“Evaluation of the effect of Vachamamsyadi yoga in Raktapeedanadhikyata (Hypertension)” Thesis submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of regulations for the Award of the degree of DOCTOR OF MEDICINE (AYURVEDA VACHASPATHI) By Shivakumarayya .S. Hiremath Guide Dr. Ch. Ranga Rao. M.D. (Ayu) Professor and Head of the Department Post Graduate and Research Center D. G. M. Ayurvedic Medical College, Gadag. Co-Guide Dr. Siva Rama Prasad Ketamakka. M.D. (Ayu) Reader in Kayachikitsa Post Graduate and Research Center D.G.M. Ayurvedic Medical College, Gadag. POST GRADUATE AND RESEARCH CENTRE (KAYACHIKITSA) D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG. 1997-2001
Evaluation of the effect of Vachamamsyadi yoga in Raktapeedanadhikyata (Hypertension), Shivakumarayya .S. Hiremath, Post Graduate Studies & Research Center, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
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“Evaluation of the effect of Vachamamsyadi yoga in Raktapeedanadhikyata
(Hypertension)”
Thesis submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
In partial fulfillment of regulations for the Award of the degree of
DOCTOR OF MEDICINE
(AYURVEDA VACHASPATHI)
By Shivakumarayya .S. Hiremath
Guide
Dr. Ch. Ranga Rao. M.D. (Ayu)
Professor and Head of the Department Post Graduate and Research Center
D. G. M. Ayurvedic Medical College, Gadag.
Co-Guide Dr. Siva Rama Prasad Ketamakka.
M.D. (Ayu) Reader in Kayachikitsa
Post Graduate and Research Center D.G.M. Ayurvedic Medical College, Gadag.
POST GRADUATE AND RESEARCH CENTRE (KAYACHIKITSA)
D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG.
1997-2001
Ayurmitra
TAyComprehended
This is to certify that Shivakumarayya .S. Hiremath (M.D. (Ayurveda) Kayachikitsa), has worked for his thesis on the topic entitled
“Evaluation of the effect of Vachamamsyadi yoga in Raktapeedanadhikyata (Hypertension)”.
Cl inical tr ials are done under my supervision and guidance.
This thesis makes a dist inct advance on scient i f ic l ines in the above
subject and the f indings are highly signif icant at the stat ist ical
evaluation and have considerably contributed to the present
knowledge of the subject.
I am ful ly satisf ied with his or iginal work and hereby forward the
thesis for the evaluat ion of adjudicators.
Co-Guide
Dr. Siva Rama Prasad Kethamakka M.D. (Ayu) (Osm)
Reader in Kayachikitsa
Head of the Department
Postgraduate and Research Center (Kayachikitsa)
D.G.M. Ayurvedic Medical College, Gadag.
This is to certify that the contents of this thesis entitled “Evaluation of the effect of Vachamamsyadi yoga in Raktapeedanadhikyata (Hypertension)” has been worked out by Shivakumarayya .S. Hiremath,
under my supervision and close guidance and co guidance of Dr. Siva Rama
Prasad Kethamakka, M.D. (Ayu) (Osm).
Even though this disease, Hypertension has not been mentioned in
Ayurvedic texts, the etiology, pathogenesis etc., as developed and explained by
Shivakumarayya .S. Hiremath is unique and scientific and will definitely help in
explaining the disease in Ayurvedic parlance and further planning the
management.
This work is applied, scientific and an original contribution in the field of
research in Ayurveda.
I am fully satisfied with the work and recommend the thesis to be put
before the adjudication.
Guide
Dr.Ch.Ranga Rao M.D. (Ayu) (Osm)
Professor and head of the department Post graduation and research center
Kayachikitsa D.G.M. Ayurvedic Medical College, Gadag.
Acknowledgement
I am highly indebted to my guide Dr. Ch. Ranga Rao H.O.D. post graduate and
research center in Kayachikitsa, shri D.G.M Ayurvedic Medical College, Gadag for his
valuable suggestions and guidance in completing this work successfully.
I have my hearty acknowledgement to my co guide Dr. K.Siva Rama Prasad, for
his guidance, supervision and suggestions for the early completion of this research work.
I am thankful to Dr. G.B. Patil principal shri D.G.M Ayurvedic College Gadag for
his help during my study.
I am also indebted to Dr. Ashok kumar panda and Dr. M.C patil, lecturers P.G
Department of Kayachikitsa for their suggestions and comments in this study.
I wish to convey thanks to my teachers Dr. G.S Juktihiremath, Dr. C.M
Sarangamath, Dr. S.A patil, Dr. G.S Hiremath, Dr. C.S Hiremath, Dr. U.V Purad, Dr. V.M
Malagoudar, Dr. R.K Gacchinamath, Dr.B.G Swamy, Dr. S.S Avvani and all other U.G
lecturers for their help and suggestions during my post graduation studies.
I wish to thank Dr. V.S Hosamath, physician in Gadag for his help during my
study.
I sincerely thank my beloved classmates Dr. V.B Kotturshetter, Dr. A.S Patil,
Dr.(Smt) Yashoda Mudigoudar, Dr. S.T Hombal, for their deep co operation and
involvement in the P.G study.
I am also thankful to all my post graduate colleagues Dr. B.M Mulkipatil, Dr.
R.Y.Shettar, Dr. J.I Hiremath, Dr. Suresh R.D, Dr. S.K Tiwari, Dr. C.V. Rajashekar,
Dr.Shyal kumar, Dr. Jayaprakash, Dr. Anil Kumar Bacha, Dr. V.N. Kulkarni and Dr. D.
Sitarama prasad, for their constant cooperation and help.
I am highly indebted to my beloved parents Mr. and Mrs. Shankarayya, T.
Hiremath and to my Uncle Dr. S.T Hiremath, my brother Totayya, Chandru and sisters
Dr. Vijjaya lakshmi, Mangala, Geeta and Shaila, for their love and affection rendered
throughout my career.
I wish to convey my thanks to beloved shri V.M Mundinamani and Mr.S.B.
Sureban for supplying me essential references in the study.
I wish to thank the physicians nursing of the hospital and their co-operation.
I thanks to Mr. P.M. Nanda kumar for his help in the statistical evaluate.
I wish to convey my thanks to beloved Dr. S.H. Doddamani, K.B.Stavaramath,
J.V. Aravanashi, Veeresh Kumbar and K.H.Surakoda for their encouragement and help.
I thanks to my beloved patients who are involved constantly in this clinical study
and obliged my advise by which this study able to get finished in stipulated time. I
express my thanks to the persons who directly or indirectly helped me in the study.
Lastly I pay my deep homage and tribute to my former teacher late Prof. Dr.
V.V.S. Sastri for his selection of this valuable project.
Shivakumarayya .S. Hiremath
“Evaluation of the effect of Vachamamsyadi yoga in Raktapeedanadhikyata (Hypertension)”
By Shivakumarayya .S. Hiremath Under the guidance of Dr.Ch.Ranga Rao
And Co-Guidance of Dr.K.Siva Rama Prasad Section - I Introduction Definition
Physiological out look of “Blood pressure”
Hypertension in Ayurveda
Proposal
Historical review
Pages: 1 to 10 Ama in hypertension
Srotas in hypertension
Focus on the title
Contents of the thesis
Influence of neurosis (Vata) in hypertension
Section - II Literary review
Shareera
Introduction
Dosha and Dooshya
Concept of dosha in relation to
Hypertension
Dushya and srotas
Agnimandya
Dietetic causes
Behavioral causes
Other causes
Hridaya (heart)
Nirukti of hridaya
Embryological development
Surface anatomy
Inner view of the heart
Spandana of Hridaya
Interference of Pleeha with hridaya
Pages: 11 to 31 Circulation of the blood
Internal transport system of
the body
Pranavata
Location of pranavata
Functions of pranavata
Sirasthita pranavata
Urahsthita pranavata
Vyanavata
Location of vyanavata
Functions of the Vyanavata
Functions of the heart
Rasavahasrotas
Rakta peedana
Srotavaigunya
Contents
Nidana
Definition of Hypertension
Raktagavata
Raktavrita vata
Siragata vata
Bhrama
Roudhira Mada
Raktapradoshaja vikaras
Avruta Vata
pittavrutha prana vayu
Pittavruta udana vata
Murcha
sanyasa ( coma)
Dhamani pratichaya
Classification of hypertension
Symptomatic classification of hypertension
Labile hypertension
Stable hypertension
Classification by blood pressure (level)
readings
Mild hypertension
Moderate hypertension
Severe hypertension
Classification by severity of vascular lesions
Stage I
Stage II
Stage III
Classification by etiology
Essential hypertension
Secondary hypertension
Classification by age groups
Juvenile hypertension
Hypertension in the elderly
Pages: 33 to 62
Epidemiology of hypertension Prevalence
Level of pressure
Genetic Influences
Environmental Influences
Geographical aspects
Age and Sex in Hypertension
Hypertension and body weight
Pathophysiology
Primary hypertension
Primary (essential) hypertension
Genetic factors
Dietary influences
Sodium chloride intake
Protein intake
Alcohol
Soft water
Psychological factors
Haemo dynamic changes
Neural changes
Secondary hypertension
(Hypertension with identifiable cause)
Hormonal contraceptives
Hypertension due to organic
disease
Clinical features of hypertension
Differential diagnosis of hypertension
Renal hypertension
Primary aldosteronism
conn’s disease
Cushing’s syndrome
Contents
Chikitsa
Management of hypertension General stagetegy
Weight reduction
Salt restriction
Smoking
Relaxation techniques
Chikitsa in Ayurveda
Management with drugs
Steps care treatment of hypertension
Mild hypertension Vasodilators
Diuretics
Beta-blockers
Calcium antagonists
Angiotensin convertor enzyme
Inhibitors
Antiadrenergic drugs
Pages: 63 to 82
Reserpine
Alpha methyldope
Guanethidine
Clonidine
Labetolol
Choice of anti hypertensive drugs (in special situations)
Hypertension in children
in the elderly
in pregnancy
in ischaemic heart disease
in cardiac failure
in renal insufficiency
Pathya and Apathya
Section - III Material and methods Pages: 83 to 114 Drug review
Composition of vachamamsyadi yoga
Punarnava (Boerhavia diffuse Linn.)
Gokshura(Tribulas terrestris Linn.)
Jatamamsi (Nordostachys jatamansi DC.)
Vacha (Acorus calamus Linn.)
Drug preparation
Storage of vachamamsyadi yoga
Posology
Review of methodology Observations
Section - IV Discussion and conclusion Pages: 115 to 134
Summary
Section - V Present trends and Bibliography
Contents
List of Charts Chart number – 1
Demographic data for “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Chart number – 2
Complaints for “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Chart number – 3 Diet and drug history in “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Chart number – 4
Emotional status and Family history in “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Chart number – 5
Assessment in “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)” Systolic hypertension
Chart number – 6
Assessment in “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)” Diastolic hypertension
Chart number – 7
Statistical Assessment in “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Chart number – 8
Significance table of “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Contents
List of Figures
Figure no 1:
Graphical demonstration of Decreased systolic Hypertension in regular intervals In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure no 2:
Graphical demonstration of Decreased diastolic Hypertension in regular intervals In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure no 3:
Showing sex ratio In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure no 4:
Religion distribution In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 5: Occupation distribution In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 6:
Economical status distribution In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 7:
Diet distribution In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 8:
Group study In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Contents
Figure number 9: Chief complaints In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 10:
Associated features In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 11:
Diet and drug history In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 12:
Emotional status In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 13:
Family history In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Figure number 14:
Result In the “Evaluation of the effect of Vachamamsyadi yoga in Rakta peedanadhikyata (Hypertension)”
Hypertension most commonly heard clinical state in the older age groups of
patients. They suffer with the risen arterial blood pressure giving rise the signs and
symptoms such as giddiness or dizziness (Bhrama), headache (Sirahsoola), fatigue
(Angasada), insomnia (Nidranasha) and palpitation (Hritdrava). An Ayurvedic
practitioner get confused as the nomenclature of Hypertension was not included in
classical texts and neither of Acharyas has affirmed such a condition elaborately.
The Hypertension, called as “Salient Killer”, drawn the attention of W.H.O. in
1978 and declared that year as “Hypertension year”. This disorder definitely has its
action over decreasing the life span by 10 to 20 years causing cardiac and renal
troubles. Further it can be said it is an important factor in increasing the morbidity and
mortality due to the cardiovascular pathology.
DEFINITION:
The definition of Hypertension is as follows. “Abnormally high tension,
especially a state of abnormally increased blood pressure with Electro cardiograph
evidence of cardio arterial derangement (left ventricular preponderance)”1 and
vernacularly “abnormally high blood pressure” and “great emotional tension”2. Other
wise it is as abnormally increased blood pressure exerting on the arterial and
arterioles more then 120mm Hg systolic and 80-mm Hg diastolic pressures. The
WHO has recommended that blood pressure of 160/95 mm Hg or above in adults
should be considered as Hypertension.
Introduction 1
As there is no definitive definition universally accepted, the joint National
committee (JNC-4) of United states on detection, evaluation and treatment of high
blood pressure defines Hypertension as systolic blood pressure (SBP) of 140 mm Hg
or more and diastolic blood pressure (DBP) of 90 mm Hg or more.
Table 1
Classification of BP in Adults aged 18 years or older 3
Diastolic Blood pressure
BP range Category #
< 85 Normal Blood pressure
85 to 89 High normal Blood Pressure
90 to 104 Mild Hypertension
105 to 114 Moderate Hypertension
> 115 Severe Hypertension
Systolic Blood pressure when DBP< 90
BP range Category
< 140 Normal Blood pressure
140 to 159 Borderline systolic Hypertension
> 160 Isolated Systolic Hypertension
# A Classification of borderline is isolated systolic hypertension (SBP 140-159 mm Hg) or Isolated hypertension (SBP>160 mm Hg ) takes precedence over high normal BP (DBP 85-89 mm Hg ) when both occur in the same patient. High normal BP (DBP 85-89 mm Hg) takes precedence over a classification of normal BP (SBP 140 mm Hg) when both occur in the same patient.
Introduction 2
Blood pressure is a continuous physical variable and is complex, being
influential by many factors. An individual can show variations through out the day
depending on physical activity, body posture, mental activity, emotional status, the
environment and consumption of drugs, alcohol and tobacco. Dynamic or isometric
exercise can also risk blood pressure in normal subjects.4
Physiological out look of Definition “Blood pressure”:
Blood pressure is generated by cardiac out put which is determined by the
rate and force of heartbeat and the resistance to the flow of blood through vessels5 in
the arterial system and the viscosity of blood6. Apart from it is the resultant of a
number of forces, among the chief of which are the contractions of the heart and the
peripheral resistance provided by the arterioles, although the elastic recoil of the
large arteries and the state of capillary bed are also of importance7.
Hypertension in Ayurveda:
Ayurveda is based on the humoral theory and establishes that the Tridoshas
have its effect over the body. These humors move all over the body. The Vata, Pitta
and Kapha rule the ages of child, youth and old age8. It also has its effect on the
divisions of the day and night, and also to the food; where dosha vitiation is seen
naturally contributed by the external factors.
While describing the diseases developed by the doshas exclusively in
Charaka samhita Sutra stana under the heading of Nanatmaja vyadhi, explained
Introduction 3
eighty varieties of vataja, forty varieties of Pittaja and twenty varieties of Kaphaja
vyadhis9.
As there is no specific nomenclature available in relation to Hypertension from
classical textbooks, we have to see the corresponding Disease State from various
Ayurvedic textbooks. Charaka has very clearly expressed all the disease and
disorders or states of illness, may not be known with specific nomenclature, but
grouped under particular modalities of classification. There by no definitive and
permanent name can be attributed to a particular condition as it is expected to
change with time to time according to its presentation. Thus by understanding the
dosha state, site of appearance and its signs and symptoms, we have to come for
conclusion and treat the state of disease or illness on the basis of vikalpa i.e.
combinations and permutations of doshas10.
Different names are recommended for the Hypertension or the Hypertensive
States are as follows –
1. Bhrama
2. Dhamani pratichaya
3. Mada
4. Moorcha
5. Pittavrita udanavata
6. Rakta gata vata
7. Raktachapadhikyata
8. Raktapradoshaja vikara
9. Raktavriddha pittavrita vata
10. Roudhiryamada
Introduction 4
11. Sanyasa
12. Siragata vata
13. Ucha rakta bhara
14. Ucha rakta chapa
Proposal:
But when the lakshanas of Hypertension are observed with its
pathophysiology, the present proposed name “Raktapeedanadhikyata” will be
relatively clear to explain state of Hypertension.
As Charaka explained, there may be only one cause for one disease or same
cause may give rise many diseases. Some times we may find so many causes gives
rise or develops one disease or many causes develops many diseases11. Thus, the
present selected disease has many synonyms, according to the state of development
of the disease or with respect to that of the disease development.
The Vata nanatmaja vyadhi consists of three conditions that appear in the
process of Hypertension pathogenesis. They are Hritdrava (palpitation), Bhrama
(Dizziness) and Aswapna (sleeplessness)12. The appearance of the above said in
Vata age and rutukala is of physiological and if it appears with Pitta and Kapha
association or age and rutukala, it becomes pathological. If Dhamani pratichaya
(atherosclerosis)13, one out of twenty Kaphaja diseases appears or associates with
the aging factor have more responsibility to give rise Hypertension or
Raktabharadhikyata.
Introduction 5
Historical review:
In ancient days the Hypertension was not described as an individual disorder.
It may be because of less prevalence as they followed strict daily and seasonal
regimens and also not much psychological interference in daily routine. But they
were not ignorant of the conditions developed by the psychological pressure
disturbances. There by they placed them under the nanatmaja vyadhis, related to
their cause and mode of development. Much more such symptoms are explained and
tagged with Vata, which can be said as that to be under neural control impairment
and very few conditions are with Pitta and Kapha.
Until 1920’s, Hypertension was considered that as beneficial, even through in
1733 Stephen Hales measured first time Atrial blood pressure. He demonstrated in a
dramatic fashion, that the blood in arteries is under a great deal of pressure. His work
was published by Royal society in 1733 as two volumes.
The instrument developed by Stephen Hales14 was improved by Karl Ludwig
(1816-1895) improved the Instrument developed by Stephen Hales by adding a float
in the measuring cylinder. Karl Vierodt (1818-1884) constructed a sphegmograph
tracking the human pulse, which estimates the blood pressure by puncturing the
vessel. It was difficult and also painful for the patient. This method was greeted by
British medical journal and followed by Samual Von Bach (1880) and later developed
by Scipione Riya Rocci in 1896.
Introduction 6
In 1905, Karokoff a Russian, introduced the auscaltatory method of estimating
blood pressure. With in few years Sphegmamanometer took place with the
stethoscope. The mercury column and spring dial sphegmamanometers were
introduced in 20th century. Late 20th century with advancements in electronics has
presented digital sphegmamanometer to the medical community apart from ECG and
Doplar studies, which will provide scope to measure, blood pressure15.
Influence of Neurosis (Vata) in Hypertension:
In 1965, Myas Nikov contended that the under lying factor of Hypertensive
disease is neurosis, as the term is interpreted by Pavlov. According to this
hypothesis, the principle etiological factor of hypertensive disease is psychological
over strain leading to impaired regulation of the vascular tone. This hypothesis is at
the support of Ayurvedic dosha, Vata interference in producing
Raktapeedanadhikyata. But at present it lost its popularity as contemporary clinicians
regard essential hypertension as a disease of uncertain origin16.
Ama in Hypertension:
Ayurveda speaks about dhamanipratichaya (arteriosclerosis) as an
associated condition with hypertension responsible for 30% of population suffering
from hypertension. The rest of 70% are solemnly under the neurotic control or may
be associated with Pitta other wises the Agni17, which is the most common cause of
initiating a pathological state by diminishing. Diminished Agni causes Ama18, and that
Ama, an endotoxin equaling to that of poison causes the pathology either localized or
generalized.
Introduction 7
Srotas in Hypertension:
Out of the samprapti ghatakas, the srotas is very important. Here in
hypertension the Raktapeedanidhikyata, the hridaya as organ and corresponding
rasvahasrotas as the srotas involved has been expressed the hridaya corresponds to
thoracic heart along with arteries attached with hridayam and dasha dhamani). With
the above Myasnilkov’s statement even sirohridaya i.e. brain (neural control) with
cranial nerves and its involvement can be thoroughly discussed. But as hridaya
(thoracic), especially the left ventricle of the heart counters the increased resistance
in areterial blood pressure and also leads to its hypertrophy which is manifested at
first by intensified apex beat, rounded left ventricular apex and characteristic ECG
changes19. We can more precisely think of the Urohridaya instead of sirohridaya, as
the Urohridaya is under the control of sirohridaya, that the consideration of
sirohridaya is stand still.
Along with the rasavaha srotas, the annavaha srotas is also to be considered
as a srotas, which permits the intake of aetiological factors in the form of vijateeya
dravyas converted in to sajateeya dravyas by the presence of Agni. At last the
mootravaha srotas which regulates the pressure of liquid part circulated in the body
i.e. rasa – rakta complex is also to be drawn attention.
Focus on the title:
Present study as a part and parcel of fulfillment of “Ayurveda Vachaspathi”
(Doctor of medicine), M.D. Ayurveda under Rajeev Gandhi University of heath
sciences, Bangalore was titled as “Evaluation of the effect of
Vachamamsyadi yoga in Raktapeedanidhikyata (Hypertension)”.
Introduction 8
There are few established anti hypertensive drugs with the combination of
sarpagandha (Rauwalfia serpentina) used in India because of its sedative and anti
hypertensive property. Reserpine, the main alkaloid of Sarpagandha was isolated
and practiced as anti hypertensive medicine.
Present study under the Ayurvedic principles suggests only regulating and
eliminating the waste byproducts from the body, which are over loaded in the body.
These toxins can be eliminated through either gastrointestinal tract or through urinary
tract. As it is found that the thickened vessels of renal interrupt formation of urination,
two herbs which support urination has been selected in the composition. They are
Punarnava (Boerhavia diffuse Linn.) and Gokshura (Tribulas terrestris Linn.). Another
perennial herb Jatamamsi (Nordostachys jatamansi DC.) also called Spiknard
possesses an important action on central nervous system. This herb also has diuretic
effect along with nerve sedative action. The fourth herb included in the study is
Vacha (Acorus calamus Linn.) is nervine and rejuvenator along with its action over
circulatory system. It has been successfully used by Dr.B.R.K.R.Ayurvedic college
postgraduate and research center and found having efficacy over hypertension along
with tranquilizer effect.
With preset inclusive and exclusive criteria the selection of patient is selected
from Postgraduate and research center, D.G.M.Ayurvedic medical college, Gadag,
and medicine was administrated under the supervision. The literary and part,
observations and results are expressed in stipulated chapters as under –
Introduction 9
“Evaluation of the effect of Vachamamsyadi yoga in Raktapeedanadhikyata (Hypertension)”
by Shivakumarayya .S. Hiremath
1. Introduction
Historical review
Focus on title
2. Literary review
Shareera (Physiology and Anatomy)
Nidana (etiology)
Samprapti (Pathophysiology)
Chikitsa (Classical treatment)
3. Material and methods
Drug review
Punarnava (Boerhavia diffuse Linn.)
Gokshura (Tribulas terrestris Linn.)
Jatamamsi (Nordostachys jatamansi DC.)
Vacha (Acorus calamus Linn.)
Drug preparation
Review of methodology
Observations
4. Discussion and conclusion
Summary
Present trends
Bibliography
Special case sheet of Raktapeedanadhikyata
Introduction 10
References: 1 Dorland’s Pocket medical dictionary ,pp310 2 The pocket Oxford dictionary of current English, pp432 3 ****, based on the average of two or more readings on two or more occasions, pp480 4 Ibid, pp480 5 Shareera kriya vijnan, pp425 6 Text book of medicine, R.J.Vakil, pp772 7 Text book of pathology, W.Boyd, pp586 8 A.H.Sareera,1/8 9 Charaka Sutra 20/10 10 Charaka Sutra 18/46 11 Charaka Nidana, 8/28 12 Charaka sutra 20/12 13 Ibid 20/15 14 A literary search on Raktachapadhikyata, S.H.Doddamani, pp1-2 15 Ibid, pp5 16 Differential diagnosis of internal disease, A.V.Vinogradov, pp88 17 Susruta Sutra, 21/9 18 A.Hridaya Sutra, 13/25 & Arunadutta on it Bhavaprakasha Madhyama Khanda 1/59 Vijaya Rakshita on Madhava Nidana 25/2 19 Differential diagnosis of internal disease ,pp89
Introduction 11
INTRODUCTION
For any research the collection of available source of hypothesis’s and its
emphasis is necessary. At present study “ Evaluation of the effect of vachamamsyadi
yoga in Raktapeedanadhikyata “ (Hypertension), it has clear interventions with that of
Vata and avritavata. In Charaka Samhita, while describing the complication of avrita
Vata in vatavyadhi Chikitsa Charaka affirms due to neglect of Avaritavatas, cardiac
disorder, abscess, spleen enlargement, Gulma and diarrhea appear as
complications1.
At the above reference we can draw a conclusion that in case of
Hypertension as Raktapeedanadhikyata. The involvement of Vata with its
characteristic feature “ Gati 2“ is known to ancient Acharyas; the influence of Gati with
its momentum and pressure exertion over Srotases especially to Dhamanis where
the Rasa Rakta complex flow is witnessed. This Rasa Rakta complex is propelled or
ejected into conduits of its attachment3. Thus a detailed study of Hridaya – Thoracic
heart with its attachments are necessary to be studied in detail or part from the
Srotases involved viz. Rakta and Mootravaha Srotases in the study.
As the clear description is available about the involvement of hridaya (thoracic
heart) along with Pleeha, a moola stana of Rakta vaha srotas; even though not
directly concern with Raktapeedana in Dhamanis and Siras, its involvement can not
be ruled out.
At this juncture a detailed anatomical and physiological study is necessary
apart from pathophysiology of Raktapeedanadhikyata i.e., Hypertension.
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Dosha and Dooshya
Present day scholars of Ayurveda Dr. P.D. Joshi, Dr Gurudeep singh and Dr
Shukla done the research on dosha pattern in essential hypertension and decided it
as Vata pradhana Vyadhi with Pitta and Kapha association.
At the observation of the disease, hypertension we found that the involvement
of Dhamani pratichaya, a Kapha nanatmaja vikara is associated with hypertension.
Not only Dhamani pratichaya even nidranasha a condition with Pitta vitiation is also
found. We can not be certain that the nidranasha as exclusively of Pitta vikara and it
may appear with Vata vitiation also. But the observations are more suggestive with
above referred scholars in Ayurveda in comparison to Acharya shri vishwanath
dwivedi who has correlated hypertension to roudhir mada and raktaja vikara. Here in
this concern Rakta can be one out of these Dooshya as it is flowing in the vessels of
blood along with Rasa and ejected out through hridaya for its “Jeevana “ function.
Dosha Vata
Anubandha dosha Pitta – nidranasha
Kapha – Angasada
Dooshaya Rasa
Rakta
Adhistana
Hridaya; thoracic heart with its connections
Brain with cranial nerves especially Vegas
Dhamani
Sira
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Concept of dosha in relation to Hypertension
The vitiated doshas are the prime important factors for a disease, they are
capable of the vitiating the other body elements like dhatus, malas and srotases46.
Doshas in kshaya (decreased state) are not capable of progressing through the
stages of kriyakalas to produce samprapti47. Doshas in vriddhi (increased state)
manifest different specific symptoms and effects of the vitiation of particular doshas.
Dushya and srotas :
Next to doshas the most important contributing factors of disease are dushya
and srotas. Among the body substance dosha, Dhatu and Mala, the latter two are
considered as dushyas. Doshas travel in the body through the channels (Srotases)
and these are formed of different Dhatus. Therefore greater importance should be
given to Dhatus.
The deformity of Srotases is called khavaigunya. "kha" means akasa or
cavity. Srotas being a channel, it necessarily consists hallow portion inside with a
covering wall around it48. Sthana samsraya is the stage of samprapti where doshas
get lodged in Srotases and start the process of amalgamation with them (dosha
dooshya sammurehana In short all the bodily activities are entirely dependent on
Srotases. All the doshas, Dhatus and Mala are dependent on Srotases for their
formation, conduction and destruction49. Hence, when Srotases get deformed, the
activities of dosha, Dhatu and Mala also become favorable for the genesis of a
disease. This state of dosha - dushya sammoorchana corresponds to the phase of
the manifestation of prodromal symptoms or poorvaroopa.
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It is therefore evident that in the event of the impairment of the integrity of a
srotas, a Dhatu either located in its own place or circulating through its srotas
definitely becomes morbid. In the present context the Rasa is the substance
conveyed by the 10 Dhamanis and it is the Rasa that has the altered physico-
chemical properties, which can change the physiology of the Dhamanis.
Agnimandya;
Charaka has clearly explained the importance of Agni; "When the Agni is
extinguished, man dies; when a man is endowed with its adequately, he lives long in
good health. When it is deranged he falls sick. Therefore the function of the Agni is
said to be the main stay of life"50.
In the present context, Agni may be disturbed under the following aspects;
1. Dietetic causes :
1. Irregular diet habits.
2. Over-eating
3. Ingestion of the following types of food:
a) Heavy and indigestible
b) Raw and uncooked
c) Fried foods
d) Which are rooksha and sita (cold)
e) Which can cause irritation and inflammation of the stomach.
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f) Unclean and contaminated foods
g) Soaked in too much of water and also for long duration.
h) Food containing articles which are incompatible to one
another.
i) Ingestion of food before the previous meal is completely
digested.
j) Ingested foods disgusting or for which one has an aversion.
2. Behavioral causes :
1. Intense emotional stresses such as grief, raga, worry, fear etc.
2. Irregulars sleep habits.
3. Lack of physical exercises
4. Suppression of natural urges.
5. Use of defective and faulty methods of vamana, vireka and sneha karmas.
3) Other causes :
1. Emaciation due to any disease.
2. Faults or changes in desha, kala and ritu.
Because of this impairment, the functions of jatharagni viz., sanghatabheda,
dahana, tapana, parinamana and paravritti of the food are not effected properly. By
virtue of asrayasrayee bhave, the impaired function of jatharagni leads to the
defective functioning of the pittadharakala (grahani). Therefore the functions of the
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samanavata are also disturbed, leading to the erratic motility of the gastrointestinal
tract. Two kinds of effects are envisaged: -
1. The grahani holds the food for longer duration leading to its fermentation
resulting in the release of the toxic substances collectively known as Ama.
2. The grahani does not hold the food ill it is digested but pushes the partly
digested food downward into the pakvasaya and sthulantra, effecting a
rapid evacuation.
The kayagni being located in its own place, not only takes part in the
digestion of the food, but also contributes to and augments the functions of other
Pitta51. Therefore it is clearly evident that on the event of the impairment of the
function of the jathargni the functions of the other Pitta are also impaired52. So the
cause and/or conditions which contribute to the impairment of the jatharagni can also
disturb the functional activity of the other Agni.
HRIDAYA (heart)
The heart (cardiac) is an important visceral organ made of Mamsa Dhatu
situated in thorax apparently in between two nipples3a. It is particularly muscular and
contractile tubular segment interposed between the veins and arteries; situated in
middle mediastinum covered by fibrous pericardium4.
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NIRUKTI OF HRIDAYA:
The term “hridaya” consists of three roots; ‘hri’, ‘da’ and ‘in’ and they
respectively mean, harana, dana and ayana (gati) which indicates three important
functions meaning the receipt, giving away and moving on continuously activity of the
two earlier functions. Therefore the word hridaya explains and signifies the functional
aspect of an organ and its identification depends on the substance, which is being
“received”, “given away” and the organ thus functioning continuously for the
purpose4a.
In the light of the above definition, there are certain organs in the body which
can qualify to be called as “Hridaya” like the thoracic heart, the lungs and the central
nervous system etc. In view of the water freely moving in and out, even every jiva
paramanu or cell can be designated as “Hridaya”. In the present context of
hypertension, Hridaya clearly indicates the thoracic heart only.
Embryological development5
Hridaya is said in Astanga sangraha as developed from Sleshma and Rakta6.
It is one out of the Matru janita avayava along with Pleeha7 in third month foetus
develops heart which has attached to the mother and mother called as “Dwohridi”:
The heart which is developed by mother is attached with Rasa vahaka nadi of
mother. The desires of foetus is thus expressed by the mother8 according to
kritaveerya hridaya develops first as it is the seat of the Buddhi and manas and
vetoed by Dhanvantari as all the anga pratyangas are going to be developed at
once9. It is explained in Sustruta Samhita the hridaya develops in 4th month.
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Rather it can be said in between the 3rd and 4th months of pregnancy the
hridaya is going to be developed which is chetanastana10, 11.
Surface anatomy
Aorta and the pulmonary trunk mainly hide the superior border of the heart,
formed by the upper margins of the atria. The right border of the heart formed by the
right atrium extends from the right end of the superior border to a point on the right
sixth costal cartilage 1-2 from the margin of the sternum. This border is slightly
convex to the right. The inferior border of the heart, formed mainly by the right
ventricle. It extends from the inferior extremity of the right border to a point (apex of
the heart) in the fifth left inter costal space immediately medial to a vertical line
dropped through the mid-point of the clavicle (midclavicular line). Normally this
border is slightly concave to inferior and becomes convex and gives the globular
shape incase of hypertrophy. A convex line to the left joining the left ends of the
superior and interior borders marks the left border. It is formed by mainly the left
ventricle and the left auricle and forms a small part of this border at superior
surface12. From the Ayurvedic classics it has been said hridaya is a Sira marma
situated in between the two breasts in the chest, looks like as that of the opening of
the Amashahya13. It has on its left side Pleeha and Puppusa and to the right Yakrit
and Kloma14. Its shape resembles the inverted long bud having chambers in it15. In
taittariyoparishat, relative placement has explained with Nabhi- the neval region it
was said Nisti above to the umbilicus the Nisti means 9 inches approximately. In
further at the same context it was explain heart look like an inverted lotus bud having
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down with its muscular pouch attached to the veins and arteries, 9 inches above to
the umbilicus16. Such hridaya is said as the placement for Ojas, Pranavahasrotas,
Rasavahasrotas, Buddhi, and Manas of so many important factors dealt in Ayurveda.
Inner view of the heart 17
The heart in adults completely divided into right and left sides and look like a
double barreled tube, receiving blood at one end (the atria) from veins and pumping it
out at the other end (the ventricles) into the arteries. Since the heart must pump
blood in only one direction it is provided values to insure against back flow from a
reason higher to one of lower pressure.
The inner lining of the heart continues with the intima of the vessels
connecting to it, is known as the endocardiaum; and does not differ especially from
the intima of the blood vessels. It also forms valves that lie between the atria and
ventricles and at the bases of the two great arterial tunnels living the heart.
The muscular part equaling to the media of blood vessels, is a special type of
muscle (cardiac muscle) found only in the heart and great vessels as the attach to it
although it is striated like voluntary muscle, it differs from in all other respects.
The cardiac muscle fibers so branching and anastamos that it is impossible to
determine to limits of a fiber. Indeed, the myocardium of both ventricles is actually
one continues muscle mass, and the myocardium of the both atria is another
continuos mass. Because of the continuity an impulse for contraction originating in an
atrium can spread through out the arterial musculature; similarly, an impulse
originating in a ventricle can spread throughout the ventricular musculature with all or
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none law. It is built in such a way rhythmical transmission initiated by the nerve
impulses keeps the heart contracting and relaxing in regular intervals. In comparison
atria musculature is thin as the work at low pressure. Ventricular musculature thicker
especially of left ventricular as it has to pump the blood for the entire the body, where
as right pumps blood only to the lungs.
No much reference is available about the heart description at the
microstructure level in Ayurveda except it has “Agarakarnika” i.e., chambers, from
Charaka Samhita18. According to Susruta it is made up of two mamsa peshis18a and
example by Dalhana with reference to its channels have their origin in khadantarm
i.e., the organ cavity the hridaya18b. Hridaya is the source of the ten Dhamanis, which
spread throughout the body, giving of even small branches during their course
ultimately end as Srotamsi which are perforce extremely fine tubules with
innumerable openings or pores in their walls, through which Rasa sravana takes
place18c.
Spandana of Hridaya
Hridaya is chetana sthana sthana35 i.e., the seat of chetana. The term
“Chetana” is being understood as animated, alive, living etc, The life of Hridaya is
expressed in the form of akunchana and prasanana (contraction and relaxation)
together termed as spandana. The spandana is characterized by the akunchana and
prasarana of the hritpeshi is maintained by the chetana or swayam prerana shakti i.e.
the auto stimulating quality. Due to its spandana, the hridaya is able to spread Rasa
and Rakta through the body for the Preenana and Jeevana kriyas.
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Interference of Pleeha with hridaya
While discussing the complications of avrita Vata Charaka has placed Pleeha
along with hridaya to get the complications. Light has to focus how and why the
Pleeha (spleen) appears here in the context.
Pleeha is placed left in the abdomen left side to that of heart, little down to it.
It is described as the mula for Raktavahasrotas19and Rakta20. Chakrapani in further
added the Rasavahasrotomula viz. hridaya and 10 Dhamanis are to be considered
as Rakta stanas21. Thus the importance and interference with the Rasavahasrotas to
Raktavahasrotas is explainable. At present we have to eliminate the interference of
Pleeha to give rise a disease state in Rasavahasrotomula i.e., hridaya, as
hypertension in association with Rakta.
The spleen is includes in a part of the mesentery of the stomach, and its
parenchyma resembles that of lymph nodes, yet it is a part of the blood vascular
system. Lymphatic within the spleen are confined to its capsule and to large
trabeculae, so that the lymphatic nodules of the spleen add lymph directly to the
blood stream instead of delivering them first into lymphatic vessels, as lymph nodes
do. Phagocytic walls of the sinusoids, a part of the reticuloendothelial system, are the
chief elements concerned with the destruction of the red blood cells and the removal
of the iron component from them in order that this can be used again in forming new
cells. The spleen filters the blood and participates with other parts of the
reticuloendothelial system in the formation of antibodies22. The processes of filtration
of crystalloid and waste recyclable product of the blood it helps to maintain the
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viscosity and specific gravity of the blood. There by blood will not be flooded with
unnecessary colloids and crystalloid to maintain normal blood pressure. Otherwise it
will be resulted into blood pressure rise.
Circulation of the blood
The circular movement of the blood (Dhatu) in the body has been mentioned
while describing the Dhatu parinama or the transformation of one Dhatu into another.
The movement of the Dhatus (which nourish the body) goes on eternally like (the
motion of) a wheel23. Chakrapani has pinpointed the Dhatus as the Rasa Dhatu etc.
The simile of the wheel is significant here. This indicates not only the circular
movement, which is continuous, without any rest is dependent upon the ejecting
force of the hridaya i.e., the stimulus of the vyanavata to the Hritpeshi.
Internal transport system of the body:
Srotamsi (conduits) represents the internal transport system of the body. The
term Srotas means a channel - it is derived from the Sanskrit root "sru sravana"
meaning to exude, to ooze, and to permeate. Charaka has defined it is "sravahat
srotamsi" meaning, the structure through which "sravanam" takes place24. According
to Charaka, no structure in the body can grow and develop or waste and atrophy,
independent of Srotamsi that transport Dhatus, which later, are constantly subjected
to (metabolic) transformations. And the Srotamsi supplies the needs of
transportation25. The Srotamsi of the body comprise of channels of different kinds
and they are separately named according to the site and functions. At the present
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context, the names Dhamani and Sira are relevant to the circulation of the blood.
Says Charaka; they are spoken of as Dhamanis because they pulsate, as Srotamsi
because they permit oozing and Siras because they maintain a continuous flow of
blood (Rasa - Rakta)"26. The Dhamanis are stated to have their origin in the heart27.
In view of the arrangement made by Charaka, specially when studied
together with the description of characteristic features of different parts of the
vascular system, it is clear that the Dhamanis end in the Srotamsi (capillaries) which
in turn unite to form Siras (veins). Thus hridaya, Dhamanis, Srotamsi and Siras
constitute a single circulatory unit, which regulate the proper flow of blood and
nutritional supply to the body.
The hridaya occupies a central place in the circulatory system as the organ
supplying the motive force for the movement of the Rasa - Rakta combination and
also as a source of Dhamanis.
There are two subdivisions of Vata, namely Pranavata and Vyanavata which
are stated to be concerned with the function of the hridaya. In brief the action of
Pranavata is hridaya Dharana and that of Vyanavata is to eject the Rasa-Rakta
combination for circulation throughout the body.
PRANAVATA
The word "prana" is composed of the root "an" with a prefix "pra" "na" means
to breath, to live. In view of this definition, the Pranavata should be responsible for all
vital functions, which are essential for human existence. The definition "pranayatiti
prana" also indicates the relationship of Pranavata with respiratory act.
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Location of Pranavata:
Charaka and Vagbhata28 state Shiras (head or mastishka) to be the seat of
Pranavata. Pranavata is sated to traverse in the regions of oral cavity, ears neck and
chest for the proper control and discharge of its functions.
Functions of Pranavata:
According to Charaka, the functions of Pranavata are the following;
1. Respiration (swasakriya)
2. Deglutition
3. Spitting out (stheevanam)
4. Sneezing (kshavadhu)
5. Belching (udgaram)
Susruta states that Pranavata assists the different vitalizing principles of the
body in discharging their functions in life, deglutition and contribution to the general
sustenance of the body29.
In addition, Vagbhata states that Pranavata maintains the actions of hridaya
(heart), Manas, Buddhi, Indriya (sensory organ) and supports the Dhamanis
(probably the vasomotor functions i.e., circulatory system)30. One of the functions of
prana vata is hridaya dharana31. The word dharana is derived from the Sanskrit root
"dhri". Which means to hold in check, to restrain and "charana" indicates the
preserving, sustaining, protecting etc. Therefore the function of Pranavata, is to be
understood as a check or restraint on Hridaya Spandana, for the preservation or
protection of the organ.
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The functions are to be considered as those of an organ/region or part of an
organ, having a shape of Nabhi and situated in the brain. The functions like
respiration, maintenance or the actions of the heart and circulatory system,
deglutition, spitting out, sneezing, bleaching and the functional maintenance of the
sensory organs are peripheral in nature and so the impulses have to leave the
central nervous system for their proper execution. On the other hand the functions
like the regulation of the sensory input, and consciousness which belong to the
Manas and Buddhi are central in character and the impulses have to reach the
respective higher centers.
Therefore some scholars, based on the regions of actions, have further
subdivided the Pranavata as: -
1) Sirasthita Pranavata which is located in the head and
2) Urahsthita Pranavata which is located in the cheat. The sirasthita Pranavata
may regularly move down into the chest through the neck, to join the urahsthita
Pranavata that goes to the oro-nasal region, ears and eyes through the throat. It
carryout the acts of sneezing, belching etc; it is clearly stated that Pranavata is
controlling the hridaya and also the Dhamanis (hridaya dharana and Dhamani
dharana). Hridaya is located in Uras and the Dhamanis are spread throughout
the body. Since the hridaya has to conduct the "vikshepa karma" for the blood to
circulate throughout the body, the conditions of the Dhamanis are particularly
relevant and associated with the function of the hridaya.
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Dhamani dharana kendras is also located in the area of Pranavata and is an
important center in that area. Its effect on Dhamanis is of two types:
1) Sankochana (contraction)
2) Vikasana (dilatation)
These two functions are possible only due to the presence of mamsa peshis
in the Dhamanis. The contraction of these peshis causes the decrease in the caliber
of the vessels (vaso - constriction) and the relaxation causes the dilatation. These
are two separate areas in the Dhamani dharana kendra, the stimulation of one cause
contraction and the stimulation of the other dilatation.
The main function of Rakta is Jeevana kriya to all the tissues of the body.
Therefore Rakta is kept in circulation by the spandana of the hridaya. The decrease
in the caliber of the Dhamanis produces a decrease in the supply of the "prana" vayu
and therefore the hridaya is stimulated for increased and forceful spandana, thereby
increasing the Raktapeedana. The decrease in the caliber of Dhamanis also causes
increased peripheral resistance. Thus the Dhamani dharana kendra can either
increase or decrease of the activity of hridaya.
VYANAVATA
Location of vyanavata : Charaka and Susruta have not mentioned any specific
place regarding the location of the Vyanavata, except that it pervades swiftly
throughout the body32. According to Vagbhata, the Vyanavata is located in 'Hridaya '
but traverses throughout the body swiftly33.
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Vagbhata states that the Vyanavata is located in "Hridaya" needs some
elucidation in view of the fact that location and function of the nervous system relates
to Vata. And the phenomenon of Vata is the phenomenon of nerve impulses. The
word 'Hridaya' signification is of an anatomical organ that depends on the dravya or
substance, with the functions "receiving" and "give away" and the organ thus
functioning continuously for this purpose. This can be better appreciated with the
understanding of the functions of Vyanavata.
Functions of the Vyanavata
The important functions of the Vyanavata can be two in the present context:
• Function of the Rasa is the nourishment of the body i.e., the dhatus34
• Effecting the outflow of the blood
The circulation of Rasa (Rakta is also included) is due to the vikshepa karma
of the heart, caused by the contraction of the musculature of the organ, due to the
stimulation by the Vyanavata.
Effecting the outflow of the blood depends not only on the effective ejecting
capacity of the heart but also the caliber of the blood vessels. An increase in the
quantity of the circulating blood causes an increased outflow. Therefore function of
Vyanavata is to be understood as to increase the caliber of the blood vessels.
It may be noticed from the above details that the Pranavata and Vyanavata
act in opposite directions with reference to the heart and blood vessels. Pranavata
not only checks or restrict the hridaya spandana but also constricts the blood
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vessels. The Vyanavata increases the hridaya spandana with forceful contraction of
the heart musculature and increases the caliber of the blood vessels.
Functions of the heart
Many functions have been mentioned in relation to Hridaya. The whole body
including viscera, consciousness, sense faculties, five objects of senses, Atma
together with its qualities like happiness etc; mind and its objects are all located in
the hridaya36. The heart represents the entire sense perception, animation and
moreover the heart is the substratum of the Ojas and it controls the mind37. As the
entire girder supports bamboo framework of the thatch, so the heart represents the
substratum of all the entities38.
The circulation of Rasa-Rakta is maintained by three factors: -
1) The muscular structure of the heart through its contractions and relaxation. The
heart is made up of two muscles. The main characteristic of the muscle in the
body is its contraction and relaxation.
2) The heart working as a pump i.e., the heart through its working takes in the blood
during relaxation and gives out the same during contraction. The definition of the
word Hridaya explains its functional nature. Since hridaya is seat of Rasa and
Rakta, Hridaya takes in and gives out the Rasa Rakta combination by
continuously functioning for the maintenance of the circulation.The actual
reference regarding the contraction and relaxation of the heart is found in Yoga-
vasistha as “Whenever expansion (relaxation) and contraction in the duct
situated in the heart occurs ….”. This statement clearly explains that the heart
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contracts and relaxes regularly. That the heart works continuously for Charaka
implicitly explains the maintenance of the circulation while dealing with the
functions of Vyanavata. "The Rasa Dhatu (the Rakta is also included) is
circulated continuously through every part of the body simultaneously by the
Vyanavata, by virtue of its physiological function of projection"39. Vyanavata is
stated to be located in hridaya. The two words used regarding the continuity of
this function are "Ajasram" is Avisratam i.e., without any rest and of the word
'sada' is "sarvakalam i.e., at all times.
This function of the heart, which is chetana stahana explained as the self
stimulating nature, to take in and give out blood continuously without any rest
resembles the action of a pump which supplies a liquid material.
3) The circular movement of the blood in the body is done by Rasavahasrotas.
Rasavahasrotas:
Rasa is the important adya Dhatu, because it has dhatu poshak dravyas
(nutrient substances) for all Dhatus in it. And also the nourishment to other Dhatus is
through it. This Rasa Dhatu is capable of spreading all over the body. Ahara Rasa
pertains to the prasada bhaga of ahara, which has been treated as 'Rasa'40. The
function of Rasa Dhatu is preenana41. It indicates the function of satisfying or
gratifying. The Rasa is produced in koshta (annavahasrotas) from food after
completion of the pakvavastha (digestion) to be absorbed through the walls of the
koshta. The circulation of Rasa by hridaya is to maintain the life by proper
nourishment to the body.
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Hridaya is the Rasa sthana, it is also the moolastana of Rasavahasrotas42.
According to Susruta, hridaya and rasa-vahini Dhamanis are the moolas of
Rasavahasrotas43. Hridaya is also the seat of Rakta and other fluids which are
capable of circulating in the body44. Therefore the hridaya is not to be considered as
the seat of Rasa only and similarly are the dasa (ten) dhamanis. Since Rakta is also
a (partially) fluid Dhatu, with its main function as jeevana kriya, to be continuously
maintained and also circulated by the hridaya. It is clear that the Rasa and Rakta
move together for the maintenance of these functions. Rakta Dhatu contains the cells
with raktamsha, which are not capable of entering most microscopic srotas. But due
to its quality of sukshma, Rasa penetrates into all Srotases. The Rasa - Rakta is
circulating in a combined state. Because of the inability of the cellular components of
the Rakta to enter all Srotases; the Rakta with its raktamsha ceases to move further
while the Rasa proceeds carrying the nutrients. Therefore hridaya and Rasavahini
dhamanis should be considered as the moolas of Rasavahasrotas.
Rasa is ejected by the hridaya into circulation and moves in the dasa
dhamanis and their branches. The Dhamanis are stated to have khani (pores ) in
their walls through which Rasa passes through to all parts of the body very much like
the minute passages present in a lotus stem45. Therefore these pores present in the
walls of the Dhamanis are also considered rasavahinisrotas.
Because of the ashrayashrya bhava (interdependence) between the srotas
and the substance conveyed through it, any change in the composition of Rasa can
vitiate the Rasavahasrotas and also its moola i.e., hridaya.
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Rakta peedana
There is no definite information regarding the normal or abnormal states of
raktapeedana (blood pressure) in Ayurvedic classics. The word "peedana" indicates
pressure and its adhikyata is an increase in the pressure in line with the action
noticed in the arteries (Dhamanis). But Rakta peedana or blood pressure is defined
as the lateral pressure exerted by blood on the vessels walls while flowing through it.
Since the rasa-rakta combination is forcefully ejected by hridaya for the maintenance
of preenana and jeevana kriyas, into the Dhamanis, some pressure is exerted by
rasa-rakta on the Dhamanis. Therefore two issues are taking part here;
• blood with its flow, (here blood is a combination rasa and rakta)
• the blood vessels (or) artery (Dhamani)
This indicates that any change in these two is likely to effect a change in the
raktapeedana. The flow of blood is dependent on the vikshepa karma of the hridaya.
Therefore provided the dhamanis are in a healthy state; the vikdhepa karma of the
hridaya and the raktapeedana are maintained by the akunchna of the hritpeshis
through the action of Vyanavata. So the maintenance of normal raktapeedana is due
to an equilibrium state between the actions of Vyanavata and Pranavata, which has
the function of "Dhamani dharana" also. Rakta adhika peedana indicates a sustained
increase in the raktapeedana and it is a feature of several distinct diseases.
1. Reduction in the caliber due to a vitiated state of Pranavata or a disturbance in
the equilibrium in functions of Pranavata and Vyanavata.
Literary review - Shareera 31
2. Srotavaigunya of the Dhamani caused by a change in the structure. This is
mainly due to dhamaniprtichaya; which is caused by a change in the composition
of the rasa-rakta. These two sates cause a reduction in the essential kriyas of
Preenana and Jeevana to the tissues of the body. Therefore in order to keep the
tissues alive, the hridaya is forced to increase the ejecting power with a
* Also obtain fasting triglyceride and high density lipoproteine cholestrol levels if the serum cholestrol level is 200mg/dl or more in patients with other cardiovascular risk factor or 240 mg/dl or more in patients with out other cardivascular risk factors. # HEENT = head, eyes, ears, nose, and throat.
Literary review - Nidana 62
Literary review - Nidana 63
MANAGEMENT OF HYPERTENSION
In general, most patients with chronic arterial hypertension have no
identifiable cause for the disease. Treatment usually involves drug therapy; and this
commits the patient and the physician to a long-term association. Prior to the
institution of an anti hypertensive regimen, however, general therapeutic measures
are necessary.
GENERAL STAGETEGY
Attention to the patient’s life style may be important in a few cases but in
general it is difficult to change. Nevertheless it is wise to dissuade people from
smoking and simultaneously to face the difficult task of losing weight, if obese, or of
not gaining if normal. The patient should be impressed with the importance of future
surveillance. Mental relaxation can be urged more easily than achieved. Sometimes
regular graded exercise will cause a simultaneous feeling of well being. Several
studies have shown the value of regular exercise in lowering arterial pressure, but
the exact mechanism of this effect eludes.
The following modes of treatment for hypertension are available: -
1. Non-pharmacological treatment
2. Pharmacological treatment
Drug treatment should always be accompanied by general measures such as ;
1. Weight reduction
2. Salt restriction
3. Moderate physical exercise
4. Moderation in alcohol ingestion
5. Cessation of smoking
6. Relaxation techniques.
Literary review - Chikitsa 63
1. Weight reduction :-
Weight loss by itself helps to lower blood pressure in obese patients. Weight loss
probably causes reduced activity by the sympathetic nervous systems. And decrease
in plasma epinephrine, non-epinephrine and renin activity. A reduction of 8-10dg if
weight reduces blood pressure by about 25mm Hg Systolic and 20mm Hg diastolic.
2. Salt restriction
It is well known that salt restriction helps to lower blood pressure. If the salt intake
is reduced from 150-200mEg/day to 50-90mEg/day, usually a reduction in the blood
pressure of 10mm Hg is achieved. The other advantage of salt reduction is that,
when diuretics are given to these patients, less sodium is available at the distal renal
tubules for exchange with potassium. Hence, there is less potassium loss. It is best
to advise patients on the following lines;
1. Avoid processed food, which usually contain more salt this
includes pickles etc;
2. Do not add salt while cooking and/or at the table.
3. If salt is still desired, use potassium salts (salt substitute)
calamenenol (C15H24O, 5.3%), and calameone (C15H26O2, 2.2%). The
crystaline body named Calameone asarone.
Action
Root and rhizome are stimulants, emetic, nauseant, stomachic,
aromatic, expectorant, carminative, antispasmodic and nervine
sedative. In large doses induces vomiting.
Useful in dyspepsia, flatulence, and loss of appetite, choleric
diarrhea of children and as anti periodic when it is given in tertian
fevers. It is also beneficial in hysteria and neuralgia.
Externally it is used in chronic rheumatism, the root being powered
and rubbed up with cashew spirits to the chest in the catarrh of
children it works as counter irritant. The powder is a very effective
insecticide.
It is used as a diuretic in calculus affections and as an anti
helmintic to expel worms.
The root is supposed by the Chinese to affect the heart and lungs
and to be beneficial for cancer. In general, it is taken as a restorative
for the body and spirits.
Material and Methods – Drug review 94
1 Indian Materia medica, A.K.Nadkarni, pp203-207, Indian Medicinal plants,K.R.Kitrtikar, pp2045-2048 2 Indian Materia medica, A.K.Nadkarni, pp1229, Indian Medicinal plants,K.R.Kitrtikar, pp420-423 3 Indian Materia medica, A.K.Nadkarni, pp840-842, Indian Medicinal plants,K.R.Kitrtikar, pp1307-1309 4 Indian Materia medica, A.K.Nadkarni, pp35-37, Indian Medicinal plants,K.R.Kitrtikar, pp2626-2629 5 Dhanvantari Nighantu – Guduchyadi Varga, 6 Dravyaguna Vijnan,Priyavat Sharma, pp631, 6a Dhanvantari Nighantu – Guduchyadi Varga 7 Indian Materia medica, A.K.Nadkarni, pp203, Chopra “I.D. of I” pp300 to 305 8 Indian Medicinal plants, K.R.Kirtikar, pp2045 9 Dhanvantari Nighantu – Guduchyadi Varga 10 Ibid 12 Ibid, K.R.Kirtikar, pp420 11 Indian Medicinal plants, K.R.Kirtikar, pp421 13 Dhanvantari Nighantu – Chandanadi Varga 14 Indian Materia medica, A.K.Nadkarni, pp36, Indian Medicinal plants,K.R.Kitrtikar, pp2628 15 Dhanvantari Nighantu – Satapushapadi Varga
Material and Methods – Drug review 95
Present study “ EVALUTION OF THE EFFECT OF VACHAMAMSYADI
YOGA IN RAKTAPEEDANADHIKYATA” (HYPERTENSION) is studied and
evaluated as below.
Introduction:
Present day living style of people making them to undergo tension which
leading to Raktapeedanadhikyata (hypertension) in the body. As a large number of
people are having this problem, it draws the attention of an Ayurvedist for a safe and
effective medication in alternative system of medicine i.e. Ayurveda.
Review of literature:
“Hypertension “ is not dealt in Ayurvedic literature by any parallel name. So
many nomenclature claimed as Hypertension are Raktabhapa, Raktabhara,
Raktavritavata etc. But as a matter of translation to the word and condition of
hypertension "Raktaoeedanadhikyata” is said to be correct because it implies to the
increase of pressure. Bhrama, moorcha are considered nearer conditions to that of
Hypertension.
The present yoga consist of VACHA ( Acorus Calamus Linn)
JATAMANSI (Nordostachys jatamansi DC) GOKSHURA ( Tribulus terrestris Linn )
and PURNARNAVA ( Boerhavia diffuse linn ).Above set of herbal origins are
effective with their diuretic, tranquilizer and Hypotensive effects. A combination of
above collectively is to be tried for the early and effectively remedy for the
hypertensive patients.
Material and Methods
95
Material and Methods:
Patients are selected from the OPD/ IPD of post Graduate and research
centerHospital, Shri D.G.M.Ayurvedic medical college, Gadag.
The trial compound ingredients are collected from the local market and the
botanist confirms the identification. The literally aspect is collected from classical
Ayurvedic texts as well as from modern literature texts as well as from modern
literature, magazines journal and meddler search.
Method of collection of data
Sample size: From OPD/IPD of PGARC hospital a sample size of minimum 30 patients are
selected irrespective of sex, in all age groups( between 35-75years) with a history of
maximum 5 years duration.
Exclusive criteria: The patients with renal complications, thyroid and adrenal diseases are
excluded from the study. Alcohol abuse and secondary hypertension patients are
also excluded.
Inclusive Criteria: All the patients are enrolled in inclusive criteria other than exclusive criteria
mentioned above. The patients are selected between the age group of 35-75 years.
Study design: Prospective, clinical trial.
Posology: 50mg/Kg. Body wt/24 hours in divided dose at the maximum of 3mg/24hrs, in
divided dose.
Material and Methods
96
Duration: 21 days
Assessment: Results are assessed by the clinical improvement and sphygmomanometer
studies.
Investigations and study of hypertension
A patient has to be carefully examined for a possible cause for hypertension and
what investigations need to be done to determination of medical treatment choice.
The identification of the cause will help in the choice of investigation and the course
of management.
A pains-taking history will often direct us to a diagnosis e.g. in a patient with a
history of use of drugs like - contraceptive pills, nasal vasoconstrictors,
glucocarticoids, phenacetin, analgesics etc; withdrawal of the offending drug is often
sufficient. Repeated urinary infections, haematuria and abdominal trauma point to a
renal cause. A history of headache, palpitation and pallor should alert one to the
possibility of a phcochromocytoma.
A history of hypertension in parents and siblings suggests a hereditary basis,
which may be of prognostic significance. Of similar significance is a history of
smoking, sedentary habits, character traits, and diabetes.
A detail examination of patient will help to grade the severity of damage due to
hypertension, as it is the only part of the body in which the state of small arteries can
actually be visualized. The case evaluation sheet as follows –
Material and Methods
97
CASE SHEET FOR “RAKTAPEEDANADHIKYATA” POST GRADUATE AND RESEARCH CENTERE,(KAYACHIKITSA)
SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE. GADAG. Guide : Dr.Ch.Ranga Rao Dr hivakumarayya.S.Hiremath.
M.D. (Ay) M.D.Scholar Co-guide : Dr. Sivarama Prasad Kethamakka. M.A.(Astro),M.D.(Ay) 1. Name of the Patient Sl.No. 2. Father’s/Husband’s Name OPD No 3. Age - Years IPD No 4. Sex - M F Bed No 5. Religion Hindu Muslim Christian Other Date of Schedule initiation Date of Schedule completion 6. Occupation - Sedentary Active Labour 7. Economical status Poor Middle class Higher middle class Higher class 8.Diet - Veg Mixed 9. Address Pin 10. Selection Included Excluded Group A Fresh Diagnosed
B Previous Diagnosed
11. Result Cured Palliative Responded Not responded Discontinued
Before After No Is it associated with Fresh <1 Yrs <5 Yrs >5 Yrs
1 Angina 2 Asthma 3 Congestive cardiac failure 4 Diabetes 5 Nephritis 6 Gout 7 Toxaemia 8 Transient Ischemic attack 9 Pakshaghatha 10 Arditavata 11 Medoroga 14. Diet and Drug History. No Items Quantity Duration 1 Alcohol 2 Cigarettes 3 Chewing Tobacco 4 Oral Contraceptives 5 Salt 6 Oil / Ghee 7 Anti Hypertensive Drugs 15.Emotional Status. Before After No Mild Moderate Severe Mild Moderate Severe 1 Fear 2 Anger 3 Depression 4 Anxiety
Material and Methods
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15. Family History. No Disease Yes No Relation Paternal Maternal Brother Sister 1 Heart Disease 2 Diabetes 3 Obesity 4 Hypertension 5 Thyroid disorders 6 Cancer 7 Any other 16. Samanya Pareeksha.
Prakruti Vataj Pittaj Kapaj Vatapittaj Vatakapaj Pittakapaj amadhoshoj a. Pulse /min b. Temp F c. Respiration /min d. Weight Kg e. Height Cms f. Heart rate Supine B A /min
Standing g. Fundus of Eye h. Oedema Stress i. Neck vein j. Peripheral pulses k. Blood pressure
Date Position Vatakala Pittakala Kaphakala Before After Before After Before After
18. Lab - Investigations Test Before Results After
Sugar Urine Albumin Serum Creatinine Blood Serum Cholesterol
E.C.G (ST segment) Any other` 19. Assesment Chart. No Bp Right Arm / Left Arm Systolic Diastolic 1 Before Treatment mm of Hg mm of Hg 2 After 3 days - mm of Hg mm of Hg 3 After 6 days - mm of Hg mm of Hg 4 After 9 days - mm of Hg mm of Hg 5 After 12 days - mm of Hg mm of Hg 6 After 15 days - mm of Hg mm of Hg 7 After 18 days - mm of Hg mm of Hg 8 After 21 days - mm of Hg mm of Hg
Material and Methods
100
Clinical examination: -
A detailed examination is carried out.
The following findings suggest a possible diagnosis: