Journal of Ayurveda and Integrated Medical Sciences

Introduction

Thyroid problems are the most common endocrine disorders seen worldwide. Thyroid gland secretes two hormones, Thyroxine (T4) and Triiodothyronine (T3). These hormones are formed within the follicular cells of the gland, which are released into the systemic circulation in response to Thyroid stimulating hormone (TSH) secreted from the thyrotropic cells of Anterior Pituitary gland. TSH plays a major role in controlling the thyroid axis and serves as the most useful physiological marker of Thyroid gland function. Sedentary lifestyle and unhealthy food habits may be considered as a primary reason behind increasing Endocrinological disorders including that of Thyroid gland. Increasing levels of stress and anxiety is also contributing to thyroid disorders as the gland is highly sensitive to stimuli. Hypothyroidism is divided into Primary and Secondary types depending on whether the condition arises from abnormality in the Thyroid gland itself or as a result of Pituitary or Hypothalamic malfunction.

Many of the Kaphaja Nanatmaja Vikaras are seen as the clinical features of Hypothyroidism viz. Gurugatrata (feeling of heaviness), Alashya (lethargy), Tandra (drowsiness), Atisthoulya (obesity/weight gain), Atinidra (excessive sleep) etc. Medodhatu is being nourished and maintained by Medodhatwagni. If there is Medodhatwagnimandya, excess deposition of Medo Dhatu (Saama Meda Dhatu) which will contribute to symptoms of Hypothyroidism. As Charaka Acharya has mentioned the Medavaha Srota Dushti Laksanas^[1] which are also the Purvarupa of Prameha: Shayyasana Sapnasukhe Rati (fatigue), Sithilangata (lethargy), Ghanangata (weight gain) etc. These features also simulate the symptoms of Hypothyroidism. Hypothyroidism is a clinico-pathological condition affecting multiple systems. There are many hypotheses formulated regarding the understanding of Hypothyroidism in Ayurveda.

Case Presentation

A female patient aged 50 years came to Ayushakti Ayurveda Pvt Ltd, Navi Mumbai branch with the following complaints:

Increased tiredness, sudden weight gain, puffiness of face, constipation and lack of concentration.

cordifolia), Nimba Mool Twak (Azadirachta indica root bark), Vasa (Adhatoda vasica), Patol (Trichosanthes diocia) and Kantakari (Solanum xanthocarpum). All ingredients being Tikta (bitter) in nature show better penetration of ghee in skin tissues. Test dose was performed with 30 ml Panchatikta ghee on day 1. On day 2, 3 and 4 it was increased by 50ml, 80ml, 100ml respectively. On day 5^th patient developed Snehasiddhi Lakshana like Vata Anulomana (passage of flatus), Mala Snigdhata (unctuous stool), Sneha Dvesha (aversion for oleation), Snigdhaangata (smoothness of body), Glani (fatigue), etc. were observed. After signs of complete oleation Sarvanga Abhyanga (external oleation) with Bala Taila and Sarvanga Bashpa Swedana (External sudation) with Dashamool decoction for 2 days were administered. Patient was advised to have diet that would facilitate Virechana Karma like Mamsa Rasa (soup prepared with meat), Amla Phala Rasa (Sour fruit juices), Chincha Saar (Soup prepared from tamarind), etc.

Table 1: Shodhana Chikitsa in detail

Pradhana Karma (Main therapeutic procedures)

On day 8, Sarvanga Abhyanaga (Therapeutic massage) and Swedana was done followed by Special Virechana tablet intake and Virechana tablet containing ingredients like Haritaki, Katuka, Bahava, Sonamukhi, Trivrit, Snuhikshir, Shuddha Jaipal. Special Virechana tablet contains ingredients namely Trivrut, Shunthi, Tankana, Pipplai, Marich and Jaipala. These ingredients predominantly have Deepana, Pachana, Rechana and Vata-Kapha Hara action, thus helpful in reducing in condition of hypothyroidism. Patient was instructed to take sip of Ushna Jala (lukewarm water) frequently and wait for Vega (motion). Patient was instructed not to strain during defecation. First

motion was observed after 45 minutes of intake of Aushadha. Total 14 Vegas were observed.

Shatavari (Asparagus racemosus) root Ghana. These ingredients have Medhya (nootropic action), Balya, Smrutikara action. The brain is a major target organ for thyroid hormones, and adult-onset hypothyroidism can have significant effects on neuropsychiatric function.^[4] Brahmi possess memory enhancing property along with its anxiolytic activity.^[5] Studies prove that Kushmandadi Ghrita show significant result in the management Chittodvega (anxiety disorders). The action has been attributed to the Medhya Prabhava as described in Ayurveda. Similar studies done on Shankhapushpi, Mundi, Jhotismati, Vacha prove their efficacy in treating anxiety and memory disorders.

Tablet Amrutarasa

It contains ingredients namely Amalaka (Emblica officinalis), Tankan (Sodi bioboras), Abhrak Bhasma (Mica), Shunthi (Zinziber officinale) rhizome, Marich (Piper nigrum), Pippali (Piper longum), Tamra Bhasma (Cuprum), Dalchini (Cinnamomum zeylenicum), Tejapatra (Cinnamomum tamala), Ela (Elettaria cardamomum), Nagakeshar (Mesua ferrea), Shankh Bhasma (Turbinella rappa), Bilva (Aegle marmelos), Karchur (Curcuma zedoria), Yashtimadhu (Glycerrhiza glabra), Triphala, Bhavana Maka Swarasa. These ingredients show Deepana, Pachana, Vata-Kaphahara action. Thus, show significant action on symptoms like sudden weight gain, constipation, tiredness etc.

Tablet Metaboost

It contains ingredients namely Pushkarmoola (Inula racemosa), Shuddha Guggulu (Balsamodendron mukul), Arjuna (Terminalia arjuna), Chitraka (Plumbago zeylanica), Amlavetasa (Garcinia pendenculata), Yavani (Trachyspermum ammi), Karchura (Curcuma zedoria), Jaharmohra Pishti (Serpentine stone), Haritaki (Terminalia chebula), Chavya (Piper chaba), Kutaj (Holarrhena antidysentrica), Moti Pishti, Abhrak Bhasma (Mica), Pippali (Piper longum), Shunthi (Zingiber officinale), Kankola (Piper cubeba), Vacha (Acorus calamus), Saindhav, Hingu (Ferula narthex), Marich (Piper nigrum), Sanchala, Yavakshara, Bid-Lavana. These ingredients act on overall metabolism of body and help to regulate the digestion and excretion process.

Result

Follow up was taken after every 2 months to check

Discussion

Hypothyroidism is a pathological condition of thyroid gland with deficiency of thyroid gland hormones. On the basis of Ayurvedic fundamentals it becomes evident that Kapha associated with Pitta Dushti and vitiation of Vata result in vitiation of Agni.^[6] All these factors lead to Annavaha and Rasavaha Srotodushti predominantly. As there is no direct correlation of hypothyroidism in Ayurvedic classics, based on the Lakshanas it can be considered under the Bahudoshavastha.

Samshodhana is indicated in Bahudoshavastha (i.e., when Doshas are aggravated). Some diseases like Sthoulya, Tandra excess Kapha and Pitta Dosha, Santarpana Janya Vyadhi are included in Bahudoshavastha Lakshanas.^[7] As patient is suffering from digestive disturbances, constipation, Mandagni etc. which indicates the involvement of Pittasthana. Virechana is the best treatment for Pitta associated with Kapha or Vata, and eliminates Pitta from Pittasthana and Kaphasthana.^[8] Production of Ama is the result of Avarana of Pittasthana by Kledakakapha, thus hampering the digestive activity of the Pachaka Pitta. Snehapana is done by Panchatikta Gritha as it is used in the preparatory procedure of Panchakarma and Jatrurdhavagata Vyadhis. And also, it acts on Tridosha and bring the Dosha from Shakha to Kostha.^[9]

Mode of action of Virechana Karma

Virechana drug possessing properties like Ushna, Teekshna, Sukshma, Vyavayi, and Vikasi reaches the Hridaya by virtue of its Veerya and then following the Dhamani, it pervades the whole body through large and small Srotas and removes the Doshas out of the body. Virechana drugs carry out the therapeutic purgation due to their Prabhava (potency). As these drugs are having Jala and Prithvi Mahabhuta dominancy, they have natural tendency to go downward and thus they can help in induction of purgation.^[10]

Constipation, a common symptom encountered in cases of hypothyroidism, is believed to impair hormonal clearance and causes elevation in estrogen, which in turn increases the thyroid-binding globulin levels and decreases the amount of free thyroid hormone available to the body.^[11] Hence administration of Virechana and Basti

7. Acharya YT ed. Charaka Samhita of Agnivesha elaborated by Charaka and Dridabala with Ayurveda Dipika commentary by Sri Chakrapanidatta, Sutrasthana, 16th chapter, 13-16^th verse, Varanasi: Chaukhamba Sanskrit Sansthan. 2017, p97.

8. Vagbhata, Astanga Sangraha, Shashilekha Sanskrit commentary of Indu; edited by; B Rama Rao, Chaukambha Vishwabharathi, Varanasi. Sutrasthana 27^th chapter 5^th verse, p384.

9. Paradakara HSS, ed. Astanga Hrdaya of Vagbhata with the commentaries Sarvangasundara Arunadatta and Ayurveda rasayana of Hemadri, Chikitsasthana, 21th chapter, 58-61 verse Varanasi: Chaukhamba Surbharati Prakashana 2020, p726.

10. Acharya YT ed. Charaka Samhita of Agnivesha elaborated by Charaka and Dridabala with Ayurveda Dipika commentary by Sri Chakrapanidatta, Kalpasthana 1st chapter, 5^th verse, Varanasi: Chaukhamba Sanskrit Sansthan 2017, p671.

11. The Thyroid-Gut Connection - Chris Kresser last accessed on 11-03-2024

12. Sarvesh Kumar Singh and Kshira Rajoria – Evaluation of Vardhamana Pippali, Kanchanar Guggulu and Lekhana Basti in the Management of Hypothyroidism. Indian Journal of Traditional knowledge Vol.14(4), October 2015, pp.513-518.