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Int J Ayu Pharm Chem
REVIEW ARTICLE
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Ayurvedic Approach on Anatomical Basis of Endocrine Disorders:
A Review
Dhannajay1*, Naresh K. Kumawat2
1
Deptt. of Rachna Sharir, S.B.L.D., Ayurved Vishwabharti, Sardarshahr, Churu, Rajasthan, India
2
Deptt. of Kayachikitsa, S.B.L.D., Ayurved Vishwabharti, Sardarshahr, Churu, Rajasthan, India
Abstract
An estimated 108 million people in India suffer from endocrine and metabolic disorders. The
disorders relating to endocrine system can be grossly divided into functional abnormalities and
structural abnormalities. While functional disorders like hypothyroidism, DM type 1, etc. are
very common in present day clinical practice, some of the common structural abnormalities
result in diseases like thyroid adenoma, undescended testis etc. Thorough understanding of the
anatomical organization of the endocrine system can help in the clinical diagnosis of these
conditions leading to early detection. The management of many of the above disorders involves
surgical measures which also require a well off anatomical understanding. Role of Ayurveda in
the determination and development of organ are many factors such as Prakruthi (constitution of
the body), Nature of Shukra (nature of sperm) and Shonita (nature of ovum), Garbhashaya
(nature of uterus), Season (fertility time), Food and deed of mother, Panchamahabhutha (five
basic element of nature).
Keywords
Doshas, Endocrine system, Anatomical disorders, Prakruthi
Greentree Group
Received 23/05/15 Accepted 03/09/15 Published 10/09/15
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2015 Greentree Group © IJAPC
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INTRODUCTION
role in hormone production as well as in
According to Ayurveda, the whole system
digestion. The endocrine system is regulated
comprises three parts- Body, Mind and
by feedback in much the same way that a
Spirit. These three work in accordance to
thermostat regulates the temperature in a
each other1. The missing link between the
room. For the hormones that are regulated
Mind and Body on which modern sciences
by the pituitary gland, a signal is sent from
had poured the money in millions is the
the hypothalamus to the pituitary gland in
endocrine system. Endocrine system works
the form of a “releasing hormone”, which
according to the master gland (most of the
stimulates
cases) which is a part of the hypothalamus
"stimulating hormone" into the circulation.
(where all the emotions located). The
The stimulating hormone then signals the
endocrine system is made up of glands that
target gland to secrete its hormone. As the
produce and secrete hormones. These
level of this hormone rises in the circulation,
hormones regulate the body's
growth,
the hypothalamus and the pituitary gland
metabolism (the physical and chemical
shut down secretion of the releasing
processes of the body), development and
hormone and the stimulating hormone,
functions. The hormones are released into
which in turn slows the secretion by the
the blood stream and may affect one or
target gland. This system results in stable
several
blood concentrations of the hormones that
organs
throughout
the
body.
the
pituitary
to
secrete
a
Hormones are chemical messengers created
are regulated by the pituitary gland2.
by the body. They transfer information from
AYURVEDIC REVIEW: In Ayurvedic
one set of cells to another to coordinate the
medicine, goitre is called ‘Galaganda’ and
functions of different parts of the body. The
is described in detail3. It classifies thyroid
major glands of the endocrine system are the
diseases
hypothalamus,
(hyperthyroidism),
pituitary,
thyroid,
into
three
types;
Vataja
Kaphaja
parathyroid, adrenals, pineal body, and the
(hypothyroidism) and Medaja (thyroidal
reproductive organs (ovaries and testes). The
cyst). The symptoms of these diseases are
pancreas is also a part of this system; it has a
described
in
detail
in
the
Ayurvedic
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medicine and modern medicine. ‘Śarīra
‘Kapha’
Vicaya’
protection, strength, stability and resistance.
is
the
Ayurvedic
term
that
performs
‘Vicaya’ means the special or detailed
understanding of body, the different entities
knowledge. As per Charaka, the detailed
representing ‘Tridosas’ at each level of
knowledge of normal human body is helpful
organization can be assumed by analyzing
to understand the factors influencing health
these functions. In generalized terms, the
and therefore such knowledge is widely
nervous,
appreciated by experts4.
mechanisms can be equated to ‘Vāta’, ‘Pitta’
Theory of ‘Tridosa’: A Physiological
and ‘Kapha’ respectively. Prakriti literally
Perspective: This theory forms the basis of
meaning constitution or nature, and consists
Ayurvedic
and
of the tridoshas (vata, pitta, and kapha)4.
pharmacology. Though, the term ‘Dosa’
The three striking constitutions of prakriti
means ‘the disturbing factor’, it has got
(vata, pitta, and kapha) present a set of
definite physiological importance in normal
metabolic
state. Basically three ‘Dosas’- ‘Vāta’, ‘Pitta’
determining the reaction of body and mind
and
for
when confronted by a stimulus. Each dosha
maintenance of homeostasis in the body, and
has its distinct properties and functions
health is nothing but a state of equilibrium
which are universal to living systems and
of these ‘Tridosas’. Disease is manifested as
are present in all organisms. In Ayurveda,
a result of disturbance in the state of
the three doshas are understood to have their
equilibrium among these ‘Dosas’. The
regions
concept of ‘Tridosa’ is basically a theory
predominate; vata below the navel, pitta
and any single substance or structure in the
between the clavicle and navel, and kapha
body can not represent a ‘Dosa’. ‘Vāta’ is
above the clavicle6. Generally there is a
responsible for all movements and it is the
natural predominance of one or more doshas
initiating and controlling factor. ‘Pitta’
in an individual. In human body, functions
performs
digestion,
like cell division, movement, and excretion
metabolism, production of heat and that is
of wastes are mainly governed by vata
why it is called ‘Agni’ meaning ‘Fire’.
prakriti;
‘Kapha’-
the
are
activities
responsible
like
based
endocrine
tendencies
within
while
the
on
like
As
pathology
is
functions
represents both Anatomy and Physiology.
physiology,
Ayurveda
the
and
immune
which
body
functional
help
where
anabolism,
in
they
growth,
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maintenance of structure, storage, and
Vata, pitta, and kapha prakriti are found to
stability are contributed by kapha; and pitta
have unique metabolic activities. According
is primarily responsible for metabolism,
to Ayurveda, kapha is slow, pitta is fast, and
thermal regulation, and homeostasis7. Each
vata
prakriti has specific physical, physiological,
metabolism. Various studies have tried to
and psychological attributes (gunas) which
establish
totally depends upon involvement of each
prakriti
dosha in an individual8. Every individual
activities occurring in the body. Recently, a
must maintain their balance of doshas as
study reported that body mass index (BMI)
determined by their prakriti in order to
in vata-pitta prakriti was significantly less
remain healthy.
as compared to kapha-pitta prakriti and the
Prakriti is believed to be determined at the
vata-pitta prakriti individuals were found to
time of conception and remain unaltered
be having maximum platelet aggregation10.
during the lifetime with contributions from
Etiology of Obesity as per Ayurveda-
environmental factors including maternal
Acharya Charaka has mentioned the Nidana
diet and lifestyle. Every individual can be
of Sthaulya analytically in most of them is
categorized into various combinations of
exogenous types of causes. Endogenous
vata, pitta, and kapha prakriti depending
types of causes have been mentioned by
upon the predominance of each dosha and is
Acharya Sushruta & Vagbhatta. Vagbhatta
independent of race, ethnicity, language, and
also mentioned Ama as causative factor.
geography, which will be specific for each
Only Charaka has defined Beejdosha as one
individual8. The susceptibility to different
of the cause of Sthaulya. In context with
diseases depends upon the type of prakriti
Sthaulya, exogenous causes are Meda
constitution in an individual. Therefore,
stimulating diet & regimens where as
assessment of prakriti analysis will not only
Dosha, Dhatu, Mala & Srotas etc. come
help in understanding the physical and
under endogenous causes. In modern scince
mental constitution of patient, but also plays
obesity is also caused by endocrinal disease
a
pituitary:- Frohlich’s syndrome, puberty
vital
role
in
prognosis,
diagnosis,
is
considered
correlation
types
to
have
between
and different
pregnancy,
variable
specific
metabolic
treatment, and prevention of many complex
adiposity,
Thyroid-
diseases.
Hypothyrodism, Adrenal cortex- cushing’s
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syndrome, Gonadal- Eunchoidism sometime
Modern view: Anatomical changes in body
polycystic
Pancrease-
related to endocrine disorder abnormal
islets-cell tumers. Some other reference of
endocrine development/function can impact
The
is
on many different systems. For example,
documented along with many hypothetical
insufficient maternal dietary iodine impacts
concepts. An anguli pramana one of them
on foetal thyroid gland thyroid hormone
The Sharir Pramana is only tool for
production, which in turn can lead to
determining the ayu of an individual.
abnormal neural development. Alternatively,
Researchers have discovered that a quick
we now know many environmental and
study of the hands more specifically, the
therapeutic chemicals have a wide range of
lengths of the index and ring fingers can tell
effects on the endocrine system. Sex
a lot about a person’s personality and risk of
hormones from the gonads have significant
disease. Of course, your digits don’t actually
effects prenatally and postnatal, specifically
control these issues; it’s closer to the other
at puberty with a role to play in male/female
way around11. In boys, “during fetal
biological maturity and have wide actions
development there’s a surge in testosterone
throughout the body. Major glands are
in the middle of the second trimester” that
pituitary,
seems to influence future health and
pineal Body, reproductive organs, ovary and
behavior, says Pete Hurd, a neuroscientist at
testis etc. Hormone Action Steroids –
the University of Alberta. One easy-to-spot
insoluble in water, carried in the blood and
result of this flood of testosterone: a ring
released near the vicinity of the target cell,
finger that’s significantly longer than the
Non-steroidal
index finger. Scientists are not at the point
growth hormone, Prostaglandins – act
where they can factor in finger length to
locally, affecting only the organ where they
arrive at a diagnosis, but they have gathered
are produced.
evidence that shows how this prenatal
Pituitary Gland12: The hormones of the
hormone imbalance can affect a person for
pituitary gland help regulate the functions of
life, from increasing or decreasing your risk
other endocrine glands. The pituitary gland
of certain diseases.
has two parts—the anterior lobe and
ovary
Ayurvedic
syndrome,
classical
literature
thyroid,
parathyroid,
hormones
-
adrenal,
epinephrine,
posterior lobe—that have two very separate
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functions. The hypothalamus sends signals
a pituitary tumour results in visual field
to the pituitary to release or inhibit pituitary
defects,
hormone production.
hemianopia15. Patients with sellar mass
The pituitary gland is often dubbed the
pressing on the optic chiasma should have a
“master gland” because its hormones control
Humphrey
other parts of the endocrine system, namely
extension of the pituitary mass to the
the thyroid gland, adrenal glands, ovaries,
cavernous sinuses can result in diplopia,
and testes. However, the pituitary doesn’t
ptosis, or altered facial sensation. There is
entirely run the show. In some cases, the
no specific headache pattern associated
hypothalamus signals the pituitary gland to
without 10%, and the majorities are micro
stimulate or inhibit hormone production.
adenomas. Most patient with functioning
Essentially, the pituitary acts after the
adenomas present with sign and symptom
hypothalamus prompts it.
related
Disorders - Pituitary adenomas arise from
Acromegaly (via the action of GH and
adenohypophyseal cells and are almost
insulin-like
always
benign13.
They
are
arbitrarily
most
to
commonly
visual
field
hormonal
growth
bitemporal
test.
Lateral
hypersecretion:
factor
-1,
IGF-1),
Cushing disease (via the action of ACTH
designated as micro adenomas (<10 mm)
and cortisol).
and macro adenoma (≥10 mm). Autopsy
Acromegaly16 is a rare disease caused by a
studies suggest that up to 20% of normal
GH-secreting pituitary adenoma in more
persons harbor pituitary microadenomas14.
than 99% of patients. At diagnosis, about
Pituitary tumours discovered by computed
75% of patients have macro adenomas. The
tomography (CT) or magnetic resonance
mean age at diagnosis is about 45 years.
imaging (MRI) examination, in the absence
Clinical features of acromegaly may be
of any symptoms or clinical findings, are
related to excess GH or IGF-1 or to
referred to as pituitary incidentalomas. The
associated
prevalence of pituitary incidentalomas found
hypopituitarism,
by MRI is a Pituitary tumor can manifest
present with pituitary macro adenomas.
with signs and symptoms of pituitary
Excess growth hormone before the fusion of
hypofunction, hormone hypersecretion, or
the epiphyseal growth plates results in
mass effect. Impingement on the chiasma by
gigantism. Acromegalic patients probably
mass
effect
because
most
including
patients
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carry an increased risk of malignancy such
limb of the child, hypogonadism may be
as premalignant adenomatous colon polyps
superadded. The bones are often thin and
and colon cancer, although published data
centre
vary greatly in their findings clinical
appearance18.
features17. Inside pituitary fossa bitemporal
THYROID DISEASES: Hyperthyroidism
loss of vision due to compression of loss of
Graves’ disease is a type of autoimmune
vision, outside pituitary fosse - diplopia
problem that causes the thyroid gland to
extra
produce too much thyroid hormone, which
ocular
papilledema,
intolerance
muscles
Weight
increase
dysfunction,
gain
loss,
sweating.
heat
skeleton
of
ossification
often
the
hyperthyroidism.
spade
present
hands,
enlargement
of
in
is called hyperthyroidism. Graves’ disease is
changes - enlargement of hand and feet,
like
delayed
underlying
cause
of
Graves'
disease
may
clinically
with
one
signs:19
of
these
supraorbital ridges, enlargement of facial
characteristic
bones and Prognathism, spacing part of
(protuberance of one or both eyes)fatigue,
teeth, clavicles thickened, changes in spine –
weight loss with increased appetite, and
osteoporosis,
other
kyphosis,
lordosis
and
symptoms
of
exophthalmos
hyperthyroidism/
scoliosis, carpel tunnel syndromes skin and
thyrotoxicosis rapid heartbeat, muscular
subcutaneous tissue tongue enlarged with
weakness. Two signs are truly 'diagnostic' of
difficulty in articulation, thickening of lips
Graves' disease (i.e., not seen in other
and nose, skin coarse and greasy, thickening
hyperthyroid conditions): exophthalmoses
of soft tissue and hand and feet mammary
and
hyperplasia, hypertrichosis. Hypopituitarism
myxoedema. G Thyroid Gland Autoimmune
in juvenile on selective gonadotropic failure
problems—of
normal or increase stature, gonadal and
different types—develop when your immune
genital underdevelopment, amenorrhea in
system causes disease by attacking healthy
female’s selective growth hormone failure
tissues. Researchers do not completely
with dwarfism. Pituitary dwarfism very slow
understand
rate of growth and hypoglycaemic attacks in
although there seems to be a genetic
childhood,
no
connection, as cases of Graves’ disease tend
disproportion in the size of the body and
to run in families. For unknown reasons, like
no
mental
defect
and
nonpitting
oedema
which
what
there
causes
pretibial
are
many
autoimmunity,
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many autoimmune diseases, Graves’ is also
hyperthyroidism.
more likely to affect women than men.
deposition of mucopolysaccharide in the
Physical Signs and Symptoms - If Graves’
dermis, which results in swelling of the
disease goes untreated, physical signs and
affected
symptoms may develop. Goitre - Goitre is
myxoedema occurring in the lower limb is
an enlarged thyroid gland. A goitre related
pretibial myxoedema a hallmark of Graves’s
to Graves’ disease is diffuse thyrotoxic
disease,
goitre. As the thyroid gets bigger, the
hyperthyroidism. Myxoedema can occur in
patient’s neck may begin to look full or
Hashimoto's thyroiditis and other long-
swollen. Sometimes
standing forms of hypothyroidism, as well
goitre
makes
Myxoedema
area.
an
One
refers
manifestation
autoimmune
form
to
of
of
swallowing difficult, causes coughing, and
as Graves’s disease.
may disrupt sleep. Eye Problems - Eye
Hashimoto's
problems connected to Graves’ disease can
thyroiditis is an autoimmune disease, a
go from very mild to very severe, which
disorder in which the immune system turns
causes protruding eyes and limited eye
against the body's own tissues. In people
movement. The medical term for this is
with Hashimoto's, the immune system
exophthalmos, and it can make you appear
attacks the thyroid. This can lead to
as though you are staring. Skin Thickening -
hypothyroidism, a condition in which the
Some patients with Graves’ disease may
thyroid does not make enough hormones for
develop thickening of the skin over the front
the body's needs. Located in the front of
of the lower leg called the tibia. The
your
disorder causes skin lesions that are patchy
hormones that control metabolism. This
and pink. Rarely are other areas of skin
includes your heart rate and how quickly
affected. This skin problem is also called
your body uses calories from the foods you
pretibial myxoedema.
eat. Hashimoto's symptoms may be mild at
In
Hypothyroidism,
Myxoedema
neck,
disease20
the
thyroid
Hashimoto's
gland
makes
or
first or take years to develop. The first sign
myxoedema is a term used synonymously
of the disease is often an enlarged thyroid,
with severe hypothyroidism. It is also used
called goitre. The goitre may cause the front
to describe a dermatological change that can
of your neck to look swollen. A large goitre
occur in hypothyroidism, and some forms of
may make swallowing difficult. Other
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symptoms of an underactive thyroid due to
Dehydration, Low blood pressure, Low
Hashimoto's may include Adrenal cortical
blood sugar level, Trouble keeping enough
hyper function:- Cushing’s Syndrome21 refer
salt in the body, Altered development of the
to the clinical manifestation induce by
external genitalia in girls, which is noted at
chronic exposure to excess glucocorticoid
birth and may require surgery to correct,
.Common symptoms of Cushing’s syndrome
Shorter than average final height, Early
(due to an adrenal, pituitary, or ectopic
signs of puberty, Irregular periods and
tumour) can include: moon face, buffalo
possible
hump, truncal obesity, upper body obesity,
trouble
getting
pregnant
(in
women),Excess
facial
hair
(in
round face and neck, and thinning arms and
women),Benign
testicular
tumors
and
legs, Skin problems, such as acne or
infertility (in men).
reddish-blue streaks on the abdomen or
underarm area, High blood pressure, Muscle
DISCUSSION
and bone weakness, Moodiness, irritability,
In Ayurvedic Samhita, some description is
or depression, High blood sugars, Slow
similar to endocrine system. Some well
growth rates in children.
known facts, e.g. concept of Ayurvedic
Congenital Adrenal Hyperplasia (CAH)
22
contraceptives,
gonads,
Shukra,
liver,
Symptoms of CAH range from mild to
Vajikarana etc., are the areas of Ayurveda
serious. Some people with mild CAH are
which can be closely correlated to the
never diagnosed because their symptoms do
modern endocrine system. An endocrine
not cause them any problems. Symptoms of
disorder – Goitre is described in Ayurveda
the mild form of CAH, which can be
as Galganda. Administration of testicular
diagnosed in children or adults, may
tissue (Organotherapy) is also described for
23
include : Shorter than average final height,
cure from impotency.
Early signs of puberty (in children), Acne,
Concept of Dosha and Endocrine system can
Irregular menstrual periods and possible
also be correlated. Dosha, which are
trouble getting pregnant (in women),Excess
invisible, are the working state and systems
facial hair (in women).
of the body. Vata shows high in activity,
Symptoms of the severe form of CAH,
Pitta is a state where body is on a hyper
which is diagnosed in children, may include:
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mode and third is the Kapha which tells that
modern sciences have poured the money in
system is slow and sluggish. The same is the
millions is the endocrine system. Endocrine
endocrinology or effect of endocrine glands
anatomical disorders, either caused by hyper
on the body. There are three states of the
or hypo functioning, are similar to the
body, under the effect of the normal, hyper
concept of Dosha in Ayurveda.
and hypo secretion of glands.
Ayurveda talks about the complete body and
in modern sciences we are concerned about
certain objects, not the complete body. So
there is nothing different in the body. If
someone is gaining the weight that is the
effect of the low Vata or high Kapha and
treatment is the balancing of these Dosha.
Healthy axis between body and mind - As
we know these hormones are more like the
axis between the mind (not the brain) and
the body, so it is important to remove the
stress and to maintain the axis properly
functioning for the complete health. A
number of glands that signal each other in
sequence are usually referred to as an axis,
for example, the hypothalamic- pituitaryadrenal axis.
CONCLUSION
The whole system comprises the three parts
– Body, mind and spirit. These three work in
accordance to each other. The missing link
between the Mind and Body on which
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