Background: Polycystic ovarian syndrome (PCOS) is increasingly recognized as a systemic metabolic-endocrine disorder rather than merely a gynecological condition. It involves complex interactions between metabolic dysfunction, hormonal imbalance, and chronic inflammation. While modern medicine explains PCOS primarily through insulin resistance and hypothalamic–pituitary–ovarian (HPO) axis dysregulation, Ayurveda offers a more foundational understanding rooted in Agni and Dhatu Parinama [1,2]. Objective: To explore the role of Agnimandya in the pathogenesis of Artava Duṣṭi in PCOS through a Kriya Śarira-based integrative review. Methods: A narrative integrative review was conducted using classical Ayurvedic texts and contemporary biomedical literature. Concepts related to Agni, Dhatu Parinama, and Artava Utpatti were critically analyzed and correlated with modern pathophysiological mechanisms [14–17]. Results: Impairment of Jatharagni and Dhatvagni leads to incomplete metabolism, resulting in Ama formation and defective tissue nourishment. Among all tissues, Medo Dhatu becomes predominantly affected, leading to metabolic disturbances analogous to insulin resistance. This ultimately causes obstruction of Artavavaha Srotas and dysfunction of Apana Vāta, manifesting as Artava Duṣṭi [3,6]. Conclusion: Thus, PCOS can be interpreted as a systemic disorder originating from Agnimandya, progressing through Medo Duṣṭi, and culminating in reproductive dysfunction.