MI overview and ayurvedic concept in ayurveda and emergency management of MI through allopathy and ayurveda.

1. Hemanta Gautam
Intern doctor, ACTH,IOM,TU.
1

2. Case scenario
A 75 years old, known diabetic(10 yrs) male patient XYZ from
sindhupalchok was brought to emergency department at TUTH and
was admitted in/to cardiology ward bed # 5 with the c/c of:
Single episode of Sudden, rapid onset severe chest pain, lasting more
than 30 min , radiating towards the medial aspect of his left arm
associated with breathlessness , nausea, heavy perspiration,
Lightheadedness, fever, cold clammy skin.
2

3. EXAMINATION REVEALS
Pulse : 48 bpm , regular, normal rhythm
BP= 115/70
Temperature= 99 degree F
RR= 12/MIN
JVP = N
Apex beat non palpable
Heart sounds muffled
3

4. • What is your most probable diagnosis ?
• What relevant investigation would u do? What complications can
arise if not managed properly?
4

5. Myocardial Infarction
Definition:
MI is defined by the demonstration of myocardial cell necrosis due to significant and
sustained ischaemia.(WHO)
Ischaemia: an inadequate blood supply to an organ or part of the body, especially
the heart muscles.
5

6. Main coronary blood supply
Right coronary artery Left coronary artery
Arises from the aorta behind the right aortic sinus
Supplies
Posterior (inferior) wall of left ventricle
Right ventricle and atrium
SA and AV node
Arises from the aorta behind the left aortic sinus
Supplies
Anterior wall of left ventricle
Anterior two thirds of the inter ventricular septum.
6

7. Etiology
• It occurs usually due to formation of occlusive thrombus at a site of
rupture of an atheromatous plaque in a coronary artery.
7

8. 8

9. The percentages of all deaths caused by heart disease in
2015, listed by ethnicity, race, and sex globally.
• Ref: www.cdc.gov, Centres for Disease Control and Prevention,2015.
9

10. 69%
31%
Risk Factor According To Gender
Male Female
10
Non- Modifiable Risk factors

11. Non- Modifiable Risk factors
0
2
4
6
8
10
12
Over 50 Below 50
Age of Patients
Age of Patients
11

12. 29%
64%
0%7%0%
Race & Ethnicity
Brahmin & Chhetri
Janajati
Madesi
Dalit
Muslim
12
Non- Modifiable Risk factors

13. 13
Modifiable Risk factors
62%
19%
12%
7%
Modifiable Risk Factor
HTN Hyperlipedimia DM Anxiety

14. Pathogenesis
Atherosclerotic coronary artery inflammation
Plaque rupture
Platelet thrombus
Embolisation
Microvascular obstruction and dysfunction
Myocardial necrosis (infarction)
14

15. Clinical features
Symptoms
Chest pain :-
Site: Central and Retro-sternal
Severity: very severe
Onset: Sudden, usually at rest
Duration: Prolonged
Character: Tight, crushing, heavy constricting
Time: greater then 20 min.(if less than 20 min. then chance of angina)
Radiation: Left shoulder, neck, jaw, left arm, ulnar border of forearm and hand, even to
epigastrium and back
Relief: Not by rest or nitrates, only by strong analgesic like morphine
15

16. Associated symptoms
• Breathlessness
• Restlessness
• Anxiety
• Fear of impending death
• Nausea and vomiting
• Sweating
• Collapse or syncopal attack
• Features of complication: Heart failure, shock
• Silent MI in elderly and diabetic patients.
16

17. Physical signs
• Signs of sympathetic activation: pallor, sweating, tachycardia
• Signs of vagal activation: vomiting, bradycardia
• Signs of impaired myocardial function:
Hypotension (B.P. first rises then decreases), Oliguria, Cold periphery
Narrow pulse pressure
Raised JVP
Prominent S3, quiet S1
Gallop’s rhythm (prominent S3 and S4 with tachycardia)
Basal crepitations
• Signs of tissue damage: fever
• Signs of complications: MR, pericarditis
17

18. CLINICAL CLASSIFICATION OF MYOCARDIAL
INFARCTION
• STEMI : infarction due to involvement of obstruction in the branches
of coronary artery
• non-ST elevation MI' (NSTEMI) : infarction due to involvement of sub-
endocardial tissue.
18

19. Differential diagnosis
• Pericarditis
• Myocarditis
• Acute aortic dissection
• Pneumothorax
• Left ventricular failure
• Peptic ulcer disease
• Basal pneumonia
• Angina Pectoris
• Anxiety
• Dyspepsia
• Endocarditis
19

20. 20
Features Angina MI
Chest pain
onset On exertion At rest
severity Less severe Very severe
Duration Short <20min. Prolonged >20min.
Relief Rest and nitrates morphine
Associated features
Nausea,vomiting Absent Present
Sweating Absent present
Pallor absent present
Anxiety Absent or mild Severe anxiety
Chest finding
Chest auscultation Normal Soft heart sounds
Gallop rhythm
Basal crepitation
Leucocytosis,ESR absent Present
Enzymes Normal Raised
ECG Normal or ST depression, T wave inversion. ST elevation,T wave inversion,Pathological
Q wave.

21. Complication of myocardial infarction
(A) Early:
Arrhythmias:
Ventricular fibrillation, Ventricular tachycardia,
Atrial fibrillation, Sinus bradycardia,Heart block
• Post infarction ischaemia (angina)
• Cardiogenic shock
• Pericarditis
• Thromboembolism
• Mechanical complications
Papillary muscle damage, Rupture of interventricular septum,
Rupture of ventricle
21

22. (B) Delayed complications
• Ventricular aneurysm
• Post MI syndrome: (Dressler's syndrome)
3Ps –
• Pericarditis
• Pleural effusion
• Persistent pyrexia
22

23. DIAGNOSIS
• Detailed Clinical History
• Detailed examination
• Relevant laboratory investigation
• Radiological Imaging
23

24. 1) ECG: - ST-elevation (convexity upward)
anterior wall: ST elevation in V1-V6
inferior wall: II,III,aVf ST elevation
Symmetrical T- wave inversion.
Pathological Q- wave
Axis deviation towards opposite site of infarction.
24

25. 2) Plasma enzymes:
• Creatinine kinase myocardial Band (CK-MB) - specific for myocardial
injury.
• 95% sensitive and specific for MI when measured within 24-36 hours
of chest pain.
• Plasma CK-MB begins to elevate at 4-6 hours after the start of pain
and
reaches a peak at 12-24 hours.
25

26. Conditions with raised CK
• Myopathy
• DC shock (Cardioversion)
• Cardiopulmonary resuscitation
• Muscle trauma
• Intramuscular injections
26

27. Troponin: T And I
• Begins to elevate 4-6 hours after start of pain.
• Remains elevated for 1-2 weeks:
• More specific than CK-MB.
27

28. Lactate dehydrogenase (LDH)
• In acute MI, elevations in LDH are detectable at 12 hours after the
onset of chest pain and peak in 24-72 hours.
• LDH levels remain elevated for 10-14 days after infarction
• An LDH-1 to LDH-2 ratio greater than 1.0 is considered evidence of
MI.
28

29. 29

30. • Random Blood sugar, blood urea, serum creatinine, and electrolytes.
• Serum lipid profile.
• Blood: TC, DC, ESR, polymorph nuclear leucocytosis, high ESR
• Chest X-ray:
Pulmonary oedema
Cardiomegaly
Pericardial effusion
30

31. • Echocardiography: To detect regional wall motion abnormalities and
other complication of MI.
• Coronary arteriography and ventriculography
31

32. Management of myocardial infarction
1) Early medical management:
• Accident and emergency
• Thrombolysis
• PCI
• CABG
32

33. ACCIDENT AND EMERGENCY
• Aspirin 150-300 mg+Clopidogrel 300 mg
• Sublingual GTN 0.3-1 mg
• Oxygen nasal cannula 2-4 l/min
• Brief HX
• I.V access + blood for markers
• Analgesic : morphine
• Antiemetics
• Beta blocker if no contraindication
• Calcium channel blocker
• (ACE) inhibitors are administered to patients with anterior wall MI and to patients who
have an MI with heart failure in the absence of significant hypotension.
• ACE inhibitors help to prevent ventricular remodeling (dilation) and preserve ejection
fraction
33

34. Thrombolysis
Streptokinase: 1.5 million units in 100 ml 0.9% Normal saline over 1 hour.(is
contraindicated in NSTEMI) administered within 6-12 hours
Or
Altepase (human tissue plasminogen activator or tPA)
Standard regimen is given over 90 minutes.
Bolus dose 15 mg followed by 0.75 mg/kg but not exceeding 50 mg over 30
minutes and then 0.5 mg/kg but not exceeding 35 mg over 60 minutes.
After 12 hours:
Heparin is used as thrombolytic drug
IV bolus of 60 units/kg (max: 4000 units), THEN 12 units/kg/hr (max 1000
units/hr) as continuous IV infusion 34

35. PCI (Percutaneous Coronary Intervention)
35

36. CABG (coronary artery bypass graft surgery)
36

37. 2) Late management
(a) Risk stratification and further investigation
• Left ventricular function: ECG, Echocardiogram and chest X-ray
• Ischaemia: exercise tolerance test
(b) Routine drug therapy
Aspirin - 150 mg * PO x daily:
B-blockers: Atenolol 50 mg x PO x daily
Nitrate: Isosorbide mononitrate 10-20 mg x PO daily
ACE inhibitors: Captopril 25 mg x TDS
(c) Risk factor modification
• Stop smoking Control weight
• Daily exercise
• Control lipid by reducing intake of fats and Antilipidaemic drugs
• Control of hypertension and diabetes mellitus
37

38. References:
• Davidson’s Principles and Practice of Medicine,23rd edition.
• Harrison's Principles of Internal Medicine, 14th Edition.
• A Textbook of Clinical Medicine, 2016 edition.
• Hutchinson’s Clinical Methods, 24th edition.
• Essentials of medical pharmacology, 7th edition.
• www.google.com
38

39. हृदय-रोग
हृ-हरति- Extracting Aahar (food), Udaka (Water), Prana (Life-oxygen) from external environment.
द- ददाति-Providing Rasa to the whole body
य- यति- in this way Continuing the motion of Rasa, thus maintaining life.
हृ
द य

40. तिदाि
माधव तिदाि २९/१
• आहार
1. अति-उष्ण
2. गुरु
3. कषाय िथा तिक्त पदाथथ तिरन्िर सेवि
• विहार
1. श्रम
2. अतिघाि
3. अध्ययि
4. अतधक तिन्िि
5. वेग-तवधारण

41. तवतिष्ट तिदाि
हृद्रोग विदाि
वाि अति रुक्ष एवं िुष्कान्ि सेवि, अल्प िोजि एवं प्रतमिासि, िोक, ियले ग्रस्ि, अतिश्रम, अतिलंघि
तपत्त अम्ल, लवण एवं तिक्त रस अतिसेवि, अजीणथ िएको बेलामा िोजि, अत्युष्ण आहार सेवि, मध्य पाि,
आिाप सेवि
कफ अति गुरु, तस्िग्ध िोजि,अतििोजि, अतिन्िि, आलस्य एवं अतधक तिद्रा
तितमज तिदोसज हृद्रोगमा घृि,क्षीर, एवं गुड सेवि, ममथ प्रदेिमा ग्रन्थी, अतधक मधुर पदाथथ सेवि

42. सम्प्राप्ति चक्र
स्वप्रकोप तिदाि सेवि आहार-तवहार व्यतििम अतग्िमान्ध्य
साम रस धािुको उत्पतत्त
स्रोिोरोध,धमिी
प्रतििय,धमिी-कातिन्य
उरोरुजा
हृद्रोग

43. तितमज हृद्रोगको सम्प्राति िि
तिदोषज हृद्रोगी तिल,गुड,क्षीर अतिसेवि
हृद-प्रदेिमा ग्रन्थको उत्पतत्त
ग्रन्थीमा रसादीद्वारा क्लेदको
उत्पतत्त
क्लेददेति ग्रन्थीमा तितमको
उत्पतत्त
कृमीद्वारा हृदयको िक्षण
तितमज हृद्रोग

44. हृच्छूल सम्प्राति
तमथ्या आहार तवहार कफ-तपत्त प्रकोप कफ-तपत्तले मागथ अवरोध
वायुको अवरोध
कुतपि वायू रस धािु संग
समुच्छथिा
कुतपि वायु+रस हृदयमा
स्थाि संश्रय
उच्छवासमा अवरोधको
साथै िीव्र िूलको अिुिूति
हृच्छुल

45. सम्प्राति घटक
दोष विदोषज, िात प्रधाि
दुष्य रस,मेद
स्रोिस प्राण-वह, रस-वह
अतधष्ठाि हृदय
स्रोि दुतष्ट संग, तवमागथ गमि
अतग्िदुतष्ट अतग्ि-मान्य
स्विाव तिरकारी

46. भेद
चरक, िाग्भट, माधिविदािको मत-अिुसार सुश्रुत मत-अिुसार
1.वातिक हृद्रोग
2.पैतत्तक हृद्रोग
3.कफज हृद्रोग
4.संतिपातिक हृद्रोग
5.तितमज हृद्रोग
1.वातिक हृद्रोग
2.पैतत्तक हृद्रोग
3.कफज हृद्रोग
4.संतिपातिक हृद्रोग

47. सामान्य लक्षण
• ि.ति.२६/७८
1.रुजा
2.श्वास
3.कास
4.आस्यवैरस्य
5.िृष्णा
6.तववणथिा
7.मूच्छाथ
8.तहक्का
9.कफोत्क्लेस
10.ज्वर
11.प्रमोह
Pain
Dyspnoea
Cough
bad taste
Thirst
Pallor/cyanosis
Syncope
Hiccough
Nausea
Fever
Stupor

48. तविेष लक्षण
Ref:सु.उ.४३, ि.सू.१७, ि.ति.२६, ि.इ.१०, मा.ति.१७, मधुकोि
भेद लक्षण
वातिक आयम्यिे आतिश्यि इव (stretching pain),िोद(pricking pain),तिमथथि(crushing pain),दारण(breaking
pain),स्फोटि(tearing pain),पाटि(cutting pain)
जकडाहट(stiffness),मुछाथ(syncope),वेष्टि, similar symptoms as chest pain,palpitation,angina and MI.
पैतत्तक िृष्णा(polydypsia),ऊष्मा(heat),दाह(burning),िोष(needling sensation),हृदय-क्लम(हृदयक्लमो हृदयाकुलोत्तम
ग्लातिररिी यावि्-मधुकोि/fatigue of cardiac muscles),धुमायि(feeling of smoke in
throat),स्वेद(sweating),मुििोष(dryness of mouth)
िम:प्रवेि(darkness in front of eyes), िेि दाह(burning in eyes),मोह(stupor),संिास(phobia),िाप वृति(increased
temperature), ज्वर(fever), पीि वणथिा(yellowish coloration of body)
कफज गौरव(heaviness), लालाप्रसेक(salivation),अरुति(anorexia),स्िम्ि(stiffness),
अतग्िमादथव(indigestion),मुिमादुयथ(sweet taste),हृदय स्िब्धिा(irregular heart beats), गौरव(heaviness in chest),
तस्ितमििा(feeling of wet cloth around body), कफप्रसेक(productive cough), ज्वर(fever),
कास(cough),िन्द्रा(drowsiness)

49. तविेष लक्षण
Ref:सु.उ.४३,ि.सू.१७,ि.ति.२६,ि.इ.१०,मा.ति.१७,मधुकोि
भेद लक्षण
तिदोषज तवदध्याि तिदोषम् त्वतप सवथतलंगम
तितमज हृद्रोग िीब्र पीडा(excessive pain),कन्दू(itching), उत्कलेद(nausea), तश्िवि (sputum expectoration), िोद (pricking
pain), िूल (myalgia), हृल्लास (nausea), िम:प्रवेस (due to severe anaemia), अरुति (anorexia), श्यावािेििा
(blackish discoloration of eyes/cyanosis), िोथ (oedema), उर प्रदेिमा तहतमक ध्विी symptoms similar to
bacterial endocarditis

50. साध्य-असाध्यिा
• साध्य- वािज,तपत्तज,कफज, िवीि संतिपािज एवं तितमज हृद्रोग
• असाध्यिा- दुबथल रोगीमा उपद्रव एवं अररष्ट लक्षण युक्त

51. उपद्रव
1.क्लम(easy fatigue)
2.अवसाद(depression)
3.भ्रम(giddiness)
4.िोष(emaciation)
मा.ति.२९/७

52. अररष्ट लक्षण
Ref: ि.ई.१०/९
1.स्िैतमत्य(cold clammy skin)
2.आयिाक्ष्य (dilated pupil)
3.िीव्र उरोग्रह(tearing retrosternal pain)

53. Heart diseases described in Ayurveda Comparable heart diseases described in modern medicine
according to symptoms only
क) सिूल हृद्रोग
हृच्छुल
वातिक हृद्रोग
पैतत्तक हृद्रोग
कफज हृद्रोग
सातन्िपातिक हृद्रोग
Heart disease with pain:
Severe angina pectoris
DO
Moderate angina pectoris
Mild angina pectoris
Angina pectoris with myocardial infarction
ि) तितमज पाण्डुजन्य हृद्रोग
तितमज हृद्रोग
Heart disease due to worm infestation and anaemia:
Manifestation of anaemia in heart due to ankylostoma duodenale
ग) सोथयुक्त हृद्रोग
वातिक सोथ
Heart disease with oedema:
Cardiac failure with oedema
घ) श्वासयुक्त हृद्रोग
क्षुद्रश्वास
Heart disease with dyspnea:
Angina pectoris having dyspnea on exertion, mild cardiac
insufficiency.

54. तितकत्सा तसिान्ि
1. तिदाि-पररवजथि
िारीररक एवं माितसक श्रमदेति तवश्राम
आहार सम्बतन्ध तियन्िण
2. संसोधि – दोष, बल, आतदको तविार गरेर
3. िमि तितकत्सा

55. वातिक हृद्रोग
वािज िैलं ससौवीरकमस्िुििं वािे प्रपेयं लवणं सुिोष्णम् ।
मूिाम्बुतसिं लवणैश्च िैलं आिाहगुल्मातिथहृदामयघ्म् ।। (ि.ति.२६/७१)
1.स्िेहि – हररिक्यादी घृि वा पुििथवादी िेल
2.िमि – घृि,सैन्धव वा दिमूल क्वाथ
3.वाि-अधीक-पुष्करमुल,तबजौरा तिम्बु, िुन्िी, किुथर, हररिकी एवं विको कषाय पाि
औषध-योग
रस/भष्म/विवि (मािा-१२५-२५० तम.ग्रा., अिुपाि- उष्णजल)
िागाजुथि रस कल्याणसुन्दर रस
हृदयािथव रस अतकक तपतष्ट
तिन्िामतण रस मुक्ता तपतष्ट
तवश्वेश्वर रस मकरध्वज
तििेि रस जवाहर मोहरा

56. िटी (मािा-२५०-५००तम.ग्रा., जल)
प्रिाकर वटी
िंकर वटी
हृद्रोग वटी
चुणण (मािा- ३-६ ग्राम,अिुपाि- जल/मह)
तपप्पली िुणथ
पुष्करमुल िुणथ
हररिाक्यादी िुणथ
क्िाथ/आसि/अररि (मािा- २०-३० तम.तल.,अिुपाि-जल)
िुन्िी क्वाथ
पुस्करादी क्वाथ
पथ्यादी कल्क
पाथाथयररष्ट

57. घृत (२०-३० तम.तल.,अिुपाि जल )
बल्लि घृि
त्र्यूषणातद घृि
हररिक्यादी घृि
पुििाथवादी िेल
अजुथि घृि बलाय घृि
िाक/अिलेह (मािा-20 ग्रा./अिुपाि-दुध)
च्यविप्राि
वासाअवलेह

58. पित्तज हृद्रोग
तपत्तजः िीिाः प्रदेहाः पररषेििाति िथा तवरेको हृतद तपत्तदुष्टे।
द्राक्षातसिाक्षौद्रपरूषकै न्स्याि् िुिे िु तपत्तापहं अन्िपािम् ।। (ि.ति.२६/९०)
1. लेप,पररिेिि - तििल द्रव्य
2. मृदु तवरेिि
3. मुलेिी िथा कुटकी तमश्री पािीको साथ पाि गराउिे
रस/भष्म/विवि/िटी – वािज हृद्रोग समाि
चुणण (मािा-३-६ ग्रा./अिुपाि-जल)
अजुथि िुणथ
मधुयतष्ट िुणथ
क्िाथ/आसि-अररि
श्रीपिी मधुक क्वाथ
पाथ्यथय-अररष्ट

59. घृत (मािा-१०-३० तम.तल./अिुपाि-उष्णजल )
द्राक्षाय घृि
किेरुकादी घृि
क्षीरिाक (५० तम.तल)
तस्थरादी क्षीर
अजुथिक्षीर पाक

60. कफज हृद्रोग
कफज तस्वन्िस्य वान्िस्य तवलङ्तघिस्य तिया कफघ्िी कफममथरोगे।
कौलत्थधान्यैश्च रसैयथवान्िं पािाति िीक्ष्णाति ि िङ्करातण ।। (ि.ति.२६/९६)
1. स्िेहि-स्वेदि
2. मृदुवमि – वि, एवं िीमको कषाय
3. तिरोधारा
4. तिलातजि रसायि कल्प सेवि
रस/भष्म/िटी/विवि
वािज हृद्रोग समाि
चुणण (मािा-३-६ ग्रा/ अिुपाि- जल/मह)
सुक्ष्म एलादी िुणथ पािातद िुणथ
पुष्करमूल िुणथ कृष्णातद िुणथ
तिवृिादी िुणथ तपप्प्लाल्यादी िुणथ

61. • क्िाथ/आसि/अररि
कटफलादी क्वाथ
दश्मुल क्वाथ
िाक/अिलेह(मािा-20 ग्रा./अिुिाि-दुध,उष्णजल)
उदुम्बरादी लेह
रसायि
तिलातजि रसायि २ िोला

62. तिदोषज हृद्रोग
सतन्िपािजा तिदोषजे लङ्घिमातदिः स्यादन्िं ि सवेषु तहिं तवधेयम् ॥
हीिातिमध्यत्वमवेक्ष्य िैव कायं ियाणामतप कमथ िस्िम्।। (ि.ति.२६/१००
1. लंघि
2. तिदोष िामक आहार तवहार सेवि
3. तवरेिि
िोट: दोषहरुको हीि, मध्य, अधीकिा हेरेर तितकत्सा गिुथपछथ
• रस/भष्म/िटी/विवि(मािा-२५०-५०० वम.ग्रा/अिुिाि-घृत)
वातिक हृद्रोग समाि +मृग तश्रंग िष्म
• चुणण(मािा-३-६ ग्रा./अिुिाि-जल,घृत,मह)
तहंग्वादी िुणथ िागबला िुणथ
पािातद िुणथ
गोधुमपाथथज िुणथ पुष्करमूल िुणथ

63. • क्वाथ/आसव-अररष्ट
पुवथ वतणथि सम्पूणथ योगहरु दोषहरुको अवस्था हेरेर युतक्तपूवथक प्रयोग गिथ सतकन्छ
• घृि/िेल
पुवथ वतणथि सम्पूणथ योगहरु दोषहरुको अवस्था हेरेर युतक्तपूवथक प्रयोग गिथ सतकन्छ
• अवलेह/पाक
गोधुमककुिातद लेह(मािा-१५-२० ग्रा./अिुपाि-दुध)

64. तितमज हृद्रोग
1. स्िेह तमतश्रि मांस, िाि, एवं दतधको साथ तिल िुणथ िीि तदिसम्म सेवि गराउिे
2. पयाथि स्िेहि पश्चाि तवरेिि गराउिे
3. लंघि,पािि, िथा तितमघ्ि औसतधहरुको प्रयोग
• रस/िष्म/वटी/तपतष्ट
पुवथ वतणथि सम्पूणथ योगहरु दोषहरुको अवस्था हेरेर युतक्तपूवथक प्रयोग गिथ सतकन्छ
• िुणथ (मािा-३-६ ग्रा./ अिुपाि- कोष्ण जल/गोमुि)
तवडंगातद िुणथ
पुष्करमूल िुणथ
तपप्पल्यादी िुणथ
पलाि बीज िुणथ

65. • क्वाथ(मािा-१०-२० तम.तल./अिुपाि-जल)
तवडंगाररष्ट
• घृि(१०-३०तम.तल./अिुपाि-उष्ण जल, दुग्ध)
बलाय घृि
अजुथि घृि
• पाक/अवलेह(मािा-20 ग्रा./अिुपाि-घृि/मधु)
तवडंगावलेह
• लौह (मािा-०.५-१ग्रा./अिुपाि-घृि,मधु)

66. Uro basti/Hridaya basti
Uro basti improves the circulation and breathing functions.
Indication: Coronary heart diseases Angina Bronchiectasis Ischemic heart diseases
Cardiomayopathy Asthma and other respiratory disorders.
The reference of Uro Vasti or Uro Basti has been found quoted and explained in the context (chapter) of Bhaktarodha (aversion
towards food) in Yogamrita text and also in Chikitsamanjari.

67. पथ्य ref.िै.र.३३/७८-८३
• आहार
पुराण रक्तिातल, जांगल पिुपतक्षको मांसरस, मूंग, कुलत्थको यूष,िडयूष,काम्बतलक,तलसौडा,
परवल,पेिा, के रा, आम, अिार, अमलिास,ियााँ मूला, एरण्डिैल, आकािको जल,सैंधव
लवण, द्राक्षा, मठ्ठा, िुण्िी, कांजी,िुक्त, िहद, मतदरा, श्वेििन्दि, इमलीको पािक, िाम्बूल,
अम्ल रस, आतद।
• तवहार
स्वेदि, वमि, तवरेिि, बतस्ि, लंघि, तवश्राम आतद।

68. अपथ्य
• आहार
• िदीको जल, िेडाको दूध, कषाय रस, तवरुि अन्ि, ऊष्ण, गुरुपाकी, तिक्त पदाथथ सेवि, पििाक, क्षार पदाथथ,
महुआ, िुष्क िाक आतद।
• तवहार
िृषा, वमि, मूि, अधोवायु, वीयथ, कास, उद्गार, श्रमज श्वास वेग धारण, अश्रु वेग धारण , दािौि, एवं रक्त तवस्रावण
आतद।

69. योग/प्राकृतिक
• प्राि:काल िांगो िुट्टाले हररयो घासमा घुम्िे।
• स्वच्छ हावामा जोर-जोरले गतहरो सांस तलिे।
• हल्का व्यायाम।
• पद्मासि, िवासि, सूयथ िमस्कार आतद योग तियाको अभ्यास।
• प्राणायाम-कुम्िक-रेिक अभ्यास
• Kundalini Yoga: It energizes the Anahata Chakra seated in the heart and thus gives positive
influence on the heart and mind energizing the whole body. Relieves stress and anxiety.

70. आत्यतयक तितकत्सा
• A successful story of Rajvaidya Tapan from Pune, he has
thrombolised 250 AMI patient in last 10 years.
• Medicine and apparatus required:
• Brihat-vata-chintamani ras
• jabaarmohara ras
• Vasantakusumaakar ras
• Vedanantak ras
• Hing
• Leaf of nagarvel(leaf of betel nut)
• Vasti yantra
• Khal
• Gomutra

71. Remove all clothes from body(this process
is done at the spot before the ambulance
arrives)
Apply hing all over chest region and
around lips
Half tea spoon full vasantakusumaakar ras
and half tea spoon full vedannatak vati are
mix with nagarvel leaf(paan) and made
paste and pasted in floor of mouth.

72. Continue….
Ready for vasti
Water (luke warm)+til
oil+lavan+dashmul+gomutra
Repeat the vasti process until the
patient becomes conscious
After the patient is conscious and stable
give 250ml of til oil per orally.

73. After patient is stable, he is shifted to hospital and all the diagnostic procedure
are done and he is kept under observation with regular ECG and cardiac injury
marker monitoring.
3 days regimen after stabilization of patient:
1.Brihatvatachintamani ras 3 vati 2 hourly
2.Vedanantak ras 3 vati 2 hourly
3.Arjunarista+ashokarishta 50ml+50ml neat TDS before food.
4.Hemjal (gold preparation) 5 drops 2 hourly
(ras tarangini/swarna tarang adhaya)
After 3 days stop 1. and 2. then start for 7 days :
1.Javahaarmohar ras 2 vati BD
2.Chatu:Shashti Pippali 2 vati BD
3.Dashmoolarishta 30ml BD before food
4.Manjishtaadi kaadaa/rasnaadi kaada 40ml BD

75. Reference : Cyril Tarquinio, A Focus on Adverse Childhood Experiences (ACEs), European Journal of Trauma &
Dissociation, 10.1016/j.ejtd.2020.100181, 4, 4, (100181), (2020).Crossref 75

76. Safety of coffee consumption after myocardial
infarction: A systematic review and meta-analysis
• longitudinal studies evaluating the impact of coffee consumption in
patients with previous myocardial infarction
• Consumption of coffee was not associated with an increased risk of
all-cause mortality and cardiovascular events in patients with
previous myocardial infarction.
Ribeiro, E. M., Alves, M., Costa, J., Ferreira, J. J., Pinto, F. J., & Caldeira, D. Safety of coffee consumption after myocardial
infarction: A systematic review and meta-analysis. Nutrition, Metabolism and Cardiovascular Diseases. 2020.
doi:10.1016/j.numecd.2020.07.016
76

77. References:
• पं.राजेश्वरदत्त िाश्िी, िरकसंतहिा, िौिम्बा िारिी एकेडेमी,२०१८.
• आिायथ तवयाधर िुक्ल ,िरकसंतहिा, िौिम्बा संस्कृि प्रतिष्ठाि,२०११.
• डा.ब्रह्मािन्द तिपािी ,माधवतिदािम्, िौिाम्बा सुरिारिी प्रकािि,२०१८.
• डा.कातििाथ समगंडी, स्वस्थवृत्त सुधा, आयुवेद संस्कृि तहतन्द पुस्िक िण्डार, २०१७.
• आिायथ तप्रयव्रि िमाथ, डा.अिन्िराम िमाथ,सुश्रुिसंतहिा, िौिाम्बा सुरिारिी प्रकािि,२०१९.
• प्रा.रामहषथ तसंह, कायतितकत्सा, िौिम्बा संस्कृि प्रतिष्ठाि,२०१६.
• प्रा.अजय कुमार िमाथ, कायतितकत्सा, िौिम्बा संस्कृि प्रतिष्ठाि,२०१६.
• Prof. (dr.) S. Suresh Babu, The Principles and practice of kaya chikitsaa , 2016.
• Jain, S., Yadav, P.P., Gill, V. et al. Terminalia arjuna a sacred medicinal plant: phytochemical
and pharmacological profile. Phytochem Rev 8, 491–502 (2009). https://doi.org/10.1007/s11101-
009-9134-8
• https://www.youtube.com/watch?v=jBOvm2gxbu8
• www.google.com

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