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Evaluation of the efficacy of
“KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN
“BHRAMA” (HYPERTENSION)By
“Chetan Sangappa Minajigi”
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfilment of the degree of
Ayurveda Vachaspati M.D.In
KayachikitsaUnder the Guidance of
Dr. Shiva Rama Prasad KethamakkaM.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]
Department of Kayachikitsa
Post Graduate Studies & Research CentreD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2002-2005
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTREGADAG - 582 103
This is to certify that the dissertation entitled “EVALUATION OF THE
EFFICACY OF “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN
“BHRAMA” (HYPERTENSION)” is a bonafide research work done by
“Chetan Sangappa Minajigi” in partial fulfilment of the requirement for the
post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)”
Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
Dr. SHIVA RAMA PRASAD KETHAMAKKA
M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]Guide
READER IN KAYACHIKITSADGMAMC, PGS&RC, Gadag
Date:
Place: Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTREGADAG, 582 103
Endorsement by the H.O.D, Principal/ head of the institution
This is to certify that the dissertation entitled “EVALUATION OF THE
EFFICACY OF “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN “BHRAMA”
(HYPERTENSION)” is a bonafide research work done by “Chetan Sangappa
Minajigi” under the guidance of Dr. SHIVA RAMA PRASAD KETHAMAKKA, M.D.
(Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Reader in Kayachikitsa, DGMAMC,
PGS&RC, Gadag, in partial fulfilment of the requirement for the post graduation
degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi
University of Health Sciences, Bangalore, Karnataka.
.
(Dr. G. B. Patil)Principal,
DGM Ayurvedic Medical College,Gadag
Date:Place:
(Dr. V. Varada charyulu)Professor & HOD
Dept. of KayachikitsaPGS&RC
Date:Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “EVALUATION
OF THE EFFICACY OF “KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN
“BHRAMA” (HYPERTENSION)” is a bonafide and genuine research work
carried out by me under the guidance of Dr. SHIVA RAMA PRASAD
KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Reader in
Kayachikitsa, DGMAMC, PGS&RC, Gadag.
Date
Place
(Chetan Sangappa Minajigi)
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this
dissertation/ thesis in print or electronic format for the academic / research
purpose.
Date
Place
(Chetan Sangappa Minajigi)
© Rajiv Gandhi University of Health Sciences, Karnataka
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” I
I express my deep gratitude to my guide Dr. K. Shiva Rama Prasad, M.D. (Ay),
M.A. (Jyo) [Ph.D. (Jy)] for his timely advises and encouragement in every step of my
success. His ideologies have been exemplar to my further career.
I express my gratefulness to my professor H.O.D., Dr. V. Varadacharyulu,
M.D.(Ayu), and Dr R. V. Shettar, M.D (Ayu) lecturer in Kayachikitsa, for their time to time
help and critical suggestions associated with expert guidance at the completion of this
dissertation.
I express my thankfulness to beloved principal Dr. G. B. Patil, for his
encouragement as well as providing all necessary facilities for this research work.
I express my profound sense of acknowledgement to various departments
H.O.D.s, teachers and colleagues of sister concern departments along with the ministerial
and sub staff of the D.G.M. Ayurvedic Medical College & Hospital, Gadag.
I express my sincere thanks to Dr. Shashidar. H. Doddamani, Dr. Kuber Sankh,
Dr. P. Shivaramudu, Dr. M.C. Patil, Dr. Danappagoudar and Dr. Santhosh Belavadi. I
express my sincere thanks to Mr. Nandakumar for his help in statistical analysis of
results. I am thankful to Dr. Nagi Reddy for his assistance in preparing the medicine and
Dr Kona for the lab assistance.
I express my sincere conceding to Dr. Shashikant Nidagundi, Dr. Jagadeesh Mitti,
Dr. Mulkipatil, Dr. U.V. Purad, Dr. Paraddi, Dr. Sajjan and Dr. B.G. Swami.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” II
I discharge my salute to my beloved Grand mother - smt. Susheela Bai Subbayya
Gudur and express my humble heart filled gratitude that stood strong to support me at my
calamities. Present existence of mine is because of my beloved parents, Late Sangappa
Chanabassappa Minajigi, and Smt. Shobha Devi, I am at their remembrance at every
movement of my success.
Behind my success, the pillars are my brothers, Dr. Ananad and Sachin, a warm
thanks to them on this regard. I am extremely thankful and obliged to Dr. Pranesh S. Gudur
and Smt. Rekha Pranesh and Ramanna S Gudur, and Smt Savitri R Gudur, who always
watched me and shaped my career. Its only their support and encouragement which made
me possible to achieve my goal. .
My sincere thanks to Dr. Chandrashekhar, Yapal Parvi, Anil Menasinakai, S.C.
Biradar and Dr.D.P.Joshi - my friend of all times, with out of their support I am always
incomplete.
My relatives and well wishers, those were supporting all the time - Jyothi,
Venkatesh, and Dr. Sudhakar. T.B, Dr. Suhashini Telang, Dr. Srinivasa Reddi, Swaroopa
Rani, Dr. Varsha Kulakarni, Dr. Pattanshetti, Dr. Mangala Patil, Dr. Jaggal, Dr. Santoji, Dr.
Bingi, Dr. Santosh Yadahalli, Dr. V.S. Hiremath, Dr. K. Hiremath, Dr. Veena Kori, Dr.
Shankaragouda, Dr. Yasmeen, Dr. Hadimani, Dr. Hanamanthagoudar, Dr. Pradeep, Dr.
Koteswar Rao, Dr. B.Y. Ghanti, Spoorti JT, Priya KR, Asha P, Shivkumar LT, Anil Biradar,
Anil Ratod, Manish jain and Harun Kowshik – I express deep thankfulness for their
inspiration during the study.
At last my sincere thanks to the subjects who cooperated at my dissertation, with
out of them it would have been not a success.
Place:
Date: Chetan Sangappa Minajigi
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” III
Abstract
Bhrama vis-à-vis essential hypertension in which the causes of increase in blood
pressure is unknown. It constitutes about 90-95% patients of hypertension. Angiotensin II
alters blood pressure by increasing both peripheral resistance and blood volume. Many
patients have a family history of high blood pressure. Lifestyle changes can significantly
improve a patient’s blood pressure. The factors influencing the relationship between
blood pressure and cardiovascular risk include systolic blood pressure, diastolic blood
pressure, circadian blood pressure patterns blood pressure variability, and cardiac and
vascular hypertrophy. Retention of sodium will cause an increase in the blood volume,
which in turn increases the blood pressure.
Evidence supports treatment of systolic high blood pressure in older persons.
Local endothelial factors may play a role in blood pressure. High blood pressure lowers
cognitive function. Increased T.P.R. + increased cardiac output = increased blood
pressure. Hypertension increases the viscosity of blood.
Treatment of the disease reduces the symptoms of high blood pressure.
Shirodhara is claimed to reduce high blood pressure. Present study registers 30 patients,
out of 68 approached patients. Parameters of co-morbidity in Bhrama are serum
creatinine, Serum cholesterol and associative LDL, VLDL with S.Triglycerides. Study of
Kakubhadi Lehya on Bhrama vis-à-vis hypertension show marked drop of 20 mm Hg of
systolic hypertension by inducting the Rasayana effect. All the objective parameters
show highly significance. After through study of the entire parameters and materials
available for the assessment of results it was drawn a conclusion of results as - 9
(30.02%) well responded, 6 (20.02%) moderately responded, 10 (33.33%) responded, 3
(10%) patients not responded and the last 2 (6.63%) patients discontinued in the study.
Thus it is concluded that the Kakubhadi Lehya is effective as Hrudya Rasayana in
the disease condition Bhrama vis-à-vis hypertension. This is recommended for the
regulation and prophylactics of Bhrama vis-à-vis hypertension.
Evaluation of the efficacy of
“Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”
(Hypertension)
By – Chetan Sangappa Minajigi
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” IV
Table of contents
Evaluation of the efficacy of
“KAKUBHADI LEHYA” AS HRIDYA RASAYANA
IN “BHRAMA” (HYPERTENSION)
Heading Page number
Chapter -1 Introduction 1 to 12
Chapter –2 Objectives 13 to 15
Chapter –3 Review of literature 16 to 67
Chapter –4 Methodology 68 to 85
Chapter –5 Results 86 to 114
Chapter –6 Discussion 115 to 178
Chapter –7 Conclusion 179 to 185
Chapter –8 Summary 186 to 189
Bibliographic References I to XIV
Annex – Case sheet 1 to 6
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” V
List of tables
Sno Table Heading Page
1 3
2 Dushyadi Vivechana of Bhrama in comparison to 38
3
in the patients with mild or moderate Hypertension - Symptoms
49
Step care treatment of hypertension 57
Showing the Pathyapathya in Hypertension (Bhrama)
6 Key items of the baseline physical and laboratory examinations 79
7 82
8 83
9 84
10 85
11 87
12 87
13 88
14 90
15 91
16 93
17 94
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” VI
18 Distribution of patients by presenting complaints 95
19 Distribution of patients by Associated features 97
20 Distribution of patients by mode of on set 98
21 Distribution of patients by Intensity 99
22 Distribution of patients by Aggravating factors 100
23 Distribution of patients by relieving factors 102
24 Distribution of patients by Shareerika Prakruti 103
25 Distribution of patients by Manasika Prakruti 105
26 Assessment of Lab investigations in Bhrama 106
27 Assessment of Subjective parameters in Bhrama 108
28 Results of Kakubhadi Lehya in Bhrama vis-à-vis Hypertension 110
29 Statistical analysis - Subjective parameters 111
30 Statistical analysis - Emotional parameters 112
31 Statistical analysis - Objective parameters 112
32 Statistical analysis - Blood pressure variances 113
33 Blood pressure levels 124
34 Four stages wherein cardiac involvement takes place 127
35 The World Health Organisation (WHO) Classification of Hypertension 127
36 Cardiovascular responses to stimulation 134
37 Apo-fraction representation of the lipoproteins 145
38 Blood pressure variances of Before to After 172
39 BMI Vs Blood Pressure 176
40 Male BMI with lipid profile variations 177
41 Female BMI with lipid profile variations 177
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”VII
List of figures
Sno Figures heading Page
1 Showing the Blood Pressure Regulation 33
2 Showing the Role of Renin-Angiotensin System 36
3 Diagrammatic expression showing dietary intake and CVD 43
4 Showing the Schematic Representation of Samprapti 50
5 Initiation of Modern Treatment in Patients with Hypertension 59
6 Showing the Approach to the Hypertensive Patient after Initiating
Anti-hypertensive Drug Treatment
60
7 Algorithm for Treating Hypertension 61
8 Ingredients of Kakubhadi Lehya 82
9 Comparison of the benign and malignant hypertension 121
10 Speculative current theory of hypertension 123
11 Summary of the aetiology 128
12 Measurement of Blood Pressure 138
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”VIII
List of graphs
Sno Graph heading Page
1 Distribution of patients by Age – Gender 89
2 Distribution of patients by Gender in Bhrama 90
3 Distribution of patients by Religion 92
4 Distribution of patients by occupation 93
5 Distribution of patients by Economic status 95
6 Distribution of patients by presenting complaints 96
7 Distribution of patients by Associated features 97
8 Distribution of patients by mode of on set 98
9 Distribution of patients by Intensity 100
10 Depicting the Aggravating factors of Bhrama 101
11 Distribution of patients by relieving factors 102
12 Distribution of patients by Shareerika Prakruti 104
13 Distribution of patients by Manasika Prakruti 105
14 Distribution by presenting complaints 109
15 Results of the Kakubhadi Lehya 111
16 Linear graph of Blood Pressure – Systolic hypertension 173
17 Linear graph of Blood Pressure – Diastolic hypertension 174
18 BMI with systolic blood pressures 175
19 BMI with diastolic blood pressure 175
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 1
Chapter-1
Introduction
iddiness or Dizziness (Bhrama), headache (Sirahsoola), fatigue
(Angasada), insomnia (Nidranasha) and palpitation (Hritdrava) are common complaints
for an Ayurvedic practitioner occasionally get confused with the presented symptoms to
correlate. As the nomenclature of Hypertension or similar was not included in classical
texts and neither of Acharyas has affirmed such a condition elaborately, undertaking the
support of the contemporary medical system is unavoidable.
Hypertension is a major risk factor for many serious health problems. We have
many weapons to combat it: prevention, lifestyle changes, and increasing knowledge
about how best to employ a growing arsenal of medications. Yet, as many as half the
patients who start hypertension treatment stop within a year. Treatment is expensive, it
can have uncomfortable side effects. When the condition itself is asymptomatic and
physicians and patients may not remain fully vigilant through lengthy treatment 1.
The Hypertension, called as “Salient Killer”, drawn the attention of W.H.O. in
over decreasing the life span of 10 to 20 years causing cardiac or renal troubles. Further it
can be said, as it is an important factor in increasing the morbidity and mortality due to
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 2
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.
Definition and classification
Arterial or systemic hypertension in a patient is defined clinically as ‘borderline’
if the systolic blood pressure is more than 140 mm Hg and diastolic pressure is above
90mmHg (currently labeled as mild hypertension), and ‘hypertensive’ when the elevation
of systolic and diastolic pressure exceeds 160 and 95mmHg respectively (now termed as
moderate hypertension). The diastolic pressure is often considered more significant.
However, blood pressure varies with many factors such as age of the patient, exercise,
emotional disturbances like fear and anxiety. Therefore, it is important to measure blood
pressure at least twice during two separate examinations under least stressful conditions.
A clinically useful classification of hypertension has been recently described by the Joint
National Committee of the WHO/International society of Hypertension, by means of
these criteria, the prevalence of hypertension is observed in about 25% of population.
Hypertension is generally classified into 2 types 2
1. Primary or essential hypertension in which the causes of increase in blood
pressure is unknown. Essential hypertension constitutes about 90-95%
patients of hypertension.
2. Diseases of the kidneys, endocrines or some other organs cause secondary
hypertension, in which the blood pressure is increased. Secondary
hypertension comprises 5-10% cases of hypertension.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 3
According to the clinical course, both essential and secondary hypertension may
be benign or malignant. Benign hypertension is moderate elevation of blood pressure and
the rise is slow over the years.
Clinical classification of hypertension
Table -1
Category Systolic (mmHg) Diastolic (mmHg)
Normal <130 <85
High normal 130-139 85-89
Hypertension
Mild (stage1) 140-159 90-99
Moderate (stage2) 160-179 100-109
Severe (stage3) 180-209 110-119
Very severe (stage4) >210 >120
Malignant hypertension >200 >140
About 90-95% patients of hypertension have benign hypertension
Malignant hypertension
Malignant hypertension is marked and rapid increase of blood pressure to 200/140
mmHg or more and the patients have papilloedema, retinal haemorrhages and
hypertensive encephalopathy. Less than 5% of hypertensive patients develop malignant
hypertension and life expectancy after diagnosis in these patients is generally less than 2
years if not treated effectively.
Essential (primary) hypertension
By definition the cause of essential hypertension is unknown but a number of
factors are related to its development. These are as under -
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 4
1. Genetic factors: The role of heredity in the etiology of essential hypertension has
long been suspected. The evidences in support are the familial aggregation,
occurrence of hypertension in twins, epidemiologic data, experimental animal studies
and identification of hypertension susceptibility gene (angiotensinogen gene)
2. Racial and environmental factors: Surveys in the US have revealed higher
incidence of essential hypertension in black than in whites. A number of
environmental factors have been implicated in the development of hypertension
including salt intake, obestity, skilled occupation, higher living standards and patients
in high stress.
3. Risk factors modifying the course of essential hypertension: There is sufficient
evidence to show that the course of essential hypertension that begins in middle life is
modified by a number of factors. These are as under -
a) Essential hypertension (90%)
(a) Genetic factors
(b) Racial and environmental factors
(c) Risk factors modifying the course
b) Secondary hypertension (10%)
1. Renal
(a) Renovascular
(b) Renal parenchymal diseases
2. Endocrine
(a) Adrenocortical hyperfunction
(b) Hyperparathyroidism
(c) Oral contraceptives
3. Coarctation of aorta
4. Neurogenic
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 5
Younger the age at which hypertension is first noted but left untreated, lower the
life expectancy. Females with hypertension appear to fare better than males. Accelerated
atherosclerosis invariably accompanies essential hypertension. This could be due to
contributory role of other independent factors like cigarette smoking, elevated serum
cholesterol, glucose intolerance and obesity. Other factors, which alter the prognosis in
hypertension, include; smoking, excess of alcohol intake, diabetes mellitus, persistently
high diastolic pressure above 115 mm Hg and evidence of endorgan damage ((i.e. heart
eyes, kidney and nervous system).
The pathogeneic mechanism in essential hypertension is explained by many
theories. These are -
High plasma level of catecholamines
Increase in blood volume i.e., arterial overfilling (volume hypertension) and
arteriolar constriction (vasoconstrictor hypertension)
Increased cardiac out put
Low-renin essential hypertension found in approximately 20% patients due to
altered responsiveness to renin release. High renin essential hypertension seen in about
15% cases due to decreased adrenal responsiveness to angiotensin II
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 subjects3.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 6
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 age4. 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.
The clinical entity of hypertension is not available as such in the classical
literatures of Ayurveda. However, according to the directions of Acharyas regarding the
approach for the study of new diseases, 5-6-7 various contemporary Ayurvedic scholars
have made efforts to findout the proper nomenclature, etio-pathogenesis and treatment of
the disease.
It is very interesting to note that Acharya Charaka says about the complication of
Avrithavata as, Avrithavata if neglected leads to Hridroga, vidradi, pleeha, gulma and
Atisara8.
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 doshas9.
In recent times many Ayurvedic scholars have tried to give an appropriate term to
hypertension in Ayurveda. Following are the different correlation and different
terminology suggested by various scholars-
Avrita Vata Roga Vaidya R.K. Sharma
Dhamani Atipurana Acharya Yogendranath Sen
Dhamani Prapoornata Vaidya G.N. Saraswathi
Dhamani Praticchaya Vaidya A.D. Athawale; Vaidya Ranajit Rai Desai
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 7
Dhamani Upalepa Prof. G. N. Chaturvedi and Dr. K.N. Shastri
Mada,Murcha, Sanyasa Kaviraj Kumud Ranjan Roy
Rakta Peedanadhikyata Prof. Dr.V.V.S. Sastry, Dr.K.S.R.Prasad,
Dr.S.S.Hiremath (Gadag), et.al.
Raktagata Vata Prof. Yadunandana Upadhyaya. And Shri.
Sudarshana Shasrti; Bhupenra Pal. (Varanasi)
Rakta Sammardhana Prof. G.N. Chaturvedi
Rakta Sampeeda Vaidya S.P. Panday
Rakta Vata Prof. Yadunandana Upadhyaya. And Shri.
Sudarshana Shasrti; Dr. Sharma (Puri)
Raktatimardam Dr. John K. George
Rakta Vega Vriddhi Vaidya V.B. Athawale
Rasa Bhara Vaidya T.S. Mishra
Roudira Mada Acharya Vishwanath Dwivedi
Siragata Vata Prof. G. N. Chaturvedi and Dr. K.N. Shastri
Sleshamavrita Vyana Dr. Gupta H.C. (Varanasi)
Uccha Rakta Bhara Dr. Pathak U.C. (Jaipur)
Uccha Rakta Nipeedana Acharya Vidyadhara Shukla
Uccha Raktachapa Prof. Madan Gopal Sharma and Dr. Ajay Kumar
Sharma
Vyana Bala Vaishamya Vaidya Brihaspati Triguna
Some of the other terminologies used by other authors are Raktavruta Vata, Rakta
Pradoshaja Vikara, Bhrama, Rakta chapadhikyata, Raktabhigarshana, Rakta vikshepa etc.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 8
Essential hypertension when symptomatic will have one or few vague symptoms.
Similarly when we consider many avrita vatas they contain one or few symptoms of
essential hypertension, those are Raktavrita Vata, Pittavrita Udana, Pittavrita Prana,
Pranavrita Udana, Samanavrita Vyana, Sleshmavrita Vyana, Apanavrita Udana,
Vyanavrita Prana, Pranavrita Vyana, Udanavrita Prana, Kaphavrita Udana, Pittavrita
Vyana, Udanavrita Apana, Kaphavrita Prana etc. In these the involvement of Vyana,
Udana and Prana seems to be more prominent.
After considering all these, when we look at the symptoms explained in Rakta
gata vata, Sira gata vata, Roudhiramada, Dhamanipratichaya etc., and the various
Avrithavata’s, it seems that each pathological entity contains one or few symptoms
explained in essential hypertension. It may be because of the fact that usually in essential
hypertension, different patients will be manifested with different symptoms. Our ancient
Acharyas diagnosed the disease on the basis of symptoms available. But when we collect
all these symptoms, it directly coincides with the symptoms explained in essential
hypertension. This indicates that our Acharyas considered this disease under Vata roga.
On close observation, it is very much evident that different scholars tried to
identify the disease on the basis of following;
1. On the basis of vitiated dhatu – like Raktapradoshaja vikara, Rakta
chapadhikyata, Rakta samvardhana etc.
2. On the basis of vitiation of Vata – like Vyana bala vaishamya etc.
3. On the basis of vascular changes – like Dhamanipraticchaya, Dhamani
prapoornata, Sira gata vata etc.
4. On the basis of Avarana – like Raktavrita vata, Pittavrita udana, Sleshmavrita
Vyana etc.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 9
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 though in
1733 Stephen Hales measured first time Atrial blood pressure and 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 Hales 10 were 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.
In 1905, Karokoff a Russian, introduced the auscaltatory method of estimating
blood pressure. With in few years Sphygmomanometer took place with the stethoscope.
The mercury column and spring dial Sphygmomanometers were introduced in 20th
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 10
century. Late 20th century with advancements in electronics has presented digital
Sphygmomanometer to the medical community apart from ECG and Doplar studies,
which will provide scope to measure blood pressure.
Proposal:
When the lakshanas of Hypertension are observed with its patho-physiology, the
present proposed name “Bhrama” 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 diseases 11. 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 Bhrama (Dizziness), Hritdrava (palpitation), 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 is (atherosclerosis) 13 one out of twenty
Kaphaja diseases appears or associates with the ageing factor have more responsibility to
give rise Hypertension or Bhrama.
Role of Rasayana Chikitsa in Bhrama vis-à-vis Hypertension
Rasayana Chikitsa not only strengthens Dhatus but also works as a “Vajikarana”
i.e. youthful vigor and vitality. This is attributed to the “Sukrala” effect of Rasayana
dravyas. The dissimilarity of Vajikarana drugs is only limited to and restricted to
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 11
‘sukrala’ effect and it can not nourish and strengthen the other Dhatus. Here it is worth
mentioning the increased activity of controlled cell-division if it can replace the old cells
by new in a short spell, will also constitute the rejuvenation of the body leading to a
longer life, i.e. the Rasayana effect.
In Ayurveda any treatment that increases the immune power and life force is
considered as Rasayana or rejuvenate. This can include herbs, food, diet or activities that
restore vitality, youthfulness and cure disease. Rasa is the juice of life, the vital fluid that
sustains health and life. As we grow older we gradually lose this "juiciness", our tissues
begin to dry out and our joints lose their lubrication and ease of movement. Rasayana
replenishes this innermost sap of the body promoting clarity of perception, physical
strength, endurance and longevity of tissues.
Rasayana's are more subtle and specific in their action than simple nutritive tonics
as they promote and sustain the optimum functioning of the body, assisting not only
longevity but also awakening of the mind. They restore youthfulness in old age and
improve memory, mental clarity and vitality. Rasayanas' nourishing and rejuvenating
action at the cellular level of the tissues promotes continued production of lives vital
essences enabling to remain active and full of enthusiasm for the entire duration of life.
Rasayana herbs are being continuously explored for their effects on immune
system. Available evidence shows that, these drugs can be used to modulate the immune
functions. At one hand they may work to enhance immune functions and build us from
deep within, or they might pacify an angry immunity cell to be in its limits on the other.
Thus, a Rasayana drug favours the host in both ways.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 12
Rasayana therapy is defined as “the means by which one gets the excellence of
Rasa, Rakta etc., (tissue elements). This Rasa is the only source of nourishment to all the
tissue of the body. This is cyclical through out day and night without interruption
supplying nutrition to all living cells of the body through the Rasa-Rakta admixture. Rasa
(essence of food) is known to be the premier nutrition of the body tissue is capable to
progress/ limit the blood-related diseases, such as hypertension.
The Rasa vitiation is one of the major situations in case of Bhrama, thus the
removal of impurities and proper transportation of the Rasa-Raktavaha srotogata dravaya
i.e. Rakta with its related components in the minute vessels and capillaries is possible
through Rasayana. Dhaturupa Rasa (plasma and such other fluid constants of the body in
association with Rakta (blood constituents), which makes the imbalance through the Rasa
are to be rectified in the same route following the most best procedure of safeguarding
the Preenana and Jeevana kriyas by the Rasayana.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 13
Chapter-2
Objectivesresent study bears the following objectives -
(a) To evaluate the efficacy of “KAKUBHADI LEHYA” in
BHRAMA (Hypertension)
(b) To evaluate the efficacy of Rasayana effect of “KAKUBHADI
LEHYA” in BHRAMA (Hypertension).
(c) To evaluate the effect of “KAKUBHADI LEHYA” over disease
predisposing factors such as Lipids.
Their detail discussion is as under -
1) To evaluate the efficacy of “KAKUBHADI LEHYA” in BHRAMA
(Hypertension)
Bhrama is a pathetic condition in which the patient has a feeling of reeling head.
This could be because of humour vitiation as in association with the Rasa and Rakta
stated in Ayurveda or because of the impaired haemo-dynamics.
In such condition the Kakubhadi Lehya is said as better by its contents. It can be
substantiated that the rational combination made in Ayurvedic text, Bhaisajya Ratnavali
at Hrudroga Chikitsa Prakarana, can establish its identity by normalising the components
of Bhrama vis-à-vis high blood pressure and equilibrating the Dosha involved. Present
study evaluates the efficacy of the Kakubhadi Lehya under the lime light of the
contemporary medical parlance.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 14
2) To evaluate the efficacy of Rasayana effect of “KAKUBHADI LEHYA” in
BHRAMA (Hypertension)
Since the need for primary and secondary health care is paramount, the
Government will direct most of its spending towards this sector14. Every individual is
responsible for the entire cleanliness of himself, his house and surroundings. When once
this is recognised and, carried out, he is sure to attain freedom from sickness. Personal
cleanliness of the body, of dwelling apartments and of surroundings, good habits, good
food, exercise, recreation and sleep are all important factors in determining the strength,
luster, happiness and long life of individual 15.
Charaka has also laid down the code of good conduct by which one can remain
healthy and long-lived. He has also emphasised on prevention of diseases for which he
has devoted a number of chapters dealing with daily routine, seasonal living etc. in the
first section of the Samhita. The Charaka Samhita shows the path by which a man,
devoid of any ailment, can live happily and enjoy the normal life span (100 years) 16.
Aswins treat Maharshi Chyavana and Nandana with Rasayana therapy and made them
young by all means. This story was said in Rigveda17.
In the present context of Rasayana the word Rasa has the sense of end products of
digestion, which influence the metabolism of the body under the influence of the daily
stress and strain undertaken in the walking food running duties society. All the herbs
have the Rasa, which influence the Ahara Rasa, very specifically the preenana function.
Thus the Kakubhadi Lehya embedded Rasas cumulative effect on the body especially as
Rasayana over the body is evaluated here in this study.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 15
3) To evaluate the effect of “KAKUBHADI LEHYA” over disease predisposing
factors such as Lipids
Carbon monoxide causes perivascular oedema of the blood vessels and hypoxia.
This alters the permeability of the endothelium and increases the deposition of lipids in
the vessel wall. Reduction or stoppages of smoking helps to reduce blood pressure even.
Obesity contributes to blood lipid abnormalities and impaired glucose tolerance; it has
particular significance as a factor underlying the increased prevalence of coronary artery
disease in hypertensive patients. For every 10% increase in weight a rise of 6.5-mm Hg
in systolic pressure was observed in Framingham study.
Susruta has mentioned medoroga leads to vatavikara. Dalhana explained that
vatavikara is produced due to medavrita marga18. Apart from this in Astauninditeeya
adhyaya of charaka sutra sthana, Charaka has described the complications of sthoulya.
Here the apakva medas when deposited in rasavaha srotas may lead to dhamani
pratichaya 19-20-21 (atherosclerosis), which is the main factor responsible for hypertension.
Kakubhadi Lehya is a medicine in which, associations of Ghee with sugar candy exists.
The medicines with the edible fats are supplied to promote good fats in the body and to
excavate the fats responsible for disturbing the Srotas and Dhatu even. At this juncture
there is a need of evaluation of such medicament study in relation to that of the lipid
profile. Thus the present objective is carried out.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 16
Chapter-3
Review of literature
here is no definite information regarding the normal or abnormal
conditions of Hypertension in Ayurvedic classics. But this especially in an abnormal
state is presently recognised as a disease state, which requires immediate attention of the
physician 22.
HYPERTENSION IN ANTIQUITY
If you just look back to the past days, the clinical entity of hypertension is not
available as such in any of the classical literatures of Ayurveda. We find more than
thousands of diseases described in Ayurveda which can be correlated or resembles one or
the other modern diseases, like Jwara, Rajayakshma, Visarpa, Switra etc., to that of
Fever, Tuberculosis, Herpes, Leucoderma etc., respectively. On the contrary it is difficult
to find a clear-cut correlation to that of hypertension in our science. But looking to the
description of hridaya, the diseases like Hridroga, Pakshaghata which can be taken as the
complications of hypertension and the drugs like Sarpagandha, Arjuna etc., we can think
of hypertension to be present in those days.
20th Century Authors on Hypertension
Based on the Dosha Dushya vivechana by 20th Century Authors and various
diseases are considered under the heading Hypertension. Different names are
recommended for the Hypertension or the Hypertensive States are as follows –
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 17
1. Bhrama
2. Dhamani pratichaya
3. Mada
4. Moorcha
5. Pittavrita udanavata
6. Rakta gata vata
7. Raktachapadhikyata
8. Raktapradoshaja vikara
9. Raktavriddha pittavrita vata
10. Roudhiryamada
11. Sanyasa
12. Siragata vata
13. Ucha rakta bhara
14. Ucha rakta chapa
1) Bhrama:
The literal meaning of Bhrama is rotation. As a disease, it has been explained as a
feeling that a person experiences the fast rotation in the shiras similar to that of fast
rotating wheel23. Charaka has considered the Bhrama as one out of the vataja nanatmaja
vyadhi. Here Bhrama corresponds to Giddiness and Vertigo. Bhrama is a disease not only
concerned to the shiras but also considered as Raktapradoshaja Vyadhi. Chakrapani has
explained Bhrama as a smruthi mohaha that means hallucination in his commentary24.
According him the Bhrama is a smruthimoha that means hallucination25.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 18
Vagbhata has mentioned that this is because of vata dosha Vruddhi and Kapha
Ksheena26, where as Charaka affirmed it as sanchaya of vata dosha blocked by vitiated
pitta dosha27. Bhrama explained as a prodromal symptom of some diseases. It is also
said as symptom and complication of many diseases. It is due to disturbed vata dosha,
either alone or combined with or obstructed by vitiated pitta dosha.
Among the shareera doshas vata, pitta and manasa dosha rajas are considered as
the causative factors for the Bhrama28. When Kapha is diminished and both Vata and
Pitta are aggravated, it produces giddiness, cramps, piercing pain, burning sensation,
cracking, trembling, bodyache, wasting, distress and fuming29. In diminution of Vata and
Pitta, Kapha, blocking up the channels, produces loss of movement, fainting and
difficulty in speech.
In Astanga Hridaya Vagbhata has mentioned that it is one of the symptom caused
by vriddhi of vata Dosha and Kapha ksheena30. Charaka explained that it is caused due to
Sanchaya of vata dosha blocked by vitiated pitta Dosha31. It is due to disturbed vata
dosha, either alone or combined with or obstructed by vitiated pitta dosha.
Bhrama explained as a prodromal symptom of some diseases. It is also explained
as symptom and complication of many diseases. For example in the pittaja kasa the
Bhrama is a complaint32.
2) Dhamani Pratichaya
According to Charaka Dhamani pratichaya is one of the kaphaja nanatmaja
Vyadhi 33. The description of dhamani prathichaya as available in Nidhana Chikitsa
hastamalaka is ati poornata of dhamani. This Atipoornata of Dhamani is because of
Adhika Poshana. Due to adhika poshana especially Rasa and Rakta dhatus the damanis in
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 19
which these dhatu circulates get dilated. Because these Dhamanis get stretched by the
fullness of the Rasa, Rakta (Vriddhi) dhatu in them, simultaneously the velocity of the
Rasa Rakta Dathu (i.e, the gati becomes manda and guru) is hampered. The stretching
i.e., increase in the circumference of the dhamani is also caused by vayu, but in those
cases where in the increase in elasticity on circurmference of the damanis is due to vayu
in them.
The Dhamani will not be guru, manda and mrudu as in the Atipoornata of
Dhamanis by Rasa, Rakta. But infact, it will be hard (Katina) and Teekshna due to
vitiation of vayu on chalatwa of vayu and because of vitiation and chalatwa of Vata it
will sometimes be Teekshana, Manda, Poorna and Ksheena depending on the vitiation of
any one of these may be present in intervals.
This description is recorded in Nidana Chikitsa Hastamalaka clubbing the views
of Chakrapani, Gangadhara, Yogendranath commentaries on the word Dhamani
pratichaya the description also include the views of Astanga Sangrahakara and
Hridayakara on the word Dhamani Pratichaya. Most of these Acharyas have used
Dhamaniupalepa to denote Dhamani Pratichayaya i.e. Atherosclerosis.
3) Raktagatavata:
The disease Raktagata Vata, which is mentioned under the context of Vatavyadhi,
can be correlated with essential hypertension. Separate nidana have not been mentioned
for Raktagatavata, so samanya nidana mentioned for Vatavyadhi can be considered as
etiology for the Raktagata Vata. Some Ayurvedic scholars have mentioned that Raktagata
Vata as Raktavata. Charaka broached lakshanas as - Teevraruja, Santapa, Vaivarnya,
Krishatha, Aruchi., Stambata soon after having food34 and Vagbhata also mentions
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 20
almost all the symptoms, which are mentioned by Charaka, in addition with – Swapam,
Raga and Bhrama35.
Shri sudarshan shastri and shri yandunandanopadhya commenting on Raktagata
Vata says that the word Raktachapa can be considered as hypertension. Acording to
Kaviraj Gananathsen, the conditions Raktagata Vata and Vata Rakta are one and the
same. But Sri Sudarshan Shastri and Sri Yandunandanopadhya conferred opinion, as
Raktagata Vata is nothing but hypertension.
4) Raktavrita Vata:
Charaka has described the disease Raktavrita Vata under the context of
Vatavyadhi but no other Acharyas have mentioned regarding this disease. Raktavrita vata
resembles to that of Raktagata vata. They are Daha in between twak, mamsa and Vedana
saragayukta shotha and mandala.
The lakshanas mentioned under Raktavrita Vata 36 resembles to that of Raktagata
vata, they are Daha in between twak and mamsa, vedana saragayukta shotha and
mandala.
5) Siragata Vata:
Siragata vata is described under Vatavyadhi. Charaka, Susrutha and Vagbhata
describe it. When there is vata prakopa in siras, it causes many diseases such as vata
sambava vyadhies. Lakshanas mentioned under siragata vata are -
Ø Mandaruja, shopha, kampa no spandana in siras but there will be
akunchana in them 37.
Ø Susrutha and Yogaratnakar supported Charaka in all aspects. While
sushruta mentioning lakshanas, shoola, sira akunchana, and purana are being
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 21
mentioned i.e akunchana means sankocha in siras and purana means stoolatwa
in siras. In Yogaratnakar, it is mentioned that when there is vata prakopa in
sira there will be shoola akunchana in siras it will be filled with vata, which in
turn causes Bahyayama and Antarayama, khalli and kubjatwa.
6) Roudhira Mada: 38
Mada is one of the Raktaja disorders. Mada is nothing but, mado
Harshaglanopanaya i.e. in this disease. Harsha and Glani of that particular dhatu takes
place.i.e; increased gati and matra of rakta takes place or utkarsha or apakarsha of rakta is
called mada.
Mada is – “Mado harshaglanopanayh” it means, Harsha and glani of Rakta takes
place, i.e. increased gati and matra of rakta takes place or other wise utkarsha or aakarsha
of rakta is called mada. In charaka samhita 43 types of raktaja vydhies are mentioned and
mada is one among them 39. In Charka Samhita 43 types of raktaja vyadhies are
mentioned and mada is one among them 40.
There are seven types of madas explained vataja, pittaja, kaphaja, sannipataja,
vishaja and roudhiramada. Roudhira mada is considered as hypertension, by Acharya
Shree Viswanath Dwivedi and clarified that the dushya involved in this disease is Rakta.
In Roudhira mada, the vitiation of Rakta results in to increase Blood by the
vitiated Rakta altered Akunchana and Purana of Raktavaha and siras takes place then
leads to Roudhira mada.
On the other hand there are seven types of madas explained - Vataja, pittaja,
kaphaja, sannipataja, vishaja and roudhiramada. Roudhira mada is considered as
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 22
hypertension by Acharya shree Vishwanath Dwivedi and clarified that the dushya
involved in this disease is Rakta.
In Roudhira mada, initially the vitiation of blood results into increased Rakta, and
there by altered Akunchana and Purana of Raktavaha and siras takes place. Then it
confers to Roudhira mada.
7) Raktapradoshaja vikaras:
In charaka samhita totally 43 diseases are mentioned in vidhishonita adhyaya all
these diseases come under the rakta pradoshaja vikara. In this group mada, raktapitta etc.,
diseases are considered 41-42-43. Hypertension is considered under the Raktapradoshaja
vikara, due to the involvement of Rakta Dhatu.
Vatashonita, Raktapitta etc., diseases are mentioned in Sushruta Samhita under
the rakta vikara 44. Mada, Bhrama etc., diseases are considered under the Raktopradoshaja
diseases in Astanga Hridaya 45. But in Astanaga Sangraha, Mada, Murcha and Sanyasa
are explained in Rakta pradoshaja vikara 46.
8) Avruta Vata
The disorders of Vata are nomenclated as many as 80. Some of the avrutha vata
disorders are also considered under the heading of hypertension. They are Pittavruta
pranavata and Pittavruta udanavata.
8a) Pittavrutha prana vayu: The lakshanas mentioned are - Murcha,
daha, bhrama, soola, vidaha, chardi and sheeta kamatwa 47.
8b) Pittavruta udana vata : The pittavruta udanavata lakshana are -
Murcha, daha, shoola, daha in the nabhi and urah region, ojobransha,
shwasa, and klama 48.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 23
8c) Pitta Avrithavata 49: If vayu is covered by Pitta the following
symptoms arise – burning sensation, thirst, pain, giddiness, feeling of
darkness, aggravation of burning sensation by the use of pungent, sour,
salty and hot things and desire for cold.
In case of covering with Kapha there are coldness, heaviness and pain, suitability
of pungent etc. and particular desire for fasting exertion, rough and hot things.
• If vayu is covered with Rakta, there is burning sensation with distress,
the space between skin and muscle becomes red and swollen and
rashes appear.
9) Murcha and Sanyasa:
Murcha is disease of raktavaha srothas which is due to vikrutha pitta and tamo
guna i.e, both sharirika and manasika vyadhi. Murcha can be considered as syncope,
which is mentioned, in modern science. A simple faint or temporary loss of
consciousness due to cerebral and it is important to note that giddiness, faintness or actual
syncope is much more frequently due to peripheral circulatory failure.
According to Astanga hridaya mada, murcha and sanyasa are the diseases of rasa,
rakta and samjnavaha sroto dusti. Acharya Susruta explained 6 types of murcha vataja,
pittaja, kaphaja, raktaja, madyaja and vishaja. While explaining about the raktaja murcha,
it is due to smell of blood or by seeing the blood it occurs. Sri sudarshan shastri and sri
Yadundana Upadhyaya opined that murcha occurring in rakta vata or high blood pressure
can be raktaja murcha.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 24
9a) Murcha:
Murcha is considered as disease entity in Madava Nidana and explained in details
with nidana panchakas. Murcha is disease of raktavaha srotas, which is due to vikruta
pitta and tama guna i.e., both sharirika and manasika Vyadhi 50. On the literacy base
murcha is nothing but syncope which is mentioned in modern science.
A simple faint or temporary loss of consciousness due to cerebral, anaemia often
caused by dilatation of the peripheral blood vessels and a sudden fall in blood pressure 51.
It is proved that it is loss of consciousness due to cerebral and it is important to note that
giddiness, faintness or actual syncope is much more frequently due to peripheral
circulatory failure.
According to Astang Hridaya – Mada, Murcha and Sanyasa are the diseases of
rasa, rakta and samjnavaha sroto-Vikruti 52. Acharya Sushruta explained 6 types Murcha
viz. Vataja, Pittaja, Kaphaja, Raktaja, Madyaja and Vishaja. While explaining about the
raktaja murcha, it is due to smell of blood or by seing the blood it occurs. Commenting
on this statement Hindi commentator of madavanidana Sri Sudarshana Shastri and Sri.
Yadunandana Upadhyaya opined that murcha occuring in rakta vata or high blood
pressure can be taken, as raktaja murcha after considering raktaja murcha is Raktavaha
Sroto Vyadhi.
9b) Sanyasa:
Sanyasa is disease of samajnavaha srotas and also called as gambhira murcha. If
murcha is not treated properly it leads to Sanyasa. According to modern science coma is a
state of unnatural heavy deep and prolonged sleep often accompanied by slow irregular
breathing and consequently ending in to death 53.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 25
10) Raktachapadhikyata
The word Raktachapadhikyata is formed by three words - Rakta, Chapa and
Adhikyata.
‘Rakta’ refers to - Shareerastha saptadhatwantargata dhatu vishesha: l
Raktam sarvashareerastham jeevasyadhara uttamaha: l S.T.M. 4
v ‘Chapa’- refers to pressure or squeezing.
v ‘Adhikyata’-refers to, high or increased.
So the meaning of “Raktachapadhikyata” is the high blood pressure or increased
blood pressure. Here it does not specify whether it is essential hypertension or secondary
hypertension. But here in this, the word Raktachapadhikyata is used to denote essential
hypertension.
Vata-caused hypertension often leads to a blood pressure that often fluctuates for
many years, until it begins to aggravate Pitta and Kapha, respectively, and becomes
increasingly more constant and more difficult to treat. Pitta-caused hypertension is the
most common in a classic Pitta body type (sometimes demonstrated through a red face
and bloodshot eyes). The patient may have quick temper with an aggressive and
competitive nature that incessantly drives him. Kapha-hypertension is often associated
with obesity and edema. This imbalance is usually long-standing and chronic. The Dosha
of Kapha can act as a storage site for all the circulatory Ama created in the doshas of
Vata and Pitta. The herbs for Vata and pita may be necessary as needed, and some
pungent and astringent herbs to detoxify accumulated Ama are important. Garlic,
cayenne (capsicum frutescens), and pippali (piper longum) or trikatu, a combination of
long pepper, black pepper and ginger are useful 54.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 26
SHAREERA VIVECHANA
Before discussing the disease Bhrama, it is very much essential to know the
functional anatomy of the heart and blood vessels with physiology of blood circulation.
Hridaya
The word ‘Hridaya’ explains and signifies only the functional aspect of an organ.
According to Shatapatabrahmana the word hridaya is made up of three dhatu’s, Hri, Da,
and Ya. These dhatus by the combination of the pratyaya and adesha, forms the dhatus,
as Hrit, Dana and Ayana.
The dhatu Hrit gives the meaning of Hanane, Apatirite i.e., to take or to receive.
The dhatu Dana gives the meaning of Tyage, Palane, Chedane i.e. to give or to eject or to
nourish. The dhatu Ayana having the paribhasha of Kayam, gives the meaning of Gati,
Chalana, or Movement.
The word hridaya has been attributed to mainly two organs, namely Mastishka or
Shirohridaya and Hridaya i.e. Urohridaya. Generally yogis attribute the word hridaya to
Mastishka or Brain, and the physicians or vaidyas denote the word hridaya to Urohridaya
or Muscular heart.
In classics the anatomy and physiology of hridaya is not explained under one
heading or at one place, we get lot of quotations and similies based on which we should
understand the anatomy and physiology of heart.
Hridaya is considered as one of the kostanga. It is situated in vaksha pradesha in
between the two stanas. It is formed by sleshma and rakta, having the shape of inverted
lotus and according to Arunadatta it is made up of mamsapeshi and rakta. It measures
two angula according to Chakrapani and four angula according to Susruta. Hridaya is the
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 27
moola of pranavaha and rasavaha Srotas 55. It is the seat of manas and para-apara ojus56.
Hridaya is the prabhava sthana of dashadhamani’s which spreads all over the body and
which carries rasa, ojas and does tarpana karma 57-58. According to Palakapya, from
hridaya siras arise and spreads all over the body just like a network, and like all rivers
join ocean, in the same fashion all siras opens in to hridaya 59. Hridaya continues to work
whether the person is in jagrutavasta or swapatavasta 60.
Many of its functions can be attributed to the doshas that are concerned to it, i.e. a
particular function of hridaya is carried out by particular dosha. These functions are
discussed below with respect to concerned doshas.
Relation of Hridaya with Doshas
Hridaya is related with all the three doshas. Among vata, it is related with
udanavayu, prana vayu and vyana vayu. Among pitta, it is related with sadhaka pitta and
pachaka pitta, and among kapha it is related with avalambaka kapha.
Hridaya and Udanavata
Charaka and Vagbhata have mentioned the uras as the sthana of udana vayu 61-62-
63. This indicates that, it is related to hridaya also. When we look at the functions of
udana vayu, the functions like prayatna (endeavour or effort), urja (enthusiasm) and bala
(strength) 64, with respect to hridaya, we can think of the conductive system of the heart,
i.e. udana vayu by the functions like prayatna and bala initiates and helps in the
conduction of the cardiac impulses in the heart.
Hridaya and Pranavata
According to Charaka and Vagbhata Pranavata is situated in Shiras 65-66. And
according to the Sharangadhara it is situated in hridaya67. Vagbhata states that pranavata
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 28
maintains the activities of hridaya (heart and circulatory system), and supports or does
dharana of dhamanis (probably the vasomotor functions) 68-69. Looking to the above
description it can be said that prana vata situated in murdha sends impulses to hridaya,
there by governing the sympathetic and parasympathetic actions / functions.
Hridaya and Vyanavata
Vyana vayu is situated in hridaya 70-71 and it pervades swiftly throughout the body
72-73. Vyana vayu is responsible for circulation of Rasa (rasadhatu) through out the body
74-75, by the regular contraction and relaxation of the heart 76. Sushruta has also
mentioned asruk sravana to be one of the functions of Vyanavata 77. Vagbhata concised
all functions of vyana vata by the statament that all the actions or movements of the body
are conducted by vyana Vata 78.
In Nadee-gnyanam, it is mentioned that the rhythmic tendency of the heart is
responsible for continuous contraction and dilatation of the hridaya and which is the
inherent tendency and capacity of hridaya.
Even Charaka has mentioned that vyana vayu is responsible for the continuous
flow of rasadhatu to all parts of the body through out the life by using the words like
ajasram and sada 79.
Hridaya with relation to Sadhakapitta
Sadhaka pitta is situated in hridaya 80-81-82, and it is responsible for achievement of
buddhi, medha, abhimana, utsaha and abhipretartha.
From this it is understood that, it is essentially connected with some of the higher
mental faculties and emotional states. The concept of sadhaka pitta therefore,
encompasses psycho-physiological actions.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 29
Hridaya and Avalambaka Kapha
Avalambaka kapha is situated in uras 83-84. It does avalambana of hridaya i.e. with
the help of rasa it gives bala to hridaya. In other way it does tarpana and kledana of
Hridaya and there by helping it to function properly.
Hridaya with relation to Manas
It is also seen that hridaya is the adhistana of Manas 85-86-87-88. Acharya Charaka
while mentioning measures to protect hridaya and oja says to avoid the thing that
produces dukh to the Manas 89. Even in Unmada chikitsa adhyaya also acharya Charaka
mentions about manovaha srotas. Chakrapani commenting on it says the dhamani’s that
originate from hridaya or the dhamani’s that are related to hridaya desha, are to be taken
as manovaha Srotas 90-91. From all these it is clear that hridaya, sadhaka pitta and manas
are related to each other and the vitiation of one causes the vitiation of other.
Relation of Hridaya with Ojas
In shareera ojas has been classified in to two types, i.e. para ojus and apara ojus.
Para ojus is situated in hridaya 92. It is asta bindu in pramana and it is said to be uttama
pranayatana (most important vital part). Even, if little of it is destroyed the body cannot
exist. Apara ojus is situated in hridaya and dhamani, and circulates all over the body. It
is ardhanjali in pramana and the deficiency of this ojus does not cause death but diseases
like prameha are likely to set in.
Looking to all these above references we cannot get a clear cut picture of anatomy
and physiology of heart. But it gives a clear idea that, the hridaya that is described is
nothing but the muscular heart or cardia. Even the classical quotations and similies given
for hridaya almost fulfil the modern description that has been given for heart.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 30
Rasa Rakta Paribhramana
Hridaya is the srotomula of rasavaha and pranavaha srotus 93. It is responsible for
rasa samvahana in the body. Samanavata brings the ahara rasa that is formed to hridaya,
and as it enters the hridaya it is considered as rasa dhatu. Now with the help of vyana
vayu and udana vayu the sankocha and vikasa i.e. the praspandana of hridaya starts.
Praspandana of hridaya can be correlated to the conductive system of the heart. Here
sankocha can be considered as systole and vikasa can be considered as diastole.
Pranavata maintains the actions of hridaya and does dharana of dhamanies. This
indicates that it governs the vasomotor functions. Once the sankocha takes place the rasa
moves in to dashadhamani, and proceeds further 94.
Here by prasarana akunchana karma, and as per kedarakulya nyaya, the rasa
moves to all parts of the body and nourishes the whole body. This function is carried out
continuously through out the life 95. Even Bhela explains that rasa samvahana takes place
through sira dhamani, which are spread all over the body and owes their origin and
insertion to hridaya. Sharangadhara while explaining rasa samvahana explains that, rasa,
rakta, oja, sneha are carried from hridaya to all parts of the body, and does tarpana karma.
Avalambaka kapha gives bala to hridaya, to carry out these functions.
Regarding rasa samvahana acharya Susruta gives a simily i.e. “Shabdarchi
Jalasantanavat” 96. This indicates that rasa moves in all directions. Dalhana commenting
on it says, urdhwagamitwa of rasa occurs like archi, adhogamitwa of rasa like jala and
tiryagamitwa of rasa like shabda.
Again this rasa is brought back to the hridaya by vyana vayu samana vayu and
hridaya vikasana takes place, followed by sankocha and rasa moving towards sarva
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 31
shareera. This cycle continues and acharya Charaka uses the word ajasra to denotes the
continuous function of hridaya in circulation of Rasa 97.
PHYSIOLOGY OF BLOOD CIRCULATION
The activity of the organs of the circulatory system, that is, of the heart and blood
vessels, ensures a constant flow of blood in the organism. Because of its movement, the
blood can perform numerous transport functions, in particular, supplying oxygen and
nutrients to the tissues, and removing waste substances formed as the result of
metabolism.
The movement of blood in the organism follows a complicated course known as
the systemic, or greater circulation, and the pulmonary or lesser. The systemic
circulation starts at the left ventricle of the heart, passes to the aorta, to the arteries,
originating from it and to all their branches, thence to the arterioles, capillaries, and the
veins of the whole body, and finally to the two venae cavae which enter the right atrium.
The pulmonary circulation begins from the right ventricle, continues along the pulmonary
artery and all its branches, then along the pulmonary arterioles, capillaries, and veins and
terminates in to the pulmonary veins, which empty into the left atrium.
The flow of blood in the vessels is due to the work of the heart. Contraction of
the ventricular myocardium ejects blood under pressure from the heart into the aorta and
pulmonary arteries. The movement of the blood further along the vessels, and its return
to the heart, is conditioned by its pressure in the large arteries being higher than in the
small arteries, the pressure in the latter being higher than in the capillaries, and the
pressure in the capillaries being higher in turn than in the veins and atria. In this way
there is difference in pressure all along the blood stream that determines its circulation in
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 32
the vascular system, blood flowing from the vessels with higher pressure to those with
lower. The gradual drop in the pressure along the blood stream (from the arteries to the
capillaries and veins) is brought about by the fact that the energy imparted by the heart is
utilised to overcome the resistance of the vessels to the movement of the fluid arising
from friction between the fluid particles and the vascular wall and between the particles
themselves.
The function of the heart is rhythmic pumping of blood that it receives from the veins
in to the arteries. It is performed by alternate rhythmic contraction and relaxation of the
muscular fibres that forms the walls of the atria and ventricles. Contraction of the
myocardium of these chambers is known as their systole, and relaxation as their diastole.
In normal physiological conditions systole and diastole occur in a definite co-
ordination and constitute the cardiac cycle. Each cycle is considered to start with the
atrial systole. The contraction begins as a wave in that part of the right atrium where the
orifices of the venecavae are, and then involves both atria, which have a common
musculature with a cardiac rhythm of 75 contractions per minute, an atrial (auricular)
systole lasts 0.1 second. As it ends, the ventricular systole begins, the atria then being in
a state of diastole, which lasts 0.7 second. The contraction of the two ventricles occurs
simultaneously, and their systole persists for about 0.3 second. After that, ventricular
diastole begins and lasts about 0.5 second. One-tenth second before the end of the
ventricular diastole a new atrial systole occurs, and a new cycle of cardiac activity begins.
Regulation of Blood Pressure
Physiologically the magnitude of the arterial pressure depends on two
fundamental hemodynamic variables; cardiacs out put and total peripheral resistance. In
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 33
other words, the arterial blood pressure is a product of cardiac out put and peripheral
vascular resistance.
Figure -1
Showing the Blood Pressure Regulation
HUMORAL FACTORSConstrictors DilatorsBLOOD VOLUME -Angiotensin II -
Prostaglandins-Sodium -Catecholamines -Kinins-Mineralocorticoids -Thromboxane -NO/EDRF*-Atriopeptin -Leukotrienes
-Endothelin
BP = CARDIAC X PERIPHERAL LOCAL FACTORSOUTPUT RESISTANCE -Autoregulation
-Ionic (pH, hypoxia)
CARDIAC FACTORS NEURAL FACTORS-Heart rate Constrictors Dilators-Contractility -�-adrenergic -�-adrenergic
* Nitric oxide / endothelium - derived relaxing factor
The Blood Pressure can be raised by increased peripheral resistance and by
increased cardiac output.
The cardiac output depends upon the heart rate, its contractibility and the blood
volume. The blood pressure can be raised by an increase in the volume of fluid
absorption of water and water retaining sodium from the intestine in to the vascular
system or an increased production of the adrenocortical hormonal aldesterone, which
blocks the excretion of sodium and water into the urine.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 34
It appears that most patients with established hypertension have abnormal cardiac
output and increased peripheral vascular resistance mainly sustains blood pressure.
The peripheral vascular resistance is determined by the arteriolar lumen, which
may expand or contract depending on the state of muscular cells in the vessel wall. This
is known as local vascular tone. Normal vascular tone depends on the competition
between vasoconstricting influences and vasodilators. Peripheral resistance depends on
the size of the lumen of some vessels. A decrease in the inner (lumen) diameter will
raise the Blood Pressure. The decrease in the lumen could be brought about by an
anatomical thickening of vessel walls (eg., intimal thickening of arteries), by their
mechanical compression from outside or most commonly by their active muscular
contraction which can be induced by a variety of vasoconstrictor mediators. The
common vasoconstricting mediators are epinephrine, norepinephrine and renin- activated
angiotensin-II. The other recently described vasoconstrictors include endothelin-I,
thromboxane and leucotrienes. Resistance vessels also exhibit auto regulation, a process
by which increased blood flow to such vessels induces vasoconstriction, an adaptive
mechanism that protects against hyperperfusion of tissues. The vasodilators include
kinins, prostaglandins and nitric oxide. Certain metabolic products such as lactic acid,
hydrogen ions, adenosine and hypoxia can also function as local vasodilators.
Recently it has been discovered that haemoglobin plays an important role in
regulation of blood pressure. In the body tissues, haemoglobin releases oxygen and
super nitric oxide (SNO) and picks up carbon dioxide. The released SNO causes
vasodilatation. At the tissue level haemoglobin also picks up excess nitric oxide (NO),
which tends to cause vasoconstriction. Thus haemoglobin helps in regulating the blood
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 35
pressure by adjusting the amonts of SNO and NO to which blood vessels are exposed.
This newly appreciated role of haemoglobin may influence development of drugs to treat
hypertension.
Further the arteriolar smooth muscle contraction can be increased by increased
sympathetic tone and also by increased sodium load and extra cellular fluid load.
The kidneys play an important role in the blood pressure regulation, and there is
considerable evidence that renal dysfunction is essential for the development and
maintenance of both essential and secondary hypertension.
The kidney influences both peripheral resistance and sodium homeostasis, and the
renin-angiotensin system appears central to these influences. Renin elaborated by the
juxtaglomerular cells of the kidney transforms plasma angiotensinogen to angiotensin-I,
and the latter is converted to angiotensin II by angiotensin converting enzyme (ACE).
Angiotensin II alters blood pressure by increasing both peripheral resistance and blood
volume. The former effect is achieved largely by it’s ability to cause vasoconstriction
through direct action on vascular smooth muscle, the latter by stimulation of aldosterone
secretion, which increases distal tubular reabsorption of sodium and thus of water.
The renin-angiotensin system
The renin-angiotensin system has been extensively studied since the introduction
of practicable essay methods for plasma renin and angiotensin patients with essential
hypertension have been subdivided into subgroups with low, normal and high plasma
renin on the grounds of the elevated pressure. The different mechanisms and in particular
those patients with low plasma renin might have excess, mineralocorticoid activity.
Plasma renin and angiotensin ii values are continuously distributed in the hypertensive
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 36
population. Further peripheral levels of plasma renin and angiotensin –II is found in
relation inversely to age in essential hypertension. Peripheral levels of anti diuretic
hormone have been reported as being slightly suppressed in uncomplicated essential
hypertension.
Figure -2
Showing the Role of Renin-Angiotensin System
J G
Renin
Renin Substrate
Angiotensin IConverting Enzyme
Angiotensin II
Vasoconstriction Increased Aldosterone Synthesis
Sodium retention
Increased Blood Pressure
• The kidney produces a variety of vasodepresser or antihypertensive substances that
presumably counter balance the vasopressin effects of angiotensin. These include the
prostaglandins, a urinary kallikrein-kinin system, platelet-activating factor, and nitric
oxide.
• When blood volume is reduced, the glomerular filtertation rate (GFR) falls, this, in
turn, leads to increased reabsorption of sodium by proximal tubules in an attempt to
conserve sodium and expand blood volume.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 37
• GFR- independent natriuretic factors, including atrial natriuretic factor (ANF), a
peptide secreted by heart atria in response to volume expansion, inhibit sodium
reabsorption in distal tubules and cause vasodilation. Abnormalities in these renal
mechanisms are implicated in the pathogenesis of secondary hypertension in a variety of
renal diseases, but they also play an important role in essential hypertension.
Approach to Clinical features of HTN
All acharyas have directed us to understand an anukta roga in terms of dosha
dushyadi bhava 98 and also they have mentioned about pratitantra siddhanta 99 i.e.
regarding the concepts of other science, with these guidelines an interdisciplinary attempt
has been made to analyse the dosha dushya in Hypertension to understand the Nidana
panchaka and for better management of it. And for this the signs and symptoms of
essential hypertension are analysed with special reference to that of Bhrama. The analysis
is undertaken on the basis of available data from contemporary medicine, where yukti
Pramana is invoked.
From the analysis made below in the chart is seen that among shareerika doshas,
all the three doshas are involved, and in manasika doshas both raja and tama are
involved, and in dushya rasa, rakta, mamsa, and medas are involved, and regarding
srotas, rasavaha, raktavaha, mamsavaha, medovaha and manovaha srotas are involved.
And it also reveals that among shareerika doshas vata is the pradhana dosha that gets
afflicted followed by pitta and kapha. Among dushya rakta is the pradhana dushya that
gets afflicted. Thus from this study it can be concluded that Bhrama (essential
hypertension) is vata pradhana tridoshaja vyadhi with rakta as the pradhana dushya.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 38
Table -2
Showing Dosha Dushyadi Vivechana of Bhrama in comparison to hypertensionSHAREEKADOSHA
MANASIKADOSHA
DUSHYASl.No.
CLINICALFEATURES
V P K Raj Tam R Ra
Ma
Me
SROTAS
1. Giddiness + + - + - + + - - RasavahaRaktavaha
2. Headache + - - - - - + - - Raktavaha3. Vertigo + + - + - - + - - Raktavaha4. Palpitation + - - - - + - - - Rasavaha5. Fatigue + + - - - - + - - Raktavaha6. Chest pain + - - - - + - + - Rasavaha7. Insomnia + + - + - - - - - Manovaha8. Irritability + + - + - - - - - Manovaha9. Anxiety + - - + - - - - - Manovaha10 Dyspnoea + - - - - + - - - Pranavaha,
Rasavaha11 Delirium + - - + - - - - - Manovaha12 Anger - + - + - - + - - Raktavaha13 Fainting + + - - + - - - - Manovaha14 Epistaxis - + - - - - + - - Raktavaha15 Tinnitus + - - - - + - - - Rasavaha16 Bounding pulse + + - - - - + - - RaktavahaNOTE: V – Vata; P – Pitta; K – Kapha; Raj – Rajas; Tam – Tamas; R – Rasa;
Ra – Rakta; Ma – Mamsa; Me - Medas
Nidana
Observation and analysis of the scriptural references of Bhrama vis-à-vis
Hypertension, a Hridroga concern reveals that the Nidana, Samprapti and Lakshana can
be categorised into three groups 100:
1. Mityahara Vihara,
2. Pragnaparadha,
3. Marmaghata.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 39
1) Mityahara Vihara:
Improper diet like consumption of excessively pungent, heavy, dry, incompatible,
unaccustomed, un-digestive foods which are basically dhatu produshaka, viruddha,
apatarpaka and ahridya ahara and also improper regimen like chintanamati chintanam
(strong emotional stress) intermittent eating, faulty therapeutic measures like
Bastivyapath, Virechana Vyapath etc., These factors are by nature rasa dhatu
pradooshaka and also rasavaha srotho dushti karakas.
These nidanas cause apatarpana of rasa dhatu which leads to Hridayavayava
Dushti by being nourished by dushita rasadhatu. And even the santarpana nidanas
mentioned like tila, guda, guru aharas also do not cause proper nourishment; but cause
amasandharana which accumulates in rasavaha srotas and proper hridaya in the form of
Upalepa (fat disposition as in cholesterol and atherosclerosis) leading to granthi
formation, which in turn hampers vyana vata sanchara, creating vyshamya in its gati.
2) Prajnaparadha:
The causative factors like instigation and inhibition of natural urges especially of
Adhovata, Trishna, Ashru, Chardi, Shramashwasa, Udgara etc., Physical exertion, Grief,
Fasting, Sexual abuse, Awakening at night, Excessive sleep etc., which are volitional
transgression of body and mind, these also include violation of Dinacharya, Ritucharya
and Swastha Vritha.
All these factors when analysed show that they are basically related with the
functioning of Pranavata, Apanavata, Udana Vata which gets vitiated simultaneously
vitiating Vyanavata, which functions in association with the rest of the vatas, leading to
Hridayavayava Dushti by gati vyshamya of vayanavata leading to Hridroga.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 40
3) Marmaghata :
Hridaya is an important Marmanga the reason why it is specially designed for
sensitivity. Any injury to this organ externally or by the internal doshas proves to be
fatal. Hence, it should be protected with care.
1) Dosha prakopa Karana
a) Vyanavata Prakopa Karanas: Atigamana, chinta, vishama chesta, viruddha ahara,
ruksha ahara, bhaya, harsha, vishada etc 101.
b) Pranavata Prakopa Karanas: Ruksha ahara, vyayama, langhana, atyahara,
abhighata, vegadharana, adhwahata etc 102.
c) Udanavata Prakopa Karanas: Kshavathu, udgara, chardi, nidra vegadharana, guru
ahara, bhara vahana, ati rodana, ati hasya etc 103.
Here all these three vata are in relation to hridaya and rasa rakta paribhramana.
So any impairment in these leads to the disturbance or impairment in the normal function
of heart and blood circulation.
2) Srotodusti Karanas
Some of the other karanas that can be held responsible are-
a) Rasa vaha Srotodusti Karanas: Guru, sheeta, atisnigdha, atimatra bhojana, adhika
chinta etc.
b) Rakta vaha Srotodusti Karanas: Vidahi, ushna, snigdha, drava bhojana, adhika
atapa and vayu sevana etc.
c) Mamsa vaha Srotodusti Karanas: Abhishyanda, sthoola, guru ahara sevana, day
sleep after bhojana etc.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 41
d) Medovaha Srotodusti Karanas: Avyayama, deewaswapna, excess of fat containing
meat, adhika madira etc.
e) Manovaha Srotodusti Karanas: Krodha, shoka, bhaya, harsha, vishada, irsha, asuya,
dainya, matsarya, kama, lobha, iccha, dwesha etc.104.
Excessive use of Lavana is described in Charaka samhita as the cause of Rakta
vriddi and leads to shonitaja roga 105. Since rakta dhatu is one of the important dushya in
the etiopathogenesis of hypertension, it is given more importance. The symptoms of
shonitaja roga are similar to this essential hypertension. Again Charaka has told that
lavana should not be consumed in excess and for longer duration 106. When excessively
used, it produces fatigue, lassitude and weakness of the body 107, which are the symptoms
usually found in the patients of hypertension.
Sushruta has mentioned medoroga leads to vatavikara 108 Dalhana explained that
vatavikara is produced due to medavrita marga. Apart from this in astauninditeeya
adhyaya of charaka sutra sthana, acharya has described the complications of sthoulya.
Here the apakva medas when deposited in rasavaha srotas may lead to dhamani
pratichaya (atherosclerosis), 109-110-111, which is the main factor responsible for
hypertension. In Ayurveda seat of manas shira and hridaya, which are in turn related to
prana and vyana vayu respectively, which have influence over function of maintaining
the blood pressure. So aggrevated vata will initiate the process of hypertension 112-113.
Raja and tama are the doshas pertaining to the mind and the types of morbidity
caused by them are kama, krodha, lobha, mada, bhaya 114 etc. Acharya Charaka has
advised to suppress these factors, 115 because they tend to elevate raja and tama gunas
which cause manodusti. These obnoxious state of mana produces manovikara with
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 42
involvement of samjnavaha or manovaha Srotas 116. Further, Chakrapani commenting on
srotomula says, hridaya and dashadhamani are the manovaha srotomula 117. In this way
this manovikara may afflict the arteries of the heart and therefore they also afflict oja
which is also asirta of hridaya, 118 and vitiation of vata and Pitta, 119-120 also takes place.
3) The causes of high blood pressure
The causes of high blood pressure are a bit of a mystery. About 5% of patients
requiring hypertension treatment can trace their high blood pressure to a physical cause
such as kidney disease. Treatment of the disease reduces the symptoms of high blood
pressure 121.
But for 95% of patients who undergo hypertension treatment, the causes of high
blood pressure are unknown. Diet and stress are suspected as prime contributors to
hypertension, but medical experts aren’t exactly certain of all the mechanisms involved.
There is a close relationship between blood pressure and weight. This applies to
all ages and groups. Studies have established that individuals who gain more weight show
more increase in blood pressure. Moreover, weight reductions have been accompanied by
a fall in arterial pressure. This is not exclusively a dietary consideration, subsequently
heredity and exercise are also the influencing factors.
Aetiology 122:
1. Occupation: Persons who are involved in nervous and mental overstrain like
scientific workers, engineers, physicians, drivers etc.,
2. Heredity: Chances of developing hypertension is greater in persons whose one of
both parents are hypertensives.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 43
3. Stress: Chronic psychological stress may lead to hypertension and acutely stressful
stimuli may cause transient rise of blood pressure.
4. Sodium intake: Excessive intake of salt in diet may be important. Hypertension
may be associated with low potassium diet.
5. Alcohol: Alcoholics are often hypertensive. Alcohol however is not a direct
pressure agent and hypertension develops during alcohol withdrawal, mediated by
sympathetic nervous system.
6. Obesity: Possible mechanisms of hypertensive effect of obesity include high food
intake such as refined carbohydrates, fats etc.,
Figure - 3
Diagrammatic expression showing dietary intake and CVD
CardiovascularDiseases
Stress
DiabetesObesity
Hypertension Hyperlipidemia
Smoking
High fat,High calorie diet
Lows fiber and high fat,high calorie diet,Glucose intolerance
Stress, high fat, high caloriediet, high salt intake, Alcoholconsumption and smoking
High intake of saturated fat andanimal foods
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 44
Causes of Moorcha attributed to Bhrama
Persons who are emaciated or debilitated, in whom the doshas have undergone
profound increase, those who indulge in incompatible foods and suppression of the urges,
those who are injured and those who are mentally weak, become afflicted with the
disease Moorcha, when the doshas invade the external and internal organs of the mind.
When sanjnavaha Srotas (channels that carry sensations) are blocked by the increased
Dosha the person goes in to the condition of Tamah pravesha 123.
As the Bhrama is also associated and affirmed in the same chapter the above
etiological factors said can be attributed to that of the Bhrama undoubtedly and
conditionally as involvement of the Dosha Vata and Pitta in associations with that of
Rajodosha. In other words it can be stated that the Bhrama, is a psycho (Rajo Dosha) and
somatic (Vata and Pitta) disease with a determinative and resoling sign of Bhrama.
Samprapti
The pathogenesis of essential hypertension is not yet cleared, a hypothetical
pathogenesis have been mentioned in many of the modern texts. But when we look in
terms of Ayurveda, it seems to be a tridoshaja vyadhi with vata pradhana, pitta
kaphanubandha and pradhana dushya involved to be as rakta. So here with the guidance
of pratitantra siddhanta 124 i.e. regarding the concepts of other science, an attempt is made
to study the samprapti of Raktachapadhikyata in the language of Ayurveda with modern
paralance.
Role of Vitiated Vata
Because of the vitiation of vata which is lodged in the blood vessels, the khara
and laghu guna causes kathinya, leading to reduction in the elasticity, as a result of it
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 45
margavarodha is produced. This may be taken as arteriosclerosis. Even the age,
vriddhavastha, which is predominant of vata, contributes to the pathology.
Because of the vitiation of vata, which is lodged in hridaya, the chalana or
praspandana karma of vyana vayu, prayatna karma of udana vayu and dharana karma of
prana vayu will be impaired.
Because of this there will be impairment in the initiation of contraction and
relaxation, conduction of impulses, as a result of which the increased doshas alter the
functions of hridaya and increases the heart rate and contraction and relaxation, there by
increasing the cardiac out put. When doshas get’s lodged in dhamani’s of vrikka, kleda
samvahana is hampered thus it adds to the blood volume resulting in to increased cardiac
out put.
Role of Vitiated Pitta
By the Drava - guna vriddhi of pitta, the rakta vriddhi takes place due to
ashrayashrayi sambandha. Pitta is considered to have the identical qualities of that of
catacholamines. Since here the pitta vriddhi takes place, this can be attributed to increase
in catacholanimes. Then, when found in increased level are liable to increase blood
pressure by increasing the peripheral resistance and cardiac output.
Role of Vitiated Kapha
The picchila guna of kapha increases the viscosity of blood, which is also one of
the factor responsible in the mechanism of high blood pressure.
Role of Ama and Medas
The snigdha, picchila, guru etc, guna of ama, excessive medas and apakwa medas
(improperly converted fat) accumulates in the blood vessels causing narrowing of lumen
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 46
of blood vessels, leading to margavarodha. This can be taken as hypercholestraemic
condition of the plasma.
The increased medas can also cause mechanical compression over the blood
vessels from out side, which is also one of the factor for increased peripheral resistance.
Role of Mamsa Dhatu
Ultimately Raktachapadhikyata in course of time produces thickening of the walls
of heart to cope up with the increased function of it. This can be taken as cardiac
hypertrophy and this condition can be taken as adhimamsata, which is the preliminary
symptom of mamsavaha srotodusti.
Thus a combined effect of all these pathological events, contribute to increased
peripheral resistance and increased cardiac output leading to Raktachapadhikyata.
At this stage the premonitory symptoms will arise, but here since it being a
vatavyadhi the poorva roopa are said to be avyakta and some vague symptoms like
shirashoola, bhrama, anidra etc., may be seen with very mild intensity.
After this, the disease progresses and the complete manifestation of disease takes
place and as a result of these pathological events the signs like raktachapadhikyata,
bounding pulse etc., are seen. And symptoms may or may not be present. If present, a
symptom comprises of shirashoola, bhrama, anidra etc. Even at this stage, if the treatment
is not started, the further vitiation of doshas takes place and land up in to complications
or upadrava.
This depends on the sthana or the organ that gets affected i.e., when mastishka is
affected, the condition or diseases like ardita, pakshaghata etc., are produced. When
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 47
vrukka is affected, shotha etc., are produced. When netra is affected, it causes drishti
mandya etc., and when hridaya is affected, it causes hridroga etc.,
Pathological Anatomy 125:
Essential hypertension gradually affects permeability of vascular walls and their
protein content. At later or grave forms of the disease, this causes sclerosis or necrosis of
small arteries and secondary changes in the tissues of organs. Walls of large vessels are
usually affected by atherosclerotic changes. The extent of vascular affection differs in
various organs and various clinicoanatomical variants of the disease therefore arise, with
a prevalent affection of the vessels of the heart, brain and kidneys.
1) Margavarodha
If kayagni/dhatvagnimandya is the prime cause in the former, rasavahasrotodushti
and of course Doshasanchaya (Kapha/Pitta) are the prime causes in the latter. However,
the site or sthana of margavarodha could be anywhere in the body. For instance, stenosis
of one or both of the renal arteries can cause hypertension and so also the coarctation of
the aorta. Examples of margavarodha are many; including, the pheochromocytoma (the
chromaffin tissue tumours of the adrenal medulla), atherosclerosis, other endocrine
tumours, Glomerulonephritis, pylonephritis etc., Any kind of obstruction anywhere in the
body affecting the flow of nutrients (Rasavahasrotas) results in "Hypertension" as one of
the manifestations 126-127.
2) DHATUKSHAYA:
v · Dhatukshaya can be a result of
v · Deficiency of the corresponding nutrients
v · Agni vikriti [Metabolic aberrations]
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 48
In either condition the resultant Vata prakopa can manifest itself in a variety of
forms 128. For instance, Hypertension is due to vaso-constriction due to neural factors.
Hypertension in which stress and electrolyte imbalance are identified as prime causes,
high B.P due to arteriolar necrosis, fatty degeneration etc., The neural factors causing
hypertension, mainly involve the sympathetic vasoconstrictor system.
Signs:
Signs or physical findings depend up on the cause of hypertension, its duration,
severity and the degree of effect on target organs. The signs of essential hypertension will
reflect the stage and duration of the disease process. These includes,
v Elevated blood pressure.
v Forcible pulse.
v Thcikened and hardened arteries.
v The apex beat will reflect the underlying hypertrophy. It will be sustained or
heaving but will not be displaced.
v 4th heart sound, due to left atrial hypertrophy.
v Loud aortic second sound.
v Aortic-ejection click and aortic or apical ejection systolic murmur caused by
turbulence secondary to aortic dilatation may also be present.
v The optic fundi may show changes of hypertension; these needs to be
differentiated from those associated with arteriosclerosis.
v Cotton wool exudates, oedematous retina, pappiloedema etc. are other specific
signs of involvement of the heart, kidney and brain that may be present.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 49
Table –3 : Key items of the base line history
in the patients with mild or moderate Hypertension - Symptoms
Blurred vision
Brochospasm
Chest pain
Claudication
Cold extremities
Cough
Depression
Dizziness
Dyspnoea
Fatigue
Flushing
Headache
Hematuria
Impotence
Joint pains
Muscle cramps
Nocturia
Palpitation
Polyuria
Skin rash
Sweating
Unsteadiness
Weakness
Weight loss or gain
Past disease History
Angina
Asthma
Diabetes
Congestive heart attack
Glomerulonephiritis
Gout
Heart block
Hepatitis
Hypertension
Lupus erythematosus
Myocardial infraction
Peptic ulcer
Pyelonephritis
Toxemia
Transient ischemic attacks
Diet and Drug History
Alcohol
Aspirin
Blood pressure medications
Cigarettes
Cocaine
Cold remedies
Chewing tobacco
Cyclosporine
Licorice
Nasal sprays
Nonsteroidal antiinflammatory agents
Oral contraceptives
Potassium (dietary)
Salt (dietary)
Tricyclic antidepressants
Family History
Coronary heart disease
Diabetes
Hereditary nephritis
Hyper lipidemia
Hyperparathyrodism
Hypertension
Phechromocytoma
Polycystic kidney disease
Renovascular hypertension
Thyroid disorders
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 50
Figure - 4. Showing the Schematic Representation of Samprapti
Prolonged indulgence in Nidana
Tridosha gets Vitiatied
Agni Dushti
Ama
Samadosha
Sahaja Karana Spreads to Hridaya and Shakhagra
Khavaigunya, any where between theRasavaha Srotomula Hridaya and Shakahgra
Dosha Dushya Sammurcchana
Resulting in to following sequalae
Vitiated Dusta Vitiated Vitiated Vitiated Vitiated Vata Medas Vata Pitta Rakta Kapha______Ama________ ___________ ________________ ___________
Narrowing of lumen Increases Heart Increases the Blood Increases theof Blood Vessels Rate Volume Viscosity ofBlood
Bhrama vis-à-vis Essential Hypertension
Increased Cardiac Output
Increased Peripheral Resistance
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 51
Chikitsa
There are three types of basics mentioned in Ayurveda, are Dinacharya,
Ritucharya and Sadvritha, which also form a part of non-drug therapy in the management
modalities.
The disease is vatapradhana tridoshaja vyadhi along with the aggravated rakta
dhatu and anubanda of pitta and kapha. Hence the general measures suggested for
Rakthadhisthita vyadhis can be adopted. The general line of treatment suggested for
raktaja vyadhi’s are:
v Virechana
v Upawasa
v Raktamokshana 129
v Hrudya Rasayana
Understanding the prakruti, adhisthana of doshas, immediately the chikitsa should be
started. With this guideline, with the view of samprapti vighatana, the ideal principles of
chikitsa of Raktachapadhikyata can be planned accordingly in the following manner –
1. Nidana parivarjana
2. Amahara chikitsa
3. Dosha pratyaneeka chikitsa
4. Vyadhi pratyaneeka chikitsa
5. Satvavajaya chikitsa
6. Yoga and other practices
These principles of chikitsa can be grouped in to two categories as,
1. Adravyabhoota chikitsa or Non pharmacological management
2. Dravyabhoota chikitsa or Pharmacological management
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 52
Adravyabhoota Chikitsa:
This includes –
(a) Nidana parivarjana
(b) Satvavajaya chikitsa
(c) Yoga and other practices
a) Nidana parivarjana:
Nidana parivarjana refers to abstaining from samanya karanas responsible for the
vitiation of vatadi dosha, dushya 130-131 etc., and other risk factors like excess salt intake,
over weight, smoking, alcohol etc. These are highlited in the later part.
b) Satwavajaya chikitsa:
In Raktachapadhikyata manasika karanas also play an important role. Raja and
tama along with tridoshas vitiates hridaya and raktavaha dhamani’s. So Achara rasayana
is advised to prevent mana getting indulged in ahita arthas.
c) Yoga and other practices
The association between ongoing life stress and hypertension is very complex and
somewhat controversial. The most important measure is to combat sresses, strains,
anxiety and tensions. So Yoga helps in raising the capacity of mind to withstand pressure
of stresses and strains. Some of the yogas that can be advised are asanas that loosens the
joints like Bhujangasana, Shalabhasana, Vajrasana, etc. Pranayama and certain
relaxation techniques like Shavasana, Yoganidra etc. Other practices such as
Transcendental meditation, progressive muscle relaxation, self hypnosis, bio–feed back,
sudarshana kriya, etc., have also shown some promising results in recent times. Apart
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 53
from these upavasa that is told in Raktapradoshaja vikara can be adapted since it is
Raktadhistita roga 132.
Dravyabhoota Chikitsa
This includes –
(a) Amahara chikitsa
(b) Dosha pratyaneeka chikitsa
(c) Vyadhi pratyaneeka chikitsa
a) Amahara Chikitsa
In Raktachapadhikyata the ama produced due to agnidusti is one of the
contributing factor in the samprapti. So amahara chikitsa is to be adopted with the help
of deepana and pachana measures and even it is very much essential before any shodhana
procedure. For this the drugs that are having laghu, ruksha guna and that are pradhana in
katu, tikta rasa should be used.
b) Dosha Pratyanika Chikitsa
Since Raktachapadhikyata is a tridoshaja vatavyadhi, prime importance is to be
given for the treatment of vata. It is seen that most of the correlations points towards
avarana. So the principles of avarana chikitsa are as follows-
� In avrita vata first avaraka is to be treated. When both kapha and pitta are avaraka,
first pitta is to be treated 133 and care should be taken not to provoke the avaraka.
� In avarana the drugs that are snigdha and srotoshuddhikaraka are to be used and at the
same time these should not increase kapha.134
� The oushadha ahara which are not kapha pitta viruddha and which does vatanulomana
should be used. 135
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 54
� Madhura anuvasana basti with yapana basti can be given or depending on the bala of
rogi, mridu virechana can be given. 136
� Sarpi, taila, vasa, majja pana, abhyanga, basti can be done. Snehana, swedana,
nivatasthana nivasa, guru pravarana, madhura, amla rasa yukta ahara sevana,
dugdhadi brihmana dravya can be taken.
The shodhana chikitsa that can be adopted here are basti and virechana due to the
involvement of vata, virechana due to the involvement of pitta, lekhana basti 137 due to
the involvement of kapha and medas. Above all it is a Raktadhistita vyadhi, so the
shodhana procedures that can be adopted are virechana and raktamokshana. Following
are the general shodhana measures that can be thought of in Raktachapadhikyata.
1) Virechana: Virechana is a special treatment for pitta.138 It can also be given in certain
conditions like pitta pradhana dosha, kapha samsrusti and pitta sthanagata kapha139. It is
not only given in these conditions, but it is also a line of treatment for Vata 140. Virechana
is advised in rakta pradoshaja vikaras too 141. Thus virechana corrects the vata and pitta
there by reducing the blood volume and ultimately reducing the increased heart rate and
cardiac output. The drugs that can be used for virechana are trivrit, shyama, danti,
dravanti, saptala etc.
2) Basti: It is the pradhana chikitsa for vata. It is also useful in pitta, kapha, rakta,
samsarga dosha and sannipata Dosha 142. The tailas, which are used in basti, subdues the
ruksha, laghu and khara gunas of vata and helps in reducing the katinyata and produces
mardavata of blood vessels. Niruha helps in elimination of malas and doshas from all the
srotases. Lekhana basti told by Susruta 143 helps in reducing medas and in shareera
lekhana.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 55
3) Raktamokshana: Sushruta recommends raktamokshana for vatavyadhi 144. Charaka
explains raktamokshana chikitsa for shonitaja roga or rakta pradoshaja vikara, as it is
raktadhistita vyadhi it can be recommended 145.
c) Vyadhi Pratyaneeka Chikitsa
Following are some of the Raktachapadhikyata shamaka dravyas and yogas, that
can be preferred.
Dravyas: Sarpagandha, Gokshura, Guggulu, Gomutra, Arjuna, Punarnava, Bala,
Pushkaramula, Brahmi, Jatamamsi, Musta, Shigru, Shatavari, Rasona, Kantakari, Vacha,
Erandamula, Shankhapuspi, Japa, Hareetaki, Vishnukranti, Parnayavani, Jyotishmati,
Bhringaraja etc.
Yogas: Prabhakara vati, Rasa sindhura, Shodashanga kashaya, Saraswatarista, Brahmi
vati, Brahma rasayana, Yogendra rasa, Amara sundaree vati, Pravala pisti, Rasaraja rasa,
Hridayeshwara rasa, Gokshuradi guggulu, Brihat vata chintamani rasa, Maha vata
vidhwamsa rasa, Chandrakala rasa etc.
Apart from these certain hridya and rasayana dravyas and yogas can be used.
Shirodhara is claimed to reduce high blood pressure. So by adopting the above line of
chikitsa, samprapti vighatana can be achieved, and also the prevention of the vyadhi can
be attained by non-pharmacological or adravyabhoota chikitsa. Thus by all these the
silent killer can be silenced to a great extent.
Single drugs used in treatment of hypertension:
Sarpagandhaa, punarnavaa, balaa, puskara moola, eranda moola, shankhapuspee,
guggulu, haritaki, gomootra, braahmi, mandookaparni, gokshura, jataamaansi, vachaa,
shigru, rasona etc.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 56
Compound drugs used in treatment of hypertension:
Rasaraaja rasa, hridayeshvara rasa, pravaalapisti, chintaamani chaturmukha rasa,
brihata vata chintaamanirasa, amara sundari vati, yogendra rasa, brahma rasaayana,
brahmi vati, choona saarvasvataarista etc.
Management of contemporary medicine
There are numerous anti hypertensive drugs. According to their mode of action, the
blood pressure lowering drugs may be broadly classified into five major groups;
1. Diuretics (drugs that effect the electrolyte and water balance and
secondarily, the total peripheral resistance)
2. Betablockers and other adrenergic receptor blockers; (drugs that interfere
with the activity of the sympathetic system, including the a-b
adrenoreceptors)
3. Calcium antagonises
4. Vasodilators (acting directly on smooth muscle of arterioles)
5. A.C.E.Inhibitors (angiotensin convertor enzyme) (Drugs that interfere
with the renin angiotensin system)
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 57
Table -4STEP CARE TREATMENT OF HYPERTENSION
Step 4others, betablockers anddiuretics
Step 3Methyldopa
ACE inhibitors and Diuretics
Step2Betablockers
Calcium antagonists
Step 1vasodilators
A step care approach has been devised to use these drugs in a rational manner,
taking into account the characteristics of the patient and the degree of elevation of blood
pressure.
The simplest and most effective drugs are used first, in step 1. If they don’t
control blood pressure, step 2 drugs are used, and then those of step 3 and 4. In most
patients, it will not be necessary to reduce blood pressure rapidly. Indeed a gradual
lowering of blood pressure may be preferable, and a “stepped care” program may
simplify therapy and reduce side effects.
Treatment options for high blood pressure
Lifestyle changes can significantly improve a patient’s blood pressure. Definite
steps that can and should be taken to lower and control blood pressure include.
Quitting smoking is perhaps the most important thing a smoker can do to
promote his or hier own health. Among many other side effects, smoking elevates blood
pressure.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 58
Loss of weight in the abdominal area can immediately reduce blood pressure and
helps to reduce the size of the heart. Weight loss accornpained by salt restriction may
allow mild hypertensives to reduce or eliminate their need for medication.
Following the DASH diet: Well –controlled studies have shown that people on
the DASH diet for only eight weeks experienced a significant reduction in blood pessure.
Hypertensive crises diagnosis and management 146
Severe hypertension is a common clinical problem encountered in various clinical
setting. Although various terms have been applied to severe hypertension, such as
hypertensive crises, emergencies, or urgencies, they are all characterised by acute
elevations in BP that may be associated with end-organ damage. The immediate
reduction of BP is only required in the patients with acute end-organ damage. Today,
wide ranges of pharmacologic alternatives are available to the practitioner to control
severe hypertension. Three quarters of those affected do not have their BP well
controlled. Less than 1% of these patients will develop one or multiple episodes of
hypertensive crises.
Headache, altered level of consciousness, and less-severe degrees of CNS
dysfunction are the classic manifestations of hypertensive encephalopathy. Advanced
retinopathy with arteriolar changes haemorrhages and exudates, as well as papilloedema,
are commonly seen on examination of fundi in the patients with hypertensive
encephalopathy. Cardiovascular manifestations of hypertensive crises may include angina
or acute myocardial infarction. Cardiac decompensatio mayleada to symptoms of
dyspnoea, orthopanoea, cough fatigue or frank fulmonryoedema. Severe injury to the
kidney may lead to renal failure with oliguria and or haematuria.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 59
Figure 5
Initiation of Modern Treatment in Patients with Hypertension
Source – 1999 WHO
Assess other risk factors. TOD & ACC
Initiate life style measures
Stratify absolute risk
SBP 140 – 180 mm Hg or DBP 90 – 110 mm Hgon several occasions
(Stage I & II Hypertension)
Begin drugtreatment
Begin drugtreatment
Monitor BP &other risk factorsfor 3 – 6 months
Monitor BP &other risk factorsfor 6-12 months
SBP � 140 orDBP � 90Begin drugtreatment
SBP < 140 orDBP < 90Continue tomonitor
SBP � 150 orDBP � 95Begin drugtreatment
SBP < 150 orDBP < 95(Borderline)Continue tomonitor
Very High High Medium Low
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 60
Figure - 6
Showing the Approach to the Hypertensive Patient after Initiating
Antihypertensive Drug Treatment
Source – 1999 WHO
Stabilization, maintenance and follow up after initiation of drug therapy.Antihypertensive drug treatment initiated
Goal blood pressure achievedHigh & Very
High RiskMedium & Low
Risk
- See every 3months- Monitor BP& risk factors- Reinforcelife stylemeasures
- See every 6months- Monitor MonitorBP & risk factors- Reinforce lifestyle measures
Not at goal blood pressureafter 3 months
- If no response, substitute a drug orlow-dose combination from otherclasses.- If partial response, increase dose,add a drug from another class, orchange to low dose combination.- Intensify life style measures.
Significant sideeffects
- Substitute a drug orlow-dose combinationfrom other classes OR- Reduce dose and add adrug from another class
Hypertension difficult to manage
* Refer to specialist physician orclinic
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 61
Figure – 7
Algorithm for Treating Hypertension
Rasayana effect 147
A most important key for a long life according to Ayurveda is to follow aachara
rasayanas, meaning code of behaviour or code of ethics. According to Charaka, the
ancient authority on Ayurveda, the one who follows all codes of conduct, need not take
other rasayanas, and those who take other rasayanas without following this code of
conduct, do not receive the optimum benefits.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 62
The traditional behavioral rasayanas help create a harmonizing effect in the
physiology and increase the production of Ojas. Ojas is the finest material that is
produced when digestion is flawless. Ojas is the link between consciousness and matter
and is responsible for establishing and maintaining balance among Vata, Pitta and Kapha.
The more the Ojas the body produces, the better the health and immunity from disease,
and happiness.
Achara Rasayana, as spoken of by Charaka emphasises on always speaking the
truth, not getting angry not indulging in alcoholic drinks, observing celibacy and the
sexual act according to the code. It insists on not being violent, avoiding over-exertion,
being calm and peaceful in mind and not hurting others with speech; speaking pleasantly.
One should always clean the ody by bathing and regular washing. One should be
courageous and not lose patience in any situation. One should donate always to others;
follow religious and virtuous acts according to one’s beliefs, respect teachers, priests,
elders, gurus, and all animals. One should not be cruel to any one and be merciful to all
those in need of help. Balance in waking and sleeping in the night must be maintained
and staying awake long in the night and sleep in daytime both must be avoided.
Several studies involving small numbers of people with hypertension showed a
reduction I blood pressure with the use of acupuncture, while these clinical trials were
conducted over a short period of time, the encouraging results suggest that it would be
worth while for scientists to conduct long term research of acupuncture for treating high
blood pressure.
Preliminary evidence suggests that people with high blood pressure who receive
chiropractic spinal manipulation experience a significant reduction in blood pressure, but
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 63
more research is needed to confirm its use for hypertension. In fact, on rare occasions, a
spinal manipulation session may actually cause extremely low blood pressure leading to
dizziness or light-headedness.
Massage may be particularly helpful for people with hypertension brought on by
stress. This is because the beneficial effects of massage are due, at least in part, to a
reduction in stress. One recent study revealed that people with hypertension who receive
massage, showed significant reductions in blood pressure and steroid hormones, an
indicator of stress. Although more studies are needed to evaluate the long-term safety and
effectiveness of massage, people with hypertension who tend to have high levels of stress
in their lives may benefit from massage therapy.
Although the association between ongoing life stress and hypertension is complex
and some what controversial many believe that relaxation techniques may be helpful in
alleviating feelings of stress, which is often a contributing factor to hypertension. While
the results of studies investigating this relationship have been mixed, one study of older
african americans living in an urban setting, found that those who participated in a
trancendental meditation (TM) or progressive muscle relaxation (PMR) programs had a
significant reduction in blood pressure compared to those who participated in a lifestyle
education program. While both techniques were beneficial. TM was twice as effective as
PMR.
In addition to TM and PMR other mind/body techniques such as self hypnosis and
biofeedback have shown promising results in recent studies. Biobeedback in particular
may reduce elevated blood pressure from stress and help individuals achieve healthy
lifestyle modifications, such as stopping smoking and losing weight.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 64
Yoga treats stress in a holistic (body and mind) concept of the entire person.
Stress is stated to be a result of bad interaction between different layers, called koshas, of
human existence yoga aims to achieve a totally stress free state. According to yoga, the
mind plays the most imortant part in causing hypertension and does so in the following
ways.
Mental causes
Worries of any nature stagnating in the mind for a long time produce tension in
the mind, therefore causing disturbances in the emotional state of mind.
Pranic causes
Prana means breath of life. If prana is disturbed, it will in turn cause disturbance
in the energy systems of the body, known as the chakras. The chakras produce cyclic
changes in the hormones of the body and these in turn cause disturbances in the energy
systems of the body.
Physical causes
Abnormalities in lifestyle, such as sedentary habits, sleep disturbances,
unbalanced diet, smoking, and drinking alcohol, as well as others also disturbances in the
metabolic and circulatory systems.
Yoga offers a comprehensive and integrated approach for the treatment, as well as
the prevention of essential hypertension. The practice of yoga integrates the activities of
the mind with those of the body. Ayurvedic yoga describes a meeting between
physiology and consciousness nd focusses on vital locations called marma points in order
to achieve relaxation and peace of mind.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 65
Breathing techniues for channel purification called nadi Shodhana can be used for
cleaning and detoxification. Finally, as the skin is the largest organ of the body and rich
in healing substances, panchakrama massage can be performed. When stimulated by
massage the skin produces anti-depressant, anti-cancer, anti-ageing substances and
promotes hormone release and healthy circulation. Last, but not least, don’t forget that
affection can always have strong emotional healing and stress reduction power.
A spiritual perspective 148
Life is the music played by soul the instrument of body. In this metaphor the body
is the instrument of the soul if the piano player is sick, does it help to repair his piano?
What an instrument produces depends not only upon the state of the instrument, but also
upon the musician. If the musician plays the blues, or soars with joy the instrument
follows. Even a tuned and polished instrument cannot soar with joy if the musician
chooses sadness or grief. In the case of our soul and body, the instrument becomes the
blues, or soars with joy. If the musician becomes consumed with grief, or anger, or
sadness, the instrument disintegrates. In some cases a broken instrument can be repaired,
but a repair at that level cannot cure what caused the breakdown.
All schools of medicine are silent on the root cause of hypertension. However it is
universally seen as a resistance to the flow of the blood and through it the life energy.
What could have caused this resistance? Clogged arteries? Increased viscosity of the
liquid of the blood? Is it is extra burden to the pump of the heart? Every school tells to
live align the way to minimise this resistance to reduce blood pressure. Allopathy calls it
life style modification, Ayurveda aachar Rasayana and numerous other names are given
to the same thing by different other schools.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 66
A personality that walks along the path of its soul creates the human experience
that is healthy, harmoniums and full of growth and joy. Everything serves that.
Hypertension is true SOS- sound of soul – to save our lives from drowning in the sea of
sufferings. It must be heard and acted upon with responsibility. Drugs exercises, life style
modifications are important but insufficient. The core of the issue is the alignment of
splintered personality with the soul.
PATHYAPATHYA
In the treatment of diseases, diet and other habits are given equal importance with
drugs and therapeutic measures. The pathyapathya that can be recommended on the basis
of dosha dushyadi are as follows,
Table -5
Showing the Pathyapathya in Hypertension (Bhrama)
PATHYA APATHYA
AHARA Mudga, Masoora, Yava, Palaka,
Methica, Jambeera, Carrot, Papaya,
Dry grapes, Orange, Ardraka,
Rasona, Hingu, Jeeraka, Mareecha,
Jangala pakshi mamsa, Godugda,
Ajadugda, Takra etc.
Anupa desha pashu pakshi mamsa,
Dadhi, Dugda vikara, Tobacco, Tea,
Coffee, Salt, Fatty substances,
Alcohol, etc.
VIHARA Samyak vishrama, Upavasa,
Shavasana, Samyak vyayama,
Sadvritta palana, Nitya abhyanga,
Krodha-Irsha-Bhaya-Chinta-
Shokadi dharaneeya vega dharana,
etc.
Divaswapna, Ativyayama,
Avyayama, Vegadharana,
Adhyashana, Atichintana,
Atikrodha, Atishrama,
Atisukhasana, Ratri jagarana, etc.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 67
Dietary recommendations 149
High blood pressure is mainly found in industrial rations that consume a diet high
in sugar animal protein and fat. Vegetarians have a much lower incidence of
hypertension.
A diet high in naturally occuring potassium and low in artifical sodium is
important in lowering blood pressure. Increase fruits and vegetables; apples, banas,
carrots, organes, potatoes zucchini and celery are all excellent foods to balance potassium
and sodium levels. Limit the use of table salt and food that high in sodium.
Cold water fish such as salmon, halibut, mackerel and herring have been shown to
reduce blood pressure. Consume fresh fish three times weekly.
Eat less red meat. Instead focus on legumes and vegetable protein foods. Eat more
garlic, onions, basil, oregano and gingerroot. These foods all have mild blood pressure
lowering effects.
Reduce or eliminate caffeine-it constricts the blood vessels walls and may
increase blood pressure. Some people with high blood pressure do well on a high protein-
low to medium carbohydrate diet. This is the premise of books such as the zone by Barry
sears and the atkins diet by Dr. Robert atkins. Check with your natural healthcare
practitioner before making radical diet changes.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 68
Chapter-4
Methodologyn the present day mechanical life style individual is often put under
Stress 150 mood upsets, worries dietic irregularities, which becomes essential etiology to
impair rajoguna and aggravate Tridosha and causes corruption in rasavaha srotas. The
symptom which are expressed as Bhrama (Vertigo), Anga sada (Body pain), Shiroruja
(Headache), Nidra Nasha (Insomnia) shriaghoornam (dizziness), chittavasada (lack of
concentration), gatrasupta (numbness in the body), etc which makes one, day today
problems disturbance in body physiology 151.
In all the above said signs and symptoms, Bhrama becomes the major presenting
symptom, Brama 152 is explained as disease in Ayurvedic classics and also as symptom
under different context viz pittavruta vata 153, Rajapittanilahmaka 154 etc.
The signs symptoms of ‘Bhrama’ are in resemble to that of Hypertension at the
present context. Hypertension 155 represents a major public health concern. It affects
about a billion people worldwide and is the most common treatable risk factor for
cardiovascular disease in the patients aged over 50. Although 156 Hypertension is usually
a symptomatic for the first 10 to 20 years, it slowly but surely strains the heart and
damages the artery .For this reason Hypertension is often called as silent killer.
The adverse effects of Hypertension principally involve the blood vessels 157, the
central nervous system, the retina, the heart and the kidneys, with 158 this ends at organ
damage, mainly 159 in more than 95% of cases a specific underlying cause of
Hypertension cannot be found. Such patients are said to have Essential hypertension.
The pathogenesis of Essential hypertension is not clearly understood.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 69
Large benefits, in terms of avoided cardiovascular disease, are expected from the
treatment of Hypertension 160. Thus the present study was proposed to check the effects
Bhramahara, Hypotensive, Cardio vascular restorative properties of herbal compound
“Kakubhadi lehya” with special reference to hypertension.
Till now about hypertension accepted dictums of the modern day that, the cause
of a majority of types of Hypertension is not known and the antihypertensives once
started are a must throughout the life for the management of Symptoms obviously
indicate the need of the day with this, all the Hypertensive drugs reduce the Blood
pressure without correcting the cause. Under such circumstances, the Ayurvedic
understanding and curative line of treatment gains much confidence.
In Veda’s and in Samhita granthas there is no direct reference or specific
nomenclature available in relation to Hypertension from classical textbooks. Even
though some of signs and symptomatologies mimic the situational condition of
Hypertension Therefore explanation of Hypertension in the language of Ayurveda is a
moot point till today.
So far nomenclature claimed as Hypertension in Ayurveda are Raktachapa,
Raktabharadhikyata, Raktapeedanadhikyata etc. But as a matter of translation or
transliteration from English, the word and condition at Hypertension refers to “Bhrama”
approximately as it implies to the condition giddiness.
Moreover, charaka12 has very clearly expressed all the diseases (Disorders) or
states of illness, may not be known with specific modalities of classification and offered
as way to introduce new diseases or conditions in to the nomenclature there by no
definite and permanent name can be attributed to a particular condition as it is expected
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 70
to change with the time to time according to its presentation 161. Thus understanding the
dosha state, site of appearance and its signs and symptoms may have to treat the
conditions on the basis of vilkalpa i.e combinations and permutations.
But Ayurveda 162 mainly speaks and considers Bhrama as a disease entity, it’s
literal meaning is rotation. In 163 charaka sutrasthna has considered Bhrama as one out of
the vataja nanatmaja Vyadhi, here Bhrama Correspond to giddiness and Vertigo. Bhrama
is a disease not only concerned to the Shiras 164 but also considered in Raktapradoshaja
Vyadhi's. As Tamasascha atidarshanam, Chakra panidatta has explained Bhrama as a
Smruti mohna that means hallucination in his commentary. Vagbhata has mentioned that
this is because of Vradhi 165 of vata dosha and kshaya 166 of kaphadosa, where as Charaka
affirmed 167 it as sanchaya of vata dosha blocked by vitiated pitta dosha. Therefore
Bhrama explained as a Nidanarthakaravyadhi of some diseases. It is also said as signs
and symptom (Lakshana), and upadrava (complication) of many diseases as like
Hypertension.
Hypertension is the other major risk factor in the development of atherosclerotic
IHD and cerebro-vascular disease. It acts probably by mechanical injury to the arterial
wall due to increased blood pressure. A systolic pressure of over 160 mm Hg or a
diastolic pressure of over 95mmHg is associated with five times higher risk of developing
IHD than in people with blood pressure with blood pressure within normal range (140/90
mm Hg or less) 168.
In contemporary medicine the principle etiological factor of Hypertensive disease
is psychological factor. Psychological over strain leads to impaired regulation of the
vascular tone. In general this hypothesiss is at the support of Ayurvedic dosha, Vata
interference in producing Bhrama. Thus the Hridhya, Bhramahara, Vatanulomaka,
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 71
srotosodhaka as well as Rasayana modalities are grouped under “KAKUBHADI
LEHYA” as Hridya Rsayana from Bhaisjya Ratnavali is to be undertaken for the study.
METHODS OF STUDY
I) Source of data:
a) Patient suffering from “Bhrama” (Hypertension) will be selected from
PGSandR Department of Kayachikitsa OPD/IPD of D.G.M. Ayurvedic
Medical College and Hospital under pre-set inclusion and exclusion criteria.
b) Literary: Literary aspect of study will be collected from classical Ayurvedic
text’s updated with recent medical journals, Magazines and Meddler search.
c) Trial Drug: “KAKUBHADI LEHYAM” 169
II) Method of Collection of Data:
a) STUDY DESIGN
Prospective Clinical Trial
b) SAMPLE SIZE:
Minimums of 30 patients are taken in randomized selection.
c) EXCLUSION CRITERIA: 170
i) Secondary Hypertension patients --
1) Renal complication. --
A) Reno vascular.
B) Renal parenchymal diseases.
2) Endocrine --
A) Adrenocortical hyperfuction.
B) Hyperparathyoidism.
C) Oral contraceptives.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 72
3) Coarctation of Aorta.
4) Neurogenic.
ii) Severe (stage 3) very severe (stage 4) Maligant HTN
iii) Below 25 years and above 65 years.
iv) Alcohol abuses.
v) Left ventricular hypertrophy.
vi) Left ventricular failure.
vii) Essential Hypertension with I.H.D.
viii) Essential hypertension with diabetes.
x) Lactating and pregnant females.
xi) Iatrogenic hypertension – Hypertension due to administration of drugs--
1) Estrogen.
2) Abuse of Compounds containing glycyrrhetive acid – (Liquorice
biogastrone).
3) Abuse of vaso – Constrictive nasal drops.
4) Abuse of analgesics, which may lead to renal lesions--
- Hormonal Contraceptives.
- Liquorice and Carbenoxolone.
- ACTH and cortico steroids.
d). INCLUSION CRITERIA:
i) Other than that of exclusive criteria mentioned above and
ii) A patient of both sexes indiscriminately.
iii) No discriminations of chronically and severity of disease.
iv) Patients with recently detected.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 73
v) Both mild and Moderate, Hypertension that is – 171
1. High normal – 130-139/85-89 mm Hg
2. Mild (stage –I) – 140-159 /90-99 mm Hg
3. Moderate (stage –2) – 160-179 /100-109 mm Hg.
vi) Essential Hypertension with --
i. Genetic factors
ii. Racial and environmental factors.
iii. Risk factors modifying the course
iv. Untreated cases of Essential hypertension
e) CRITERIA OF DIAGNOSIS 172
1) Diagnosis is made on the basis of measurements of
sphygmomanometer.
2) Diagnosis as described by the joint national committee of the WHO/
International society (ISH) of Hypertension (1995)
Approach to the patients with hypertension methods 173
Since there is no dividing line between normal and high blood pressure, arbitrary
levels have been established to define persons who have an increased risk of developing a
morbid cardiovascular event and/or will clearly beniefit from medical therapy. These
definitions should take into account not only the level of diastolic pressure but also
systeolic pressure, age, sex, and race. For example, patients with a diastolic pressure
greater than 90 mm Hg have a significant reduction in morbidity and mortality rate if
they receive adequate therapy. These, then, are patients who have hypertension and who
should be considered for treatment.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 74
The level of systolic pressure is also important in assessing the influence of
arterial pressure on cardiovascular morbidity. Males with normal diastolic pressure
(<82mmHg) but elevated systolic pressures (>158mmHg) have a cardiovascular mortality
rate 2.5 times higher than individuals who have similar diastolic pressures but whose
systolic pressures clearly are normal (<130mmHg). A reduction in mortality and
morbidity with treatment, specifically in the elderly, has been documented in these
patients. This beneficial effect results mainly from a reduction in strokes and occurs in
women as well. Other significant factors that modify the influence of blood pressure on
the frequency of morbid cardiovascular events are age, race, and sex, with young black
male being most adversely affected by hypertension.
When hypertension is suspected, blood pressure should be measured at least twice
during two separate examinations after the initial screening. In adults a diastolic pressure
below 85mmHg is considered to be normal; one between 85 and 89mmHg is high
normal; one of 90 to 104mmHg presents mild hypertension; one of 105 to 114mmHg
represents moderate hypertension; and one of 115 mmHg or greater represents severe
hypertension. When the diastolic pressure is below 90 mmHg, a systolic pressure below
140 mmHg indicates normal blood pressure; one between 140 and 159 mmHg indicates
borderline isolated systolic hypertension and one of 160 mmHg or higher indicates
isolated sstolic hypertension. Increasing use of 12 or 24 hours blood pressure monitoring
may provide additional useful information in the patients who are difficult to classify.
However normal values for this procedure and its usefulness in relation to therapeutic out
come are not currently known.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 75
Patient evaluation
In evaluating patients with hypertension the initial history, physical examination,
and laboratory tests should be directed at
1. uncovering correctable secondary forms of hypertension
2. establishing a pretreatment baseline
3. assessing factors that may influence the type of therapy or be changed
adversely by therapy
4. determining if target organ damage is present and
5. determining whether other risk factors for the development of arteriosclerotic
cardiovascular disease are present
Ideally, this evaluation also would determine the underlying mechanisms in
essential hypertension, particularly if such information leads to a more specific
therapeutic program. Unfortunately, at present this aspect of the evaluation is limited by
lack of knowledge of some of the underlying mechanisms, by uncertainty as to the
correct treatment for a distinct subset even if the underlying mechanisms are known, or
by the prohibitive cost of defining a subset of hypertensive patients even if specific
therapy were available. However with the accumulation of additional information, this
sixth component of the evaluation of patients with hypertension may become increasingly
important.
Symptoms and signs most patients with hypertension have no specific symptoms
referable to their blood pressure elevation and are identified only in the course of a
physical examination. When symptoms do bring the patient to the physician, they fall
into three categories. They are related to -
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 76
1. the elevated pressure it self,
2. the hypertensive vascular disease and
3. The underlying disease, in the case of secondary hypertension.
Though popularly considered a symptom of elevated arterial pressure, headache is
characteristic only of severe hypertension; most commonly such headaches are localized
to the occipital region and are present when the patient awakens in the morning but
subside spontaneously after several hours. Other complaints that may be related to
elevated blood pressure include dizziness, palpitations, easy fatigability and importance.
Complaints referable to vascular disease include epistaxis, hematuria, blurring of vision
owing to retinal changes, episodes of weakness of dizziness due to transient cerebral
ischemia, angina pectoris, and dyspnea due to cardiac failure. Pain due to dissection of
the aorta or to a leaking aneurysm is an occasional presenting symptom.
Examples of symptoms related to the underlying disease in secondary
hypertension are polyuria, polydipsia, and muscle weakness secondary to hypokalemia in
patients with primary aldosteronism or weight gain and emotional lability in patients with
cushing’s syndrome. The patient with a pheochromocytoma may present with episodic
headaches, palpitations, diaphoresis, and postural dizziness.
History
A strong family hostory of hypertension, along with the reported finding of
intermittent pressure elevation in the past, favors the diagnosis of essential hypertension.
Secondary hypertension often develops before the age of 35 or after 55 or after 55. A
history of use of adrenal steroids or estrogens is of obvious significance. A history of
repeated urinary tract infections suggests chronic pyelonephritis, although this condition
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 77
may occur in the absence of symptoms; nocturia and polydipsia suggest renal or
endocrine disease, while trauma to either flank or an episode of acute flank pain may be a
clue to the presence of renal injury. A history of weight gain in compatible with
Cushing’s syndrome, and one of weight loss is compatible with pheochromocytoma. A
number of aspects of the history aid to determining whether vascular disease has
progressed to a dangerous stage. These include angina pectoris and symptoms of
cerebrovascular insufficiency. Congestive heart failure, and or peripheral vascular
insufficiency. Other risk factors that should be asked about include cigarette smoking,
diabetes mellitus. Lipid disorders, and a family history of early deaths due to
cardiovascular disease. Finally, aspects of the patients’s lifestyle that could contribute to
the hypertension or affects its treatment should be assessed, including diet, physicl
activity, family status, work, and educational level.
Physical examination
The physical examination starts with the patients’ general appearance. For
instance are the round faces and truncal obesity of cushing’s syndrome present is
muscular development in the upper extremities out of proportion to that in the lower
extremities, suggesting coarctation of the aorta? The next step is to compare the blood
pressure and pulses in the two uper extremities and in the supine and standing positions
(for at least 2 min). A rise in diastolic pressure when the patient goes from the supine to
the standing position is most compable with essential hypertension; a fall, in the absence
of antihypertensive medications, suggests secondary forms of hypertension. The patient’s
height and weight should be recorded. Detailed examination of the ocular fundi in
mandatory, as funduscopic findings provide one of the best indications of the duration of
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 78
hypertension and prognosis. A useful guide is the keith-wagener barker classification of
funduscopic changes the specific changes in each fundus should be recorded nd a grade
assigned. Palpation and ausculatation of the carotid arteries for evidence of stenosis or
occlusion are important narrowing of a carotid artery may be a manifestation if
hypertensive vascular disease and it also may be a clue to the presence of a renal arterial
lesion, since these two lesions may occur together. In examination of the heart and lungs,
evidence of left ventricular hypertrophy and cardiac decompensation should be sought. Is
there a left ventricular lift? Are third and fourth heart sounds present? Are there
pulmonary rales? A third heart sound and pulmonary rales are unusual in uncomplicated
hypertension. Their presence suggests ventricular dysfunction. Chest examination also
includes a search for extracardiac murmurs and palpable collateral vessels that may result
from coarctation of the aorta.
Basic test for intial evaluation
Always included
1. urine for protein, blood and glucose
2. hamatocrit
3. serum potassium
4. serum cretinine and /or blood urea nitrogen
5. electrocardiogram
- Usually included, depending on cost and other factors
1. microscopic urinalysis
2. white blood cell count
3. plasma/blood glucose, cholesteril, HDL cholesterol, and
triglycerdes
4. serum calcium phoshate and uric acid
5. chest x-ray echocardiogram
-Special studies to screen for secondary hypertension
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 79
v Renovascular disease angiotension coverting enzyme inhibitor renogram,
renal duplex ultrasound.
v Pheochromocytoma; 24-h urine assay for cretinine, metaephrines, and
catecholamines or plasma catecholamines
v Cushing’s syndrome; overnight dexamethasone suppression test or 24-h urine
cortisol.
Tabel - 6
Key items of the baseline physical and laboratory examinationsin patients with mild or moderate hypertension
Physical examination
GENERALAppearanceBloodpressure(supine orsiting;standing;both arms)heart rate(supine orsitting;standing)
HEENT #
Carotid bruitFundiNeck veinsTemporalarteriesThyroidgland
CHEST
AorticregurgitationApeximpulseBreastRalesS3, S4
SystolicmurmurWheezes
ABDOMEN
BruitPalpablekidneys
EXTREMITIESEdemaPeripheralpulsesPeripheralbruits
NEUROLOGICFocal signsProximalmusclestrength
Laboratory examination
GENERAL
HemoglobinHematocritWhite blood cellcount
KIDNEYS
Blood urea nitrogenCreatinineUrine dipstickUrine sediment
METABOLIC
CalciumCholesterol *Glucose (fasting)PotassiumUric acid
MISCELLANEOUS
Chest x rayECGEchocadiogram
* Also obtain fasting triglyceride and high density lipoproteine cholestrol levels if theserum cholestrol level is 200mg/dl or more in patients with other cardiovascular risk factoror 240 mg/dl or more in patients with out other cardivascular risk factors.# HEENT = head, eyes, ears, nose, and throat.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 80
Patients who monitor their blood pressure at home have a lower clinic blood
pressure than those whole blood pressures is monitored in the healthcare system 174. A
greater proportion of them also achieves blood pressure targets when assessed in the
clinic.
f) POSOLOGY –
Internal 5gms twice daily.
g) STUDY DURATION –
30 Days.
h) FOLLOW UP –
15 days.
Assessment of Result:
The clinical data and sphygmomanometer studies assess results. Subjective and
objective parameter to the baseline data compared to after treatment data for the
assessment of results.
i) Subjective parameter:
As shown in the classical (Bhrama) and Contemporary texts (Hypertension)
j) Objective parameters:
1) BLOOD PRESSURE
A) Standing
B) Sitting
C) Lying down posture – These have been recorded in seven
visits, under study duration.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 81
2) LIPID PROFILE
Laboratory investigations
a) Serum cholesterol
b) Serum triglycerides
c) High-density lipoprotein cholesterol (HDL)
d) Low density lipoprotein cholesterol (LDL).
e) Very low density lipoprotein cholesterol (VLDL)
k) Investigations for exclusion:
X-ray.
Electro cardio gram (ECG)
Random Blood sugar (R.B.S) -- Are to be under taken.
By these above parameters, in order to assess the severity of illness and
the effect of treatment each case will be evaluated prior to commencement of treatment
and periodically during the course of treatment and also after the completion of treatment
respectively. The assessment was made with systolic, diastolic and with mean arterial
blood pressure and the results will be assessed based on the lipid profile and Blood
pressure findings and also the signs and symptoms of Bhrama as per classics for which
students paired t-test will be applied.
III) MATERIALS OF TRAIL
Preparation of Medicine:
All the drugs will be identified and collected from local area. Good manufacturing
practice will be followed for preparation of Avalehya. As above mentioned Kakubhadi
Lehya is explained in choorna kalpana, but for easy administration and to attain the
Rasayana effect it is formulated in the form of avalehya.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 82
The detailed study of the Kakubhadi Lehya with its content analysis and
preparation of the Kakubhadi Lehya is as follows. The combination and properties of
Kakubhadi Lehyam is as Follows.
Table – 7
Contents and Proportion of Kakubhadi Lehya
Sanskrit name Latin name Family Proportion
1. Arjuna 175-340-341 Terminalia arjuna Combretaceae 1 Part
2. Vacha 176-342-343 Acorus calamus Araceae 1 Part
3. Rasna 177-344-345 Pluchea lanceolata Zingiberaceae 1 Part
4. Bala 178-179-180 Abatilon indicum Malvaceae 1 Part
5. Nagabala 181-183 Grewia hirsute Tiliaceae 1 Part
6. Abhaya 184-186 Terminalia chebula Combretaceae 1 Part
7. Shati 187-189 Curcuma zedooria Zingiberaceae 1 Part
8. Pushkaramula190-192
Innula vacemosa Compositteae 1 Part
9. Pippali 193-195 Piper longum Piperaceae 1 Part
10. Vishwabheshaja196-198
Zingiber officinale Scitaminae 1 Part
The chosen drug “Kakubhadi Lehya” assumed as the best Hrudya Rasayana
because of its contents and in further its action towards the Bhrama vis-à-vis
hypertension. The ingredients are botanically identified and under the GMP stipulations
with equal quantities of the ingredients are formulated as Lehya. The individual drug
pharmaco dynamics are tabulated as under –
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 83
Table – 8
Describing the pharmacological properties of Kakubhadi Lehya
Name of theingredient
Rasa Guna Veerya Vipaka Prabhava
1) Arjuna Kashya Rookshalaghu
Sheeta Katu HrudyaMutrala
2) Vacha Katu tiktha Laghutikshnasara
Ushna Katu MedhyaKaphaharaMootrakruchrahara
3) Rasna Tikta Guru Ushna Katu VishagnaKaphavataharaSwasaharaUdarahara
4) Bala Madhura Guru,Snigdha,picchila
Madhura Madhura VatapittaharaAnulomakaMutralaNidrakaram
5) Nagabala Madhura,kashaya
Guru,Snigdha,picchila
Sheetha Madhura VatapittaharaMutralaMutrakruchrahara
6) Abhaya Kashaya,Tikta, katu,madhura,Amla
Laghu,Rooksha
Ushna Madhura TridoshaharaRechakaRasayanamAyushyamHrudrogaharamTwakdoshaharamShothaharam
7) Shati Katu, tikta,kasaya
Laghu,tikshna
Ushna Katu MutralaDeepanaPachanaKasa-Swasa hara
8) Pushkaramula Tikta katu Laghu,Tikshna
Ushna Katu VatakaphaharaKasa-Swasa haraPanduhara (RN)
9) Pippali Katu Laghu,Snigdha,tiksshna
Anushnasheeta
Madhura VatakaphaharaYogavahiDeepanaPachanaRechanaUdarahara
10) Vishwabheshaja Katu Guru,rooksha,tikshna
Ushna Katu Kapha haraAmavataharaHrudrogaharaGrahiPanduhara
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 84
Table – 9
Describing the therapeutic values of Kakubhadi Lehya
Name of theingredient
Indications Preparations
1) Arjuna Bhagna, hrudroga, kshaya,trushna, sadhyavruna, prameha
Kakubhadi Churna, arjunarishta,arjunagrutha
2) Vacha Unmada, apasmara, jwara Saraswatha Churna, medhyaRasayana
3) Rasna Shotha, Swasa, vatashoola ,kasa, jwara
Rasnadi kwatha, rasnadi taila,rasnadi ghruta
4) Bala Vrunashotha, pakshaghata,Ardhita, gruhani, hrudroga,hrudourbalya, raktapitta,urahkshata, Mootrakrichra jwara
Baladi kwata, baladi ghruka,baldhyarishta, chandana balalakshadi taila
5) Nagabala Rakta srava, kshata vruna,vatavyadhi, amlapitta,hrudhroga, Rakta Pitta, kasa,Swasa, urakshata, yakshma,mootra kruchra,vishmajwara,dourbalya
Naga bala ksheera, nagabalapayasa, naga baala Rasayana
6) Abhaya Gulma,arsha, kamala, gruhani,hrudhdaurbalya, vatarakta,shoota, kasa, Swasa hika,Mootrakricchra, mootraghata,visharpa
Abhaya modhaka, abhuya rishta,pathyadi vati, vyaghri haritaki,chitraka haritaki, pathyadi Churna
7) Shati Swasa kasahika, udarashoola,hruddourbalya, arsha, rakthaviksheena, twakdosha,
Satyadi Churna, satyadi Vata.
8) Pushkaramula
Agnimandhya, vatavikara,hrudhyashoola, hika swasa,parshwa shoola, jwara, shotha,pandhu, meda vrudhi.
Pushkara mooladhi Churna,pushkaradhi Churna
9) Pippali Hrudhadourbalya, pandu,raktavikara, kasa, Swasa, aruchi,Agni mandhya, kshata.
Guda pippali, pippali khada,pippalyasava
10) Vishwabheshaja
Hrudourbaya, hrutshoola,shlipadha, shota, amvata ,sheethaPitta
Ardrakakhanda, panchasamaChurna, samasharkara Churna,rasnadi kwatha, soubhagya shunthi ,shunthi sura
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 85
Table – 10
Describing the Chemical constituents of Kakubhadi Lehya
Name of theingredient
Chemical constituents
11) Arjuna B-sitostirol, elagic acid, arjunoic acid, arjuna glycosides, arjunetin,fridelin, Tenin – 20-25%, Calcium – 0.33%, Magnesium – 0.78%,Alumunim – 0.076%,In fruits – 7-20% tannin present
12) Vacha In rhisome 1.5-3.5 volatile oil is present in that asaryl aldehyde inthat two active acidic that is A-asarone B-asarone are present otherchemical components like acorin, augenol, caffine
13) Rasna In leaves – kwarsitin and aisoraimanetin, and in panchanga pluchinis present
14) Bala Ksharabha (acidic) 0.085%, in seed 0.32% Ksharabha (acidic)present main Ksharabha (acidic) i.e., eqhdrine with these steroied,phaitostirol, ral, ral acid, musin, and potassium nitrate.
15) Nagabala B- phenenthylamines quinazoline, gossypol, steroculic acid,linoleic acid etc/
16) Abhaya Tanin – 24.6-32.5 in that chebumagic acid corilagin and 18 aminoacids phosphoric, succinic, clinic, shikimic acid, and yellow colouroil. Is present about 36.4%
17) Shati The dried rhizomes of commerce yield, 4% of an essential oil withthe characteristic odour and pungent taste of rhizomes. It containsstarch 52% carbonic acid a glycocide, and ash 46% the principleconstituent of the oil is the ethyl ester of p- methoxy cinnamic acid.
18) Pushkaramula Inulin-10%, Volatile -1.3%, Contents:- oiland alantolactone and itis called as teevra krimighna.
19) Pippali Volatile oil – 0.8%, Piperine – 4-5%, Pipalatine and sesamine andpiplasterol- 0.15- 0.18% and pipalartin-0.13-0.20% piperlanguminon, steroid, glycoside
20) Vishwabheshaja Dry Ness 80.9, protein 2.6, fat 0.9, fibre 2.4, carbohydrate 12.3,metals 1.2%, calcium 20, phosphorus 60, iron 2.6 mg, each 100 gmother then these iodine chlorine are also present vitamin A,B,C arealso present
Preservation of the Medicine:
The prepared medicine is preserved in the glass jars of 500 gms quantity with air tight
sealing. As on the patients approached and fit under the norms of the trail the Kakubhadi
Lehya is distributed at regular intervals.
Periodical check-ups are under taken as par the norms and pre-determined
parameters.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 86
CHAPTER-5
RESULTSresent study registers 30 patients, out of 68 approached patients.
Out this, 2 patients were discontinued hence their data has not been included in the
assessment. The remaining 28 patients of Bhrama viz. Hypertension, fulfilling the criteria
of diagnosis and inclusive criteria were included in the study.
All the patients were examined before and after the trail, according to the case
sheet format given in the annex. Both the subjective and objective criteria were recorded.
The data recorded are presented under the following headings.
A. Demographic data
B. Evaluating disease Data
C. Result of the Kakubhadi Lehya in Bhrama viz. Hypertension and
D. Statistical analysis of the clinical and objective parameters
A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 28 patients is as
follows.
A1) distribution of patients by Age
Age – gender distributions Observation and Results:
An interval of 10 has considered from the ages 25 to 65 as discussed in the
methods. In the study it is revealed that stress is continued from the ages of 25 onwards
and as age advances the sample are settled. At the older age group of 55-65 only 2
(10.52%) patients are reported. Where in 25-35 and 35-45 age groups reported with 6
(31.5%) patients in each group. 45-55 age group reported with the 5 (26.4%) patients
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 87
with the symptoms of Bhrama vis-à-vis hypertension. The tabulations are depicted as
under.
Table- 11
Distribution of patients by Age- gender
Male patients Female patients Total patientsAge
Number % Number % Number %
25-35 6 31.5 0 0 6 20
35-45 6 31.5 1 9.1 7 23.4
45-55 5 26.4 1 9.1 6 20
55-65 2 10.6 9 81.8 11 36.6
Total 19 100 11 100 30 100
Table- 12
Distribution of Male patients by Age
Age
Tot
al n
o of
patie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
% Not
Res
pond
ed%
Dis
cont
inue
d
%
25-35 6 31.5 4 66.6 2 33.3 0 0 0 0 0 0
35-45 6 31.5 1 16.6 2 33.3 2 33.3 0 0 1 16.6
45-55 5 26.4 4 80 0 0 0 0 0 0 1 20
55-65 2 10.6 0 0 0 0 1 50 1 50 0 0
Total 19 100 9 4 3 1 2
Here in this study an attempt is made to understand the male female responses to
the management with respect to that of the age groups.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 88
Observations of well-responded group in the Male gender comparison is, 25-35
interval 4 (66.6%) patients, 35-45 interval 1 (16.6%) patient, 45-55 interval 4 (80%)
patients and 55-65 interval no patients in the study. Observations of Moderately
responded results group in Male gender comparison is, 25-35 interval 2 (33.3%) patients
and 35-45 interval and 2 (33.3%) patients. Observations of responded results group in
Male gender comparison is 35-45 interval 2 (33.3%) patients and 1 (50%) in 55-65
interval and no patients in other groups of the study. Observations of not-responded
group in the Male gender comparison are 1 patient of 55-65 is found. One each of the
males discontinued from the age groups of 35-45 and 45-55.
Table- 13
Distribution of Female patients by Age
Age
Tot
al n
o of
patie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
25-35 0 0 0 0 0 0 0 0 0 0 0 0
35-45 1 9.1 0 0 0 0 1 100 0 0 0 0
45-55 1 9.1 0 0 1 100 0 0 0 0 0 0
55-65 9 81.8 0 0 1 11.1 6 66.6 2 22.2 0 0
Total 11 100 0 2 7 2 0
At the female side of the results major number (9 cases – 81.8%) of the cases are
from the 55-65 age group. No patients reported at the 25-35 class of age group. One
patient (9.1%) reported from that of 35-45 age group responded to the treatment. Out of 1
(9.1%) patient of the age group of 45-55 has moderately responded to the treatment. The
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 89
major group of the 55-65 in females has the no patients of well responded and
discontinued. Many i.e. 6 (66.66%) patients responded to the treatment and 1 (11.1%)
patient moderately responded and 2 (22.22%) patients have not responded to the
management in the study.
Graph – 1
DISTRIBUTION OF PATIENTS BY AGE – GENDER
The observation of this study suggests that the hypertension is directly
proportional to that of age in the females and inversely proportional in the male
populations. The pictorial representation is as under.
DISTRIBUTION OF PATIENTS
BY AGE - GENDER1
1
92
6
5
60
0 2 4 6 8 10
25-35
35-45
45-55
55-65
Female 0 1 1 9
Male 6 6 5 2
25-35 35-45 45-55 55-65
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 90
A2) Distribution of patients by Gender
Table- 14
Distribution of patients by Gender in Bhrama
GenderT
otal
no
ofpa
tient
s% W
ell
Res
pond
ed
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Female 11 36.67 1 9.09 2 18.2 5 45.4 3 27.3 0 0
Male 19 63.33 8 42.1 4 21.1 5 26.3 0 0 2 10.5
Total 30 100 9 6 10 3 2
Graph - 2
Distribution of patients by Gender in Bhrama
GENDER DISTRIBUTION
Male63.33%
Female 36.67%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 91
Gender distributions Observation and Results:
The male female ratio in the study is 19:11 patients. The percentage of the
distribution does not show any gender differentiation to get this anxiety-related disease.
The observations are 19 Patients i.e. (63.33%) male and 11 patients i.e. (36.67%) were
female.
As the results observed, out of 19 (63.33%) males, 8 (42.1%) patients well
responded, 4 (21.05%) patients moderately responded, 5 (26.31%) patients responded, 2
(10.52%) patients of discontinued are recorded. As the results observed, out of 11
(36.67%) female, 1 (9.09%) patient well responded, 2 (18.18%) patients moderately
responded, 5 (45.45%) patients responded and 3 (27.27%) patients of not responded are
recorded.
A3) distribution of patients by Religion
Table- 15
Distribution of patients by Religion
Religion
Tot
al n
o of
patie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
% Not
Res
pond
ed
%D
isco
ntin
ued
%
Hindu 25 83.3 8 32 6 24 7 28 2 8 2 8
Muslim 5 16.7 1 20 0 0 3 60 1 20 0 0
Christian 0 0 0 0 0 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0 0 0 0 0 0
Total 30 100 9 6 10 3 2
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 92
Religion distributions Observation and Results:
At the results observed, out of 25 (83.3%) of Hindu patients, 8 (32%) patients
well responded, 6 (24%) patients moderately responded, 7 (28%) patients responded, 2
(8%) patients of each not responded and discontinued are recorded. On the other hand the
results observed at Muslim community are, out of 5 (16.7%), 1 (20%) patient well
responded, 3 (60%) patients responded and 1 (20%) patient not responded. The graphical
representation is as under.
Graph – 3
Distribution of patients by religion
A4) Distribution of patients by Occupation
At the results observed, out of 8 (26.6%) of sedentary patients, 1 (12.5%) patient
is well responded, 1 (12.5%) patient moderately responded, 4 (50%) patients responded
and 2 (25%) patients not responded. At the active group, out of 20 (66.6%) patients, 8
Christian 0.00%
Hindu83.33%
Muslim16.67%
Others0.00%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 93
(40%) patient well responded, 4 (20%) patients moderately responded, 6 (30%) patients
responded and 2 (10%) patients discontinued. At the results observed, out of 2 (6.67%) of
Labour patients, 1 (50%) patient moderately responded and another patient (50%) is not
responded. The tabulation and graphical representation is as under.
Table- 16
DISTRIBUTION OF PATIENTS BY OCCUPATION
Occ
upat
ion
Tot
al n
o of
patie
nts
%W
ell R
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Sedentary 08 26.6 1 12.5 1 12.5 4 50 2 25 0 0
Active 20 66.6 8 40 4 20 6 30 0 0 2 10
Labour 02 6.67 0 0 1 50 0 0 1 50 0 0
Total 30 100 9 6 10 3 2
Graph - 4
DISTRIBUTION OF PATIENTS BY OCCUPATION
PATIENTS BY OCCUPATIONActive66.67%
Sedentary26.67%
Labour6.67%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 94
A5) Distribution of patients by economic status
Table- 17
Distribution of patients by Economic statusE
cono
mic
sta
tus
Tot
al n
o of
patie
nts
%
Wel
l Res
pond
ed
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Poor 2 6.6 0 0 1 50 0 0 1 50 0 0
Middle 15 50 5 33.3 2 13.3 6 40 2 13.3 0 0
Higher
Middle13 43.4 4 30.7 3 23.1 4 30.7 0 0 2 15.4
Higher 0 0 0 0 0 0 0 0 0 0 0 0
Total 30 100 9 6 10 3 2
Economic status distribution Observation and Results:
At the results observed, out of 2 (6.6%) of poor patients, 1 (50%) patient is
moderately responded and 1(50%) patient is not responded. Out of 15 (50%) of Middle
class patients, 5 (33.3%) patient is well responded, 2 (13.3%) patients moderately
responded, 6 (40%) patients responded and 2 (13.3%) patients not responded. From
higher middle class 13 (43.4%) patients reported and out of them 4 (30.7%) patients are
well responded, 3 (23.1%) patients moderately responded, 4 (30.7%) patients responded
and 2 (15.4%) patients are discontinued. No patients are reported from the higher class of
classification. The pictorial graph is as follows.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 95
Graph- 5
DISTRIBUTION OF PATIENTS BY ECONOMIC STATUS
B) Data related to the disease.
B1) Distribution of patients by presenting complaints
Table-18
Presenting complaints Patients Before Percentage
Bhrama 30 100
Shira shoola 20 66.6
Angasada 14 46.6
Nidranasha 13 43.33
Hrudrava 7 23.33
Klama 6 20.0
Urah shoola 2 6.7
2
15
13
00
2
4
6
8
10
12
14
16
Poor Middle Higher Middle Higher
by economical statusPatients
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 96
As the above table explains about the different symptoms evaluated at the study
under the heading of Bhrama vis-à-vis hypertension with the presenting complaints are
foot forth here. The first and fore most complaint is Bhrama i.e. giddiness. All the
patients in the study (100%) reported the Bhrama. The next most common complaint is
shira shoola i.e. headache. 20 patients (66.6%) reported with the headache. The third
complaint is angasada, with the 14 (46.6%) patients and associated with the nidranasha
(Sleeplessness) of 13 (43.3%) patients. Not at the least but still the patients reported with
the complicate complaints such as Hrudrava (7 patients – 23.33%), Klama (6 patients –
20%) and Urah shoola (2 patients – 6.7%). The graphical representation is as under.
Graph – 6
Distribution of patients by presenting complaints
B2) Distribution of patients by Associated features
As many as features are associated with the study Bhrama vis-à-vis hypertension
with the associated complaints are foot forth here. Many complaints of associative are not
Distribution by Presenting Complaints
30
20
14
13
7
6
2
0 5 10 15 20 25 30 35
Bhrama
Shira shoola
Angasada
Nidranasha
Hrudrava
Klama
Urah shoola
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 97
observed in the study. Toxemia, Transient Ischemic attack, Pakshaghatha and Ardita vata
is not observed in the study. Common complaint is medoroga with 7 patients (23.33%)
followed by Asthma with 5 (16.6%) patients and the last associated complaint observed is
Gout (1 patient – 3.33%). The tabulations and graphical representation are as under.
Table- 19
Associated features Total no of patients Percentage
Asthma 5 16.6
Gout 1 3.33
Toxemia 0 0
Transient Ischemic attack 0 0
Pakshaghatha 0 0
Ardita vata 0 0
Medoroga 7 23.33
Graph – 7Distribution of patients by Associated features
Distribution by Associated features
5
1
7
0
0
0
0
0 1 2 3 4 5 6 7 8
Asthma
Gout
Toxemia
Transient Ischemic attack
Pakshaghatha
Ardita vata
Medoroga
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 98
B3) Distribution of patients by mode of on set
Table- 20
DISTRIBUTION OF PATIENTS BY MODE OF ON SET
Modeof onset
Tot
al p
atie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Gradual 17 56.67 4 23.5 1 5.8 8 47 3 17.6 1 5.8
Sudden 13 43.33 5 38.4 5 38.4 2 15.3 0 0 1 7.6
Total 30 100 9 6 10 3 2
Graph –8
DISTRIBUTION OF PATIENTS BY MODE OF ON SET
The modes of onset of the Bhrama vis-à-vis hypertension results observed are as
under. Out of 17 (56.67%) of Gradual onset patients, 4 (23.5%) patients are well
responded 1 (5.8%) patient is moderately responded and 8 (47%) patients responded, 3
(17.6%) patients are not responded and 1 (5.8%) patient discontinued. Out of 13
PATIENTS BY MODE OF ON SET
Gradual 56.67%
Sudden43.33%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 99
(43.33%) of Sudden onset patients, 5 (38.4%) patients are well responded 5 (38.4%)
patients are moderately responded and 2 (15.3%) patients responded and 1 (7.6%) patient
discontinued. There were no patients from the category of discontinued.
B4) Distribution of patients by Intensity
Table- 21
Distribution of patients by Intensity
Intensity
Tot
al p
atie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Mild 11 36.7 5 45 3 27.2 2 18.2 0 0 1 9.1
Moderate 14 46.7 4 28.5 3 21.4 4 28.5 2 14.3 1 7.1
Severe 5 16.6 0 0 0 0 4 80 1 20 0 0
Total 30 100 9 6 10 3 2
The intensity distributions of the Bhrama vis-à-vis hypertension results are
observed as under. It classified under three headings as mild, moderate and severe. Out of
11 (36.7%) of mild intensity patients, 5 (45%) patients are well responded 3 (27.2%)
patients are moderately responded, 2 (18.2%) patients are responded and 1 (9.1%) patient
is discontinued. No patients reported from the category of not responded. Out of 14
(46.7%) of moderate intensity patients, 4 (28.5%) patients are well responded 3 (21.4%)
patients are moderately responded, 4 (28.5%) patients responded, 1 (7.1%) patient
discontinued and 2 (14.3%) patients are not responded to the management. Out of 5
(16.6%) of severe intensity patients, 4 (80%) patients are responded and 1 (20%) patient
is not responded to the management. The graphical expression is as under.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”100
Graph – 9
DISTRIBUTION OF PATIENTS BY INTENSITY
B5) Distribution of patients by Aggravating factors
Table -22
Agg
rava
ting
fact
ors
Tot
al p
atie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Travel 16 53.34 4 25 3 18.7 6 37.5 2 12.5 1 6.25
Anxiety 27 90 8 29.7 6 22.2 9 33.3 2 7.5 2 7.5
Emotion 19 63.34 5 26.4 4 21.1 6 31.6 3 15.8 1 5.3
Stress 23 76.6 7 30.5 3 13.1 8 34.8 3 13.1 2 8.7
Physicalstress
5 16.67 1 20 1 20 2 40 1 20 0 0
The aggravating factorial distributions of the Bhrama vis-à-vis hypertension
results are observed as under. It classified under three headings as Travel, Anxiety,
PATIENTS BY INTENSITY
Severe16.67%
Mild 36.67%
Moderate46.67%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”101
Emotions and stress. Out of 16 (53.34%) of Travelling patients, 4 (25%) patients are well
responded 3 (18.7%) patients are moderately responded, 6 (37.5%) patients are responded
and 1 (6.25%) patient is discontinued. 2 (12.5%) patients reported from the category of
not responded. Out of 27 (90%) of Anxiety referred patients, 8 (29.7%) patients are well
responded 6 (22.2%) patients are moderately responded, 9 (33.3%) patients responded, 2
(7.5%) patients discontinued and 2 (7.5%) patients are not responded to the management.
Out of 19 (63.34%) of emotional referred patients, 5 (26.4%) patients are well
responded 4 (21.1%) patients are moderately responded, 6 (31.6%) patients responded, 1
(5.3%) patient discontinued and 3 (15.8%) patients are not responded to the management.
Out of 23 (76.6%) of stress referred patients, 7 (30.5%) patients are well responded 3
(13.1%) patients are moderately responded, 8 (34.8%) patients responded, 2 (8.7%)
patients discontinued and 3 (13.1%) patients are not responded to the management. Out
of 5 (16.67%) of physical stress referred patients, 1 (20%) patient is well responded, 1
(20%) patient is moderately responded, 2 (40%) patients are responded and 1 (20%)
patient is not responded to the management. The graphical expression is as under.
Graph – 10
Depicting the Aggravating factors of Bhrama
16
27
19
23
5
0
5
10
15
20
25
30
Travel Anxiety Emotion Stress Physicalstress
Depicting the Aggravating factors of Bhrama
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”102
B6) Distribution of patients by relieving factors
Table -23Relieving
factors
Tot
al p
atie
nts
%
Wel
l Res
pond
ed
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
%
Not
Res
pond
ed
%
Dis
cont
inue
d
%
Rest 18 60 6 33.3 2 11.1 7 38.8 1 5.55 2 11.1
Tranquilliser 0 0 0 0 0 0 0 0 0 0 0 0
Sleep 28 93.3 8 28.5 6 21.4 9 32.1 3 10.7 2 7.14
Anti
Depressants0 0 0 0 0 0 0 0 0 0 0 0
Graph – 11
Depicting the relieving factors of Bhrama
18
0
28
0
0
5
10
15
20
25
30
Depicting the relieving factors of Bhrama
3-D Column 1 18 0 28 0
Rest Tranquilliser SleepAnti
Depressants
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”103
The relieving factorial distributions of the Bhrama vis-à-vis hypertension results
are observed as under. It classified under three headings as rest, tranquilliser, sleep and
anti-depressants. Out of 18 (60%) of resting patients, 6 (33.3%) patients are well
responded 2 (11.1%) patients are moderately responded, 7 (38.8%) patients are responded
and 2 (11.1%) patients are discontinued. 1 (5.55%) patient is reported from the category
of not responded. The second category of well slept patients of 28 (93.3%), 8 (28.5%)
patients are well responded 6 (21.4%) patients are moderately responded, 9 (32.1%)
patients are responded and 2 (7.14%) patients are discontinued. 3 (10.72%) patients are
reported from the category of not responded. No patients have reported getting the
tranquillisers or anti-depressants.
B7) Distribution of patients by Shareerika Prakruti
Table- 24
Distribution of patients by Shareerika Prakruti
ShareerikaPrakruti
Tot
al n
o of
patie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
% Not
Res
pond
ed%
Dis
cont
inue
d
%
Vata Pitta 11 36.6 5 45.4 2 18.2 3 27.2 0 0 1 9.1
Pitta Kapha 15 50 3 20 3 20 6 40 2 13.3 1 6.56
Kapha Vata 04 13.4 1 25 1 25 1 25 1 25 0 0
Tridosha 00 0 0 0 0 0 0 0 0 0 0 0
Total 30 100 9 100 6 100 10 100 3 100 2 100
The Shareerika Prakruti distributions of the Bhrama vis-à-vis hypertension results
are observed as under. It classified under four headings as Vata Pitta, Pitta Kapha, Kapha
Vata and Tridoshaja. Out of 11 (36.6%) of Vata Pitta patients, 5 (45.4%) patients are well
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”104
responded 2 (18.2%) patients are moderately responded, 3 (27.2%) patients are responded
and 1 (9.1%) patient is discontinued. No patients are reported from the Vata Pitta
category of not responded. The second category is of Pitta Kapha Prakruti with the 15
number (50%) of patients, out of well-responded 3 (20%), moderately responded 3 (20%)
patients and responded are 6 (40%). 1 (6.56%) patient is discontinued and 2 patients
(13.3%) are not responded. Out of 4 (13.4%) of Kapha Vata Prakruti patients, 1 (25%)
patient is well responded 1 (25%) patient is moderately responded, 1 (25%) patient is
responded and 1 (25%) patient is not responded. No patients are reported from the Kapha
Vata category of discontinued. It is practically difficult to ascertain the Tridosha Prakruti,
thus there is no candidature recorded. The pictorial expression of the shareerika Prakruti
is as under.
Graph -12
Distribution of patients by Shareerika Prakruti
Distribution by Shareerika Prakruti
Kapha Vata13.33%
Vata Pitta36.67%
Pitta Kapha50.00%
Tridosha0.00%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”105
B8) Distribution of patients by Manasika Prakruti
Table -25
ManasikaPrakruti
Tot
al n
o of
patie
nts
% Wel
lR
espo
nded
%
Mod
erat
ely
Res
pond
ed
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Raja Guna 21 70 7 33.3 4 19.1 7 33.3 1 4.76 2 9.52
Raja TamoGuna
9 30 2 22.2 2 22.2 3 33.3 2 22.2 0 0
Total 30 100 9 6 10 3 2
Graph -13
Distribution of patients by Manasika Prakruti
The Manasika Prakruti distributions of the Bhrama vis-à-vis hypertension results
are observed as under. It classified under two headings as rajoguna and rajotamoguna.
Out of 21 (70%) of rajoguna, 7 (33.3%) patients are well responded 4 (19.1%) patients
are moderately responded, 7 (33.3%) patients are responded, 1 (4.76%) patient is not
responded and 2 (9.52%) patients are discontinued. Out of 9 (30%) of rajotamoguna, 2
Distribution by Manasika Prakruti
Raja Guna 70.00%
Raja Tamo Guna
30.00%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”106
(22.2%) patients are well responded 2 (22.2%) patients are moderately responded, 3
(33.3%) patients are responded, 2 (22.2%) patients are not responded and no patients of
discontinued.
C) Result of the Kakubhadi Lehya in Bhrama vis-à-vis Hypertension
C1) Assessment of Lab investigations in Bhrama
Table -26
Investigation Mean Before Mean After Mean Difference1. Temperature 98.02 97.78 0.24
2. Weight 63.61 63.37 0.24
3. Hemoglobin % 12.397 12.84 0.443
4. RBC count 4.328 4.579 0.251
5. Serum Creatinine 0.8623 0.8703 0.008
6. Serum Cholesterol 202.446 196.653 5.793
7. HDL Cholesterol 46.18667 46.93333 0.74666
8. LDL Cholesterol 117.0393 111.8067 5.2326
9. VLDL Cholesterol 40.27333 37.98 2.29333
10. Serum Triglyceride 199.0667 189.9867 9.08
It is put forth for the assessment many parameters in the study. The direct
significant parameters are included along with the parameters, which are helpful to assess
the co-morbid conditions, such as lipid profile. Some parameters that can influence the
blood pressure through its physiological or patho-physiological nature also included, such
as temperature. The variances are observed not only to assess the regression of the
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”107
disease but also to assess the Rasayana effect induced in the body by the chosen
medicament. The data analysis is as follows.
The factors that have the influence on the physiology (temperature, weight) are
decreased with the baseline mean data in the study. The temperature shows the mean
difference of 0.24 in the study, which is a point of observation to assess the Rasayana
effect induction in the body. The second factor weight has reduced by 0.24 mean value,
suggesting the induction of good health through Rasayana, there by the regulation of the
Bhrama vis-à-vis hypertension.
The third factor of objective parameter observed is haemoglobin percentage. It
shows marked increase of 0.443 mean value. Which is suggestive of inducting Rasayana
effect and also capacitating the oxygen exchange ratio and there by the controlling the co-
morbid conditions or associative such as hypoximea. The associate factor of haemoglobin
is RBC count. This has shown 0.251 mean value increase in the study reflects to the
percentage rise of the haemoglobin and there by regulating the Bhrama vis-à-vis
hypertension.
The next parameter of co-morbidity in Bhrama vis-à-vis hypertension is serum
creatinine. It has shows a rise in the study with a mean value of 0.008. It suggests that the
Angiotensin and Renin involvement in the Bhrama vis-à-vis hypertension have been
successfully reduced and provide the Rasayana effect not only at the cardiac but also in
the renal area. The small amount changes are as a process of regulation in the KUB
system.
Serum cholesterol and associative LDL, VLDL with S.Triglycerides are risk
factors in the pathology of Bhrama vis-à-vis hypertension. Out of these associated the
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”108
HDL cholesterol is good for the body and all the rest offers co-morbidity. As the results
observed except the HDL cholesterol all other cholesterol drop in the study in
comparison of mean values. The mean value of HDL is 0.74666-difference rise in the
study. The rest of co-morbid influencing factors enumerated are LDL (5.2326), VLDL
(2.29333), Serum cholesterol (5.793) and S. Triglyceride (9.08), show the significant
drop and suggest that the effect of the Kakubhadi Lehya on Bhrama vis-à-vis
hypertension with reference to its Rasayana effect over the Bhrama vis-à-vis
hypertension.
C2) Assessment of Subjective parameters in Bhrama
Table- 27
Presenting complaints Patients Before % Patients After %
Bhrama 28 100 0 0
Shira shoola 19 67.85 2 7.14
Angasada 14 50 1 3.57
Nidranasha 13 46.42 2 7.14
Hrudrava 7 25 0 0
Klama 6 21.42 2 7.14
Urah shoola 2 7.14 0 0
The presenting complaints of the Bhrama vis-à-vis hypertension are enumerated
here under the limelight of the contemporary and Ayurvedic methods. The first fore most
complaint is Bhrama, which is a pratyatma niyata Lakshana of the Bhrama. All the 28
(100%) patients included and received full-length treatment are exhibiting this symptom
and relieved 100 % at the end of the schedule.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”109
The second major complaint expressed in the study is shira shoola by 19 (67.85%)
and outs of them 2 (7.14%) patients’ shows the persistence of the shira shoola at the end.
Angasada, a complaint observed in the study for 14 (50%) patients and one (3.57%)
patient hang on with the complaint at the end of the study. Next complaint is nidranasha,
which is always associated is observed on 13 (46.42%) patients and found that the same 2
(7.14%) patients are having the complaint at the end of the study. Hrudrava, another
relative complaint of the corresponding organ is observed in 7 (25%) patients and at the
end the Rasayana effect of the Kakubhadi Lehya made them not to have the complaint.
The klama is observed in 6 (21.42%) patients and at the end 2 (7.14%) patients are
assiduous with the complaint. The last subjective parameter observed in the study is urah
shoola for 2 (7.14%) patients and both were relieved with the complaint at the end of the
study of Kakubhadi Lehya on Bhrama vis-à-vis hypertension. The graphical
representation is as under.
Graph - 14
Distribution by Presenting Complaints
28
19
14
13
7
6
2
2
1
2
2
0
0
0
0 5 10 15 20 25 30
Bhrama
Shira shoola
Angasada
Nidranasha
Hrudrava
Klama
Urah shoolaAfter
Before
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”110
C3) Results of Kakubhadi Lehya in Bhrama vis-à-vis Hypertension
The result in the study ascertains the best activity of the Kakubhadi Lehya over
the Bhrama vis-à-vis hypertension. For the convenience the results are grouped as five
categories, viz. Well-Responded, Moderately Responded, Responded, Not responded and
Discontinued.
The result declaration is done following the norms and conditions of the inclusive
factors and study of the subjective parameters in association with the sphygmomanometer
studies of three postures. The co-morbid stimulating factors especially LDL, VLDL and
S. Triglycerides are considered in while declaring the results. The factors which make the
Rasayana effect over the body also included to assess the results.
After through study of the entire parameters and materials available for the
assessment of results it was drawn a conclusion of results as - 9 (30.02%) well responded,
6 (20.02%) moderately responded, 10 (33.33%) responded, 3 (10%) patients not
responded and the last 2 (6.63%) patients discontinued in the study. The tabulation and
graphical expression pi-diagram is as under.
Table-28
Result Number of patients Percentage
Well Responded 9 30.02
Moderately Responded 6 20.02
Responded 10 33.33
Not Responded 3 10.00
Discontinued 2 6.63
Total 30 100
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”111
Graph – 15
Results of the Kakubhadi Lehya
D) Statistical analysis of the clinical and objective parameters
D1) Subjective parameters
Table -29
Subjectiveparameters
Mean SD SE t-Value p-Value
sign
ific
ance
Bhrama 0.964 0.188 0.0357 27 <0.001 HS
Shira shoola 0.928 0.262 0.049 18.398 <0.001 HS
Angasada 0.285 0.46 0.086 3.31 <0.001 HS
Hrudrava 0.214 0.417 0.078 2.743 <0.001 HS
Klama 0.107 0.314 0.059 1.813 >0.05 NS
Urah Shoola 0.071 0.262 0.049 1.44 >0.05 NS
Results of Kakubhadi Lehya in Bhrama vis-à-vis Hypertension
Not Responded 10.00%
Moderately Responded
20.00%
Well Responded 30.00%
Responded 33.33%
Discontinued6.67%
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”112
D2) Emotional parameters
Table -30Emotionalparameters Mean SD SE t-Value p-Value Significance
Fear 0.537 0.692 0.131 4.09 <0.001 HS
Anger 1.0 0.72 0.136 7.35 <0.001 HS
Depression 0.571 0.79 0.149 3.83 >0.001 NS
Anxiety 0.8571 0.650 0.122 7.02 <0.001 HS
Irritability 0.428 0.69 0.13 3.29 <0.001 HS
Aggressiveness 0.321 0.475 0.089 3.606 <0.001 HS
Delirium 0.428 0.634 0.119 3.59 <0.001 HS
D3) Objective parameters
Table -31Objective
parameters Mean SD SE t-Value p-Value Significance
Temperature 0.278 0.428 0.080 3.475 <0.001 HS
Weight 0.443 0.291 0.055 8.054 <0.001 HS
Haemoglobin % 0.532 0.326 0.061 8.721 <0.001 HS
RBC count 0.287 0.178 0.033 8.696 <0.001 HS
Serum Creatinine 0.071 0.079 0.014 5.071 <0.001 HS
Serum Cholesterol 8.3 6.47 1.22 6.803 <0.001 HS
HDL Cholesterol 2.692 2.826 0.534 5.041 <0.001 HS
LDL Cholesterol 8.063 6.501 1.228 6.565 <0.001 HS
VLDL Cholesterol 3.201 5.85 1.107 2.891 <0.001 HS
Serum Triglyceride 9.71 7.22 1.36 7.139 <0.001 HS
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”113
D4) Blood pressure variances
Table -32
Blood pressurevariances
Mean SD SE t-Value p-Value
Sign
ific
ance
Standing Systolic 18.857 8.868 1.675 11.2579 <0.001 HS
Standing Diastolic 9.5 3.911 0.7391 12.85 <0.001 HS
Supine Systolic 17.92 8.476 1.6 11.2 <0.001 HS
Supine Diastolic 9.5 3.595 0.679 13.99 <0.001 HS
Sitting Systolic 18.5 8.478 1.6 11.56 <0.001 HS
Sitting Diastolic 9.428 4.1 0.775 12.165 <0.001 HS
All the subjective parameters except Klama and Urah shoola show highly
significance. Consider hypothesis that the drug is not responsible for the changes in the
readings of the patients, before and after the treatment, i.e. reducing the Bhrama vis-à-vis
hypertension. To test the hypothesis paired t-test is used. The parameter Bhrama shoes
highly significance with more mean effect and with least variation and it is also having
the uniform effect on the patients (by comparing the t-value) as p is <0.05 and coefficient
of variation. The parameter Urah shoola shows the non-significant with less mean effect.
The parameter Angasada is having more variation. The parameter Anger and Anxiety
shows more significant than fear and rest of the parameters. The parameter Anxiety is
having the more net mean effect and Depression having with more variation. Where as
the parameter Aggressiveness have less mean effect with less variation.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”114
All the objective parameters show highly significance. The haemoglobin, weight,
RBC shows more or less highly significance. The parameter Serum Cholesterol is having
less mean effect with less variation. Where as the parameter serum Triglyceride having
high net mean effect with more variation. The diastolic blood pressure in all the three
different positions, the mean net effect is the same, but the supine position there is high
significance witnessed. There is much variation observed in the sitting position. The
mean effect after the treatment of diastolic blood pressure is more in the position of
standing is more with more variation.
The mean net effect of the systolic blood pressure in the standing position is
more, but there is high significance of systolic blood pressure in sitting position. The
mean effect systolic blood pressure in sitting position is more, where as standing position
show the uniform effect. In the diastolic blood pressure again the standing position show
more uniformity.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”115
Chapter – 6
Discussionertigo 199resembles giddiness or Dizziness by all means, but the difference
is vertigo is because of the Auditory nerve impairment and the Dizziness is a systemic
malfunction expression. As Ayurveda explains, the Majja Dhatu dusti i.e. a nervous
system intervention or Rasa Dhatu dusti i.e. mal-nourishment, which impacts the
Hrudaya and Dashadhamani or a Medo Dhatu dusti which involves the associative pre
disposing factors to generate dizziness are also to be considered. It is evident from that of
pathology expressions of Ayurveda, as example in Vataja Arshas the Karan nada is
witnessed and associated even with that of dizziness. All the above conditions are to be
ruled out and only a hypertensive concerns are to considered as Bhrama, with a special
reference to that of psycho-metabolic pathological condition Bhrama vis-à-vis
hypertension.
Demographic information of Hypertension represents a major public health
concern. It affects about a billion people worldwide and is the most common treatable
risk factor for the cardio vascular disease. In patients aged over 50 and also affecting the
10 to 15 percent of adult population and nearly 50 percent of all deaths in elderly people
is related to hypertension or its complications.
Here high blood pressure (hypertension) has often been called the “silent killer of
man kind” because mild to moderate levels usually go unnoticed by patient until serious
damage has already been done. Epidemiological studies revealed that it is the most
important single factor responsible for death from cardiovascular and cerebro-vascular
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”116
disease. Therefore its epidemology drawn the attention of W.H.O in 1978 and declared
that year as “HYPERTENSION YEAR”.
Because of the threshold of 21st century is plagued with reward of fast living,
insatiable needs fanned by easy obsolescence slick marketing and industrialization. The
science at the service of mankind has its own pros and cons. The advancement of medical
science and technology is touching new horizons each day, but with each dawn serious
health hazards are creeping in to our lives, with strange pathological complications.
Hypertension is one such ailment.
So far hypertension in various system of medicines like Ayurveda, Unani,
homeopathy and allopathic-claim success in preventing, controlling hypertension. But the
fundamental factor that blood pressure is not a disease but a reaction is manifested by the
cardiovascular system against unnatural behaviours in relation to one’s Ahara and Vihara
(mithya hara vihara). Among these system of medicines Ayurveda adopts the treatment
for the benefit of life “chikitsaachayausho hitayopadishyate” and life is nothing but the
feeling of self or self-consciousness “ttrayusho chetananu vruttihi” Ayurveda is eternal
and ever lasting principle. Ayurvedic drugs have shown re-constructive or rejuvenate
effect.
So far scientists call blood pressure a child of modern civilisation. The word
civilisation as it is understood to day implies deviation from nature. For the present life is
most artificial eating food which is never meant for “natural” human being food
especially manufactured processed and tinned which acts partly as stimulating and partly
as nourishment. Out of these tobacco, alcohol, tea, coffee, cold drinks and ice cream,
flesh and spices are most important, adding insult to the injury are the present day toxic
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”117
medicines. The strain of these artificialities hammers the resistance power, vitality and
susceptibility of man. Having lost his health man resorts to modern chemical drugs
knowing not ultimate hazards of it.
Stress and strain are supposed to be the major causes for hypertension and their
effects are clinically widely seen. In other words hypertension is one of the gross and
material manifestation in individuals caused by their own mind and mind of the society.
Thinking process ideas, concepts, attitude, philosophies, convictions etc., are all abstracts
but they very much affect and alter the matter is clearly seen in hypertension
World wide, though the rates of hypertensive admission are not stabilised, there is
a evidence of increasing in hospitalisation or mortality. Death rates continue to cause
concern. In the context of an increase in hypertensive patients and in deaths it is crucial
that we should gain more in sight in to its causation and management.
The overall picture of health of the present civilised man is very gloomy. He is
still being kept under illusion, that filling his stomach with drugs is the only way back to
health. Drugs have only proved to be acting and palliative and none of them is without its
toxic bad effects. In fact correcting blood pressure disorders by drugs is to in correct it
even the simple innocent example is tranquilliser fed under this category of modern
drugs. These drugs when given to pregnant woman produced such shocking results that
the drugs are known as “Generation killer”, because hypertension in pregnancy remains
as a major cause of maternal and foetal morbidity and mortality. It is a late manifestation
of a multi-factorial multi-system disease inhibited very early in pregnancy, the feature of
which suggests an inadequate maternal response to pregnancy. So the patient of
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”118
hypertension is expected to be on medication for long tem and also high blood pressure is
more a controllable factor than a curable one.
Therefore in the present era cardio-vascular disorders from the largest group of
fatal diseases. Framingham prospective study first focussed attention by bringing about
the fact that 37 percent men and 51 percent women who died of cardiovascular disease
had an arterial pressure above 140/90-mm Hg on at least three occasions. This normal
blood pressure that is hypertension is one such disease, which is chief contributory cause
for arterial degeneration in advanced age. High blood pressure may be produced by
increased cardic out put in the pressure of normal peripheral resistance on increased
peripheral resistance in the presence of normal cardiac out put. The latter is by for the
common situation arterial hypertension can be broadly divided into two forms primary on
essential where the cause is unknown and secondary where there is some associated
lesions such as chronic nephritis or adrenal cortial tumour etc.
Thus it is high time that we should release the gravity of the situation. Turn our
backs to the chemical drugs and return backs to the nature to find out physiological
measures for the understanding and controlling blood pressure disorders.
Though there is no difficulty in understanding the disease of hypertension from
modern point of view, there are some difficulties in identifying the condition with a
known disease entity of Ayurveda. The general tendency even among the scholars to
equate a disease mentioned in Ayurveda with some of the diseases mentioned in modern
medicine on vice versa cannot be totally resisted. It may not be desirable to equate a
disease from one system with that of the other system. On the basis of superficial
similarity as there is fundamental difference in the approach of each system in describing
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”119
the pathogenesis still the above tendency may help to some extent to communicate ones
ideas regarding the diseases.
Like wise, regarding hypertension, to have the investigative part and knowledge
of complication in modern days is very appreciable and adaptable. The comprehensive
and wholesome approach of Ayurveda to understand the problem and treat it on the same
lines is the admirable features.
Patients with mild to moderate hypertension require only a simple schedule of
investigation, especially if there is a history of hypertension in first degree relatives. Tests
are necessary to profile other cardio-vascular risk factors and to detect target organ
damage with only limited screening for secondary hypertension. Careful history, physical
examination, repeated blood pressure measurements over months and measurements of
body mass index complete lipid profile, haemoglobin, serum Creatinine serum glucose,
ECG and red blood cells are all that are required.
More over till explanation of hypertension in the language of Ayurveda is a root
point till to day. A number of renowned Ayurvedic physicians and academicians have
made an attempt to explain this condition and its effective treatment in hypertension
according to the mortality of Dosha.
The affliction of different Dhatus is argued in the pathogenesis of hypertension.
Few names of the disease are suggested representing the essential hypertension. Easiest
way of translating hypertension in to Sanskrit it also tried. The different names suggested
embodying the hypertension in Ayurveda.
So in this context on the basis of theoretical and clinical symptomatology
“Bhrama” studied only restricting on comparing only to the hypertension, occurring in
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”120
the cardiovascular system. But so far nomenclature claimed in Ayurveda are Rakta chapa,
Rakta bharadhikyata, Rakta peedanadhikyata and raktasammardhan etc. As a matter of
fact the translation or transliteration of English is “the word and condition at hypertension
refers to Bhrama approximately”, which implies to that of Bhrama i.e. a condition of
giddiness. Here Ayurveda mainly speaks and considers Bhrama as a disease entity.
Charaka has considered Bhrama as one out of the vataja nanatmaja Vyadhi.
Chakrapani on that explained Bhrama is a disease not only concerned to that of Shiras but
also for Rakta as its pradoshaja Vyadhi. As “tamasacha atidarsharam” and also said it as
Smruti mohaka, Bhrama also explained as nidanarthaka Vyadhi of some diseases. It is
also said as signs and symptoms (Lakshana) and upadrava (complications) of many
diseases as like hypertension.
The principle etiological factor of hypertension is psycho-emotional overstrain
this factor leading to impaired regulation of the vascular tone. In general this hypothesis
is at the support of Ayurvedic Dosha Vata interference in producing Bhrama.
Thus one among such formulation which was not even established any where,
which is Bhrama hara, Hrudaya vatanulomaka, srotoshoodhaka as well as Rasayana
modalities are grouped under “Kakubhadi Lehya” as Hrudya Rasayana from Bhaisajya
Ratnavali is to be under taken for the study. These by helping the person to have an
overall sense of well being. So drug therapy and this prevention of mortality and
morbidity arising out of its complications can control it.
Spectrum of disease
Hypertension is a major risk factor for many serious health problems. As there is
no definitive definition universally accepted, the joint National committee (JNC-4) of
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”121
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. Dynamic or isometric exercise can also risk blood
pressure in normal subjects.
Figure-9
Comparison of the benign and malignant hypertension
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”122
About 90% to 95% of all high blood pressure cases are what is called primary, or
essential, hypertension.
There will be an increased risk of high blood pressure if a person is -
• Have a family history of high blood pressure.
• African Americans develop high blood pressure more often than whites, and it
tends to happen earlier in life and be more severe.
• Are male. Women are at an increased risk after age 55.
• Are older than 60. Blood vessels become more brittle with age and are not as
flexible.
• Face high levels of stress. In some studies, stress, anger, hostility, and other
personality traits have been shown to lead to high blood pressure, but the findings
have not always been consistent. Emotional factors most likely add to the risk of
high blood pressure for people who also have other risk factors.
• Are overweight or obese.
• Use tobacco products. Smoking damages your blood vessels.
• Use oral contraceptives. Women who smoke and use oral contraceptives greatly
increase their risk.
• Eat a diet high in saturated fat.
• Eat a diet high in salt (sodium).
• Drink more than a moderate amount of alcohol. Experts say that moderate intake
is an average of one to two drinks per day for men and one drink per day for
women. One drink is defined as 1½ fluid ounces (fl oz) of 80-proof spirits (such
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”123
as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine,
or 12 fl oz of beer.
• Are physically inactive.
• Have diabetes.200
That means the real cause of the high blood pressure is not known, but a number
of factors are associated with the condition.
Figure –10
Figure –
Aetiology of hypertension
Ayurvedic management for Unknown disease
Ancient Acharyas had suspected that new diseases could manifest in the future,
owing to the various changes in environmental, cultural and socio-economic factors.
They have guided us on how to manage such diseases, when not mentioned in the
classics, “The physician should not get disheartened at not knowing the name of a
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”124
disease”, instead, he should research and try to collect information with regard to the
signs.
New high blood pressure guidelines
New recommendations for tighter control of high blood pressure may drastically
reduce the number of individuals who die each year from hypertension-related illnesses,
according to the Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). A summary
report is published in today’s JAMA Express, and the full report will be published this
summer in Hypertension: Journal of the American Heart Association.
The new classification – “pre-hypertension” – describes people with blood
pressures between 120-139 millimeters of mercury (mm Hg) systolic (the top number in a
blood pressure reading) or 80-89 mm Hg diastolic (bottom number) 201. This is
considered as Poorvaroopa of Ayurvedic literature.
Table-33BLOOD PRESSURE LEVEL (mm Hg)202
Category Systolic Diastolic
Optimal** less than 120 less than 80
Normal less than 130 less than 85
High Normal 130-139 85-89
High Blood Pressure
Stage 1 140-159 90-99
Stage 2 160-179 100-109
Stage 3 Greater than or equal to 180 greater than or equal to 110
* For those not taking medicine for high blood pressure and not having a short-termserious illness. These categories are from the National High Blood Pressure EducationProgram.** Optimal blood pressure with respect to heart disease risk is below 120/80 mm Hg.However, unusually low readings should be evaluated for clinical significance.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”125
Current Guidelines
JNC VI 203 is our most recent and comprehensive guide to treating hypertension.
Its recommendations introduced several innovations and new directions for treatment,
placed a new emphasis on both prevention and the efficacy of lifestyle changes, and
established several important goals.
Guidelines of most other groups identify two threshold pressures, one for the
diagnosis of hypertension, which for diastolic pressure is 90 mm Hg or higher and for
systolic pressure, 140 mm Hg or higher, and one for the initiation of drug treatment based
on BP level alone 204-208. The drug treatment threshold for diastolic BP alone differs
considerably amongst the guidelines 209 being 90, 95, 210-212 or 100 mm Hg. Most
guidelines suggest that factors other than BP should influence the decision to begin drug
treatment of patients with pressures between the thresholds for diagnosis and routine
treatment of hypertension 213.
There are few differences amongst the guidelines on factors that interact with
hypertension to increase the likelihood of cardiovascular risk and include older age, male
gender, smoking cigarettes, hyper-cholesterolemia, diabetes, hypertensive target organ
damage, and the presence of cardiovascular disease. Most guidelines recommend
diuretics or beta-blockers as initial drug therapy for patients in whom there are no
specific contradictions; 214-218 the World Health Organisation /International Society of
Hypertension guidelines suggest, however, that any particular class of anti-hypertensive
agent may be chosen 219. The primary goal of treatment in most guidelines is a diastolic
BP below 90 mm Hg, and even lower levels in certain situations such as the presence of
renal disease in diabetic patients 220. All guidelines recommend a more individualised
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”126
therapeutic approach in special circumstances although even here the American Joint
National Committee guidelines still tend to favour diuretics and beta-blockers as initial
therapy in most instances 221. The Preventive Services Task Force recommends that BP
be measured regularly in all persons aged 3 and above 222-223.
PRIMARY OR ESSENTIAL HYPERTENSION
About 80% hypertensive cases belong to this category wherein aetiology is not
known. The primary function of the heart is to supply blood and thereby oxygen to every
cell of the body. In doing so, blood pressure rises. This essential rise to meet the demand
of adequate supply of oxygen of the cell is perhaps designated as essential hypertension
224. Normal systolic blood pressure is maintained as 110 - 140 (mm Hg) and normal
diastolic blood pressure is maintained as 70 to 90 mm Hg. Blood pressure = cardiac
output x peripheral resistance Hence, the mean arterial pressure is the product of cardiac
output and the total peripheral resistance. If one of the factors is affected, it results into a
change of blood pressure 225-228.
Cardiac output is the product of stroke volume (the quantity of blood ejected by
each left ventricular contraction) and the number of contraction per minute (heart rate).
Hence cardiac output depends on stroke volume, heart rate and venous capacitance.
Venous dilatation causes less return or pre-load to heart while venous constriction causes
more volume to return to the heart. Total peripheral resistance (TPR) depends on calibre
of arteriolar bed, elasticity of aortic and arterial walls and the viscosity of blood.
Vasoconstriction results in increased TPR, while vasodilatation results in decreased TPR
229-230. The traditional concept that the elevated arterial pressure is caused by increased
total peripheral resistance with normal cardiac output needs to be modified 231.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”127
TABLE - 34
Four stages wherein cardiac involvement takes place
Stage I Normal size heart with no evidence ofcardiac involvement by ECG or chest X-ray.
Stage II Early left ventricular hypertrophy, detectedleft arterial abnormality (ECG) and fourthheart sound.
Stage III Clinical evidence of left-ventricularhypertrophy by chest X-ray and by ECG.
Stage IV Left ventricular failure
TABLE -35
The World Health Organisation (WHO) Classification of Hypertension
Stage Clinical characteristicsWHO 1 Latent hypertension. Uncomplicated after
labile elevation of blood pressure usually inyounger individuals.
WHO 2 Established hypertension - Stable elevationof blood pressure with signs ofcardiovascular hypertrophy usually inmiddle-aged individuals.
WHO 3 Advanced hypertension - associated withsigns of organic damage caused byelevation of blood pressure e.g. cerebralsclerosis, coronary sclerosis, myocardialinsufficiency and nephrosclerosis.
Borderline hypertension
The haemo-dynamic changes in this group demonstrate increased cardiac output
with normal peripheral resistance where increased heart rate and increased oxygen
consumption is observed. The mechanism behind these changes is still obscure. Probably
an imbalance between sympathetic and parasympathetic nervous system takes place.
Drugs acting on sympathetic system are very effective in achieving control over such
hypertension.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”128
Definite hypertension
Blood pressure climbs consistently above 160/95 mm Hg. Elevation of diastolic
pressure is classified further as -232 -
1. Mild 95 to 104 mm Hg
2. Moderate 105 to 114 mm Hg
3. Severe or malignant 115 mm Hg or above
Figure –11Summary of the aetiology
There is fair evidence to measure BP in young and middle-aged adults (B
Recommendation). Case finding should be considered in all persons aged 21 to 64 years;
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”129
individual clinical judgement should be exercised in all other cases. Accurate BP
measurement by sphygmomanometer in the physicians’ office remains the principal
method of diagnosis. There is insufficient evidence to recommend the routine use of
echocardiography, self-measurement of BP or ambulatory BP monitoring in diagnosis.
While there is good evidence to recommend anti-hypertensive therapy for young
and middle-aged adults (ages 21 to 64 years) with diastolic pressures of 90 mm Hg or
over. There is insufficient evidence to evaluate therapy in persons –
1) with elevated pressure aged under 21 years; or
2) with isolated systolic hypertension defined as a systolic pressure of 140 mm
Hg or higher and diastolic pressure less than 90 mm Hg 233.
Bhrama at the evaluation:
Vagbhata has mentioned that this is because of vata dosha 234 where as Charaka
affirmed it as sanchaya of vata dosha blocked by vitiated pitta Dosha 235. Bhrama
explained as a prodromal symptom of some diseases. Vagbhata has mentioned that it is
one of the symptoms caused by vriddhi of Vata Dosha 236. Charaka explained that it is
caused due to Sanchaya of Vata Dosha blocked by vitiated Pitta Dosha 237. Bhrama
explained as a prodromal symptom of some diseases.
Major factors responsible for the development of the disease are -
1. On the basis of vitiated Dhatu
The Dhatu interrelated in this condition are Rasa and Rakta. Rasa’s main function
is Preenana i.e. nourishment. Essential elements for the body also to be considered here
as the Rakta transports it. The interference of the calcium is such thing in this concern.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”130
Apart from the above, the Ca ion is compared with the Vata functions, which regulates
and makes the Rakta to move all around the body i.e. Vyanavata.
Regulation of intracellular calcium
Calcium in the free form as ions is referred to as activator calcium. This forms a
complex with calmodulin for the phosphorylation of contractile proteins, which helps
actinmyosin bridging. Thus, calcium brings about the vascular smooth muscle cell
contraction. This mechanism could be mediated by the influx of calcium via slow
calcium channels. Putting calcium into the cell brings about the second mechanism by
sodium/calcium exchange mechanism.
However, this exchange mechanism may not be operative in smooth muscle cell,
although we know that this exchange mechanism has a great importance in the
myocardial muscle cell. Mobilising calcium from sub-cellular pools can also increase
intracellular calcium. The effective concentration of calcium extrusion pumps that takes
care of calcium extrusion. It is not very clear how the plasma natriuretic factor blunts the
pump action 238. The receptors of the sympathetic nervous system, specifically the alpha-
1 and alpha-2 adreno receptors move calcium into the cell by opening up the slow
calcium channels and thereby increasing the intra cellular calcium 239-240, and by the
prostaglandins.
Normally, the sodium/calcium exchange pump operates as shown below.
With three ions of sodium moving from lumen to cytoplasm, one ion of calcium and two
ions of potassium move from cytoplasm to lumen side. The Ca++ dependent ATPase or
calcium pumps embedded in the sarcoplasmic reticulum membrane is responsible for
active transport of Ca++ ions against its concentration gradient from cytoplasm to the
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”131
lumen. There are two types of responses responsible for the influx of calcium ions. The
tonic response is induced by acetylcholine, serotonin, histamine, nor-adrenaline on the
transmembrane activation of myofibrillar ATPase.
The histamine, noradrenaline, acetylcholine and serotonin also produce phasic
response on the calcium stores. This phasic response is via calcium release from the
calcium stores activating thereby myofibrillar ATPase. Both these responses result in
vasoconstriction in addition to the effects of high extracellular potassium, cardiac
glycosides and electrical stimuli. Acetylcholine does not initiate the vasculature
originating from systemic arteries. However, noradrenaline produces contraction of extra-
mural coronary vasculature only after previous beta-receptor blockade. Vasoconstriction
occurs if the free intracellular calcium concentration is elevated and binding to
calmodulin leads finally to the splitting of ATP and to mechanical tension development.
This increase of intracellular calcium concentration can be produced by the
transmembrane calcium influx through so called potential or receptor operated membrane
calcium channels and generally leads to contractions of tonic characters. Calcium
antagonists in minute concentrations inhibit this transmembrane calcium influx into
smooth muscle cells, producing thereby vasodilatation.
The second mode of delivery of activated calcium in vascular smooth muscle cell
consists of calcium liberation from cellular stores heading to the phasic contraction.
Calcium antagonists do not directly block the cellular release but seem to interfere with
transmembrane replenishment of the cellular calcium stores thus eventually, both tonic
and phasic vascular smooth muscle activity can be damped by calcium antagonists.
During the excitation of the heart muscle fibres, an increase in transmembrane calcium
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”132
influx occurs together with liberation of calcium from endoplasmic stores resulting in a
rapid rise in intracellular concentration of free calcium ions. This initiates the splitting of
ATP by the calcium dependent ATPase of the myofibrils, so that phosphate bond energy
is transformed into mechanical energy. In other words, calcium ions act as mediators
between the excitatory processes at the surface and the intracellular biochemical
reactions, which involve ATP utilization for contraction. In short, a positive ionotropic
influence on the contractile tension development is developed by the various
mechanisms, which helps the contraction. However, calcium channel blockers resulting
in vasodilatation produce a negative ionotropic effect. Calcium glycosides improve the
availability of calcium to the contractile system.
2. On the basis of vitiation of Vata
The Vata involvement in the process of hypertension is evaluated in the literary
review. Out of the factors involved is compared with the nervous system of contemporary
medicine is as follows.
Vata verses old age:
Evidence supports treatment of systolic high blood pressure in older 241-242
persons. A review of the medical literature suggests that older persons with systolic
hypertension (and systolic blood pressure of at least 160 mm Hg) should receive
treatment.
Over activity of the Sympathetic Nervous System
Over activity of the sympathetic nervous system may be a fundamental
mechanism in hypertension. Plasma norepinephrine in the heart and kidneys is elevated
in young individuals with hypertension 243-244. Heightened activity of the renal
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”133
sympathetic nerves contributes to increased renal vascular resistance in essential
hypertension.6 Increased muscle nerve sympathetic overactivity is seen in mildly
hypertensive patients 245. Renal vascular disease or vascular remodeling follows
sympathetic overactivity in the early stages of hypertension. Hypoxia-driven arterial
chemoreceptors are potent stimulators of sympathetic activity. Recurrent episodic
hypoxia stimulates carotid chemoreceptors and, thus, sympathetic activity. Subsequently,
adrenal and renal sympathetic nerves maintain this heightened sympathetic activity 246.
Local endothelial factors may play a role in blood pressure.
The neural control
Experimentally, stimulation of several areas in the central nervous system
(Medulla, nucleus tractus soliterius, vasomotor centre and vagal nuclei) has shown to
raise or lower blood pressure. The CNS pressure impulses that are transmitted through
the autonomic nervous system network and finally through the sympathetic
postganglionic nerve fibres, affect the heart and vascular structure, due to the release of
norepinephrine. This norepinephrine - stimulates the adrenergic receptors in the
cardiovascular system. When the alpha-receptors located primarily in the vascular tissues
are stimulated, the vasoconstriction in arteriolar and venular region takes place. When
beta-2 receptors of blood vessels are stimulated a slight degree of vasodilatation takes
place.
While, stimulation of beta-1 receptors, which are, located in myocardium increase
the heart-rate, thereby increasing the force of myocardial contraction, it shortens the
ejection rate. Sinus node is also stimulated causing thereby an increase in heart rate.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”134
Therefore, 247-250 over-activity of central nervous system leads to a hyperadrenergic state,
i.e. hypersecretory state of adrenal-medulla 251-254.
TABLE 36Cardiovascular responses to stimulation
Adreno receptors Organ affected Response
Alpha-1 Arterial and venous tissues Vaso constriction
Beta-2 Arterial and venous tissues Slight vasodilatation
Shortening of ejection rate.Beta-1 Myocardium sinus node
Increase in force
myocardial contraction
(From Cards : A Clinical Guide to Hypertension, 1985)
Overall effect of CNS stimulation
1. Alpha receptor - stimulation results in
v Arteriolar vasoconstriction resulting in increase in total peripheral resistance
(T.P.R.).
v Venous constriction resulting in increased preload.
2. Beta receptors - stimulation results in
a. Increased heart rate
b. Increased myocardial contraction
c. Increased cardiac output
3. Increased T.P.R. + increased cardiac output = increased blood pressure
Adrenergic neural activity affects the plasma renin activity.
Effect of adrenaline and nor-adrenaline could be summarised as follows.
Adrenaline
1. Stimulates beta-receptors of the Heart
2. Increases heart rate
3. The force of contraction is increased
4. Cardiac output is increased
5. Metabolism of the myocardium is increased which increases oxygen
consumption.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”135
6. It abbreviates cardiac systole. Due to high cardiac rate, there is an incomplete
filling of blood during cardiac diastole, therefore, a fall in cardiac output (volume)
is decreased.
7. It enhances conduction across AV node and may produce ventricular arrhythmia.
Nor Adrenaline:
Has similar action like that of Adrenaline, however, 2-10 times less than that of
Adrenaline.
Effect on blood pressure
1. It produces vaso-constrictive effect on blood vessels of skin and mucous
membrane.
2. It dilates the vessels of skeletal muscles on account of preponderance of beta-
receptors.
3. The net effect of the above two is the decrease in peripheral resistance.
4. Thus adrenaline raises the systolic blood-pressure by its cardiac action, and it
lowers the diastolic pressure by its peripheral action. The myocardial effects of
these two hormones could be blocked by beta receptor blocking agents like
propranolol etc. AV conduction is suppressed with the result that the contraction
of the heart is delayed.
3. On the basis of vascular changes
An adult can counter prenatal and childhood influences on blood pressure by
adopting a healthy lifestyle. But she added that research has uncovered the beginnings of
clogged arteries even in children, and this may not be completely reversed by healthy
habits later in life 255.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”136
MODULATORS OF VASOCONSTRICTORY MECHANISMS
Calcium plays an important role in the vasoconstrictory mechanism and therefore
should be treated as an important modulator. An intracellular calcium role in the trans
induction of the hormone action will have to be attributed special importance in
development of high blood pressure.
4. On the basis of Avarana
Pittavrutha Pranavata lakshanas includes Murcha and Bhrama, Pittavruta
Udanavata lakshana also included Murcha and Pitta Avrithavata exhibits the giddiness
and feeling of darkness. In case of covering with Kapha there are coldness, heaviness and
pain, suitability of pungent etc. and particular desire for fasting exertion, rough and hot
things. If Vata is covered with Rakta, there is burning sensation with distress, the space
between skin and muscle becomes red and swollen and rashes appear.
The above conditions exhibit because of either Dhatu kshaya or Avarana, the
different planes of the aetiology discussed and the psycho-pathological condition Bhrama
vis-à-vis hypertension is precipitated, for which the Rasayana treatment is ultimate.
Role of Rasayana Chikitsa in hypertension vis-à-vis Bhrama
Rasa (essence of food) is known to be the premier nutrition of the body tissue is
capable to progress/ limit the blood-related diseases, such as hypertension.
v Reduction or stoppage of smoking helps to reduce blood pressure.
v Atherosclerosis, which is the main factor responsible for hypertension.
Vyanavata is situated in hridaya, 256-257 and it pervades swiftly throughout the
body 258-259. Vyanavata is responsible for circulation of Rasa (rasadhatu) through out the
body 260-261. Sadhakapitta is situated in hridaya 262-265. Even in unamada Chikitsa adhyaya
also acharya Charaka mentions about manovaha Srotas 266.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”137
Concept and management of hypertension in Ayurveda
Charaka provides us opportunity to comprehend the nature of the disease by
detailed evaluation of vikaraprakriti adhisthana and samuthana visesha and recommends
treating them accordingly. So in the forgoing illustration we have drawn the conceptual
pathogenesis of hypertension and the plan of its treatment.
Spectrum of Setting
High blood pressure lowers cognitive function 267, researchers say,
• High blood pressure in adults between the ages of 18 and 83 is associated with a
measurable decline in cognitive powers, according to a report published today by
University of Maine researchers.
• In their study, younger individuals (18-47 years) performed at a higher level than
older individuals (48-83 years), but they, like older individuals, showed blood
pressure-related decline in cognitive function over time.
• Subjects in the study exhibited a normal range of cognitive functioning, as
determined by the Wechsler Adult Intelligence Scale (WAIS).
• The researchers analysed data from four types of cognitive function tests focusing
on visualisation-fluid ability, memory, crystallised-verbal ability and speed.
• Other studies have related high blood pressure to cognitive decline but have not
compared younger and older individuals and have not measured cognitive
performance over an extended time period.
• The results emphasise the importance of reducing high blood pressure even in
younger adults, the researchers said.
• "To the extent that BP (blood pressure) effects on cognition are not reversible, it
is important to prevent an increase in BP levels as early as possible in the life
cycle," they added.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”138
Measurements of BP 268
Figure -12
Accurate BP measurement by sphygmomanometer in the physicians’ office
remains the principal method of diagnosis. There is insufficient evidence to recommend
the routine use of echocardiography, self-measurement of BP or ambulatory BP
monitoring in diagnosis 269. While there is good evidence to recommend anti-
hypertensive therapy for young and middle-aged adults with diastolic pressures of 90 mm
Hg or over, the clinical decision to initiate pharmacologic treatment should take into
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”139
account the individual’s absolute risk for cardiovascular disease, particularly when the
average diastolic pressure is in the range of 90 to 99 mmHg and there is no hypertensive
target organ damage or other concomitant diseases 270.
Incidence:
Despite many recommendations, poor control of SH is increasing. A recent study
examining trends in hypertension control found that isolated elevation of SBP was the
most common finding among patients being treated for hypertension (high blood
pressure), occurring in 76 percent of patients in 1999 compared with 57 percent in 1990-
1995.
Three out of every 10 Chinese adults have high blood pressure, one of the highest
rates of hypertension in the world. The prevalence of hypertension among people aged 35
to 74 has reached 27.2 percent, putting the blood pressure of 130 million adults above the
normal level 271. A recent study of 111 African-American people with high blood
pressure found that a meditative technique lowered blood pressure on par with anti-
hypertensive drugs 272. With 50 million adults suffering from high blood pressure in the
United States, worries about the state of the nation's health are increasing. And your
pressure being just a little more than 120 over 80 may not be good enough any more.
Millions of people do not even know if they have hypertension. That is why it is called
the silent killer 273. Research has shown that hypertension is on the rise in India,
especially in urban populations where it has been linked to lifestyle changes and the
stress of urban living 274.
Around 10 million people in the UK have high blood pressure, in which one in
five of UK living 275. In 90 to 95 percent of high blood pressure cases, the cause is
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”140
unknown, when the cause is unknown, you have what's called essential or primary
hypertension 276. As many as 60 percent of American adults have hypertension or are
borderline under revised thresholds for high blood pressure. Chicago researchers,
published in the Archives of Internal Medicine, reported that 58.2 percent of adults in a
1999- 2000 government survey either suffered from high blood pressure or were pre-
hypertensive under new guidelines set last year. New Jersey researchers - estimated that
as many as two-thirds of people between the ages of 45 and 64 and 80 percent of those
between 65 and 74 might have pre-hypertension or residual hypertension -- having a top-
number blood pressure of 140 millimetres of mercury or higher despite treatment. High
blood pressure affects about 50 million Americans, and contributes to more than 250,000
deaths each year. But researchers believe only about a third of people with high blood
pressure have it controlled by medication 277.
Hereditary:
The researchers found that parents' BMI -- before pregnancy for mothers, and
during pregnancy for fathers -- was related to their 5-year-old's blood pressure, as was the
child's own BMI. In addition, both parents' weights influenced their child's blood
pressure, which rose in tandem with mothers and dad's body mass index (BMI) 278.
Tobacco usage
Tobacco smoking or chewing not only causes the nicotine deposition in the
respiratory endothelial system and in the gastrointestinal system but also elevates the
blood pressure significantly to cause circulatory disorders resulting in an infarct. Besides
this, it also creates its carcinogenic effects. Some studies were conducted in AMI
patients, who were smokers or non-smokers in order to visualise the effect of nicotine on
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”141
lipid parameters. It was concluded that the lipid parameters are not altered by the nicotine
concentration. The aetiology of infarct in these cases may be other than the smoking or
chewing of tobacco.
Co-morbid conditions
Cholesterol
Cholesterol is a chemical that is made in the liver from fatty foods that you eat. A
certain amount of cholesterol is present in the bloodstream. We need some cholesterol to
keep healthy. However, if you have a high blood cholesterol level, you have an increased
risk of developing atheroma. A build up of atheroma can cause heart diseases such as
angina and heart attacks, stroke, transient ischaemic attack (TIA or 'mini-stroke'), and
peripheral vascular disease (narrowing of the arteries to the legs). Patches of atheroma are
like small fatty lumps which develop within the inside lining of arteries (blood vessels).
A patch of atheroma makes an artery narrower, which may reduce the blood flow. Over
time, patches of atheroma can become larger and thicker.
Causes of atheroma development
The following are the causes of atheroma development.
• Smoking.
• Hypertension (high blood pressure).
• High cholesterol level.
• Diabetes.
• Obesity.
• Lack of exercise.
• An unhealthy diet.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”142
• A strong family history. This means if you have a father or brother who
developed heart disease or a stroke before they were 55, or in a mother or sister
before they were 65.
• Being male.
• Ethnic group (for example, southern Asians in the UK have an increased risk.)
Some risk factors are more 'risky' than others. For example, smoking causes a greater risk
to health than a lack of exercise. Also, risk factors interact. So, if you have two or more
risk factors, your health risk is much more increased than if you just have one.
'High’ cholesterol level 279
As a rule, the higher the cholesterol levels the greater the risk to health. As a
guide, a level less than 5 mmol/l is considered 'good', and is often the target advised to
aim for. A 'risk factor calculator' is used by doctors and nurses to predict the health risk
for an individual. The calculated score takes into account all your risk factors. Current
guidelines advise that you should lower your cholesterol level if your score gives you a 3
in 10 risk (or more) of developing heart disease within the next 10 years, and your
cholesterol level is higher than 5.0 mmol/l.
Causes high cholesterol
• In most people, your cholesterol level reflects the amount of fat that you eat. This
is not the full story as different people who eat the same amount of fat can make
different amounts of cholesterol. However, in general, if you eat less fat your
cholesterol level is likely to go down.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”143
• In some people a high cholesterol level is due to another condition. For example,
an underactive thyroid gland, obesity, drinking a lot of alcohol, and some rare
kidney and liver disorders can raise the cholesterol level.
• In a small number of people a very high level of cholesterol runs in the family due
to an inherited genetic problem. One example is called familial
hypercholesterolaemia.
Importance of lipids
Cholesterol occurs as the alcohol (free cholesterol) and in the esterified form, in a
proportion that is fairly constant. About 70% of the cholesterol are esterified except in
obstructive disease of the liver and some rare diseases. Practically all the sterol in plasma
is 280-281 cholestene - 3 beta-ol.
Cholesterol is deposited in the intima of artery. In the later stages, calcium gets
deposited along with cholesterol in the vascular system. This deposition is referred to as
sclerosis of the arteries. This causes a greater resistance to the flow of blood. In order to
comply with the demand of oxygen from the body cells, the heart has to pump with more
force of contraction and in doing so the blood pressure increases due to the increase in the
heart rate. As a result of this in the prolonged state of uncontrolled hypertension, the left
ventricular hypertrophy occurs and the size of the heart is also increased.
The level of cholesterol in plasma is decided mainly by the following factors :
a. Dietary intake of cholesterol
b. Cholesterol catabolism of hormones
c. Endogenous biosynthesis of cholesterol
d. The excretion of cholesterol
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”144
The net result of these four factors is the cholesterol level in the blood. It will be
therefore appropriate to discuss the above factors.
It has been observed that uncontrolled diabetes leads to the abnormal deposition
of cholesterol producing thereby atherosclerosis and circulatory disorders. Apart from
this, it creates, hazards viz. impotency in the sexual system, especially in the males, by
excessive production of prostaglandins due to uncontrolled intake of unsaturated fatty
acids. Intake of aspirin daily not only prevents the clot formation but also overcomes the
sexual hazards.
Excessive intake of triglycerides in the diet elevates the plasma triglyceride
concentration due to the absorption of lipids. In diabetes mellitus, when there is a total
failure of the pancreas, both in the production of insulin and that of pancreatic lipase,
triglycerides of the diet are not hydrolysed. With the result, they are accumulated in the
blood causing thereby an increase of plasma triglyceride concentration. This increases the
viscosity of blood. Such viscous blood will affect the blood flow and the pressure and
eventually will affect the blood circulation, which in turn affects the oxygen supply to
various tissues of the body. High triglyceride concentrations are associated with an
increased risk of ischaemic heart diseases. However, the increased risk cannot be
attributed to triglycerides alone, since these values are associated with high total
cholesterol concentration and lower values of HDL concentration 282. It has been said
before that the intake of small chain fatty acids in limited amounts and their esterification
with glycerol (butter) will help the requirements of fat in the diet. This may restrict the
consumption of saturated fatty acids.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”145
Lipoproteins: Lipoproteins are characterised by the presence of one or more proteins or
polypeptides known as apoproteins. As per the “A B C” nomenclature, the corresponding
apo-fractions represent the lipoproteins carried with them as follows:
Table – 37Apo-fraction representation of the lipoproteins
Apo AI
Apo AIIHDL
Apo B LDL,VLDL and chylomicronsApo CI
Apo CII
Apo CIII
(Smaller polypeptides) VLDL, HDL Chylomicrons
To summarise therefore, Factors responsible for blood pressure would be -
1. Hormones of adrenal medulla
a) Adrenaline
b) Nor-adrenaline
Their effect on heart
function
2. Cardiac output x peripheral resistance
3. Heart rate Na : K ratio(intracellular)
* Intracellular Na+
* Intracellular Ca++
Effective K+ action
4. Effective renin-angiotensin system (Effective blocking)
Angiotensin I
Converting EnzymeAlpha-2 globulin Renin
Angiotensin II
Angiotensin III
5. Dietary intake of sodium and potassium
Atrial natriurectic Factor : Aldosterone Angiotensin III
6. Dietary intake of lipids
Role of CholesterolTriglyceridesSaturated and unsaturatedFatty acids freefatty acidsLipoproteinsApolipoproteins
7. Prostaglandins and oxygen free radicalsFormation depends upon
phospholipids and arachidonic acid.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”146
8. Degree of atherosclerosis
Adipose tissue Catabolism
Cyclic AMP FFA formation
9. Dietary intake of serotonin, tryptophan etc.
10. Ratio of testosterone to oestradiol
However, if one estimates the HDL-cholesterol, LDL cholesterol and VLDL
cholesterol, the risk factor can also be concluded. Various people in this field have
observed that decrease in concentrations of HDL-cholesterol with simultaneous rise in
the concentration of LDL-cholesterol indicates the risk of ischaemic heart disease.
Apolipoprotein B-100 (Apo B) is the major structural compound of very low-density
lipoprotein (VLDL) and low-density lipoproteins (LDL). Therefore, VLDL apo-B and
LDL apo B determination could be a good diagnostic index for the risk involved in the
development of CAD. As there is one molecule of apo-B per lipoprotein particle,
determination of total serum levels of apo B provides a measure of total number of
VLDL and LDL particles in the circulation 284-290.
Episodic Hypoxia and Sympathetic Output
Acute hypoxia contributes to an acute rise in blood pressure during and following
apnea. In fact, the level of oxygen-hemoglobin desaturation during acute apnea is directly
related to the magnitude of blood pressure change associated with apnea. Supplemental
oxygen provided to subjects with simulated recurrent apneas ameliorates the blood-
pressure increase in response to apnea 291-292.
Syndrome Z
The features of syndrome Z include hypertension, central obesity, insulin
resistance, hyperlipidemia, and OSA. The factors influencing the relationship between
blood pressure and cardiovascular risk include systolic blood pressure, diastolic blood
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”147
pressure, circadian blood pressure patterns (dippers vs nondippers), blood pressure
variability, and cardiac and vascular hypertrophy. Abnormal vascular endothelial
function has been reported in hypertension, diabetes mellitus, and hyper-lipidemia. This
may precede the onset of cardiovascular disease symptoms by many years. As discussed
above, abnormal endothelial function may be present in the patients with sleep apnea and
hypertension. Whether sleep apnea affects endothelial function independently of
hypertension and insulin resistance requires further research.
OSA is closely linked to the cluster of cardiovascular risk factors known as
syndrome X (a cluster of risk factors including systemic hypertension, insulin resistance,
hyperlipidemia, and central obesity) and the converse is also likely but has not yet been
proven (syndrome Z) 293-294.
Plasma renin concept
Renin is the enzyme synthesised by juxta-glomerular cells with the help of cyclic
AMP or cyclic GMP. Cyclic AMP is formed by the action of adenylcyclase on adenosine
triphosphate (ATP). This formed cyclic AMP is destroyed by the enzyme
phosphodiesterase to produce 5’ AMP. Insulin promotes this action whereas ACTH,
TSH, glucagon, catacholamines, growth hormone and gluco-corticoids activate
adenylcyclase and promote the formation of cyclic AMP. The effective concentration of
cyclic AMP that is the availability of cyclic AMP in juxtaglomerular cell decides the
level of plasma renin formation. It will be interesting to note that prostaglandin E1 and
prostaglandin E2 block the lipolytic activity by effectively blocking the formation of the
cyclic AMP, which is under the control of bradykinins 295-299.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”148
Renin acts on a alpha-2 globulin known as angiotensinogen and converts it to
angiotensin I which consists of 10 amino acids. Angiotensin I is further acted upon by
converting enzyme and is converted to angiotensin II which consists of eight amino acids.
Angiotensin II has a stronger vasoconstrictory action than that of angiotensin I.
Angiotensin II is further converted to angiotensin III. The action of converting enzyme is
blocked by angiotensinase. Drugs like captopril block the formation of angiotensin II and
angiotensin III. Pressor activity of angiotensin II is 200 times more than that of
norepinephrine. Both angiotensin II and angiotensin III exhibit the sodium retention
property and act like aldosterone. Therefore, plasma renin has a larger role, in handling
sodium and potassium. Patients with high renin in essential hypertension have been
considered to be of vasoconstrictory type and to have a contracted plasma volume due to
the overwhelming pressor effect of angiotensin II. Propranolol, a beta-adrenergic receptor
blocker nhibits the release of renin by the kidney.
Dr. Laragh’s associates especially Dr. Brunner suggested that renin is a
vasculotoxic substance. The vascular sequelae of high renin levels in essential
hypertension should include strokes, myocardial infarction, renal damage, retinopathy
and encephalopathy. Mroczek and Finnerty found that there were many Negro patients in
U.S.A. who had high renin levels in essential hypertension but did not suffer from
vascular sequelae. It is therefore clear that high renin alone may not be the cause of
vasculotoxicity. A sustained hypertension may be cardiogenic and vasculotoxicity may
be due to sodium and calcium load.
When the Species of anti-hypertensive drugs 300 are administered to patients with
essential hypertension, it induces a significant drop in diastolic pressure in those with
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”149
high renin, intermediate drops in those with normal renin 301-302 and very little or no
response in individuals with low renin. Patients with essential hypertension could be
classified with levels of renin as 303-304 - Low renin -30% (Approx.), High renin - 15%
(Approx.) and Normal renin - 55% (Approx.).
The possible aetiology of renin elevation in juxta-glomerular cells in renal cortex is
1. decreased arterial blood flow
2. partial ischaemia of kidney region
3. low sodium concentration in ascending limb of Loop of Henle and distal
convoluted tubule and
4. low potassium levels in plasma and in intracellular compartments.
Renal kallikrein-kinin system
Urinary kallikrein is an enzyme synthesised by the kidney 305. It is involved in the
generation of vasodilating peptides called kinins, which include bradykinin 306. Tissues
other than kidneys, viz. Pancreas and salivary glands also possess kallikrein-kinin system
307-309. All these are similar to one another, but they differ from activity of the plasma
kallikrein-kinin system 309. It is postulated that the renal kallikrein system may be
involved in the pathogenesis of hypertension 310. Kidney kallikrein reacts with kininogen
(brady-kininogen), a substrate found in liver to yield bradykinin. The action occurs in
interstitial cells of the renal medulla. Bradykinin is a vasodilator and it may be that this
effect is partially related to the ability of kinin to stimulate synthesis of prostaglandins.
Conversely, prostaglandin themselves may stimulate renal kallikrein release.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”150
Prostaglandins 311
Prostaglandins are derived from C20 eicosanoic or arachidonic acid with
methylene interrupted bonds. Prostaglandin E2 and prostaglandin A2 produce peripheral
vasodilatation and hence lower the blood pressure. However, prostaglandin F2 constricts
arterioles and the overall circulatory system and also increases the heart rate thereby
increasing the force of heart contraction. The resultant effect of vasoconstriction and
vasodilatation decides net blood pressures. Serotonin is vasoconstrictory in action and
raises the blood pressures. Therefore, its presence in food (Ahara in Annavaha srotas) or
the presence of large amount of tryptophane in diet should therefore multiply the effects
of vasoconstriction and eventually high blood pressure will result.
It is an established fact that sodium stimulates the sinoatrial node in the
myocardium and the impulses are further carried to emphasise a systole, the magnitude of
which affects the overall resultant force of contraction of the heart. The sino-atrial node is
also governed by the presence of calcium ions. Conversely to this force of contraction, is
the inhibitory effect produced by potassium ion, which induces bradycardia and governs
a diastole.
The relationship of sodium to potassium ions is to be taken into account while
discussing the role. The retention of sodium takes place by the loss of potassium ion from
the body. Administration or intake of sodium chloride causes the excessive accumulation
of sodium intra-cellularly with the loss of potassium. It has been already established with
increase in Na++ and that of Ca++ produces a vasoconstrictory effect while potassium
nullifies this effect. Therefore, it will be worthwhile to discuss the mechanism by which
the concentration of Na+ and Ca++ is raised.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”151
Na-K Pumping:
This is an active process of diffusion of Na+ and K+ in the opposite direction
which is described as "Antiport" process while the diffusion in the same direction is
referred to as "Symport". ATPase enzyme, present in the cell-membrane hydrolyses ATP
molecule to the aspartate residue. This reaction is coupled with removal or transference
of 3 Na+ ions from intracellular region to extracellular region, with simultaneous transfer
of 2 K+ ions from extracellular region to intracellular region. This process of active
transport, which is energy bound, is influenced by two factors namely.
1. Atrial natriuretic factor
2. Release of aldosterone or some compound produced by the kidney tissue exerting
aldosterone like activity.
Atrial-natriuretic factor
This factor was earlier reported in the 1980s in the crude extracts of atrial heart
muscles. This crude extract was from majority of atrial muscle fibres (cardiocytes in
mammalian atria) and appeared to be morphologically differentiated as both contractile
and secretory cells. These cells contain numerous membrane bound granules called as
atrial granules storing the polypeptide hormone. This polypeptide exerts its action as a
diuretic and therefore is referred to as natriuretic peptide or factor; and it contains 28
amino acids, which are identified as peptide chain. This peptide was sequenced in 1984.
On its secretion, the aldosterone production is inhibited. Therefore, it promotes the
sodium excretion. It has been observed that it increases the glomerular filtration rate and
a large amount of volume is excreted with a hypotonic urine formation 312.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”152
The discovery of ANP led to search for other peptides with natriuretic activity. In
1988, the brain natriuretic peptide (BNP) and in 1990, the C-type natriuretic peptide
(CNP) was identified 313 ANP, BNP and CNP are structurally similar but only 12 amino
acids are common to all three peptides out of 28 amino acids for ANP, 32 amino acids for
BNP and 22 amino acids for CNP. Though, both BNP and CNP were originally identified
in porcine brain, concentrations of BNP are much more higher in the heart than in the
brain.
Normally, ANP is stored in large concentrations in atria with much less
concentrations than in the ventricles, whereas, BNP is derived from the cardiac ventricles
to a much greater extent. The ventricles secrete a large amount of BNP though they store
only a small quantity. Plasma concentrations of ANP are usually higher than the plasma
concentrations of BNP. However, it has been observed that plasma BNP concentrations
are increased in cardiac failure. In congestive cardiac failure due to a left ventricular
hypertrophy, plasma BNP concentrations exceed the plasma ANP concentrations and
therefore, plasma BNP is regarded as a very sensitive indicator of left ventricular failure.
The overall biological effects of BNP are very similar to ANP in promoting the
sodium excretion and causing vasodilatation. The inhibitory effect on aldosterone
production is through the release of GMP. Richards et al 314-315 found an inverse
correlation between plasma BNP and cardiac output. Davies et al 316 has noted high ANP
concentrations, in-patients who subsequently developed cardiac failure. However, it has
been proved that BNP is a good early marker for left ventricular failure, which can
identify hypertrophic obstructive cardiomyopathy better than echocardiography 317-319.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”153
It would be interesting to note the exact mechanism of sodium excretion caused
by the formation of these peptides. When excessive retention of sodium occurs in the
body in the intracellular region, it stimulates the release of atrial natriuretic peptide 320.
Retention of sodium will cause an increase in the blood volume which inturn increases
the blood pressure.
The factor ANP has a direct effect on the ATPase pump mechanism in the kidney.
When the blood circulates through the hypothalamic region, the oscmoreceptors located
in this region are stimulated by the increased osmolarity of the blood, with the result the
ANP synthesis takes place. With the formation of ANP, aldosterone activity is inhibited.
As there is no or less aldosterone activity, reabsorption of sodium does not take place and
it allows excess of sodium excretion from the tubule. It may be noted that ANF formation
suppresses the aldosterone activity by suppressing the ATPase activity, thereby causing a
loss of sodium in the urine along with increased volume. Figure represents the normal
Na-K pump, which maintains the normal sodium and potassium ratio at the intracellular
level.
The overall effect of excessive intake of sodium results in the change of Na: K
ratio thereby affecting the normal physiological function of the cell. This becomes an
unexplained evident aetiology for the essential hypertensive disorders 321. Recently,
Spencer from the University of Minnesota Medical School 322, while studying the use of
diuretics in the patients with heart failure had reported studies on dietary sodium.
Normally, ingestion of 6 g/day would be matched by a loss of the same approximate
amount in the urine excluding some negligible losses in stool and in sweat - for a zero net
balance. In the patient with heart failure, consumption of 6 g of sodium/day may result in
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”154
excretion of only half that amount, leaving a net positive balance of 3 g/day. Over a long
period, this not positive balance is associated with congestion and oedema in the
pulmonary, abdominal and peripheral compartments. Retention of this 3 g/day of sodium
has been reduced to 1 g/day by the use of diuretics.
Effects of Na-restricted diet with adequate intake of K
Average consumption of adults is estimated as 9.5 gms and Adult men consume
11 gms and women 8 gm 323 per day. As pointed out earlier, a high intake of sodium will
result in high intracellular concentration of sodium and ratio of Na:K will be altered. This
creates an adverse effect on systolic and diastolic pressures 324. However in such a
condition, the intake of salt free diet meaning thereby salt is not added while cooking or
while eating, produces a change in intracellular concentration of Sodium and Potassium,
thereby correcting the altered Na:K ratio. As the intake of salt is reduced by way of diet,
the added source is eliminated, yet the body receives sodium by way of water and natural
liquid intake. It has been said before that salt restriction corrects this Na:K ratio.
A supplement of normal intake of K will facilitate this correction of ratio, which
results in achieving an early control over blood pressure 325-326. However, as the ATPase
reaction is energy bound, the authors in the above studies have added a mixture of 17
mEq of NaCl and 67 mEq of K and left the body to decide its own homeostatic
mechanism - to correct this Na:K ratio. Once the ratio is corrected on prolonged
treatment with combined regime of salt (NaCl + KCI) therapy the normal operation of the
ATPase continues in maintenance of Na:K ratio 327-329.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”155
Ama vis-à-vis free Radicals
Free Radicals
Molecular oxygen has a very little capability of oxidising other chemical
compounds. Instead, it must be first converted into an active form of oxygen. There are
several different forms of active oxygen and these forms are often called as oxidising free
radicals. One of the most important forms is the superoxide free radical (O2-).
Even when the partial pressure of oxygen is at normal level i.e. 40 mm of Hg,
small amounts of free radicals are continually formed from the dissolved molecular
oxygen. However, the tissue contains multiple enzymes that rapidly remove the free
radicals including especially peroxidase, catalase and superoxide dismutase. Therefore,
the normal haemoglobin-oxygen buffers mechanism functions properly resulting thereby
in the maintenance of the normal tissue partial pressure of oxygen. The removal of free
radicals from this tissue under the maintenance of the tissue partial pressure of O2 is so
fast that the free radicals have practically no adverse effect on the tissue.
Treatments:
1) Virechana: Castor Oil cleansing
Castor oil cleansing is very good for hypertension because it tends to cleanse the
liver and the intestines and reduce the salt in the body 330.
2) Pancha bhoota healing for Hyper Tension 331
Hypertension has become one of the most prevalent health problems. Diet, stress
and sedentary life style are some of the most important causes. Pancha bhoota healing
uses all the five elements to bring the blood pressure to normal.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”156
Water therapy helps to detoxify the body from toxins and eliminates the salt.
Detoxification through diet, pranayama, yoga and relaxation will facilitate the healing
better.
Reducing refined foods and eating natural foods is the best approach for
hypertension. Juicing is one of the best way to reduce pressure. Here are some
suggestions.
3) Folate Lowers High Blood Pressure Risk for Women 332
Folate, a vitamin already known for its power to prevent birth defects, also
appears to reduce the risk of high blood pressure for women both young and old. Folate
also reduced the risk of high blood pressure in older women, but to a lesser degree, the
study found. Folate is a B vitamin that is found naturally in leafy green vegetables such
as spinach and turnip greens, fruits, dried beans and peas. To consume 800 micrograms a
day, you would need to take a multivitamin plus eat three-quarters of a cup of breakfast
cereal fortified with 400 micrograms of folate, or other foods. A half cup of spinach, for
instance, has 100 micrograms, and three ounces of beef liver has 185 micrograms.
4) Stress Management
In one study, 132 healthy men and women were put under various stresses. Blood
pressures typically went up, depending on the level and type of stress.
5) Stress Reduction through Transcendental Meditation 333
127 African-American men and women attending an inner city hypertension
clinic were allocated to one of three groups. The first practised Transcendental
Meditation 334 (TM) for 20 minutes twice a day, the second used progressive muscular
relaxation for the same amount of time, and the third received an educational lifestyle
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”157
modification program. At the end of three months the blood pressure in the TM group
was lower than in the educational group (by 10/6 mm Hg mm Hg -- systolic/diastolic -- in
the women, and 13/8 in the men). Inconsistent changes were seen in the relaxation group.
The blood reductions with TM were equally big in people who had high or low levels of
stress. In both active treatment groups the compliance with the program was very high
(97% of people in the TM group and 81% in the relaxation group practiced their
technique twice a day).
At the end of three months the blood pressure in the TM group was lower than in
the educational group (by 10/6 mm Hg mm Hg -- systolic/diastolic -- in the women, and
13/8 in the men). Inconsistent changes were seen in the relaxation group. The blood
reductions with TM were equally big in people who had high or low levels of stress. In
both active treatment groups the compliance with the program was very high (97% of
people in the TM group and 81% in the relaxation group practised their technique twice a
day) 335.
6) Supplements
You can incorporate dietary supplements into your diet that specifically address
hypertension. Note that it is extremely important that the proper dosage be taken. It is
also wise to work in partnership with a qualified health practitioner. Anti-hypertensive
medications should not be abruptly discontinued.
Supplements that are known to positively influence hypertension include 336-
1) Magnesium
2) Potassium
3) Calcium
4) Coenzyme Q10
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”158
5) Garlic
6) Taurine
7) Herbs such as Hawthorn, and
8) Essential fatty acids may also help to control blood pressure.
7) Yoga and Blood pressure management 337
While practising the Pranayama i.e. Kumbhaka, if the Jalandhar Bandha is not
performed properly by contracting the neck muscles the blood pressure will rise the BP
and it may lead to permanent Hyper Tension. Hence it is essential to perform the
Jalandhar Bandha properly to keep the BP on the lower side during the practice of
Pranayama with Kumbhaka.
8) Weight therapy to lower Blood pressure
Blood pressure can be controlled by losing weight, exercising, quitting smoking,
eating less salt and consuming no more than one or two alcoholic drinks per day. If
lifestyle changes aren't enough, drugs usually can bring blood pressure under control.
However, many people stop taking medications, or take their pills intermittently.
The UIC study found that only 69 percent of adults with hypertension knew they
had the condition. And only 31 percent of patients with high blood pressure had
succeeded in getting their numbers below 140 over 90. These findings point to a "serious
problem of low awareness and inadequate management of hypertension," the researchers
wrote.
9) Treatments of Blood Pressure 338
The first course of action usually involves lifestyle changes, especially for people
with pre-hypertension.
• Start eating a low-fat and low-salt diet.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”159
• Lose weight, if you need to.
• Begin a regular exercise program.
• Learn to manage stress.
• If you smoke, quit.
• Drink alcohol in moderation, if at all. Remember that moderate intake is an
average of one or two drinks per day for men and one drink per day for women.
Pathya:
Principles of the diet 339
• Low calories , Low sodium , Low fat , Cholesterol, Normal protein intake
Firstly, if the person is obese his weight needs to be reduced. This can be done by
reducing the intake of calories -- to 20 kcals per kg ideal body weight. And increase the
energy spent by increasing exercise, the safest being brisk walking. Protein in the form of
dals, sprouts, legumes can be taken in the normal quantity. Normal servings of chapati,
rice, pasta or other cereals are allowed. Fat intake needs to be reduced considerably. Fat
added while cooking needs to be restricted to about 2-3 tsp per day than to ghee, butter,
cream, are a strict no since they are high in cholestrol. Some foods themselves are high in
fat like animal products. The fat in them contains cholesterol, which is lethal to
hypertensives.
Foods high in cholesterol are egg yolk, ghee, butter, cream, cheese, kidney, liver,
brain, red meat. Fish and fish oils are however beneficial for hypertensives. They contain
the n-3 fatty acids, which controls hyperlipidemia, reduce incidence of blood coagulation,
thereby reducing the incidence of a blood clot and an infarct (heart attack or stroke).
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”160
A general question asked by many hypertensives is that which oil should be used.
The answer is groundnut oil is the best choice. It has the near perfect ratio of poly and
mono unsaturated fatty acids that is beneficial to maintain good cardiovascular health.
SODIUM:
Sodium is osmogenic, which means the higher the sodium content in the blood it
will draw more water from the surrounding tissues into the blood to dilute it thereby
increasing its volume and thus pressure on the walls of the arteries and veins and creating
what is commonly known as blood pressure. Thus, by reducing sodium one is
automatically reducing the blood pressure. Mild hypertension can be controlled by diet
alone that is by controlling sodium and fat. Common salt is the highest in sodium (it
chemical formula is sodium chloride).
Other foods high in sodium
are:
1) Salted butter
2) Cheese
3) Salted bread
4) Tinned foods
5) Tomato sauce
6) Soya sauce
7) MonoSodiumGlutamate
(Aginomoto)
8) Wafers
9) Cakes
10) Biscuits
11) Baking powder
12) Cornflakes
13) Pickles
14) Papad
15) Lobster
16) Shellfish
17) Beacon
18) Peanut butter
19) Frozen foods
20) All foods where salt has been added
on the top
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”161
Sodium sources
Canned, prepared, and “fast” foods are loaded with sodium; so are condiments
such as ketchup. Even some foods that don’t taste salty contain high amount sodium.
Consider the values below:
Food-----------------------Milligrams of sodium1 can tomato soup------------------------8721 hot dog-----------------------------------6391 cheeseburger----------------------------7091 tablespoon ketchup---------------------1561 dill pickle--------------------------------9281 cup corn flakes--------------------------256
Other high-sodium sources include baking powder, baking soda, barbecue sauce,
bouillon cubes, celery salt, chili sauce, cooking wine, garlic salt, onion salt, softened
water, and soya sauce. Surprisingly, many medicines and other nonfood items contain
sodium, such as alkalizes for indigestion, laxatives, aspirin, cough medicine mouthwash,
and toothpaste.
CALCIUM: Calcium is involved in the control of strength with which blood is pumped
by the heart. Increasing calcium intake reduces the incidence of hypertension and all
other cardiovascular disease.
FIBRE: A high fibre diet helps to physically entangle some amount of ingested
cholesterol and fat from the food and throw it out of the body even before it can be
digested via the faeces. Secondly it adds bulk to the diet thereby the person feels full yet
he has taken in much lesser calories than if he had ingested the same quantity of low fibre
foods. Foods high in fibre are vegetables (preferably raw and with the peel wherever
possible), leafy vegetables, legumes (again wherever possible with the skin). One
important thing all cardiovascular patients need to remember: Do not eat large meals this
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”162
will build the pressure on oxygen requirement since it is required for food digestion if
more is drawn for this function less will be available for other important functions
thereby causing breathlessness. Hence small frequent meals are advisable. Diet control
and exercise generally alone control mild to moderate hypertension. Only in cases of
severe hypertension diet, exercise and medication together can control the blood pressure.
Evaluation of the subjective parameters of Bhrama
Different symptoms evaluated at the study under the heading of Bhrama vis-à-vis
hypertension with the presenting complaints are foot forth here for discussion.
The first and fore most complaint is Bhrama i.e. giddiness. All the patients in the
study (100%) reported the Bhrama, which is said as the “Pratyatma Niyata Lakshana”.
The giddiness may be either hypoxia or mal-function of haemopoitic system including
respiratory system or even it is because of the involved neural controls. But the ultimate
cause could be attributed to that of the high salt intake. Ultimately a Symptom giddiness is
witnessed in the Bhrama is undoubted.
The next most common complaint is shira shoola i.e. headache. 20 patients
(66.6%) reported with the headache. The Shiras is also termed as Hrudaya in Ayurveda.
The Rasayana effect imposes the normal function of the head concerns i.e. and disposes
the person to attain the sleep there by the symptom sleeplessness and headache are
relieved.
The third complaint is anhgasada, with the 14 (46.6%) patients and associated
with the nidranasha (Sleeplessness) of 13 (43.3%) patients. This clearly states that the
involvement of the head and neural control in the disease. Induction of the sleep is a
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”163
function of the psychotropic drug. Here the psychotropic drug is Bala. It acts over the
condition Bhrama, which is a psychophysical state of disease.
Not at the least but still the patients reported with the complicate complaints such
as Hrudrava (7 patients – 23.33%), Klama (6 patients – 20%) and Urah shoola (2 patients
– 6.7%). All these symptoms are pertained to that of the Uro-Hrudaya, i.e. cardiac heart.
The cardiac protective phenomenons are to be induced whenever the management of the
hypertension vis-à-vis Bhrama is undertaken.
Materials (Kakubhadi Lehya) evaluation
Chiefly the composition of the “Kakubhadi Lehya” consists of pancha Rasa
except the Lavana Rasa. Predominant Rasa is Madhura added with that of the Katu Rasa.
The actions of these Rasa are emphasised as nourishing and cleansing. The chief
pathology lies in the arteries in which the “Dhamani Pratichaya” is witnessed. The
Dhamani Pratichaya i.e. aetherotic plaques can be prevented and removed by the Tikta
and Katu Rasa. The Madhura Rasa nourishes the entire body through its preenana effect
through the adyarasa Dhatu, which is circulated through out the body till to Rasayani i.e.
arterioles. The other Rasa present in the composition are Amla and Kashaya. The Amla
Rasa plays major role in the citrus acid cycle and prevents the formation of the LDL and
VLDL cholesterol in the body. In further the Amla Rasa acts over the conversion of the
Rasa in to Rakta Dhatu under the influence of the Ranjakapitta. Thus the action of the
Rasas in the “Kakubhadi Lehya” is substantiated.
Hrudya – the origin of the disease is heart, thus the medicine is expected to act on
the organ concerned. In further the heart propels the blood under the influence of the
Vyanavata and there by the blood attains the stroke volume and velocity. The normal
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”164
function of the heart to resume is the primary duty of a physician who is treating such
condition. Many a times it is drawn attention to treat symptomatically rather than
strengthening the concern organ i.e. heart. Here an attempt is made to promote the vitality
of the heart and there by regulating the blood pressure through the Hrudya property of the
Kakubhadi Lehya as Hrudya Rasayana.
Rasayana – the condition hypertension is long associated, thus the disease needs
the long tern protective management instead of the temporary symptomatic management.
In this trail it is brought in to focus as the need of the Rasayana, which helps the body in
total and also fortifies the heart and circulation. The Rasayana chronologically nourishes
the Rasa to Sukra and there by normalise the body humours and functions. Kakubhadi
Lehya is such a combination in which many Rasayana properties are embedded.
Mutrala – the primary management of the hypertension is diuresis in the
contemporary medical practice, because of the involvement of the renin – angiotensin in
renal system. A medicament, which helps to regulate the water system in the body and
there by regulating the pressure in arteries, is the basic mechanism at the first step of
management in the Bhrama vis-à-vis hypertension. In this Kakubhadi Lehya many
mutrala prabhava herbs are included as to give a proper elimination of the waste from the
body in association with regulating the renin – angiotensin mechanism.
Kasaswasahara- Acute hypoxia contributes to an acute rise in blood pressure
during and following apnea, which resembles the conditions pertaining to that of the
pranavaha Srotas and there by a pharmacological property which regulates the respiratory
system and ventilation is necessary. Proper ventilation and regulation of the haemoglobin
makes an individual to respond properly to that of Rasayana management. More over the
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”165
Kakubhadi Lehya with increased values as kasa swasahara restore the lung functions,
which are very basic of a disease concerned to blood and its circulation.
Anulomaka – is a property to control the disease-disposing factor Vata (neural
control). Experimentally, stimulation of several areas in the central nervous system
(Medulla, nucleus tractus soliterius, vasomotor centre and vagal nuclei) has shown to
raise or lower blood pressure. The anulomana makes the regulation and pacification of
the Vata there by the neural controls is regulated through the Kakubhadi Lehya, which is
a Vata Kapha hara in nature.
Panduhara – is a property directly related to that of regulation of the blood and its
contents. Many conditions may terminate in to the Pandu i.e. anaemia. Mainly the lack or
breach of the haemopoitic system can cause effect over many areas espicially on heart
and kidneys, which are directly involved in the pathology of hypertension vis-à-vis
Bhrama. Kakubhadi Lehya is such a medicine acts over the loss of haemoglobin and the
other factors in the formation of the blood either directly or indirectly.
Yogavahi – is such a property termed in Ayurveda, in which the drug penetrates
in to the micro areas of living i.e. deep in to the cellular repair. Contemporary practices
may not think of the deep root effect of the hypertension vis-à-vis Bhrama, but an
Ayurvedic practitioner mean it. Thus the property embedded Pippali is one of the
components of Kakubhadi Lehya, which permits the penetrability of the anti-
hypertensive effect deep in to the cellular level, where the real Na and K exchange and
regulation is needed.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”166
Individual components of Kakubhadi Lehya explored
1) Arjuna
(1) The hypotensive and cardiotonic properties are reported (Hippokrates, 1982).
(2) The diuretic, hypotensive and cardiotonic properties are reported (J. Res. Edu. Ind.
Med. 1988 Oct- Dec. P.31-36).
(3) In a clinical study the role of Arjuna is studied over IHD and the drug is found to be
effective in correcting the T-wave changes (Chaturvedi, 1967).
(4) The cardiotonic activity of Arjuna (T.arjuna) is reported from NIA, jaipur (Jha,
1983)
(5) Its bark significantly decreased the elevated cholesterol and increased the HDL
cholesterol. It was also noted that the prostaglandin levels which were low have
been increased and high levels of catecholamines were brought down by the
administration of the drug besides relief from symptoms like pain, palpitation etc
(Dwivedi, 1986).
(6) Serum lipids were found to be lowered by administration of bark powder in triton-
induced hyperlipaemia. T. arjuna altered lipolytic activities in plasma, liver, heart
and adipose tissues of hyper lipidemic rats. The lipid lowering effect of this natural
product was found to be mediated through inhibition of hepatic cholesterol
biosynthesis, increased faecal bile- acid excretion and enhanced plasma lecithin:
cholesterol acyltransferse activity and stimulation of receptor mediated catabolism of
low lipoprotein (khanna et al., 1996)
(7) Marked reduction in total cholesterol and raise in the HDL are observed (Intl. J. of
Crude. Drug Res. 1990, 28 (1) : p. 43-47
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”167
2) Vacha
1) Cardiac depressant activity was observed both with asarone and B- asarone. Both
showed moderate degree of hypotensive action in anaesthetized dogs (Sharma&
Dandiya, 1962)
2) It was found that the sedative effect of asarone was dependent on the depression of
the ergotropic division of the hypothalamus (Menon &dandiya, 1967).
3) Rasna
1) An important clinical difference was that the plant extract supressed the delayed
periarticular changes more as compared to the acute inflammatory phase (Prasad D. N. cl
al. Ind. J. Meel. Res. 54: 582 (1966).
4) Bala
1) Used for Colds, high fever, mumps, hives [China] Fever [India]
2) An anti- microbial alkaloid cryptolepine, ephedrine and vasicine are reported from the
different species of Sida plant(Guntilaka, A. A. L. et al.: Plania Med. 39: 66 (1980).
5) Nagabala
1) Decoction of the root-bark and root is used in mild cases of debility and fever
2) It is alternative and restorative (promotive) and analgesic action.
3) The management of heart disease has use of Nagbala. The powder of Nagbala root
and Arjuna (bark of tree Terminalia arjuna) are mixed and used with milk.
6) Abhaya
1) Resin and a purgative principle of the nature of anthraquinone and sennoside are also
present in Abhaya. (Tripathi, V. N. et. al.: sachitra Ayurveda, 740, (1983).
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”168
2) Triphala is an important formulation in the ayurvedic pharmacopoeia containing
haritaki. Triphala and each of its constituents are well known rasayana drugs . They are
used to prevent aging and impart longevity, immunity and body resistance against
disease. They have beneficial effects on all the tissues(Abhang, R. Y.: Deerghayu, 2: 3
(1976).
7) Shati
1) Hypotensive effect of alcoholic extract of the plant was also reported and attributed to
cholinergic or histaminc responses (shaw, 1980)
2) The alcoholic extract showed spasmolytic effect on the smooth muscles and tracheal
chain. It could counteract the effect of spasmogens like acetylcholine and histamine.
The plant also showed negative inotropic and chronotropic effect on frog heart. It
induced a mild vasodilatory effect (Sharma 1974. 1975).
3) Essential oil of rhizomes showed tranquilising activity of short duration ;
4) it depressed conditioned avoidance response, rotarod performance and
potentiated pentobarbitone hypnosis (Ind. J. Pharmacol. 1979,11, 147).
8) Pushkaramoola
1) Cardiotonic activity – (a) Cordiotonic activity of ag. And adcoholic extracts were
studied on isolated frog’s heart (Sharma & Tripathi, 1986).
2) Hypotensive activity- Hypotensive activity was reported.
3) The extract showed negative inotropic and negative chronotropic effect on frog heart.
Hence indicate that I recemosa may have adranergi beta-blooking activity (Tripathi et
al., 1988).
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”169
4) Anti-platelet activity – it is reported to possess anti-platelet aggregation activity
(Dwivedi & Amrita, 1993).
5) Its serum cholesterol lowering effect was found to be highly significant (Sharma, et
al., 1983).
9) Pippali ( Neogi et al.,1971)
1) Piperene revealed a hypotensive effect in dogs and also produced a non-specific
blockade of contractions induced by acetylcholine, histamine and serotonin in
isolated intestine of guinea pig and rat. It also had mild antipyretic activity. ( Neogi
et al.,1971)
10) Viswabheshaja
1) Bio availability enhancer property of Z officinale is also reported (Zutsi., 1986)
2) In a clinical study on Grahani roga the effect of Z. officinale has been found
significant in term of control of number of motions, improvement of body weight,
appetite, Hb% etc (Nanda et., 1985).
3) (E)-8- beta, 17 – exoxylabel-12ene-15, 16-dial (ZT) showed inhibitory effect on the
cholesterol biosynthesis (Tanabe et al., 1993)
4) Significantly reduced the hyperlipidemia-induced by feeding orally on atherogenic
diet for 10 weeks in male albino rabbits (Bhandari & Sharma, 1995).
Evaluation of the objective parameters of Bhrama
It is put forth for the assessment many parameters in the study. The direst
significant parameters are included along with the parameters, which are helpful to assess
the co-morbid conditions, such as lipid profile. Some parameters that can influence the
blood pressure through its physiological or patho-physiological nature also included, such
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”170
as temperature. The variances are observed not only to assess the regression of the
disease but also to assess the Rasayana effect induced in the body by the chosen
medicament. Different objective criteria are considered to evaluate the Bhrama vis-à-vis
hypertension. The data analysis is as follows.
The factors that have the influence on the physiology (temperature, weight) are
decreased with the baseline mean data in the study. The temperature shows the mean
difference of 0.24 in the study, which is a point of observation to assess the Rasayana
effect induction in the body. The second factor weight has reduced by 0.24 mean value,
suggesting the induction of good health through Rasayana, there by the regulation of the
Bhrama vis-à-vis hypertension.
The third factor of objective parameter observed is haemoglobin percentage. It
shows marked increase of 0.443 mean value. Which is suggestive of inducting Rasayana
effect and also capacitating the oxygen exchange ratio and there by the controlling the co-
morbid conditions or associative such as hypoximea. The associate factor of haemoglobin
is RBC count. This has shown 0.251 mean value increase in the study reflects to the
percentage rise of the haemoglobin and there by regulating the Bhrama vis-à-vis
hypertension.
The next parameter of co-morbidity in Bhrama vis-à-vis hypertension is serum
creatinine. It has shows a rise in the study with a mean value of 0.008. It suggests that the
Angiotensin and Renin involvement in the Bhrama vis-à-vis hypertension have been
successfully reduced and provide the Rasayana effect not only at the cardiac but also in
the renal area. The small amount changes are as a process of regulation in the KUB
system.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”171
Serum cholesterol and associative LDL, VLDL with S.Triglycerides are risk
factors in the pathology of Bhrama vis-à-vis hypertension. Out of these associated the
HDL cholesterol is good for the body and all the rest offers co-morbidity. As the results
observed except the HDL cholesterol all other cholesterol drop in the study in
comparison of mean values. The mean value of HDL is 0.74666-difference rise in the
study. The rest of co-morbid influencing factors enumerated are LDL (5.2326), VLDL
(2.29333), Serum cholesterol (5.793) and S. Triglyceride (9.08), show the significant
drop and suggest that the effect of the Kakubhadi Lehya on Bhrama vis-à-vis
hypertension with reference to its Rasayana effect over the Bhrama vis-à-vis
hypertension.
Analysis of disease results
The result in the study ascertains the best activity of the Kakubhadi Lehya over
the Bhrama vis-à-vis hypertension. For the convenience the results are grouped as five
categories, viz. Well-Responded, Moderately Responded, Responded, Not responded and
Discontinued. The result declaration is done following the norms and conditions of the
inclusive factors and study of the subjective parameters in association with the
sphygmomanometer studies of three postures. The co-morbid stimulating factors
especially LDL, VLDL and S. Triglycerides are considered in while declaring the results.
The factors which make the Rasayana effect over the body also included to assess the
results. After thorough study of the entire parameters and materials available for the
assessment of results it was drawn a conclusion of results as - 9 (30.02%) well responded,
6 (20.02%) moderately responded, 10 (33.33%) responded, 3 (10%) patients not
responded and the last 2 (6.63%) patients discontinued in the study.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”172
Age with systolic and diastolic blood pressures enumerated
In this study as we examine different age groups an attempt is made to understand
the linear systolic and diastolic values of baseline data to that of the final data. Whenever
two or more patients of the same age are seen mean values are considered. In this process
the age related blood pressure chart is drawn is explained as above.
Table –38Blood pressure variances of Before to AfterSystolic Blood Pressure Diastolic Blood Pressure
AgeBefore After Before After
28 144 124 92 8029 148.6 127.3 94 82.6632 154 128 86 8233 140 124 88 8234 140 122 90 8435 144 124 88 8237 154 127 96 8638 160 132 96 8439 144 126 98 8840 144 128 92 8646 148 124 92 8249 154 127 93 8451 164 134 92 8252 169 143 108 9055 165.5 145.5 104.5 9259 167 158 100 9360 168.6 149.3 104.6 9261 168 144 94 8465 170 154 108 100
As it is observed that the systolic blood pressure has taken a rise till to 32 years of
age and show a down fall to the age of 34. From that a gradual increase is observed to age
of 38 and stable to the ages of 40. From 40 a rising gradient is observed till to 52 years of
age and becomes more or less stable to the forwarded ages. A linear line drawn in
comparison to that of baseline data to final shows markedly 20 mm Hg differences in the
study. Though many may not give attention to that of the systolic hypertension, which
could be pacified with the rest and regulations needs to drag the attention. At present
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”173
study, the effect of Kakubhadi Lehya over the Bhrama vis-à-vis hypertension show
marked drop of 20 mm Hg of systolic hypertension by inducting the Rasayana effect. The
graphical expression with the linear graph is as follows.
Graph –16Linear graph of Blood Pressure - systolic hypertension
Another important reading of the blood pressure is diastolic. It is observed that the
small variances in it can cause the Bhrama vis-à-vis hypertension. The arterial diastolic
blood pressure measured in the study was put for the keen observations, as there are 28-
29, 37-39 and 52-55 age groups show marked elevations. This could be because of the
tension, anxiety, stress, strain etc, psychophysical factors. The linear line is drawn an
observed as the cumulative effect of the Kakubhadi Lehya varies from 15 mm Hg to
20mm Hg of diastolic from the early ages to late. The older people those who receive the
80
90
100
110
120
130
140
150
160
170
180
28 29 32 33 34 35 37 38 39 40 46 49 51 52 55 59 60 61 65
Age
Syst
olic
HT
N
PtsSysBeforeNor SysPtsSysyAfterLinear (PtsSysBefore)Linear (PtsSysyAfter)
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”174
Hrudya Rasayana well responded and show the marked relief for the condition. The
diastolic blood pressure graphical expression is as follows.
Graph – 17Linear graph of Blood Pressure - Diastolic hypertension
BMI with systolic and diastolic blood pressures enumerated
At this study one attempt is made to understand the relationships of the BMI with
systolic and diastolic blood pressure. As it is observed that the linear graph drawn on the
basis of data obtained show a clear evidence of the relationship to the BMI and systolic
and diastolic blood pressures. It is an observation expressed that as the BMI is increased
the response to the medicine is decreased or other wise it can be stated that the BMI is
inversely proportional to that of response to the medicine. As the people get more BMI, a
risk factor to the heart and where the depositions of the LDL and VLDL cholesterol are
anticipated is witnessed as a factor determining the result of the medicine. The
70
75
80
85
90
95
100
105
110
28 29 32 33 34 35 37 38 39 40 46 49 51 52 55 59 60 61 65
Age
Dia
stol
ic H
TN
PtsDiasBeforeNor DiastPtsDiasAfterLinear (PtsDiasBefore)Linear (PtsDiasAfter)
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”175
tabulations of BMI Vs BP and graphical expressions with linear BMI relationships are as
follows.
Graph – 18BMI with systolic blood pressure
Graph –19BMI with systolic and diastolic blood pressure
TABLE –
100
110
120
130
140
150
160
170
180
18.69
20.95
21.18
21.59
21.77
23.16
23.35
24.05
24.88
25.31
26.13
26.74
29.14
30.53
BMI
Syst
olic
HT
N
PtsSysBeforePtsSysyAfterLinear (PtsSysBefore)Linear (PtsSysyAfter)
70
75
80
85
90
95
100
105
110
115
18.69
20.95
21.18
21.59
21.77
23.16
23.35
24.05
24.88
25.31
26.13
26.74
29.14
30.53
BMI
Dia
stol
ic H
TN
PtsDiasBeforePtsDiasAfterLinear (PtsDiasAfter)Linear (PtsDiasBefore)
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”176
Table – 39
BMI vs Blood Pressure
S.No BMI SystolicBefore
SystolicAfter
DiastolicBefore
DiastolicAfter
1 18.69 144 126 98 882 19.94 154 128 86 823 20.95 158 126 98 884 21.07 160 132 96 845 21.18 170 142 110 906 21.48 164 134 92 827 21.59 162 154 100 928 21.64 172 148 110 949 21.77 144 124 88 8210 22.48 144 124 92 8011 23.16 140 124 88 8212 23.18 140 122 96 8413 23.35 158 132 92 8414 23.35 168 144 94 8415 24.05 144 122 92 8016 24.75 150 122 94 8417 24.88 154 126 98 8618 25.11 172 162 106 9819 25.31 172 154 108 9420 26.04 156 124 102 8421 26.13 160 142 98 8822 26.22 168 144 106 9023 26.74 162 138 98 8424 26.875 148 124 92 8225 29.14 172 162 100 9426 29.77 174 162 110 10227 30.53 148 134 92 8228 36.97 170 154 108 100
Mean 24.51232 158.1429 136.7857 98 87.28571
The mean difference of the systolic blood pressure is 21.3572 and that of diastolic
is 10.71429. These differences are the marked in the study as the raised BMI is directly
proportional to the systolic and diastolic blood pressures of the study.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”177
Lipid profile with systolic and diastolic blood pressures enumerated
Table – 40Male BMI with lipid profile variations
BMI HDL LDL VLDL Sch STG0.95 -6 5.5 -6.32 -6.8 -31.6
30.53 0 -1 2 1 1018.68 1 -5 1 -3 424.88 3 -5 -3 -1 736.97 1 2 2 5 924.75 1 4 2 7 11
26.875 2 -7 1 -4 521.77 -6 19 0 13 626.21 -2 8 4 12 2019.94 -12.4 -1.4 -2.6 -16 -13.221.18 2 -5 1 2 621.48 -1 2 2 3 722.48 -1 15 0 14 023.16 0 7 2 9 923.18 0 -8 2 -6 1023.35 1 -3 2 4 926.04 -1 6 2 7 1224.05 -3 2 3 2 225.11 2 4 1 7 7
24.29395 -1.02105 2.057895 0.793684 2.589474 4.694737Table – 41
Female BMI with lipid profile variationsBMI HDL LDL VLDL Sch STG
21.07 1 -4 5 2 2521.59 -2 15 5 18 2521.64 -2 10 0 8 323.35 -3 10 1 8 325.11 -4 21 32 17 -425.31 -1 4 1 4 826.13 -3 15 -1 11 -426.22 -4 4 4 6 1226.74 0 27 1 28 729.14 9 4.88 3.72 17.6 18.229.77 -4 11 2 9 9
25.09727 -1.18182 10.71636 4.883636 11.69091 9.290909Another important observation made in this study is BMI relationships to that of
the lipid profiles of baseline data to the final data, at the gender identification. The male
Vs BMI and Female Vs BMI are tabulated as above.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”178
Limitation of the study
1. the sample size was small
2. limited to that of one particular geographical area
3. the period of study was limited
4. longer follow up was not done
5. parameters like ECG is considered to check the co-morbid condition but
not analysed
Future Scope for the further study
The following recommendations are made on the basis of observations
and conclusions made in the study, as guidelines for the further studies, which
are made in future to over come the limitations listed.
1. Same study can be repeated by taking a large number of samples and
longer duration.
2. The effect of Rasayana can be vividly studied.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”179
Chapter –7
Conclusion1. Primary or essential hypertension in which the causes of increase in blood pressure is
unknown. But for 95% of patients who undergo hypertension treatment, the causes of
high blood pressure are unknown.
2. Essential hypertension constitutes about 90-95% patients of hypertension.
3. Secondary hypertension comprises 5-10% cases of hypertension.
4. About 90-95% patients of hypertension have benign hypertension
5. Increase in blood volume i.e., arterial overfilling (volume hypertension) and arteriolar
constriction (vasoconstrictor hypertension)
6. Angiotensin II alters blood pressure by increasing both peripheral resistance and
blood volume.
7. About 5% of patients requiring hypertension treatment can trace their high blood
pressure to a physical cause such as kidney disease. Treatment of the disease reduces
the symptoms of high blood pressure.
8. Many patients have a family history of high blood pressure.
9. Lifestyle changes can significantly improve a patient’s blood pressure. Among many
other side effects, smoking elevates blood pressure.
10. Reduce or eliminate caffeine-it constricts the blood vessels walls and may increase
blood pressure.
11. Iatrogenic hypertension is Hypertension due to administration of drugs by physicians.
12. Evidence supports treatment of systolic high blood pressure in older persons.
13. Local endothelial factors may play a role in blood pressure.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”180
14. Increased T.P.R. + increased cardiac output = increased blood pressure
15. High blood pressure lowers cognitive function, researchers say.
16. Hypertension increases the viscosity of blood.
17. The factors influencing the relationship between blood pressure and cardiovascular
risk include systolic blood pressure, diastolic blood pressure, circadian blood pressure
patterns, blood pressure variability, and cardiac and vascular hypertrophy.
18. Retention of sodium will cause an increase in the blood volume, which in turn
increases the blood pressure.
19. Essential fatty acids may also help to control blood pressure.
20. Shirodhara is claimed to reduce high blood pressure.
21. Present study registers 30 patients, out of 68 approached patients. Out this, 2 patients
were discontinued hence their data has not been included in the assessment. The
remaining 28 patients of Bhrama viz. Hypertension, fulfilling the criteria of diagnosis
and inclusive criteria were included in the study.
22. The temperature shows the mean difference of 0.24 in the study, which is a point of
observation to assess the Rasayana effect induction in the body.
23. Weight factor has reduced by 0.24 mean value, suggesting the induction of good
health through Rasayana, there by the regulation of the Bhrama vis-à-vis
hypertension.
24. Haemoglobin percentage shows marked increase of 0.443 mean value. Which is
suggestive of inducting Rasayana effect and also capacitating the oxygen exchange
ratio and there by the controlling the co-morbid conditions or associative such as
hypoximea.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”181
25. The associate factor of haemoglobin is RBC count. This has shown 0.251 mean value
increase in the study reflects to the percentage rise of the haemoglobin and there by
regulating the Bhrama vis-à-vis hypertension.
26. The next parameter of co-morbidity in Bhrama vis-à-vis hypertension is serum
creatinine. It has shows a rise in the study with a mean value of 0.008. It suggests that
the Angiotensin and Renin involvement in the Bhrama vis-à-vis hypertension have
been successfully reduced and provide the Rasayana effect not only at the cardiac but
also in the renal area. The small amount changes are as a process of regulation in the
KUB system.
27. Serum cholesterol and associative LDL, VLDL with S.Triglycerides are risk factors
in the pathology of Bhrama vis-à-vis hypertension. Out of these associated the HDL
cholesterol is good for the body and all the rest offers co-morbidity. As the results
observed except the HDL cholesterol all other cholesterol drop in the study in
comparison of mean values. The mean value of HDL is 0.74666-difference rise in the
study. The rest of co-morbid influencing factors enumerated are LDL (5.2326),
VLDL (2.29333), Serum cholesterol (5.793) and S. Triglyceride (9.08), show the
significant drop and suggest that the effect of the Kakubhadi Lehya on Bhrama vis-à-
vis hypertension with reference to its Rasayana effect over the Bhrama vis-à-vis
hypertension.
28. The presenting complaints of the Bhrama vis-à-vis hypertension are enumerated here
under the limelight of the contemporary and Ayurvedic methods. The first fore most
complaint is Bhrama, which is a pratyatma niyata Lakshana of the Bhrama. All the 28
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”182
(100%) patients included and received full-length treatment are exhibiting this
symptom and relieved 100 % at the end of the schedule.
29. Another major complaint expressed in the study is shira shoola by 19 (67.85%) and
outs of them 2 (7.14%) patients’ shows the persistence of the shira shoola at the end.
Angasada, a complaint observed in the study for 14 (50%) patients and one (3.57%)
patient hang on with the complaint at the end of the study.
30. Nidranasha, which is always associated is observed on 13 (46.42%) patients and
found that the same 2 (7.14%) patients are having the complaint at the end of the
study. Hrudrava, another relative complaint of the corresponding organ is observed in
7 (25%) patients and at the end the Rasayana effect of the Kakubhadi Lehya made
them not to have the complaint.
31. The klama is observed in 6 (21.42%) patients and at the end 2 (7.14%) patients are
assiduous with the complaint.
32. Urah shoola for 2 (7.14%) patients and both were relieved with the complaint at the
end of the study of Kakubhadi Lehya on Bhrama vis-à-vis hypertension. The
graphical representation is as under.
33. The result in the study ascertains the best activity of the Kakubhadi Lehya over the
Bhrama vis-à-vis hypertension. For the convenience the results are grouped as five
categories, viz. Well-Responded, Moderately Responded, Responded, Not responded
and Discontinued.
34. The result declaration is done following the norms and conditions of the inclusive
factors and study of the subjective parameters in association with the
sphygmomanometer studies of three postures. The co-morbid stimulating factors
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”183
especially LDL, VLDL and S. Triglycerides are considered in while declaring the
results. The factors which make the Rasayana effect over the body also included to
assess the results.
35. After through study of the entire parameters and materials available for the
assessment of results it was drawn a conclusion of results as - 9 (30.02%) well
responded, 6 (20.02%) moderately responded, 10 (33.33%) responded, 3 (10%)
patients not responded and the last 2 (6.63%) patients discontinued in the study. The
tabulation and graphical expression pi-diagram is as under.
36. As it is observed that the systolic blood pressure has taken a rise till to 32 years of age
and show a down fall to the age of 34. From that a gradual increase is observed to age
of 38 and stable to the ages of 40. From 40 a rising gradient is observed till to 52
years of age and becomes more or less stable to the forwarded ages. A linear line
drawn in comparison to that of baseline data to final shows markedly 20 mm Hg
differences in the study. Though many may not give attention to that of the systolic
hypertension, which could be pacified with the rest and regulations needs to drag the
attention. At present study, the effect of Kakubhadi Lehya over the Bhrama vis-à-vis
hypertension show marked drop of 20 mm Hg of systolic hypertension by inducting
the Rasayana effect.
37. Another important reading of the blood pressure is diastolic. It is observed that the
small variances in it can cause the Bhrama vis-à-vis hypertension. The arterial
diastolic blood pressure measured in the study was put for the keen observations, as
there are 28-29, 37-39 and 52-55 age groups show marked elevations. This could be
because of the tension, anxiety, stress, strain etc, psychophysical factors. The linear
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”184
line is drawn an observed as the cumulative effect of the Kakubhadi Lehya varies
from 15 mm Hg to 20mm Hg of diastolic from the early ages to late. The older people
those who receive the Hrudya Rasayana well responded and show the marked relief
for the condition.
38. At this study one attempt is made to understand the relationships of the BMI with
systolic and diastolic blood pressure. As it is observed that the linear graph drawn on
the basis of data obtained show a clear evidence of the relationship to the BMI and
systolic and diastolic blood pressures. It is an observation expressed that as the BMI
is increased the response to the medicine is decreased or other wise it can be stated
that the BMI is inversely proportional to that of response to the medicine. As the
people get more BMI, a risk factor to the heart and where the depositions of the LDL
and VLDL cholesterol are anticipated is witnessed as a factor determining the result
of the medicine.
39. The mean difference of the systolic blood pressure is 21.3572 and that of diastolic is
10.71429. These differences are the marked in the study.
40. Another important observation made in this study is BMI relationships to that of the
lipid profiles of baseline data to the final data, at the gender identification.
41. All the subjective parameters except Klama and Urah shoola show highly
significance i.e. reducing the Bhrama vis-à-vis hypertension.
42. The parameter Urah shoola shows the non-significant with less mean effect.
43. The parameter Angasada is having more variation.
44. The parameter Anger and Anxiety shows more significant than fear and rest of the
parameters.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”185
45. The parameter Anxiety is having the more net mean effect and Depression having
with more variation.
46. Where as the parameter Aggressiveness have less mean effect with less variation.
47. All the objective parameters show highly significance. The haemoglobin, weight,
RBC shows more or less highly significance.
48. The parameter Serum Cholesterol is having less mean effect with less variation.
Where as the parameter serum Triglyceride having high net mean effect with more
variation.
49. The diastolic blood pressure in all the three different positions, the mean net effect is
the same, but the supine position there is high significance witnessed.
50. There is much variation observed in the sitting position. The mean effect after the
treatment of diastolic blood pressure is more in the position of standing is more with
more variation.
51. The mean net effect of the systolic blood pressure in the standing position is more,
but there is high significance of systolic blood pressure in sitting position.
52. The mean effect systolic blood pressure in sitting position is more, where as standing
position show the uniform effect. In the diastolic blood pressure again the standing
position show more uniformity.
53. Thus it is concluded that the Kakubhadi Lehya is effective as Hrudya Rasayana in the
disease condition Bhrama vis-à-vis hypertension.
54. This is recommended for the regulation and prophylactics of Bhrama vis-à-vis
hypertension.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”186
Chapter –8
SummaryPrimary or essential hypertension in which the causes of increase in blood
pressure is unknown. Essential hypertension constitutes about 90-95% patients of
hypertension. Secondary hypertension comprises 5-10% cases of hypertension.
Evidence supports treatment of systolic high blood pressure in older persons.
Local endothelial factors may play a role in blood pressure. Increased T.P.R. + increased
cardiac output = increased blood pressure. High blood pressure lowers cognitive function,
researchers say.
The factors influencing the relationship between blood pressure and
cardiovascular risk include systolic blood pressure, diastolic blood pressure, circadian
blood pressure patterns blood pressure variability, and cardiac and vascular hypertrophy.
Retention of sodium will cause an increase in the blood volume which inturn increases
the blood pressure. Essential fatty acids may also help to control blood pressure.
On close observation, it is very much evident that different scholars tried to
identify the disease on the basis of following;
5. On the basis of vitiated dhatu – like Raktapradoshaja vikara, Rakta
chapadhikyata, Rakta samvardhana etc.
6. On the basis of vitiation of Vata – like Vyana bala vaishamya etc.
7. On the basis of vascular changes – like Dhamanipraticchaya, Dhamani
prapoornata, Sira gata vata etc.
8. On the basis of Avarana – like Raktavrita vata, Pittavrita udana, Sleshmavrita
Vyana etc.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”187
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).
Dhamani pratichaya is (atherosclerosis) one out of twenty Kaphaja diseases
appears or associates with the ageing factor have more responsibility to give rise
Hypertension or Bhrama.
The Rasa vitiation is one of the major situations in case of Bhrama, thus the
removal of impurities and proper transportation of the Rasa-Raktavaha srotogata dravaya
i.e. Rakta with its related components in the minuet vessels and capillaries is possible
through Rasayana. Dhaturupa Rasa (plasma and such other fluid constants of the body in
association with Rakta (blood constituents), which makes the imbalance through the Rasa
are to be rectified in the same route following the most best procedure of safeguarding
the Prenana and Jeevana kriyas by the Rasayana.
The chosen drug “Kakubhadi Lehya” assumed as the best Hrudya Rasayana
because of its contents and in further its action towards the Bhrama vis-à-vis
hypertension.
The first and fore most complaint is Bhrama i.e. giddiness. All the patients in the
study (100%) reported the Bhrama, which is said as the “Pratyatma Niyata Lakshana”.
The giddiness may be either hypoxia or mal-function of hemopoitic system including
respiratory system or even it is because of the involved neural controls. But the ultimate
cause could be attributed to that of the high salt intake. Ultimately a sypotom giddiness is
witnessed in the Bhrama is undoubted.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”188
Here an attempt is made to promote the vitality of the heart and there by
regulating the blood pressure through the Hrudya property of the Kakubhadi Lehya as
Hrudya Rasayana.
Mutrala effect – the primary management of the hypertension is diuresis in the
contemporary medical practice is observed in the study.
It is put forth for the assessment many parameters in the study. The direst
significant parameters are included along with the parameters, which are helpful to assess
the co-morbid conditions, such as lipid profile. Some parameters that can influence the
blood pressure through its physiological or patho-physiological nature also included, such
as temperature. The variances are observed not only to assess the regression of the
disease but also to assess the Rasayana effect induced in the body by the chosen
medicament.
All the subjective parameters except Klama and Urah shoola show highly
significance.
All the objective parameters show highly significance. The haemoglobin, weight,
RBC shows more or less highly significance. The parameter Serum Cholesterol is having
less mean effect with less variation. Where as the parameter serum Triglyceride having
high net mean effect with more variation.
The result in the study ascertains the best activity of the Kakubhadi Lehya over
the Bhrama vis-à-vis hypertension. For the convenience the results are grouped as five
categories, viz. Well-Responded, Moderately Responded, Responded, Not responded and
Discontinued.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama”189
The result declaration is done following the norms and conditions of the inclusive
factors and study of the subjective parameters in association with the sphygmomanometer
studies of three postures. The co-morbid stimulating factors especially LDL, VLDL and
S. Triglycerides are considered in while declaring the results. The factors which make the
Rasayana effect over the body also included to assess the results.
After through study of the entire parameters and materials available for the
assessment of results it was drawn a conclusion of results as - 9 (30.02%) well responded,
6 (20.02%) moderately responded, 10 (33.33%) responded, 3 (10%) patients not
responded and the last 2 (6.63%) patients discontinued in the study.
The mean effect systolic blood pressure in sitting position is more, where as
standing position show the uniform effect. In the diastolic blood pressure again the
standing position show more uniformity.
Thus it is concluded that the Kakubhadi Lehya is effective as Hrudya Rasayana in
the disease condition Bhrama vis-à-vis hypertension. This is recommended for the
regulation and prophylactics of Bhrama vis-à-vis hypertension.
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” I
Bibliographic References
1) Sheldon G. Sheps, MD, Treating Hypertension, vol-13, No-11, 20 frames, 14-2-2003,http://www.hippocrates.com/archive/December1999/contents.html
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55) Agnivesa, Charaka Samhita, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (KasiSanskrit series 228), Vimana, 5 chapter
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series 4), Sutra 12/564) Agnivesa, Charaka Samhita, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi
Sanskrit series 228), Chikitsa 28/7)65) Ibid, 28/666) Vagbhata, Astanga Hrudaya, Varanasi: Krishnadas Academy; 1982.. (Krishnadas Academic
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Sanskrit series 228), Chikitsa 28/973) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series
51), Nidana 1/1774) Agnivesa, Charaka Samhita, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi
Sanskrit series 228), Chikitsa 28/975) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series
51), Nidana 1/17-1876) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series
51), Sutra 15/377) Ibid, Nidana 178) Vagbhata, Astanga Hrudaya, Varanasi: Krishnadas Academy; 1982.. (Krishnadas Academic
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82) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series51), Sutra 21
83) Vagbhata, Astanga Hrudaya, Varanasi: Krishnadas Academy; 1982.. (Krishnadas Academicseries 4), Sutra 12/15-16
84) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series51), Sutra 21/13
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86) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series51), Shareera 4/31
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151) Charaka Samhita, edited by Ganga sahay Panday with commentary of Ayurveda deepika bychakra pani datta, published by Chaukambha Sanskrit Samsthan Varanasi, in 1998, VimanaSthana 28th chapter, Sloka Number 23, Page No. 780
152) Madhava Nidana, edited by Yadunandana Upadhyaya, with commentary of Madhukosha , ByVijaya rakshita, published by chaukambha Sanskrit Orientalia Varanasi, in 1980, Purvardha 17th
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154) Madhava nidhan, edited by Yadunandana Upadhyaya, with commentary of Madhukosha , ByVijaya rakshita, published by chaukambha Sanskrit Orientalia Varanasi, in 1980, Purvardha 17th
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Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” IX
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234) Vagbhata, Astanga Hrudaya, Varanasi: Krishnadas Academy; 1982.. (Krishnadas Academicseries 4), Sutra 11/61
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Hypertension. 1983;5:86-99.244) Oparil S. The sympathetic nervous system in clinical and experimental hypertension. Kidney
Int. 1986;30:S437-S452245) Anderson EA, Sinkey CA, Lawton WJ, Mark AL. Elevated sympathetic nerve activity in
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250) Ibrahim MM, Tarazi RC, Dustan HP et al. Cardioadrenergic factor in essential hypertension.Am Heart J 1974; 88 : 724-32.
251) DeQuatlro V, Chan S. Raised plasma catecholamines in some patients with primaryhypertension. Lancet 1972; 1 : 806-09. Sever PS,
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256) Vagbhata, Astanga Hrudaya, Varanasi: Krishnadas Academy; 1982.. (Krishnadas Academicseries 4), Sutra 20/4;
257) Ibid, 2/6258) Agnivesa, Charaka Samhita, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi
Sanskrit series 228), Chikitsa 28/9259) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas
Ayurveda series 51), Nidana 1/17260) Agnivesa, Charaka Samhita, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi
Sanskrit series 228), Chikitsa 28/9
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261) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurvedaseries 51), Sutra 15/3
262) Vagbhata, Astanga Sangraha, Prof.K.R.Shrikhantamurthy editor. Varanasi: ChaukhambhaOrientalia; 1996. (Jaikrishnadas Ayurvedic series 79),Sutra 20/5
263) Vagbhata, Astanga Hrudaya, Varanasi: Krishnadas Academy; 1982.. (Krishnadas Academicseries 4), Sutra 12/11
264) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurvedaseries 51), Sutra 30/4,13
265) Ibid, 30/13266) Agnivesa, Charaka Samhita, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi
Sanskrit series 228), Vimana 9/5;267) Source: http://www.hindustantimes.com/news/181_1044436,0050.htm, Thursday, November
04, 2004 commentary: http://www.newstarget.com/001082.html268) Prepared by Alexander G. Logan, MD, FRCPC, Professor of Medicine, University of Toronto,
Ontario, Screening for Hypertension in Young and Middle-Aged Adults,http://www.ctfphc.org/Abstracts/Ch53abs.htm, http://www.ctfphc.org/Tables/Ch53tab.htm,http://www.ctfphc.org/References/Ch53bib.htm
269) Haynes RB, Lacourciere Y, Rabkin SW, et al: Report of the Canadian Hypertension SocietyConsensus Conference: 2. Diagnosis of hypertension in adults. Can Med Assoc J 1993; 149:409-418
270) Jackson R, Barham P, Bills J, et al: Management of raised blood pressure in New Zealand: adiscussion document. BMJ 1993; 307: 107-110
271) http://www.china.org.cn/english/Life/41064.htm, http://english.eastday.com/ August 31, 2002,272) Article Review: Managing Hypertension Without Drugs, http://www.vita-
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275) Neal Uren, consultant cardiologist and Dr Dan Rutherford , Hypertension (high blood pressure)- Treatment/Reducer-www.livingiseasy.co.uk, Added : (Thu Oct 28 2004)
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285) Stuart J. Pocock et al. Concentration of HDL cholesterol, triglycerides and total cholesterol inischaemic heart disease. Brit Med J 1989; 298 : 998-1002.
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294) Carlson JT, Rangemark C, Hedner JA. Impaired endothelium-dependent vascular relaxation inpatients with sleep apnea. J Hypertens. 1996;14:577-584.
295) Brunner HR, Laragh JH, Baer L. Essential hypertension - Renin and Aldosterone, Heart attackand stroke. N Engl J Med 1972; 286 : 441-49.
296) Brunner HR, Gavras H, Laragh JH. Angiotensin II blockade in man by Sarlatal angiotensin IIfor understanding and treatment of high blood pressure. Lancet 1973; 2 : 1045-48.
297) Brunner HR, Gavras H, Laragh JH. Hypertension in man. Exposure of the renin and sodiumcomponents using angiotensin I blockade. Cir Res 1974; 34 (Suppl.I) : I-35 - I-45.
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304)Laragh JH, Baer L, Brunner HR, et al. Renin angiotensin and aldosterone system inpathogenesis and management of hypertensive vascular disease. Am J Med 1972; 52 : 633-52.
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306) Ibrahim MM, Tarazi RC, Dustan HP et al. Cardioadrenergic factor in essential hypertension.Am Heart J 1974; 88 : 724-32.
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311) Nasjletti A, Malik KU. Relationships between the kallikrein-kinin and prostaglandin system.Life Sci 1979; 25 : 99-110.
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323) http://www.thehindubusinessline.com/2004/11/07/03hdline.htm, Mumbai Nov. 6Financial Daily from THE HINDU group of publications, Sunday, Nov 07, 2004324) Skarabal F et al. Low sodium/high potassium diet for pre vention of hypertension; probable
mechanism of action. Lancet 1981; 895 : 1981.325) (Brunner HR, Baer L, Sealey JE, Ledingham JGG, Laragh JH. Influence of potassium
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820-827; November 1995334) http://www.alltm.org/Transcendental_Meditation.html
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337) Yogacharya Vishwas Mandlik, Effect Of Jalandhar Bandh On Blood Pressure,http://www.yogapoint.com/info/research4.htm
338) High Blood Pressure (Hypertension), http://www.tmc.edu/thi/hbp.html,339) http://www.goodhealthnyou.com/doctors/radhadoshi.htm340) J.L.N. Shastri, Dravyaguna Vijnan, vol-1, first ed., Chaukhambha Orientalia, 2004, Varanasi, p
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Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 1
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA D.G.M.A.M.C.GADAG
SPECIAL CASE SHEET FOR EVALUATION OF“KAKUBHADI LEHYA” AS HRIDYA RASAYANA IN “BHRAMA (HYPERTENSION)”
Guide:
Dr. Shiva Rama Prasad Kethamakka,
M.D (Ayu), C.O.P.(German) M.A.(Astro), Ph.D (Astromed)
1) Name of the Patient Sl.No
2) Sex Male Female OPD No
3) Age Years IPD No
4) Religion Hindu Muslim Christian Other
5) Occupation Sedentary Active Labor
6) Economical status Poor Middle Higher middle Higher class
7) Address
Pin
8) Birth data Place of Birth
AMDate Month Year Time
Hours Minutes PM
9) Selection Included Excluded
10) Schedule Initiation Date Completion Date
Well responded Moderately responded11) Result
Responded Not responded Discontinued
12) INFORMED CONSENT
I Son/Daughter/Wife of am
exercising my free will, to participate in above study as a subject. I have been informed to my
satisfaction, by the attending physician the purpose of the clinical evaluation and nature of the drug
treatment. I am also aware of my right to opt out of the treatment schedule, at any time during the course
of the treatment.
Patient's Signature
Scholar:
Dr. Chetan Sangappa Minajigi
Annexure
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 2
13) Chief complaints with durationDuration At the treatment (day’s)No Complaints
Fres
h
< 1
Yrs
< 5
Yrs
> 5
Yrs
5 10 15 20 25 30
1 Bhrama (Dizziness)2 Sirashoola (Headache)3 Anga sada ( Body pain)4 Nidranasha (Insomnia)5 Hrit Drava (Palpitation)6 Klama (Fatigue)7 Urah shoola8 Others9
14) Associated FeaturesBefore treatmentNo ComplaintsFresh <1Yrs < 5Yrs > 5Yrs
Aftertreatment
1 Asthma2 Gout3 Toxemia4 Transient Ischemic attack5 Pakshaghatha6 Ardita vata7 Medoroga8 Other Associated features
15) History of present illnessMode of onset[Atanka samutpatti]Course of the disease[Vedana samucchaya]Frequency [Pravrutti]Intensity Mild Moderate Severe
Travel Anxiety EmotionAggravating[Anupashaya] Stress Physical stress If any other
Rest Tranquilizersfact
ors
Relieving[Upashaya] Sleep Anti depressant’s
Others
16) History of past illness if any
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 3
17) Previous treatment history if anyPrevious MedicationDrug used
Dose DurationResponse Controlled Not controlledPresent status
18) Habits and Drug historySleep time During
night /hrs Waking time /hrs
Nature of sleep Sound DisturbedDreams Yes NoDay sleep Yes No
Sleep
OtherYear of starting Cigarette / BeediDaily / occasionally Frequency of smokingChain smoker
Smoking
If left how manyday’s back
Present condition ofsmoking
Alcohol Year of starting Hot drinks / BeerDaily/ Occasionallyand qty
Present condition ofdisking
Tobacco/pan-Chewing
Year ofstarting
Daily /Occasionallyand qty
Presentcondition
Tea /coffee
Oral contraceptives Yes No Duration DoseAnti hypertensives Yes No Duration DoseOther's
19) Emotional StatusBT AT BT AT
1 Fear (Bhaya) 5 Irritability (Kshobha)2 Anger (Kopa) 6 Aggressiveness (Samprahara)3 Depression (Deenata) 7 Delirium (Mada)4 Anxiety (Udvega) 8 Other's20) Family History (Write relationship in the column)Heart Disease CancerHypertension Thyroid disordersObesity Any otherDiabetes
21) Personal historyVegetarian Salt BitterMixed food Pungent SweetOil/Ghee Sour Astringent
a) Ahara
Stored food
Taste inpredominance
others
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 4
b) vyayama shakti Heena Madhyama Uttamac) Kosta Krura Madhyama Mrudud) Jatharagni bala Manda Teekshna Vishama Samae) Pureesha pravritti Vitvibandha Dravavit Prakrita Frequencyf) Mutra pravritti Frequency day Night Mutradahag) Nidra Sukh Alpa Ati Vaishamyah) Occupational historyType of employmentWork involving any mental strain Yes NoIf yes Mild Moderate SevereWhether symptoms produced during working hours Yes NoWeather symptoms relieved by change of place Yes NoFor womenMenarche Yes No AgeMenopause Yes No AgeRegular IrregularDuration of flow Normal Excessive ScantyNature of flow Dysmenorrhoea LeucorrhoeaPregnancies Abortion Miscarriages Still birth
22) General examinationPulse /min Temp °F Respiration rate /minWeight /kgs Height heart rate /minFundus of Eye OedemaNeck vein Peripheral pulses BMI
23) Aturabala pareeksha
Prakruti Shareerika V P K VP VK PK SamaManasika S R T SR ST TR Sama
Sara Twak Rakta Mamsa Meda Asthi Shukra Majja SatwaSamhanana Pravara Madhyama AvaraSatmya Pravara Madhyama AvaraSatwa Pravara Madhyama AvaraVyamashakti
Pravara Madhyama Avara
Vaya Balya Madhya JeernaDesha Jangala Anupa Sadharana24) Systemic examination (vishesha pariksha):- Cardiovascular systemPeripheral Vascular systemA) JVP Pressure WavesB) Pulse Rate Rhythm Volume
Equality Upstroke Downstroke
Condition of vesselwall
Apex pulse deficitCharacter
Carotid bruit Radio femoral delay
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 5
C) Blood pressure - Standing Sitting SupineIn mm/hg Systolic Diastolic Systolic Diastolic Systolic DiastolicLt. upperRt. upper
1) Pericardium2) Apex impulse3) Other pulsation Para sternal Epigastric
Supra sternal In the neck
In the second Leftspace
On the right side
4) Dilated veins
Insp
ecti
on
5) Scars Sinuses 6) Others1) Apex beat2) Left para sternal heave3) Diastolic shock (palpable S2)4) ThrillsP
alpa
tion
5) Other pulsation1) Left second & Intercostal space dullness2) Upper border3) Right border4) Left border
Per
cuss
ion
5) Lower sternal resonance1) Heart sounds2) Murmur Systolic Diastolic Continuous3) Rate4) Rhythm
Aus
cult
atio
n
5) Other soundsOther systems: - (If any)25) Laboratory investigations: -
Before After Changes observedHemoglobin %Serum cholesterolSerum triglyceridesHigh density lipoproteinLow density lipoproteinVery low density lipoproteinRatio26) Subjective parameters
Before After DifferenceBhramaSirashoolaAnga sadaHrit DravaKlamaUrah Shoola
Kakubhadi Lehya” as Hridya Rasayana in “Bhrama” 6
27) Objective parameters: -a) Blood pressure readings. :-
Systolic Diastolic Changes observedBefore mm/hg mm/hg mm/hgStandingAfter mm/hg mm/hg mm/hgBefore mm/hg mm/hg mm/hgSittingAfter mm/hg mm/hg mm/hgBefore mm/hg mm/hg mm/hgSupine
position After mm/hg mm/hg mm/hgBefore After Differences
Hemoglobin %TemperatureWeightE.C.GRBC countSerum CreatinineRandom Blood GlucoseHDL Cholesterol28) Medicine distributions/Advises record: - (Date in Brackets)Day Date Systolic Diastolic Complaints if any advise
051015202530354045
Investigators note :-
Signature of Guide:Dr. Shiva Rama Prasad Kethamakka,
Signature of Scholar: Dr. Chetan Sangappa Minajigi