Role Of Ayurvedic Medicine And Panchakarma In

Hypothyroidism: Narrative Literature Review

Dr Kusum Thapa1*, Dr Pankaj Kumar Katara2, Dr Arun Gupta3
1
*P.G. Scholar (Department Of Panchakarma), Post Graduate, Department Of Panchakarma, Ch. Brahm Prakash Ayurved Charak
Sansthan Khera Dabar, New Delhi-110073, Email: Kusum456thapa@Gmail.Com
2
assistant Professor (Department Of Panchakarma), Post Graduate, Department Of Panchakarma, Ch. Brahm Prakash Ayurved Charak
Sansthan Khera Dabar, New Delhi-110073, Drpankajkatara@Gmail.Com,
3
head Of Department & Professor (Department Of Panchakarma). Post Graduate, Department Of Panchakarma, Ch. Brahm Prakash
Ayurved Charak Sansthan Khera Dabar, New Delhi-110073

*Corresponding Author: - Dr Kusum Thapa

*P.G. Scholar (Department Of Panchakarma), Post Graduate, Department Of Panchakarma, Ch. Brahm Prakash Ayurved Charak
Sansthan Khera Dabar, New Delhi-110073, Email: Kusum456thapa@Gmail.Com
DOI: 10.47750/pnr.2022.13.S07.958

Abstract
The pathological condition of thyroid hormone insufficiency, known as hypothyroidism, occurs when the thyroid gland does not
generate enough thyroxine. It can cause a variety of symptoms, such as the inability to tolerate cold, lethargy, constipation, a slow
heartbeat, sadness, and weight gain. Around 4-5% of people globally are hypothyroid. According to Ayurveda, hypothyroidism causes
the Pitta Dosha kshaya and the Kapha Dosha and Vata Dosha vruddhi to be evoked. Thyroid hormone, which is connected to Agni's
role in Ayurveda, controls the bulk of bodily metabolic processes. According to Ayurveda, the cause of hypothyroidism is assumed to
be due to underactive Agni and an unbalanced state of the Doshas Therefore, Ayurvedic treatments for hypothyroidism include
Vamana, Virechana, Basti, Nasya Karma, Shirodhara, and Shamana Aushadhi.

Keywords- Vata-Kapha, Shamana Aushadhi, Panchkarama, Vamana, Nasya karma

INTRODUCTION
Hypothyroidism is described as the thyroid glands inability to generate enough thyroxine, including conditions that
directly impact the thyroid gland, such as hypothalamus or pituitary illness, widespread tissue resistance to thyroid
hormone, and others1. The most prevalent type of thyroid disorder is hypothyroidism, which is a problem that is frequently
seen in clinical settings. It is possibly one of the most prevalent endocrine illnesses in the world; India is also not an
exception. Environmental iodine deficiency is the most common cause of hypothyroidism on a worldwide basis. In areas
of iodine sufficiency, the most common cause of hypothyroidism is chronic autoimmune thyroiditis. Autoimmune thyroid
diseases (AITDs) have been estimated to be 5-10 times more common in women than in men.2

Thyroxine (T4) and Triiodothyronine (T3) are two hormones produced by the thyroid gland (T3). These hormones are
primarily responsible for metabolic regulation and are necessary for the appropriate development and differentiation of
all body cells.3 Thyroid disorder may be linked with increased perceived stress 4.

In Ayurveda we can’t directly correlate Hypothyroidism as a whole disease, signs and symptoms of the disease can be
seen in Ayurvedic texts. The symptoms can be correlated to symptoms of Kapha Avruta Vata, Kaphaja Grahani in
particular and Mandagni Janya Vikara and Bahudoshavashtha in general and Galganda. Mandagni Lakshana like
Gatrasadanam (weakness of the body)5,Adhamanam(distension of abdomen), Gaurava (feeling of heaviness)6; Kapha
Avruta Vata Lakshana like Shaitya (cold intolerance), Gaurava (feeling of heaviness), Shula (pain)7; and many symptoms
Bahudoshavastha like Avasada(depression), Klama(fatigue), Sthoulya(obesity), Alasya(malaise), Dourbalya(weakness),
Avipaka(indigestion)8. According to Acharaya Vagbhata, Jatharagni is related to Dhatvagni, who conveys a proposal
that gives moiety to Dhatus9. Dhatu and other Agni rise when Pachakagni does, and vice versa. Therefore, it can be
claimed that the Agni's malfunction caused it. Hypofunction in Jatharagni ultimate affects Dhatvagni, which leads to the
emergence of pathology and, ultimately, the sick condition. As a result, we can refer to hypothyroidism as
dhatwagnimandya in a broader sense. The primary treatment philosophies to take into account when treating a condition
are Kaphanashaka Chikitsa, Srotoshodhana, Agnideepana, and Vatanulomana.

Patients with hypothyroidism are more prone to develop stress, anxiety, depressive symptoms, and these mental disorders
may be also accompanied by various subtle thyroid abnormalities. 10

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We can correlate these mental disorders with Vata Nanatmaj Vikar “Vishad”11and Avsaada in Ayurveda. And in
Ayurvedic text Rogavardhananam called for Vishad12.

“विषादोरोगिर्धनानाां ”
So if we treat stress (Vishad) then the disease will not get worse and will not cause any other complications and also will
not hamper our day to day life.

AIM AND OBJECTIVES

Aim:
This review study is primarily planned to review previous conducted clinical researches based on the type of Ayurvedic
intervention i.e. various Panchakarma interventions, Ayurvedic medicines used for management of Hypothyroidism and
to make its specific treatment protocol.

Objective:
To assess the efficacy and safety of Ayurvedic medicines and Panchakarma Chikitsa for management of Hypothyroidism.

MATERIAL AND METHODOLOGY

All the information relevant to the study is compiled from previous research studies, i.e. clinical trials, randomized or not
having interventions of various panchakarma modalities and published in various peer reviewed journals and also
available on multiple databases such as Pubmed, Google scholars, Research Gate etc.

OBSERVATIONS AND RESULTS

This review is based on information from a total 10 interventional studies by critically analyzing them to verify the
necessity and assess the role of Ayurvedic medicines and Panchakarma chikitsa.

OBSERVATIONS:
1. Sharma AK, Basu I, Singh S.2018 March, Efficacy and Safety of Ashwagandha Root Extract in Subclinical
Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial.13 This study was performed at
Sudbhawana Hospital, Varanasi, India between May 2016 and September 2016. 50 subjects with elevated serum TSH
levels (4.5-10 μIU/L) aged between18-50 were randomized in either treatment (n = 25) or placebo (n = 25) groups for
an 8-week treatment period. Ashwagandha root extract (600 mg daily) or starch as placebo.
2. Shah SB, Guttal GK, Chikkanna U, Sajjanar NJ. Efficacy of Pippali in vardhamana and fixed dosage pattern in
primary hypothyroidism - A randomized clinical trial. J Ayurveda Integrated Med. 2022 Apr-Jun.14 40 patients
randomized into two groups Escalating and Fixed were administered Vardhamana Pippali in two dosage forms for
19 days. Serum T3, T4, and TSH were assessed at baseline and on the 20th day along with the assessment of clinical
score through Zulewskis's clinical score for measuring tissue hypothyroidism. The total pippali administered in both
groups was 69 g.
3. Roli Bansal, Effect of Vamana Karma in the management of Hypothyroidism. Research article in
International Ayurvedic medical journal Vol 4, Issue 7.July 2016.15
The study was conducted on 31 patients of Hypothyroidism, who were taking levothyroxine and almost having normal
thyroid profile but still they have some sign and symptoms.. Efficacy of the study was evaluated on the basis of
subjective and objective criteria. Clinical study was conducted on two Groups. In Group A (n = 15) Vamana karma
was administered to the patients followed by Samsarjana Krama and Placebo was given for 4 weeks. In group-B (n =
15) Placebo was given to the patients for 6 weeks. During trial Levothyroxine was continued in both Group. It was
found that Vamana Karma has given better relief than Placebo Group.
4. Sarvesh Kumar Singh and Kshira Rajoria – Evaluation of Vardhamana Pippali, Kanchanar Guggulu and Lekhana
Basti in the Management of Hypothyroidism 16. This study was done with primary aim to treat hypothyroidism. In
this study, 30 diagnosed patients with proven subclinical and clinical hypothyroidism were randomly assigned in two
groups of 15 patients in each group. Group A was subjected to Kanchnar guggulu in the dose of 1 gm both time in a
day and Vardhamana pippali for 12 weeks. Groups B was also subjected to similar therapy but there was addition of
Phalatrikadi lekhana basti regime for 30 days. On completion of whole regime it was observed that there was
significant improvement on the S.TSH, S.T3, S.T4, total serum cholesterol and two clinical scores assessing symptoms
and signs of hypothyroidism (Billewicz and Zulewski scores).
5. N. Kavya, B.A. Lohith, An Experimental and Clinical evaluation on the effect of Dwipanchamooladi Niruha
Basti in the management of Hypothyroidism.17 In the study, 15 patients were registered and treated. All the patients
were given Dwipanchamooladi Niruha Basti and Anuvasanabasti was given with 100ml of Brihat Saindhavadi Taila
in modified yoga Basti schedule for 5 days. The cardinal symptoms like Agnidourbalya (loss of appetite) (53%),
weight gain (30%), constipation (44%), oedema (43%), dry skin (45%), lethargy (48%) etc were reduced moderately.
Serum TSH levels (44%) were reduced. After observing the changes during and after the treatment.
6. According to "A Clinical Study on the role of Vamana and Shamana in the management of Kaphaja Galaganda with
special reference to Hypothyroidism18", 14 patients of Hypothyroidism were taken for study and divided in two groups.
In Group A; Vamana Karma was done followed by Shamana Aushadhi (Bhallataka vati and Galagandahar vati). In
Group B; only Shamana Aushadhi was given. Duration of the trial was two months. The results of this study showed
7894 Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 07¦ 2022
 that Vamana Karma provided significant relief in symptoms of puffiness of face, oedema, generalized pain, dry
skin, excessive sleep and lethargy. It also significantly reduced the body weight and body mass index (BMI). Vamana
Karma provides moderate improvement to 28.6% patients and mild improvement to 71.4% patients.
7. Singh K, Thakar AB. 2018 “A clinical study to evaluate the role of Triphaladya Guggulu along with Punarnavadi
Kashaya in the management of hypothyroidism.”19 In this study fifteen eligible hypothyroid patients with serum TSH
>4.5 μIU/ml and serum T3 & T4 lower than their respective normal range were selected and treated with Triphladya
Guggulu pills and Punarnavadi Kashayam for 45 days. Patients were advised to discontinue any medicine they might
be taking for the management of hypothyroidism to assess the unbiased effect of therapies. Significant improvement
was observed on subjective parameters, after clinical trial, 6.66% of the patients continued their previous dosage of
levothyroxine, while 80% of the patients had withdrawn their hormone replacement therapy.
8. Rashmi Joshi, Pravesh Kumar, Balkrishan Panwar, & Uttam Kumar Sharma. (2019). CLINICAL EVALUATION OF
ARAGHVADHADI VIRECHANA YOGA IN THE MANAGEMENT OF HYPOTHYROIDISM. In present study,
total 20 patients of hypothyroidism with TSH more than 5.0 mIU/ml. Effect of Virechana karma was seen extremely
significant on symptoms like fatigue, dry and coarse skin, unexplained weight gain, muscle ache, puffiness of
face and breathlessness. This is observed that the TSH level was reduced up to 9.88%. 20
9. Sindhujakavya Veerashetti, & Mythrey R. C. (2021). An explorative clinical study to evaluate the combined effect of
Nirgundi Taila Nasya and Chopachinyadi Choorna in the management of Hypothyroidism.21 A single group open
clinical study with pre-post test design was carried out in Government Ayurveda Medical College and Hospital,
Mysuru and through conducting special camps. Nasya Karma with Nirgundi Taila for 7 days, Chopachinyadi Choorna
with Shigru Patra Kwatha as Anupana for 60 days were taken as intervention. The intervention used in the study was
more effective in reducing the symptoms of Hypothyroidism, than normalizing the TSH value.
10. Successful Management of Hypothyroidism through Ayurveda: A Case Study Rishu Sharma and Gyanendra Datta
Shukla Department of Panchkarma, Rishikul University, Haridwar, Department of Panchkarma, Gurukul University,
Haridwar, India22. A better line of management is the need of this present era which not only helps managing the
disease but also not develops dependency. A Hindu, married, 45yr old Female patient visited the outpatient department
of the institute, Rishikul, with complaint of k/c/o Hypothyroidism with Sudden Weight gain, hair fall, Anxiety. After
administration of Virechana, much better results were seen in just 7 months. During the entire treatment procedure,
patient didn’t take any allopathic medication.

DISCUSSION
Hypothyroidism is a serious multi-systemic metabolic disorder, which has itseffects on the daily routine one’s life.
Hypothyroidism is very difficult to link to any one of Ayurveda nominated ailments. However, the symptoms can be
linked to Galganda, Mandagnijanya Vikara, Kaphaavrutavata, Kaphaja Grahani, and Bahudoshavashtha problems.

• Effect of Ashwagandha- A detailed analysis revealed that daily treatment with Ashwagandha for a period of 8 weeks
produced a significant decrease in serum TSH level and an increase in serum T3 & T4 levels compared to placebo. An
inverse relationship exists for regulation of HPT and hypothalamic–pituitary–adrenal axis. Chronic stress activates HPA
axis by increasing cortisol levels, which in turn inhibits HPT axis and reduces serum T3 and T4 levels. 23 Treatment with
Ashwagandha lowers serum cortisol levels by down regulation of HPA axis, which in turn up regulates HPT axis to
normalize the levels of the thyroid indices. Other factors like inflammation and dopamine levels also up regulate HPA
axis and down regulate HPT axis.2425 The anti-inflammatory and antidopaminergic properties of Ashwagandha may
contribute to the thyroid modulating effect of the plant extract. 26 27

• Effect of Vamana- For vitiated Kapha, Vamana is the most effective remedy28. Rasadhatu Dushti additionally occurs
in hypothyroidism. Vamana is a form of Langhan, which is a line of therapy for Rasaj Vikara, and since Vamana soothes
Rasa Dhatudushti29 symptoms, Langhan. Vamana will assist with Sroto Vishodhan in this case because hypothyroidism
is a Srotoavrodh Pradhana vyadhi. In addition to assisting with Sroto Vishodhan30, Vamana also aids in bringing Vata's
Pratiloma Gati back into balance and alleviating its symptoms. Drugs called Vamanas circulate throughout the body
because of their efficacy and reach the heart thanks to their Ushna, Tikshna, and Sukshma Guna. They liquefy the evil
Dosha and bring it to the Amashaya31. Vamana was ejected from the room. Additionally useful, it has a direct impact on
Agnisthana32.

• Effect of Nasya karma- The management of hypothyroidism with Nasya may be a better alternative because the
thyroid glands Sthana are Urdhwajatru, a Kaphasthana. The nose is regarded as the entryway to the head, just as in
Ayurveda. Therefore, in the case of Urdhva-Jatrugata diseases33, the nose is the appropriate route for medicine delivery.
Nasya Dravya activates the olfactory bulb by stimulating the peripheral olfactory nerve, which serves as chemo receptors.
This further activates the hypothalamus and pituitary's upper centres, which affects the endocrine system's ability to
secrete thyroid hormones normally34. Sneha enters the brain and affects key areas that regulate endocrine activities, having
a variety of consequences.

CONCLUSION-
Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 07¦ 2022 7895
In treatment of Hypothyroidism, Shamana Aushadhi with Shodhan chikitsha including Nasya karma plays a vital role not
only symptomatically but in overall manner.

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