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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 99-105

A comparative clinical evaluation of “Varuna Kwatha” and “Kanchnara Triphala Kwatha” in the management of Dhatvagnimandhya with special reference to hypothyroidism


Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India

Date of Submission04-Jul-2021
Date of Decision14-Oct-2021
Date of Acceptance29-Nov-2021
Date of Web Publication4-Jul-2022

Correspondence Address:
Rani Gurmeet
Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_202_21

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  Abstract 


Introduction: Hypothyroidism is one of the most common thyroid disorders in India, its incidence increasing day by day. The current issue was chosen for research and its treatment by using Ayurvedic principles due to the vast range of the disease and its high incidence in society. The aim of the present study is to compare the efficacy of Varuna Kwatha and Kanchnara Triphala Kwatha in the management of Dhatvagnimandhya (Hypothyroidism). Methods: This was a randomized, interventional type and comparative study, in which 30 confirmed hypothyroidism patients with elevated serum thyroid-stimulating hormone >.5 μIU/ml were selected and treated with Varuna Kwatha and Kanchnara Triphala Kwatha for 30 days. To measure the unbiased impact of treatments, patients were instructed to stop using any hypothyroidism medications they were consuming. Results: Both the groups showed statistically highly significant (P < 0.001) improvement in tiredness, weakness, dyspnea, and dry coarse skin, while in a hoarse voice, hypomenorrhea, menorrhagia, oligomenorrhea, and cold intolerance, the groups showed the insignificant result. In objective parameters, both groups showed highly significant results (P < 0.001) in decreasing weight and body mass index. Both the groups showed insignificant result in T3, T4 parameters. Group A showed a 5.08% decrease in TSH, but statistically, it was insignificant, while Group B showed a significant result (P = 0.0234) with 30.54% relief. Conclusion: Kanchnara Triphala Kwatha showed better results than Varuna Kwatha.

Keywords: Hypothyroidism, Kanchnara Triphala Kwatha, Varuna Kwatha


How to cite this article:
Gurmeet R, Ajay SK, Rashmi M. A comparative clinical evaluation of “Varuna Kwatha” and “Kanchnara Triphala Kwatha” in the management of Dhatvagnimandhya with special reference to hypothyroidism. J Ayurveda 2022;16:99-105

How to cite this URL:
Gurmeet R, Ajay SK, Rashmi M. A comparative clinical evaluation of “Varuna Kwatha” and “Kanchnara Triphala Kwatha” in the management of Dhatvagnimandhya with special reference to hypothyroidism. J Ayurveda [serial online] 2022 [cited 2022 Aug 10];16:99-105. Available from: http://www.journayu.in/text.asp?2022/16/2/99/349763




  Introduction Top


Hypothyroidism is a condition in which the body's metabolic demands are not fulfilled due to low thyroid hormone production.[1] Around 200 million population in the world is suffering from hypothyroidism. TSH levels exceeding 10 mIU/l were found to be seven times more frequent in females than males in population-based studies.[2] Levothyroxine has to be taken life long and the more common side effects of levothyroxine can include increased appetite, weight loss, heat sensitivity, restlessness, weakness of muscle, osteoporosis.[3] Hence, there is a need for drugs having good efficacy without side effects. Thyroxine's main purpose is to increase oxygen consumption and metabolism in each of the body's cells.[4] In Ayurveda, Agni (Jatharagni, Dhatvagni, and Bhutagni) in our body causes transformations/metabolism of tissue at various levels, hence sustaining the basal metabolic rate.[5] Irregular diet pattern, sedentary lifestyle, and stress cause Jatharagnimandhya, Ama (partially digested matter) formation resulting in Sama Rasa Dhatu Vriddhi, formation of Malaroopi Kapha, and it vitiates Rasavaha Srotas.[6] Similar properties of Kapha and Meda cause more synthesis of Meda Dhatu and obstruct the channels of Medovaha Srotas and hinder the synthesis of Asthi, Majja, and Shukra Dhatu.[7] Vitiated Rasa and Meda Dhatu symptoms are similar to hypothyroidism. Looking into the clinical presentation of hypothyroidism, Mandagni, and Ama formation, the involvement of Tridosha can be thought of, in which Kapha Dosha is the main culprit associated with Pitta Kshaya and Vata Vriddhi, Rasavaha, and Medovaha Strotodushti predominantly. On the basis of clinical symptoms of hypothyroidism, there is predominantly vitiation of Vata and Kapha and the trial drug Varuna Kwatha and Kanchnara Triphala Kwatha was chosen on the basis of their Vatakaphahara quality. Varuna bark extract possesses antihypothyroid activity. Kanchnara is widely being practised for the management of hypothyroidism. Thus, keeping in mind the possible effects of trial drugs, they were selected to evaluate their efficacy in the management of hypothyroidism.


  Materials and Methods Top


Methodology

Aim and objective

The present study aim is to compare the efficacy of Varuna Kwatha and Kanchnara Triphala Kwatha and objective of the study was to evaluate clinical efficacy of Varuna Kwatha and Kanchnara Triphala Kwatha in the management of Dhatvagnimandhya W. S. R. to hypothyroidism.

Study design

This was a open-label, randomized, interventional type, comparative study. Only those patients affected with hypothyroidism with elevated serum thyroid-stimulating hormone (TSH) >5.5 μIU/ml were randomly divided into two groups as per the inclusion and exclusion criteria, with each group having 15 individuals. To measure the unbiased impact of treatments, patients were instructed to stop using any hypothyroidism medications they were consuming. All the individuals had given written consent prior to commencement of the trial. Random allocation sequence was generated by using a computer program that generates the random sequence.

Inclusion criteria

Patients between the ages of 18–60 years of either sex and who are newly diagnosed or mild case of hypothyroidism with increased TSH levels (more than 5.5 μIU/ml and <30 μIU/ml), patients who are ready to switch over to Ayurvedic medicine and have signed the consent form and who are already diagnosed as hypothyroidism and under levothyroxine medication but still presented with the increased TSH level, and patients who had discontinued using levothyroxine before the starting of the trial were included in the study.

Exclusion criteria

Patients suffering from congenital hypothyroidism and secondary hypothyroidism; pregnant women; patients with hyperthyroidism, neoplasia, and toxic goiter; patients who have any type of thyroid surgery; patients whose symptoms are worsely aggravated after leaving the modern drug levothyroxine (for washout period of 1 month); mentally ill/retarded patients; and patients with drug-induced hypothyroidism were excluded from the study.

Materials

Sample size

A total of 30 patients were registered with 0 dropouts. All patients had completed treatment.

Method of preparation of drugs

In Varuna Kwatha, stem bark of Varuna was taken and prepared it in Yavakuta form. In Kanchnara Triphala Kwatha, the bark of Kanchnara and fruits of Amalaki, Haritaki, and Bibhitaki were used and all contents were used in equal quantity and were prepared in Yavakuta form. For Prakshepa, fine powder of Pippali was prepared. All medicines were prepared in the pharmacy.

Posology

In Group A, the trial drug was Varuna Kwatha with Maakshika Prakshepa.[8] The dose of Kwatha was 40 ml with 10 ml Prakshepa. In Group B, the trial drug was Kanchnara Triphala Kwatha with Pippali Prakshepa.[9] The dose was 40 ml with 500 mg Prakshepa.[10] The time of administration was before food in the morning and evening time. For the preparation of Kwatha, patients were advised to boil 20 g of Yavakuta in 16 times amount of water and reduce it to one-eighth over low heat and consume it twice daily. The duration of therapy was for 30 days.

Ethical approval

The plan of the research study was accepted by the Ethical Committee under reference no. IEC/ACA/2019 dated May 28, 2019. The research study was registered in CTRI on April 15, 2020, with registration no. CTRI/2020/03/024124

Criteria for assessment

The following parameters were assessed before treatment and 30 days after completion of the treatment course with subjective parameters as weakness, tiredness, hair loss, constipation, dyspnea, hoarseness of voice, oligomenorrhea, hypomenorrhea, menorrhagia, dry coarse skin, cold intolerance, puffy face and peripheral edema, and bradycardia and objective parameters, i.e., thyroid profile, body weight, and body mass index (BMI). Patients were assessed at 0th day and 30th day after completion of the trial.

Statistical analysis

For intragroup comparison in nonparametric data, Wilcoxon signed-rank test was used, and for intergroup comparisons, Mann–Whitney test was used to check the result of intervention in subjective criteria. For intragroup comparison in parametric data, Student's Paired t-test was used and in intergroup comparisons for parametric data, unpaired t-test was used. Aspire software international company software Sigma Stat 4.0 from United state was used on data obtained by various parameters, results were calculated in terms of mean, standard deviation (SD), and standard error, etc.


  Results Top


Result of subjective parameter in Group A

In Group A, patients were treated with Varuna Kwatha with Prakshepa of Maakshika, which showed highly significant results (P < 0.01, P < 0.001) in following subjective parameter tiredness, weakness, dyspnea, and dry and coarse skin, with % relief 76.47%, 77.77%, 73.07%, and 31.11%, respectively. Puffy face and peripheral edema showed significant results (P < 0.05) with 63.63% relief. Other subjective parameters, i.e., hair loss, constipation, hoarse voice, oligomenorrhea, hypomenorrhea, menorrhagia, and cold intolerance, showed insignificant results (P > 0.05) [Table 1].
Table 1: Effect of intervention over subjective parameters

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Result of subjective parameter in Group B

In Group A, patients were treated with Kanchnara Triphala Kwatha with Prakshepa of Pippali, which showed highly significant results (P < 0.01, P < 0.001) in the following subjective parameters: tiredness, weakness, hair loss, dyspnea, dry and coarse skin, puffy face, and peripheral edema with % relief 84.37%, 95.65%, 46.87%, 83.33%, 45.45%, and 100%, respectively. There was a 100% relief in constipation which shows significant results (P < 0.05). Other subjective parameters, i.e., hoarse voice, oligomenorrhea, hypomenorrhea, menorrhagia, and cold intolerance, showed insignificant results (P > 0.05) [Table 1].

Result of objective parameter in Group A

Body weight and body mass index

At baseline, the mean value of body weight was 67.267, SD ± 7.713. After 30 days of intervention, the mean value was 66.067, SD ± 7.363. It was highly significant (P < 0.001) with 2.58% relief. At baseline, the mean value of BMI was 26.467, SD ± 3.237. After 30 days of intervention, the mean value was 25.973, SD ± 3.078. It was highly significant (P < 0.001) with 1.80% relief.

Thyroid function test

At baseline, this test showed that the mean serum values of TSH, triiodothyronine (T3), and thyroxine (T4) were 10.939, SD ± 3.768 μIU/mL, 0.989, SD ± 0.151 ng/mL, and 7.249, SD ± 1.743 μg/dL, respectively. After 30 days of intervention, the mean serum levels of TSH, T3, and T4 were noted as 10.383, SD ± 13.655 μIU/mL, 0.945, SD ± 0.218 ng/mL, and 7.399, SD ± 2.615 μg/dL, respectively. Results were statistically insignificant (P > 0.05) with 5.08%, −4.58%, and 2% relief in TSH, T3, and T4, respectively [Table 2].
Table 2: Effect of intervention over objective parameters

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Result of objective parameter in Group B

Body weight and body mass index

At baseline, the mean value of body weight 65.447, SD ± 8.344. After 30 days of intervention, the mean value was 64.420, SD ± 9.024. It was highly significant (P < 0.001) with 1.72% relief. At baseline, the mean value was BMI 25.887, SD ± 2.884. After 30 days of intervention, the mean value was 25.507, SD ± 2.963. It was highly significant (P < 0.001) with 1.52% relief.

Thyroid function test

At baseline, the mean serum values of TSH, triiodothyronine (T3), and thyroxine (T4) were 14.627, SD ± 7.098 μIU/mL, 1.091, SD ± 0.391 ng/mL, and 15.187, SD ± 27.916, μg/dL, respectively. After 30 days of intervention, the mean serum levels of TSH, T3, and T4 were noted as 10.159, SD ± 7.704 μIU/mL, 1.370, SD ± 1.302, ng/mL, and 16.207, SD ± 30.703 μg/dL, respectively. TSH showed statistically significant result (P < 0.05) with 30.54% relief. Results were statistically insignificant (P > 0.05) with 20.3% and 6.2% relief in T3 and T4, respectively [Table 2].

Intergroup comparison

Intergroup comparison of both groups showed statistically insignificant results (P > 0.05) which means that there is no statistical difference in efficacy of both treatments on all subjective parameter except hair loss. Hair loss showed significant results (P < 0.01) and objective parameters of both groups showed insignificant results (P > 0.05) [Table 1] and [Table 2].


  Discussion on Observation Top


In this study, 93.33% of patients were female. According to modern science, it is due to hormonal imbalances and fluctuations during menstrual cycles, premenopause and menopause, during pregnancy, and after childbirth. Another cause may be due to their comparative sedentary lifestyle and household stress. Levels of progesterone fall during stress, allowing estrogen to easily flow throughout the body. The immune system's inflammatory response can be boosted by estrogen. Estrogen may have a role in the thyroid gland's onslaught.[11] About 73.33% belonged to urban areas. It may be due to stressful and sedentary lifestyles among urban residents. About 60% of patients had a history of Mandagni. This shows the predominance of Kapha Dosha. In this study, Aaharaja Nidana of the patient was Abhishyandhi food (66.66%), high calorie diet Dadhi (83.33%), Madhura Rasa dominant diet (56.66%), Adhyasana (40% eating before the digestion of previous food), Vishmashana (26.66% taking diet before or after the actual time for meals). Viharaja Nidana of the patient was Avyayama (43.33%) and daytime sleep (66.66%) and in Manasika Nidana stress was found as a causative factor in 56.67% patients. These etiological factors cause Jatharagnimandhya, Malaroopi Kapha formation, and vitiate the Rasavaha Srotasa (microchannels for transportation of assimilated food and lipid contents) and Medovaha Srotasa.

Discussion on subjective parameter

Weakness is caused by Samarasa Dhatu Vriddhi and due to Kapha Dosha Vriddhi. Tiredness and dyspnea both are Rasapradoshaja and Medopradoshaja Vikara. Mandagni causes vitiation of Rasa Dhatu which leads to a lack of Prinana (nutrition) of the Deha resulting in decreased Dehabala and causes symptoms such as weakness and tiredness. Varuna Kwatha and Kanchnara Triphala Kwatha have Kaphavatashamaka property and by its Kashaya Rasa absorbs Meda, Kleda, and Kapha Dosha.[12] Kashaya Rasa eliminates the blockage and cleans Srotas through the Shodhana property.[13] Tikta Rasa has Deepaniya, Pachaniya, and also Lekhana, Shodhana property. The Srotas are scraped by the Lekhana Guna, which eliminates extra Kapha and Meda.[14] Deepana- Pachana- property of the drug does Ama Pachana and Agnideepana. Agnideepana leads to the proper formation of Rasa Dhatu and relieves symptoms of weakness and tiredness. Kanchnara Triphala Kwatha group patients showed better percentage improvement in weakness and tiredness than Varuna Kwatha group. Triphala, due to its Rasayan property, helps one to attain longevity, memory, intelligence, disorder-free living, youthfulness, luster, and complexion.[15] Hair loss can be caused by decreased formation or vitiate Asthi Dhatu. As hairs are the waste product of Asthi Dhatu and are dependent on Asthi Dhatu for nutrition, hair loss is caused by decreased formation or vitiation of the Asthi Dhatu. Shodhana property of Kanchnara Triphala Kwatha and Varuna Kwatha removes obstruction from Medovaha Srotas and results in proper formation of Meda Dhatu and Asthi Dhatu. In this study, Kanchnara Triphala Kwatha group patients showed better improvement in hair loss than Varuna Kwatha group. Triphala is a strong hair tonic that stimulates the follicles and roots, promoting hair growth. Amla in Triphala also helps to restore the scalp's proper pH balance and keeps hair healthy.[17] Adhyasana and hypofunctioning of Agni are the cause of Purishavaha Srotodushti.[18] Constipation (Vibandha) occurs due to vitiation of Vata Dosha, especially Apana Vata.[19] Ama in the Koshtha obstructs the free movement of Samana Vayu and Apana Vayu. Ama itself when mixes with Purisha makes it abnormal and sticky, which causes the elimination process difficult. Constipation can impair hormone clearance and cause an elevation in estrogen, which, in turn, raises thyroid-binding globulin levels and decreases the amount of thyroid hormones available to the body.[20] Both groups showed 100% improvement in constipation. Dry coarse skin is caused by vitiation of Vata and depletion of Rasa. Both the drugs possess Kapha-Vatashamaka property. Triphala has potent antioxidant property, radical-scavenging ability, delaying cellular senescence, building structural proteins such as collagen and elastin, and restoring skin barrier function along providing hydration to the skin.[21] Kanchnara Triphala Kwatha group showed better percentage relief in dry coarse skin than Varuna Kwatha. Cold intolerance is caused by Kapha and Vata vitiation and was pacified by Kapha-Vata suppression property of formulation. Kanchnara Triphala Kwatha showed 46.15% improvement and Varuna Kwatha showed 38.46% improvement. Puffy face and peripheral edema are caused by vitiation of Kapha Dosha. This is a condition that occurs due to the accumulation of waste products and fluids in the body due to low thyroid function. Due to Shodhana and Kleda Shoshana property of drug patients got relief in puffy face and peripheral edema symptoms. Kanchnara Triphala Kwatha group showed better percentage relief in puffy face and peripheral edema than Varuna Kwatha. Hoarseness of voice is caused due to the vitiation of Vata Dosha. There was no improvement in hoarseness of voice. Menstrual irregularities are caused by vitiated Rasa Dhatu. Every month, after adequate digestion of food, there is proper formation of Rasa Dhatu.[22] The Updhatu of Rasa Dhatu, i. e., Raja, becomes vitiated together with Mala Kapha during the Dhatuparinamana process. Hypothyroidism cause increased synthesis of thyroid-releasing hormone, which triggers the pituitary to release thyroid-releasing hormone and prolactin. Stress can cause hyperprolactinemia.[23] Due to this, monthly irregularities can arise, delaying ovulation and infertility. Animal studies have shown that Triphala reversed stress-induced behavioral alterations and biochemical changes such as increased lipid peroxidation and corticosterone levels.[24] Varuna Kwatha showed 40% improvement and Kanchnara Triphala Kwatha showed 100% improvement in oligomenorrhea patients. The above data may give an idea about Tridoshaja nature of disease with predominant affection of Kapha and Vata Dosha and Kshaya of Pitta with involvement of Rasa and Meda Dhatu.

Discussion on objective parameters

Fluid retention and extravascular deposit of albumin or other proteins contribute to weight gain. In Ayurveda, Kapha vriddhi and abnormal increase of Meda Dhatu results in increasing of weight. Both drugs showed highly significant results in weight reduction due to their Kleda, Meda, and Kapha Doshahara properties. Varuna Kwatha showed a 5.08% improvement in decreasing serum TSH, 2% improvement in increasing T4, but it decreases the T3 level to 4.58%. In a pharmacological study, Crateva nurvala bark extract, i. e., ethanolic, has been shown to maintain the normal thyroid function by retaining iodothyronine deiodinases activity at greater dosages, promoting the peripheral exchange of T4 into T3, and maintaining normal thyroid gland histoarchitecture in contrast to a smaller dose.[25] Kanchnara Triphala Kwatha reduced overall TSH level 30.54% and level of T4 increase 6.2% and T3 level increase 20.3%. Triphala has Tridoshahara properties and supports healthy digestion and absorption. It is a powerful antioxidant, protecting cells from the damage of free radicals.[26] Piper longum increases the absorption of selenium, whose deficiency can impair thyroid function because the conversion of T4 into T3 is catalyzed by specific selenoproteins.[27]

Mode of action

Varuna Kwatha and Kanchnara Triphala Kwatha by their Kashaya Rasa absorbs Meda, Kleda, and Kapha Dosha and corrects the Srotosavrodha through the Shodhana Property. Madhura Rasa of both the drugs boosts all Dhatu and Oja. Honey's fatty acids help to increase peristalsis and digestion, reduce flatulence, and boost overall metabolism. Triphala has traditionally been used to treat constipation, indigestion, and poor meal absorption.[28],[29] Pippali has been stated to be “Yogvahi Dravya.” Piperine active compound of Pippali is a well-established bio-enhancer used for potentiating the bioavailability and efficacy of many drugs.[30] Pippali has been mentioned as Deepaniya, Pachaniya, used in Agnimandhya and Anahaprashamana by Acharya Charaka.[31] Preventing the formation of Ama can correct the pathogenesis at the beginning itself. Once the channels of Asthayi dhatu (through which various nutritious element is transported) become clear, then nutritious element can reach to Dhatu without uninterruption.


  Conclusion Top


Although there is no description of hypothyroidism in Ayurveda, it is found to possess a strong correlation with Agnimandhya and Ama, Tridosha involvement, and later, it involves Dhatu (especially Rasa and Meda). Both the groups showed statistically highly significant improvement in tiredness, weakness, dyspnea, and dry coarse skin but percentage relief was better in Kanchnara Triphala Kwatha group than Varuna Kwatha group. In objective parameters, both groups showed highly significant results in decreasing weight and BMI. Kanchnara Triphala Kwatha group showed better percentage relief in thyroid profile. On the basis of the result, we can say that Kanchnara Triphala Kwatha has shown better results than Varuna Kwatha.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
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