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Int J Ayu Pharm Chem REVIEW ARTICLE www.ijapc.com e-ISSN 2350-0204 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 ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 254 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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 ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 255 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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, ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 256 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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 ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 257 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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 ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 258 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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 ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 259 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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, ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 260 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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 ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 261 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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: ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 262 [e ISSN 2350-0204] Int J Ayu Pharm Chem 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 ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 263 [e ISSN 2350-0204] Int J Ayu Pharm Chem REFERENCES 1. Charak samhita of Agnivesh: Vidyotini hindi commentary by Pt. Kashinath Shastri and 14. http://clevelandclinicmeded.comm/medicalp ubs/diseasemanagement/endocrinology/pitui tarydisorder. Dr. Gorakhnath Chaturvedi; Choukhamba 15. http/clevelandclinicmeded.comm/medicalpu Bharti Academy, Reprint 2005, Part-1, bs/diseasemanagement/endocrinology/pituit Pg.No.18. arydisorder. 2. http//www.wikypwdia.com. 3. http//www.ncbi.nih.gov/pmc/article/pmc316 9859/#2. 4. Ibid I, Cha.Sha.6/3. Page no-894 5. http//www.ncbi.nih.gov/pmc/article/pmc401 2357#reff11. 6. http//www.ncbi.nih.gov/pmc/article/pmc401 2357#reff12. 7. http//www.ncbi.nih.gov/pmc/article/pmc401 2357#reff1. 8. http//www.ncbi.nih.gov/pmc/article/pmc401 2357#reff12. 9. http//www.ncbi.nih.gov/pmc/article/pmc401 2357#reff13. 10. http//www.ncbi.nih.gov/pmc/article/pmc401 16. http/clevelandclinicmeded.comm/medicalpu bs/diseasemanagement/endocrinology/pituit arydisorder. 17. Golwalla’s medicine by Aspi F. Golwala and Sharukh A. Golwalla; Published by Aspi F. Golwala, 23 Edition, Pg. No.354. 18. Ibid 19. http://www.endocrineweb.com/conditions/gr aves-disease/graves-disease. 20. http://www.wcbmd.com/women/hosimoto/th yriditis/symptom/cause 21. http://www.ncbi.nih.gov/helth/topic/cushing. 22. http://www.ncbi.nih.gov/helth/topic. 23. http://www.ncbi.nih.gov/helth/topic/adrenal gland. 2357#reff14. 11. http//www.ncbi.nih.gov/pmc/article/pmc401 2357#reff14. 12. www. Discover magzine.com) may 2013 issue discover magazines. 13. www.endocrineweb.com/endocrinology/ove rview-pituitary-gland. ________________________________________________________________________________________________________ Dhannajay and Kumawat 2015 Greentree Group © IJAPC Int J Ayu Pharm Chem 2015 Vol. 3 Issue 2 www.ijapc.com 264 [e ISSN 2350-0204]