Introduction

In the present era of globalization, people are increasingly adopting Western culture, which is causing significant changes in their way of life. These changes, such as irregular eating habits, stress, and a lack of proper sleep, have led to the emergence of various metabolic disorders like Hypothyroidism, Diabetes Mellitus, Hypertension, and Coronary Vascular diseases. Lifestyle-related disorders have become a primary cause of mortality in recent years. The thyroid gland, located in the front of the neck, produces two crucial hormones, Thyroxin (T4) and Triiodothyronine (T3), which play a vital role in metabolism, growth, and overall development of the body. The primary function of the thyroid gland is to facilitate the maintenance of oxidative metabolism. Hypothyroidism, characterized by an underactive thyroid, is a condition in which the thyroid gland produces an insufficient amount of thyroid hormones. It affects large number of the general population, with an additional estimated 5% remaining undiagnosed.1-6 Ayurveda, a holistic science of life, has a primary goal of promoting human health. It can provide fresh perspectives on understanding the causes and effective treatment of hypothyroidism. In Ayurvedic texts, there isn't a specific term for hypothyroidism, as many contemporary diseases are not explicitly mentioned. Nevertheless, Ayurvedic principles offer profound insights that enable successful treatment. According to Acharya Charak, it's not crucial for every ailment to have a specific name; the key is comprehending the potential causes, such as Dosha and Dushya imbalances. Once understood, effective treatment becomes possible. In Ayurveda, Hypothyroidism can be linked to the concept of Agnimandya Avastha, particularly Dhatu agnimandya, which exhibits specific symptoms at different stages, closely resembling the symptoms of Hypothyroidism.7-9

Ayurvedic view

The thyroid gland holds a crucial role within the endocrine system, overseeing various bodily functions, including metabolism, respiration, cardiovascular activity, digestion, the nervous system, and reproduction, either directly or indirectly. When the body lacks sufficient thyroid hormone or its tissues become resistant to the hormone's metabolic demands, it leads to a condition known as hypothyroidism. Hypothyroidism is a significant health concern in both developed and developing regions, with a prevalence of 2-5% in the developed world and approximately 4-15% for subclinical hypothyroidism. In urban India, the prevalence of hypothyroidism is notably high at 10.95%, with a considerable portion, around 3.47%, remaining undiagnosed. This condition is more common among females and older individuals. Autoimmunity plays a pivotal role in its development. Hypothyroidism can lead to complications such as dyslipidemia, a major risk factor for various serious illnesses, and at its peak, it can even pose life-threatening conditions.10-12

INVOLVEMENT OF TRIDOSHA

Symptoms involved Dosha involved

1. Weight Gain - Kapha vruddhi,Pitha kshaya

2. Puffiness of body features - Kapha Vruddhi

3. Loss of appetite - Kapha Vruddhi,Pitta Kshaya

4. Dry & coarse skin - Vata Vruddhi, Pitta Kshaya

5. Minimal or absent sweating - Pitta Kshaya

6. Anaemia Kapha-Vata Vruddhi, Pitta Kshaya

7. Constipation - Vata Vruddhi

8. Hoarseness of Voice Kapha- Vata Vruddhi

9. Generalised Aches, Pain - Vata Vruddhi

10. Muscular cramps, stiffness - Vata Vruddhi 13-15

Involvement of Dhatu Dhatu

1. Rasa  - Weight gain, Loss of appetite,Heaviness of body, Lethargy, Generalised aches, Somnolence, premature aging symptoms like hairloss, Cold intolerance, Puffiness, Anaemia, Menustral disturbances, Infertility

2. Rakta - Slow pulse rate, Dry skin, Slowing of mental activity, Lethargy

3. Mamsa - Heaviness in the body, Muscle ache, granthi, Galaganda

4. Meda - Tiredness, Sleepiness, Hyperlipidemia, Dysnpnea on exertion

5. Asthi - Osteoporosis, Osteoarthritis

6. Majja - Osteoporosis

7. Shukra - Loss of libido, infertility12-16

Involvement of Srotas

1. Annavaha  - Loss of appetite, malabsorption

 2. Rasavaha - Weight gain, Loss of appetite, Heaviness of body, Lethargy, Generalised aches, Somnolence, premature aging symptoms like hair loss, Cold intolerance, Puffiness, Anaemia, Menstrual disturbances, Infertility

3. Raktavaha - Slow pulse rate, Dry skin, Slowing of mental activity, Anaemia

4. Mamsavaha - Oedema, Galaganda

5. Medovaha - Tiredness, Sleepiness, Sluggishness, Hyperlipidemia

6. Asthivaha - Osteoporosis, Osteoarthritis, Hair loss

7. Majjavaha - Osteoporosis

8. Shukravaha - Loss of libido, Infertility

9. Purishavaha - Constipation

10. Swedavaha - Dry & coarse skin, absent/minimal sweating12-16

CHIKITSA (Ayurvedic Treatment) :

The treatment of hypothyroidism is similar to the treatment of vata and kapha. The majority of the symptoms are caused by the kapha energy. However, the majority of patients who have this condition also have low ojas as a result of previous vata and pitta vitiation.The Hypothyroidism Chiktisa Siddhanta revolves around the Chiktisa of Ama Dosha, namely Pachana, Deepana, and Shodhana after Sneha and Sweda Karma.The line of management aims at Dhatwagni Deepana; Dhatugata mala Pachana; Srotoshodhana; Vata-Kapha Shaman; Manoharshana; Rasyana; Yoga.17

• Deepana - The diet or medicine which stimulate digestive fire.

Single drug - Shatapushpa,Pippali,Maricha,Sunthi

Ayurvedic formulations - Shaddharanam Choornam, Panchkola Choorna, Indukanta Ghrita

• Pachana - The diet or medicine which leads to digestion of undigested food or Ama. This process does not increase or stimulate digestive capacity (Agni) at primary level.

Single Drug- Nagkeshar Ayurvedic formulations, Hingwashtaka Churna, Lavanbhaskara Churna, Panchkola Churna, Chitrakadi Vati, Lashunadi Vati, Shiva Gutika, Guduchyadi Kwatha.

• Shodhana - The process by which vitiated Doshas are expelled out from the body by their nearest route Doshas might sometimes aggravate even after treatment with Deepana and Pachana. But they never reoccur if they are subdued with evacuative therapy.18

Vaman (Kapha Chedana)- Madanaphaladi Yoga,Vacha, Yashtimadhu

Virechana – Trivrutta Avleha

Nasya – Shadbindu Taila

Vata Kapha Shamana Ø Punarnavadi Kwatha, Navaka Guggulu

• Rasayana - Amalaki, Shatavari,Ashwagandha , Triphala Rasayana , Guduchi Rasayana
• Yoga - Some beneficial Yoga postures in Hypothyroidism are: Sarvangasana (Shoulder stand); Viparita Karani Asana (Inverted Pose); Janu Sirsasana (Seated head to knee pose); Matsyasana (Fish pose); Halasana (Plough pose); Surya Namaskara (Sun salutation); Pranayama (Kapalbhati); Ujjayi; Pranayama; Bhastrika, Nadi Shodhana, etc.19-20
• Pathya- Apathya - The Pathya include Purana Ghrita Pana, Jeerna Lohita Shali, Yava, Mudga, Patola, Rakta Shigru, Ruksha Katu Dravyas and Deepana Dravyas. Apathya include Kshira Vikruti, all types of Mamsa, Pishtaannam, etc.21

Discussion

The concept of Agni (Fire) is unique to Ayurveda. Based on these symptoms, Hypothyroidism in Ayurveda is classified as a disease caused by Agni (Fire) malfunction or Agnidushti (Fire Malfunction). According to Acharya Charaka, the reason for life, color, strength, health, enthusiasm, plumpness, complexion, Ojas (Immunity), Tejas (Luster), other varieties of Agni (Fire), and Prana (Life) is Jatharagni (Principal Fire). Extinguishment of this Jatharagni (Principal Fire) causes death; proper maintenance allows a person to live a long life; and impairment causes diseases. As described by Aacharya Vagbhata, Agnidushti (Malfunctioning of Fire) occurs as a result of various ill dietary habits and lifestyle changes, resulting in the formation of Ama (Undigested Food). Obstruction of the channel, Loss of strength, feeling of heaviness in the body, Inactivity of vata (Air element in our body), Lassitude, Loss of digestive power, Increased expectoration, Accumulation of wastes, Anorexia, Exhaustion are all symptoms of Lakshana.22-24

Clinical manifestations of hypothyroidism include lethargy, fatigue, heaviness in the body, sleepiness, and loss of appetite. Acharya Vagbhata classified Ama Dosha treatment into three categories based on the severity of the Doshas involved. Langhana (Fasting) is recommended when Alpa (Less) Doshas are present. In the case of Madhyama (moderate) Doshas, Langhana (Fasting) and Pachana (proper Digestion) are advised, whereas Doshavsechan (expulsion of toxins from the body) is the preferred line of treatment. Samsodhana (Purification Process) is also known as Doshavsechan (expulsion of toxins from the body), which can be either Vaman (therapeutic emesis) or Virechana (therapeutic purgation).22-23 Virechana treats this condition by correcting the altered metabolism through Agni Dushti (Digestive Fire). Virechana drug, which has the properties Ushna (Hot), Tikshna (Sharp), Sukshma (Minute), Vyavayi (quick absorption), and Vikasi (that causes bond loosening), reaches the Hridaya (Heart) via its veerya (active principles), and then pervades the entire body via large and small Srotas (Small channels). They are quickly absorbed due to the Vyavayi guna of Virechana dravyas. Laxatives, according to modern science, probably induce limited low-grade inflammation in the small and lower bowel to promote water and electrolyte accumulation and stimulate intestinal motility. According to the above, purgative drugs are mild irritants to the stomach and intestinal mucosa, causing inflammation. As a result, the permeability of the membrane changes, and substances that would not normally come out come out as a result of the changed permeability. This medically induced mild inflammation aids in the initial absorption of the veerya of the drug. Later on, it aids in the excretion of morbid matters that are not normally excreted through the mucosa of the gut. It is only possible because inflammation increases capillary permeability, allowing absorption and excretion of substances that are not permitted in normal conditions. 24-27

Conclusion

Rather than treating symptoms for the rest of a patient's life, Ayurveda attempts to heal the underlying imbalance of hypothyroidism. According to the research, if a patient is willing to reduce their stress through lifestyle changes and take key therapeutic herbs, they may be able to recover from this chronic disease. To appease vata and pitta, necessary lifestyle changes must include slowing down in a fast-paced and demanding society. This would alleviate anxiety and depression, which may be prodromal symptoms of hypothyroidism, as well as pacify the vata and pitta energies in the body. Changing our lifestyle from multitasking and getting things done will certainly prove difficult in this modern era, but it is clear from the research that for those who are dedicated enough to do what it takes to get results will find success.