BINOD KUMAR SINGH.
M.D.(Kayachikitsa), HYD.
Lecturer, Ayurveda Campus,IOM, TU, Kirtipur.
Lot of attempts has made to put an ayurvedic frame to the disease hypothyroidism. There are quite a few concepts which may probably resemble few symptoms of the disease.
Some of them are
1.Agnimandya, including Jatharagni, Bhutagni and Dhatwagni.
2.Kaphaja sotha, with myxoedema.
3.Astaunindita purusha, atihraswa with cretinism.
Agnimandhya:
The major function of thyroid gland is to control the rate of metabolism. The principle function of it is to act as a catalyst –of the nature of a ‘’spark’’ for the maintenance of oxidative metabolism in most tissues. Cells in the body take their “cue” from thyroxine. The amount of stimulation the cells receive from thyroxine will determine how “quickly” they perform their functions.
Agni is derived from the word “angati vyapnoti iti agnihi” means which is capable of penetrating into minute spaces. So some believe that thyroxine has a close resemblance with agni.
All the ayurvedic physicians are very much aware about the importance of Agni.
Vagbhata enumerated agni as
• Jatharagni
• Bhutagni
• Dhatwagni
If these Agni’s fail to perform their optimum function, their sub normality leads to agnimandhya at different levels. The following points will support the concept of agnimandhya i.e Jatharagni, Bhutagni, Dhatwagni mandhya in hypothyroidism.
In Susruta Samhita Sareera Stahna 3rd chapter he described about the hump-backed, crooked armed, lame dwarf child occurring due to the desires of the douhrada not being gratified. This can be correlated with congenital hypothyroidism. Similar description is found Astanindita Purusha description, in which Atihraswa purusha may be correlated with cretin child.
Kaphaja sotha : some consider kaphaja sodha as myxedema. The only symptoms correlates here was “peedite nonnamati”, non pitting edema.
Table showing the normal and abnormal functions of the agni related to hypothyroidism.
|
Agni |
Normal function |
Features of Mandagni /hypothyroidism |
|
Jatharagni |
Digestion and assimilation of food constituents.
|
Diminished power of digestion, assimilation, constipation, poor appetite, |
|
Rasagni |
Supply of absorbed nutritive material to all body tissues for growth and repair.
|
Easy fatigability, dry skin, irritability, lack of sweating As artava is the upadhatu, menstrual irregularities come under this. |
|
Raktagni |
Responsible for tissue nutrition, adequate haemopoeisis, which in turn gives luster to the body. |
Anemia, Skin infections like vitiligo, alopecia, Edema, brittle dull hair, brittle nails, cold intolerance etc. |
|
Mamsagni |
Maintenance of adequate muscle mass, physical strength.& greasyness to the skin. |
Physical strength lowered. Muscle cramps, stiffness etc noted |
|
Medogni |
With adequate fat and sweating gives unctuous skin &physical strength |
Hyperlipidemia, obesity, goiter, |
|
Asthyagni |
Creation of healthy bones, joints, body hair, nails etc. physical and mental activeness |
Loss of body hair, pains in the bones and joints and easy fatigability |
|
Majjagni |
Adequate unctuousness of body, maintaining fertility |
Lowered physical strength, vertigo |
|
Sukragni |
Maintaining fertility and libido of the individual |
Decreased libido, infertility etc |
CHIKITSA YOJANA
vikaaranaamaakushalo na jihriyata kadaachana
nahi sarva vikaaranamah naamato asti dhruba sthati Cha. su. 18/44
Ayurveda doesn’t emphasize on the exact nomenclature of the disesase rather than it insists on diagnosis of the constitutional status of the disease as mentioned in charaka.
On the basis of Ayurvedic principles the following are the main causes for hypothyroidism.
1. Genetical and hereditary defects comes under adibala pravritta vyadhis, so no treatment suggested.
2. Congenital defects come under janmabala pravritta vyadhis. Thyroid gland Agenesis, Dysgenesis, Ectopic thyroid gland comes under this category.
3. Iodine deficiency is the main common cause for hypothyroidism. So ‘’Sarvadha sarva bhavanam samanyam vriddhikaranam’’ applies here.
4. Auto immunity is another common cause so Immuno modulatory drugs are recommended here.
5. Side effects of surgery and radiation: kasta sadhya.
6. For transient hypothyroidism no specific treatment is required.
7. If there is functional loss of thyroid tissue or functional defects thyroid stimulatory drugs are beneficial.
8. Selection of drugs acting at various levels:
1. At hypothalamo pituitary level: anti stress drugs, medhya rasayana drugs, nasya karma may be beneficial.
2. At thyroid gland level: thyroid stimulatory drugs are recommended here.
3. At metabolism level: deepana, pacahana, ushna, teekshna, sukshma, ,lekhana drugs which pep-up body metabolism is recommended.
4. Immuno modulatory drugs for autoimmune related hypothyroidism.
“Samprapti vighatana” is one of the main principles of treatment. Whatever may be the etiology of the disease, it results in under active condition of the thyroid gland and ultimately slowing down of the body’s metabolism. So the treatment should aim to stimulate the thyroid gland. Thyroid stimulatory drugs like guggul should be selected to treat the disease.
As the symptoms of hypothyroidsm are notorious, the symptomatic treatment is followed according to the suitably of the individual cases, i.e., sthoulya, sodha etc.
Selenium is required for a number of enzymes known as selenoproteins. The chemical reaction, which converts thyroid hormone T4 into T3, is catalyzed by specific selenoproteins. Selenium deficiency can impair thyroid function.
In recent studies Selenium supplementation reduced thyroid antibodies (TPOAb) by 40% in three months in a blinded controlled prospective study in female patients with autoimmune thyroiditis. Selenium is also a cofactor for type I hepatic 5’-deiodinase, the enzyme that converts T4 to the more active T3, and degrades T3. The drug Pippali, increases the absorption of Selenium it is very helpful in this condition; this may be cause for the effectiveness of vardhamana pipppli in hypothyroid conditions.
Shilajit is believed to be useful in hormonal imbalance conditions, nasya with anutaila, pushpadhanwaras, arogyavardhinivati, punarnravamandura, chandraprabhavati, navakaguggulu, kumbha jatuvati, loha rasayana are found in usage, but requires scientific studies to know its efficacy, dosage, complications, duration etc. The main cause of hypothyroidism is iodine deficiency, as per sarvadha sarva bahvanam-iodine containing drugs like shigru, jalakumbhi are advised .
Zinc is required for the action of Thyroid Stimulating Hormone. The zinc/copper balance also has a big influence on the progesterone/estrogen balance in women, which has a significant influence on thyroid function. so the drugs which contain zinc may be useful.
Iron is essential for the conversion of phenylalanine, an essential amino acid, to tyrosine. So the iron containing medications may be useful.
Heavy metals such as cadmium, lead & mercury can inhibit thyroid function. So care must be taken when prescribing lead and mercury preparations to the hypothyroid patients.
Further research is required to prove the efficacy of these drugs.
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