Polycystic Ovary Syndrome: Classical Unani Perspectives, Contemporary Understanding, and Therapeutic Approaches: A Narrative Review
Abstract
Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine and metabolic disorders affecting women of reproductive age and is characterized by menstrual irregularities, hyperandrogenism, anovulation, infertility, obesity, and insulin resistance. Despite its high prevalence and significant impact on reproductive and metabolic health, the etiopathogenesis of PCOS remains complex and multifactorial. Although PCOS is not explicitly described in classical Unani literature, several of its clinical manifestations, including amenorrhoea, oligomenorrhoea, obesity, hirsutism, infertility, and acne, have been documented by eminent Unani physicians such as Rāzī, Ibn Sīnā, and Jurjānī. Unani scholars attributed these manifestations to disturbances in temperament (Su’-i-Mizāj), particularly the predominance of Barid wa Ratab (cold and moist) qualities and derangements of Balghamī humour. This review aims to explore the understanding of PCOS from both contemporary and Unani perspectives and to highlight the therapeutic potential of Unani medicine in its management. Relevant classical Unani texts and contemporary scientific literature were reviewed to examine the epidemiology, pathophysiology, clinical features, complications, and treatment approaches of PCOS. The review describes the role of Ilāj bi’l-Tadbīr (regimenal therapy), Ilāj bi’l-Ghidhā’ (dietotherapy), and Ilāj bi’l-Dawā’ (pharmacotherapy) in restoring humoral balance and improving reproductive and metabolic functions. Several medicinal plants, including ginger, liquorice, cinnamon, fenugreek, flaxseed, Nigella sativa, Tribulus terrestris, and Asparagus racemosus, have demonstrated beneficial effects on insulin resistance, hyperandrogenism, menstrual irregularities, and fertility. Classical compound formulations such as Majūn Suparī Pāk, Ḥabb-i-Mudīr, Majūn Dabīd al-Ward, and Itrīfal Shāhtra may further support the management of PCOS through their emmenagogue, uterine tonic, anti-inflammatory, and blood-purifying actions. The available evidence suggests that Unani medicine offers a holistic and individualized approach to the management of PCOS by addressing both its metabolic and reproductive dimensions. Further well-designed clinical studies are warranted to validate the efficacy and safety of these traditional interventions and to facilitate their integration into evidence-based healthcare practices.
Keywords: Polycystic Ovary Syndrome, PCOS, Unani Medicine, Amenorrhoea, Hirsutism, Insulin Resistance, Ilāj bi’l-Tadbīr, Ilāj bi’l-Ghidhā’, Pharmacotherapy
Keywords:
Polycystic Ovary Syndrome, PCOS, Unani Medicine, Amenorrhoea, Hirsutism, Insulin Resistance, Ilāj bi’l-Tadbīr, Ilāj bi’l-Ghidhā’, PharmacotherapyDOI
https://doi.org/10.22270/jddt.v16i7.7874References
1. Zhao H, Zhang J, Cheng J, Nie X, He B. Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. Vol. 16, Pt. 91. 2023;16(1). https://doi.org/10.1186/s13048-022-01091-0 PMid:36631836 PMCid:PMC9832677
2. Teede HJ, Tay CT, Laven J, Dokras A, Moran L, Piltonen TT, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Vol. 38, Pt. 1655-1679. 2023;38(9).
3. Dowd MJ, Phillip EE. The History of Obstetrics and Gynaecology. The Parthenon Publishing Group. 265-66 p.
4. Razi Z. Al Havi Fil Tib. Vol IX. New Delhi: CCRUM; 2001. 151-68 p.
5. Farooq I, Yousuf-ud-din M, Ullah F, Pareveen N, Pasha SO. Integrative insights into polycystic ovarian syndrome (PCOS): A comparative review of unani and modern medical perspectiv. Vol. 10, Pt. 13-20. 2026;10(1). https://doi.org/10.33545/2616454X.2026.v10.i1a.421
6. Kwon CY, Cho IH, Park KS. Therapeutic Effects and Mechanisms of Herbal Medicines for Treating Polycystic Ovary Syndrome: A Review. Vol. 11, Pt. 1192. 2020;11. https://doi.org/10.3389/fphar.2020.01192 PMid:32903374 PMCid:PMC7434855
7. Farquhar C. Introduction and history of polycystic ovary syndrome. Polycystic ovary syndrome. 2007;2:4-24. https://doi.org/10.1017/CBO9780511545191.002
8. Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human reproduction. 2016;31(12):2841-55. https://doi.org/10.1093/humrep/dew218 PMid:27664216
9. Naz MSG, Tehrani FR, Majd HA, Ahmadi F, Ozgoli G, Fakari FR, et al. The prevalence of polycystic ovary syndrome in adolescents: A systematic review and meta-analysis. International journal of reproductive biomedicine. 2019;17(8):533. https://doi.org/10.18502/ijrm.v17i8.4818 PMid:31583370 PMCid:PMC6745085
10. Akgül S, Düzçeker Y, Kanbur N, Derman O. Do different diagnostic criteria impact polycystic ovary syndrome diagnosis for adolescents? Journal of pediatric and adolescent gynecology. 2018;31(3):258-62. https://doi.org/10.1016/j.jpag.2017.12.002 PMid:29233731
11. Kostroun KE, Goldrick KM, Mondshine JN, Robinson RD, Brown CC, Knudtson JF. Impact Of New 2018 International Diagnostic Criteria For The Diagnosis Of Polycystic Ovary Syndrome. Fertility and Sterility. 2020;114(3):e401. https://doi.org/10.1016/j.fertnstert.2020.08.1176
12. Yu O, Covey J, Grafton J, Cronkite D, Kelley A, Hansen K, et al. Identification of a diagnostically complex condition, polycystic ovarian syndrome, in a population-based cohort using electronic health record data. In: Vol. 30. WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA; 2021. p. 240-1.
13. Cioana M, Deng J, Nadarajah A, Hou M, Qiu Y, Chen SSJ, et al. Prevalence of polycystic ovary syndrome in patients with pediatric type 2 diabetes: a systematic review and meta-analysis. JAMA network Open. 2022;5(2):e2147454. PMCid:PMC8848210 https://doi.org/10.1001/jamanetworkopen.2021.47454 PMid:35166782
14. Vink J, Sadrzadeh S, Lambalk C, Boomsma D. Heritability of polycystic ovary syndrome in a Dutch twin-family study. The Journal of Clinical Endocrinology & Metabolism. 2006;91(6):2100-4. https://doi.org/10.1210/jc.2005-1494 PMid:16219714
15. Tunç S, Özkan B. Analysis of new biomarkers for the diagnosis of polycystic ovary syndrome in adolescents. 2021. https://doi.org/10.4274/jcp.2021.22599
16. Kocaay P, Siklar Z, Buyukfirat S, Berberoglu M. The diagnostic value of anti-Müllerian hormone in early post menarche adolescent girls with polycystic ovarian syndrome. Journal of Pediatric and Adolescent Gynecology. 2018;31(4):362-6. https://doi.org/10.1016/j.jpag.2018.02.126 PMid:29462707
17. Hayes MG, Urbanek M, Ehrmann DA, Armstrong LL, Lee JY, Sisk R, et al. Genome-wide association of polycystic ovary syndrome implicates alterations in gonadotropin secretion in European ancestry populations. Nature communications. 2015;6(1):7502. https://doi.org/10.1038/ncomms8502 PMid:26284813 PMCid:PMC4557132
18. Zhao H, Lv Y, Li L, Chen ZJ. Genetic studies on polycystic ovary syndrome. Best practice & research Clinical obstetrics & gynaecology. 2016;37:56-65. https://doi.org/10.1016/j.bpobgyn.2016.04.002 PMid:27264388
19. Day F, Karaderi T, Jones MR, Meun C, He C, Drong A, et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS genetics. 2018;14(12):e1007813.
20. Zhang Y, Ho K, Keaton JM, Hartzel DN, Day F, Justice AE, et al. A genome-wide association study of polycystic ovary syndrome identified from electronic health records. American journal of obstetrics and gynecology. 2020;223(4):559-e1. https://doi.org/10.1016/j.ajog.2020.04.004 PMid:32289280
21. Risal S, Pei Y, Lu H, Manti M, Fornes R, Pui HP, et al. Prenatal androgen exposure and transgenerational susceptibility to polycystic ovary syndrome. Nature medicine. 2019;25(12):1894-904. https://doi.org/10.1038/s41591-019-0666-1 PMid:31792459
22. De Leo V, Musacchio M, Cappelli V, Massaro M, Morgante G, Petraglia F. Genetic, hormonal and metabolic aspects of PCOS: an update. Reproductive biology and endocrinology. 2016;14(1):1-17. https://doi.org/10.1186/s12958-016-0173-x PMid:27423183 PMCid:PMC4947298
23. Wallach EE, Coney P. Polycystic ovarian disease: current concepts of pathophysiology and therapy. Fertility and sterility. 1984;42(5):667-82. https://doi.org/10.1016/S0015-0282(16)48189-6 PMid:6237940
24. Polycystic Ovary Syndrome Gabor T. Kovacs Robert Norman Cindy Farquhar. 2007. 4-7 p.
25. Nafees IB. Kulliyat Nafeesi (Urdu translation by Kabeeruddin M). New Delhi: Idara Kitab-us-Shifa; 1954.
26. Sina I. Kulliyat Qanoon (Translated by Hakeem Kabeerud Din). New Delhi: Aijaz Publication House; 2006. 42, 56, 154, 156, 159,180, 190, 211, 212, 344-350, p.
27. Majoosi IA. Kaamilus Sana (Urdu Translation by GH Kantoori). Vol I, Vol II. New Delhi: Idara Kitab-us-Shifa; 2010. 110-112, 533-35 p.
28. Sina I. Al-Qanoon Fit Tibb (Urdu Translation by GH Kantoori). New Delhi: Idara Kitab-us-Shifa; 2010. 280, 328, 1088-89, 1095-98 p.
29. Jurjani HA. Zakheerae Khwazam Shahi (Urdu Translated by Hkm. Hadi Hussain Khan). Vol VI. New Delhi: Idara Kitab-us-Shifa; 2010. 597-602 p.
30. Stepto NK, Cassar S, Joham AE, Hutchison SK, Harrison CL, Goldstein RF, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Human reproduction. 2013;28(3):777-84. PMCid:PMC9868474 https://doi.org/10.1093/humrep/des463 PMid:23315061
31. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine reviews. 1997;18(6):774-800. https://doi.org/10.1210/er.18.6.774 PMid:9408743 PMCid:PMC12499726
32. Thomson RL, Teede HJ, Stepto NK, Banting LK, Moran LJ. The Role of Diet and Lifestyle Modification in the Treatment of Polycystic Ovary Syndrome. Boca Raton, FL: CRC Press; 2015. 42-65 p. https://doi.org/10.1201/b18190-3
33. Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nature reviews endocrinology. 2011;7(4):219-31. PMCid:PMC9868474 https://doi.org/10.1038/nrendo.2010.217 PMid:21263450
34. Teede HJ, Mlsso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, et al. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Medical Journal of Australia. 2011. https://doi.org/10.5694/mja11.10915 PMid:21929505
35. Teede HJ, Hutchison SK, Zoungas S. The management of insulin resistance in polycystic ovary syndrome. Trends in Endocrinology & Metabolism. 2007;18(7):273-9. https://doi.org/10.1016/j.tem.2007.08.001 PMid:17698366
36. Jassim W, Al-Obaidi M, Abdulhameed W. The effect of insulin resistance on oocyte maturation and embryo quality in PCOS patients undergoing ICSI. Int J Pharm Phytopharm Res. 2019;9(1):36-42.
37. Guzick D. Polycystic ovary syndrome: symptomatology, pathophysiology, and epidemiology. American journal of obstetrics and gynecology. 1998;179(6):S89-93. https://doi.org/10.1016/S0002-9378(98)70238-8 PMid:9855614
38. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Human reproduction update. 2010;16(4):347-63. https://doi.org/10.1093/humupd/dmq001 PMid:20159883 PMCid:PMC9868474
39. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. The Journal of Clinical Endocrinology & Metabolism. 2010;95(5):2038-49. https://doi.org/10.1210/jc.2009-2724 PMid:20375205 PMCid:PMC9868474
40. DuRant E, Leslie NS. Polycystic ovary syndrome: A review of current knowledge. The Journal for Nurse Practitioners. 2007;3(3):180-5. https://doi.org/10.1016/j.nurpra.2007.01.018
41. Ashtiani A. Study of changes in the plasma levels of chemerin of women with overweight and obese during a period of endurance training on a cycle-ergometer using hydroalcoholic extract of urtica. Pharmacophore. 2018;9(2-2018):72-9.
42. Azziz R. PCOS: a diagnostic challenge. Reproductive biomedicine online. 2004;8(6):644-8. https://doi.org/10.1016/S1472-6483(10)61644-6 PMid:15169578
43. Alnahdi HS. The Possible Ameliorative Mechanisms of Curcumin and/or Coenzyme Q10 Against Hyperthyroidism Induced Liver Damage in Rats. Entomology and Applied Science Letters. 2018;5(1-2018):7-16.
44. Eden JA. Polycystic Ovary Syndrome: A Woman’s Guide to Identifying and Managing PCOS. Sydney, Australia: Allen & Unwin; 2005.
45. Office on Women’s Health. 2016. Polycystic Ovary Syndrome (PCOS) Fact Sheet.
46. Hameed L, Farooq AD, Qureshi T, Mohiuddin E. Dietary management of Takayus al mebyadh (Polycystic ovarian syndrome). Hamdard Medicus. 2017;6(1):67-81.
47. Anjum F, Mubeen U, Tabasum H, Rehman H. Physiological perspective of Hirsutism in Unani Medicine: An overview and update. International Journal of Herbal Medicine. 2013;1(3):79-85.
48. Yang H, Kim HJ, Pyun BJ, Lee HW. Licorice ethanol extract improves symptoms of polycytic ovary syndrome in Letrozole-induced female rats. Integrative medicine research. 2018;7(3):264-70. https://doi.org/10.1016/j.imr.2018.05.003 PMid:30271715 PMCid:PMC6160501
49. Goswami PK, Khale A, Ogale S. Natural remedies for polycystic ovarian syndrome (PCOS): a review. Int J Pharm Phytopharmacol Res. 2012;1(6):396-402.
50. Borzoei A, Rafraf M, Niromanesh S, Farzadi L, Narimani F, Doostan F. Effects of cinnamon supplementation on antioxidant status and serum lipids in women with polycystic ovary syndrome. Journal of traditional and complementary medicine. 2018;8(1):128-33. https://doi.org/10.1016/j.jtcme.2017.04.008 PMid:29322000 PMCid:PMC5755995
51. Heydarpour F, Hemati N, Hadi A, Moradi S, Mohammadi E, Farzaei MH. Effects of cinnamon on controlling metabolic parameters of polycystic ovary syndrome: A systematic review and meta-analysis. Journal of ethnopharmacology. 2020;254:112741. https://doi.org/10.1016/j.jep.2020.112741 PMid:32151755
52. Amoura M, Lotfy ZH, Neveen E, Khloud A. Potential effects of Mentha piperita (peppermint) on Letrozole-induced polycystic ovarian syndrome in female albino rat. International journal. 2015;3(10):211-26.
53. Maharjan R, Nagar PS, Nampoothiri L. Effect of Aloe barbadensis Mill. formulation on Letrozole induced polycystic ovarian syndrome rat model. Journal of Ayurveda and integrative medicine. 2010;1(4):273. https://doi.org/10.4103/0975-9476.74090 PMid:21731374 PMCid:PMC3117319
54. Soumya V, Muzib YI, Venkatesh P. A novel method of extraction of bamboo seed oil (Bambusa bambos Druce) and its promising effect on metabolic symptoms of experimentally induced polycystic ovarian disease. Indian Journal of Pharmacology. 2016;48(2):162-7. https://doi.org/10.4103/0253-7613.178833 PMid:27127318 PMCid:PMC4825433
55. Singh A, Gainder S, Banerjee P, Goel A, Kumar P, Mondal B, et al. Efficacy of a proprietary fenugreek seed extract (Trigonella foenum-graecum, furocyst®) in women with polycystic ovary syndrome (PCOS): a randomized, double-blind, placebo-controlled study. Journal of the american nutrition association. 2023;42(7):651-9. https://doi.org/10.1080/27697061.2022.2126410 PMid:36219198
56. Firdose KF, Shameem I. An Approach to the Management of Poly Cystic Ovarian Disease in Unani System of Medicine: A Review. International Journal of Applied Research. 2016;2(6).
57. Nagarathna P, Rajan PR, Koneri R. A detailed study on poly cystic ovarian syndrome and it’s treatment with natural products. Int J Toxicol Pharmacol Res. 2014;5(4):109-20.
58. Fuloria S, Mehta J, Chandel A, Sekar M, Rani NNIM, Begum MY, et al. A comprehensive review on the therapeutic potential of Curcuma longa Linn. in relation to its major active constituent curcumin. Frontiers in Pharmacology. 2022;13:820806. https://doi.org/10.3389/fphar.2022.820806 PMid:35401176 PMCid:PMC8990857
59. Heshmati J, Moini A, Sepidarkish M, Morvaridzadeh M, Salehi M, Palmowski A, et al. Effects of curcumin supplementation on blood glucose, insulin resistance and androgens in patients with polycystic ovary syndrome: A randomized double-blind placebo-controlled clinical trial. Phytomedicine. 2021;80:153395. https://doi.org/10.1016/j.phymed.2020.153395 PMid:33137599
60. Amanullah KZ, Zeenat F, Ahmad W, Firoz S, Naeela A. A comprehensive review on a Unani medicinal plant: Tribulus terrestris Linn. Int J Herb Med. 2021;9(1):23-8.
61. Nagarathna P, Rajan PR, Koneri R. A detailed study on poly cystic ovarian syndrome and it’s treatment with natural products. Int J Toxicol Pharmacol Res. 2014;5(4):109-20.
62. Zaidi Z, Khan AA, Jabeen A, Jahangir U. A Review of Pharmacological & Clinical Researches on Shoneez (Nigella sativa Linn.)-A Unani Medicine. Indo American Journal of Pharmaceutical Research. 2015;5:2805-11.
63. Parhizkar S, Latiff LA, Rahman SA, Ibrahim R, Dollah A. In vivo estrogenic activity of Nigella sativa different extracts using vaginal cornification assay. J Med Plant Res. 2011;5(32):6939-45. https://doi.org/10.5897/JMPR11.275
64. Moin MS, Siddiqui JI, Alam MA, Khatoon F, Khan S, Minhajuddin A. Ethnomedicinal potential of widely used plant Azadirachta indica A. Juss: A comprehensive review. The Journal of Phytopharmacology. 2021;10(6):456-67. https://doi.org/10.31254/phyto.2021.10606
65. Quraishi HA, Islam N, Iqbal A, Bhat SA, Ahmed J, Ashraf SS, et al. Therapeutical and medicinal properties of Neem (Azadirachta indica) in context of Unani system of medicine: A review study. Journal of Drug Delivery and Therapeutics. 2018;8(6):394-9. https://doi.org/10.22270/jddt.v8i6-s.2141
66. Akdoğan M, Tamer MN, Cüre E, Cüre MC, Köroğlu BK, Delibaş N. Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytotherapy Research: An International Journal Devoted to Pharmacological and Toxicological Evaluation of Natural Product Derivatives. 2007;21(5):444-7. https://doi.org/10.1002/ptr.2074 PMid:17310494 PMCid:PMC1808184
67. Singh AK, Srivastava A, Kumar V, Singh K. Phytochemicals, medicinal and food applications of Shatavari (Asparagus racemosus): An updated review. The Natural Products Journal. 2018;8(1):32-44. https://doi.org/10.2174/2210315507666170922145258
68. Majeedi SF, Shameem I, Roqaiya M. Efficacy of Asparagus recemosus (Satavar) in stimulating follicular growth and ovulation in anovulatory infertility: a randomized controlled trial. Int J Reprod Contracept Obstet Gynecol. 2016;5(2):310-6. https://doi.org/10.18203/2320-1770.ijrcog20160362
69. Nfum (National Formulary of Unani Medicines). New Delhi: CCRUM, Ministry of Health and Family Welfare; 2005.
70. Kabeeruddin HM. Bayaz-e-Kabeer. Idara Kitab-us-Shifa; 2010.
71. Azmi HWA. Murakkabat-e-Advia. New Delhi: Idara Kitab-us-Shifa.
72. Mimouni NEH, Paiva I, Carreau S, Golovine K, Neal-Perry G. Pathophysiology of polycystic ovary syndrome revisited: Current understanding and perspectives regarding future research. Vol. 21. 2022;21(4). https://doi.org/10.1002/rmb2.12487 PMid:36310656 PMCid:PMC9601867
73. Ansari AP. ‘Ilāj bi’l-Tadbīr (regimenal therapy): a core mode of Unani treatment. Vol. 18, Pt. 449-458. 2021;18(3). https://doi.org/10.1515/jcim-2020-0048 PMid:32853166
74. Ansari AP, Ahmed ZN, Wadud A, Arif M, Khanday S. Ilaj bil Ghiza (Dietotherapy): A Core Mode of Unani Treatment. Journal of Advanced Research in Pharmaceutical Sciences and Pharmacology Intervention. 2018;2(2-3).
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