Hypothyroidism is a clinical syndrome resulting from insufficient production of thyroid hormones, which is common endocrinal disorder seen all over the world. It is more prevalent among females. Hypothyroidism is one of the burning issues in current scenario and is affecting the life of many people on various levels. Since this condition is associated with many complications, on many systems, ranging from generalized tiredness to infertility, thereby compromising quality of life, it has become a need to study this disease critically. This review is made with an effort to understand the disease in Ayurvedic perspective. On reviewing the clinical presentation from all classical texts, it is found that in hypothyroidism there is abnormality of Jatharagni and Dhatwagni along with abnormality of Kapha and Vata Dosha as well as Rasavaha, Raktavaha, Medovaha, Sukravaha and Manovaha Srotases. Dosha-Dushya Samoorchhana in various Dhatus results in systemic manifestation of the disease

Vd. Pravin P. Patil

Vd. Siddhi Dinanath Raul

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

                                                      REVIEW ARTICLE Sept-Oct 2020  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2020 | Vol. 5 | Issue 5 494  Hypothyroidism - Through Ayurvedic Vision Vd. Siddhi Dinanath Raul1, Vd. Pravin P. Patil2 1Post Graduate Scholar, 2Assistant Professor, Dept. of Samhita and Siddhanta, A.P.M’s Ayurved Mahavidyalaya, Sion, Mumbai, Maharashtra, INDIA.                   INTRODUCTION The concept that lifestyle is responsible for the genesis of a disease is very old and well known in Ayurveda. Nowadays there has been drastic change in the dietary habits and lifestyle of individuals due to modernization and influence of western culture. Unhealthy eating habits, along with sedentary lifestyle, cause various diseases including metabolic disorders. The thyroid gland is considered to be one of the most important glands in endocrine system after pituitary gland as it regulates nearly all bodily functions. Failure of  thyroid  hormone  to  meet  the  metabolic need of  Address for correspondence:  Vd. Siddhi Dinanath Raul Post Graduate Scholar, Dept. of Samhita and Siddhanta, A.P.M’s Ayurved Mahavidyalaya, Sion, Mumbai, Maharashtra, INDIA. E-mail: siddhiraul1994@gmail.com Submission Date: 26/09/2020 Accepted Date: 18/10/2020 Access this article online Quick Response Code Website: www.jaims.in  Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA the body results in hypothyroidism. Lack of thyroid hormone or resistance of the body tissue to thyroid hormone with respect to metabolic demand result in disorder called as hypothyroidism. Hypothyroidism is posing major health challenge in both developing as well as developed world. Most common cause is auto immune condition. Prevalence rate of the disease is 2-5% in developed world. This review is carried out to understand hypothyroidism according to the principle of Ayurveda. The presentation of the disease is reviewed critically by searching pathogenesis and symptoms from various research databases. The symptoms of hypothyroidism are studied in terms of imbalance of Dosha, Srotas, etc. and an effort is made to obtain standard possible Samprapti of the disease. Thus the line of treatment involves Deepana, Pachana, Srothoshodhana and Kapha Vata Shamana. MATERIALS AND METHODS This study is done by literature search and critical review of the obtained facts. Literature search has been done by manually searching Ayurvedic texts or Samhitas. A B S T R A C T  Hypothyroidism is a clinical syndrome resulting from insufficient production of thyroid hormones, which is common endocrinal disorder seen all over the world. It is more prevalent among females. Hypothyroidism is one of the burning issues in current scenario and is affecting the life of many people on various levels. Since this condition is associated with many complications, on many systems, ranging from generalized tiredness to infertility, thereby compromising quality of life, it has become a need to study this disease critically. This review is made with an effort to understand the disease in Ayurvedic perspective. On reviewing the clinical presentation from all classical texts, it is found that in hypothyroidism there is abnormality of Jatharagni and Dhatwagni  along with abnormality of Kapha and Vata Dosha as well as Rasavaha, Raktavaha, Medovaha, Sukravaha and Manovaha Srotases. Dosha-Dushya Samoorchhana in various Dhatus results in systemic manifestation of the disease. Key words: Hypothyroidism, Anukta Vyadhi, Jatharagni, Dhatwagni.  Vd. Siddhi Dinanath Raul et al. Hypothyroidism - Through Ayurvedic Vision ISSN: 2456-3110                                                      REVIEW ARTICLE Sept-Oct 2020  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2020 | Vol. 5 | Issue 5 495  OBSERVATION AND DISCUSSION There are two major thyroid hormones -T3 and T4 which affects all body systems either directly or indirectly at all stages of life. Thyroid hormones also 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 the thyroid hormone as it stimulates glucose uptake, glycogenolysis, gluconeogenesis.[6]  These actions may be compared to functions of Rasavaha Srotas as it supplies nutrition and energy to all body tissues.[3] They help in fat metabolism by mobilizing lipids from adipose stores and accelerate oxidation of lipids to produce energy. Lipid metabolism can be compared to functions of Medovaha Srotas. Thyroid hormones also increase basal metabolic rate (BMR) in all tissues except brain, spleen and gonads. This results in increased heat production, increased oxygen consumption. This increased metabolic rate also results in increased utilization of energy substrates causing weight loss. These actions can be compared to the functions of Agni in the body. The adrenergic receptors in the blood vessels are also increased by the action of thyroid hormone leading to regulation of blood pressure. Thyroid hormone plays a vital role in tissue growth particularly in skeletal, nervous system and reproductive system Cardiovascular action of thyroid hormones are to increase cardiac output, heart rate and contractility. They affect the respiratory system indirectly through increased BMR causing increased demand for oxygen and increased excretion of carbon dioxide. These physiological actions if looked from an Ayurvedic perspective are the action of Pitta and Vata Dosha in their normalcy. The Srotases affected by thyroid hormone are mainly Rasavaha Srotas, Mamsavaha Srotas, Medovaha Srotas, Asthivaha srotas, Sukravaha Srotas.[4] Etiology/ Nidana Hypothyroidism is classified into, 1. Primary hypothyroidism - It is due to inadequate function of the thyroid gland itself. Most common causes of Primary hypothyroidism are iodine deficiency, autoimmune thyroid disease, Congenital, drugs and iatrogenic causes. 2. Secondary Hypothyroidism - it is due to not getting enough stimulation by thyroid stimulating hormones. Pathogenesis / Samprapti Primary Hypothryoidism results from two mechanisms: 1. Deficiency of Thyroid Hormones - caused by destruction of thyroid follicles, as in Hashimoto’s thyroiditis (Autoimmune disorder).[6] 2. Resistance of peripheral tissues to thyroid hormones. In Ayurveda, we can consider these two pathologies in the following way: 1. Dhatukshaya Janya (Beejadosha Janita) Due to Apathya Nidan Sevana and also Bijadosha, there is Tridosha Dushti leading to Jatharagni Mandya, which causes Dhatwagnimandya, leading to Uttarrottara Dhatu Vikriti, ultimately causing Oja Vikriti. This Vikrita Ojas (in this case it is often caused by the presence of Pitta Dosha) affects the Vyadhi Kshamatva of the body, attacking the thyroid gland and the autoimmune condition develops. Thus, it is a Kaphapitta Samsarga condition.[1] 2. Avarana Janya Thyroid hormone functions are similar to the functions of Agni (Jatharagni, Dhatwagni and Bhootagni) in our body causing transformations /tissue metabolism at various levels and thus maintaining the BMR. Agnimandya at any level due to Kaphakara Nidana results in increased Dhatugata Mala Sanchaya, resulting in Srotorodha causing compromised Dhatu Saras leading to both physical and mental features in hypothyroidism. Vata acts as a Yogavahi in aggravating the Kapha Dushti. Thus, it is a Vata-Kapha Samsarga condition.[1] Samprapti Ghatakas ▪ Dosha - Vata-Kapha ▪ Dushya - Rasa, Rakta, Mamsa, Meda, Asthi, Shukra Vd. Siddhi Dinanath Raul et al. Hypothyroidism - Through Ayurvedic Vision ISSN: 2456-3110                                                      REVIEW ARTICLE Sept-Oct 2020  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2020 | Vol. 5 | Issue 5 496  ▪ Agni - Jatharagnimandya, Dhatwagnimandya ▪ Srotodushti - Sanga, Vimargagamana ▪ Rogamarga - Bahya, Abhyantara, Madhyama Clinical Presentation/ Roopa As discussed above, Hypothyroidism results in slowing down of the metabolic process. It usually results in a number of clinical signs and symptoms. The severity of the signs and symptoms depends on the degree of thyroid dysfunction and the time course of development of the disease. The symptoms of hypothyroid are very nonspecific. So, the common presentation of hypothyroidism along with Ayurvedic prospective are tabulated below, Signs and symptoms of hypothyroidism Signs and symptoms Dosha involved Srotas involved Fatigue, loss of energy Vata Rasavaha Muscle pain, joint pain, weakness in the extremities Vata Asthivaha, Mansavaha Dry skin Vata Rasavaha Hair loss, coarse, brittle, straw-like hair, axillary hair, pubic hair Vata Asthivaha Dull facial expression, depression, emotional liability, mental impairment, forgetfulness, impaired memory, inability to concentrate Vata Manovaha Fullness in throat, hoariness Kapha Pranvaha Decreased perspiration Vata Medovaha Paresthesia, nerve entrapment syndromes Vata Rasa, Meda, Majja Vaha Srotas Menstrual disturbance, impaired fertility Vata Artavaha, Sukravaha Constipation Vata Purishvaha Jaundice, pallor Pitta Raktavaha, Rasavaha Lethargy, sleepiness Kapha Rasavaha Weight gain Kapha Rasavaha Decreased appetite Kapha Anavaha, Rasavaha Coarse facial features, periorbital puffiness, macroglossia Kapha Rasavaha Goiter Kapha Rasavaha, Mansavaha, Medhovaha Bradycardia, decreased systolic blood pressure and decreased diastolic blood pressure Vata Rasavaha, Raktavaha Hyporeflexia, ataxia Vata Rasavaha, Raktavaha, Manovaha Anukta Vyadhi Acharyas had vision of forthcoming new diseases; hence they explained the concept of understanding the new diseases i.e. Anukta Vyaadhi. Anukta Vd. Siddhi Dinanath Raul et al. Hypothyroidism - Through Ayurvedic Vision ISSN: 2456-3110                                                      REVIEW ARTICLE Sept-Oct 2020  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2020 | Vol. 5 | Issue 5 497  Vyaadhis are the diseases which are neither elaborated or nor described in lexicons of Ayurveda. Such concepts are used to describe, understand, adopt and extend new things, such as identification of new Hetu, Linga and Aushadha based on existing principles of Ayurveda.[5] To understand and appreciate the concept of Anukta Vyadhi, it is essential to consider basic concepts of Ayurveda viz, Dosha Dhatu Mala Vijnana, Agni, Srotas, Ojus and Manas. Understanding the Rasapanchaka of Ahaara Dravyas, is also helpful to know its effects on above factors which are responsible for the manifestation of disease. Though Anukta Vyadhis are not interpreted by their names, the cluster of signs and symptoms and the underlying pathology can be understood by the basic principles stated above which not only helpful in understanding the pathogenesis but also gives a direction to think in terms of treatment for the same. Due to innumerable diseases, the one who cannot label a disorder with some name should not feel ashamed because all disorders have no established footing by name. As disease cannot occur without involvement of Doshas, hence even if the disease is not specifically mentioned, the intelligent clinician should treat the disease as manifested by the signs and symptoms of vitiated Doshas. Hypothyroidism is one among them, which is a new disease also included in lifestyle disorders, which didn’t possess any Ayurvedic name and not found directly in Ayurvedic texts. Hence the signs and symptoms of this disease is to be understood first based on the contemporary science. By observing Doshas, Srotas involved, Samprapti Ghatakas and treat thereby. CONCLUSION The disease hypothyroidism has not described in classical Ayurvedic texts. So it’s an Anukta Vyadhi. Based on its clinical presentation, Samprapti (pathogenesis) can be understood as follows, Nidana - Santarpanottha, Dosha – Kapha Vata, Dushya - Rasa, Rakta, Mamsa, Meda, Asthi, Shukra, Samuthana - Amasaya, Adhisthana - Sarva Sareera, Srotodushti - Sanga, Vimargagamana, Rogamarga - Bahya, Abhyantara, Madhyama, Agnimandya, Ama Rasa- Rakta. We have come to an understanding that Hypothyroidism is primarily under activity of Agni. Due to various Hetus, there is diminished Agni at Dhatu level. There is Sanga in various Srotas. Hence, the related Dhatu functions are also impaired. Consequently, the Dhatusaras are compromised leading to both physical and mental symptoms. Hence, Hypothyroidism is mainly a Vata-Kapha Samsarga condition in which Vata acts as a Yogavahi in aggravating Kapha Dushti and the various systemic manifestations of the disease are due to Dosha-Dushya Samoorchana at various Dhatus. During the treatment of hypothyroidism all these pathogenetic factors have to be targeted with special attention to strength of body, mind, and Dosha.  REFERENCES 1. Charaka Samhita of Agnivesha elaborated by Charaka and Drudhabala with the Ayurveda Dipika commentary by Chakrapani Dutta, Sutrasthana, Chapter-20, Verse No-11,12,17,18, Edited by: Vaidya Jadavji Trikamji Acharya, Published by Choukhambha Prakashan, Varanasi, Edition Reprint 2005,  2. Charaka Samhita of Agnivesha elaborated by Charaka and Drudhabala with the Ayurveda Dipika commentary by Chakrapani dutta, Sutrasthana, Edited by: Vaidya Jadavji Trikamji Chapter- 28, Verse No-9-22. 3. Charaka Samhita of Agnivesha elaborated by Charaka and Drudhabala with the Ayurveda Dipika commentary by Chakrapani Dutta, Sutrasthana, Chapter- 24, Verse No-25-27, Edited by: Vaidya Jadavji Trikamji Acharya Published by Choukhambha Surbharati Prakashan, Varanasi, Edition Reprint 2005;  4. Charaka samhita, with English translation by Prof.P.V.Sharma Vol I, Reprint 2008,   Chaukambha Orientalia, Varanasi. Sutrasthana, Chapter-28 Verse-9-10. 5. Yadavaji Trikamaji (editor). Commentary: Ayurveda Deepika of Chakrapani on Charaka Samhita of Charaka, Siddhi sthana, chapter 12, verse no.42, Varanasi: Chowkhambha Sanskrit Series; 2006. Vd. Siddhi Dinanath Raul et al. Hypothyroidism - Through Ayurvedic Vision ISSN: 2456-3110                                                      REVIEW ARTICLE Sept-Oct 2020  Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct  2020 | Vol. 5 | Issue 5 498  6. Davidson’s Principle and practice of Medicine edited by Nicholas A. Boon, Nicki R, Brain R. Walker 20th Edition, 2006:752,753      *******************************  How to cite this article: Vd. Siddhi Dinanath Raul, Vd. Pravin P. Patil. Hypothyroidism - Through Ayurvedic Vision. J Ayurveda Integr Med Sci 2020;5:494-498.  Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2020 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  

Hypothyroidism - Through Ayurvedic Vision

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Hypothyroidism - Through Ayurvedic Vision

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