“Hypothyroidism” An Ayurvedic Perspective: A Review

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Date of Acceptance : 26 Dec 2024

Date of Publication : 31 Dec 2024

Article ID : SD-IJAY_117

How to cite this article : http://doi.org/10.55552/SDNJAY.2024.2402

Abstract

Purpose: Thyroid disorders, particularly hypothyroidism, are among the most common endocrine disorders globally, affecting approximately 4–5% of the population. While Ayurvedic classics do not explicitly mention thyroid disorders, this study aims to explore the understanding and management of hypothyroidism within the framework of Ayurveda. Methods: A comprehensive review of Ayurvedic texts, journals, and other research articles was conducted to establish the Ayurvedic diagnosis (Nidan Panchak) and treatment (Chikitsa) of hypothyroidism. Results: Common clinical symptoms of hypothyroidism include fatigue, weakness, weight gain, reduced appetite, sensitivity to cold, and peripheral oedema. Ayurveda identifies similar conditions such as Dhatwagnimandhya, Sthaulya, Shotha, and Galganda. In hypothyroidism, there is an increase in Kapha dosha and a decrease in Pitta dosha. Upon analysing the symptoms of hypothyroidism through the lens of Ayurvedic literature, the involvement of Rasa and Medovaha Srotas is evident. The Ayurvedic management involves Agnidipana, Kapha-Medahara, along with the principles of Shaman and Shodhana. Conclusion: The prevalence of hypothyroidism is rising, and there is growing interest in addressing this condition through Ayurvedic medicine. This study aims to provide insights into the understanding and management of hypothyroidism in Ayurveda, offering potential strategies for effective treatment.

Keywords: Agnimandya, Dhatwagnimandya, Galaganda, Shotha

Introduction

The thyroid gland is one of the most vital organs in the endocrine system, playing a crucial role in regulating nearly all body functions, including metabolic, cardiovascular, respiratory, digestive, nervous, and reproductive processes, either directly or indirectly. In urban India, the prevalence of hypothyroidism is 12.95 %.⁽¹⁾ ypothyroidism is characterized by insufficient thyroid hormone production, which can result from various causes, with autoimmune conditions being the most significant contributor. This condition can lead to complications such as dyslipidaemia, a major risk factor for several serious illnesses.⁽²⁾  Individuals with hypothyroidism typically require lifelong hormonal replacement therapy. If left untreated, hypothyroidism can increase morbidity and mortality, making it a major health challenge. Understanding hypothyroidism through the lens of Ayurvedic principles and establishing an effective management plan within the Ayurvedic system of medicine is essential. A review of clinical presentations from classical Ayurvedic texts reveals that hypothyroidism involves abnormalities in Jatharagni, Dhatwagni, and Doshas, particularly Kapha and Vata, along with the involvement of multiple Srotas. Therefore, treatment focuses on Agni Deepana, Aama Pachana, Kapha-Vata Shamana, and Srotoshodhana. Often referred to as a "silent disease," hypothyroidism's symptoms are non-specific and commonly mimic those of other conditions, making it frequently undiagnosed or misdiagnosed. ⁽³⁾

Discussion

In Ayurveda, the focus is not on the exact nomenclature of diseases but on diagnosing the constitutional status of the disease, as outlined in Ashtang Hridaya.(4) According to Ayurvedic principles, the following conditions are correlated with hypothyroidism based on its clinical presentation.

Clinical presentation of Hypothyroidism according to Dosha and Srotas involvement.

Pathogenesis (Samprapti) of Hypothyroidism as per Ayurveda

1. Hypothyroidism primarily arises from the dysfunction of Agni. The condition is triggered by Kapha-Vata Prakopa, along with Agnimandya caused by Rasapradoshaka nidan, Bijadosha, and subsequent Tridosha dushti. This leads to Jatharagni mandya, which in turn causes Dhatwagni mandya. The Manda guna of Kapha dosha plays a crucial role in the development of this condition, and with the involvement of Vata, it becomes a Vata-Kapha samprapti in nature. The yogavahi property of Vata significantly contributes to the pathogenesis of this condition, exacerbating Kapha dosha disturbances. Various Srotas such as Annavaha, Udakavaha, Rasavaha, Raktavaha, Mamsavaha, Medovaha, and Asthivaha are affected by Sanga-type Srotodushti, further compromising tissue functions. The involvement of multiple Srotas and Dhatus leads to systemic manifestations of the disease, affecting both physical and mental health.
2. Hypothyroidism as a Swatantra Vyadhi: Charakacharya describes Galganda as a solitary swelling.⁽⁹⁾  In contrast, Harita Samhita highlights the role of dushtambu and krimidosha in the development of Galganda.⁽¹⁰⁾

      In Ayurveda, Galganda is primarily caused by the vitiation of Kapha dosha, though Vata    and Meda dhatu can also be involved.⁽¹¹⁾ In Charak Samhita, various symptoms associated with Kaphavrit Vata, Kaphavrit Vyana, Kaphavrit Udana, Kaphavrit Samana, and conditions such as Shotha-Kaphaja and Rasapradoshaja are correlated with the clinical presentation of hypothyroidism. These include symptoms like Shaitya, Gaurav, Sarv Sandhi Asthi Ruja, Daurbalya, Vanhi Mandya, and Shotha, which are commonly seen in hypothyroid patients.

3. Hypothyroidism as Partantra Vyadhi: When considering hypothyroidism as a Partantra    Vyadhi, associated conditions such as Ajeerna, Agnimandya, Grahanipradosha, Kapha and Kapha-Vata imbalances, Agnimandya, Krimikostha, and Pandu can also be considered.

Samprapati factors

1. Dosha:

Vata- Primarily Vyana, Samana, Udana

Pitta- Primarily Pachak, Sadhaka, Ranjaka

Kapha- Primarily Kledaka, Sleshaka,Tarpaka

2. Dhatu: all seven but specifically Rasa, Rakta, Meda, Mamsa, Asthi, Shukra

3. Srotasa: Anna, Udaka, Rasa, Rakta, Mamsa, Meda

4. Agni: Dhatvagni esp.Rasa, Rakta, Medovaha,

    Bhutagni: Parthiva and Jala

5. Aam: Usually Present

6. Updhatu: Raja and Snayu

7. Gunas: Vitiation Snigdha, Manda, Picchila, Guru, Ruksha and Sheeta

Principle of Management (Chikitsa)

On the basis of above discussion, the line of treatment with specific target to Agni along with Dhatwagni, Rasavaha, Mamsavaha, Medovaha, Manovaha Srotas as well as Tridosha specifically Vata and Kapha Dosha should be administered in Hypothyroidism.

1. Nidan parivarjana

2. Shamana: Vata Kapha Dosha Shamana

3. Agni Deepan, langhana at the beginning and repeatedly.

4. Dhatugatha Malapachana

5. Shodhana: Strotoshodhana

6. Rasayana

7. Yogasana

1. Nidan Parivarjana: This refers to avoiding the several causes of the illness. It is the initial course of treatment for any illness. The symptoms of hypothyroidism are caused by
Agnimandya, Rasa Dhatudushti, Amadosha formation, and Kapha-vatavriddhi

2. Shamana, Agni Deepan, Dhatugata Malapachana:

Single herbs: -

Kanchnara (Bauhinia variegata): Kanchnara is considered as a drug of choice for Granthi vikara and Galagand due to its action like kapha-Pittahara External application of Kanchanara bark is done in Gandmala. Fresh bark of Kanchanara is grinded with Tanduodaka (Rice water) and mix with Shunthi and used internally. ^(12,13)

Shigru: (Moringa oleifera): Shigru leaf extracts can be used in Hypothyroidism condition to normalize hormone levels.⁽¹⁴⁾

Ashwagandha:(Withania somnifera): Ashwagandha is an adaptogenic popular herb that has shown incredible results for lowering cortisol and balancing thyroid hormones. It has adaptogens which works well with the hormones of the endocrine system which brings balance to the thyroid hormonal level. It increases the hormones which are secreted by thyroid gland. Ashwagandha is an immunomodulator herb so it is useful in autoimmune thyroid conditions. ⁽¹⁵⁾

Polyherbal drugs like: -

Triphala: It is one of the most popular herbal remedies which cleanse by promoting bowel movement. It is having Deepana, Pachana, Vatanulomana and Srotoshodhana properties. Hence it helps digestion and assimilation. It significantly reduces serum cholesterol and lipid levels (as hypercholesterolemia occurs due to Hypothyroidism).⁽¹⁶⁾  

Trikatu: Trikatu is having katu Rasa, katu vipaka and ushana virya, ushna, tikshna, laghu, ruksha guna therefore it having properties like Deepan, Pachana and Strotoshodhana along with it pacify the Kapha-Vata. It is commonly used to treat the condition of Mandagni and Aamdosha hence effective in correcting the dysfunction of Agni seen in Hypothyroidism.⁽¹⁷⁾

Panchkola: It comprises of five drugs i.e., Pippali, Pippalimula, Chavya, Chitraka and Sunthi. Panchkola is predominantly having ushna, tikshna, laghu, ruksha, katu rasa and vipaka, ushna virya. Panchkola is considered as one of the excellent drugs to treat the condition of Mandagni along with Aamdosha and Kapha-Vata disorders. (17)

Yogas like:

Kanchanar Guggul, Kaishor Guggul, Triphala Guggul, Arogyavardhini Vati are useful for treatment of Hypothyroidism

Triphala Guggul: It has Deepana, Pachana and Vatanulomana Properties. It relieves Aama and gives strength to Agni. ⁽¹⁸⁾

Kanchnar Guggul: It is an amazing formulation that helps in maintaining the secretion of thyroid hormones. It also regulates the functioning of the thyroid gland and improves the conditions. In addition, it enhances the glandular functioning to reduce the swelling caused due to goitre. It has the properties like Agni Deepan, Aam Pachan and Raktaprasadana.⁽¹⁹⁾

Kaishor Guggul: It have properties like Dhatwagni deepan, Rasa-Rakta Pachana and Prasadana, Kledghna, Kaphavata shamana, Medoghna, also use in chronic constipation, joint pain, diabetic condition, Anaemia, menstrual related problems. This can be use when Hypothyroidism diagnosed as Partantra vydhi (Secondary disorder).

Shodhana:

Vamana- for Kapha chedana and removing Avarana according to Bala of rugna and disease condition.

Virechana- It maintains Pitta- Rakta Shuddhi. It brings Vatanulomana and Srotoshudhi.

Nasya- It is good to eliminate sanchita mala from uthamanga in Hypothyroidism. It brings Indriyabala and Manobala.

Rasayana:⁽²⁰⁾

Rasayana are to be given after Samyak Shodhana in Hypothyroidism. Rasayana work at Dhatwagni Level correcting Dhatwagni mandya which are seen in Hypothyroidism. Shilajatu is most commonly used in Hypothyroidism.  

Yogasan:

Sarvangasana (Shoulder stand) and Surya Namskar (Sun salutation) are the most suitable and effective asana for the thyroid gland.

Conclusion

Hypothyroidism is not described in classical Ayurvedic texts. It is a condition primarily under the activity of Agni. Due to various hetus there is aggravating Kapha-Vata Dosha and diminished Agni at dhatu level. The Various systemic manifestations of the disease are due to Dosha-dushya involment at various Dhatus along with mainly Rasa, Rakta Mansa srotas involment. During the treatment of Hypothyroidism all these pathogenetic factors have to be targeted. So, drugs having Agni along with Dhatwagni Deepana, Pachana, Kapha shamana, Vata anulomana and Srotoshodhana properties seems to be effective in this condition along with Rasayana and proper lifestyle as described in Ayurvedic text.

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