Evaluation of the efficacy of“KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN               “BHRAMA” (HYPERTENSION)                ...
D.G.M.AYURVEDIC MEDICAL COLLEGEPOST GRADUATE STUDIES AND RESEARCH CENTRE                            GADAG - 582 103       ...
J.S.V.V. SAMSTHE’S                     D.G.M.AYURVEDIC MEDICAL COLLEGE      POST GRADUATE STUDIES AND RESEARCH CENTRE     ...
Declaration by the candidate        I here by declare that this dissertation / thesis entitled “EVALUATIONOF THE EFFICACY ...
Copy right             Declaration by the candidate        I here by declare that the Rajiv Gandhi University of Health Sc...
I express my deep gratitude to my guide Dr. K. Shiva Rama Prasad, M.D. (Ay),M.A. (Jyo) [Ph.D. (Jy)] for his timely advises...
I discharge my salute to my beloved Grand mother - smt. Susheela Bai SubbayyaGudur and express my humble heart filled grat...
Abstract                             Evaluation of the efficacy of           “Kakubhadi Lehya” as Hridya Rasayana in “Bhra...
Table of contents                Evaluation of the efficacy of      “KAKUBHADI LEHYA” AS HRIDYA RASAYANA             IN “B...
List of tablesSno                               Table Heading                                   Page1                     ...
18   Distribution of patients by presenting complaints                                  9519   Distribution of patients by...
List of figuresSno                              Figures heading                                   Page1     Showing the Bl...
List of graphsSno                                Graph heading                                     Page1     Distribution ...
Chapter-1                                                                     Introduction                           iddin...
As there is no definitive definition universally accepted, the Joint NationalCommittee (JNC-4) of United states on detecti...
According to the clinical course, both essential and secondary hypertension maybe benign or malignant. Benign hypertension...
1. Genetic factors: The role of heredity in the etiology of essential hypertension has   long been suspected. The evidence...
Younger the age at which hypertension is first noted but left untreated, lower thelife expectancy. Females with hypertensi...
Ayurveda is based on the humoral theory and establishes that the Tridoshas haveits effect over the body. These humors move...
Dhamani Upalepa                 Prof. G. N. Chaturvedi and Dr. K.N. Shastri   Mada,Murcha, Sanyasa            Kaviraj Kumu...
Essential hypertension when symptomatic will have one or few vague symptoms.Similarly when we consider many avrita vatas t...
Historical review:       In ancient days the Hypertension was not described as an individual disorder. Itmay be because of...
century. Late 20th century with advancements in electronics has presented digitalSphygmomanometer to the medical community...
‘sukrala’ effect and it can not nourish and strengthen the other Dhatus. Here it is worthmentioning the increased activity...
Rasayana therapy is defined as “the means by which one gets the excellence ofRasa, Rakta etc., (tissue elements). This Ras...
Chapter-2                                                                           Objectives              resent study b...
2) To evaluate the efficacy of Rasayana effect of           “KAKUBHADI LEHYA” inBHRAMA (Hypertension)       Since the need...
3) To evaluate the effect of “KAKUBHADI LEHYA” over disease predisposingfactors such as Lipids       Carbon monoxide cause...
Chapter-3                                                       Review of literature                here is no definite in...
1.     Bhrama                      2.     Dhamani pratichaya                      3.     Mada                      4.     ...
Vagbhata has mentioned that this is because of vata dosha Vruddhi and KaphaKsheena26, where as Charaka affirmed it as sanc...
which these dhatu circulates get dilated. Because these Dhamanis get stretched by thefullness of the Rasa, Rakta (Vriddhi)...
almost all the symptoms, which are mentioned by Charaka, in addition with – Swapam,Raga and Bhrama35.       Shri sudarshan...
mentioned i.e akunchana means sankocha in siras and purana means stoolatwa           in siras. In Yogaratnakar, it is ment...
hypertension by Acharya shree Vishwanath Dwivedi and clarified that the dushyainvolved in this disease is Rakta.       In ...
49               8c) Pitta Avrithavata          : If vayu is covered by Pitta the following               symptoms arise –...
9a) Murcha:        Murcha is considered as disease entity in Madava Nidana and explained in detailswith nidana panchakas. ...
10) Raktachapadhikyata       The word Raktachapadhikyata is formed by three words - Rakta, Chapa andAdhikyata.‘Rakta’ refe...
SHAREERA VIVECHANA       Before discussing the disease Bhrama, it is very much essential to know thefunctional anatomy of ...
moola of pranavaha and rasavaha Srotas 55. It is the seat of manas and para-apara ojus56.Hridaya is the prabhava sthana of...
maintains the activities of hridaya (heart and circulatory system), and supports or does                                  ...
Hridaya and Avalambaka Kapha       Avalambaka kapha is situated in uras 83-84. It does avalambana of hridaya i.e. withthe ...
Rasa Rakta Paribhramana       Hridaya is the srotomula of rasavaha and pranavaha srotus 93. It is responsible forrasa samv...
shareera. This cycle continues and acharya Charaka uses the word ajasra to denotes thecontinuous function of hridaya in ci...
the vascular system, blood flowing from the vessels with higher pressure to those withlower. The gradual drop in the press...
other words, the arterial blood pressure is a product of cardiac out put and peripheralvascular resistance.               ...
It appears that most patients with established hypertension have abnormal cardiacoutput and increased peripheral vascular ...
pressure by adjusting the amonts of SNO and NO to which blood vessels are exposed.This newly appreciated role of haemoglob...
population. Further peripheral levels of plasma renin and angiotensin –II is found in    relation inversely to age in esse...
•      GFR- independent natriuretic factors, including atrial natriuretic factor (ANF), a    peptide secreted by heart atr...
Table -2    Showing Dosha Dushyadi Vivechana of Bhrama in comparison to hypertensionSl.                       SHAREE MANAS...
1) Mityahara Vihara:       Improper diet like consumption of excessively pungent, heavy, dry, incompatible,unaccustomed, u...
3) Marmaghata :      Hridaya is an important Marmanga the reason why it is specially designed forsensitivity. Any injury t...
d) Medovaha Srotodusti Karanas: Avyayama, deewaswapna, excess of fat containingmeat, adhika madira etc.e) Manovaha Srotodu...
116.involvement of samjnavaha or manovaha Srotas                Further, Chakrapani commenting on                         ...
3.      Stress: Chronic psychological stress may lead to hypertension and acutely stressful        stimuli may cause trans...
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Evaluation of the efficacy of “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN
“BHRAMA” (HYPERTENSION) By Chetan Sangappa Minajigi, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  1. 1. Evaluation of the efficacy of“KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN “BHRAMA” (HYPERTENSION) By “C hetan Sangappa Minajigi” Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfilment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)] Department of Kayachikitsa Post Graduate Studies & Research CentreD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2002-2005
  2. 2. D.G.M.AYURVEDIC MEDICAL COLLEGEPOST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103 This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN “BHRAMA” (HYPERTENSION)” is a bonafide research work done by “Chetan Sangappa Minajigi” in partial fulfilment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. Date: Dr. SHIVA RAMA PRASAD KETHAMAKKA Place: Gadag M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)] Guide READER IN KAYACHIKITSA DGMAMC, PGS&RC, Gadag
  3. 3. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG, 582 103 Endorsement by the H.O.D, Principal/ head of the institution This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN “BHRAMA” (HYPERTENSION)” is a bonafide research work done by “Chetan Sangappa Minajigi” under the guidance of Dr. SHIVA RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Reader in Kayachikitsa, DGMAMC, PGS&RC, Gadag, in partial fulfilment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka.. (Dr. V. Varada charyulu) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Kayachikitsa DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place:
  4. 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled “EVALUATIONOF THE EFFICACY OF “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN“BHRAMA” (HYPERTENSION)” is a bonafide and genuine research workcarried out by me under the guidance of Dr. SHIVA RAMA PRASADKETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Reader inKayachikitsa, DGMAMC, PGS&RC, Gadag.DatePlace (Chetan Sangappa Minajigi)
  5. 5. Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation/ thesis in print or electronic format for the academic / researchpurpose.DatePlace (Chetan Sangappa Minajigi) © Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. I express my deep gratitude to my guide Dr. K. Shiva Rama Prasad, M.D. (Ay),M.A. (Jyo) [Ph.D. (Jy)] for his timely advises and encouragement in every step of mysuccess. His ideologies have been exemplar to my further career. I express my gratefulness to my professor H.O.D., Dr. V. Varadacharyulu,M.D.(Ayu), and Dr R. V. Shettar, M.D (Ayu) lecturer in Kayachikitsa, for their time to timehelp and critical suggestions associated with expert guidance at the completion of thisdissertation. I express my thankfulness to beloved principal Dr. G. B. Patil, for hisencouragement as well as providing all necessary facilities for this research work. I express my profound sense of acknowledgement to various departmentsH.O.D.s, teachers and colleagues of sister concern departments along with the ministerialand sub staff of the D.G.M. Ayurvedic Medical College & Hospital, Gadag. I express my sincere thanks to Dr. Shashidar. H. Doddamani, Dr. Kuber Sankh,Dr. P. Shivaramudu, Dr. M.C. Patil, Dr. Danappagoudar and Dr. Santhosh Belavadi. Iexpress my sincere thanks to Mr. Nandakumar for his help in statistical analysis ofresults. I am thankful to Dr. Nagi Reddy for his assistance in preparing the medicine andDr Kona for the lab assistance. I express my sincere conceding to Dr. Shashikant Nidagundi, Dr. Jagadeesh Mitti,Dr. Mulkipatil, Dr. U.V. Purad, Dr. Paraddi, Dr. Sajjan and Dr. B.G. Swami. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” I
  7. 7. I discharge my salute to my beloved Grand mother - smt. Susheela Bai SubbayyaGudur and express my humble heart filled gratitude that stood strong to support me at mycalamities. Present existence of mine is because of my beloved parents, Late SangappaChanabassappa Minajigi, and Smt. Shobha Devi, I am at their remembrance at everymovement of my success. Behind my success, the pillars are my brothers, Dr. Ananad and Sachin, a warmthanks to them on this regard. I am extremely thankful and obliged to Dr. Pranesh S. Gudurand Smt. Rekha Pranesh and Ramanna S Gudur, and Smt Savitri R Gudur, who alwayswatched me and shaped my career. Its only their support and encouragement which mademe possible to achieve my goal. . My sincere thanks to Dr. Chandrashekhar, Yapal Parvi, Anil Menasinakai, S.C.Biradar and Dr.D.P.Joshi - my friend of all times, with out of their support I am alwaysincomplete. My relatives and well wishers, those were supporting all the time - Jyothi,Venkatesh, and Dr. Sudhakar. T.B, Dr. Suhashini Telang, Dr. Srinivasa Reddi, SwaroopaRani, Dr. Varsha Kulakarni, Dr. Pattanshetti, Dr. Mangala Patil, Dr. Jaggal, Dr. Santoji, Dr.Bingi, Dr. Santosh Yadahalli, Dr. V.S. Hiremath, Dr. K. Hiremath, Dr. Veena Kori, Dr.Shankaragouda, Dr. Yasmeen, Dr. Hadimani, Dr. Hanamanthagoudar, Dr. Pradeep, Dr.Koteswar Rao, Dr. B.Y. Ghanti, Spoorti JT, Priya KR, Asha P, Shivkumar LT, Anil Biradar,Anil Ratod, Manish jain and Harun Kowshik – I express deep thankfulness for theirinspiration during the study. At last my sincere thanks to the subjects who cooperated at my dissertation, without of them it would have been not a success.Place:Date: Chetan Sangappa Minajigi Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” II
  8. 8. Abstract Evaluation of the efficacy of “Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” (Hypertension) By – Chetan Sangappa Minajigi Bhrama vis-à-vis essential hypertension in which the causes of increase in bloodpressure is unknown. It constitutes about 90-95% patients of hypertension. Angiotensin IIalters blood pressure by increasing both peripheral resistance and blood volume. Manypatients have a family history of high blood pressure. Lifestyle changes can significantlyimprove a patient’s blood pressure. The factors influencing the relationship betweenblood pressure and cardiovascular risk include systolic blood pressure, diastolic bloodpressure, circadian blood pressure patterns blood pressure variability, and cardiac andvascular hypertrophy. Retention of sodium will cause an increase in the blood volume,which in turn increases the blood pressure. Evidence supports treatment of systolic high blood pressure in older persons.Local endothelial factors may play a role in blood pressure. High blood pressure lowerscognitive function. Increased T.P.R. + increased cardiac output = increased bloodpressure. Hypertension increases the viscosity of blood. Treatment of the disease reduces the symptoms of high blood pressure.Shirodhara is claimed to reduce high blood pressure. Present study registers 30 patients,out of 68 approached patients. Parameters of co-morbidity in Bhrama are serumcreatinine, Serum cholesterol and associative LDL, VLDL with S.Triglycerides. Study ofKakubhadi Lehya on Bhrama vis-à-vis hypertension show marked drop of 20 mm Hg ofsystolic hypertension by inducting the Rasayana effect. All the objective parametersshow highly significance. After through study of the entire parameters and materialsavailable for the assessment of results it was drawn a conclusion of results as - 9(30.02%) well responded, 6 (20.02%) moderately responded, 10 (33.33%) responded, 3(10%) patients not responded and the last 2 (6.63%) patients discontinued in the study. Thus it is concluded that the Kakubhadi Lehya is effective as Hrudya Rasayana inthe disease condition Bhrama vis-à-vis hypertension. This is recommended for theregulation and prophylactics of Bhrama vis-à-vis hypertension. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” III
  9. 9. Table of contents Evaluation of the efficacy of “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN “BHRAMA” (HYPERTENSION) Heading Page numberChapter -1 Introduction 1 to 12Chapter –2 Objectives 13 to 15Chapter –3 Review of literature 16 to 67Chapter –4 Methodology 68 to 85Chapter –5 Results 86 to 114Chapter –6 Discussion 115 to 178Chapter –7 Conclusion 179 to 185Chapter –8 Summary 186 to 189 Bibliographic References I to XIV Annex – Case sheet 1 to 6 Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” IV
  10. 10. List of tablesSno Table Heading Page1 32 Dushyadi Vivechana of Bhrama in comparison to 383 49 in the patients with mild or moderate Hypertension - Symptoms Step care treatment of hypertension 57 Showing the Pathyapathya in Hypertension (Bhrama)6 Key items of the baseline physical and laboratory examinations 797 828 839 8410 8511 8712 8713 8814 9015 9116 9317 94 Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” V
  11. 11. 18 Distribution of patients by presenting complaints 9519 Distribution of patients by Associated features 9720 Distribution of patients by mode of on set 9821 Distribution of patients by Intensity 9922 Distribution of patients by Aggravating factors 10023 Distribution of patients by relieving factors 10224 Distribution of patients by Shareerika Prakruti 10325 Distribution of patients by Manasika Prakruti 10526 Assessment of Lab investigations in Bhrama 10627 Assessment of Subjective parameters in Bhrama 10828 Results of Kakubhadi Lehya in Bhrama vis-à -vis Hypertension 11029 Statistical analysis - Subjective parameters 11130 Statistical analysis - Emotional parameters 11231 Statistical analysis - Objective parameters 11232 Statistical analysis - Blood pressure variances 11333 Blood pressure levels 12434 Four stages wherein cardiac involvement takes place 12735 The World Health Organisation (WHO) Classification of Hypertension 12736 Cardiovascular responses to stimulation 13437 Apo-fraction representation of the lipoproteins 14538 Blood pressure variances of Before to After 17239 BMI Vs Blood Pressure 17640 Male BMI with lipid profile variations 17741 Female BMI with lipid profile variations 177 Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” VI
  12. 12. List of figuresSno Figures heading Page1 Showing the Blood Pressure Regulation 332 Showing the Role of Renin-Angiotensin System 363 Diagrammatic expression showing dietary intake and CVD 434 Showing the Schematic Representation of Samprapti 505 Initiation of Modern Treatment in Patients with Hypertension 596 Showing the Approach to the Hypertensive Patient after Initiating 60 Anti-hypertensive Drug Treatment7 Algorithm for Treating Hypertension 618 Ingredients of Kakubhadi Lehya 829 Comparison of the benign and malignant hypertension 12110 Speculative current theory of hypertension 12311 Summary of the aetiology 12812 Measurement of Blood Pressure 138 Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” VII
  13. 13. List of graphsSno Graph heading Page1 Distribution of patients by Age – Gender 892 Distribution of patients by Gender in Bhrama 903 Distribution of patients by Religion 924 Distribution of patients by occupation 935 Distribution of patients by Economic status 956 Distribution of patients by presenting complaints 967 Distribution of patients by Associated features 978 Distribution of patients by mode of on set 989 Distribution of patients by Intensity 10010 Depicting the Aggravating factors of Bhrama 10111 Distribution of patients by relieving factors 10212 Distribution of patients by Shareerika Prakruti 10413 Distribution of patients by Manasika Prakruti 10514 Distribution by presenting complaints 10915 Results of the Kakubhadi Lehya 11116 Linear graph of Blood Pressure – Systolic hypertension 17317 Linear graph of Blood Pressure – Diastolic hypertension 17418 BMI with systolic blood pressures 17519 BMI with diastolic blood pressure 175 Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”VIII
  14. 14. Chapter-1 Introduction iddiness or Dizziness (Bhrama), headache (Sirahsoola), fatigue(Angasada), insomnia (Nidranasha) and palpitation (Hritdrava) are common complaintsfor an Ayurvedic practitioner occasionally get confused with the presented symptoms tocorrelate. As the nomenclature of Hypertension or similar was not included in classicaltexts and neither of Acharyas has affirmed such a condition elaborately, undertaking thesupport of the contemporary medical system is unavoidable. Hypertension is a major risk factor for many serious health problems. We havemany weapons to combat it: prevention, lifestyle changes, and increasing knowledgeabout how best to employ a growing arsenal of medications. Yet, as many as half thepatients who start hypertension treatment stop within a year. Treatment is expensive, itcan have uncomfortable side effects. When the condition itself is asymptomatic andphysicians and patients may not remain fully vigilant through lengthy treatment 1. The Hypertension, called as “Salient Killer”, drawn the attention of W.H.O. inover decreasing the life span of 10 to 20 years causing cardiac or renal troubles. Further itcan be said, as it is an important factor in increasing the morbidity and mortality due to Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 1
  15. 15. As there is no definitive definition universally accepted, the Joint NationalCommittee (JNC-4) of United states on detection, evaluation and treatment of high bloodpressure defines Hypertension as systolic blood pressure (SBP) of 140 mm Hg or moreand diastolic blood pressure (DBP) of 90 mm Hg or more.Definition and classification Arterial or systemic hypertension in a patient is defined clinically as ‘borderline’if the systolic blood pressure is more than 140 mm Hg and diastolic pressure is above90mmHg (currently labeled as mild hypertension), and ‘hypertensive’ when the elevationof systolic and diastolic pressure exceeds 160 and 95mmHg respectively (now termed asmoderate hypertension). The diastolic pressure is often considered more significant.However, blood pressure varies with many factors such as age of the patient, exercise,emotional disturbances like fear and anxiety. Therefore, it is important to measure bloodpressure at least twice during two separate examinations under least stressful conditions.A clinically useful classification of hypertension has been recently described by the JointNational Committee of the WHO/International society of Hypertension, by means ofthese criteria, the prevalence of hypertension is observed in about 25% of population.Hypertension is generally classified into 2 types 2 1. Primary or essential hypertension in which the causes of increase in blood pressure is unknown. Essential hypertension constitutes about 90-95% patients of hypertension. 2. Diseases of the kidneys, endocrines or some other organs cause secondary hypertension, in which the blood pressure is increased. Secondary hypertension comprises 5-10% cases of hypertension. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 2
  16. 16. According to the clinical course, both essential and secondary hypertension maybe benign or malignant. Benign hypertension is moderate elevation of blood pressure andthe rise is slow over the years.Clinical classification of hypertension Table -1 Category Systolic (mmHg) Diastolic (mmHg) Normal <130 <85 High normal 130-139 85-89 Hypertension Mild (stage1) 140-159 90-99 Moderate (stage2) 160-179 100-109 Severe (stage3) 180-209 110-119 Very severe (stage4) >210 >120Malignant hypertension >200 >140 About 90-95% patients of hypertension have benign hypertensionMalignant hypertension Malignant hypertension is marked and rapid increase of blood pressure to 200/140mmHg or more and the patients have papilloedema, retinal haemorrhages andhypertensive encephalopathy. Less than 5% of hypertensive patients develop malignanthypertension and life expectancy after diagnosis in these patients is generally less than 2years if not treated effectively.Essential (primary) hypertension By definition the cause of essential hypertension is unknown but a number offactors are related to its development. These are as under - Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 3
  17. 17. 1. Genetic factors: The role of heredity in the etiology of essential hypertension has long been suspected. The evidences in support are the familial aggregation, occurrence of hypertension in twins, epidemiologic data, experimental animal studies and identification of hypertension susceptibility gene (angiotensinogen gene)2. Racial and environmental factors: Surveys in the US have revealed higher incidence of essential hypertension in black than in whites. A number of environmental factors have been implicated in the development of hypertension including salt intake, obestity, skilled occupation, higher living standards and patients in high stress.3. Risk factors modifying the course of essential hypertension: There is sufficient evidence to show that the course of essential hypertension that begins in middle life is modified by a number of factors. These are as under - a) Essential hypertension (90%) (a) Genetic factors (b) Racial and environmental factors (c) Risk factors modifying the course b) Secondary hypertension (10%) 1. Renal (a) Renovascular (b) Renal parenchymal diseases 2. Endocrine (a) Adrenocortical hyperfunction (b) Hyperparathyroidism (c) Oral contraceptives 3. Coarctation of aorta 4. Neurogenic Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 4
  18. 18. Younger the age at which hypertension is first noted but left untreated, lower thelife expectancy. Females with hypertension appear to fare better than males. Acceleratedatherosclerosis invariably accompanies essential hypertension. This could be due tocontributory role of other independent factors like cigarette smoking, elevated serumcholesterol, glucose intolerance and obesity. Other factors, which alter the prognosis inhypertension, include; smoking, excess of alcohol intake, diabetes mellitus, persistentlyhigh diastolic pressure above 115 mm Hg and evidence of endorgan damage ((i.e. hearteyes, kidney and nervous system). The pathogeneic mechanism in essential hypertension is explained by manytheories. These are -High plasma level of catecholamines Increase in blood volume i.e., arterial overfilling (volume hypertension) andarteriolar constriction (vasoconstrictor hypertension)Increased cardiac out put Low-renin essential hypertension found in approximately 20% patients due toaltered responsiveness to renin release. High renin essential hypertension seen in about15% cases due to decreased adrenal responsiveness to angiotensin II Blood pressure is a continuous physical variable and is complex, being influentialby many factors. An individual can show variations through out the day depending onphysical activity, body posture, mental activity, emotional status, the environment andconsumption of drugs, alcohol and tobacco. Dynamic or isometric exercise can also riskblood pressure in normal subjects3. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 5
  19. 19. Ayurveda is based on the humoral theory and establishes that the Tridoshas haveits effect over the body. These humors move all over the body. The Vata, Pitta and Kapharule the ages of child, youth and old age4. It also has its effect on the divisions of the dayand night, and also to the food; where dosha vitiation is seen naturally contributed by theexternal factors. The clinical entity of hypertension is not available as such in the classicalliteratures of Ayurveda. However, according to the directions of Acharyas regarding the 5-6-7approach for the study of new diseases, various contemporary Ayurvedic scholarshave made efforts to findout the proper nomenclature, etio-pathogenesis and treatment ofthe disease. It is very interesting to note that Acharya Charaka says about the complication ofAvrithavata as, Avrithavata if neglected leads to Hridroga, vidradi, pleeha, gulma andAtisara8. Thus by understanding the Dosha state, site of appearance and its signs andsymptoms, we have to come for conclusion and treat the state of disease or illness on thebasis of vikalpa i.e. combinations and permutations of doshas9. In recent times many Ayurvedic scholars have tried to give an appropriate term tohypertension in Ayurveda. Following are the different correlation and differentterminology suggested by various scholars- Avrita Vata Roga Vaidya R.K. Sharma Dhamani Atipurana Acharya Yogendranath Sen Dhamani Prapoornata Vaidya G.N. Saraswathi Dhamani Praticchaya Vaidya A.D. Athawale; Vaidya Ranajit Rai Desai Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 6
  20. 20. Dhamani Upalepa Prof. G. N. Chaturvedi and Dr. K.N. Shastri Mada,Murcha, Sanyasa Kaviraj Kumud Ranjan Roy Rakta Peedanadhikyata Prof. Dr.V.V.S. Sastry, Dr.K.S.R.Prasad, Dr.S.S.Hiremath (Gadag), et.al. Raktagata Vata Prof. Yadunandana Upadhyaya. And Shri. Sudarshana Shasrti; Bhupenra Pal. (Varanasi) Rakta Sammardhana Prof. G.N. Chaturvedi Rakta Sampeeda Vaidya S.P. Panday Rakta Vata Prof. Yadunandana Upadhyaya. And Shri. Sudarshana Shasrti; Dr. Sharma (Puri) Raktatimardam Dr. John K. George Rakta Vega Vriddhi Vaidya V.B. Athawale Rasa Bhara Vaidya T.S. Mishra Roudira Mada Acharya Vishwanath Dwivedi Siragata Vata Prof. G. N. Chaturvedi and Dr. K.N. Shastri Sleshamavrita Vyana Dr. Gupta H.C. (Varanasi) Uccha Rakta Bhara Dr. Pathak U.C. (Jaipur) Uccha Rakta Nipeedana Acharya Vidyadhara Shukla Uccha Raktachapa Prof. Madan Gopal Sharma and Dr. Ajay Kumar Sharma Vyana Bala Vaishamya Vaidya Brihaspati Triguna Some of the other terminologies used by other authors are Raktavruta Vata, RaktaPradoshaja Vikara, Bhrama, Rakta chapadhikyata, Raktabhigarshana, Rakta vikshepa etc. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 7
  21. 21. Essential hypertension when symptomatic will have one or few vague symptoms.Similarly when we consider many avrita vatas they contain one or few symptoms ofessential hypertension, those are Raktavrita Vata, Pittavrita Udana, Pittavrita Prana,Pranavrita Udana, Samanavrita Vyana, Sleshmavrita Vyana, Apanavrita Udana,Vyanavrita Prana, Pranavrita Vyana, Udanavrita Prana, Kaphavrita Udana, PittavritaVyana, Udanavrita Apana, Kaphavrita Prana etc. In these the involvement of Vyana,Udana and Prana seems to be more prominent. After considering all these, when we look at the symptoms explained in Raktagata vata, Sira gata vata, Roudhiramada, Dhamanipratichaya etc., and the variousAvrithavata’s, it seems that each pathological entity contains one or few symptomsexplained in essential hypertension. It may be because of the fact that usually in essentialhypertension, different patients will be manifested with different symptoms. Our ancientAcharyas diagnosed the disease on the basis of symptoms available. But when we collectall these symptoms, it directly coincides with the symptoms explained in essentialhypertension. This indicates that our Acharyas considered this disease under Vata roga. On close observation, it is very much evident that different scholars tried toidentify the disease on the basis of following; 1. On the basis of vitiated dhatu – like Raktapradoshaja vikara, Rakta chapadhikyata, Rakta samvardhana etc. 2. On the basis of vitiation of Vata – like Vyana bala vaishamya etc. 3. On the basis of vascular changes – like Dhamanipraticchaya, Dhamani prapoornata, Sira gata vata etc. 4. On the basis of Avarana – like Raktavrita vata, Pittavrita udana, Sleshmavrita Vyana etc. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 8
  22. 22. Historical review: In ancient days the Hypertension was not described as an individual disorder. Itmay be because of less prevalence as they followed strict daily and seasonal regimensand also not much psychological interference in daily routine. But they were not ignorantof the conditions developed by the psychological pressure disturbances. There by theyplaced them under the nanatmaja vyadhis, related to their cause and mode ofdevelopment. Much more such symptoms are explained and tagged with Vata, which canbe said as that to be under neural control impairment and very few conditions are withPitta and Kapha. Until 1920’s, Hypertension was considered that as beneficial, even though in1733 Stephen Hales measured first time Atrial blood pressure and demonstrated in adramatic fashion, that the blood in arteries is under a great deal of pressure. His work waspublished by Royal society in 1733 as two volumes. 10 The instrument developed by Stephen Hales were improved by Karl Ludwig(1816-1895) improved the Instrument developed by Stephen Hales by adding a float inthe measuring cylinder. Karl Vierodt (1818-1884) constructed a sphegmograph trackingthe human pulse, which estimates the blood pressure by puncturing the vessel. It wasdifficult and also painful for the patient. This method was greeted by British medicaljournal and followed by Samual Von Bach (1880) and later developed by Scipione RiyaRocci in 1896. In 1905, Karokoff a Russian, introduced the auscaltatory method of estimatingblood pressure. With in few years Sphygmomanometer took place with the stethoscope.The mercury column and spring dial Sphygmomanometers were introduced in 20th Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 9
  23. 23. century. Late 20th century with advancements in electronics has presented digitalSphygmomanometer to the medical community apart from ECG and Doplar studies,which will provide scope to measure blood pressure.Proposal: When the lakshanas of Hypertension are observed with its patho-physiology, thepresent proposed name “Bhrama” will be relatively clear to explain state ofHypertension. As Charaka explained, there may be only one cause for one disease or same causemay give rise many diseases. Some times we may find so many causes gives rise or 11develops one disease or many causes develops many diseases . Thus, the presentselected disease has many synonyms, according to the state of development of the diseaseor with respect to that of the disease development. The Vata nanatmaja vyadhi consists of three conditions that appear in the processof Hypertension pathogenesis. They are Bhrama (Dizziness), Hritdrava (palpitation), andAswapna (sleeplessness) 12. The appearance of the above said in Vata age and rutukala isof physiological and if it appears with Pitta and Kapha association or age and rutukala, it 13becomes pathological. If Dhamani pratichaya is (atherosclerosis) one out of twentyKaphaja diseases appears or associates with the ageing factor have more responsibility togive rise Hypertension or Bhrama.Role of Rasayana Chikitsa in Bhrama vis-à-vis Hypertension Rasayana Chikitsa not only strengthens Dhatus but also works as a “Vajikarana”i.e. youthful vigor and vitality. This is attributed to the “Sukrala” effect of Rasayanadravyas. The dissimilarity of Vajikarana drugs is only limited to and restricted to Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 10
  24. 24. ‘sukrala’ effect and it can not nourish and strengthen the other Dhatus. Here it is worthmentioning the increased activity of controlled cell-division if it can replace the old cellsby new in a short spell, will also constitute the rejuvenation of the body leading to alonger life, i.e. the Rasayana effect. In Ayurveda any treatment that increases the immune power and life force isconsidered as Rasayana or rejuvenate. This can include herbs, food, diet or activities thatrestore vitality, youthfulness and cure disease. Rasa is the juice of life, the vital fluid thatsustains health and life. As we grow older we gradually lose this "juiciness", our tissuesbegin to dry out and our joints lose their lubrication and ease of movement. Rasayanareplenishes this innermost sap of the body promoting clarity of perception, physicalstrength, endurance and longevity of tissues. Rasayanas are more subtle and specific in their action than simple nutritive tonicsas they promote and sustain the optimum functioning of the body, assisting not onlylongevity but also awakening of the mind. They restore youthfulness in old age andimprove memory, mental clarity and vitality. Rasayanas nourishing and rejuvenatingaction at the cellular level of the tissues promotes continued production of lives vitalessences enabling to remain active and full of enthusiasm for the entire duration of life. Rasayana herbs are being continuously explored for their effects on immunesystem. Available evidence shows that, these drugs can be used to modulate the immunefunctions. At one hand they may work to enhance immune functions and build us fromdeep within, or they might pacify an angry immunity cell to be in its limits on the other.Thus, a Rasayana drug favours the host in both ways. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 11
  25. 25. Rasayana therapy is defined as “the means by which one gets the excellence ofRasa, Rakta etc., (tissue elements). This Rasa is the only source of nourishment to all thetissue of the body. This is cyclical through out day and night without interruptionsupplying nutrition to all living cells of the body through the Rasa-Rakta admixture. Rasa(essence of food) is known to be the premier nutrition of the body tissue is capable toprogress/ limit the blood-related diseases, such as hypertension. The Rasa vitiation is one of the major situations in case of Bhrama, thus theremoval of impurities and proper transportation of the Rasa-Raktavaha srotogata dravayai.e. Rakta with its related components in the minute vessels and capillaries is possiblethrough Rasayana. Dhaturupa Rasa (plasma and such other fluid constants of the body inassociation with Rakta (blood constituents), which makes the imbalance through the Rasaare to be rectified in the same route following the most best procedure of safeguardingthe Preenana and Jeevana kriyas by the Rasayana. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 12
  26. 26. Chapter-2 Objectives resent study bears the following objectives - (a) To evaluate the efficacy of “KAKUBHADI LEHYA” in BHRAMA (Hypertension) (b) To evaluate the efficacy of Rasayana effect of “KAKUBHADI LEHYA” in BHRAMA (Hypertension). (c) To evaluate the effect of “KAKUBHADI LEHYA” over disease predisposing factors such as Lipids. Their detail discussion is as under -1) To evaluate the efficacy of “KAKUBHADI LEHYA” in BHRAMA(Hypertension) Bhrama is a pathetic condition in which the patient has a feeling of reeling head.This could be because of humour vitiation as in association with the Rasa and Raktastated in Ayurveda or because of the impaired haemo-dynamics. In such condition the Kakubhadi Lehya is said as better by its contents. It can besubstantiated that the rational combination made in Ayurvedic text, Bhaisajya Ratnavaliat Hrudroga Chikitsa Prakarana, can establish its identity by normalising the componentsof Bhrama vis-à-vis high blood pressure and equilibrating the Dosha involved. Presentstudy evaluates the efficacy of the Kakubhadi Lehya under the lime light of thecontemporary medical parlance. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 13
  27. 27. 2) To evaluate the efficacy of Rasayana effect of “KAKUBHADI LEHYA” inBHRAMA (Hypertension) Since the need for primary and secondary health care is paramount, theGovernment will direct most of its spending towards this sector14. Every individual isresponsible for the entire cleanliness of himself, his house and surroundings. When oncethis is recognised and, carried out, he is sure to attain freedom from sickness. Personalcleanliness of the body, of dwelling apartments and of surroundings, good habits, goodfood, exercise, recreation and sleep are all important factors in determining the strength,luster, happiness and long life of individual 15. Charaka has also laid down the code of good conduct by which one can remainhealthy and long-lived. He has also emphasised on prevention of diseases for which hehas devoted a number of chapters dealing with daily routine, seasonal living etc. in thefirst section of the Samhita. The Charaka Samhita shows the path by which a man, 16devoid of any ailment, can live happily and enjoy the normal life span (100 years) .Aswins treat Maharshi Chyavana and Nandana with Rasayana therapy and made themyoung by all means. This story was said in Rigveda17. In the present context of Rasayana the word Rasa has the sense of end products ofdigestion, which influence the metabolism of the body under the influence of the dailystress and strain undertaken in the walking food running duties society. All the herbshave the Rasa, which influence the Ahara Rasa, very specifically the preenana function.Thus the Kakubhadi Lehya embedded Rasas cumulative effect on the body especially asRasayana over the body is evaluated here in this study. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 14
  28. 28. 3) To evaluate the effect of “KAKUBHADI LEHYA” over disease predisposingfactors such as Lipids Carbon monoxide causes perivascular oedema of the blood vessels and hypoxia.This alters the permeability of the endothelium and increases the deposition of lipids inthe vessel wall. Reduction or stoppages of smoking helps to reduce blood pressure even.Obesity contributes to blood lipid abnormalities and impaired glucose tolerance; it hasparticular significance as a factor underlying the increased prevalence of coronary arterydisease in hypertensive patients. For every 10% increase in weight a rise of 6.5-mm Hgin systolic pressure was observed in Framingham study. Susruta has mentioned medoroga leads to vatavikara. Dalhana explained thatvatavikara is produced due to medavrita marga18. Apart from this in Astauninditeeyaadhyaya of charaka sutra sthana, Charaka has described the complications of sthoulya.Here the apakva medas when deposited in rasavaha srotas may lead to dhamanipratichaya 19-20-21 (atherosclerosis), which is the main factor responsible for hypertension.Kakubhadi Lehya is a medicine in which, associations of Ghee with sugar candy exists.The medicines with the edible fats are supplied to promote good fats in the body and toexcavate the fats responsible for disturbing the Srotas and Dhatu even. At this juncturethere is a need of evaluation of such medicament study in relation to that of the lipidprofile. Thus the present objective is carried out. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 15
  29. 29. Chapter-3 Review of literature here is no definite information regarding the normal or abnormalconditions of Hypertension in Ayurvedic classics. But this especially in an abnormalstate is presently recognised as a disease state, which requires immediate attention of thephysician 22.HYPERTENSION IN ANTIQUITY If you just look back to the past days, the clinical entity of hypertension is notavailable as such in any of the classical literatures of Ayurveda. We find more thanthousands of diseases described in Ayurveda which can be correlated or resembles one orthe other modern diseases, like Jwara, Rajayakshma, Visarpa, Switra etc., to that ofFever, Tuberculosis, Herpes, Leucoderma etc., respectively. On the contrary it is difficultto find a clear-cut correlation to that of hypertension in our science. But looking to thedescription of hridaya, the diseases like Hridroga, Pakshaghata which can be taken as thecomplications of hypertension and the drugs like Sarpagandha, Arjuna etc., we can thinkof hypertension to be present in those days.20th Century Authors on Hypertension Based on the Dosha Dushya vivechana by 20th Century Authors and variousdiseases are considered under the heading Hypertension. Different names arerecommended for the Hypertension or the Hypertensive States are as follows – Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 16
  30. 30. 1. Bhrama 2. Dhamani pratichaya 3. Mada 4. Moorcha 5. Pittavrita udanavata 6. Rakta gata vata 7. Raktachapadhikyata 8. Raktapradoshaja vikara 9. Raktavriddha pittavrita vata 10. Roudhiryamada 11. Sanyasa 12. Siragata vata 13. Ucha rakta bhara 14. Ucha rakta chapa1) Bhrama: The literal meaning of Bhrama is rotation. As a disease, it has been explained as afeeling that a person experiences the fast rotation in the shiras similar to that of fastrotating wheel23. Charaka has considered the Bhrama as one out of the vataja nanatmajavyadhi. Here Bhrama corresponds to Giddiness and Vertigo. Bhrama is a disease not onlyconcerned to the shiras but also considered as Raktapradoshaja Vyadhi. Chakrapani hasexplained Bhrama as a smruthi mohaha that means hallucination in his commentary24.According him the Bhrama is a smruthimoha that means hallucination25. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 17
  31. 31. Vagbhata has mentioned that this is because of vata dosha Vruddhi and KaphaKsheena26, where as Charaka affirmed it as sanchaya of vata dosha blocked by vitiatedpitta dosha27. Bhrama explained as a prodromal symptom of some diseases. It is alsosaid as symptom and complication of many diseases. It is due to disturbed vata dosha,either alone or combined with or obstructed by vitiated pitta dosha. Among the shareera doshas vata, pitta and manasa dosha rajas are considered asthe causative factors for the Bhrama28. When Kapha is diminished and both Vata andPitta are aggravated, it produces giddiness, cramps, piercing pain, burning sensation,cracking, trembling, bodyache, wasting, distress and fuming29. In diminution of Vata andPitta, Kapha, blocking up the channels, produces loss of movement, fainting anddifficulty in speech. In Astanga Hridaya Vagbhata has mentioned that it is one of the symptom causedby vriddhi of vata Dosha and Kapha ksheena30. Charaka explained that it is caused due toSanchaya of vata dosha blocked by vitiated pitta Dosha31. It is due to disturbed vatadosha, either alone or combined with or obstructed by vitiated pitta dosha. Bhrama explained as a prodromal symptom of some diseases. It is also explainedas symptom and complication of many diseases. For example in the pittaja kasa theBhrama is a complaint32.2) Dhamani Pratichaya According to Charaka Dhamani pratichaya is one of the kaphaja nanatmaja 33Vyadhi . The description of dhamani prathichaya as available in Nidhana Chikitsahastamalaka is ati poornata of dhamani. This Atipoornata of Dhamani is because ofAdhika Poshana. Due to adhika poshana especially Rasa and Rakta dhatus the damanis in Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 18
  32. 32. which these dhatu circulates get dilated. Because these Dhamanis get stretched by thefullness of the Rasa, Rakta (Vriddhi) dhatu in them, simultaneously the velocity of theRasa Rakta Dathu (i.e, the gati becomes manda and guru) is hampered. The stretchingi.e., increase in the circumference of the dhamani is also caused by vayu, but in thosecases where in the increase in elasticity on circurmference of the damanis is due to vayuin them. The Dhamani will not be guru, manda and mrudu as in the Atipoornata ofDhamanis by Rasa, Rakta. But infact, it will be hard (Katina) and Teekshna due tovitiation of vayu on chalatwa of vayu and because of vitiation and chalatwa of Vata itwill sometimes be Teekshana, Manda, Poorna and Ksheena depending on the vitiation ofany one of these may be present in intervals. This description is recorded in Nidana Chikitsa Hastamalaka clubbing the viewsof Chakrapani, Gangadhara, Yogendranath commentaries on the word Dhamanipratichaya the description also include the views of Astanga Sangrahakara andHridayakara on the word Dhamani Pratichaya. Most of these Acharyas have usedDhamaniupalepa to denote Dhamani Pratichayaya i.e. Atherosclerosis.3) Raktagatavata: The disease Raktagata Vata, which is mentioned under the context of Vatavyadhi,can be correlated with essential hypertension. Separate nidana have not been mentionedfor Raktagatavata, so samanya nidana mentioned for Vatavyadhi can be considered asetiology for the Raktagata Vata. Some Ayurvedic scholars have mentioned that RaktagataVata as Raktavata. Charaka broached lakshanas as - Teevraruja, Santapa, Vaivarnya,Krishatha, Aruchi., Stambata soon after having food34 and Vagbhata also mentions Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 19
  33. 33. almost all the symptoms, which are mentioned by Charaka, in addition with – Swapam,Raga and Bhrama35. Shri sudarshan shastri and shri yandunandanopadhya commenting on RaktagataVata says that the word Raktachapa can be considered as hypertension. Acording toKaviraj Gananathsen, the conditions Raktagata Vata and Vata Rakta are one and thesame. But Sri Sudarshan Shastri and Sri Yandunandanopadhya conferred opinion, asRaktagata Vata is nothing but hypertension.4) Raktavrita Vata: Charaka has described the disease Raktavrita Vata under the context ofVatavyadhi but no other Acharyas have mentioned regarding this disease. Raktavrita vataresembles to that of Raktagata vata. They are Daha in between twak, mamsa and Vedanasaragayukta shotha and mandala. The lakshanas mentioned under Raktavrita Vata 36 resembles to that of Raktagatavata, they are Daha in between twak and mamsa, vedana saragayukta shotha andmandala.5) Siragata Vata: Siragata vata is described under Vatavyadhi. Charaka, Susrutha and Vagbhatadescribe it. When there is vata prakopa in siras, it causes many diseases such as vatasambava vyadhies. Lakshanas mentioned under siragata vata are - Ø Mandaruja, shopha, kampa no spandana in siras but there will be akunchana in them 37. Ø Susrutha and Yogaratnakar supported Charaka in all aspects. While sushruta mentioning lakshanas, shoola, sira akunchana, and purana are being Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 20
  34. 34. mentioned i.e akunchana means sankocha in siras and purana means stoolatwa in siras. In Yogaratnakar, it is mentioned that when there is vata prakopa in sira there will be shoola akunchana in siras it will be filled with vata, which in turn causes Bahyayama and Antarayama, khalli and kubjatwa.6) Roudhira Mada: 38 Mada is one of the Raktaja disorders. Mada is nothing but, madoHarshaglanopanaya i.e. in this disease. Harsha and Glani of that particular dhatu takesplace.i.e; increased gati and matra of rakta takes place or utkarsha or apakarsha of rakta iscalled mada. Mada is – “Mado harshaglanopanayh” it means, Harsha and glani of Rakta takesplace, i.e. increased gati and matra of rakta takes place or other wise utkarsha or aakarshaof rakta is called mada. In charaka samhita 43 types of raktaja vydhies are mentioned and 39mada is one among them . In Charka Samhita 43 types of raktaja vyadhies arementioned and mada is one among them 40. There are seven types of madas explained vataja, pittaja, kaphaja, sannipataja,vishaja and roudhiramada. Roudhira mada is considered as hypertension, by AcharyaShree Viswanath Dwivedi and clarified that the dushya involved in this disease is Rakta. In Roudhira mada, the vitiation of Rakta results in to increase Blood by thevitiated Rakta altered Akunchana and Purana of Raktavaha and siras takes place thenleads to Roudhira mada. On the other hand there are seven types of madas explained - Vataja, pittaja,kaphaja, sannipataja, vishaja and roudhiramada. Roudhira mada is considered as Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 21
  35. 35. hypertension by Acharya shree Vishwanath Dwivedi and clarified that the dushyainvolved in this disease is Rakta. In Roudhira mada, initially the vitiation of blood results into increased Rakta, andthere by altered Akunchana and Purana of Raktavaha and siras takes place. Then itconfers to Roudhira mada.7) Raktapradoshaja vikaras: In charaka samhita totally 43 diseases are mentioned in vidhishonita adhyaya allthese diseases come under the rakta pradoshaja vikara. In this group mada, raktapitta etc., 41-42-43diseases are considered . Hypertension is considered under the Raktapradoshajavikara, due to the involvement of Rakta Dhatu. Vatashonita, Raktapitta etc., diseases are mentioned in Sushruta Samhita underthe rakta vikara 44. Mada, Bhrama etc., diseases are considered under the Raktopradoshaja 45.diseases in Astanga Hridaya But in Astanaga Sangraha, Mada, Murcha and Sanyasaare explained in Rakta pradoshaja vikara 46.8) Avruta Vata The disorders of Vata are nomenclated as many as 80. Some of the avrutha vatadisorders are also considered under the heading of hypertension. They are Pittavrutapranavata and Pittavruta udanavata. 8a) Pittavrutha prana vayu: The lakshanas mentioned are - Murcha, daha, bhrama, soola, vidaha, chardi and sheeta kamatwa 47. 8b) Pittavruta udana vata : The pittavruta udanavata lakshana are - Murcha, daha, shoola, daha in the nabhi and urah region, ojobransha, shwasa, and klama 48. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 22
  36. 36. 49 8c) Pitta Avrithavata : If vayu is covered by Pitta the following symptoms arise – burning sensation, thirst, pain, giddiness, feeling of darkness, aggravation of burning sensation by the use of pungent, sour, salty and hot things and desire for cold. In case of covering with Kapha there are coldness, heaviness and pain, suitabilityof pungent etc. and particular desire for fasting exertion, rough and hot things. • If vayu is covered with Rakta, there is burning sensation with distress, the space between skin and muscle becomes red and swollen and rashes appear.9) Murcha and Sanyasa: Murcha is disease of raktavaha srothas which is due to vikrutha pitta and tamoguna i.e, both sharirika and manasika vyadhi. Murcha can be considered as syncope,which is mentioned, in modern science. A simple faint or temporary loss ofconsciousness due to cerebral and it is important to note that giddiness, faintness or actualsyncope is much more frequently due to peripheral circulatory failure. According to Astanga hridaya mada, murcha and sanyasa are the diseases of rasa,rakta and samjnavaha sroto dusti. Acharya Susruta explained 6 types of murcha vataja,pittaja, kaphaja, raktaja, madyaja and vishaja. While explaining about the raktaja murcha,it is due to smell of blood or by seeing the blood it occurs. Sri sudarshan shastri and sriYadundana Upadhyaya opined that murcha occurring in rakta vata or high blood pressurecan be raktaja murcha. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 23
  37. 37. 9a) Murcha: Murcha is considered as disease entity in Madava Nidana and explained in detailswith nidana panchakas. Murcha is disease of raktavaha srotas, which is due to vikruta 50pitta and tama guna i.e., both sharirika and manasika Vyadhi . On the literacy basemurcha is nothing but syncope which is mentioned in modern science. A simple faint or temporary loss of consciousness due to cerebral, anaemia oftencaused by dilatation of the peripheral blood vessels and a sudden fall in blood pressure 51.It is proved that it is loss of consciousness due to cerebral and it is important to note thatgiddiness, faintness or actual syncope is much more frequently due to peripheralcirculatory failure. According to Astang Hridaya – Mada, Murcha and Sanyasa are the diseases of 52.rasa, rakta and samjnavaha sroto-Vikruti Acharya Sushruta explained 6 types Murchaviz. Vataja, Pittaja, Kaphaja, Raktaja, Madyaja and Vishaja. While explaining about theraktaja murcha, it is due to smell of blood or by seing the blood it occurs. Commentingon this statement Hindi commentator of madavanidana Sri Sudarshana Shastri and Sri.Yadunandana Upadhyaya opined that murcha occuring in rakta vata or high bloodpressure can be taken, as raktaja murcha after considering raktaja murcha is RaktavahaSroto Vyadhi. 9b) Sanyasa: Sanyasa is disease of samajnavaha srotas and also called as gambhira murcha. Ifmurcha is not treated properly it leads to Sanyasa. According to modern science coma is astate of unnatural heavy deep and prolonged sleep often accompanied by slow irregularbreathing and consequently ending in to death 53. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 24
  38. 38. 10) Raktachapadhikyata The word Raktachapadhikyata is formed by three words - Rakta, Chapa andAdhikyata.‘Rakta’ refers to - Shareerastha saptadhatwantargata dhatu vishesha: l Raktam sarvashareerastham jeevasyadhara uttamaha: l S.T.M. 4 v ‘Chapa’- refers to pressure or squeezing. v ‘Adhikyata’-refers to, high or increased. So the meaning of “Raktachapadhikyata” is the high blood pressure or increasedblood pressure. Here it does not specify whether it is essential hypertension or secondaryhypertension. But here in this, the word Raktachapadhikyata is used to denote essentialhypertension. Vata-caused hypertension often leads to a blood pressure that often fluctuates formany years, until it begins to aggravate Pitta and Kapha, respectively, and becomesincreasingly more constant and more difficult to treat. Pitta-caused hypertension is themost common in a classic Pitta body type (sometimes demonstrated through a red faceand bloodshot eyes). The patient may have quick temper with an aggressive andcompetitive nature that incessantly drives him. Kapha-hypertension is often associatedwith obesity and edema. This imbalance is usually long-standing and chronic. The Doshaof Kapha can act as a storage site for all the circulatory Ama created in the doshas ofVata and Pitta. The herbs for Vata and pita may be necessary as needed, and somepungent and astringent herbs to detoxify accumulated Ama are important. Garlic,cayenne (capsicum frutescens), and pippali (piper longum) or trikatu, a combination oflong pepper, black pepper and ginger are useful 54. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 25
  39. 39. SHAREERA VIVECHANA Before discussing the disease Bhrama, it is very much essential to know thefunctional anatomy of the heart and blood vessels with physiology of blood circulation.Hridaya The word ‘Hridaya’ explains and signifies only the functional aspect of an organ.According to Shatapatabrahmana the word hridaya is made up of three dhatu’s, Hri, Da,and Ya. These dhatus by the combination of the pratyaya and adesha, forms the dhatus,as Hrit, Dana and Ayana. The dhatu Hrit gives the meaning of Hanane, Apatirite i.e., to take or to receive.The dhatu Dana gives the meaning of Tyage, Palane, Chedane i.e. to give or to eject or tonourish. The dhatu Ayana having the paribhasha of Kayam, gives the meaning of Gati,Chalana, or Movement. The word hridaya has been attributed to mainly two organs, namely Mastishka orShirohridaya and Hridaya i.e. Urohridaya. Generally yogis attribute the word hridaya toMastishka or Brain, and the physicians or vaidyas denote the word hridaya to Urohridayaor Muscular heart. In classics the anatomy and physiology of hridaya is not explained under oneheading or at one place, we get lot of quotations and similies based on which we shouldunderstand the anatomy and physiology of heart. Hridaya is considered as one of the kostanga. It is situated in vaksha pradesha inbetween the two stanas. It is formed by sleshma and rakta, having the shape of invertedlotus and according to Arunadatta it is made up of mamsapeshi and rakta. It measurestwo angula according to Chakrapani and four angula according to Susruta. Hridaya is the Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 26
  40. 40. moola of pranavaha and rasavaha Srotas 55. It is the seat of manas and para-apara ojus56.Hridaya is the prabhava sthana of dashadhamani’s which spreads all over the body and 57-58.which carries rasa, ojas and does tarpana karma According to Palakapya, fromhridaya siras arise and spreads all over the body just like a network, and like all riversjoin ocean, in the same fashion all siras opens in to hridaya 59. Hridaya continues to workwhether the person is in jagrutavasta or swapatavasta 60. Many of its functions can be attributed to the doshas that are concerned to it, i.e. aparticular function of hridaya is carried out by particular dosha. These functions arediscussed below with respect to concerned doshas.Relation of Hridaya with Doshas Hridaya is related with all the three doshas. Among vata, it is related withudanavayu, prana vayu and vyana vayu. Among pitta, it is related with sadhaka pitta andpachaka pitta, and among kapha it is related with avalambaka kapha.Hridaya and Udanavata Charaka and Vagbhata have mentioned the uras as the sthana of udana vayu 61-62-63. This indicates that, it is related to hridaya also. When we look at the functions ofudana vayu, the functions like prayatna (endeavour or effort), urja (enthusiasm) and bala(strength) 64, with respect to hridaya, we can think of the conductive system of the heart,i.e. udana vayu by the functions like prayatna and bala initiates and helps in theconduction of the cardiac impulses in the heart.Hridaya and Pranavata 65-66 According to Charaka and Vagbhata Pranavata is situated in Shiras . Andaccording to the Sharangadhara it is situated in hridaya67. Vagbhata states that pranavata Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 27
  41. 41. maintains the activities of hridaya (heart and circulatory system), and supports or does 68-69dharana of dhamanis (probably the vasomotor functions) . Looking to the abovedescription it can be said that prana vata situated in murdha sends impulses to hridaya,there by governing the sympathetic and parasympathetic actions / functions.Hridaya and Vyanavata Vyana vayu is situated in hridaya 70-71 and it pervades swiftly throughout the body72-73. Vyana vayu is responsible for circulation of Rasa (rasadhatu) through out the body74-75, 76 by the regular contraction and relaxation of the heart . Sushruta has also 77.mentioned asruk sravana to be one of the functions of Vyanavata Vagbhata concisedall functions of vyana vata by the statament that all the actions or movements of the bodyare conducted by vyana Vata 78. In Nadee-gnyanam, it is mentioned that the rhythmic tendency of the heart isresponsible for continuous contraction and dilatation of the hridaya and which is theinherent tendency and capacity of hridaya. Even Charaka has mentioned that vyana vayu is responsible for the continuousflow of rasadhatu to all parts of the body through out the life by using the words likeajasram and sada 79.Hridaya with relation to Sadhakapitta Sadhaka pitta is situated in hridaya 80-81-82, and it is responsible for achievement ofbuddhi, medha, abhimana, utsaha and abhipretartha. From this it is understood that, it is essentially connected with some of the highermental faculties and emotional states. The concept of sadhaka pitta therefore,encompasses psycho-physiological actions. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 28
  42. 42. Hridaya and Avalambaka Kapha Avalambaka kapha is situated in uras 83-84. It does avalambana of hridaya i.e. withthe help of rasa it gives bala to hridaya. In other way it does tarpana and kledana ofHridaya and there by helping it to function properly.Hridaya with relation to Manas 85-86-87-88 It is also seen that hridaya is the adhistana of Manas . Acharya Charakawhile mentioning measures to protect hridaya and oja says to avoid the thing that 89.produces dukh to the Manas Even in Unmada chikitsa adhyaya also acharya Charakamentions about manovaha srotas. Chakrapani commenting on it says the dhamani’s thatoriginate from hridaya or the dhamani’s that are related to hridaya desha, are to be taken 90-91.as manovaha Srotas From all these it is clear that hridaya, sadhaka pitta and manasare related to each other and the vitiation of one causes the vitiation of other.Relation of Hridaya with Ojas In shareera ojas has been classified in to two types, i.e. para ojus and apara ojus. 92.Para ojus is situated in hridaya It is asta bindu in pramana and it is said to be uttamapranayatana (most important vital part). Even, if little of it is destroyed the body cannotexist. Apara ojus is situated in hridaya and dhamani, and circulates all over the body. Itis ardhanjali in pramana and the deficiency of this ojus does not cause death but diseaseslike prameha are likely to set in. Looking to all these above references we cannot get a clear cut picture of anatomyand physiology of heart. But it gives a clear idea that, the hridaya that is described isnothing but the muscular heart or cardia. Even the classical quotations and similies givenfor hridaya almost fulfil the modern description that has been given for heart. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 29
  43. 43. Rasa Rakta Paribhramana Hridaya is the srotomula of rasavaha and pranavaha srotus 93. It is responsible forrasa samvahana in the body. Samanavata brings the ahara rasa that is formed to hridaya,and as it enters the hridaya it is considered as rasa dhatu. Now with the help of vyanavayu and udana vayu the sankocha and vikasa i.e. the praspandana of hridaya starts.Praspandana of hridaya can be correlated to the conductive system of the heart. Heresankocha can be considered as systole and vikasa can be considered as diastole.Pranavata maintains the actions of hridaya and does dharana of dhamanies. Thisindicates that it governs the vasomotor functions. Once the sankocha takes place the rasamoves in to dashadhamani, and proceeds further 94. Here by prasarana akunchana karma, and as per kedarakulya nyaya, the rasamoves to all parts of the body and nourishes the whole body. This function is carried outcontinuously through out the life 95. Even Bhela explains that rasa samvahana takes placethrough sira dhamani, which are spread all over the body and owes their origin andinsertion to hridaya. Sharangadhara while explaining rasa samvahana explains that, rasa,rakta, oja, sneha are carried from hridaya to all parts of the body, and does tarpana karma.Avalambaka kapha gives bala to hridaya, to carry out these functions. Regarding rasa samvahana acharya Susruta gives a simily i.e. “ShabdarchiJalasantanavat” 96. This indicates that rasa moves in all directions. Dalhana commentingon it says, urdhwagamitwa of rasa occurs like archi, adhogamitwa of rasa like jala andtiryagamitwa of rasa like shabda. Again this rasa is brought back to the hridaya by vyana vayu samana vayu andhridaya vikasana takes place, followed by sankocha and rasa moving towards sarva Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 30
  44. 44. shareera. This cycle continues and acharya Charaka uses the word ajasra to denotes thecontinuous function of hridaya in circulation of Rasa 97.PHYSIOLOGY OF BLOOD CIRCULATION The activity of the organs of the circulatory system, that is, of the heart and bloodvessels, ensures a constant flow of blood in the organism. Because of its movement, theblood can perform numerous transport functions, in particular, supplying oxygen andnutrients to the tissues, and removing waste substances formed as the result ofmetabolism. The movement of blood in the organism follows a complicated course known asthe systemic, or greater circulation, and the pulmonary or lesser. The systemiccirculation starts at the left ventricle of the heart, passes to the aorta, to the arteries,originating from it and to all their branches, thence to the arterioles, capillaries, and theveins of the whole body, and finally to the two venae cavae which enter the right atrium.The pulmonary circulation begins from the right ventricle, continues along the pulmonaryartery and all its branches, then along the pulmonary arterioles, capillaries, and veins andterminates in to the pulmonary veins, which empty into the left atrium. The flow of blood in the vessels is due to the work of the heart. Contraction ofthe ventricular myocardium ejects blood under pressure from the heart into the aorta andpulmonary arteries. The movement of the blood further along the vessels, and its returnto the heart, is conditioned by its pressure in the large arteries being higher than in thesmall arteries, the pressure in the latter being higher than in the capillaries, and thepressure in the capillaries being higher in turn than in the veins and atria. In this waythere is difference in pressure all along the blood stream that determines its circulation in Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 31
  45. 45. the vascular system, blood flowing from the vessels with higher pressure to those withlower. The gradual drop in the pressure along the blood stream (from the arteries to thecapillaries and veins) is brought about by the fact that the energy imparted by the heart isutilised to overcome the resistance of the vessels to the movement of the fluid arisingfrom friction between the fluid particles and the vascular wall and between the particlesthemselves. The function of the heart is rhythmic pumping of blood that it receives from the veinsin to the arteries. It is performed by alternate rhythmic contraction and relaxation of themuscular fibres that forms the walls of the atria and ventricles. Contraction of themyocardium of these chambers is known as their systole, and relaxation as their diastole. In normal physiological conditions systole and diastole occur in a definite co-ordination and constitute the cardiac cycle. Each cycle is considered to start with theatrial systole. The contraction begins as a wave in that part of the right atrium where theorifices of the venecavae are, and then involves both atria, which have a commonmusculature with a cardiac rhythm of 75 contractions per minute, an atrial (auricular)systole lasts 0.1 second. As it ends, the ventricular systole begins, the atria then being ina state of diastole, which lasts 0.7 second. The contraction of the two ventricles occurssimultaneously, and their systole persists for about 0.3 second. After that, ventriculardiastole begins and lasts about 0.5 second. One-tenth second before the end of theventricular diastole a new atrial systole occurs, and a new cycle of cardiac activity begins.Regulation of Blood Pressure Physiologically the magnitude of the arterial pressure depends on twofundamental hemodynamic variables; cardiacs out put and total peripheral resistance. In Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 32
  46. 46. other words, the arterial blood pressure is a product of cardiac out put and peripheralvascular resistance. Figure -1 Showing the Blood Pressure Regulation HUMORAL FACTORS Constrictors Dilators BLOOD VOLUME -Angiotensin II -Prostaglandins -Sodium -Catecholamines -Kinins -Mineralocorticoids -Thromboxane -NO/EDRF* -Atriopeptin -Leukotrienes -Endothelin BP = CARDIAC X PERIPHERAL LOCAL FACTORS OUTPUT RESISTANCE -Autoregulation -Ionic (pH, hypoxia) CARDIAC FACTORS NEURAL FACTORS -Heart rate Constrictors Dilators -Contractility --adrenergic --adrenergic * Nitric oxide / endothelium - derived relaxing factor The Blood Pressure can be raised by increased peripheral resistance and byincreased cardiac output. The cardiac output depends upon the heart rate, its contractibility and the bloodvolume. The blood pressure can be raised by an increase in the volume of fluidabsorption of water and water retaining sodium from the intestine in to the vascularsystem or an increased production of the adrenocortical hormonal aldesterone, whichblocks the excretion of sodium and water into the urine. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 33
  47. 47. It appears that most patients with established hypertension have abnormal cardiacoutput and increased peripheral vascular resistance mainly sustains blood pressure. The peripheral vascular resistance is determined by the arteriolar lumen, whichmay expand or contract depending on the state of muscular cells in the vessel wall. Thisis known as local vascular tone. Normal vascular tone depends on the competitionbetween vasoconstricting influences and vasodilators. Peripheral resistance depends onthe size of the lumen of some vessels. A decrease in the inner (lumen) diameter willraise the Blood Pressure. The decrease in the lumen could be brought about by ananatomical thickening of vessel walls (eg., intimal thickening of arteries), by theirmechanical compression from outside or most commonly by their active muscularcontraction which can be induced by a variety of vasoconstrictor mediators. Thecommon vasoconstricting mediators are epinephrine, norepinephrine and renin- activatedangiotensin-II. The other recently described vasoconstrictors include endothelin-I,thromboxane and leucotrienes. Resistance vessels also exhibit auto regulation, a processby which increased blood flow to such vessels induces vasoconstriction, an adaptivemechanism that protects against hyperperfusion of tissues. The vasodilators includekinins, prostaglandins and nitric oxide. Certain metabolic products such as lactic acid,hydrogen ions, adenosine and hypoxia can also function as local vasodilators. Recently it has been discovered that haemoglobin plays an important role inregulation of blood pressure. In the body tissues, haemoglobin releases oxygen andsuper nitric oxide (SNO) and picks up carbon dioxide. The released SNO causesvasodilatation. At the tissue level haemoglobin also picks up excess nitric oxide (NO),which tends to cause vasoconstriction. Thus haemoglobin helps in regulating the blood Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 34
  48. 48. pressure by adjusting the amonts of SNO and NO to which blood vessels are exposed.This newly appreciated role of haemoglobin may influence development of drugs to treathypertension. Further the arteriolar smooth muscle contraction can be increased by increasedsympathetic tone and also by increased sodium load and extra cellular fluid load. The kidneys play an important role in the blood pressure regulation, and there isconsiderable evidence that renal dysfunction is essential for the development andmaintenance of both essential and secondary hypertension. The kidney influences both peripheral resistance and sodium homeostasis, and therenin-angiotensin system appears central to these influences. Renin elaborated by thejuxtaglomerular cells of the kidney transforms plasma angiotensinogen to angiotensin-I,and the latter is converted to angiotensin II by angiotensin converting enzyme (ACE).Angiotensin II alters blood pressure by increasing both peripheral resistance and bloodvolume. The former effect is achieved largely by it’s ability to cause vasoconstrictionthrough direct action on vascular smooth muscle, the latter by stimulation of aldosteronesecretion, which increases distal tubular reabsorption of sodium and thus of water.The renin-angiotensin system The renin-angiotensin system has been extensively studied since the introductionof practicable essay methods for plasma renin and angiotensin patients with essentialhypertension have been subdivided into subgroups with low, normal and high plasmarenin on the grounds of the elevated pressure. The different mechanisms and in particularthose patients with low plasma renin might have excess, mineralocorticoid activity.Plasma renin and angiotensin ii values are continuously distributed in the hypertensive Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 35
  49. 49. population. Further peripheral levels of plasma renin and angiotensin –II is found in relation inversely to age in essential hypertension. Peripheral levels of anti diuretic hormone have been reported as being slightly suppressed in uncomplicated essential hypertension. Figure -2 Showing the Role of Renin-Angiotensin System JG Renin Renin Substrate Angiotensin I Converting Enzyme Angiotensin II Vasoconstriction Increased Aldosterone Synthesis Sodium retention Increased Blood Pressure• The kidney produces a variety of vasodepresser or antihypertensive substances that presumably counter balance the vasopressin effects of angiotensin. These include the prostaglandins, a urinary kallikrein-kinin system, platelet-activating factor, and nitric oxide.• When blood volume is reduced, the glomerular filtertation rate (GFR) falls, this, in turn, leads to increased reabsorption of sodium by proximal tubules in an attempt to conserve sodium and expand blood volume. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 36
  50. 50. • GFR- independent natriuretic factors, including atrial natriuretic factor (ANF), a peptide secreted by heart atria in response to volume expansion, inhibit sodium reabsorption in distal tubules and cause vasodilation. Abnormalities in these renal mechanisms are implicated in the pathogenesis of secondary hypertension in a variety of renal diseases, but they also play an important role in essential hypertension. Approach to Clinical features of HTN All acharyas have directed us to understand an anukta roga in terms of dosha 98 99 dushyadi bhava and also they have mentioned about pratitantra siddhanta i.e. regarding the concepts of other science, with these guidelines an interdisciplinary attempt has been made to analyse the dosha dushya in Hypertension to understand the Nidana panchaka and for better management of it. And for this the signs and symptoms of essential hypertension are analysed with special reference to that of Bhrama. The analysis is undertaken on the basis of available data from contemporary medicine, where yukti Pramana is invoked. From the analysis made below in the chart is seen that among shareerika doshas, all the three doshas are involved, and in manasika doshas both raja and tama are involved, and in dushya rasa, rakta, mamsa, and medas are involved, and regarding srotas, rasavaha, raktavaha, mamsavaha, medovaha and manovaha srotas are involved. And it also reveals that among shareerika doshas vata is the pradhana dosha that gets afflicted followed by pitta and kapha. Among dushya rakta is the pradhana dushya that gets afflicted. Thus from this study it can be concluded that Bhrama (essential hypertension) is vata pradhana tridoshaja vyadhi with rakta as the pradhana dushya. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 37
  51. 51. Table -2 Showing Dosha Dushyadi Vivechana of Bhrama in comparison to hypertensionSl. SHAREE MANASI DUSHYANo CLINICAL KA KA SROTAS. FEATURES DOSHA DOSHA V P K Raj Tam R R M M a a e1. Giddiness + + - + - + + - - Rasavaha Raktavaha2. Headache + - - - - - + - - Raktavaha3. Vertigo + + - + - - + - - Raktavaha4. Palpitation + - - - - + - - - Rasavaha5. Fatigue + + - - - - + - - Raktavaha6. Chest pain + - - - - + - + - Rasavaha7. Insomnia + + - + - - - - - Manovaha8. Irritability + + - + - - - - - Manovaha9. Anxiety + - - + - - - - - Manovaha10 Dyspnoea + - - - - + - - - Pranavaha, Rasavaha11 Delirium + - - + - - - - - Manovaha12 Anger - + - + - - + - - Raktavaha13 Fainting + + - - + - - - - Manovaha14 Epistaxis - + - - - - + - - Raktavaha15 Tinnitus + - - - - + - - - Rasavaha16 Bounding pulse + + - - - - + - - Raktavaha NOTE: V – Vata; P – Pitta; K – Kapha; Raj – Rajas; Tam – Tamas; R – Rasa; Ra – Rakta; Ma – Mamsa; Me - Medas Nidana Observation and analysis of the scriptural references of Bhrama vis-à-visHypertension, a Hridroga concern reveals that the Nidana, Samprapti and Lakshana canbe categorised into three groups 100: 1. Mityahara Vihara, 2. Pragnaparadha, 3. Marmaghata. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 38
  52. 52. 1) Mityahara Vihara: Improper diet like consumption of excessively pungent, heavy, dry, incompatible,unaccustomed, un-digestive foods which are basically dhatu produshaka, viruddha,apatarpaka and ahridya ahara and also improper regimen like chintanamati chintanam(strong emotional stress) intermittent eating, faulty therapeutic measures likeBastivyapath, Virechana Vyapath etc., These factors are by nature rasa dhatupradooshaka and also rasavaha srotho dushti karakas. These nidanas cause apatarpana of rasa dhatu which leads to HridayavayavaDushti by being nourished by dushita rasadhatu. And even the santarpana nidanasmentioned like tila, guda, guru aharas also do not cause proper nourishment; but causeamasandharana which accumulates in rasavaha srotas and proper hridaya in the form ofUpalepa (fat disposition as in cholesterol and atherosclerosis) leading to granthiformation, which in turn hampers vyana vata sanchara, creating vyshamya in its gati.2) Prajnaparadha: The causative factors like instigation and inhibition of natural urges especially ofAdhovata, Trishna, Ashru, Chardi, Shramashwasa, Udgara etc., Physical exertion, Grief,Fasting, Sexual abuse, Awakening at night, Excessive sleep etc., which are volitionaltransgression of body and mind, these also include violation of Dinacharya, Ritucharyaand Swastha Vritha. All these factors when analysed show that they are basically related with thefunctioning of Pranavata, Apanavata, Udana Vata which gets vitiated simultaneouslyvitiating Vyanavata, which functions in association with the rest of the vatas, leading toHridayavayava Dushti by gati vyshamya of vayanavata leading to Hridroga. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 39
  53. 53. 3) Marmaghata : Hridaya is an important Marmanga the reason why it is specially designed forsensitivity. Any injury to this organ externally or by the internal doshas proves to befatal. Hence, it should be protected with care.1) Dosha prakopa Karanaa) Vyanavata Prakopa Karanas: Atigamana, chinta, vishama chesta, viruddha ahara,ruksha ahara, bhaya, harsha, vishada etc 101.b) Pranavata Prakopa Karanas: Ruksha ahara, vyayama, langhana, atyahara,abhighata, vegadharana, adhwahata etc 102.c) Udanavata Prakopa Karanas: Kshavathu, udgara, chardi, nidra vegadharana, guruahara, bhara vahana, ati rodana, ati hasya etc 103. Here all these three vata are in relation to hridaya and rasa rakta paribhramana.So any impairment in these leads to the disturbance or impairment in the normal functionof heart and blood circulation.2) Srotodusti Karanas Some of the other karanas that can be held responsible are-a) Rasa vaha Srotodusti Karanas: Guru, sheeta, atisnigdha, atimatra bhojana, adhikachinta etc.b) Rakta vaha Srotodusti Karanas: Vidahi, ushna, snigdha, drava bhojana, adhikaatapa and vayu sevana etc.c) Mamsa vaha Srotodusti Karanas: Abhishyanda, sthoola, guru ahara sevana, daysleep after bhojana etc. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 40
  54. 54. d) Medovaha Srotodusti Karanas: Avyayama, deewaswapna, excess of fat containingmeat, adhika madira etc.e) Manovaha Srotodusti Karanas: Krodha, shoka, bhaya, harsha, vishada, irsha, asuya,dainya, matsarya, kama, lobha, iccha, dwesha etc.104. Excessive use of Lavana is described in Charaka samhita as the cause of Raktavriddi and leads to shonitaja roga 105. Since rakta dhatu is one of the important dushya inthe etiopathogenesis of hypertension, it is given more importance. The symptoms ofshonitaja roga are similar to this essential hypertension. Again Charaka has told that 106.lavana should not be consumed in excess and for longer duration When excessivelyused, it produces fatigue, lassitude and weakness of the body 107, which are the symptomsusually found in the patients of hypertension. 108 Sushruta has mentioned medoroga leads to vatavikara Dalhana explained thatvatavikara is produced due to medavrita marga. Apart from this in astauninditeeyaadhyaya of charaka sutra sthana, acharya has described the complications of sthoulya.Here the apakva medas when deposited in rasavaha srotas may lead to dhamani 109-110-111,pratichaya (atherosclerosis), which is the main factor responsible forhypertension. In Ayurveda seat of manas shira and hridaya, which are in turn related toprana and vyana vayu respectively, which have influence over function of maintainingthe blood pressure. So aggrevated vata will initiate the process of hypertension 112-113. Raja and tama are the doshas pertaining to the mind and the types of morbidity 114caused by them are kama, krodha, lobha, mada, bhaya etc. Acharya Charaka has 115advised to suppress these factors, because they tend to elevate raja and tama gunaswhich cause manodusti. These obnoxious state of mana produces manovikara with Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 41
  55. 55. 116.involvement of samjnavaha or manovaha Srotas Further, Chakrapani commenting on 117.srotomula says, hridaya and dashadhamani are the manovaha srotomula In this waythis manovikara may afflict the arteries of the heart and therefore they also afflict ojawhich is also asirta of hridaya, 118 and vitiation of vata and Pitta, 119-120 also takes place.3) The causes of high blood pressure The causes of high blood pressure are a bit of a mystery. About 5% of patientsrequiring hypertension treatment can trace their high blood pressure to a physical causesuch as kidney disease. Treatment of the disease reduces the symptoms of high bloodpressure 121. But for 95% of patients who undergo hypertension treatment, the causes of highblood pressure are unknown. Diet and stress are suspected as prime contributors tohypertension, but medical experts aren’t exactly certain of all the mechanisms involved. There is a close relationship between blood pressure and weight. This applies toall ages and groups. Studies have established that individuals who gain more weight showmore increase in blood pressure. Moreover, weight reductions have been accompanied bya fall in arterial pressure. This is not exclusively a dietary consideration, subsequentlyheredity and exercise are also the influencing factors. Aetiology 122: 1. Occupation: Persons who are involved in nervous and mental overstrain like scientific workers, engineers, physicians, drivers etc., 2. Heredity: Chances of developing hypertension is greater in persons whose one of both parents are hypertensives. Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 42
  56. 56. 3. Stress: Chronic psychological stress may lead to hypertension and acutely stressful stimuli may cause transient rise of blood pressure.4. Sodium intake: Excessive intake of salt in diet may be important. Hypertension may be associated with low potassium diet.5. Alcohol: Alcoholics are often hypertensive. Alcohol however is not a direct pressure agent and hypertension develops during alcohol withdrawal, mediated by sympathetic nervous system.6. Obesity: Possible mechanisms of hypertensive effect of obesity include high food intake such as refined carbohydrates, fats etc., Figure - 3 Lows fiber and high fat, High fat, high calorie diet, High calorie diet Stress Glucose intolerance Obesity Cardiovascular Diabetes Diseases Hypertension Hyperlipidemia Smoking Stress, high fat, high calorie High intake of saturated fat and diet, high salt intake, Alcohol animal foods consumption and smoking Diagrammatic expression showing dietary intake and CVD Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 43

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