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Role of Ayurveda in the Management of Hypothyroidism - A Case Report

Kapoor, Alka (Babbar); Raturi, Shweta 1

Deputy Medical Superintendent, Hospital, All India Institute of Ayurveda, 1Department of Prasuti Tantra and Stri Roga, All India Institute of Ayurveda, New Delhi, India

Address for correspondence: Dr. Alka (Babbar) Kapoor, Room No - 5, First Floor, Admin Block, Hospital Building, All India Institute of Ayurveda, New Delhi, India. E-mail: [email protected]

Received May 19, 2022

Received in revised form November 24, 2022

Accepted November 25, 2022

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Compromised daily habits such as more sugar intake, lack of exercise, stress, familial tendencies, etc., lead to various lifestyle diseases impacting the normal functioning of the human body systems. Hypothyroidism is one such disease that is caused due to inadequate production of thyroid hormones. The thyroid gland regulates the body's metabolism and growth. In Ayurveda, this is attributed to a function of Agni . Clinical symptoms of this disease closely resemble Agnimandya and symptoms precipitated consequentially. A 24-year-old female patient visited the hospital with complaints of irregular menstruation, heaviness all over the body, gradual weight gain, and constipation. After thorough examination and investigations, she was diagnosed with a case of hypothyroidism with increased thyroid- stimulating hormone levels. Her ultrasound findings also showed a polycystic ovary syndrome -like presentation with mildly enlarged bilateral ovaries with multiple small follicles and increased ovarian stroma. She was effectively treated with an Ayurvedic treatment approach for 5 months (five cycles).

Introduction

Diseases of the thyroid gland are among the most prevalent endocrine disorders worldwide, second only to diabetes. Hyperthyroidism, as well as hypothyroidism, occur in about 2% and 1% worldwide population, respectively. Prevalence in men is about one-tenth of that of women.[ 1 , 2 ] Reduced production of thyroid hormone is the central feature of the clinical state termed hypothyroidism.[ 3 ] Hypothyroidism may lead to decreased libido in both sexes. In females, there may be oligomenorrhea or amenorrhea in long-standing diseases but menorrhagia may occur at an early stage. Fertility is reduced and the incidence of miscarriage is increased.[ 4 ] Although hypothyroidism is typically rewarding to treat, about 30%–50% of individuals are either overtreated or undertreated and remain at risk of the adverse effects of thyroid dysfunction. Furthermore, a proportion of individuals remain symptomatic despite appearing to be biochemically euthyroid. The management of these patients is challenging and often unsatisfactory for patients and clinicians alike.[ 5 ] Side effects of thyroxine replacement therapy and the long-term effect of hypothyroidism call for an effective, alternate approach for the management of hypothyroidism. The present study is a case report of a 24-year-old female presented with complaints of scanty and delayed menses ( artava kshaya ), heaviness all over the body ( gatraguruta ), weakness ( klama ), and constipation ( vibandha ). After a detailed history, clinical examination, and investigations, the patient was diagnosed with a case of hypothyroidism which was successfully managed with an Ayurvedic approach. Along with the improvement in signs and symptoms, there has been a sustained reduction in thyroid- stimulating hormone (TSH) levels with a resolution in the polycystic appearance of bilateral ovaries.

Case Report

Patient information.

A 24-year-old female patient, Hindu by religion, student, moderately built, came to the outpatient department (OPD) of the hospital on February 02, 2019 (UHID No: 28330) with complaints of scanty and delayed menses ( artava kshaya ), heaviness all over her body ( gatraguruta ), weakness ( klama ), and constipation ( vibandha ).

According to the patient, she was apparently well about 1.4 years ago, when she developed complaints of incomplete bowel evacuation and also observed irregularity in her menstrual cycle. Initially, there was a decrease in interval between two menstrual cycles, which gradually started increasing with a decrease in flow. Subsequently, she developed the following symptoms, namely, feeling of heaviness, lethargy, and little or no motivation to do work, gradual weight gain, constipation off and on, irregular menses characterized by increased interval (with a cycle length of 45–60 days) of menses, scanty bleeding, blackish brown, and associated with mild pain in the lower abdomen and lower back.

Previous menstrual history

Age of menarche – 13 years, duration – 5–6 days, interval – 28–30 days, and moderate flow with mild pain in the lower abdomen and lower back.

Present menstrual history

Duration – 2–3 days, interval – 45–60 days, and scanty bleeding blackish brown associated with mild pain in the lower abdomen and lower back.

Medical history of past illness

There was no history of diabetes mellitus /h ypertension or any other major medical or surgical history.

Ever since she started noticing changes in her body and menstrual cycle, she was seeking medical help but there was no relief.

Personal history

Vegetarian, nondrinker, nonsmoker, irregular or no exercise schedule owing to busy academic routine, frequent eating outside, and consumption of junk food such as pizza, burgers, and fries.

Family history

There was no relevant family history.

Clinical Findings

General examination of the patient revealed that the patient was moderately built, well nourished (apparently), able to maintain normal/ straight decubitus and afebrile. No Pallor/Icterus/cyanosis/ clubbing/enema/lymphadenopathy was observed. Hair were dry, brittle and rough. Skin was also dry. Tongue was moist and Coated. At the time of examination Pulse rate was 88/min with normal rhythm. On examination of the respiratory system, chest field was found clear with normal vesicular breathing sound and no added sounds, cardiovascular system, gastrointestinal system, and central nervous system also did not reveal any abnormality.

Patient's baseline Ultrasound (USG) of pelvic region (uterus and adnexa) suggested uterus was normal in size, shape, and echotexture, B/L ovaries are mildly enlarged. Right ovarian volume was 10 mm 3 and left ovarian volume was 11 mm 3 with multiple small follicles and increased ovarian stroma which is suggestive of polycystic ovaries.

(Patient had already got the USG done (August 19, 2018) and was getting treatment for polycystic ovarian disease but there was no relief, instead, symptoms were gradually adding on .

Further serum TSH was advised and it was 7.18 mIU/L as on February 2, 2019.

Ashtavidha Pariksha

Nadi Pariksha (pulse examination) revealed vata -kaphaja gati with a pulse rate of 88/min. Mala pravratti was noticed as having difficulty in defecation with hard stool in consistency; Mutra prvratti was 5–6 times a day in frequency with slight yellowish-colored urine. Jiwha was found sama (coated and moist). During shabda pariksha, the speech was found clear with formed words and sentences. During sparsha pariksha, anushnasheetata was noticed. Drik was samanya in terms of movement and appearance, eye contact was made. Akriti of the patient was found to be madhyam .

Timeline of chief complaints

Irregular periods * 1 year 4 months; constipation ( Vibandha )/incomplete bowel evacuation * 1 year; Scanty and delayed menses ( Artava Kshaya ) *10 months; heaviness all over the body ( Gatra guruta ) *10 months; weakness ( Klama ) *10 months; gradual weight gain * 10 months; lethargy, increased hair fall, and dry skin * 10 months.

Treatment was given for 5 months.

Diagnostic Assessment

The diagnosis was made by laboratory evaluation for thyroid function which showed increased TSH level and ultrasonography of the lower abdominal region. USG findings revealed mildly enlarged b/l ovaries with multiple small follicles and increased ovarian stroma suggestive of polycystic ovaries.

Therapeutic Intervention

After an initial assessment of the patient, Kanchnar Guggulu, Chitrakadi Vati, tablet thyrin , Kumaryasava, and a combination of Haritaki and Guduchi churna were given for 5 months [ Table 1 ].

Follow-Up and Outcome

The treatment was given for almost 5 months, and monthly follow-up was done. There were five follow-ups during the course of treatment and 02 follow-ups after 5 and 15 months of stopping the treatment wherein the TSH level was assessed. Significant improvement was observed during follow-ups. At the end of 2 months, constipation was relieved. There was an improvement in the flow of the menstrual cycle. By the third follow-up, heaviness and lethargy were completely resolved. A regular menstrual cycle was achieved by the end of the 4 th month. TSH level was reduced to normal limits. Ultrasonographical findings revealed the resolution of multiple small follicles in b/l ovaries with a reduction in ovarian volume.

• First visit (February 2, 2019) – The patient came to OPD with the complaint of scanty and delayed menses, heaviness all over the body, weakness, and constipation. TSH was 7.13, USG suggestive of polycystic ovaries
• First follow-up (March 26, 2019) – Mild-to-moderate relief in the complaint of weakness and heaviness all over the body was noted. Constipation was relieved
• Second follow-up (April 30, 2019) – USG was repeated which was suggestive of a normal study with the reduction in bilateral ovarian volume and ovarian stroma. Improvement in menstrual flow was observed. TSH showed a value of 5.246 (April 29, 2019)
• Third follow-up (May 21, 2019) – The patient was feeling zestful in daily routine activity
• Fourth follow-up (July 30, 2019) – S. TSH was repeated which showed a TSH value of 4.13 mIU/L (June 24, 2019). The menstruation cycle was regular with moderate flow for 5 days with intervals of 28–30 days
• Fifth follow-up after stopping the medicines for 2 months, S. TSH was repeated and showed a value of 3.86 mIU/L. The menstrual cycle was also regular according to the patient
• Follow-up was also done after 5 months and about 15 months after stopping the medicines. During this period, the patient was not on any medication; however, she was advised to follow pathya-apathya as advised during the treatment. TSH values were found within normal limits [ Table 2 ].

Hypothyroidism is a clinical syndrome resulting from inadequate production of thyroid hormones. It disrupts the metabolism of the body even at the cellular level and can almost affect any organ.

Even though the disease hypothyroidism as such is not described in classical Ayurvedic texts, it can primarily be considered under the activity of Agni. Thirteen types of Agni have been described in Ayurvedic texts, the prime one being the Jathragni . Their state of equilibrium is dependent on ahara and vihar. [ 6 ] Habitual consumption of guru , madhur , sheet , and drava food items and lack of activity, exercise, shodhan, etc., results in the vitiation of kapha which leads to Agnimandya, accumulation of ama, and dhatwagni mandyata, as was seen in the present case. Ras dhatu thus produced is vikrit in nature. A rtava being updhatu of rasa dhatu thus formed is also vitiated. Obstruction of artavavaha strotas by vitiated Vata and Kapha may lead to Artava kshaya. [ 7 ] Vitiated rasa dhatu and dhatwagnimandyata also result in the production of vitiated uttarottardhatus. [ 8 ]

Vikrit Uttrotar dhatus, especially Meda dhatu along with vikrit kapha is responsible for the formation of granthi . In the present context, it was observed that more visible symptoms were artava kshaya , gurugatrata , and bharavriddhi , with the polycystic appearance of bilateral ovaries ultrasonographically and Increased levels of thyroid stimulating hormone (TSH) indicating the presence of hypothyroidism. This finding is also supported by a study conducted by Singla et al . which shows that the ovaries become polycystic in the presence of hypothyroidism.[ 9 ] Hence, after thoroughly understanding the pathophysiology of the case, a treatment protocol was developed for bringing the vitiated Agni and doshas back to their natural state. To attain this, formulations having agnideepaka, strotoshodhak, vatakaphashamaka, and granthihar properties were prescribed [ Figure 1 ]. A combination of five formulations was given as treatment, namely, Chitrakadi Vati – contains Panchkola , Kshara dwaya, ajmoda, saindhava, sauvarchala lavan, [ 10 ] etc. The preparation mainly contains ingredients having katu vipaka, ushna veerya, and deepana , pachana properties making it perfect drug for agnideepana . It improves the jathragni , balances vata and kapha , and removes the aam from the body, leading to improved digestion and proper formation of rasa dhatu . KanchnarGuggulu – mainly contains kanchnar and guggulu . It has been described as Granthihara and Gandmalanashaka in classical Ayurveda texts.[ 11 ] Guggulu is considered vata medohara. [ 12 ] By virtue of its laghu , ruksha, and lekhana properties, it pacifies kapha and meda and removes the obstruction from macro- and microcirculation. It reduces the kapha and meda due to its astringent properties. Kanchnar has laghu and rukhsha properties and kashaya rasa . It has specific action ( prabhava ) of gandamalanashana as described in Ayurvedic texts. It reduces the kapha and meda due to its astringent properties. Tablet thyrin – It mainly contains Brahmi, guggulu, gandir, pippali, and rakta marich . In a study, hypothyroid rats were treated with 200 mg per kg of brahmi and levothyroxine has been used as a standard replacement drug. Plasma levels of thyroid hormones (T3, T4, and TSH), lipid profile, and liver antioxidants (catalase, superoxide dismutase, reduced glutathione, and lipid peroxidation levels) were determined. A histological study of the thyroid glands was carried out. The results thus obtained suggest that brahmi ameliorated hypothyroidism as evidenced by the reversal of various biochemical changes as well histology of thyroid gland in rats. Thus, the plant could be considered for therapeutic management of clinical conditions associated with hypothyroidism.[ 13 ] Kumaryasava – Kumaryasava contains kumari, haritaki, and jatamansi [ 14 ] as main ingredients with many other herbal drugs which exhibit hepatoprotective activity. The formulation has vatakapha shamaka and pittavardhak properties. Tikshna Guna of drugs favors the strotoshodhana . Its artavapravartana karma may help in regularizing the cycle. Drugs have deepana , pachana actions which regulate jatharagni, dhatvagni, and bhutagni , correct metabolism at the cellular level, and thus result in proper formation of dhatus and upadhatus ( artava ). Haritaki and Guduchi – Haritaki has been described as strotoshodhak, doshanuloman, and deepana-pachana. [ 15 ] Similarly, Guduchi has been described as having vibandhanashana and deepaneeya properties.[ 16 ] They collectively help in clarifying the obstructed artava vahastrotas due to their strotoshodhak and vibandhnashana properties. Haritaki being doshanulomana helps in the attenuation of doshas . Moreover, haritaki and guduchi being deepanapachana collectively pacify the accumulated Aam . The treatment was given for 5 months and the medicines given have shown promising results.

The causative factors leading to hypothyroidism when viewed from the perspective of Ayurveda , may be Agnimandya and aama resulting from aahara-vihara vaishamya . Hence, the treatment plan included medicines with agnideepaka, strotoshodhak, and vatakaphashamaka properties. Symptomatic relief was observed within 1 month of onset of Ayurvedic treatment and other investigations such as USG and serum TSH were found normal even after 3 months of discontinuation of treatment. Thus, it may be concluded that treatment protocol prescribed with an approach toward correction of Agnimandya and aama may lead to the normalization of thyroid functions and alleviation of associated symptoms.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Artava kshaya ; Ayurveda ; hypothyroidism; thyroid

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Ayurvedic management of Prameha - A Single Case Study

• Sreeraj P. Assistant Professor, Department of Swasthavritta and Yoga, Yenepoya Ayurveda Medical College and Hospital, Mangaluru, Karnataka, India.
• Veeraj P. Hegde Professor & HOD, Department of Swasthavritta and Yoga. Yenepoya Ayurveda College and Hospital, Mangaluru, Karnataka, India.

Diabetes mellitus (DM) type 2 is one of the global problems of the present day and it is gaining more attention. It is expected to continue as a major health problem and leads to serious complications. India is one of the top 5 countries with the highest prevalence of DM. The IDF Diabetes Atlas (2021) reports that 10.5% of the adult population (20-79 years) has diabetes, with almost half unaware that they are living with the condition. By 2045, IDF projections show that 1 in 8 adults, approximately 783 million, will be living with diabetes, an increase of 46%. [1] The signs and symptoms of diabetes can be correlated to Prameha of Ayurveda. The management of Prameha is mentioned in Ayurveda as preventive and curative aspects. Ayurveda has recommended an appropriate use of Oushadha Yogas along with proper Pathya (wholesome) Ahara, and Viharas. On the same principles a patient was treated at OPD basis, this case report analyses the same. A male patient, aged 45 years, diagnosed case of Prameha 5 years back presented with dryness in the mouth, increased frequency of micturition, Excessive thirst, weakness of the body, and burning sensation at the sole. The treatment planned was use of Shamana Oushadhis along with proper Pathya (wholesome) Ahara, and Vihara for three months. After three months of treatments results were compared. There was a marked reduction in signs and symptoms like burning sensation, numbness, excessive thirst, and increased micturition.

IDF Diabetes Atlas. International Diabetes Federation. Available from: https://idf.org/about-diabetes/facts-figures/

Waghe. Textbook of Roga Nidana & Vikriti Vigyana; First Edition; Nagpur; Rashtra Gaurav Publication; 2019. p. 204.

Vagbhata. Astanga Hrudaya, Nidanasthana, Atisaara grahaniroga Nidana, 8/30, edited by Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya, Chaukhamba Sanskrit Sansthan, Varanasi, Reprint: 2009. p. 497.

Vidhyadhara Shukla, Ravidatta Tripathi. Charaka Samhita of Acharya Charaka. Reprint edition, Varanasi; Chaukhambha Sanskrit Pratishthan; 2006. p. 169.

Bramhanand Tripathi. Madhav Nidana of Acharya Madhava. Varanasi; Chaukhambha Surbharati Pratishthana; 2011. p. 4.

Vidhyadhara Shukla, Ravidatta Tripathi. Charaka Samhita of Acharya Charaka. Reprint edition. Varanasi; Chaukhambha Sanskrit Pratishthan; 2006. p. 168.

Sahasrayogam (3rd ed.) Dr Ramnivas Sharma, Surendra Sharma (Eds.), Vol. 318, Chaukambha Sanskrit Sansthan, Delhi (2002). p. 4.

Tripathi Brahmanand, editor. Sharangadhara Samhita, Sutrasthana, 1st ed. Ch. 15, Ver. 19-20. Varanasi: Choukambha Sanskrit Pratisthana; 2013. p. 200.

http://aamjournal.in/fulltext/70-1528447830 .

R H Singh. Charak Samhita of Agnivesha, Chawkhambha Surabharati Prakashana, Varanasi. 1st edition, reprint, 2011; 2: 1042.

Bedarkar PB, Ranpara N, Sawaliya V, Nariya MB, Prajapati PK, Patgiri B. Antihyperglycemic activity of Nishamalaki-An Ayurvedic formulation of Turmeric and Emblica officinalis. EJBPS. 2017; 4: 853-6.

Dr G. Prabhakar Rao (Ed.), Sahasrayogam: compendium of 1000 ayurvedic formulations (1st ed.), Chaukhambha Publications (2016), pp. 106-107.

https://www.ayurmedinfo.com/2017/12/21/dia-p-capsule/

https://www.researchgate.net/publication/327076993_Therapeutic_Role_of_Yoga_in_Type_2_Diabetes

Shastri Satya Narayana, Charaka Samhita, Chaukhambha Bharti Academy, Reprint edition, 2016 Sutra Sathana ch 27.20, P-529.

https://journals.indexcopernicus.com/api/file/viewByFileId/396435.pdf

Srichamroen A, Thomson ABR, Field CJ, Basu TK. In vitro intestinal glucose uptake is inhibited by galactomannan from Canadian fenugreek seed (Trigonella foenum graecum L) in genetically lean and obese rats. Nutrition Research, 29, 2008, 49-54.

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• J Ayurveda Integr Med
• v.13(2); Apr-Jun 2022

Ayurveda management of infertility associated with Poly Cystic Ovarian Syndrome: A case report

M.a. asmabi.

a Government Ayurveda Dispensary, Karakurissi, Palakkad, Kerala, India

M.K. Jithesh

b Department of R and D, Vaidyaratnam P.S.Varrier's Kottakkal AryavaidyaSala, Kottakkal, Malappuram, Kerala, India

Infertility associated with Poly Cystic Ovarian Syndrome (PCOS) is a major cause of concern in the present generation among the reproductive age groups due to undesirable lifestyle changes. This is a case report of an infertile couple who had not been able to conceive since 11 yrs. The wife was diagnosed with PCOS. They underwent conventional treatments of primary infertility including IUI (Intra Uterine Insemination) and hormonal therapy both the treatments were unsuccessful. The objective of the present treatment included Ayurvedic management of PCOS, ensuring regular ovulation and thereby helping to develop healthy pregnancy and successful childbirth. Based on the parameters of Ayurvedic science this case was diagnosed as Vandhyatva (Infertility) due to Nashtartava (Amenorrhea). Treatment plan included both Shodhana (Purification) and Shamana (mitigation) therapies. During the treatment period she lost 20 kg of weight and regained regular menstruation thereafter. The outcome of the Ayurvedic intervention was the conception of the patient within 8 months of treatment and delivery of a healthy baby girl.

1. Introduction

Infertility is one of the predominant health issues faced by the married couple nowadays. Infertility is defined as the inability to conceive after 1 year of uninterrupted intercourse of reasonable frequency [ 1 ]. It is common in 10–15% of couples [ 2 ]. As per the current statistics male infertility problems constitutes 30–40% and Female infertility problems constitutes 40–55% and both are responsible in about 10% cases. Remaining 10% unexplained [ 3 ]. A critical evaluation on female infertility shows that ovulatory factors contribute almost 30–40% of the case. Among anovulatory causes of infertility, Poly Cystic Ovarian Syndrome (PCOS) plays a major role [ 4 ]. Diagnosis of PCOS is based on anovulation, elevated androgen levels and presence of multiple ovarian cysts on USG findings [ 5 ]. Most of the time these conditions are presented with signs and symptoms such as obesity, amenorrhea and hirsutism [ 6 ]. A direct description of Poly Cystic Ovarian Syndrome in classical Ayurveda Texts is not available. After considering clinical features, Dosha involvement management principles of Vandhya , [ Nashtartava , Sthaulya (obesity)] [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] were adopted.

2. Patient information

Married couple who were school teachers, presented at private consultation OPD of home clinic with the complaint of inability to conceive even after 11 years of regular unprotected sexual life. The semen parameters of husband were found to be within normal limits. The wife, aged 32, had menstrual irregularities since past 9yrs. The menstrual history of the patient showed 6 days duration with an interval of 6–7 months between the next cycles. They underwent 10 years of hormonal treatment and Intra Uterine Insemination twice. Rapid weight gain observed during this time period. At their first OP visit her last LMP was 10/6/2018 which of course may be due to hormone induced withdrawal bleeding with the duration of 6 days. Patient complained itching on vagina along with abnormal vaginal discharge. Painful intercourse was also one of the main concerns Table 1 .

Table 1

3. Clinical findings

The patient was obese with a body weight of 95 kg and BMI of 34.89. There were clear evidences of acanthosis nigricans on neck and hirsutism with prominent hair growth on chin and upper lip during physical examination. The findings obtained on per vaginal and per speculum examinations were clitoromegaly, bulky uterus, eroded cervix and abnormal vaginal discharge. USG reports showed both ovaries with polycystic morphology, and 12 cc volume of each ovary. Uterus measured 75 × 34 × 38 mm and ante-verted.

4. Diagnostic assessment

On detailed evaluation of subjective and objective parameters patient was diagnosed as primary infertility associated with PCOS. From Ayurvedic perspective this condition could be considered as Vandhyatva associated with Nashtartava where Avarana (enclosure) of Artavavavaha srotas (channel transporting Artava) Kapha Medoduṣhti and Srotorodha became the causative factors. Detailed analysis of her signs and symptoms showed the increase of Vata Kapha and reduction of Pitta [ 7 ]. Considering all those factors treatment principles of Vandhya, Nashtartava and Medohara were followed in this case.

5. Therapeutic intervention

Table 2 .

Table 2

Therapeutic intervention.

These set of medicines were continued for a period of 3 weeks. Once the functioning of Agni is maintained through the above said group of medicines, Shodhana therapies were executed, which are detailed in Table 3 , Table 4 .

Table 3

Table 4

Medicines used.

6. Follow-up and outcomes

After the treatment body weight of the patient reduced to 75 kg and BMI was found to be 27.43. Her menstrual cycle became frequency improved substantially. On per speculum examination it was observed that abnormal vaginal discharge and other visible changes due to cervicitis reduced considerably.

7. Discussion

The diagnosis was confirmed as primary infertility associated with PCOS. According to Ayurveda this disease is Vandyatwa due to Nashtartava where Avarana of Artavavaha srotasa becomes the chief causative factor [13, Sharira sthana 2/21]. The Nidana (causative factors) attributed could be Avyayama (sedentary) and intake of excess Abhishyandi Ahara leading to Kapha Medo Dushti and Srotorodha. Here the movement of Vata especially Apana vata got obstructed by the increased Kapha which in turn obstructed the natural functioning of Arthava also. According to Ayurveda disintegration of Samprapti (pathogenesis) is the way to treat any disease. In this case we can consider Kapha and Vata as Dosha , Rasa , Rakta , Mamsa , Medas as Dooshya . Rasavaha, Rakthavaha, Mamsavaha, Medovaha and Arthava vaha are involved in the etio-pathogenesis of the disease. Samga (blockage) and Granthi (cyst) can be considered as their Dushti karana (vitiating factor) . Site of origin of the disease is Koshta and the specific site of manifestation is Garbhashaya (uterus).

The ultimate aim of the treatment was to release the obstructed Vata and to enable its normal functioning in the Koshṭa especially in Garbhasaya . The obstruction was because of the accumulated Kapha in the channels of Vata especially in Arthavavavaha Srotas . The combination of Chiruvilvadi kwahta and Vaisvanara Churna is VatakaphaShamana in its action along with added benefits including kindling the Agni and alleviating the Moodhavata . The other set of medicine, Nirgundyadi kashaya and Triphala gugulu is also Kapha Shamana with an added property of Kriminashana . As a result, Kapha might have been pacified and thus the pruritus and abnormal vaginal discharge diminished. Annabhedisindoora is Chedana, Lekhana, Vatakapha Shamana with a specific action Rajapravarthaka when given with Jambira Svarasa as Sahapana it becomes Deepana, Anulomana and also induces the bleeding.

Once the expected outcome from Purva karma is obtained, it was decided to move to the next phase- Shodhana therapies. As Kapha and Meda became the key factors for the development of the disease, it was decided to opt Ruksana procedure as a preliminary step. Udvarthana along with Takrapana was Kaphamedonasana by default [[ 11 ], Sutrasthana 2/15], [[ 11 ], Sutrasthana 5/33]. It took 9 days to obtain Rukṣaṇa [[ 11 ], Sutrasthana 16/35]. The next step was Snehapana with plain Sarṣhapa taila which became the ideal medicine for Snehana in the conditions where predominance of Kapha and Vata . It was decided to go for Accha Snehapana and the initial dose given was 25 ml. It took total 6 days to observe the ideal signs and symptoms which were expected to occur after Accha Snehapana . After Abhyanga Swedana and Utklesana, Vamana was the selected Shodhana therapy because of the involvement of Kapha doṣa [[ 11 ], Sutrasthana 1/25]. The standard operative procedure of Vamana was carried out and the symptoms of Samyak yoga including Pittadarsana were obtained. Then Virechana was administed using Gandharva hastadi eraṇḍa taila .

It was decided to administer Basti as a next step because of the involvement of Vatadoṣa. Specific indications including Rajonasa also pointed to the necessity of Basti Anuvasana basti was given with Pipalyadi Anuvasana taila which is Vata Anulomana and KaphaShamana in nature [[ 11 ], Sutrasthana 19/2–3]. For achieving the complete relief from Kaphamedovruddhi, Lekhana Basti which is a modified form of Eraṇḍa moola kvatha basti was selected [[ 11 ], Kalpasthana 4/7–10]. Uttarabasti which forms the prime treatment in Garbhasaya roga was also administered during the course [[ 11 ], Sutrasthana 19/70]. Mahanarayana taila which is Brimhna, VataShamana with an added indication in Vandhyatva was selected as Uttara Basti medicine. Uttara Basti was repeated on 12th, 13th and 14th days of her next menstrual cycle. Shodhana treatment may have contributed in reduction of fat deposits and acceleration of the maturation of graffian follicles. Thus, the follicles ruptured and ovulation occurred detected in USS on 8/07/2019. She was given Phalasarpis to improve quality of endometrium and achiveving Garbhasthapana . Urine pregnancy test was suggested after a week of absence of menses and the result found to be positive [[ 11 ], Utaratantra 34/63–67].

She delivered a female baby on 8/3/2020 through LSCS. Each andevery phase of the management were monitored and recorded carefully. Through the Ayurvedic interventions it took a total of 8 months to get the positive result (as the initial visit of the patient in OP was on 11/10/2018). While she conceived, her date of LMP was 22/06/2019. The successful outcome in the present case signifies the relevance of logical selection of medicines according to the stage, judicious combination of internal medicines, procedures, diet and regimen for the complete cure of the disease.

8. Conclusion

This case report shows an insight into systematic learning how to manage primary infertility associated with PCOS effectively through Ayurvedic treatment modalities. The result obtained in this single case study is encouraging and the protocol followed here may be subjected for trial in larger samples.

Informed consent

Written consent was obtained from the couple for the purpose of publication of their clinical details.

Source of Funding

No funding sources.

Conflict of Interest

None declared.

Author contributions

M.A. Asmabi was the physician responsible for the assessment, treatment plan and interaction with the patient.

M..K. Jithesh contributed in data analysis, interpretation, discussion and drafting of the case report.

Acknowledgment

The authors would like to thank Dr. P. Rammanohar, Research Director, Amrita school of Ayurveda and Dr Mukesh E, Assistant professor, Dept of Roga N idana , VPSV Ayurveda college, Kottakkal for their valuable guidance.

Peer review under responsibility of Transdisciplinary University, Bangalore.

Journal of Clinical Case Reports

ISSN: 2165-7920

Case Report - (2024) Volume 14, Issue 1

Ayurvedic Management of Autism - A Single Case Study

Received: 20-Dec-2023, Manuscript No. jccr-23-123152; Editor assigned: 22-Dec-2023, Pre QC No. P-123152; Reviewed: 05-Jan-2024, QC No. Q-123152; Revised: 11-Jan-2024, Manuscript No. R-123152; Published: 18-Jan-2024 , DOI: 10.37421/2165-7920.2024.14.1590 Citation: Dhuri, Kalpana and Drakshya Dipanita Das. “Ayurvedic Management of Autism - A Single Case Study.” J Clin Case Rep 14 (2024): 1590. Copyright: © 2024 Dhuri K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

A five years old known case of Autism Spectrum Disorder (ASD) is being treated with integrative approach with the combination of Ayurvedic medicines and panchakarma procedures. Patient was taking occupational and speech therapy more than one year with very little improvement in symptoms. Ayurvedic panchakarma procedures such as Nasya therapy (administration of medicines through nose), Rajyapana Basti (medicated enema) along with some Ayurvedic medicines orally. ISAA score and symptoms of patient were assessed every 15 days for 3 months. Patient had shown substantial improvement in social communication, language, eye contact, hyper activeness.

Autism spectrum Disorder • ISAA • Ayurveda

Introduction

Autism Spectrum Disorder (ASD) involves refraining social communication, repetitive behaviour and constrained activities [ 1 ]. In some cases there may be a genetic condition. ASD begins before the age of 3 years and can last throughout a person’s life [ 2 ]. In some cases with ASD, the young ones attain new skills and grow well as per milestones up to age of 18 to 24 months and then suddenly stop further development [ 3 ]. The children with ASD may have difficulties evolving and retaining friendships, communicating socially or understanding what behaviours are expected in school or outside [ 4 ]. Prevalence of autism is ~1% globally which is accepted by WHO [ 5 ]. In India, as per the report by Choudhari KS, et al. [ 6 ] ASD prevalence across five States in north and west India was as high as one in 125 children between 2-6 years age group and one in 80 among children in 6-9 years age. In India the prevalence is estimated to be 1in 89 [ 7 ].” Autism is a neurodevelopmental disease that has not been directly mentioned in Ayurvedic Samhitas though some Ayurvedic physicians correlate it with unmaada as there is a similarity in symptoms [ 8 ]. ISAA is the Indian scale For Assessment of Autism in Indian children [ 9 , 10 ]. We hereby report a case of Autism assessed by ISAA and treated based on Ayurvedic fundamentals.

Case Presentation

Patient information

A five years old boy was brought by his mother to D Y Patil School of Ayurveda Outdoor Patients Department of Kaumarbhritya (Ayurvedic Paediatrics), Navi Mumbai, India. The mother reported that the child was unable to concentrate, not paying attention to the instructions, making unnecessary noises and shouting, no initiation of social interaction, poor eye contact, failure to respond if called out by his name, impaired body postures and gestures, not following toilet training, constipation, temper tantrum since 10 months.

Case history of the patient

The patient was the second child of non-consanguineous marriage. Patient was born at full-term baby through vaginal delivery weighing 2600 gms. Child cried immediately after the delivery. He was on exclusive breast feeding for 7 months. Weaning was started at the age of 4 months. Immunization schedule was given as recommended by IAP (Indian Association of Pediatrics).

Motor development was normal, delayed language and social development was observed. According to mother child did not respond to commands or name calling. He did repetitive stereotypic movements. His sleep was disturbed and he continuously made different sounds. He was always fibbing with something. He never used to sit at one place. His concentration span was not more than 5 min. The patient watched mobile more post corona. The parent reported that they used to calm him down with mobile screening.

Clinical findings

On examination the child was moderately built and nourished. His growth percentile was 75. He was hyperactive and irritable and had poor eye contact. He was producing shrieking sound repeatedly. He did not respond to any instructions. Even after giving some toys he refused to play. Growth parameters and vital signs were within normal limits. No abnormality was detected in respiratory system. The cranial nerves, motor system, reflexes, sensory system and gait were normal with absence of cerebellar abnormal signs.

The patient had developing symptoms such as child is unable to concentrate, not paying attention to the instructions, making unnecessary noises and shouting, no initiation of social interaction, poor eye contact, failure to respond if called out by his name, impaired body postures and gestures, not following toilet training, constipation, temper tantrum since 10 month. The timeline of clinical events in the case is described in Table 1 .

The investigations revealed that his haemoglobin was 12.5 gm%, Vit D (25 hydroxy D) was 22 ng/ml serum calcium was 9.2 mg/dl. There was no abnormality reported in urine and stool. Auditory test (BERA) was done and shows no abn ormality.

Diagnosis assessment

The ISAA score of patients at baseline was 122. ISAA is Indian Scale for Assessment of Autism.

Intervention

The child was given Musta ( C. rotundus ) churna 125 mg with Shunthi ( Z offcinale ) churna 25 mg twice a day for 5 days. Normal regular vegetarian diet was advised. The mother was told not to give oily spicy food, junk food and aerated drinks. Also Screen time was strictly reduced to 30 min per day. After 5 days, Yastimadhu ( G. glabra ) ghrita 5 ml warm was given once a day. Bramhi ghana vati 125 mg twice a day with warm water was given in powdered form. A mixture of Jyotismati ( C. paniculata ), Bramhi ( B. monneri ), Sankhapuspi ( C. pleuricaulis ) 125 mg was given two times a day along with honey for 30 days.

The patient was advised for jihwa pratisaran (application of mixture on the tip and side of tongue) with Vacha choorna ( A. calamus ) for 15 days. The child was given Abhyangam (full body massage) with Ksheerbala tailam and Nadisweda (fomentation) with Dashmool kwath for 7days. After which Rajayapana Basti was given for 16 days. Basti is the administration of medicines through anal route. 20 ml of basti (medicated enema) was given through anal route daily morning at 10 in the morning for 16 days. Shirodhara (continuous dripping) of Bala ( S. cordifolia ) oil and Brahmi ( B. monnieri ) oil in equal proportion was given for 10 min for 15 days. The screen time for patient was restricted to half an hour dalily. Patient was advised to continue occupational and speech therapy along with all medication.

The Assessment Scale for Autism (ISAA) was done on the first day (Baseline) and later 30 th , 60 th , 90 th day. All vital parameters were normal. The patient was followed up for all symptoms every 15 days. The child had malakathinya (hard stools) and passed stools once in two days earlier. After treatment from third day, he started passing the stools twice a day. The sleep improved in 15 days. The patient started responding after calling his name in 15 days. After 30 days, patient also started answering to the question as what is his name. After 60 days child was able to say A to Z letters and could point out different pictures when asked about them. In 90 days child started interacting with peers happily. The hyperactivity was reduced post 30 days of treatment. In 90 days, the child’s concentration span increased from 5 min to almost 15 min [ 11 ].

After 90 days of treatment the autism score was gradually decreased from 122 to 99. As per Charakacharya any disease can be treated when dosha dushya samurchana (Configuration of Dosha and the vitiated tissues and systems involved) and samprapti (Pathogenesis)is known [ 12 ]. We developed a protocol following Ayurvedic Fundamentals (Chikitsasutra) to manage this case of autism. Vata prakopa causes irrelevant speech (Udan vayu) [ 13 ] and hyperactivity (Vyan vayu). Medha (intelligence and wisdom, concentration) is disturbed when pitta gets vitiated [ 14 ]. The neurodevelopmental changes can be attributed to vitiated Vata and Pitta. Annavaha (Digestive system), Rasavaha (lyphatic) and Monovaha srotas (neurobehavioral) are involved.

Musta ( C. rotundus ) in addition to its action on digestion and metabolism; also acts as neuroprotective which has been confirmed experimentally [ 14 , 15 ]. Shunthi ( Z. officinale ) is also antioxidant and anti-inflammatory [ 15 ].

Bramhi ( B. monnieri ) is a well-known medhya rasayan that enhances cognitive functions [ 16 ]. Earlier Choudhari KS, et al. [ 6 ] have reported significant improvement in cognitive function including memory of medical students in a 6 weeks randomised double blind placebo controlled study. In another in-vivo model of Autism Spectrum Disorder in rats; where Brahmi extract showed significant improvement in abnormal behavioural patterns such as social deficits, repetitive behaviour, learning and memory impairments, and motor coordination [ 17 ]. Yastimadhu ghrita 5 ml was given once a day. Yastimadhu ( G. glabra ) is also medhya as well as is good for language and speech development [ 18 ]. It has been proven for nootropic cativity [ 19 ]. Patient has delayed language development. Vacha churna was given as jihwa pratisarana. (local application on tongue). Vacha ( A. calamus ) is Dipaniya, (helps to increase appetite) Medhya, (Memory concentration, intelligence) Kanthya specifically for language development. Acorus calamus methanolic extract significantly reversed stereotypical behaviour and catalepsy in mice [ 20 ].

Vata is tantayantadhara which means the controller of all movements [ 21 ]. In autism there is a prakopa (vitiation) of Vata. Basti(administration of medicines through anal route) is the best treatment for vata prokopa [ 22 ]. Earlier Shailaja U, et al. [ 23 ] have reported excellent results with yapana basti in understanding ability, speech and in fine motor functions. Patient was also given shirodhara with Bramhi taila and Ksheerbala taila. Shirodhara is a method where oil or any medicated liquid is dripped over a forehead in a continuous stream. Earlier Dhuri and Vaidya had given shirodhara and found excellent results in alpha and theta waves in EEG mapping post shirodhara indicating its stress reducing activity [ 24 ].

Parent perspective

The parent reported that his hyperactivity is reduced and his concentration span which was five minutes has increased up to fifteen minutes. The child started sitting at one place for more than an hour. Earlier the child was denied the admission in the school. The same school happily gave the admission for this child.

Autism has seen to be increased post corona periods may be because of increased screening time. The earlier the diagnosis, better are the chances of improvement. Following basic fundamentals (Chikitsasutra) of Ayurveda can give good results. Single-case reports provide the leads to large group randomized studies. This case can give a hope to further research in this area.

Acknowledgements

We would like to thank the parents, who consented to have their child case presented and published.

Financial Support and Sponsorship

Conflicts of interest.

There are no conflicts of interest.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the parents have given their consent for his images and other clinical information to be reported in the journal.

The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Credit Author Statement

KD treated the patient. DDD analysed and interpreted the data. KD and DDD drafted the article. KD helped in editing.

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Research on aerodynamic characteristics of three offshore wind turbines based on large eddy simulation and actuator line model.

1. Introduction

2. numerical method, 3. verification and validation, 3.1. single turbine parameter settings, 3.2. results of the mesh independence test, 3.3. comparison and validation with existing literature results, 4. three-turbine array configuration, 4.1. three-turbine configuration and computational domain grid division under full wake cases, 4.2. cases of three turbines under staggered arrangement, 5. comparative analysis of three-turbine simulation results, 5.1. three turbines under full wake conditions, 5.1.1. comparison of aerodynamic performance results, 5.1.2. comparison of wake characteristics results, 5.1.3. unsteady aerodynamic characteristics of three turbines under full wake conditions, 5.2. three turbines under staggered cases, 5.2.1. comparison of aerodynamic performance results, 5.2.2. comparison of wake characteristics results, 5.2.3. unsteady aerodynamic characteristics of three turbines under staggered conditions, 6. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest, abbreviations.

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Fu, C.; Zhang, Z.; Yu, M.; Zhou, D.; Zhu, H.; Duan, L.; Tu, J.; Han, Z. Research on Aerodynamic Characteristics of Three Offshore Wind Turbines Based on Large Eddy Simulation and Actuator Line Model. J. Mar. Sci. Eng. 2024 , 12 , 1341. https://doi.org/10.3390/jmse12081341

Fu C, Zhang Z, Yu M, Zhou D, Zhu H, Duan L, Tu J, Han Z. Research on Aerodynamic Characteristics of Three Offshore Wind Turbines Based on Large Eddy Simulation and Actuator Line Model. Journal of Marine Science and Engineering . 2024; 12(8):1341. https://doi.org/10.3390/jmse12081341

Fu, Chen, Zhihao Zhang, Meixin Yu, Dai Zhou, Hongbo Zhu, Lei Duan, Jiahuang Tu, and Zhaolong Han. 2024. "Research on Aerodynamic Characteristics of Three Offshore Wind Turbines Based on Large Eddy Simulation and Actuator Line Model" Journal of Marine Science and Engineering 12, no. 8: 1341. https://doi.org/10.3390/jmse12081341

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