Ayurveda Understanding of Hyperparathyroidism

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Introduction to Hyperparathyroidism

Hyperparathyroidism is a condition wherein the parathyroid glands make high amounts of parathyroid hormone in the bloodstream. In short, ‘increased parathyroid hormone in the bloodstream = hyperparathyroidism’.

Excessive production of Parathyroid Hormone (PTH) causes hypercalcemia – high amounts of calcium in blood and destruction of bone.

Hyperparathyroidism is of two types – Primary Hyperparathyroidism and Secondary Hyperparathyroidism.

Symptoms of Hyperparathyroidism

Symptoms of active disease may range from being mild and nonspecific (of disease or parathyroid function) or severe. The important (noticeable) signs and symptoms of hyperparathyroidism include osteoporosis, bone and joint pain, easy tiredness, frequent illness, kidney stones and excessive urination, loss of appetite, nausea, vomiting and or abdominal pain, depression or forgetfulness.

Related Reading – Hyperparathyroidism

Hyperparathyroidism – Ayurveda Understanding

Hyperparathyroidism – in comparison with Asthi Kshaya and Vata vitiation 

We cannot compare any one condition explained in Ayurveda as equivalent to Hyperparathyroidism. So, we will try to understand hyperparathyroidism and the symptoms produced therein hypothetically in comparison to certain aspects of diseased conditions and imbalances explained in Ayurveda treatises.

In hyperparathyroidism, in spite of all symptoms, we see that the main event that happens (which might give rise to many signs, symptoms and complications in the long run) is bone destruction and related events which happen in and around. Even in the treatment of hyperparathyroidism the important strategy will be to address and check this part of pathogenesis.

Bone loss or destruction (and related rise in calcium levels in blood) can be compared to a condition explained as Asthi Kshaya. Asthi means bone, Kshaya means destruction or loss.

Asthi kshaya is not a disease but a pathological manifestation of decrease of bone tissue. This can be compared to hyperparathyroidism in which parathyroid hormone is increased in blood levels. One of the main symptoms of this condition is fragile bones that can easily fracture i.e. osteoporosis. This condition can be considered to be caused by increased vata in bones.

This condition points towards the involvement of vitiated vata in the causation of clinical picture similar to hyperparathyroidism.

When we see through the symptoms of hyperparathyroidism, most symptoms are those of increased vata. Osteoporosis, bone and joint pain, weakness, easy tiredness, abdominal pain – are all caused by aggravated vata as per Ayurveda understanding.

Asthi-Vata link

Bone is said to be an abode of Vata. Bone is also one of the important seats of vata in the body. Vata aggravation in the bones would cause damage and destruction of bone. This is called ashraya ashrayi bhava.

Treatment of Hyperparathyroidism – Ayurveda perspective

As discussed, hyperparathyroidism should be treated on the lines of treating ‘asthi kshaya’.

Key strategies and goals of treatment –

–        Bringing aggravated Vata to a state of balance so as to prevent further damage and destruction of bone tissue

–        Medicines and foods to support and nourish the bone tissue

Both these goals can be achieved simultaneously. This is because if vata is controlled the bone damage and destruction gets checked. If systemic vata aggravation is controlled by administration of therapies like vasti – medicated enemas, vata aggravation at all the seats of vata including the bones will be automatically controlled. The medicines and anti-vata diet will also serve the same purpose.

Treating Vayu

Treating the aggravated vata and bringing it to a state of balance will be one of the prime strategies of treating hyperparathyroidism. This includes inclusion of vata mitigating foods, activities and behaviors.

Treating vata includes administration of medicated oils and ghee for external and internal use, herbal oil massages, sudation, pouring of medicated oils over the body and purgation, consumption of hot, sweet, sour and salty foods, medicated enemas with lukewarm oils and ghee and oral administration of medicated ghee processed with deepana (appetizer) and pacana (ama digesting) herbs. On the other side one needs to avoid foods and lifestyle activities which aggravate vata.

Panchakarma

Basti / Vasti – medicated enemas are the best way to treat hyperparathyroidism. Medicated enemas are said to be the best treatments to balance severely aggravated vata. Pakvashaya – colon is said to be the chief seat and controlling station of vata and vata related activities. Enemas given in vasti act like ‘root treatment’ i.e. treating vata at its root. This will in turn control vata aggravation in bones also. This is a very good remedy for bone loss and various kinds of pains associated with hyperparathyroidism. Enemas will check the bone tissue loss and will enable reformation of bone tissue. In the process enemas might also control the hyperactivity of parathyroid glands and excessive production of parathyroid hormones.

Tikta Kshira Basti – Enemas prepared with bitter tasting herbs and in milk base (a type of niruha basti / decoction enema) are the best in treating bone, joints and bone marrow related disorders. These enemas might just be the ultimate weapon in dealing with symptoms of hyperparathyroidism.

Tikta Ghrta Pana – Drinking ghee medicated (processed) with bitter tasting herbs is useful in this condition.

Virechana – Therapeutic purgation shall be preferred choice of treatment when the parathyroid glands are inflamed and hyperactive. A judicious combination of virechana and vasti / tikta vasti will work wonders in hyperparathyroidism.

Nasya – Errhines / nasal instillation of medicines controls and balances the doshas in the head and neck mainly.

External Therapies

These are not direct remedies for hyperparathyroidism. But they may indirectly work by calming the doshas and mind, mainly vata and pitta, take control over the stress, and in that way control and balance hormonal activities in the body.

The effective therapies might include –

–        Abhyanga – herbal oil massage

–        Samvahana – mild anointing of body with herbal oil

–        Sarvanga dhara – pouring of medicated oils and milk over the body in streams / showering

–        Shirodhara – pouring in stream of medicated oils or milk over the head

Other principles

Hyperparathyroidism may also be treated on the lines of treating –

–        Asthigata vata – vata aggravation in the bones

–        Majjagata vata – vata aggravation in the bone marrow

–         Asthyavruta Vata – vata enveloped or blocked by bone tissue

–        Asthivaha sroto dushti – contamination of channels which help in formation of bone tissue and transportation of materials required for formation of bones and the diseases caused by the same

–        Asthi pradoshaja Roga – Asthi bheda (splitting pain / fractures in bone?) and Asthi Shula (bone pain) have been mentioned among the symptoms of asthi pradoshaja roga (diseases due to contamination of the bones). These symptoms are also found in hyperparathyroidism.

–        Bhagna Chikitsa (fracture treatment) – If the bones have become brittle and if fractures are evident in hyperparathyroidism patients, ‘bhagna chikitsa’ i.e. treatment of fractures as explained in Ayurveda should be adopted. Stream pouring of medicated oils and milk (seka), application of medicinal pastes (lepa), bandages (bandhana) and cold treatments, comforts and medicines (shitopacara) are included.

Correction of Agni – the bone fire

Agni or central digestive fire located in the gut (unless specified) is a sophisticated system which controls almost all metabolic activities in the body and functions of tissues, organs, mind and senses. The balance of agni in turn is under the control of vata, pitta and kapha located in its vicinity. The main agni located in the gut is called ‘jatharagni’. This agni controls the other types of fires located in the body by a feedback mechanism. This includes the fires located in the tissues (responsible for formation and maintenance of the tissues) – the dhatu agnis. In hyperparathyroidism there will be imbalance of tissue fires of bones, fat and bone marrow (mainly).

According to Ayurveda fat, bone and bone marrow are formed in that chronology.

High fire of fat tissue will lead to depletion of fat and inadequate and improper formation of bones. High fire activity of ‘bone fire’ will cause excessive destruction of bone tissue and deficit / improper formation of bone marrow. Increased bone marrow fire will lead to depletion of bone marrow and deficit formation of semen.

All these mechanisms will lead to osteoporosis, bone and joint pains, body pains, fatigue and other bone and joint related issues which are also found in case of hyperparathyroidism. So, these tissue fires shall be brought to balance while treating hyperparathyroidism. On the other hand the physician should also monitor the chief ‘gut / metabolic’ fire and also balance it. Oral administration of tikta ghrtas and virechana therapy will help as the first line of treatment. Diet and lifestyle changes which could balance pitta and agni shall be a part of the treatment protocol.

The other mechanism of pathogenesis is also possible. Low fat fire will lead to accumulation of excessive fat. This excessive fat would cause blockage of all the channels and cause depletion of all tissues including bone tissue. This can cause osteopenia, osteoporosis and painful symptoms related to the same. Here disturbance of metabolism, indigestion and metabolites are said to be the initial culprits. In these conditions loss of appetite, indigestion and any symptom related to upper or lower gastro-intestinal tract persisting for a longer duration should not be taken lightly. They should be corrected by administration of ghee processed with deepana (fire stimulating or appetizing) and pachana (digestion promoting or ama destroying) drugs or the same drugs mixed in ghee. Medicines can be given in other forms also herbal powders, medicated ghee etc. Ex: Ardhraka Ghrita, Guggulutiktakam Ghritam / Kashayam, Tiktaka Ghritam / Kashayam, Pippalyadi Ghritam, Indukantam Ghritam, Trikatu Churna, Panchakola churna etc. The same medications correct errors of dhatugata agnimandhya (low tissue metabolism) and strengthen the tissues, the medo dhatvagni and asthi dhatvagni in this case.

Medo-chikitsa / Medoroga chikitsa – treatment of excessive fat / errors and diseases of fat metabolism

Meda (fat) is the immediate precursor of Asthi dhatu (bone tissue). Therefore treatment and medications to prevent or reduce accumulation of fat in the body should be administered. This should be done especially if the patient has a weight putting tendency or is obese and also if the patient has family history of osteoporosis or osteopenia.

Virechana (therapeutic purgation), Lekhana Vasti (fat eliminating enemas) and Udwarthana (massage done with herbal powders in the reverse direction) are also useful in this context.

Anti-obesity medications should be given to reduce weight and fat. Ex: Varadi Kashayam, Varanadi Kashayam, Guggulutiktakam Kashayam, Medohara vidangadi lauha, Navaka Guggulu etc.

Useful herbs in Hyperparathyroidism

These herbs would be the same which would control / balance / mitigate vata and also good for bones and bone health –

–        Asthishrunkala – Cissus quadrangularis

–        Guggulu – Commiphora mukul

–        Arjuna – Terminalia arjuna

–        Babul – Vachellia nilotica / Acacia nilotica

–        Amalaki – Emblica officinalis

–        Laksha – Lac

–        Pravala – Coral

–        Tila – Sesame seeds

–        Ashwagandha – Withania somnifera

–        Nagabala – Grewia hirsute

–        Shatavari – Asparagus racemosus

–        Shigru – Moringa oleifera (drumstick)

–        Ashoka – Saraca indica

–        Triphala – Fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis

Useful Medications

–        Asthishrunkala (Cissus quadrangularis) – medicated ghee or juice of this plant taken with ghee are useful.

–        Babul – its bark or seed powder is given with honey.

–        Equal parts of garlic, lac, honey and sugar mixed with ghee should be given.

–        Pravala Bhasma (coral ash) – with honey or ghee

–        Powder of Arjuna bark mixed in milk

Useful formulations in Hyperparathyroidism    

–        Aabhadi Guggulu

–        Lakshadi Guggulu

–        Trayodashanga Guggulu

–        Yogaraja Guggulu

–        Medohara Vidangadi Lauha

–        Navaka Guggulu

–        Vatagajankusha Rasa

–        Vata vidhwamsini Rasa

–        Mukta shukti Bhasma / Mukta shukti pishti – Pearl calcium

–        Jawar Mohar Pishti

–        Kamadudha Rasa

–        Mukta Bhasma / Mukta pishti

–        Shringa Bhasma

–        Akik pishti

–        Maharasnadi Kashayam

–        Dhanwantaram Kashayam

–        Ashwagandharishtam

–        Dashamoolarishtam

–        Balarishtam

–        Tiktaka Ghritam

–        Guggulutiktaka Ghritam

–        Shatavari Ghritam

–        Ashwagandhadi Ghritam

–        Kalyanaka Ghritam

–        Shatpala Ghritam

–        Amruta Ghritam

–        Gandha Tailam

–        Ksheerabala tailam 101

–        Dhanwantaram 101

Useful food materials in Hyperparathyroidism

–        Foods rich in fats (oil, ghee)

–        Foods having sweet, sour and salt tastes,

–        Hot foods and drinks

–        Meat soup

–        Cooked rice

–        Medicated milk

–        Vata mitigating foods

Useful Yoga postures in Hyperparathyroidism

–        Shavasana – Corpse Pose

–        Urdhwa Dhanurasana – Upward Bow (Wheel) Pose

–        Halasana – Plow / Plough Pose

–        Janu Sirsasana – One legged forward bend Pose

–        Matsyasana – Fish Pose

–        Marjaryasana – Cat-Cow Pose

–        Sarvangasana – Shoulder Pose

–        Viparita Karani – Legs Up The Wall Pose

–        Navasana – Boat Pose

–        Ushtrasana – Camel Pose

–        Bhujangasana – Cobra Pose