90 e- ISSN 0976-1047 Print ISSN 2229-7499 International Journal of Biopharmaceutics Journal homepage: www.ijbonline.com IJB EFFICACY OF VAMANA AND KANCHANARA YOGA IN THE MANAGEMENT OF KAPHAJA GALAGANDA VIS - A -VIS HYPOTHYROIDISM Pushpawati Chaudhari, 1 Ravi Kumar Gupta, 1 T Rambabu, 1 B Sandhya, 2 R Vidyanath* *,1 P.G. Scholars, 2 P.G. Professor & H.O.D. Ayurveda Samhita, Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad-500038, Andhra Pradesh, India. ABSTRACT Nowadays life style in every aspect is changing rapidly and Hurry-Worry-curry becomes part and parcel of individuals life. This creates lots of diseases like hypertension, obesity and so many endocrine related disorders like diabetes, hypothyroidism etc. Increasing trend of hypothyroidism is common in the present society and more prevalent among the females. Ratio of the disease occurrence among females and males is 6:1. So it is the right time to search the management of this type of challenging disease through the heritage of Ayurveda. By analyzing the symptomatology of hypothyroidism in the light of Ayurvedic principles it is observed that hypothyroidism may be compared with Kaphaja Galganda as it occurs predominantly due to vitiation of Kapha Dosha and Rasa Dhatu.30 patients of Hypothyroidism between the age group of 16 to 55 years irrespective of sex, diet, occupation and religion are selected for this study from the O.P.D. of Dr. B. R. K. R. Govt. Ayurvedic College Hospital Hyderabad. The patients are divided into two groups Viz. Group A and Group B. In Group A, only Kanchanara Yoga (3-6gms with Tandulodaka) is administered and in Group B Kanchanara Yoga is given with the same dosage after conducting Vamana Karma. It is observed that statistically significant results are seen with Group B. Key words: Kaphaja Galaganda, Hypothyroidism, Vamana, Kanchanara Yoga. INTRODUCTION Today man has achieved high peaks in the field of medicine with the development of various techniques. However Ayurveda the ancient Indian system of medicine, which has its roots in Vedas, is still enjoying high profile in serving mankind. Man is the most precious creature on earth. Health is supreme foundation and diseases are destroyers of health. The interaction and exchange between Loka and Purusha continues in a Corresponding Author Dr. R. Vidyanath E-mail: vnratnakaram@gmail.com natural way as the man breaths air, drink water and consume food articles available in nature. As long as this interaction is wholesome the man is in optimum health, when there is any set back in this harmonious relationship the disease state ensues. The changing life style of human being by means of nutritional and behavior pattern plays a major role in the manifestation of several disorders including hypothyroidism. Hypothyroidism can result in from any of the abnormalities that lead to insufficient synthesis of thyroid hormones. Increasing trend of hypothyroidism is becoming more common in the present society and is more prevalent among the females. It is not only confined to metropolitan population but also extends to urban and
91 rural areas. Ratio of disease occurrence among females & males is 6:1 and is usually found 10-50 in no. per thousand population (Davidson s). In Ayurveda there is no clear cut evidence of hypothyroidism, but on the basis of its clinical presentation, it may be correlated with different of certain entities viz. Rasaja Vikaras, Kaphaja Nanatmaja Roga, Galaganda etc. diseases as well as the symptoms. Hence it is difficult to put a single Ayurvedic term for it. There are many systems which involve in the pathogenesis of hypothyroidism, the mixed signs and symptoms of all these systems lead to a complex clinical picture of hypothyroidism. In Ayurveda the disorders of thyroid gland are explained under the heading of Galaganda. By analyzing the symptomatology of hypothyroidism in the light of Ayurvedic literature, it is observed that hypothyroidism may be correlated with Kaphaja Galaganda as it occurs predominantly due to vitiation of Kapha Dosha and Rasa Dhatu (Sushruta). Thus, here an attempt has been made to treat Hypothyroidism by herbal medicines after compiling all available references from classical authentic texts. Hypothyroidism leads to a long life of pathological events and makes the affected person to remain dependant on hormonal supplement till the end of mortal life. Looking at its chronicity, its effect on various body systems, and due to inadequate success in combating the disease with modern medications, there is need of careful search to find out an effective and safe remedy against this soul harrowing monster. Aims & objectives To evaluate the role of Vamana Karma in the management of hypothyroidism along with oral administration of Kanchanara Yoga. To compare the efficacy of Vamana Karma along with Shamana therapy with oral administration of Kanchanara Yoga only. To find out a safe and effective remedy for hypothyroidism. MATERIAL AND METHODS Study design A simple randomized single blind clinical study. Plan of study 30 patients of Hypothyroidism are selected irrespective of sex, diet, occupation and religion between age group of 16 to 55 years from O.P.D. of Dr B.R.K.R. Govt. Ayurvedic College and Hospital, Hyderabad. The patients are divided into two groups. In group A, oral administration of drug - Kanchanara Yoga is given in a dose of 3-6gms B.D. for a period of 60 days and in group B, both oral drug as well as Vamana therapy is given. SELECTION CRITERIA Inclusion criteria of patients The patients having classical symptoms of Kaphaja Galaganda Weight gain or unable to lose weight Oligomenorrhoea / menorrhagia Puffiness of face and feet Goiter Exclusion criteria of patients Patients with cardiac anomalies. Patients who are above 60 Yrs Patients who are suffering from Hypothyroidism for > 15Yrs. Any congenital anomaly and autoimmune disease. PLAN OF TREATMENT For fresh cases medicine is started immediately after the diagnosis is confirmed. For the patients who are already using Thyronorm, are advised withdraw the 25mcg of the drug before starting the trial drug. The patients are observed carefully for one month, if they are comfortable with drug and dosage and TSH levels are maintained well then they are advised to withdraw another 25mcg. In this way the drug is totally replaced with trial drug. Group A In this group, Kanchanara Yoga is advocated to the patients as an internal medication in a dose of 3-6 grams B.D. with Tandulodaka for a period of 60 days. Group B In this group both Vamana and Kanchanara Yoga have given. Following steps are taken into consideration prior to Vamana Karma-Deepana, Pachana followed by Abhyantara Snehapana with Go- Ghrita and Bashpa Sweda. After proper Samshodhana, Shamana therapy is advocated. Total duration is kept for 60 days. Follow up is one month. Diet and restrictions Eating goiterogenic foods such as rapeseed, cabbage, broccoli, cauliflower, sweet potato should be avoided. Foods that contain iodine such as Kelp, beetroot, radish, fish, oatmeal, and banana should be kept in the diet. ASSESSMENT CRITERIA Subjective assessment The general symptoms like constipation, anorexia, insomnia, generalised pain, oedema, weight gain and fatigue are taken into consideration. They are assigned grade according to their severity as follows: Objective parameters Change in body weight and BMI before and after the treatment
92 Change in Thyroid profile before and after the treatment Criteria for assessing total effect Complete releif-100% Markedly improvement - > 75% but < 100% Moderate improvement - Between 51 to 75% Mild improvement Between 25% to 50% No relief - <25% All the observations are analyzed statistically in terms of Mean (x), Standard Deviation (S.D.) and Standard Error (S.E.), Paired t test, Unpaired t test and Chi Square test is carried out at p < 0.05, p < 0.01 & p<0.001 levels. OBSERVATIONS Maximum number of the patients i.e. 70% is in between the age group of 16-35 years and out of 30 patients, 80% patients are females and remaining 20% are males. In this study 53.33% are housewives following 23.33% of patients belong to student community, 66.67% are on allopathic medication and remaining 33.33% of the patients are diagnosed first time under this study, 63.33% of this study is reported chronicity of the disease in between 1 to 5 years, 76.67% of the patients are on mixed diet, 83.33% have constipated bowel habit, 60% of the patients of this study belong to Kapha-Vata Prakriti and 23.33% of the patients come under Kapha-Pitta Prakriti and the remaining 16.67% of the patients are related to Kapha Prakriti, 87.50% of the patients are having a history of scanty and irregular menstrual cycle, 12.50% of the patients had a history of menopause and complaints like edema, generalized pain are present in all the patients of both the groups while most of the patients are reported to be having coarse/ dry skin (90%), constipation (83.33%), muscle cramps (76.67%), loss of appetite (90%), menstrual irregularities (87.50%), forgetfulness (93.33%), fatigue (93.33%) and excessive sleep (83.33%). RESULTS Table 1. Assessment of Signs & Symptoms Grading Signs& Symptoms 0 1 2 3 Oedema on lower / Oedema on both upper Oedema No oedema upper extremities and lower extremities Generalized pain Absent Mild Moderate Severe Muscle Cramps(in Twice / Thrice in a Not present Once in a week seven days) week Anorexia Good appetite Quantum of regular food reduce- Irregular food habit Oedema on all over the body Continuously present Complete loss of interest in food Twice / Thrice in a Constipation Not present Once in a week Continuously present week Dryness whole day but Dryness whole day but Dryness after bath Dry/coarse skin No dryness relieved by oil not relieved even after oil only application application Excessive sleep 6-7 hours / day 8 hours / day 10 hours / day More than 10 hours / day Menstrual regular cycles with regular cycles with regular cycles irregular cycles irregularities scanty menstruation excessive menstruation Fatigue Absent Mild Moderate Severe Table 2. Effect of Shamana drug on signs and symptoms Signs and symptoms Mean Score % of B.T. A.T. relief Mean ± SD ±SE t p Oedema 2.4 1.67 30.56 0.73 0.59 0.15 4.78 <0.001 Generalized pain 2.26 1.53 32.35 0.73 0.70 0.18 4.03 <0.01 Muscle cramps 1.27 0.87 31.58 0.4 0.50 0.13 3.05 <0.01 Anorexia 1.6 0.8 50 0.8 0.56 0.14 5.52 <0.001 Constipation 1.93 1.13 41.37 0.8 0.67 0.17 4.58 <0.001 Coarse skin 2.2 1.53 22.72 0.5 0.58 0.15 3.35 <0.01 Excessive sleep 1.87 1.13 40.18 0.75 0.5 0.13 5.81 <0.001 Forgetfulness 1.47 1 34.09 0.5 0.58 0.15 3.35 <0.01 Menstrual irregularities 1.93 1 38.79 0.75 0.95 0.26 2.82 <0.01 Fatigue 2.07 1.07 48.39 1 0.57 0.15 6.75 <0.001
93 Table 3. Effect of Vamana along with Shamana on Signs and symptoms Signs and symptoms Mean Score % of B.T. A.T. relief Mean ± SD ±SE t p Oedema 2.06 0.47 77.41 1.6 0.74 0.19 8.41 <0.001 Generalized pain 2.13 0.47 78.12 1.67 0.62 0.16 10.46 <0.001 Muscle cramps 1.8 0.67 62.69 1.13 0.99 0.25 4.43 <0.001 Anorexia 1.67 0.47 72 1.2 0.86 0.22 5.39 <0.001 Constipation 2.13 0.33 84.37 1.8 0.94 0.24 7.41 <0.001 Coarse skin 1.87 0.73 80.36 1.5 0.58 0.15 10.06 <0.001 Excessive sleep 1.87 0.33 80.35 1.5 0.58 0.15 10.06 <0.001 Forgetfulness 1.93 0.8 51.72 1 0.82 0.21 4.74 <0.001 Menstrual irregularities 1.53 0.6 48.91 0.75 0.5 0.15 4.97 <0.001 Fatigue 1.8 0.67 62.96 1.13 0.57 0.15 7.65 <0.001 From above, it is proved that percentage relief in all 10 subjective parameters and objective parameters were found better in Group-A than Group-B To study the comparative effect of the therapy of both the Groups on each parameter statistically, an unpaired t test has to be applied with the following assumption- H 0 = Both the Groups are equally effective. H 1 = Group B is more effective than Group Table 4. Comparative study of effect of treatment of both groups on each parameter Sr. Criteria of Mean- Degree of Probability of S.E. T cal No Difference Mean freedom Chance 1 Oedema 0.867 0.14 6.17 28 2 Generalized pain 0.933 0.207 4.49 28 3 Muscle cramps 0.733 0.219 3.37 21 4 Anorexia 0.4 0.172 2.32 25 P > 0.05 P > 0.001 5 Constipation 1 0.159 6.26 27 6 Coarse skin 1 0.154 6.48 25 7 Excessive sleep 0.25 0.154 6.48 25 8 Forgetfulness 1 0.180 1.38 26 P > 0.05 P > 0.001 9 Menstrual P > 0.05 0 0.174 0 22 irregularities P > 0.001 10 Fatigue 0.133 0.117 1.14 26 P >0.05 P >0.001 Thus the difference observed is statistically significant in Oedema Generalized pain Muscle cramps Constipation Excessive sleep Inference Gr.B > Gr.A Gr.B > Gr.A Gr.A > Gr. B Gr.B > Gr. A Gr.B> Gr. A Gr.A = Gr. B
94 Table 5. Comparative effect of treatment of both the groups on Thyroid profile in 30 patients of Kaphaja Galaganda Thyroid profile Group-A Group-B Serum T3 (ng/ml) 43.31% 58.08% Serum T4 (µg/dl) 46.02% 58.41% Serum TSH(µ IU/ml) 48.76% 63.36% Table 6. Comparative effect of treatment of both the groups on Weight and BMI in 30 patients of Kaphaja Galaganda Group-A Group-B Weight ( in kg) 1.36 1.96 Body mass index 1.32 2.36 Table 7. Total effect of treatment Effect of Therapy No. of Patients Total %age Group A Group B Complete remission (100% Relief) 0 (0%) 0 (0%) 0 0.00% Markedly improved (76-100%) 0 (0%) 4 (26.67%) 4 13.33% Moderately improved (51-75%) 1(6.67%) 10(66.667%) 11 36.67% Mildly improved (25 50%) 13 (86.67%) 1(6.67%) 14 46.67% No relief (< 25%) 1(6.67%) 0 (0%) 1 3.33% Regarding total effect of therapy it is evident from above table that 3.33% patients are markedly improved, 53.33% are moderately improved, and 43.33% are mildly improved with the therapy. DISCUSSION Hypothyroidism as such is not mentioned in Ayurveda, but with the help of its clinical presentation and Dosha-Dushya Siddhanta of Ayurveda it can be very well understood and managed. In Ayurveda the disorders of thyroid gland are described under the title of Galaganda. Sushruta has mentioned that it appears Mushkavat in Gala which means it hang like a scrotum in neck region (Sushruta). It indicates towards the two lobes of thyroid gland. The signs and symptoms of hypothyroidism mentioned in modern medical science resembles the disease Kaphaja Galaganda described in Ayurvedic literature and in which Kapha Dosha plays a major role along with Vata Dosha in its pathogenesis. From the Dhatu point of view, it can be said that mainly the Dushti of Rasa Dhatu is seen in hypothyroidism. It is also observed that most of the signs and symptoms of hypothyroidism can be seen in the Kaphaja Nanatmaja Roga (Dravya GV, Sharma PV) and Rasaja Vikaras (Charaka). Dhatvagni Mandya plays a major role in the manifestation of this disease. On the basis of all these observations hypothyroidism may be compared with Kaphaja Galaganda. Because of its slow onset, hypothyroidism is categorized under the group of chronic diseases where the Dosha involvement reaches at its peak level. In this study 80% patients are females. This findings is in accordance with the reported finding that hypothyroidism occurs predominantly in females. It is probably because hormonal variation during the menstruation period. 83.33% are having disturbed sleep. Disturbed sleep may lead to vitiation of Kapha causing Kaphaja Galaganda. 83.33% are having costive bowel (Krura Kostha) and 60% of the patients are reported to have Mandagni. Krura Kostha results in due to predominance of Vata Dosha and Mandagni due to the involvement of Kapha Dosha. By the above factors it can be inferred that Kapha and Vata are directly as well as indirectly also involving in the pathogenesis of Kaphaja Galaganda. Mode of action of Kanchanara Yoga The disease Kaphaja Galaganda is occurred due to vitiation of Kapha and Vata. The Kanchanara Yoga is the combination of two drugs Kanchanara and Sunthi. The two lobes of leaves of Kanchanara establish Loka- Purusha Samvaya Siddhanta with two lobes of thyroid gland and its effectiveness on hypothyroidism. The synonym of Kanchanara, Gandari itself shows its activity on hypothyroidism. Kanchanara possess Kashaya Rasa, Laghu, and Ruksha Guna by which it pacifies Kapha Dosha and ignite the Agni. It has the properties of Shothahara and Lekhana. It promotes the normalcy in hypothyroidism patients as its Prabhava as Gandamalanashaka. Sunthi mollify Kapha and Vata by its Ushna Virya and Madhura Vipaka. Sunthi has also Deepana Pachana property which is beneficial for hypothyroidism patients for Anupana Tandulodaka is chosen. Recent researches also revealed that unpolished rice contain good amount of Zinc and selenium. Selenium is very important component in the formation of many thyroid hormones (Saravanan P et al., 2007). So because of
95 possessing selenium in Tandulodaka, it is beneficial for the patients of hypothyroidism Mode of action of Vamana Almost all the text books of Ayurveda have mentioned that Vamana is to be performed in the morning hours, i.e. at "Purvahna" when levels of Kapha are high. During this time (approximately 6.00 am to 10.00 am) Kapha is naturally in the provoked state. So it becomes easy to eliminate the Kapha Dosha during this time. In modern point of view, it is well established that TSH has a distinct circadian rhythm and this circadian rhythm of TSH is maintained in patients treated witht4 andt3. It has generally been observed that TSH levels reach a maximum between 0200 and 0400 hr and a nadir between 1600 and 2000 h. By this the body becomes normal and increased T3and T4 levels due to the distinct circadian rhythm. Vamana is not merely a gastric lavage as considered by modern physicians, but it is a complete therapy of Kapha Dosha as well as disorders caused by it (Charaka). CONCLUSION In Group-A, none of the patient of hypothyroidism got marked relief, 6.67% of the patients got moderate relief and 86.67% patients got mild relief and in one patient (6.67%) no relief is observed. On the other hand in Group-B 26.67% of the patients are found marked relief,66.67% of the patients got moderate relief and mild relief is observed in one patient. Thus the effect of the therapy of Group B is better in treating Kaphaja Galaganda in comparison with the therapeutic effect of Group A. REFERENCES Charaka Samhita Kalpasthana. Ayurveda Dipika commentary. 1/5. Charaka Samhita Sutrasthana. 20/17, 28/9, 10. Davidson s. Principles and practice of medicine- Endocrine disease. 21 st edition.750. Dravyaguna Vignana, Sharma P V, Gandamalanasaka. 234, 331. Saravanan P, Siddique H, Simmons DJ, Greenwood R, Dayan CM. Twenty-four hour hormone profiles of TSH, Free T3 and free T4 in hypothyroid patients on combined T3/T4 therapy. Exp. Clin. Endocrinol. Diabetes. 2007; 115: 261 267. Sushruta Samhita Nidana Sthana. 11/22.