|Year : 2022 | Volume
| Issue : 4 | Page : 276-280
Management of hypothyroidism with the help of principles of Anukta disease concept: A case study
Amruta Rajendra Suryawanshi, Prasad Vitthal Kulkarni
Kayachikitsa Department, Government Ayurved College and Hospital, Nanded, Maharashtra, India
|Date of Submission||25-Apr-2022|
|Date of Decision||17-Oct-2022|
|Date of Acceptance||01-Dec-2022|
|Date of Web Publication||31-Dec-2022|
Dr. Amruta Rajendra Suryawanshi
Kayachikitsa Department, Government Ayurved College and Hospital, Nanded, Maharashtra
Source of Support: None, Conflict of Interest: None
Lack of thyroid hormone and resistance of the body tissue to thyroid hormone with respect to metabolic demand result in disorder called hypothyroidism. As per conventional science, Synthetic thyroid hormone used to manage hypothyroidism makes the patient drug dependent and still not helping in resolving underlying pathology. Hence Ayurveda is opted for study and to manage the conditions like hypothyroidism by means of Ayurvedic principle like anukta vyadhi vichar (Unstated Disease Concept): In this case, a female patient of age 35 yrs old had complainets of shwasakashtata (Breathlessness), mukhashotha (facial puffiness), hrudadrava (Palpitations), daurbalya (Weakness) was examined thoroughly with the help of ayurvedic methodology aspect like Dashavidha pariksha as patient has kaphapitta pradhan hetu and lakshana hence diagnosed as kaphaj pandu awastha as stated in classics. Treatment protocol given in samhita for this particularly diagnosed kaphaj pandu awastha which is samshodhana (Purification), Snehana (oleation) and shamana (internal medicines) was followed and successfully treated. Symptomatic relief and to wean the patient off the synthetic hormone supplement are the intent to treat the condition of hypothyroidism in this patient. This case study concludes that by means principle of Anukta vyadhi vichar, one can diagnose and successfully manage the conditions like hypothyroidism which are not stated in ayurvedic classics.
Keywords: Agni, Anukta vyadhi, hypothyroidism, Kaphaj Pandu
|How to cite this article:|
Suryawanshi AR, Kulkarni PV. Management of hypothyroidism with the help of principles of Anukta disease concept: A case study. J Indian Sys Medicine 2022;10:276-80
|How to cite this URL:|
Suryawanshi AR, Kulkarni PV. Management of hypothyroidism with the help of principles of Anukta disease concept: A case study. J Indian Sys Medicine [serial online] 2022 [cited 2023 Feb 9];10:276-80. Available from: https://www.joinsysmed.com/text.asp?2022/10/4/276/366510
| Introduction|| |
Hypothyroidism refers to any state that results in a deficiency of thyroid hormone, including hypothalamic or pituitary disease and generalized tissue resistance to thyroid hormone and disorders that affect the thyroid gland directly. The global incidence of hypothyroidism is increasing widely as the thyroid gland easily responds to stimuli like stress and anxiety which is a part and parcel of todays lifestyle. Thyroid hormone is required and essential for the normal functioning of each and every tissue of the body, hence its deficiency manifests as multisystem involvement which is the issue of concern. Hypothyroidism is most common having prevalence of 5.4%. Hypothyroidism is a burning issue and the present treatment by conventional science like hormone supplement is not helping much in resolving the underlying pathology. Synthetic thyroid hormone derivative may bring the value of TSH and T4 to normal range, but the increased dosage and continuous medicine makes the patient drug dependent. Even after years of treatment, it is failed to provide relief in clinical manifestation, moreover excessive thyroid hormone replacement causes serious long term metabolic complication like accelerated osteoporosis.
Due to wide spectrum of the disease and high prevalence, which is suboptimally treated by conventional science, the Ayurveda is opted for study and management by means of Ayurvedic principles. If patient is already taking thyroxine, the methodology is to wean the patient off the drug needs further brainstorming and that is the intent to treat by Ayurveda. Though any disease condition is not described in Ayurveda which is similar to hypothyroidism, yet several references are scattered in various texts. Ayurvedic system of medicine insists of understanding the constitutional status of disease and adopting an appropriate treatment principle. To understand and appreciate the concept of anukta vyadhi (Unstated diseased condition), it is essential to consider basic concepts of Ayurveda like dosha, dhatu, agni (digestive fire), srotasa (channels), manasa (mind). Though anukta vyadhi (unstated diseased condition) are not interpreted by their names, the cluster of signs and symptoms and pathology can be understood by the basic principle stated above which is not only helpful in understanding the pathogenesis but also gives a direction to think in term of treatment for the same.
If we try to understand the pathogenesis of hypothyroidism, thyroid gland is a spark for the maintenance of oxidative metabolism in most tissues, in Ayurveda parlance this is attributed as the function of agni (digestive fire). By way of analogy, the action of thyroid hormone is akin to agni and cause of the disease that is impaired metabolism can be compared with agnimandya (Hypofunctioning of digestive fire). Hypofunctioning of jatharagni, which in turn affects dhatwagni (fire for tissue transformation), eventually brings out pathological sequence and ultimately, the diseased condition developed. Hypothyroidism is found to possess a strong correlation with agnimandyajanita ama. Clinical presentation of hypothyroidism shows resemblance with different clinical condition such as kaphaj pandu,kaphavritta udana,kaphavritta samana,kaphaj grahani. Looking to the pathogenesis and complications of hypothyroidism, it requires a systemic and radical therapy for which Ayurveda may provide a ray of hope through its holistic approach. So here an attempt was made to understand pathology and management of hypothyroidism on the basis of Ayurveda principles.
In this case study, it is observed that thorough examination of any diseased condition helps to diagnose that particular stage of disease and one can successfully treat those conditions with the help of principles which are already stated in Samhita. In this case study, we have treated only one patient by studying the pathology and treated accordingly hence one should not claim that this is the line of treatment for hypothyroidism. As Ayurveda stated “Purusham Purusham Veekshya” there is different line of treatment for same disease in different person, hence more research work has to be done to conclude any kind of treatment that is useful to treat hypothyroidism.
| Case Description|| |
A 35 yrs old female patient came to Kaychikitsa OPD, Government Ayurved Hospital, Nanded had complaints of - Shwasakashtata (Dyspnoea on exertion)
- - Aalasya and Angagaurava (Heaviness of body)
- - Keshapatan (Hairfall)
- - Hrudadrava (Palpitation)
- - Daurbalya (Weakness)
- - Mukhashotha (Facial puffiness)
Patient is known case of Hypothyroidism from past 8 yrs, and on treatment, Tb. Eltroxin 100 mcg OD. She had history of Typhoid illness and was admitted in private hospital for the same, during course of illness she had generalized oedema with dyspnoea and hence accidentally diagnosed as a case of hypothyroidism and started synthetic thyroid hormone as per advised by endocrinologist. She has regular menses with normal menstrual flow. She has two male child – Full term normal delivery. She doesn’t have history of any major illness like Diabetes Mellitus, Hypertension etc. She doesn’t have any history of abortion. She is a housemaker and doesn’t have any type of addiction.
| Diagnosis|| |
Hetusevana: (Causative Factors)
Aaharaja:Atyambupana (Excess water intake), Katu rasadhikya (Acrid food), Vidahi bhojana (Spicy food), Snehadhikya (Oily food), Paryushita Aahar (Stale food).
Viharaja:Divaswapa (Day time sleepiness), Avyayama (sedentary lifestyle), Aatapasevana (excessive sunlight exposure), Khandita nidra (disturbed sleep).
Manasa:Krodhadhikya (Fury behaviour and irritability), Sheeghrakopitwa (short tempered), Atichinta (Stress).
Samprapti Ghataka: (Pathological Contents)
Dosha: Kapha vriddhi (increased kapha), Pitta dushti (vitiated pitta), Vata Prakopa (provokated vata).
Dushya: All dhatu mainly Rasa, Rakta, Meda.
Agni: Jatharagni (digestive fire) and dhtwagni (fire for tissue transformation)
Srotasa: Annavaha srotas, Rasavaha srotas, Raktavaha srotas mainly and all srotasa (channels).
Srotodushti: Sanga (obstruction), Vimargagamana (in wrong or opposite direction).
Adhisthana: Galapradesha (Neck region)
Udbhavasthana: Amashaya (Upper part of digestive tract)
Vyaktasthana: sampurna Sharira.(whole body)
- • Sarvanga Snehana (Oleation) with Tila taila, Swedana (Therapeutic steam) with Dashamula kwath for 7 days.
- • Sadya Vamana:(Therapeutic emesis) On 1st day
- - Vacha siddha Dugdhapana- 250ml
- - Vamaka Yoga (Madanaphala pippali + Vacha+ Yashtimadhu+ Saidhava)- 10gm (Chatana with Madhu)
- - Yashtimadhu Phanta - Akanthapanartha
- - Saidhava Jala – Akanthapanartha.
- - Assessment of Vamana karma:Yashtimadhu phanta - around 5500 ml Saidhava jala – around 2200 ml was taken by patient during akanthapana
- - Vega assessment:Brihat vega: 08Madhyama vega: 07Laghu vega: 12Pittanta Vaman
- • Samsarjana krama:
Samsarjana krama was advised for 2 days as Mudga Yusha for 2 annakala, Mudga Krushara for 2 annakala and then laghu aahara was advised.
- • Matrabasti was started after 2 days of samsarjana krama with sahachara taila 30ml + Chandanabalalakshadi taila 30ml for 5 days.
- • Dadimadi Ghrita 30ml – Rasayanakale with koshna jala.
- • Navayasa Loha – 250 mg TDS with koshna jala.
- • Vasaguduchyadi Kashaya 15ml TDS with koshna jala with 10ml Erandasneha in HS dose
- • Tb. Eltroxine 50mcg - 1 OD
Treatment on Discharge
- • Sarvanga Snehana with Tila taila and Sarvanga Swedana with Dashamula kwath.
- • Anutaila Nasya – 2 -2 drops
- • Dadimadi Ghrita – 30ml Rasayanakale with koshna jala. (Oleation)
- • Vasaguduchyadi Kashaya- 15ml TDS with koshna jala
- • Laghumalini vasant 250 mg + Guduchi churna 250 mg + Navayasa loha 250 mg – Vyanodane with madhu.
- • Tb Eltroxine 50 mcg – 1 OD.
After 1 month:
- • All internal medicines were continued.
- • We’re withheld Anu taila Nasya and Vasaguduchyadi Kashaya.
- • Started Jwaraghna + Nimbadi + Vachadi + Rechak + Ashwagandha churna 250 mg Each – TDS with madhu
- • Tb. Eltroxin 25mcg – 1 OD
After 2 months:
- • All internal medicines were continued
- • Tb. Eltroxin 25 mcg – 1 OD on alternate day.
| Discussion|| |
Anukta vyadhi vichar explained by Acharya charak, Acharya Vagbhata helps the physician to visualise etiopathogenesis and optimum management of diseases like hypothyroidism which are not mentioned in ayurvedic classics. In this case, Aharaja and viharaja and manasa hetu are responsible for vitiation of tridosha. Divaswapa, Avyayama, Snehadhikya, etc are responsible for kapha vriddhi. Vidahi, katu aahara causes vitiation of pitta and paryushita ahara, atapasevana causes vata prakopa. Causative factors like atyambupana causes agnimandya which is one of the main factors of pathogenesis. Krodhadhikya, Sheegrakopitva, Atichinta causes sadhaka pitta dushti and rasavaha srotasa dushti. As above mentioned, samprapti takes place and results into Nissar dhatu, sharir, Indriya shows symptoms like palpitations, dyspnoea, generalized weakness, hairfall, facial puffiness, heaviness of body which have resemblance with Kaphaja pandu lakshana. By studying hetu (causative factors), samprapti along with samprapti ghataka (pathogenesis) and lakshana (signs and symptoms) this condition is diagnosed as Kaphaja pandu.
The line of treatment for kaphaj pandu as stated in Charaka Samhita is Srotoshodhana (Purification), sansarjana krama (Therapeutic diet), yathadosha shamana aushadhi (Conservative treatment), snehapana (Oleation). When we follow samprapti vighatana chikitsa, (to break the pathology) there is involvement of kaphapradhana tridosha i.e. bahudoshavastha hence samsodhana chikitsa (Purification treatment) need to be adopted for kaphaharana and for releasing margavarodha (blockage of channels) and agnidipana (increase in digestive fire), vatanulomana (pacification of vata dosha)are main principles for treatment. Results of the treatment was mentioned in [Table 1].
Vamana karma: (Therapeutic Emesis)
Rasadhatwagnimandya leads to vriddhi of malarupi kapha so vaman helps to eliminate kapha. Langhana is a line of treatment in rasajavikara. Vamana, one of the type of langhana pacifies the symptoms related to rasadhatu dushti. The Ushna, teekshna, sukshma guna of vamana dravya reaches to Hridaya by the virtue of their potency and thereby circulate all over the body. They liquify the morbid dosha and expel it out through oral route. It has direct effect on agni, hence vamana helps in sampraptivighata chikitsta.
Matrabasti: (Unctuous Enema)
After Srotoshodhana and agnidipana, Vatanulomana is the next aim of the treatment for which Matrabasti was opted. Sneha, guru and Ushna guna of taila pacifies ruksha, laghu and sheeta guna of vata respectively and hence balances the vitiated vata dosha and gives strength to agni.Sahachar taila is vatashamak and maintain the anuloma gati of vata and mainly used in urdhwajatrugata vikara.Chandanabalalakshadi taila is saptadhatuvardhaka and specifically used as pandunashaka.
According to samprapti, due to jatharagnimandya and dhatwagnimandya, there is shaithilya of dhatu, indriya and sharira. Ghrita alleviates pitta and vata, and is beneficial for rasa, shukra, ojas. It provides good strength, nourishment, healthy progeny, digestive strength and strength of sense organs. In this case, Dadimadi Ghrita was given 30ml rasayanakale with koshna jala. Dadimadi ghruta is vyadhipratyaneek bheshaja explained by Acharya charaka. Dadima, Chitraka, Shunthi, Pippali like contents causes agnidipana and pacifies vitiated vata and pitta and doesn’t cause kaphavriddhi even if it’s a ghritakalpana. Dadimadi ghrita is causes mudhavatanulomana.
Nasya: (Nasal Insufflation)
Nasya with Anutaila is useful to pacify Tridosha and improves the efficacy of Indriyas.
Trikatu, Triphala, Musta, Vidanga, chitraka causes jatharagnivriddhi which will be resulted as dhatwagnivriddhi.Navayasa churna contains 9 parts of lohabhasma which gives strength to Rakta dhatu. It pacifies tridosha prakopa and balances dosha and dhatu in samanaavastha and provides rasayana effect on body. This is also a vyadhipratyanika bheshaja.
Kashaya contains vasa, guduchi, aragvadha are vatapittahara. This Kashaya is vataraktajanit vyadhihara.
Katu, tikta, Kashaya rasa, ushnaveerya and Madhur vipaka causes Tridoshaharana. Guduchi causes agnidipana and rasayana karma.
Vasantakalpa are used to treat jeernadhatugata awastha, raktadushtijanya vikara, pittapradhana vikara.Rasaka bhasma gives strength to the rasavahi srotasa and rasadhatu with the help of rasadhatwagnivriddhi which will ultimately provide strength to the uttarottar dhatu.
When patient came to our OPD, she was taking Tb. Eltroxin 100mcg 1OD even if her TFT reports were normal as above shown [Table 2]. After the treatment of first 7 days, we advised to take tb. Eltroxin 50 mcg 1 OD. Patient was getting relief symptomatically, hence aim of the treatment was to wean patient off synthetic thyroid hormone. After 1 month of treatment we had repeated investigation and again TFT reports were normal, then advised to take tb. Eltroxin 25 mcg 1 OD. On last follow up, TFT investigated after 1 month, T3,T4 and TSH were normal so was advised that Tb. Eltroxin 25 mcg on alternate day. Now from past two months patient is taking thyroid hormone in the dosage of 25 mcg on alternate day and there is no relapse of symptoms or any other new complaint have been noticed.
Above mentioned treatment protocol which was designed for this case of hypothyroidism was based on hetupratyaneek, doshapratyaneek chikitsa. By this treatment, we were able to achieve Sampraptivighatana (to break the pathogenesis) and dosha dhatu samanavastha (equilibrium) in this case.
| Conclusion|| |
By means of Anukta vyadhi vichar, one can diagnose and successfully manage the conditions like hypothyroidism which are not mentioned in ayurvedic classics. As Ayurveda classics stated that every disease condition is different for person to person hence more and more such case studies should be carried out to obtain thorough knowledge about various hormonal or lifestyle disorders like hypothyroidism in ayurvedic perspective.
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Conflicts of Interest
There are no conflicts of interest.
| References|| |
Cap J Hypothyroidism substitution and adrenal insufficiency in diabetic patient. VnitrLek 2009;55:371-4.
Aswathy Prakash C, Byresh A Understanding hypothyroidism in Ayurveda. IAMJ 2015;3:2349-57.
Journal of the Association of Physicians of India [Internet]. Available from: https://www.japi.org/u2f48444/thyrotoxicosis
. [Last accessed on 2022 Oct 16].
Nuovo J, Ellsworth A, Christensen DB, Reynolds R Excessive thyroid hormone replacement therapy. J Am Board Fam Pract 1995;8:435-9.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor. Sutra sthana; Ashtaunindita adhyaya: chapter 21,Verse 4. Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 116.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor. Sutra sthana; Maharoga adhyaya: chapter 20,Verse 20. Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 115.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor. Chikitsa sthana; Yonivyapata chikitsa: chapter 30, Verse 292. Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 646.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Sutra sthana; Trishothiya adhyaya: chapter 18, Verse 44-47, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 108.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Grahani chikitsa: chapter 15, Verse 3–4, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 512.
Singh K, Thakar AB A clinical study to evaluate the role of triphaladya guggulu along with punarnavadi kashaya in the management of hypothyroidism. Ayu 2018;39:50-5.
Vagbhat, Astangahridaya. Pt. H.S.S. Paradakara, editor, Sutra sthana; Doshopakramaniya Adhyaya: chapter 13, verse 24–25, Varanasi: Chaukhamba Sanskrut Sansthan; 2020, p. 216.
Vagbhat, Astangahridaya. Pt. H.S.S. Paradakara, editor, Sutra sthana; Doshopakramaniya Adhyaya: chapter 13, verse 23, Varanasi: Chaukhamba Sanskrut Sansthan; 2020. p. 216.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Pandu chikitsa: chapter 16, Verse 23–25, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 527.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Vatavyadhi chikitsa: chapter 28, Verse 224, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 626.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Vatavyadhi chikitsa: chapter 28, Verse 226, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 626.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Grahani chikitsa: chapter 15, Verse 67–70, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 518.
Vagbhat, Astangahridaya. Pt. H.S.S. Paradakara, editor, Sutra sthana; Doshabhediya Adhyaya: chapter 12, verse 67–68, Varanasi: Chaukhamba Sanskrut Sansthan; 2020. p. 207.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Vimana sthana; Srotovimaniya adhyaya: chapter 5, Verse 13, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 251.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Pandu chikitsa: chapter 16, Verse 39–43, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 528.
Ranajan M Review on Ayurvedic management of hypothyroidism with critical analysis. IJAPR 2015;3:83-8.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Sutra sthana; Vividhashitapeetiya adhyaya: chapter 28, Verse 25, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 179.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Siddhi sthana; Kalpanasiddhi adhyaya: chapter 1, Verse 15, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 680.
Chark, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Siddhi sthana; Kalpanasiddhi adhyaya: chapter 1, Verse 29–30, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 682.
Shreegovindadas, Bhaishajyaratnavali. 11th ed. Kaviraj Ambikadattashastri, editor, Mukharogadhikara: Verse 134–135, Varanasi: Chaukhamba Sanskrit Sansthan; 1993. p. 680.
Shreegovindadas, Bhaishajyaratnavali. 11th ed. Kaviraj Ambikadattashastri, editor. Jwararogadhikara: Verse 1379–1386, Varanasi: Chaukhamba Sanskrit Sansthan; 1993. p. 138.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Sutra sthana; Snehadhyaya: chapter 13, Verse 14, 43, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 82-4.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Pandu chikitsa: chapter 16, Verse 44–46, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 529.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Sutra sthana; Matrashitiyadhyaya: chapter 5, Verse 63–70, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 41.
Charak, Charak Samhita of Agnivesha. Prof R.H. Singh, editor, Chikitsa sthana; Pandu chikitsa: chapter 16, Verse 70–71, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 530.
Gune G Ayurvediya Aushadhigunadharmshastra. Delhi: Chaukhamba Sanskrit Pratishthan; 2014. Part 1- Bhasma: 12- Lohabhasma. p. 92.
Sharma R Sahasrayogam. Delhi: Chaukhamba Sanskrit Pratishthan; 2014. Kwatha Kalpna; Vasaguduchyadi Kashaya. p. 291.
Chunekar K Bhavaprakashnighantu. Varanasi: Chaukhamba Bharati Academy; 2020. Guduchyadi Varga; Guduchi. Verse 8–10. p. 257.
Gune G Ayurvediya Aushadhigunadharmshastra. Delhi: Chaukhamba Sanskrit Pratishthan; 2014. Part 3- Samyuktakalpa: 78-Ladhumalinivasanta. p. 23.
Gune G Ayurvediya Aushadhigunadharmshastra. Delhi: Chaukhamba Sanskrit Pratishthan; 2014. Part 1- Bhasma: 4 - Jasadabhasma. p. 29.
[Table 1], [Table 2]