Cardiovascular diseases account for far greater morbidity and mortality all over the world than any other ailment. The Coronary artery disease (CAD) is ranked number one killer, The global burden of disease study reported almost 25% out of total deaths (2.3 million) due to cardiovascular diseases. It is predicted that by 2020 there would be a 111% increase in cardiovascular deaths in India. The cause of this increase is said to the epidemiological transition. Ayurveda is a rich heritage and a vast scientific system. The Ancient scholars like Charaka (1500 BC), Sushruta (300-400 AD) and Vagbhata (500AD) have compiled the art and science of Ayurveda practiced at their times. They were in a position to explain Anatomical, Physiological, Pathological and Emergency medical Care with special reference to conservation of heart.
The oldest scripture i.e. Rigveda mentioned the basis of Ayurveda is dependent on the theories of triguna, panchamahabhuta, tridosha, triguna and sapta dhatu – forming the pivot on which the science of Ayurveda revolves.
vata is a dynamic or vital force which causes senses to perform their functions, holds together all the elements of the body, assisting adhesion of the particles and is cause of speech, sound and touch perception. prepares the material to be absorbed and metabolized at macro and micro levels i.e. it manifests itself in different forms viz. chemical activities like digestion and assimilation and it generates the heat. on the other hand participates in various secretions of the body, be it from mucous membranes and other tissues and preserves their functions. It generates strength of the limbs, growth, courage and vitality.
Ayurveda considers hrudaya (heart) as one of the vital organ of the body. As it is one among the trimarams, any injury to the hrudaya leads to severe complications & even death. Cardiovascular diseases are the largest cause of mortality. Overall, CVDs accounted for around one-fourth of all deaths in India in 2008.It will be the largest cause of death and disability by 2020 in India. It has been forecasted that 2.6 Million people will die from coronary heart disease, which constitutes 54% of deaths caused due to cardiovascular disease, making an impact to the society and the economy even more significant. Although many types of cardiovascular diseases are enlisted in contemporary science, only a few explanations are available in Ayurvedic clas- sics. As heart diseases are the current burning problem in the society understanding the heart dis- eases with respect to dosha and dushya involved in them is very essential. An attempt has been made in this article for consideration of doshas and dushyas involved in the pathogenesis of various cardiac disorders.
Hrudaya is an organ which draws blood from all over the body and then supplies it to all parts of the body. Embryologically, it originates from the essence of rakthadhatu and kapha dosha. The shape of heart has been described as ‘inverted lotus’. Hrudaya forms the seat of udana, vyana & prana vayu, sadhaka pitta, avalambaka kapha & ojas. In Ayurveda the word prana vayu is used for oxygen and functional com- ponent of nervous system controlling respiration and deglutition. Oxygen is re- quired for very existence of all cells, organs and life. It is vital for functioning of heart, mind and intellect. Vyana vata controls all the movements of body both voluntary and involuntary. It controls contraction, relaxation and rhythmicity of heart. Sadhaka pitta represents enzymes in the heart eg: SGOT, aldose etc. whereas avalambaka kapha represents interstitial fluid in the heart and lungs. Embryologically endocardium is derived from rasa (body fluids) and rakta (blood). Myocardium is derived from mamsa dhatu (muscular tissue) and pericar- dium is derived from meda dhatu (fatty and connective tissue). Each of these layers can be affected by one or all the three doshas. Equilibrium of these doshas present in the heart is responsible for normal functioning of heart. Vitiation of any of them is invariably necessary for causation of heart dis- eases. In general hetu (causes) can be broadly classified as doshaja hetu (that causing doshic vitiation) and vyadhija hetu (those directly causing vyadhi). Doshaja hetu can be further classified as shareerika hetu (physical factors) and manasika hetu (psychological factors). Improper treatment to any disease, trauma and improper purifi- catory therapies acts as vyadhija hetu for hrudroga. Ruksha shushka alpa bhojana and upavasa, Ushna amla lavana katu kshara pradhana ahara along with madya sevana and guru snigdha bhojana, achesta act as shareerika hetus for production of vataja, pittaja and kaphaja variety of hrudroga re- spectively. Whereas shoka, krodha and achinta (kapha prakopa kara) act as mana- sika nidanas in causing hrudroga.
Pathogenesis of hrudroga begins with hetusevana causing doshadusti and agni- dusti. Because of mandagni (agnidusti) there will be formation of ama, which in combination with vitiated doshas produces samado- shas. As there will be predisposition of kha- vaigunyata in hrudaya, these samadoshas takes sthana samshraya in hrudaya. The presence of samadoshas causes improper nourishment of hrudaya due to srotorodha or margavarodha (obstruction to channels carrying nourishment) leading to improper functioning of hrudaya producing symptoms like vaivarnyata, ruja, murcha, shwasa,shotha and atisweda. Thus causes hrudroga.
CLASSIFICATION OF VARIOUS CAR- DIAC DISEASES
The general classification of diseases as ex- plained in Sushruta Samhita can be applied to various cardiac diseases also. It is as follows:
- Bijadoshaja (adibalapravrutta)- hereditary cardiovascular disorders
- Douhrudaapacharaja (janmabalapra- vrutta)- congenital cardiovascular disorders
- Sanghatabalapravrutta- heart disease due to trauma.
- Upasargaja– infective cardiac disorders
The heart being a muscular organ derives its nutrition from rasa, its oxygen from rakta and its vital energy from ojas. Its movements are controlled by vyanavata. Sadhaka pitta represents intracellular enzymes in the cells of the heart and helps it to digest and utilise the nutrients and oxygen. Avalambakakapha represents the intracellular and interstitial fluid of the heart and chest. Any imbalance in these basic elements disturbs the normal function of the heart and there by causes heart diseases. Rasa carries all the essential nutrients to all the cells of the body. Rasa kshaya symptoms are encountered in dehydration or state of shock. The sluggish circulation of both these states acts as a precipitating factor for coronary thrombosis. Red blood corpuscles carry oxygen to all tissues. Increased blood volume can lead to hypertension and gives rise to fullness of veins which is a sign of congestive cardiac failure. Acute blood loss may lead to shock. And chronic anaemia can give rise to heart failure. All these are resultant of raktadusti. As heart is a muscular organ and factors which affect muscular tissue can affect the heart. Myocarditis, hypertrophy of heart owing to glycogen storage etc as well as tumour of the heart arises due to vitiation of muscular tissues of the heart. Poor contraction of heart leads to congestive cardiac failure.
Variety of symptoms experienced by the patients have been described in Ayurvedic literature, like stiffness in cardiac region, stabbing pain in cardiac region, heaviness in heart, weakness of heart, Cutting pain in heart, pericardial discomfort, pain and discomfort in heart region, feeling emptiness of heart, pericardial suppression, heaviness of the heart, burning sensation, fluttering of the heart or palpitation, Tachycardia, Precordial twitching + tachycardia etc. Modern medicine relates cardiac disease to changed lifestyle, sedentary habits, type of food, smoking, hypertension, hyper-lipidemia, increased waist-hip ratio, diabetes mellitus, alcoholism and stress resulting in athero-sclerosis, plaque formation in the coronary arteries and ultimately clogging. This leads to ischemic damage to cardiac muscle and subsequently the cardiac dysfunction…(more)
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