In Charak-Samhita, eight type of Nindita Purushas viz. Atidirgha, Atihrusva, Atiloma, Aloma, Atigaura, Atikrishna, Atisthula, Atikrisha have been discussed which can be taken as functional disorders of endocrine gland.
Normalcy of all mechanisms of the body is totally dependent upon the normal functioning of Agni.
According to allopathic systems, metabolic activity of the body is controlled by thyroid hormone secretion and if we move our eyes towards Ayurveda, we will find that metabolic processes of the body are under the control of Jatharagni, Bhutagni and Dhatvagni, as quoated by Charaka, So the cause of disease i.e. impaired metabolism can be compared with vitiation of Agni according to Ayurveda.
If due to any etiological factor causing vitiation of Agni, whatsoever it may be, Agni get vitiated resulting in start of pathological events which, eventually, leads to diseased condition of the body. This vitiation of Agni results in formation of Ama Dosha(undigestrd food). This Amadosha can be produced at three levels:
At Jatharagni level- Due to improper digestion of food in Amashaya (because of hypofunctioning of Jatharagni), products undergo some toxic changes called as Aama. According to modern science intestinal dysbiogenesis,infection,leaky gut are responsible for the development of immune dysregulation or autoimmunity which is the cause of the disease and can be correlated with Aama.
At Bhutagni level – Physicochemical aspect of digestion is dealt with Bhutagnipaka. Whenever Ahara (diet) is unprepared or uncooked, though at an early stage respective Bhutagni accept it and may digest but continuous supply of this Nidana(cause) makes changes in Bhutagni also. Hence, here Ama is formed due to
- Fault in supply (The external factor)
- Fault in respective Bhutagni (the internal factor)
As far as thyroid physiology is concerned, iodine is nothing but Bhutagni only according to Dr. Laxmi Prasuna.Selective trapping of Iodide,transport, uptake by thyroid cells and organification-these all come under Bhutagni Paka.Intrathyroid and peripheral tissue deiodinase enzymes,thyroperoxidase(TPO) and H2O2 can be considered as Bhutagni Amsha only and deficient iodine trapping or deficient iodine coupling or deficient enzymes,deiodinases are the causes of the disease according to modern medicine .
Unless and until the internal factor is not vitiated fully, full-fledged pathogenesis cannot be possible.
At Dhatvagni level- Ama at Dhatvagni level can be considered to have two-fold origin:
- On the basis of exterior factor (when Asthayi Poshkamsha of Dhatu is in vitiated form)
- Due to interior factor –when tissue capacity to digest (Dhatvagni) even the balanced Poshakamsha(nutrients) is hampered.
Vagbhata has related Jatharagni to Dhatvagni carrying a suggestion that contributes moieties of itself to Dhatus. An increase in Pachakagni makes an increase of Dhatus, other Agnis and vice versa .Hence Due to improper functioning (Hypofunctioning) of Pachakamsha present in Dhatus leads to states analogous to myxedema resulting in Dhatu Vruddhi .
Clinical presentation of thyroid includes symptoms like lethargy, fatigue, weakness, heaviness in the body, sleepiness, hypochlorhydria, constipation, loss of appetite which denote presence of Aamavastha in the disease.
Involvement of Tridosha in thyroid:
Looking in to clinical presentation of thyroid, involvement of Tridosha should be considered in which Kapha Dosha is main culprit associated with Pitta Kshaya and Margavaranajanya Vata Vriddhi can be considered.
|1.||Weight Gain||Kapha vruddhiPitta Kshaya|
|2.||Puffiness of body features||Kapha vruddhi|
|3.||Loss of appetite||Kapha Vriddhi ;Pitta Kshaya|
|4.||Dry and coarse skin||Vata Vriddhi;Pitta Kshaya|
|5.||Minimal/absent sweating||Pitta Kshaya|
|6.||Anemia||Kapha Vriddhi;Pitta Kshaya;Vata Vriddhi|
|8.||Hoarseness of voice||Kapha Vriddhi;Vata Vriddhi|
|9.||Generalised aches,pain||Vata Vriddhi|
|10.||Muscular cramps,stiffness||Vata Vriddhi|
INVOLVEMENT OF DHATU IN THYROID:
In the pathogenesis of thyroid involvement of Rasa and Meda Dhatu can be considered predominantly.
|1.||Rasa||Weight Gain; Loss of appetite (hypochlorhydria);Heavyness in the body, lethargy; Generalised aches; Somnolence; premature aging symptoms like hair loss etc.; Cold intolerance ; Puffiness; Anemia ; Menstrual disturbances; Infertility|
|2.||Rakta||Slow pulse rate; Dry and coarse skin; Slowing of mental activity; Lethargy|
|3.||Mamsa||Heaviness in the body; Muscle ache; Granthi; Galaganda|
|4.||Meda||Tiredness; Sleepiness; Sluggishness; Hyperlipidaemia; Dyspnea on exertion|
|7.||Shukra||Loss of libido; Infertility|
INVOLVEMENT OF SROTAS IN THYROID:
Because of wide ranging effects of thyroid hormone, thyroid can have profound detrimental effects on numerous organ systems .
|1.||Annavaha||Loss of appetite;hypochlorhydria;malabsorption|
|1.||Rasavaha||Weight Gain; Loss of appetite;Heavyness in the body,lethargy;Generalised aches; Somnolence; premature aging symptoms like hair loss etc.;Cold intolerance;Puffiness; Anemia; Menstrual disturbances;Infertility|
|2.||Raktavaha||Slow pulse rate;Dry and coarse skin;Slowing of mental activity;Lethargy;anemia|
|4.||Medovaha||Tiredness;Sleepiness; Sluggishness; Hyperlipidaemia; Dyspnea on exertion|
|5.||Asthivaha||Osteoporesis, Osteoarthritis;Hair loss|
|7.||Shukravaha||Loss of libido; Infertility|
|9.||Swedavaha||Sweating minimal/absent; Dry and coarse skin|
|10.||Artavavaha||Lossof LibidoInfertility (secondary usually)Secondary amenorrhoea|
Some Clinical Conditions Correlating With Thyroid:
- Acharya Charaka described a clinical condition in Dosha Vikalpa Kalpana presenting as Pitta Kshaya with Kapha and Vata Vriddhi which includes Stambha (Stiffness), Shaitya (cold intolerance), Toda (generalised aches), Gaurava (heaviness in the body), Agni Mandya (impaired metabolism), Bhaktaashraddha (Loss of appetite) shows resemblance with clinical presentation of thyroid.
- Kaphavritta Vata: Symptoms quoted by Acharya Charaka in Kaphavritta Vata, Kaphavritta Udana,Kaphavritta Samana, Kaphavritta Vyana conditions show similarity with clinical presentation of thyroid to some extent.
- Kaphaja Pandu: Gaurava (heaviness in body), Tandra(sleepiness), Panduta(pallor), Klama(fatigue), Shvasa(dyspnea on exertion), Aalasya( lethargy), Aruchi(loss of appetite), Svaragraha(hoarseness of voice), Ushnakamita are the symptoms of Kaphaja Pandu which show similarity with thyroid.
- Kaphaja Grahani: Purvarupa of Grahani like Aalasya (lethargy), Balakshaya(weakness), Anna Vidaha, Sharira Gaurava(Heaviness in body) and Rupa (symptoms) of Kaphaja Grahani like Strishu Aharshanam(loss of libido), Akrushasyaapi Daurbalyam can be correlated with clinical features of thyroid. This condition denotes poor gut health which is responsible for suppression of thyroid hormones.
Bahudosha Lakshana: Most of the symptoms of Bahudoshavastha show clinical features similar with thyroid.
Glancing at the nature of the disease, it can be concluded that Dhatvagni Vikriti (Hypofunctioning) plays very important role in causing pathogenesis which in turn is caused by hypofunctioning of Jatharagni. As the prime factor in causation of disease is Agnimandya, therefore, factors causing vitiation of Agni can be considered under Nidana factors of the disease.
(1) Physiological factors affecting Dhatvagni like Prakriti, Ritu, Bala, Age, Psychological factors when, tend to be abnormal, cause pathogenesis.
(2) Under Adhyatamika Hetus, Adibala Pravritta, Janmabala Pravritta and Dosha Bala Pravritta Hetus help in causing diseased condition.
(a) In Adibala Pravritjanya Vyadhi, Bijabhaga Dushti takes place. According to modern, inheritance may be the cause (Congenital Thyroid).
(b) Under Janmabala Pravritta Vyadhis, Sushruta has given examples of Muka, Vamana, Jadatypes. Here, Jada (Mandabuddhi) can be considered as cretin baby (Neonatal Thyroid).
(c) Vitiation of Sharira as well as Mansika Dhoshas may be the causative factors considered under Dosha Bala Pravritta Hetus.
(3) As we know that Dhatuparampara (qualitative and quantitative production of Dhatus) is maintained by two factors.
(1) Intensity of Agni. (2) Availability of the fuel (Ahara Rasa)
Therefore, anything affecting these two factors can be considered to cause disease.
These are as follows-
Excessive intake of water, erratic intake of food, Vegavidharana (suppression of urge), day sleep etc. and psychological factors e.g. anxiety, fear, greed, anger and jealousy.
(4) Non-gratification and dishonour of the desires of Dauhrida can lead to the occurrence of disease. This can be interpreted as follows-
(a) According to Sushruta, development of fetus takes place in fourth month which is also a stage of Dauhrida in mother. If, at this stage, mother’s desires are not fulfilled then it may lead to the birth of a paralyzed, hump-backed, crooked arms, lame, dwarfed, defective eyed child etc. This condition may be analyzed according to modern parlance as a child of congenital thyroid (cretinism) (i.e. stunting of body growth and retardation of mental development).
(b) According to modern science, thyroid is formed in 8th week and trapping of I2 occurs from 12th week (4th month) which is again, a period of Dauhrida as per Ayurveda. This may happen that non gratification of mother’s desires at this stage may lead to deformity in particular organ functions. This hypothesis, however, needs further evaluation.
PURVARUPA (PRODROMAL SYMPTOMS):
Purvarupas are the caution lights to warn the patient and doctor about the pathogenesis happening in the body and makes us run towards exact diagnosis of the disease. In Thyroid, it goes unnoticed for several years. Therefore, prodromal features are not mentioned in books.
Rupa is a manifested stage of disease. It, on one hand, provides clue for the confirmed diagnosis and simultaneously, on the other hand, tells about severity and chronicity of the diseased condition. Rupas always appear after Doshadushyasammurcchna, Rupa (symptomatology) of this disease as per Ayurveda is as follows-
(1) ABNORMAL WEIGHT GAIN – It occurs due to imbalance between calorie intake and energy expenditure which, in thyroid results due to disturbed metabolic processes. This can be considered as Dhatvagni Mandya(hypofunctioning) which causes Dhatuvriddhi
(2) PUFFY APPEARANCE OF BODY FEATURES – Puffiness of face especially eyelids, hands and feet result due to accumulation of hydrophilic mucoproteins subcutaneously which may be categorized under Kaphavargiya Dravya as per Ayurveda. As Kapha is found in augmented state, due to its Prithvi and Apa Mahabhuta predominance, properties of heaviness and steadiness, this puffiness appears.
(3) LOSS OF APETITE – It may happen as a result of hypofunctioning of Jatharagni which produces Ama and Kapha which further causes Jatharagni and Dhatvagnimandya.
(4) DRY, COARSE SKIN / HAIR – Rasa Dhatvagni Mandya produces vitiated Rasa Dhatu which leads to improper nutrition to Uttara Dhatu i.e. Rakta, therefore leads to coarseness of skin & hair. Vitiated Vata Dosha also causes dryness of skin. Moreover, Twaka, Updhatu of Mamsa Dhatu, gets affected because of vitiated Mamsa Dhatu & loses normalcy.
(5) MINIMAL / ABSENT SWEATING – Physiologically, body temperature is controlled by Pitta because it loses excessive heat from the body in the form of Sweda (sweat). Its hypofunctioning leads to above said manifestation.
(6) ANEMIA – In succession to Dhatvagnimandya, Rasa Dhatu get vitiated which is unable to nourish Uttara (next) Dhatu, Rakta. Pandu (anaemia)has been described under Rasa Dushtijanya Vikara too.
(7) CONSTIPATION –Vayu Prakopa results in Gadhavarchastvam (constipation) and aggravated Kapha (Manda Guna) may cause decrease in Apa Karshani Gati of Mahasrotas which leads to constipation.
(8) HOARSENSESS OF VOICE – Hoarseness of voice in Thyroid, mostly results either from mucinuous deposits in vocal cords (intralaryngeal cause) or by external pressure on laryngeal nerve (extralaryngeal cause). According to Sharangdhar, hoarseness of voice arises from vitiated Kapha (Manda Guna).
(9) GENERALISED ACHES AND PAIN – Rasaja Vikara arises from Dhatvagnimandya and aggravated Vata Dosha (increased Toda) may lead to causation of this symptom.
(10) SLUGGISHNESS – In other words, Shaithilaya, Alasya(lazyness) results from vitiated Rasa and Kapha.
(11) TIREDNESS – It results from aggravated Vata due to increased Shrama.
(12) MENSTRUAL DISTURBANCES – Due to hypofunctioning of Agni, Rasa Vridhi result which is in Asthayi form. This vitiated Dhatu can’t nourish Updhatu Artava and Stanya properly.Hence, menstruation caeses. Secondly, provocated Doshas causes Artvavahasrotodushti and obstruction of these Srotas results in Anartva (Secondary amenorrheoea)
(13) COLD INTOLERANCE – Suppression of Pitta Mandoshmata, also propagation of Shitaguna of Kapha and Rasa Dhatu leads to Shaitya.
(14) FORGETFULNESS – Vitiated Kapha may cause Buddhimandya. Also,Manovaha Srotas are affected by vitiated Doshas. All this makes a patient to be forgetful.
(15) SLEEPINESS – Vitiated rasa and Kapha induce sleepiness.
(16) SLOW PULSE RATE – It may be due to Manda Guna of vitiated Kapha.
(17) MUSCLE CRAMPS/STIFFNESS – It results due to over functioning of Vayu. Moreover, Kandara and Snayu, Upadhatus of Rakta and Medodhatu respectively, don’t get proper nutrition which results in their improper function or it may be correlated with slow relaxation of muscles, hence, stiffness ensues.
CONCEPT OF KRIYAKALA:
Acharya Sushruta has described ‘Shat Kriyakala’ for the development of any disease which seems to be more logical and scientific in considering aetiopathogenesis of thyroid according to Ayurveda. Here, a humble attempt is being made to describe pathogenesis of Thyroid on the basis of ‘Shat Kriyakala’.
- Dosha Sanchayavastha –In Thyroid, stress and other etiological factors stimulate brain and starts synthesizing or liberating certain biogenic amines. Due to various Nidana factors, Tridosha as well as Agni vitiation ensues, which results in augmentation and accumulation of Kapha.
- Second Kriyakala – It is also known as Kala of Dosha Prakopavastha. Aforesaid certain biogenic amines stimulate hypothalamus, pituitary, thyroid and adrenal medulla etc. Due to impairment of Agni, improper digestion of food results in production of Ama Annarasa which may further augment vitiated Kapha.
- Third Kriyakala– This is a stage of Dosha Prasaravastha. Stimulation of above said glands induce secretion of releasing factors or hormones in the blood and biochemical alterations get started. Vitiated Rasa Dhatu and Rasagni Mandya causes Srotodusti. Progression of the pathological events is ensued by Uttarottara(progressive) Dhatvagnimandya and Uttarottara vitiation of Dhatus. Moreover, circulation of Ama Anna Rasa may increase Srotorodha.
- Fourth Kriyakala– This stage can be termed as Sthanasamshraya. Aforesaid, bio-chemical alterations start inducing an organopathological change in thyroid gland which depends upon tissue or cell susceptibility. Vitiated Rasa and augmented Kapha create Dosha Dushya Sammurchna.
- Fifth Kriyakala– also called as Vyaktavastha. Organopathological changes happening in thyroid gland start developing their various signs and symptoms in different systems of the body. Doshadushya Sammurchna, if not treated, leads to manifestation of symptoms of disease.
- Sixth Kriyakala– Progression of disease untreated with manifestation of complications results. E.g. Myxedema Coma, Myxedema madness.
Different Aaharaja(dietery),Viharaja(lifestyle) and Manasika(psychological) etiological factors will lead to Tridosha vitiation including dominance of Kapha associated Pitta Dushti and Margavaranajanya Vataprokopa. This Dosha vitiation and Agnimandyakara Nidana will cause vitiation of Agni and vitiation of Annavaha Srotas. When Jatharagni gets impaired, on one hand, this Jatharagnimandya leads to formation of Aama (qualitative) which in turn causes Rasavaha Srotodushti and Srotorodha. while, on the other hand, its moieties which are distributed to Dhatvagnis get impaired disturbing status of Dhatvagnis too.Due to above pathological sequences, vitiated Rasa Dhatu is formed causing impairment of other Dhatus too and Malarupi Kaphavriddhi will lead to Srotolepa causing again Rasavaha Srotodushti. Thus, a chain of pathological events is started producing symptoms of Rasa Dushti like Aruchi (loss of appetite), Gaurava (Heaviness),Tandra (sleepiness),Panduta (pallor),Srotorodha(obstruction of channels) etc. Vitiated Rasa Dhatu will produce vitiated Uttarottara Dhatu with respective Sroto Dushti and thus a syndrome involving many organ systems will get developed.Hence Samprapti Ghataka involved can be summarized as follows:
- Dosha: Kapha Vriddhi associated with Pitta Dushti and Margavaranajanya Vata Vriddhi
- Dushya: Rasa,Meda predominantly
- Agni: Jatharagni, Dhatvagni
- Ama: Jatharagni mandya Janita, Dhatvagnimandya Janita
- Srotas: Rasavaha Srotas,Medovaha Srotas predominantly
- Srotodusti: Sanga, Vimarga-gamana
- Adhisthana: Thyroid Gland
- Udbhavasthana: Amashaya
- Rogamarga: Bahya
- Vyaktisthana: Sharira
SADHYA – ASADHYATA:
Prognosis, in case of adult thyroid is good, if the ailment is started early (without complication). Patients generally lead to normal life after treatment. In cases of cretinism (where chances of intellectual abnormalities are greatest in proportion), if treatment is started before age of 4 months, then neurological damage can be prevented with better intellectual development. This is the reason; babies should be screened for Thyroid after birth. Once the therapy is stared, it should be continued for long. According to Ayurveda, Vyadhi can be considered as Krichasadhaya.
Health is like a vehicle which runs only on the balanced motion of four wheels viz. Sharira, Indriya, Satva and Atma. Any deterioration to above leads to diseased condition. To get rid of this deterioration, Chikitsa is essential. Chikitsa derives measures adapted to the removal of the factors of the disease. It not only directs towards removal of causative factors but also aims at Doshika equilibrium.
In treatment of Thyroid, by keeping the impairment of metabolism at base, we can treat patients fruitfully by acquiring Agnivardhaka Chikitsa. But an increase in Pitta need not always result in an increase of Agni / digestive efficiency. It depends on Amshamsha Kalpana or Vikalpa Samprapti. In other words, it depends upon the nature and degree of increase of Pachaka Pitta. Capacity of digestion depends upon qualitative increase of Ushna Guna of Pitta whereas quantitative increase leads to increase in Dravata which results in Agnimandya. Therefore, drugs which increase digestive capacity of Pitta (quality of Pitta) can help in combating Samprapti of the disease.
As clinical presentation of thyroid resembles with Bahudosha Lakshana, Samshodhana therapy is best choice of treatment for it which includes Vamana (emesis),Virechana (purgation)