This document describes a clinical study evaluating the effects of Niragni Swedan, Nasya, and Vishwadi Kashayam in comparison to Thyroxine Sodium in the management of hypothyroidism. 40 patients will be divided into two groups - Group A receiving Ayurvedic treatment and Group B receiving Thyroxine Sodium for 45 days. The study aims to evaluate the efficacy of the Ayurvedic regimen compared to the standard allopathic treatment of hypothyroidism. Diagnosis will be based on signs/symptoms and laboratory tests measuring TSH, T3 and T4 levels.

1. “EVALUATION OF THE EFFECTS OF NIRAGNI SWEDAN, NASYA
AND VISHWADI KASHAYAM IN COMPARISION TO THYROXINE
SODIUM IN THE MANAGEMENT OF HYPOTHYROIDISM”
SCHOLAR
Dr. SHALU JAIN
GUIDE CO-GUIDES
Dr. UMESH SHUKLA Dr. KAMINI SONI
Dr. PREETI CHATURVEDI
Dr. BABITA DASH
Dr. VINOD KOTHARI
DEPARTMENT OF PANCHAKARMA

2. Introduction
• Inadequate production of thyroid hormone is considered as hypothyroidism
, which is characterized by slower metabolic rate, weight gain, fatigue,
constipation, hair fall, forgetfulness, sleepiness, dry and coarse skin,
menstrual irregularities etc.
• Most common disorder of thyroid gland
• Commonest endocrine disorder.
• Very commonly observed clinical entity.

3. • In Ayurveda classics, there is no direct mention about how to
understand the pathogenesis of hypothyroidism, however, certain
pathogenic phenomenon that includes Kaphavarit-Vata, Kapha-
Medo-Avrita Vata, Galgand in Urdhvjatrugat Rogas,
Dhatvagnimandhya Janya Vikriti appear to be pathological entities
that paves the way to understand the disease manifestation.
• Niragni Swedan is indicated in Kaph-Meda-Avrita Vata. Niragni
Swedan, although 10 of types,in present study opted in the form of
Vyayam. Vyayam is belived to do kindling of Agni and increases
basal metabolic rate which is found to be decreased in case of
Hypothyroidism.

4. • Thyroid gland is situated in supraclavicular region
(Urdhvajatrugata Sthana) ,which is a Kaphsthana.
• Nasya is considered as the most specific procedure for disease
of head and neck region. As in Ayurveda nose is considered as
the door of head, and the suitable route for drug administration
in Urdhvajatugata Rogas.
• Vishwadi Kashayam is indicated in Kapha Dosha and
Agnimandhya but it also have Lekhan, Agnideepan,
Shrotoshodhan and Medhya properties to deal with Medodushti,
Agnimandhya, Avrit-Vata. Hence was selected for oral use.
• Thus, the combination of above three regimen has been planned
to evaluate its effect in the management of hypothyroidism.

5. Need of study
• Global incidence of Hypothyroidism is rising rapidly and it is posing
major health challenges in both developing as well as developed
world.
• The prevalence of hypothyroidism is high, affecting approximately
one in 10 adults in population and more prevalent among the
females, with male to female ratio being 1:6
• It is found to be 10.95% in adult urban population with significantly
female number outweighing the males i.e. 15.86% in females and
5.02% in males. The prevalence of primary Hypothyroidism is high
accounting for over 95% of total Hypothyroidism patients. Central
Hypothyroidism of pituitary origin, occurrence rate is even lower i.e.
1 from 1000 cases.

6. • Hypothyroidism influences the standard of life of individuals. Inspite of
many progresses the modern management of hypothyroidism remains
disappointing.
• The only treatment available is synthetic thyroid hormone which patient
has to take lifelong and has certain side effects causes cardiac
arrhythmia, palpitation, muscle cramp, weakness, restlessness,
osteoporosis etc.

7. • Looking into the pathogenesis and complications of
hypothyroidism, it requires a systemic and radical therapy for
which ayurveda may provide a ray of hope through
Panchakarma, which is believed to facilitate to regulate
metabolism and better improvement in quality of life of affected
person.
• Some of the scientific works also have been done by using
Ayurveda regimen. However the specific line of treatment,
comprising of Niragni Swedan and Nasya along with Vishwadi
Kashyam needs to be studied and verified to generate the
scientific evidence. Hence the present study has been planned.

8. Aimand objectives
• To evaluate the efficacy of treatment regimen comprising of Niragni
Swedan (Vyayam), Nasya (Katutumbi Tail) and Vishwadi Kashayam on the
patients of Hypothyroidism.
• To compare the efficacy of treatment regimen comprising of Niragni
Swedan (Vyayam), Nasya (Katutumbi Tail) and Vishwadi Kashyam with
that of Thyroxin Sodium on the patients of Hypothyroidism

9. Review of literature
• All the literature related to Niragni Swedan, Nasya and the
concept of Urdhvjatrugat Sthan Vikar, Kapha-Avritta- Vata and
Dhatvaagnimand-Janya vikar by which hypothyroidism is
correlated to be identical disease condition find place in
classics, are being explored and all the details of literary
review. At the same time modern literature including recent
advances in the field are also being reviewed.

10. previous research works done
• Pandya-Tridosha vis-à-vis endocrine gland -1966.
• Trivedi (MS) A.U.- evaluation of Kshargutika in the cases of
hypothyroidism L-1907 Govt. Akhandanand college & hospital 1992
• Lineswala Gaurang - A clinical study on the role of Vamana and Shamana in
the management of Kaphaja Galaganda w.s.r. to hypothyroidism. – 2002
Jamnagar
• Gupta Chanchal- comparative study of pippali prayoga and Shodhan-
Poorvaka Shamana Chikitsa in the management of Dhatvagni-Vikrati
(hypothyroidism). -2003 Jamnagar.

11. • Kankaran Komal-clinical evaluation of kanchanara guggul and pippali
Vardhman rasayan in the management of hypothyroidism-2003 NIA.
Rajasthan University.
• Sherekar Dipali -A Clinical study on Vamana karma in the management of
Hypothyroidism-An Ayurvedic approach-2008 GAMC Blore, R.G.U.H.S.
• Mali Anjali -The effect of Vamanottara Virechana Karma followed by
Vardhamana Pippali Rasayana in the management of Hypo-thyroidism -2012
Jamnagar.
• Bansal Roli- Effect of Vamana Karma in the Management of Hypothyroidism -
2013 Jamnagar.

12. • Patariya Pratiksha– A clinical study on the role of vaman and virechan in the
management of hypothyroidism with punarnava guggulu -2014 Jamnagar
• P.Murali Krishna– A clinical study on combined effect of vamankarm and
Gomutra Haritaki in the Management of Hypothyroidism 2015 Sri.
Dharmsthalamanjunatheshwar college of Ayurveda and Hospital, Hassan
• Singh Karishma Mahi Pal Singh- A Comparative Clinical Study Of Virechana
And Triphladya Guggulu Along With Punarnavadi Kashaya In The
Management Of Hypothyroidism -2017 Jamnagar
• Sahu Sarita– evaluation of the effect of Udvartana of Basti Karma along with
Varun Twaka Kashayam, in comparison to Thyroxin Sodium- 2020 Bhopal

13. Disease Review
 Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid
hormones. It results in a generalized slowing of metabolic processes.
 The clinical manifestation of hypothyroidism, depending upon the age at
onset of disorder, are divided into 2 forms
1. CRETINISM: It is the development of severe hypothyroidism during infancy
and childhood, results in marked slowing of growth and development with
serious permanent consequences including mental retardation.
2. ADULT HYPOTHYROIDISM: causes a generalized decrease in
metabolism
MYXOEDEMA is the severely advanced adult hypothyroidism.

14. Classification of hypothyroidism
PRIMARY HYPOTHYROIDISM
1. Subclinical hypothyroidism
2. Overt hypothyroidism
CENTRAL HYPOTHYROIDISM
1. Secondary hypothyroidism
2. Tertiary hypothyroidism

15. PRIMARY HYPOTHYROIDISM
 There are two degrees of primary hypothyroidism:
1. SUBCLINICAL HYPOTHYROIDISM: defined as a
high serum TSH concentration in the presence of
normal serum T4 and T3 concentrations. Other terms
for this condition are mild hypothyroidism, preclinical
hypothyroidism, and decreased thyroid reserve.
2. OVERT HYPOTHYROIDISM: defined as a high TSH
concentration in the presence of a low serum T4
concentration.

16. Central hypothyroidism
It is rare and is caused due to
failure of TSH and TRH
production due to disease
of anterior pituitary (SECONDARY
HYPOTHYROIDISM)
or hypothalamus (TERTIARY
HYPOTHYROIDISM)

17. Clinical manifestation
 Early symptoms of hypothyroidism are nonspecific and insidious in onset.
 A generalized slowing of metabolic processes can lead to abnormalities
such as fatigue, slow movement and slow speech, cold intolerance,
constipation, weight gain, stiffness and cramping of muscles and
Bradycardia.
 Accumulation of matrix glycosaminoglycans in the interstitial spaces of
many tissues can lead to coarse hair and skin, expressionless facies,
periorbital puffiness, enlargement of the tongue, and hoarseness

18. Ayurvedicview
• Although, after mere knowledge of disorder pertaining the thyroid gland
from view of modern system of medicines, we can’t directly correlate in
Ayurveda as a whole disease yet signs and symptoms which we approach in
day-to-day clinical practice can be seen in Ayurvedic texts in different
manners.
• Certain pathogenic phenomenon that includes Kaphavarit-Vata,
Kapha-Medo-Avrita Vata, Galgand in Urdhvjatrugat Rogas,
Dhatvagnimandhya Janya Vikrati appear to have pathological
significance in disease manifestation.

19. S.N.
Clinical manifestation of
Hypothyroidism
Lakshanas of
Kaphavrit Saman
and Udan
Ca.Ch.28/226-
227
Su.Ni.1/37 A.H.Ni.16/48
1.
Dry skin, loss of sweating Aswednam
+ - +
2. Loss of appetite Mandagni + - +
3.
Hoarseness of voice Vakswargriha
+ - +
4. Weakness Daurbalya + - +
5. Loss of appetite Aruchi + - +
6. Weight gain Gurugatrtvam + - +
Hypothyroidism vis-a-vis Avaran

20. S.N.
Cinical manifestation of
Hypothyroidism
Lakshnas Involved Dhatu
1.
Loss of appetite, Aruchi
2.
3. Heaviness in body
Somnolence
Gaurava
Tandra
RASA Ca.Su.28/9-10
4.
Generalized ache Angamarda
5.
Anaemia Panduroga
6.
Loss of libido Klaibya
7.
Indigestion Agnimandhya
1.
Wt. gain
Sthaulya
MEDA
2.
Sleepiness Nidraadhikya Ca.Su.28/15
3.
Drowsiness Tandra Ca.Su.21/3
4.
Breathlessness Swasa Ca.Ni.4/47
5.
Edema Sopha Su.Sa.9/12
Su.Su.15/19
Hypothyroidism and involved Dhatu- Rasa & Medas

21. S.N Clinical manifestation
of Hypothyroidism
Lakshanas Involved dosha
1. Cold intolerence Saityam Kapha vata vriddha hinapitta (Ca.su.17/56)
2. Weight gain Gauravam -
3. Loss of appetite Mandagni ,Asradha -
4. Anaemia Nakha dinam shuklatvam -
5. Dry and coarse skin Gatra parusyam -
7. Constipation Malsanga Vata vruddhi (Ca.Su.11/6)
8. Weakness Bala bhransha, Bala Hani Vata vruddhi,Pitta kshaya (Su.Su.15/18)
9. Depression Avsad Kapha vruddhi (Su.Su.15/18)
10. Somnolence Tandra -
11. Excessive sleep Atinidrata Kapha vruddhi ( AH.Su.11/7)
12. Laziness Alasya -
Hypothyroidism and involved Dosha

22. S.N. Clinical manifestation of
Hypothyroidism
Ama lakshanas
(A.H.13/23-
24)
1. General Weakness Balbhransha
2. Heaviness in the body, swollen, puffyy
oedematous look of face, weight gain
Gaurav
3. Laziness Alasya
4. Indigestion Apakti
5. Constipation Malsanga
6. Loss of appetite Aruchi
7. Tiredness Klama
Symptoms of Ama in Hypothyroidism

23. Samprapti ghatak
Dosha Kapha vriddhi associated with pitta dushti and
margavaranjanya vatvriddhi
Dushya All dhatus mainly rasa and meda dhatu
Srotas Rasvaha, Medovaha predominantly
Srotodushti Sanga, vimarggaman
Agni Jathragnimandhya, dhatvagnimandhya
Adhisthan Gala pradesh
Udbhavsthan Aamashaya
Vyakta sthan Sarvang
Roga marga Bahya and aabhyantar
Vyadhi swabhav Chirkari

24. NidanaSevana
KaphaPrakop
Jatharagnimandya
AamaUtpatti
Rasa Dhatvagnimandya
MedaDhatvagnimandya
MalarupKaphaVriddhi
Srotorodh,
Margavrodha
KaphavruttaVata
Kaphavrutta
Saman Vata
Kaphavrutta
Udaan Vata
KaphaVata
VriddaHin
a Pitta
Cold intolerance,
weightgain, anaemia,
loss of appetite, dry
and coarse skin
Loss of appetite,
heaviness of body,
lethargy,somnolenc
e, anaemia,
infertility
sluggishness,sleepin
ess,Tiredness,
weight gain due to
meda dhatu vriddhi
Cold intolerance, weight
gain,oedema, generalized ache
Dry and coarse skin, loss of
sweating, loss of appetite
Clinical
Manifestation of
Hypothyroidism
Loss of appetite, Hoarseness
of voice, weakness
Ras SrotoDushti
Probable samprapti

25. Clinical Study
 For the clinical study on Hypothyroidism 40 patients, fulfilling the
criteria of diagnosis selected, irrespective of their religion, caste, sex
and socioeconomic status from OPD & IPD of Pt. Khushilal Sharma
Govt. Autonomous Ayurveda College & Institute, Bhopal (M.P.) being
registered.
 The Drug required for the Clinical study has been procured and
prepared in the department of Rasa Shastra and Bhaishajya Kalpana of
Pt. Khushilal Sharma Govt. Autonomous Ayurvedic College and
Institute, Bhopal M.P.
 The patients are being registered based on a detailed proforma
comprising of all clinical signs and symptoms of Hypothyroidism and
modern investigation as advised in the criteria designed.

26. Grouping
Group A( N=20)
Niragni Swedan (Vyayam) and
Katutumbi Taila. Nasya along with
Vishwadi Kashayam
Group B (N=20)
Thyroxin sodium
Dose- calculated as per guidelines
Study duration- 45 days
Follow up– 15 days

27. Diagnostic Criteria
 The diagnosis of the Hypothyroidism is made on the basis clinical signs and
symptoms. (Harrison’s principle of internal medicine 19th edition)
 Laboratory investigation-
1. Serum TSH
2. Serum T3
3. Serum T4

28. Inclusion criteria
• Newly diagnosed cases of Hypothyroidism.
• Patients age- above 21- 45 years.
• Patients those fit for Nasya & Niragni Sweda
• Based on thyroid profile elevated level of serum TSH level or low
level of serum T3 &T4. However, the cases, where T3 and T4 levels
are within normal range and TSH level is high (TSH value
>5.0mIU/ml)
• Patients those have given written consent to participate in the study.

29. Exclusion criteria
• All complicated cases of Hypothyroidism, myxedema,
severe mental illness, thyroid cancer etc and other
disease associated with endocrine imbalance.
• Patients having chronic systemic illness.
• Congenital hypothyroidism
• Pregnant women and Lactating Mother.
• Patients having undergone thyroid surgery

30. Criteriafor assessment
SUBJECTIVE
PARAMETERS
• Weight gain
• Excessive Sleep
• Muscle ache
• Oedema
• Dry and coarse
skin
• Constipation
• Tiredness
• Hair fall
OBJECTIVE
PARAMETERS
BMI
BIOCHEMICAL
PARAMETERS
• S.TSH
• S.T3
• S.T4

31. Grading system sahu sarita et.al
Parameters Criteria Grading
1. BMI Between 18.5 to 24.9 0
25to29.9 1
30 to34.9 2
Above 35 3
2. Excessive sleep 6-7 hrs/ day 0
8 hrs/ day 1
10 hrs/ day 2
More than 10hrs/ day 3

32. Parameters Criteria Grade
3. Muscle cramp Not present 0
Once in a week 1
Twice /thrice in aweek 2
Continuously present 3
4. Oedema No oedema 0
Oedema on lower/ upper extremities 1
Oedema on upper and lower extremities 2
5. Dry and coarse skin No dryness 0
Dryness after bath only 1
Dryness whole day but relieved by oil application 2
Dryness whole day and not relieved by oil
application
3

33. Parameters Criteria Grading
6. Constipation No constipation 0
Motion once in a day w/o complete evacuation 1
Motion once in two days 2
Motion once in more than two days with hard stool 3
7. Tiredness Absent tiredness 0
Pt. like to stand in comparison to walk 1
Pt. like to sit in comparison to walk 2
Pt. like to lie in comparison to sit 3
8. Hair fall Absent 0
Hair fall on washing 1
Hair fall on combing 2
Hair fall on stretching 3

34. Overall Assessment Criteria
Total effect of the therapies will be graded as follows:
Complete remission 100% relief
Marked improvement 75% to < 100% relief
Moderate improvement 50% to < 75% relief
Mild improvement 25% to < 50% relief
No improvement < 25% relief

35. TREATMENT REGIMEN
Procedure Duration Drug DOSE TIME
Nasya 1-21 Days
(7 Days + 1day Rest +7
Days + 1day Rest
+5days Nasya)
Katutumbi Tail 6 drop in each nostril Purvahn Kaal
Niragni Swedan 1-21 Days Vyayam Till Balardh Vyayam
Lakshan appear
Purvahn Kaal
Shaman Drug 1-45 Days Vishwaadi Kashayam 40 ml. Twice a day

36. DRUG REVIEW
VISHWADI KASHAYAM (SAHASRAYOG KASHAY KALPANA -499)
S. No. Drug Latin Name Family
1. Vishwa Aconitum hetrophyllum Ranunculaceae
2. Abhya Terminalia chebula Combretaceae
3. Guduchi Tinospora cordifolia Meninspermaceae
4. Shunthi Zingiber officnales Zingiberaceae
5. Chavya Piper retrofractum Piperceae
6. Chitrak Plumbego zeylanica Piperceae
7. Pippalimool Piper longum Piperceae
8 Pippali Piper longum Piperceae
9. Marich Piper nigrum Piperceae
10. Tejpatra Cinnamon zelanicum lauraceae

37. KATUTUMBI TAIL (GADNIGRAH 4TH KHAND CHAPTER-VERSE 72-73S)
S. No. Drug Latin Name Family
1. Vidang Embelia ribes Myrsinaceae
2. Vacha Acorus calamus Araceae
3. Rasna Pluchia lanceolata Compositae
4. Shunthi Zingiber officnales Zingiberacae
5. Ikshvaku Lagenaria siceraria Cucurbitacae
6. Devdaru Cedrus deodara Pinaceae
7. Sarshap Brassica campestris Cruciferae

38. Null Hypothesis
Group A (Niragni swedan, Nasya
and Vishwadi kashayam) and Group
B (Thyroxin Sodium) are equally
effective in the management of
Hypothyroidism.
hypothesis
Alternate Hypothesis
1. Group A is more effective than Group B
in the management of Hypothyroidism.
2. Group B is more effective than Group
A in the management of Hypothyroidism.

39. Statisticleanalysis
The observation will be recorded and presented in tabulation form and result will be
analyzed statistically by applying appropriate statistical test.
expected outcome
It is expected that at the end of the study we would be able to demonstrate the
effects of Niragni swedan, Nasya and Vishwadi kashayam in the
management of hypothyroidism. It is further expected that this study would be
able to provide comparative efficacy between the trialed treatment is that.

40. ETHICAL CONSIDERATION
study was approved by institutional ethical Committee.
InformedConscent
An informed written consent in language suitable to the patients was obtained from all
enrolled subjects.

41. DEMOGRAPHIC DATA
EFFECT OF THERAPY

42. Demographic Data
• In this study, majority of patients
(52.5%)belonged to the age group
between21-30 years. People in
this age group are busy and
stressed out about making a good
living, despite the fact that this is
the time in life when a person
wishes to enjoy himself to the
fullest and can’t following
Dincharya, Rutucharyaetc. while
engaging in either of these
activities may lead to vitiation of
doshas may become more
vulnerable to Agni derangement.
10
11
6 6
7
0
2
4
6
8
10
12
21-25 26-30 31-35 36-40 41-45
No
of
Patients
Age in years
21-25
26-30
31-35
36-40
41-45
Age wise distribution

43. Gender wise distribution
• It is supported by prevalence of
disease i.e.; male female ratio 1:6.
Hypothyroidism is most common
in females.
• Qiu Y, Hu Y, Xing Z, et al.
reported that the females using
contraceptive for more than 10
years have significant association
with developing Hypothyroidism.
•
Male
5%
Female
95%

44. Religion wise distribution
• Nothing can be inferred from
this observation because it
may be an outcome of
demographic considerations
as the study area is a Hindu-
dominated area.
Hindu
97%
Other
3%

45. Marital status wise distribution
• Hypothyroidism in married
patients may be brought on by
lack of exercise, family
responsibilities, and various
types of stress. American
Thyroid Association claims
that, hypothyroidism incidence
is most common after
pregnancy and postpartum this
could be reason why marital
status slaved and association
with the disease.
82%
15%
3%
married unmarried widow

46. Education wise distribution
• Understanding its prevention
and control measures is
greatly aided by education.
This generally shows that the
educated class is more aware
hence are more likely to
undergo diagnostic and
treatment procedures to
overcome it. A larger sample
size is needed in order to
correlate education with the
occurrence of disease.
5% 7%
7%
10%
38%
33%
Primary
Middle school
High school
Higher secondary
Graduate
Post graduate

47. Occupation wise distribution
• this high incidence may be due
to their sedentary life style,
which results in less energy
expenditure than uptake.
Housewives are confined to
their homes; technology has
lightened the load of
household chores, however
since it was not a survey study
which in large scale may
prove the above observation.
15%
65%
5% 12%
3%
Student
House wife
Desk work
FW with intellectual
FW with physical
labour

48. Socioeconomic status wise distribution
• Due to their lofty aspirations
and the current competitive
environment, people in upper
middle class are more
vulnerable to stress. They lead
a life in which making money
is their only priority. This
group of people also exhibits
negligence in healthy lifestyle
which can contribute to the
development of the disease
hypothyroidism.
66%
30%
4%
Upper middle Lower middle Upper Lower Lower

49. Habitat wise distribution
• This may be due to the reason
that the present study was
undertaken in urban area.
Usually, urban people are
having sedentary lifestyle,
inconsistent dietary pattern;
consume junk food etc.
7%
93%
Rural
Urban

50. Family History wise distribution
• The well-documented genetic
risk factors for autoimmune
hypothyroidism are HLA-DR
polymorphisms.Despite the
fact the sample size is too
small to draw any firm
conclusions. To determine
whether hypothyroidism runs
in families or not, more
research is required.
30%
70%
Positive Negative

51. Diet pattern
• This can be because of the
Hindu community consumes
primarily vegetarian food.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Group A Group B TOTAL
14
17
31
6
3
9
Mix
Veg

52. Appetite wise distribution
• maximum no of patients (52 %)
had good appetite, followed by
35% had moderate appetite and
only 13%% had poor appetite.
52%
35%
13%
Good
Moderate
Poor

53. Bowel wise distribution
• 67% of the patients in
this series had regular
bowel habits. However
33%of the patients had
irregular bowel habit.
Regular
67%
Irregular
33%

54. Stress wise distribution
• 52% of patients had stressful
life and remaining had no
stress in life.
52%
48%
Yes
No

55. Kostha wise distribution
• in the present study, 70%
patients had Madhyama
Kostha followed by 23% had
Krura Kostha and 7% had
Mrudu Kostha.
7%
70%
23%
Mradu
Madhyam
Kroor

56. Prakruti wise distribution
• The Kaphaj-Vataj Prakruti
persons are more likely to
develop hypothyroidism. It
might be caused by a similar
Dosha to the pathophysiology
of Hypothyroidism. To
determine which Prakruti is
more prone to the disease's
development, a sizable sample
size is necessary.
VP
27%
PK
15%
VK
58%

57. Vyayam Shakti wise distribution
• This observation supports the
nature of the disease which
makes lethargy and fatigueto the
person to avoid exercise.
Additionally, the majority of
study participants were
overweight, and it was discovered
that these patients had less ability
to exercise. Hypothyroid
individuals' ability to exercise is
further limited by lower cardiac
output and stroke volume, as well
as by diminished muscular
strength and increased muscle
fatigue.
75%
25%
Pravar
Madhya
Avar

58. Agni wise distribution
• maximum (62%)
patients were possessing
Mandagni followed by
30% patients were
possessing Vishamagni.
Mand
62%
Sama
8%
Visham
30%

59. Distribution of 40 patients according to BMI
• Medodhatvagnimandyaresulting
in Sama Medo Dhatu
Vriddhileading to Sthaulyata.
• It is however yet to be seen
whether inactivity and weight
gain influence to hypothyroidism
or vice-versa.
• These findings suggest that the
DushtiofMeda Dhatu in
hypothyroid patients.
0
2
4
6
8
10
12
14
16
Under
weight
Normal Over weight Obese -I &II
Group A
Group B
TOTAL

60. Symptoms wise distribution
62.5%
67.5%
17.5%
82.5%
50%
25%
47.5%
77.5%
25%
10%
30%
0
5
10
15
20
25
30
35
weight gain Constipation Excessive
sleep
Tiredness Hair fall Dry skin Generalized
ache
Muscle cramps Edema Puffiness of
face
Menstrual
irregularity
No.
of
Patients
Symptoms wise distribution of patients

61. • in the present study Tiredness was present in 82.5% patients followed by muscle
cramp 77.5% in patients. Constipation was found in 67.5% patients,weight gain was
found in 62.5% patients whilehair fall was observed in 50% patients, generalized ache
& pain was observed in 47.5% patients. Menstrual irregularity was found in 30%
patients, Dry skin was found in 25% patients while edema was observed in 25%
patients and the excessive sleep was observed in 17.5% patients.
•

62. Effect of Therapies

63. Effect of Therapies on Constipation
Constipation Mean Mean
difference
% Relief SD SE P value &
W value
BT AT
Group A 1.000 0.2000 0.8000 80% 0.5231 0.1170 P <0.0001
ES
W=120.00
Group B 1.150 0.7500 0.4000 34% 0.5982 0.1138 P =0.0156 S
w=28.000
Mann Whitney test p =0.0211, U =124.50, Cosidered significant

64. Effect of Therapies on Excessive Sleep
Excessive sleep Mean Mean
difference
%
Relief
SD SE P value &
W value
BT AT
Group A 0.5500 0.05000 0.5000 90% 0.6882 01539 P =0.0078
VS
W=36.000
Group B 0.6500 0.4500 0.2000 30.7% 0.4104 0.09177 P=0.1250
NS
W=10.000
Mann Whitney test p =0.0686, U -147.000, not quite significant

65. Effect of Therapies on Tiredness
Tiredness Mean Mean
difference
%
Relief
SD SE P value &
W value
BT AT
Group A 1.850 0.8000 1.050 56.7% 0.8256 0.1846 P =0.0001
W=105 ES
Group B 1.800 1.150 0.6000 33.3% 0.6806 0.1522 P =0.0020
W=55.000
VS
Mann Whitney test U=145.00, p =0.1179, Insignificant

66. Effect of Therapies on Hair Fall
Hair Fall Mean Mean
difference
%
Relief
SD SE P value &
W value
BT AT
Group A 1.750 0.900 0.8500 48.5% 0.6708 0.1500 P=0.0001
W=105.00
ES
Group B 1.600 1.100 0.5000 31.2% 0.6882 0.1539 P=0.0078
W=36.000
VS
Mann Whitney test U=146, p=0.1080,Consider Insignificant

67. Effect of Therapies onDry Skin
Dry Skin Mean Mean
difference
% Relief SD SE P value & W
value
BT AT
Group A 1.250 0.200 1.050 84% 0.9987 0.2233 P=0.0005
W=78.000
ES
Group B 0.800 0.400 0.400 50% 0.5982 0.1338 P=0.0156
W=28.000 S
Mann Whitney test U= 127.000, p=0.0328 Considered Significant

68. Effect of Therapies on Muscle Ache
Muscle Ache Mean Mean
difference
% Relief SD SE P value &
W value
BT AT
Group A 1.550 0.7000 0.8500 54.8% 0.5871 0.1313 P<0.0001
ES
Group B 1.100 0.4000 0.7000 63.6% 0.6569 0.1469 P=0.0005
W =78.000
ES
Mann Whitney test U =165.000, p=0.2882, Insignificant

69. Effect of Therapies on Edema
Edema Mean Mean
difference
% Relief SD SE P value &
W value
BT AT
Group A 0.4000 0.1500 0.2500 75% 0.4702 0.1051 P=0.0313
W=21.000 S
Group B 0.2500 0.1000 0.1500 60% 0.3663 0.08192 P=0.2500
w = 6.000
NS
Mann Whitney test U =170, p =0.2701, Insignificant

70. BMI Mean Mean
difference
SD SE t-value P value &
W value
BT AT
Group A 27.840 26.770 1.070 1.140 0.2549 4.198 P=0.0005
ES
Group B 25.210 24.900 0.3100 0.8220 0.1838 1.687 P=0.1080
NS
Unpaired t test p= 0.0205, t= 2.418, considered significant
Effect of Therapies on BMI

71. S.TSH Mean Mean
difference
SD SE t-value P value & W
value
BT AT
Group A 10.292 5.812 4.480 5.328 1.192 3.759 p=0.0013 VS
Group B 8.626 4.495 4.131 2.975 0.6653 6.208 p<0.0001 ES
Unpaired t test p= 0.7995, t= 0.2557, considered Insignificant
Effect of Therapies on Serum TSH

72. Overall assessment of Therapy
Total Effect
Group A Group B
No. of patient % No. of patient %
Complete remission
(100%relief)
0 0 0 0
Marked improvement
(>75% to <100%relief)
0 0 0 0
Moderate improvement
(>50% to75%relief)
10 50 04 20
Mild improvement
(25% to 50% relief)
09 45 16 80
No improvement
(<25%relief)
01 5 0 0

73. DISCUSSION

74. Probable mode of action of NiragniSwedan (Vyayam)
• The reason for selecting Niragni Swedan in hypothyroidism, because it is specifically
indicated in the management of KaphaMedaAvrittaVata is found to be involved in the
pathogenesis Vyayam is a type of Niragni Swedan and is included in type of langhan
also. They do langhan by production of sweat.
• NiragniSwedana (Vyayam) liquifies Sama Kapha and Meda which comes throughout
microchannels of the body. Kleda is the Mala of Meda Dhatu. Swedana Karma helps
in flushing the vitiated Meda or Kleda which is present in inter or intra cellular place
in the form of excess body weight.

75. • Niragni Swedan (Vyayam) helps in Vishyandan (liquefaction), Doshpaka, Srotomukh
Shodhan and Vayu Nigrah because of its Vata-Kaphahar property. Vyayam rises the
metabolic rate in the body, dilates the capillaries and increased circulation leads to
more elimination of waste product in the form of Sweda by sweating.
• Due to rising temperature to all parts of the body the triglycerides present in the
subcutaneous tissue will breakdown in the fatty acid. These fatty acids are carried out
to the liver due to the vasodilatation and convert in to bile. In this treatment less
caloric diet is supplied along with brisk walk the body leads more oxygen to meet the
same in the absence of carbohydrate and increased metabolic rate due to heat. fat is
utilized for the purpose of energy production which deposited in the form of Meda.

76. Probable mode of action of Nasya
• Hypothyroidism is Kapha predominant disease condition; hence the drugs which are
having Kaphashamaka properties such as Ushna, Teekshna Guna should be used in
curing the disease. KatutumbiTaila have Ushna, Teekshna and Kaphashamaka
properties. The Sthana of the thyroid gland being Urdhwajatru, which is a
Kaphasthana, hence the management of hypothyroidism is by Katutumbi Tail Nasya
may be a better option. As in ayurveda, Nasa is the only gate way of Sirah. Hence
nose is the suitable route for drug administration in case of Urdhva-Jatrugata
disease.

77. • With the help of previous pharmacological research, we found that all the herbs
evaluated here act on hypothalamus and pituitary gland directly or indirectly and
stimulate the thyroid gland by Nasya action i.e.; peripheral olfactory nerve, which
acts as chemo receptors are stimulated by Nasya Dravya which stimulates the
olfactory bulb. This further stimulates higher centers of hypothalamus and pituitary,
thus having the effect on endocrine system secreting the normal secretion of thyroid
hormones. Katutumbi Tail reaches the brain and acts on important centers controlling
endocrine functions and thus having systemic effects.

78. • Drugs in the form of lipid soluble have greater affinity for passive absorption through
the nasal mucosa, also be enhanced by local massage and fomentation. Facilitates by
the structure of facial nerve, communicate intra cranial circulation.
• Urdhvang Abhyanga and Swedan and Paschat Karma helps to drain out the excess
Kleda formation. Most of the herbs, used in the preparation of Katutumbi Tail,
evaluated above have their action upon thyroid gland. Katutumbi Taila Nasya only
provides relief in various symptoms but also directly alters the secretions of different
hormones involved in pathogenesis of the disease.

79. Probable mode of action of VishwadiKasayam
• The management of Hypothyroidism primarily focused on to remove the Avaran,
Srotoshodhan and increase the Dhatwagni. Drugs under Vishwadi Kashayam
(Vidang, Vacha, Rasna, Shunthi, Marich, Pippali, Saindhav Lavan, Yavkshar,
Chitrak, Devdaru Katutumbi , Katu Tail) having Ushna Virya, Tridoshhar and
Vedanasthapak, Deepan, Anuloman, Shothagn, Lekhan, Medhya, Srotoshodhan
properties balance the vitiated Doshas in this disease.
• Vishwadi Kashayam indicated in Agnimandya, thus prevents the jathragni-
mandyajanya vikar followed by Dhatvagnimandyajanya vikar.
•

80. CONCLUSION

81. • An analysis various data and its results drawn therein following conclusions are placed as under:
 Hypothyroidism is the most common form of thyroid disorders and commonly encountered problem
in clinical practice, it is also the commonest endocrine disorder worldwide and India too.
 In Ayurveda although there is no specific terminology or clinical entity described as such, probably
because the disease is biochemically diagnosed and not just only on the basis of symptomatology.
 In the present study, in group A Complete and Marked improvement was not found in any of
patients, Moderate improvement was found in 50% patients and Mild improvement was recorded in
45% patients.

82.  In the present study, in group B Complete and Marked improvement was not found in any of the
patients, 20% patients had shown Moderate improvement and 80% patients reported with mild
improvement.
 Ayurvedic treatment regimen comprising of Niragni Swedan, Nasya and Vishwadi Kashayam
provided statistically significant results on clinical signs and symptoms and Serum TSH of the
patient suffering from the Hypothyroidism.
 On comparing Ayurvedic treatment regimen (Niragni Swedan, Nasya and Vishwadi Kashayam) to
that of Standard control (Thyroxin sodium), By observing and analyzing the data statistically, it was
found that the group A was more effective in Subjective parameters and both groups are equally
effective in Thyroid profile.