosing and treating ovarian cysts presents challenges due to the variety of symptoms and overlap with other gynaecological conditions. Traditional diagnosis relies on imaging, such as USG, and markers like Cancer Antigen (CA) which help identify cyst characteristics but cannot always, confirm malignancy without further testing. This case presented a large cyst (66.2×44.2 mm), where standard treatment typically involves surgical removal, especially if symptomatic, as in this case. However, the patient sought Ayurvedic intervention over surgery, posing an opportunity to explore non invasive options but challenging due to limited empirical studies validating Ayurvedic management effectiveness on ovarian cysts.

Ovarian cysts are a prevalent issue in gynaecology and are categorised into two main types: physiological and pathological [1]. Normal cysts, like follicular and luteal cysts, are considered physiological. Conversely, pathological cysts are categorised as ovarian tumours, which can be benign, malignant, or borderline. Benign tumours typically occur more frequently in younger females, whereas malignant tumours are more commonly diagnosed in older females [2].

In Ayurvedic Samhitas, there is a detailed description of Granthi described by Acharyas, which refers to anatomical structures described akin to nodules or growths [3]. Granthi typically forms due to an imbalance in doshas (biological energies) [4]. Ovarian cysts can be correlated with Kaphaja Granthi Roga in Ayurveda [5]. The pathogenesis of Granthi Roga involves the dominance of Vata and Kaphadoshas in the body, along with the imbalance of the Tridosha [6]. Therefore, the treatment for Granthi Roga focuses on Vata and Kapha pacifying medications. Additionally, the tissues (Dushya) involved in this condition are Rakta (blood), Mamsa (muscle), and Meda (fat) [4], indicating the need for medications possessing Vatahara (anti-inflammatory) and Lekhana (scraping or reducing) properties.

Similar studies [7-9] have consistently shown that oral medications (ShamanaChikitsa), Shodhana Chikitsa, and Basti procedures play a major role in treating ovarian cysts [Table/Fig-3]. The treatment resulted in a significant reduction in cyst size, verified by follow-up USGs.

Specific Ayurvedic formulations were chosen based on their properties:

Kanchnar guggulu, is a herbal formulation that is widely used for managing various health conditions, particularly those related to the thyroid gland, cysts, tumours, lymphatic system, and inflammatory disorders. Main component is Kanchnar, which is known for its anti-inflammatory and anti-tumour properties [10]. Chandraprabha vati supports the reproductive and urinary systems. The main ingredients of ChandraprabhaVati typically include a combination of herbs and minerals. These ingredients are combined in specific proportions according to Ayurvedic principles to balance the tridoshas (Vata, Pitta, and Kapha) and to support the functioning of the urinary system and reproductive organs. Bruhat panchmula kwath, with its bitter taste (Katu rasa), heating potency (Ushnaveerya), and light, dry nature, acts as an Aamapachana, aiding toxin digestion and clearing Kapha-induced blockages. Its anti-inflammatory properties and uterine tonic effects also help balance Vata dosha and support reproductive health [11].

Varunadi kashyam is a Shodhanaadi Gana formulation, known for its Kapha-Medohara properties, reduces Kapha and fat tissues, disrupting the Samprapti of Granthi Roga. It is effective for indigestion, obesity, abdominal tumours, enlarged glands, and Vata-related nervous disorders [12]. Ajmodadi churna, a classical Ayurvedic formulation with Ajmoda (Apium graveolens) as its key ingredient, supports joint health, digestion, respiratory wellness, and inflammation management. It combines herbal synergy to enhance overall balance and well-being [13].

The goal was to reduce cyst size, manage pain, and restore the menstrual cycle without invasive measures. Follow-ups every month helped in monitoring and adjusting treatment based on symptomatic changes and USG findings. This case study suggests that with proper patient selection and dosha assessment, Ayurvedic treatment can be an effective alternative to surgery for managing certain types of ovarian cysts. Practitioners should assess the cyst size, symptoms, and patient’s preference for non invasive treatments.

This case study demonstrates that Ayurvedic shamana chikitsa may effectively manage ovarian cysts without the need for surgical intervention. Through carefully selected Ayurvedic formulations and regular follow-ups, the patient experienced significant cyst reduction and symptom relief over six months. This outcome suggests that, with appropriate dosha assessment and patient monitoring, non invasive Ayurvedic therapy could offer a viable alternative to conventional treatment for ovarian cysts.

[1]. Grimes DA, Jones LB, Lopez LM, Schulz KF, Oral contraceptives for functional ovarian cysts Cochrane Database Syst Rev 2014 4:CD00613410.1002/14651858.CD006134.pub5  [Google Scholar]  [CrossRef]

[2]. Hongqian L, Xiangao W, Donghao L, Zhihong L, Gang S, Ovarian masses in children and adolescents in China: Analysis of 203 cases J Ovarian Res 2013 6:4710.1186/1757-2215-6-4723826706PMC3729529  [Google Scholar]  [CrossRef]  [PubMed]

[3]. Acharya YT, Charak Samhita with Chakrapani commentary, Chikitsasthana, Adhyaya 12, verse 81. Reprint ed 2015 VaranasiChaukhambha Orientalia:489  [Google Scholar]

[4]. Shastri HS, Ashtanga Hridyam with Sarvangasundara of Arundatta commentary, Uttaratantra, Adhyaya 29, verse 1. Reprint ed 2016 VaranasiChaukhamba Sanskrit Sansthana:881  [Google Scholar]

[5]. Fernando KAB, Pushpakumari WLAR, Effectiveness of ayurveda treatment for ovarian cyst: A case report International Journal of Scientific and Research Publications 2020 10(7):245-48.10.29322/IJSRP.10.07.2020.p10330  [Google Scholar]  [CrossRef]

[6]. Acharya YT, Sushrut Samhita with Nibandh Sangrah commentary, Nidanasthana, Adhyaya 11, verse 3. Reprint ed 2017 VaranasiChaukhamba Sanskrit Sansthana:310  [Google Scholar]

[7]. Bhaskar PA, Laxman PM, Clinical efficacy of Ayurved treatment on simple ovarian cyst- A case study Ayushdhara 2019 6(6):2492-94.  [Google Scholar]

[8]. Priyanka R, Jiji V, Sreedhar A, Ayurvedic management of ovarian cyst: A case report International Journal of Ayurveda and Pharma Research 2021 9(4):74-77.10.47070/ijapr.v9i4.1915  [Google Scholar]  [CrossRef]

[9]. Deepika Kumar A, Tanwar S, Ayurvedic treatment regime of ovarian hemorrhagic cyst: A case report IRJAY 2023 6:47-50.10.47223/IRJAY.2023.6606  [Google Scholar]  [CrossRef]

[10]. Mishra D, Sharangdhar Samhita, Madhyam Khanda, Adhyaya 7, verses 94-100. First ed 2010 VaranasiChaukhambha Sanskrit Series Office:313  [Google Scholar]

[11]. Murthy KRS, Bhavaprakasa Nighantu, Purva Khanda, Adhyaya 6(IV), Guducyadi varga, verses 13-28. Reprint ed 2016 VaranasiChowkhamba Krishnadas Academy:229-231.  [Google Scholar]

[12]. Shastri HS, Ashtanga Hridyam with Sarvangasundara of Arundatta commentary, Sutrasthana, Adhyaya 15, verses 21-22. Reprint ed 2016 VaranasiChaukhamba Sanskrit Sansthana:236  [Google Scholar]

[13]. Mishra D, Sharangdhar Samhita, Madhyam Khanda, Adhyaya 6, verses 114-118. First ed 2010 VaranasiChaukhambha Sanskrit Series Office:294-295.  [Google Scholar]