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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

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INTRODUCTION digestion. The endocrine system is regulated

According to Ayurveda, the whole system by feedback in much the same way that a

comprises three parts- Body, Mind and thermostat regulates the temperature in a

Spirit. These three work in accordance to room. For the hormones that are regulated

each other1. The missing link between the by the pituitary gland, a signal is sent from

Mind and Body on which modern sciences the hypothalamus to the pituitary gland in

had poured the money in millions is the the form of a releasing hormone, which

endocrine system. Endocrine system works stimulates the pituitary to secrete a

according to the master gland (most of the "stimulating hormone" into the circulation.

cases) which is a part of the hypothalamus The stimulating hormone then signals the

(where all the emotions located). The target gland to secrete its hormone. As the

endocrine system is made up of glands that level of this hormone rises in the circulation,

produce and secrete hormones. These the hypothalamus and the pituitary gland

hormones regulate the body's growth, shut down secretion of the releasing

metabolism (the physical and chemical hormone and the stimulating hormone,

processes of the body), development and which in turn slows the secretion by the

functions. The hormones are released into target gland. This system results in stable

the blood stream and may affect one or blood concentrations of the hormones that

several organs throughout the body. are regulated by the pituitary gland2.

Hormones are chemical messengers created AYURVEDIC REVIEW: In Ayurvedic

by the body. They transfer information from medicine, goitre is called Galaganda and

one set of cells to another to coordinate the is described in detail3. It classifies thyroid

functions of different parts of the body. The diseases into three types; Vataja

major glands of the endocrine system are the (hyperthyroidism), Kaphaja

hypothalamus, pituitary, thyroid, (hypothyroidism) and Medaja (thyroidal

parathyroid, adrenals, pineal body, and the cyst). The symptoms of these diseases are

reproductive organs (ovaries and testes). The described in detail in the Ayurvedic

pancreas is also a part of this system; it has a medicine and modern medicine. arra

role in hormone production as well as in Vicaya is the Ayurvedic term that

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represents both Anatomy and Physiology. understanding of body, the different entities
Vicaya means the special or detailed representing Tridosas at each level of
knowledge. As per Charaka, the detailed organization can be assumed by analyzing
knowledge of normal human body is helpful these functions. In generalized terms, the
to understand the factors influencing health nervous, endocrine and immune
and therefore such knowledge is widely mechanisms can be equated to Vta, Pitta
appreciated by experts4. and Kapha respectively. Prakriti literally
Theory of Tridosa: A Physiological meaning constitution or nature, and consists
Perspective: This theory forms the basis of of the tridoshas (vata, pitta, and kapha)4.
Ayurvedic physiology, pathology and The three striking constitutions of prakriti
pharmacology. Though, the term Dosa (vata, pitta, and kapha) present a set of
means the disturbing factor, it has got metabolic tendencies which help in
definite physiological importance in normal determining the reaction of body and mind
state. Basically three Dosas- Vta, Pitta when confronted by a stimulus. Each dosha
and Kapha- are responsible for has its distinct properties and functions
maintenance of homeostasis in the body, and which are universal to living systems and
health is nothing but a state of equilibrium are present in all organisms. In Ayurveda,
of these Tridosas. Disease is manifested as the three doshas are understood to have their
a result of disturbance in the state of regions within the body where they
equilibrium among these Dosas. The predominate; vata below the navel, pitta
concept of Tridosa is basically a theory between the clavicle and navel, and kapha
and any single substance or structure in the above the clavicle6. Generally there is a
body can not represent a Dosa. Vta is natural predominance of one or more doshas
responsible for all movements and it is the in an individual. In human body, functions
initiating and controlling factor. Pitta like cell division, movement, and excretion
performs the activities like digestion, of wastes are mainly governed by vata
metabolism, production of heat and that is prakriti; while anabolism, growth,
why it is called Agni meaning Fire. maintenance of structure, storage, and
Kapha performs the functions like stability are contributed by kapha; and pitta
protection, strength, stability and resistance. is primarily responsible for metabolism,
As Ayurveda is based on functional thermal regulation, and homeostasis7. Each
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prakriti has specific physical, physiological, establish correlation between specific


and psychological attributes (gunas) which prakriti types and different metabolic
totally depends upon involvement of each activities occurring in the body. Recently, a
dosha in an individual8. Every individual study reported that body mass index (BMI)
must maintain their balance of doshas as in vata-pitta prakriti was significantly less
determined by their prakriti in order to as compared to kapha-pitta prakriti and the
remain healthy. vata-pitta prakriti individuals were found to
Prakriti is believed to be determined at the be having maximum platelet aggregation10.
time of conception and remain unaltered Etiology of Obesity as per Ayurveda-
during the lifetime with contributions from Acharya Charaka has mentioned the Nidana
environmental factors including maternal of Sthaulya analytically in most of them is
diet and lifestyle. Every individual can be exogenous types of causes. Endogenous
categorized into various combinations of types of causes have been mentioned by
vata, pitta, and kapha prakriti depending Acharya Sushruta & Vagbhatta. Vagbhatta
upon the predominance of each dosha and is also mentioned Ama as causative factor.
independent of race, ethnicity, language, and Only Charaka has defined Beejdosha as one
geography, which will be specific for each of the cause of Sthaulya. In context with
individual8. The susceptibility to different Sthaulya, exogenous causes are Meda
diseases depends upon the type of prakriti stimulating diet & regimens where as
constitution in an individual. Therefore, Dosha, Dhatu, Mala & Srotas etc. come
assessment of prakriti analysis will not only under endogenous causes. In modern scince
help in understanding the physical and obesity is also caused by endocrinal disease
mental constitution of patient, but also plays pituitary:- Frohlichs syndrome, puberty
a vital role in prognosis, diagnosis, adiposity, pregnancy, Thyroid-
treatment, and prevention of many complex Hypothyrodism, Adrenal cortex- cushings
diseases. syndrome, Gonadal- Eunchoidism sometime
Vata, pitta, and kapha prakriti are found to polycystic ovary syndrome, Pancrease-
have unique metabolic activities. According islets-cell tumers. Some other reference of
to Ayurveda, kapha is slow, pitta is fast, and The Ayurvedic classical literature is
vata is considered to have variable documented along with many hypothetical
metabolism. Various studies have tried to concepts. An anguli pramana one of them
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The Sharir Pramana is only tool for we now know many environmental and
determining the ayu of an individual. therapeutic chemicals have a wide range of
Researchers have discovered that a quick effects on the endocrine system. Sex
study of the hands more specifically, the hormones from the gonads have significant
lengths of the index and ring fingers can tell effects prenatally and postnatal, specifically
a lot about a persons personality and risk of at puberty with a role to play in male/female
disease. Of course, your digits dont actually biological maturity and have wide actions
control these issues; its closer to the other throughout the body. Major glands are
way around11. In boys, during fetal pituitary, thyroid, parathyroid, adrenal,
development theres a surge in testosterone pineal Body, reproductive organs, ovary and
in the middle of the second trimester that testis etc. Hormone Action Steroids
seems to influence future health and insoluble in water, carried in the blood and
behavior, says Pete Hurd, a neuroscientist at released near the vicinity of the target cell,
the University of Alberta. One easy-to-spot Non-steroidal hormones - epinephrine,
result of this flood of testosterone: a ring growth hormone, Prostaglandins act
finger thats significantly longer than the locally, affecting only the organ where they
index finger. Scientists are not at the point are produced.
where they can factor in finger length to Pituitary Gland12: The hormones of the
arrive at a diagnosis, but they have gathered pituitary gland help regulate the functions of
evidence that shows how this prenatal other endocrine glands. The pituitary gland
hormone imbalance can affect a person for has two partsthe anterior lobe and
life, from increasing or decreasing your risk posterior lobethat have two very separate
of certain diseases. functions. The hypothalamus sends signals
Modern view: Anatomical changes in body to the pituitary to release or inhibit pituitary
related to endocrine disorder abnormal hormone production.
endocrine development/function can impact The pituitary gland is often dubbed the
on many different systems. For example, master gland because its hormones control
insufficient maternal dietary iodine impacts other parts of the endocrine system, namely
on foetal thyroid gland thyroid hormone the thyroid gland, adrenal glands, ovaries,
production, which in turn can lead to and testes. However, the pituitary doesnt
abnormal neural development. Alternatively, entirely run the show. In some cases, the
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hypothalamus signals the pituitary gland to adenomas. Most patient with functioning
stimulate or inhibit hormone production. adenomas present with sign and symptom
Essentially, the pituitary acts after the related to hormonal hypersecretion:
hypothalamus prompts it. Acromegaly (via the action of GH and
Disorders - Pituitary adenomas arise from insulin-like growth factor -1, IGF-1),
adenohypophyseal cells and are almost Cushing disease (via the action of ACTH
always benign13. They are arbitrarily and cortisol).
designated as micro adenomas (<10 mm) Acromegaly16 is a rare disease caused by a
and macro adenoma (10 mm). Autopsy GH-secreting pituitary adenoma in more
studies suggest that up to 20% of normal than 99% of patients. At diagnosis, about
persons harbor pituitary microadenomas14. 75% of patients have macro adenomas. The
Pituitary tumours discovered by computed mean age at diagnosis is about 45 years.
tomography (CT) or magnetic resonance Clinical features of acromegaly may be
imaging (MRI) examination, in the absence related to excess GH or IGF-1 or to
of any symptoms or clinical findings, are associated mass effect including
referred to as pituitary incidentalomas. The hypopituitarism, because most patients
prevalence of pituitary incidentalomas found present with pituitary macro adenomas.
by MRI is a Pituitary tumor can manifest Excess growth hormone before the fusion of
with signs and symptoms of pituitary the epiphyseal growth plates results in
hypofunction, hormone hypersecretion, or gigantism. Acromegalic patients probably
mass effect. Impingement on the chiasma by carry an increased risk of malignancy such
a pituitary tumour results in visual field as premalignant adenomatous colon polyps
defects, most commonly bitemporal and colon cancer, although published data
hemianopia15. Patients with sellar mass vary greatly in their findings clinical
pressing on the optic chiasma should have a features17. Inside pituitary fossa bitemporal
Humphrey visual field test. Lateral loss of vision due to compression of loss of
extension of the pituitary mass to the vision, outside pituitary fosse - diplopia
cavernous sinuses can result in diplopia, extra ocular muscles dysfunction,
ptosis, or altered facial sensation. There is papilledema, Weight gain loss, heat
no specific headache pattern associated intolerance increase sweating. skeleton
without 10%, and the majorities are micro changes - enlargement of hand and feet,
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spade like hands, enlargement of characteristic signs:19 exophthalmos


supraorbital ridges, enlargement of facial (protuberance of one or both eyes)fatigue,
bones and Prognathism, spacing part of weight loss with increased appetite, and
teeth, clavicles thickened, changes in spine other symptoms of hyperthyroidism/
osteoporosis, kyphosis, lordosis and thyrotoxicosis rapid heartbeat, muscular
scoliosis, carpel tunnel syndromes skin and weakness. Two signs are truly 'diagnostic' of
subcutaneous tissue tongue enlarged with Graves' disease (i.e., not seen in other
difficulty in articulation, thickening of lips hyperthyroid conditions): exophthalmoses
and nose, skin coarse and greasy, thickening and nonpitting oedema pretibial
of soft tissue and hand and feet mammary myxoedema. G Thyroid Gland Autoimmune
hyperplasia, hypertrichosis. Hypopituitarism problemsof which there are many
in juvenile on selective gonadotropic failure different typesdevelop when your immune
normal or increase stature, gonadal and system causes disease by attacking healthy
genital underdevelopment, amenorrhea in tissues. Researchers do not completely
females selective growth hormone failure understand what causes autoimmunity,
with dwarfism. Pituitary dwarfism very slow although there seems to be a genetic
rate of growth and hypoglycaemic attacks in connection, as cases of Graves disease tend
childhood, no mental defect and no to run in families. For unknown reasons, like
disproportion in the size of the body and many autoimmune diseases, Graves is also
limb of the child, hypogonadism may be more likely to affect women than men.
superadded. The bones are often thin and Physical Signs and Symptoms - If Graves
centre of ossification delayed in disease goes untreated, physical signs and
appearance18. symptoms may develop. Goitre - Goitre is
THYROID DISEASES: Hyperthyroidism an enlarged thyroid gland. A goitre related
Graves disease is a type of autoimmune to Graves disease is diffuse thyrotoxic
problem that causes the thyroid gland to goitre. As the thyroid gets bigger, the
produce too much thyroid hormone, which patients neck may begin to look full or
is called hyperthyroidism. Graves disease is swollen. Sometimes goitre makes
often the underlying cause of swallowing difficult, causes coughing, and
hyperthyroidism. Graves' disease may may disrupt sleep. Eye Problems - Eye
present clinically with one of these problems connected to Graves disease can
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go from very mild to very severe, which against the body's own tissues. In people
causes protruding eyes and limited eye with Hashimoto's, the immune system
movement. The medical term for this is attacks the thyroid. This can lead to
exophthalmos, and it can make you appear hypothyroidism, a condition in which the
as though you are staring. Skin Thickening - thyroid does not make enough hormones for
Some patients with Graves disease may the body's needs. Located in the front of
develop thickening of the skin over the front your neck, the thyroid gland makes
of the lower leg called the tibia. The hormones that control metabolism. This
disorder causes skin lesions that are patchy includes your heart rate and how quickly
and pink. Rarely are other areas of skin your body uses calories from the foods you
affected. This skin problem is also called eat. Hashimoto's symptoms may be mild at
pretibial myxoedema. first or take years to develop. The first sign
In Hypothyroidism, Myxoedema or of the disease is often an enlarged thyroid,
myxoedema is a term used synonymously called goitre. The goitre may cause the front
with severe hypothyroidism. It is also used of your neck to look swollen. A large goitre
to describe a dermatological change that can may make swallowing difficult. Other
occur in hypothyroidism, and some forms of symptoms of an underactive thyroid due to
hyperthyroidism. Myxoedema refers to Hashimoto's may include Adrenal cortical
deposition of mucopolysaccharide in the hyper function:- Cushings Syndrome21 refer
dermis, which results in swelling of the to the clinical manifestation induce by
affected area. One manifestation of chronic exposure to excess glucocorticoid
myxoedema occurring in the lower limb is .Common symptoms of Cushings syndrome
pretibial myxoedema a hallmark of Gravess (due to an adrenal, pituitary, or ectopic
disease, an autoimmune form of tumour) can include: moon face, buffalo
hyperthyroidism. Myxoedema can occur in hump, truncal obesity, upper body obesity,
Hashimoto's thyroiditis and other long- round face and neck, and thinning arms and
standing forms of hypothyroidism, as well legs, Skin problems, such as acne or
as Gravess disease. reddish-blue streaks on the abdomen or
Hashimoto's disease20 Hashimoto's underarm area, High blood pressure, Muscle
thyroiditis is an autoimmune disease, a and bone weakness, Moodiness, irritability,
disorder in which the immune system turns
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or depression, High blood sugars, Slow In Ayurvedic Samhita, some description is


growth rates in children. similar to endocrine system. Some well
Congenital Adrenal Hyperplasia (CAH)22 known facts, e.g. concept of Ayurvedic
Symptoms of CAH range from mild to contraceptives, gonads, Shukra, liver,
serious. Some people with mild CAH are Vajikarana etc., are the areas of Ayurveda
never diagnosed because their symptoms do which can be closely correlated to the
not cause them any problems. Symptoms of modern endocrine system. An endocrine
the mild form of CAH, which can be disorder Goitre is described in Ayurveda
diagnosed in children or adults, may as Galganda. Administration of testicular
23
include : Shorter than average final height, tissue (Organotherapy) is also described for
Early signs of puberty (in children), Acne, cure from impotency.
Irregular menstrual periods and possible Concept of Dosha and Endocrine system can
trouble getting pregnant (in women),Excess also be correlated. Dosha, which are
facial hair (in women). invisible, are the working state and systems
Symptoms of the severe form of CAH, of the body. Vata shows high in activity,
which is diagnosed in children, may include: Pitta is a state where body is on a hyper
Dehydration, Low blood pressure, Low mode and third is the Kapha which tells that
blood sugar level, Trouble keeping enough system is slow and sluggish. The same is the
salt in the body, Altered development of the endocrinology or effect of endocrine glands
external genitalia in girls, which is noted at on the body. There are three states of the
birth and may require surgery to correct, body, under the effect of the normal, hyper
Shorter than average final height, Early and hypo secretion of glands.
signs of puberty, Irregular periods and Ayurveda talks about the complete body and
possible trouble getting pregnant (in in modern sciences we are concerned about
women),Excess facial hair (in certain objects, not the complete body. So
women),Benign testicular tumors and there is nothing different in the body. If
infertility (in men). someone is gaining the weight that is the
effect of the low Vata or high Kapha and
DISCUSSION treatment is the balancing of these Dosha.
Healthy axis between body and mind - As
we know these hormones are more like the
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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- pituitary-
adrenal 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
modern sciences have poured the money in
millions is the endocrine system. Endocrine
anatomical disorders, either caused by hyper
or hypo functioning, are similar to the
concept of Dosha in Ayurveda.

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