|Year : 2018 | Volume
| Issue : 3 | Page : 158-161
Efficacy of virechana karma in the management of obesity and hypothyroidism: A case study
Meenakshi Gusain, Alok Kumar Srivastava, Gyanendra Datta Shukla, Kshiteeja Choudhary
Department of Panchkarma, Uttarakhand Ayurved University, Rishikul Campus, Haridwar, Uttarakhand, India
|Date of Submission||25-Jul-2017|
|Date of Decision||08-Dec-2019|
|Date of Acceptance||24-Dec-2019|
|Date of Web Publication||10-Feb-2020|
Dr. Gyanendra Datta Shukla
Department of Panchkarma, Uttarakhand Ayurved University, Rishikul Campus, Haridwar - 249 401, Uttarakhand
Source of Support: None, Conflict of Interest: None
Overweight and obesity have become major health problems that can lead to or aggravate other medical problems such as Hypertension and Diabetes Mellitus. Hypothyroidism is defined as failure of the thyroid gland to produce sufficient thyroid hormone to meet the metabolic demands of the body. A female patient aged 36 years and was a housewife reported to the Panchakarma O.P.D. of Rishikul campus, Haridwar with complaints of increase in weight, heaviness in the body, pain and stiffness in joints and sore throat with known case of hypothyroidism and was on medication of thyroxine 25μg OD for 2 months. She had earlier taken hormonal therapy (progesterone) for infertility. The patient had undergone Virecana Karma (medicated purgative therapy), in which dīpana–pācana (increasing digestive fire for digesting undigested material) with Pañcakola Phāṇṭa, snehapāna (internal oleation) with goghṛta (cow's butter fat), virecana (medicated purgative therapy) with Trivṛt Leham, Kuṭakī, Āragvadha, jaggery and Icchābhedī Rasa followed by anupāna ( drink taken with or after medicine) of Drākṣā was given. After saṃsarjana krama ( a diet regimen after Pañcakarma for improving digestion and regaining strength of patient), Ārogyavardhinī Vaṭi was introduced for 7 weeks in a dose of 2 tablets twice in a day (Each tab 250 mg) with lukewarm water. There was marked relief in the symptoms of heaviness, pain, stiffness, weight reduction from 76 kg to 72 kg with significant improvement in TSH level from 7.98 μg/dl to 2.07 μg/dl after completion of saṃsarjana krama (a diet regimen after Pañcakarma for improving digestion and regaining strength of patient). 18 days after it, TSH level become 3.83 μg/dl and weight reduced to 70 kg. Again after seven weeks TSH was 2.99 μg/dl and weight was 67 kg. Six weeks after discontinuation of Ārogyavardhinī Vaṭi TSH was 2.32 μg/dl and weight was 67 kg. Virecana (medicated purgative therapy) is effective in management of obesity and Thyroid level.
Keywords: Hypothyroidism, Pañcakarma, Virecana karma (medicated purgative therapy), weight management
|How to cite this article:|
Gusain M, Srivastava AK, Shukla GD, Choudhary K. Efficacy of virechana karma in the management of obesity and hypothyroidism: A case study. Ancient Sci Life 2018;37:158-61
| Introduction|| |
Almost 30–65% of adult urban Indians are either overweight or obese or have abdominal obesity. Overweight in Ayurveda can be correlated as ati sthūla purusha (overweight or obese) which is categorized by Caraka under Aṣṭa nindita Puruṣa (eight types of despicable personalities). Caraka describes characters of obese persons as short life span, hampered in movement, difficulty in sexual intercourse, debility etc., The etiological factors of obesity are over-saturation or intake of heavy, sweet, cold and fatty diet and a sedentary life style. There is excess of Medo dhātu i.e. fat in body and it causes sroto-avarodha (obstruction in body's micro channels) which hinders and prevents formation other vital constituents of body (uttara dhātus viz. asthi, majjā, śukra). Sroto-avarodha leads to various kinds of systemic disorders and shortening of life span. Vāta, due to its passage having been obstructed with fat moves abundantly in body and thus affects agni. Here agni is the metabolic and digestive fire of a person. Agni is responsible for life, and disturbed agni leads to various severe disorders. Here in hypothyroidism we consider medo sroto-duṣṭi (fatty tissue vitiation or disturbed lipid metabolism) due to disordered agni (digestive fire). Texts such as Caraka Saṃhitā, Aṣṭāṅga Hṛdaya have prescribed saṃśodhana cikitsā (medicated detox therapy) for treatment of santarpaṇa-janya vyādhis (diseases due to over nutrition) such as sthaulya.Virecana is one of them. Due to its two modes of action – 1. Systemic- by which it brings down the morbid doṣa (toxins) from body to Koṣṭha (gut). 2. Local evacuant – evacuation of these doṣas in the form of mala from the gut by adho-bhāga-hara property i.e. rectal route, which does removal of the obstruction and cleansing of micro channels and finally stabilizing the agni.
| Case Report/patient Information|| |
A female patient aged 36 years and was a housewife and a native of Jwalapur, Haridwar, reported to the Pañcakarma O.P.D. of Rishikul campus, Haridwar with complaints of increase in weight, heaviness in the body, pain and stiffness in joints and sore throat.
H/O present illness
According to the patient she was asymptomatic before seven yrs. She had an abortion of at seven months of pregnancy. After that she took various hormonal treatments (progesterone) for six years. After that she had an IVF baby. After sometime, she was diagnosed for cervical spondylitis and gradually developed increasing weight with pain and stiffness in multiple joints. She took various medications but did not get significant relief and her condition worsened with time. She also had a problem of sore throat. She was a diagnosed case of Hypothyroidism since last 2 months and she was on medication of Thyroxine 25 μg OD.
- Family history – NAD
- Past history – Patient took various allopath treatments for infertility for five years
- Gynecological history – One female test tube baby (1.5yrs)
- Clinical Findings – General Condition – Normal, Blood Pressure – 124/36 mm Hg, Pulse Rate – 84/min, Appetite – good, Bowel – clear, Bladder – normal, Sleep – normal, Diet – vegetarian, Menstrual History – 3 – 4/28 days and regular
- Ayurvedic Assessment – koṣṭha (gut)– madhyama, prakṛti – vāta-kaphaja, vikṛti – pitta-kaphaja
- Physical examination – All the systemic examinations were found to be normal. Pain with stiffness in multiple joints especially in b/l knee and cervical vertebral region
- Diagnostic Assessment – Weight – 76 kg, Height - 5'4'', BMI-28.7 (Overweight)
- Laboratory findings – T.S.H.-7.98μg/dl.
- Intervention – Virecana karma (medicated purgative therapy). It is an Ayurvedic Pañcakarma procedure of medicated purgation in which detoxification of body is done through rectal route
- Administration of intervention - [Table 1], Treatment Plan.
Follow up and outcomes/Results
After 5 days of Virecana – Weight –72kg, T.S.H. – 2.07 μg/dl.
| Results|| |
After treatment there was marked relief in joint pain and stiffness with significant reduction in weight and TSH level. Now, she was feeling quite light and healthy. She stopped thyroxine tablets after virecana and started Ārogyavardhinī Vaṭi as a Śamana drug (that pacifies the remaining doṣas). After 18 days the TSH level was 3.83 μg/dl and weight was 70 kg. After seven weeks of Saṃsarjana krama (a diet regimen after Pañcakarma for improving digestion and regaining strength of patient) TSH was 2.99 μg/dl and weight was 67 kg. After that, Ārogyavardhinī Vaṭi was discontinued and TSH level after two months of discontinuation was 2.32 μg/dl while weight was 67 kg the same have been shown in [Table 2] and [Figure 1]. There was marked relief in pain and inflammation of cervical spondylitis after virecana therapy.
There was no adverse or unanticipated events such as like weakness, vertigo etc.
| Discussion|| |
Obesity can be considered as atisthaulya inAyurveda. Sthaulya is predominantly a rasaja vikāra (disorder due to abnormal digestive juice) as per Suśruta, while Caraka classifies it as a medoja vikāra (disorder due to disturbed fat metabolism).Agnimāndya (diminished digestive fire).at the level of rasa and medo dhātu (fat tissue)is an important factor to be corrected.
As observed, dīpana-pācana (increasing digestive fire for digesting undigested material)drugs can remove the obstruction at the dhātu (tissue) followed by snehapāna which can dissolve the medo dhātu doṣa (fatty tissue toxins). These wastes or toxins are further eliminated by virecana (medicated purgative therapy) procedure. Moreover, it can give additional benefits of feeling of well-being in sense organs, good sleep, correction of appetite and digestion and bowel movements.
Thyroid gland and its diseases are not directly mentioned in Ayurveda, but on the basis of etiological signs and symptoms we can find its line of treatment. While analyzing the signs and symptoms of Hypothyroidsm in Ayurveda, we note the involvement of all srotasas (micro-channels). We see kapha and vāta doṣa vṛddhi i.e. their increment and pitta doṣa kṣaya i.e., alleviation. The conceptual analysis of symptomatology of Hypothyroidism helps us to identify it as kapha pradhāna tridoṣa vyādhi (fat dominating toxins)with rasa and medo duṣṭi (fatty tissue vitiation or disturbed lipid metabolism) predominantly.Virecana actually improves metabolism by removing various toxic substances, removing srotolepa (obstruction or coating of the body tissues by toxins)and resolving agnimāndya (diminished digestive fire).
The treatment depends on two pillars, firstly to maintain hormone levels and second is to improve metabolism. Modern drugs fulfill the first criterion but Ayurvedictherapy will help in both these aspects.
Thus in this study we can consider virecana to be effective in hypothyroidism.
| Conclusion|| |
Although no disease condition similar to Hypothyroidism is described in Ayurveda, using yukti (skills) it can be considered as a condition which results due to agniduṣṭi (imbalanced digestive fire). Kapha and vāta doṣa vṛddhi and pitta doṣa kṣaya results due to agnimāndya.Dhātvagnimāndya (slow metabolism of tissue), specially rasa and medo dhātvagnimāndya (slow metabolism of digestive juice and fatty tissue) contributes to obesity and overweight which leads to this condition. Results could have been more effective if study would have been done for longer duration. If the patient is Diabetic or Hypertensive, the treatment plan should be designed with more caution.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]