Download - Galaganda kc027 gdg
Evaluation of the efficacy of
AMRUTADI YOGA IN GALAGANDA (GOITER)By
Renjith. P. Gopinath
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the degree of
Ayurveda Vachaspati M.D.In
KayachikitsaUnder the Guidance of
Dr. V. Varada CharyuluM.D. (Ayu) (Osm)
Dr. Shiva Rama Prasad KethamakkaM.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]
Department of Kayachikitsa
Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2002-2005
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103
Endorsement by the H.O.D, Principal/ head of the institution
This is to certify that the dissertation entitled “Evaluation of the efficacy of
AMRUTADI YOGA IN GALAGANDA (GOITER)” is a bonafide research work done by
“Renjith. P. Gopinath” under the guidance of Dr. V. VARADA CHARYULU, M.D.
(Ayu) (Osm), Professor & HOD and Dr. SHIVA RAMA PRASAD KETHAMAKKA,
M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Reader in Kayachikitsa, DGMAMC,
PGS&RC, Gadag, in partial fulfillment of the requirement for the post graduation degree of
“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health
Sciences, Bangalore, Karnataka.
.
(Dr. G. B. Patil)Principal,
DGM Ayurvedic Medical College,Gadag
Date:Place: Gadag
(Dr. V. Varada charyulu)Professor & HOD
Dept. of KayachikitsaPGS&RC
Date:Place: Gadag
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103
This is to certify that the dissertation entitled “Evaluation of the efficacy of
AMRUTADI YOGA IN GALAGANDA (GOITER)” is a bonafide research work done by
“Renjith. P. Gopinath” in partial fulfillment of the requirement for the post graduation
degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of
Health Sciences, Bangalore, Karnataka.
Dr. V. VARADA CHARYULU
M.D. (Ayu) (Osm)Guide
Professor & HOD
Dept. of Kayachikitsa
PGS&RC
Date:
Place: Gadag
Dr. SHIVA RAMA PRASADKETHAMAKKA
M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]Co- Guide
READER IN KAYACHIKITSA
DGMAMC, PGS&RC, Gadag
Date:
Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “Evaluation of the efficacy of
AMRUTADI YOGA IN GALAGANDA (GOITER)” is a bonafide and genuine research
work carried out by me under the guidance of Dr.V.Varada Charyulu M.D. (Ayu) (Osm) and
Dr. SHIVA RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D
(Jyotish)], Reader in Kayachikitsa, DGMAMC, PGS&RC, Gadag.
Date
Place
(Renjith. P. Gopinath)
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation/ thesis in print or electronic
format for the academic / research purpose.
Date
Place
(Renjith. P. Gopinath)
© Rajiv Gandhi University of Health Sciences, Karnataka
Abstract
Evaluation of the efficacy of Amrutadi yoga in Galaganda (goiter)
By - Renjith. P. Gopinath
The thyroid disorders are characterized by physical and mental interference. Wecan correlate goiter and some tumor pathology of thyroid to ‘Galaganda’ where thyroidfunctions may or many not are affected.
Susruta defines Galaganda as a swelling (mass in the neck region), by thevitiation of Vata, Kapha and medo Dhatu where in Charaka named only Kaphacirculates in and around neck is the cause. Mental factors like chinta, sokha, krodha,bhaya, etc vitiate Vata Dosha. Goitrogens - suppress thyroid function and can inducehypothyroidism and goiter.
Iodine restriction will cause the thyroid to increase in size (goiter) in an effort tofilter more blood to get more iodine. Once copper is replenished and copper metabolismis working properly, the body will tolerate iodine without increasing thyroid hormoneproduction. Lack of thyroid hormone can cause constipation. Thyroid hormonesincreases the rapidity of cerebration but also often dissociates this conversely, lack ofthyroid hormone decreases this function.
Anemia is pre-condition for the production of thyroid disease. Greatly increasedthyroid hormones almost always decrease the body weight, and greatly decreasedhormone almost always increases the body weight.
This study is a prospective clinical study of Amrutadi thailam in Galaganda. 17patients were selected for the study in one group. The goiter is present in both types ofthyroid disorders such as hypo thyroidism and hyperthyroidism.
After the assessment of both subjective and objective parameters the results are,hypothyroidism patients were responded to the treatment, the euthyroid patients weremaintained with the treatment and the hyper thyroid patients were not responded to thetreatment.
The observations are - thyroid disease is common in the middle-aged womenwith family history. It plays a vital role in the change of the character, and mental stateof the patients.
In hypothyroidism patients the body weight will be increased and inhyperthyroidism patients, it will be reduced. The group Hyperthyroidism differssignificantly from Group Hypothyroidism and Group Euthyroidism. GroupHypothyroidism is Significant.
AcknowledgementAt first my sincere thanks to the subjects who cooperated at my dissertation, with
out of them it would have been not a success.
I express my deep gratitude to my guide Dr. V. Varadacharyulu M.D.(Ayu),
Professor & H.O.D., for his advice and encouragement of every step of this work.
I express my obligation to my co-guide Dr Kethamakka Shiva Rama Prasad,
M.D.(Ayu) M.A,Ph. D (Jyotish), Reader in Kayachikitsa, for his time to time help and
critical suggestion associated with expert guidance at the completion of this dissertation.
I express my obligation to beloved principal Dr. G. B. Patil, Principal for his
encouragement as well as providing all necessary facilities for this research work.
I express my profound sense of gratitude to various departments H.O.D.s, teachers
and colleagues of sister concern departments along with the ministerial and sub staff of the
D.G.M. Ayurvedic Medical College, Gadag.
I express my sincere thanks to Dr. Shashidar. H. Doddamani, Dr. R. V. Shettar, Dr.
Kuber Sankh, Dr. P. Shivaramudu, Dr. Dilipkumar, Dr. V.M.Sajjan, Dr. U.V.Purad, Dr.
Santhosh Belavadi and Dr Pawadshettar. I express my sincere thanks to Mr. Nandakumar
for his help in statistical analysis of results.
I express my deepest gratitude to my beloved parents, Dr.P.S.Gopi, and
Dr.M.K.Indira, to my relatives and well wishers Rejitha.P.G, Dr.M.K.Unnikrishnan,
Dr.M.K.Sathy, Dr.M.K.Baby, Mr. Babuprasad, M.Sc (IT) and Dr.M.Balakrishna Pillai for
their inspiration.
With respect and affection, I acknowledge my ever-remembering late Grand father
Shri M.P. Kunjan Vaidyan who inspired me all the time
Place:Date:
Renjith. P. Gopinath
Table of contents
Evaluation of the efficacy of Amrutadi yoga in Galaganda (goiter)
Heading Page number
Chapter -1 Introduction 1 to 4
Chapter –2 Objectives 5 to 7
Chapter –3 Review of literature 8 to 53
Chapter –4 Methodology 54 to 79
Chapter –5 Results 80 to 112
Chapter –6 Discussion and Conclusion 113 to 134
Summary 135 to 139
Bibliographic References i to vi
Annex – Case sheet 1 to 5
Tables
Tables - Amrutadi yoga in Galaganda (goiter) Page
1 Lakshana of Vataja Galaganda 31
2 Lakshana of Kaphaja Galaganda 32
3 Lakshana of Medoja Galaganda 33
4 Showing clinical features of Hyperthyroidism 35
5 Showing clinical features of Hypothyroidism 36
6 Differential diagnosis of Galagraha and Apachi 50
7 Differential features of Galaganda, Galavidradhi, Kanthashaluka andMamsatana.
51
8 General survey of the thyroid patients for Hyper or Hypo thyroidism 629 Distribution of patients by age 80
10 Distribution of patients by sex 82
11 Distribution of patients by religion 84
12 Distribution of patients by occupation 85
13 Distribution of patients by economical status 87
14 Distribution of patients by mode of onset 88
15 Distribution of patients by intake of Goitrogens 90
16 Distribution of patients by family history 91
17 Distribution of patients by Agni 92
18 Distribution of patients by sleep 94
19 Distribution of patients by psychological features 95
20 Distribution of patients by habits 97
21 Distribution of patients by menstrual cycle 98
22 Distribution of patients by built and nutrition 100
23 Distribution of patients by Aharaja and Viharaja Nidana 101
Tables – continued : Amrutadi yoga in Galaganda (goiter) Page
24 Distribution of patients by with systems involved 103
25 Distribution of patients by chief complaints 105
26 Subjective parameters enumerated (a) 106
27 Subjective parameters enumerated (b) 106
28 Showing the statistical analysis of the chief complaints 107
29 Showing the statistical analysis of the lab investigations 107
30 Anova – Table for the parameter T3 108
31 Anova – Table for the T4 parameter 108
32 Table show which pair of group is significant 108
33 Anova- Table for parameter T.S.H. 109
34 To show which pair of group is significant 109
35 Showing the result of Amrutadi taila capsules in Galaganda 112
36 Hyperthyroidism - Discussion on General and local symptoms 119
37 Hyperthyroidism Systemic evaluation - Cardiovascular symptoms 119
38 Hyperthyroidism Systemic evaluation - CNS symptoms 120
39 Hyperthyroidism Systemic evaluation - Gasto-intestinal symptoms 120
40 Hyperthyroidism Systemic evaluation - Dermatological symptoms 121
41 Hypothyroidism -General features of hypothyroidism 121
42 Hypothyroidism Systemic evaluation - Cardiovascular symptoms 122
43 Hypothyroidism Systemic evaluation - CNS symptoms 122
Graphs
Graphs - Amrutadi yoga in Galaganda (goiter) Page
1 Showing Patients by age distribution 81
2 Showing Patients by gender distribution 83
3 Showing Patients by religion distribution 85
4 Showing Patients by occupation distribution 86
5 Showing Patients by economical status distribution 88
6 Showing Patients by mode of onset distribution 89
7 Showing Patients by intake of Goitrogens distribution 90
8 Showing Patients by family history distribution 92
9 Showing Patients by Agni distribution 93
10 Showing Patients by sleep distribution 95
11 Showing Patients by psychological features distribution 96
12 Showing Patients by habits distribution 98
13 Showing Patients by menstrual cycle distribution 99
14 Showing Patients by built and nutrition distribution 101
15 Showing Patients by Aharaja and Viharaja Nidana distribution 102
16 Showing Patients by with systems involved 104
17 Depicting the results of Amrutadi yoga on Galaganda 112
Figures
Figures – Amrutadi yoga in Galaganda (goiter) Page
1 Location and anatomy of the Thyroid gland 20
2 Functions of the thyroid follicles 23
3 Auto regulation of the thyroid hormone 25
4 Schematic representation of the Galaganda Samprapti 40
5 Contents of Amrutadi taila (Photograph) 66
1
INTRODUCTION
Ayurveda, the science of life is the holistic alternative system of medicine. The
origin of this science is already evident in Atharvanaveda. Eventually Ayurveda was
originated into its own compact system of health and considered as a branch of
Atharvanaveda. The main aims of this science are to maintain one’s health and to protect the
human beings from various diseases, which are acquired.
Among many things man aspires to attain in life, a healthy body and healthy mind
are the first to be sought for. The aim of all medical system should be a healthy body and
healthy mind. Ayurveda is one such system that prevailed from many years. Health is
defined as the condition in which the sharirika and the manasika bhavas exist in a state of
equilibrated normalcy.
Ayurveda mentions comfort (sukha) as health (arogyam) with synonyms of Arogya
and Swasthya. The Ayurvedic concept of evolution of a disease is remarkably wide.
According to Ayurveda Vyadhi i.e. disease has been defined as the state in which both body
and mind are subjected for pain and agony respectively.
At the present millenium has shown us numerous disorders and we know that the
changes in atmosphere and the living conditions or habits are among the causes. This results
in serious multi systemic metabolic disorders like diabetes, thyroid problems, hepatic
disorders etc., Ayurveda is the best way to handle them safe and naturally.
The thyroid disorders are characterized by physical and mental interference.
Previously it was thought that these groups of disorders are of sporadic in nature in some
2
parts of India. For e.g. Goitre is common among people of the Himalayas due to the iodine
deficiency. As medical aids reached to the feet of common man and communication is
developed in association with that of luxuries and changed dietetics this disorder prevailed
all over the globe and especially a developing country, India. An increasing number of
patients of Goitre and many more Thyroidectomies, either partial or complete are evidential
for the above discussion.
Ayurveda is a golden mean between pure sciences and philosophical sciences.
Therefore it becomes interesting to know how Ayurveda looks to a problem, which appears
to be untouched in Ayurveda. Endocrine disorders and concept of hormone are such
problems noted here.
In Ayurveda there is not an exact term for thyroid gland. Therefore it is not possible
to get an explanation of physiology and pathology of thyroid gland from our ancient books.
Some of the later Ayurvedic scholar tried to name the thyroid gland, but they could not
compare many thyroid disorders with any of the ancient descriptions.
We can correlate goitre and some tumor pathology of thyroid to ‘Galaganda’ where
thyroid functions may or may not is affected. But hypothyroidism and hyper thyroidism
have the symptoms related to many portions of the body. It is very difficult to correlate these
two entities with any of the nomenclated diseases of Ayurveda. Further hypothyroidism and
hyperthyroidism are not single disease entities and many conditions are included under each
heading. It is therefore, better not to restrict thyroid dysfunction to any one of the diseases.
Similarly, there are not mere localized disorders. In such a situation, an Ayurvedist need not
be specific to it but can treat the disease by knowing the condition of Dosha, Dhatu and
Agni components of pathogenesis etc. and their interrelation with the disease condition.
3
The competition among the medical systems is increasing day by day. The
contemporary systems use the most advanced techniques in assessing the disease and in the
aspect of treatment and research studies. So, it is our duty to conduct proper research and
invent new methods and medicines, which serves to the mankind.
The need for study
In this fast forward life, the life style of man has changed. He is very much busy with
the day today schedules to acquire more earnings. This more desire have made the man to
deviate from following the swastha vrutta, thereby becoming a victim of diseases. So in the
young adult age itself man, has become victim of severe degenerative diseases like
Sandhivata, Manyasthamba etc., and other multi systemic metabolic disorders like endocrine
diseases, diabetes, etc., Among such diseases Galaganda (goiter) is a common one
nowadays. The gradual increase and prevalence of Galaganda draws attention over the
deviation of lifestyle and balanced diet in the modern society.
Mass in the neck, pain in the neck etc characterizes the disease 1, and it is a serious
metabolic disorder, as it affects almost all systems of the body. It is most common nowadays
in every part of the world. Which is considered as a serious metabolic disorder that makes a
strong impact on one’s daily life. Contemporary medical science are able to pacify the
disease through anti thyroid drugs, radio active iodine and if needed through the surgical
treatment as the final with its own limitations.
In Ayurveda we can offer safe and effective management for Galaganda. So to
overcome this problem at young age without producing any complication, the research in
this area is essential. Ayurveda the ancient system of medicine has suggested good old
4
techniques and recipes to pacify the swelling (mass in neck) and other symptom without
causing any complication.
Since this area is prevalent in goiter, I have taken the present study as ‘Evaluation of
Amrutadi thailam in Galaganda with positive thoughts. Still more research works are
essential to establish the same by using research techniques and by statistical methods.
Role of Ayurveda in this area and recent advances
In the contemporary system of medicine the treatment given to thyroid disorders are
anti-thyroid drugs, radio active iodine and surgery which has its own disadvantages and side
effects. The drug-induced goitre is an evident example of it2.
Ayurveda the traditional Indian system of medicine, describes a reliable and
effective management of diseases with due consideration to protect the normal health also.
Ayurvedic approach to the disease ‘Galaganda’ is to reduce the Ganda (mass in the
neck), toda (pain around the neck), kandu (itching around the neck), difficulty in breathing
etc., and to strengthen the Dhatus and pacifying the Vata and Kapha Dosha which has
special importance in the management.
The recent studies carried out in the past are: -
1. Effect of kanchanara (Valvina variegata and Balvina purpura) in Galaganda by
Sijoria K in 1977 at BHU, Varanasi.
2. Use of indigenous drugs in Galaganda by Pandit R K in 1987 at BHU, Varanasi3.
3. Galagandarog par jalakumbhiprayog by Manekar H B in 1991 at Shri Ayurved
Mahavidyalay, Nagpur4.
5
OBJECTIVES OF THE STUDY
The aims of the study are -
1. Evaluate the anti Goitrogenic effect of Amrutadi thailam in Galaganda.
2. Evaluate the effect of Amrutadi thailam on T3, T4 and TSH in Galaganda.
3. To evaluate the efficacy of Amrutadi thailam Pratimarsha Nasya in Galaganda
Amrutadi thailam mentioned in Yogaratnakaram is a wonderful combination, which
reduces the swelling pain rashes, which restores the voice, as it is Kantyam, alleviates Vata,
Kapha and Medas. So, this combination is most suitable in the treatment of Galaganda.
The present work by Amrutadi thailam is focussed exclusively in Galaganda (goiter).
In this study the most modern techniques are adopted in terms of diagnosis, investigations
assessment and medicine preparation. All together this study gives a scientific approach in
the management of Galaganda.
6
1. To evaluate the anti Goitrogenic effect of Amrutadi thailam in Galaganda.
The condition is said to be affecting the neck region as a swelling mentioned by
various authors in Ayurveda is termed as Galaganda and its management through various
methods, one out of them is Amrutadi thailam, which is included in the present study.
The specificity of the anti-Galaganda properties is studied as the anti Goitrogenic
effect. The anti Goitrogenic effect of Amrutadi thailam in Galaganda can be evaluated by
understanding the cumulative effect of the said yoga.
The Amrutadi thailam comprises of the 9 herbs, which are of Kapha, Vata and Medo
hara in nature, which may reduce the mass and there by regulate the effect of concern organ
pathology i.e. Galaganda viz., goiter.
This can be understood that by the study of baseline data to the final data differences
after the drug administration to the affected patients those who are included by the preset
parameters of exclusion and inclusion criteria.
As there is an elaborate discussion made under the drug review of individual drugs, a
cumulate effect is drawn out of as Shothahara – anti tumor property, Kantyam – regulatory
effect of neck pathology and Rakta shodhaka – blood purification. These said properties are
effective over Dosha predominance and Dushya – Dhatus to regulate to normalcy by
fragmenting the underneath pathologies.
2. To evaluate the effect of Amrutadi thailam on T3, T4 and TSH in Galaganda.
T3, T4 and TSH are the objective parameters to ascertain the functional capacities of
the thyroid. The present study under takes the said lab investigations to evaluate the efficacy
of Amrutadi thailam in thyroid problem of either Hypothyroidism or hyperthyroidism. This
7
data with precise information regarding the functional capacities to estimate the prognosis
and the medical management to the said Galaganda with reference to that of Goitrogenic and
thyroid pathologies are anticipated.
Thus the present study intends to have the study of Amrutadi thailam with reference
to the T3, T4 and TSH assay.
3) To evaluate the efficacy of Amrutadi thailam Pratimarsha Nasya in Galaganda
Nasya karma a therapeutic procedure of intranasal drug administration, is one of the
well-known Panchakarma. According to the disease of medicine. It is divided as marsha
nasya and Pratimarsha nasya. Pratimarsha Nasya is a daily 2-3 drops in each nostril, without
any poorva karma and pathyas. The finest specification of this therapy is made in the
Ayurvedic books, as acting on the body parts above the neck, that is the parts lying up on
inside the skill. The ancient authors of Samhita proclaim that the drugs administered in
Nasya shall enter the head.
In the Galaganda, a disease developed above to the clavicle is evaluated with the
Amrutadi taila Pratimarsha Nasya, which has the rechana property and with the Ushna,
teekshana Gunas alleviates the Kapha Dosha.
8
LITERARY REVIEW
There are vast areas in India with iodine deficiency disorders (IDD). Besides the sub
Himalayan region, other flood- prone regions and reverine areas, deltas and costal regions
are now recognized to have iodine deficiency, i.e. the iodine content of water is <1ppm.
There are an estimated 150 million people in India who are considered to be at risk of iodine
deficiency, and of these 54 million have goiter. Earlier the only recognized effect of iodine
deficiency on health was goiter; however, there is now a better understanding of the
perspective of IDD. IDD now includes the following 5 : -
1. Goitre at all ages
2. Endemic cretinism with associated mental retardation, deaf- mutism, spatic
diplegia and lesser degree of neurological deficit.
3. Impaired mental function in children and adults.
4. Increased rates of abortion, stillbirth and perinatal and infant mortality.
Etymology of Galaganda 6
The word Galaganda comprises of two parts - gala and ganda.
Gala - is a word of masculine gender and it is derived by the union of ‘Gal’
dhatu and ‘Ap’ pratyaya or by the union of ‘Gru’ dhatu and ‘Vyap’ pratyaya.
It means the pathway of food, i.e., kantha.
Ganda - is a word of masculine gender. It is derived either by the union of
‘Gadi’ dhatu and ‘Ach’ pratyaya or ‘Gata’ and ‘Njantadda’ sutra. As per
Medini Kosha, it means pidaka or budbuda and as per Ramanathateeka on
Amarakosha, it means sphotaka or granthi.
9
In a nutshell, Galaganda relays the meaning, the sphotaka or ganda in the ganda. The
relative term from the contemporary medical science is goiter.
Goitre 7- The term goitre is derived from the French word ‘ goiter’; which is
originally derived from the Latin word ‘gutter’- means ‘throat’. We use the
term ‘goiter’ to denote the enlargement of thyroid gland irrespective of its
cause.
The pocket oxford dictionary speaks the meanings of Goitre as –
Goitre n. (Brit. goitre) morbid enlargement of the thyroid gland. [Latin guttur
throat] 8,
Goitre n. (US goiter) morbid enlargement of the thyroid gland. [Latin guttur
throat]
The thyroid gland first discovered by Mr. Wharton in the 19th century, weighs
around 20gms in adults. The thyroid (from GK, thyroid meaning a shield, because it shields
the trachea9.
Definitions
In almost all Ayurvedic treatises Galaganda is described elaborately.
Susruta defines it as a swelling (mass in the neck region), by the vitiation of Vata,
Kapha and medo dhatu10. But Dalhana and Gayadasa, in their commentaries mention it as a
swelling in the neck (Nibadhaswayathu) 11.
Charaka mentioned that when a vitiated Kapha Dosha circulates around the neck, it
will cause swelling slowly is termed as Galaganda12.
Madhava Nidana explanation is more authentic as it states that Galaganda is a
swelling attached to the neck which hangs down like a scrotum13. He also quotes the
definition of Bhoja here as “Mahantam shopham alpam va hanu manya galashraye” 14 i.e. A
10
swelling resembling and hanging like a scrotum in the Hanu, Manya, and Gala is called as
Galaganda.
From the contemporary medical science, Goitre is defined as a benign, non-toxic
enlargement of the thyroid gland usually secondary to some form or other of the iodine
deficiencies. The disease is characterized by swollen throat, hoarseness of voice, slight pain,
in the neck region, difficulty to swallow, etc 15.
Historical review:-
The Vedas are the old and prime documented source of knowledge. There is no
reference regarding the disease Galaganda in the Vedic literatures. Ayurveda, a medical
science deals with almost all diseases, mentions elaborately about Galaganda as one among
those disease, which were explained in concern with Kaphaja Vyadhis.
There was a period were the science developed and flourished much and considered as
the golden period of Ayurveda. Almost all Acharyas had mentioned Galaganda in their
respective treatises.
Among Brihatrayees, Susruta mentioned Galaganda elaborately. Likewise the other
Acharyas also followed the same descriptions in separate chapters except Charaka. Acharya
Charaka has mentioned about Galaganda in Trishopheeyam adhyaya of sutra sthana 16.
In Susruta Nidana, mentions about the Galaganda Samprapti are very clear. It states
that, the Vata, Kapha and Medo Dhatu will got vitiated by its etiological factors and produce
the Ganda (mass in the neck); which have the symptoms of the three respectively. Susruta
describes the Lakshana, Bheda, and Sadyaasadhyata in Nidana sthana and the detail Chikitsa
at its Chikitsa sthana 18th chapter 17-18.
11
In Charaka Samhita, mentions of Galaganda are from Trishopheeyam chapter of sutra
sthana describing it as a ‘Shopham’ – swelling occurring in the neck due to vitiated Kapha.
Here the vitiated Kapha will stay around the neck region and produce swelling, which is
called as Galaganda 19.
In Astanga Hrudaya and Astanga Sangraha, Vagbhatas mentioned Galaganda Nidana,
Bhedas, Lakshanas in the Mukha roga vijnaneeyam adhyayam of the Uttara sthana and
Chikitsa in Mukha roga pradheeshedam adhyaya 20.
In Madhava Nidana, Madhavakara quoted the same as that of Susruta and mentions the
Nidana, Lakshana, Bhedas, and Sadyasadyata of Galaganda in detail 21.
The other treatises, such as Yogaratnakara 22, Bhavaprakasha 23, Chakradutta 24,
Vangasena 25, etc also mentions about Galaganda. They elaborately described about the
Lakshanas, Bhedas, Samprapti, and Chikitsa in their respective works.
In the contemporary system of medicine, the disease Galaganda can be correlated with
‘Goiter’. Goitre is a common disease in the modern society as there is a gradual increase in
the deviation of lifestyles and balanced diet. It is mainly common in area where the Iodine
content of water is less than 1PPM 26.
Epidemiology:-
The thyroid disorders and goitre are common in the females, in the certain ages, in
specific part of the world. So the epidemiological evidences of these diseases are very much
important in detecting the cause and is useful to decide the treatment and in the prevention
of those diseases also 27.
12
Age:-
The age of the patient is a Very important consideration. Simple goitre is commonly
seen in girls approaching puberty and in pregnant women because in puberty and in
pregnancy, the requirement of hormone is augmented.
Both multi-nodular and solitary nodular goitres as well as colloid goitres are found in
women of 20s and 30s. The primary toxic goitre is usually present in young ones, where in
Hashimoto’s disease the victims are middle-aged women.
Sex:-
Majorities of the thyroid disorders are seen in females. All types of simple goitres are
far more common in the female than in male. Thyro-toxicosis is 8times common in females
than in males. Even thyroid carcinomas are more often seen in females in the ratio 3:1.
The prevalence of hyperthyroidism is about 20/1000 females; males are affected 5
times less frequently. The female to male ratio 28 of hypothyroidism is 6:1.
Geographical distribution
Except endemic goitres due to iodine deficiency, no other thyroid disorders lies
among peculiar geographical distribution.
Certain areas are particularly known to have low iodine and food. These areas are,
Rocky Mountains, e.g.-Himalayas, the Vindyas, the Satpudha ranges, which form the goitre
belts in India. Such goitres are common in Southern India than in Northern India.
Endemic goitres are common in low land areas where the soil lacks iodides or the
water supply comes from far away mountain ranges. Calcium is also Goitrogenic and areas
producing chalks and limestones are also Goitrogenic areas.
13
Nidana
According to the treatment point of view, the knowledge of hetu is important so as to
enable the physician to advice the patient to avoid the practice of Nidana, as it is mentioned
“Nidana Parivarchanam Eva Chikitsa” 29.
Madhava Nidana has clearly mentioned that Nidana of all the disease is due to the
vitiation of Mala 30.
Galaganda is a Kaphaja nanamatja Vyadhi 31and it is mentioned by all treatises. But
the etiological factors are not directly mentioned in the classical texts. Charaka 32 has
mentioned Galaganda as a lump situated in the neck where the swelling generated slowly, or
a Sopham – edematous; especially with the Kapha and Vata Dosha predominance. Susruta
Samhita states, as like Charaka and adds to it that the Galaganda does not occur due to Pitta
(Dalhana).
When we review the lakshanas of the Vata, Kapha, and Medoja Galaganda, the
symptoms are similar that of Vataja and Kaphaja sopham.
The different etiological factors from various texts are referred as under with rational
headings such as – Ahara Nidana, Vihara Nidana etc.,
1.Aharaja Nidana 33-34
It can be divided into Vata prokapa, Kapha prakaopa and Medoprakopa
karanas.Consumption of Aharas having Vatika and Kaphaja predominance causes vitiation
of Kapha, Vata in the body.
The intake of tikta, katu, kashaya rasa , rookshannam, alpamatara bhojanam etc
vitiate then Vata Dosha . The intake of madhura,amla,Lavana,snigdha, guru,abhishyanda,
seeta, types of foods will vitiate Kapha Dosha .
14
The method and time of taking the food is also important. As abhojana,
heenabhojana,suskhabhojana vitiates the Vata Dosha . The virudha bhojana, atibhojana,
vitiates the Kapha Dosha .
2.Viharaja nidanam 35-36
Vegadharanam, Vegotheeranam, Nisajagaranam, Atyuchabhashanam,
Shodanadiatiyogam, Bhayam, Dukham, Chinta, Sramam, Upavasam, etc will vitiate Vata
Dosha. Aasyasukham, Swapnasukham, Ajeeranam, Divaswapnam, brhmanatiyogam,
Shodanadi ayogam, Avyayamam, etc will vitiate the Kapha Dosha.
These two factors (the aharaja and viharaja factors) will vitiate the Vata and Kapha
Dosha. These are all the etiological factors of Vataja and Kaphaja sopham also.
3.Manasika karanas 37
Mental factors like chinta, sokha, krodha, bhaya, etc vitiate Vata Dosha. Direction
of sense organs is one of the functions of Manas and Vata is said to be the controller and
conductor of mind. Therefore, by above factors Vata prakaopa occurs in the indreeyaayatana
and produce psychic as well as the somatic disorders; as there is a pivot role for mind in
producing the thyroid disorders also by unbalancing the production of thyroid hormones.
4. Medovaha Sroto dhushti
The increased Vata and Kapha Dosha in the neck will vitiate the medo Dhatu by its
prakopa karanas respectively.
Causes of vitiation of Medovaha Srotas 38
i. Avyayama( lack of exercises)
ii. Divaswapna (sleep during the day time)
iii. Excessive intake of fatty foods
iv. Excessive intake of wines.
15
According to modern science
The deficiency of iodine content in the food is the main cause for goitre.
Goitrogens 39
Goitrogens are foods, which suppress thyroid function. In normal, Goitrogens can
induce hypothyroidism and goiter. In hypos, Goitrogens can further depress thyroidal
function and stimulate the growth of the thyroid (goiter).
In hyperthyroid, Goitrogens may help suppress thyroidal function until normal
thyroidal functioning can be restored. However, this may not be a good strategy. Goitrogens
work by interfering with the thyroidal uptake of iodine. While many hyper secretaries to
limit thyroid output by iodine restriction, this strategy can backfire. Iodine restriction will
cause the thyroid to increase in size (goitre) in an effort to filter more blood to get more
iodine. When iodine is then re-introduced to the diet or accidentally ingested, the now larger
thyroid gland has the capacity for greater thyroid hormone production.
The iodine restriction is not a good long-term method for controlling thyroid
hormone production. Therefore the consumption of Goitrogens is not a good strategy. It is
better to increase copper metabolism by supplementation of copper and the assisting
nutrients. Once copper is replenished and copper metabolism is working properly, the body
will tolerate iodine without increasing thyroid hormone production
The gotrogens can be divided into two varieties:-
1. Goitrogens in the form of food items
2. Goitrogens in the form of drugs
16
1) Goitrogens in the form of food items 40
The vegetables of the Brassica family, sea-weeds, oats, calcium rich foods, etc, are
Goitrogens in nature. Many Goitrogens are generally members of the brassica family.
These include: Broccoli, Cauliflower, Brussell Sprouts, Cabbage, Mustard, Kale,
Turnips, Rape seed (Canola Oil),
Other goitrogens include - Soy, Pine nuts, Millet, Peanuts Brassica family vegetables
not only inhibits thyroid production, but they also inhibit cancer growth. We know that
sulfur, copper, and iron, work closely together and that excessive sulfur can deplete copper
and/or iron. The excessive kale consumption will cause anemia. Generally anemia is the
result of low iron and/or copper.
Because copper and iron are so important for thyroid function, it is not advisable to
eat plants of the brassica family. The primary pre-condition for the production of thyroid
disease is the onset of anaemia. Brassica vegetables, with their high sulphur content, may be
foods, which induce anaemia and consequently thyroid disease.
2) Goitrogens in the form of drugs:- 41
Thiocyanates, Anti thyroid drugs, lithium, iodides, p- amino salicylic acid, etc are
also Goitrogenic. Iodides in large quantities are also Goitrogenic as they inhibit the organic
binding of iodine to give rise to ‘iodide goitre’.
Hereditary Factors
The goitre may be seen in families as well. The inborn error in the metabolism is
generally inherited as an autosomal recessive gene. There is enzyme deficiency in the
thyroid gland. This may impair iodine accumulation, oxidation or coupling of iodotyrosine.
This leads to formation of decreased level of thyroid hormones, which will increase TSH,
17
and simple goitre is formed. Hyperthyroidism is often seen in several members of the same
family 42.
Endemic Goitre 43
In certain places there is low iodine content in the water and food. So the inhabitants
do not get minimum requirement of iodine. This leads to reduced levels of thyroid hormones
and hence the goiter. These areas are Himalayas, Alps, Mountain areas, etc. In low land
areas around the lakes, the soil lacks iodide. Calcium is available plenty in chalks and
limestones are Goitrogenic and places where they are available there the goiters are
common.
Physiological Causes
In certain cases when there are high metabolic demands diffuse hyperplastic goiter
may be seen. Such conditions are puberty, pregnancy, etc. In these conditions there is more
demand of the thyroid hormones than normal and if the thyroid gland falls to rise to the
occasion, TSH will be secreted more and leads to goiter 44.
Causes of Hypothyroidism 45-46
§ Congenital developmental defect
§ Interference with thyroid hormone synthesis
§ Iodine deficiency
§ Primary idiopathic
§ Radioactive iodine, Surgery
§ Post radiation
§ Bio-synthetic defects
§ Drug induced (Lithium, iodides, p-aminosalicylic acid etc)
§ Chronic thyroiditis
§ Hashimotos thyroiditis
18
Causes of Hyperthyroidism 47-48
§ Graves disease, 76%, which is idiopathic
§ Multinodular goiter
§ Thyroiditis
§ Iodide-induced
§ Autonomously functioning thyroid nodule
§ Ingestion of exogenous thyroid hormone
Anatomy 49-50 and physiology
The thyroid is an endocrine gland, situated in the lower part of the front and sides of
neck. It regulates the B.M.R, stimulates somatic and psychic growth and plays an important
role in calcium metabolism.
The gland consists of right and left lobes that are joined to each other by the isthmus.
A third pyramidal, lobe may project up wards from the isthmus (or from one of the lobes).
Some times a fibrous or fibromuscular band (levator of the thyroid gland) descends from the
body of the hyoid bone to the isthmus or to the pyramidal lobe. Accessory thyroid gland is
sometimes found as small-detached masses of thyroid tissue in the vicinity of the lobes or
above the isthmus.
Situation and extent
The gland lies against vertebrae C-5, 6 and 7 and T1 clasping the upper part of
trachea. Each lobe extends from the middle of the thyroid cartilage to the fourth or fifth
tracheal ring. The isthmus extends from the second to the third tracheal ring.
19
Dimensions and weight
Each lobe measures about 5cm +1.2cm. On an average the gland weights about 25g.
However it is larger in females than in males and further increases in size during
menstruation and pregnancy.
Capsules of thyroid
The true capsule is the perepheral condensation of the connective tissue of the gland.
The false capsule is derived from the pre tracheal layer of the deep cervical fasica a dense
capillary plexuses is present deep to the true capsule. To avoid hemorrhage during operation
the thyroid is removed along with the true capsule.
Arterial supply
Superior thyroid arteries supply the thyroid gland, which is the first anterior branch
of external carotid artery. Inferior thyroid artery is a branch of the thyro-cervical trunk,
which arises from sub-clavian artery.
Venous drainage
Lymph from the upper part of the gland reaches the upper deep cervical lymph nodes
through pre-laryngeal nodes. Lymph from lower part drains into lower deep cervical nodes.
Nerve supply
Nerves are derived mainly from the middle cervical ganglian and partly also from the
superior and exterior cervical ganglia. There are vaso constrictors
Structure and function
The thyroid gland is made up of two types of secretary cells. Follicular cells lining
the follicles of the gland secrete tri-iodothyronin and tetera iodothyronin (thyroxin) which
stimulate the B.M.R and somatic and psychic growth. Para follicular cells lie in between the
20
follicles they secrete thyro-calcitonin which promotes deposition of calcium salts in skeletal
and other tissues and tends to produce hypo-calcium.
Applied anatomy
Any enlargement of the thyroid gland is called a goiter. Removal of the thyroid may
be needed in hyperthyroidism (thyrotoxicosis). Hypothyroidism causes cretinism in children
and Myxodema in adults. Benign tumors of gland may displace and even compress
neighbouring structure pressure symptoms and nerve involvement is common in carcinoma
of the gland.
Figure - 1
Location and anatomy of the Thyroid gland
21
Thyroid follicles and thyroid hormones 51
The thyroid gland contains large numbers of thyroid follicles. Individual follicles are
spheres lined by a simple cuboidal epilhelium. The follicle cells surround a follicle cavity.
This cavity holds a viscous colloid, a fluid containing large quantities of suspended protein.
A network of capillaries surrounds each follicle delivering nutrients and regulatory
hormones to the glandular cells and accepting their secretary products and metabolic wastes.
Follicular cells synthesis a globular protein called thyroglobulin and secretes into the
colloid of the thyroid follicles. Each thyroglobulin molecule contains the amino acid
tyrosine, the building block of thyroid hormones. The formation of thyroid hormones
involves three basic steps.
1. Iodide ions are absorbed from the diet at the digestive tract and delivered
to the thyroid gland by the circulation. Carrier proteins in the basal
membrane of the follicle cells transport iodide ions (I-) into the
cytoplasm. The follicle cells normally maintain intracellular
concentration of iodide that is many times higher than those in extra
cellular fluid.
2. The iodide ions diffuse to the apical surface of each follicle cells, where
they converted into an activated form of iodide (I+) by an enzyme called
thyroid peroxidase. This reaction sequence also attaches either one or two
of these iodide ions to the tyrosine molecules of thyroglobulin.
3. Tyrosine molecules to which iodide ions have been attached are paired
forming molecules of thyroid hormones that remain incorporated into
thyroglobulin. The pairing process is probably performed by thyroid
22
peroxidase. The hormone thyroxin also known as tetraidothyroxine or
simply T4, which contains four iodide ions. Eventually, each molecule of
thyroglobulin contains four to eight molecules of T3, T4 hormones or
both.
The major factor controlling the rate of thyroid hormones release is the concentration
of TSH in circulating blood. TSH stimulates iodide transport into the follicle cells and
stimulates the production of thyroglobulin and thyroid hormones. Under the influence of
TSH the following steps occur.
1. Follicle cells remove thyroglobulin from the follicles through endocytosis.
2. Lysosomal enzymes then break the protein down and the amino acids and thyroid
hormones enter the cytoplasm. The amino acids are recycled and used to
synthesise thyroglobulin.
3. The released molecules of T3 and T4 diffuse across the basement membrane and
enter circulation. Thyroxine (T4) accounts for roughly 90% of all thyroid
secretions, and tri-iodothyronine (T3) is secreted in comparatively small
amounts.
4. Roughly 75% of the T4 and 70% of the T3 molecules entering the circulation
become attached to transport proteins called thyroid – binding globulin (TBGs).
Most of the rest of the T4 and T3 in the circulation is attached to transthyretin,
also known as thyroid binding prealbumin (TBPA) or to albumin, one of the
plasma proteins.
23
Figure –2
Functions of the thyroid follicles
Control of the thyroid secretion 52
There are three major ways of controlling the thyroid secretion anterior pituitary -
1. the hypothalamus
2. auto regulation besides, some other factors like
3. sympathetic stimulation
4. exposure to cold are also important
TSH of the anterior pituitary
TSH is secreted by the specialized cells, called thyrotrophs of the anterior pituitary.
24
1. T.S.H stimulates almost all the major steps of thyroxin biosynthesis as well
as the release of thyroid hormones. Hence more T.S.H = more secretion of
thyroid.
2. In addition, it causes increased vascularity and cellular growth of the thyroid
gland.
T.S.H is controlled by ‘ negative feed back ‘ mechanism exerted by T4 and T3. The
circulating T4 is converted into T3 at the level of the anterior pituitary and thus both T4 and
T3 are active. Therefore when circulating T4 is in high concentration, the pituitary
thyrotrophs is inhibited so that T.S.H secretion is depressed resulting in correction of excess
T4 in blood. Reverse occurs when T4 concentration of blood is low. Hence more T4 = low
T.S.H. T.S.H is the single most important regulator of the thyroid secretion.
Hypothalamus
From the Hypothalamus, TRH is secreted. TRH acts on pituitary thyrotrophs and
stimulates them to secrete TSH. Hence more TRH = more TSH. Probably T4 and T3 do not
operate at the level of the hypothalamus for the negative feed back mechanism. Another
hormone called somateostatin inhibits the TSH secretion. It is released from the
hypothalamus (somateostatin also secreted by the islets of Langerhans and stomach).
Auto regulation of thyroid
If there is deficiency of food iodine, the iodine trapping mechanism of the follicular
cells become super efficient. If there is excess of the food iodine, the iodine trapping
mechanism is less efficient and organifaction of the extra amount of iodine does not occur.
Mechanism of auto regulation may be as follows - Less iodine makes thyroid gland more
sensitive to TSH and viseversa.
25
Figure – 3
Auto regulation of the thyroid hormone
Mechanism of action of thyroid hormones 53
The thyroid hormones act somewhat like steroid hormones. The free T4 enters the
target cells (all most all tissues are target cells of T4, specially not able are the neurons,
heart, liver, skeletal muscles, adipose tissue, mammary gland) converted into T3 HR
(hormonerecepter) complex is formed within the nucleus HR attachment with DNA occurs
more m RNA production synthesis of more proteins are biological action.
26
Iodine and thyroid hormones 54
Iodine in the diet is absorbed at the digestive tract as I-. The follicle cells in the
thyroid gland absorb 120 to 150 of I- each day, the minimum dietary amount needed to
maintain normal thyroid function. The iodide ions are actively transported into the thyroid
follicle cells, so the concentration of iodine inside thyroid follicle cells is generally above 30
times higher than that in the plasma. If plasma iodine levels rise, so do levels inside the
follicle cells.
The thyroid follicle contains most of the iodide reserve in the body. The active
transport mechanisms for iodide is stimulate by TSH and the increased movement of iodide
into the cytoplasm accelerates the formation of thyroid hormones.
A typical diet in developed countries provides approximately 500 g of iodide per
day, roughly three times the minimum daily requirements. Much of the excess is due to the
addition of iodine to the table salt sold in the grocery stores as iodized salt. Thus iodide
deficiency is seldom responsible for limiting the thyroid hormone production (this is not the
case in other developing countries). Excess iodine is filtered out of the blood at the kidneys,
and each day the liver into the bile excretes a small amount of iodine. The losses in the bile,
which continue even if the diet contains less than the minimum iodine requirements can
gradually deplete the iodide reserves in the thyroid. Thyroid hormone production may
decline, regardless of the circulating levels of TSH. Thus various thyroid disorders manifests
gradually.
27
Effect of thyroid hormone on growth 55
Thyroid hormone has both general and specific effects on growth. For instance, it has
long been known that thyroid hormone is essential for the metamorphic changes of the
tadpole into frog.
In human, the effect of thyroid hormone on growth is manifest mainly in growing
children. In those who are hypo thyroid, the rate of growth is greatly retarded. In those who
are hyper thyroid, excessive skeletal growth often occurs, causing the child to become
considerably taller at an earlier age. However, the bones also mature more rapidly and the
epiphyses close at an early age, so that the direction of growth and the eventual height of the
adult may actually be shortened.
An important effect of thyroid hormone is to promote growth and development of
brain during fetal life and first few years of post natal life.
Effect of thyroid hormones on specific bodily mechanism 56
1. Stimulation of carbohydrate metabolism - the thyroid hormone stimulates almost all
aspects of carbohydrate metabolism, including rapid uptake of glucose by the cells
enhanced glycosis, enhanced gluconeogenesis, increased rate of absorption from the
gastro intestinal tract even increased insulin secretion etc.., all these effects probably
result from the over all increase in cellular metabolic enzymes caused by thyroid
hormone.
2. Stimulation of fat metabolism - all aspects of fat metabolism is also enhanced under the
influence of thyroid hormone. In particular lipids are mobilized rapidly from the fat
tissue. Which decreases fat stores of the body to a greater extent.
28
3. Effect on plasma and liver fats - increased thyroid hormone decreases the concentration
of cholesterol, phospolipids and triglycerides in the plasma, even though it increases the free
fatty acids. Conversely, decreased thyroid secretion greatly increases the plasma
concentrations of cholesterol, phospholipids and triglycerides and almost always causes
excessive deposition of fat in the liver as well.
Increased requirement for vitamins
As thyroid hormones increases the quantities of many bodily enzymes and because
vitamins are essential part of some of enzymes and co-enzymes thyroid hormones causes
increased need for vitamins. Therefore a relative vitamin deficiency can occur when excess
thyroid hormone is secreted.
Increased BMR
As thyroid hormone increases metabolism in almost all cells of the body, excessive
quantities of the hormone can occasionally increased the BMR to 60 to 100% above normal.
Conversely when no thyroid hormone is produced the BMR falls almost to one – half
normal.
Effect on body weight
Greatly increased thyroid hormones almost always decrease the body weight, and
greatly decreased hormone almost always increases the body weight.
Effect of thyroid hormone on Cardio vascular system
Increased metabolism in the tissues causes more rapid utilization of oxygen. This
effect causes vasodilatation in most of the body tissues, thus increasing blood flow. As a
consequence of the increased blood flow, cardiac output also increases, some times rising to
29
60% or more, when excessive thyroid hormone is present and falling to only 50% of normal
in very severe hypothyroidism.
Increased gastro-intestinal motility
Thyroid hormone increases both the rates of secretion of digestive juices and the
motility of the gastro intestinal tract. Diarrhea often results in hyper thyroidism. Lack of
thyroid hormone can cause constipation.
Excitatory effect on the central nervous system
Thyroid hormones increases the rapidity of cerebration but also often dissociates,
conversely, lack of thyroid hormone decreases this function. The hyper thyroid individual is
likely to have extreme nervousness and many psycho neurotic tendencies, such as anxiety,
extreme worry paranoia.
Effect on the functions of the muscles
Slight increase in thyroid hormone usually makes the muscles react with vigour, but
when the quantity of hormone becomes excessive, the muscles become weakened because of
excessive protein catabolism. Conversely, lock of thyroid hormone causes the muscle to
become sluggish and they relax slowly after a contraction.
Effect on sleep
Because of the exhausting effect of thyroid hormone on the musculature and on the
CNS the hyperthyroid subject often has a feeling of constant tiredness, but because of the
excitable effects of thyroid hormone on the synapses, it is difficult to sleep. Conversely
extreme somnolence is characteristic of hypothyroidism, with sleep some times lasting 12 to
14 hours a day.
30
Effect of thyroid hormone on sexual function
In men lack of thyroid hormone is likely to cause loss of libido, impotence, excess of
hormone. In women the same causes menorrhogia and polymenorrhea, in other women it
may cause irregular periods and even amenorrhea.
Poorvarupa
Poorvarupa are the prodromal symptoms of the forthcoming disease, which do not
clarify the Samprapti of the disease. These symptoms will be few and not clear 57.
According to Madhava Nidana, Poorvarupa are the symptoms which are produced
during the process of sthana samsraya by vitiated Doshas, when Samprapti has not been
completed and disease has not been manifested 58.
But prodromal symptoms of Galaganda are not mentioned in any of the classical
texts. From the recorded data of the patients we can say the purvarupa in general. The
vitiated Kapha, Vata, and medas will show some lakshnas such as mild swelling of the neck,
pain the neck, heaviness of the body, hoarseness of voice etc.
Lakshana of Galaganda in detail
All the authors except Charaka have mentioned the types of Galaganda. It is of three
types as Vataja Galaganda, Kaphaja Galaganda and Medoja Galaganda. The Lakshana
mentioned by various Acharyas are enlisted in the table. Description of Vataja, Kaphaja, and
Medoja Galaganda are as follows: -
1) Vataja Galaganda
The lakshanas of Vataja Galaganda 59 are toda (pain in the neck region),
krishna sira avannadha (blackish veins in the neck), krishna aruna ganda (blackish or
reddish mass), meda anvitham (coupled with medas), snigdata (unctuous to touch),
31
arucha (without pain), parushyata (roughness of the mass), chiravridhi ganda (mass
manifests slowly), apaka (no paka),aruchi (tastelessness) and talu gala prashosha
(dryness and weakness of throat and palate).
Table - 1
Lakshana of Vataja Galaganda 60-61-62-63
SN Lakshana Susruta Vagbhata YogaRatnakara
Bhavaprakasha
1 Toda + + + +
2 Krishnasiravanadha + - + +
3 Krishna-aruna ganda + + + +
4 Medan avita ganda + - - -
5 Snigdhatara + - - -
6 Aruja + - - -
7 Parushyayukta + - + +
8 Chiravrudhi ganda + - + +
9 Apaka + - + -
10 Yadrucha paka + _ + +
11 Talugala prasosha + + + +
12 Aasyavairasya + + + +
13 Krishnarajiman + - -
2) Kaphaja Galaganda 64
The lakshanas of Kaphaja Galaganda are sthira ganda (compact mass in the neck),
savarnavat (same as body color), alpa ruk (little pain), ugra kandu (more itching), seetha
(cold to touch), mahan ganda (large mass), chirabhivridhi (manifests slowly), paka (paka
32
present), madhuraasyata (sweetnes in the mouth), talu gala pralepa (coating in the palate and
throat) and kandu (itching).
Table -2
Lakshana of Kaphaja Galaganda 65-66-67-68
SN Lakshana Susruta Vagbhata YogaRatnakara
Bhavaprakasha
1 Sthira ganda + + + +
2 Savarnavat + + + +
3 Alparuk + - + +
4 Ugra kandu + + + +
5 Seetha sparsha + + + +
6 Mahan ganda + - + +
7 Chira abhivrudhi + - + +
8 Chira paka + - + +
9 Madhura asyata + + + +
10 Talu gala pralepa + + + +
11 Guru - - + +
3) Medoja Galaganda 69
The lakshanas of Medoja Galaganda are snigda (unctuous to touch), mrudu (soft),
panduvarna (yellowish), durganda (bad smell), avedana (no pain), pralambhate (hanging),
dehanurupa kshaya, vridhi (when body grows, mass grows and vice versa), snigdaasyata
(unctuous in the mouth), aspashtasabdavat (irregular voice), swasa (difficulty in breathing)
and swara sada(hoarseness of voice).
33
Vagbhata had stated that apart from these Medoja Galaganda might present some
Lakshanas of Kaphaja gala ganda also 70.
The lakshanas explained by various texts are summarized in the tables.
Table -3
Lakshana of Medoja Galaganda 71-72-73-74
Sl.No Lakshana Susruta Vagbhata YogaRatnakara
Bhavaprakasha
1 Snigdha + - + +
2 Mrudu + - - +
3 Pandura + - + +
4 Anishtagandha + - + +
5 Neeruk + - - -
6 Atikandu + - + +
7 Alabuvat pralambana + - + +
8 Dehanuroopa
kshayavrudhiyukta
+ + + +
9 Snigdha asyata + - + +
10 Anusabdakara + - + +
11 Swasa - + - -
12 Svarasada - + - -
13 Guru - - + -
14 Alparuk - - + +
34
Clinical features according to contemporary science
1) Hyperthyroidism 75
Hyperthyroidism or thyrotoxicosis refers to a state wherein there is an excess of
circulating thyroid hormones, T3 or T4. Thyrotoxicosis is designated primary when the
gland is diffusely enlarged and there are signs of hyper metabolic state, eye signs may or
may not be present. Thyrotoxicosis is designated secondary when the patient had previously
abnormal gland, i.e. nodular goitre (single or multiple), and now assumes hyper functional
status.
Clinical manifestation of Hyperthyroidism: 76
Clinical features could be broadly stated as follows:-
• Evidence of Hyper kinesis
• Objective evidence of hyper metabolic state(weight loss, catabolic state)
• Presence of Goitre with or without Opthalmopathy
The American Thyroid Association has classified the eye signs of Graves disease as
follows 77:-
Class Definition
0 No signs and symptoms
1 Only signs, no symptoms (signs limited to upper lid
retraction, stare, lid lag)
2 Soft tissue involvement (symptoms and signs)
3 Proptosis more than 20mm (measured by Hertel
Exophthalmo meter)
4 Extra –ocular muscle involvement
5 Corneal involvement
35
Table –4 showing clinical features of Hyperthyroidism 78-79-80
Symptoms SignsGeneralDemour of anxiety, generalizedweakness, heat intolerance2,skin tanning, apathy3, thirst, andfatigue2
Restlessness, inability to keep still,weight loss, excessive sweating,hair thinning and straightening
Cardiovascular systemPalpitation2, irregular beats, shortnessof breath, angina, dyspnoea onexertion2,exacerbation of asthma
Tachycardia, increased pulse pressure,ectopic beats, atrial fibrillation3, sick sinus
syndrome, cardiac failure3
Central nervous system
Hyperactivity, nervousness, emotionallability2
Fine tremors, hyperreflexia, proximal muscleweakness, periodic paralysis*, ill sustained clonus
Gastro-intestinal systemDiarrhoea (non-infective), weight lossdespite normal or increased appetite2,anorexia3, vomiting
Rapid bowel transit time2, steatorrhea*
Reproductive systemOligomenorrhea or aminorrhea,impotence, spontaneous abortion, lossof libido
Gynacomastia*
ThyroidEnlargement in anterior part, neckpressure symptoms
Diffuse or nodular goitre, bruit1, thrill
Dermatological systemIncreased sweating2, pigmentation,alopecia, pruritis
Vitiligo1, digital clubbing1, pretibial myxoedema1
Ophthalmic System
Stare, gritty sensation1, increasedlacrimal secretion1, diplopoia1,diminished visual activity1
Lid retraction, lid lag1, chemosis1,infiltrative ophthalmopathy, ocularmuscle paresis, exposure keratitis
* - Less frequent1 – Features of Graves disease only
2 – Most common symptoms/signs of Hyperthyroidism irrespective of cause 3 - Features found particularly in elderly patients
36
2) Hypothyroidism
Clinical manifestation due to lack of thyroid hormone is designated as hypothyroidism.
The presentation varies depending on 81: -
a) the age of the patient,
b) the cause of the disorder, primary or secondary, and
c) Pre-existing health status.
In utero, a lack of thyroid hormone results in irreversible brain damage to the foetus.
In children, there can be a reduction in growth and an arrest of pubertal development.
Clinical features of Hypothyroidism
Table –5Showing clinical features of Hypothyroidism 82-83-84
Symptoms Signs
General featuresTiredness, cold intolerance, somnolencehoarseness; monotonous, coarse speech
Weight gain, goiter, peri-orbital puffiness,psychomotor retardation, hypothermia,Mucous membrane infiltration of laryngealmuscles
Dermatological systemDry flaky skin and hair, hair loss, purplishlips and malar flush
Non-pitting oedema, carotenaemia,erythema ab igne (Granny’s tartan),alopacia, vitiligo
Cardiovascular systemShortness of breath, angina, congestivecardiac failure*
Bradicardia, ischeamic heart disease,pericardial and pleural effusion,hypertension
Central nervous systemMuscle aches and pains, stiffness,deafness, psychosis, slowing of motorfunctions
Delayed retraction of tendon reflexes,myotonia*, carpel tunnel syndrome,slowing of cerebartion
Gastro intestinal systemConstipation Ileus*, ascites*
Reproductive system Irregular menstruation (usuallymenorrhagia), infertility, galactorrhoea*
High FSH/LH, hyper prolactinaemia,impotence*
37
HeamatologicalPallor, none- responsive anaemia, bleedingtendency, iron deficiency (pre- menopausalwomen)
Dimorphic anemia, pernicious anemia,megaloblastic anemia, co-agulation defects
* - Rare, but well-recognized features
Galaganda Samprapti
The etiological factors contributing to disease and the vitiation of Doshas attack the
body every now and then. Some factors can be avoided by taking precautions, but factors
like kala, deha etc are mostly inevitable. If the body’s resistance, Vyadhikshamatwa is high
and dhatus, srotases and Agni are functioning well, the body fights against the etiological
factors. But if the etiological factors are stronger than the resistance power of the body, they
vitiate the Dosha and Dosha dooahya samoorchana takes place and the process of disease
starts. The pathological changes taking place in the body day to day Nidana sevana till the
complete manifestation of disease is termed as Samprapti.
The knowledge of Samprapti is very much essential from the Chikitsa point of view
as it helps in understanding the pathogenesis of a disease.
Susruta has mentioned the vitiation of Vata, Kapha, and Medo dhatu by the
etiological factors of the same; will manifests in the neck region and make a ‘Ganda’(mass
in the neck).it exhibits the symptoms of three respectively 85.
But while describing the commentary Dalhana and Gayadasa are of the opinion that
Galaganda is a swelling in the neck, ”Nibadha swayathu” 86.
Charaka has mentioned Galaganda as a swelling in the neck by the vitiation of
Kapha Dosha .He describes that, the Kapha Dosha vitiated by the etiological factors will
manifests in the frontal part of the neck and produce a swelling slowly 87.
38
Vagbhata mentions the Samprapti in another way. The Vata, Kapha, and Medas got
vitiated by the etiological factors will produce the Galaganda in the outside part of the neck.
It hangs like a scrotum without pain if left untreated 88.
Madhavakara mentions the Galaganda in the Samprapti as ‘Nibadha swayathu’.
I.e., a swelling attached to the neck which hangs down like a scrotum, which may be large or
small in size. The swelling is slowly produced by the Vata, Kapha, and Medas, which is
vitiated by the etiological factors89.
1. Sankhya Samprapti of Galaganda
There are three varieties of Galaganda are mentioned in all the classics except
Charaka. They are Vataja galaganda, Kaphaja galaganda, and Medoja galaganda.
2. Vikalpa Samprapti of Galaganda
In Galaganda the Doshas involved are Kapha and Vata. The aggravating factors of
them are Seeta, Snigda, guru, manda etc
3. Pradhanya Samprapti of Galaganda
The Samprapti caused by a major of independent Dosha is called as pradhanya
samprapti, and that which is caused by a minor or dependant Dosha is called as apradhana
Samprapti. Also it can be understood as the Samprapti of swatantara vyadhi is called as
pradhanya Samprapti.
4. Bala Samprapti of Galaganda
The strength of a disease is depending upon the Nidana, purvarupa, and rupa and
manifest disease in total. Here almost all patients had the symptoms manifested completely.
So the bala is more.
39
5. Kala samprapti
It is the Samprapti which confirms the role of a particular Dosha in a disease, which
can increase the same with the change in time- like the day, night, season, with stages of
digestion etc.
Here the main Dosha is Kapha and there is involvement of Vata in it. At the same time
there is the involvement of Agni; i.e. is the derangement of Agni bala is present. So
according to the condition it may vary. No specific time, season, and stages of digestion are
provoking this disease.
Samprapti Ghatakas
Dosha : Kapha, Vata
Dushya : Medas, Rakta, Rasam
Srotas : Medovaha, Raktavaha, Rasavaha
Agni : Jataragni, Dhatwagni
Ama : Jataragnimandya, dhatwagnimandya
Rogamarga : Bahya Roga marga
Udbhavastanam : Amashaya
Vyaktasthanam : Gala pradasha
40
Figure -4
Schematic representation of the Galaganda Samprapti
VataprakopaKarana
KaphaprakopaKarana
MedoprakopaKarana
Vitiates VataVitiates Kapha Vitiates Medas
Vitiation ofMedodhatwagni
Sanchita Medas
Sanchita Vataand Kapha
Gala (Kanta) Stanasamshraya
Manifestation of Lakshana corresponding to theStana, Dosha and Vyadhi
Galaganda
41
Sadhyasadyata
The physician who knows the difference between curable and incurable diseases and
begins the treatment in time with a through knowledge of the case succeeds in his efforts
without fail. So the physician, who knows the avasthas of the disease, can plan the treatment
and can reject the cases, which are incurable 90. The sadyasadyata of Galaganda is
mentioned in Susruta Samhita and are enlisted here 91-
1. Kruchra Swasa - severe difficulty in breathing
2. Softness of the body parts
3. Aruchi – tastelessness
4. Ksheena gatrata – emaciated body and
5. Bhinna swara – broken voice
Upadrava (complications)
Upadrava is produced after the formation of main disease and it is dependent on the
main disease. Upadrava can be major or minor. It is a secondary disease or complication,
produced by the same Dosha it responsible for the formation of main disease 92. Susruta also
opines that upadrava is a super added disease for which the basic causes, i.e. the Dosha
responsible is the same as in the main disease 93.
The upadravas of Shopham are swasa, daha, balakshaya, jwara, chardi, aruchi, hikka,
atisaram, kasa.The upadravas of Galaganda are not mentioned in any Samhitas 94.
As per the modern science concerned some complication are described. The
complications of the hypothyroidism and the hyperthyroidism are 95-
42
a) Thyroid crisis
The hyperthyroid patients, the complications can be termed as hyperthyroid crisis. The
most prominent signs are fever, agitation, confusion, tachycardia or atrial fibrillation and in
older patients cardiac failure. It is a medical emergency and despite early recognition and
treatment, the mortality rate is 10%.
The crisis is precipitated by the following 96:-
a. Stress as resulting from acute infection, trauma or emotional upheaval
b. Surgical handling of thyroid without prior achievement of Eumetabolic state
c. Metabolic upset, uncontrolled diabetes, electrolyte imbalance or parturition
d. Sudden interruption of anti thyroid drug treatment
b) Hypo thyroid complication 97
i) Myxodema coma
Patient with extreme degree of hypothermia, when subjected to stressful situation,
can assume a grave clinical state which if not reverted with timely treatment may end
fatally. Extreme cold weather, use of narcotics, phenothiazines or anasthetic agents,
infections or situations that can cause hypertension, may be the precipitating events for
myxodema coma.
Cardinal features of myxedema coma are Hypothermia, Altered consciousness and
Hypo ventilation.
Pathology of goitre according to contemporary medicine 98
Hypothalomo-pituatiry disorders can be responsible for inducing under active or
overactive thyroid states.
The thyroid disorders can be divided into three: -
43
1. Diseases of thyroid itself
2. hypothalamo – pituitary diseases
3. Thyroid hormone resistance syndrome
Basically it can be divided into:-
1. Hyperthyroidism
2. Hypothyroidism
In both of the (Hyper and Hypo) the goitre is present as the main clinical feature.
Pathology of goitre 99
The thyroid gland is diffusely enlarged and smooth. It may be nodular. There are
certain stages through which this type of goitre gradually passes through. In the first stage
due to TSH stimulation the lobules are composed of active follicles. This is called” stage of
diffuse hyperplasia “. When TSH stimulation ceases by ingestion of iodine the second
stages appears. This is the stage of involution forming large follicles filled with colloid. If
this condition continues i.e., in the third stage the gland enlarges to an enormous extent that
is known as colloid goitre. Sometime due to fluctuating TSH levels a mixed pattern develops
with areas of active lobules and areas of inactive lobules.
Pathology of Hyperthyroidism 100
In “graves disease” the thyroid is uniformly enlarged and the surface is
characteristically smooth, though slight modularity may be detected. Microscopically the
thyroid is hyperplastic and the epithelia which line the acni are high columnar instead of
flattened cuboidal type which is found in normal thyroid gland. They’re only minimal
amount of colloid in the acini and many of them are even empty and others contain
vacuolated colloid. The nuclei of the thyroid cells exhibit mitoses. Papillary projections of
44
the hyperplstic epithelium into the acini are common. Lastly there is vascularity and
lymphoid tissue around the acini.
The clinical manifestation of the hyperthyroidism include changes referable to the
hyper-metabolic state, included by excess of thyroid hormones as well as those related to
over activity the sympathetic nervous system.
Excessive levels of thyroid hormones result in an increase in Basal Metabolic Rate.
Cardiac manifestations are the earliest and most consistent feature. Those patients with
Hyperthyroidism can have an increased cardiac output owing to -
a) increased cardiac contractivity
b) Increased peripheral oxygen requirement.
In older patients’ atrial fibrillation occur frequently, but the actual cause is not
known. Pathological changes often call attention to hyperthyroidism- lid lag, staring gaze
and wide appearances of the eye are due to sympathetic over stimulation of levator palpebre
superioris.
In the neuromuscular system- increased activity of sympathetic nervous system
produces- Tremor, Hyper activity, Emotional disturbances, Anxiety, Muscle weakens, etc.
The skin of the patient tends to be warm, moist and flushed because of increased
blood flow and peripheral vaso-dilatation to increase heat loss. Increased sweating is due to
higher levels of calorigens.
In the G.I.T system increased gut motility are due to increased sympathetic activity
cause Increased thyroid hormone in the skeletal system, which stimulate the bone resorption,
makes ultimately Increased porosity and reduced volume of bone i.e. osteoporosis.
45
Pathogenesis of Graves disease 101
“Graves disease” is caused by an autoimmune reaction against the thyroid.
Antibodies react with the receptor for the thyroid- stimulating hormone and other antigens
on the surface of the thyrocytes. Some of the antibodies stimulate the thyrocytes, causing
hyperplasia. Some block the action of the thyroid-stimulating hormone some do not affect
the function of the thyrocytes.
The first stimulatory antibody the blood of patients with “Graves disease” is called
the long acting thyroid stimulator because it causes a long continued release of iodinated
compounds from the thyroid in the animals. It or similar stimulatory antibodies are
demonstrable in the plasma of almost all patients with “Graves disease” and are the principle
cause of hyperplasia.
Antibodies against thyroglobulin or against the microsomes the thyrocytes arev
present in 95% of the patients, usually in higher titer than in the patients with a non-toxic
goitre or carcinoma of thyroid, though not in the higher titer usually in Hashimotos
thyroiditis.
Hashimotos disease is unduly frequent in the families of patients with Graves disease
is incidence of “Graves disease” is increased in the families of patients with Hashimotos
disease. Relatives of patients with “Graves disease” often have in their blood the antibodies
of Hashimotos disease.
Occasionally a patient with Hashimotos disease develops “Graves disease”, or a
patient with Graves disease ends with Hashimotos disease. Genetic factors are important in
the pathogenis of “Graves disease” in some patients, abnormal immuno-globulins of Graves
disease are present in the plasma of close relatives in 60% of the patients. The frequency of
46
the antigens HLA-DR3 and HLA-B8 is increased in caucascians with “Graves disease”.
HLA-BW 36 is unduly common in Japanese, HLA- BW 46 in Chinese.
Probably the autoimmune response in Graves disease is initiated by a mechanism
similar that in Hashimotos disease. HLA- DR antigens are present on the thyrocytes in the
patients with Graves disease, as they are in Hashimotos disease. Some think they are carried
by a viral infection and initiate the auto immune reaction against the thyroid. Some think
that the primary fault is in the suppressor T- cells and that the expression of the HLE-DR
antigens is caused by the autoimmune reaction. The pathogens of the opthalmopathy in
“Graves disease” are unknown. It is not due to the excess of thyroid hormones and is not
caused by the thyroid stimulating hormone. The cause of dermoapthy found in “Graves
disease” is unknown.
Non toxic goitre Pathogenisis 102
Iodine deficiency is the most common cause of both endemic and sporadic forms of
non-toxic goitre. In all regions in which nontoxic goitre is endemic, the diet is deficient in
iodine. In some patients toxic agents called Goitrogens are important in the causation of the
goitre. In some, an enzyme deficiency causes the enlargement of thyroid. In some patients
with sporadic goitre, the cause of the disease is unknown. If the intake of iodine is low, its
concentration the plasma and its excretion by the kidneys fall. The thyroid gland is unable to
take up enough iodine to maintain normal function and becomes hyperplastic. The
hyperplasia may be caused by increased secretion of the thyroid stimulating hormones
caused by a fall in the concentration of thyroid hormones in the plasma, but more probably
iodine deficiency causes the thyroid to respond exclusively to a normal concentration of the
TSH.
47
Goitrogens cause non-toxic goitre or enhance the effect of iodine deficiency. In some
Himalayan villages, a Goitrogens in the drinking water causes an agent produced by Esch.
Coli non-toxic goitre, most probably an agent produced by Esch. Coli. Cabbage and related
vegetables contain Goitrogens related to thiourea.
Thiocyanates, perchlorate, paraamino salicylic acud, and other drugs inhibit the
metabolism of the thyroid gland and cause goitre if given fir a long period. Fluoride and
other halogens displace iodine and contribute to the causation of non-toxic goitre. Even
excess of iodine can cause non-toxic goitre.
The enzyme deficiency sometimes cause non-toxic goitre in children. Minor
anomalies of this sort may explain some sporadic goitre. Sometimes sporadic goitres are of
familial, suggesting the possibility of a genetic defect. Antibodies against thyroid antigens
are often present in the patients with a non-toxic goitre.
Pathogenesis of hypothyroidism 103
Hypothyroidism can be again divided into Cretinism, Myxedema, Hashimotos
Thyroditis, Sub-acute lymphocytic Thyroditis.
Cretinism
Cretinin refers to Hypothyroidism developing in infancy or early childhood. The
severity of the mental impairment in cretinism appears to be directly influenced by the thime
at which thyroid deficiency occurs in utero. Normally, the maternal hormones, including T3,
T4 cross the placenta and are critical to fetal brain development. If there is maternal
thyroidal thyroid deficiency before the development of fetal thyroid gland, mental
retardation is severe.
48
Pathogenisis of Hashimotos thyroiditis 104
The disease is caused primarily by a defect of T- cells. One model fir this disorder
proposes that T-cells from patients with this disorder recognized processed thyroid antigens
in association with specific types of major Hist Compatibility Complex (MHC) antigens.
Diminished suppresser T-cells may also play a role in the emergence of thyroid specific
helper T-cells. These activated T- cells have two roles in the disease.
a. They interact with B cells and stimulate the secretion of a variety of anti
thyroid antibodies, which may activate antibody- dependent cyto-toxicity
mechanisms.
b. The helper T- cells may induce the formation of CD8+ cells, which can be
cyto-toxic to thyroid cells. B-lymphocytes from thyroid tissue of patients
with Hashimotos thyroditis are activated and secrete a number of auto-
antibodies detected against thyroid antigens.
i. Thyroglobulin and thyroid peroxidase
ii. TSH receptor
iii. Iodine transporter
Many thyroid auto-antibodies can fix compliments. As a result, complement-
dependant, antibody mediated cytotoxicity may contribute to destruction pf thyroid tissue in
patients with Hashimotos thyroiditis.
Investigations 105
1) Serum Thyroxine (T4 )
Thyroxine is transported in the plasma mainly in the bound form with Thyroxin
Binding Globulin (TBG), and by Thyroxin Binding Pre- albumin. Only a small amount
49
circulates in the blood in the free form. Measurement is more difficult and can be measured
by competitive Protein binding or Radio immuno assay method. The normal range varies
from 58 to 140 µmol/L.
2) SerumT3
The estimation is very difficult and is only possible by radio immuno assay method.
This test is more effective in the sense that some cases of hyperthyroidism are due to
excessive production of T3 without any association of Serum T4. The normal range varies
from 1.22 to 2.22 µmol/L.
3) Serum TSH
It is also measured by immuno assay method. The normal level is 0.3 to 4.0 µu/L It is
raised in primary hypothyroidism and almost undetectable in hyperthyroidism. This test is of
more help in the diagnosis of hypothyroidism rather than hyperthyroidism. It also of value to
measure TSH level is following radio-iodine therapy and sub total thyroidectomy.
4) Thyroids scan.
Scanning with tracer dose determines the functioning and not functioning (Hot or
Cold) of either full or part of the thyroid gland. A solitary nodule is palpated. Scanning is
helpful in the following way -
1. In case of suspected retro sternal goiter
2. Ectopic thyroid tissue
A single non-functioning thyroid nodule is an indication of surgery. The other tests
are BMR, Serum cholesterol, ECG, etc. these are of little value in the diagnosis, but to
determine the complications, ECG etc can be used.
50
5) Free thyroxine index
This is calculated from the formula. The formula is as follows.
FTI = serum T4 (or PBI) X T3 uptake %
The normal range is from 3.5 to 8.0. it correlates with the level of free T4 in the
serum and this accurately reflects the thyroid states of an individual. This can be considered
as best single test available at present.
6) Radiography
This is helpful to diagnose the position of the trachea, whether displaces or narrowed
from the midline. Straight X-ray is also helpful to diagnose retro-sternal goiter.
Differential diagnosis
Galaganda has to be differentiated from various systemic diseases like Galagraha,
Apachi, Kanthashaluka, Galavidradhi, Mamsatana etc. Table showing differentiating
features of Galaganda.
Table -6
Differential diagnosis of Galagraha and Apachi 106
Sl. Galaganda Galagraha Apachi
1 Nidana – Vata-Kapha-medo vrudhikara ahara-vihara
Nidana –Kaphavrudhikaraahara-vihara
Nidana – Medo-Kaphavrudhikara ahara-vihara
2 Dosha – Kapha & Vata Dosha – Kapha Dosha – Kapha
3 Dushya – Medas - Dushya – Meda
4 Sthana – Hanu, manya &gala
Sthana – Kantha Sthana – Hanu, kaksha, galaakshaka, bahusandhi & manya
5 Sopha in the neck Sopha inside thekantha
Granthi
6 Big or small swelling - Round shaped granthi
7 Nature of Sopha –Mushkavat
- Amalakasthi ormatsyandajalavat
8 Single swelling Single swelling More in number
51
Table showing differential features of Galaganda, Galavidradhi, Kanthashaluka andMamsatana.
Table -7
Differential features of Galaganda, Galavidradhi, Kanthashaluka and Mamsatana 107
No Galaganda Galavidradhi Kanthashaluka Mamsatana
1 Kapha-vata-medojanya
Sannipathaja Kaphajanya TriDosha ja
2 Mushkavatsopha
- Kolasthimatrasopha
Avalambi swayathu
3 Sopha in theneck region
Sarvagalavyapyasopha
- Pratanavanswayathu
4 Sopha Vidradhi Granthi Sopha
5 Alparuk Atiruk Neeruk Neeruk
Galaganda Chikitsa
Principles of treatment:-
The main principle of the treatment is the pacification of Kapha and Vata Dosha. As
per Susruta the sequence of the treatment is as follows 108-
Vataja galaganda
Nadisweda,- Raktamoksha, -Vranashudhi – Lepanam
Firstly the vataja Galaganda patient should be given swedanam with vatahara drugs
then the rakta mokshana should be done. The vrana shuddhi is carried out. Then lepanam
with shana, atasimoola, shigru, priyala,punnarnava, arka etc
Kaphaja galaganda
Nadisweda, Upanaha sweda, Rakta bokshanam, then Lepanam. The procedures
Vamanam, Shirovirechana, and Dhumapana are also usefull.
52
The Kaphaja Galaganda patients should be given Nadi and Upanaha swedam After
good sweating rakta mokshana is carried out. Then Lepanam with Kaphahara drugs,and
Palashaksharam Pippalyadi gana thailam is to be taken internally with Saindava lavana. The
procedures Vamana, Shirovirechana and Dhumapana etc should be carried out accordingly.
If it becomes paka then treat like Vranam.
Medoja Galaganda
Shareera snigdada should be done firstly-Sira vedam of the Urumoolam– Lepanam.
The Medoja Galaganda rogi should be given good Snehana of the shareera. Then the
Siraveda in the Urumoola is done.after that Lepanam with Arka, Syama,Lohapureesha,
Rasanchanam Danti etc should be pasted and applied. Salasaradi gana kwatha +Gomootram
should be taken internally daily. If the ganda is big in size, then surgery should be done. i.e.,
Ganda should be incised and the dushta medas is cleared off and stiched.or Agni karma with
heated Majja, Ghrita, Medas, Madhu etc, after samyak yoga madhu, ghrita should be
applied. Annabhedi, Thutham Gorochanam etc should applied.
Shamana oushadhies 109-110-111-112
i. Kanchanara guggulu
ii. Amrutadi thailam
iii. Jalakumbhi bhasmam
iv. Aparajita ghritam
v. Tumbhi thailam
vi. Tikta alabu thailam
vii. Mandoora bhasmam
viii. Asanadi choornam
53
ix. Ajagandhadi lepam
x. Kshara thailm
xi. Varanadi kashaym
xii. Nimbadi thailam
xiii. Bharngi moola kashayam
xiv. Sakhoshtakadi thailam
Pathyapathyam 113-114
Always the Galaganda rogi should take Triphala and eat Yavannam.
Pathya Ahara:-
Mudgam, yavam, triphala, iodized salt, fruits rich in vitamins, iron etc, kodrava, shundi,
nimba.
Pathya Vihara
Swedanam,Rakta mokshanam, Vamanam.
Apathya Ahara:-
Amlam, madhauram, gudam, dadhi, vasa, ksheera, ghritam, pishtham made of rice
and other guru aharas etc,madhyam, anoopa mamsam. Goitrogens such as Cabbage, kale,
turnips, Brussels, and vegetables of Brassica family.
Apathya Vihara
Divaswapnam, maidhunam, avaak sayyam, smoking.
54
Methodology
Research is an unbiased investigation or inquiry in a systematic manner to establish
new inventions and facts, correcting or modifying the old one. The ultimate aim of any
research in the field of medical science is to find out suitable remedies for particular ailment
and to promote health. Research methodology involves the systemic procedures by which
the researcher starts from the initial identification of problem to its final conclusion.
The materials and methods of the present study consists of -
1. Selection of patients
2. Methods of examinations
3. Treatment schedule and administration of drug
4. Assessment of result
Research approach
Experimentation is the most powerful research approach. In the present study the
objective is to evaluate the efficacy of Amrutadi thailam in Galaganda. The efficacy can be
analyzed by finding out the difference between the baseline data and the assessment data.
Study design
The study design made for the present study is prospective clinical trial. The study
was done in one group. The trial drug was administered for 3 months.
1) Selection of the patients
20 patients of Galaganda fulfilling the criteria of diagnosis were selected for the
study from the OPD of PGS&RC, DGMAMC HospitalGadag. Three patients were excluded
as they default at the treatment schedule. Ultimately 17 patients were included for the study
based on the inclusion and exclusion criteria in one group.
55
Inclusion criteria
v Patients between 15 to 65 years of age group
v Of any Doshanubandha
v No discriminations of chronicity of severity of disease
v All others other than that of exclusion criteria
Exclusion criteria
v Patients below 15 and above 65 years of the age
v Patients with cancer thyroid
v Complicated with other serious systemic diseases
v Pregnant women and lactating mother
Criteria of diagnosis
The symptoms of Galaganda mentioned in Ayurveda will be the basis of diagnosis
along with altered T3, T4 and TSH levels
Sample size
The sample size for the present study consist of 20 patients in a single group
Duration of the study
The study duration was 90 days treatment schedule and 30 days follow up period
was designed.
Data collection
Patients selected are thoroughly examined with both subjective and objective
parameters. Detailed general history and physical examination findings were noted.
Laboratory investigations such T3, T4, TSH, Random Blood Sugar and hemoglobin % were
conducted. Routine investigations of blood were undertaken to exclude other pathology
under veined.
56
2) Methods of examination
Thyroid disorders nowadays is common kind of metabolic multi systemic disorder
present in all ages. A through physical and general examination is mandatory for the patient
with thyroid diseases.
Before taking the history, a glance of the patient itself reveals some valuable findings
such as in hyper thyroidism the facial expression of excitement, tension, nervousness or
agitation with or without variable degree of exophthalens. In case hypothyroidism, one can
see puffy face without any expression (mask-like face)
In this study the presenting complaints are as follows-
1. Ganda (mass in neck)
2. Toda (pain over the man)
3. Vivarnata (discoluration of skin over the mass)
4. Kanda (itching around the mass)
5. Difficulty in swallowing
6. Difficulty in breathing
These complaints are assessed before and after the along with the serum T3 T4 and
TSH level
Ganda
Ganda is the swelling present on the thyroid. In Ayurveda it is mentioned as a mass
in the neck, but in the contemporary science it is mentioned as a swelling of the thyroid
gland. It can be detected by the inspection and palpation methods. As the swelling cannot be
measured and it is difficult to grade according to the size in numerical values. So here the
main tool to detect the swelling is by visualizing it and palpates to confirm the same
57
Inspection of the thyroid gland 115
It was carried out by the Pizzilto’s methods as mentioned. By this method the
following things were detected.
1. The swollen thyroid very clearly
2. While deglutition the thyroid swelling was seen moving up wards
Palpation of the thyroid gland116
It was carried out by lahey’s method and crile’s method as mentioned. By this
method the thyroid swelling was clearly detected by palpation. The scores of assessment for
ganda are as follows.
Ganda grading (mass in the neck)
1. No mass seen
2. Mild sized mass
3. Moderate sized mass
4. Large sized mass
Toda
Toda is mainly mentioned in the Ayurvedic classical test as a main
symptom of Galaganda. But in the modern system of medicine, goitre is
usually a painless condition, some inflammatory conditions of the thyroid are
painful. So in the present study the toda also assessed before and after the
treatment. It is assessed through the grading predetermined is as follows-
Toda grading
1. No pain
2. Tells on inquiry
3. Tolerable pain
4. Severe pain
58
Vivarnata
The discoloration of skin over the mass is mentioned by Ayurvedic
scholars as a main symptom of Galaganda in their Samhita’s. So it is taken as
one of the parameter for assessment. It is assessed according to the grading is
as follows –
1. No discoloration
2. Mild discoloration
3. Moderate discoloration
4. Severe colour change
Kandu
The itching around the mass is mentioned in Ayurvedic classics as a
main symptom of Galaganda. In contemporary science skin rashes in
different parts is mentioned. So it is taken as a parameter for assessment. It is
assessed according to the grading are as follows-
1. No itching
2. Mild itching
3. Moderate itching
4. Severe itching
Difficulty in swallowing
It is mentioned as a main symptom in the contemporary science for
goitre in the Ayurvedic system also there is mentioning about the hoarseness
of voice. The grading of difficulty in swallowing is as follows -
1. No complaints
2. Difficulty to swallow solids
3. Difficulty to swallow liquids
59
Difficulty in breathing
This symptom is mentioned in both the system of medicine as a main
symptom for Galaganda. Difficulty in breathing is assessed by the grading is
as follows -
1. No complaints
2. Mild
3. Moderate
4. Severe
Examination of thyroid gland
In this modern era there is a increase in the incidence of endocrine disorder due to
the deviation of man from following the swasthavritta. Out of them nowadays, the thyroid
disorder are common in every part of the globe. So it is necessary to study the history of the
thyroid gland in detail. For that purpose, to confirm the disease and to reveal various clinical
manifestations adhered to the thyroid gland, it is essential to examine the thyroid gland
elaborately.
ΙΙ) HISTORY 117
1) Age:
Age of the patient is a very important consideration. Simple goitre is commonly seen
in girls approaching puberty. It also appears in conditions of need, i.e., during pregnancy and
puberty.
Both multi-noddular and solitary nodular goiters, as well as colloid goitre are found
in women of 20s and 30s. A word of caution is very much needed in this context. Carcinoma
of thyroid is not necessarily a disease of old age. Papillary carcinoma is seen in young girls
and follicular carcinoma in middle age women.
60
2) Sex
Majorities of thyroid disorders are seen in females. All types of simple goitres are far
more common in female. Thyrotoxicosis is 8 times commoner in females than in males.
Even thyroid carcinomas are often seen in females in the ratio of 3:1.
3) Occupation
Even though occupation has hardly any relation with thyroid disorders,
Thyrotoxicosis may appear in individuals working under stress sand strain.
4) Residence
Except endemic goitre due to iodine deficiency, no other thyroid disorder has any
peculiar geographical disturbance. The Rocky Mountains, low land areas, areas producing
chalks and limestone are the prone areas of goitre genesis.
5) Swelling
The neck is examined for evidence of thyroid enlargement. Significant thyroid
enlargement is evident by palpation. The thyroid gland always moves on swallowing. The
palpation is carried out from behind the patient with the fingers encircling the neck, asking
the patient to flex the neck slightly. The landmarks for palpation are the laryngeal
cartilage’s, just below the cricoid cartilage and the isthmus of thyroid.
In case of thyroid swelling history about the onset, duration, rate of the growth and
whether associated with pain should be noted. Simple goitres grow very slowly or remain of
same size for quite some time, multi-nudular or solitary nodular goitre increases in size.
6) Pain
The goitre is usually a painless condition. Inflamatory conditions of the thyroid are
painful.
61
7) Pressure effects
The enlarged thyroid may press the trachea to cause dyspnoea or may press the
esophagus to causes dysphagia or press on the recurrent laryngeal nerve to cause hoarseness
of voice.
8) Past history
Inquiry must be made about the course of treatment the patient had and its effect on
swelling. Also should inquire, whether the patient had taken any anti thyroid drugs, as some
of them itself are Goitrogenic.
9) Personal history
Dietary habits is important as vegetables of brassica family such as cabbage, kale,
brussels are Goitrogenic. Types of sea fish i.e., the sea-weeds are also Goitrogenic.
10) Family history
It is often seen that goitres occur in more than one member of the family, while
endemic goitres may affect more members in the same family. Enzyme deficiencies within
the thyroid gland, which are concerned in the synthesis of thyroid hormones, are also seen to
run in the families.
Primary thyrotoxicosis and thyroid cancers has been seen in more than one member
of the same family.
62
II. Physical examination 118-119
Table – 8General survey of the thyroid patients for Hyper or Hypo thyroidism
Hyperthyroidism Hypothyroidisma) thin built Obeseb) under weight Over weightc) more sweating Less sweatingd) wasting of muscles Not presente)facial expressions:- excitement,nervousness, tension, with or withoutexophthalmos
Puffy face without any expression(mask likeface)
f) Hyper thyroid patients are active but willbe tired due to various reasons
Naturally dull with low intelligence( more in cretins)
g) pulse rate rapid and irregular, sleepingpulse rate
Pulse rate slow
h) moist and warm skin usually Skin is dry and inelasticI) less sleep More sleep
III.Local examination 120
1. Inspection of the thyroid gland
It was carried out by the pizzillo’s method, in which hands are placed behind the
head and the patient is asked to push the head backwards against the clasped hands on the
occiput. Normal thyroid gland is not obvious on inspection. It can be seen only when the
thyroid gland is swollen.
The thyroid swelling may be uniform involving the whole of the thyroid gland or
isolated nodules of different sizes may be seen in the thyroid region.
The next important physical sign to watch is while deglutition a thyroid swelling will
move upwards. This is due to the fact that thyroid gland is fixed to the larynx. So to confirm
the thyroid swelling inspection has carried out while examination.
63
2. Palpation of the thyroid gland
The patient is asked to sit in a chair and asked to flex the neck slightly. The clinician
should stand behind the patient. The thumbs of the both hands are placed behind the neck
and the other four fingers of each hand are placed on each lobe and the isthmus. Careful
assessment of the margin of the thyroid gland is important particularly the lower margin.
Palpation of each lobe is best carried out by Lahey’s method. In this the examiner
stands in front of the patient. To palpate the left lobe properly, the thyroid gland is pushed to
the left from the right side by the left hand of examiner. This makes the left lobe prominent.
So the examiner can easily palpate the lump thoroughly with his right hand.
During palpation the patient should be asked to swallow in order to settle the
diagnosis of the thyroid swelling. Slight enlargement of the thyroid can be detected simply
by placing the thumb on the thyroid gland while the patient swallows. (Crile’s method)
During palpation the following points should be noted.
1. Whether the whole thyroid gland is enlarged.
If so note its surface: –
Smooth surface –primary thyrotoxicosis, colloid goiter,
multinodular goiter
Firm – primary thyrotoxicosis, hashimoto’s disease
Softer – colloid goitre
Hard – thyroditis
2. When a swelling is localized, note its
Position
Size
Extent
Consistency
64
3. The mobility should be noted in both horizontal and vertical places. Fixity means
malignant tumour or chronic thyroditis.
4. To palpate and feel below the thyroid gland is an important test to discard the
possibility of retrosternal extension.
5. Pressure effects from the thyroid swelling should be carefully looked for:-
Pressure on larynx or trachea – leads to dyspnoea
Pressure on oesophagus – leads to dysphagia
Pressure on recurrent laryngeal nerve – leads to hoarseness of voice
6. Whether there is any toxic manifestations or not
Primary toxic thyroid generally not enlarged. Enlarged thyroid are
nodular thyroid with toxic manifestation is a case of secondary
thyrotoxicosis.
7. Whether myxoedema present or not
8. Whether swelling malignant or not
9. Whether any pulsation or thrill in the thyroid
10. Palpation of cervical lymph nodes to exclude any malignancy.
2. Percussion: This is done over the manubrium sterni to exclude the presence of a
retrosternal goiter.
3. Auscultation: In primary toxic goitre – systolic bruits may be heard over the goitre due to
vascularity.
Measurement of the circumference of the neck at the most prominent part of the
swelling may be taken at intervals. This will determine whether the swelling is increasing or
65
decreasing in size. Then all the system also should be examined, as it affects almost all
systems. It was carried out while examining the patient.
Investigations
These serum T3, T4 and TSH tests were investigated to determine which type of
thyroid disorders. These three tests are taken for assessment also it is assessed before and
after the treatment. RBS is done to rule out the diabetes and hemoglobin % to rule out the
anemia and ECG is to rule out cardiac emergencies in the process of excluding the patient
from treatment.
Treatment schedule
Amrutadi thailam capsule of 250mg is the trial drug given internally and Amrutadi
thailam is administered for Pratimarsha Nasya.
Internally
Treatment schedule is planned for 3 months with a periodic interval of 1 month.
Each patient is administered 2 capsule twice daily i.e. 2 in the morning at empty stomach
and the rest of 2 capsules at evening 5 PM.
Dose – 250mg capsule twice daily
Anupana – warm water
Externally
Pratimarsha Nasya is under taken.
Dose - 1-2 drops in each nostrils in the morning
Pathya – Apathya
Advised to take iodized salt and warm water after the intake of capsules. The
Goitrogens such as cabbage, cauliflower, teekshna, Guru and spicy foods are advised to
avoid during and after the treatment.
66
Drug review
This study is a prospective clinical study of Amrutadi thailam in Galaganda. Here a
detailed and separate description of the individual drug is going to mention.
Trail drug
The trial drug is Amrutadi thailam. It is a combination of nine drugs, which is
mentioned in Yogaratnakara in the chapter Galagandadhikara
Criteria for selection of drug
1. The composition of this drug is purely herbal
2. There is no proved toxicity or drug incompatibility
3. It is easily available in the local market
4. There is no controversial single drug used in this combination
5. Easy to manufacture and to make the capsule.
6. The drug is in the form of taila, which is (11 times avarthita) which gives more
effects.
7. It can be used as an internal medicine and externally as Nasya also
8. This is a unique attempt and no clinical study conducted with this composition.
Detailed description of each component of Amrutadi thailam
1.GUDUCHI:-121-122
Botanical name – Tinospora cordifolia
Family – Menispermaceae
Synonym – Amruta, Chinnaruha, Madhuparni
Ganas – vayasthapana, daha prashamana, guduchyadi patoladi, aragwadhadi, kakolyadi,
stanyasodhaka
67
Description:-
It is a long lasting creeper climbing over the trees like mango, Neem, etc., the stem is
covered by transparent layer and can be pealed off. It has many tentacles hanging down.
Leaves heart shaped, individualized, pointed at the tip and slimy. Flowers – small yellow
flowers appearing in clusters. Fruit – bean shaped, appearing red on ripening and flourish in
cold and moderate climate. It is seen all over India.
Parts used - bark (kandam)
Properties-
Rasa – Tikta Kashaya
Guna – guru, Snigdha
Veerya – Ushna
Vipaka – Madhura
Doshakarma – Tridosha samakam
Prabhava – vishagna
Chemical composition:-
It consists of berberine, a bitter substance and Giloin – a glucoside that is also bitter
in taste.
Therapeutic uses –
Deepana, Pachana, Anulomana, Krimighna, Trishna Nigrahana, Chardinigrahana.
Used for Tridosha shamana, controls emesis and thirst, antacid, kushta, jwara,
vataraktam, prameha, Agnimandya, kamala, yakritvikara, raktavikara, and skin diseases.
Vishista yogam –
Guduchyadi choornam, Guduchayadi kwatha, Amrudharistha, Guduchayadi satva
Dosage – decoction – 60 to 100ml, Powder – 1 to 3 grams, Satva – ¾ to 2 grams
68
2.HINGU:- 123-124
Botanical name – Ferula foetida
Family – Umbellifereae
Synonym – sahasraveda, jatuk, balhik, ramada
Ganas – samngasthapana, deepaniya, katukaskanda, pippalyadi, ushakadi.
Description:-A small perinneal shrub, 2-3 meters height. Leaves delicate, ciliated with 2-4
wings, stalk bears a single leaf with broken margin at the tip. Fruit – 1cmx1cm, the latex
called Hing.
Varieties: – White and black, white variety oozes latex which is scented, like diamond and
crystal clear. This is called hirahing and used in medicine. Black variety foul smells. Many
varieties are available in market, which are attributed to habitat, tree and mode of
preservation.
Habitat:-Iran, turkey, afghanistan, punjab and peshawar
Parts used –latex
Properties- Rasa – Katu
Guna – Laghu, Snigdha, teekshana, sara
Veerya – Ushna
Vipaka – Katu
Dosha karma – Vata Kapha hara
Chemical composition –
6 to17% of volatile oil. This contains rason oil and allyl persulphide, which emits a
special smell, 65% resin, wax etc.
69
Therapeutic uses: deepana, pachana, vedana sthapana, samnja sthapana, kandughna, balya,
chedana, krimighna.
Used for Kapha Vata shamana, shoola prasamana, sopha prasamana,
vedanasthapana, pakshagata, ardita, gridrash, gulma, Agnimandya, hridruga, Swasa,
mutrakatha.
Vishishta yogam –
Hingwashakchurnam,
Hingwadivati,
Rajapravartinivati
Dosage: – 0.25 to 0.5g
3.NIMBA:-125-126
Bonanical name – Azadirachta indica
Family – Meliaceae
Synonyms – pichumarda, hinguniryas, arishta
Ganas: – kandughna, tiktaskanta, argwadadhi guduchyadi, lakshadi
Description –
A tree measuring 8-10 meters in height. Trunk straight with branches in all
directions, bark is thick, black, rough from which secretion (latex) is obtained. Leaves
compound, equidistant eye shaped, 6-14 paired foliated bilateral on the stalk. Flowers –
small white scented. Fruit – green and hard on ripening it turns yellow and soft. Fruits
contain sweet slightly pungent and sticky pulp and a single seed. Oil is extracted from the
seed.
Habitat – it is seen all over India
Parts used – flowers, leaves, bark, seed and oil
70
Properties:-
Rasa – Tikta Kashaya
Guna – Laghu
Veerya – Sheeta
Vipaka – katu
Doshakarma – Kapha Pitta shamaka
Chemical composition
External skin astringent but internal is pungent. Bark contains a bitter resin called
margosin. It also contains volatile oil, gum, white secretion, glucose seeds contains 40%
stable oil and traces of sulfur. The other chemical constituents are nimbin, nimbinin,
nimbidin, nimbosterol, tanin, potassium, calcium etc.,
Therapeutic uses:–
kushthagna, grahi, krimigna, yakrituttejaka shoshanam, rakta shodaka, daha
prashamana, pachana chakshushya.
Used in Kapha Pitta vikaras, vidradhi, granthi, aruchi, rakta vikaras, kasa, kushta,
netra roga, pramaha.
Vishista yoga: –
Nimbadichurna,
Nimbaristha,
Nimbaharedra khanda
Dosage: – Powder 1-2 g, Leaf juice – 12 to 14cc and Oil – 4-10 drops
4.ABHAYA:-127-128
Botanical name-Terminalia chebula
Family-Combrataceae
Synonyms -pathya,rohini,shreyasi,pachani,shiva
Ganas:- triphala, amalakyadi, parushakadi, prajasthapana, kusthaghna, kasaghna, assoghna.
71
Description:-
A big tree, 25-30 meters height. Its wood is hard and bulky. Leaves are 10-30cms in
length and are pointed. The vasculature of the leaves has 6-8 pairs of veins. The inferior
aspects of the leaves show two small nodules near its attachment with the stalk.
The flowers have short stalks, white or yellow in colour and have a strong smell.
Fruits are 3-6 cms in length. Initially it will be green but on rippening, they become
yellowish brown. Each fruit contains one seed. Seeds are oval and hard. On breaking the
shell of the seed, an oval shaped pulped is obtained.
Habitat
Haritaki found almost every where in India this tree grows at places up to a height of
about 2000 mts from sea level.
Parts used – fruits
Properties
Rasa – Madhura, Amla, Katu, Tikta, Kashaya
Guna - Laghu, rooksha
Veerya – Ushna
Vipaka – Madhura
Prabhava – Tridosha hara
Dosha karma – Tridosha shamana
Chemical composition
In the fruits, tanin is present (25-30%). It also contains chebulagic acid, chebulinic
acid, corilagin. Traces of phosphorus, glucose, amino acids etc are present.
72
Therapeutic uses: tridhosha shamana sophahara, vedana sthapana, vrna sothana, balya,
medya, deepana, pachana, yakruduttyaka, mrudu rechana, shouitasthapana, kusthaghna,
Rasayana, srotoshodska.
Vishista yoga:
abhayaristham, pathyadi kwath, agastya rasayanam, vyaqkhri hareetaki.
Dose – 3 to 6 gms for shodanam, 1 gm Rasayana.
5) VRUKSHAKA 129-130
Botanical name – Holarrhena anti dysentrica
Family – Apocynaceae
Synonyms – kutoja, kalinga, vatsaka, yavaphala, girrimallika.
Description
The tree is 7-9 Mts tall. The bark is pale or brownish colour. The inner wood is pale
and soft, leaves 10-3- cms long and 3-5 cms wide. They appear similar to that kadamba-
always green and shiny. They are 10-16 in pairs with prominent veins on them. Flowers –
white, fragment similar to jasmine flowers, 2.5- 3.75 cms in length fruits – two pods arise on
the same stalk. They are long and hard, 20-40 cms in length and thin.
Habitat - through out India but mainly in the jungles of saharanpar.
Parts used – stem, bark, seeds.
Properties:- Rasa - Tikta, Kashaya
Guna- rooksha, Laghu
Veerya- Sheeta
Vipaka- Katu
Doshakara- kaphapitta shamaka
73
Chemical composition:-
The bark and seeds contain kurhicine and karchine. The others chemical constituent
are concession, tanin, volatile oil seeds.
Therapeutic uses:-
vruna ropana, vamaka, deepana, sthambhana, arshoghna, krimighna, rakta shodaka,
lekhana. Used in Kapha Pitta vikaras, jwara, Atisara, Agnimandya, Pravahika, arsas, kasha,
Vata rakta, lekhana in atisthoola.
Visihista yogan –
Kutajaristha
kutajaualeha
Dose – 20-30gms for kwatha
3-6gms for choornam.
6) PIPPALI 131-132
Botanical name – Piper longum
Family – Piperaceae
Synonyms –magadhi, krishna, vaidhi, kana,ushna,chapala
Gana – kasa hara, shiroveerechana, vamana, deepanihya, pipalyadi, urdhuabhagahara,
Description :-
It is a creeper, which spreads on the ground, or climbs up near by trees for support
leaves 5-6 cms long, resemble betel leaf and has veins. They are bitter to taste. Flowers-
unisexual fruits long, reddish on ripering and turn black when dried. It flowers during rainy
season and gives fruits during autumn.
Habitat – piper logum is grown in almost all over India
74
Parts used – fruit
Properties –
Rasa – Katu
Guna – Laghu, Snigdha, tekshna
Veerya – Anushna Sheeta
Vepaka – Madhura
Dosha Karma – Kapha Vata haram
Chemical composition-
Resin, volatile oil, starch, gum, fatty oil, inorganic matter and resin – piperine 1-2%,
the other alkaloids present are pipartine, sesamin piplasterol.
Therapeutic uses –
shiro virechana, rakta uhcleshaka medya, deepana, vatanulomana, yakridutteyakam,
raktashodaka, mootrala, kusthaghna, Rasayana. It is used in Kapha Vata vikaras sopham
Vata Vyadhi, yakritvikara, and agnemandya pandu, rakta vikara, kasa, Swasa, kwatha.
Vishishta yoga –
Pipalyasana
Pippalikhanda
guda pippalli
Dose – 5-10 gm choornam
7) BALA 133-134
Botanical name – Sida cordifolia
Family – Malvaceae
Synonyms – bhadra, kharayasthika, vattika
75
Description
A small shrub of height 5 to 10 cm. Root and trunk are strong hence it is called as
bala. Leaves alternate 2.5 to 5 cm long 5cm broad ciliate, round having 7-9 veins on it and
serrated margin. Flowers – like moonga, divided into 5 parts. Seeds small dusty block and
look like bees. The seeds are called as beeja banda. The plant bears flowers and fruits at the
end of rainy season.
Habitat – all over India srilanka
Parts used – root, seeds and leaves
Properties – Rasa – Madhura
Guna – guru, Snigdha, pichila
Veerya – Sheeta
Vipaka – Madhura
Dosha karma – Vata, Pitta hara
Chemical composition –
Major components of seeds are alkaloids. Alkaloids contain mainly ephedrine it also
contains fatty acid, mucin, pottassium nitrate and resin.
Therapeutic use –
sophagnam, balya, grahi, rakta shodhaka, mootrala, brhmana, ojovardhaka. Used in
Vata pittavikaras. Vrnasopha, netra roga, ardita, pakshagata, Grahani, mootra krudra,
dourbalya, kshayaroga, krushata
Vishistha yoga – balaristha, baladyaghruta
Dose – swarasa – 10-20ml
Choorna – 3-6gm
76
8) ATIBALA 135-136
Botanical name – abutilon indicum
Family – malvaceae
Synonyms – kwaketika, rushyh prokta
Description
Shrub of height 1.25 to 2metres. Leaves – serrated, soft, and ciliate. Flowers –
yellow the tube of androecium is elongated and gynaecium are 15 or more in number. Fruit
– round but surrounded by spikes on all sides. Seeds 15-20 in number, dusty block and
called as beeja banda.
Habitat – all over India and srilanka
Rest of the qualities and uses are same as that bala.
9) DEVDARU137-138
Botanical name – Cedrus deodara
Family – Pinaceae
Synonym – suradaru, bhadradaru, suravha
Description
Big tree of height 8.5 meters. Stem – big, having circumference of 12 meters bark –
thick and crocked. Leaves – are green elongated with tapering ends. Flowers – green yellow
and appear in clusters. Fruit – ripe fruit is black having seeded 1cm long. The tree bears new
fruits in October, which ripe within a year. Deodar tree has a long life span of 600 years
Habitat – at the height of 2000 to 3000 meters in Himalayas
Parts used – inner substance of wood and oil (kanda sara)
77
Properties –
Rasa – Tikta, Katu
Guna – Laghu, Snigdha
Veerya – Ushna
Vipaka – Katu
Doshakaram – Kapha Vata haram
Chemical composition
It contains dark coloured oil and resin. The oil contains a chemical constituent called
sesquiterpene.
Therapeutic uses – sophaharam, vedanasthapanam, kusthaghna, krimighna, swedajananam.
Used in Kapha Vata vikaras sopha vedana yukta rogas skin diseases, sandhivata, grudhrasi
rakta shodakam, medoroga.
Vishista yoga – devadaruadi kwath, devadarvadichoorna
Dose – choornam 3-6gm
Taila – 20-40ml
Preparation of Amrutadi thailam 139
Amrutadi thailam is mentioned in yogaratnakara in galaganda prakaranam. The
preparation of medicine is according to the sneha vidhi of sarngadara. All the ingredients are
well identified and collected and cleaned well. Then on an auspicious day all drugs are
chopped and taken as 6 parts to that 96 parts water is added. Which is then kept on mrudu
Agni and boiled. It is then reduced to ¼ parts. This 24-part kashaya is mixed with 1/6 part
kalka and 6-part tila thailam and prepared on mrudu Agni. It is taken out from the fire, when
the paka is mrudu consistency and filtered.
78
The next day again to this 1/6 part kalka, 6-part-tila thailam and 24-part kashaya is
added, boiled and filtered mrudu paka attains. This process is done for 11times.
After the manufacturing of the avartha thailam, it is transferred to a clean bottle and
then capsulated to the size of 250mg. The oil for the Pratimarsha Nasya is also bottled on the
same day. Good manufacturing principle is followed through out the whole process.
Hypothesis of Avarthita taila 140
In general the entire procedure of sneha paka involves three components viz. Oil,
decoction and paste of herbs. The basic aim of the procedure is being to acquire the liquid
soluble essence in to the oil. While preparing the decoction most of the volatile oil get
evaporated and water-soluble active principles come in to the final product.
The decoction inters acts with the oil and emulsion like stage is reached when the
complex alkaloids get entangled with the glycoside Easters of the fatty acids. The paste
comes directly into contact with the oil as it is prevented from burning by continues stirring
and the entire process being operated over mild heat, it is possible to get fat soluble
components of herbs and even some volatile oils mixed into oil. The essential components
coming into contact of per unit oil is more and the oil thus formed is more concentrated in
case of reprocessing.
Assessment of response to treatment
In this study Ayurvedic and modern approaches were utilized through out the study.
The chief symptoms were recorded and assessed according to their grading before and after
the treatment. The investigation serum T3 T4 and TSH were done before and after
treatment. Then its progress is noticed and recorded. All the parameters were reviewed
statically also.
79
Over all assessment
Over all assessment is made with the subjective parameters enumerated in the study
and their respective percentages of the disease regression is estimated. There by the
cumulative effect is valued and percentages of disease regression with symptom regression
are noted. In further the drug progressive effect over the objective parameters are estimated.
The result is declared as the subjective parameters show significant results in all the subjects
with the variations found in the objective parameters. The T3, T4 or TSH in hyper, Hypo or
Euthyroidisms, does not show the significant differences in the study, the values towards the
normal deviations are considered to that of responded and the small value deviations are
emphasized as maintained. The others those who were not significant were put under the
Not responded.
80
Results
20 patients were registered for the present study. Out this, 3 patients were
discontinued, hence their data has not been included here. The remaining 17 patients of
Galaganda, fulfilling the criteria for diagnosis, were treated.
All the patients were examined before and after the treatment, according to the case
sheet format given in the annex. Both the subjective and objective criteria were recorded.
The data recorded are presented under the following headings.
A. Demographic data
B. Data related to the disease.
C. Data related to the overall response to the treatment
D. Statistical analysis of the clinical and functional parameters and inter group comparison.
A) Demographic data:
The details of age sex, religion, and occupation etc. of the 17 patients is as follows.
A1) DISTRIBUTION OF PATIENTS BY AGE
Table-9
Age
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
15-254
20 2 50 1 25 0 0 1 25
25-352
10 1 50 0 0 1 50 0 0
35-456
30 2 33.3 3 50 1 16.6 0 0
45-555
25 1 20 2 40 1 20 1 20
55-653
15 0 0 2 66.6 0 0 1 33.3
Total 20 100 6 30 8 40 3 15 3 15
81
Age distributions:
Observation:
As we observe in the study, the age factors are discussed under the class intervals of
10 each from 15 to that of 65 years of ages. The patients observed from the observations are
of 17. The distributions are observed as maximum from that of the middle age groups such
as 35- 45. But still the age interval of 45-55 show remarkably increased number, i.e. 5
patients. The distributions as observed at the intervals of are 15-25 as 4 patients, 25-35 as 2
patients, 35-45 as 6 patients, 45-55 as 5 patients and 55-65 as 3 patients.
Graph – 1Showing Patients by age distribution
15-2520%
35-4530%
55-6515%
25-3510%
45-5525%
82
The individual results based upon the age distributions along with percentages are as
follows.
It is observed as – in the 15-25-age interval show the significant results and out of 4
patients, 2 (50%) patients responded, 1 (25%) patient maintained and 1 (25%) patient
discontinued. In 25-35 age group, 2 patients reported and 1 (50%) responded and the other
patient (50%) is not responded. In 35-45 interval, 6 patients reported and out of them 2
(33.3%) patients responded, 3 (50%) maintained and 1 (16.6%) patient is not responded. In
45-55-age interval, 5 patients reported, out 1 (20%) patient responded and 2 (40%) patients
maintained and 1 (20%) patient not responded and 1 (20%) falls under discontinued
categories. The subsequent interval of 55-65 years of the age group, out of reported 3
patients, 2 (66.6%) maintained and 1 (33.3%) patient discontinued from the treatment, i.e.
Amrutadi Yoga taila capsules as internal medication in association with the Amrutadi yoga
taila Pratimarsha Nasya.
A2) DISTRIBUTION OF PATIENTS BY SEX
Table-10
Sex
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Female 18 90 5 27.7 8 44.4 2 11.1 3 16.6
Male 2 10 1 50 0 0 1 50 0 0
Total 20 100 6 30 8 40 3 15 3 15
Observation:
The male female ratio is observed as 1:9. The percentage of the distribution does
show the gender differentiation to get this metabolic disease. The observations are 2 Patients
i.e. (10%) were male and 18 patients i.e. (90%) were female.
83
Result:
In which, out of reported Males 1 (50%) patient responded and another (50%) patient
is not responded. Out of the females reported (18 patients) 5 (27.8%) are responded and 8
(49.4%) maintained, 2 (11.1%) patients are not responded and 3 (16.6%) patients are
discontinued.
Graph –2
Showing Patients by gender distribution
Male10%
Female 90%
84
A3) DISTRIBUTION OF PATIENTS BY RELIGION
Table- 11
Religion
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Hindu16
80 5 31.25 8 50 1 6.25 2 12.5
Muslim4
20 1 25 0 0 2 50 1 25
Christian0
0 0 0 0 0 0 0 0 0
Others0
0 0 0 0 0 0 0 0 0
Total20
100 6 30 8 40 3 15 3 15
Distribution by religion:
Observation:
For the convenience of the study, the religion communities are grouped as 1) Hindu,
2) Muslim, 3) Christian and 4) Others. Out of the 20 patients reported 16 patients belong to
Hindu and only 4 patients are of Muslim community. No other community patients were
reported, as this locality is a Hindu dominated area.
Result:
Out of the 16 patients of Hindus, 5 (31.2%) patients responded, 8 (50%) patients
maintained, 1 (6.25%) patient not responded and 2 (12.5%) patients discontinued. Out of
reported 4 Muslims 1 (25%) patient responded, 2 (50%) not responded and one (25%)
patient discontinued.
85
Graph – 3Showing Patients by religion distribution
A4) DISTRIBUTION OF PATIENTS BY OCCUPATION
Table- 12
Occupation
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%D
isco
ntin
ued
%
Sedentary15
75 3 20 8 40 2 13.3 2 0
Active3
15 2 66.6 0 0 1 33.3 0 0
Labour0
0 0 0 0 0 0 0 0 0
Others2
10 1 50 0 0 0 0 1 50
Total20
100 6 30 8 40 3 15 3 15
Christian 0%
Hindu80%
Muslim20%
Others0%
86
Observation:
For the convenience of the study common occupational listing are grouped. They are
based on the work mode as, sedentary, active, labor and others. Out of the 20 patients, 15
(75%) patients are of sedentary and 3 (15%) are active. No patients reported from labor class
and 2 (10%) patients reported as other category.
Result:
Out of 15 patients of sedentary, 3 (20%) responded, 8 (40%) patients maintained and
2 (13.3%) patients are not responded. 2 (13.3%) patients of sedentary group have
discontinued the treatment. Out of active class, 2 (66.6%) patients responded and 1 (33.3%)
patient is not responded. Out of the 2 patients of other class, 1 (50%) patient responded and
1 (50%) patients is discontinued.
Graph –4Showing Patients by occupation distribution
Labour0%
Sedentary75%
Active15%
Others10%
87
A5) DISTRIBUTION OF PATIENTS BY ECONOMIC STATUS
Table-13
Economicstatus
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Belowpoverty line
210 0 0 2 100 0 0 0 0
Middle 1365 4 30.7 5 38.4 2 15.3 2 15.3
Upper middleclass
420 2 50 0 0 1 25 1 25
Higher class 15 0 0 1 100 0 0 0 0
Total 20100 6 30 8 40 3 15 3 15
Observation:
In this study the common four groups of economical states are considered. They are
1) BPL class, 2) Middle class, 3) upper Middle class and 4) Higher classes.
Out of 20 patients reported, maximum numbers of 13 (65%) patients are from middle
class. 2 (10%) patients reported from the BPL class, 4 (20%) patients are from upper middle
class and 1 (5%) patient is from high class.
Result:
Out of the 13 patients of middle class, 4 (30.8%) patients responded, 5 (38.5%)
patients’ maintained, 2 (15.4%) patients discontinued and 2 (15.4%) patients were not
responded. From the BPL class all 2 (100%) patients maintained to the management. Out of
the 4 patients of upper middle class, 2 (50%) patients responded 1(25%) patient
discontinued and 1 (25%) patient were not responded. The patient (100%) reported from that
of higher class is maintained for the management.
88
Graph –5Showing Patients by economical status distribution
B) Data related to the disease.
B1) DISTRIBUTION OF PATIENTS BY MODE OF ON SET
Table- 14
Mode of onset
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Gradual17
85 6 35.2 6 35.2 2 11.7 3 17.6
Sudden0
0 0 0 0 0 0 0 0 0
Insidious3
15 0 0 2 66.6 1 33.3 0 0
Total20
100 6 30 8 40 3 15 3 15
2
13
4
1
0
2
4
6
8
10
12
14
Below povertyline
Middle Upper middleclass
Higher class
by economical statusPatients
89
Observation:
In this study the common three groups of onset states are considered. They are 1)
gradual class, 2) sudden class and 3) insidious class.
Out of 20 patients reported, maximum numbers of 17 (85%) patients are from
gradual class. 3 (15%) patients are reported from the insidious class and no patients are
from sudden onset class.
Result:
Out of the 17 patients of gradual class, 6 (35.3%) patients responded, 6 (35.3%)
patients’ maintained, 3 (17.7%) patients discontinued and 2 (11.8%) patients were not
responded. From the insidious class 2 (66.7%) patients maintained to the management and 1
(33.3%) patient is not responded.
Graph –6Showing Patients by mode of onset distribution
Insidious15%
Gradual85%
Sudden0%
90
B2) DISTRIBUTION OF PATIENTS BY INTAKE OF GOITROGENS
Table- 15
Intake ofGoitrogens
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Present12
60 4 33.3 4 33.3 1 8.3 3 25
Absent8
40 2 25 4 50 2 25 0 0
Total20
100 6 30 8 40 3 15 3 15
Observation:
In this study the common groups of Goitrogens Intakes are considered as present or
not present. Out of 20 patients reported, maximum numbers of 12 (60%) patients are at the
usage of Goitrogens Intake and the rest of 8 (40%) were not directly give any reference of
Goitrogens Intake food substances.
Graph –7Showing Patients by intake of Goitrogens distribution
Distribution by Goitrogens Intake
Present60%
Absent40%
91
Result:
Out of the 12 patients of Goitrogens Intake class, 4 (33.3%) patients responded 4
(33.3%) patients’ maintained, 3 (25%) patients discontinued and 1 (8.3%) patient has not
responded. From the non-Goitrogens Intake class 4 (50%) patients maintained to the
management, 2 (25%) patient is not responded and 2 (25%) patient is responded.
B3) DISTRIBUTION OF PATIENTS BY FAMILY HISTORY
Table- 16
Familyhistory
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Present10
50 4 40 2 20 3 30 1 10
Absent10
50 2 20 6 60 0 0 2 20
Total20
100 6 30 8 40 3 15 3 15
Observation:
In this study the common groups of Family history are considered as present or not
present. Out of 20 patients reported, maximum numbers of 10 (50%) patients are with
Family history and the rest of 10 (50%) were not directly give any reference of Family
history.
Result:
Out of the 10 patients with Family history class, 4 (40%) patients responded 2 (20%)
patients’ maintained, 1 (10%) patient discontinued and 3 (30%) patients have not responded.
From the patients those not reported with Family history class 6 (60%) patients maintained
to the management, and 2 (20%) patient is responded. The other 2 (20%) patients
discontinued the treatment.
92
Graph – 8Showing Patients by family history distribution
B4) DISTRIBUTION OF PATIENTS BY Agni (APPETITE)
Table- 17
Appetite
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Poor5
25 0 0 1 20 1 20 3 60
Moderate7
35 4 57.1 3 42.8 0 0 0 0
Good7
35 2 28.6 4 57.1 1 14.2 0 0
Severe1
5 0 0 0 0 1 100 0 0
Total20
100 6 30 8 40 3 15 3 15
Observation:
In this study the common groups of Agni history is considered as poor, moderate,
good and severe. Out of 20 patients reported, 5 (25%) patients reported with mandagni (poor
Distribution by Family history
Present50%
Absent50%
93
appetites) which is said as the cause of all diseases in Ayurveda. The category of moderate
appetites i.e. samagni patients are 7 (35%) and the good appetite patients are 7 (35%). The
one (5%) patient reported with severe appetite, which is considered in Ayurveda as
Teekshnagni
Result:
Out of the 5 patients with mandagni class, 1 (20%) patient maintained, 3 (60%)
patient discontinued and 1 (20%) patient is not responded. From the patients those not
reported with samagni moderate history of appetite 3 (42.8%) patients maintained to the
management, and 4 (57.2%) patients are responded. Out of the 7 patients with good appetite,
4 (57.2%) patient maintained 2 (28.6%) patients responded and 1 (14.9%) patient is not
responded. Out of the category of Teekshangni the patient reported is not responded to the
treatment.
Graph – 9Showing Patients by Agni distribution
Distribution by Agni (APPETITE)
Good35%
Poor25%
Moderate35%
Severe5%
94
B5) DISTRIBUTION OF PATIENTS BY SLEEP
Table- 18
Sleep
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Sound sleep8
40 1 12.5 5 62.5 2 25 0 0
More sleep5
25 2 40 1 20 0 0 2 40
Less sleep4
20 2 50 1 25 1 25 0 0
Disturbedsleep
315 1 33.3 1 33.3 0 0 1 33.3
Total20
100 6 30 8 40 3 15 3 15
Distribution by Nidra (sleep)
Observation:
In this study the common groups of Nidra history is considered as sound, more,
disturbed and less. Out of 20 patients reported, maximum numbers of 8 (40%) patients
reported with sound sleep. The category of more sleep i.e. Atinidra patients are 5 (25%) and
with the disturbed sleep are 3 (15%). The patients with less sleep are 4 (20%) in the study.
Result:
Out of the 8 patients with sound sleep class, 5 (62.5%) patients maintained 2 (25%)
patients not responded and 1 (12.5%) patient is responded. From the patients those who are
with Atinidra, 1 (20%) patient maintained in the management and 2 (40%) patients are
responded, the rest 2 (40%) patients are discontinued the treatment. Out of the 3 patients
with disturbed sleep, 1 (33.3%) patient maintained 1 (33.3%) patient responded and 1
(33.3%) patient is discontinued. Out of the category of less sleep reported patients, 1 (25%)
patient maintained 2 (50%) patient responded and 1 (25%) patient is not responded.
95
Graph –10Showing Patients by sleep distribution
B6) DISTRIBUTION OF PATIENTS BY PSYCOLOGICAL FEATURES
Table- 19
Psychological features
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%D
isco
ntin
ued
%
Present19
95 6 31.8 7 36.8 3 15.8 3 15.8
Absent1
5 0 0 1 100 0 0 0 0
Total20
100 6 30 8 40 3 15 3 15
Distribution by Psychological features
Observation:
In this study the common groups of psychological features are considered as present
or not present. Out of 20 patients reported, maximum numbers of 19 (95%) patients are with
Distribution by Nidra (sleep)
Less sleep 20%
Sound sleep 40%
More sleep 25%
Disturbed sleep 15%
96
the psychological features interfered and the rest of 1 (5%) patient is not directly given any
reference of psychological features exposed.
Result:
Out of the 19 patients of psychological features interfered class, 6 (31.6%) patients
responded 7 (36.8%) patients’ maintained 3 (15.78%) patients discontinued and 3 (15.78%)
patient has not responded. From the second category of no reference with psychological
interference class patient (100%) patient maintained to the management.
Graph –11
Showing Patients by psychological features distribution
Distribution by Psychological features
Present 95%
absent5%
97
B7) DISTRIBUTION OF PATIENTS BY HABITS
Table- 20
Habits
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
No Habit17
85 5 29.4 7 41.8 3 17.6 2 11.8
Smoking2
10 1 50 1 50 0 0 0 0
Alcohol0
0 0 0 0 0 0 0 0 0
Tobacco1
5 0 0 0 0 0 0 1 100
Total20
100 6 30 8 40 3 15 3 15
Distribution by Vyasana (Habits)
Observation:
In this study the common groups of vyasana history is considered as No Habit,
Smoking, Alcohol and Tobacco usage. Out of 20 patients reported, maximum numbers of 17
(85%) patients are with no habits as the study is loaded with female population. 2 (10%)
smokers and 1 (5%) patient of tobacco user is reported in the study.
Result:
Out of the 17 patients with No Habit class, 7 (41.17%) patients maintained 3
(17.64%) patients not responded, 2 (11.76%) patients discontinued and 5 (29.41%) patient is
responded. From the patients those who are with smoking, 1 (50%) patient maintained in the
management and the other (50%) patient are responded. Patient reported with tobacco usage
is reported discontinued from the study.
98
Graph –12Showing Patients by habits distribution
B8) DISTRIBUTION OF PATIENTS BY MENUSTRAL CYCLETable-21
Menstrualcycle
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%D
isco
ntin
ued
%
Regular8
44.4 4 50 2 25 0 0 2 25
Irregular5
27.7 1 20 2 40 2 40 0 0
Menopause5
27.8 0 0 4 80 0 0 1 20
Total18
100 5 27.8 8 44.4 2 11.1 3 16.7
Observation:
In this study the common groups of menstrual cycle history is observed as the
maximum number of the patients are of females. The categories are Regular, Irregular and
Menopause. Out of 18 patients reported, maximum numbers of 8 (44.4%) patients are with
Distribution by Vyasana (Habits)
Alcohol0%
No Habit85%
Smoking10%
Tobacco5%
99
regular menstrual cycle and 5 (27.8%) irregular menstrual cycle and 5 (27.8%) population
reported cessation of menstrual cycle is reported in the study.
Result:
Out of the 8 patients with regular menstrual cycle, 2 (25%) patients maintained 4
(50%) patients not responded and 2 (25%) patients discontinued. From the patients those
who are with irregular menstrual cycle, 2 (40%) patient maintained in the management 1
patient (25%) responded and the other 2 (40%) patient are not responded. From the patients
those who are with menopause, 4 (40%) patient maintained in the management 1 patient
(20%) discontinued.
Graph –13
Showing Patients by menstrual cycle distribution
Distribution by Menstrual cycle
Menopause28%
Regular44%
Irregular28%
100
B9) DISTRIBUTION OF PATIENTS BY BUILT AND NUTRITION
Table- 22
Built andnutrition
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Well7
35 3 42.9 4 57.1 0 0 0 0
Thin8
40 2 35 2 25 3 37.5 1 12.5
Obese5
25 1 20 2 40 0 0 2 40
Total20
100 6 30 8 40 3 15 3 15
Distribution by built and nutrition
Observation:
In this study the common groups of built and nutrition is considered as well built,
thin built and obese. Out of 20 patients reported, maximum numbers of 8 (40%) patients are
with thin built. 7 (35%) well built and 5 (25%) patients of obese are reported in the study.
Result:
Out of the 8 patients with thin built class, 2 (25%) patients maintained 3 (37.5%)
patients not responded, 1 (12.5%) patient discontinued and 2 (25%) patients are responded.
From the patients those who are well built, 4 (57.2%) patient maintained in the management
and the other 3 (42.8%) patients are responded. Out of the Patients reported with obese, 1
(20%) responded, 2 (40%) maintained and 2 (40%) patients are reported discontinued from
the study.
101
Graph – 14
Showing Patients by built and nutrition distribution
B10) DISTRIBUTION OF PATIENTS BY AHARAJA AND VIHARA NIDANA
Table- 23
Aharaja Nidana
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Gurubhojana 17 85 6 35.3 7 41.8 1 5.9 3 17.6
Virudhabhojana 18 90 6 33.3 6 33.3 3 16.7 3 16.7
Avvaksayana11
55 3 27.3 6 54.5 1 9.09 1 9.09
Distribution by Aharaja Vihara Nidana
Observation:
In this study the common groups Aharaja Nidana is considered as guru and Viruddha
bhojana. Out of 20 patients reported, maximum numbers of 17 (85%) patients are with
Distribution by built and nutrition
Obese, 5
Well, 7
Thin, 8
0 1 2 3 4 5 6 7 8 9
Well
Thin
Obese
102
Gurubhojana and 18 patients reported with the Virudhabhojana. In this study it is evident
that the different dietetics which were told by the Acharyas has much values.
The vihara Nidana is observed with the 11 patients of Avvaksayana. Out of 20
patients reported, 11 (55%) patients are with Avvaksayana.
Result:
Out of the 17 patients with Guru bhojana, 7 (41.17%) patients maintained 1 (5.88%)
patients not responded, 3 (17.64%) patients discontinued and 6 (35.29%) patient is
responded. From the patients those who are with Virudhabhojana, 6 (33.33%) patient
maintained in the management 3 (16.66%) patients not responded, 3 (16.66%) patients
discontinued and the 6 (33.33%) patient are responded.
Out of the 11 patients with Avvaksayana, 6 (54.54%) patients maintained 1 (9.09%)
patients not responded, 1 (9.09%) patients discontinued and 3 (27.27%) patients are
responded.
Graph –15
Showing Patients by Aharaja and Viharaja Nidana distribution
Distribution by Aharaja Vihara Nidana
Avvaksayana, 11
Gurubhojana, 17
Virudhabhojana, 18
0
2
4
6
8
10
12
14
16
18
20
Gurubhojana Virudhabhojana Avvaksayana
103
B12) DISTRIBUTION OF PATIENTS WITH SYSTEMS INVOLVED
Table- 24
Systems
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Cardio
respiratory12 60 3 25 5 41.7 2 16.7 2 16.7
Gastro intestinal 9 45 3 33.3 2 22.2 2 22.2 2 22.2
Dermatological 16 80 5 31.3 7 43.8 2 12.5 2 12.5
Neuro muscular 11 55 4 36.4 4 36.4 2 18.9 1 9.09
Reproductive 2 10 0 0 0 0 0 0 2 100
Total 50 250 15 30 18 36 8 16 9 18
Distribution by systems involved
Observation:
In this study the common groups of systems involved are included. Out of 20
patients reported, maximum numbers of 16 (80%) patients are with dermatological problems
and 12 patients of cardio- respiratory along with 11 (55%) patients with neuro muscular
complaints are received.
The other systems witnessed are 9 (45%) of GIT problems and 2 (10%) of
reproductive problems.
Result:
Out of the 16 patients with dermatological problems, 7 (43.75%) patients maintained
2 (12.5%) patients not responded, 2 (12.5%) patients discontinued and 5 (31.25%) patient is
responded.
104
Out of the 12 patients with cardio-respiratory problems, 5 (41.7%) patients
maintained 2 (16.7%) patients not responded, 2 (16.5%) patients discontinued and 3 (25%)
patient is responded.
Out of the 11 patients with neuro-muscular problems, 4 (36.7%) patients maintained
2 (18.2%) patients not responded, 1 (9.09%) patient discontinued and 4 (36.7%) patient is
responded.
Out of the 9 patients with gastro-intestinal problems, 2 (22.2%) patients maintained 2
(22.2%) patients not responded 2 (22.2%) patients discontinued and 3 (33.3%) patient is
responded.
Out of the 2 patients with reproductive problems, all the patients discontinued from
the management.
Graph –16
Showing Patients by with systems involved
12
9
16
11
2
0 2 4 6 8 10 12 14 16
Cardio respiratory
Gastro intestinal
Dermatological
Neuro muscular
Reproductive
Distribution by systems involved
105
C) Data related to the overall response to the treatment
C1) DISTRIBUTION OF PATIENTS BY CHIEF COMPALINTS
Table- 25
Chiefcomplaints
Tot
al n
o of
pati
ents
%
Res
pond
ed
%
Mai
ntai
ned
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Ganda 17 100 6 35.3 8 47 3 17.7 0 0
Toda 17 100 6 35.3 8 47 3 17.7 0 0
Vivarnata 17 100 6 35.3 8 47 3 17.7 0 0
Kandu 17 100 6 35.3 8 47 3 17.7 0 0
Difficult to
swallow17 100 6 35.3 8 47 3 17.7 0 0
Difficulty to
breath17 100 6 35.3 8 47 3 17.7 0 0
Distribution by systems involved
Observation:
All most all the symptoms, which are evaluated, show the al 17 patients involving
with the symptoms in the disease. It is clear and significant that the disease explained in the
Ayurveda and compared on contemporary systems substantiate the present study patterns.
Results:
The results are discussed as symptoms react to that of the management. This is
reflecting the as it is of the result final, which will be discussed as under in the subjective
parameters enumerated.
106
C2) subjective parameters enumerated (a)TABLE -26
Ganda Toda Vivarnata Kandusl
noB A D % B A D % B A D % B A D %
1 3 1 2 66.66 3 1 2 66.6 2 1 1 50 4 2 2 502 2 1 1 50 2 1 1 50 3 1 2 66.6 3 1 2 66.63 3 2 1 33.3 3 1 2 66.6 2 1 1 50 3 2 1 33.34 3 2 1 33.3 3 1 2 66.6 2 1 1 50 2 1 1 505 2 1 1 50 3 1 2 66.6 4 1 3 75 3 1 2 66.66 3 2 1 33.3 3 1 2 66.6 2 1 1 50 2 1 1 507 3 2 1 33.3 2 1 1 50 2 1 1 50 3 2 1 33.38 2 1 1 50 3 1 2 66.6 3 1 2 66.6 3 1 2 66.69 3 1 2 66.6 2 1 1 50 3 1 2 66.6 2 1 1 50
10 3 2 1 33.3 3 1 2 66.6 3 1 2 66.6 2 1 1 5011 4 3 1 25 3 1 2 66.6 3 2 1 33.3 3 1 2 66.612 3 1 2 66.6 2 1 1 50 3 1 2 66.6 3 1 2 66.613 3 2 1 33.3 3 1 2 66.6 2 1 1 50 3 1 2 66.614 3 2 1 33.3 3 1 2 66.6 2 1 1 50 3 1 2 66.615 2 1 1 50 2 1 1 50 2 1 1 50 3 1 2 66.616 3 2 1 33.3 3 1 2 66.6 3 1 2 66.6 4 1 3 7517 3 2 1 33.3 2 1 1 50 3 1 2 66.6 4 2 2 50
TABLE -27Subjective parameters enumerated (b)
difficulty inswallowing
difficulty inberatingsl
no
B A D % B A D %
over all % Result
1 2 1 1 50 2 1 1 50 55.4 Maintained2 2 1 1 50 2 1 1 50 55.5 Responded3 2 1 1 50 3 1 2 66.6 49.98 Maintained4 2 1 1 50 3 1 2 66.6 52.8 Maintained5 2 1 1 50 2 1 1 50 59.72 Maintained6 2 1 1 50 1 1 0 0 49.99 Maintained7 2 2 0 0 2 1 1 50 43.32 Not Responded8 2 1 1 50 3 1 2 66.6 61.06 Not Responded9 2 1 1 50 3 1 2 66.6 58.3 Responded
10 2 1 1 50 3 1 2 66.6 55.54 Responded11 2 2 0 0 3 1 2 66.6 51.65 Responded12 2 1 1 50 3 1 2 66.6 61.1 Not Responded13 2 1 1 50 3 1 2 66.6 47.21 Maintained14 2 1 1 50 2 1 1 50 52.77 Responded15 2 1 1 50 2 1 1 50 52.77 Maintained16 2 1 1 50 3 1 2 66.6 59.71 Maintained17 2 1 1 50 2 1 1 50 49.98 Responded
107
R = Responded, M = Maintained, NR = Not Responded, D = Discontinued
The subjective parameters evaluated in the study such as Ganda, Toda, Vivarnyata,
Kandu, difficulty in swallowing and difficulty in breathing are mentioned in the grading
evaluated in the study as before after with percentage of difference. The total values are
cumulated and told to get the summated net results of Amrutadi Yoga in the management of
the Galaganda vis-à-vis goiter.
D) Statistical analysis of the clinical and functional parameters
D1) showing the statistical analysis of the chief complaints
Table -28Parameters Mean S.D S.E t-value p-value Remarks
Ganda 1.176 0.392 0.095 12.378 <0.001 H.S.
Toda 1.647 0.492 0.119 13.84 <0.001 H.S.
Vivarnata 1.529 0.624 0.151 10.125 <0.001 H.S.
Kandu 1.705 0.588 0.142 12.00 <0.001 H.S.
Difficulty In
Swallowing
0.882 0.332 0.08 11.025 <0.001 H.S.
Difficulty In
Breathing
1.47 0.624 0.151 9.735 <0.001 H.S.
HS = Highly Significant, S = Significant, NS = Not Significant
D2) showing the statistical analysis of the lab investigations
Table -29Parameters Mean S.D. S.E. t-value p-value Remarks
T3 0.041 0.059 0.0143 2.86 <0.05 H.S.
T4 0.241 1.712 0.415 0.58 >0.05 N.S.
T.S.H. 2.215 9.301 2.255 0.982 >0.05 N.S.
HS = Highly Significant, S = Significant, NS = Not Significant
108
D3) Anova – Table for the parameter T3
Table - 30
Source ofVariation
Deg
rees
of
free
dom
Sum
of
squa
re
Mea
n su
m o
fsq
uare
F c
alcu
late
dV
alue
F t
able
Val
ue a
t 5%
p-va
lue
Rem
arks
Groups 2 1.07 0.535
Error 14 2.984 0.213
Total 16 4.054 -
2.511 3.74 P > 0.05 N.S.
HS = Highly Significant, S = Significant, NS = Not Significant
D4) Anova – Table for the T4 parameter
Table –31
Source ofVariation
Deg
rees
of
free
dom
Sum
of
squa
re
Mea
n su
m o
fsq
uare
F c
alcu
late
dV
alue
F t
able
Val
ue a
t 5%
p-va
lue
Rem
arks
Groups 2 23491.988 11745.994
Error 14 8255.578 589.68
Total 16 31747.56 -
19.19 3.74 P < 0.05Si
gnif
ican
t
D5) Table show which pair of group is significant
Table - 32Group Mean Difference
Hyperthyroidism 207.02 $ -
Eu-thyroidism 102.5 $ 104.52 $
Hypothyroidism 86.55 $ 120.47 $ 15.95 #
$ - Significant # - Not significant
109
Least Significance difference value = t 0.05 SE� 1
/ni + 1/nj
or Critical difference (C.DOR L.S.D). Where t0.05 in t- table value at 5% level of significance
for error degrees of freedom. SE2 is mean error sum of squares. And ni , nj are the number
of observations in the two groups.
L.S.D =2.12� 589.68 X � 1/2 + 1/8
For II and III group
= (2.12) (24.283) (0.8017)
= 41.271
L.S.D for Hypothyroidism and Euthyroidism group = 26.64
L.S.D for Hypothyroidism and hyperthyroidism group = 40.69
D6) Anova- Table for parameter T.S.H.
Table -33
Source ofVariation
Deg
rees
of
free
dom
Sum
of
squa
re
Mea
n su
m o
fsq
uare
F c
alcu
late
dV
alue
F t
able
Val
ue a
t 5%
p-va
lue
Rem
arks
Groups 2 1324.514 662.257
Error 14 1931.759 137.98
Total 16 3256.274 -
4.79 3.74 P < 0.05
Sign
ific
ant
D7) to show which pair of group is significant
Table - 34Group Mean Difference
Hypothyroidism 19.23 $ - -
Euthyroidism 2.208 # 17.202 $ -
Hyperthyroidism 0.055 # 19.175 # 1.973 #
$ = Significant # = Not Significant
110
v Least Significance difference (L.S.D) value for Hypothyroidism and
Euthyroidism group = 12.886
v Least Significance difference (L.S.D) value for Hypothyroidism and
Hyperthyroidism group = 19.687
v Least Significance difference (L.S.D) value for Hyperthyroidism and
Euthyroidism group = 19.965
Conclusion
v All parameters show highly significant (from table –D1-D2). The
parameters Toda show highly significant before and after treatment in the
group (By using paired t- test as P<0.001).
v The Ganda and Kandu parameters having approximately same effect,
Even though they show highly significant (By comparing t- value). There
is much variation in Vivarnata and Difficulty in breathing (By comparing
variances).
v The objective parameter T3 is not significant (as p< 0.05). The parameter
T4 and TSH are highly significant.
v Further if we want to study the mean effects of Hypothyroidism,
Hyperthyroidism and Euthyroidism by making them as three different
groups. Group I as Hypo, Group II as hyper and Group III as
Euthyroidism.
v The parameter T3, i.e. mean effects on three groups is same. (Not
Significant as P> 0.05) from table –D3
111
v The parameter T4 from table –D4. The mean effects on three groups are
not same (significant as (P<0.05). to find out which pair groups is
significant, by comparing the Least significance difference value the
following conclusions can be made out (from table D5).
a. The group Hyperthyroidism differs significantly from
Group Hypothyroidism and Group Euthyroidism.
b. The Group Euthyroidism and Group Hypothyroidism
also differ significantly.
c. Group Hypothyroidism is not significant.
v The parameter TSH from table-D6, the mean effects on three groups is
not same (significant as P<0.005). To find out which pairs Groups are
significant, by comparing Least significance difference value (table D7),
the following conclusions can made out.
1. Group Hypothyroidism is Significant
2. Group Hyperthyroidism and Group Euthyroidism are
Significant
3. Group Hyperthyroidism is not significant.
E) Result of the Amrutadi taila over Galaganda
In the study it is found that Responded patients are 6 (30%) and the Maintained
patients are 8 (40%), 3 patients (15%) in the last category of Not-responded associated with
3 patients (15%) discontinued the treatment. The results are compared with the parameters
of subjective and objective together. The graphical representation of the study is as follows.
112
Table – 35
Showing the result of Amrutadi taila capsules in Galaganda
Result Patients Percentage
Responded 6 30
Maintained 8 40
Not Responded 3 15
Discontinued 3 15
Total 20 100
Graph – 17Depicting the results of Amrutadi yoga on Galaganda
Results of Amrutadi yoga on Galaganda
Not Responded, 3
Responded, 6
Maintained, 8
Discontinued, 3
113
Discussion
The thyroid disorders are characterized by physical and mental interference. In
Ayurveda there is not an exact term for thyroid gland. Some of the later Ayurvedic scholar
tried to name the thyroid gland, but they could not compare many thyroid disorders with any
of the ancient descriptions.
We can correlate goitre and some tumour pathology of thyroid to ‘Galaganda’ where
thyroid functions may or may not are affected. It is therefore, better not to restrict thyroid
dysfunction to any one of the diseases.
In this study total 20 patients were reported. Out of them 17 patients were selected
for the study in one group. 3 patients were discontinued. This was a unique study, in which
the trail medicine was in the form of oil. The oil is made 11-avarthi to enhance the
cumulative effect of said combination. The avartha taila is then capsulated in the gelatinous
form; under GMP specification and used as internal medicine the same avartha taila is used
for Pratimarsha Nasya.
The discussion is to be mainly focussed on the objectives. The three objectives of
this study are as follows
1. To evaluate the anti-Goitrogenic (galandaharatwam) of Amrutadi taila in
Galaganda
2. To evaluate of the effect Amrutadi taila on T3, T4 and TSH in Galaganda
3. To evaluate the effect of Pratimarsha Nasya in Galaganda
The discussion is made in the form of analytical approach of a single case study
along with over all assessments. For that the discussion is classified as follows
114
1) Galaganda vis-a-vis Goitre.
2) Discussion on the signs and symptoms of Galaganda in Ayurveda and
contemporary science
3) Demographic data discussion
4) Discussion on the Disease related data
5) Discussion on the individual drug action and the cumulative effect of the
Amrutadi yoga
6) The evaluation of Pratimarsha Nasya in Galaganda
7) Over all assessments
8) Discussion on statistical analysis of subjective and objective parameters
9) The concepts to be focussed in the forth coming study
10) Limitations of the study
11) Conclusion
1) Galaganda - vis-à-vis goitre
Galaganda is a disease pertaining to gala pradesha, it is characterise by ganda
(swelling in the neck), todam (slight pain in the neck) vivarnata (discoloration of the mass)
kandu (itching around the neck). The goitre also possesses the swelling in the neck,
difficulty in breathing, difficulty to swallow, itching and skin rashes in various places. The
goitre is present in both types of thyroid disorders such as hypo thyroidism and
hyperthyroidism. The various signs and symptoms mentioned in the contemporary sciences
can not be correlated as such with the Galaganda, which is a disease pertaining to the neck
region but the goitre is affecting many systems.
115
2) Discussion on the signs and symptoms
The signs and symptoms of Galaganda mentioned in Ayurvedic system is taken for
the study. But as the goitre in the contemporary system effects all the systems of the body it
also should be considered so the discussion on sign and symptoms is classified into two as
follows -
1. The discussion on the signs and symptoms mentioned in Ayurveda
2. The discussion on the signs and symptoms mentioned in the
contemporary medicine
The chief complaints in this study were ganda (mass in the neck), toda (slight pain In
the neck) vivarnata (discoloration of skin around the mass), kandu (itching around the mass),
difficulty to swallow and difficulty in breathing. Recording them before assesses these
symptoms and after the treatment and difference is emphasized the symptoms discussed here
are as follows.
1) The discussion on the signs and symptoms mentioned in Ayurveda
A) Ganda
All the 20 patients were presented with ganda in varying degrees, which is
recorded according to the grading in the annex. The after treatment data of 17
patients (3 discontinued) were assessed by comparing the before treatment and after
treatment and difference is made. The swelling reduced can be evaluated by
examination of the thyroid, by inspection, palpation.
It is also can be evaluated by the reduction in symptoms such as difficulty to
deglutition, difficulty in respiration, dragging sensation of the neck etc., which were
reduced satisfactorily. The ganda was reduced in all most all patients which was
116
assessed statistically on the result was highly significant. The cumulative effect of
Amrutadi yoga especially, shophaharatnam will be the basis of the reduction of
ganda in this study.
B) Todam
All the 20 patients presented with todam (a vedana vishesham of pain) in
distributing degrees, which is recorded according to the grading mentioned in annex.
After treatment data of 17 patients (3 discounted) were assessed by comparing the
before treatment and after treatment values.
The todam is reduced in parlance with the swelling, as the swelling will
compress the trachea. When the difficulty swallow is reduced the pain also reduced.
All the patients, the pains while swallowing was relieved many of the drugs have the
vedanasamakatwam, sophakaratwam property that is dealt in detail. The discussion
on drug is the basis of probable mode of action, which makes the reduction in toda. It
is assessed statistically and the result was highly significant.
C) Vivarnata
The 20 patients was presented with the slight vivarnata (discoloration of mass) the
vivarnata as is a chief symptom of Galaganda was recorded in 17 patients (3
discontinued) the after treatment data is then compared with before treatment data to
make the result. Examining the neck assesses the vivarnata progress, normally body
colour will be different from the abnormal discoloration present due to various
pathologies. Some presented with discoloration with blackish spots and some others
with reddish spots. All the patients got relief from vivarnata caused by disease during
the treatment with the Amrutadi yoga. The drugs, which are useful in reducing the
vivarnata, are elaborately discussed in the drug discussion. Those are the probable
117
action of reduction of vivarnata, it is assessed statistically also and the result was
highly significant.
D) Kandu
The 20 patients presented in the study complaint of some form are other types of
kandu (itching around the neck region). 3 patients presented with severe itching. The
before and after treatment data of 17 patients (3 discontinued) were recorded. It is
then compared and made the difference to know the result. The itching was present
in the other parts of the body also with skin rashes and dry skin. It was also noted
under the kandu. The treatment was considerably effective in maintain the symptom
kandu in all the patients. The kanduharatwam of the drugs can be evaluated by the
considerably decrease in itching around the mass and in other parts of the body. As
there is a role of the Rakta Dhatu also to be evaluated here in the manifestation of
kandu. The most of the drugs in the said yoga have rakta sodhaka property which an
evident example for reduction of this symptom. This was assessed statically also and
the result was highly significant.
2) The discussion according to contemporary medicine
The thyroid disease is a serious multi systemic disorder, so the evaluations of
the various systemic problems are necessary. The thyroid disease is broadly
classified into two, hypo thyroidism and hyper thyroidism. Even though the chief
symptoms of the Galaganda is discussed, as the symptoms of contemporary science
are also important in due consideration of the nature of the disease, it is also
discussed. In this study after the lab investigation the thyroid diseases are classified
into hyperthyroidism, hypo thyroidism and euthyroid.
118
A) Difficulty to swallow
All the 20 patients were presented with difficulty to swallow. The before
treatment and after treatment data are recorded of the 17 patients (3 discontinued)
this is an important symptom as it is in parlance with the mass in the neck. If the
mass in the neck is reduced, the difficulty to swallow will also reduced. The
difficulty to swallow was reduced in all 17 patients. The grading assesses this
mentioned in the annex. By inspection we can find out the swelling which is
reduced or not. The swelling is reduced by the Amrutadi taila in the majority of the
drugs have the property of sophahatwam. It was assessed statistically also and found
highly significant.
B) Difficulty in breathing
20 patients present in study complaint of varying degrees of difficulty in
breathing. The before and after treatment data are recorded in the 17 patients (3
discontinued). It is then compared and made the difference to know the result. The
symptoms were reduced in all the 17 patients. The responded group patients and the
maintained group patients got more relief from difficulty in breathing. The 3-
hyperthyroidism patients got relief by the treatment but asked as the disease
progressed again the attacks of difficulty in breathing also manifested. The drugs of
the Amrutadi taila comprised of kaphahara property and the drugs such as guduchi,
pippali, etc., reduces the srotorodham caused by Kapha Dosha. The symptoms were
assessed statistically also and found highly significant.
C) Group study
The various symptoms of this group are to be discussed. After the assessment
of both subjective and objective parameters the results are, hypo thyroid patients
119
were responded to the treatment, the euthyroid patients were maintained with the
treatment and the hyper thyroid patients were not responded to the treatment. The
statistical analysis also shows the same. So the discussion were classified into the not
responded group, and the responded group.
I) Hyperthyroidism
The not responded group consists of three patients of hyperthyroidism the signs and
symptoms are classified into 3, general and local, systemic and psychological.
i) General and local symptoms
Table -36
Symptoms Signs
Generalize weakness Weight loss
Heat in tolerince Excessive sweating
Thirst,fatigue Restlessness, hair thining, goitre
The above all signs symptoms were present in the 3 hyperthyroid patients. Out of
them generalised weakness, fatigue, and restlessness got relief by the treatment. Other
symptoms were not relieved considerably the goitre was present in 1 patient, which was
nodular one. It was not relieved by the treatment.
ii) Systemic evaluation
Table – 37: Cardiovascular
Symptoms Signs
Dyspnoea,on exertion Increased pulse rate
Palpitation Tachycardia
120
The above signs and symptoms were present in all the 3 patients reported with hyper
thyroidism. The symptom dyspnoea on exertion got relief and the rest of the signs of
symptoms were not relieved.
Table – 38:
Central Nervous System
Symptoms Signs
Nervousness Fine tremors
Emotional liability Hyper reflexia
The symptom nervousness and emotional liability are present in all the 3 patients
reported with hyper thyroidism. Fine tremors were present in 1 patient of the
hyperthyroidism patients. The other sign hyper-reflexia was not present in any of the 3-
hyperthyroidism patients.
There was slight relief from the symptom fine tremors of the patients. The
nervousness and emotional problems persisted after the treatment also.
Table –39:
Gastro-intestinal tract
Symptoms Signs
Diarrhea Rapid bowel transit time
Anorexia Weight loss despite increase apetite
The symptom anorexia was present in 1 patient, the increased appetite was present in
all the 3,and the loose motions were present in 1 patient of the hyper thyroidism. The
anorexia was relieved after the treatment.
121
Table –40:
Dermatological
Symptoms Signs
Pigmentation No signs
Skin rashes in the several parts of body
The symptoms were present in all the 3 patients reported with hyper thyroidism.
There were only maintained with the treatment.
Psychological
All the 3 patients of hyperthyroidism reported with the symptoms such as anxiety,
nervousness, and emotional liability. These symptoms persisted after the treatment also.
Hypothyroidism
The patients reported with hypothyroidism were 8 in number. Out of them 6 patients
responded to the treatment. The signs and symptoms presented by those patients were
classified into 3 as such general features, systemic and psychological
Table- 41:
General features of hypothyroidism
Symptoms Signs
Tiredness, Weight gain
Cold in tolerance Puffy face (mask like face)
Hoarssness of voice Goitre
The hoarseness of voice, colds in tolerance tiredness were present in 8 patients
reported with hypo thyroidism. The weight gain and goitre was present in 6 cases and puffy
face was present in 2 patients.
122
The hoarseness of voice and tiredness were reduced considerably. The patients
presented with cold in tolerance can with stand some cold after the treatment. The puffy face
was reduced in the 2 patients. The weight gain was changed with the maximum of 2kg in 1
patient. The goitre present in all the 6 patients reduced in size after the treatment
Table –42
Cardio Vascular system
Symptoms Signs
Shortness of breath Hypertension
Bradicardia
The symptoms were maintained by the treatment, but the hypertension persisted after
the treatment.
Table –43
Central Nervous System
Symptoms Signs
Muscle aches and pain Delayed retraction of tendon reflexes
Stiffness, slowing of motor functions
All the symptoms were present in the hypothyroidism patients. The signs were
present in 3 patients only. The symptoms such as muscle pain and stiffness were relieved
completely. The slowing of motor functions are progressed after the treatment.
Gastro-intestinal tract
All of the hypothyroidism patients presented with constipation either occasionally or
regularly. They were responded to the treatment and constipation was relieved completely
after the treatment.
123
Reproductive system
Irregular delayed menstruation, were present in 3 patients of hypothyroidism. They
were brought back to normalcy after the treatment.
Psychological
All the hypothyroidism patients were present with the symptoms such as anxiety,
nervousness and emotional liability. The symptoms persisted after the treatment also.
3) Demographic data discussion
a) Age
The thyroid diseases are common in the middle-aged women. It is also manifested in
the teenaged girls and pregnant women, as the hormonal imbalance will be due to the more
needed at that time. It is common in 35-55 age group, the patients, reported were 11 in
number.
b) Sex
There is no doubt the thyroid abnormalities are common in Females at a ratio 6:1.
All types of Goitres are far more common in females. In this study out of the total 20
patients, 18 were females.
c) Occupation
Most of the patients belong to the sedentary group. The lack of activities is an
important factor in manifesting the diseases. The detailed descriptions of the demographic
data of the other factors are given in the results.
124
4) Disease related data
a) Mode of onset
The majority of the patients reported with gradual onset of the disease.in this study
of 20 patients, 17 presented with gradual onset of the disease. 3 patients were reported with
insidious onset.
b) Intake of Goitrogens
The Goitrogens are the pre-disposing factors, which enhance the production of
thyroid disease. They are vegetables of Brassica family, other drugs etc. In this study 12
patients presented with intake of Goitrogens. Educating them about the consequences of it
can prevent this disease.
c) Family history
The thyroid diseases are often seen to run in families. In this study 10 patients came
with family history. Enzyme deficiency with in the thyroid gland is seen in the families.
d) Agni
The Agni is the main factor, which is affected by the thyroid disorders. As there is
diminished appetite in the hypothyroidism and increased in the hyperthyroidism. In this
study the patients reported with poor appetite are 5, moderate appetite are 7, good appetite
are 7 and 1 patient presented with severe appetite.
e) Sleep
It is also affected by the thyroid disease as the Hypos will have the tendency to sleep
more, and the hyperthyroidism patients will be disturbed or less sleep. In this study the
patients with sound sleep are 8, with more sleep are 5, less sleep are 4 and disturbed sleep
are 3 in number.
125
f) Psychological features
The thyroid diseases play a vital role in the change of the character, and mental state
of the patients. This affects the patients seriously changing the emotional attributes. Out of
the 20 patients, 19 were presented with psychological problems.
g) Habits
As the majority of the patients were females in this study, the habits were not
relevant.
h) Menstrual cycle
It is also disturbed by the thyroid problems. As most of the patients were females, it
is also considered as an important data to be evaluated. Out of the female patients reported
in this study, 8 have regular menstruation, 5 had irregular and 5 were menopause.
i) Built and nutrition
The impact of the thyroid problems exhibits the metabolic derangement in under
weight and over weight of the body. In hypos the body weight will be increased and in
hyperthyroidism patients, it will be reduced. The treatment had impact over the hyperthyroid
patient, as the weight was reduced 2kg in maximum in one patient.
j) Nidana
The Nidana such as Aharaja and Viharaja are considered in the study. The virudha
Ahara and guru Ahara will produces the increased Kapha and ultimately the dushta Kapha
will vitiate the medas and produces the Galaganda. All the patients presented with both the
guruahara and virudha ahara.11 patients presented with the Viharaja Nidana Avvaksayana.
The intake of Goitrogens dealt before is an important Nidana of Galaganda. The lack of
126
iodine is also an important factor in the production of goiter. So the patients are educated
with to take the iodized salt.
5) Amrutadi yoga - Drug Discussion (individual and cumulative effects)
A) The cumulative effect of Amrutadi tailam
The Amrutadi thailam is directly said in the Yogaratnakara specifically for
Galaganda. It is stated in the yoga to take the same in the taila form. So the 11-avarthi
thailam is made to enhance the guna of its constituents. The Amrutadi thailam has the
properties such as Kandughna, Sophaharatwam, Vedanasthapanam, Kapha-Vata haratwam,
Medoghnam, Lekhana, Chedana etc in total. The most of the drugs used in the yoga belongs
to Shirovirechaneeya gana, and some of them are Srotoshodakam; which reduces the Kapha
Dosha, and dushta medas by it’s chedana etc property as mentioned above. This yoga also
pacifies the Sopham, Todam, Vivarnata, the Difficulty in breathing and the difficulty to
Swallow by the cumulative effect.
B) Individual drug emphasis
The drugs of Amrutadi taila are guduchi, hingu, nimba, abhaya, kutaja, pippali, bala,
atibala, and devadaru.
The mode of action of drugs is based on the theory of Pancha mahabhutas. As the
body is compared of Pancha mahabhuta, considering the Pancha mahabhuta will give more
action in term of Dosha Dhatu and malas should alter any abnormality occurring.
In the constituents of Amrutadi taila, most of the drugs are of tikta, kashaya, katu
Rasa that pacifies Kapha Dosha. The other constituents have madura Rasa and which have
ushnaveerya will pacify Vata Dosha. The drugs having combined such as lekhana, chedana,
veedanasthabana, kandughna, sophaharatwa, vrnaroana, siroverachana, and Rasayana.
127
Individual drug action
1) Guduchi: It has tikta kashaya Rasa and ushaveerya and prabhava of
vishagna. Uses are deepana pachana, anulomana, kandughnam,
yakrithuttegaka, raktasodhana.
Chemical constituents – it contains berberine, a bitter substance and giloin, a
gluco side which also better in taste.
2) Hingu: It has katu, teekshana, Guna and ushanaveerya. It specific action
on the body are veedhana, stabana, kandughna, chadana and
sophaprashamana. It is useful in reducing the medus. It contains volatile oils,
resins, wax etc.,
3) Nimba: It has tiktakashaya Rasa and seetaveerya. It is kaphapittaharam.
Its main uses are kandughna, raktasodakam, shoshanam and sophaharam. The
water soluble part of the alcoholic extract of Azadracta indica shows
significant anti-inflammatory activity.
4) Abhaya: It is a good Rasayana, and tridoshaharam. It’s other uses of
sophaharam, vedhanam,stabana, mrudu rechanam and srodosodhaka.
Chemical constituents – the fruit contains 25-30% tanin, which inhibits the
mucus membrane.
5) Kutaja: It is Tikta, Kashaya rasa, Rookshna guna, and Katu Vipaka. It
reduces Kapha. The properties are Lekhna, Ropana, Raktashodana. The bark
contains, Kurhin which Anti Diarrheal action.
128
6) Pippali: It is Katu rasa, Laghu, Teekshna and Snigda guna. It is Vata,
Kapha hara, Shirovirechaniyam, Raktashodakam, Sophaharam,
Ojovardhakam. It has anti tumerous activity.
7) Bala: Bala is a drug of choice for Vata rogas. It reduces Sopham. The
other uses are Raktashodakam, Ojovardhakam. The methanolic extract of the
Abotilinum indicum showed significant oedema suppresent activity. Probable
mode action may be due to it’s inhibitory effect on release of mediators of
inflammation such as histamine, hydroxy triptanine, bradikinin etc.
8) Devadaram : It is Tikta, Katu rasa. Laghu, Ushna veeryam, Katu
vipakam. It is Kapha, Vata haram and also have the property of Sophaharam,
Vedanasthapanam, Raktashodakam, Medoroghaghnam. The hexane soluble
extracts of the wood of Cedrus deodara were found to posses significant anti-
allergic activity. The devadarm contains dark coloured oil and resin.
6) The evaluation of Pratimarsha Nasya in Galaganda
In this study along with the internal medication, the Pratimarsha Nasya was also
administered. As in the classics it is stated that by doing Nasya karma, the disease above the
clavicle will be cured. The Nasya karma is classified into two, Pratimarsha Nasya / Marsha
Nasya. The action of Pratimarsha Nasya done in this study is satisfactorily along with the
internal medicine. It can be even more enhanced if it is given as Marsha Nasya. The Marsha
Nasya is done after doing the Poorvakarmas. So the action will be more. So in the forth-
coming studies it can be included. The mode of action of the Nasya karma is as follows.
The absorption of the drugs is carried out in three ways. They are through blood
circulation, after absorption through mucous membrane. The direct pooling into venous
129
sinuses of brain through the inferior ophthalmic veins and the last one the absorption
directly into the cerebro-spinal fluid.
Apart from the small emissary veins entering the cavernous sinuses of the brain; a pair
of venous branch emerging from alae nesi will drain into facial vein. Almost in the opposite
direction inferior ophthalmic veins also enter the facial veins. These opthalmics in other
hand also drains into cavernous sinus of the meninges and in addition neither the facial vein
nor the ophthalmic vein have any veinal valves. So there are more chances of blood draining
from facial vein into the cavernous sinuses in the lowered head position.
The nasal cavity directly opens with the frontal maxillary and sphenoidal air sinuses,
epithelial layer is also, continuous through out them. The momentary retention of the drug in
naso-pharynx and suction causes oozing of drug material into air sinuses. These sites are
rich with blood vessels entering the brain and meninges through the existing foramen in the
bones. So there is better chances drug transportation in this route.
Recent authors as middle cephalic fossa of the skull have explained the shringataka
marma. It is consisting with para nasal sinuses and meningial vessels and nerves. One can
see the truth of narration made by Vagbhata here. The drug administered enters the para
nasal sinus especially frontal and sphenoidal sinuses, i.e., shringataka where the ophthalmic
veins and the other veins.
The sphenoidal sinuses are in close relation with intra-cranial structures. Thus there
may be a so far undetected route between air sinuses and cavernous sinuses enabling the
transudation of fluids. As a whole, the mentioning of the sringataka in this context seems to
move reasonable.
130
7) Overall assessment of Amrutadi Yoga in Galaganda
The lab-investigations were done before treatment and after treatment. In these study
the parameters are T3, T4, and TSH. It is dependent on each other in the thyroid disorders
hypothyroidism and hyperthyroidism. So a difference in them has no value as the TSH is
increased in the hypothyroidism and it is decreased in the hyperthyroidism. So a common
assessment is not possible. It is then done by classifying the whole data into three groups as
by assessing the appropriate values of T3, T4 and TSH in concern with the three types of
thyroid diseases.
The result is calculated as Responded, Maintained and Not responded from the
values of the lab-investigations. The responded group patient’s shown the value reduced
considerably in parlance with the normal values. These patients belong to the
Hypothyroidism. So it can be decided that the Amrutadi thailam is more effective in
hypothyroidism patients.
The TSH was not increased in the hyperthyroid patients, so they were considered as
Non responded.
The other patients who were Euthyroidism have the TSH values in the borderline of
the hypothyroidism. They were 8 in numbers and kept under, maintained group as they were
maintained by the treatment.
These classification is given to the subjective parameters also and compared the
percentage of response to the treatment. As the lab- investigation is an unbiased one it is
taken to declare the results.
131
8) Discussion on statistical analysis of subjective and objective parameters
All parameters show highly significant (from table –D1 and D2). The parameters
Toda show highly significant before and after treatment in the group (By using paired t- test
as P<0.001).
The Ganda and Kandu parameters having approximately same effect, Even though
they show highly significant (By comparing t- value). There is much variation in Vivarnata
and Difficulty in breathing (By comparing variances).
The objective parameter T3 is not significant (as p< 0.05). The parameter T4 and
TSH are highly significant.
Further if we want to study the mean effects of Hypothyroidism, Hyperthyroidism
and Euthyroidism by making them as three different groups. Group I as Hypo, Group II as
hyper and Group III as Euthyroidism.
The parameter T3, i.e. mean effects on three groups is same. (Not Significant as P>
0.05) from table –D3.
The parameter T4 from table –D4, The mean effects on three groups are not same
(significant as (P<0.05). to find out which pair groups is significant, by comparing the Least
significance difference value the following conclusions can be made out (from table D5).
4. The group Hyperthyroidism differs significantly from Group Hypothyroidism and
Group Euthyroidism.
5. The Group Euthyroidism and Group Hypothyroidism also differ significantly.
6. Group Hypothyroidism is not significant.
132
The parameter TSH from table-D6, the mean effects on three groups is not same
(significant as P<0.005). To find out which pairs Groups are significant, by comparing Least
significance difference value (table D7), the following conclusions can made out.
2) Group Hypothyroidism is Significant
3) Group Hyperthyroidism and Group Euthyroidism are Significant
4) Group Hyperthyroidism is not significant.
9) The concepts to be focussed in the forth coming study
a. The study duration should be increased to explore the effects of the medicine.
b. Educating the people about the importance of thyroid diseases, its causes
especially in young age and pregnant women as need of the thyroid hormones
will be more.
c. More research should be conducted to explore the chemical constituents of
the each drug used in Yoga.
d. More advanced techniques of the Serum analysis of the thyroid should
conducted.
10) Limitations of the study
1. As the thyroid diseases are serious multi systemic metabolic disorders, its influence
will also will be more. The study duration was less. So the duration of the treatment
should be increased.
2. The study was limited to the patients who attended the OPD wing of DGM
Ayurvedic medical college, Gadag.
3. As the T3, T4 and TSH were not cost- effective, the patients’ co-operation was not
satisfactorily.
133
4. The study must include more serum analysis, thyroid scan and other tests, then the
study will be more authentic.
5. Most of the patients were females, and illiterate, so even after the awareness about
the consequences of iodine deficiency, they still continue to take the local salt. They
will also take several Goitrogens during the treatment. If the patients were self-
realized about the Pathya and Apathyas, the result would have been excellent.
12) Conclusion
1. Galaganda (goiter) is a serious multi-systemic metabolic disorder, which has its
effects on the daily routine one’s life.
2. The Galaganda mentioned in Ayurveda can be compared with goiter in the
contemporary science by the similarity of some symptoms like swelling, kandu,
vivaranta, difficulty in breathing etc.,
3. The Galaganda is a sophapradana Vyadhi, the vishashana of Kapha Dosha is the
main cause of it. There is involvement of Vata and medus in the pathogenesis of
Galaganda.
4. Out of the sample size of 20 patients, 17 patients were included in the study as 3
discontinued. In the age group maximum number of patients came in the age group
35-55, i.e., 11 the male to female to ratio was observed as 1:9 the percentage of
distribution does show the gender differentiation to get thus metabolic disease as
90% were female. The majority of the patients present with middle economic status
do not have any habits. The 7 patients of the Agni group had moderate Agni, five
had mandagni, out of the patients in the sleep category 5 had more sleep, 4 had less
sleep and 8 had sound sleep. 95% of the patients were effected psychologically due
134
to this disease. 8 female reported with regular menstruation 5 had irregular
menstruation and rest 5 was menopause. 7 patients reported well built,8 thin built
and 5 were obese. The Nidana factors were present in all patients like the guru and
virudha Ahara. The systemic problems were also present as 60% effected with cordio
respiratory problems, 45% with gastrointestinal tract problems, 80% with
dermatological problems 55% with neuromuscular and 10% with reproductive
pathologies.
5. The result declaration was made on the basis of lab investigations, as it is an
unbiased data, which states as responded – 6, maintained –8 and not responded-3
patients.
6. The patients responded in the treatment were 6 in number, they were all hypo thyroid
and the 8 maintained almost of them were in the borderline of hypo thyroidism, but
they were present with euthyroid. So a conclusion on the result can be made as drug
has more action in the hypo thyroidism. The 3 not responded patients were of the
hyperthyroidism.
7. In this study the medicine was in the form of oil which is a direct reference from
Yogaratnakara. It was made by 11 avarthi of the taila, so the effect of the drug will
be more enhanced by the repeated processing of the taila each time with the
kwatham and kalkam.
8. The internal medicine has responded well in reducing the chief symptom such as
ganda, toda, vivarnata, kandu etc., considerably along with the prademarshanasya.
135
Summary
The thyroid disorders are characterized by physical and mental interference. In
Ayurveda there is not an exact term for thyroid gland. We can correlate goiter and some
tumor pathology of thyroid to ‘Galaganda’ where thyroid functions may or many not are
affected.
In the contemporary system of medicine the treatment given to thyroid disorders are
anti-thyroid drugs, radio active iodine and surgery which has its own disadvantages and side
effects.
The main ambitions in the study are - 1) Evaluate the anti Goitrogenic effect of
Amrutadi thailam in Galaganda (Hypothyroidism or hyperthyroidism), 2) Evaluate the effect
of Amrutadi thailam on T3, T4 and TSH in Galaganda and 3) to evaluate the effect of
Amrutadi thailam Pratimarsha in Galaganda.
Susruta defines Galaganda as a swelling (mass in the neck region), by the vitiation of
Vata, Kapha and medo dhatu. Charaka mentioned that when a vitiated Kapha Dosha
circulates around the neck, it will cause swelling slowly is termed as Galaganda
From the contemporary medical science, Goitre is defined as a benign, non-toxic
enlargement of the thyroid gland usually secondary to some form or other of the iodine
deficiencies. The disease is characterised by swollen throat, hoarseness of voice, slight pain,
in the neck region, difficulty to swallow, etc.
There is no reference regarding the disease Galaganda in the Vedic literatures. In
Susruta Nidana, mentions about the Galaganda Samprapti are very clear. Here the vitiated
Kapha will stay around the neck region and produce swelling, which is called as Galaganda.
136
The intake of tikta, katu, kashaya rasa , rookshannam, alpamatara bhojanam etc
vitiate then Vata Dosha. Mental factors like chinta, sokha, krodha, bhaya, etc vitiate Vata
Dosha. The increased Vata and Kapha Dosha in the neck will vitiate the medo Dhatu by its
prakopa karanas respectively. The deficiency of iodine content in the food is the main cause
for goitre.
Goitrogens are foods, which suppress thyroid function. In normal, Goitrogens can
induce hypothyroidism and goiter. In hypos, Goitrogens can further depress thyroidal
function and stimulate the growth of the thyroid (goiter).
The thyroid disorders and goiter are common in the females, in the certain ages, in
specific part of the world. The primary toxic goiter is usually present in young ones, where
in Hashimoto’s disease the victims are middle-aged women. Majorities of the thyroid
disorders are seen in females. Even thyroid carcinomas are more often seen in females in the
ratio 3:1. In men lack of thyroid hormone is likely to cause loss of libido, impotence.
Except endemic goitres due to iodine deficiency, no other thyroid disorders lies
among peculiar geographical distribution.
While many hyper secretaries to limit thyroid output by iodine restriction, this
strategy can backfire. Iodine restriction will cause the thyroid to increase in size (goitre) in
an effort to filter more blood to get more iodine. When iodine is then re-introduced to the
diet or accidentally ingested, the now larger thyroid gland has the capacity for greater
thyroid hormone production.
The iodine restriction is not a good long-term method for controlling thyroid
hormone production. Once copper is replenished and copper metabolism is working
properly, the body will tolerate iodine without increasing thyroid hormone production
137
The primary pre-condition for the production of thyroid disease is the onset of
anemia. Brassica vegetables, with their high sulphur content, may be foods, which induce
anaemia and consequently thyroid disease. Thiocyanates, Anti thyroid drugs, lithium,
iodides, p- amino salicylic acid, etc are also Goitrogenic. There is enzyme deficiency in the
thyroid gland. This leads to formation of decreased level of thyroid hormones, which will
increase TSH, and simple goitre is formed. This leads to reduced levels of thyroid hormones
and hence the goitre. Interference with thyroid hormone synthesis
As thyroid hormone increases metabolism in almost all cells of the body, excessive
quantities of the hormone can occasionally increased the BMR to 60 to 100% above normal.
Conversely when no thyroid hormone is produced the BMR falls almost to one – half
normal. Greatly increased thyroid hormones almost always decrease the body weight, and
greatly decreased hormone almost always increases the body weight.
Thyroid hormone increases both the rates of secretion of digestive juices and the
motility of the gastro-intestinal tract. Lack of thyroid hormone can cause constipation.
Thyroid hormones increases the rapidity of cerebration but also often dissociates this
conversely, lock of thyroid hormone decreases this function.
Poorvarupa are the prodromal symptoms of the forthcoming disease, which do not
clarify the Samprapti of the disease. The vitiated Kapha, Vata, and medas will show some
lakshnas such as mild swelling of the neck, pain the neck, heaviness of the body.
Charaka has mentioned Galaganda as a swelling in the neck by the vitiation of
Kapha Dosha .He describes that, the Kapha Dosha vitiated by the etiological factors will
manifests in the frontal part of the neck and produce a swelling slowly. Hypo-thalomo-
pituitary disorders can be responsible for inducing under active or overactive thyroid states.
138
1. This study is a prospective clinical study of Amrutadi thailam in Galaganda.
2. 17 patients were selected for the study in one group.
3. The goitre is present in both types of thyroid disorders such as hypo thyroidism
and hyperthyroidism.
4. The signs and symptoms of Galaganda mentioned in Ayurvedic system is taken
for the study.
5. The difficulty to swallow was reduced in all 17 patients.
6. The drugs of the Amrutadi taila comprised of kaphahara property and the drugs
such as guduchi, pippali, etc., reduces the srotorodham caused by Kapha Dosha.
The symptoms were assessed statistically also and found highly significant.
7. After the assessment of both subjective and objective parameters the results are,
hypo thyroid patients were responded to the treatment, the euthyroid patients
were maintained with the treatment and the hyper thyroid patients were not
responded to the treatment.
8. The not responded group consists of three patients of hyperthyroidism.
9. The patients reported with hypothyroidism were 8 in number. Out of them 6
patients responded to the treatment. The signs and symptoms presented by those
patients were classified into 3 as such general features, systemic and
psychological.
10. The weight gain and goitre was present in 6 cases and puffy face was present in 2
patients.
11. The symptoms were maintained by the treatment, but the hypertension persisted
after the treatment.
139
12. The thyroid diseases are common in the middle-aged women. It is common in
35-55 age group, the patients, reported were 11 in number.
13. Most of the patients belong to the sedentary group.
14. The majority of the patients reported with gradual onset of the disease. In this
study of 20 patients, 17 presented with gradual onset of the disease. 3 patients
were reported with insidious onset.
15. The thyroid diseases are often seen to run in families. In this study 10 patients
came with family history.
16. The thyroid diseases play a vital role in the change of the character, and mental
state of the patients. This affects the patients seriously changing the emotional
attributes. Out of the 20 patients, 19 were presented with psychological
problems.
17. In hypothyroidism patients the body weight will be increased and in
hyperthyroidism patients, it will be reduced. The treatment had impact over the
hyperthyroid patient, as the weight was reduced 2kg in maximum in one patient.
18. All the patients presented with both the guruahara and virudha ahara.
19. The parameter T4 and TSH are highly significant in the study.
20. The group Hyperthyroidism differs significantly from Group Hypothyroidism
and Group Euthyroidism.
21. The Group Euthyroidism and Group Hypothyroidism also differ significantly.
22. Group Hypothyroidism is Significant
Bibliographic References i
Bibliographic References
1. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23. Varanasi: KrishnadasAcademy; 1980. p. 314. (Krishnadas Ayurveda series 51).
2. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.Seditor. Mumbai: Association of Physicians of India. p. 953-955.
3. Baghel M S Dr, Researches in Ayurveda chapter 4. Jamnagar: Mrudu AyurvedicPublications; p. 73.
4. Ibid p. 73.5. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.S
editor. Mumbai: Association of Physicians of India. p. 951.6. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 2, 3rd ed. Varanasi:
Chaukhambha Sanskrit Series; p. 150. (Chaukhambha Samskrita Granthamala-93).7. Das Somen, A Concise textbook of Surgery chapter 37. 2nd ed. Calcutta: Dr.S.Das; 1999.
p. 646.8. Pocket oxford dictionary, march 1994, Walton street, Oxford, Computer edition9. Chaudiri k Sujit, Concise Medical Physiology chapter 6. 2nd ed. Calcutta: New Central
Book Agency Pvt. Ltd; 1993. p. 289.10. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23. Varanasi: Krishnadas
Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).11. Dalhana, Nibandha samgraha teeka on Sushruthasamhitha Nidanasthana chapter 11 sloka
23. Varanasi: Krishnadas Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).12. Agnivesa, Charakasamhitha Suthrasthana chapter 18 sloka 21. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 107. (Kasi Sanskrit series 228).13. Madhavakara, Madhavanidana chapter 22 sloka 212. Varanasi: Chaukhambha
Surbharathi Prakashan; Chaukhambha Ayurvijnana Granthamala 46, 1998. p. 520.14. Ibid 18 sloka 2115. Vakil Jal Rustom, Text book of medicine, The association of Physician India, Bombay,
1969, pp 32516. Agnivesa, Charakasamhitha Suthrasthana chapter 18 sloka 21. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 107. (Kasi Sanskrit series 228).17. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23. Varanasi: Krishnadas
Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).18. Ibid Chikitsasthana chapter 19 sloka 74.19. Agnivesa, Charakasamhitha Suthrasthana chapter 18 sloka 21. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 107. (Kasi Sanskrit series 228).20. Vagbhata, Ashtangahridaya Utharasthana chapter 21 sloka 43. Varanasi: Krishnadas
Academy; 1982. p. 749. (Krishnadas Academic series 4).21. Madhavakara, Madhavanidana chapter 22 sloka 212. Varanasi: Chaukhambha
Surbharathi Prakashan; 1998. p. 520. (Chaukhambha Ayurvijnana Granthamala 46).22. Yogaratnakara Galaganda nidana Sloka 1. Vaidya Lakshmipatisastry editor. Varanasi:
Chaukhambha Sanskrit Sansthan; 1988. p. 143. (Kasi Sanskrit series 160).23. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 44 sloka 2. 5th ed. Varanasi:
Chaukhambha Orientalia; 1988. p. 442. (Chaukhambha Sanskrit series 130).24. Chakrapanidatta, Chakradatta chapter 41. P.V.Sharma, editor. Varanasi: Chaukhambha
Publishers; 1998. p. 320. (Kasi Ayurveda series 17).
Bibliographic References ii
25. Vangasena, Vangasenasamhitha Galaganda adhikara sloka 186-190. Jain SankarlaljiVaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 754.
26. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.Seditor. Mumbai: Association of Physicians of India. p. 951.
27. Das Somen, A manual on Clinical Surgery chapter 27. 4th ed. Calcutta: Dr.S.Das; 1996.p. 284.
28. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. 17th ed. CRWEdwards, editor. London: Churchill Livingston 1995. p. 686.
29. Agnivesa, Charakasamhitha Vimanasthana chapter 4 sloka 21. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 198. (Kasi Sanskrit series 228).
30. Madhavakara, Madhavanidana chapter 1 sloka 4. Varanasi: Chaukhambha SurbharathiPrakashan; 1998. p. 6. (Chaukhambha Ayurvijnana Granthamala 46).
31. Ashtangasangraha Suthrasthana chapter 20 sloka 11.Prof.K.R.Shrikhantamurthy editor.Varanasi: Chaukhambha Orientalia; 1996. p. 374. (Jaikrishnadas Ayurvedic series 79).
32. Agnivesa, Charakasamhitha Suthrasthana chapter 18 sloka 21. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 107. (Kasi Sanskrit series 228).
33. Vagbhata, Ashtangahridaya Nidanasthana chapter 1 sloka 14-15. Varanasi: KrishnadasAcademy; 1982. p. 444. (Krishnadas Academic series 4).
34. Agnivesa, Charakasamhitha Suthrasthana chapter 18 sloka 21. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 107. (Kasi Sanskrit series 228).
35. Vagbhata, Ashtangahridaya Nidanasthana chapter 1 sloka 17. Varanasi: KrishnadasAcademy; 1982. p.445. (Krishnadas Academic series 4).
36. Agnivesa, Charakasamhitha Suthrasthana chapter 18 sloka 21. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 107. (Kasi Sanskrit series 228).
37. Sushrutha, Sushruthasamhitha Suthrasthana chapter 21 sloka 5. Varanasi: KrishnadasAcademy; 1980. p. 165. (Krishnadas Ayurveda series 51).
38. Agnivesa, Charakasamhitha Vimanasthana chapter 5 sloka 16. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 265. (Kasi Sanskrit series 228).
39. http://www.northmemorial.com/40. J Larry Jameson, Harrison’s Principles of Internal Medicine Disorders of thyroid Chapter
330. 15th ed. McGraw-Hill2003. p. 1077.41. J Larry Jameson, Harrison’s Principles of Internal Medicine Disorders of thyroid Chapter
330. 15th ed. McGraw-Hill2003. p. 1077.42. Das Somen, A Concise textbook of Surgery chapter 37. 2nd ed. Calcutta: Dr.S.Das; 1999.
p. 647.43. Das Somen, A Concise textbook of Surgery chapter 37. 2nd ed. Calcutta: Dr.S.Das; 1999.
p. 647.44. Das Somen, A Concise textbook of Surgery chapter 37. 2nd ed. Calcutta: Dr.S.Das; 1999.
p. 647.45. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.S
editor. Mumbai: Association of Physicians of India. p. 955.46. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. 17th ed. CRW
Edwards, editor. London: Churchill Livingston 1995. p. 692.47. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.S
editor. Mumbai: Association of Physicians of India. p. 953.
Bibliographic References iii
48. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. 17th ed. CRWEdwards, editor. London: Churchill Livingston 1995. p. 686.
49. Chaurasia B D, Human Anatomy Vol-3 chapter 12.3rd ed. 1995.CBS publishers anddistributors New Delhi p. 135.
50. Peter. L. Williams Grays Anatomy Chapter 6. 38th ed. Philadelphia: Churchill LivingStone; 2000. p. 354.
51. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 5. 4th ed. New Jersey:Prentice Hall Inc. Simon & Schuster; 1998. p. 609-612.
52. Chaudiri K Sujit, Concise Medical Physiology chapter 7. 2nd ed. Calcutta: New CentralBook Agency Pvt. Ltd; 1993. p. 293.
53. Chaudiri k Sujit, Concise Medical Physiology chapter 7. 2nd ed. Calcutta: New CentralBook Agency Pvt. Ltd; 1993. p. 293.
54. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 5. 4th ed. New Jersey:Prentice Hall Inc. Simon & Schuster; 1998. p. 612.
55. Guyton and Hall Text Book of Medical Physiology chapter 76. 10th ed. New Delhi:Harcourt India Pvt Ltd; 2001. p. 861.
56. Guyton and Hall Text Book of Medical Physiology chapter 76. 10th ed. New Delhi:Harcourt India Pvt Ltd; 2001. p. 861-3.
57. Vagbhata, Ashtangahridaya Nidanasthana chapter 1 sloka 4. Varanasi: KrishnadasAcademy; 1982. p.442. (Krishnadas Academic series 4).
58. Madhavakara, Madhavanidana chapter 1 sloka 6. Varanasi: Chaukhambha SurbharathiPrakashan; 1998. p. 7. (Chaukhambha Ayurvijnana Granthamala 46).
59. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23-24. Varanasi:Krishnadas Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).
60. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23-24. Varanasi:Krishnadas Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).
61. Vagbhata, Ashtangahridaya Utharasthana chapter 21 sloka 43. Varanasi: KrishnadasAcademy; 1982. p. 749. (Krishnadas Academic series 4).
62. Yogaratnakara Galaganda nidana sloka 3. Vaidya Lakshmipatisastry editor. Varanasi:Chaukhambha Sanskrit Sansthan; 1988. p. 143. (Kasi Sanskrit series 160).
63. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 44 sloka 3. 5th ed. Varanasi:Chaukhambha Orientalia; 1988. p. 442. (Chaukhambha Sanskrit series 130).
64. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23-24. Varanasi:Krishnadas Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).
65. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23-24. Varanasi: Krishnadas Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).66. Vagbhata, Ashtangahridaya Utharasthana chapter 21 sloka 43. Varanasi: Krishnadas
Academy; 1982. p. 749. (Krishnadas Academic series 4).67. Yogaratnakara Galaganda nidana sloka 3. Vaidya Lakshmipatisastry editor. Varanasi:
Chaukhambha Sanskrit Sansthan; 1988. p. 143. (Kasi Sanskrit series 160).68. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 44 sloka 4. 5th ed. Varanasi:
Chaukhambha Orientalia; 1988. p. 442. (Chaukhambha Sanskrit series 130).69. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23-24. Varanasi: Krishnadas Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).70. Vagbhata, Ashtangahridaya Utharasthana chapter 21 sloka 43. Varanasi: Krishnadas
Academy; 1982. p. 749. (Krishnadas Academic series 4).
Bibliographic References iv
71. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23-24. Varanasi: Krishnadas Academy; 1980. p. 314. (Krishnadas Ayurveda series 51).72. Vagbhata, Ashtangahridaya Utharasthana chapter 21 sloka 43. Varanasi: Krishnadas
Academy; 1982. p. 750. (Krishnadas Academic series 4).73. Yogaratnakara Galaganda nidana sloka 3. Vaidya Lakshmipatisastry editor. Varanasi:
Chaukhambha Sanskrit Sansthan; 1988. p. 143. (Kasi Sanskrit series 160).74. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 44 sloka 4. 5th ed. Varanasi:
Chaukhambha Orientalia; 1988. p. 443. (Chaukhambha Sanskrit series 130).75. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.S
editor. Mumbai: Association of Physicians of India. p. 953.76. Ibid77. Ibid78. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. 17th ed. CRW
Edwards, editor. London: Churchill Livingston 1995. p. 687.79. J Larry Jameson, Harrison’s Principles of Internal Medicine Disorders of thyroid Chapter
330. 15th ed. McGraw-Hill2003. p. 2070.80. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.S
editor. Mumbai: Association of Physicians of India. p. 953.81. Ibid p. 955.82. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. 17th ed. CRW
Edwards, editor. London: Churchill Livingston 1995. p. 693.83. J Larry Jameson, Harrison’s Principles of Internal Medicine Disorders of thyroid
Chapter- 330. 15th ed. McGraw-Hill2003. p. 2067.84. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.S
editor. Mumbai: Association of Physicians of India. p. 955.85. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 23. Varanasi: Krishnadas
Academy; 1980. p. 304. (Krishnadas Ayurveda series 51).86. Dalhana & Gayadasa, Nibandha samgraha & Nyayapanjika commentaries on
Sushruthasamhitha Nidanasthana chapter 11 sloka 23. Varanasi: Krishnadas Academy;1980. p. 304. (Krishnadas Ayurveda series 51).
87. Agnivesa, Charakasamhitha Suthrasthana chapter 18 sloka 21. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 107. (Kasi Sanskrit series 228).
88. Vagbhata, Ashtangahridaya Nidanasthana chapter 21 sloka 43. Varanasi: KrishnadasAcademy; 1982. p. 749. (Krishnadas Academic series 4).
89. Madhavakara, Madhavanidana chapter 22 sloka 212. Varanasi: ChaukhambhaSurbharathi Prakashan; 1998. p. 520. (Chaukhambha Ayurvijnana Granthamala 46).
90. Agnivesa, Charakasamhitha Suthrasthana chapter 10 sloka 7-8. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 56. (Kasi Sanskrit series 228).
91. Sushrutha, Sushruthasamhitha Nidanasthana chapter 11 sloka 28. Varanasi: KrishnadasAcademy; 1980. p. 314. (Krishnadas Ayurveda series 51).
92. Madhavanidana chapter 22 sloka 212. Varanasi: ChaukhambhaSurbharathi Prakashan; 1998. p. 520. (Chaukhambha Ayurvijnana Granthamala 46).
93. Sushrutha, Sushruthasamhitha Suthrasthana chapter 35 sloka 18. Varanasi: KrishnadasAcademy; 1980. p. 152. (Krishnadas Ayurveda series 51).
94. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 23 sloka 7-9. Varanasi: KrishnadasAcademy; 1980. p. 486. (Krishnadas Ayurveda series 51).
Bibliographic References v
95. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. 17th ed. CRWEdwards, editor. London: Churchill Livingston 1995. p. 692.
96. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.Seditor. Mumbai: Association of Physicians of India. p. 954.
97. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed. Sainani.G.Seditor. Mumbai: Association of Physicians of India. p. 956.
98. Cotran SR, Pathologic Basis of Disease chapter 20. 6th ed. Philadelphia: Saunders; 2003.p. 1131.
99. Das Somen, A Concise textbook of Surgery chapter 37. 2nd ed. Calcutta: Dr.S.Das; 1999.p. 647.
100.Das Somen, A Concise textbook of Surgery chapter 37. 2nd ed. Calcutta: Dr.S.Das; 1999.p. 652.101.Ritchie A C, Boyd’s Textbook of Pathology Volume II. 9th ed. Philadelphia: Lea &Febriger (U.K); 1990. p .1440.102. Ritchie A C, Boyd’s Textbook of Pathology Volume II. 9th ed. Philadelphia: Lea &Febriger (U.K); 1990. p .1441.103.Cotran SR, Pathologic Basis of Disease chapter20. 6th ed. Philadelphia: Saunders: 2003.p .1133.104. Cotran SR, Pathologic Basis of Disease chapter20 .6th ed. Philadelphia: Saunders: 2003.P .1134.105.Das Somen, A manual on Clinical Surgery chapter 27. 4th ed. Calcutta: Dr.S.Das; 1996.p. 292.106.Sushrutha, Sushruthasamhitha Nidanasthana chapter 11, sloka 10-12, 23. Varanasi:Krishnadas Academy; 1980. p. 312, 314. (Krishnadas Ayurveda series 51).107.Sushrutha, Sushruthasamhitha Nidanasthana chapters 11 &16. Varanasi: KrishnadasAcademy; 1980. p. 314, 331. (Krishnadas Ayurveda series 51).108. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 18 sloka 43-55. Varanasi:Krishnadas Academy; 1980. p. 474, 475. (Krishnadas Ayurveda series 51).109. Yogaratnakara Galaganda nidana sloka 3. Vaidya Lakshmipatisastry editor. Varanasi:Chaukhambha Sanskrit Sansthan; 1988. p. 147. (Kasi Sanskrit series 160).110. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 44 sloka 4. 5th ed. Varanasi:Chaukhambha Orientalia; 1988. p. 443. (Chaukhambha Sanskrit series 130).111. Chakrapanidatta, Chakradatta chapter 41. P.V.Sharma, editor. Varanasi: ChaukhambhaPublishers; 1998. p. 320. (Kasi Ayurveda series 17).112. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 18 sloka 43-55. Varanasi:Krishnadas Academy; 1980. p. 474, 475. (Krishnadas Ayurveda series 51).113. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 18 sloka 43-55. Varanasi:Krishnadas Academy; 1980. p. 474, 475. (Krishnadas Ayurveda series 51).114. Chakrapanidatta, Chakradatta chapter 41. P.V.Sharma, editor. Varanasi: ChaukhambhaPublishers; 1998. p. 320. (Kasi Ayurveda series 17).115. Das Somen, A manual on Clinical Surgery chapter 27. 4th ed. Calcutta: Dr.S.Das; 1996.p. 286.116. Das Somen, A manual on Clinical Surgery chapter 27. 4th ed. Calcutta: Dr.S.Das; 1996.p. 287.117. Das Somen, A manual on Clinical Surgery chapter 27. 4th ed. Calcutta: Dr.S.Das; 1996.p. 284.
Bibliographic References vi
118. Davidson Stanley Sir, Principles and Practice of Medicine chapter 12. 17th ed. CRWEdwards, editor. London: Churchill Livingston 1995. p. 687,693.119. Ahuja M.M.S, API Textbook of Medicine section XV Endocrinology. 6th ed.Sainani.G.S editor. Mumbai: Association of Physicians of India. p. 953,955.120. Das Somen, A manual on Clinical Surgery chapter 15. 4th ed. Calcutta: Dr.S.Das; 1996.p. 286.121. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 359.122.Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 761. (Varanasi Ayurveda series).123. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 519.124. Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 350. (Varanasi Ayurveda series).125. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 409.126. Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 149. (Varanasi Ayurveda series).127.Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 515.128. Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 753. (Varanasi Ayurveda series).129. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 343.130. Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 463. (Varanasi Ayurveda series).131. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 424.132.Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 275. (Varanasi Ayurveda series).133. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 433.134. Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 735. (Varanasi Ayurveda series).135. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 435.136. Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 736. (Varanasi Ayurveda series).137. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plantsMumbai: Bharatheeya Vidyabhavan; 2000. p. 396.138. Sharma. PV, Dravyagunavigyan vol 2. 5th ed. Varanasi: Chaukhambha BharathiAcademy; 1981. p. 75. (Varanasi Ayurveda series).139. Sharangadhara, Sharngadharasamhitha Utharakhanda chapter 2. 3rd ed. Varanasi:Chaukhambha Orientalia; 1983. p. 294. (Jaikrishnadas Ayurveda Granthamala 53).140.Sandeep Madanan, The fortification of medicated oil, Ayurvedline. 7th ed. Bangalore:Sitaram prasad. 2005.p .151.
1
SPECIAL CASESHEET FOR GALAGANDA (GOITRE)Post Graduate Studies And Research Center (Kayachikitsa)
Shree DGM Ayurvedic Medical College, Gadag.Guide : Dr. V.Varadacharyalu, PG Scholar :Co- Guide : Dr. K.Shivaramprasad Renjith. P. Gopinath
1. Name of the patient : Sl. No :
2. Father’s / Husband’s Name : OPD No :
3. Age : IPD No :
4. Sex :
5. Religion :
6. Occupation :
7. Economical Status :
8. Diet :
9. Address :_____________________________ Phone No : ____________________________
_____________________________Pin
10. Selection Included : Excluded :
11. Date of Schedule Initiation :
Date of Schedule Completion :
12. Result :
Informed Consent
I_________________ Son / Daughter /Wife of ___________________-am exercising
my free will, to participate in above study as a subject. I have been informed to my
satisfaction, by the attending physician the purpose of the clinical evaluation and nature
of the drug treatment. I am also aware of my right to quit the treatment at any time
during the course.
Patient’s Signature
Hindu Muslim Christian others
Sedentary Active Labour others
BPL Middle Upper middle class High class
Relieved MajorImprovement
MinorImprovement
NotResponded
Discontinued
M F
Veg Mixed
2
13. Presenting Complaints & Assessment.
Complaints DurationBefore
treatmentAfter
treatment
AfterFollow
up1. GANDA ( Mass in the neck)
2. TODA (Pain over the mass)
3. VIVARNATA (Discoloration of skinover the mass)
4. KANDU (Itching around the mass)
5. DIFFICULTY IN SWALLOWING
6. DIFFICULTY IN BREATHING
Scores for assessment
1) Ganda (Mass in the Neck) 1. No mass seen, 2. Mild sized mass,
3. Moderate sized mass, 4. Large sized mass
2) Toda (Pain over the Mass) 1. No Pain 2. Tells on enquiry
3. Tolerable Pain 4. Severe
3) Vivarnata (Discoloration 1. No Discoloration 2. Mild Discoloration
of skin over the Mass) 3. Moderate Discoloration 4. Severe colour change
4) Kandu (Itching around 1. No Itching 2. Mild Itching
the Mass) 3. Moderate Itching 4. Severe Itching
5) Difficulty in Swallowing 1. No complaints 2. Difficulty to swallow solids
3. Difficulty to swallow liquids
6) Difficulty in Breathing 1. No complaints 2. Mild
3. Moderate 4. Severe
14. History of present illness
a) Mode of onset :- Gradual Sudden Insidious
b) Nature of symptoms :- Progressive Constant Regressive
15. History
a) Past illness
b) Any Goitrogenic drugs :-
c) Radiation therapy :-
d) Radioactive iodine :-
e) Any member of the family affected with similar complaints
f) Any intake of goitrogens :
g) Appetite:- Poor Moderate Good Severe
3
h) Bowel:- Constipated Loose Normal
i) Urine :- Frequency Day Night Painful micturation
j) Sleep :- Sound Less More Disturbed
k) Psychiatric Features
Mental State –
Behaviour and emotions –
l) Habits :- No Smoking Alcohol Tobacco
m) Menstrual Cycle :- Regular Irregular Menopause
n) Built and nutritions Well Thin Obese
16) Vital Examination
Temperature oc Pulse /min
Blood Pressure /mmhg Weight kg
Respiratory rate /min Height cm
17. Special Examination
Ayurvedic
Nidana
Ahara ViharaGurubhojana Avaak shayya
Virudhabhojana Smoking
Roopa
Vataja P A Kaphaja P A Medoja P A
Toda Sthira
ganda
Snigdhata
Krishnasira
avanadha
Manda
ruk
Mrudu
Vivarnata Kandu Pandu varna
Shaitya Durgandha
Atikandu
4
Contemporary
General examination ( Physical) :-
Lean Obese
Weight gain Weight loss
Wasting of muscles Over sweating
Exophthalmos Puffy face
Myxoedema Thirst
Severe appetite
Psychological :-
Excitement
Tension
Nervousness
Systemic :-
System Observed Symptoms if any
Cardiorespiratory
Gastrointestinal
Dermatological
Neuromuscular
Reproductive
18.Laboratory investigations
ValuesName of
the test Before After
Serum T3
Serum T4
T S H
R.B.S
E.C.G
Scan
19. Diagnosis :-
5
20.Treatment Protocol
Distribution Amruthadiyoga Remarks
Initial – Day1
2nd – 1st month
1st Month – 2nd Month
2nd Month- 3rd Month
21.Investigator’s Note
Signature of Scholar
Signature of Co-guide Signature of Guide