E-ISSN:2456-3110

Research Article

Hypothyroidism

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 6 July
Publisherwww.maharshicharaka.in

An observational study to explore the Samprapti Ghatakas in Hypothyroidism

Ashwini P.1*, Markande G.2, Jain P.3
DOI: http://dx.doi.org/10.21760/jaims.7.6.10

1* PK Ashwini, Final Year Post Graduate Scholar, Dept. of PG Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

2 Geetha B Markande, Professor, Dept. of PG Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

3 Prashanth Jain, Professor & HOD, Dept. of PG Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

Background: Hypothyroidism is the most common functional disorder of the thyroid gland. It is a hypometabolic clinical state resulting from inadequate production of thyroid hormones for prolonged periods. The prevalence of this disease in India is 6% and more than 10 million cases per year are reported. It is a multisystemic disorder which has a wide range of clinical symptoms. This condition is not mentioned in Ayurveda classics by any specified name. In Ayurveda, determining the elements that contribute to Samprapti is essential in developing a treatment plan. Hence, the current study attempts to evaluate the Samprapti Ghatakas and as a result, formulate probable Samprapti. Objectives: To study and explore the Samprapti Ghatakas of hypothyroidism and to propose possible Samprapti. Methods: The study was conducted in 100 cases of hypothyroidism between the age of 16 to 70 years. A case proforma was prepared which includes history taking, physical signs and symptoms and required examination. The calculations were done in Microsoft excel and the values obtained were assessed on the basis of percentage of individual parameters in relation with Samprapti Ghatakas of hypothyroidism. Results: Kapha and Vata are the main Doshas involved in the Samprapti. Important Dooshyas are Rasa, Meda. Agni involved is Dhatwagni and the disease is caused primarily due to Dhatwagnimandya. Udakavaha, Annavaha, Medovaha, Swedavaha, Purishavaha, Rasavaha are the main Srotas involved with Sanga type of Srotodushti. Udbhava Sthana can be considered as Amashaya; Sanchara Sthana, Vyakta Sthana and Adhishtana is Sarva Shareera. All the three Rogamarga are involved.

Keywords: Hypothyroidism, Agni, Dosha, Dushya, Srotas, Sroto Dushti, Ama

Corresponding Author How to Cite this Article To Browse
PK Ashwini, Final Year Post Graduate Scholar, Dept. of PG Studies in Roganidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.
Email: 		PK Ashwini, Geetha B Markande, Prashanth Jain, An observational study to explore the Samprapti Ghatakas in Hypothyroidism. J Ayu Int Med Sci. 2022;7(6):65-76.
Available From
https://jaims.in/jaims/article/view/1947

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-30 2022-05-31 2022-06-07 2022-06-14 2022-06-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by PK Ashwini, Geetha B Markande, Prashanth Jainand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

The endocrine system consists of ductless glands which, by releasing chemical signals (hormones) in the blood stream, regulate function in distant organs.[1]

Thyroid is the largest endocrine gland in the human body. The body’s master metabolic centre is considered to be the thyroid. It is considered to be one of the most important organs of the endocrine system, as it regulates nearly all the bodily functions either directly or indirectly. But an overactive or underactive thyroid can result in a wide range of complications.

Thyroid disorders are the most common disorders of the endocrine system. About 42 million people suffer from thyroid disorders in India.[2] Hyperthyroidism and hypothyroidism are the two common functional disorders of the thyroid gland, among which the most common is hypothyroidism.

Hypothyroidism is a hypometabolic clinical state resulting from inadequate production of thyroid hormones for prolonged periods, or rarely, from resistance of peripheral tissues to the effects of thyroid hormones.[3] Approximately 1 in 10 Indian adults suffer from hypothyroidism.[4]

Women are 6 times more prone than men.[5] It can result from a defect anywhere in the Hypothalamic-Pituitary-Thyroid axis. In this condition, TSH will be high, as the pituitary produces more TSH to stimulate thyroid to produce more thyroid hormones. It is divided into Primary and Secondary hypothyroidism depending upon whether the hypothyroidism arises from an abnormality in the thyroid gland itself, or occurs as a result of pituitary or hypothalamic disease.

Ayurveda is the science of Medicine that believes in complete health and wellbeing of an individual. It not only deals with treatment of diseases but also concentrates more on their preventive aspects. Hypothyroidism is a multisystemic disorder which has a wide range of clinical symptoms, which includes even psychological symptoms.

This condition is not mentioned in Ayurveda classics by any specified name. There are many hypotheses put forward regarding the understanding of hypothyroidism in Ayurveda. The Ashtonindita Purusha chapter[6] incorporates the hampered

functions of the endocrine system to the major extent. Besides these, hypothyroidism is a metabolic disorder.

Ayurveda has explained a similar concept called Agni, which plays a major role in digestion, transformation and metabolism. When Agni is in a diminished state, the body’s metabolic rate slows down, resulting in a variety of clinical manifestations. The shadows of functions of Agni can be seen in thyroid hormones.

In Ayurveda, it is clearly mentioned that the root cause of majority of diseases is the hypo functioning of Agni and Ama.

Here an attempt was made to appraise the condition from an Ayurvedic standpoint, based on the components involved in Samprapti.

Materials and Methods

Sample Source: 100 diagnosed cases of Hypothyroidism have been selected from OPD and IPD of Alva’s Ayurveda Medical College Hospital and other referrals irrespective of social, economic or religious status.

Study Design: This is an observational clinical study of 100 patients suffering from hypothyroidism.

Diagnostic Criteria

TSH level more than 5.0milli IU/L.

The signs and symptoms of hypothyroidism[7]

Tiredness, Dry skin, Feeling cold, Hair loss, Difficulty in concentrating and poor memory, Constipation, Weight gain with poor appetite, Dyspnea, Hoarse voice, Menorrhagia, Paresthesia, Impaired hearing, Cool peripheral extremities, Puffy face, Diffuse alopecia, Bradycardia.

The diagnosis was based on those who are having TSH level more than 5.0milli IU/L and those having minimum 4 signs and symptoms listed above.

Inclusion Criteria

1. Patients between the age of 16 to 70 years.

2. Patients who are not on anti-thyroid medication or undergone anti thyroid treatment.

3. TSH level more than 5.0milli IU/L.



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Exclusion Criteria

1. Pregnancy

2. Congenital hypothyroidism.

3. Patients undergone thyroid surgery.

Assessment Criteria

This study includes assessment of various parameters like Dosha, Dooshya, Agni, Ama, Srotas, Srotodushti prakara (for deriving a Samprapti) individually in patients, then knowing about Udbhava Sthana, Sanchara Sthana and Vyakta Sthana of hypothyroidism.

Investigations

Thyroid function test, Blood routine.

Observations

On Demographic Data

In the present study, maximum percentage i.e., 38% belongs to the age group of 31-45 years, 94% were females, 80% belonged to Hindu community, 39% were housewives, 67% were graduates, 74% were married, 74% were belonging to middle class and 88% belonged to Anupa Desha.

jaims_1947_01.JPG

Figure 1: Distribution of patients based on Demographic Data

On Clinical Features

Among the cases, 96% were having tiredness, 82% were having hair loss, 81% had feeling cold and cool peripheral extremities, 73% had dry skin and difficulty in concentration and poor memory, 60% had poor appetite, 54% had weight gain, 48% had constipation, 44% had puffy face, 27% had hoarse voice, 23% had paraesthesia, 22% had

menorrhagia, 19% had dyspnoea, 12% had bradycardia, 8% had impaired hearing and 5% had diffuse alopecia.

jaims_1947_02.JPGFigure 2: Distribution of patients based on Clinical Features

On Dosha Vriddhi Lakshanas

Vata Vriddhi Lakshanas - Among 100 cases, 96% of them had Bala Bhramsha, 92% had Ushna Kamita, 48% Shakrit Graha, 47% Anaha, 23% Bhrama, 21% Nidra Bhramsha, 9% Indriyabhramsha 6% Krishnavarna, 4% Dinata and 3% had Karshya.

Pitta Vriddhi Lakshanas - 21% were having Alpa Nidra and 16% were having Ati Trishna.

Kapha Vriddhi Lakshanas - 96% had Alasya, 85% had Gourava, 82% Sheetasparsha, 73% Agnisada, 40% Atinidrata, 36% Shlatangatva and 19% Shwasa.

Overall data related to Dosha Vriddhi Lakshanas - Kapha and Vata were present among majority of cases i.e., 43% and 29% respectively and in case of Pitta it was only 5.2%.

jaims_1947_03.JPG

Figure 3: Distribution of patients based on Dosha Vriddhi Lakshanas



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On Dhatu Vriddhi Lakshanas

Rasa Dhatu Vriddhi Lakshanas - 96% had Alasya, 85% had Gourava, 82% Sheetasparsha, 73% Agnisada, 40% Atinidrata, 36% Shlatangatva and 19% Shwasa.

Rakta Dhatu Vriddhi Lakshanas - 73% had Agninasa and 10% had Kushta.

Mamsa Dhatu Vriddhi Lakshanas - 75% had Udara Vriddhi, 18% had Ganda Vriddhi and 18% had Adhimamsa around Kanta.

Medo Dhatu Vriddhi Lakshanas - 98% had Shrama, 85% had Alpacheshta Shwasa, 75% had Udara Lambana, 71% had Sphik Lambana and 62% had Stana Lambana.

Majja Dhatu Vriddhi Lakshanas - 85% of them had Anga Gourava and 10% had Netra Gourava.

Overall data related to Dosha Vriddhi Lakshanas - Medo Dhatu was involved in majority cases i.e., 78.2%.

Rasa Dhatu was involved in 43% of cases, Majja Dhatu in 31.6 % cases, Mamsa Dhatu in 18.5% and Rakta Dhatu in 5.5%.

jaims_1947_04.JPG

Figure 4: Distribution of patients based on Dhatu Vriddhi Lakshanas

On Sroto Dushti Lakshanas

Pranavaha Srotas - 19% of them had Pranavaha Sroto Dushti Lakshanas like Atibaddham, Alpalpam, Sashabdam and Ucchvasantham.


Annavaha Srotas - 74% of the people had Avipaka, 60% of the people had Arochaka and 43% had Anannabhilasha which are the Annavaha Sroto Dushti Lakshanas.

Udakavaha Srotas - 80% patients had Oshtasosha, 73% patients had Jihwasosha and Kantasosha, 68% had Talusosha and 17% had Atipipasa.

Rasavaha Srotas - 85% patients had Gourava, 73% patients had Agninasa, 60 had Aruchi, 58% had Saada, 45% had Pandutva, 35% had Angamarda, 16% had Tandra, 15% had Asyavairasya, 9% had Tama and 3% had Krishangata.

Raktavaha Srotas - 22% had Asrgdhara, 10% had Kushta and 4% had Asyapaka Lakshanas.

Mamsavaha Srotas - 41% patients had Adimamsa Lakshana and 18% had Galaganda.

Medovaha Srotas - 96% patients had Alasya, 79% had Jatilibhava of Kesha, 76% had Mukhasosha, 73% had Kantasosha, 68% had Talusosha, 40% had Sarvakaala Nidra, 21% had Padasupti, 17% had Karasupti, Pipasa, Angasupti, 16% had Tandra and 12% had Madhurasyata.

Asthivaha Srotas - 82% of the total had Keshadosha, 15% had Nakhadosha and 11% had Asthishoola.

Majjavaha Srotas - 23% of patients had Bhrama, 9% had Parvaruk, 9% had Tamodarshana and 5% had Murccha.

Purishavaha Srotas - 48% had Krichrena, 48% had Atigradhita, 45% had Alpalpam and 38% had Sashoola Lakshana.

Swedavaha Srotas - 77% had Aswedana, 73% had Parushya and 23% had Atiswedana.

Overall data related to Sroto Dushti Lakshanas - Udakavaha Srotas was involved in majority cases i.e, 51.8% and was not involved in remaining cases.

Annavaha, Medovaha, Swedavaha, Purishavaha, Rasavaha, Pranavaha, Asthivaha, Majjavaha, Mamsavaha and Raktavaha Srotodushti were present among 44.2%, 32.9%, 28.8%, 25.5%, 23.4%, 12.6%, 9.8%, 9.2%, 5.9% and 1.7% respectively.


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jaims_1947_05.JPG

Figure 5: Distribution of patients based on Sroto Dushti Lakshanas

On Agni

Among 100 patients, majority i.e., 57% had Mandagni, 40% had Vishamagni and reamining 3% had Tikshnagni.

jaims_1947_06.JPG

Figure 6: Distribution of patients based on Agni

On Ama Lakshana

96% of the patients had Balabhramsha and Alasya, 85% had Gourava, 74% had Apakti, 60% had Aruchi, 52% had Anilamoodatha and 48% had Malasanga. In the remaining it was absent.

jaims_1947_07.JPG

Figure 7: Distribution of patients based on Ama Lakshana

On Thyroid Function Test

Among 100 patients, minimum value of TSH was found to be 5.47µIU/ml, T3 0.93ng/dl, T4 0.9µg/dl and maximum value of TSH 150µIU/ml, T3 167ng/dl, T4 11.97µg/dl.

jaims_1947_08.JPG

Figure 8: Distribution of patients based on Thyroid Function Test

Discussion

In the present study, majority of the patients falls under Madhyama Vaya Avastha. The incidence of exposure to occupational stress is more in this age group. Whenever there is increased stress, the cortisol level will be increased and


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the body’s metabolism will be reduced. Too much cortisol makes the thyroid gland work harder to produce enough thyroid hormones. Majority of the cases were females. Hypothyroidism is 6 times more common in females than males. In females, there is an interplay between thyroid hormones and the hormones that fluctuate during the menstrual cycle. Hormones play a big role in women’s lives throughout menstruation, pregnancy, lactation and menopause. In this study, majority was housewives. This is in accordance with the increasing prevalence of the disease among females as well as stress that these women may adopt in order to be more susceptible to the disease. 26% were students and this may be due to the increased stress. Majority of the subjects were graduates. This may be due to a combination of factors including age and the literacy rate distribution in and around the area taken for the study. 74% of the subjects were married. This is because patients between the age group of 16- 70 years were chosen based on the inclusion criteria. A maximum percentage of 74 were belonging to middle class. As hypothyroidism can be sub clinical also, people from lower socioeconomic classes may be unaware of the disease and may not have undergone screening tests. Most of the patients belonged to Anupa Desha. This is because the area selected for the study is Anupa Desha and it is of Kapha predominance.

Majority were found to have family history of hypothyroidism with a percentage distribution of 54. One of the most important etiological factors in hypothyroidism is genetic element. Hereditary studies have suggested that up to 67% of circulating thyroid hormones and TSH are genetically determined. Mutations in genes disrupts normal development of the thyroid gland. The diseases caused due to morbidity of sperm and ovum are Adibalapravrutta Vyadhi. Improperly or abnormally developed organs is seen in Janmabalapravrutta Vyadhi. These can also be considered as one of the causative factors of hypothyroidism. In this study, majority of the patients were females of reproductive age group and were estimated to be 76%. Out of these, 48% were having irregular menstruation and 28% were having regular menstruation. 60% were not having any complaints of dysmenorrhoea while 16% were complaining of dysmenorrhoea. 54% had no complaints of menorrhagia and 22% experienced menorrhagia. Among the females studied,

76% have not attained menopause and 18% have attained menopause. Menorrhagia is one of the clinical features of hypothyroidism. In persons with hypothyroidism, excessive Thyroid Releasing Hormone (TRH) can cause infrequent menstrual cycles. The pituitary gland releases prolactin in response to elevated TRH levels. The ability of the ovaries to make oestrogen is hampered by too much prolactin. Reduced oestrogen levels can cause a variety of reproductive health symptoms like irregular menstruation, menorrhagia, etc. According to the classics, vitiated Rasa Dhatu fails to nourish the Upadhatu Artava due to Agnimandya, resulting in irregular menstrual bleeding. Irregularity in menstruation may be due to the vitiation of Vata by the obstruction of Kapha.

Majority of the patients were taking mixed diet i.e., 84%. Non vegetarian food contains more triglycerides. Increased triglycerides hamper the physiological metabolism resulting in hormonal imbalance. Non vegetarian diets, which are Guru, Snigdha and Abhishyandi, produce an increase in Kapha Dosha, which causes Agnimandya resulting in the production of Ama and as a result the disease manifests. 84% patients were taking Akalabhojana, 81% were consuming Viruddhahara and 74% were consuming Vishamashana. When there is untimely intake of food, thyroid functioning will be slowed down significantly, leading to hypothyroidism. Akalabhojana, Viruddhahara and Vishamashana leads to Ajirna, which in turn causes Agnimandya, thereby producing Ama and results in disease manifestation. 80% were taking diet dominant of Madhura Rasa. Since Madhura Rasa is predominant of Prithvi and Jala Mahabhuta and is Guru in nature, it is difficult to get digested. Excessive intake of Madhura Rasa aggravates Kapha and causes Agnimandya. This triggers Ama in vulnerable persons and thereby leading to disease. 60% of the cases had poor appetite. Majority of the patients were having Avara Abhyavaharana Shakti and Avara Jarana Shakti i.e., 59% and 53% respectively. Since the hormone thyroxine decreases appetite and food intake, in case of hypothyroidism there is reduced appetite due to decreased T4. In hypothyroidism, there will be hypo functioning of Agni, which causes decreased appetite. Agni Mandya may be the initial step in the Samprapti of the disease. 48% had constipated bowel. The hormone thyroxine increases the secretions and movements of GIT and thus lack of T4 decreases peristaltic


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activity. So, in case of hypothyroidism, due to hypo secretion of T4, constipation is seen in many patients. Due to Manda Guna of Kapha, the Anuloma Gati of Mala and Vata is hampered and causes obstruction to Vata leading to Vata Prakopa, resulting in Gaada Varchas. 40% of the patients had excess sleep and 39% of them had sound sleep. Normal thyroxine is necessary to maintain normal sleep pattern. Excess sleep may be due to fatigue and lack of energy. The vitiated Rasa and Kapha induces sleepiness in a person with hypothyroidism. In this study, 87% of the patients were not doing any kind of exercises. Majority of the patients were having Madhyama Vyayama Shakti with a percentage distribution of 53% and 46% were having Avara Vyayama Shakti. Lethargy and fatigability are the common symptoms of hypothyroidism which makes the patients to avoid exercise. According to several studies, exercise enhances tissue sensitivity to the thyroid hormones and promotes thyroid gland secretion. There will be increased Kapha and Medo Dushti which makes the person unable to do physical activities. Agni Dipana is one of the benefits of Vyayama, according to Acharya Vagbhata. As a result, it is understood that if one does not engage in active physical activity, his Agni will be weakened and if a vulnerable individual does the same, the Agni will be impeded, resulting in pathogenesis. Avyayama is also one among the Medovaha Sroto Dushtikara Nidanas.

Majority of the subjects i.e., 61% were having Kapha-Vata Prakriti. Acharyas have mentioned that Prakriti of a person influences the diseases that occur in that person. So, persons with Kapha-Vata Prakriti will be more prone to Kaphaja and Vataja diseases. Since Kapha and Vata are involved in the Samprapti of Hypothyroidism, the persons with Kapha-Vata Prakriti are more vulnerable to this disease. Majority of the patients have Madhyama Pramana and was estimated to be 81%. 62% were having normal BMI and 32% were having overweight and 3% were obese. Some studies have been conducted with a conclusion that the level of TSH in obese and overweight people is higher. But here the sample size is too less to arrive at a proper conclusion. 64% were having Avara Satva. In hypothyroidism, there will be impairment in the mental status of the person. One of the main clinical presentations of the disease is difficulty in concentrating and poor memory. Shoka, Chinta, Bhaya were seen in patients with hypothyroidism which can be considered in this context.

Discussion on Clinical features

In the present study, 96% of patients were complaining of tiredness. In people living with an underactive thyroid, the body’s metabolism slows down and the process of breaking down food and transforming the nutrients into energy also hampers. This results in diminution of energy levels. Mandagni is one of the main causative factors for hypothyroidism. The Ahara Rasa formed is in Apakva Avastha,resulting in Rasa Dushti, so it fails to nourish the Uttarothara Dhatus and since the Dhatus are not getting nourishment, Ojas will also get hampered leading to Dourbalya. One of the main functions of Agni is to impart Bala in a person. Here, since the Agni is hampered, it causes Balahani.

In this study, 82% were having hair loss. The thyroid hormones play an essential role in the development and maintenance of hair follicles. Irregular functioning of T3 and T4 can cause regrowth cycle of the hair to be disturbed, meaning that there will be thinning of hair over time, without hair replacement. Kapha and Rakta does the Samrodhana in Romakupa causing hair loss.

In this study, 81% of patients were experiencing cold feeling and cool peripheral extremities. Whenever there is decreased thyroid hormones, there will be reduction in stroke volume and heart rate and the cardiac output at rest also decreases. This causes an increase in peripheral vascular resistance and blood volume will be reduced leading to decreased blood flow to tissues causing cold sensation. In hypothyroidism, there is decreased Pitta and also Sheeta Guna of both Kapha and Vata makes the person feel cold.

Out of 100 patients, 73% were complaining of dry skin. The secretion of sweat glands and sebaceous glands are reduced leading to dry, coarse skin. Sapta Twacha are formed from Rakta.

The quality and quantity of Rakta depends on the quality and quantity of Rasa Dhatu and it can be understood that the features of Twak represents the Rasa Saarata. Rasa Dhatu Dushti in turn causes Dushti of Rakta Dhatu i.e., vitiated Rasa Dhatu cannot nourish the Rakta Dhatu resulting in dryness of the Twak. Twak Parushyata may also be due to the Heena Pitta and Vriddha Vata Dosha involved in the Samprapti.


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In the present study, 73% of the patients were complaining of difficulty in concentration and poor memory. The hormone thyroxine increases blood flow to brain, so the normal functioning of brain needs the presence of thyroxine. In hypothyroidism, due to decrease in thyroxine, the person will have difficulty in concentrating and poor memory. Natural state of Kapha is Bala for the body. But in hypothyroidism, Kapha is in vitiated state and as a result Dehabala, Agnibala and Manobala is also hampered. Reduced Manobala may cause poor memory and difficulty in concentration.

In this study, 54% of patients were complaining of weight gain. The hormone thyroxine is essential for maintaining body weight. Whenever there is a decrease in thyroxine, the body weight increases due to fat deposition. Weight gain may also be due to the imbalance between calorie intake and energy expenditure. When there is Dhatwagimandya, there will be Vriddhi of Dhatus and increase in Medo Dhatu and Mamsa Dhatu results in weight gain. The Guru Guna of Kapha due to Prithvi and Jala Mahabhuta may also be a reason for weight gain.

In the present study, 44% patients were having puffiness in the face. Hypothyroidism causes accumulation of hyaluronic acid which alters the composition of ground substance in dermis and other tissues causing puffiness. Vitiated Kapha obstructs Rasavaha Srotas and causes puffy face.

Among 100 patients, 27% were having hoarse voice. It occurs due to mucinous deposits in larynx or due to external pressure on the laryngeal nerve. According to Acharya Sharangadhara, Swarabheda is one among the Kaphaja Vikaras. He also said that increase in Manda Guna of Kapha produces hoarseness of voice.

23% of the patients were complaining of paraesthesia. Thyroid hormones exert multiple effects on neural function. Hypothyroidism can cause fluid retention resulting in swollen tissues that exert pressure on peripheral nerves causing paraesthesia. Since there is accumulation of Kapha in the Samprapti of hypothyroidism, it gets lodged in the peripheral parts of the body which causes Vata Prakopa resulting in Suptata in certain parts of the body.

22% of the patients were complaining of menorrhagia. Without sufficient thyroid hormones ovaries may not be able to produce progesterone

and endometrial proliferation persists. This may be the reason for menorrhagia in persons with hypothyroidism. The vitiated Kapha involved in the Samprapti mixes with Rakta and cause this.

According to the present study, Nidanas of hypothyroidism are as follows:

Dosha Hetu: This includes the factors which directly cause Dosha vitiation. In hypothyroidism, Agnimandya is the crucial step in the formation of the disease. Agnimandya takes place in the Jataragni and Dhatwagni level. Any Nidana which diminishes Agni can be considered here. They can be further divided into Aharaja, Viharaja and Manasika Nidanas. Aharaja Nidanas includes the Nidanas causing Dushti of Kapha and Vata. Increase in the Guru, Snigdha, Abhishyandi Guna of Ahara causes vitiation of Agni. Intake of Dadhi, Dugdha, Snigdhahara, Guru Ahara, Abhishyandi Ahara, Masha, Godhuma, Mamsa, Madhura Rasa, etc. causes Kapha Dushti. Vishamashana, Alpahara causes Vata Dushti. Viharas predominantly includes Divaswapna, Alasya, Avyayama and Sedentary lifestyle, which causes Dushti of Kapha and Meda. Vata Prakopa occurs due to Vegadharana of Mutra and Pureesha, Ucchabhashana, Ati adhyayana and Bharaharana. Manasika Nidanas include Chinta, Shoka, Bhaya, etc. The Manasika Bhavas represent the current stressful life. These have a direct effect on the Rasavaha Srotas and does its Dushti at the Dhatu level, resulting in Ama.

Vyadhi Hetu: Vyadhi Hetu includes specific etiological factors responsible for a particular disease irrespective of Doshas. Vishas and Dooshi Vishas can be considered here. The role of certain drugs in the manifestation of hypothyroidism is proved. Administration of drugs like lithium, antithyroid drugs, p-aminosalicyclic acid, interferon-α and other cytokines, aminoglutethimide, dopamine agonists, rexinoids are found to be causing hypothyroidism. These drugs act as a Dooshi Visha which in turn alters the normal physiology of the thyroid gland.

Viprakrishta Hetu: Viprakrishta Nidanas are the distant cause of the disease which does not produce the disease immediately. The accumulative effects of all these Nidanas leads to disease manifestation. In today’s society, majority of people consume unhealthy food and lead unhealthy lifestyle. The body’s metabolism is disrupted


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as a result of the cumulative impacts of this. Deviations from following the healthy diet habits, lifestyle, Prajnaparadha, Asatmyendriyartha Samyoga, Kala Parinama and imbalance of Trayopasthambha can be taken as Viprakrishta Nidanas. Also, continuous exposure to particular Ahara, Vihara causing a Sroto Vaigunya at Medo Dhatu level can also be considered as Viprakrishta Hetu.

Poorvarupas are the Avaykta Lakshanas. The prodromal symptoms of hypothyroidism cannot be seen in any of the medical textbooks. Here, Avyakta Ama Lakshanas in the Koshta can be taken as the Poorvarupa. It includes heaviness of the body, low digestive power, fatigue, weakness, etc in the milder form.

Discussion on Dosha

In the present study, it was observed that Kapha and Vata were present among majority of cases i.e., 43% and 29% respectively and in case of Pitta it was only 5.2%. From this it can be understood that Kapha is the important Dosha involved in the Samprapti of hypothyroidism. This is based on the symptoms including fatigue, lethargy, weight gain, poor concentration and memory, puffiness of the face and cold intolerance. Guru, Sheeta, Mridu, Snigdha, Manda, Sthira and Picchila are Kapha Gunas that appear to be linked with these symptoms. Even though all these properties of Kapha are involved in the Samprapti of hypothyroidism, Manda Guna of Kapha Dosha is the key property in Vikalpa Samprapti of this disease which align with the symptoms of an underactive thyroid. Along with this, Vata gets involved making it a more or less Vata- Kapha Samsarga condition. When these Kapha Gunas get vitiated, they cause Vata Samrodhana. The Yogavahi property of Vata has strong contribution in this particular Roga Samprapti. Vata aggravates Kapha Dushti in hypothyroidism. Chala is one of the Gunas of Vata. Vata can be considered as any mobile unit of the organism. The effect of Vata can be related to the synthesis of thyroid hormones, which includes iodide trapping, oxidation of iodide and iodination of tyrosine. Chala and Sukshma Guna of Vata are predominantly responsible for the transportation of hormones through Sthoola and Sukshma Srotas.

The positive and negative feedback mechanism of hormones can be thought to be controlled by Vata

as it is the initiator for any stimulation or inhibition. Vata, as a result of Avarodha by Kapha can cause cold intolerance, constipation and tiredness. As a result, Vata and Kapha are two Doshas that may be included. The Kapha Dosha prevents Pitta Dosha from its cellular level functions, thus impairing Agni.

Discussion on Dhatu

Among the Sapta Dhatu, Medo Dhatu was involved in majority cases i.e., 78.2%. Rasa Dhatu was involved in 43% of cases, Majja Dhatu in 31.6%, Mamsa Dhatu in 18.5% and Rakta Dhatu in 5.5%. The most essential Dhatus involved in the Samprapti of hypothyroidism are Rasa and Meda, as can be seen from this. Dosha-Dooshya Sammurcchana in different Dhatus results in systemic manifestation of the disease. One of the main clinical presentations of hypothyroidism includes weight gain along with poor appetite. This indicates Agnimandya of both Jataragni and Dhatwagni. It further leads to the production of Sama Rasa Dhatu which qualitatively and quantitatively lacks Poshakas and Poshyas. Ama, as a part of Mala is increased and vitiates Rasa Dhatu thereby producing Lakshanas like Agnisada, Alasya, Sheetasparsha, Shlatangatva, Shwasa, Atinidrata, Arochaka, Avipaka, Gourava, Tandra, Saada. Generalised weakness, cold intolerance, excess sleep, dyspnoea, poor appetite, etc are the common presentations of hypothyroidism.

The Guru Guna of Kapha Dosha and excess Meda Dhatu prevents Pitta Dosha from its cellular level functions, thus impairing Agni. Due to Dhatwagnimandya, the Poshaka Rasa of Meda undergoes Apaka leading to Medo Roga. Vitiated Meda produces Lakshanas like Shrama, Alpa Cheshta Shwasa, Lambana of Sphik, Sthana, Udara, Alasya, Sarvakaala Nidra etc. The common presentations of hypothyroidism include Tiredness, dyspnoea, weight gain, excess sleep, puffy face, swelling of the neck, etc.

Discussion on Srotas

Udakavaha Srotas was involved in majority cases i.e., 51.8% and was not involved in remaining cases. Annavaha, Medovaha, Swedavaha, Purishavaha, Rasavaha, Pranavaha, Asthivaha, Majjavaha, Mamsavaha and Raktavaha Srotodushti were present among 44.2%, 32.9%, 28.8%, 25.5%, 23.4%, 12.6%, 9.8% 9.2%, 5.9% and 1.75% respectively. As evidenced by the data,


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the common Srotas involved in the disease hypothyroidism are Udakavaha, Annavaha, Medovaha, Swedavaha, Purishavaha and Rasavaha Srotas. The common feature of hypothyroidism includes reduced appetite. This concludes that Agnimandya affects primarily on the Annavaha Srotas producing symptoms like Arochaka, Avipaka, Anannabhilasha, Asyavairasya. It further leads to the production of Ama where the Adyarasa undergoes Apakvata, vitiates the Rasavaha Srotas thereby producing Lakshanas in addition to the above said Lakshanas such as Gourava, Tandra, Saada. Thyroid hormones promote growth as they enhance amino acid uptake by tissues and enzymatic systems involved in protein synthesis thus promoting bone growth. Carbohydrate metabolism is also regulated by thyroid hormones as it stimulates glucose uptake, gluconeogenesis. These actions may be compared to functions of Rasavaha Srotas as it supplies nutrition and energy to all body tissues. Weight gain, numbness of limbs, loss of strength of hair, dryness of mouth, lips, throat, tiredness, etc symptoms of hypothyroidism can be understood as vitiation of Medovaha Srotas. Thyroid hormones help in fat metabolism by mobilizing lipids from adipose stores and accelerates oxidation of lipids to produce energy. Lipid metabolism can be compared to functions of Medovaha Srotas. Constipation and reduced sweating can be understood as the vitiation of Purishavaha and Swedavaha Srotas respectively. Apana Vata Dushti results in symptoms like Anaha, Adhmana, Gaadavarchas, etc. Decreased thyroid hormones decreases motility of GI tract which results in delayed digestion and evacuation and causes constipation. Sweda is the Mala of Medo Dhatu. Whenever there is Medo Dhatu Dushti, it leads to Sweda Dushti. Vriddha Vata, due to its Rooksha Guna, decreases Jalaamsha, thereby leading to Aswedana. Hence, the probable Srotas involved are Udakavaha, Annavaha, Medovaha, Swedavaha, Purishavaha and Rasavaha Srotas.

Discussion on Agni

The proper functioning of Agni is foremost important for maintaining good health. The energy expenditure, thermogenesis, development and growth are all signalled by thyroid hormones. Moreover, skeletal muscles are target of thyroid hormones. Thyroid hormones have effect over the complexion also. As every cell in the body depends on thyroid hormones for regulation of their

metabolism, so the health of an individual depends on thyroid hormones. They also have effect over the mood swings which indirectly decides the enthusiasm of the person. Alteration in the levels of thyroid hormones affects the functions of immune system too. So, the shadows of functions of Agni and its importance can be seen in the thyroid hormones. Agnidushti in the form of Mandagni, Teekshnagni or Vishamagni can produce disease. In this study, among 100 patients, 57% had Mandagni and 40% had Vishamagni. From this, it is clear that hypothyroidism has a direct impact on Agni. Mandagni is the root cause for almost all diseases and that holds true in this case also. The use of Agnivaishamyakara Ahara Vihara Seva results in Agnimandya. It further leads to the formation of Apakva Annarasa which results in Ama. Since the Gunas of Ama and Kapha are similar, Kapha has a tendency to become vitiated. Moreover, Mandagni is common amongst Kapha Prakriti individuals. In this study, majority belonged to Kapha Pradhana Prakriti. The Kapha Dosha prevents Pitta Dosha from its cellular level functions and impairs Agni.

Discussion on Ama

The use of Agnivaishamyakara Ahara Vihara Seva results in Agnimandya leading to the formation of Ama which is the prime step involved in the Samprapti of hypothyroidism. These Ama in turn causes vitiation of Doshas resulting in Sama Doshas especially Kapha Dosha. The presence of Ama will have its own set of signs and symptoms like Srotorodha, Balabhramsha, Gourava, Anilamoodatha, etc. The symptoms of hypothyroidism reflect the symptoms of Ama like- Srotorodha and Stunted growth, Balabhramsha and delayed milestones, Gourava and puffiness of face, weight gain, Anilamoodatha and respiratory turbulence, Alasya and lethargy, sleepiness, Apakti and decreased appetite, Malasanga and constipation, reduced perspiration, etc. Out of 100 cases, Ama Lakshanas like Balabhramsha, Alasya, Gourava, Apakti, Aruchi, Anilamoodatha, Malasanga can be seen in 96%, 96%, 85%, 74%, 60%, 52% and 48% respectively. The Ahara Rasa formed is in Apakva Avastha, so it fails to nourish the Uttarothara Dhatus and since the Dhatus are not getting nourishment, Ojas will also get hampered leading to Dourbalya. Mandagni is one of the main causative factors for hypothyroidism. One of the main functions of Agni is to impart Bala in a person. Here, since the Agni is hampered,


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it causes Balahani and Alasya. In hypothyroidism, there will be hypo functioning of Agni, which causes Aruchi. Due to Manda Guna of Kapha, the Anuloma Gati of Mala and Vata is hampered and causes obstruction to Vata leading to Vata Prakopa, resulting in Gaada Varchas and Anilamoodata.

Discussion on remaining Samprapti Ghatakas

Here, in this disease the type of Srotodushti is Sanga. Hypothyroidism is a hypo metabolic clinical state resulting from inadequate production of thyroid hormones. There will be fall in serum concentrations of thyroid hormones. Since there is a lack of hormone production, it can be considered as Sanga type of Srotodushti. Hypothyroidism is a disorder that is strongly linked to the involvement of Agni.

Kapha is the primary Dosha involved in the disease pathogenesis. Amashaya is the seat of Kapha Dosha. As a result, Amashaya is the Udbhava Sthana. Thyroid hormones are having impact over every biochemical configuration of the body. The Doshas after getting vitiated spread throughout the body. So, the Sanchara Sthana can be considered as Sarva Shareera. The clinical manifestations of hypothyroidism can be seen in the whole body. So, Vyakta Sthana can be understood as Sarva Shareera.

Since the clinical manifestations can be seen in the whole body, Adhishtana can be considered as Sarva Shareera. Since the clinical presentations of this disease can be seen in the whole body, it can be considered as a disease involving Bahya, Abhyantara and Madhyama Rogamarga.

Samprapti Ghatakas

Table 1: Samprapti Ghatakas of Hypothyroidism

Dosha Kapha, Vata
Dooshya Rasa, Meda
Agni Dhatwagni
Ama Dhatwagnimandya Janya Ama
Srotas Udakavaha, Annavaha, Medovaha, Swedavaha, Purishavaha, Rasavaha
Srotodushti Sanga
Udbhava Sthana Amashaya
Sanchara Sthana Sarva Shareera
Vyakta Sthana Sarva Shareera
Adhishtana Sarva Shareera
Rogamarga Bahya, Abhyantara, Madhyama

Probable Samprapti of Hypothyroidism

Figure 9: Probable Samprapti of Hypothryoidism

Nidana Sevana

↓

Kapha Pradhana Dosha Prakopa

↓

Dhatwagnimandya (Medo Dhatu)

↓

Production of Sama Rasa Dhatu

↓

Sama Rasa qualitatively and quantitatively lacks Poshakas and Poshyas

↓

Ama is increased as a part of Mala and accumulates in Uttarothara Dhatus

↓

Improper formation of Uttarothara Dhatus from Rasa to Shukra

↓

Manifestation of Dhatu Dushti Lakshanas

↓

Signs and symptoms of Hypothyroidism

Conclusion

In this study, an attempt was made to explore the Samprapti Ghatakas of hypothyroidism and to frame probable Samprapti of the disease. After the completion of this study, following conclusions were drawn. Aharaja Nidanas includes the Nidanas causing Dushti of Kapha and Vata. Increase in the Guru, Snigdha, Abhishyandi Guna of Ahara causes vitiation of Agni. Intake of Dadhi, Dugdha, Snigdhahara, Guru Ahara, Abhishyandi Ahara, Masha, Godhuma, Mamsa, Madhura Rasa, etc. causes Kapha Dushti. Vishamashana, Alpahara causes Vata Dushti. Viharaja Nidana predominantly includes Divaswapna, Alasya, Avyayama and sedentary lifestyle, which causes Dushti of Kapha and Meda. Vata Prakopa occurs due to Vegadharana of Mutra and Pureesha, Ucchabhashana,


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Ati Adhyayana and Bharaharana. Manasika Nidanas include Chinta, Shoka, Bhaya, etc. Hypothyroidism has a direct impact on Agni. Mandagni is the root cause for almost all diseases and that holds true in this case also. Due to Nidana Sevana, Kapha Pradhana Dosha Prakopa happens, leading to Dhatwagnimandya (Medo Dhatu). Agnimandya of both Jataragni and Dhatwagni occurs. It further leads to the production of Sama Rasa Dhatu which qualitatively and quantitatively lacks Poshakas and Poshyas. Ama, as a part of Mala is increased and vitiates Rasa Dhatu. This Ama accumulates in Uttarothara Dhatus resulting in improper formation of Rasa Dhatu to Shukra Dhatu. Thus, there will be manifestation of Dhatu Dushti Lakshanas ending up in the clinical signs and symptoms of hypothyroidism. Kapha and Vata are the main Doshas involved in the Samprapti. Important Dooshyas are Rasa, Meda. Agni involved is Dhatwagni and the disease is caused primarily due to Dhatwagnimandya. Udakavaha, Annavaha, Medovaha, Swedavaha, Purishavaha, Rasavaha are the main Srotas involved with Sanga type of Srotodushti. Udbhava Sthana can be considered as Amashaya; Sanchara Sthana, Vyakta Sthana and Adhishtana is Sarva Shareera. All the three Rogamarga are involved.

Reference

1. Munjal YP. API Textbook of Medicine. Tenth ed. New Delhi: Jaypee Brothers Medical Publishers; 2015. Volume 1.p. 566.

2. https://www.downtoearth.org.in/news/health/1-in-10-indians-have-hypothyroidism-61693#:~:text=42%20million%20people%20in%20India,affecting%20one%20in%20ten%20adults

3. Harsh mohan. Textbook of Pathology. Sixth ed. New Delhi: Jaypee Brothers Medical Publishers; 2010.p.803.

4. www.theweek.in.thyroiddisorders

5. Colledge R Nicki, Walker R Brian, Ralston H Stuart. Davidson’s Principles and Practice of Medicine. Twenty first ed. Elsevier Health Sciences; 2010.p.741.

6. Vaidya Jadavji Trikamji Acharya, Charaka Samhita by Agnivesa with Ayurveda Dipika Commentary of Cakrapanidatta, Sutra Sthana; Chapter 21, Verse 3. Varanasi: Chaukambha Krishnadas Academy, 2015; p.116.

7. Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison’s Principles of Internal Medicine. Sixteenth ed. New York: McGraw-Hill Medical Publishing Division; 2005.Volume II.p.2109.


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