Brief Summary
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Introduction: Hypothyroidism is pathological condition of thyroid gland producing deficiency of thyroid hormones. It is usually primary disease of thyroid but may be secondary due to disturbances of hypothalamic-pituitary axis. The hormones regulate essential functions such as heart rate, digestion, physical growth and mental development. An insufficient supply of this hormone can slow life-sustaining processes, damage organs and tissues in every part of the body and lead to lifethreatening complications. According to the concept of Ayurvedic pathophysiology, the fundamental cause behind it is diminution of Agni. Agni converts Ahara dravya into Ahara rasa and then with the help of Bhutagni and Dhatwagni, Poshakansh is made available to the body. Hence any Vikriti i.e. hypo or hyperfunctioning of the Agni is the prime cause of pathogenesis of any disease. There is no direct reference of Hypothyroidism in Ayurveda, but the symptoms can be correlated to symptoms of KaphaAvruta Vata, in particular Kaphaja Grahni and Mandagni Janya Vikara and Bahudoshavastha in general. Acharya Vagbhata has related Jatharagni to Dhatwagni. An increase in Panchakagni makes an increase of Dhatu, other Agni and vice versa. So it can be said that it is basically caused due to dysfunctioning of the Agni. Hypofunctioning of Jatharagni, which in turn, affects Dhatwagni, eventually, brings out pathological sequence & ultimately, the diseased condition is developed. So in a wider term we can infer Hypothyroidism as Dhatwagnimandya. Looking into the Samprapti of the disease, Kaphanashaka chikitsa, Srotoshodhana, Agnideepana and Vatanulomana are the main treatment principles to be considered. Among Panchakarma, Vaman Karma is the best therapy for the elimination of Kapha Dosha and related morbid factors. In Hypothyroidism dominance of Kapha and Dushti of Rasa Dhatu are the main features. Thyroid Gland is situated in neck region which is the Sthan of Kapha Dosha Kapha predominant symptoms are present in patients of Hypothyroidism. So Vaman Karma is selected as main treatment in one Group for Dhatwagnimandya. Certain symptoms of hypothyroidism are similar to KaphaAvruta Vayu lakshana, So in another group Basti karma was selected as it works on KaphaAvruta Vayu condition. In both the groups, Vidangadi Leha was given after Vaman Karma and Basti Karma to augment the Agni, which regulates all metabolic activities. Materials and Methods: In the present clinical study entitled “An Open Randomized Comparative Clinical Study to evaluate the efficacy of Vaman Karma and Madhutailika Basti followed by Vidangadi Leha in the management of Dhatwagnimandya w.s.r. to Hypothyroidismâ€, 40 patients were registered. After complete examination and investigations, were divided into two groups. Only 36 patients completed their treatment in the present study, other 4 patients were registered, but treatment could not be started in any of them due to COVID-19 pandemic. None of the patients in any group discontinued the treatment. WASH OUT PERIOD: 15 DAYS Patients were randomly divided into two groups as mentioned below- Group A- In this group, 17 patients were treated with Vaman Karma followed by oral administration of Vidangadi Leha in a dose of 5gm B.D. after food for 1month. Group B- In this group, 19 patients were administered with Madhutailika Basti followed by oral administration of Vidangadi Leha in a dose of 5gm B.D. after food for 1month. Vaman procedure - First of all Deepana, Pachana with Panchakol Choorna (5 gm) twice a day after food till appearance of Nirama Lakshana was given. Snehapana with Murcchit Go-Ghrita for 3-7 days as per Kostha was done till the appearance of Samyak Snigdha Lakshana. Sarvanga Abhyanga by Dashamoola Taila and Sarvanga Swedana by the Dashamoola Kwatha was done for 2 days. Vaman was induced by administrating Madanaphala Vamaka Yoga. After Vamana Karma, Dhoompana was done followed by Samsarjana Karma as per the type of Shuddhi. Madhutailika Basti: The preparation of patient and procedure was done as per SOP of Panchakarma department of National Institute of Ayurveda, Jaipur. The Basti was given for 16-days on empty stomach in the morning hours. Basti Dravya parts- Makshika (Honey)- 4 parts, Saindhava (Rock Salt)- 1 part, Tila Taila – 4 parts, Shatapushpa Kalka- 2 parts and Erandamool Kwatha- 8 parts. Shamana Aushadha- Both the groups were given with Vidangadi Leha in the dose of 5gm twice a day after food with lukewarm water. The Leha was given after completion of Samsarjana Krama in Group A and after completion of Madhutailika Basti in Group B. The Leha was given for a duration of 30 days. RESULTS- In Group A there was mean increase in T3 by 2.28%, in T4 by 0.534% and decrease in TSH 4.582% by after complete treatment (Vaman Karma + Vidangadi Leha). Weight and BMI decreased by 5.36% respectively 0.750% after complete treatment. The Total Cholesterol decreased by 12.55%, Serum triglycerides by 26.41%, HDL increased by 12.94%, VLDL decreased by 27.92%, LDL decreased by 21.85%. In Subjective parameters, Zulewski’s clinical score decreased by 14.03%, oedema decreased by 82.63%, puffiness reduced by 78.92%, improvement in dry and coarse skin by 28.56%, reduction in breathlessness by 46.66%, relief in constipation by 80.97%, reduction in lethargy by 87.97%, muscle cramps reduced by 84.18%, sleepiness decreased by 61.54%, changes in duration of menstrual blood were non-significant, improvement between two menstrual cycles were non-significant and reduction in hair fall by 81.48%. The overall symptoms reduced by 79.30%. In Group B there was mean increase in T3 by 1.98%, increase in T4 by 0.11% and decrease in TSH by 0.681% after complete treatment (Madhutailika Basti + Vidangadi Leha). Weight and BMI decreased by 0.79% and 0.561% respectively after complete treatment. The Total Cholesterol decreased by 2.83%, Serum triglycerides by 5.52%, HDL increased by 12.12%, VLDL decreased by 12.79%, LDL decreased by 7.92%. In subjective parameters, Zulewski’s clinical score decreased by 7.25%, oedema by 35.99%, puffiness reduced by 47.37%, improvement in dry and coarse skin by 82.02%, reduction in breathlessness by 41.17%, relief in constipation by 75.01%, reduction in lethargy by 84.64%, muscle cramps reduced by 86.35%, sleepiness by 85.72%, changes in duration of menstrual blood and improvement between two menstrual cycle were non-significant and reduction in hair fall by 50.01%. The overall symptoms reduced by 35.47%. Intergroup comparison shows that though there was relief in all the Groups, but percentage wise, Group A is better than Group B in increasing T3, T4 and decreasing TSH. In decreasing body weight and BMI Group A is more effective than Group B. In reducing Total cholesterol, Serum triglycerides, Group A was better than Group B. In Subjective parameters, Group A was better in reducing Zulewski’s clinical score, oedema, puffiness of face, breathlessness, constipation, lethargy, hair fall, sleepiness and general symptomatology and regulating the interval between the cycles than Group B. In reducing dry and coarse skin and muscle cramps parameters Group B was better than Group A. CONCLUSION- Vaman Karma followed by Vidangadi Leha is more effective than Madhutailika Basti followed by Vidangadi Leha in the management of Dhatwagnimandya (hypothyroidism).
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