A Clinical Study On The Role Of Vamana & Virechana In The Management Of Hypothyroidism With Punarnava-Amritaadya-Guggulu Scholar Dr. Pratiksha Pateriya M.D. Scholar Co-Guide Dr. A. B. Thakar M.D.(Ayu) Ph.D. H.O.D. & Associated Professor Dept. of Panchakarma Guide Prof. M.S. Baghel M.D. (AYU.) PH.D. Director OF I.P.G.T. & R.A. Jamnagar Co-Guide Dr. M.A. Santwani M.D. CIH Occupational Health Consultant Department of Panchakarma Institute for Postgraduate Teaching & Research in Ayurveda Gujarat Ayurved University Jamnagar-361 008, 2011-2014. Introduction  Frequently misunderstood, and too often overlooked and misdiagnosed, thyroid disease affects almost every aspect of health and , so understanding more about the thyroid, and the symptoms that occur when something goes wrong with this small gland, can help people protect or regain good health.  Women are at the greatest risk, developing thyroid problems seven time more often than men, a risk that increase with age and for those with a family history of thyroid problem • In India, 42 million people -Thyroid disorders hypothyroidism is most common*. • Millions of people are currently hypothyroid and do not know about it due to its gradual onset. Ref- http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001393/ *Clinical Endocrinology in India WHY VAMANA ? • k) SwananupuvIR icikTsa • k)j ¢h[I icikTsa- ¢h{ya< ðe:mÊòaya< vimtSy ywaivix, c ic 15 • k)av&Ä vat……….inéhaí vmn< sivrecnm! , c ic 28,187 • k)e ivdXyaÖmn< s<yaege va k)aeLb[e (A.H.Su. 18/1) WHY VIRECHANA? DEFICIENCY OF THYROID HORMONES MALFUNCTIONING OF AGNI AiGn> @v ZarIre ipTtaNtgRt> kuiptakuipt>Zau_aaZau_aain kraeit. c su 12,11 PITTA DUSHTI PITTA USHNA GUNA /AGNI MANDYA Therefore, therapy which increase digestive capacity of Pitta means quality of Pitta, can helps in combating Samprapti of the disease. Aims and Objective To evaluate the efficacy of Vamana Karma in the management of Hypothyroidism To evaluate the efficacy of Virechana Karma in the management of Hypothyroidism. DISEASE REVIEW HYPOTHYROIDISM Clinical state resulting from a deficiency of thyroid hormones due to decreased activity of the thyroid gland. • Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid. Underactive=inadequate thyroid hormone# Ref- #www.btf-thyroid.org(reference) Symptoms And Risk Factors Risk Factors *Family member with a thyroid problem *Another Pituitary or endocrine disease *Family member have another autoimmune disease *Diagnosed with chronic fatigue syndrome *Diagnosed with *Fibromyalgia Female *Over 60 *Just had a baby *Near menopause or menopausal *Smoker *Exposed to radiation *Treated with lithium *Exposed to certain chemicals(e. g. Perchlorate fluoride HYPOTHYROIDISM IN AYURVEDA......? KAPHAJA PANDU KAPHAJA GRAHANI KAPHA VATA PRAKOPA AND PITTA DUSHTI KAPHAVRITTA VAYU HYPOTHYROIDISM Study Design Group A Group B Group C • Patients in this group were administered Vamana by Madanaphala churna ,after Samsarjana Karma Punarnava-AmritaadyaGuggulu was given in a dose of 1g Tid after meal with luke warm water • Patients in this group were administered Virechana by Trivrittadya snuhi yoga ,after Samsarjana Karma Punarnava-AmritaadyaGuggulu was given in a dose of 1g Tid after meal with luke warm water • Patients in this group were administered • Tab levothyroxin dose Rx As directed by phycisian. Inclusion And Exclusive Criteria Inclusion  Diagnosed cases of hypothyroidism on the basis of Sr.TSH, T3 and T4 levels (Patient’s Sr. TSH level above 5mU/L upto 100mU/L)  Patients having clinical features of hypothyroidism  Age 20-60 years Exclusion Criteria Ischemic heart diseases Uncontrolled hypertension Uncontrolled DM Myocardial infraction Pregnancy Active malignant disease Observation & Result DEMOGRAFIC DATA SHODHANA DETAILS CLINICAL FINDINGS Distribution of 45 Patients of HYPOTHYROIDISM No. of Patients Group Total A B C Registered 15 16 14 45 Completed 15 15 13 43 Discontinued 0 1 1 2 EFFECT ON THYROID FUNCTION TESTS 100 80 60 86.36 69.049 47.39 40 20 V-PAG 0 VR-PAG -20 -40 -60 -16.66 -20.57 -27.63 SCG -37.84 -32.81 -48.91 Effect On Lipid Profile 23.25 25 20 15 10 22.12 15.96 15.44 12.3 11.98 9.58 8.75 V-PAG VR-PAG 3.19 5 SCG 0 0 -0.31 -4 -5 -6.26 -10 -10.69 -15 13.39 Effect On Chief & Associated Complaints The present era is full of 89 chaos stress and 90 80 strain Change in 71 72 70 69 due to 68life style 68 modification, 70 64 61 dietary habits, urbanization 55 and industrialization. 60 This has lead in the upsurge of many diseases 50 40 33 and one of them is Diabetes. 30 22.2 18 17.39 V-PAG 20 8.33  10 In Ayurvedic texts the given characteristic VR-PAG 0 features of Sthula Pramehi shows marked SCG similarity with the syndrome of Diabetes mellitus. % percentage Effect On Chief & Associated Complaints 100 90 80 81 79 72 70 74 72 68 71 66 60 V-PAG 50 VR-PAG 40 30 27.8 20 20 19 13.6 10 0 **Constipation **Dry and coarse skin **Weakness % percentage *Fatigue SCG Effect On Chief & Associated Complaints 90 80 70 83 82 74 68 76 74 71 71 60 50 40 30 17 20 10 7.14 2 0 % percentage 7.14  Puffiness and peripheral oedema-. Snehapana with GoGhrita followed by Samshodhana and PAG leads to Srotoshodhana, Doshanirharana and Agnidipti thus helps to reduce the symptoms.  Dry and coarse skin-It may due to Srotoshodhana, Vatanulomana and Deepana property of Samshodhana therapy resulting into better nourishment and tissue perfusion.  Breathlessness- Due to accumulation of Kapha and Meda causing obstruction to the movement of Vata. Weight reduction found max. in group B. So may be breathlessness is relieved. Cont….      Constipation- Due to Mandagni, Krura Koshtha and Vata Prakopa. Samshodhana were cause Vatanulomana and Agnidipti . Weight gain- Due to fluid retention which can be correlated with Kapha/Mala Sanchaya. Samshodhana therapy may help by doing Srotoshodhana, Vatanulomana. Weakness, lethargy, fatigue-Kaphadosha/Malasanchaya Nirharana, Vatanulomana, Agnidipti may help to relieve symptoms. Loss of initiative somnolence-All these symptoms denote neuro-psycho-endocrinological relation Muscle ache and stiffness- Due to deposition of hyaluronan. Samshodhana helps to remove Malasanchaya cause Srotoshodhana Comparison Between the Effect Of Therapy On Objective criteria (unpaired ‘t’ test ) On comparing the effect of therapies by unpaired ‘t’ test was found that there is  Highly significant difference (<0.001) in the effect of therapies in V-PAG group & SCG on Weight & BMI reduction.  Significant difference (<0.05) in the effect of therapies in VPAG group & SCG on VLDL level.  Highly significant difference (<0.001) in the effect of therapies in VR-PAG group & SCG on Weight & BMI reduction . On Subjective criteria of V-PAG & SCG ᵪ2 ‘P’ Puffiness of face & eyelid 10.734 <0.01 Bilateral peripheral oedema 8.908 <0.01 Dry and coarse skin 10.008 <0.01 Breathlessness 0.024 >0.05 Constipation 10.008 <0.01 Weakness 10.734 <0.01 Lethargy 9.266 <0.01 Fatigue 7.2 <0.01 Muscle ache 0.025 <0.05 Abhyavaharanashakti 0.0001 <0.01 Jaranashakti <0.0001 <0.01 SYMPTOMS On Subjective criteria of VR-PAG & SCG ᵪ2 ‘P’ Puffiness of face & eyelid 12.778 <0.01 Bilateral peripheral oedema 12.778 <0.01 Dry and coarse skin 6.717 <0.05 Breathlessness 0.5879 >0.05 Constipation 8.269 <0.05 Weakness 5.79 <0.05 Lethargy 3.689 >0.05 Fatigue 0.08 >0.05 0.00487 <0.05 Abhyavaharanashakti 3.248 >0.05 Jaranashakti 12.778 <0.05 SYMPTOMS Muscle ache OVERALL EFFECT OF THERAPY 84.61 90 80 70 53.33 53.33 60 50 40 30 V-PAG 26.67 26.67 20 20 15.39 VR-PAG SCG 20 10 0 0 Moderate improvement Mild Improvement Unchanged % percentage Conclusion In the present study ,V-PAG therapy was found more effective than HRT(Levothyroxine) in thyroid function tests. V-PAG & VR-PAG therapies were found more effective than HRT(Levothyroxine) in Weight & BMI reduction. However VR-PAG therapy showed better result than V-PAG therapy. V-PAG therapy was found more effective than HRT (Levothyroxine) in reduction of level of Sr. Cholesterol ,Sr.triglycerides & VLDL. However both V-PAG & VR-PAG showed better result than HRT (Levothyroxine) on increasing level of HDL. Though both the Shodhana group provided improvement on Signs & Symptoms of Hypothyroidism than HRT(Levothyroxine) which was statistically significant however V-PAG group provided better result than VR-PAG group. 4 Lifestyle Tips for Hypothyroidism Fill Up with Healthy Foods Exercise Regularly, and Mix It Up Get Some Much-needed Stress Relief Hit the Snooze Button Thank You