E-ISSN:2456-3110

Research Article

Raktadusti

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 3 April
Publisherwww.maharshicharaka.in

Clinical evaluation of Raktadusti in Hypothyroidism w.s.r. to Vidhishonitiya Adhyaya of Charaka Samhita

Majumder B.1, Ray S.2*
DOI: http://dx.doi.org/10.21760/jaims.7.3.2

1 Bijita Majumder, Assistant Professor, Department of Ayurved Samhita & Siddhanta, Kalawati Ayurvedic Medical College & Research Centre & Hospital, Gorha, Kasgunj, Uttar Pradesh, India.

2* Sukalyan Ray, Associate Professor & H.O.D, Department of Roga Nidan Avum Vikriti Vigyan, Raghunath Ayurved Mahavidyalay & Hospital, Contai, West Bengal, India.

Introduction: Rakta is regarded as one of the Pranayatana (sit of vitality) and is required to be maintained properly to sustain the life and the homeostatic state of the body. As result of intake of different factors which are responsible for Raktadusti, different kind of diseases occurr in our body known as Raktaja Roga. Hypothyroidism is a pathological condition caused by hypo-functioning of thyroid gland. Hormonal output from thyroid gland is mediated by thyroid stimulating hormone (TSH) secreted by anterior pituitary. In hypothyroidism, there is decreased level of T3 & T4 along with elevated level of TSH in circulating blood. As consequence of Raktadusti, the pathological conditions which are mentioned as Raktaja Roga by Acharya Charaka are combination of independent disease as well as sign and symptoms. Among them many identical features are also found in hypothyroidism. Aim: The present study was carried out to evaluate clinical features of Raktadusti & Raktaja Roga in hypothyroidism along with to evaluate the efficacy of the stipulated Raktadusti Nashak therapeutic procedure to combat hypothyroidism. Materials and Methods: In selected 35 patients of hypothyroidism having the Raktadusti Lakshan based on inclusion and exclusion criteria, selected Raktadusti Nashak Chikitsa (combining Shodhana and Shamana therapy) was administered for 60 days. Result: The subjective parameters for Raktadusti are clinically present in a maximum number of hypothyroidism patients. The result also reveals the significant efficacy of Shodhana (Virechana by Trivrit) and Shamana (Phalatrikadi Kashayam) Chikitsa on relevant subjective and objective parameters with a 'p-value <0.001 in majority of subjective and objective parameters. Conclusion: The features of Raktadusti and Raktaja Roga can be clinically verified in patients of hypothyroidism. Thus it can be said that, Raktadusti has a definite role to play in pathogenesis of hypothyroidism. Rakta should be regarded as one of the main Dushya in hypothyroidism. The patients suffering from hypothyroidism can be treated with the therapeutic procedure responsible to combat Raktadusti.

Keywords: Rakta, Raktadusti, Raktaja Roga, hypothyroidism

Corresponding Author How to Cite this Article To Browse
Sukalyan Ray, Associate Professor & H.O.D, Department of Roga Nidan Avum Vikriti Vigyan, Raghunath Ayurved Mahavidyalay & Hospital, Contai, West Bengal, India.
Email: 		Bijita Majumder, Sukalyan Ray, Clinical evaluation of Raktadusti in Hypothyroidism w.s.r. to Vidhishonitiya Adhyaya of Charaka Samhita. J Ayu Int Med Sci. 2022;7(3):7-16.
Available From
https://jaims.in/jaims/article/view/1788

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-03-02 2022-03-04 2022-03-11 2022-03-18 2022-03-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Bijita Majumder, Sukalyan Rayand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Human body is composed of Dosha, Dhatu and Mala.[1] Agni is the main factor for digestion, absorption and metabolism.[2]The root of Annavaha Srota food channels) is Amashaya (stomach) and Vamaparshva (omentum).[3] The food provides nourishment to the tissue elements of body, which are homologous and not contrary in nature.[4]

The ingested food material at first goes through digestion followed by absorption and metabolism with the action of Jatharagni, Bhutagni and Dhatvagni respectively. The pure and waste product of food after digestion and metabolism enter into circulation through the same channel. Each Dhatu has its own channel for circulation.[5] By the virtue of the seven categories of Agni, the tissue elements get metabolised in the way of transformation of nourishing materials and transformation of waste products[6] where the Kshira-Dadhi-Nyaya (law of transformation), Kedari-Kulya-Nyaya (law of transmission) and Khale-Kapota-Nyaya (law of selectivity) are implied.[7] Jatharagni and Bhutagni acts at the level of gastro intestinal tract, whereas Dhatwagni acts at cellular level. Dhatus help in the nourishment of body and provides nourishment to the subsequent Dhatu where Upadhatu only nourish the body.[8]

Among the seven Dhatus, Rakta Dhatu (blood) or Shonita is considered as most important for its broad spectrum effect on wellbeing of human body and also due to the adverse effect on body caused by vitiation of it.  Rakta is regarded as one of the Pranayatana[9] (sit of vitality) and is required to be maintained properly to sustain the life and the homeostatic state of the body. The importance of Rakta can be assumed from the fact that, Acharya Sushruta has given it the fourth important place after three Doshas - Vata, Pitta and Kapha in relation with Vrana Chikitsa.[10] Acharya Charaka has dedicated an entire separate chapter namely - Vidhishonitiya Adhyaya (chapter no. 24) in Charaka Samhita, Sutrasthan[11] to describe the various aspect of Rakta including - it’s normal property, functions, factors responsible for its vitiation, the diseases produced due to its vitiation, management of vitiation of Rakta among others. Rakta circulates along the human body through multiple macro and micro channels, known as Raktavaha Srota, consisting of Raktavahi Sira and Dhamani (blood vessels) with their root lying in Yakrit (liver) and Pliha (spleen).[12]

Concept of Raktadusti (vitiation of blood)

The factors which are responsible for vitiation of blood act through three possible pathways - vitiation of Dosha (Dosha Prakopan), weakening of Rakta (Dhatu Daurvalya) and impairment in Raktavaha Srotas (Khavaigunya).[13] Rakta being the Dushya or Dhatu, does not possess the ability of self-vitiation by the effect of Nidan, rather this vitiation known as Rakta Dusti occurs as secondary phenomenon after vitiated Doshas afflict Rakta Dhatu.[14] So whenever any person intakes any Nidan, it directly causes weakening of Rakta and also produces impairment of Raktavaha Srotas. When a vitiated Dosha afflicts a Dhatu this indicates there is some sort of impairment within the Dhatu. It is because, in presence of Vala (can be compared with Vyadhikshamatwa i.e., immunity) which is regulated by Dhatus, a disease cannot occur or if it occurs its strength will be much more less.[15] So, when there is impairment of Vala, a Dhatu becomes weaker and it cannot resist itself against the vitiated Dosha and gets afflicted by it. This impairment of Dhatu or depletion of Vala of Dhatu should be attributed to various effect of Nidan. So, it can be said that Nidan causes impairment of Dhatus which ultimately becomes susceptible to affliction by vitiated Doshas. When a Dosha gets vitiated after intake of Nidan, it moves through different channels along the body and gets localized where there is an impairment of channel - subsequently afflicts the respective Dhatu, the phenomenon known as Dosha Dushya Sammurchhana. This phenomenon results into vitiation of channels, known as Srotadusti and ultimately vitiation of Dhatus, known as Dhatudusti. Again, it can be said that, Dhatudusti actually means Dhatukshaya as in pathogenesis of almost every diseases Dhatukshaya occurs.[16] The whole complex process lays the foundation of genesis of different diseases within body and manifested as different clinical sign and symptoms.  That’s why, it has been said by Acharya Charaka that, the features of Dhatuvaha Srotadusti are identical with those diseases which are caused by vitiation of those Dhatus.[17] In terms of Rakta Dhatu, Acharya Charaka has clearly mentioned in Vidhishonitiya Adhyaya that, as result of intake of different factors which are responsible for Raktadusti, different kind of diseases occurred in our body known as Raktaja Roga.[18] All Doshas in their vitiated state afflict Rakta Dhatu, but Pitta Dosha has a


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specific predilection towards Rakta Dhatu as Agneya Guna lies in common between these two[19] and also it has been said that, Pitta Dosha takes shelter within Rakta Dhatu following the hypothesis of “Ashraya Ashrayee Bhava” due to similarities in their properties.[20] So most of the causative factors which are said to be responsible for vitiating Rakta Dhatu secondarily, actually primarily vitiate Pitta Dosha most. Acharya Charaka in Vidhishonitiya Adhyaya has mentioned several dietary factors along with regimens which are responsible for Raktadusti like : intake of unwholesome, hot and sharp wine and food in large quantity; exceedingly saline, alkaline, acidic and pungent food in large quantity; Kulattha (Dolichos biflorus Loinn.), Masa (Phaseolus radiatus Linn.), Niṣpava (a type of Śimbi), and Til oil; Pindalu and all green eatables like radish etc.; meat of aquatic marshy and Prasaha type of animal and animal living in holes; curd, sour whey, vinegar, wine, and Souvirak type of liquor; rotten or stale food; putrefied food articles and those having mutually contradictory qualities and any other type of food in excessive quantity. Blood also get vitiated by sleeping during after taking liquid, unctuous and heavy food; excessive anger, excessive exposure to sun and fire; suppression of urge of vomiting; absence of bloodletting therapy (in autumn); exertion, external injury, heat, taking food before previous food is digested; by the very nature of autumn season.[21]

Hypothyroidism is a pathological condition caused by hypo-functioning of thyroid gland.  The thyroid gland, which is the largest and one of the most important endocrine gland in human body, is located on the anterior side of the neck, right below the larynx. It has two lobes and is composed of many thin follicular cells with a type of epithelial tissue origin. These follicles store thyroid hormones in the form of thyroglobulin molecules until body requires them. Thyroid gland synthesizes and secrets two major hormones, known as 3,5,3’ –triiodothyronine (T3) and thyroxin, which can sometimes be referred to as 3,5,3’,5’ – tetraiodothyronine (T4). These hormones are necessary for thermo-genic and metabolic homeostasis in adult.[22]

Hormonal output from thyroid gland is mediated by thyroid stimulating hormone (also known as TSH or thyrotropin) secreted by anterior pituitary. The secretion of thyrotropin itself is mediated by thyrotropin releasing hormone (TRH) secreted

by hypothalamus. The thyroid axis is a classic example of an endocrine feedback loop. Hypothalamic TRH stimulates pituitary production of TSH, which in turn stimulates thyroid hormone synthesis and secretion. Thyroid hormones, acting predominantly through thyroid hormone receptor beta-2, feedback to inhibit TRH and TSH production. The ‘set point’ in this axis is established by TSH. TSH plays a pivotal role in control of the thyroid axis and serves as most useful physiologic marker of the thyroid hormone action.[23]

Iodine uptake is the critical first step in thyroid hormone synthesis. The most common disorders of thyroid gland include hyperthyroidism, hypothyroidism and thyroid nodules, which are generally benign thyroid neoplasm but may change to thyroid cancer.[24] Iodine deficiency remains the most common cause of hypothyroidism worldwide. In areas of iodine sufficiency, autoimmune disease (Hashimoto's thyroiditis) and iatrogenic causes (treatment of hyperthyroidism) are most common.[25]

Iodine deficiency is responsible for endemic goitre and cretinism but is an uncommon cause of adult hypothyroidism unless the iodine intake is very low or there are complicating factors, such as the consumption of thiocyanates in cassava or selenium deficiency.[26] Autoimmune hypothyroidism may be associated with a goitre (Hashimoto's, or goitrous thyroiditis) or, at the later stages of the disease, minimal residual thyroid tissue (atrophic thyroiditis).[27]

The mean annual incidence rate of autoimmune hypothyroidism is up to 4 per 1000 women and 1 per 1000 men.[28] The mean age at diagnosis is 60 years, and the prevalence of overt hypothyroidism increases with age. Subclinical hypothyroidism is found in 6–8% of women (10% over the age of 60) and 3% of men.[29]

As consequence of Raktadusti, the pathological conditions which are mentioned as Raktaja Roga by Acharya Charaka are combination of independent disease as well as sign and symptoms. Among them many identical features are also found in hypothyroidism. Studies of these features help us to understand the character of hypothyroidism and its evaluation in the line of Raktadusti & Raktaja Roga. A comparative study has been given below (Table 1) between the Raktaja Roga and the clinical features found in hypothyroidism


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Table 1: Comparative study between features of Raktadusti and hypothyroidism:[30]

SN Clinical Features Raktadusti Lakshan Features of hypothyroidism
01. Mukhapaka (ulcer in mouth) ++  
02. Akshiraga (redness of eye) ++  
03. Putighrana Asya Gandhita (foul smell from mouth & nose) ++  
04. Gulma (tumor) ++  
05. Upakush (disease of mouth) ++  
06. Visarpa (rapidly spreading skin disease / dermatitis) ++ ++
07. Raktapitta (bleeding disorders) ++  
08. Pramilaka (absent mind / state of stupor) ++ ++
09. Vidradhi (abcess) ++  
10. Raktameha (haematuria) ++  
11. Pradara (heavy menstrual bleeding) ++ ++
12. Vatashonita (gouty arthritis) ++  
13. Vaivarnya (pallor) ++ ++
14. Agnisada (diminution of digestive power) ++ ++
15. Pipasa (thirst) ++  
16. Gurugatrata (heaviness of body) ++ ++
17. Santap (rise of temperature) ++  
18. Ati Daurvalya (excessive weakness) ++ ++
19. Aruchi (anorexia) ++ ++
20. Shira Ruja (headache) ++  
21. Vidaha Annapanascha (burning sensation after intake of food) ++  
22. Tikta Amla Udgiran (sour and bitter eructation) ++  
23. Klama (feeling of tiredness) ++ ++
24. Krodha Prachurata (irritability) ++ ++
25. Buddhi Sammoha (impairment of intellectuality) ++ ++
26. Lavana Asyata (salt taste in mouth) ++  
27. Sweda (excessive sweating) ++  
28. Sharira Dourgandhya ( bad body odour) ++  
29. Mada (intoxication) ++  
30. Kampa (tremor) ++ ++
31. Swarakshaya (hoarseness of voice) ++ ++
32. Tandra (drowsiness) ++ ++
33. Nidra Atiyog (excessive sleeping) ++ ++
34. Tama Darshan (blackout) ++  
35. Kandu (itching) ++ ++
36. Kotha, Pidaka (urticaria) ++ ++
37. Kustha (skin disease / dermatitis) ++ ++
38. Charmadala (skin disease) ++  

In the above context, the present study was carried out keeping the following aims and objectives

1. Evaluation of the concept of Raktadusti and its clinical diagnosis

2. Evaluation of Raktadusti in hypothyroidism

3. Assessment of efficacy of the stipulated therapeutic procedure (Virechana by Trivrit Churna along with Shamana by Phalatrikadi Kashayam) as Raktadustihara Chikitsa in management of hypothyroidism.

Materials and Methods

The literary information regarding the similarities between Raktadusti Lakshan and features of hypothyroidism has been verified through clinical study. Assessment of homologous features of Raktadusti and hypothyroidism were done on the basis of subjective and objective criteria. The study has been also carried out to evaluate the efficacy of stipulated therapeutic procedure (Virechana by Trivrit Churna along with Shamana by Phalatrikadi Kashayam) as Raktadustihara Chikitsa in the management of hypothyroidism. The subjective and objective criteria have been evaluated before and after treatment for assessment of the efficacy of administered therapy.

Selection of Patients: 35 patients were selected from OPD of Institute of Post Graduate Ayurvedic Education & Research, at Shyamadas Vaidya Sastra Pith hospital, Kolkata -9, irrespective of their sex, occupation and religion. The patients having low serum thyroid hormone level (T3 & T4) with raised serum TSH level were selected for the study and subsequently the features of Raktadusti were evaluated on the basis of subjective and objective parameters. Prior to carry out the study the informed patient consent form was duly signed by the patients.

Inclusion Criteria

1. Patients above 20 years of age and below 60 years of age, irrespective of their occupation, sex and religion.

2. Patients who are willing to include themselves into the study.

3. Patients having the serum TSH level > 4.25 μIU/mL


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4. Patients having the serum T3 level < 77 ng/dL & serum T4 level < 5.4 μg/dL

5. Primarily detected hypothyroidism patient, not taking any type of medication.

6. Primarily detected hypothyroidism patient without any other chronic and acute disease.

Exclusion Criteria

1. Patients below 20 years of age and above 60 years of age, irrespective of their occupation, sex and religion.

2. Patients who are not willing to include themselves into the study.

3. Patients having the serum TSH level less than 4.25 μIU/mL

4. Patients having the serum T3 level greater than 77 ng/dL & serum T4 level greater than 5.4 μg/dL

5. Primarily detected hypothyroidism patient, taking thyroxin medication.

6. Primarily detected hypothyroidism patient with any other chronic and systemic disease.

Subjective Parameters

Subjective parameters were selected on the basis of identical features between Raktadusti and hypothyroidism:

1. Vaivarnya (pallor)

2. Agnisada (diminution of digestive power)

3. Gurugatrata (heaviness of body)

4. Daurvalya (weakness)

5. Aruchi (anorexia)

6. Krodha Prachurata (irritability)

7. Pradara (heavy menstrual bleeding)

8. Buddhi Sammoha (impairment of concentration)

9. Tandra (drowsiness)

10. Kustha (dermatitis)

Objective Parameters

1. Estimation of serum TSH level

2. Estimation of serum T3 level

3. Estimation of serum T4 level

Adoption of Therapeutic Procedure

Virechana (therapeutic purgation) is a type of Samshodhan Chikitsa (bio purification therapy) which is indicated in all types of Raktadusti and Raktaja Roga as per Vidhishonitiya Adhyaya of Charaka Samhita.[31]Similarly Phalatrikadi Kashayam is a well-known drug indicated as Shaman Chikitsa (pacifying management) in the management of Pandu & Kamala.[32] As both the disease arise due to vitiation of Rakta Dhatu mainly, so it has been considered to be effective in all types of Raktadusti along with Raktaja Roga. The stipulated drug has been prepared as per formulation given in Sharangadhar Samhita[33] in the apothecary department of the study conducting institution. The above two therapy has been administered as: 1. Virechana Karma by root powder of Trivrit (Operculina turpethum) - 3 gm with warm water after food at bed time (night), along with 2. Phalatrikadi Kashayam - 50 ml with honey before lunch and dinner. Each of the therapy has been continued simultaneously for consecutive 60 days. After 60 days the effect of the stipulated therapeutic regimen has been evaluated.

Study Protocol

Duration of Study

The duration of the study was 60 days.

Assessment Criteria

Assessment has been done on the basis of subjective and objective criteria before and after treatment. For the statistical evaluation each of the subjective parameters has been arranged as per gradation.

Follow up of Patients

All the patients were reviewed after 60 days from the date of administration of first dose. Any special information regarding the general health of the patient was recorded accordingly.

Study Sample

Total 35 patients of hypothyroidism with features of Pandu Roga were included in the study.

Statistical Analysis

The information gathered on the basis of observation made about various parameters has been subjected to statistical analysis in


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terms of Mean, Standard Deviation (SD) and Standard Error (SE). Paired‘t’ test was carried out at P<0.05 and P<0.001. The obtained results were interpreted as -P<0.05 is significant & P<0.001 is highly significant.

Observations and Results

Among the 35 patients total 5 patients were dropped out during study course. Hence complete clinical survey was done in 30 patients.

Distribution of subjective parameters of Raktadusti among the 30 patients of hypothyroidism shows that, Vaivarnya (pallor) present in 18 patients, Agnisada (diminution of digestive power) presents in 30 patients, Gurugatrata (heaviness of body) present in 26 patients, Daurvalya (weakness) present in 29 patients, Aruchi (anorexia) present in 29 patients, Krodha Prachurata (irritability) present in 21 patients, Pradara (heavy menstrual bleeding) present in 21 patients out of 24 female patient, Buddhi Sammoha (impairment of concentration) present in 25 patient, Tandra (drowsiness) present in 28 patients & Kustha (dermatitis) present in 16 patients  [Table no. 2].

Statistical analysis of subjective and objective parameters in 30 patients of hypothyroidism before and after 60 days of treatment shows that Shodhan therapy in terms of Virechan and Shaman therapy in terms of Phalatrikadi Kashayam have significant efficacy on both the subjective and objective parameters with ‘p’ value <0.001 in most of the parameters after 60 days. [Table no. 2].

Table 2: Distribution of subjective parameters of Raktadusti among the 30 patients of hypothyroidism:

SN Subjective Parameters No. of patients Percentage
01. Vaivarnya (pallor) 18 60%
02. Agnisada (diminution of digestive power) 30 100%
03. Gurugatrata (heaviness of body) 26 87%
04. Daurvalya (weakness) 29 96.67%
05. Aruchi (anorexia) 29 96.67%
06. Krodha Prachurata (irritability) 21 70%
07. Buddhi Sammoha (impairment of concentration) 25 83.33%
08. Tandra (drowsiness) 28 93.33%
09. Kustha (dermatitis) 16 53.33%
10. Pradara (heavy menstrual bleeding) 21 (out of 24 female patient) 87.5%

Table 3: Statistical analysis of subjective and objective parameters in 30 patients of hypothyroidism before and after 60 days of treatment:

Parameters Mean BT Mean AT SD+/- SE+/- ‘t’ value ‘p’ value
Vaivarnya 2.77 2.23 0.98 0.18 3.0 <0.05
Agnisada 3.23 1.13 2.31 0.42 4.98 <0.001
Gurugatrata 3.0 1.36 2.01 0.37 4.59 <0.001
Daurvalya 2.24 1.4 1.19 0.22 3.87 <0.001
Aruchi 3.16 1.10 2.23 0.41 5.024 <0.001
Krodha Prachurata 2.16 0.87 1.53 0.28 4.64 <0.001
Buddhi Sammoha 1.33 0.97 0.79 0.14 2.57 <0.05
Tandra 2.8 1.3 1.88 0.34 4.39 <0.001
Kustha 2.27 0.87 1.64 0.30 4.66 <0.001
Pradara 3.10 1.10 2.22 0.41 4.88 <0.001
Serum TSH 8.13 4.85 4.05 0.74 4.45 <0.001
Serum T3 67.86 76.86 8.47 2.26 3.98 <0.01
Serum T4 2.63 5.70 3.584 0.654 4.794 <0.001

Discussion

With the progression of each era, there are emergence of new diseases and various pathological conditions. As Acharya Charaka has famously said, not every disease or a pathological condition can be given a stipulated name,[34] so each of the newly emerged pathological condition which has not been clearly defined in our ancient texts previously, should be analysed on the basis of involvement of Dosha, Dushya etc. Hypothyroidism is such a pathological condition which has not been explicitly described in our classical compendiums. This pathological condition should be studied in the line of Dosha, Dushya, Srotas, Agni etc. as described in our compendiums. Hypothyroidism is primarily a metabolic disorder where there is less synthesis of thyroid hormones. According to Ayurvedic philosophy, all the metabolic functions are regulated by Dhatwagni.[35] Thus, diminished synthesis of thyroid hormones can be attributed to hypo function of Dhatwagni. Dhatwagni helps to regulate Dhatwagnipaka (identical to metabolism) where there is production of Rakta Dhatu from Rasa Dhatu and with the help of Raktagni, further the Poshak part of Rakta Dhatu transforms in to Mamsa Dhatu (as per Kshira Dadhi Nyaya).[36] By this process there is production of Rakta Oja which helps to maintain the normal strength of Rakta.[37] So, whenever there is impairment of Dhatwagni, there is impairment of Dhatu Paka, as result of this there is less production of Rakta Dhatu


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as well as Raka Oja. The diminution of Rakta Oja makes Rakta Dhatu vulnerable and it becomes susceptible to vitiated Doshas which ultimately leads to Raktadusti. From this point of view, it can be said that Raktadusti is an inevitable phenomenon in case of hypothyroidism.

Iodine deficiency remains the most common cause of hypothyroidism worldwide.[38] Iodide uptake by thyroid gland cells is a critical first step for thyroid hormone synthesis. Thyroid gland extracts iodine from the circulation in a highly efficient manner.[39] Deficiency of iodine as a part of diet will lead to hypothyroidism. Where there is no deficiency of iodine, autoimmune disease (Hashimoto thyroiditis) is the most common cause of hypothyroidism. In Hashimoto's thyroiditis, there is a marked lymphocytic infiltration of the thyroid with germinal centre formation, atrophy of the thyroid follicles accompanied by oxyphil metaplasia, absence of colloid, and mild to moderate fibrosis. [40] In both the cases, there is decreased level of T3 & T4 in circulating blood. Raktadusti should be compared with Rakta Dhatu Kshaya as described earlier. The term Dhatu Kshaya can be interpreted as Dravyata Kshaya (loss of whole tissue element), Gunata Kshaya (diminished component of tissue element) and Karmata Kshaya (diminished function of tissue element) in accordance with concept of Samanya Visesh.[41] Here decreased level of T3 & T4 in circulating blood can be interpreted as Gunata Rakta Kshaya. It can be hypothetically said that, in case of Hashimoto thyroiditis, autoimmune inflammatory reaction is induced by vitiation of Pitta Dosha, mainly due to vitiation of Ushna, Tikshna and Katu Guna of Pitta.[42] Lymphocytic infiltration can be compared with vitiation of Rakta Dhatu. Atrophy of the thyroid follicles can be termed as consequence of obstruction of Raktvaha Srotas – the chief source of cellular nutrition as described in compendium.[43] Table 2 shows that, most of the cases included under the present study were satisfying all the subjective criteria, which are identical features between Raktadusti and hypothyroidism. It signifies that, the textual understanding regarding Raktadusti Lakshan and features of hypothyroidism can be validated clinically.

Statistical analysis of various subjective and objective parameters of 30 patients, before and after 60 days of treatment in Table 3 shows the ‘p’ value <0.001 in most of the parameters, which

indicates that, the therapeutic procedure is significantly efficacious in the management of hypothyroidism after 60 days. Virechan by Trivrit Churna eliminates vitiated Pitta Dosha as well as it is helpful in the management of vitiation of Rakta Dhatu.[44] Phalatrikadi Kashayam is a compound drug which is very effective in the management of Raktadusti. This drug consist Amlaki, Haritaki, Vibhitaki, Guduchi, Katuki, Nimba, Chirayata and Vasa. Majority of the ingredients have Pittanashak as well as Rakta Shodhak property, thus are very effective in Raktadusti.[45] Thus combination of the above two therapeutic procedure is significantly effective against Raktadusti as well as hypothyroidism.

Conclusion

In absence of categorical description of hypothyroidism in ancient Ayurvedic texts, this pathological condition should be studied in accordance with involved Dosha and Dushya. The features of Raktadusti and Raktaja Roga can be clinically verified in patients of hypothyroidism. Thus, it can be said that, Raktadusti has a definite role to play in pathogenesis of hypothyroidism. Rakta should be regarded as one of the main Dushya in hypothyroidism. Management of Raktadusti as described in our ancient compendiums in form of Shodhan Chikitsa (Virechan) and Shaman Chikitsa (Phalatrikadi Kashayam) are very effective to combat hypothyroidism. Thus, the patients suffering from hypothyroidism can be treated with the therapeutic procedure responsible to combat Raktadusti.

Reference

1. Sushrut Samhita of Maharshi Sushrut, Ayurvedtatwasandipika Hindi commentary by - Sastri Ambikadutta, published by - Chaukhamba Sanskrit Sansthan, Varanasi; 2012 edition, Sutrasthan, chapter 15, sloka no. - 3, page no. 73

2. Charak Samhita of Agnivesh, Vidyotini Hindi commentary by Sastri Kashinath & Chaturvedi Gorakhnath, published by - Chaukhamba Bharti Academy, Varanasi; 2015 edition; Chikitsastha, chapter 15, sloka no. - 3-4, page no. - 452

3. Charak Samhita of Agnivesh, Vidyotini Hindi commentary by Sastri Kashinath & Chaturvedi Gorakhnath, published by - Chaukhamba


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Majumder B et al: Clinical evaluation of Raktadusti in Hypothyroidism

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