• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Hypretension kc043 gdg
 

Hypretension kc043 gdg

on

  • 1,952 views

Evaluation of the efficacy of Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to ...

Evaluation of the efficacy of Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to
Essential Hypertension, By SANJEEV KUMAR, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

Statistics

Views

Total Views
1,952
Views on SlideShare
1,952
Embed Views
0

Actions

Likes
0
Downloads
57
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Hypretension kc043 gdg Hypretension kc043 gdg Document Transcript

    • “Evaluation of the efficacy of Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to Essential Hypertension” By SANJEEV KUMAR Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. Raghavendra V. Shettar M.D. (Ayu), Asst. Professor in Kayachikitsa Department of Kayachikitsa Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009
    • D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 This is to certify that the dissertation “Evaluation of the efficacy of Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to Essential Hypertension” is a bonafide research work done by Sanjeev Kumar in partial fulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.Date: GuidePlace: Gadag. Dr. Raghavendra V. Shettar, M.D. (Ayu), Asst. Professor. Dept. of Kayachikitsa DGMAMC, PGS&RC, Gadag
    • J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER 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 ofShilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to EssentialHypertension” is a bonafide research work done by Sanjeev Kumar under theguidance of Dr. Raghavendra V. Shettar, M.D. (Ayu), Asst. Professor, Dept. ofKayachikitsa in partial fulfillment of the requirement for the post graduation degree of“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University ofHealth Sciences, Bangalore, Karnataka.. Professor & HOD (Dr. G. B. Patil) Dept. of Kayachikitsa Principal, PGS&RC DGM Ayurvedic Medical College, Date: Gadag Place: Gadag Date: Place:Gadag.
    • Declaration by the candidate I here by declare that this dissertation / thesis entitled “Evaluation of theefficacy of Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to EssentialHypertension” is a bonafide and genuine research work carried out by me under theguidance of Dr. Raghavendra V. Shettar, M.D. (Ayu), Asst. Professor, Dept. ofKayachikitsa, DGMAMC, PGS&RC, Gadag.Date:Place: Sanjeev Kumar
    • 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 this dissertation/thesis in print or electronic format for the academic / research purpose.Date:Place: Sanjeev Kumar© Rajiv Gandhi University of Health Sciences, Karnataka
    • Acknowledgement Acknowledgement First of all I would like to pay grateful thanks to my lord i.e. my parents Shri Raghubir Singh Choudhary and Smt. Raj Kumari, who made me mentally strong and capable to face and solve the problems in the life without any tension and fear and made me able to fulfill my duties. I am enormously happy to articulate my deepest sense of gratefulness to mydearly loved and respected guide Dr. Raghvendra V. Shettar, Ass.Prof. (M.D.Ayu).He has been very kind to guide me in the preparation of compilation and for whoseextraordinary efforts, tremendous encouragement and most valuable thoughtsprovoking advice made me to complete this work. I would like to thank specially to my Grand parents with whose blessings, I was able to do this work successfully. I have no words to express my feelings towards my brother: Er. Gaurav KumarChoudhary and sisters: Er. Vendana, who always provided me great support in all thesituations. I am thankful to my relatives who always gave me support andencouragement. I express my gratitude to Dr. V. V. Varadacharyulu (Professor & H.O.D.) for his good suggestions and encouragement in every step of this work. I pay my humble respects to Honorable Principal Dr. G. B. Patil for providing all the essential facilities to make this study success. I extend my gratefulness to my Co-guide Dr. Shankar Gouda for his guidance and untiring effort for this work. I am extremely thankful to Prof. Dr. K. Shiva Rama Prasad M.D., C.O.P. (German), M.A., [Ph.D.] and Dr. B.M. Mulkipatil M.D. for his encouragement and co-operation throughout my study period. I
    • Acknowledgement I extend my gratitude to Dr. G. Purushottamacharyulu, Dr. Mulgund, Dr. P. Shivaramudu, Dr. M. C. Patil, Dr. G. S. Hiremath, Dr. B.G .Swami, Dr. Purad, Dr. G.N. Danappagoudar, Dr. S. N. Belawadi, Dr. Nedugundi, Dr. Kuber sankh, Dr. J. G. Mitti. Dr. Mulki Patil. Dr. Yasmin A.P, Dr. Samudri, for their kind help. I express my enormous thanks to my statistician Mr. P.M. Nandakumar, Mr. Tippanagoudar (Lab), Sri. V.M. Mundinamani (librarian), Shyavi and Kerur for facilitating me in collection and production of my thesis. I take this moment to express my thanks Dr Ashok M.G. Dr. Kamalaxi, Dr.Ratna, Dr. Shivaleela, Dr. Sulochana, Dr. Shekhar Sharma, for their constant help during the study. “Faithful friends are the medicine of life” Dr.Prassan V.Joshi, Dr.Neeraj Kumar, Dr.Vijayalakshmi, Dr. Veena. Jigalur, Dr. Anupama, Dr.Ishawar, Dr. Bodake, Dr. Praveen, Dr. V S Kanti, Dr Trupti, Dr. Adarsha, Dr. Nataraja, Dr. Udaya, Dr Shaileja, Dr. Ravi, Dr. Shivakumar, Dr. Sanat, Dr. Shabareesh, Dr. Rajesh, Dr.Deepak, Dr. Jaishankar, Mr. Shakti, Dr. Joshi, Dr. Bhagyesh, Dr. Aneesh, Dr. Baba, Dr. Dash, Dr. Vinod, Dr. Patil, Dr. Vijay, Dr. Surej, Dr. Kavitha. Dr. Sarvamangala, Dr Savitha, Dr. Bhopesh, Dr. Gorpade, Dr. Deepa and Dr. Asha, deserves special thanks to their affection and constant help throughout my study. I would like to thank all my patients without whose co-operation this workcould not have been completed. Last but not least I express my deepest thankfulness whose names are nottaken here but helped me a lot along with my kit and kins to my family members Dr. Sanjeev Kumar Choudhary II
    • Abstract Abstract “Evaluation of the efficacy of “Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to Essential Hypertension”Key words: Pittavruta udana, Essential hypertenshion, Shilajatu Guggulu Rasayana. Avarana is the obstruction to movement of Vata, Avaraka is the cause for it. Inthis regard Hypertension is compared to that of Pittavruta udana, which is havingsymptoms Bharama, Kalama, Moorcha and Daha by Acharya Shusruta and otherswhereas Acharya Charka add Ojobharamsha and Avasada in the above symptoms. Asthis symptomatology manifest later stages of Hypertension hence taken forcomparison. Although hypertension is usually asymptomatic for the first 10-20 yrs, itslowly but surely strains the heart and damages the arteries. For this reasonhypertension is often called as silent killer. The pathogenesis of essential hypertension is not clearly understood. Thus thepresent study was undertaken to evaluate the efficacy of Shilajatu Guggulu Rasayanain the management of Pittavruta udana with respect to Essential hypertension. The symptoms, which are expressed in Essential hypertension, are very nearerto the symptoms of Pittavruta udana. Pittavruta udana is explained as disease inAyurvedic classics. So the sign and symptoms of Pittavruta udana are simulate to thatof essential hypertension at the present context. In this regard Shilajatu Guggulu Rasayana is best for the treatment ofAvarana. Guggulu is having its effect over atherosclerosis, obesity and is proven anti-inflammatory drug. Shilajatu is presumed to posses the unique drug for the Dhatuposhana and Tridosha prashamana. Hence this medicine if used wisely will accountfor samprapti vightana, nullifies avarana pathology and generates healthy tissues. III
    • Abstract The subjective parameter Bhrama and Daha showed 100% response, where asShirah shoola shown 91% result and Klama shown 86% result. The objectiveparameters like Systolic blood pressure shown 92% result where as Diastolic bloodpressure shown 83% result in this study. The present study revealed that the meandifference of Serum cholesterol was found 36.86 i.e. lower than the before treatmentmean, mean difference of Serum triglycerides was found 29.94 i.e. lower than thebefore treatment mean, mean difference of Low density lipoprotein was found 26.72i.e. lower than the before treatment mean whereas mean difference of Very lowdensity lipoprotein was found 06.00 i.e. also lower than the before treatment mean.Net mean results of the therapies (All subjective and objective in to the consideration)= 92% i.e. Good response. Totally Shilajatu Guggulu Rasayana has shown good response in Pittavrutaudana w.s.r. to Essential hypertension in the present study. IV
    • Contents ContentsSl. No. Contents Page no. 01. Introduction 1-5 02. Objectives 6–8 03. Literary review 9 – 102 04. Materials and methods 103 - 107 05. Observations and results 108 – 134 06. Discussion 135 – 162 07. Conclusion 163 – 165 08. Summary 166 – 167 09. Bibliography I - XXVIII 10. Annexure i - vi V
    • List of TablesTable Content PageNo. No. 01. Showing the opinion of Acharyas regarding Sira, Dhamani & Srotas 27 02. Showing samanya prakopaka karanas 48 03. Showing possible reason for manifestation of disease 48 04. Showing the Lakshana and Dosha involvement 60 05. Showing the Vyavachedaka nidana of Pittavruta udana 65 06. Showing the Vyavachedaka nidana of Hypertension 66 07. Showing the classification of blood pressure 74 08. Showing the classification of secondary hypertension 76 09. Showing the Korotkoff Sounds 83 10. Showing the classification of Chikitsa 86 11. Showing the efficacy of Non-Pharmacological management 90 12. Showing the treatment of Hypertension 92 13. Showing the Pathyapathya in Pittavruta udana 93 14. Showing the properties of Ingredients 102 15. Showing the composition of Shilajatu Guggulu Rasayana 103 16. Showing Age wise distribution of total 30 patients 108 17. Showing Sex wise distribution of total 30 patients 109 18. Showing Religion wise distribution of total 30 patients 109 19. Showing Occupation wise distribution of total 30 patients 110 20. Showing Economical Status wise distribution of total 30 patients 110 21. Showing Marital Status wise distribution of 30 patients 111 22. Showing Intake Rasa predominance wise distribution of 30 patients 111 23. Showing Nidra wise distribution of total 30 patients 112 24. Showing Malapraviti wise distribution of 30 patients 112 25. Showing Addiction wise distribution of 30 patients 113 26. Showing Ahara wise distribution of total 30 patients 113 27. Showing Manasika Prakriti wise distribution of total 30 patients 114 28. Showing Shareera Prakriti wise distribution of total 30 patients 114 29. Showing Sara wise distribution of total 30 patients 115 30. Showing Samhanana wise distribution of total 30 patients 115 31. Showing Satmya wise distribution of total 30 patients 116 32. Showing Satwa wise distribution of total 30 patients 116 33. Showing Vyayama Shakti wise distribution of total 30 patients 117 34. Showing Vaya wise distribution of total 30 patients 117 35. Showing Pramana wise distribution of total 30 patients 11836-A. Showing Abhyvarana (AS) wise distribution of total 30 patients 11836-B. Showing Jarana (AS) wise distribution of 30 patients 119 37. Showing Jatharagni Bala wise distribution of total 30 patients 119 38. Showing Koshta wise distribution of total 30 patients 120 39. Showing Family History wise distribution of total 30 patients 120 40. Showing Chronicity wise distribution of 26 patients (Previously 121 diagnosed) 41. Showing Onset History wise distribution of 30 patients 121 42. Showing Intensity wise distribution of total 30 patients 122 43. Showing Relieving Factors wise distribution of total 30 patients 122 VI
    • Table Content PageNo. No. 44. Showing Aggravating Factors wise distribution of total 30 patients 123 45. Showing Drug History wise distribution of total 30 patients 123 46. Showing Symptoms wise distribution of total 30 patients 124 47. Showing Associated complaints wise distribution of total 30 patients 124 48. Showing Systolic Blood Pressure (Average) of 30 patients 125 49. Showing Diastolic Blood Pressure (Average) of 30 patients 125 50. Showing the effect of therapy on Bhrama 127 51. Showing the effect of therapy on Klama 127 52. Showing the effect of therapy on Shirah shoola 127 53. Showing the effect of therapy on Daha 128 54. Showing the effect of therapy on Systolic hypertension 128 55. Showing the effect of therapy on Diastolic hypertension 128 56. Showing the over all response on Subjective and Objective parameters 129 57. Showing the effect of therapy on Biochemical Parameters 129 58. Showing the effect of therapy on Bhrama 130 59. Showing the effect of therapy on Klama 130 60. Showing the effect of therapy on Shirah shoola 130 61. Showing the effect of therapy on Daha 131 62. Showing the effect of therapy on Moorcha 131 63. Showing the effect of therapy on Systolic hypertension 131 64. Showing the effect of therapy on Diastolic hypertension 132 65. Showing the effect of therapy on Serum Cholesterol 132 66. Showing the effect of therapy on Serum triglycerides 132 67. Showing the effect of therapy on High density lipoprotein 133 68. Showing the effect of therapy on Low density lipoprotein 133 69. Showing the effect of therapy on Very Low density lipoprotein 133 70. Showing overall result of the therapy 156 71. Showing the effect of therapy on Pittavruta udana (Essential 160 hypertension) 72. Showing Demographic Data i 73. Showing Subjective parameters Before and After treatment ii 74. Showing Objective parameters Before and After treatment iii 75. Showing Lipid Profile values Before and After treatment iv 76. Showing Scoring Before and After the Treatment of all the parameters v 77. Showing Net Response of the Treatment (all the parameters) vi VII
    • List of Figure & PhotoFigure Content PageNo. No.01. Showing the Blood Pressure Regulation 3302. Showing the role of Renin-Angiotensin System 3603. Showing the diagramatic presentation of concept of Avarana 4104. Showing the Environmental factors and Cardiovascular events 5205. Showing Obesity and Sodium sensitivity in Hypertension 5306. Showing Samprapti chart of Pittavruta udana 6207. Photo showing the Shilajatu Guggulu Rasayana 10308. Showing Age wise distribution of total 30 patients 10809. Showing Sex wise distribution of total 30 patients 10910. Showing Religion wise distribution of total 30 patients 10911. Showing Occupation wise distribution of total 30 patients 11012. Showing Economical Status wise distribution of total 30 patients 11013. Showing Marital Status wise distribution of 30 patients 11114. Showing intake Rasa Predominance wise distribution of 30 patients 11115. Showing Nidra wise distribution of total 30 patients 11216. Showing Malapraviti wise distribution of 30 patients 11217. Showing Addiction wise distribution of 30 patients 11318. Showing Ahara wise distribution of total 30 patients 11319. Showing Manasika Prakruti wise distribution of total 30 patients 11420. Showing Shareera Prakriti wise distribution of total 30 patients 11421. Showing Sara wise distribution of total 30 patients 11522. Showing Samhanana wise distribution of total 30 patients 11523. Showing Satmya wise distribution of total 30 patients 11624. Showing Satwa wise distribution of total 30 patients 11625. Showing Vyayama Shakti wise distribution of total 30 patients 11726. Showing Vaya wise distribution of total 30 patients 11727. Showing Pramana wise distribution of total 30 patients 11828-A. Showing Abhyvarana (AS) wise distribution of total 30 patients 11828-B. Showing Jarana (AS) wise distribution of 30 patients 11929. Showing Jatharagni Bala wise distribution of total 30 patients 11930. Showing Koshta wise distribution of total 30 patients 12031. Showing Family History wise distribution of total 30 patients 12032. Showing Chronicity wise distribution of 26 patients (Previously 121 diagnosed)33. Showing Onset History wise distribution of total 30 patients 12134. Showing Intensity wise distribution of total 30 patients 12235. Showing Relieving Factors wise distribution of total 30 patients 12236. Showing Aggravating Factors wise distribution of total 30 patients 12337. Showing Drug History wise distribution of total 30 patients 12338. Showing Symptoms wise distribution of total 30 patients 12439. Showing Associated Complaints wise distribution of 30 patients 12440. Showing Systolic Blood Pressure (Average) of 30 patients 12541. Showing Diastolic Blood Pressure (Average) of 30 patients 12642. Showing overall result of the therapy 157 VIII
    • Introduction Introduction Research is a process of finding out the old hidden facts from the old theoriesand concepts as well as discovery of new facts. The chief goal of any medicalresearch will be clinical application. Ayurveda, the science of life is an amicabledictum of life principles, which benefits health, happiness and harmony to thehumanity. The aim of Ayurveda is “to maintain the health in the healthy person and toalleviate the disorders in the diseased”1. This supports the fact that any research takingplace in the world of Ayurveda must be having its impact or role in the clinical field. Blood pressure is the pressure exerted by the blood on the walls of bloodvessels. Persistent high arterial blood pressure without a known cause is essentialhypertension when the elevation of systolic blood pressure is more than 140 mm ofHg and diastolic blood pressure is above 90 mm of Hg2. Our Acharyas have described the various kinds of ailments in Ayurveda i.e.more than thousands of diseases, Ayurveda, an ancient medical science has a richliterature regarding a plenty of disorders. Hypertension in Ayurveda may fall underPittavruta udana3, Raktagata vata4, Pittavruta vata5, Raktavruta vata6, Pranavrutaudana7, Rakta vega vridhi, Rasa bhara, Rakta Samvardhana, Vyanabala,Uccharaktachapa, Siragata vata8, Bhrama9,10,11, Raktamada12, Moorcha13,14,Sanyasa15,16 and Dhamanipratichaya17 etc. As Ayurveda is a technical science, yukthi pramana is a pre-requisite inpragmatic practice, to achieve the talent a vaidya should process unbeatableknowledge of the scriptures and discriminating skill in handling the patients therefore,Ayurveda emphasizes on efficiency and discrete knowledge of the physician. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 1
    • Introduction In this competitive world, time becomes more precious for human being. The20th century described as the age of anxiety and stress. People don’t have time to thinkabout themselves, so they are becoming less concerned regarding health and aretaking more stress and strain. Therefore, these irregularities regarding health andmental stress leads to many physical and mental disorders, out of these hypertensionis one of the alarming diseases. The great physiologist of modern science, Dr. Chaudhury18 has toldhypertension is an ancient disease. More then 2500 years ago Acharya Charka, theFather of Hindu system of medicine describes the condition admirably. Essentialhypertension cannot be permanently cured but the level of blood pressure in suchpatients can substantially reduce by drugs and measures. A large number ofhypertensives in the early stages have no symptoms often with high blood pressure isdetected on a routine check up and physical examination 19, 20. Until now, the cause of majority of types of hypertension is unknown. All theanti hypertensive drugs reduce the blood pressure without correcting the cause.Hypertension is an established risk factor for all clinical manifestations ofatherosclerosis. It is a common and powerful independent predisposing factor fordevelopment of coronary heart disease (C.H.D.), stroke, peripheral arterial diseaseand heart failure. The high prevalence of hypertension, its powerful impact on theincidence of cardiovascular disease (C.V.D.) and the potential impact on controljustify high priority efforts to detect and treat elevated blood pressure (BP) 21. Nearly 15% of the world population is labeled hypertensive, either knowing orunknowingly by doctors. In India approximately 14% of people suffer fromhypertension and majority of them had essential hypertension, which is indicated itssignificance and prevalence. In the recent survey in Mumbai, diagnosis of Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 2
    • Introduction 22hypertension (SBP >140 mm of hg & DBP >90 mm of Hg) was based on theaverage of three readings a confirmed on two subsequent occasions. Indian council of medical researches (ICMR) All India institute of medicalscience (AIIMS) study declared India as a nation of hypertension. 40-45 millionIndians are believed to be suffering for the disease that are a key risk factor forcoronary artery disease, diabetes and renal failure. Thus considering the prevalence and significance of the problem it should beof academic interest to Ayurvedic clinician to diagnose and treat it through Ayurveda.So the concept of hypertension, when clearly understood can be used as an effectivetool for various purposes. The modern life style, stress, smoking, etc. that interferes with homeostaticmechanism and circadian rhythmic patterns, thus manifests its ill effects. The ill effects of faulty regimens of Triupastambha23, Asatmendriyanrthasanyoga, Pragnyaparadha and Parinama24 etc. influence the Rajodosha in Manas, thusdirectly bring out the dosha vitiation so as it cause the ailment. The faulty regimens i.e. deviating from dinacharya, ritucharya an extremecompetitive life thus directly predisposes hypertension. The symptoms, which are expressed in essential hypertension, are very nearerto the symptoms of Pittavruta udana. Pittavruta udana is explained as disease inAyurvedic classics. So the sign and symptoms of Pittavruta udana are in resemble tothat of hypertension at the present context. Although hypertension is usually asymptomatic for the first 10-20 yrs, itslowly but surely strains the heart and damages the arteries. For this reasonhypertension is often called as silent killer 25. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 3
    • Introduction The adverse effects of hypertension principally involve the blood vessels, theCNS, the retina, the heart and the kidneys 26, ending in organ damage. The pathogenesis of essential hypertension is not clearly understood inAyurveda. Thus, the present study was undertaken to evaluate the efficacy ofShilajatu Guggulu Rasayana in the management of Pittavruta udana with respect toEssential hypertension. Explanation of Hypertension is not at all found in Ayurvedic literature.Acharya Charaka has mentioned that due to the time and geographical change diseasewould occur and the physician of that era should diagnose and treat disease according 27to dosha, dushya vichara . Therefore, Ayurveda provides three-fold approach tomanage any disease i.e. Hetu, Linga and Aushadha28. Avarana is the obstruction to movement of Vata, Avaraka is the cause for it 29.Hypertension is compared to that of Pittavruta udana, which is having symptoms likeBhrama, Klama, Moorcha and Daha, which resembles sign and symptoms ofHypertansion. Acharaya Sushruta30 and others 31, 32, 33 opines the same while AcharyaCharaka34 added Ojobharamsha and Avasada to the above symptoms. As thesesymptomatology manifests later stages of Hypertension, for this reason taken forassessment. In general for all the Avarana, Rasayana is the best treatment as it pacify thevitiated doshas and conducive to the dhatus35, 36. In this regard, Shilajatu Guggulu Rasayana is best for the treatment ofAvarana37. Guggula38 is having its effect over atherosclerosis, obesity and is provenanti-inflammatory drug. Shilajatu39, 40 is presumed to posses the unique drug for thedhatu poshana and tridosha prashamana. Hence, this medicine if used wisely will Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 4
    • Introductionaccount for samprapti vighatana, nullifies avarana pathology and generates healthiertissues. Apart from this, the medicine proposed for this study is cost effective andeasily available hence present clinical study; “Evaluation of the efficacy ofShilajatu Guggulu Rasayana in Pittavruta udana” with special reference toEssential hypertension” was undertaken.Study hypothesis: Diseases always takes new form from their original existing diseases may notbe there in olden days vis-à-vis olden day’s diseases may not exist now. In this regard Acharya Charaka has told, one should diagnose the diseases onthe basis of dosha dushya vivechana. Many of recent researchers have made attemptto correlate Hypertension with many conditions told in Ayurveda. In the present study an attempt was made to correlate the Essentialhypertention with Pittavruta udana. Vata is responsible factor for the gati, the blood flow. So dosha dushyavivechana in Essential hypertension fit for Vata dosha vikriti. In VidhishoniteeyaAdhyaya of Charaka, we get plenty of refferences regarding Raktadusti, which aresimulates to the probable etiological factors for Essential hypertension. On the basisof Ashrayaashrayi sambandha, vitiation of Rakta is mainly because of Pitta. Pittavikruti thus assumed in Essential hypertension. This hypothesis built in the presentstudy and justified. The clinical symptoms of Pittavruta udana are mimic the Essentialhypertension at one or the other stages of Hypertension. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 5
    • Objectives Objectives of the study Essential hypertension with special reference to Pittavruta udana is a verysignificant as its symptoms are not explained separately in our classics, so we cancompare it with the other symptomatically diseases. Then why this problem has beentaken for Research work. There are so many positive reasons behind the selection ofthis topic because every one wants to do something different and get success. Therefore, it becomes necessary that each and everyone should have someextra qualities, which make his or her personality special to others. Success is dependsupon hard work. Thus to achieve the goals it is very important to develop somedifferent characteristics and personality.Objectives of the study:1. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in the management ofPittavruta udana.2. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in the management ofEssential hypertension.3. To evaluate the anti hypertensive effect of Shilajatu Guggulu Rasayana.4. To evaluate the efficacy of Rasayana effect of Shilajatu and Guggulu.1. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in themanagement of Pittavruta udana: Avarana is the obstruction to movement of Vata, avaraka is the reason for it.The symptoms of Pittavaruta udana are Bhrama, Klama, Moorcha and Daha,according to Acharaya Sushruta and others, while Acharya Charaka further addsOjobhramsha and Avasada to it. As this symptomatology manifest later stages ofHypertension, hence taken for comparison. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 6
    • Objectives In general for all the Avarana, Rasayana is the best treatment as it pacify thevitiated doshas and conducive to the dhatu’s. In this view, Shilajatu GugguluRasayana is the best treatment for Avarana.2. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in themanagement of essential hypertension: High Blood Pressure is not a disease in itself. It is only; at best, a risk factorfor future vascular accidents in the various target organs like the heart, brain, kidney,eyes, etc. It carries the same significance as other risk factors for vascular diseases.Hypertension is a symptomatic but is having a direct relation to that of vasculature.Atherosclerosis and arteriosclerosis are the phenomena, which affects the individualsif neglected accounts for morbidity and mortality, which needs an effective of carefulapproach. Now it is the time to highlight the Ayurveda in the world of hypertension withits unique aspects. The adverse reactions of modern antihypertensive and higher costof therapy are also one of the causes to look towards Ayurveda for its humeralapproach. The pathogenesis of essential hypertension is difficult to understand. Thus, thepresent study was conduct to evaluate the efficacy of Shilajatu Guggulu Rasayana inthe management of Essential hypertension.3. To evaluate the anti hypertensive effect of Shilajatu Guggulu Rasayana: A multiplicity of treatment modalities exist and newer ones are continuouslybeing introduced to undertake the hypertensive problems in modern era. Until now,the cause of majority of types of Hypertension is unknown. All the anti hypertensivedrugs reduce the blood pressure without correcting the cause. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 7
    • Objectives Guggulu is having its effect over atherosclerosis, obesity and is establishedanti-inflammatory drug. Shilajatu is presumed to posses the unique drug for the Dhatuposhana and Tridosha prashamana. Hence, this medicine if used wisely will accountfor samprapti vightana, nullifies Avarana pathology and generates healthier tissues.4. To evaluate the efficacy of Rasayana effect of Shilajatu and Guggulu: The modern life style, stress, smoking, alcohol etc. interfere with homeostaticmechanism and circadian rhythmic patterns, thus manifests its ill effects.The ill effects of faulty regimens of Triupastambha, Asatmendriyanrtha samyoga,Pragnyaparadha, Parinama etc. influence the Rajodosha in Manas, thus directly bringsout the dosha vitiation so as it cause the ailment. Acharya Charka has laid down the code of good conduct by which one canremains healthy and long life. The Charka Samhita shows the path by which we canavoid the ailment and enjoy the normal life span. Rasayana gives the strength to all the dhatus of the body and refreshes the vitalorgans of the humankind. Rasayana gives longevity, intelligence, good memory,health, good complexion, luster and strength to the body.Rasayana chikitsa maintains equilibrium of doshas and dhatus. Makes strong andhealthy dhatus of the body and prevents the diseases. Apart from this, the medicine proposed for this study is cost effective andeasily available hence present clinical study; to evaluate the efficacy of Rasayanaeffect of Shilajatu Guggulu. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 8
    • Literary review Historical Review History says that past paves the way for future & knowing about past events,aids in a having a better present. Thus, history study is important to know about thesystematic growth and improvement of the subject to decide plans for furtherestablishment and research designing. Here are some Historical facts regardingHypertension.The division of Historical aspect is: A) Vedic Kala B) Pre-samhita Kala C) Samhita Kala.A) Vedic Kala: In Vedas, the references are in a scattered manner. Some of the referencesregarding Heart and blood flow are found which are as follows:In Rigveda: Hridaya as a organ described & also give description about Hridroga inMantras form.In Yajurveda: In human being Hridaya - Heart is considered to be seat of Shubha - AshubhaSankalpa.In Athervaveda: The flow of Rasa in body has been stimulated to the rivers flowing towards thesea. The direction of flow of this Ragayukta fluid (red colored) has been described interms of Urdhwa Dhaminis or Lohini. These vessels carrying Lohitas are stated as ‘HIRA’. These are hollow organsi.e. having lumen. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 9
    • Literary reviewB) Pre-Samhitas Kala:Brahmanas & UpanishadsIn Brihad - Aranyaka Upanishad: Here ‘Hridaya’ is formed by three words - Hri-da-ya. Hri is to take (Aharana),Da is to give (pana), Ya is to control or move constantly (yachhati). It means that the Hridaya receives Rasa and Rakta from whole body &supplies the Suddh Rasa, Rakta, gives nutrition and controls the circulation by itsspecific action of Sanckocha and Vikasa. Hridaya is the origin of five Indriyas i.e.Shabda, Sparsha, Rupa, Rasa and Gandha. Hridaya is situated in the middle of thechest wall and connect with various Nadies.In Chhandogya Upnishada: One hundred and one nadies emerge from Heart & towards whole body.In Mandakopnishad: Hridaya collect Rasa and circulate the Rasa in all over body. Hridaya is stated to be seat of kapha.In Vayu Purana: Hridaya situated in mid body and it is considers as the seat of Manas (mind) &Panchbhutas- seat of Pran & Agni are discussed in new perspective.In Skanda Purana: Hridaya is the seat of Sadhaka Agni.C) Samhita kala: The description of Heart, Blood Circulation, Dhamanis, Shiras etc. are foundin Samhita Kala. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 10
    • Literary reviewCharaka Samhita: Hridaya is the Adhistana and root of the Pranavaha, Rasavaha41, Manovaha,Sangnyavaha srotas. Hridaya is said as the seat of Ojas42. Hridaya is root cause for the maintenance of six organs Mana, Atma, Vigyana,Indriya, Pancha-artha and Trigunas including it various Vishaya43 and also explainsthe Hridaya roga prakarana separately44.Sushruta Samhita: Hridaya is the Adhistana and root of the Pranavaha and Rasavaha srotas45.Hridaya is said to be seat of Chetana46 and is to be found adhomukha just like lotusflower47.Astanga Samgraha & Astanga Hridaya: Here more description about Hridaya, Dhamani, Siras, Srotas etc. are found.Hridaya is said to be place of Chetana, shleshma rakta prasadat and is to be foundadhomukha just like lotus flower48. Hridaya is the sthana of ojus and the origin ofdashamoola shiras49.Kashyapa Samhita: Hridaya is said to be the seat of Shonitha and it motivates the Mana andIndriyas50.Sharangdhar Samhita: Sharangadhar visualize the significance of Oxygen is extensively distributedthrough the body from Heart and give description about rasa, rakta, blood circulationwith Hridaya51. He was the first Physician to incorporate Nadi pariksha into orthodoxmedicines, mentioned different types of pulses on the bases of Doshas and certainphysiological condition52. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 11
    • Literary reviewHistorical milestone in blood pressure: In modern medicines normal Blood Circulation & Pulse tension is knownsince very early period. But the name of Hypertension & specifically Essentialhypertension is given a little more then one century. First time Blood circulation was described by Galen. He also established theAutonomous movements without the control of Nervous system.1559: Calsalpino (ITALY) introduced term circulation with reference to movement ofblood in Arteries & Veins.1628: The inventor of blood circulation “William Harvey” was the first to learn thewhole structure.1731: Blood circulation described by Galen first time. He also established theautonomous movement without the control of nervous system.1789: The English clinician Richard Bright (1789-1858) made an importantcontribution to the understanding of the link between Hypertension and renal disease,based on his observations of patients. In a paper published in 1836, Bright noted thatpathological changes in the kidney are often accompanied by hypertrophy of the leftventricle of the heart, although he did not link the two conditions to Hypertension. However, he did speculate that the presence of small vessels disease in thetissues might require a greater cardiac force to overcome the increased resistance toblood flow. The condition that Bright described where nephritis and albuminuria wereusually accompanied by edema and elevated blood pressure became known asBright’s disease. Bright’s work led others to realize the significance of Hypertensionas a cause of some of the pathological changes in the kidneys and other organs andhence, to recognize Hypertension as disease. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 12
    • Literary review1836: Richard Bright (England) established association of blood pressure in Kidneydiseases.1852: Charles Brown-Sequard (1817-1894) outlined the effects of sympatheticinnervations on the vasculature. He demonstrated that cutting of the sympatheticnerve leads to vasodilatation, whereas stimulating the peripheral sympathetic nerveendings causes vasoconstriction.1855: Introduction of the Sphygmograph by Kari Vicrodt.1874: Frederick Mohamed (1849-1884) - was the first to notice “high tension in thearterial system” occurs “previous to the commencement of any kidney change, or tothe appearance of albumin in the urine.1876: Sir William Richard Gower’s (1845-1915) - a neurologist and one of thepioneers of the ophthalmoscope, noted the presence of vascular changes in the retinain patients with Bright’s disease. He published a paper in which he demonstrated aclose correlation between constrictions of retinal arterioles and raised arterialpressure.1880: Introduction of the Sphygmograph by Vas Basch.1896: Albutt introduced the term ‘Hyperplesia’ in to distinguish patients withelevated blood pressure alone from those with Bright’s disease. The disease was laterrenamed ‘Essential Hypertension’.1897: Hill & Barnard developed an arm occluding sphygmomanometer.1904: Theodore Janewaydrew attention to the striking response to stresses such assurgery, tobacco and anxiety.1911: Frank first gave the name Essential Hypertension.1920: McLeod (1876-1935) - produced his acclaimed text on physiology, in which heoutlined the major factors controlling blood pressure. Later, in 1934, Goldblatt and Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 13
    • Literary reviewcolleagues demonstrated that Hypertension could be induced in dogs by clamping therenal artery.1939: Keith and colleagues published a paper in which they showed a correlationbetween retinal abnormalities and prognosis in Hypertension. The relation betweenHypertension and arteriosclerosis was appreciated in 1948, although its nature was notfully understood at that time.1940: Anyuman & Gold shine established that Blood Pressure measured at home waslower then in clinic.1944: Smirk assessed blood pressure behavior in the individual by measuring basedblood pressure.1955: Pereira described the natural history of Hypertension and its frequentprogression to end-organ complications, largely resulting from acceleration of theprocesses of arteriosclerosis. He was one of the first to question the existence ofbenign form of Hypertension.1964: George Pickering showed for first time profound fall Blood Pressure recordduring sleep.1970: Physiology & pharmacology of B.Adrenergic Receptor by Black for which hegot noble prize in 1998.1994: Smik assessed Blood Pressure Behavior in the individual by measure basalBlood Pressure.Review of previous research work:Ahamedabad: Shah J.R. - Studied appraisal of dosha in H.T.N. (1984) Solanki P.V.-An effect of Virechana & Shaman on Essential Hypertension. (1987) Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 14
    • Literary review Vashishta A.G. - A clinical study on the role of Basti-Chikitsa in the managementof E.H.T.(1994) Bhupendra Pal- A clinicopathological study of Raktagata Vata (H.T.N.) &management by Jatamansi Churna. (1994)Banaras Hindu University (B.H.U.): S.P.Pande- Study of Arterial H.T.N. and role of Japapushpa (Hibiscus Rosasine sis) in its management. (1977) Ram Singh- A Clinical & experimental evolution of certain indigenous dugsand its significance in the management of E.H.T. (1993) G.J.Sayakarars- Study of Avritta in the light of H.T.N. (1993) Murti Krishana.P.- A clinical study in Ayurvedic management of H.T.N. withspecific reference to some non-pharmacological measures. (1993)Ph.D. Thesis: H.C.Gupta- A new care treatment of H.T.N.(Shleshmavrita Vayana). (1990). Ritu Bhardwaj- A clinical & competitive study Shodhana (Virechana) purvakashaman & shamana chikitsa in the management of E.H.T. (1998)Hyderabad Govt. Ayurvedic collage: Anjanedya.S- A clinical study of the effect of Vacha on H.T.N. (1985). J.V. Rao- A study on the effect of Jyothishmati & Punarnava in H.T.N. (1985) K.Bhushan- Effect of Sarpagandhadi yoga on H.T.N. (1989)I.P.G.T & R.A. Jamnager: G.B.Pandey- Avarut Vata Vigyana. (1960) O.C.Birla- Abhivridha Raktachapa par Sirodhara. (1973) P.D.Joshi- Role of Dosha-Dushya in H.T.N. (1979) Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 15
    • Literary review Maheshwar Shukla- Effect of Shirodhara by Takra in patients suffering fromH.T.N. (1983) A.R.Dev (MRS)- A comparative study on the Rasayana drug & Jaladhara inthe management of Uccharaktachapa. (1988) Jay Krishana Jani- A study on the Etiopathogenesis of E.H.T. and itsmanagement with certain Ayurvedic drugs. (2000) Mahopty K.- Critical study of Srotovijananam in Brihatrayi w.s.r. toRaktavaha Srotodusti & its management B.P. (2000) Sumit Pathania- Role of Takradhara & Sarpangandha Ghanvati in themanagement of Uccharaktachapa. (2000) Dhananjay Patel- The role of Mansikbhavas in the Etiopathologenesis ofUchharaktachapa & its management with Medhya-rasayan & shirodhara. (2003) Ramesh Bhayala- The role of Virechana & Shaman Chikitsa in themanagement of E.H.T. (2003)Govt. College of Indian Medecine Mysore: R.Mohammed - A study of H.T.N. on Ayurvedic apporach. (1987)Titlak Ayurved Mahavidhayalaya Pune: P.P.Patil - Efficiency of Rasgandha vati in H.T.N. (1995) H.D.Datkhile - Study of H.T.N. according to Ayurveda. (1994-95) Ahiv Rao B.G.- Relation of B.P.(Raktabhar) & Prakrati. (1984-85)Gopa Bandhu Ayurvada Mahavidhyalaya Puri: Chandra B. - Management of H.T.N. with Jatanmansi. (1993) G.C.D.Sharma - Study on the effect of Sarpagandha churna with Jatamansikwatha on Benign Arterial H.T.N. (1989) Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 16
    • Literary reviewGovt. Ayurvedic College-Raipur (P.T. Ravishankar University): Tamrakar B.C.- Comparative therapeutic evolution of shirodhara(Panchakarma therapy) in H.T.N. (1987) N.Mishara - Ayurvedic drishtikon se Uccharaktachap ka nidanik evamvaignyanik adhyayana. (1985) Anil Singhai-A clinical study of Ayurvedic compound in arterial H.T.N. (1987)Govt. Ayurveda College (Kerala University) Trivendram: Ravindranath M. N. - Management of H.T.N. (1984) P.N.Jaya Singh - Management of H.T.N. with Shodashanga kashaya. (1993)N.I.A. Jaipur: J.P.Pathak - Raktachap evam Bramhi Rasayana-uccha raktachap ka nidanchikitsatamak adhyayana. (1983) S. Malik - Avrit Vyan udan vayu (Uccharaktachapa) per Rasona Guggulu kachikitsatmak adhyayana. (1996)Views of ayurvedic scholarsVidya Ranjit Rai Desai: In his book Nidana Chikitsa Hasthamalaka, he has opined that the diseasehypertension is a raktaja Vyadhi. Langhana, virechana and Raktamokshana etc,samanya chikitsa sutras of raktajavyadhi can give fruitful results in the managementof Hypertension. He has clearly stated that the hypertension is due to RaktavrutaVyana vata.Vaidya Shri.Sudarshan Shastri, Shri.Yadunanda Upadhyaya: They have opined that hypertension is due to Raktagata vata and is to be takenas pravruddha raktachapa. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 17
    • Literary reviewVaidya Shri.Gananath Sen: He has opined that high blood pressure is Raktagata vata or Raktavruta vata.Here vitiated vata will become Raktagata or Raktavruta and manifests the disease.Here the symptoms are not only due to the Hridaya but also due to the vikriti ofvrukka also.Vaidya Shri.V.V.Shastry: In his paper, he has considered raktapeedanadhikya as hypertension anddhamanipratichaya to be one of the major causes for causing the high blood pressure.He has given the following causes, which cause the dhamani pratichaya: As this is a shlaishmika disease, a shlaishmika and snigdha substance may besmear or added to the vessel wall, consequently producing a growth and increase inthe thickness of the vessel wall. This may finally lead to the obstruction of srotas(srotorodha). The dhamani which loose the elasticity due to the increase in the thickness ofthe vessel wall, also loose the quality of dhamana, thereby necessitating an increasedforce in the contraction of the hridaya to maintain the preenana and jeevana kriyas. Asa consequence there is rakta peedanadhikyata.Vaidya Shri. M.Mahadevashastry: He has suggested the following treatment during the management of raktasamurdam (hypertension). Shodhana and shamana as in vatashonita and medasavrita Vata, Anavaranavata, Sudation and cleansing, use of purana guggulu with tila taila, internal use ofunsaturated seed oils, Ksheerabalataila, shilajatu, guduchi, in atheroma andatherosclerosis. Brihat Vatachintamani, Agatsya hareetaki etc. strengthen hridaya,brain, arterioles and renal vessels. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 18
    • Literary reviewVaidya Shr. D.T.Giri and Vaidya Smt. Jayashree.R.Shah: In the Aug. 85 issue of Ayu magazine, Dr.Giri and Dr.Jayashree haveconsidered hypertension as uchcha raktachapa. They have classified hypertension intothree categories, namely, i) Vataja, ii) Pittaja, iii) Kaphaja, according to do dosha onthe basis of dosha vriddhi lakshana. As per their opinion Chinta, Bhaya, Shoka, Vegadharanadi, Vatavriddhikaranas are the nidanas for vataja uchcharaktachapa, Krodha, Shoka, Mamsa sevana,Katurasa sevana, Dhumra pana etc, are said to be the nidana for pittaja uchcharaktachapa, And Diwaswapna, Alasya, Amlarasa, Lavanarasa, Guruahara sevana,Madhura rasa sevana, Masha etc, are the nidanas for Kaphaja Uchcha Rakta Chapa. In Vataja uchcharaktachapa- dhamani kathinyata and rakta vahi sankocha isthe main pathogenesis. In paithika uchcharaktachapa rajoguna vriddhi are due toushna teekshna gunas of pitta. Then vata vriddhi and paithika uchcharaktachapa ismanifested. They have stated that shodhana chikitsa in uchcharaktachapa should beaccording to doshas involved. In vatapradhana uchcharaktachapa, basti karma is indicated. In pitta pradhanauchcharaktachapa, virechana is indicated and in Kapha pradhana raktachapa, vamanais indicated. They have told that this shodhana karma in uchcharaktachapa is only anupashaya, which gives the knowledge of predominant dosha in the patients sufferingfrom uchcharaktachapa.Hypertension in Ancient Period: Ayurveda an ancient medical science has a rich literature regarding a plenty ofdisorders but it is difficult to find a clear-cut correlation to that of hypertension in ourscience. However, looking to the description of hridaya, the diseases like Hridroga, Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 19
    • Literary reviewPakshaghata that can be taken as the complications of hypertension. We can think thathypertension might be present in those days.Diseases considered under the heading Hypertension by 20th Century Authors is asfollows – 1) Pittavruta udana vata, 2) Pittavruta prana vata, 3) Pittavruta vata, 4)Dhamani pratichaya, 5) Mada, 6) Moorcha, 7) Bhrama, 8) Sanyasa, 9) Rakta gatavata, 10) Raktachapadhikyata, 11) Raktapradoshaja vikara, 12) Raktavruta vata, 13)Roudhiryamada, 14) Siragata vata, 15) Ucharakta bhara, 16) Ucha rakta chapa,17) Pranavruta udana vata, 18) Raktamada, 19) Vyanabala, 20) Raktasamvardhana,21 )Raktavega vridhi, 22) Rasabhara.Pittavruta udana vata The Pittavruta udanavata lakshana are - Murcha, Daha, Bhrama, Klama,Avasada, daha in the nabhi and urah region and Ojobhransha53.Pittavrutha prana vayu The lakshanas are- Murcha, Daha, Bhrama, Shoola, Vidaha, Chardi andSheeta kamatwa54.Pittavruta vata In Pittavruta vata, the following symptoms are- Daha, Trishna, Shoola,Bhrama, Tama, aggravation of daha by the use of Katu, Amala, Lavana, Ushana andSheetakamita55.Raktavruta vata Acharya Charaka has described the disease Raktavruta Vata36 under thecontext of Vatavyadhi but no other Acharyas have mentioned regarding this disease.In Raktavruta vata, the symptoms are - Daha in between twak, Mamsa, Raga,Mandalas and Kshavathu56. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 20
    • Literary reviewRaktapradoshaja vikaras Raktapradoshaja vikaras are explained under the vidhishonita adhyaya. Incharaka samhita totally 43 diseases are mentioned in vidhishonita adhyaya all thesediseases come under the rakta pradoshaja vikaras. In this group mada, raktapitta etc.,diseases are considered57.Raktagatavata The lakshanas of Raktagatavata, according to Acharya Charaka- Teevraruja,Santapa, Vaivarnya, Krishata, Aruchi and Stambhata soon after having food58.Acharya Vagbhata also explained almost all the symptoms, which are explained byAcharya Charaka, in addition with – Swapam, Raga and Bhrama59. Sri Sudarshan Shastri and Sri Yandunandanopadhya conferred opinion, asRaktagata Vata is nothing but hypertension.Siragata Vata The Lakshanas of siragata vata are- Mandaruja, shopha, Shushyati, Spandyate,Suptasatanvyo in siras60.Bhrama: It is one of the symptoms of Pittavruta udana. It is one of the vataja nanatmajavyadhi61. The shareerika doshas vata, pitta and manasika dosha rajas are considered asthe causative factors for the Bhrama. Bhrama means Giddiness or rotation, a personfeels the fast rotation in the shirah62.Dhamani Pratichaya It is one of the kaphaja nanatmaja vikara63. Due to adhika poshana especiallyRasa and Rakta dhatus the dhamanis in which these dhatu circulates get dilated.Because of these, the gati becomes manda and guru. The Dhamani will not be guru,manda and mrudu as seen in Atipoornata but it will be Katina and Teekshna due to Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 21
    • Literary reviewvitiation of Vata. It will sometimes be Teekshana, Manda, Poorna and Ksheena due tothe vitiation of Vata.Roudhira Mada Mada is one of the rakta dushti vikaras. In the seven type of mada theRoudhira mada is considered as hypertension and stated that the dushya involved inthis disease is Rakta whereas Vata, Pitta, and Kapha plays an important role in theformation of Roudhira Mada64.RaktachapadhikyataRaktachapadhikyata is created by three words - Rakta, Chapa and Adhikyata. Rakta’ refers to – Vishesha dhatu among all dhatus and rakta indicates life. ‘Chapa’- refers to pressure or squeezing. ‘Adhikyata’-refers to, high or increased.Raktachapadhikyata” means high blood pressure65.Moorcha Madhava Nidana66, 67 has explained the moorcha in detail. It is due to vitiatedVatadidosha, rakta dusti and tama dosha. It can be considered as syncope. Lose ofconsciousness induced by a temporarily insufficient flow of blood to the brain. Acharya Vagbhata68 mentioned the mada, moorcha and sanyasa. AcharyaCharka and Acharya Sushruta explained the types of moorcha.Sanyasa It is the disease of rakta dushti and samjnya vaha srotas. It is due to thevitiated doshas. If moorcha is not treated properly, it leads to Sanyasa. According tocontemporary science coma is a state of unnatural heavy deep and prolonged sleepoften accompanied by slow irregular breathing and consequently ending in to death69. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 22
    • Shareera Shareera Vivechana Anatomy-Physiology of the heart and blood vessels with physiology of bloodcirculation is very much indispensable in Pittavruta udana w.s.r.t. Essentialhypertension before going to discussion part.Hridaya The word ‘Hridaya’ in Ayurveda is a synonym for the word Heart. Hridaya isderived from two verbs. ‘Hri’ which means to bring back forcibly and ‘Da’ whichmeans to donate. According to Shatapatabrahmana the word hridaya is made up ofthree dhatu’s, Hri, Da, and Ya. These dhatus by the combination of the pratyaya andadesha, forms Hrit, Dana and Ayana. The dhatu Hrit gives the meaning of Hanane, Apatirite i.e., to take or toreceive. The dhatu Dana gives the meaning of Tyage, Palane, Chedane i.e. to give orto eject or to nourish. The dhatu Ayana having the paribhasha of Kayam, gives themeaning of Gati, Chalana, or Movement. The word hridaya has been attributed to mainly two organs, namely Mastishkaor Shirohridaya and Hridaya i.e. Urohridaya. Generally, yogis attribute the wordhridaya to Mastishka- and the physicians or Vaidyas denote the word hridaya toUrohridaya or Muscular heart. The anatomy and physiology of Hridaya is not explained under one heading orat one place in classics, we get lot of quotes and descriptions based on which weshould appreciate the anatomy and physiology of heart. Hridaya is considered as one of the kostanga. It is situated in vaksha pradeshain between the two stanas. It is formed by shleshma and rakta, having the shape ofinverted lotus and according to Arunadatta it is made up of mamsapeshi and rakta. Itmeasures two angula according to Chakrapani and four angula according to Sushruta. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 23
    • Shareera Hridaya is the moola of pranavaha and rasavaha Srotas70. It is the seat ofmanas and para-apara ojus71. Hridaya is the sthana of dashadhamani’s which spreadsall over the body and which carries rasa, ojas and does tarpana karma72, 73. Hridayacontinues to work whether the person is in jagrutavasta or swapatavasta74. The particular function of hridaya is conceded out by particular dosha. Thesefunctions are discussed below:-Doshas related to Hridaya The three doshas are related with Hridaya i.e. among vata, the Udana vata,Prana vata and Vyana vata75related to Hridaya. Among pitta, the Sadhaka pitta76, andamong kapha, the Avalambaka kapha is related to Hridaya77.Udanavata with Hridaya Acharya Charaka and Vagbhata have mentioned the uras as the sthana ofUdana vata78, 79, 80 and is related to hridaya. The functions of Udana vata are prayatna(Endeavour or effort), urja (enthusiasm) and bala (strength)81, with respect to hridaya,we can think of the conductive system of the heart, i.e. Udana vata by the functionslike prayatna and bala initiates and helps in the conduction of the cardiac impulses inthe heart. It is the coordinator of speech, memory, strength etc82, 83.Pranavata with Hridaya Acharya Charaka and Vagbhata have mentioned the Shiras84, 85 are the sthanaof Pranavata and acc. to Acharya Sharangadhara, Prana is situated in hridaya86.Acharya Vagbhata states that Prana vata maintains the activities of hridaya and doesdharana of dhamanis87. Thus, Prana vata is situated in murdha and sends impulses tohridaya, there by overriding the sympathetic and parasympathetic actions or functions.Prana is central controller of all the motor activities of body88. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 24
    • ShareeraVyanavata with Hridaya Acharya Vagbhata stated that Vyana vata is situated in hridaya89,90 and itmoves quickly all over the body91,92. Vyana vata is responsible for circulation of Rasa(Rasadhatu) all through the body93, 94. Acharya Sushruta has also mentioned asruksravana to be one of the functions of Vyana vata95. Acharya Vagbhata summarizingall functions of Vyana vata by the statement that Vyana vata96 conducts all the actionsor movements of the body. Even Acharya Charaka has mentioned that Vyana vata is responsible for thecontinuous flow of rasadhatu to all parts of the body throughout the life by using thewords like ajasram and sada97 and controls the circulation of Rasa, Rakta and Swedain the body98.Sadhakapitta with Hridaya Acharya Sushruta and Vagbhata stated that Sadhaka pitta is situated inhridaya99, 100, 101 and is responsible for attainment of buddhi, medha, abhimana, utsahaand abhipretartha. Therefore, it is connected with some of the higher mental faculties andemotional states. Hence, Sadhaka pitta related with psycho-physiological actions.Avalambaka Kapha with Hridaya Acharya Vagbhata and Sushruta stated that Avalambaka kapha is situated inuras102, 103, 104. It does avalambana of hridaya i.e. with the help of rasa it gives bala tohridaya. It also does tarpana and kledana of Hridaya.Manas with Hridaya Acharya Charka and Acharya Sushruta stated that hridaya is the adhistana ofManas105, 106. Acharya Charaka while mentioning measures to protect hridaya and oja Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 25
    • Shareerasay to avoid the thing that produces dukha to the Manas. Even in Unmada chikitsaadhyaya also Acharya Charaka mentions about manovaha srotas.Ojas with Hridaya Ojas has been classified in to two types, i.e. para ojus and apara ojus. Paraojus is located in hridaya107 and pramana is ashta bindu. It is said to be uttamapranayatana even, if a very little is destroyed the body cannot exist. Apara ojus islocated in hridaya and dhamani, and circulates all over the body. It is ardhanjali inpramana and the deficiency of this ojus does not cause death.Rasa Rakta Paribhramana Hridaya is the srotomula of rasavaha and pranavaha srotas108 and responsiblefor rasa samvahana in the shareera. Samanavata brings the ahara rasa that is fashionedto hridaya, and in hridaya it is called as rasa dhatu. At the present with the help ofUdana vata and Vyana vata the sankocha and vikasa i.e. the praspandana of hridayastarts. Praspandana of hridaya can be correlated to the conductive system of the heart.Now sankocha can be .considered as systole and vikasa can be considered as diastole.Prana vata maintains the actions of hridaya and does dharana of dhamanies. Thisindicates that it governs the vasomotor functions. Once the sankocha takes place therasa moves in to dashadhamani, and proceeds further109. As per kedarakulyanyaya, the rasa moves to all parts of the body andnourishes the whole body. This function is conceded constantly all over the life Afterwards this rasa is brought back to the hridaya by Vyana vata, Samanavata and Hridaya vikasana takes place, followed by sankocha and rasa movingtowards sarva shareera. This cycle continues and Acharya Charaka uses the wordajasra to denote the continuous function of hridaya in circulation of rasa110. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 26
    • ShareeraBlood Vessels and Shareera The concept of blood vessels in Ayurveda has not been cleared till today.Different Acharyas have different opines regarding this. The three terms i.e. Sira,Dhamani and Srotas are used with different meanings depending on the context atdifferent places. Dalhana in Dhamaneevyakarana adhyaya has described regardingsira, dhamani and srotas, elaborately. He has differentiated these three based on fourpramanas, i.e. lakshana, moola, karma and agama. Dalhana giving the reason forthese three being read together says, though they are differentiated, however hassimilarity in vahana karma.Table-01: Showing the opinion of Acharyas regarding Sira, Dhamani and Srotas Sira Dhamani SrotasDefinition: Definition: Definition: 111 112“Saranat Siraha” “Dhmand Dhamanyaha” “Sravanat Srotamsi” 113 Chakrapani, Gangadhara, Chakrapani, Gangadhara,Chakrapani, Gangadhara, Gananathsen’s opinion goes in Gananathsen’s opinion goes inGananathsen’s opinion goes in favour of artery. Shuddha favour of capillaries.favour of vein. raktavahini’s are considered as It has paryayas like sira,Ashuddha raktavahini’s are dhamani and can be referred as dhamani, rasayanya, nadi,considered as sira and can be artery (Atharvaveda). The word pantha, marga etc.referred as vein (Atharvaveda). dhamani has been used with thePandit Hariprapannaji considers meaning of Jnyanatantu.sira to be vein. Pittavaha siras At parishad shabdartha it wascan be considered as vein. concluded that dhamani can beThe word sira has been used considered as artery, nerve orwith the meaning of kandara. vein, or any vessel in the body.The word sira has been used The word dhamani has beenwith the meaning of dhamani. used with the meaning ofThe word sira denotes vein, rasavahini.artery and lymphatics. The word dhamani has been used with the meaning of sira. Therefore, by the above, it is very difficult to come in a conclusion thatwhether sira is considered as artery or dhamani is considered as artery. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 27
    • Shareera Acharya Charaka is more of the opinion of considering dhamani to be asartery, while Acharya Sushruta considers rohini sira or asrugvaha sira as the artery.Even the parishad that was conducted on shabdartha could not conclude on thiscontroversy. Therefore, now based on pulsatile feature, dhamani is taken as artery inthis study. Acharya Sushruta has used the word sira pratana to describe the plexus ofarteries or veins. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 28
    • Shareera The Heart (Anatomy) Greek name is cardia from which we have the adjective cardiac, Latin nameis cor from which we have the adjective coronary. The heart is a conical, hollow muscular organ, situated in the middlemediastinum. It is enclosed within the Pericardium. It pumps the blood to variousparts of the body. The heart is placed obliquely behind the body of the sternum andadjoining parts of the costal cartilages, so that 1/3rd of it lies to the right, 2/3rd to theleft of the median plane. The direction of blood flow, from atria to the ventricles, isdownwards, forwards and to the left. The heart measures about 12×9 cm (5×3 or 3 ½inches) and weighs about 300 gms in males, 250 gms in females114.External features The human heart has four chambers. These are right and left atria and the rightand left ventricles. The atria lie above and behind the ventricles. On the surface of theheart, they are separated from the ventricles by an atrioventricular groove. The atriaare separated from each other by an interatrial groove. The Ventricles are separatedfrom each other by inter-ventricular groove, which is subdivided into anterior andposterior parts. The upper part of each atrium has an appendage called the auricle.The heart has an apex directed downwards, forwards and to the left; a base (orposterior surface) directed backwards; and anterior, inferior and left surfaces. Thesurfaces are demarcated by upper, lower, right and left borders115.Arteries and veins of the heart The heart is supplied by two coronary arteries, arising from the ascendingaorta. Both arteries run in the coronary sulcus116. The venous blood is drained by great cardiac vein, the middle cardiac vein, thesmall cardiac vein, the posterior vein of the left ventricle, the oblique vein of the left Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 29
    • Shareeraatrium, the right marginal vein, the anterior cardiac veins, and the venae cordisminimae. All these except last two drain into the coronary sinus which opens into theright atrium. The anterior cardiac veins and the venae cordis minimae open directlyinto the right atrium117.Lymphatic and the nerve supply of the heart Lymphatic of the heart accompany the coronary arteries and from two trunks.The right trunk ends in the brachiocephalic nodes, and the left trunk ends in thetracheobronchial lymph nodes at the bifurcation of the trachea. Parasympathetic nerves reach the heart via the vagus. These are cardioinhibitory; on stimulation they slow down the heart rate. Sympathetic nerves arederived from the upper 3-5 thoracic segments of the spinal cord. These arecardioaccelaratory, and on stimulation they increase the heart rate, and also dilate thecoronary arteries. Both parasympathetic and sympathetic nerves form the superficialand deep cardiac plexuses, the branches of which run along the coronary arteries toreach the Myocardium118.Anatomy of Artery and Arterioles The whole circulatory system from the finest capillaries up to and includingthe heart is lined by a smooth, continuous single layered endothelium. The walls of allvessels except capillaries and sinusoids are formed by three analogous zones (coats)i.e., from inside outwards the tunica intimae, tunica media, and tunica adventitia.These coats confer on the vessels a number of important properties, including anendothelial lining low in friction and connective tissue components able to withstandlongitudinal and circumferential stress due to prevailing blood pressure. The smallest arteries terminate in muscular arterioles 100-50 µm in diameter,which branch into terminal arterioles less than 50 µm in diameter. Metarterioles are Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 30
    • Shareerabranches of terminal arterioles, 10-15 µm in diameter at their origin and decreasingover 5-100 µm to as little as 5 µm, where they open in to the capillary bed. They aresurrounded by a strong circular layer of non striated myocytes forming precapillarysphincters, which affect the final control of blood flow through the capillaries. Precapillary sphincters have been seen to open and close periodically with a cycle of 2-8seconds.Physiology of Blood Circulation The activity of the organs of the circulatory system, that is, of the heart andblood vessels, ensures a constant flow of blood in the organism. Because of itsmovement, the blood can perform numerous transport functions, in particular,supplying oxygen and nutrients to the tissues, and removing substances formed as theresult of metabolism. The movement of blood in the organism follows a complicated course knownas the 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, then to the arterioles, capillaries, and theveins of the whole body, and finally to the two venacavae which enter the rightatrium. The pulmonary circulation begins from the right ventricle, continues along thepulmonary artery and all its branches, then along the pulmonary arterioles, capillaries,and veins and terminates in 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 aortaand pulmonary arteries. The movement of the blood further along the vessels, and itsreturn to the heart, is conditioned by its pressure in the large arteries being higher thanin the small arteries, the pressure in the latter being higher than in the capillaries, and Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 31
    • Shareerathe pressure in the capillaries being higher in turn than in the veins and atria. In thisway, there is difference in pressure all along the blood stream that determines itscirculation in the vascular system, blood flowing from the vessels with higherpressure to those with lower. The gradual drop in the pressure along the blood stream(from the arteries to the capillaries and veins) is brought about by the fact that theenergy imparted by the heart is utilized to overcome the resistance of the vessels tothe movement of the fluid arising from friction between the fluid particles and thevascular wall and between the particles themselves. The function of the heart is rhythmic pumping of blood that it receives fromthe veins in to the arteries. It is performed by alternate rhythmic contraction andrelaxation of the muscular fibers that forms the walls of the atria and ventricles.Contraction of the myocardium of these chambers is known as their systole, andrelaxation 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 wherethe orifices of the venacava 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 beingin a state of diastole which lasts 0.7 second. The contraction of the two ventriclesoccurs simultaneously, and their systole persists for about 0.3 second. After that,ventricular diastole begins and lasts about 0.5 second. One-tenth second before theend of the ventricular diastole a new atrial systole occurs, and a new cycle of cardiacactivity begins. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 32
    • ShareeraRegulation of Blood Pressure Physiologically the magnitude of the arterial pressure depends on twofundamental homodynamic variables; cardiac out put and total peripheral resistance.In other words, the arterial blood pressure is a product of cardiac out put andperipheral vascular 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 -α-adrenergic -β-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 theblood volume. 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, which Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 33
    • Shareerablocks the excretion of sodium and water into the urine. It appears that most patients with established hypertension have abnormalcardiac output and blood pressure is mainly sustained by increased peripheral vascularresistance. The peripheral vascular resistance is determined by the arteriolar lumen,which may expand or contract depending on the state of muscular cells in the vesselwall. This is known as local vascular tone. Normal vascular tone depends on thecompetition between vasoconstricting influences and vasodilators. Peripheralresistance depends on the size of the lumen of some vessels. A decrease in the inner(lumen) diameter will raise the Blood Pressure. The decrease in the lumen could bebrought about by an anatomical thickening of vessel walls (eg., intimal thickening ofarteries), by their mechanical compression from outside or most commonly by theiractive muscular contraction which can be induced by a variety of vasoconstrictormediators. The common vasoconstricting mediators are epinephrine, norepinephrineand renin- activated angiotensin II. The other recently described vasoconstrictorsinclude endothelin I, thromboxane and leucotrienes. Resistance vessels also exhibitauto regulation, a process by which increased blood flow to such vessels inducesvasoconstriction, an adaptive mechanism that protects against hyperperfusion oftissues. The vasodilators include kinins, prostaglandins and nitric oxide. Certainmetabolic products such as lactic acid, hydrogen ions, adenosine and hypoxia can alsofunction 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), Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 34
    • Shareerawhich tends to cause vasoconstriction. Thus haemoglobin helps in regulating theblood pressure by adjusting the amounts of SNO and NO to which blood vessels areexposed. This newly appreciated role of haemoglobin may influence development ofdrugs to treat hypertension. 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 thereis considerable 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, andthe renin-angiotensin system appears central to these influences. Renin elaborated bythe juxtaglomerular cells of the kidney transforms plasma angiotensinogen toangiotensin I, and the latter is converted to angiotensin II by angiotensin convertingenzyme (ACE). Angiotensin II alters blood pressure by increasing both peripheralresistance and blood volume. The former effect is achieved largely by it’s ability tocause vasoconstriction through direct action on vascular smooth muscle, the latter bystimulation of aldosterone secretion, which increases distal tubular reabsorption ofsodium and thus of water.The renin-angiotensin system The renin-angiotensin system has been extensively studied since theintroduction of practicable essay methods for plasma renin and angiotensin patientswith essential hypertension have been subdivided into subgroups with low, normaland high plasma renin on the grounds of the elevated pressure. The differentmechanisms and in particular those patients with low plasma renin might have excess,mineralocorticoid activity. Plasma renin and angiotensin ii values are continuously Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 35
    • Shareeradistributed in the hypertensive population. Further peripheral levels of plasma reninand angiotensin –II is found in relation inversely to age in essential hypertension.Peripheral levels of anti diuretic hormone have been reported as being slightlysuppressed in uncomplicated essential hypertension. Figure-2: Showing the role of Renin-Angiotensin System 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. GFR- independent natriuretic factors, including atrial natriuretic factor (ANF), a peptide secreted by heart atria in response to volume expansion, inhibit sodium Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 36
    • Shareerareabsorption in distal tubules and cause vasodilation. Abnormalities in these renalmechanisms are implicated in the pathogenesis of secondary hypertension in avariety of renal diseases, but they also play an important role in essentialhypertension. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 37
    • Disease Review Disease ReviewImportance of Avruta vata Vata is most significant and commanding among three doshas in many ways, forexample Pitta, Kapha and Dhatus are pangu without Vata consequently Vata regulatestheir functions, another one is its ashukaritwa. Gati is the unique feature of vata, whenever its gati is disturbed due to Avarana orother cause then its vitiation occurs. According to chakrapani, because of avarana, thespeed of the moment of vata gets arrested which leads to its aggravation. Vata gets vitiates in to two ways i.e. by marga Avaranas or by the dhatu kshaya,whereas Pitta have single rout of its vitiation. Before going to the Avarana aspect of vata,first its various pathological conditions are being discussed.Pathological Conditions of Vata: Acharya Sushruta had point out the three pathological condition of Vata i.e. Kevala vata Dosha-Yukta Vata & Avruta Vata119 Kevala Vata Disordrders: Kevala Vata indicate Shudha Vata. The word kevala refers to Dosha-Asamsristai.e pathological state of Vata without association of other Dosha120. Due to the nidanas of Vata, the body tissues under goes destruction resulting inincrease of Akasha i.e.Vaccum and to fill this vaccum, by marga Avaranas Vata leads toits prakopa. The treatment can be given to Vata only. However, certain care has taken forthis disorder. Here it may produce both Nanatmaja and samanyaja types of Vata Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 38
    • Disease Reviewdisorders. The nanatmaja disorders are produced only by vata not by other dosha. On theother hand, its samanyaja disorders are produced by the the dosha, which may be of vatatype only or may be due to samasarga and sannipata with other Dosha. Doshayukta Vata i.e. Samsarga and sannipata: Doshayukta vata indicate the association of other Doshas, which is different fromAvarana121. It is a pathological state of Vata due to the association of Pitta or Kapha orboth, which may be caused by the mutual hetus. Clinical manifestations of Vata as wellas of the associated Dosha as Anubandha may be there. In that case, generally theprimary Dosha i.e Vata dominates in all the sphere of hetu, symptoms and treatment. Usually, with the treatment of primary Dosha, the secondary Dosha orcomplications is also relieved provided a care is taken because the treatment is notopposed to associated Dosha. The Samsarga or Sannipata may occur in the simple way of prakriti samasamaveta i.e like physical mixture of Dosha, where the mixed symptoms of both theinvolved Dosha are manifested. On the other hand, when the combination of Dosha is inthe form of Vikriti Vishama Samaveta then there may be some peculiar symptoms, whichmay not be belonging to either of the Dosha.Gata Vata: The word GATA has 2 meanings- • Related with movement • Related to Destination / Site /Adhishthana122 Initially Vata is vitiated by its own nidanas, afterward, following the specificpath of its pathogenesis, when involves some specific site i.e Dhatu, Upadhatu or Ashaya, Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 39
    • Disease Reviewthen such condition is termed by adding adjective of that site (Dhatu or Ashaya e.gPakvashaya Gata Vata or Rakta Gata vata and so on123. The symptoms developed according to the severity, site of participation etc. Painis the common and chief complaint in all the conditions of Gatavata. On the other hand,character of the pain varies according to the site of localization. For example, unbearablepain associated with burning sensation is the symptom of Rakta Gata Vata, deep-seatedaching pain is the typical feature of Mamsa Gata Vata124. Avruta Vata: Like Ama, the Avarana is also a unique concept of disease pathogenesis,especially of Vata vyadhis. Term Avarana means; achhadana, avarodha, obstruction,occlusion, to cover or to mask. Gati is unique feature of Vata, whenever the gati of vatagets arrested which leads to its aggravation125. Avarana of vata is a characteristicpathological condition, where obstruction to its Gati occurs due to the nidanas other thenits own, leading to its Prakopa resulting into various Avaranas. The Dosha, Dhatu, Mala,Anna, Ama & sub type of Vata can cause the Avarana.Synonyms of Avaranas: Avintah Samyuktah126.Meaning of term used in Avarana: The three terms are used to understand the Avarana i.e. Avarana, Avarka andAvruta described below:- Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 40
    • Disease Review Avarana: Avarana denotes the obstruction of vata movements. This obstruction can be dueto Pitta, Kapha, Rasadi dhatus, Malas or even by panchavidha vata. Avaraka: The factor, which causes obstruction of vata, is called Avaraka. For example ifPitta cause obstruction of Vata, then Pitta is called Avaraka. Avruta: The gati of Vata, which is affected by the Avaraka is known as Avruta.The substance, which obstructs the pathway of Vata, is termed as Avaraka while Vatawhose avarana occurs is termed as Avarita.127. Figure 3: Showing the diagramatic presentation of concept of Avarana PITTA VATA PITTA (Avaraka) (Avruta) (Avaraka) This concept of Avarana is particularly stated for Vata. According to Chakrapani, the excessively strong Avaraka suppresses the normaldealings of Vata. The excessively increased Avaraka manifests its actions. Avarana ofVata leading to its prakopa, thus the symptoms is also manifested depending upon its siteinvolvement128. In the initial stage of the situation, as the Avaraka is strong and Vata is nearly inthe normal status, there will be decrease in the functions of Vata, in the beginning with Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 41
    • Disease Reviewincrease in the function of Avaraka. When the obstruction is complete, it leads to Prakopaof Vata resulting in its disorder129. Hence, it is clear that Vata is initially in its normal state, but development ofAvaraka occurs. The Vata Prakopa occurs after the obstruction is completed. Hence theVata disorders are produced without indulging of its own nidana.How to know Avruta-Avraka: Charak samhita describes certain guidelines to identify the affected Avruta, andAvaraka, the causative factor of Avarana in 28th chapter cikitsa sthana. i) If Avaraka is stronger than Avruta, i.e. Avruta dosha looses its functions andthere is increase in the activity of the Avaraka factor (it may be vata, kapha or pitta etc.). ii) However, if the Avruta dosa (Vata) is stronger due to sanchaya, prakopa etc.than the Avaraka, then there is increase in the functions of Avruta and decrease in thefunctions of Avaraka. iii) According to some scholars, the decrease of the functions of the Avruta,increase in the functions of the Avaraka130. By observing these lakshanas in a particular case of Avarana one has to analyzethem to identify Avruta-Avraka etc.Indicator composite in Avruta Vata: Repeatedly the symptoms manifested are comprised of disturbed function of theobstructing factor as well as the obstructed Vata. The symptoms produced are based onthe principles of Karma Hani (Rupahani), Karma Vriddhi (Rupa Vriddhi) and AnyaKarma (Rupantara)131. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 42
    • Disease Review These are depending upon the intensity of the obstruction i.e. partial or complete,functional or organic, acute or chronic, transient or persistent, etc. For example, the lessstrong obstruction of Vata will lead to its aggravation, where as the very powerfulobstruction may make it weak and like wise. The symptomatology of the Avarana depends up on the place where the Dosha-Dushya Sammurchana has takes place. For instance, the symptom of Shoola of AvrutaVata may occur in the different parts like head, ears, abdomen, back, depending upon theorgan involved in the process of Avarana.Avarana Bhedas: Avarana may be innumerable132. However, 42 types of Avarana of Vata havebeen described in the texts; these are categorized under the following hading. Murta Avarana133,134: Pitta & Kapha Dosha, Dhatus, Mala and Anna are the Murta substances, whichobstruct the gati of Vata and this state is called as Murta Avarana. These are 22 innumbers i.e. Doshavruta Panchabedha of Vata Pittaavruta Udana-1, Pittaavruta Apana -1, Pittaavruta Samana-1, Pittaavruta Vyana-1, Pittaavruta Prana-1, Kaphavruta Udana-1, Kaphavruta Prana-1, Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 43
    • Disease Review Kaphavruta Apana-1, Kaphavruta Samana-1, Kaphavruta Vyana-1 & Pitta avruta Vata-1, Kapha avruta vata-1. Dhatavarita Vata Rakta avruta Vata-1, Mamsa avruta Vata-1, Meda avruta Vata-1, Asthi avruta Vata-1, Majja avruta Vata-1, Shukra avruta Vata-1, Sarva Dhatvarita Vata -1 & Malavruta Vata -1, Mutravruta Vata -1, Anna vrita Vata -1. Amurta Avarana135,136: When sub-type of Vata obstruct the function of each other, is called Amurta orAnyonya Avarana. It is of 20 in number i.e. Vyana avruta Udana-1, Vyana avruta Prana-1, Vyana avruta Samana-1, Vyana avruta Apana-1, Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 44
    • Disease Review Udana avruta Prana-1, Udana avruta Apana-1, Udana avruta Samana-1, Udana avruta Vyana-1, Samana avruta Prana-1, Samana avruta Apana-1, Samana avruta Udana-1, Samana avruta Vyana-1, Apana avruta Prana-1, Apana avruta Samana-1, Apana avruta Udana-1, Apana avruta Vyana-1, Prana avruta Samana-1, Prana avruta Apana-1, Prana avruta Udana-1 & Prana avruta Vyana-1. Mishra Avarana: In this, two or more factors are involved in the pathogenesis of Avarana, herevariation and combinations of Pitta and Kapha and sub-type of Vata resulting ininnumerable numbers of Pathologies of Avarana137,138.Avarana and Sama Dosha: Sama state of Dosha and Dushya is very important to produce Margavarana in thesrotas and avayava. The sama Dosha or Mala is capable of producing srotosanga, which Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 45
    • Disease Reviewin turn obstruct the Gati of Vata. In this way, Ama may also help in producing theAvarana of Dosha and Dushya etc. indirectly.Avarana-As atypical Clinical presentation: The symptom complex produced by Avarana is always an analytic challenge. Toidentify the accurate cause and pathogenesis of Avarana requires a special diagnosticskills and expertise. Some time it misleads the physician because of its complex atypicalpresentation. Acharya Charaka alarms about its atypical presentation by mentioning that vataobstructed by Meda and Kapha produced pain (shula), Numbness (supti) and Oedema(shvayathu) The Physician ignorant of the condition of Avarana, thinking that vata prakopa isthere, may prescribe unctuous enema, which may further decline the conditions139. Allthese references indicate towards its atypical presentation, which may lead to diagnosticerror resulting in mismanagement too.Diagnostic Method of pathologies of Vata: Kshaya, Vriddhi and Gatatva condition of Vata can be diagnosed easily with thehelp of symptomatology’s mentioned in the text. The Avarana requires a special diagnosis between the conditions of Kevala Vata,Samsarga Vata and Avruta Vata. The diagnosis can be made based on their symptomsand by applying reasoning. Some times it may not be possible to diagnose the Avarana and Anyonya-Avaranastraightforwardly and in that case it can be diagnosed with the help of the exclusionmethods with proper reasoning on the basis of its altered physiology 140. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 46
    • Disease ReviewDiagnosis of Avarana Some times it is very hard to analyze that condition of Avarana so it requiresrepeated clinical examination and frequent administration of Upashaya before getting toproper clinical diagnosis141. For example madhumeha is described in two types in Charaka Samhita. Amongwhich one type is due to Vata avaruta by Kapha, Pitta, Medas and Mamsa142. and anothertype is due to Dhatukshaya or Shuddha Vata143. The etiological factors described in the sutra sthana are of Avaraka i.e of Kapha,Pitta etc. and in the nidana sthana is due to dhatu kshayajanya. The descriptions ofetiological factors of both these varieties are:A) Etiological factors of Madhumeha due to Avarana: By taking excess heavy, unctuous, sour, and salty articles; by using new cerealsand drinks, by over indulgence in sleep, sedentary habits, by not undergoing seasonalpurification, the Kapha, Pitta, Meda and Mamsa increases excessively leading toMadhumeha144.B) Etiological factors of Madhumeha due to Kevala Vata: The habitual use of astringent, pungent, bitter, dry, light and cold articles; overindulgence in sexual act, exercise, emesis, purgation, enema and errhines; suppression ofnatural urges, fasting, trauma, sun-heat, worry, grief, depletion of blood, waking in thenight and unwholesome postures of the body, lead to immediate provocation of vata145.Finally, the Madhumeha is same but fashioned by different nidanas. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 47
    • Nidana Nidana Nidana (etiological factor) is defined as a cause of the disease. Lacking ofnidana, disease can not be manifested. In Ayurvedic as well as Modern texts, theexact cause for Pittavruta udana w.s.r.t. ETH is not explained. The samanyaprakopaka karana are given below:Table2: Showing samanya prakopaka karanasFactors Vata Pitta RaktaRasa Katu, Tikta and Katu, Amla, and Lavana, Amala, Kashaya146. Lavana147. Katu and Kshara148.Guna Ruksha, Laghu, Sheeta, Ushna, Teekshna, Drava, Snigdha & Khara, Sukshma, Daruna Laghu, Vidahi, and Guru161. and Chala149. Kshara150.Aharaja Pulses like Uddalaka, Peenyaka, Atasi, Dushita, adhika, Masha, Adaki, Kalaya, Kulatha, Sarshapa, atiteekshna, Nishpava and Harenu. Greenleafy vegetables atiushna, Madira Dried leafy vegetables, like Harenuka, the sevana, Kulatha, Vallura, millets like flesh of Godha, fish or Masha, Nishpava, Varaka, Koradusha, goat, curds, whey, Pindalu, Moolaka, Syamaka and Neevara. buttermilk and sura. Dadhi, Kanji, Sura, Mastu, Saktu and Souveera.Table3: Showing possible reason for the manifestation of disease Nidana Possible reasonsExcess amala rasa Pittakarka, agni vardhaka and rakta dushtikara. Produces daha, shotha and other Pitta vikaras152.Excess lavana rasa Causes Pitta prakopa, Rakta dushti, Vidaha, moorcha, santapa, trishanakarka, indriya glani, vivarnta and other Pittaja & Raktaja vikaras153.Excess katu rasa It is vata and agni guna bahulya and pittakaraka. Produces avasada, moorcha, bhrama, tama, santapa, trishana, daha, bala kshaya, kampa, toda, bhedavat vedana and vata vikaras154. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 48
    • Nidana Nidana Possible reasonsExcess tikta rasa It produces shira shoola, bhrama, toda, bheda, moha, vata vikaras and causes bala kshaya155.Excess kashaya rasa Causes hrudaya vedana, rasavahi srotas avarodha, trishna, stambhata, akunchana, akshepaka, tingling sensation, convulsions and is khara, vishada, rooksha guna pradhana156.Excess Teekshna It is agni mahaboota pradhanya and pittakara, it produces daha,guna ahara paka, etc. and it results in bala ksheenata157.Excess Ushana guna It is pitta vardhaka, agni guna pradhana and sweda pravartaka.ahara It produces daha, paka, moorcha, trishana etc158.Excess Laghu ahara It is vata vardhaka and agni vardhaka159.Excess Drava ahara It is pitta vardhaka160.Excess Rooksha It is vata vardhaka and agni vardhaka. It produces moorcha,guna ahara bhrama etc161.Excess Snehayukta It is pitta and kapha vardhaka162.aharaAtimatrahara Leads to ama dosha163, causes durvipaka.Viruddha ahara This ahara cause tejo, bala, smruti, indriyan, chitta nasha and causes mrityu just like visha164. According to Acharya Charka, it acts like “visha” and can cause moorcha, napunsakata etc. Such ahara could cause mrityu165.Tila sevana The properties of tila taila are Ushna veerya, Madhura, Tikta, Kashaya, Katu rasa. It is Raktapitta karaka, vata kapha hara. With excessive intake, Pitta vardhana166.Kshara Kshara possesses the following qualities: ushana, teekshana,laghu and pitta vardhaka167.Mamsa Hamsa, Kukkuta, Mahisha Tittira, mamsa and matsaya are Ushna and Kaphapittakaraka. Shushka mamsa is Kashaya, Amla rasa Katu vipaka, Ruksha, Sheeta168.Sarshapa Guru, Ushna, Sarvadoshakrit, Baddha vinmootram169.Madya pana Madya is Amla Rasa, Katu in vipaka, has Teekshna, Vidahi guna and Ushna virya170. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 49
    • NidanaThe some expected nidanas are: Adhyashana, Ajeerna, Anashana, Kulatha, Vidahi ahara, Vishma ahara, Vegadharana, Krodha, Chinta, Bhaya, Samprahara, Udvega, Kshobha, Deenata, Atimaithuna, Shoka, Ati vyayama, Kriya atiyoga, Atapasevana etc.Dosha prakopa Karana:Pitta prakopka nidana: Katu, teekshana, ushana, Krodha and vidahi anna171.Udanavata Prakopa Karanas: Kshavathu, udgara, chardi, nidra vegadharana, guruahara, bhara vahana, ati rodana, ati hasya172 etc.Srotodusti Karanas:Rasa vaha Srotodusti Karanas: Guru, sheeta, atisnigdha, atimatra bhojana, adhikachinta173 etc.Rakta vaha Srotodusti Karanas: Vidahiannapanani, ushna, snigdha, drava ahara,adhika atapa and vata sevana174 etc.Manovaha Srotodusti Karanas: Krodha, shoka, bhaya, harsha, kama, lobha, moha,chinta, ayasa, udvega and aghata175 etc.Margavarodha: The site or sthana of margavarodha176 could be anywhere in the body. Forinstance, stenosis of one or both of the renal arteries can cause hypertension and soalso the coarctation of the aorta. Examples of margavarodha are many; including, thepheochromocytoma (the chromaffin tissue tumours of the adrenal medulla),atherosclerosis, other endocrine tumours, Glomerulonephritis, pylonephritis etc., Anykind of obstruction anywhere in the body affecting the flow of nutrients (Rasavahasrotas) results in "Hypertension" as one of the manifestations. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 50
    • NidanaEtiology: In 90–95% of hypertension cases, the etiological factors that are responsiblefor the blood pressure increase remain unknown177i.e. the cause of disease is notknown; however in recent years, experimental, epidemiological and therapeuticevidence seems to indicate that essential hypertension is due to one or combination ofetiological factors. The probable factors which are responsible for the development ofessential hypertension are:-1) Genetic Factors: The role of heredity in the etiology of essential hypertension has long beensuspected. The evidences in support are the familial aggregation, occurrence ofhypertension in twins, epidemiologic data, experimental animal studies andidentification of susceptibility gene (angiotensinogen gene). Acharya Charaka while describing the genetic influence in disease says, at thetime of conception, if the beeja (shukra or ovum), beeja bhaga (chromosome) or beejabhaga avayava (genes) get vitiated, It is likely to travel in subsequent generations178. Dalhana has also commented that beeja dushti does not mean whole dushti, butthere may be a dushti of a part of beeja, that is the organ developing from thatparticular part are also defective or abnormal179. Acharya Sushruta, while classifying the diseases, has mentioned adibala pravruttavyadhi and is said to originate due to deformity of raja or veerya of the parents at thetime of conception180.2) Racial and Environmental Factors: Surveys in the US have revealed higher incidence of essential hypertension inblacks than in whites. But in rural Africa hypertension is relatively rare, suggestingthat the high prevalence in the US is not because of the genetic tendency, rather, it Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 51
    • Nidanamight be due to adaptation of western life style by American blacks181. There is a lotof controversy in the environmental factors. One of the evidence showing that, theenvironment in which a person lives affects his blood pressure.Figure-4: Showing the Environmental factors and Cardiovascular events1823) Salt Intake: For a long time salt is suspected, to have an etiological influence on the bloodpressure. It is also known that only an increased salt content of diet intake alone willnot lead to high blood pressure. Invariably there are some predisposing factors likeheredity or renal diseases. In such patients alone increased intake of salt more then 10grams per day leads to renal retention of salt and water, which in turn increases theplasma and extravascular fluid volume. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 52
    • Nidana Ultimately peripheral resistance increases, which leads to increase bloodpressure. Excessive use of Lavana causes rakta dushti and leads to shonitaja roga183.since rakta dhatu is one of the important dushya in the etiopathogenesis ofhypertension, it is given more importance. Therefore salt should not be consumed inexcess and for longer duration184. When excessively used, it produces fatigue andweakness of the body185, which are the symptoms usually found in patients ofhypertension.4) Obesity: There is a strong link between excess body fat, blood pressure levels andprevalence of hypertension. As obesity contributes to blood lipid abnormalities andimpaired glucose tolerance. Acharya Sushruta has mentioned medoroga leads to vatavikara186. Figure-5: Showing Obesity and Sodium sensitivity in Hypertension187 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 53
    • Nidana5) Stress: The stressful stimuli certainly raise blood pressure and may be moreargumentative in subjects who have familial hypertension. Sustained or repeatedemotional stress (anger, frustration, envy, hatred, fear and worry) causes arteriolarcontraction through an outpouring of nor-epinephrine from the sympatheticvasomotor nerve endings and epinephrine from the adrenal medulla. In some persons,the blood pressure increases due to the presence of a doctor (white coat hypertension).This is possibly due to the temporary emotional stress. Raja and tama are the doshas pertaining to the mind and the types of morbiditycaused by them are kama, krodha, lobha, mada, bhaya etc188. Acharya Charaka hasadvised to suppress these factors189, because they tend to elevate raja and tama gunaswhich cause manodusti resulting in manovikara with involvement of samjnavaha ormanovaha srotas190. Further, Chakrapani commenting on srotomula says, hridaya anddashadhamani are the manovaha srotomula191. In this way the arteries of the heartmay get afflicted by these manovikara and therefore they also afflict oja which is alsoashirta of hridaya192,and vitiation of Vata193 and Pitta also takes place. Hence it may be concluded that all the psychological factors directly provokeVata and Pitta which can produce hypertensive state.6) Meals: After meals the blood pressure is little higher.7) Emotion: Anger and fear raise the blood pressure. However, there may be faintingattacks. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 54
    • Nidana8) Sleep: Sleep causes a fall of blood pressure. However, sleep associated withfrightening dreams may cause rise of blood pressure.9) Exposure to cold: It causes rise of blood pressure. This is due to hypothalamic stimulation.There is cutaneous vasoconstriction leading to increased resistance to the blood flowand elevation of blood pressure (cutaneous vasoconstriction causes conservation ofheat within the body).10) Geographic factors: Several studies have shown that high altitude residents have lower bloodpressure. Possible constituting factors include - Lower peripheral resistance due to increased capillarisation of tissues. Hypoxia causing reduced thyroid activity and Primitive conditions.11) Physical activity: Several population studies have suggested that individuals who undertakeregular physical exercise have lower blood pressures. Regarding exercises, dynamic exercise raises blood pressure and isometricexercise raises it a lot more. Despite this, there is good evidence that people who takeregular exercises are healthier and have lower blood pressures than those who takenone.In Ayurveda idle sitting is told to be one of the astamaha doshakarabhava194.12) Other Trace Metals: More hypertension has been seen in association with long-term exposure toarsenic and carbon disulfide. Long-term exposure to even low levels of lead may leadto hypertension, perhaps by increased production of reactive oxygen species beyond Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 55
    • Nidanathe probability that increased intracellular calcium is involved in the pathogenesis ofhypertension195. The following findings usually are noted in uncomplicated, untreatedprimary hypertension: Lower dietary intake of calcium Increased urinary calcium excretion, which is likely the reason for an increased incidence of kidney stones. Lower plasma ionized calcium levels. Increased levels of parathyroid hormone in some, likely related to reduced intake of calcium. Parathyroid hormone levels are even higher in Blacks than Whites and are potentially able to raise BP.Intake of more sodium leads directly to an increase in calcium excretion.13) Socio-economic status: A very large study in Mumbai found no difference between high and lowsocio-economic groups. So higher or lower socio-economic status does not havesignificant effect on blood pressure.14) Age: Older people tend to have higher blood pressure than young people. Almostall surveys show that blood pressure rises with age in both men and women. Due tothe thickening of vessel wall, an increase in sub-endothelial layer and the media,which increase collagen content and elastic fragmentation. In Vriddhavasta vata ispredominant and in Youvana avastha Pitta is predominant196.15) Sex: Though Hypertension affected both sexes, the incidence is slightly lower inthe female up to 40 years. However after that females are more prone toHypertension. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 56
    • Nidana16) Smoking: The nicotine in cigarette smoke acutely raises blood pressure(BP), even inaddicted smokers. No tolerance develops, so the BP remains high as long as thepatient continues to smoke. However, the effect of each cigarette is transient and isover within 30 minutes; if the BP is taken in a smoke-free environment, as in mostphysicians offices and clinics, the pressure effect may be missed. Cigars, if inhaled,and smokeless tobacco also raise BP, but nicotine replacement therapies do not appearto do so. Cross-sectional data on smokers and nonsmokers are not consistent: Somestudies find smokers to have a higher BP, whereas others find smokers to have alower BP. Regardless, all who smoke should be strongly advised to quit. Smoking isassociated with insulin resistance and an attenuation of endothelium-dependentrelaxation. These multiple adverse effects obviously add to the major cardiovasculardamage induced by smoking197.17) Caffeine: Acutely, consumption of the caffeine contained in 3 cups of coffee will raiseBP an average of 4/3 mm Hg. Some develop tolerance to this effect and only anaverage 2.4/1.2 mm Hg higher pressure has been noted in those who drink 5 cups ormore of coffee per day compared to nondrinkers. In contrast, increasing caffeineintake, ascertained by multiple careful dietary recalls, was associated with lower BPamong the participants in the Multiple Risk Factor Intervention Trial. Three cups ofblack tea raised the BP even more than seen with 3 cups of coffee, but the pressureeffect was prevented when the tea was accompanied with food198.18) Alcohol: The possible role of alcohol, in amounts consumed by a large part of theoverall population, needs special emphasis. In contrast to its immediate vasodepressor Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 57
    • Nidanaeffect, chronic consumption, even of only moderate quantities, may raise the BP; inlarger quantities, alcohol may be responsible for a significant amount ofhypertension199. In madatyaya chapter, Acharya Charaka has explained that, when madya istaken in large quantity, it shall affect channels of rasa (rasavaha srotas) and byentering hridaya it affect the dhatus situated in hridaya (rasa, oja, rakta). The gunas ofalcohol like ushna, teekshna, sukshma, vyavayi etc. are exactly opposite to the gunasof oja200, which also provoke vata-pitta dosha. Acharya Charaka has also described pradusta, bahu (excessive), ushna,teekshna madyapana and surapana as causative factors of shonita dusti201. Further, itis the shelter to moha, krodha, shoka and mrityu202. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 58
    • Poorvaroopa Poorvaroopa The Purvaroopa manifests in the Sthana Samshraya stage of Shatkriya kala.Charaka has quoted that avyakta lakshanas of vata vyadhi are to be taken as itsPoorvaroopa203. Commentator Vijayarakshita explains the term Avyakta as the symptomswhich are not manifested clearly204. Hence Mild exhibition of actual features of the disease Pittavruta udana priorto the manifestation of Pittavruta udana may be taken as purvaroopa. According to most of the 20th century authors and with the available referenceswe can compare essential hypertension to that of Avruta Vata. Since the poorvarupaof Vata vyadhi are avyakta, the poorvarupa of Hypertension are also avyakta. Inmodern science also prodromal symptoms have not been explained. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 59
    • Roopa Roopa A disease is produced on the completion of dosha dushya sammurchana.Signs and symptoms of the fully manifested disease indicating the specificcharacteristics of the disease (in the vyaktavastha) are called roopa. These becomeevident in the fifth stage of kriyakala i.e. vyaktavastha.Pittavruta udana: The Pittavaruta udana having symptoms Bhrama, Klama, Moorcha, Daha.Acharya Sushruta205 and others206, 207, 208 opine the same while Acharya Charaka209added ojobhramsha and avasada to the above symptoms. Shira shoola added to aboveaccording to contemporary texts. Table-4: Showing the lakshana and Dosha involvement Lakshana Dosha involvementsAcc. to Acharya Susruta, Bhavaprakasha, Gadanigraha and Madhava NidanaKlama Fatigueness, languor, it is due to Rakta210, 211.Daha Burning, conflagration. It is due to Pitta and Rakta212, 213, 214.Bhrama Confuse, perplex, giddiness. It is due to Vata and Pitta215, 216, 217.Moorcha Fainting, delusion, swooning. It is due to Pitta218, 219.Acharya Charka some more added in the above symptomsDaha in nabhi Burning sensation in nabhi and uras. It is due to Pitta220, 221, 222.and urasAvasada Fainting, exhaustion. It is due to Vata223, 224.Ojobharamsha Bhramsha means decline, losing, falling down225.According to contemporary text books explanation with AyurvedaShiroshoola. Headache. It is due to Vata and Rakta226, 227, 228, 229.According to contemporary texts: A large number of hypertensives in the early stages have no symptom i.e., whyit is called as the silent killer230. Most patients with hypertension have specific Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 60
    • Roopasymptoms referable to their blood pressure elevation and are identified only in thecourse of a physical examination231. Mild to moderate essential hypertension is usually associated with normalhealth and well being for many years. So essential hypertension may be- • Asymptomatic or • Symptomatic. The first and foremost symptom of essential hypertension is headache later theother symptoms like dizziness, easy fatigability, insomnia, chest pain, and palpitationcan be seen232, 233. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 61
    • Samprapti Samprapti The whole sequence of manifestation of disease starting from the causative factors, dosha dushti till the appearance of lakshanas is known as Samprapti234. Direct reference regarding the samprapti of Pittavruta udana is not available in the classics. Hence to understand the samprapti of Pittavruta Udana, the general samprapti of avarana can be considered. By observing the lakshanas of Pittavruta udana, the doshas and dooshyas involved in the samprapti to cause this condition can be assessed as follows. Nidana Nidana Vata prakopaka NidanaPitta prakopaka Nidana Pitta prakopa Vata Prakopa Avarodha of UdanaVata by Pitta Vata Avarana Pittavruta udana Figure-6: Showing Samprapti chart of Pittavruta udana Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 62
    • SampraptiSamprapti: The Pittavruta udana comes under Vata vyadhi chapter. If Pitta Vitiatedand then obstruct the Udana vata comes under samanyaja vyadhi. Hence in thesamprapti of Pittavruta udana, Vata and Pitta vitiates by their own nidanas andthen vitiated Vata comes in contact with vitiated Pitta which causes more Pittavikruti, resulting in the obstruction of Udana vata leading to the Pittavruta udana.Samprapti-Ghatakas:-Doshas: Vata (Udana) – Shirashoola and bhrama235,236. Pitta (anubandi) – Daha, bhrama and moorcha237, 238, 239.Dushyas: Rakta – daha, klama and Shira shoola240.Agni: Jatharagni.Srotas: Rasavaha, Raktavaha & Manovaha.Srotodushti-Prakara: Sanga type of srotodusti.UdbhavaSthana: Pakvashaya-Amashaya Samudbhava.Avayava: Hridaya, Dhamani.Adhisthana: Manodaihika (Psychosomatic, Sira, Dhamani, Srotas).Sanchara-sthana: Sarva Sharira.Rogamarga: Madhyama Rogamarga. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 63
    • Upshaya and Anupshaya Upshaya and AnupshayaFor Vata dosha: Upashaya of Avruta Vata is not at hand; on the contrary, Upshaya of Avarakais present. For Example in Pittavruta vata, the patient gets Vidaha from the Upshaya ofVata i.e, Amla, Lavana and Ushna. In Kaphavruta Vata there is Upashaya from Katuetc and patient shows desire for Fast, Exercise, Ruksha etc. things which are Upshayafor Kapha and Anupshaya for Vata241.For Pitta dosha: In Pittavruta vata, patient feels Daha, Trishana, Shoola, Bhrama, Tama andgets Vidaha from Amla, Lavana, Katu and Ushna veerya dravyas. On the other hand,the patient shows the desire for cold (sheeta) things, which is Upashaya for Pitta242. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 64
    • Vyavachedaka Nidana Vyavachedaka Nidana Vyavachedhaka Nidana or differential diagnosis plays a prime role in arrivingat an exact decision between diseases presenting a similar clinical feature. Whilemaking the diagnosis of Pittavruta vata the following disorders that are having similarfeatures has to be excluded.Table-5: Showing the Vyavachedaka nidana of Pittavruta Udana Sl. Laxanas Pittavruta Pittavruta Pittavruta Pittavruta No Udana243 Vyana244 Prana245 Samana246 1. Klama + + - - 2. Bhrama + - + - 3. Daha + + + + 4. Moorcha + - + + 5. Avasada + - - - 6. Ojobhramsha + - - - 5. Gatravikshepana - + - - 6. Santapa - + - - 7. Vedana - + + - 8. Vidaha - - + - 9. Chardana - - + - 10. Aruchi - - - + 11. Atisweda - - - + 12. Agni upaghata - - - + Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 65
    • Vyavachedaka Nidana In modern science essential hypertension should be differentiated fromsecondary hypertension given below:Table-6: Showing the Vyavachedaka nidana of HypertensionFactors Essential Hypertension Secondary HypertensionIncidence 95% 5%Etiology Unknown etiology Known etiologyPathology Pathogenesis is not clearly Pathogenesis depends on the disease understood. that has caused hypertension.Blood Pressure A rise in diastolic pressure A fall in the absence ofRecording when the patient goes from antihypertensive medication with the supine to the standing the treatment of the cause, suggest position is most compatible secondary forms of hypertension. with essential hypertension.Symptoms Symptomatic or Symptoms will be present with the asymptomatic. If underlying disease. symptomatic, vague symptoms like headache, dizziness, easy fatigability etc., will be present.Investigations Sr. creatinine, Blood urea, Depending on the basic disease, the Lipid profile, fasting blood values of these laboratory sugar, ECG and chest X-ray. investigations, ECG and chest X-ray ECG and chest X-ray will be varies. Some other investigations normal. are needed to rule out the secondary hypertension.Prognosis It is controllable with proper It is curable. When cause is treated, treatment. It requires life the elevated blood pressure comes long monitoring and down to normal. treatment may require periodic adjustments.Treatment Treatment comprises of Treatment depends on the cause and Drug and Non Drug therapy requires drug therapy during severe condition. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 66
    • Sadhyasadhyata Prognosis of Avarana In Dosha Avarana, the Avarana of Prana and Udana by Pitta and Kaphaare more severe and difficult to treat (Gurutaram) because of their vital function inthe body physiology i.e. to provide life (Jivana-Ayu) and strength (Bala). Among the Dhatu avarana conditions, Medavruta Vata is comparativelymore difficult to treat due to its complications and poor therapeuticresponse247,248,249,250. In Anyonya Avarana conditions Udanavruta prana, the condition ofocclusion of Prana by Udana leads to loss of all sensory and motor functions(Karma Kshaya), loss of vital essence (Oja Kshaya), loss of strength (Bala,kshaya) and complexion, and it may result even in death of the patient251. Sodepending on the type of Avarana and Avaraka prognosis of the Avaranapathology varies. Similarly if the condition persists for one year, its management is delayedor improper, then it may land up in difficult to cure or incurable state. So earlydiagnosis and timely management make the prognosis good252. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 67
    • Upadrava Upadrava Improper diagnosis and delayed treatment of different Avarana conditions orof one year chronicity lead to complications like Hridroga (heart disease) due toPranavruta udana vata, udavarta, Gulma (Localized enlargement of abdomen) due toVyanavruta apana253. There are many conditions like Sthaulya, Prameha, Urustambha,which occur through the pathogenesis of Avarana. Additionally, Dalhana mentionsthat in sthaulya and many other types of Vata vikara may occur as complications dueto avarana type of pathology. For example, Medavruta vata in which meda obstructsthe Gati of Vata leads to the vitiation of Vata resulting in different Vata disorders254. In this way, it can be stated that Avarana may occur as independent disease aswell as part of the pathogenesis of certain diseases. It may also help in understandingthe pathogenesis of many conditions described in modern medicine as well as todecide their management on Ayurvedic lines. Further it has been mentioned that theremay be innumerable Avarana disorders255. It means the few conditions of Avaranamentioned in the texts are just for example and by involving different sites otherspecific condition of Vata may be produced. For instance, the Pittavruta andKaphavruta incident occurs in different organs like stomach, head, heart256 etc.resulting in the symptomatology pertaining to that particular organ. In this way byconsidering the findings of the modern medicine the diseases like cerebral thrombosisand embolism leading to hemiplegia, coronary thrombosis and embolism leading tomyocardial infraction etc can be interpreted by the Avarana pathology of Ayurvedaand accordingly their management may also be evolved purely based on Ayurvedicprinciples. Acharya Charaka has mentioned the use of Rasayana drugs particularlyShilajatu and Guggulu in the management of Avarana257. So the globe of indicationsof these drugs may be widened to treat such conditions. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 68
    • Hypertension Essential hypertension A large number of hypertensive in the early stages have no symptoms oftenwith high blood pressure is detected on a routine check up and physicalexamination258, 259. Hypertension is a major risk factor for the development of cardiovasculardisease260.Definition of Essential Hypertension Varieties of factors are responsible for Blood Pressure261. These factors areinterconnected with each other and difficult to find out the particular causes forhypertension. Thus, when a specific cause of Hypertension can not be identified, thenthe hypertension is called as essential hypertension262. In more than 95% of cases, a specific underlying cause of hypertension cannotbe found such patients are said to have essential hypertension263. Hypertension is saidto be an essential when the cause is unknown264. Blood pressure is the pressure exerted by the blood on the walls of bloodvessels. Persistent high arterial blood pressure without a known cause is essentialhypertension, when the elevation of systolic blood pressure is more than 140 mm Hgand diastolic blood pressure is above 90 mm Hg upon repeatedsphygmomanometric265, 266. Till now the cause of majority of types of hypertension is not known. All theanti hypertensive drugs reduce the blood pressure without correcting the cause. Unfortunately there was no clinical or laboratory tests which can give anaffirmative diagnosis of essential hypertension. However, essential hypertension is aclinical entity in itself, though its pathogenesis is not known. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 69
    • Hypertension Even though hypertension is usually asymptomatic for the first 10-20 yrs, itslowly but surely strains the heart and damages the arteries. For this reasonhypertension is often called as silent killer267. The difficulty in studying a disease process such as hypertension begins withthe fact that the etiology of hypertension is heterogeneous. Hypertension can beprimary or secondary to a defined process, such as renal artery stenosis268. According to 7th Report of the Joint National Committee, the “normal” or“high normal” blood pressure is called as “prehypertension which differs fromEuropean Society of Hypertension/European Society of Cardiology. The definitionsof hypertension proposed by the 2003 European Guidelines and the 7th Report of theJoint National Committee incorporate aspects of disease characterization that are notpreviously defined. One is the classification of patients into different categories atblood pressure values, 140/90 mmHg, which is based on the continuous relationshipto cardiovascular risk in the normotensive range269.Classification The sign and symptoms of Essential Hypertension are not explained separatelyin our classics. But According to modern medicine Hypertension can be classified innumber of ways i.e. A. Systolic and Diastolic Hypertension. B. Essential or Primary and Secondary Hypertension. C. Accelerated and Malignant Hypertension. D. On the basis of Severity.A. Systolic and Diastolic Hypertension Since the mid-1920s, a relationship has been known to exist between diastolicand systolic blood pressures and life expectancy. Highly elevated blood pressure was Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 70
    • Hypertensioncalled malignant hypertension because 79% of affected individuals died within 1 yearof this diagnosis. From the 1920s until the 1980s, the risks of coronary heart diseaseand stroke have been attributed predominantly to elevated diastolic blood pressure.Diastolic blood pressure would be a better predictor of cardiovascular risk270. Systolic hypertension a) Increased cardiac output • Aortic valvular insufficiency • Atrioventricular fistula, patent ductus arteriosus • Thyrotoxicosis • Paget’s disease of bone • Beriberi • Hyperkinetic circulationb) Rigidity of aorta or small arteries271.B. Essential and Secondary Hypertension Essential Hypertension is said in which the cause of increases in bloodpressure is unknown272. Secondary Hypertension is said in which the increase in blood pressure iscaused by disease of the kidney, endocrine gland, central nervous system, aorta orsome other organs273.A. Primary, essential or idiopathic:B. Secondary:- Renal : a) Renal parenchymal disease: • Acute glomerulonephritis • Chronic nephritis Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 71
    • Hypertension• Polycystic disease• Diabetic nephropathy• Hydronephrosisb) Renovascular• Renal artery stenosis• Intrarenal vasculitisc) Renin-producing tumorsd) Renoprivale) Primary sodium retention (Liddle’s syndrome, Gordon’s syndrome)Endocrine :a) Acromegalyb) Hypothyroidismc) Hyperthyroidismd) Hypercalcemia (hyperparathyroidism)e) Adrenal i. Cortical Cushing’s syndrome Primary aldosteronism Congenital adrenal hyperplasia Apparent mineralocorticoid excess (licorice) ii. Medullary pheochromocytomaf ) Extra-adrenal chromaffin tumorsg) Carcinoidh) Exogenous hormones Estrogen Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 72
    • Hypertension Glucocorticoids Mineralocorticoids Sympathomimetics Tyramine-containing foods and monoamine oxidase inhibitorsCoarctation of the aortaPregnancy-induced hypertensionSleep apneaNeurologic disorders a) Increased intracranial pressure Brain tumor Encephalitis Respiratory acidosis b) Quadriplegia c) Acute porphyria d) Familial dysautonomia e) Lead poisoning f) Guillain–Barre´ syndromeAcute stress, including surgery a) Psychogenic hyperventilation b) Hypoglycemia c) Burns d) Pancreatitis e) Alcohol withdrawal f) Sickle cell crisis g) Postresuscitation Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 73
    • Hypertension h) Postoperative Increased intravascular volume Alcohol274 Drug use eg. Oral contraceptives containing oestrogens, anabolic steroids, carbenoxolone, corticosteroids, sympathomimetic agents, NSAIDs275 etc.C. Accelerated and Malignant Hypertension These forms of Hypertension have become less common with the widespread useof antihypertensive therapy. It represents a sudden acceleration in the vascular diseaseassociated with essential hypertension276.D. Based on Severity A commonly accepted classification would be the one adopted from “The SixthReport of the Joint National Committee on Detection, Evaluation, and the Treatmentof High Blood Pressure (JNC-VI)” Archives of Internal Medicine 1572413-2446,1997.Table-7: Showing the classification of blood pressure277Classification Systolic (mm Hg) Diastolic (mm Hg)Optimal* <120 <80Normal <130 <85High normal 130-139 85-89HYPERTENSION**Stage I. HTN (Mild) 140-159 90-99Stage II. HTN (Moderate) 160-179 100-109Stage III. HTN (Severe) ≥180 ≥ 110Stage IV. HTN (Very Severe) >210 >120JNC of WHO/International society of HTN (ISH). Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 74
    • Hypertension *Optimal BP with respect cardiovascular risk is <120/80 mm of Hg. However,unusually low reading should be evaluated for clinical significance. **Based on the average of > 2 readings taken at each of two or more visitsafter an initial screening.Hypertension in some other forms:Borderline Hypertension:If the SBP is more than 140 mm of Hg and DBP is above 90 mm of hg278.Isolated Systolic Hypertension: The systolic B.P is 160mm Hg and above, and fluctuates from time to time, highin the morning and low at night279.Benign Hypertension: Is moderate elevation of B.P, and the rise is slow over the years280.Malignant Hypertension: The marked and rapid increase of blood pressure to 200/140 mm of Hg ormore, the complications like papilledema, retinal exudates, haemorrhage281 are seen.White coat Hypertension: White coat hypertension is the most commonly used term to describe patientswhose blood pressure is high only in a medical setting. The concept of White coathypertension has been widely adopted in the lay press as well as professionalpublications. White coat hypertension should be distinguished from the white coateffect, which is a measure of the pressure response to the clinic visit and is generallydefined as the difference between the average clinic blood pressure and the daytimeambulatory blood pressure. The white coat effect is present to a greater or lesserdegree in most hypertensive patients and is greatest in patients with the highest clinicpressures282. The causes of Secondary hypertension are as follows:- Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 75
    • HypertensionTable-8: Showing the classification of secondary hypertension Renal endocrinal Cardiovascular MiscellaneousGlomerulonephritis Adrenal Cortex PregnancyPyelonephritis Cushing Syndrome Coarctation of Drugs:Polycystic kidney Hyper Aldosteronism Aorta Oral ContraceptivesDiabetic Nephropathy ADERNAL LiquoriceRini Produceing MEDULLA Cortico SteroidsTumour PheorochromocytomaRenal Artery Stenosis Amphetamines Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 76
    • Blood Pressure Measurement Blood pressure measurement The blood pressure should be taken lying, sitting and standing positions andcan be recorded directly or indirectly. There are three common devices used for theindirect recording of blood pressure – Sphygmomanometers, either mercury column or aneroid Electronic devices Automated ambulatory blood pressure devices On the other hand, mercury Sphygmomanometer remains the gold standard forrecordingIndirect Blood Pressure Measurement: Indirect blood pressure measurement is safe, painless, and provides reliableinformation when performed accurately. These guidelines based on BP’s, obtained byAmerican Heart Association (AHA) standardized indirect measurement method. Health professionals base crucial clinical decisions on these measurements;therefore, the proven benefits of treating high BP can be completed only when BPmeasurement is taken accurately. The accurate BP measurement requires the ability tohear, interpret, record Korotkoff sounds and operate the equipment properly.Selecting the Blood Pressure Measurement Equipment: The manometer is mercury or an aneroid instrument calibrated to the nearest 2mm Hg. The mercury manometer’s reading is at the top edge (the meniscus) of themercury column. It is the most accurate measurement device available. The aneroid manometer consists of a metal bellows that expands as thepressure in the cuff increases and its reading is at the point indicated by a needle on itsdial. The accuracy of the mercury manometer is assessed by noting whether the Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 77
    • Blood Pressure Measurementmercury meniscus rests at zero. Users cannot be certain that it is accurate even whenthe needle is positioned at zero. The use of automated devices is discouraged in most clinical settings becausethey are often difficult to calibrate, fail to give accurate readings on many individuals,and do not eliminate human error.Steps Needed to Obtain Accurate and Reliable Readings283:Step 1: Environment: The setting should be private and quiet, with a comfortable room temperature.To get the best estimate of the patients usual BP, environmental factors that maycause BP variation or interfere with hearing Korotkoff sounds must be controlled. The manometer must be positioned so the observer can view it at eye level.Viewing the manometer above or below the observers eye, level results in inaccuratereadings. The room should have a straight-backed chair to seat the patient next to atable or desk with feet flat on the floor. A seat for the BP observer should be provided along with an adjustablesurface to support the arm at heart level during standing measurements. The height ofthe table should be such that the midpoint of the cuff is in place on the patients rightarm (or the arm that is known to produce the higher BP reading) and is supported atheart level. It is important to avoid errors induced by differences in hydrostatic pressurebetween the point of artery compression by the cuff and the heart. If the center of the cuff on the arm or leg is above the heart level, the readingwill be falsely low by 0.8 mm Hg for each 1 cm above the heart level. If below heartlevel, it will be falsely high by a similar amount. Supporting the back in the seated Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 78
    • Blood Pressure Measurementposition and the arm in any position avoids increases in BP due to isometric musclecontraction.Step 2: Preparation and rest period: Inquire about biologic factors that may affect the reading at this time,including the time and dose of medications. If not wearing short, loose sleeves,patients should nude their arm. To get the best estimate of the patients usual BP, biologic factors that maycause BP variation such as pain, stress, full urinary bladder, and recent meal should beminimized. Recent ingestion of prescription, over-the-counter or street drugs,caffeine, and nicotine can affect BP readings. Clothing interferes with cuff placement,pressure, and sound transmission. Proper preparation avoids elevated readings due toanxiety about the procedure. Repeated readings increase accuracy. Instruct patients to sit up straight with legs uncrossed, back resting against thechair, and feet flat on the floor, and to remain silent until after BP readings. Allow a 5-minute rest period before the first reading. The lack of back andfoot support, such as occurs when the patient is seated on an examination table, causesBP elevation averaging 5 mm Hg diastolic. Talking or active listening duringmeasurement causes BP elevation.Step 3: Proper cuff (bladder) size: To get an accurate reading, the width of the cuff bladder should encircle atleast 40% of the arm circumference; the length of the cuff bladder should encircle atleast 80% of the arm circumference. At the first visit, measure circumference at the midpoint of the upper arm,between the olecranon and acromion processes. Chart the arm circumference forfuture reference. Arms >53 cm in circumference should have the BP measured with a Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 79
    • Blood Pressure Measurementcuff of the appropriate size on the forearm. When arm circumference measurement isnot practical, as during screening situations, it is acceptable to estimate the proper cuffsize by comparing the bladder width and length to arm circumference. When BP is not measured in both arms, the reading should be taken in theright arm unless it is known that BP in the left arm is higher. Note the appropriate cuff and bladder size on each chart. Using a bladder thatis too narrow or short for the limb is a common error that is serious because it yieldsfalse high readings.Step 4: Cuff placement: Locate the patients brachial artery at the midpoint of the upper arm bypalpating between the biceps and triceps muscles on its inner surface. Wrap the cuffsmoothly and snugly around the arm with its bladder center directly over the palpatedartery and the lower edge of the cuff 2.5 cm above the antecubital fossa. This technique avoids false high readings that occur when cuff pressure is notequally distributed over the artery and avoids errors that result from extra soundswhen the stethoscope is exposed to the cuff or tubing.Step 5: Determine the maximum inflation level: Before listening for the BP, determine the inflation level necessary to obtainan accurate systolic reading, the maximum inflation level. To do this, locate the radialpulse and note the heart rate and rhythm. When the heart rate is irregular, systolic BPmay vary beat to beat, and additional readings are needed to get the best estimate ofthe systolic BP. Continue feeling the pulse and rapidly inflate the cuff to 60 mm Hg, and thenby 10-mm increments until the pulse is no longer palpable. This is the first estimate ofthe palpated pressure. Stop inflating the cuff. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 80
    • Blood Pressure Measurement Begin deflation at 2 mm Hg per second. Note the pressure at which the pulsereappears. This is the palpated systolic pressure and is usually within 10 mm Hg ofthe level at which the pulse disappeared. Immediately release all pressure. Add 30 mm Hg to the palpated systolicreading to determine the maximum inflation level. This maneuver determines theminimum pressure needed to get an accurate systolic BP on a patient, decreasespatient discomfort, and avoids errors that result from failure to inflate above systolicBP reading, including an inaccurately low systolic BP reading, which occurs when theobserver begins listening during an auscultatory gap.Step 6: Stethoscope placement284: Position the stethoscope earpieces pointing forward in your ears. Sound is nottransmitted well when the ear tips fail to point into the ear canal. Find the point atwhich the brachial artery pulse is the strongest, usually just above the antecubitalfossa on the inner aspect of the arm. Using light pressure, position the chest piece over this point with all edgesgently touching the skin surface. The stethoscope bell or a low-frequency detector isrecommended. The loudest sounds can be heard over this pulse and errors owing todifficulty hearing and interpreting Korotkoff sounds are minimized along with errorsfrom too much stethoscope pressure that may cause artery occlusion and distortion ofBP sounds. Do not allow the stethoscope head to touch the cuff or tubing becauseextraneous sounds mask and confuse Korotkoff sounds. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 81
    • Blood Pressure MeasurementStep 7: Inflation and Deflation: Rapidly inflate the cuff to the maximum inflation level. If sounds are heardimmediately, completely release all pressure and repeat step five to repeat thepalpated pressure. Rapid inflation to the correct maximum inflation level ensures listening abovesystolic BP. Slow inflation traps venous blood in the arm and may result in pain anddiminished or distorted sounds. Release the air from the cuff so that the mercury fallsat a rate of 2 mm Hg per second until Korotkoff sounds are heard. Continue deflation at the rate of 2 mm Hg per beat. If unable to hear soundsclearly, quickly release all pressure and check position of ear tips and stethoscope.Repeat the procedure. Slow deflation is necessary to allow the observer to hear thesystolic and diastolic pressures at the point of onset. A reading can be no moreaccurate than the rate of deflation (i.e., a deflation rate of 10 mm Hg/second results ina pressure accurate to only 10 mm Hg, and if 1 beat, is missed, to only 20 mm Hg).Step 8: Systolic blood pressure: Read to the nearest 2 mm Hg mark. Remember the systolic pressure at theonset of Korotkoff phase 1. Forgetting the reading is a very common source of errorsof 8 to 10 mm Hg, especially in the presence of a wide pulse pressure (differencebetween the systolic and diastolic pressures). Concentrate and remember the reading by silently repeating the systolicnumber with every heartbeat until you confirm disappearance. Observers must learnto rule out sound artifacts. Single sounds inconsistent with heart rate are insignificantartifacts unless the pulse was irregular during palpation. In the case of arrhythmia,additional readings are needed to get the best estimate of the systolic BP. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 82
    • Blood Pressure MeasurementTable-9: Showing the Korotkoff Sounds The Korotkoff Sounds are classified under five phases*Phase 1 The pressure level at which the first faint, consistent tapping sounds are heard. The sounds gradually increase in intensity as the cuff is deflated. The first of at least 2 of these sounds is defined as the systolic pressure.Phase 2 Times during cuff deflation when a murmur of swishing sounds are heard.Phase 3 The period during which sounds are crisper and increase in intensity.Phase 4 The time when a distinct, abrupt muffling of a sound (usually of a soft blowing quality) is heard. This is defined as the diastolic pressure in anyone in whom sounds continue to zero.Phase 5 The pressure level when the last regular blood pressure sound is heard and after which all sound disappears. This is defined as the diastolic pressure unless sounds are heard to zero.*To avoid error, the observer must be prepared to recognize two normal Korotkoffsound variations associated with BP readings. The auscultatory gap is a period of silence occurring during Korotkoff phases1 and 2. This disappearance of sound is temporary and is usually short, but the gapcan occur over a period of 40 mm Hg. It seems to be associated with higher BPreadings. An absent Korotkoff phase 5 occurs when sounds are heard to zero. Whenthis is the case, phase 4 should be recorded along with phase 5. In this case, phase 4 isthe best reference for diastolic pressure.Step 9: Diastolic blood pressure: Remember the point at which the last regular Korotkoff sound is heard.Korotkoff sounds are designated as K1 through K5. When the sounds continue to verylow diastolic levels or zero, remember the reading at the onset of K4, the point atwhich sounds begin to muffle, as well as the last sound heard. The onset of K5 is more reliably interpreted when observers listen for the lastsound heard. The absence of K5 occurs often in children, during pregnancy, and inother high-cardiac-output states. In these cases, the onset of K4 is the most accurate Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 83
    • Blood Pressure Measurementdiastolic indicator. If the diastolic BP is heard above 90 mm Hg, listen for anadditional 40 mm Hg. Otherwise, listen for 10 to 20 mm Hg below the last sound toconfirm disappearance to avoid inaccurately high diastolic BP owing to failure tolisten until sounds reappear after a period of silence (auscultatory gap).Step 10: Recording: Immediately record the reading, the arm used, the position of the patient, andthe cuff size used to avoid recall artifact. Record the reading as K1/K5. If K4 isrecorded, write the three numbers as K1/K4/K5. If sounds do not cease, record K5 as zero. Standardized recording methods arenecessary to correctly interpret and compare readings by different observers. Whenphase 5 is absent, Korotkoff phase 4 is the best indication of diastolic pressure.Step 11: Repeat the reading: Make certain all air is out of the cuff and wait 1 to 2 minutes, then repeat steps6 through 10. BP normally changes from minute to minute, especially during clinicalmeasurements. The average of two or more BP readings in a single arm is morereliable and a better indicator of usual readings than is a single reading or one readingin each arm.Step 12: Repeat the process285: Repeat the measurements in the other arm during initial workup and standingor supine as dictated by the patients situation. Postural changes in BP are measuredafter 1 and 3 minutes of standing. Note the arm with the higher reading for futurecomparisons. BP can differ by >10 mm Hg between arms. The higher pressure moreaccurately reflects intra-arterial pressure.Special Techniques and Populations286: Absence of Korotkoff phase 5: When cardiac output is high, as in some children, Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 84
    • Blood Pressure Measurementin thyrotoxicosis, during fever, and in pregnant women, K5 is often absent. In thisevent, Korotkoff sounds are heard until the mercury column falls to zero. BP shouldbe recorded as three numbers (K5/K4/0).Blood pressure measurement in children287: The principles of measurement are the same in newborns, infants, andchildren. A most important consideration is the selection of a cuff that is appropriatefor the arm circumference, as described above.Blood pressure measurement in the elderly288: In the elderly, the brachial arteries occasionally become very thickened andstiff. When this happens, the indirect cuff pressure may overestimate intra-arterialpressure, because higher cuff pressure is required to compress such a rigid vessel. The presence of a radial artery that is still palpable after the cuff is inflatedabove the systolic BP should be a warning of this error. If the artery feels excessivelythick when rolled back and forth under the finger, the BP reading measured withindirect techniques may be falsely high. Recheck the pressure by palpation in theforearm. If the palpated systolic pressure differs by >15 mm Hg, then a direct arterialpuncture may be needed to be certain of the true pressure, although this is rare.Very large, cone-shaped, and muscular arms289: If the patients arm is >41 cm in circumference or if it is shaped so that a cuffdoes not fit on it well, then accurate pressure measurement may be impossible. In thiscase, palpated and auscultator readings should be attempted, with a cuff of theappropriate size, in the upper arm and forearm. If these differ by greater than 15 mmHg, then a better estimate of true pressure is the palpated systolic pressure with thecuff on the forearm. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 85
    • Chikitsa Chikitsa The aim of chikitsa is not only to remove of the causative factors of the disease,but also the restoration of doshik equilibrium. The prime importance of chikitsa is tobreakup the samprapti ghatakas290. Here the specific chikitsa as well as chikitsa sutra ofPittavruta udana has not been mentioned in classics. Therefore our Acharyas havementioned towards the new diseases i.e. understanding the prakruti, adhistana of doshas,immediately the chikitsa should be started291, 292.Because of the above explanation, the chikitsa can be planed under following headings: Table-10: Showing the classification of chikitsa ChikitsaDravyabhoota chikitsa Adravyabhoota chikitsaVyadhi pratyaneeka chikitsa Nidana parivarjanaDosha pratyaneeka chikitsa Satvavajaya chikitsa Yoga and other practicesAdravyabhoota chikitsa:i) Nidana parivarjana: Nidana parivarjana refers to abstaining from samanya karanas responsible for thevitiation of vatadi dosha293 etc. and other risk factors like excess salt intake, over weight,smoking, alcohol etc. These are highlighted in the later part.ii) Satwavajaya chikitsa: The manasika karanas also play a important role. Raja and tama along withtridoshas vitiates hridaya and raktavaha dhamani’s. So Achara rasayana is advised toprevent mana getting indulged in ahita arthas.iii) Yoga and other practices: The most important cause is stress, strain, anxiety, tensions etc. So Yoga helps to Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 86
    • Chikitsaelevate the capacity of mind and removes the stress and strain. Some of the importantyogas like Bhujangasana, Shalabhasana, Vajrasana, Pranayama, Shavasana, Yoganidra,and sudarshana kriya, etc., have shown hopeful results in recent times.Dravyabhoota Chikitsa:i) Dosha Pratyanika Chikitsa In Pittavruta udana, main importance is to be given for the treatment of Pitta andVata. Some of the shodhana chikitsa can be adopted, these are basti and virechana. Basticorrects the vata where as virechana corrects the pitta. Following are the generalshodhana measures that can be used:a) Virechana: Virechana is a special treatment for pitta294. It can also be given in pitta pradhanadosha295. Virechana is advised in rakta pradoshaja vikaras296.b) Basti: Basti is the pradhana chikitsa for vata297. It is also useful in pitta, kapha, rakta,samsarga dosha and sannipata dosha298. The tailas which are used in basti suppress theruksha, laghu and khara gunas of vata and helps in reducing the katinyata and producesmardavata of blood vesselsc) Raktamokshana: Sushruta recommends raktamokshana for vatavyadhi299. Charaka explainsraktamokshana chikitsa for rakta pradoshaja vikara300.ii) Vyadhi Pratyaneeka Chikitsa Following are the dravyas and yogas that can be preferred.Dravyas: Shilajatu, Guggulu, Gomutra, Brahmi, Jatamamsi, Shatavari, Hareetaki etc.Yogas: Shilajatuguggulu rasayana, Brahmi vati, Brahma rasayana, Pravala pisti, Brihatvata chintamani rasa, Chandrakala rasa etc. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 87
    • Chikitsa Apart from these, certain hridya and rasayana dravyas and yogas can be used.Shirodhara is used to reduce high blood pressure.General Management for Avarana: The principles of avarana chikitsa are as follows- In avruta vata301 first avaraka is to be treated. When both kapha and pitta are avaraka, first pitta is to be treated then kapha and care should be taken not to provoke the avaruta. General principles of Vatopakrama can be adopted302. The oushadha and ahara which are not Pitta prakopa and does vatanulomana should be used303. The Avarana should be treated by measures, which are Anabhishyandi (Non- obstructive), Snigdha (unctuous) and sroto-Shudhi Karaka (depuration of body channels)304. In case, Vata is obstructed at all the places (Sarva Sthana Avarita), prompt (Ashu) measures, which are regulative of Vata and at the same time not antagonistic to Pitta and Kapha are beneficial305. A vitiated Dosha attains great strength in its natural seats, hence it should be first subdued by suitable medications such as emesis, purgation, enema and sudation306. Madhura anuvasana basti with yapana basti can be given or depending on the bala of rogi, mridu virechana can be given307. In Avarana the drugs that are snigdha and srotoshuddhikaraka are to be used and at the same time these should not increase kapha308. In condition of Pittavruta Vata, the treatment of Pitta, which is not antagonistic to vata, should be prescribed. In the condition of Kaphavruta Vata, the treatment of Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 88
    • Chikitsa Kapha, which is anulomana to Vata, should be prescribed309. In case of Raktagata vata according to therapeutic response towards blood letting, one has to decide the associated Avarana Pathology and should be continued accordingly310. Rasayana therapy: All the palliative and preventive Rasayana drugs are useful for the prevention and treatment of avrita induced disorders. Especially Shilajitu, Guggulu, Chyavanaprasha and Bramha Rasayana are indicated after proper Shodhana311. According to specific pathologies of Doshavarana, Dushyavarana, and Mishravarana treatment modalities varies. For example, alternative administration of cold and hot therapeutics in case of Pittavruta Vata312.Anyonya Avarana When one type of Vata obstructs the function of other types of Vata is calledAnyonya Avarana e.g. Prana avruta vyana313. They should be treated by means of massage, unctuous potion, enema and allother similar therapies and by cold and hot measures alternatively314. Generally Udana should be regulated upward and the Apana downwards. TheSamana should be pacified and the Vyana should be treated by all these three measures.Prana should be maintained with due care in comparison to other types of Vata, becauselife depends on the proper maintenance of it. Thus the various types of Vata that areoccluded or misdirected (Vimargamana) should be established in their normal habitat315.Treatment: The aim of treatment is to prevent the morbidity and mortality of hypertension.The benefits of treatment have to be considering against side effects and inconvenience Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 89
    • ChikitsaTreatment of blood pressure includes non-pharmacological and pharmacologicalmeasures. Non-pharmacological involvement through life style modification is promoteras preliminary therapy for essential hypertension.Non-Pharmacological Management Includes: Relief of emotional and environmental stress. Sodium intake: Elderly people are more sensitive to sodium intake. So advised to reduce the sodium intake i.e. 6 gms per day is suggested. Weight reduction: Weight reduction is most beneficial in patients who are more than 10% over weight. However even a 5% reduction in weight will result in significant lowering of blood pressure. Avoidance of excessive alcohol intake. Avoidance of excessive smoking. Reduction of cholesterol and saturated fat intake Regular physical exercise.Table-11: Showing the efficacy of Non-Pharmacological management316Modification Recommendation ApproximateRecommendation reduction (range)Weight reduction Maintain normal body weight (body mass 5–20 mmHg/10 kg index 18.5–24.9 kg/m2)Adopt eating plan Consume a diet rich in fruits, vegetables, and 8–14 mmHg (74) low-fat dairy products with a reduced content of saturated and total fatDietary sodium Reduce dietary sodium intake to no .100 2–8 mmHg (74)reduction mmol/day (2.4 g sodium or 6 g sodium chloride)Physical activity Engage in regular aerobic physical activity 4–9 mmHg such as brisk walking (at least 30 min/day, most days of the week)Moderation of Limit consumption to no more than two drinks; 2–4 mmHgalcohol (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proofconsumption whiskey) per day, in most men and to no more than one drink per day, in women and lighter weight persons. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 90
    • Chikitsa Pharmacological Management:- General Management:1. Start with a low dose of an agent and, if blood pressure is not controlled, increase slowly with diet control therapy.2. Start with an agent that may also treat and/or not harm a coexisting condition.3. Add a second agent from a different, complementary class, if blood pressure is not controlled with a moderate dose of the first agent.4. Start with an agent that the patient is likely to tolerate best; long term compliance is related to tolerability and efficacy of the first agent used.5. Use a diuretic when two agents are used, in nearly all cases. If the blood pressure is controlled, then a slowly reduce the dose and withdrawal of some of the agents with regular observation. In general, there are six classes of drugs; diuretics, anti adrenergic agents, vasodilators, calcium entry blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor antagonists. Fish Oil317: From a physiologic viewpoint, it is attractive to propose that fish oil lowers BP. Fish oil has highly unsaturated fatty acids that stimulate the synthesis of vasodilating prostaglandins, inhibit platelet aggregation, and limit the release of vasoconstrictors. Fish oil is often prescribed as capsules that contain 1 ml of purified oil or as crude cod liver oil. Large doses of fish oil (e.g., 30 to 45 ml daily) clearly lower BP levels in hypertensive patients. A smaller dose (e.g., 6 capsules daily) had no effect in hypertensive and normotensive persons. The unpleasant taste of the fish oil and belching interfere with compliance. Therefore, fish oil is not considered a practical therapy for hypertension. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 91
    • ChikitsaTable-12: Showing the treatment of HypertensionClass of Compelling Possible Compelling Possible ContraDrug Indications Indications Contra Indications IndicationsDiuretics Heart failure, Diabetes Gout Dyslipidemia, Elderly patients, Sexually active Systolic malaes hypertensionBlockers Angina, After Heart failure, Asthma & COPD, Dyslipidemia, myocardial Pregnancy, Heart block Athletes & infarct, Tachy Diabetes Physically active arrhythmias patients, Peripheral vascular diseaseACE – Heart failure, Left Pregnancy,Inhibitors ventricular Hyperkalaemia, dysfunction, After Bilateral renal myocardial artery stenosis infarct, Diabetic nephropathyCalcium Angina, Elderly Peripheral Heart block Congestive heartAntagonists patients, Systolic vascular failure hypertension diseaseBlockers Prostatic Glucose Orthostatic hypertrophy intolerance, hypotension DyslipidemiaAngiotensin ACE-inhibitor Heart failure Pregnancy,IIAntagonists cough Bilateral renal artery stenosis, Hyperkalaemia Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 92
    • Pathya-Apathya Pathya- Apathya That which is not against the srotas and priya to manas318. Srotas is always animportant integral part of samprapti of a disease, which needs to be corrected by themeans of chikitsa. Pathya sevana along with the proper Aushada will always reducethe recovery phase of a disease. Acharya Lolimbaraja who was known as the best poetphysician was the first to explain the significance of pathya in his work VaidhyaChintamani. He feels that if a person knows all about pathya then there is no necessityof taking the oushadha for the disease319. The specific Pathya-Apathya is not mentioned for Pittavruta udana, but thegeneral Pathya-Apathya mentioned for Pittavruta vata and Vatavyadhis are good forPittavruta udana. In the treatment of diseases, diet and other habits are given equalimportance with drugs and therapeutic measures. The pathyapathya that can be suggested are as follows,Table-13: Showing the Pathyapathya320 in Pittavruta udana Pathya Apathya Ahara Mamsa of jangla pradesha Other than Jangala mamsa, Dadhi, animals and birds, Yava, Tobacco, Tea, Coffee, Salt, Fatty Shalee. substances, Alcohol, Amala, Lavana, Katu rasa, stored food etc. Vihara Samyak vishrama, Upavasa, Divaswapna, Ativyayama, Avyayama, Shavasana, Samyak vyayama, Vegadharana,Adhyashana, Sadvritta palana, Nitya Atichintana, Atikrodha, Atishrama, abhyanga, Krodha-Irsha- Atisukhasana, Ratri jagarana, etc. Bhaya-Chinta-Shokadi dharaneeya vega dharana, etc. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 93
    • Drug Review Drug ReviewShilajatu: Shilajatu is an exudation from rock during hot sunny days. Though it may beoccurring in many parts of the world but India was the first to highlight its wonderfultherapeutic value for many centuries. Ayurveda mentions it as wonderful medicine. Itdescribes that shodhita Shilajatu can cure even the assadhya diseases. AcharyaCharaka says “there are hardly any curable diseases which can not be controlled orcured with the help of Shilajatu321”.Names according to Language322:Sanskrit: Shilajatu, Hindi: Shilajita, Nepali: Kalo Shilajita, Arabic: Hajar–ul–Musa,Bengali: Shilajita, English: Black Bitumen or Mineral Pitch, Gujarati: Shilajita,Marathi: Shilajita Latin: Asphaltum punjabinum, Malayalam: Kanmadam, Unani:Momiye and Shilajita, Parsi : Momiya Phacyral Yahud.Synonyms of Shilajatu323, 324,325: Adrija, Adreyam, Ashmaja, Ashmotham, Girija, Gaireya, Shaila, Shilodbhava,Jatu, Adrijatu, Ashmajatuka, Girijatu, Shilajatu, Shilaniryasa, Shilasveda, Shilamaye,Shiladhatu, Shaildhatuja, Shaileya, Shilaya, Shilaj, Ashamlaksha, Atithi, Shilaha,Shail, Ashamsara, Dhatuja, Ashamajatu, Ashamj-jatu, etc.Test: The testing techniques for Shilajatu are as follows:i. Shilajatu put on fire it erects perpendicularly and burn with out smoke.ii. If pure Shilajatu put in water, through the tip of a thin erect glass it will come downslowly after spreading like fibre326.Properties: Rasa, Guna, Virya, Vipaka, Karma can be considered as the properties of thedrug. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 94
    • Drug Review The texts like Rasa Ratna Samucchaya believed that Shilajatu possess all theproperties of rasa, uparasa, parada, ratna and lauha together in itself327.Rasa328: Tikta, KatuGuna: The samanya guna of Shilajatu is considered to be sheeta by Rasa Paddhati,where as Acharya Charaka mentions it to be of natiushna-sheeta329 whereas anotherplace Acharya Charka mentioned the types of shilajatu as sheeta Veerya330.Virya: Ushna virya331.Vipaka: Katu vipaka332Karma: Mutrala, Yogavahi, Rasayana333, Chedana, Tridosha hara334 etc.Uses: According to Charaka Samhita there is no curable disease on earth whichShilajatu can not perforce subdue. When administered at right time, well prepared andin the right manner, it will secure for the healthy subject the optimum measure ofvitality. It removes old age and disease, gives great firmness of the body, increasesintelligence and memory and promotes prosperity335.Pathya–Apathya: While taking a course of Shilajatu care should be taken to see that, irritatingand heavy articles are excluded form the dietary. Exercise, sun light, direct air andchittsantapa should be avoided. During the administration of Shilajatu the followingmaterials are contraindicated: 1. Vidahi 2. Guru 3. Kulatha 4. Kapota mamsa. Kulatha is kashaya rasa, ushna virya, kapota mamsa is alo ushana veerya.Shilajatu is katu, kashaya, Tikta rasa and ushna virya. So the above properties causeuntoward effect in the body. Therefore should be avoided double the days ofadministration336. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 95
    • Drug ReviewChemical Composition337: Analyzed by Hooper it yielded:Water = 09.5%, Organic matter = 36.20%, Mineral matter = 34.65%, Nitrogen =01.3%, Lime = 07.80%, Potash = 09.07%, Phosphoric acid = 00.16%, Silica =01.35%.Guggulu: Guggulu gum is used to produce standardized or purified extracts calledguggulipids or guggulsterones. Heart drugs based on Guggulu extracts are sold inIndia, where almost all of the research on Guggulu has been done in the past thirtyyears338.Vernacular name:Sanskrit: In Sanskrit, Guggulu means “that which protects against diseases”. Anothertraditional Sanskrit name for Guggulu is palnkash- pal means flesh and kash means toreduce. It is one of the best herb for obesity339.Latin: Commiphora Mukul.Family: Burseracae340.English: Indian bedelliumCommon Name: Bdellium Gum, Guggulipid, Gum Gugal, Gumgu Ggulu, Salaitree,Commiphora mukul, Balasmodendron mukul341.Hindi: Gugal, Guggal. Kanada: Kanthagana, Gugggula, Gugulugida, Guggulu.Telugu: Guggipannu. Assam: Guggulu. Malayalam: Guggulu. Marathi: Guggul.Urdu: Muqil (Shihappu). Gujarati: Gugal. Oriya: Guggulu. Punjabi: Guggal.Kashmiri: Kanth Gan342.Synonyms: Devdhoop, Jatayu, Koushik, Pur, Kumbholookhlak, Mahishaksh,Kalaniryas, Natankchar, Shiv and Durg, Palnkash343,344. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 96
    • Drug ReviewHabitat Sindh, Rajasthan, Eastern Bengal, Assam, Mysore, Northeast Africa,Afghanistan, Bihar, Bellary etc345.Characteristics: Guggulu is obtained from a tree, which exudes a resinous sap out of incisions,that are remade on its bark. This resin has been used for centuries. The fresh the oleo-gum resin is moist, viscid, fragrant and of a golden color. It burns in fire, melts in thesun, & forms a milky emulsion with hot water346.Gunakarma:Rasa: Tikta, Katu, Kasaya, Virya: Usna, Vipaka: Katu, Prabhava: TridosaharaGuna: Laghu, Ruksha, Tikshna, Vishada, Sukshma, Sara347.Part used: Resin / Gum348.Phytoconstituents349: Guggulu an extract of the exudate (gum guggulu) of Mukul myrrh treecontains phytosterols named guggulsterones, organic acids, aromatic acids,diterpenes, lignans, sterols, steroids, esters and fatty acid alcohols. Guggulu ispreferred to crude gum guggulu because it is safer and more effective. 0.37% volatileoil consisting chiefly myrcene, dimyrcene, gum resin & bitter principle.Actions: Analgesic, highly potent anti inflammatory, rejuvenator, aphrodisiac,diaphoretic, diuretic, astringent, hypocholesterolaemic / hypolipidaemic, demulcent,alterative, carminative, appetizer, antispasmodic, emmenagogue, antirheumatic,antiarthritic, antisuppurative, antiseptic, hypercholestremia, enhances phagocytosis,immunostimulant, thyroid stimulant, uterine stimulant350,351. The pharmacological action of the oleo resin resembles in many ways with theactions of copaiba cubebs. Its active components, Z-guggulsterone and E- Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 97
    • Drug Reviewguggulsterone, have an ability to lower both cholesterol and triglyceride levels.Specifically, gugulipid lowers VLDL and LDL cholesterol and triglycerides whilesimultaneously raising HDL cholesterol. This indicates Guggulu primary use forproviding a protective effective against atherosclerosis. These effects are due toGuggulu action on the liver and thyroid. The thyroid is stimulated to increase the bodys metabolic rate, and the liver isstimulated to metabolize LDL cholesterol, effectively lowering the amount in thebloodstream352.Theraputic uses: Obesity, nervous diseases, arthritis, diabetes, hemiplegia, leprosy, leucorrhea,marasmus, muscle spasms, neuralgia, neurasthenia, ophthalmia, pertussis, pneumonia,pyelitis, pyorrhea, rheumatism, scrofula, skin disorders, sore throat, spongy gums,ulcerative pharyngitis, hypertension, ischemia, heart diseases, urinary disorders, skindiseases, applied locally in hemorrhoids, abscesses, bad ulcers. A number of studieshave supported the claims that Guggulu extracts can help to reduce heart disease riskfactors, with reductions in both blood fats and total cholesterol of 15-30 percent overthree months. Guggulu extracts have been shown to lower overall blood fats, reduce "bad"LDL cholesterol, and raise "good" HDL cholesterol. If it is also true, as some studiessuggest, that guggulu extracts can reduce platelet stickiness, this herb would rankamong the most important since few substances have a positive impact on both bloodfats and platelets353.Triphala354: This includes three drugs: (a) Haritaki (b) Vibhitaki (c) Amalaki.Synonyms355: Phalatrika, Vara. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 98
    • Drug ReviewRasa: Kshaya Pradhana.Vipaka: Madhura.Veerya: Anushna.Properties : Tridoshahara, Chakshushya, Dipana, Vrishya, Sara. 1) Haritaki356:Latin name - Terminalia chebula Retz.Family - CombretaceaeParyaya357:Sanskrit - Abhaya, Pathya, Shiva, Girija, Pramthya, Amrita.Hindi – Harad, Kannada – Anilekayi, Gujarati – Harde, Marathi – Harda.English – Chebulic myrobalan.Fruit: Drupe, glabrous, pendulous 1-2 inch long, ellipsoid ovoid from a broad base,more or less five ribbed.Test of genuine Haritaki: It should be fresh, smooth, dense, heavy and round inshape, when put into water it should sink.Chemistry: Fruits contain about 24.6-32.5% of tennin and also contains chebulagicacid, glucose, corilagin, amino etc.Guna Karma:Rasa - Kashaya pradhana Tikta, Katu, Madhura, Amla, Virya – Ushna, Guna -Laghu, Ruksha, Vipaka - Madhura, Prabhava - Tridoshahara.Action and uses: Medhya, Rasayana, Brimhana, Anulomana, Ayushya, Chakshushya,Mootrala etc. and used in Prameha, Sopha, Hridroga, Eye diseases, Tvakroga etc.Part used – Fruit 2) Vibhitaki358:Latin name – Terminalia bellirica Roxb. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 99
    • Drug ReviewFamily – CombretaceaeParyaya359:Samskrita- Kalidruma, Kasaghna, Aksha, Karshaphala, KalpavrikshaHindi – Baheda, Gujarati – Beheda, Kannada – Tarekayi, Marathi – BehdaEnglish – Belliric myrobalan.Fruit: 10-25 mm in diameter, ovoid, grey suddenly narrowed into a very, short stalk,velvety, obscurely 5 angled when dried.Chemistry – Fruits contain about 21.4% B-sitosterol, gallic acid, ellagic acid,chebulagic acid, galloyl, glucose, Mannitol, galactose, ethyl gallate, fructose,rhamnose, a new cardiac glycoside, belliricanin, and kernels yielded yellow fatty oil.Guna Karma:Rasa – Kashaya. Guna – Ruksha, LaghuVirya – Ushna, Vipaka – Madhura, Doshaghnata – Tridosha, mainly Kaphahara.Action and uses: Dipana, Anulomana, Grahi, Chakshushya, Kanthya, Swasakasahara,Raktashodhana. It is used in Kasa, Swasa, Swarabheda, Vatavyadhi, Arsha etc.Part used – Fruit 3) Amalaki360:Latin name – Emblica officinalis Gaertn.Family – EuphorbiaceaeParyaya361:Samskrita – Dhatri, Vayastha, Amruta phala etc.Hindi – Amla, Anvla, Kannada – Nellikayi, Gujarati – Anvla, Marathi – Awle,English – Emblic myrobalan.Gana: Virechnopag, Vayahsthapana etc.Distribution: This tree is common in the mixed deciduouis forests of India Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)100
    • Drug ReviewFruit: 1.3-1.6 cm in diameter, fleshy, globosely, with 6 obscure vertical furrows. Thefruit is green, changing to light yellow when mature; it is sour and astringent in taste.Chemistry: Fruit contains mineral matter (0.7%), fiber (3.4%), Protein (0.5%)carbohydrate (14.1%), fat (0.1%) calcium (0.05%), phosperous (0.02%), ferrous (1.2mg), vit.C, nicotinic acid (0.2mg/100gm), tenic acid, gelic acid etc.Guna Karma:Rasa – Amla (Pradhana), Kashya, Tikta, Katu, Madhura., Guna – Guru, Ruksha,Sheeta, Vipaka – Madhura, Virya – Sheeta, Doshaghnata –TridoshaghnaAction and uses – Rasayana, Vrishya, Shonita and Garbha sthapana, Mootrala etc.Part used – Fruit (without seed) Gomutra:Gana, Guna and Karmadi of Gomutra:Gana : Acharya Charaka has described Gomutra in Katuskanda362. Sushruta inshirovirechana gana363.Guna Karmadi364, 265:Rasa – Katu, Tikta, Kashaya, Madhura, Lavana, Guna – Tikshna, Laghu, Virya –Ushna.Karma366,367 – Kaphavata shamaka, Pitta janaka, Agni pradeepaka, Medhya.Other properties: According to Bhava Prakasha, the simple mutra is taken as Gomutra. Differenttypes of mutras are used in the treatment of different diseases but Gomutra is highlyeffective in all the mutras368. Acharya Sushruta has advised to use Shilajatu, Guggulu,Gomutra and Triphala in the treatment of Sthaulya369. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)101
    • Table-14: Showing the properties of IngredientsSl Drug Latin name Paryoga Rasa Guna Veerya Vipaka Doshaghnata Karmukatano Anga1 Shilajatu Asphaltum Ishat- Amla Mridu Sama- Katu Balya, Yogavahi, punjabinum Kashaya Sheetoshna Vrishya, Rasayana, Medhohara, Hritshoolanashaka2 Guggulu Commiphora Niryasa Tikta, Katu Laghu ,Ruksha, Ushana Katu Vata Kapha Hridya,Rakta mukul Teekshna,Visha Shamaka prasadana, da Mutrala,Shothahara, Sukshma, Medohara,3 Hareetaki Terminalia Phala Lavana Laghu ,Ruksha Ushana Madhura Tridosha hara Hridya,Shonita chebula varjita- sthapana, Mutrala Pancharasa Shotha hara, Kashaya4 Vibhitaki Terminalia Phala Kashaya Laghu , Ruksha Ushana Madhura Tridosha hara Rakta stambhana, bellarica (Kapha hara) Sleshama hara5 Amalaki Emblica Phala Ppancharasa Guru , Ruksha Sheeta Madhura Tridosha hara Hridya, Shonita officinalis Lavanavarjita Sheeta Pittashamaka sthapana, Amla Rasayana, Mutrala6 Gomutra Katu, Tikta, Tikshna, Ushna, Ushna Katu Kaphavata Deepana, Pachana, Kashaya, Laghu shamaka, Anulomana, Madhura, Pitta Amapachana, Lavana prakopaka Malashodhana, used (anurasa) in Shula, Vataroga, Shopha etc.102
    • Material & Methods Materials and MethodsSource of dataPatients: Patients suffering from Essential hypertension were selected from departmentof Kayachikitsa Post graduation studies and research O.P.D. of Shri D.G.MAyurvedic medical college and hospital by preset inclusion and exclusion criteria.Literary: Literary aspects of study were collected from classical Ayurvedic and Moderntexts, updated with recent journals.Composition of Trial Drug: Table-14: Showing the composition of Shilajatu Guggulu Rasayana Sl.No Sanskrit Name Botanical Name Proportion 1 Shilajatu Black bitumen 1 Part 2 Guggulu Commiphora mukul 1 PartPreparation of yoga: All the drugs were identified and collected from local area, Goodmanufacturing practice was followed for the preparation.Method of collection of dataStudy design: Present study is prospective clinical study. The patients with Pittavruta udanaw.s.r. to Essential Hypertension within the age group of 35 yrs to 70 yrs. wereselected randomly from O.P.D of D.G.M. A M.C.,H.& Research Center afterfulfilling the inclusion and exclusion criteria irrespective of their sex, occupation andsocio-economic status. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)103
    • Material & MethodsSample size: A minimum of 30 patients was taken excluding the dropouts. The presentstudy is a single group study where as patients were assigned in one group. It is aSimple random sampling technique clinical trial.Exclusion criteria: - Following were the criteria to exclude the patients from the study: - Essential hypertension with diabetes. Essential hypertension with ischaemic heart diseases. Secondary hypertension. Left ventricular hypertrophy. Left ventricular failure. Renal hypertension. Patient with malignant hypertension. Lactating and pregnant females. Hypertension secondary to malignancy.Inclusion Criteria The selection of the patient for clinical study was done with following criteria: Patients were selected between the age group of 35 to 70 years. Patients of both sexes were selected indiscriminately. Patients with following conditions were considered for the clinical trial: • Freshly detected and untreated case of essential hypertension. • Established and treated case of essential hypertension and who had discontinued the treatment before the clinical trial was taken for the study. • Asymptomatic and symptomatic cases were taken for the study. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)104
    • Material & Methods • Both mild and moderate cases. • Racial of environmental factors. • No discriminations of chronicity and severity of disease. • Other than the exclusive criteria mentioned above.Criteria of Diagnosis The symptomatology of Pittvaruta udana mentioned in Ayurvedic text were the basic diagnostic criteria. The symptomatology of essential hypertension explained in modern text were the basic diagnostic criteria. Estimation of high blood pressure according to American Heart association (A.H.A) diagnostic criteria. Diagnosis is made on the basis of measurements of sphygmomanometer.Posology Abhyantara 6 gms per day/24 hrs, in three divided doses. Sadhyo virechanahas been carried out with 30 ml of Gandharvahastadi castrol prior to the initiation ofthe treatment.Study DurationStudy: 30 days.Follow-up: The duration of follow up was 30 days.Assessment of Result The subjective and objective parameters of base line data to pre and postmedication were compared for assessment of the results. All the result were analyzedstatistically for “p” value using student‘t’ test, Paired t- test. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)105
    • Material & MethodsSubjective parameters The symptoms of Pittavruta udana mentioned in classical text as Daha,Moorcha, Bhrama, Klama, and symptoms of hypertension mentioned in contemporarytext were the subjective parameters.Objective ParametersBlood pressure:- Standing Sitting Laying down posture These have been recorded regularly during study duration.InvestigationsDiagnostic and exclusion:- Lipid profile: • Very low density lipoprotein cholesterol (VLDL) • Low-density lipoprotein cholesterol (LDL) • High-density lipoprotein cholesterol (HDL) • Serum cholesterol • Serum triglycerides Chest X-Ray Electro cardiogram (E.C.G) Fasting blood sugar (F.B.S) Blood urea Serum creatinine Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)106
    • Material & MethodsPreparation of medicine: 1. Shilajatu shodana370: The Shilajatu which was exuded from the stones was collected, powdered andkept immersed in hot water for three hours. Later it was vigorously squeezed andfiltered through cloth and collected in a clean mud plate and exposed to bright sun.The scum that collects at the top is separated and dried in the sun till it becomes ahard mass in about two months of time. This is fit to be used as medicine. The sign ofgood Shilajatu when put on fire assumes the shape of a linga(round mass) and doesnot emit smoke. The water which remains underneath in the earthen plate might alsoyield some Shilajatu if kept in sun light for a number of days. 2. Guggulu Shodhana371: i) Guggulu ii) Triphala iii) Gomutra Guggulu must be bundled in a strong cloth and boiled in dolayantra containing 4parts of Triphala kashaya prepared with Gomuthra. When all the guggulu dissolves inTriphala kashaya, pottali is removed and the liquid is evaporated to collect purifiedGuggulu. Guggulu and Shilajatu are powdered and mixed properly. Then 90 gms of yoga isstored airtight container. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)107
    • Observations Observations In this study total 33 patients were registered, out of which 3 patients left thestudy before completion and 30 no. of patients have completed their course oftreatment with Shamana Oushdha (Shilajatu Guggulu Rasayana).Table-16: Showing Age wise distribution of total 30 patients with percentage Age Male patients Female patients Total patients Number % Number % Number % 36-42 01 3.33% 01 3.33% 02 6.66% 43-49 04 13.33% 03 10% 07 23.33% 50-56 07 23.33% 03 10% 10 33.33% 57-63 02 6.66% 04 13.33& 06 20.00% 64-70 04 13.33% 01 3.33% 05 16.66% Total 18 12 30 Age wise distribution of all thirty patients shows that maximum patients werefrom 50-56 years age group i.e. 10 (33.33%) patients, where 07 (23.33%) were maleand 03 (10%) were female. In age group of 43-49 years 07 (23.33%) patients werereported, in these patients 04 (13.33%) were male and 03 (10%) were female, in agegroup of 57-63 years 06 (20%) patients had undergone the treatment, here 02 (6.66%)were male and 04 (13.33%) were female and in age group of 64-70 years 05(16.67%) patient were approached, in these patients 04 (13.33%) were male and 01(3.33%) were female and in the age group of 36-42 years total 02 (6.67%) i.e. 01(3.33%) were male and 01 (3.33%) were female patients had completed the treatment.Figure-08: Showing Age wise distribution of total 30 patients 1010 9 7 7 8 6 7 36-42 Years 6 5 43-49 Years 5 4 4 4 50-56 Years 3 3 4 57-63 Years 3 2 2 1 1 64-70 Years 2 1 1 0 MALE FEMALE TO TAL Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 108
    • Observations Table-17: Showing Sex wise distribution of total 30 patients with percentage Sex Total no. of Patients % age Male 18 60.00% Female 12 40.00% Total 30 In the present study 18 (60%) of the patients were male and 12 (40%) were female. Figure-09: Showing Sex wise distribution of total 30 patients 18 18 16 12 14 12 Male 10 8 Female 6 4 2 0 Table-18: Showing Religion wise distribution of total 30 patients with percentage Religion Total no. of Patients % age Hindu 26 86.67% Muslim 04 13.33% Christian 00 00 Others 00 00 Total 30 In this study 26 (86.67%) of the patients belongs to Hindu category and 04 (13.33%) belongs to Muslim. Figure-10: Showing Religion wise distribution of total 30 patients30 262520 Hindu Muslim15 Christian10 Others 4 5 0 0 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 109
    • ObservationsTable-19: Showing Occupation wise distribution of total 30 patientsOccupation Male patients Female patients Total patients Number % Number % Number %Sedentary 08 26.66% 12 40.00% 20 66.67%Active 06 20.00% 00 - 06 20.00%Labour 04 13.33% 00 - 04 13.33%Total 18 - 12 - 30 - In the occupation wise distribution 20 (66.67%) of the patients had sedentarylife style where 08 (26.66%) male and 12 (405) were female, 06 (20%) were malepatients had active occupation and 04 (13.33%) were male patients are of labour class.Figure-11: Showing Occupation wise distribution of total 30 patients 20201816 121412 Sedentary 810 6 6 Active 8 4 4 Labour 6 4 0 0 2 0 MALE FEMALE TO TALTable-20: Showing Economical status wise distribution of 30 patients Economical status Total no. of Patients % agePoor 04 13.33%Middle 24 80.00%Higher class 02 6.67%Total 30 Here, 04 (13.33%) of the patients comes from Poor Class, 02 (6.67%) of thepatients come from Higher Class and 24 (80.00%) of the patients comes from MiddleClass.Figure-12: Showing Economical status wise distribution of total 30 patients 242520 Poor15 Middle10 4 Higher class 250 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 110
    • Observations Table-21: Showing Marital status wise distribution of 30 patients with percentage Marital Status Total no. of Patients % age Unmarried 00 00 Married 30 100% Total 30 All the 30 patients i.e. 100% approached are married. Figure-13: Showing Marital status wise distribution of total 30 patients 30302520 Married15 Unmarried10 5 0 0 Table-22: Showing Intake Rasa predominance wise distribution of 30 patients Rasa predominance Total no. of Patients % age Madhura 20 66.67% Amala 08 26.67% Lavana 17 56.67% Katu 30 100.00% Tikta 00 00 Kashaya 00 00 In this study maximum 30 (100%) patients have taken Katu Rasa predominantly in their diet, followed by 20 (66.67%) Madhura Rasa, 17 (56.67%) Lavana Rasa and 08 (26.67%) Amala Rasa. Excessive use of Katu, Lavana and Amala Rasa may be the etiological factors of this disease. Figure-14: Showing Intake Rasa predominance wise distribution of 30 patients 303025 20 Madhura 17 Amala20 Lavana15 8 Katu10 Tikta5 Kashaya 0 00 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 111
    • Observations Table-23: Showing Nidra wise distribution of total 30 patients with percentage Nidra Total no. of Patients % age Sound sleep 12 40.00% Disturbed sleep 18 60.00% Total 30 The present study shows that maximum 18 (60%) of the patients had disturbed sleep and 12 (40%) of the patients had sound sleep. Figure-15: Showing Nidra wise distribution of total 30 patients 18 18 16 14 12 12 10 Sound sleep 8 Disturbed sleep 6 4 2 0 Table-24: Showing Malapraviti wise distribution of 30 patients with percentage Malapraviti Total no. of Patients % age Prakruta 22 73.33% Constipated 08 26.67% Total 30 In this study 08 (26.67%) of the patients had constipated stool where as 22 (73.33%) of the patients had normal stool. Figure-16: Showing Malapraviti wise distribution of total 30 patients25 222015 Prakruta 8 Constipated10 5 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 112
    • Observations Table-25: Showing Addiction wise distribution of 30 patients with percentage Addiction Total no. of Patients % age Tea 20 66.67% Coffee 22 73.33% Smoking 06 20.00% Alcohol 10 33.33% Tobacco Chewing 06 20.00% The present study shows 22 (73.33%) of the patients had addiction to Coffee, 20 (66.67%) of the patients to Tea, 06 (20%) of the patients to Tobacco, 10 (33.33%) of the patients to Alcohol and 06 (20%) patients had Smoking addiction. Figure-17: Showing Addiction wise distribution of total 30 patients 2225 2020 Tea Coffee15 10 Smoking 6 610 Alcohol Tobacco Chewing 5 0 Table-26: Showing Ahara wise distribution of total 30 patients with percentage Ahara Total no. of Patients % age Vegetarian 14 46.66% Mixed 16 53.33% Oil 17 56.66% Ghee 11 36.66% Stored Food 16 53.33% In the present study 14 (46.66%) of the patients had vegetarian diet, 16 (53.33%) of the patients had mixed diet where as 17 (56.66%) of the patients had more oily diet, 11 (36.66%) of the patients had used ghee and 16 (53.33%) of the patients had used stored food. Figure-18: Showing Ahara wise distribution of total 30 patients 16 17 1618 141614 11 Vegetarian12 Mixed10 Oil 8 6 Ghee 4 Stored Food 2 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 113
    • Observations Table-27: Showing Manasika Prakruti wise distribution of total 30 patients Manasika Prakruti Total no. of Patients % age Bhaya 09 30.00% Kopa 17 56.67% Deenata 19 63.33% Udvega 08 26.67% Kshobha 20 66.67% Samprahara 09 30.00% Mada 06 20.00% In this study 20 (66.67%) of the patients had Kshobha, 19 (63.33%) of the patients had Deenata, 17 (56.67%) of the patients had Kopa, 09 (30%) of the patients had Bhaya, 09 (30%) of the patients had Samprahara, 08 (26.67%) patients had Udvega and 06 (20%) of the patients had Mada. Figure-19: Showing Manasika Prakruti wise distribution of total 30 patients 20 19 17 20 18 Bhaya 16 Kopa 14 Deenata 12 9 8 9 10 Udvega 6 8 Kshobha 6 Samprahara 4 2 Mada 0 Table-28: Showing Shareera Prakriti wise distribution of total 30 patients Shareera Prakriti Total no. of Patients % age VP 18 60.00% VK 10 33.33% PK 02 06.66% Total 30 The above table shows 18 (60%) of the patients had vatapitta prakriti, 10 (33.33%) of the patients had vatakapha prakriti and 02 (6.66%) of the patients had pittakapha prakriti. Figure-20: Showing Shareera Prakriti wise distribution of total 30 patients 18181614 1012 VP10 VK8 PK64 220 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 114
    • Observations Table-29: Showing Sara wise distribution of total 30 patients with percentage Sara Total no. of Patients % age Twak 02 06.66% Rakta 10 33.33% Mamsa 12 40.00% Meda 05 16.66% Asthi 01 03.33% Majja 00 00 Shukra 00 00 Satwa 00 00 Total 30 The above table shows 12 (40%) of the patients had Mamsa Sara, 10 (33.33%) of the patients had Rakta Sara, 05 (16.66%) of the patients had Medha Sara, 02 (6.66%) of the patients had Twak Sara and 01 (3.33%) of the patients had Asthi Sara. Figure-21: Showing Sara wise distribution of total 30 patients 12 12 10 Twak Rakta 10 Mamsa 8 5 Meda 6 Asthi 2 4 1 Majja 0 0 0 2 Shukra 0 Satwa Table-30: Showing Samhanana wise distribution of total 30 patients Samhanana Total no. of Patients % age Susamhita 25 83.33% Madhyama samhita 05 16.66% Heena samhita 00 00 Total 30 The above table shows 25 (83.33%) of the patients had Susamhita and 05 (16.66%) of the patients had Madhyama Samhanana. Even single patient also has not had Heena Samhanana. Figure-22: Showing Samhanana wise distribution of total 30 patients 252520 S usamhita15 Madhyama samhita10 5 Heena samhita 5 0 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 115
    • Observations Table-31: Showing Satmya wise distribution of total 30 patients with percentage Satmya Total no. of Patients % age Pravara 05 16.66% Madhyama 20 66.66% Avara 05 16.66% Total 30 The above table shows 20 (66.66%) of the patients were having Madhyama Satmya and 05 (16.66%) of the patients were having Pravara Satmya and 05 (16.66%) of the patients were having Avara Satmya. Figure-23: Showing Satmya wise distribution of total 30 patients 2020181614 Pravara1210 Madhyama 8 5 5 Avara 6 4 2 0 Table-32: Showing Satwa wise distribution of total 30 patients with percentage Satwa Total no. of Patients % age Pravara 04 13.33% Madhyama 19 63.33% Avara 07 23.33% Total 30 The above table shows 19 (63.33%) of the patients had Madhyama Satva and 07 (23.33%) of the patients had Avara Satva and 04 (13.33%) of the patients were having Pravara Satva. Figure-24: Showing Satwa wise distribution of total 30 patients 1920181614 Pravara1210 7 Madhyama 8 Avara 4 6 4 2 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 116
    • Observations Table-33: Showing Vyayama Shakti wise distribution of total 30 patients Vyayama shakti Total no. of Patients % age Pravara 04 13.33% Madhyama 06 20.00% Avara 20 66.66% Total 30 The above table shows 06 (20.00%) of the patients had Madhyam Vyayamashakti, 20 (66.66%) of the patients had Avara Vayamashakti and 04 (13.33%) of the patients had Pravara Vyayamashakti. Figure-25: Showing Vyayama Shakti wise distribution of total 30 patients 20 20 18 16 14 12 Pravara 10 Madhyama 6 8 Avara 4 6 4 2 0 Table-34: Showing Vaya wise distribution of total 30 patients with percentage Vaya Total no. of Patients % age Balya 00 00 Madhya 23 76.66% Vruddha 07 23.33% Total 30 The above table shows 23 (76.66%) of the patients had Madhyama Vaya and 07 (23.33%) of the patient’s had Vruddha Vaya. Figure-26: Showing Vaya wise distribution of total 30 patients 232520 Balya15 Madhya 710 Vruddha 5 0 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 117
    • ObservationsTable-35: Showing Pramana wise distribution of total 30 patients Pramana Total no. of Patients % ageSupramanita 28 93.33%Adhika 01 03.33%Heena 01 03.33%Total 30 The above table shows 28 (93.33%) of the patients Supramanita, 01 (3.33%)of the patients had Adhika Pramana and 01 (3.33%) of the patients had HeenaPramana.Figure-27: Showing Pramana wise distribution of total 30 patients 28302520 Supramanita15 Adhika Heena10 1 1 5 0 Table showing Ahara Shakti (AS) wise distribution:-Table-36-A: Showing Abhyvarana (AS) wise distribution of total 30 patients A) Abhyvarana Total no. of Patients % agePravara 00 00Madhyama 30 100.00%Avara 00 00Total 30 The above table shows 30 (100%) patients had Madhyama Abhyvarana Shaktiand no patients were seen in Pravara and Avara kind of Ahara Shakti.Figure-28-A: Showing Abhyvarana (AS) wise distribution of 30 patients 30302520 Pravara15 Madhyama Avara10 0 0 5 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 118
    • Observations Table-36-B: Showing Jarana (AS) wise distribution of 30 patients B) Jarana Total no. of Patients % age Pravara 00 00 Madhyama 30 100.00% Avara 00 00 Total 30 The above table shows 30 (100%) patients had Madhyama Jarana Shakti and no patients were seen in Pravara and Avara kind of Ahara Shakti Figure-28-B: Showing Jarana (AS) wise distribution of 30 patients 30302520 Pravara15 Madhyama Avara10 5 0 0 0 Table-37: Showing Jatharagni Bala wise distribution of total 30 patients Jatharagni bala Total no. of Patients % age Manda 19 63.33% Teekshna 02 6.66% Vishama 09 30.00% Sama 00 - Total 30 - The above table shows 19 (63.33%) of the patients had Manda Agni, 09 (30%) of the patients had Vishama Agni and 02 (6.66%) of the patient had Teekshana Agni Not even the single patint Sama Agni. Figure-29: Showing Jatharagni Bala wise distribution of total 30 patients 1920 18 16 14 Manda 12 9 Teekshna 10 Vishama 8 6 Sama 2 4 0 2 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 119
    • Observations Table-38: Showing Koshta wise distribution of total 30 patients with percentage Koshta Total no. of Patients % age Krura 09 30.00% Madhyama 19 63.33% Mrudu 02 6.66% Total 30 - The above table shows 02 (6.66%) of the patients had Mrudu Koshta, 19 (63.33%) of the patients had Madhyama Koshta and 09 (30%) of the patients had Krura Koshta. Figure-30: Showing Koshta wise distribution of total 30 patients 1920 18 16 14 12 Krura 9 10 Madhyama 8 Mrudu 6 2 4 2 0 Table-39: Showing Family History wise distribution of total 30 patients Family history HTN Total no. of Patients % age Yes 13 43.33% No 17 56.67% Total 30 In this study 13 (43.33%) of the patients had family history of Hypertension and 17 (56.67%) of the patients’ family were devoid of Hypertension. Figure-31: Showing Family History wise distribution of total 30 patients 1718 1316141210 Yes8 No6420 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 120
    • Observations Table-40: Showing Chronicity wise distribution of 26 patients (Previously diagnosed) with percentage Chronicity Total no. of Patients % age Up to 6 Month 06 20.00% Up to1 Years 12 40.00% Up to2 Years 06 20.00% Up to3 Years 02 6.66% Total 26 - In this study 06 (20%) of the patients had minimum of 6 months Chronicity, 12 (40.00%) of the patients had 6 months to 1 year Chronicity, 06 (20.00%) of the patients had 1 to 2 years Chronicity, and 02 (6.67%) of the patients had 2 to 3 years Chronicity. Figure-32: Showing Chronicity wise distribution of total 30 patients 121210 6 Up to 6 Month8 6 Up to1 Years6 Up to2 Years 24 Up to3 Years20 Table-41: Showing Onset history wise distribution of total 30 patients Onset history Total no. of Patients % age Acute 04 13.33% Chronic 26 86.67% Total 30 The study shows that 26 (86.67%) of the patients had Chronic Onset and 04 (13.33%) of the patients had Acute Onset of history. Figure-33: Showing Onset history wise distribution of total 30 patients 26 30 25 20 Acute 15 Chronic 4 10 5 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 121
    • ObservationsTable-42: Showing Intensity wise distribution of total 30 patients Intensity Total no. of Patients % ageMild 02 6.66%Moderate 14 46.66%Severe 14 46.66%Total 30 - Here in this study 14 (46.66%) of the patients had Moderate Intensity ofHypertension, 14 (46.66%) of the patients had Severe Intensity of Hypertension and02 (6.66%) of the patients had Mild Intensity of Hypertension.Figure-34: Showing Intensity wise distribution of total 30 patients 14 14141210 Mild8 Moderate6 Severe4 220Table-43: Showing Relieving Factors wise distribution of total 30 patients Relieving factors Total no. of Patients % ageRest 23 76.67%Sleep 28 93.33%Tranquillizer 01 3.33%Anti Depressants 06 20.00% In the present study, Relieving factors of 28 (93.33%) of the patients hadSleep, 23 (76.67%) of the patients had Rest, 06 (20%) of the patients had AntiDepressants and 01 (3.33%) of the patients had Tranquillizers.Figure-35: Showing Relieving Factors wise distribution of total 30 patients 2830 2325 Rest20 Sleep15 Tranquillizer 610 Anti Depressants 1 5 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 122
    • Observations Table-44: Showing Aggravating Factors wise distribution of total 30 patients Aggravating factors Total no. of Patients % age Traveling 02 6.67% Anxiety 07 23.33% Emotion 15 50.00% Stress 28 93.33% Physical stress 14 46.67% In the present study, Aggravating factors of 28 (93.33%) of the patients had Stress, 14 (46.67%) of the patients had Physical Stress, 15 (50%) of the patients had Emotions, 07 (23.33%) of the patients had Anxiety and 02 (6.67%) of the patients had Travelling. Figure-36: Showing Aggravating Factors wise distribution of total 30 patients 28 30 25 Traveling 15 20 14 Anxiety 15 Emotion 7 Stress 10 2 Physical stress 5 0 Table-45: Showing Drug History wise distribution of total 30 patients Drug history Total no. of Patients % age Allopathic Medicine 19 63.33% Ayurvedic Medicine 00 - Discontinued Medicine 07 23.33% Others 00 - In this study 19 (63.33%) of the patients had Allopathic Medicine where as 07 (23.33%) patients had discontinued the medicine. Figure-37: Showing Drug History wise distribution of total 30 patients 1920181614 Allopathic Medicine12 Ayurvedic Medicine 710 Discontinued Medicine 8 Others 6 4 0 0 2 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 123
    • Observations Table-46: Showing Symptoms wise distribution of total 30 patients Symptoms Total no. of Patients % age Shirah shoola 25 83.33% Klama 27 90.00% Bhrama 24 80.00% Daha 05 16.67% Moorcha 00 00 The present study revealed that maximum 27 (90%) of the patients had Klama following 25 (83.33%) of the patients had Shirah Shoola, 24 (80%) of the patients had Bhrama and 05 (16.67%) of the patients had Daha but Moorcha was not seen in any patient. Figure-38: Showing Symptoms wise distribution of total 30 patients 2730 25 2425 Shirah shoola20 Klama15 Bhrama Daha10 5 Moorcha5 00 Table-47: Showing Associated Complaints wise distribution of total 30 patients Associated complaints Total no. of Patients % age Avsada 04 13.33% Dourbalya 19 63.33% Ati-sweda 00 - Daha in nabhi and uras 00 - Others 00 - In this study, the associated complaints of 19 (63.33%) of the patients had Dourbalya and 04 (13.33%) of the patients had Avsada. The rest of the complaints were not seen in any patient. Figure-39: Showing Associated Complaints wise distribution of total 30 patients 19 20 18 16 Avsada 14 Dourbalya 12 10 Ati-sweda 8 4 Daha in nabhi and uras 6 0 Others 4 0 0 2 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 124
    • Observations Table-48: Showing Systolic Blood Pressure (Average) of 30 patients Systolic blood pressure Total no. of Patients % age Normal 00 - Stage I (140-159) 02 6.67% Stage II (160-179) 14 46.67% Stage III (180-209) 14 46.67% Stage IV >210 00 00 Total 30 The above table revealed that maximum 14 (46.67%) of the patients were recorded Stage II and Stage III Average Systolic Blood Pressure followed by 02 (6.67%) of the patients were suffer from Stage I Average Systolic Blood Pressure. No patients were recorded of Stage IV. Figure-40: Showing Systolic Blood Pressure (Average) of 30 patients 14 141412 Normal10 Stage I (140-159)8 Stage II (160-179)6 Stage III (180-209)4 2 Stage IV >2102 0 00 Table-49: Showing Diastolic Blood Pressure (Average) of 30 patients Diastolic blood pressure Total no. of Patients % age Normal 08 26.67% Stage I (90-99) 15 50.00% Stage II (100-109) 07 23.33% Stage III (110-119) 00 - Stage IV >120 00 - Total 30 The above table revealed that maximum 15 (50%) of the patients were recorded Stage I Average Diastolic Blood Pressure followed by 07 (23.33%) of the patients were suffering from Stage II Average Diastolic Blood Pressure and 08 (26.67%) of the patients were in Normal Stage. No patients were recorded of Stage III and IV Average Diastolic Blood Pressure. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 125
    • ObservationsFigure-41: Showing Diastolic Blood Pressure (Average) of total 30 patients 15161412 Normal10 8 S tage I (90-99) 7 8 S tage II (100-109) S tage III (110-119) 6 S tage IV >120 4 2 0 0 0 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 126
    • Results Results Results of any research work are like always a new outcome in the medicalfield. The results are obtained by the different observations which are collected duringthe clinical trial. All these findings are tabulated in different headings.Table-50: Showing the effect of therapy on Bhrama Parameter Score Percentage Net result Response (BT - AT) Total scoring 36 100% (Bhrama) BT 100% Good response. Total scoring 00 00% (Bhrama) AT The present study revealed that 36 score was found before the treatmentwhereas 00 score was found after the treatment. This study illustrated that the effectof Shilajatu Guggulu Rasayana on Bhrama gives 100% result i.e. Good response.Table-51: Showing the effect of therapy on Klama Parameter Score Percentage Net result Response (BT - AT) Total scoring 42 100% (Klama) BT 86% Good response. Total scoring 06 14% (Klama) AT The present study shows that 42 score was found before the treatment whereas06 score was found after the treatment. This study demonstrated that the effect ofShilajatu Guggulu Rasayana on Klama gives 86% result i.e. it also comes under Goodresponse.Table-52: Showing the effect of therapy on Shirah shoola Parameter Score Percentage Net result Response (BT - AT) Total scoring 45 100%(Shirah shoola) BT 91% Good response. Total scoring 04 09%(Shirah shoola) AT Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 127
    • Results The present study revealed that 45 score was found before the treatmentwhereas 04 score was found after the treatment. This study illustrated that the effectof Shilajatu Guggulu Rasayana on Shirah shoola gives 91% result i.e. Good response.Table-53: Showing the effect of therapy on Daha Parameter Score Percentage Net result Response (BT - AT) Total scoring 06 100% (Daha) BT 100% Good response. Total scoring 00 00% (Daha) AT The present study shows that 06 score was found before the treatment whereas00 score was found after the treatment. This study demonstrated that the effect ofShilajatu Guggulu Rasayana on Daha gives 100% result i.e. it also comes under Goodresponse. As the symptom Daha was found only in 5 patients.Table-54: Showing the effect of therapy on Systolic hypertension Parameter Score Percentage Net result Response (BT - AT) Total scoring 72 100% (SBP) BT 92% Good response. Total scoring 06 8% (SBP) AT The present study revealed that the highest 72 score was found before thetreatment whereas 06 score was found after the treatment. This study illustrated thatthe effect of Shilajatu Guggulu Rasayana on Systolic blood pressure gives 92% resulti.e. the result comes under Good response.Table-55: Showing the effect of therapy on Diastolic hypertension Parameter Score Percentage Net result Response (BT - AT) Total scoring 29 100% (DBP) BT 83% Good response. Total scoring 05 17% (DBP) AT The present study revealed that 29 scores was found before the treatmentwhereas 05 score was found after the treatment. This study demonstrated that the Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 128
    • Resultseffect of Shilajatu Guggulu Rasayana on Diastolic blood pressure gives 83% result i.e.it shows Good response.Table-56: Showing the over all response on Subjective and Objective parameters Net Result Percentage Net results of all Response therapies (X/N) Systolic B.P. 92% Diastolic B.P. 83% Shirah shoola 91% Klama 86% 92% Good response. Bhrama 100% Daha 100% N=6 X = 552 Net mean results of the therapy on all parameters (all subjective and objectivein to the consideration) showed 92%. This study demonstrated that the effect ofShilajatu Guggulu Rasayana on all parameters showed Good response.Table-57: Showing the effect of therapy on Biochemical Parameters Biochemical Parameters Mean score Mean difference Net Relief BT ATSerum cholesterol 193.81 156.95 36.86Serum triglycerides 172.94 143.00 29.94High density lipoprotein 47.63 43.39 4.24Low density lipoprotein 111.69 84.97 26.72Very low density lipoprotein 34.54 28.54 06.00 The present study revealed that the mean difference of Serum cholesterol wasfound 36.86 i.e. lower than the before treatment mean, mean difference of Serumtriglycerides was found 29.94 i.e. lower than the before treatment mean, meandifference of High density lipoprotein was found 4.24 i.e. lower than the beforetreatment mean, mean difference of Low density lipoprotein was found 26.72 i.e.lower than the before treatment mean whereas mean difference of Very low densitylipoprotein was found 06.00 i.e. also lower than the before treatment mean, hencethis shows that the effect of Shilajatu Guggulu Rasayana on Lipid Profile. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 129
    • ResultsStatistical Analysis Table-58: Showing the effect of therapy on Bhrama Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence Bhrama BT 1.2 0.80 - - 0.147 29 8.163 <0.001 HS AT 0.0 0.0 1.2 0.805 In order to assess the Parameter the patients were examined according to theclinical findings and the results were analysed from the statistical analysis. In parameter Bhrama Mean ±SD before was 1.2 ±0.8 and after the treatment itis reduced to 0.0 ±0.0 with Mean difference 1.2 and standard of mean 0.147 and testshows more highly significant before and after the treatment as P<0.001. Table-59: Showing the effect of therapy on Klama Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence Klama BT 1.44 0.77 - - 0.121 29 9.917 <0.001 HS AT 0.2 0.40 1.2 0.664 In parameter Klama Mean ±SD before was 1.44 ±0.77 and after the treatmentit is reduced to 0.2 ±0.40 with Mean difference 1.2 and standard of mean 0.121 andtest shows more highly significant before and after the treatment as P<0.001. Table-60: Showing the effect of therapy on Shirah shoola Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence Shirah BT 1.5 0.86 - - 0.139 29 9.827 <0.001 HS shoola AT 0.13 0.34 1.366 0.764 In parameter Shira shoola Mean ±SD before was 1.5 ±0.86 and after thetreatment it is reduced to 0.13±0.34 with Mean difference 1.366 and standard of mean Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 130
    • Results0.139 and test shows more highly significant before and after the treatment asP<0.001. Table-61: Showing the effect of therapy on Daha Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence Daha BT 0.2 0.48 - - 0.0884 29 5.475 <0.001 HS AT 0.0 0.0 0.2 0.484 In parameter Daha Mean ±SD before was 0.2 ±0.48 and after the treatment itis reduced to 0.0 ±0.0 with Mean difference 0.2 and standard of mean 0.0884 and testshows more highly significant before and after the treatment as P<0.001. Table-62: Showing the effect of therapy on Moorcha Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence Moorcha BT 0.0 0.0 - - 0.0 29 - - - AT 0.0 0.0 0.0 0.0 In parameter Moorcha before and after the treatment is not seen. Table-63: Showing the effect of therapy on Systolic hypertension Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence Systolic BT 2.4 0.62 - - 0.121 29 18.18 <0.001 HS B.P. AT 0.2 0.55 2.2 0.664 In parameter Systolic B.P. Mean ±SD before was 2.4 ±0.62 and after thetreatment it is reduced to 0.2 ±0.55 with Mean difference 2.2 and standard of mean0.121 and test shows more highly significant before and after the treatment asP<0.001. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 131
    • ResultsTable-64: Showing the effect of therapy on Diastolic hypertension Para Dura Mean Mean SD of SE DF T- P- Rem Meter tion ± SD differ Differ Value Value arks ence ence Diastolic BT 0.96 0.71 - - 0.1 29 8.00 <0.001 HS B.P. AT 0.16 0.37 0.8 0.55 In parameter Diastolic B.P, Mean ±SD before was 0.96 ±0.71 and after thetreatment it is reduced to 0.16 ±0.37 with Mean difference 0.8 and standard of mean0.55 and test shows more highly significant before and after the treatment as P<0.001.Effect of therapy on Biochemical Parameters: Table-65: Showing the effect of therapy on Serum Cholesterol Para Dura Mean Mean SD of SE D T- P- Rem meter tion ± SD differ Differ F Value Value arks ence ence Choleste BT 193.81 29.22 - - 3.34 29 11.26 <0.001 HS rol AT 156.95 29.7 37.63 18.29 1 In parameter Cholesterol Mean ±SD before was 193.81 ±29.22 and after thetreatment it is reduced to 1560.95 ±29.70 with Mean difference 37.63 and standard ofmean 18.298 and test shows more highly significant before and after the treatment asP<0.001. Table-66: Showing the effect of therapy on Serum Triglycerides Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence Trigly BT 0.96 0.71 - - 4.72 29 8.73 <0.001 HS ceride AT 0.16 0.37 0.8 0.55 In parameter Triglyceride Mean ±SD before was 172.94 ±60.41 and after thetreatment it is reduced to 143.0 ±57.43 with Mean difference 41.206 and standard of Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 132
    • Resultsmean 4.72 and test shows more highly significant before and after the treatment asP<0.001. Table-67: Showing the effect of therapy on High Density Lipoprotein Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence H.D.L. BT 47.63 10.03 0.66 29 7.29 <0.001 HS AT 43.39 8.03 4.813 3.619 In parameter H.D.L Mean ±SD before was 47.63 ±10.03 and after thetreatment it is reduced to 43.39 ±8.03 with Mean difference 4.813 and standard ofmean 0.66 and test shows more highly significant before and after the treatment asP<0.001. Table-68: Showing the effect of therapy on Low Density Lipoprotein Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Valu arks ence ence e L.D.L BT 111.69 30.13 - - 2.974 29 9.781 <0.0 HS AT 84.97 24.64 29.09 16.29 01 In parameter L.D.L. Mean ±SD before was 111.69 ±30.13 and after thetreatment it is reduced to 84.97 ±24.64 with Mean difference 29.09 and standard ofmean 2.974 and test shows more highly significant before and after the treatment asP<0.001. Table-69: Showing the effect of therapy on Very Low Density Lipoprotein Para Dura Mean Mean SD of SE DF T- P- Rem meter tion ± SD differ Differ Value Value arks ence ence V.L.D.L BT 34.54 12.10 - - 0.949 29 9.16 <0.001 HS AT 28.54 11.46 8.694 5.201 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 133
    • Results In parameter V.L.D.L. Mean ±SD before was 34.54 ±12.10 and after thetreatment it is reduced to 28.54 ±11.46 with Mean difference 8.694 and standard ofmean 0.949 and test shows more highly significant before and after the treatment asP<0.001. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 134
    • Discussion Discussion Discussion is the most important part of any research where the observationsare discussed and given reasons by the researcher. Here researcher conveys thepractical experience with special reference to textual explanations. The significantresults and insignificant results will be discussed in the same section with reasons.Hence it becomes important to discuss the clinical study in detail.Discussions on this study are made under the following headings: 1) Discussion on Disease Review 2) Discussion on Drug Review 3) Discussion on Clinical study. 4) Discussion on Results1) Discussion on Disease Review: Pittavruta udana is explained as disease in Ayurvedic classics. The symptoms,which are expressed in essential hypertension, are similar to the symptoms ofPittavruta udana. As Ayurveda explains, Pitta pangu, Kapha pangu without vata, sovata plays an important role in the formation of diseases. Vata is a unique Dosha as itdiffers from other Doshas in many ways, for example Vata regulates the functions ofPitta and Kapha. In the pathological state also it has double path of its vitiation i.e itsvitiation may occur by the depletion of dhatus or by the obstruction, while Pitta andKapha have a single route of vitiation. Most of the hypertensive patients showminimal cause in vascular integrity. Acharya Vagbhata clearly states that vascularintegrity is maintained by Vata (Prana). In one word he says “Dhamani dharana” is afunction of Prana Vata. Nearly 15% of the world population is labelled hypertensive, either knowingor unknowingly by doctors. In India approximately 14% of peoples suffer from Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)135
    • Discussionhypertension and majority of them had essential hypertension which indicates itssignificance and prevalence. At present, Indian Council of Medical Research (ICMR)and All India Institute of Medical Sciences (AIIMS) also have declared India as anation of hypertension. Although hypertension is usually asymptomatic for the first10-20 yrs, it slowly but surely strains the heart and damages the arteries. For thisreason hypertension is often called as silent killer5 because mild to moderate levelsusually ignored by patient until serious damage has been done. Epidemiological studies revealed that it is the most important single factorresponsible for death from cardiovascular and cerebro-vascular disease. Therefore itsepidemiology has drawn the attention of W.H.O in 1978 and declared that year as“Hypertension Year”. So far hypertension in various systems of medicines likes Ayurveda, Unani,homeopathy and allopathic-claim success in preventing, controlling hypertension. Butthe fundamental factor that blood pressure is not a disease but a reaction, ismanifested by the cardiovascular system against unnatural behaviours in relation toone’s Ahara and Vihara (mithya hara vihara). Among these systems of medicinesAyurveda adopts the treatment for the benefit of life and life is nothing but the feelingof self or self-consciousness. Ayurveda is eternal and ever lasting principle.Ayurvedic drugs have shown re-constructive or rejuvenate effect. So many Allopathic medications like beta-blockers, calcium channel blockers,ACE inhibitors etc. are invented, to keep the blood pressure in normal ranges. But allthese medicines have big adverse effects, where as Ayurvedic medicines cure thedisease without producing the adverse effects and give side benefits as a substitute ofside effects. Therefore, the Ayurvedic therapeutics has attracted considerable glamourfor providing safe and effective remedies. Several researches have been done to tell Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)136
    • Discussionoff the significance of medication. However, it is necessary to conduct the furtherresearch to find out some safe and effective therapy with no adverse effects andprotect the hypertensive population. In Ayurvedic literature, the disease essentialhypertension is not described by its name. But, from compilation of scatteredreferences it is concluded that Essential hypertension is a condition that simulates thePittavruta udana vyadhi. After understanding essential hypertension on the basis ofAyurvedic fundamentals, the treatment selected was more effective and also costeffective. The clinical trial was conducted in a randomized sample of 30 patients. Thedrugs and doses have already been described in the clinical study. The results wereassessed individually on various parameters, monitored carefully; subjected to biostatistical analysis.Nidana PanchakaI. Nidana: In the classics there are no direct references regarding nidanas of Pittavrutaudana. Vriddhi of avaraka along with avaruta dosha is essential to cause avarana. Sothe nidanas which causes mainly Pittavriddhi along with vatavriddhi to some extentbe considered as the hetus for Pittavruta udana. Many of Raktadustikara Nidanascontribute to the Pitta vruddhi, intern’s manifestation the Avarana to Vata producingclinical manifestation. While discussing about Nidana of Vata prakopa, Acharyaclearly mentioned that viruddha/vishama ahara leads to margavrodha. This can beunderstood as obstructive pathology, the prime factor of Essential hypertension. In the present study majority of patients have irregular and incompatible foodstyle. Tea/Coffee may contribute to agni vaishamya interns Pitta and Vata prakopatakes place. Particularly Pitta makes the margavarana to Vata leads to Hypertension. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)137
    • DiscussionII. Poorvaroopa: The Poorva roopa for this condition is not described in the classics. Charakahas quoted that avyakta lakshanas of vata vyadhi are to be taken as its Poorvaroopa.III. Roopa: Shirah shoola: is due to the Vata, shiro daha is due to Vata and Pitta. Here Vata as well as Pitta vitiation occurs. Klama: is due to vitiation of Rakta Daha: is due to the vitiation of Pitta Bhrama: is due to vitiation of Vata and Pitta Moorcha: is due to the vitiation of PittaIV. Upashaya and Anupshaya For Vata: Upashaya of Avruta Vata is not at hand; on the contrary, Upashayaof Avaraka is present. For Example in Pittavruta vata, the patient gets Vidaha fromthe Upashaya of Vata i.e, Amla, Lavana and Ushna. In Kaphavaruta Vata there isUpashaya from Katu etc and patient shows desire for Fast, Exercise, Ruksha etc.things which are Upashaya for Kapha and Anupashaya for Vata. For Pitta: In Pittavruta vata, patient feels Daha, Trishana, Shoola, Bhrama,Tama and gets Vidaha from Amla, Lavana, Katu and Ushna veerya dravyas. On theother hand, the patient shows the desire for cold (sheeta) things, which is Upashayafor Pitta.V. Samprapti: The whole sequence of manifestation of disease starting from the causativefactors, dosha dushti till the appearance of lakshanas is known as Samprapti. Thesamprapti ghatakas i.e. dosha, dushya, srotas, agni etc. having great significance inthis process, whereas Acharya Sushruta’s describes the stages of the development of a Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)138
    • Discussiondisease. The shatkriyakala’s are chaya, prakopa, prasara, sthanasanshraya, vyakti andbheda avasthas372. To understand the samprapti of Pittavruta udana (Essentialhypertension), it is necessary to know about the nidana factors of the disease becausethe three chief events of the healthy human being towards the disease happen onlyfrom the fractions of nidana factors. These chief events are a). Dosha Prakopa b). Kha Vaigunya c). Dhatu Shaithilya In this perspective, it is necessary to take note of the involved factors i.e.samprapti ghatakas viz ; dosha, dushya, srotas, agni, ama etc. Direct referenceregarding the samprapti of Pittavruta udana is not available in the classics. Hence tounderstand the samprapti of Pittavruta udana, the general samprapti of avarana can beconsidered. Like ama, the Avarana is also unique concept of disease pathogenesis,especially of Vata vyadhis. Vata dosha is the chief among Tridoshas373, because of itsasukaritwa & its ability to carry on the all life process in association with Pitta,Kapha, Saptadhatus & Trividha mala. It is composed of “Rajo guna bahulya374”which is the “Pravartaka-sarvabhavanam” and other two doshas are of turn describedas Pangu without the involvement of Vata dosha375. Such dynamic factor Vata,naturally causes more number of diseases in the body than the other doshas. One ofthe reasons behind causation of the 80 diseases by Vata376 is because it is provokedby two principle factores: 1. Dhatus kshaya (Emaciation of body tissues) 2. Margasya Avarana (by the occlusion of its channel of circulation) Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)139
    • Discussion Acharya Chakrapani377 mentions that Vata get aggravated in two differentways. Because of second type of cause Avarana, the speed (vega) of Vata getsarrested which leads to its aggravation. However, when Vata is obstructed in thesame way, it is specifically called Avarana.Explanation of the word Avarana: The words Avarana means– Achhadana i.e covering or avarodha i.eobstruction. The three terms are used to understand the Avarana i.e. Avarana, Avarkaand Avrutah.i. Avarana: Avarana denotes the obstruction of vata movements. This obstructioncan be due to Pitta, Kapha, Rasadi dhatus, Malas or by the panchavidha vata.ii. Avaraka: The factor, which causes obstruction of vata, is called Avaraka or themain sources which cause the obstruction is Avaraka. For example if Pitta causeobstruction of Vata, then Pitta is called Avaraka.iii. Avruta: The gati of Vata, which is affected by the Avaraka is known as Avruta orwhich is arrested by other dosha is known as Avruta. The substance, which obstructsthe pathway of Vata, is termed as Avaraka while Vata whose avarana occurs is termedas Avruta. To understand the samprapti of Pittavruta udana, it is necessary to know aboutthe nidana i.e. karanas of the disease because the disease Pittavruta udana comesunder Vata vyadhi chapter. If Pitta Vitiated and then obstruct the Udana vata comesunder samanyaja vyadhi. Hence in the samprapti of Pittavruta udana, Vata and Pittavitiates by there own nidanas and then vitiated Vata comes in contact with vitiatedPitta causes more Pitta vikruti and results the obstruction of Udana vata. So by seeingthis samprapti Avarana comes under Vata vyadhi chapter (nanatmaja vikara).By observing the lakshanas of Pittavruta udana, the doshas and dooshyas involved in Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)140
    • Discussionthe samprapti to cause this condition can be assessed as follows:Samprapti-Ghatakas:-Doshas: Vata (Udana) – Shirashoola and bhrama. Pitta anubandi– Daha, bhrama and moorchaDushyas: Rakta – daha, klama and Shira shoolaAgni: JatharagniSrotas: Rasavaha, Raktavaha & ManovahaSrotodushti-Prakara: Sanga type of srotodustiUdbhavaSthana: Pakvashaya-Amashaya SamudbhavaAvayava: Hridaya, DhamaniAdhisthana: Manodaihika (Psychosomatic, Sira, Dhamani, Srotas)Sanchara-sthana: Sarva ShariraRogamarga: Madhyama Rogamarga.Prognosis: In dosha avarana, the Avarana of Prana and Udana by Pitta and Kapha aremore severe and difficult to treat because of their vital function in the bodyphysiology i.e. to provide life and strength. Therefore Pittavruta udana is difficult totreat. If the condition continues for one year, its management is delayed or improperand then it may difficult to treat or is incurable. So early diagnosis and timelymanagement make the prognosis good.Modern concept of Essential Hypertension: Blood pressure is the pressure exerted by the blood on the walls of bloodvessels. Persistent high arterial blood pressure without a known cause is essential Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)141
    • Discussionhypertension when the elevation of systolic blood pressure is more than 140 mm Hgand diastolic blood pressure is above 90 mm Hg. Arterial pressure depends on the cardiac out put and total peripheral resistance.The Blood Pressure can be raised by increased cardiac output and increased peripheralresistance. The cardiac output depends upon the heart rate, its contractibility and theblood volume. 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 hormone aldesterone, whichblocks the excretion of sodium and water into the urine. It appears that most patients with established hypertension have abnormalcardiac output and blood pressure is mainly sustained by increased peripheral vascularresistance. The peripheral vascular resistance is determined by the arteriolar lumen,which may expand or contract depending on the state of muscular cells in the vesselwall. This is known as local vascular tone. Normal vascular tone depends on thecompetition between vasoconstriction influences and vasodilators. Peripheralresistance depends on the size of the lumen of some vessels. A decrease in the inner(lumen) diameter will raise the Blood Pressure. The decrease in the lumen could bebrought about by an anatomical thickening of vessel walls (e.g. intimal thickening ofarteries), by their mechanical compression from outside or most commonly by theiractive muscular contraction which can be induced by a variety of vasoconstrictormediators. The common vasoconstricting mediators are epinephrine, norepinephrineand renin- activated angiotensin II. The other recently described vasoconstrictorsinclude endothelin I, thromboxane and leucotrienes. Resistance vessels also exhibitauto regulation, a process by which increased blood flow to such vessels induces Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)142
    • Discussionvasoconstriction, an adaptive mechanism that protects against hyper perfusion oftissues. The vasodilators include kinins, prostaglandins and nitric oxide. Certainmetabolic products such as lactic acid, hydrogen ions, adenosine and hypoxia can alsofunction 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 theblood pressure by adjusting the amounts of SNO and NO to which blood vessels areexposed. This newly appreciated role of haemoglobin may influence development ofdrugs to treat hypertension. 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 thereis considerable 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 the renin-angiotensin system appears central to these influences. Renin elaborated by the juxtaglomerular 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 blood volume. The former effect is achieved largely by it’s ability to cause vasoconstriction through direct action on vascular smooth muscle, the latter by stimulation of aldosterone secretion, which increases distal Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)143
    • Discussion tubular reabsorption of sodium and thus of water. 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 re-absorption of sodium by proximal tubules in an attempt to conserve sodium and expand blood volume. GFR- independent natriuretic factors, including atrial natriuretic factor (ANF), a peptide secreted by heart atria in response to volume expansion, inhibit sodium re-absorption in distal tubules and cause vasodilatation. 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.Chikitsa: In classics several treatment modalities are explained for Pittavruta vata. Thedravyas which are not abhishyandi but having snigdha and srotoshodhaka gunasshould be used. The oushadhi drayas which are not virudha to Pitta, which causesVatanulomana and Vatashamana are to be administered. In Vata enclosed by Pitta,alternative application of cold and hot things is desirable. Jeevaneeya sarpi, meat ofwild animals, barely, shali rice, sustaining milk enema, purgation, intake of milkboiled with panchamoola and bala are employed. Then sprinkling with madhu yastitaila, bala taila, ghee, ksheera panchamoola decoction or cold water are useful. Recent studies’ shows significant improvement of Essential hypertension bychikitsa like Virechana, Shirodhara, Rasayana. If we look in to the chikitsa principlesof Avarana, Virechana is the best shodhana chikitsa. Pitta and Vata both are regulised Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)144
    • Discussionby Virechana. Shirodhara also had beneficial role in management of Essentialhypertension. In all encircled conditions, the regular use of Rasayana such as ShilajathuGuggulu with milk would be beneficial or use of chyavana prasha should beemployed with milk diet. In Pithavrutha panchavata the measures to be adopted arePittaghna remedies which never derange Vata. Treatment of Vata is not effective whereas the treatment of Avaraka iseffective. When Vata is occluded by Pitta, it leads to Vata Prakopa manifested by thesymptom of Shula. It may be the main symptom disturbing the patient very much. Inaddition other symptoms of Pitta like burning, thirst, giddiness and darkness beforeeyes may be there. Here to relive dominant symptom of Vata i.e Shula, Pittaalleviating treatment should be undertaken as the basic pathology is due to theincreased Pitta. Hence the administration of Vata alleviating treatment such as use ofhot, sour and salt substances, which are antagonist to Pitta, may deteriorate thecondition. If Kapha occludes Vata, it leads to Vata prakopa manifested by thesymptom of Shoola. It may be the main symptom disturbing the patient very much. Inaddition other symptoms of kapha such as cold, heaviness, pronounced desire topungent and similar other articles and carving for fasting, exertion, dry and hot things.Here to relive dominant symptom of Vata i.e Shoola, Kapha alleviating treatmentsuch as katu, kashaya etc. articles should be used, as the basic pathology is due to theincreased Kapha though this therapy is antagonist to Vata.2. Discussion on Drug Review:Shilajatu: By its tikta rasa and naatiushna gunas, acts on Pitta dosha and by ushna veryaact on Vata dosha. Because of tikta rasa, it removes avarana of Vata dosha and their Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)145
    • Discussionby Vata anulomana occurs. As it is having rasayana property, hence does Vatashamana. Shilajatu is one of the best mootrala dravya. Its diuretic property isestablished. Because of its mootrala properties, it reduces the blood volumeautomatically blood pressure reduced. In Essential hypertension diuretic property isvery beneficial. By its virtue of diuretic property Shilajatu showed significant bestresult in the present study.Guggulu: By its tikta and kashaya rasas it makes Pitta shamana, by its tikta rasa, ushnaand teekshna gunas it removes the Avarana of Vata. Because of Ushna veerya andRasayana properties it is Vatashamaka. The Guggulu shodhana was done with the Triphala kwatha, which is preparedwith Gomutra. Consequently it is necessary to consider the effects of these dravyas onPittavruta udana. A number of studies have supported the claims that Gugguluextracts can help to reduce heart disease risk factors, with reductions in both bloodfats and total cholesterol of 15-30 percent over three months. Guggulu extracts havebeen shown to lower overall blood fats, reduce "bad" LDL cholesterol and alsonormalizing the weight. It also reduces blood triglycerides which are known tocontribute to atherosclerosis and heart attack. As some studies suggest, that Gugguluextracts can reduce platelet stickiness, this herb would rank among the most importantsince few substances have a positive impact on both blood fats and platelets. Theseeffects are due to Guggulu action on the liver and thyroid. The thyroid is stimulated toincrease the bodys metabolic rate, and the liver is stimulated to metabolize LDLcholesterol, effectively lowering the amount in the bloodstream and is Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)146
    • Discussionantihypertensive. Due to its diuretic action it reduces the blood pressure. Although theuse of Guggulu is appears to be safe and non-toxic. Triphala is mainly Pitta shamaka and Vatanulomaka. Hareetaki and Vibhitakiby their Kashaya, Tikta and Madhura rasa and by Madhura vipaka it acts on Pittadosha. Amalaki, by its Kashaya and Madhura rasa, Madhura vipaka and Sheetaveerya, does Pitta shamana. Hareetaki and Vibhitaki by their Madhura rasa andvipaka, Ushna veerya and anulomana properties it acts on Vata dosha. Amlaki by itsAmla, Madhura rasa and vipaka and Rasayana properties it pacifies Vatadosha. Gomutra has srotoshodhaka property. We have made Guggulu shodhana byGomutra siddha Triphala kwatha. Because of Gomutra shodhita Guggulu, it may actas Vatanulomaka and srotoshodhaka although Gomutra is Pitta prakopaka but becauseof the Triphala, it may not aggravate Pitta. By its Ushna guna and veerya, Lavana andMadhura rasa it dose Vata shamana. By summarising all these factors, this yoga is effective in Pittavruta udanabecause of sroto shodhaka, Vata and Pitta shamaka, Vatanulomaka and Rasayanaproperties.3) Discussion on Clinical study: In this study total 33 patients were registered, out of which 3 patients left thestudy before completion and 30 no. of patients have completed their course oftreatment with Shamana Oushadha (Shilajatu Guggulu Rasayana). All 30 patients arescreened for hypertension before and after the clinical trial. Before to initiation of thetreatment, all patients are screened for cardiac abnormalities, renal abnormalities,metabolic abnormalities like diabetes, hypo/hyper thyroidism etc. Patient’s bloodlipids are assessed before and after the treatment. For the safety purpose X-ray andECG are taken before to include in the trial. Once he/she found with normal findings Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)147
    • Discussionof X-ray, ECG then included in the study. Throughout the clinical trial, all patients areclosely observed for any adverse changes. Telephonic communication was keptthrough the clinical trial. After the clinical trial, patients are put on control drug i.e.Sarpagandha Ghana vati 1 TID for further management, with consent of thePhysician. Some patients are referred to concerned Physician for further management.Observations:Age: Age wise distribution of all thirty patients shows that maximum patients werefrom 50-56 years age group i.e. 10 (33.33%) patients where 07 (23.33%) were maleand 03 (10%) were female. In age group of 43-49 years 07 (23.33%) patients werereported, in these patients 04 (13.33%) were male and 03 (10%) were female, in agegroup of 57-63 years 06 (20%) patients were undergone the treatment, here 02(6.66%) were male and 04 (13.33%) were female and in age group of 64-70 years 05(16.67%) patient were approached, in these patients 04 (13.33%) were male and 01(3.33%) were female and in the age group of 36-42 years total 02 (6.67%) i.e. 01(3.33%) were male and 01 (3.33%) were female patients had completed the treatment. The age is the important factor in the manifestation of the disease becausehypertension is establish mostly in middle and senile age group. In Ayurveda, theVaya has been significant factor in the manifestation and prognosis of the disease.Seeing that the hypertension normally occurs in middle and senile age, hence it canmainly related to Pitta and Vata pradhana378 because of the dosha pradhanyataaccording to the age. Essential hypertension is more prevalent in the middle and oldage. According to Acharya Vagbhata, the dosha pradhanyata according to age makesdifficult to treat379. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)148
    • DiscussionSex: The present study showed that 18 (60%) of the patients were male and 12(40%) were comes under female category. In female, occurrence is mainly due to age,hormonal changes and increase in blood pressure take place due to menopause also.Thus in the present study the percentage of females is less than that of males.Religion: In this study 26 (86.67%) of the patients belongs to Hindu category and 04(13.33%) belongs to Muslim. It may be due to Hindu dominant population. As thesample size is too small, it is difficult to rule out the exact difference in their life styleconcern to etiology of hypertension as both communities had taken lavana, katu,amala etc. rasa yukta ahara.Occupation: In the occupation wise distribution 20 (66.67%) of the patients had sedentarylife style where 08 (26.66%) male and 12 (405) were female, 06 (20%) were malepatients had active occupation where as 04 (13.33%) were male patients are of labourclass. In the sedentary life style patients have taken heavy diet, excessive fat meal,excessive salty diet and having more tension. The active occupation related strain andstressful work where as in the labour occupation also having the stressful work. Eventhough physical exercise is beneficial to Essential hypertension but dynamic exerciseraises blood pressure and isometric exercise raises it a lot more. These are theimportant cause for increase in blood pressure.Marital Status: The present study showed that all the 30 patients i.e. 100% approached aremarried. Stress and tension was the most common factor observed in married life.Oppositions of opinion between the partners, the worry for their children and family Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)149
    • Discussionetc. after marriage these could be the reason for the high blood pressure.Economical Status: Here, 04 (13.33%) of the patients comes from Poor Class, 02 (6.67%) of thepatients come from Higher Class and 24 (80.00%) of the patients comes from MiddleClass. The middle class peoples suffer with more anxiety. Stress may because offinancial insecurity or work tension and the negligence to proper Ahara and Viharamay be the cause of hypertension.Ahara: In the present study 14 (46.66%) of the patients had vegetarian diet, 16(53.33%) of the patients had mixed diet where as 17 (56.66%) of the patients hadmore oily diet, 11 (36.66%) of the patients had used ghee and 16 (53.33%) of thepatients had used stored food. The geographical population takes more oily food, salt,chillies, stored food, mixed food, ghee etc., therefore it can be concluded that patientswere taken the ahara which have been the nidana of hypertension so leads tohypertension.Intake of dominant Rasas: In this study maximum 30 (100%) patients have taken Katu Rasapredominantly in their diet, followed by 20 (66.67%) Madhura Rasa, 17 (56.67%)Lavana Rasa and 08 (26.67%) Amala Rasa. The more use of Katu, Lavana and AmlaRasa may be the nidana of this disease and these provokes the Pitta also, where asMadhura rasa was used for the taste or after food. To make diet tastier Katu, Lavanaand Amla are used and they have taken spicy food.Addictions: The present study shows 22 (73.33%) of the patients had addiction to Coffee,20 (66.67%) of the patients to Tea, 06 (20%) of the patients to Tobacco, 10 (33.33%) Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)150
    • Discussionof the patients to Alcohol and 06 (20%) patients had addiction with Smoking. Coffeeand tea becomes a most commonly used in this era, so it should not be considered asaddiction. On the other hand in liable persons nicotine and caffeine in higherconcentration may work as nidanas. Tobacco is toxic thing and having Vyavayi,Vikasi, Ushna and Tikshna gunas, can vitiate Rakta Dhatu. Alcohol also vitiates theRakta and Pitta.Family History: In this study 13 (43.33%) of the patients had family history of Hypertension.This was important factor in the formation of disease because of involvement ofgenetic factors in this disease.PrakritiSharirika: The study shows 18 (60%) of the patients had vatapitta prakriti, 10 (33.33%)of the patients had vatakapha prakriti and 02 (6.66%) of the patients had pittakaphaprakriti. This shows that Vata and Pitta plays more important role in the formation ofdisease. The Samprapti of hypertension is having the route of Avarana. The Vataalways gets vitiated by Avarana Pitta and Pitta Prakriti persons are more susceptiblePittaja Vikaras. So in Pitta prakruti person the Vata get aggravating themselves. If theDosha matches with Prakriti and other factors like Dushya, Desha, Kala, Bala etc.then the curability of disease becomes very difficult380.Manasika: In this study 20 (66.67%) of the patients had Kshobha, 19 (63.33%) of thepatients had Deenata, 17 (56.67%) of the patients had Kopa, 09 (30%) of the patientshad Bhaya, 09 (30%) of the patients had Samprahara, 08 (26.67%) patients hadUdvega and 06 (20%) of the patients had Mada. The stressful stimuli certainly raise Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)151
    • Discussionblood pressure. Mada, Bhaya, Kama, Krodha, Lobha etc. elevate raja and tama gunaswhich cause manodusti results in manovikara with involvement of samjnavaha ormanovaha srotas381. These factors are responsible for the disease formation becausestress, strain like nidanas are plays majour role in Hypertension. Hence it may beconcluded that all the psychological factors directly provoke Vata and Pitta which canproduce hypertensive state.Satva: The study shows 19 (63.33%) of the patients had Madhyam Satva and 07(23.33%) of the patients had Avara Satva and 04 (13.33%) of the patients were havingPravara Satva. Hypertension is stated as psychosomatic disease. Acharya Charka hastoled that satva is nothing but mana382. The Pravara Sattva patients have less attentionto exposing the disease because tension plays a major role in the formation of disease.The stress and strain contribute highly in Essential hypertension. So Pravara satvawhen reduces, the person will be victim for stress and strain hence Madhyama andAvara Satva patients have more chances to get the disease.Satmya: The study shows 20 (66.66%) of the patients were having Madhya Satmya and05 (16.66%) of the patients were having Pravara Satmya and 05 (16.66%) of thepatients were having Avara Satmya. Sarva Rasa intake is designate to accomplishequipoise state of Dhatus383, but further Chakrapani has make clear that it does notmean to take all Rasas in equal quantity. For example Vata Prakriti persons mayrequire more diet of Madhura, Amla and Lavana Rasa. Thus the part of Rasa requiresaccording to the bodily constitution, season, and dietetic properties384. So it is difficultto look for the effect of Satmyata of Rasa in the manifestation of disease. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)152
    • DiscussionAgni: The present study shows 19 (63.33%) of the patients had Manda Agni, 09(30%) of the patients had Vishama Agni and 02 (6.66%) of the patient had TeekshanaAgni not even a single patient had Sama Agni. Manda Agni385 is major cause for alldisorders. Dooshya Rasa and Rakta which are involved in Essential hypertensiondepend on Agni. Mandagni always responsible for srotoavarodha and is thepredominant factor in manifestation of Pittavruta Udana.Koshtha: The present study shows 02 (6.66%) of the patients had Mrudu Koshta, 19(63.33%) of the patients had Madhyama Koshta and 09 (30%) of the patients hadKrura Koshta. Koshatha is also related to Agni hence also plays an important role inthe formation of disease.Onset history: The study shows that 26 (86.67%) of the patients are known hypertensiveamong them 19 are on medication, 7 are discontinued. Before to the initiation of thetreatment, all were advised to taper down the previous medications. Data wascollected after the withdrawal of medication and found hypertensive and 04 (13.33%)of the patients are newly diagnosed. After observation of the patients and monitoringof the blood pressure, they were found hypertensive and were included in the clinicaltrial with pre requisite inclusion criteria.Intensity: Here in this study 14 (46.66%) of the patients had Moderate Intensity ofHypertension, 14 (46.66%) of the patients had Severe Intensity of Hypertension and02 (6.66%) of the patients had Mild Intensity of Hypertension. The present clinicaltrial was mainly aimed on antihypertensive effect of the trial drug. Majority of Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)153
    • Discussionpatients approached are known cases. As we discussed earlier all patients who aretaking medications for hypertension advised to stop the pervious medication. Becauseof that majority of patients comes under the category of moderate and severeintensity.Vaya In this study 23 (76.66%) of the patients had Madhya Vaya and 07 (23.33%)of the patient’s had Vruddha Vaya. The Vaya is also plays an important role in themanifestation of disease because hypertension is mostly found in Madhya andVruddha Vaya. In Ayurveda, the Vaya has been significant factor in the manifestationand prognosis of the disease. In Madhya Vaya Pitta pradhanta and in Vruddha VayaVata pradhanta occures. Essential hypertension is more prevalent in the Madhya andVruddha Vaya.Vyayama shakti The above table shows 06 (20.00%) of the patients had MadhyamVyayamashakti, 20 (66.66%) of the patients had Avara Vyamashakti and 04 (13.33%)of the patients had Pravara Vyayamashakti. In observation, table no 33, showed that66.67% patients are of sedentary life style. Global survey of the hypertension confinethat, sedentary life style may contribute to hypertension.Nidra: The present study shows that maximum 18 (60%) of the patients had disturbedsleep and 12 (40%) of the patients had sound sleep. Majority of the patients withdisturbed sleep showed imbalanced condition of mind due to some psychologicalconditions like anxiety, stress etc. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)154
    • DiscussionAggravating & Relieving factors: In the present study, emotional and physical stress was observed asaggravating factor. Aggravating factors of 28 (93.33%) patients had Stress, 14(46.67%) patients had Physical Stress, 15 (50%) of the patients had Emotions, 07(23.33%) of the patients had Anxiety and 02 (6.67%) of the patients had Travelling.Whereas sleep and rest was observed as a relieving factor in the patients. Relievingfactor of 28 (93.33%) patients had Sleep, 23 (76.67%) of the patients had Rest, 06(20%) of the patients had Anti Depressants and 01 (3.33%) of the patients hadTranquillizers. Therefore stress i.e. manovikaras plays a major role in Essentialhypertension.Symptomatology: The present study revealed that 27 (90%) of the patients had Klama following25 (83.33%) of the patients had Shirah Shoola, 24 (80%) of the patients had Bhramaand 05 (16.67%) of the patients had Daha but Moorcha was not seen in any patient.As klama and shirashoola are raktapradoshaja vikaras which were observed in 90%and 83.33% patients respectively and Daha in 16.67%, indicates predominance ofPitta. The presence of Bhrama in 80% of patients indicates vataprakopa in presentcondition. As shirashoola is the laxana of both Raktadusti and Vataprakopa, itindicates involvement of both Vata and Pittadosha in Pittavruta vata.Associated complaints: Regarding the associated complaints of 19 (63.33%) of the patients hadDourbalya and 04 (13.33%) of the patients had Avsada. The rest of the complaintswere not seen in any patient. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)155
    • DiscussionSystolic Blood Pressure: The study revealed that maximum 14 (46.67%) of the patients were recordedStage II and Stage III average Systolic Blood Pressure followed by 02 (6.67%) of thepatients were of Stage I average Systolic Blood Pressure. No patients were recordedof Stage IV. As the Allopathic medicine were withdrawn from the patients who hadundergone the Allopathic treatment. This may be the reason that maximum patientswere having stage II and stage III systolic hypertension.Diastolic Blood Pressure: Table no 49 revealed that maximum 15 (50%) of the patients were recordedStage I average Diastolic Blood Pressure followed by 07 (23.33%) of the patientswere suffering from Stage II average Diastolic Blood Pressure and 08 (26.67%) of thepatients were in Normal Stage. No patients were recorded of Stage III and IV averageDiastolic Blood Pressure. Here also by the same reason patients having stage I andstage II diastolic hypertension.4) Discussion on Results: Results are drawn on cumulative effects of therapy on subjective and objectiveparameters. In the present study 25 patients showed good response and 5 respondedmoderately.Table-70: Showing Overall Result of the therapyResult No of patients PercentageGood response 25 83.33%Moderate response 05 16.66% Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)156
    • DiscussionFigure-42: Showing Overall Result of the therapy 83% 17% good response moderate responseEffect of Therapy on Bhrama: The present study illustrated that the effect of Shilajatu Guggulu Rasayana onBhrama gives 100% result. As Bhrama is due to Vata and Pitta dosha, the Shilajatuand Guggulu having the rasayana properties hence act on the Vata dosha whereasGuggulu having kashaya rasa act on Pitta dosha., the drug Triphala having theproperties of Pitta hara and madhura rasa hence act on Vata and Pitta. Gomutrahaving the properties of anulomana with madhura and hence give the effect toShilajatu and Guggulu to act on Vata dosha. Like this Shilajatu and GugguluRasayana, helps in regulating Bhrama. In parameter Bhrama Mean ±SD before was 1.2 ±0.8 and after the treatment itis reduced to 0.0 ±0.0 with Mean difference 1.2 and standard of mean 0.147 and testshows more highly significant before and after the treatment as P<0.001.Effect of Therapy on Klama: The present study demonstrated that the effect of Shilajatu Guggulu Rasayanaon Klama gives 86% result. As Klama is due to Rakta dushti, the drug Triphalahaving the properties of Pitta hara and madhura rasa hence acts on Pitta. The Shilajatu Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)157
    • Discussionhaving sheeta guna and Guggulu having kashaya rasa hence acts on Pitta dosha. Bythese properties Shilajatu and Guggulu Rasayana, helps in reducing Klama. In parameter Klama Mean ±SD before was 1.44 ±0.77 and after the treatmentit is reduced to 0.2 ±0.40 with Mean difference 1.2 and standard of mean 0.121 andtest shows more highly significant before and after the treatment as P<0.001.Effect of Therapy on Shirah shoola: The present study revealed that the effect of Shilajatu Guggulu Rasayana onShirah shoola gives 91% result. As Shirah shoola is due to Vata dosha and Raktadushti, , the Shilajatu and Guggulu having the rasayana properties hence act on theVata dosha whereas Guggulu having kashaya rasa and Shilajatu having sheeta gunaact on Pitta dosha. Triphala having the properties of Pitta hara and madhura rasahence act on Vata and Pitta. Gomutra having the properties of anulomana withmadhura hence give the effect to Shilajatu and Guggulu to act on Vata. By theseproperties Shilajatu and Guggulu Rasayana helps in subsiding Shirah shoola In parameter Shira shoola Mean ±SD before was 1.5 ±0.86 and after thetreatment it is reduced to 0.13±0.34 with Mean difference 1.366 and standard of mean0.139 and test shows more highly significant before and after the treatment asP<0.001.Effect of Therapy on Daha: The present study shows that the effect of Shilajatu Guggulu Rasayana onDaha gives 100% result. As Daha is due to Pitta dosha, the drug Triphala having theproperties of Pitta hara and madhura rasa whereas Shilajatu having sheeta guna andGuggulu having kashaya rasa hence acts on Pitta dosha. Therefore Shilajatu andGuggulu Rasayana, regulates Daha. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)158
    • Discussion In parameter Daha Mean ±SD before was 0.2 ±0.48 and after the treatment itis reduced to 0.0 ±0.0 with Mean difference 0.2 and standard of mean 0.0884 and testshows more highly significant before and after the treatment as P<0.001.Discussion on Moorcha: In the present study none of the patient gives the history of moorcha. Itdevelops in the later stage of the hypertension and mostly observed during malignanthypertension, where reduction in blood supply to the brain was established.Effect of Therapy on Systolic hypertension: The present study revealed that the effect of Shilajatu Guggulu Rasayana onSystolic blood pressure gives 92% result. As Shilajatu and Guggulu having themutrala properties hence reduces the blood pressure. In parameter Systolic B.P. Mean ±SD before was 2.4 ±0.62 and after thetreatment it is reduced to 0.2 ±0.55 with Mean difference 2.2 and standard of mean0.121 and test shows more highly significant before and after the treatment asP<0.001.Effect of Therapy on Diastolic hypertension: The present study revealed that the effect of Shilajatu Guggulu Rasayana onDiastolic blood pressure gives 83% result. As Shilajatu and Guggulu having themutrala properties hence reduces the blood pressure. In parameter Diastolic B.P, Mean ±SD before was 0.96 ±0.71 and after thetreatment it is reduced to 0.16 ±0.37 with Mean difference 0.8 and standard of mean0.55 and test shows more highly significant before and after the treatment as P<0.001.Over all response on Subjective and Objective parameters: Net mean results of the therapy on all parameters (all subjective and objectivein to the consideration) showed 92%. This study demonstrated that the effect of Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)159
    • DiscussionShilajatu Guggulu Rasayana on all the parameters. The drug Shilajatu and Gugguluhaving the Rasayana affects hence Vata shamka, whereas Guggulu having kashayarasa and Shilajatu having sheeta guna hence Pitta shamka. Triphala having Pittaharaproperties with madhura rasa hence act on Vata and Pitta dosha. Gomutra having theproperties of anulomana with madhura and hence give the effect to Shilajatu andGuggulu to act on Vata dosha. Therefore by these properties Shilajatu and GugguluRasayana, act on all parameters.Table71: Showing the effect of therapy on Pittavruta udana (Essentialhypertension) Net Result Percentage Net results of all Response therapies (X/N) Systolic B.P. 92% Diastolic B.P. 83% Shirah shoola 91% Klama 86% 92% Good response. Bhrama 100% Daha 100% N=6 X = 552Effect of therapy on Biochemical Parameters:Effect of Therapy on Serum Cholesterol: In parameter Cholesterol Mean ±SD before was 193.81 ±29.22 and after thetreatment it is reduced to 1560.95 ±29.70 with Mean difference 37.63 and standard ofmean 18.298 and test shows more highly significant before and after the treatment asP<0.001.Effect of Therapy on Serum Triglycerides: In parameter Triglyceride Mean ±SD before was 172.94 ±60.41 and after thetreatment it is reduced to 143.0 ±57.43 with Mean difference 41.206 and standard ofmean 4.72 and test shows more highly significant before and after the treatment asP<0.001. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)160
    • DiscussionEffect of Therapy on High Density Lipoprotein: In parameter H.D.L Mean ±SD before was 47.63 ±10.03 and after thetreatment it is reduced to 43.39 ±8.03 with Mean difference 4.813 and standard ofmean 0.66 and test shows more highly significant before and after the treatment asP<0.001. Although HDL is highly significant in statistical analysis but clinically it isinsignificant.Effect of Therapy on Low Density Lipoprotein: In parameter L.D.L. Mean ±SD before was 111.69 ±30.13 and after thetreatment it is reduced to 84.97 ±24.64 with Mean difference 29.09 and standard ofmean 2.974 and test shows more highly significant before and after the treatment asP<0.001.Effect of Therapy on Very Low Density Lipoprotein: In parameter V.L.D.L. Mean ±SD before was 34.54 ±12.10 and after thetreatment it is reduced to 28.54 ±11.46 with Mean difference 8.694 and standard ofmean 0.949 and test shows more highly significant before and after the treatment asP<0.001.Over all effect of therapy on Biochemical Parameters: The present study revealed that the mean difference of Serum cholesterol wasfound 36.86 i.e. lower than the before treatment mean, mean difference of Serumtriglycerides was found 29.94 i.e. lower than the before treatment mean, meandifference of High density lipoprotein was found 4.24 i.e. lower than the beforetreatment mean, mean difference of Low density lipoprotein was found 26.72 i.e.lower than the before treatment mean whereas mean difference of Very low densitylipoprotein was found 06.00 i.e. also lower than the before treatment mean. AsGuggulu is the best drug to act on Serum cholesterol and Serum triglycerides where as Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)161
    • DiscussionGuggulu promotes the High density lipoprotein but in this study High densitylipoprotein mean difference was found 4.24, lower than the before treatment, this maybe due to the other cause. Even though it is highly significant in statistical analysis butclinically it is insignificant. The Low density lipoprotein and Very low densitylipoprotein are the calculation of the rest of lipid profile. Hence the action of ShilajatuGuggulu Rasayana on Lipid Profile has been seen.OVER ALL RESPONSE: Overall in almost all parameter the drug shows highly significant except HDLcholesterol before and after the treatment. Majority of patients showed significantcontrol in the blood pressure. Except HDL, Serum Cholesterol, Serum Triglyceride,LDL and VLDL are significantly reduced. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)162
    • Conclusion ConclusionFollowing conclusion can be drawn from the present study:The symptoms of Pittavruta udana is correlated to certain extent with essentialhypertension.Avarana means the obstruction to movement of Vata, avaraka is the cause forit. In this regard hypertension is compared to that of Pittavruta udana, which ishaving symptoms Bhrama, klama, moorcha daha opined by Acharaya Sushrutaand others Acharya Charaka added ojobhramsha and avasada to the abovesymptoms.Mainly in more than 95% of cases a specific underlying cause of hypertensioncannot be found such patients are said to have essential hypertension.Hypertension usually asymptomatic for the first 10-20 yrs, slowly but surelystrains the heart and damages the arteries often called as silent killer.Hypertension is asymptomatic but is having a direct relation to that ofvasculature. Atherosclerosis and arteriosclerosis are the phenomena, whichaffects the individuals if neglected accounts for morbidity and mortality, whichneeds an effective of careful approach.Dr. Chaudhury great physiologist has mentioned hypertension is an ancientdisease, even Acharya Charaka; the Father of Hindu system of medicinedescribed the condition admirably more than 2500 years ago.In the present study most of the patients had symptoms like bhrama, klama andshirashoola.Among the patients of present study only five had daha as one of the symptom.Moorcha one of the symptom of Pittavruta udana, not observed in any of thepatients. Shilajatu Guggulu Rasayana in Pittavruta Udana (Essential Hypertension)163
    • ConclusionIn the present study 13 patients had the family history of hypertension itsuggests that there is strong involvement of genetic factors.Among the 30 patients 4 patients newly diagnosed and rest 26 patients werepreviously suffering with the hypertension.Life style also have significant role in the manifestation of hypertension as 20patients of the present study had sedentary life style.A minimum of 2 months to maximum of three years chronic was noticed in thepresent study.14 patients had moderate to severe intensity of hypertension.6 patients had the habit of smoking followed by 10 patients had alcoholconsumption as habit which are the triggering factors of hypertension.Even 22 and 20 patients respectively had frequent intake of coffee and tea asthey contain certain triggering factors.In the present study all patients were taking katu rasa pradhana ahara followedby 17 patients were consuming lavana rasa pradhana ahara as which are thepitta, vata and rakta prakopaka rasas.As all patients had involvement of manovaha sroto vikruti as stress and strain isthe strong etiology behind the screen.Shilajatu Guggulu Rasayana is best for the treatment of Avarana.Guggulu is having its effect over atherosclerosis, obesity and is proven anti-inflammatory drug.Guggulu is the best drug to act on Serum cholesterol and Serum triglycerideswhere as Shilajatu is presumed to posses the unique drug for the Dhatu poshanaand Tridosha prashamana. Shilajatu Guggulu Rasayana in Pittavruta Udana (Essential Hypertension)164
    • Conclusion Both Shilajatu and Guggulu having the property of mootrala hence act as diuretics as per modern system of medicine. Diuretic is the first aid in some cases of hypertension. The subjective parameter bhrama and daha shown 100% response, where as shirah shoola shown 91% result and klama shown 86% result. The objective parameters like systolic blood pressure shown 92% result where as diastolic blood pressure shown 83% result in this study. The present study revealed that the mean difference of Serum cholesterol was found 36.86 i.e. lower than the before treatment mean, mean difference of Serum triglycerides was found 29.94 i.e. lower than the before treatment mean, mean difference of Low density lipoprotein was found 26.72 i.e. lower than the before treatment mean whereas mean difference of Very low density lipoprotein was found 06.00 i.e. also lower than the before treatment mean. Overall in almost all parameter the drug shows highly significant before and after the treatment i.e., good response. Net mean results of the therapies (All subjective and objective in to the consideration) = 92% i.e. Good response Totally Shilajatu Guggulu rasayana has shown good response in Pittavruta udana (essential hypertension) in the present study.Suggestion for future study: Present study showed encouraging results. The same study if done with large sample more data can be obtained. Present study showed good response on lipid profile. Further research may show hopeful out come in hyperlipidaemia. Shilajatu Guggulu Rasayana in Pittavruta Udana (Essential Hypertension)165
    • Summary Summary The thesis entitled “Evaluation of the efficacy of “Shilajatu GugguluRasayana in Pittavruta udana” with special reference to Essential hypertension”comprises following parts.1. Introduction2. Objectives of the study3. Review of literature4. Methodology5. Observation and results6. Discussion7. Conclusion1. Introduction: This part includes importance of the disease entity Pittavruta udanacomparison with Essential hypertension with its prevalence and about the importanceof Shilajatu Guggulu Rasayana in all type of Avarana with its individual effects.2. Objectives of the study: It includes importance of Avarana and our acharyas opinion on Pittavrutaudana, effect of Shilajatu Guggulu Rasayana on Avarana with its anti hypertensiveeffects, effects of Essential Hypertension in modern life style, objectives of the study,and reasons behind the selection of drug for this disease.3. Review of literature: This part includes historical review, description of Hridaya in ancient time,review of previous research works, views of Ayurvedic scholars; Review of Pittavrutaudana includes disease etymology description of Avarana with classifications,Description regarding nidana, lakshanas, nidana, poorvaroopa, roopa, samprapti, Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)166
    • Summaryupashaya-anupashaya, pathya-apathya etc., Description regarding the Hypertensionand its classification and different types of treatments. In the drug review descriptionconcerning about the properties and preparation of Yoga.4. Methodology: This includes the selection criteria, study design, plan of the study, subjectiveand objective parameters, posology, preparation of yoga, sample size, literary aspect,criteria of diagnosis, inclusion and exclusion criteria and preparation of drug.5. Observation and result: It includes observation on all demographic data with their percentage andgraphical representation, regarding the observation nidanas, poorvaroopas, lakshanasand results of individual symptoms followed overall response of the treatment.6. Discussion: Shilajatu Guggulu Rasayana vis-à-vis of Essential Hypertension, Discussionon disease review, Discussion on drug review, Discussion on clinical study,Discussion on results, Discussion on the patients of Pittavruta udana (EssentialHypertension) who underwent the trial, Mode of Action of Shilajatu GugguluRasayana.7. Conclusion: This is the last part of the present study. This section comprises of theConclusion on the whole study. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)167
    • Bibilography Bibliography1) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-30/26, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-565.2) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003, Published by: The Association of Physicians of India, pp-453.3) Vaidya Jadavji Trikamji Acharya edited Susrutasamhita, Nidana sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 4th edition 1980, chapter-1/35, Published by Chaukhambha orientalia,Varanasi, pp- 263.4) Brahmanand Tripathi edited Charaka samhita, Chikitsa sthana, Charaka chandrika Hindi commentary, Reprint 2002, Chapter-28/31, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-942.5) Ibid, Chapter-28/61, pp-949.6) Ibid, Chapter28/63, pp-949.7) Ibid, Chapter28/206,207, pp-975.8) Ibid, Chapter28/36, pp-942.9) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-20/11, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-390.10) Yadunandana Upadhyaya edited Madhava Nidana-I, with Madhukosha Sanskrit commentary by Shri Vijayaraksita and Srikanthadatta, with the Vidyotin hindi commentary by Shri Sudarsana sastri, 30th edition 2000, Chapter-17/1, Published by: Choukhamba Sanskrit sansthan Varanasi, pp-346.11) Chetan sangappa minajigi, “Evaluation of the efficacy of Kakubhadi Lehya as Hridya Rasayana in Bhrama (Hypertension)” Dept. of Kayachikitsa, P.G.S.R.C. Shri. D.G.M.A.M.C. Gadag. Year-2002 to 2005.12) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-24/34, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-436.13) Ibid Chapter-24, pp-436.14) Yadunandana Upadhyaya edited Madhava Nidana-I, with Madhukosha Sanskrit commentary by Shri Vijayaraksita and Srikanthadatta, with the Vidyotin hindi commentary by Shri Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) I
    • Bibilography Sudarsana sastri, 30th edition 2000, Chapter-17, Published by: Choukhamba Sanskrit sansthan Varanasi, pp-333.15) Ibid, Chapter-17, pp-348.16) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-24, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-437.17) Ibid Chapter-20/17, pp-39518) Sujit K. Chaudhuri edited Concise Medical Physiology, 5th edition 2004, section-V-9, Published by: New Central book Agency (P) Ltd. Calcutta, pp.-213.19) Anthony S. Fauci, Joseph B. Martin, Eugene Braunwald, Kurt J. Isselbacher, Jean D. Wilson, Dan L. Longo, Stephen L. Hauser, Dennis L. Kasper edited Harrison’s Principles of internal medicine-I, 14th edition 1998, Part 8th section 4-246, Published by: McGraw- Hill Health Professions Division New York. pp-203.20) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited, Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by: Churchill Livingstone Elsavier, pp-551.21) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder, Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter B81, Published by Lippincott Williams & Wilkins, New York, pp-235.22) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003, Published by: The Association of Physicians of India, pp-452.23) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-11/35, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-238.24) Ibid, Chapter-11/43, pp-244.25) Daryl Fox edited Elaine N. Marieb Human anatomy and physiology, 4th edition 1998, Unit- IV, Chapter-20, Published by Benjamin/Cummings science California pp-. 709.26) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited Davidson’s Principles & practice of medicine, edited by 20th edition 2006, Chapter-18, Published by: Churchill Livingstone Elsavier, New york, pp-610.27) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-18/44-47, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-378. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) II
    • Bibilography28) Ibid, Chapter-1/24, pp-9.29) Dr. S. Suresh babu edited Principles and practice of Kayachikitsa-I, 1st edition 2003 Chapter- 14, Choukhambha Orientalia, Varanasi-I , pp-141,142.30) Vaidya Jadavji Trikamji Acharya edited Susrutasamhita, Nidana sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 4th edition 1980, chapter-1/35, Published by Chaukhambha orientalia,Varanasi, pp- 263.31) Sri Harihar prasad pandeyen edited Bhavaprakasha, Udradhah, Vidhyotani namikya bhasha teekya samvrita, 5th edition, Chapter-24/222, Published by: Choukhambha Sanskrit sansthan varanasi, pp-260.32) Ganga sahaya pandeya edited Gadanigraha, Vydyotini hindi commentary, 1st edition 1969, Chapter-21/26, Published by Chaukhambha Sanskrit series, Varanasi-1, pp-474/47533) Yadunandana Upadhyaya edited Madhava Nidana-I, with Madhukosha Sanskrit commentary by Shri Vijayaraksita and Srikanthadatta, with the Vidyotin hindi commentary by Shri Sudarsana sastri, 15th edition 1985, Chapter-22/23, Published by: Choukhamba Sanskrit sansthan Varanasi, pp-419.34) Brahmanand Tripathi edited Charaka samhita, Chikitsa sthana, Charaka chandrika Hindi commentary, Reprint 2002, Chapter-28/223-224, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-978.35) Ibid, Chapter-28/241-242, pp-981.36) Ibid, Chapter-1/1/7-8, pp-5.37) Ibid, Chapter-28/241-242, pp-981.38) Dr. J.L.N. Sastry edited Dravyaguna vijnana-II, 1stedition 2004, S. no.-18, Published by Choukhambha Orientalia Varanasi, pp-116,117.39) Brahmanand Tripathi edited Charaka samhita, Chikitsa sthana, Charaka chandrika Hindi commentary, Reprint 2002, Chapter-1/3/49, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-54.40) Ibid, Chapter-1/3/61, pp-58.41) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-5/8, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 250.42) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/7-8, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 184.43) Ibid, Chapter-30/4, pp-183. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) III
    • Bibilography44) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-26/78-103, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 602.45) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Shareera Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-9/12, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 386.46) Ibid, Chapter-4/34, pp-358.47) Ibid, Chapter-4/32, pp-35848) Dr. Shivprasad Sharma edited Astanga Samgraha, Shareera Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-5/47, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-304.49) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Shareera Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-3/18-19, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp- 389.50) Sri Satyapala Bhisagacharya edited Kashyapa Samhita, Garbhakrantishareera adhyaya, The Vidyotini Hindi Commentary and with Sanskrit Introduction, 3rd edition, Shaloka-5-10, Published by: Chaukhamba Sanskrit Sansthan, Varansi, pp-74.51) Pandit Parasurama Sastri, Vidyasagar edited Sarngadhara Samhita, Prathma Khanda, with the commentary of Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, 6th edition 2005, Chapter-6/9-10, Published by Chaukhambha Orientalia Varanasi, pp-68.52) Pandit Parasurama Sastri, Vidyasagar edited Sarngadhara Samhita, Prathma Khanda, with the commentary of Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, 6th edition 2005, Chapter-3, Published by Chaukhambha Orientalia Varanasi, pp-28.53) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/223-224, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 626.54) Ibid, Chapter-28/221-222, pp-626.55) Ibid, Chapter-28/61-62, pp-619.56) Ibid, Chapter-28/63-64, pp-619.57) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 124. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) IV
    • Bibilography58) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/31, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 617.59) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-15/10, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-531.60) Ibid, Chapter-28/36, pp-617.61) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/11, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 113.62) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 346.63) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/17, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 115.64) Ibid, Chapter-24/15,34, pp-124,126.65) Arun.K.Tiwari, details on Hypertension, Heritage healing, Professional publications pvt. Ltd, Madhurai, May 2002, pp-14.66) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1-3, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 333.67) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 124.68) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-6, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-485.69) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/42-44, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 126. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) V
    • Bibilography70) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-5/8, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 250.71) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/7, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 184.72) Ibid, Chapter-30/3-4, pp-183.73) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Shareera Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-3/13-15, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-388.74) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Shareera Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-4/32, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 358.75) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/5-9, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.76) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-21/10, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 101.77) Ibid, Chapter-21/14, pp-102.78) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/5, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.79) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-20/6, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-156.80) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/7, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.81) Ibid82) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/5, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) VI
    • Bibilography83) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/14, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.84) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/6, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.85) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/4, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.86) Pandit Parashurama Shastri and Vidyasagar edited Sharangadhara Samhita, Poorvakhanda, Anonymous Adhamalla Dipika Sanskrit commentary, Edition 3rd 1983, Chapter-5/27-28, Published by Chaukhambha Orientalia,Varanasi-01, pp-5087) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/4, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.88) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda- Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/6, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.89) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/6, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.90) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-20/6, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-156.91) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/9, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.92) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/17, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.93) Ibid, Chapter-1/17-18, pp-260.94) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/9, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) VII
    • Bibilography95) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/17, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.96) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/7, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.97) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-15/36, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 516.98) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/17-18, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.99) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/13, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-194.100) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-20/7, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-157.101) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-21/10, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 101.102) Ibid, Chapter-21/14, pp-102.103) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/15-16, Published by: Chaukhambha Surbharati Prakashana Varansi, pp- 194.104) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-20/8, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-157.105) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/4,13, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 183,185. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) VIII
    • Bibilography106) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Shareera Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-4/31, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 358.107) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/7 Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 184.108) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-5/8, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 250.109) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/8, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 185.110) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-15/36, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 516.111) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/12, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 185.112) Ibid.113) Ibid.114) B.D. Chaurasia edited Human Anatomy Regional and Applied, Section-2 Chapter-18, Vol-1, 3rd edition, Fourth Reprint 1999, published by: CBS Publishers and Distributors, New Delhi pp-216.115) Ibid.116) Ibid, pp-226.117) Ibid, pp-228.118) Ibid, pp-229.119) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-5/29, Published by Chaukhamba Surbharati Prakashan, Varanasi, pp- 429.120) Ibid121) Ibid122) Raja Radhakanta Deva edited Shabda-Kalpadrum, Part-2, 3rd edition 1967, Published by Chaukhamba Sanskrit Series Office, Varanasi-1, pp- 298. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) IX
    • Bibilography123) Brahmanand Tripathi edited Charaka samhita, Chikitsa Sthana, Charaka chandrika Hindi commentary, Reprint 2002, Chapter-28/24-37, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-939.124) Ibid, Chapter-28/31-32, pp-942.125) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/59, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.126) Dr. S. Suresh Babu edited The Principles and Practice of Kaya Chikitsa (Ayurveda’s Internal Medicine), Vol-1, Edition:1st 2003,Jaikrishnadas Ayurveda Series No. 116, Chapter- 14, Published by Chaukhambha Orientalia,Varanasi-1, pp- 141.127) Ibid, pp-142.128) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/216, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 626.129) Ibid, Chapter-28/215, pp-626.130) Ibid, Chapter-28/215-216, pp-626.131) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-16/47, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-420.132) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-16/30, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-538.133) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/61-71, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.134) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-16/43, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-420.135) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/199-216, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 625.136) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-16/44, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-420. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) X
    • Bibilography137) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/233, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 626.138) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-16/48, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-421.139) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sidhi Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/57, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 686.140) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-5/29, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 429.141) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-16/55, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-540.142) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-17/78-81, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 103.143) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-4/36-37, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 215.144) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-17/78-79, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 103.145) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-4/36, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 215.146) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-1/66-67, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-36.147) Ibid.148) Ibid Chapter-24/5, pp-429.149) Ibid Chapter-1/59, pp-32.150) Ibid Chapter-1/60, pp-32. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XI
    • Bibilography151) Ibid Chapter-24/8, pp-430.152) Ibid Chapter-26/42-2, pp-482.153) Ibid Chapter-26/42-3, pp-483.154) Ibid Chapter-26/42-4, pp-483.155) Ibid Chapter-26/42-5, pp-484.156) Ibid Chapter-26/43, pp-484157) Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol-1, 2nd part, Chapter-2, Reprint 2001, Published by: Chaukhambha Bharati Academy Varansi, pp-142.158) Ibid , pp-139.159) Ibid , pp-138.160) Ibid , pp-147.161) Ibid, pp-140.162) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-1/11-12, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-9- 10.163) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-25/40, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-454.164) Dr. Ravidutt Tripathi edited Astanga Samgrah, Sutra sthana, Saroja Hindi Vyakhya Sahit, Reprint 2001, Chapter-9/29, Published by: Chaukhambha Sanskrit Pratishthan Delhi, pp-193.165) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-26/102-103, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-498.166) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Poorvardham, Tailaverga, Shaloka-2-6, 5th edition 1969, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-779.167) Brahmanand Tripathi edited Charaka samhita, Vimana sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-1/17, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-660.168) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-27/66-86, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-509-511. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XII
    • Bibilography169) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-6/101, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-107.170) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Poorvardham, Sandhanaverga, Shaloka-19-20, 5th edition 1969, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-785.171) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-1/16, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-445.172) Ibid Chapter-16/21, pp-537.173) Brahmanand Tripathi edited Charaka samhita, Vimana sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-5/13, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-699.174) Ibid Chapter-5/14, pp-699.175) Brahmanand Tripathi edited Charaka samhita, Nidana sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-7/4, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-639.176) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-13/23-24, Published by: Chaukhambha Surbharati Prakashana Varansi, pp- 216.177) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles and Practice, Published in 2005, Chapter-2, Published by Taylor & Francis Group, new York, pp-16.178) Brahmanand Tripathi edited Charaka samhita, Shareera sthana, Charaka chandrika Hindi commentary, Reprint 2003, Chapter-3/17, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-872.179) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-24/5, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 114.180) Ibid.181) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003, Published by: The Association of Physicians of India, pp-452. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XIII
    • Bibilography182) Norman M. Kaplan edited Kaplans Clinical Hypertension, 9th copyright 2006, Chapter-3, Printer: Quebecor World –Taunton, pp-173.183) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/5, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 124.184) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/15, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 234.185) Ibid, Chapter-1/18, pp-234.186) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/32, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 73.187) Norman M. Kaplan edited Kaplans Clinical Hypertension, 9th copyright 2006, Chapter-3, Printer: Quebecor World –Taunton, pp-176.188) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-6/5, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 254.189) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-7/27, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 50.190) Ibid, Chapter-24/25, pp-125.191) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Indriya Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-6/41, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 363.192) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/23, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 72.193) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/16-17, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 617.194) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Siddi Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-12/11, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 730. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XIV
    • Bibilography195) Norman M. Kaplan edited Kaplans Clinical Hypertension, 9th copyright 2006, Chapter-3, Printer: Quebecor World –Taunton, pp-182.196) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-1/12, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-5.197) Norman M. Kaplan edited Kaplans Clinical Hypertension, 9th copyright 2006, Chapter- 3, Printer: Quebecor World –Taunton, pp-183.198) Ibid, pp-183.199) Ibid, pp-183.200) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/30-31, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 583.201) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/5, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 124.202) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/56, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 585.203) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/19-20, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 617.204) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-22/5, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 410.205) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 4th edition 1980, Chapter-1/35, Published by Chaukhambha orientalia Varanasi, pp- 263.206) Sri Harihar prasad pandeyen edited Bhavaprakasha, Udradhah, Udradhah, Vidhyotani namikya bhasha teekya samvrita, 5th edition, Chapter-24/222, Published by: Choukhambha Sanskrit Sansthan Varanasi. pp-260.207) Ganga Sahaya Pandeya edited Gadanigraha, Vydyotini hindi commentary, 1st edition 1969, Chapter-21/26, Published by Chaukhambha Sanskrit Series, Varanasi-1, pp-474/475 Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XV
    • Bibilography208) Yadunandana Upadhyaya edited Madhava Nidana-I, with Madhukosha Sanskrit commentary by Shri Vijayaraksita and Srikanthadatta, with the Vidyotin hindi commentary by Shri Sudarsana Sastri, 15th edition 1985, Chapter-22/23, Published by: Choukhamba Sanskrit Sansthan Varanasi, pp-419.209) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-28/223,224, Published by Chaukhambha Sanskrit Sthana Varanasi, pp- 626.210) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16, Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.211) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-169.212) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16, Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.213) Ibid. Chapter-20/14, pp-114.214) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-250.215) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/11, Published by Chaukhambha Sanskrit stahan Varanasi, pp-113.216) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 346.217) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-414.218) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 4th edition 1980, Chapter- 15/13, Published by Chaukhambha orientalia Varanasi, pp- 70.219) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-444. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XVI
    • Bibilography220) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16, Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.221) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/14, Published by Chaukhambha Sanskrit stahan Varanasi, pp-114.222) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-250.223) Ibid, pp-62.224) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/12, Published by Chaukhambha Sanskrit stahan Varanasi, pp-114.225) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-414.226) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16, Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.227) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/11, Published by Chaukhambha Sanskrit stahan Varanasi, pp-113.228) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited, Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by: Churchill Livingstone Elsavier, pp-551.229) Anthony S. Fauci, Joseph B. Martin, Eugene Braunwald, Kurt J. Isselbacher, Jean D. Wilson, Dan L. Longo, Stephen L. Hauser, Dennis L. Kasper edited Harrison’s Principles of internal medicine-I, 14th edition 1998, Part 8th section 4-246, Published by: McGraw- Hill Health Professions Division New York. pp-203.230) Daryl Fox edited Elaine N. Marieb Human anatomy and physiology, 4th edition 1998, Unit-IV, Chapter-20, Published by Benjamin/Cummings science California pp-. 709.231) Anthony S. Fauci, Joseph B. Martin, Eugene Braunwald, Kurt J. Isselbacher, Jean D. Wilson, Dan L. Longo, Stephen L. Hauser, Dennis L. Kasper edited Harrison’s Principles of internal medicine-I, 14th edition 1998, Part 8th section 4-246, Published by: McGraw- Hill Health Professions Division New York. pp-203.232) Ibid. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XVII
    • Bibilography233) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited, Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by: Churchill Livingstone Elsavier, pp-551.234) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-1/8, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-443.235) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/11, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 113.236) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 346.237) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/14, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 114.238) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 346.239) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/13, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 70.240) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/11-16, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 124.241) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/61-62, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.242) Ibid, Chapter-28/61, pp-619.243) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/223-224, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 626.244) Ibid, Chapter-28/227-228, pp-626. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XVIII
    • Bibilography245) Ibid, Chapter-28/222-223, pp-626.246) Ibid, Chapter-28/221-222, pp-626.247) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/233-235, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 626.248) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-5/29, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 429.249) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-16/56-57, Published by: Chaukhambha Surbharati Prakashana Varansi, pp- 206.250) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-16/50, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-421.251) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/208-209, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 625.252) Ibid, Chapter-28/235,236, pp-626.253) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/206- 207,211-212, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 625.254) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/32, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 73.255) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-16/31, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-538.256) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/61-62, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.257) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/241-242, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 627. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XIX
    • Bibilography258) Anthony S. Fauci, Joseph B. Martin, Eugene Braunwald, Kurt J. Isselbacher, Jean D. Wilson, Dan L. Longo, Stephen L. Hauser, Dennis L. Kasper edited Harrison’s Principles of internal medicine-I, 14th edition 1998, Part 8th section 4-246, Published by: McGraw- Hill Health Professions Division New York. pp-203.259) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by: Churchill Livingstone Elsavier, pp-551.260) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003, Published by: The Association of Physicians of India, pp-452.261) Harsh Mohan edited Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee brother’s medical publishers (P) Ltd. New Delhi, pp-708.262) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by: Churchill Livingstone Elsavier, pp-608.263) Ibid.264) Harsh Mohan edited Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee brother’s medical publishers (P) Ltd. New Delhi, pp-708.265) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003, Published by: The Association of Physicians of India, pp-453.266) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles and Practice, Chapter-2, Published in 2005, Published by Taylor and Francis Group, New york, pp-16.267) Daryl Fox edited Elaine N. Marieb Human anatomy and physiology, 4th edition 1998, Unit-IV, Chapter-20, Published by Benjamin/Cummings science California pp-. 709.268) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder, Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter A41, Published by Lippincott Williams & Wilkins, New York, pp-120.269) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles and Practice, Chapter-2, Published in 2005, Published by Taylor and Francis Group, New York, pp-16-17.270) Ibid.Chapter-3, pp-37.271) Ibid.Chapter-14, pp-217. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XX
    • Bibilography272) Harsh Mohan, Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee brother’s medical publishers (P) Ltd. New Delhi, pp-709.273) Ibid.274) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles and Practice, Chapter-14, Published in 2005, Published by Taylor and Francis Group, New York, pp-217.275) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by: Churchill Livingstone Elsavier, pp-609.276) Robert C. Schlant, R. Wayne Alexander edited The Heart, 8th international edition, Copyright 1994, Vol.-2, Chapter-75, Published by McGraw-Hill,Inc Health Professions Division, New York, pp-1397.277) Harsh Mohan, Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee brother’s medical publishers (P) Ltd. New Delhi, pp-709.278) Ibid, pp-708-709.279) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003, Published by: The Association of Physicians of India, pp-453.280) Harsh Mohan, Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee brother’s medical publishers (P) Ltd. New Delhi, pp-709.281) Ibid.282) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder, Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter B101, Published by Lippincott Williams & Wilkins, New York, pp-296.283) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder, Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter C109, Published by Lippincott Williams & Wilkins, New York, pp-322.284) Ibid, pp-323.285) Ibid, pp-324.286) Ibid.287) Ibid.288) Ibid.289) Ibid. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXI
    • Bibilography290) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-2/4, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-358.291) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/66, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-206.292) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/103-104, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 621.293) Sri Satyapala Bhisagacharya edited Kasyapa Samhita, Garbhakrantishareera adhyaya, The Vidyotini Hindi Commentary and with Sanskrit Introduction, 3rd edition, Chapter-16/42, Published by: Chaukhamba Sanskrit Sansthan, Varansi, pp-338.294) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/16, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 115.295) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit Commentary by Indu, Reprint 2006, Chapter-27/4, Published by: Chaukhamba Sanskrit Series Office, Varansi, pp-203.296) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/18, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 125.297) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/13, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 114.298) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-35/6, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 525.299) Ibid, Chapter-4/7, pp-420.300) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/18, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 125.301) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/245, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 627. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXII
    • Bibilography302) Ibid, Chapter-28/75,183, pp-620,624.303) Ibid, Chapter-28/239, pp-627.304) Ibid.305) Ibid.306) Ibid, Chapter-28/198, pp-625.307) Ibid, Chapter-28/240, pp-627.308) Ibid, Chapter-28/239, pp-627.309) Ibid, Chapter-28/245, pp-627.310) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-4/7, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 420.311) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/241-243, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 627.312) Ibid, Chapter-28/183-184, pp-624.313) Ibid, Chapter-28/200-202, pp-625.314) Ibid, Chapter-28/218, pp-626.315) Ibid, Chapter-28/219,221, pp-626.316) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles and Practice, Chapter-23, Published in 2005, Published by Taylor and Francis Group, New york, pp-361.317) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder, Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter B95, Published by Lippincott Williams & Wilkins, New York, pp-276.318) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-25/45, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 133.319) Dr. In Dradeva Tripathi edited Lolimbaraja, Vaidhyajeevanam, prathama vilasa, 10th shloka, 3rd edition 2005, Chawkhambha Orientalia Varanasi, pp-4.320) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/185, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 624. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXIII
    • Bibilography321) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/65, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp-59.322) Dr. Chanderbhooshan jha edited Ayurved Rasashastra, , reprint 2003, Chapter-6, Published by Chaukhambha Surbharti Prakashan Varanasi, pp- 225.323) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-73, First edition 1982, Published by Chaukhambha Orientalia Varanasi, pp-117.324) Pandit Kashinath Shastri edited Rasatrangini,11th edition 1979, Chapter-22/60-61, Published by Motilal Banarsidas Varanasi, pp-582.325) Dr. Chanderbhooshan jha edited Ayurved Rasashastra, , reprint 2003, Chapter-6, Published by Chaukhambha Surbharti Prakashan Varanasi, pp- 225.326) Dr. Indra Dev Tripathi edited Rasaratna Samuchchaya, with Rasaprabha hindi commentary, 2nd edition 2003, Chapter-2/207, Published by Chaukhambha Sanskrit Bhawan,Varanasi, pp- 20.327) Ibid, Chapter-2/208-209, pp-20.328) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-73, First edition 1982, Published by Chaukhambha Orientalia Varanasi, pp-117.329) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/48-49, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 54.330) Ibid, Chapter-1/3/58-59, pp-57.331) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-73, First edition 1982, Published by Chaukhambha Orientalia Varanasi, pp-117.332) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/48-49, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 54.333) Pandit Kashinath Shastri edited Rasatrangini,11th edition 1979, Chapter-22/84, Published by Motilal Banarsidas Varanasi, pp-588.334) Pandit Shiva Sharma edited Ayurveda Prakasha, with the Arthavidyotini and Arthaprakasini Sanskrit and Hindi commentaries, reprinted 1999, Chapter-4/100-104, Published by Chaukhambha Bharati Academy Varanasi, pp- 428.335) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/65, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp-59. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXIV
    • Bibilography336) Pandit Shiva Sharma edited Ayurveda Prakasha, with the Arthavidyotini and Arthaprakasini Sanskrit and Hindi commentaries, reprinted 1999, Chapter-4/126-127-104, Published by Chaukhambha Bharati Academy Varanasi, pp- 433.337) Pandit Kashinath Shastri edited Rasatrangini,11th edition 1979, Chapter-22, Published by Motilal Banarsidas Varanasi, pp-582.338) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm.339) Ibid.340) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Vedanasthapana- 20, Chapter-1, Published by Chaukhambha Bharati Academy Varanasi, pp-54.341) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm.342) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Karpooradiverga-25, 5th edition 1969, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-205.343) Ibid, pp-204.344) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-59, First edition 1982, Published by Chaukhambha Orientalia Varanasi, pp-112.345) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Karpooradiverga-25, 5th edition 1969, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-205.346) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Vedanasthapana- 20, Chapter-1, Published by Chaukhambha Bharati Academy Varanasi, pp-54.347) Ibid, pp-55.348) Ibid, pp-57.349) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm.350) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Vedanasthapana- 20, Chapter-1, Published by Chaukhambha Bharati Academy Varanasi, pp-54.351) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm352) Ibid.353) Ibid.354) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-1, Pratham Khanda, reprint: 2001, Chapter-9, Published by Chaukhambha Bharati Academy Varanasi, pp-99-100.355) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Haritkyadiverda, 5th edition 1969, Shaloka-43, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-12. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXV
    • Bibilography356) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Jawaraghanadiverga-340, Chapter-9, Published by Chaukhambha Bharati Academy Varanasi, pp-753.357) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Haritkyadiverda, 5th edition 1969, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-7.358) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Chenadiverga-93, Chapter-4, Published by Chaukhambha Bharati Academy Varanasi, pp-239.359) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Haritkyadiverda, 5th edition 1969, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-9.360) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Jawaraghanadiverga-340, Chapter-9, Published by Chaukhambha Bharati Academy Varanasi, pp-758.361) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, Haritkyadiverda, 5th edition 1969, Shaloka-43, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-10.362) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/142, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 284.363) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-39/6, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 171.364) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, 5th edition 1969, Mootraverga, shaloka-1-6, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-778.365) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/94,101, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 21.366) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-45/220-221, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 213. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXVI
    • Bibilography367) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, 5th edition 1969, Mootraverga, shaloka-1-6, Published by Chaukhambha Sanskrit Series office Varanasi-1, pp-778.368) Ibid.369) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/32, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 73.370) Pandit Parasurama Sastri, Vidyasagar edited Sarngadhara Samhita, Madhyama Khanda, with the commentary of Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, 6th edition 2005, Chapter-11/94-98, Published by Chaukhambha Orientalia Varanasi, pp-255.371) The Ayurvedic formulary of India, Part-1, 1st edition 1978, Govt.of India, Ministry of Health and Family Planning Department of Health, Delhi, pp-55.372) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, `Sutra Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-21/36, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 106.373) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-17/118, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 105.374) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/8, Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 257.375) Pandit Parasurama Sastri, Vidyasagar edited Sarngadhara Samhita, Prathma Khanda, with the commentary of Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, 6th edition 2005, Chapter-5/25, Published by Chaukhambha Orientalia Varanasi, pp-50.376) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/11, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 113.377) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/59, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 619.378) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/122, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 280. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXVII
    • Bibilography379) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-1/31, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-18.380) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/101, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 278.381) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/25, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 125.382) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/119, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 279.383) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-7/41, Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 52.384) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-3/57, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-50.385) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana, Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint 2007, Chapter-12/1, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-513. Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) XXVIII
    • Table72: Showing Demographic Data Sl OPD Age Sex Religion F.S. M.S. Occ. O.S. Int Diagnosis F.H. Nidra M.V. Diet Vyasana Prkruti. Re.01. 5276 70 M H M M S C S P N D KDKs M T VP GR02. 5285 70 M H M M S C S P N D KDKs M T VP GR03. 5719 58 F H M M S C Mo P N D BD V C VK GR04. 5774 55 M H M M S C S P Y S BKKsSa V TCA VP GR05. 5735 48 M H M M S C Mo P Y D DKs V CA VK GR06. 5892 45 M H P M L C S P N S KDSa M TA VP MR07. 6342 50 M H M M S C Mo P Y D KKsSa M C VK GR08. 6341 40 F M M M S C Mi P N S KKsSa M C VP GR09. 6457 56 M H M M S C Mo P Y D KDKs V TC VP GR10. 6529 66 M H M M S C S P Y S KKsSa M TCSA VK MR11. 6530 58 F H M M S C Mo P Y S DUKs M C VK MR12. 1225 38 M H H M A C Mo P N D BKKs V C VP GR13. 4905 46 F H M M S C Mo P Y S BD M C VK MR14. 5899 55 F M M M S C S P Y S KKsSa M TC VK GR15. 345 55 M H P M L C Mo P Y D BDKs V TSA VP GR16. 347 58 F H M M S C S P N S DU V T PK GR17. 349 65 F H M M S C S P Y D DKsM V TC VP GR18. 494 68 M H M M A C S P N S KKsSaM V T VP GR19. 459 49 M H M M A C S P N D KDUKsSa V C VP GR20. 496 45 M H M M S C S P N D KSaM M TSA VK GR21. 527 57 F M M M S C Mo P N D KUKs M TC VP GR22. 531 44 F H M M S A Mi N Y S BDKs V TC VP GR23. 1219 53 F H M M S C Mo P N D DU V TC VP GR24. 1218 52 M H M M A A S N N S KKsM M CSA VP GR25. 1217 58 M H P M L C Mo P N D BDUM V TSA VK GR26. 1445 48 F H H M S A Mo N N D BKDUM V TC VP GR27. 1435 50 F M M M S C S P N S BDU M C VK GR28. 1442 55 M H P M L C S P N D DKs M TSA PK MR29. 1446 50 M H M M A A Mo N Y D D M TC VP GR30. 1444 60 M H M M A C Mo P Y D KKs M TCA VP GRSex: M- Male, F- Female, Religion: H-Hindu, M-Muslim, FS-Fiscal Status: P-Poor, M- Middle, H- Higher class, Occ-Occupation: S- Sedentary, A-Active, L-Labor,MS-Marital Status: M-Married, OS-Onset: C-Chronic, A-Acute, Intensity: S-Severe, Mo-Moderate, Mi-Mild, Diagnosis: P-Previously diagnosed, N-Newlydiagnosed, FH- Family History of HTN: Y-Yes, N-No, Nidra: S-Sound, D-Disturbed, MV-Mansika Vritanta: B-Bhaya, K-Kopa, D-Deenta,, U-Udvega, Ks-Kshobha,Sa-Samprahara, M-Mada, Diet: V-Vegetarian, M-Mixed, Vyasana: T-Tea, C-Coffee, S-Smoking, A-Alcohal, Prakruti: VP-Vatapitta, VK-Vatakapha, PK-Pittakapha,Re-Remarks: GR-Good Response, MR-Moderate Response.i
    • Table73: Showing Subjective parameters Before and After treatmentSl. OPD Bhrama Klama Shirah shoola Daha MoorchaNo. NO BT AT % BT AT % BT AT % BT AT % BT AT %01. 5276 3 0 100 3 0 100 2 0 100 0 0 - 0 0 -02. 5285 1 0 100 2 0 100 1 0 100 0 0 - 0 0 -03. 5719 2 0 100 2 1 50 1 0 100 1 0 - 0 0 -04. 5774 1 0 100 2 0 100 1 0 100 0 0 - 0 0 -05. 5735 2 0 100 0 0 - 2 0 100 0 0 - 0 0 -06. 5892 1 0 100 2 1 100 3 1 67 0 0 - 0 0 -07. 6342 2 0 100 1 0 100 1 0 100 0 0 - 0 0 -08. 6341 0 0 - 2 0 100 2 0 100 0 0 - 0 0 -09. 6457 1 0 100 2 0 100 0 0 100 0 0 - 0 0 -10. 6529 2 0 100 3 1 67 0 0 - 0 0 - 0 0 -11. 6530 2 0 100 2 1 50 2 1 50 0 0 - 0 0 -12. 1225 1 0 100 1 0 100 2 0 100 0 0 - 0 0 -13. 4905 0 0 - 2 1 50 3 1 67 0 0 - 0 0 -14. 5899 2 0 100 1 0 100 2 0 100 0 0 - 0 0 -15. 345 2 0 100 1 0 100 1 0 100 0 0 - 0 0 -16. 347 2 0 100 1 0 100 2 0 100 0 0 - 0 0 -17. 349 2 0 100 1 0 100 1 0 100 0 0 - 0 0 -18. 494 0 0 - 1 0 100 2 0 100 0 0 - 0 0 -19. 459 1 0 100 1 0 100 2 0 100 1 0 100 0 0 -20. 496 1 0 100 2 1 50 2 0 100 0 0 - 0 0 -21. 527 1 0 100 2 0 100 2 0 100 1 0 100 0 0 -22. 531 1 0 100 1 0 100 1 0 100 0 0 - 0 0 -23. 1219 2 0 100 1 0 100 0 0 - 0 0 - 0 0 -24. 1218 0 0 - 1 0 100 2 0 100 0 0 - 0 0 -25. 1217 1 0 100 1 0 100 2 0 100 0 0 - 0 0 -26. 1445 0 0 - 0 0 - 2 0 100 2 0 100 0 0 -27. 1435 1 0 100 1 0 100 0 0 - 0 0 - 0 0 -28. 1442 1 0 100 0 0 - 2 1 50 0 0 - 0 0 -29. 1446 0 0 100 1 0 100 2 0 100 0 0 - 0 0 -30. 1444 1 0 100 2 0 100 0 0 - 1 0 100 0 0 -BT- before treatment, AT- after treatment, Total- total number of patients,% - percentage ii
    • Table74: Showing Objective parameters Before and After treatmentSL OPD Blood PressureNo. No. Systolic B.P.(S.B.P) Diastolic B.P.(D.B.P) BT AT % BT AT % 01. 5276 3 0 100 % 0 0 - 02. 5285 3 0 100 % 0 0 - 03. 5719 2 0 100 % 2 1 50 % 04. 5774 3 0 100 % 1 0 100 % 05. 5735 2 0 100 % 0 0 - 06. 5892 3 2 33 % 2 1 50 % 07. 6342 2 0 100 % 1 0 100 % 08. 6341 1 0 100 % 0 0 - 09. 6457 2 0 100 % 2 0 100 % 10. 6529 3 2 33 % 2 1 50 % 11. 6530 2 0 100 % 2 1 50 % 12. 1225 2 0 100 % 1 0 100 % 13. 4905 2 0 100 % 2 1 50 % 14. 5899 3 0 100 % 1 0 100 % 15. 345 2 0 100 % 0 0 - 16. 347 3 0 100 % 1 0 100 % 17. 349 3 0 100 % 1 0 100 % 18. 494 3 0 100 % 1 0 100 % 19. 459 3 0 100 % 1 0 100 % 20. 496 3 1 67 % 1 0 100 % 21. 527 2 0 100 % 0 0 - 22. 531 1 0 100 % 1 0 100 % 23. 1219 2 0 100 % 1 0 100 % 24. 1218 3 0 100 % 1 0 100 % 25. 1217 2 0 100 % 0 0 - 26. 1445 2 0 100 % 1 0 100 % 27. 1435 3 0 100 % 0 0 - 28. 1442 3 1 67 % 1 0 100 % 29. 1446 2 0 100 % 1 0 100 % 30. 1444 2 0 100 % 2 0 100 %BT- before treatment, AT- after treatment, Total- total number of patients,% - percentage, SBP- Systolic blood pressure, DBP- Diastolic blood pressure,GR- Good Response, MR- Moderate Responce iii
    • Table75: Showing Lipid Profile values Before and After treatment LIPID PROFILESl. OPD. Cholesterol Triglyceride H.D.L. L.D.L. V.L.D.L.No. No. BT AT BT AT BT AT BT AT BT AT1. 5276 256.5 215.7 154.4 92.9 58.3 50.0 167.4 147.2 30.8 18.52. 5285 165.5 140.9 100.4 118.2 31.8 39.7 113.7 77.6 20.0 23.63. 5719 197.3 201.8 103.5 169.8 57.2 42.8 119.4 125.1 20.7 33.94. 5774 154.6 136.2 123.6 117.1 59.7 55.7 70.2 57.8 24.7 23.45. 5735 177.4 145.3 298.7 190.1 67.5 53.5 50.2 53.8 59.7 38.06. 5892 203.0 147.5 197.9 154.2 59.2 47.8 104.3 68.9 39.5 30.87. 6342 189.1 163.6 194.5 152.8 37.9 35.4 112.3 97.6 38.9 30.58. 6341 172.2 128.1 134.0 101.2 35.4 34.0 110.0 73.9 26.8 20.29. 6457 186.2 133.1 102.6 86.2 37.2 34.0 128.4 81.8 20.5 17.210. 6529 196.0 148.2 196.1 138.1 50.5 48.2 106.3 72.3 39.2 27.611. 6530 146.5 132.1 145.6 86.1 41.9 38.2 75.5 76.6 29.1 17.212. 1225 159.0 132.2 155.0 130.0 50.0 49.4 52.0 57.0 31.0 26.013. 4905 207.5 143.2 118.1 92.1 48.6 45.1 135.3 79.7 23.6 18.414. 5899 218.4 168.2 140.2 122.4 53.7 50.0 136.7 93.7 28.0 24.415. 345 198.7 163.7 192.1 165.2 39.2 35.0 121.0 95.6 38.4 33.016. 347 183.1 148.2 163.6 137.5 32.1 30.0 118.2 90.7 32.7 27.517. 349 210.2 165.1 180.1 132.7 53.7 49.5 120.4 89.0 36.0 26.518. 494 232.0 172.9 192.2 148.2 55.0 52.1 138.5 91.1 38.4 29.619. 459 225.0 232.0 308.0 382.0 35.7 30.3 157.0 125.3 61.6 76.420. 496 223.0 220.0 334.0 218.0 39.3 40.0 116.9 137.0 66.8 43.021. 527 214.1 178.9 221.7 184.2 37.4 35.2 132.4 106.8 44.3 36.822. 531 216.5 159.4 126.0 170.2 55.6 49.3 135.7 76.1 25.2 34.023. 1219 173.2 113.9 168.1 107.2 39.0 32.9 100.5 59.6 33.6 21.424. 1218 192.3 142.7 128.7 92.5 43.5 37.0 123.0 87.2 25.14 18.525. 1217 184.3 130.7 118.7 92.4 40.0 37.2 120.5 75.0 23.7 18.426. 1445 250.1 184.2 248.6 192.1 59.2 55.9 141.2 89.9 49.7 38.427. 1435 185.7 157.2 140.3 137.1 47.4 47.0 110.3 81.9 28.0 27.428. 1442 200.3 153.1 130.9 92.9 55.7 48.2 118.4 86.3 26.18 18.529. 1446 168.5 132.3 201.1 150.9 62.3 55.2 65.9 46.9 40.2 30.130. 1444 128.3 118.2 169.7 135.9 45.0 43.2 49.3 47.8 33.9 27.1BT- before treatment, AT- after treatment, H.D.L- High density lipoproteinL.D.L. - Low density lipoprotein, V.L.D.L. - Very low density lipoprotein,Cholesterol- Total serum cholesterol, Triglyceride- Serum triglycerides iv
    • Table76: Showing Scoring Before and After the Treatment of all the parametersSl. OPD. Scoring Before Treatment (all the parameters) Scoring After Treatment (all the parameters)No No. Bhrama Klama Shirah Daha Systolic Diastolic Total Bhrama Klama Shirah Daha Systolic Diastolic Total shoola B.P. B.P shoola B.P. B.P1. 5276 3 3 2 0 3 0 11 0 0 0 0 0 0 02. 5285 1 2 1 0 3 0 7 0 0 0 0 0 0 03. 5719 2 2 1 1 2 2 10 0 1 0 0 0 1 24. 5774 1 2 1 0 3 1 8 0 0 0 0 0 0 05. 5735 2 0 2 0 2 0 6 0 0 0 0 0 0 06. 5892 1 2 3 0 3 2 11 0 1 1 0 2 1 57. 6342 2 1 1 0 2 1 7 0 0 0 0 0 0 08. 6341 0 2 2 0 1 0 5 0 0 0 0 0 0 09. 6457 1 2 0 0 2 2 7 0 0 0 0 0 0 010. 6529 2 3 0 0 3 2 10 0 1 0 0 2 1 411. 6530 2 2 2 0 2 2 10 0 1 1 0 0 1 312. 1225 1 1 2 0 2 1 7 0 0 0 0 0 0 013. 4905 0 2 3 0 2 2 9 0 1 1 0 0 1 314. 5899 2 1 2 0 3 1 9 0 0 0 0 0 0 015. 345 2 1 1 0 2 0 6 0 0 0 0 0 0 016. 347 2 1 2 0 3 1 9 0 0 0 0 0 0 017. 349 2 1 1 0 3 1 8 0 0 0 0 0 0 018. 494 0 1 2 0 3 1 7 0 0 0 0 0 0 019. 459 1 1 2 1 3 1 9 0 0 0 0 0 0 020. 496 1 2 2 0 3 1 9 0 1 0 0 1 0 221. 527 1 2 2 1 2 0 8 0 0 0 0 0 0 022. 531 1 1 1 0 1 1 5 0 0 0 0 0 0 023. 1219 2 1 0 0 2 1 6 0 0 0 0 0 0 024. 1218 0 1 2 0 3 1 7 0 0 0 0 0 0 025. 1217 1 1 2 0 2 0 6 0 0 0 0 0 0 026. 1445 0 0 2 2 2 1 7 0 0 0 0 0 0 027. 1435 1 1 0 0 3 0 5 0 0 0 0 0 0 028. 1442 1 0 2 0 3 1 7 0 0 1 0 1 0 229. 1446 0 1 2 0 2 1 6 0 0 0 0 0 0 030. 1444 1 2 0 1 2 2 8 0 0 0 0 0 0 0B.P.- Blood Pressurev
    • Table77: Showing Net Response of the Treatment (all the parameters)Sl. OPD BT AT BT AT NET REMARKSNo. No. (SCORE) (SCORE) (%) (%) RESPONSE (%)01. 5276 11 0 100 000 100 GR02. 5285 7 0 100 000 100 GR03. 5719 10 2 100 20 80 GR04. 5774 8 0 100 000 100 GR05. 5735 6 0 100 000 100 GR06. 5892 11 5 100 45 55 MR07. 6342 7 0 100 000 100 GR08. 6341 5 0 100 000 100 GR09. 6457 7 0 100 000 100 GR10. 6529 10 4 100 40 60 MR11. 6530 10 3 100 30 70 MR12. 1225 7 0 100 000 100 GR13. 4905 9 3 100 33 67 MR14. 5899 9 0 100 000 100 GR15. 345 6 0 100 000 100 GR16. 347 9 0 100 000 100 GR17. 349 8 0 100 000 100 GR18. 494 7 0 100 000 100 GR19. 459 9 0 100 000 100 GR20. 496 9 2 100 22 78 GR21. 527 8 0 100 000 100 GR22. 531 5 0 100 000 100 GR23. 1219 6 0 100 000 100 GR24. 1218 7 0 100 000 100 GR25. 1217 6 0 100 000 100 GR26. 1445 7 0 100 000 100 GR27. 1435 5 0 100 000 100 GR28. 1442 7 2 100 29 71 MR29. 1446 6 0 100 000 100 GR30. 1444 8 0 100 000 100 GRGR- Good Response, MR- Moderate Response, MdR- Mild Response, NR– No Response.TOTAL RESPONSE :GOOD RESPONSE - 25MODERATE RESPONSE - 05MILD RESPONSE - 00NO RESPONSE - 00 vi
    • Special Case sheet Department of Post Graduate Studies in Kayachikitsa D.G.M. Ayurvedic Medical College & Hospital GADAG Special case sheet for evaluation of Shilajatu Guggulu Rasayana in Pittavaruta udana w.s.r.to Essential Hypertension Guide: Dr. R.V. Shettar, M.D (Ayu), Scholar: Sanjeev Kumar (Asst. Professor, P.G. Dept of Kayachikitsa.) 1) Name of the Patient 2) Father’s / husband’s name Sl.No 3) Sex Male Female OPD No 4) Age (in years) Birth place IPD No 5) Religion Hindu Muslim Christian Other 6) Occupation Sedentary Active Labor 7) Marital status Married Unmarried 8) Economical status Poor Middle Higher middle Higher class 9) Address Contact No: Pin 10) Selection Included Excluded 11) Schedule Initiation Date Completion Date 12) Result Well responded Moderately responded Mild responded Poor responded Discontinued 13) INFORMED CONSENT I Son/Daughter/Wife of amexercising my free will, to participate in above study as a subject. I have been informed to my satisfaction, bythe attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am alsoaware of my right to opt out of the treatment schedule, at any time during the course of the treatment.EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw ___________________________________________________£À£Àß ¸ÀéEZÉÒ¬ÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞwAiÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtðªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ AiÀiÁªÁUÁzÀgÀÄ aQvÉì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÉÛ£É.gÉÆÃVAiÀÄ gÀÄdÄ/Patient’s Signature Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) I
    • Special Case sheet14) Pradhana vedana: Sl.no. Complaints Present / Absent Duration Fresh < 1 Yrs < 5 Yrs > 5 Yrs 1 Bhrama 2 Klma 3 Shirah shoola 4 Daha 5 Moorcha15) Anubandha vedana: Sl. Complaints Present/Absent Duration no Fresh <1Yrs < 5Yrs > 5Yrs 1 Daha in nabhi and uras 2 Avsada 3 Ati sweda 4 Others16) Adhyatana vyadhi vrittanta: Mode of onset Acute Chronic [Atanka samutpatti] Course of the disease Yrs / Month [Vedana samucchaya] Intensity Mild Moderate Severe Aggravating Traveling Anxiety Emotion Factors [Anupashaya] Stress Physical stress If any other Relieving Rest Tranquilizers [Upashaya] Sleep Anti depressant’s Others17) Poorva vyadhi vrittanta:18) Kula vrittanta: (Write relationship) Heart Disease Cancer Hypertension Thyroid disorders Obesity Hemiplegic Diabetes Any other Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) II
    • Special Case sheet19) Chikitsa vrittanta: Newly Diagnosed Previously Diagnosed Previous Medication Ayurvedic Allopathic Discontinued Drug 1. 2. used Dose Duration Dose Duration Response Controlled Not controlled Oral Yes No Duration Dose contraceptives Anti depressant Yes No Duration Dose20) Vyasna: Smoking Duration Cigarette/Beedi Daily Beedi Frequency of smoking Chain smoker Alcohol Duration Hot drinks / Beer Daily Quantity Occasionally Tea /coffee Tobacco Chewing Duration Quentity21) Vyaktika vrittanta: Nidra Night sleep Hrs. Day sleep Hrs. Nature of sleep Sound Disturbed Dreams Yes No Ahara Vegetarian Madhura Amala Mixed food Rasa Lavana Katu Oil/Ghee predominance Tikta Kshaya Stored food Kostha Krura Madhyama Mrudu Jatharagni bala Manda Teekshna Vishama Sama Occupational history Sedentary Active Labour Work involving any mental stress Yes No If yes Mild Moderate Severe Whether symptoms produced during working hours Yes No Weather symptoms relieved by change of place Yes No22) Rutuchakra vrittanta: (For women) Menopause attained Yes No If yes the age of attainment No.of days of flow Regular Irregular Duration of flow Normal Excessive Scanty Nature of flow Dysmenorrhoea Leucorrhoea Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) III
    • Special Case sheet 23) Mansika vrittanta:Sl. BT AT SI BT AT1 Bhaya (Fear) 5 Deenata (Depression)2 Kopa (Anger) 6 Samprahara (Aggressiveness)3 Mada (Delirium) 7 Kshobha (Irritability)4 Udvega (Anxiety)24) Samanya Pareeksha: Pulse /min Temp °F Respiration rate /min Weight /kgs Height Heart rate /min25) Vishesha pariksha: Fundus of Eye Peripheral pulses Neck vein BMI Pitting Non pitting Oedema Pedal Face Back26) Aturabala pareeksha:Ashta vidha pareeksha :- 1.Nadi Rate Type 4. Jihwa 2.Mala Varna Times/day 5. Shabda Consistency 6. Sparsha 3.Mootra Varna 7. Druk Times/day 8. AkrutiDashavidha pareeksha:- Prakruti Shareerika V P K VP VK PK Sama Sara Twak Rakta Mamsa Meda Asthi Shukra Majja Satwa Samhanana Susamhita Madhyama samhita Heena samhita Satmya Pravara Madhyama Avara Satwa Pravara Madhyama Avara Vyama shakti Pravara Madhyama Avara Vaya Balya Madhya Vruddha Pramana Supramanita Adhika Heena Ahara shakti Abhyvarana Jarana Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) IV
    • Special Case sheet27) Systemic examination:-Cardiovascular system A) JVP Pressure B) Pulse Rhythm Volume Character C) Blood pressure - Standing Sitting Supine In mm/hg Systolic Diastolic Systolic Diastolic Systolic Diastolic Lt. Upper Rt. Upper 1) Shape of Chest wall 2) Other pulsation Para sternal Epigastric Inspection Supra sternal In the neck Second Left space On the right side 3) Dilated veins 4) Scars Sinuses 6) Others 1) Apex beat Palpation 2) Left Parasternal heave 3) Thrills 4) Other pulsation 1) Left second & Intercostal space dullness Percussion 2) Upper border 3) Right border 4) Left border 5) Lower sternal resonance 1) Heart sounds S1 S2 S3 S4 Auscultation 2) Murmur Systolic Diastolic Continuous 3) Rate 4) Rhythm 5) Other soundsRespiratory System:InspectionPalpationPercussionAuscultationAbdomen:Inspection Liver Palpation Spleen Percussion Auscultation Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) V
    • Special Case sheetOther systems (If any):28) Laboratory investigations: Before After Changes observed Serum Cholesterol Serum Triglycerides High Density Lipoprotein Low Density Lipoprotein Very Low DensityLipoprotein Serum Creatinine Fasting Blood Sugar Blood UreaOther Investigations: Before After Changes observed E.C.G. Chest X -Ray29) Chikitsa: Yoga: Shilajatu Guggulu Rasayana. Posology: 6 gms per day in three divided doses. Anupana: Warm MilkMedicine distributions/advises record: Day Date Systolic Diastolic Complaints if any advise 0 7 14 21 30 45 60 Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) VI
    • Special Case sheet Assessment SheetClinical Parameters During treatment schedule Follow upa) Subjective 1 day 7 days 14 days 21 days 30 days F1 F2 45 days 60 days 1. Bhrama 2. Klama 3. Shirah shoola 4. Moorcha 5. Dahab) Objective Blood Pressure 1. Supine 2. Sitting 3. StandingAverage Systolic (SBP)Average Diastolic (DBP) Blood Pressure GradingSystolic (SBP)Diastolic (DBP)c) Lab Investigations BT ATSerum CholesterolSerum TriglyceridesHigh Density LipoproteinLow Density LipoproteinV.L.D.L.Blood UreaSerum CreatinineFasting Blood GlucoseE.C.G.Chest X-RayInvestigators note :-Signature of Guide: Signature of Scholar: (Dr.R.V. Shettar) (Dr. Sanjeev Kumar) Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) VII
    • Special Case sheet SUBJECTIVE PARAMETERSCriteria Score Particulars1) Shirah shoola 0 No pain. 1 Pain tolerable. 2 Not disturb the normal work 3 Disturb the normal work 4 Intolerable.2) Bharama 0 No brama. 1 1-2 episodes in 24 hrs. 2 On physical work. 3 Continuous. 4 Even at rest.3) Klama 0 No klama. 1 Wishes to stand while walking. 2 Wishes to sit while standing. 3 Wishes to lie down while sitting. 4 Wishes to sleep while lying down.4) Daha 0 Nil. 1 Mild. 2 Moderate. 3 Severe. 4 Extensive.5) Moorcha 0 Nil. 1 Transient attack. 2 Unconscious not more than 2 to 3 second. 3 Unconscious less than 30 second. 4 Unconscious less than 1 minute. OBJECTIVE PARAMETERSBlood Pressure 0 Normal. 1 Stage I (Mild). 2 Stage II (Moderate). 3 Stage III (Severe). 4 Stage IV (Very severe).Note:- CLASSIFICATION SYSTOLIC (mm Hg) DIASTOLIC (mm Hg) Optimal <120 <80 Normal <130 <85 High normal 130-139 85-89 HYPERTENSION Stage I. HTN (Mild) 140-159 90-99 Stage II. HTN (Moderate) 160-179 100-109 Stage III. HTN (Severe) 180-209 110-119 Stage IV. HTN (Very Severe) >210 >120 Malignant HTN >200 >140 Joint National Committee of WHO/International society of HTN (ISH) Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension) VIII