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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 34-39

Efficacy of Triphaladya guggulu and Punarnavadi kashaya in the management of Hypothyroidism


1 Department of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Department of Rasa Shastra and Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi, India

Date of Web Publication7-Jul-2022

Correspondence Address:
S Karishma
Department of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2667-0593.350098

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  Abstract 


Changed life style of current scenario has provoked several disharmonies in the biological system. Hypothyroidism is one such manifestation, which is believed to be a common health issue in India. The pathogenesis of Hypothyroidism according to Ayurveda is basically due to the abnormal functioning of Agni, which in turn affects Dhatwagni, eventually brings out pathological sequence and ultimately the disease condition develops. This condition can be managed by Ayurveda principles. A diagnosed case of Hypothyroidism presenting with puffiness of face and eyelids, weakness, lethargy, fatigue, prolonged intermenstrual period, dry and coarse skin, was managed with Triphaladya guggulu (1000 mg twice a day) and Punarnavadi kashaya (50 ml twice a day) for a period of 45 days. Thyroxine (100 mcg) that was being used by the patient since one year was withdrawn one week before starting the treatment. Serum TSH levels were reduced from 93.250 μIU/ml to 53.701 μIU/ml by the end of treatment. Triphaladya guggulu and Punarnavadi kashaya are beneficial countering signs and symptoms and bringing down the TSH levels. As the observations were drawn from a single case; can be revalidated through well designed clinical trials.

Keywords: Case report, Hormone replacement therapy, Hypothyroidism, Punarnavadi kashaya, Triphladya guggulu


How to cite this article:
Karishma S, Anup B T, Prajapati P K. Efficacy of Triphaladya guggulu and Punarnavadi kashaya in the management of Hypothyroidism. J Ayurveda Case Rep 2018;1:34-9

How to cite this URL:
Karishma S, Anup B T, Prajapati P K. Efficacy of Triphaladya guggulu and Punarnavadi kashaya in the management of Hypothyroidism. J Ayurveda Case Rep [serial online] 2018 [cited 2022 Dec 9];1:34-9. Available from: http://www.ayucare.org/text.asp?2018/1/1/34/350098



Introduction: Hypothyroidism is one of the most common and challenging disease conditions in today’s era. The prevalence of hypothyroidism in India is around 11[1]. Hypothyroidism is a condition in which the thyroid gland does not produce enough Thyroxine (T4) and Tri-iodothyronine (T3).

Iodine deficiency and auto-immunity are the main causes of Hypothyroidism, out of which auto-immunity is common in the areas of iodine replete. There is no promising cure in contemporary systems for Hypothyroidism. The only available treatment is lifelong use of synthetic thyroxine that invites complications in the long run.

Concept of Agni (digestive fire) and Ama (unwanted by product of improper digestion) are the central dogma of Ayurvedic therapeutics in general and in particular in the management of auto-immune pathologies. Agni, when becomes Manda (weak), is unable to metabolize leading to accumulation of intermediate metabolic by- products in the body at different levels. Such unwanted by-products (sometimes may act as free radicals) becomes toxic and may initiate pathologies of auto- immunity.

As most body cells have receptors for thyroid hormones; T3 and T4 exert their effects throughout the body.[2] These hormones stimulate diverse metabolic activities in most tissues, leading to an increase in basal metabolic rate. Without thyroid hormones, almost all the chemical reactions of the body would become sluggish. These hormones can be considered as a part of Kayagni on which the entire metabolic activities depends.[3] Hence, impaired metabolism can be compared with vitiation of Agni according to Ayurveda. Thus, principles that correct the functioning of Agni will be beneficial in treating various pathologies. Following these guidelines, a case of Hypothyroidism was managed.

Case report: A 30 years old female suffering with Hypothyroidism attended Panchakarma OPD, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar with the complaints of puffiness of face and eyelids, weakness, lethargy, fatigue, prolonged inter menstrual period, dry and coarse skin since one year with elevated levels of Serum TSH (Thyroid Stimulating Hormone). She was under Hormone replacement therapy (Tab Thyroxine 100 mcg OD) since one year. No positive family history was noticed.

The Prakriti was found to be Vata pitta. Despite of continuous consumption of Thyroxine for one year; she could not get satisfactory relief in the signs and symptoms and approached Ayurveda for better management.

As malfunctioning of Agni is considered in the pathogenesis; Triphaladya guggulu (1000 mg twice a day) along with Punarnavadi kashaya (50 ml twice a day) were chosen in the current case and were administered for a period of 45 days.[4],[5] Composition formulation of these two formulations has been placed at [Table 1],[Table 2].
Table 1: Composition of Triphaladya guggulu

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Table 2: Composition of Punarnavadi kashaya

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Triphaladya guggulu was prepared by dissolving Triphala shodhita guggulu in Kanchanara twak kwatha until it attained a sticky consistency, followed by addition of powders of Trikatu and Triphala along with quantity sufficient honey for making pills of 500 mg size. It was administered in a dose of two pills (1000 mg) twice a day with luke warm water after meal for a period of 45 days.

For preparation of Punarnavadi kashaya; patients were advised to add 400 ml potable water to 25 g of coarse powder of the ingredients and reduce to 50 ml and consume on empty stomach twice daily for a period of 45 days.

Along with the oral medication, Pathya and Apathya ahara and Vihara (wholesome and unwholesome diet and lifestyle) were also advised to the patient. She was asked to consume luke warm water in place of normal / cold water during the treatment period. In addition, was advised to avoid consuming diet that is difficult to digest; consuming diet before complete digestion of earlier diet; frequent and excessive intake of curd and day sleep. Thyroxine (100 mcg) that was being used by the patient was withdrawn one week before starting the treatment. Tests for thyroid profiles were conducted and the patient was assessed on subjective parameters before starting the treatment and after 45 days of treatment.

Assessment criteria: Improvement was assessed on the basis of percentage relief observed in the presenting complaints. Grading criterion being followed in the institute was adopted to assess the effectiveness of the therapy.[6] [Table 3].
Table 3: Grading criteria

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Observations and Results: Considerable improvement was noticed in complaints as placed at [Table 4].
Table 4: Effect of therapy on chief complaints

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Discussion: Thyroid hormones stimulate diverse metabolic activities in most tissues, leading to an increase in basal metabolic rate, may be playing the role of Kayagni, which possess its Amshas (components) and influence all over the body.[7] A role of the gut bacteria is to assist in converting inactive T4 into the active form of thyroid hormone T3. About 20% of T4 is converted to T3 in the gastrointestinal tract, in the form of T3 sulfate (T3S) and tri-iodoacetic acid (T3AC). The conversion of T3S and T3AC into active T3 requires an enzyme called Intestinal sulfatase. This intestinal sulfatase is released from healthy gut bacteria. Intestinal dysbiosis, an imbalance between pathogenic and beneficial bacteria in the gut, significantly reduces the conversion of T3S and T3AC to T3.[8] All of these connections make it clear that one can’t have a healthy thyroid without a healthy gut and vice versa. Fixing the gut is the foremost step to achieve a healthy thyroid.

Ingredients of Punarnavadi kashaya exert diverse activities. Punarnava (Boerhaavia diffusa Linn.) owing to its Shothahara property is an excellent remedy for treating generalized oedematous condition and its roots are reputed to be diuretic and laxative.[9],[10] Devadaru is Kapha vata shamaka and acts as Deepana pachana in addition to its immunomodulatory and anti-inflammatory activity.[11],[12] Shunthi has Agni deepana property.[13]

Triphladya guggulu is especially indicated for the management of Gandamala. Acharya Sushruta has indicated Guggulu in Shotha[14] that is one of the most commonly observed clinical manifestation in cases of hypothyroidism. It acts on Medo vaha srotas and does Lekhana karma (desiccation), thus might be helpful in managing obesity which is a common presentation of hypothyroidism. It also possess anti-inflammatory property.[15] Animal studies have reported a ketosteroid isolated from oleoresin of Guggulu showed a strong thyroid stimulatory action.[16] It is also found to have anti- oxidant effect because of Gugglusterone that counters oxygen free radicals.[17] Kanchanara possesses anti- oxidant, anti-inflammatory, and immuno-modulatory activities.[18]

Agnimandya (impaired digestive functions) is the causative factor as well as one of the consequences of Hypothyroidism. It leads to the formation of Ama, which initiates auto-immune responses in the body. Trikatu through its Deepana properties,[19] help in maintaining Agni, thus preventing further formation of Ama.

Triphala supports healthy digestion and absorption.[20] It is a powerful antioxidant, protect cells from the damage of free radicals.[20] Constipation, a symptom in Hypothyroidism, can impair hormone clearance and can elevate oestrogen levels, which in turn raises thyroid binding globulin levels and decrease the levels of thyroid hormones in the body.[8] Triphala can prove to be beneficial in avoiding constipation, thus help in maintaining physiological levels of thyroid hormones.

Vitamin-C is an active component of Devadaru and Amalaki.[21],[22] Studies have shown that natural antioxidants such as vitamin-C can reverse thyroid damage by optimizing functions of thyroid.[23] Thyroid gland need Vitamin-C to keep it healthy.[24] Effect of therapy on Thyroid profile also validates the role of Agni and vitamin-C [Table 5].
Table 5: Effect of therapy on Thyroid Profile

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As Hypothyroidism is caused due to the malfunctioning of Agni and Ama; and the ingredients of trial drugs helps in repairing them; Samata (association with Ama) and Strotorodha (obstruction in channels) might have got cleared that pacified symptoms of Hypothyroidism by maintaining physiological thyroid profiles.

Improved Agni might have helped in optimizing the function of thyroid gland thus yielding positive results not only in the subjective parameters, but also on the objective parameters of Hypothyroidism.

Conclusion: This was a single case study that validated the efficacy of Triphaladya guggulu and Punarnavadi kashaya in the management of Hypothyroidism. Though Thyroxine was discontinued, the symptoms were under control with the current trail drugs. As the observations are encouraging, there is a need to evaluate actual impact of the trial drugs in larger number of patients and draw more concrete conclusions. Awareness regarding Ayurveda is to be drawn among the masses so that a maximum number of sufferers can utilize the services and have the benefit of an enhanced quality of life.

Source of support: Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar - 361008, Gujarat, India.

Conflicts of interest: None declared.



 
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Shastri AD, editor. Sushruta Samhita of Sushruta, Chikitsa Sthana, Shopha Chikitsa, chapter 23, verse 12, Chaukhamba Sanskrit Sansthana, Varanasi: Reprint 2010; p. 130.  Back to cited text no. 14
    
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Sharma PC, Yelne MB, Dennis TJ. Database on Medicinal Plants used in Ayurveda Volume 2, Central Council for Research in Ayurvedic Sciences, Ministry of Health and Family Welfare, Government of India. Reprint 2005. p. 226.  Back to cited text no. 15
    
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Tripathi YB, Malhotra OP, Tripathi SN. Thyroid stimulating action of Z-guggulsterone obtained from Commiphora mukul. Planta medica. 1984; 50(1): 78-80.  Back to cited text no. 16
    
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Sarup P, Bala S, Kamboj S. Pharmacology and Phytochemistry of Oleo-Gum Resin of Commiphora wightii (Guggulu). Scientifica. 2015.  Back to cited text no. 17
    
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Chandra TR, Suresh C, Sanghamitra D, Kumar GR. Kanchnara (Bauhinia variegate Linn.) - A Critical Review. International Journal of Ayurveda and Pharma Research. 2015; 3(7).  Back to cited text no. 18
    
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Shastri AD, editor. Sushruta Samhita of Sushruta, Sutra Sthana, Dravya sangrahaniyam, chapter 38, verse 59, Chaukhamba Sanskrit Sansthan, Pune: Reprint 2012. p. 188.  Back to cited text no. 19
    
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Billore KV, Yelne MB, Dennis TJ, Chaudhari BG. Database on Medicinal Plants used in Ayurveda Volume 7, Central Council for Research in Ayurvedic Sciences, Ministry of Health and Family Welfare, Government of India. 2005. p. 74.  Back to cited text no. 21
    
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Sharma PC, Yelne MB, Dennis TJ. Database on Medicinal Plants used in Ayurveda Volume 3, Central Council for Research in Ayurvedic Sciences, Ministry of Health and Family Welfare, Government of India. Reprint 2005. p. 14.  Back to cited text no. 22
    
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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