Title A Study of Cardiovascular Diseases in Ayurveda with special emphasis on the role of Ayurveda as a complementary medicine in selected CardiovascularDiseases. A research project completed as a partial requirement for the qualification of the Diploma of Ayurvedic Medicine 2007 John Vorstermans Supervisor: Dr Vijayendra Srinivasa Murthy, BAMS. M.S. Head of Faculty Ayurveda Wellpark College of Natural Therapies. 6 Francis Street, Grey Lynn Auckland Wellpark College Of Natural Therapies P.O. Box 78-229, 6 Francis Street, Grey Lynn, Auckland Phone: 0-9-360 0560 Fax: 0-9-376 4307 Email:
[email protected] Certificate This is to certify that John Vorstermans has successfully completed a research project/paper on the topic; A Study of Cardiovascular Diseases in Ayurveda with special emphasis to the role of Ayurveda as a complementary medicine in selected Cardiovascular Diseases, towards the partial fulfilment of the a Diploma of Ayurvedic Medicine. Date ............................................ Supervisor..................................... Place .......................................... Principle: ...................................... A Study of Cardiovascular Disease in Ayurveda John Vorstermans Table of Contents 1. 2. 3. 4. 5. 6. Acknowledgement........................................................................................................4 Introduction..................................................................................................................5 Aims and objectives......................................................................................................8 Materials and Methods.................................................................................................9 An Overview of Ayurveda.........................................................................................10 Literature Review.......................................................................................................29 6.1 Cardiovascular Disease statistics.....................................................................29 6.1.2 History of Cardiovascular Disease .............................................................31 6.2 Cardiovascular Disease.........................................................................................33 6.2.1 Overview.......................................................................................................33 6.3 Development of Cardiovascular Disease........................................................45 6.3.1 The medical model........................................................................................45 6.3.2 Ayurveda model..........................................................................................47 6.4 Risk Factors........................................................................................................55 6.4.5 Medical Pathophysiology of Cardiovascular Disease..................................63 6.4.6 Ayurvedic Pathogenesis (Samprapti) .........................................................64 6.5 Clinical Manifestation.....................................................................................69 6.5.1 Symptomatology - Western Medical ..........................................................69 6.5.2 Symptomatology - Ayurveda ......................................................................69 6.6 Treatment.............................................................................................................71 6.6.1 Medical Treatment.......................................................................................71 6.6.2 Ayurvedic Treatment...................................................................................75 6.6.3 Medical Drugs..............................................................................................81 6.7 Correlation between Ayurveda and Modern Medicine...................................89 6.8 Classifying Ayurvedic Herbs on Modern Pathology......................................91 6.9 Research on Ayurvedic Herbs.........................................................................93 6.10 Details of Ayurvedic Herbs under research.................................................103 6.11 Drug Interactions.........................................................................................129 7. Discussion .................................................................................................................134 8. Conclusion.................................................................................................................139 9. Recommendation for Further Study..........................................................................141 Illustrations index......................................................................................................142 Table index.................................................................................................................142 Abbreviations..............................................................................................................143 Glossary of Sanskrit Terms........................................................................................144 Bibliography...............................................................................................................147 Page 3 I would wish to acknowledge further outstanding tutors. Barbara Cook and Thomas Mueller who have given much of their time in sharing their individual expertise and knowledge of Ayurveda. All this would not have been possible without the patient understanding and support of my partner. with an emphasis on the use of Ayurveda as a complementary medicine alongside today's modern medical systems. Margarita Sisam to whom my heartfelt thanks goes to.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 1. who has proved himself a very skilled learning facilitator. attention and perseverance over the last three years in facilitating my journey and understanding of Ayurvedic Medicine. It has been a privilege to spend time with a tutor who lives and practises the principles that he teaches. Acknowledgement I would like to acknowledge the staff and tutors at Wellpark College for their dedication. His depth of understanding of both Ayurveda and the modern medical systems have been invaluable throughout the course and his dedication and understanding of both classical and modern Ayurveda have added an extra depth to the learning experience. I especially wish to acknowledge the dedication and skills of Dr Vijayendra Srinivasa Murthy. Page 4 . . By the time this century had begun. perspective? Modern medicine is comparatively new in its approach to Cardiovascular Disease. which dates back over 5.. even cool observations of sick people. From the demands for the manufacture of these drugs grew the Is it possible to effectively use both from a complementary 2. Introduction This research paper focuses on a literary review of both the modern and Ayurvedic approaches to cardiovascular disease. objective.i” Modern medicine. as we know it today grew in prominence through several important landmark events over the last 80 years. diagnoses and treats some common cardiovascular diseases and finally discuss the commonalities and differences of approach. “The history of modern medicine starts sometime in the 1830s when a few courageous physicians acknowledged that virtually everything they did – bleeding. [to be replaced by] meticulous. so that patients and their families could be told not only the name of the illness but also. purging.000 years. with some reliability.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 2. Accurate diagnosis became the central purpose and justification for medicine and as the methods improved. prescribing complicated diets – was useless. Introduction Page 5 . James Le Fanu in The Rise & Fall or Modern Medicine says. it was becoming generally accepted as the principle responsibility of the physicians. having built up its understanding over the last 200 years in comparison to Ayurveda. how it was most likely to turn out. accurate prognosis also became possible. We will look at how each modality views. such as the discovery of Penicillin in 1941 and Cortisone in 1949. The distinguished medical commentator Lewis Thomas elaborates: Gradually over succeeding decades the traditional therapeutic ritual of medicine was given up. 2. due in some part to the serious side-effects of some drugs after being released to the public. all being integrated aspects. The symptoms however. which over the course of the last century grew to became a large and powerful industry. Introduction Page 6 . In the 1990 drug companies began to focus their attention on techniques for screening millions of chemical compounds for their biological activity. which date back to its inception.000 years and through this time has developed its own tried. hoping to identify the lead components that might have the sort of genuine therapeutic effect that could form the basis of new drugs. Over the last 2. By the 1960s over seventy new drugs were being introduced every year but by the 1970s that had reduced to less that 20 a year due to the introduction of legislation requiring much stricter means for testing drugs. some of which are considered controversial by modern medicine today.A Study of Cardiovascular Disease in Ayurveda John Vorstermans pharmaceutical industry. Ayurvedic medicine has also formed its own medicines based on herbs. which are involved in the pathology of a disease. Its focus is on treating the cause rather than just the symptoms. Like modern medicine it has a well developed and accurate diagnosis and prognosis framework for the helping the sick. give a good insight into the the underlying cause. minerals and metals. emotions and mind. Ayurveda recognises the person as a whole composite being and treats the person on the level of physical body. focusing much of its work on the the development and supply of a constant stream of new drugs for use in modern medicine. Ayurveda is a system that has been in use now for 5.000 years further medicines have been developed in Ayurveda using herbs. although they have a long proven record of success when used by indigenous Ayurvedic practitioners in their place of origin. from and Ayurvedic perspective. These medicines have proven to be effective in helping people with mild and chronic diseases over this time. tested and unique approach to health and disease. It will explore both systems of health and healing and where they are most useful for the well-being of the patient. In general it appears that Modern Medicine is suited well to deal with acute cardiovascular conditions while ayurveda is more suited to deal with cardiovascular disease in its earlier stages.A Study of Cardiovascular Disease in Ayurveda John Vorstermans This paper explores aspects of both the Modern and Ayurvedic approaches to selected cardiovascular diseases. Page 7 . benefiting from its unique understanding of the pathology of these diseases from an Ayurvedic perspective. A Study of Cardiovascular Disease in Ayurveda John Vorstermans 3. Aims and objectives. Look at similarities in both approaches. Analyse and present possibilities for use of Ayurveda as a complementary medicine in selected Cardiovascular Diseases. Look at the methods of how both approach the various Cardiovascular Diseases. Research the differences in each approach to Cardiovascular Disease. Study the treatment methods of each approach. Aims and objectives. Page 8 . 3. The objective is to: Study medical research completed in both modalities. The aim of this literature review is to compare side by side the approach of Modern Medicine with that of Ayurveda with regard to cardiovascular disease and to discuss the approach of each science to the development and treatment of the disease. K. Cardiomyopathy. Cardiology in Ayurveda by Dr V. 4.K. Included is an outline of the Ayurvedic and Modern Medical framework of CVD with particular focus on Arteriosclerosis. Heart Disorders & Their care in Ayurveda by Prof. diseases of the Aorta and its branches. Not included are Cardiovascular tests.B. Merck Manual. This is a literature review on Cardiovascular Disease from a Modern Medical and Ayurvedic perspective comparing and contrasting both approaches to Cardiovascular Disease. Ajay Kumar Sharma 3. Athavale 4. Understanding Pathology by Sue E. Charaka Samhita translated by R. High Blood Pressure. Sources: 1. venous and lymphatic disorders and cardiac tumours. Sastry and Dr. Page 9 .L. 5. McCance 6. Valvular disorders. Ayurvedic Management for Heart Diseases by Dr J.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 4. Peripheral arterial disease and Angina. Aneurysm. eighteenth edition Methods: Included in the study are a review of Cardiovascular Disease as relates primarily to the heart. Sharma and V Bhagwan Dash 2. Materials and Methods. although some references to these may be made as passing comments. Nistewar. Coronary Artery Disease. Arrhythmias. Pericardial disease. Materials and Methods. Huether & Katheryn L. endocarditus. Heart Failure. Current knowledge about Ayurveda is mostly drawn from relatively later writings. the Ashtang Hrdyam (approximately 500 AD). the sacred texts of India believed to be the oldest writings in the world. An Overview of Ayurveda This overview is provided to give some background understand of how Ayurveda looks at the human being and thereby create a meaningful context for the discussion later in the paper." The knowledge of Ayurveda is believed to be of Divine origin. being communicated to the saints and sages of India who received its wisdom through deep meditation.1 Brief History Ayurveda dates back around 5. the Vedas cover a vast number of subjects from grammar to health care.000 years and is widely considered to be the oldest form of health care in the world. Ayurvedic knowledge was thereafter passed down orally through the generations and then written down in the Vedas. primarily the Charaka Samhita (approximately 1500 BC). It is believed by many scholars that knowledge of Ayurveda spread out from India and influenced the ancient Chinese system of medicine. Written in Sanskrit.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 5. The Charaka Samhita is a monumental work comprising 120 chapters grouped into 5. They also contain vast clinical information on the management of a multitude of diseases expanded upon by later writings and research. and the Sushrut Samhita (300 . It is for this reason that Ayurveda is often referred to as the "Mother of all healing.400 AD). These three classics describe the basic principles and theories from which Ayurveda has evolved. 5. and the humoral medicine practised by Hippocrates of Greece. An Overview of Ayurveda Page 10 . The Vedas were written approximately 2500 BC or earlier. Unani medicine. 1 Mythological Personages The more mythological personages are seen today as the gods of Indian. 7. Siddhi ('Success') Sthana. An Overview of Ayurveda Page 11 . Nidana ('Diagnosis') Sthana. Sutra ('Aphorism') Sthana.2 Luminaries of Ayurveda Ayurveda has a long history and through this time has been influenced by many great personages. 6. 5. methodology and medical ethics. Eight chapters on anatomy and embryology and on 5. 3. metaphysiocs and ethics. Vimana ('Measure') Sthana. general principles. philosophy and theories. Chikitsa ('Treatment') Sthana. 2. including physiology. Twelve chapters on pharmacy 8. Twelve chapters on prognosis. Indriya ('Sense organ') Sthana. Sharira ('Body') Sthana.2. 5. Thirty chapters on Ayurveda's origin. Eight chapters on the cause and symptoms of disease. John Vorstermans 1. Such as: Brahma: Believed to have been the creator of the Universe and also the fountainhead of all knowledge. Eight chapters on many subjects. Kalpa ('Preparation') Sthana.A Study of Cardiovascular Disease in Ayurveda eight sections. 4. some going back so far in time that little evidence exists of them but the writing they left while others a better know. It is believed that the great Veda were propounded by him as well as the science of Ayurveda which was first taught of Prajapathi Daksha who passed this on to 5. Twelve chapters on purification therapy. Thirty chapters on therapeutics. belong to the linage of Both Charaka and Sushruta samhitas Atharvangirasa who was the propounder of Atharvaveda. the twin sons of Vivaswat (sun) came to be known as Aswinikumaras. mention many of their wonderful feats. Rigveda describes that Nasatya and Dasra. An Overview of Ayurveda Page 12 . Bhardhwaja. providing artificial limbs. They performed many wonderful feats including restoring youth.2. in the course of time 5. He came out of the ocean proficient in Ayurveda. Aswinikumaras: The twin deities still remain as an enigma to scholorship both ancient and modern.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Aswinis who in turn passed the knowledge onto Indra. Prajapathi Daksha: He learned Ayurveda from Brahma and passed on his knowledge to the two Aswins. During the time of the Rigveda they were considered as celestial physicians coming down to earth whenever propitiated by faithful men to cure their ills. then Agnivesha and so on. then to sage Bharadawja. Dhanwantari is one of the products of churning the milky ocean.2 Semi-historical personages Some of the Semi-historical personages of note are: Bharadhwaja: or Bharadhwaja Vagineya in full. Not much reference is available either in general Sanskrit literature or Ayurveda literature as to his contribution to the science of Ayurveda except as the preceptor of Aswins. According to the Ramayana and Mahabharata. substituting organs in the body. There are also other stories of Dhawantaris beginings but he is recognised as one of the first god physicians in the three worlds and has been considered by some an incarnation of the great god Vishnu. 5. then onto Punarvasu Atreya. Dhanwantari: Is a great celebrity in the field of Ayurveda about whom many different views are found in ancient Indian literature. Shounaka who wrote a treatise. Narada. John Vorstermans His name stands out in the Rigveda and Artharvaveda as well as in the Ramayana and Mahabharata. Shoundaka lanta of poisons and evil of inauspicious elements. the author of Graga samhita. Markandeya. on on law (Vaishtadharma shastra) and another on medicine (Vaishta samhita). the author of Jeevadana. Chyavana. he imparted it to other sages systematically lying the firm foundations of logical concepts. He is credited with two great achievements. He is credited with two great treatises. Vasista: one among the saptarrishis. a treatise on Ayurveda. available today. the author of Markeandeya Purana and a treatise on medicine – Nadi Prakasha dealing with the science of pulse. Vyasa or Krishna Dwaipayana Vyasa in full reputed to be the author of The later is quoted by Trimalla Bhatta in his yoga-tarangini but is not Mahabarata and Brahmasutra and founder of the Mimamsa school of philosophy. Sanatkumara. He also learnt Ayurveda from Bharadwaja. Having learnt the science of healing from Indra. a treatise on Ayurveda.A Study of Cardiovascular Disease in Ayurveda acquired great fame and became a Rishi. a treatise on medicine. An Overview of Ayurveda Page 13 . how wrote Kanada samhita. In his latter life he crossed the Vindhya mountains and settled in south India. There are of course many others such as Graga. Agastya: His name appears in the Tigveda as the author of several hymns. composed the Sanathakumara samhita which is part of Pancharatragama dealing with treatment of eye diseases. He is quoted as the medical author by Arunadata. he learnt Ayurveda from Bharadhwaja. the author of Narada samhita on music and Dhatulaksana on Ayurveda dealing with pulse reading. Kanda. having brought the heat of the sun to the earth for the benefit of living beings and also the science of healing. only one section of this 5. During the time of Sri Rama he was living in Chitrakoota mountains in South India. the book par-excellence on Kayachikitsa identifies itself as the teaching of Atreya. John Vorstermans Atri: Was another great sage. Some scholars believed he lived around 8th cent B. the Nadi pariksha which contains 150 versus on the study of the pulse. the school of surgery. The Sushruta Samhita that is extant now is shown by scholars to be not the 5. a treatise on medicine which is found quoted by later medical authors. He is said to have written Atri samhita. Sushruta: was the son of of Viswamitra and learnt the science of medicine from Divodasa. It is believed that he was the author of Agnivesha tanta which is not available today. Punarvasu Atreya: the son of sage Atri was well versed in many sciences.C. He was a great scholar of that time and was proficient in Ayurveda. A treatise on diagnosis and treatment of diseases embodying the teaching of Dattatreya by the name of Daditawanidhi is available today with commentary by Telugu. a composer of hymns and one of the saptarishas.A Study of Cardiovascular Disease in Ayurveda work is now available. especially Kayachikitsa. Agni nidana giving a few important symptoms to almost every disease under Kayachilitsa. He is the father of Punarvasu Atreya and Dattatreya. Divodasa: was the king of Kashi. An Overview of Ayurveda Page 14 . Further authors are Bhela who wrote a treatise on medicine called Bheda samhita which parts of are still available and is said to be comparible to the Charaka Samhita. Dattatreya: the son of Atri is said to be an incarnation of Vishnu and worshipped as such even today. He is the founder of Salya Chikitsa. Charaka samhita. mature in philosophy and a teacher of the science of medicine. Agnivesha: The illustrious pupil of Punarvasu Atreya composed a treatise embodying the teachings of his preceptor. the metallurgist and 3) Bhadanta Nagarjuna. the aphorisms of the Yoga school of philosophy. 3)Loha Sastra. that Charaka was the court physician of king Kanishka. which deals with one of the fundamental theories in Ayurveda. eye diseases. tumours. 5. Pantanjali as there are a number of individuals by this name.) the author of Rasavaiseshika Sutra. Nagarjuna: is the name referring to three great scientists of India. (1st Century A. Thus it could be a name of several personages. Some say The reputed teacher of Jivaka the famous Charaka and Patanjali.C. the six tastes. the grammarian are identical. It is said he affected wonderful cures in dropsy.3 Historical Personages Bhikshu Atreya: (7th Century B. Charaka: Agnivesha Samhita written by Agnivesha embodying the teaching of Punarvasu Atreya is now available not in its original name but in the name of its redactor the celebrated Charaka.D. a treatise on metallurgy and 4) as the redactor or commentator of Charaka Samhita.) was the well known physician of Buddha.A Study of Cardiovascular Disease in Ayurveda John Vorstermans original treatise written by Sushruta but a revised and redacted version of it. 2) the Yoga Sutras.C. An Overview of Ayurveda Page 15 . It is not sure if Charaka was a person or a school to which he belonged or a title given to someone. 2) Siddha Nagarjuna. Jeevaka: (6th Century B. Pantanjali: In ancient Indian literature we come across this revered name as the author of 1) Mahabhasya – a commentary on Vyakarana sutra of Panini. It is uncertain of the identity of 5. swelling glands and even performed cranial operations.) physician of the Buddha. 1) the Buddhist monk Nagarjuna who was also an alchemist. He studied medicine for seven years at the famous University of Takshashila from the reknowned physician by name Bhikshu Athreya.2. Vagbhata: author of Asthanga Sangraha. 5. Ayurveda gained ground and new schools began to be established. It was a first attempt to produce books from a subject perspective. After India gained its independence in 1947. Europe and later New Zealand.). More than five hundred Ayurvedic companies and hospitals have opened in the last ten years. Interest in Ayurveda in the West began in the mid 1970's as Ayurvedic teachers from India began visiting the United States. By sharing their 5.) wrote the famous book Rugvinischata known today as Madhavanidana.) A notable name in veterinary medicine in ancient India. it went through a period of decline in India when Western medical education became dominant during the era of British rule.D. No longer available in full. Bhattara Harichandra (4th . An Overview of Ayurveda Page 16 . and several hundred schools have been established. the trend toward complementary care is emerging. Little is known of author or dates.D. Ayurveda became a second-class option used primarily by traditional spiritual practitioners and the poor. Although Ayurveda remains a secondary system of health care in India. He produced the Palakapya Samhita or Hastuayurveda. Madhavakara: (8th Century A.3 Recent History Before Ayurveda began its recent growth in the West. many authors with same name. a large work on elephants describing in detail their diseases and treatment both medical and surgical.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Palakapya: (1st or 2nd Century A.5th A. Asthanga Hridaya and Rasaratna Samuchaya. and Western and Ayurvedic physicians often work side by side.D. Wrote a commentary on Charaka Samhita called Charaka Nyasa which is the earliest known commentary on this treatise. improper food combinations and choices. A fundamental aim of Ayurveda is to prevent illnesses by timely adherence to a natural way of life that falls within the bounds of a person's nature. the Ayurvedic approach is very individualised. Ayurveda defines disease as the natural end result of living out of harmony with our original constitution (prakruti). or seasonal and weather changes. Ayurveda is a science of self-understanding.4 An Overview of Ayurvedic Anatomy and Physiology The Western allopathic medicine is based on a medical model of the human being. which brings about changes in our original constitution that may lead to disorders and disease. 5. both internal and external. Therefore. Australia. depending upon their unique constitution or prakruti. Many factors. can disturb our delicate balance. we can take appropriate actions to nullify or minimise their effects and eliminate the causes of imbalance. An Overview of Ayurveda Page 17 . since the path to good health is different for each person. Ayurveda looks at the human body as being an integral part of nature and is based on the theory of biological humors and body energies. It considers only the physical body and treats the mind as a physical entity.A Study of Cardiovascular Disease in Ayurveda John Vorstermans knowledge they have inspired a vast movement toward body-mind-spirit medicine. By understanding our own unique nature or constitution we can begin to understand how we interact with our environment and thus make choices that will lead us toward greater health. New Zealand and the United States. physical trauma. Today Ayurvedic colleges are opening throughout Europe. Some of these factors include emotional and physical stresses. Once we understand how these factors affect us on a constitutional level. This helps it to get to the root of the problem rather than simply addressing the symptoms. 5. Pitta and Kapha. called doshas . They co-ordinate. The Vata nature notably has these attributes: • • Cold Light • • Quick Subtle • • Dry Mobile • • Rough Hard Pitta Dosha Pitta Dosha is associated with the transformations in the body.Vata. The Pitta nature notably has these attributes: • • Hot Light • • Sharp Flowing • • Moist Liquid • • Sour Slightly Oily Kapha Dosha 5. Vata signifies the kinetic energy of the body.A Study of Cardiovascular Disease in Ayurveda Ayurveda looks at the human from the following perspective: John Vorstermans 5. Vata Dosha Vata Dosha is associated with motions. transportation and electromagnetic activities. control and direct all the biological functions of human body and therefore are considered extremely important. It controls digestion of food and is responsible for emotions. Pitta represents the fire principle. An Overview of Ayurveda Page 18 . these qualities appear in human beings. In different proportions.5 Doshas (Bodily Humors) According to Ayurveda the functional aspects of the body are determined by three biological humors. This knowledge plays a crucial role in the diagnosis and treatment in Ayurveda. It deals with the chemical changes taking place in a body including consumption and conversion. Depending on the anatomy and body function. A perfect balance of these three Doshas are important in maintaining a healthy life. Since Pitta and Kapha cannot move without it. This Dosha signifies the potential energy of the body. heart rhythm. perspiration. Vata is considered the leader of the three Ayurvedic principles in the body. Pitta and Kapha • Vyana Vata: Blood flow.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Kapha follows the principle of water and earth. sense of touch 5. elimination of wastes. Each of them has different significance and a different quality. 5. each of which has a special function in relation to the main dosha. An Overview of Ayurveda Page 19 .6 Sub-Doshas As well as the above doshas. breathing and the movement of thoughts across the mind. Ayurveda divides each dosha into a further five subdoshas. Vata Vata governs all movement in the mind and body. creative thinking. leader of all 15 categories of Vata. It controls such things as blood flow. The Kapha nature notably has these attributes: • • Heavy Oily • • Sweet Cold • • Steady Slow • • Soft Slimy All these Doshas are connected with life. These are the sub-categories or sub-doshas under Vata – • Prana Vata: The senses. enthusiasm. five types of Kapha Doshas have been identified. reasoning. bones. and directs all biochemical reactions and the process of energy exchange. growth. metabolism for healthy nutrients and tissues Ranjaka Pitta: Healthy. movement of thoughts Samana Vata. menstrual cycle Pitta Pitta governs bodily functions concerned with heat and metabolism. and how we discriminate between right and wrong. and formation of all the seven tissues – nutritive fluids. lubrication for the joints and lungs. muscles. spirituality Kapha Kapha governs the structure and cohesion of the organism. drive. Pitta controls how we digest foods. For example. blood. It is responsible for biological strength. natural tissue resistance. Pitta governs the important digestive "Agnis" or fires of the body. fat. An Overview of Ayurveda Page 20 . assimilation. how we metabolize our sensory perceptions.A Study of Cardiovascular Disease in Ayurveda • • • John Vorstermans Udana Vata: Quality of voice. memory. and proper body structure. These are the sub-doshas of Kapha – 5. marrow and reproductive tissues. It controls weight. toxin-free blood Alochaka Pitta: Functioning of the eyes Bhrajaka Pitta: Healthy glow of the skin Sadhaka Pitta: Desire. Movement of food through digestive tract Apana Vata: Elimination of wastes. sexual function. decisiveness. Pitta dosha is further divided into the following sub-doshas – • • • • • Pachaka Pitta: Digestion. It also governs lubrication in the mind and body. A Study of Cardiovascular Disease in Ayurveda • • • • • • John Vorstermans Kledaka Kapha: Moisture of the stomach lining for good digestion Avalambaka Kapha: Protects the heart. They are • • • • • • • Rasa . An Overview of Ayurveda . eyes and brain Bhodaka Kapha: Sense of taste. as well as maintenance of the structure of the mind. healthy lungs Sleshaka Kapha: Lubrication of the joints. there are seven Dhatus in our body. which means "foundation". Mala and Agni.fat tissues Asthi . Dhatu.muscle Meda .7 Dhatus (Tissues) According to the basic fundamentals of Ayurveda. strong muscles. Dhatus provide nourishment to tissues. our body is composed of four basic factors .semen Page 21 5. It helps in the growth. The function of Dhatu is to support the body by providing basic nutrition. According to Ayurveda.bone Majja . The root of the word "Dhatu" is "Dha". which is essential for good digestion 5.Dosha. soft and supple skin Tarpaka Kapha: Moisture for nose.marrow Shukra .plasma Rakta . mouth.blood Mamsa . These srotases carry food. Different body parts as well as organs are made of Dhatus. It is important to note that as they form a chain system in our body this points to one thing . air and water. air and thoughts. Charaka Samhita. and then transformed to another. In this way. rakta vaha srotas (circulatory system) and the prana vaha srotas (respiratory system). The formation and maintenance of each of these Dhatus. it will in turn affect the other tissues. An Overview of Ayurveda Page 22 .if the first tissue is not formed properly.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Each Dhatu is developed from the previous Dhatu. seven srotases associated with dhatus. Any disturbance in the equilibrium of these Dhatus causes disease. lists thirteen srotases in his book. water. and their perfect balance is very important for our health. Presently there are sixteen srotases identified. the Dhatus form a chain system in our body. Only three srotases or channels are recognized by modern medical science – they are the anna vaha srotas (the digestive system).8 Srotases (Bodily Channels) Srotases or channels are present in all living things. 5. Significance of Dhatu Dhatus are the foundation for growth and existence. minerals. Three srotases for food. and three srotases for excretion. The first three srotases are: Prana vaha srotas carries breath Anna vaha srotas carries solid and liquid food Udaka vaha srotas carries water in the body 5. A block in a srotases is the beginning of diseases. They exist in multiple forms. They are known as Malas because their main characteristic is to detoxify. Shukra vaha srotas supplies nutrients to sexual organs and carries reproductive cells and liquids. the nervous system and the brain.A Study of Cardiovascular Disease in Ayurveda The seven srotases associated with dhatus are: Rasa vaha srotas carries plasma and lymphatic liquid Rakta vaha srotas carries blood – circulatory system Mamsa vaha srotas carries nutrients to and from muscle tissue Meda vaha srotas supplies fat to adipose tissues Asthi vaha srotas supplies nutrients to bones John Vorstermans Majja vaha srotas supplies nutrients to bone marrow. An Overview of Ayurveda Page 23 . It is necessary to remove these waste products in order to 5. The three srotases associated with malas (excretion) are: Purisha vaha srotas carries feces Mutra vaha srotas carries urine Sveda vaha srotas carries sweat The three additional srotases that are not described in Charaka Samhita are: Two women-only srotases are: Artava vaha srotas carries menstrual fluids Stanya vaha srotas carries breast milk One srotas associated with mind is: Mano vaha srotas carrying thoughts and wisdom 5. The metabolic activities going on in the body will result in the excretory by-products.9 Mala (Waste products) The waste products of the body are called Malas. An Overview of Ayurveda Page 24 . There are three main types of Malas. Ayurveda classifies Agni into thirteen forms of which the most important is Jatharagni. 5. Dushyas These can cause an imbalance in the doshas and can cause diseases. So the balance of Agni with the other factors is important for a fit and healthy body. This is essential in maintaining proper health.10 Agni (Digestive Fire) The meaning of Agni is fire. The digestive power and immune system depends on the proper functioning of Agni. The waste products formed out of the food should be removed at appropriate intervals. Ayurveda calls the biological fire Agni. Help in carrying out the metabolic reactions of the body. The metabolic activities as well as the digestive activities of the body take place with the help of Agni. The main function of Jatharagni is to take part in the digestion process and 5. • • • Purisha (Stool) Mutra (Urine) Sweda (Sweat) The essence of the ingested food will nourish the tissues. John Vorstermans The main excretory products of the body are also known as. The main functions of Agni are to: • • • Take the essence of nourishment from food. Help the immune system by destroying harmful organisms and toxins.A Study of Cardiovascular Disease in Ayurveda maintain a healthy body. The various enzymes present in the body can be considered as aspects of Agni. Thus the person remains in a state of good mental and physical health.11 Prakriti Unlike other medicinal systems. Ayurveda is interested in the individual. It is determined at the time of conjugation of the male seed (sperm) and female egg (ovum). Ayurveda tradition gives particular emphasis to the condition of body as well as mind. 5. John Vorstermans To maintain fitness we have to understand the key factors in maintaining the balance of the Agni in the human body. Prakriti and Vikriti By Prakriti. A state of disease occurs whenever there is a deviation from the normal physical or mental constitution of a human being. This is often called a Vikriti. The Individual Constitution Ayurveda believes that the constitution of a humanbeing is genetic in origin. fire. excellent circulation of nutrition and proper tissue formation. When Agni is healthy there will be good digestion. not only the disease. 5.A Study of Cardiovascular Disease in Ayurveda separate nutrients from waste products. Then it examines the diseased state or Vikriti. According to Vedic wisdom. Ayurveda means the individual constitution of the human body. every material object in this universe is composed of five elements called Pancha Mahabhutas (ether. air. Ayurveda examines the Prakriti first. During the diagnosis and treatment. During diagnosis. The resulting embryo then carries the individual constitution of the parents. water. Ayurveda treats the individual as a whole. proper elimination of waste products. An Overview of Ayurveda But for the Page 25 . earth). These doshas need not be present in equal proportion in an individual to ensure balance. An Overview of Ayurveda Page 26 . the natural balance of the doshas in an individual can be disturbed by a 5. 5.A Study of Cardiovascular Disease in Ayurveda John Vorstermans functioning of living beings. but they need to be functioning in harmony with each other. when Pitta is in balance in an individual. Ayurveda identifies Tri Doshas (Tri = three) for body constitution and Tri Gunas responsible for mental constitution. but an aggravated Pitta can result in ulcers and acid indigestion. each individual will have a unique Prakriti. Tri Doshas • • • Vata Pitta Kapha Tri Gunas • • • Satva Rajas Tamas Different individuals will have different combinations of these doshas and therefore. Ayurveda treats these doshas as the manifestation of five elements in the human body. disorders stem from an excess of a dosha or a shortage of a dosha. digestion is normal.12 Restoring Balance An individual may have a natural predominance of one or more doshas. According to Ayurveda. whereas maintaining balance of the doshas results in good health. Over time. For example. through dietary and lifestyle recommendations as well as herbal formulations. poor digestion. but the underlying imbalance. such as improper diet. 5. The goal is not to treat surface symptoms. thus creating long-term health and a strong immune system. An Overview of Ayurveda Page 27 . high day-to-day stress levels and environmental pollution and chemicals. The Ayurvedic approach to health is all about restoring this natural balance.A Study of Cardiovascular Disease in Ayurveda John Vorstermans number of factors. e. An Overview of Ayurveda Page 28 . Force & Ego Inertia & Negativity Dosha Humour 3 in number Dhatu Tissues 7 in number Mala Excretory Material 3 in number Purusha Stools Mutra Urine Sweda Sweat Vata dosha Agency of Propulsion Pitta dosha Agency of Conversion Kapha dosha Agency of Cohesion Rasa Lymph Plasma Rakta RBCs (for keeping life (for nourishment) force) Mamsa Muscle Tissue (for covering of body & other tissues) Meda Fat Tissue (for keeping the body slimy) Asthi Bone (for support of body) Majja Bone Marrow & Brain. Tamas i. Nerves Shukra Semen Ovum (for reproduction (for filling up & enjoyment) the space specifically in deep bone tissue) Table 1 The Human Body 5.e.e.A Study of Cardiovascular Disease in Ayurveda John Vorstermans The Human Body is made up of 5 Elements Time Direction Mind Soul 3 Qualities Sattva i. Knowledge & Positivism Rajas i. In Figure 1a . However.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. 6. Literature Review. Another almost 20% is from stroke. CV diseases are generally uncommon in the very young and the statistics generally begin around age 20. or sudden cardiac death (discussed in more detail below). but in 75% of the cases it is a consequence of extensive heart damage following a heart attack.Prevalence of CV Diseases in Men and Women 20 years of age and older–source AHA women the prevalence is about 5% at age 20 and increases also to 80% by age 75. there are distinct prevalence of CV Diseases in Men and differences between men and women in the years. The frequency increases dramatically with age. The third most common cause of death. As you can see.1 Cardiovascular Disease statistics. Page 29 . More than half of the deaths in the USA and New Zealand are due to coronary Cardiovascular Disease or “hardening of the arteries” resulting in heart attacks and what is called SCD. The frequency in women remains generally lower than in men until 6. the prevalence is only about 6% at age 20 and increases to 80% by age 75. congestive heart failure (pump failure) has a number of causes. In men. Literature Review. What is the frequency of cardiovascular diseases related to age and gender? The prevalence (frequency) of cardiovascular (CV) diseases in the US is shown in the figure below. Thus nearly 80% of deaths from cardiovascular disease come from diseases that take years to become clinically apparent and are caused by the development of atherosclerotic plaque in the heart and its arteries (coronary arteries) or in the arteries that supply blood to the brain. Coronary Cardiovascular Disease rates in women after menopause are 2-3 times those of women the same age before menopause. Coronary Cardiovascular Disease caused more than 1 of every 5 deaths in the United States in 2001. Cardiovascular Disease and general atherosclerotic disease (the most common causes of CV disease deaths) increases in frequency as we get older. which is mainly Cardiovascular Disease related. This year an estimated 700. Depending on their age and clinical outcome. accounting for 19% of disability allowances by the Social Security Administration. permanent disability in the US labour force.A Study of Cardiovascular Disease in Ayurveda John Vorstermans around age 50 (the timing of the onset of menopause) and then accelerate to equal that of men. is roughly ten years behind that of men of the same age. Symptomatic atherosclerotic disease takes years to develop. Between the ages of 25 and 55. Page 30 . Coronary Cardiovascular Disease is the leading cause of premature.5 to 15 times higher than that of the general population.000 Americans will have a initial heart attack. About 500. Literature Review. although data in heart transplant donors (who died mostly from accidents or suicide) have shown that 25% of teenagers already have developed some atherosclerotic plaque in their coronary arteries. the prevalence of CV disease in women. The lifetime risk of developing coronary Cardiovascular Disease after age 40 is 49% for men and 32% for women.000 will have a recurrent heart attack. people who survive a first heart attack have a risk of hospitalization or death that is 1. Within 6 years of a first heart attack: • 18% of men and 35% of women will have a second heart attack • 7% of men and 6% of women will experience sudden cardiac death • 22% of men and 46% of women will be disabled with heart failure • 8% of men and 11% of women will have a stroke 6. these diseases are and will remain the number one cause of death in industrialized countries. do not resolve spontaneously. Males accounted for 53. In 2002. with 6287 deaths. In 2003. Chronic diseases are illnesses that are prolonged. morbidity. Males accounted for 52. Cardiovascular diseases are preventable. and the calculated Māori female rate was 92 percent higher than the non-Māori female rate.2 History of Cardiovascular Disease Cardiovascular disease is an established chronic disease for the population of developed and developing countries. The major cardiovascular diseases are coronary Cardiovascular Disease (CHD). Despite the gradual decline in cardiovascular death rates over the last few decades. and are rarely cured completely. Literature Review. myocardial infarction (MI). Ischaemic heart disease was the second leading cause of death after cancer in 2003.3 percent of these deaths. and health care cost. stroke and congestive heart failure (CHF). and the calculated Māori female rate was 84 percent higher than the non-Māori female rate. 6. but the male agestandardised rate was almost twice the female rate in 2002. the calculated Māori male age-standardised rate of death from ischaemic heart disease was 97 percent higher than the non-Māori male rate.A Study of Cardiovascular Disease in Ayurveda Cardiovascular disease in New Zealand [Mortality] John Vorstermans Ischaemic heart disease was the second leading cause of death after cancer in 2002.1.0 percent of these deaths. Cardiovascular disease refers to variety of diseases and conditions affecting the heart and blood vessels. with 6196 deaths. the calculated Māori male age-standardised rate of death from ischaemic heart disease was 120 percent higher than the non-Māori male rate. This disease causes a significant burden in mortality. 6. Page 31 . A Study of Cardiovascular Disease in Ayurveda John Vorstermans In this region, 48.6 percent of deaths were caused by cardiovascular disease in the year 2000 (WHO1, 2002). By 2020, 46.4 percent deaths are expected to be attributable to CVD in this region. Moreover, CVD will soon become the main cause of death and disability in the developing world as well; by 2020, a third (33.8 percent) of all deaths are expected to be due to CVD (WHO, 2002). In the year 2000, 16.7 million people died from CVD, accounting for 30.3 percent of all deaths worldwide; more than half of these deaths were in developing countries (WHO, 2001). Not only is cardiovascular disease a considerable health burden (e.g. high morbidity and high mortality), it causes also a significant health care cost (i.e. economic burden), which will continue to grow as the population ages. The ongoing economic and technological developments taking place in the developing countries will in all likelihood cause the pattern seen in developed world to be repeated. The epidemic of cardiovascular disease is expected initially to emerge in those who are wealthy and subsequently to spread to those who are less wealthy. Likewise, when the epidemic starts to slow, this will first become apparent among the affluent, with the disease continuing to have a high prevalence in those who live in poverty. The burden of CVD, although already high in developed world, is therefore expected to increase on a global scale as the developing countries start to contribute significantly to this (WHO, 2002). The presence of rising CVD underscores the imperative need to develop effective and appropriate prevention policies.ii 1 WHO = World Health Organisation 6. Literature Review. Page 32 A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6.2 Cardiovascular Disease. 6.2.1 Overview Cardiovascular disease is a term used to describe a large range of diseases that affect the heart or blood vessels. There are various diseases considered as cardiovascular disease includes coronary artery disease, heart attack, heart failure, high blood pressure and stroke. The term "cardiovascular disease" is often used interchangeably with “heart disease” because both terms refer to diseases of the heart or arteries. Whatever name is used — cardiovascular disease or heart disease – it is clear that diseases of the heart and blood vessels are serious problems. Cardiovascular disease is the No. 1 worldwide killer of men and women, as mention previously under “Cardiovascular Disease Statistics” 6.2.2 Cardiovascular Disease from a Medical Perspective Cardiovascular disease refers to many different types of heart or blood vessel problems. It is used most often to describe damage caused to the heart or blood vessels by atherosclerosis. This is a disease that affects the arteries. Arteries are blood vessels that carry oxygen and nutrients from your heart to the rest of the body. Healthy arteries are flexible, strong and elastic. Over time, however, too much pressure in the arteries can make the walls thick and stiff — sometimes restricting blood flow to the organs and tissues. This process is called arteriosclerosis, or hardening of the arteries, and atherosclerosis is the most common form of this disorder. 6. Literature Review. Page 33 A Study of Cardiovascular Disease in Ayurveda John Vorstermans The ultimately causes of atherosclerosis are an unhealthy diet (lots of saturated fats), lack of exercise, being overweight and smoking. All of these are major risk factors for developing atherosclerosis and, in turn, cardiovascular disease. Some forms of cardiovascular disease are not caused by atherosclerosis. Those forms include diseases such as congenital Cardiovascular Disease, heart valve diseases, heart infections or disease of the heart muscle called cardiomyopathy. Causative Theory There are two main theories about why atherosclerosis develops: 1. High levels of cholesterol in the blood injure the artery's lining, causing an inflammatory reaction and enabling cholesterol and other fatty materials to accumulate there. 2. Repeated injury to the artery's wall may occur through various mechanisms involving the immune system or through direct toxicity. In both cases, there are changes that can lead to the formation of atheromas. The two theories are probably interrelated and are not mutually exclusive. ”Infection may have a role in the development of atherosclerosis. infection may be due to The bacteria (Chlamydia pneumoniae, which can cause pneumonia, or Helicobacter pylori, which can contribute to stomach ulcers) or to a virus (as yet unidentified). Infection may Figure 1 – Formation of atheromas in arteries. 6. Literature Review. Page 34 Sannipatika Sanghatabalapravrutta: (a) Traumatic. Each of these three layers of the heart can be affected by one or all of the doshas. Endocarditis. Daivabalakruta: Table 2 . embryologically. bad luck due to bad deeds of previous lives.iii John Vorstermans 6. The diseases of each organ are classified and treated according to the tissue (dhatu) and dosha affected. Ayurveda classifies Cardiovascular Disease under the following: Adibalapravrutta: Janmabalapravrutta: Doshabala pravrutta: Hereditary Cardiovascular Disease e.g. For example. death Psychological factors leading to Cardiovascular Disease or hypertension Idoipathic. ageing.g. if it is a Vata disorder then this will lead to valvular 6. Looking at the endocardium. metabolic diseases Congenital Cardiovascular Disease Vata.A Study of Cardiovascular Disease in Ayurveda damage the lining of the artery's wall.. Myocardium is derived from muscular tissue (Mamsa) and pericardium is derived from fatty (Meda) and connective tissue.g. Myocarditis. Kapha. enabling atherosclerosis to begin.3 Cardiovascular Disease from an Ayurvedic Perspective. (b) Poisoning Kalabalapravrutta: Upasargaja: Environmental or seasonal Infectious Pericarditis Swabhavabalakruta: Adhyatmika: Natural diseases e. endocardium is derived from Rasa and Rakta dhatus. Page 35 .Ayurveda Cardiovascular Disease. Pitta. Literature Review. diseases e.2. which can damage the arteries and cause atherosclerosis. usually from a lifetime of unhealthy habits.2. such as smoking. 6. glycogen storage diseases. If Pitta is effected then we would include bacterial endocarditis and if Kapha the endocardial fibroelastosis. and Kapha to atherosclerosis changes.A Study of Cardiovascular Disease in Ayurveda John Vorstermans affections like aortic and mitral stenosis and regurgitation. if they involved Vata then we would see atrophy or fibrosis of the heart muscle which would result in dilation of the heart. if Pitta then specific or non-specific arteritis. Literature Review.4 Types of cardiovascular disease The cardiovascular system consists of the heart and all blood vessels throughout the body. it gives rise to angina pectoris. For each of the above classifications of Cardiovascular Disease Ayurveda has a different treatment approach. Some specific terms used to describe the various forms of cardiovascular disease are: 6. For diseases of the myocardium. It would be treated by strengthening Rasa and Rakta and restoring the balance to the Doshas involved. Diseases ranging from aneurysms to valve disease are types of cardiovascular disease. A person may be born with some types of cardiovascular disease (congenital) or acquire others later on. For diseases affecting the coronary arteries. If Pitta is involved then we would see myocarditis and with Kapha. if a Vata disorder. Page 36 . hypertrophy of heart muscle as well as for example. The treatment in these cases would look at strengthening the muscular tissue (Mamsa) and treating the affected Doshas. Coronary artery disease and the resulting reduced blood flow to the heart muscle can lead to other heart problems." often abbreviated MI. such as chest pain (angina) and heart attack (myocardial infarction). a largely preventable type of vascular disease. Deposits of lipids and calcium represents deposition of Kapha (water & earth element) in the degenerated vessels resulting in irregular thickening of blood vessels. Ayurveda views atherosclerosis according to the symptoms. Ayurveda therefore concludes that this disease is caused by an increase of Vata and vitiation of Kapha in the blood vessels. John Vorstermans This is a common form of cardiovascular disease. Degeneration of the blood vessels is caused by increased Vata in the blood vessels. Figure 2 – Coronary Artery Disease causing heart attack A heart attack (see Figure 2) is an injury to the heart muscle caused by a loss of blood supply. dry and rough. Sometimes known as CAD.A Study of Cardiovascular Disease in Ayurveda Coronary artery disease. which make them hard. coronary artery disease is the leading cause of heart attacks. The medical term for heart attack is "myocardial infarction. reducing blood flow to the heart muscle. It generally means that blood flow through the coronary arteries has become obstructed. Literature Review. thin. Heart attack. Page 37 . The most common cause of such obstructions is a condition called atherosclerosis. Coronary artery diseases are diseases of the arteries that supply the heart muscle with blood. A heart attack usually occurs when a blood clot blocks the flow of blood through a coronary 6. Literature Review. while others occur for reasons that are less well understood. which means the cause is unknown. Types of cardiomyopathy include ischemic. Ayurveda would look at this as being associated with a pathology of Mamsa dhatu and a blockage. Congenital heart disease. Interrupted blood flow to your heart can damage or destroy a part of the heart muscle. These diseases can affect the formation of the heart muscle or its chambers or valves. dilated. Cardiomyopathy Cardiomyopathy means diseases of the heart muscle. 6. while others may not be detected until later in life. Some congenital heart defects may be apparent at birth. which is caused by loss of heart muscle from reduced coronary blood flow. Cardiomyopathy idiopathic dilated cardiomyopathy — an enlarged heart without a known cause. Congenital heart disease is a broad term and includes a wide range of diseases and conditions. Congenital heart disease refers to a form of heart disease that develops before birth (congenital). One of the most common types of cardiomyopathy is Figure 3 .A Study of Cardiovascular Disease in Ayurveda John Vorstermans artery — a blood vessel that feeds blood to a part of the heart muscle. means muscle is thickened. the heart hypertrophic. Some types of cardiomyopathy are genetic. which means the heart chambers which are enlarged. Page 38 . and idiopathic. They include such conditions as narrowing of a section of the aorta (coarctation) or holes in the heart (atrial or ventricular septal defect). caused by toxins in the Mamsa Vaha srotas. The most common sites include the abdominal aorta and the arteries at the base of the brain. Aneurysms can occur in arteries in any location in your body. fluid accumulation (pericardial effusion) and 6. Pericardial disorders include inflammation (pericarditis). You may be born with valvular disease. infections (infectious endocarditis). These are diseases of the heart valves. Aneurysms usually get bigger over time. Because of that. Four valves within your heart keep blood flowing in the right direction. they have the potential to rupture and cause life-threatening bleeding. Pericardial diseases. These are diseases of the sac that encases the heart (pericardium). connective tissue disorders. and certain medications or radiation treatments for cancer. John Vorstermans Figure 4 Aneursyms Ayurveda classifies aneurysm as gulma and understands that this is caused by weakness of muscular tissue (Mamsa) and an increase in Vata. or the valves may be damaged by such conditions as rheumatic fever. An aneurysm is a bulge or weakness in a blood vessel (artery or vein) wall.A Study of Cardiovascular Disease in Ayurveda Aneurysm. leaking (regurgitation or insufficiency) or improper closing (prolapse). Page 39 . Valvular heart diseases. Literature Review. Valves may be damaged by a variety of conditions leading to narrowing (stenosis). pericarditis can occur after a heart attack and. Ayurveda recognises that a mild disturbance in the balance of Vata. It may occur as a result of other cardiovascular conditions that have damaged or weakened the heart. For instance.A Study of Cardiovascular Disease in Ayurveda stiffness (constrictive pericarditis). Heart failure. while fluid fluid accumulation (pericardial effusion) with Kapha and stiffness (constrictive pericarditis) with Vata. The causes of pericardial disease vary. Not all heart failure is congestive. is a condition in which the heart can't pump enough blood to meet the needs of your body's organs and tissues. lead to pericardial effusion or chest pain. John Vorstermans Figure 5 Pericardial effusion From and Ayurvedic perspective the inflammation (pericarditis) is associated with Pitta. often called congestive heart failure. such as coronary artery disease or cardiomyopathy. "Congestive" heart failure is technically reserved for situations in which heart failure has led to fluid buildup in the body. With this less effective pumping. as do the problems they may lead to. Heart failure may develop suddenly or over many years. These can occur alone or together. Heart failure. Literature Review. vital organs don't get Figure 6 Congestive Heart Failure enough blood. but the terms are often used interchangeably. Page 40 . Pitta and 6. causing such signs and symptoms as shortness of breath. fluid retention and fatigue. as a result. It doesn't mean your heart has failed and can't pump blood at all. Pitta and Kapha in the heart muscle give rise to uncompensated heart failure. Literature Review. Although potentially life-threatening. High blood pressure. Sharma suggests that Rakta Vata is Figure 7 Blood Pressure possibly the most appropriate ayurvedic equivalent. Page 41 . such as stroke and heart failure. A stroke occurs when blood flow to the brain is interrupted (ischemic stroke) or when 6. Stroke. it's one of the most preventable and treatable types of cardiovascular disease. High blood pressure (hypertension) is the excessive force of blood pumping through your blood vessels. which is usually compensated by augmenting the heart rate and increasing the force of ventricular contraction.V. The cause is generally due to a low agni which causes toxins (ama) along with increased Kapha and deposits of fat like substances in the blood vessels in the body resulting an disturbance of Vyana Vata in Rasa and Raktavaha srotas which triggers hypertension. P. Ayurveda has no corresponding condition in the ancient texts. High blood pressure also causes many other types of cardiovascular disease. It's perhaps the most common form of cardiovascular disease in the Western world. rather the varying symptoms are described in various sections. Marked disturbance in the balanced state of Vata. affecting about one in four Americans.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Kapha in the heat muscle results in the impairment of the cardiac function. claudication is a symptom of peripheral arterial disease.A Study of Cardiovascular Disease in Ayurveda John Vorstermans a blood vessel in the brain ruptures (hemorrhagic stroke). Both can cause the death of brain cells in the affected areas. you may have such symptoms as pain in your legs only during strenuous exercise. However. When this happens. claudication is often referred to as a disease itself. Peripheral arterial disease and claudication. too slow or irregularly. such as high blood pressure. Page 42 . Heart rhythm problems (arrhythmias) occur when the electrical impulses in your heart that coordinate your heartbeats don't function properly." Strictly speaking. Stroke is also considered a neurological disorder because of the many complications it causes. Other forms of cardiovascular disease. your legs receive less blood than they need to keep up with demand. You may be more familiar with the term "claudication" — which usually refers to pain in your legs during exercise — than you are the term "peripheral arterial disease. Arrhythmias. increase your risk of stroke. causing your heart to beat too fast. Figure 8 Peripheral arterial disease When the obstruction is mild. 6. As the disease progresses and arteries become more obstructed. Other forms of cardiovascular disease can cause arrhythmias. Literature Review. Peripheral arterial disease is a disorder in which the arteries supplying blood to your limbs — usually your legs — become narrowed or blocked. you may have pain or cramping in your legs even at rest. Claudication may then develop. increases calcium flux in arterial smooth muscle or impaired production or release of prostaglandin or thromboxane. Pain is caused by vasospasm of one or more major coronary arteries with or without associated atherosclerosis. It is usually experienced by chest discomfort ranging from a sensation of heaviness or pressure to moderately severe pain. Silent Ischemia. or occasionally to the back or down the right arm. People who do not experience angina often have silent episodes of myocardial ischemia. so that affected vessels cannot dilate in response to increased myocardial demand associated with physical exertion or emotional stress. Discomfort is commonly mistaken for indigestion.A Study of Cardiovascular Disease in Ayurveda Stable Angina John Vorstermans Also known as Angina pectoris is chest pain caused by myocardial ischemia. Prinzmetal angina is chest pain attributed to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest. Mental Stress induced Ischemia. The pain often occurs at nigh during rapid eye-movement sleep and may have a cyclic pattern of occurrence. Ischemia can be totally asymptomatic which is referred to as silent ischemia. Prinzmetal angina. left arm and left shoulder. Stable angina is caused by gradual luminal narrowing and hardening of the arterial walls. It usually last from 3 to 5 minutes and if the blood flow is restored no permanent change or damage results. Myocardial ischemia often does not cause detectable symptoms such as angina. Literature Review. Page 43 . lower jaw. Discomfort may radiate to the neck. The angina may occur from hyperactivity of the sympathetic nervous system. 6. laboratory tests. Hypertensive Cardiovascular Disease is generally 1. Hypertension. suggest that the increases in blood pressure induced by mental stress and the increase in myocardial oxygen demand play a role in the pathophysiology of mental stress-induced myocardial ischemia.iv Chronic stress has been linked to a hypercoagulable state that may contribute to acute ischemic events. Hypertension strongly predisposes to atherosclerosis and so most patients with elevated blood pressure have significant coronary atherosclerosis. electrocardiography. A history of hypertension. These observations confirmed in similar studies. including risk factors. Left ventricular hypertrophy in the absence of other cariovascular pathology and 2. the majority of cases (83%) were silent. ultrasonography. Judicious use of x-ray. Literature Review. 6. particularly coronary vessels. The heart then must maintain a normal cardiac output against this increased peripheral resistance and can accomplish this only by hypertrophy of myofibres causing cardiac enlargement Evaluation This is generally done by taking a complete history. Rozansky documented myocardial ischemia by radionuclide angiography (RNA) during mental stress. nuclear scanning and angiography may be necessary to identify affected vessels. Page 44 . a physical examination.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Recent study has suggested that an artery is occluded in some individuals during mental stress. Stress management has been associated with a significant reduction in CAD events in men. The vascular disease increases peripheral resistance and viscosity in the arteries. The word Atherosclerosis is derived from the Greek athere (porridge) and scleros (hardness).A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. Atherosclerosis Atherosclerosis is a form of arteriosclerosis is which soft deposits of intra arterial fat and fibrin on the vessels walls of medium to large arteries harden over time. causing stiffness and thickening. Literature Review. 6. which gradually narrow the arterial lumen. cholesterol and phospholipid metabolism within the tunica intima also contribute to arteriosclerosis. being the main cause of death in approximately 50% to 60% of people in the developed world. Page 45 . Modern medicine looks at several factors which contribute to Cardiovascular Disease. Atherosclerosis is the most common vascular disease.1 The medical model. It is believed that changes in the lipid. Smooth muscle cells and collagen fibres migrate into the tunica intima.3 Development of Cardiovascular Disease 6. The factors that cause Cardiovascular Disease are classified into modifiable and nonmodifiable. Examples of this are genetic polymorphisms. The nonmodifiable risk factors refer to variables that cannot be altered by persons wishing to decrease their risk of cardiovascular disease. Numerous types of genetic susceptibilities to CAD have been identified in individuals with a family history of Cardiovascular Disease.3. Arteriosclerosis This is a chronic disease of the arterial system resulting in the abnormal thickening of and hardening of the walls of the blood vessels. In plaque rupture. where the main artery in the abdomen becomes abnormally wide with a thin wall.A Study of Cardiovascular Disease in Ayurveda John Vorstermans It is the main cause of ischaemic coronary Cardiovascular Disease. this can cause ischaemia in the cerebral arteries. Peripheral vascular disease (PVD). In this process. Coronary thrombosis is typically due to plaque rupture. In turn. Page 46 . "Heart attack" most commonly indicates myocardial infarction. and has reduced vascular smooth muscle cells (which normally make collagen). presenting either as transient ischaemic attack or cerebral infarction. This stimulates clotting that blocks off the artery (occlusive thrombus). the plaque inflammation erodes the fibrous lining (fibrous cap) to the point where it breaks apart (possibly under added hemodynamic stresses). Heart attack and stroke are very loose terms. can be relieved by rest. carotid artery stenosis by occlusion or thromboembolism. which causes intermittent claudication or gangrene of the extremities. Abdominal aortic atherosclerotic aneurysm. It is sometimes used to denote dysrythmia. the Figure 9 Atherosclerosis atherosclerotic lesion (abnormal area of artery) has a thin fibrous lining that is more mechanically weak. releasing necrotic debris containing tissue factor in the lipid necrotic core into contact with blood. can burst. has increased macrophage cells. Unless reopened by drugs or percutaneous coronary intervention the blocked artery causes the heart muscle to die of lack of nutrients and oxygen. This is termed a myocardial infarction. 6. pain in the legs when walking. Literature Review. A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6.3.2 Ayurveda model Heart Tissue The heart is a muscle (mamsa dhatu). It derives its nutrients from Rasa, its oxygen from Rakta and its vital energy from Ojas. The movements of the heart are controlled by Vyana Vata (autonomic nervous system). Sadhaka Pitta represents the intracellular enzymes in the cells of the heart, which helps it to digest and utilise the nutrients and oxygen. Avalambaka Kapha represents the intracellular and interstitial fluid of the heart and chest. Any of these eight basic elements, that is, Rasa, Rakta, Mamsa (muscular tissue), Ojas, Prana Vata, Vyana Vata, Sadhaka Pitta and Avalambaka Kapha, when affected can disturb the function of the heart and cause Cardiovascular Disease. Rasa and the Heart It is important to maintain and protect the volume and composition of Rasa, the body fluids, at all times. Any disturbance in Rasa can impair the movement of essential nutrients to our bodies cells and organs. This will then affect all our tissues (dhatus), Rakta (blood), Mamsa (muscle), Meda (fat), Asthi (bone), Majja (nervous tissue), Shukra (reproductive tissue), Ojas (vital fluid) which in turn will effect our sense organs and mind. Any effect to the channel that carries Rasa (Rasa Vaha Srotas) will cause imbalance in Rasa. Rasa can be vitiated (rasa-dusthi), increased (rasa-vruddhi) or decreased (rasakshaya) Vitiation of Rasa is generally caused by eating too much heavy, fatty or cold food or by excessive thinking or worry. It gives rise to anorexia, inability to appreciate taste, nausea, 6. Literature Review. Page 47 A Study of Cardiovascular Disease in Ayurveda John Vorstermans weak digestive power, body ache, drowsiness, fever, malnutrition, premature hair greying, baldness, impotence. This can lead to hypercholesterolemia and heart attack. However and increase in rasa – body fluids which can be indicated by excess salivation, nausea, regurgitation, weak digestive power, heaviness, coldness of body, excess sleep, pallor, cough and breathlessness. This can lead to hypertension and congestive cardiac failure. This leads to kapha cardiovascular disease. A decrease in rasa – body fluids. This manifests as thirst, weak digestive power, malnutrition, exhaustion, inability to bear loud noises, headache, sluggish moments, giddiness, tremors and cardiac pain. Symptoms can be dehydration and shock and can precipitate coronary thrombosis. Rakta and the Heart In general, to vitiation of Rakta, occurs by intake of excessive fermented, hot, fatty foods and drinks and by working in hot environments or in the heat of the Sun. Signs that Rakta (blood vessels) are affected are generally - a dark bluish or purplish colouration of the skin, pallor, fever, burning, increase in blood volume, contraction of blood vessels, congested eyes and bleeding. This is often associated with hypertension and bleeding disorders due to capillary fragility. A vitiated Rakta (dusthi) gives rise to bleeding disorders, splenomegaly, cyanosis, pallor, gout and various skin diseases. Deficiency in coagulation factors gives rise to bleeding disorders, and hemoglobin decrease can indirectly affect heart conditions. However an increase (vruddhi) in blood volume also leads to bleeding tendency, red discolouration of skin eyes and urine. The veins appear full and give rise to skin disorders and vatarakta. This can lead to hypertension and congestive heart failure. If there is a decrease (kshaya) in the number of red blood cells which leads to anemia, malnutrition, weak digestive power, 6. Literature Review. Page 48 A Study of Cardiovascular Disease in Ayurveda John Vorstermans exertional breathlessness, desire for cold and sour food and drinks, dry and pale skin and symptoms of diminished blood. Acute blood loss can result in shock and chronic anemia can give rise to heart failure. Mamsa and the Heart The heart as a muscular tissue is affected by weakness of mamsa dhatu in the body. Weakness is caused by sleeping during the day and eating excess heavy foods which when absorbed retain fluid in the body. Mamsa-dusthi or vitiation can lead to atrophy of the muscle tissue or tumours of the muscles and oedema. Others effects are Myocarditis or inflammation of the heart muscle, hypertrophy of the heart. These can all lead to poor contraction of the heart and heart failure. Ojas and the Heart Ojas is the essence of the vital fluid, which supplies energy to the different tissues in the body. Its nature is heavy, cold, soft, smooth, sweet, stable, sticky and unctuous. It contains the energy for the body and mind to function well. It gives good complexion and voice. The heart is the main site of Ojas and pumps it throughout the body along with Rasa. An increase in ojas, which in turn gives strength and energy to all the organs of the body, including the heart. Ojas disorders, such as vitiation show up in psychological factors such as anger, sorrow, worry and physical factors such as hunger, injury, exertion or excessive travelling. A decrease can lead to weakness, discolouration of skin, exhaustion, emaciation, fear, constant worry, improper function of sense and motor organs, fainting, delirium, unconsciousness and ultimately death. 6. Literature Review. Page 49 Proper action of the heart and indirectly circulation and intelligence are dependent on sadhaka pitta. Any spasms of the coronary artery by abnormal Vyana Vata leads to angina attacks. Sadhaka Pitta represents the enzymes in the heart. slow respiration. Also valvular disorders like stenosis and regurgitation. Literature Review. movement of the valves within the heart. The symptoms are dyspnoea. Avalambaka Kapha provides the necessary lubrication and strength to the heart for its continuous work. namely pericardial and pleural fluid as well as the fluid in the cavity of the chest. hunger and wasting of body tissues. Disorders lead to weak action of heart and ultimately heart failure. Avalambaka Kapha represents interstitial fluid in the heart. It is also responsible for intercellular digestion of nutrients brought by the coronary arteries. heart block. It controls contraction. Vyana Vata is responsible for all voluntary and involuntary movements on the body. In thrombosis or blockage of any of the coronary arteries the supply of oxygen and therefore Prana Vata is affected. noisy breathing. The subdoshas that are most applicable to the heart and its proper function are: Prana vata which on a practical level is responsible for supply of oxygen and respiration as well as for some of the functional component of the nervous system. clouding of one's consciousness or sense organs. auricular and ventricular fibrillation.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Doshas and the Heart. A disturbance here can lead to feeble or forceful contraction of the heart or any disturbance to its rhythm such as extrasystoles. relaxation and rhythmicity of the heart. cough. tachypnoea. intellect and mind and eventually death. lungs and mediastinum. hiccup. as 6. difficulty in exhaling. Prana vata disorders are generally caused by excess breath retention or excessive exercise. Page 50 . anxiety. intelligent). The former entity includes blood (Rasa and Rakta) circulating between Hridaya [heart] and Maha Srotas [the GIT]. pain. The mind affects the ability of the heart. pleasure. fear. Stress is an experience of imbalance. pleural effusion and pulmonary oedema. Heart is affected in intellectual pursuits and in emotional upheavals like rage. It is interesting to note that “Charaka's concept in that Pranavaha srotas is comparable to pulmonary circulation including the circulation of visceral organs and Rasavaha srotas is comparable to systemic circulation. cutaneous circulation and skeletal muscle circulation”v Mind and Emotions of the Heart In Ayurveda the mind. depression or excitement. Literature Review. Page 51 . Rajasic (energetic. Coronary circulation (Hridya) and pulmonary circulation (Phupphusa).A Study of Cardiovascular Disease in Ayurveda John Vorstermans well as preventing friction between the cells and between the heart and mediastinum. stress occurs when a person is unable to receive information into the mind/body system in a balanced way. Hepatic circulation (Amashaya-Agniashaya-Pakvashaya-Unduka). sorrow. Splenic circulation (Rudhirashaya). The mind is classified as being sattvic (light. Srotas and the Heart. That is why heart is considered to be the seat of mind and intellect. Under Maha Srotas the following visceral organs are involved viz. When its function is abnormal it will impair the action of the heart and can lead to pericardial effusion. grounded). Renal Circulation (Mutrashaya). Whether it is brought on by a physical event or by an emotion.. the way we think and our intentions play a very important role in our constitution. focused) or Tamasic (sluggish. Charaka's view on Rasavaha srotas reflects: capillary. 6. defending themselves and repairing damage. Although Vata imbalance is associated with several forms of heart problems including palpitations and arrhythmias. Doing this harms the heart in both its emotional and physical aspects. Symptoms of Vata related Cardiovascular Diseases include shortness of breath. Under normal conditions. the cells in our body are hard at work nourishing themselves. Each cell contains an intelligence which can heal and reverse disease and harm. The face turns red when someone is angry and 6. Literature Review. Anger is a hot emotion. Pitta dosha. it is generally less significant in coronary Cardiovascular Disease than Pitta and Kapha imbalances. Below is a summary of how emotions and stress affect each of the doshas: Vata dosha is characterised by sudden change and unpredictability. Insomnia. Our bodies can handle high levels of stress for short periods of time.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Many of life's stresses. We constantly find ourselves under stress. so it is important that we do all we can to ensure that stress does not hinder the basic functioning of the body. Emotions can be associated with the three Doshas in Ayurveda. However when we are under stress these cells actually stop this process of renewal as they are called on to perform other activities to meet the demands of the situation. having different effects on the cardiovascular system. dry cough and fainting. Page 52 . though hardly dramatic when viewed as separate incidents. be it at work due to irritating work problems or when we are at odds with the ones we that matter most to us. unhealthy diet and an inability to relax are common Vata behaviours that can exacerbate the problems. but we are not made to endure ongoing stresses for long periods of time. nonetheless take their toll on us as they are repeated over and over again. A Study of Cardiovascular Disease in Ayurveda John Vorstermans perspiration may suddenly start as if there was high fever. Since Pitta dosha is associated with fire and heat, Ayurveda describes chronic anger and hostility as arising primarily from a Pitta imbalance. Moreover, since coronary Cardiovascular Disease arises out of an irritation or inflammation of the arterial walls, CHD can be understood as a Pitta related illness. In general when Pitta accumulates to excess many of its negative qualities manifest. Perfectionism, compulsive behaviour, impatience and hostile judgements of others are characteristic. There is a need to assert total mastery over oneself, over other people, and over the world in general. Since that level of complete control is impossible to achieve, a sense of frustration builds up, which expresses itself in the generalised hostility characteristic of Pitta imbalances. This can significantly raise the risk of coronary Cardiovascular Disease. Kapha dominant people are naturally slow and easygoing. Unlike Pittas, they are not particularly attached to tight schedules and planned routines in their everyday lives. They tend to be tolerant and forgiving, and they will put up with unpleasantness for long periods before becoming angry. The general slowness of their nature, however, means that Kapha are retentive individuals. They require long periods of time to process an experience, whether it's a heavy meal or a perceived insult. High blood cholesterol is a common Kapha related problem, both because Kaphas tend to eat rich foods and because their systems are slow to metabolise the residues of such a diet. This same sluggishness can express itself in the emotional lives of Kapha types as well. They may hold on to hurts, betrayals and disappointments; this can create toxic feelings of hostility just as undigested foods can give rise to toxins in the body. Dealing with emotions. From an Ayurvedic perspective negative emotions can literally be deadly. There are 6. Literature Review. Page 53 A Study of Cardiovascular Disease in Ayurveda John Vorstermans many ways to prevent them from taking root in our consciousness. The seven steps below are a guideline to help the system metabolise and release emotional toxins. 1. Identify the emotion. What are you really feeling? Is it anger, sadness, hurt, betrayal or some other toxic emotion? 2. Be mindful of the physical sensation in your body. Negative feelings express themselves not only as thoughts but as actual pain in the body. It may be a headache, muscle stiffness, or chest pains that prefigure a heart attack. 3. Take responsibility for what you're experiencing and recognise that you have a choice in the matter. You can't always control the circumstances of your life, but you can always control your responses. 4. Express your feelings in private. You may want to do this through writing, or even out loud. Do you believe that someone has injured or offended you? If so, imagine that you are speaking directly to that person. What would you say to convey exactly how you feel? What would you write in a letter to that person? 5. Let go of the emotion through some personal ritual. Physical exercise is often useful for this, especially when combined with the Ayurvedic breathing techniques. 6. Share what you're feeling with another person, but don't undertake this until you feel calm and composed. You should be able to share your feelings without ascribing blame to anyone and without looking for pity. 7. Celebrate and rejuvenate! Reward yourself for taking control of the situation in ways that are best for physical and emotional health. 6. Literature Review. Page 54 A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6.4 Risk Factors 6.4.1 Risk factors from a medical perspective. The major modifiable atherosclerotic risk factors include smoking, hypertension, hyperlipidaemia, diabetes and obesity. Obesity is a mild independent risk factor and very common, and contributes to development of hypertension, hyperlipidaemia and diabetes. Established adult risk factors Unmodifiable traits that predict risk Behaviours that affect risk Physiological conditions increasing risk Cardiovascular endpoints Smoking Age Sex Race Psychological Exercise factors Diabetes Death Alcohol Diet consumption Hypertension Hypercholester Obesity olemia Stroke CHF CHD MI Source: Stolley and Lasky, (1995) Table 3 Adult Risk Factors 6.4.2 Major Risk Factors High Blood Pressure (Hypertension). High blood pressure increases the risk of cardiovascular disease, heart attack, and stroke. Though other risk factors can lead to high blood pressure, you can have it without having other risk factors. If obese, smoking, or there is high blood cholesterol levels along with high blood pressure, the risk of cardiovascular disease or stroke greatly increases. Blood pressure can vary with activity and with age, but a healthy adult who is resting 6. Literature Review. Page 55 A Study of Cardiovascular Disease in Ayurveda John Vorstermans generally has a systolic pressure reading between 120 and 130 and a diastolic pressure reading between 80 and 90 (or below). sometimes referred to as 'bad' cholesterol. Extra cholesterol enters the body when food is eaten. and tropical oils such as coconut oil. is found in all of the body's cells. eggs. and high-density lipoprotein (HDL) cholesterol. Although the cholesterol found in foods is blamed for raising blood Figure 10 Cholesterol cholesterol. taking it back to the liver to be excreted from the body in 6. or 'good' cholesterol. Literature Review. a fat-like substance carried in your blood. Low density lipoprotein (LDL) cholesterol is called 'bad' because it is a major contributor to the development of atherosclerosis . fat from red meat. The liver produces all of the cholesterol which the body needs to form cell membranes and to make certain hormones. One of the major risk factors for cardiovascular disease is high blood cholesterol. High Blood Cholesterol. Foods rich in saturated fat include butter fat in milk products. There are two major types of cholesterol found in the blood: low-density lipoprotein (LDL) cholesterol. Cholesterol. the main culprit is the saturated fat in food.the sticky plaques that can form inside blood vessels and contribute to problems like stroke. that comes from animals (meats. High density lipoprotein (HDL) is 'good' because it helps remove cholesterol from these developing plaques. and dairy products). Page 56 . Figure 11 Diabetes – glucose build-up 6. Page 57 . Asian and Pacific Islanders. What is a 'normal' cholesterol level? There is no simple answer to this question .5 mmol/L HDL-cholesterol > 1. or diabetes mellitus. The National Heart Foundation and The Cardiac Society of Australia and New Zealand give the following target levels: Total cholesterol < 4. Hispanics. Literature Review.we still don't know exactly how much of each type of cholesterol is 'good' for us. especially in the case of adult-onset or Type II diabetes (also known as noninsulin-dependent diabetes). such as a family history of the disease. and Native Americans) have a greater risk of developing diabetes. though. In people with no other risk factors. In general. it is healthier to have low levels of LDL-cholesterol and high levels of HDL-cholesterol.A Study of Cardiovascular Disease in Ayurveda John Vorstermans bile. The American Heart Association estimates that 65% of patients with diabetes die of some form of cardiovascular disease.0 mmol/L LDL-cholesterol < 2. Levels of HDL in the body can be raised for example by things like exercise. Certain racial and ethnic groups (African Americans.0 mmol/L These numbers indicate a level to aim for in patients with other risk factors for coronary Cardiovascular Disease. safe levels may be slightly higher. and lowered by smoking. Heart problems are the leading cause of death among people with diabetes. Diabetes. tightens major arteries. but fewer realize that it also greatly increases the risk of cardiovascular disease and peripheral vascular disease (disease in the vessels that supply blood to the arms and legs). Page 58 . Obesity increases the chances of developing other John Vorstermans Table 4 Graph of Risk Factors for CVD risk factors for cardiovascular disease. which is a formula of kilograms divided by height in metres squared (BMI =W [kg]/H [m2]). high blood cholesterol. Those with a number over 30 are considered obese. more than 400. Smoking. Lung. Many of these deaths are because of the effects of smoking on the heart and blood vessels. which increases the risk of stroke in people who already 6.A Study of Cardiovascular Disease in Ayurveda Obesity and Overweight. and Blood Institute (NHLBI). According to the American Heart Association. Extra weight is thought to lead to increased total cholesterol levels. high blood pressure. Smoking also raises blood pressure. Most people know that cigarette and tobacco smoking increases the risk of lung cancer. Many doctors now measure obesity in terms of body mass index (BMI). being overweight is defined as having a BMI over 25. all of which make the heart work harder. and can create irregularities in the timing of heartbeats. especially high blood pressure. and diabetes. Literature Review. According to the National Heart. Research has shown that smoking increases heart rate. and an increased risk of coronary artery disease.000 Americans die each year of smoking-related illnesses. Literature Review. men have a higher risk of heart attack than women. This increases the risk of a blood clot that can lead to a heart attack. Page 59 . People who are not active have a greater risk of heart attack than do people who exercise regularly. the risk of cardiovascular disease is about the same between the sexes when other risk factors are similar. Exercise also strengthens the heart muscle and makes the arteries more flexible. Overall. either at work or through exercise. possibly by injuring the vessel walls. helps to control cholesterol levels and diabetes. Risk factors (including high blood pressure. After the age of 65. Those who actively burn 500 to 3500 calories per week. And they also affect cholesterol and levels of fibrinogen.A Study of Cardiovascular Disease in Ayurveda John Vorstermans have high blood pressure. Even moderate-intensity exercise is helpful if done regularly. Heredity. 6. which is a blood-clotting material. Cardiovascular disease tends to run in families. But the difference narrows after women reach menopause. Physical Inactivity. Gender. These chemicals lead to the buildup of fatty plaque in the arteries. Although nicotine is the main active agent in cigarette smoke. diabetes. can expect to live longer than people who do not exercise. For example. this then creates a greater risk for cardiovascular disease than someone who does not have that family history. other chemicals and compounds like tar and carbon monoxide are also harmful to the heart in a variety of ways. and may lower blood pressure. if parents or siblings had a heart or circulatory problem before age 55. and obesity) may also be passed from one generation to another. Exercise burns calories. The heart's walls may thicken. Because of these changes. For example. In fact. Page 60 . 6. That is because we all deal with stress differently: how much and in what way stress 6. Because of their sex hormones. As we age. with the white population used as a comparison. our hearts tend to not work as well. and then their risk increases. Age. and socioeconomic status on the risk of cardiovascular disease and heart attack have not been proven. Literature Review. Women 65 and older have about the same risk of cardiovascular disease as men of the same age. Risk factors for cardiovascular disease in other minority groups are still being studied.3 Contributing Risk Factors Stress. behaviour habits. women are usually protected from cardiovascular disease until menopause. The effects of emotional stress. Older age is a risk factor for cardiovascular disease. studies have shown that African Americans have more severe high blood pressure and a greater risk of cardiovascular disease than whites.A Study of Cardiovascular Disease in Ayurveda Race. the risk of developing cardiovascular disease increases with age. John Vorstermans Researchers have found that some forms of cardiovascular disease are more common among certain racial and ethnic groups. The bulk of cardiovascular research for minorities has focused on African Americans and Hispanics. and the heart is less able to pump blood to the muscles of the body. arteries may stiffen and harden. Stress is considered a contributing risk factor for cardiovascular disease because little is known about its effects. In New Zealand it has been shown that Maori have a greater risk of cardiovascular disease also. about 4 of every 5 deaths due to cardiovascular disease occur in people older than 65.4. and taking these pills increased the chances of cardiovascular disease and stroke. the walls may harden or thicken. Stressful situations raise the heart rate and blood pressure. the chances that a woman will have a heart attack greatly increase. cardiovascular disease is rare. John Vorstermans Researchers have identified several reasons why stress may affect the heart. Literature Review. or chest pain. These hormones raise blood pressure. around the time when most women go through menopause. in people who already have cardiovascular disease. This need for oxygen can bring on angina pectoris. people who are stressed may overeat for comfort. which can injure the lining of the arteries. making is easier for plaque to build up. Birth control pills. and makes it more likely that a clot will form. Sex hormones. For example. Stress may also contribute to other risk factors. women make up about half of all heart attack victims. When the arteries heal. Early types of birth control pills contained high levels of estrogen and progestin. start smoking.A Study of Cardiovascular Disease in Ayurveda affects us can vary from person to person. who 6. or smoke more than they normally would. During times of stress. But between the ages 40 and 65. However birth control pills today contain much lower doses of hormones. Stress also increases the amount of blood clotting factors that circulate in the blood. especially in women older than 35 who smoked. increasing the the heart's need for oxygen. From 65 onward. Clots may then block an artery narrowed by plaque and cause a heart attack. Sex hormones appear to play a role in cardiovascular disease. Birth control pills are considered safe for women younger than 35. the nervous system releases extra hormones (usually adrenaline). Among women younger than 40. Page 61 . And the average drink has between 100 and 200 calories. Literature Review. 30 ml of 100-proof spirits. John Vorstermans If smoking or have other risk factors. especially if older than 35. women who take birth control pills should have yearly checkups to test blood pressure. Scotch. and cardiomyopathy (disease of the heart muscle). Studies have shown that the risk of cardiovascular disease in people who drink moderate amounts of alcohol is lower than in nondrinkers. It is not recommended that nondrinkers start using alcohol or that drinkers increase the amount that they drink. which may increase the risk of cardiovascular disease. or 360 ml of beer. gin. Calories from alcohol often add fat to the body. birth control pills will increase the risk of cardiovascular disease and blood clots. stroke. According to the American Heart Association. 6.A Study of Cardiovascular Disease in Ayurveda do not smoke or have high blood pressure. vodka. Alcohol. One drink is defined as 1 fluid ounce (fl oz) or 30 ml of 80-proof spirits (such as bourbon. Experts say that moderate intake is an average of one to two drinks per day for men and one drink per day for women. 120 ml of wine. Page 62 . irregular heartbeats. triglyceride and glucose levels. However drinking more than a moderate amount of alcohol can cause heart-related problems such as high blood pressure. etc). 4 Ayurvedic Aetiology of Cardiovascular Disease Aetiology of Heart Diseases Aetiological factors 1.. vexation laziness. defecation. sneezing disease etc. Page 63 . retains fluids in body.g. Complication of other diseases + + + + + + + + + + + + + Table 5 Ayurvedic Aetiological of Cardiovascular Disease 6. Pitta and Kapha Low fat diet. tension. causes leading to Vatam milk and jaggery. sorrow.B. The macrophages adhere to the injured endothelium 6.5 Medical Pathophysiology of Cardiovascular Disease Inflammation plays an important role in mediating all the steps in the initiation and progression of atherogenesis. worry & tension. excessive study Combination of the Excess of sesame seeds. Diet excess. Sexual intercourse In excess In excess 5. Worry. Low calorie diet Pitta (from Cardiology in Ayurveda by Dr V. fish + milk Excess fermented food Over exertion or over Over exertion or over work.g.e.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. 2. Carefree state. Alcohol in excess disease 7. holding the breath during inspiration and expiration Leads to Pitta hear 6. pungent. heavy diet. high Low calorie diet calorie diet. e. Inflamed endothelial cells express adhesion molecules that bind macrophages and other inflammatory and immune cells. The injured endothelial cells become inflamed and cannot make normal amounts of antithrombic and vasodilating cytokines. banana + milk + Ama promoting food Diet to which one is not used to No work at all. activity immediately after food.g. Athavale) Kapha Tridosha Krumi Anger. worry and tension. dry diet.4. Atherosclerosis begins with the injury of the endothelial cells that line artery walls.4. Microbial infection& parasitic + + infestations 8. excessive travelling work in sun or hot climate 4. vegetables + milk e. excess Abnormal or excessive sleep. + Excess of cold beverages and food e. Excess of bitter. high fat diet i. Activity Excess of cold beverages Excess of hot beverages and food and food. Excess of sweet. Excess sour. Traumatic heart lesion ++ 10. Psychological Diet – Calories (a) Fat (b) Taste Vata Fear. ( c ) Temperature of drinks & food (d) Dietetic incompatibilities (e) Indigestion 3. Suppression of natural urges like Leads to Vata heart urination. sour Eating food like salt and salty food or which retains fluid in excess of food with body. yawning. Literature Review. pungent astringent food and salty food. Iatrogenic (a) Toxic effects of drugs + + (b) Improper management of disease + + ++ + ( c) Abnormal or excessive use of emetics. purgatives or enemas 9. smooth muscle cells proliferate. resulting in platelet adherence to the lesion. worms. As the plaque continues to develop. Literature Review. These would be classified as being imbalances of 1) Vata. producing collagen and migrate over the fatty streak forming a fibrous plaque.A Study of Cardiovascular Disease in Ayurveda John Vorstermans and release enzymes and toxic oxygen radicals that further injure the vessel wall and result in oxidation of low-density lipoprotein (LDL). 3) Kapha. When they accumulate in significant amounts they form lesions called fatty streak. Oxidized LDL is engulfed by macrophages. To prevent this process antiplatelet medications such as aspirin are used. 6. Once formed these fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes resulting in progressive damage to the vessel of the walls. bacteria (Krumi). This results in narrowing of the blood vessel lumen and reduces blood flow to distal tissue.6 Ayurvedic Pathogenesis (Samprapti) Cardiovascular Disease from an Ayurvedic perspective can be classified into: 1. It is currently though the treatment to lower LDL. that this process may be reversed. Causes which are important for maintaining physiological functions of the heart. Cardiovascular Disease as a complication of other diseases. 4) Tridoshas (all three doshas). As this process happens. 3. 6. 2. which then penetrate into the intima of the vessel. Platelet adherence to the plaque can initiate the coagulation cascade and result in rapid thrombus formation with complete vessel occlusion causing tissue ischemia and infarction. Causes which directly act on the heart. Page 64 . 2) Pitta.4. or 5) Parasites. continued inflammation leads to instability of the plaque and can result in ulceration and rupture. viruses. 3. iatrogenic. Vitiation of Doshas 2. the eight basic elements that maintain the integrity of the cellular structure and functions of the heart are. alcohol in excess. Thus. due to the impairment of nutrition of the cardiac muscle (by Rasa) the outcome is some 6. trauma to the heart. activity. worms and other toxins. Pitta and Kapha and in turn Rasa which enters the heart and gives rise the Cardiovascular Disease. improper management of disease. excessive sexual indulgence. Vyana vata. In summary. Literature Review. abnormal or excess use of emetics. Rasa. 1. Ayurveda describes the following types of pathogenesis of cardiac disease. Accumulation of Vitiated Doshas and Vitiated Rasa Dhatu in the heart. bacteria. Rakta. In Ayurveda the pathogenesis provides insights into the development of the disease process. purgatives or enemas. causes effects of drugs. Derangement of Rasa Dhatu The following can be seen as the interpretation of the Samprapti of Cardiovascular Disease. Mamsa. Prana vata. showing in detail how the doshas when aggravated by certain aetiological factors effect the dhatus and srotas of the body. The various factors which lead to the different types of Cardiovascular Disease are listed in Table 5. diet. suppression of natural urges. These will cause abnormal increase or decrease in Vata. Development of Obstruction in the heart and impairment of physiological function of the heart. Page 65 . Sadhaka pitta and Avalambaka kapha. eventually manifesting in disease. viruses. complications of other diseases. Ojas.A Study of Cardiovascular Disease in Ayurveda John Vorstermans The aetiological factors are generally classified as psychological factors. However as the Ama increases it will start to move into the bodily tissues (dhatus). the heart and eventually weaken the sub-doshas of Prana Vata.T. which is the cause of leaving food undigested. Ama (toxins created by undigested food) causes blockages in places in the body where they have a predisposition to settle in. 6. creating toxins. Vyana Vata. along with the krimi which can eventually attack the entire heart causing severe pain and may lead to death. In the later stages the vitiated doshas vitiate the Hridayastha (heart). The ama. Ama is produced by Agnimandhya . Sadhaka Pitta. Pitta in Grahani and Vata in Pakwashaya (colon). exploit whatever weakness there is in the body. first entering into Rasa and then eventually into Rakta etc. Various pathogenic organism are likely to grow in this area. These can continue to grow. if left to continue to grow will eventually.A Study of Cardiovascular Disease in Ayurveda sort of Cardiovascular Disease. Literature Review. which may cause obstruction in the cardiac region. and hollow organs. Avalambaka Kapha. When it has entered Rasa. Organic changes in the structure of the heart by the formation of nodules lead to the distortion of normal structure of the heart. it will affect the organ that is the seat of Rasa.I. Vyana Vata. in the particular part where Dosha which are vitiated lives. In the early stage of the Nidana Kapha is in Amashaya (duodenum). the aspects of Doshas that are vitiated are Prana Vata. Sadhaka Pitta. Thus the development of Krimi Cardiovascular Disease which results in growths/tumours in parts of the heart. First it manifests in the G.a decrease in the digestive fire or metabolism. John Vorstermans Organic changes. In Cardiovascular Disease. Role of Vitiated Doshas Doshas become vitiated by the continual cycle of incorrect lifestyle and diet (Nidana). Avalambaka Kapha. Page 66 . This may result in a build-up of fluid. John Vorstermans The reason the heart is affected in some people rather than everyone. If the proper treatment of Cardiovascular Disease (Hridroga) is not followed and the causative factors are continued the doshas in the heart become more and more vitiated along with the development of various During this process the complications. deformities in the Rasavaha Srotas are well established and there is an excess flow (atipravritti) or growth (granthi) established in the heart region which will cause the dosha or dhatu to increase or decrease. Page 67 . Such weakness (Khaivaigunaya) will attract Ama and block this major channel in the body. “Marma- 6. is because there is an inherent weakness at this level. Literature Review. (See Figure 12).A Study of Cardiovascular Disease in Ayurveda and Ojas. Avastha”. although Cardiovascular Disease is very common these days. Development Once the condition reaches stage III (sthana Sansharaya) the symptoms of Cardiovascular Disease appear clinically. This condition is called “Bheda In this condition the circulation of RasaFigure 12 Samprapti Heart Disease Rakta may be affected and is also called Upaghata”. Page 68 .A Study of Cardiovascular Disease in Ayurveda John Vorstermans Figure 13. Diagramtic representation of Samprapti of Hrdroga 6. Literature Review. One of the most common manifestations is coronary artery disease caused by atherosclerosis being the major cause for myocardial ischemia. aversion to loud sounds.1 Symptomatology . insomnia and twitching pain.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. stiffness in the chest. Malnutrition of the organs. Chronic coronary obstruction causes reoccurring predictable chest pain referred to as stable angina. pricking pain. rough and hard. Abnormal vasospasm of the coronary vessels result in unpredictable chest pain called Prinzmetal angina. Vata symptoms are severe pain. particularly in old age. edema.5 Clinical Manifestation 6. Atherosclerotic obstruction of the vessels supplying 6. exhaustion or inability to cope with 6. As the lesion causes increasing obstruction the result can be thrombosis. Irritability. shrunken. Page 69 . breathlessness.Ayurveda The symptoms differ and give an indication of what type of Cardiovascular Disease we are looking at.Western Medical Initial signs and symptoms come from inadequate perfusion of tissue because of the obstruction of the vessels that supply them. convulsions. shortened.2 Symptomatology . Initially partial obstruction may lead to ischemic events when exercising or under stress. feeling of emptiness in the chest. Myocardial ischemia that does not cause detectable symptoms is called silent ischemia. Literature Review. sudden attacks.5.5. dry feeling inside the chest. tense. make the tissue of the heart dry. the brain is the major cause of stroke. anorexia. vomiting. Thickening and hardening of the arteries will occur. and chest pain. darkness before the eyes. Tridosha symptoms will be a combination of the above. dyspnoea. nausea. frightened. darkness before the eyes. Page 70 . restless. excessive sweating. tiredness. scissoring pain in the heart. vomiting. persistent bitter taste. itching. feelings of a stone in the heart. fever. tearing pain. anorexia. sour and bitter belching or burping. laziness. edema. persistent sweet taste. Krimi (parasite) symptoms include pain like pricking needles.A Study of Cardiovascular Disease in Ayurveda John Vorstermans emergency demands cause spastic contractions or rapidity of contraction and produce pain and fatigue in a short time-frame and depletion of body fluids may all provoke Vata. fever. fever. dryness of mouth. and severe burning sensation. Pitta symptoms include heart burn. vertigo. Kapha symptoms include numbness or heaviness in the heart. wasting. cough. Literature Review. drowsiness. syncope. 6. sluggish and flabby due to deposits of fat (meda) or hypertrophy (mamsa). thirst. Increase in size and shape making the heart heavy. excessive sleep. severe pain. partial or complete loss of consciousness. yellowish colouration. Drying and density of Rasa dhatu produces obstruction and prevents free movement. nausea. Inflammatory changes leading to tissue destruction and attendant with high fever. Examples of aerobic exercise include walking. swimming. helping to maintain mobility. Aerobic exercise should last for at least 30+ minutes. Cardiac patients should avoid weight training. Treatment of cardiovascular disease depends on the specific form of the disease in each patient.6. or replace damaged blood vessels.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. However common treatments are listed below: Aerobic Exercise Regular exercise strengthens muscles and keeps them flexible. aspirin and the statin cholesterollowering drugs may be helpful. running and sports like squash and tennis without first getting medical advice.1 Medical Treatment The primary goal of treatment is to restore adequate blood flow to the aeffected tissue. This would include exercise. smoking cessation and control of hypertension and diabetes where appropriate while reducing LDL cholesterol by diet or medications or both. repair. When the situation is not considered serious then the focus is on management or removal of the cause to prevent lesions progressing. In some circumstances. Literature Review. surgery or angioplasty may be warranted to reopen. make use of large muscles groups and increase the heart rate.6 Treatment 6. such as blood pressure reducing medications. bicycling and light aerobics. Page 71 . but effective treatment always includes preventive lifestyle changes. Treatment for Cardiovascular disease varies depending on the practitioner. without a large increase in blood pressure. it can also help to control weight and improve the sense of well being. Medications. Gym and 6. Not only does exercise improve the ability to perform usual physical tasks. If the ischema is acute then intervention is specific according to the area effected. giving more room for the blood to flow through the previously narrowed artery. This improved flow of blood reduces the risk of heart attack and sudden death due to Cardiovascular Diseases. Generally. this procedure lasts 1 to 2 hours in the respective cardiac centres in hospitals or other medical centres. Literature Review. The time period for inflation can last from seconds to several minutes. There may be some minor discomfort during the process. The Figure 14 Angioplasty catheter is then passed into the artery all the way towards the heart. The procedure itself involves inserting a balloon-tipped pipe (a catheter) into the femoral artery in the groin or upper thigh. Multiple inflations of the balloon may be 6. The catheter will be inserted further into the exact location of the narrowing. and then the balloon at the tip of the catheter will be inflated. the patient Figure 15 Stent may feel the same type of chest pain as they feel in angina. Page 72 .A Study of Cardiovascular Disease in Ayurveda John Vorstermans aerobics classes should only be done with an instructor who is trained in treating heart patients. During this period because there is no blood flow to the heart muscle. Angioplasty The aim of angioplasty is to push the plaque (Figure 14) against the artery wall. the artery is dilated and bigger . This means an x-ray of the coronary arteries will be taken to locate and measure the narrowing of arteries. A video monitor is used to guide the process. Once the catheter reaches the designated area. a coronary angiogram will be done. With such. Literature Review. emergency heart surgery may be needed. However by giving medications such as aspirin and clopidogrel (a drug used to prevent clotting) in combination. Some minor complications include local collection of blood at the catheter insertion site (haematoma) or local infection. usually a stent will be implanted at the site of narrowing. the catheter will be taken out . the risk is significantly reduced. A stent is a small wire-mesh tube. wrist or inner chest to attach to 6. Finally. These are usually benign but can be dangerous if they are widespread. This is important to reduce the chances where the dilated artery may become narrowed again (known as restenosis) after angioplasty. Following angioplasty. John Vorstermans After the inflation. Coronary Artery Bypass Grafting CABG CABG surgery involves using a vessel from the leg. and it is reduced further by inserting a stent during angioplasty. Complications One of the complications of angioplasty is sudden closure of the affected vessel.A Study of Cardiovascular Disease in Ayurveda needed in the same area. Although the insertion of stents during angioplasty has reduced this risk. It acts as a scaffolding tube that supports the weakened artery. further coronary angiograms will be done to assess the narrowing of the artery. the risk is rare. Sudden closure of the artery can lead to a heart attack and also sudden death. this is still a relatively common occurrence. Page 73 . However. Another risk of the procedure would be narrowing of the artery at the same site after angioplasty (known as restenosis). Other risk include blood clots forming after the procedure. If this occurs. one of which includes the left anterior descending near its origin. Usually an incision is made down the centre of the chest and an open operation performed. CABG surgery is one of three different treatment modalities for coronary artery disease. Literature Review. This group of patients is the most common indication. the left ventricle. • Patients with triple vessel disease. The left coronary artery supplies most of the heart muscle including the main pumping chamber. this allows blood to get to the remainder of the heart muscle by bypassing the blockage. • Patients with disease of the left main Figure 16 CABG coronary artery. The left ventricle also has reduced contractile function. a large area of heart muscle will not get sufficient blood supply. Page 74 . The decision for surgery is largely based on the symptoms and severity of disease. If this important vessel is blocked close to its beginning. meaning that 3 big vessels (the left anterior descending. Blockage of this vessel can have severe consequences. Studies have shown that the following patients benefit from CABG surgery over the alternative treatment options: • Patients with persistent symptoms of angina despite medical therapy or who cannot tolerate medical therapy.A Study of Cardiovascular Disease in Ayurveda John Vorstermans the coronary vessels on the outside of the heart. Much like a detour on the road. right coronary and circumflex arteries) have blockages from atherosclerotic plaques. 6. • Patients with two vessel disease. 6. overeating. Vata Cardiovascular Disease i. obesity (medaroga) and rhematoid arthritis (Amavata). he should be administered medicated oil or ghee followed by Vamana herbs consisting of dashamula decoction. lack of exercise. stress. give strength and stamina (bala) and are have a regenerative effect on the tissue (rasayana). Treatment of Cardiovascular disease. such as in diabetes (prameha). Vamana (Emesis) is normally contraindicated in Vata Cardiovascular Disease. These are lifestyle factors such as 6. ii.2 Ayurvedic Treatment. However if Kapha dosha is also present and the patient is strong. So it is a matter of looking at the predisposing factors.6. The Ayurvedic approach is generally focused on prevention rather than cure. Literature Review.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. The predisposing factors for Cardiovascular Disease are similar to those of other Ayurvedic pathologies. then curative measures are necessary and the aim is to treat the underlying cause. Generally the treatment is considered under two headings. Tila Taila (oil) medicated with Vata alleviating drugs should be used for administrating Basti Therapy (Enema) in adequate quantity.2. The treatment is quite different depending on the dosha involved.1 Shodana Treatment (Curative) The aim of this treatment is to remove the vitiated or aggravated dosha from the body. If one is already suffering from a cardiovascular disease. Ghrita (medicated ghee) and lavana (salt). namely curative (shodana) and palliative (Shamana) types of treatment. For this Ayurveda uses herbs with have an agreeable action on the heart (hyridya) . Page 75 . 6. iii. Basti Therapy. iv. Parusaka is very effective purgative preparation.A Study of Cardiovascular Disease in Ayurveda John Vorstermans iii. Jaggery and water is indicated in strong patients with Kapha constitution. • • Paste of Yastimadhu and Kutaki should be taken with sugar and water. Oral administration of Kashaya prepared with Madanadi gana or Mustadi gana or Triphala. sugar. Cold application and cold shower. Kapha Cardiovascular Disease i. Literature Review. local Mrudu Sweda with luke warm medicated oil massage over the chest may help in relieving the symptoms. Haritakyadi Churna – dried black grapes and Haritaki powder should be mixed with sugar and taken with luke warm water. Virecana (purgation) • Mixture of grapes. Normal Swedana (Fomentation) over the Cardiac region should be avoided. Vamana (emesis) with mixture of Katphala. honey. If the patient is constipated. Basti with Tila Oil medicated with honey and liquorice should be administered. ii. Sugar. Honey. iii. ii. Page 76 . Pitta Cardiovascular Disease i. Yastimadu. Vamana with Vaca or Nimba kwartha. Virecana (purgation) by administering ghee prepared with Shyama and Trivrit kalka. 6. But during the stage of pain and feeling of constriction in the chest. Snehana followed by diet of meat soup or cured meat for three days. Afterwards virechana should be done. However Vamana in the early stages of Cardiovascular Disease if the patient is strong if permitted. Literature Review. Meal consisting of Yavaana and Vidanga curna is also prescribed. the respective lines of treatment as mentioned under different doshas above may be performed.A Study of Cardiovascular Disease in Ayurveda John Vorstermans iv. sugar. 6.6. The following 6. Jiraka. Basti with Bala taila shall be performed after taking all the necessary precautions. v. vi. Krimi (parasites) i. Saindhava lavana. However vamana is contraindicated in serious cardiac illness. suggestions are from the classical references. Fasting. Kaphahara (kapha pacifying) procedure are to be adopted.2. Note: Vamana is generally contraindicated in Cardiovascular Disease due to morbid doshas as well as in Cardiovascular Diseases due to krimi. ii. iii. iv. Sneha (oleation). Vidanga may be given. Tridosha Depending on the predominant dosha. Herbs of Dhanyamla along with Sugandha dravya.2 Shamana Treatment (Palliative) Different herbs are used for the different types of pathology. Page 77 . Swedana (sweating) and Vamana are to be conducted at first and afterwards. Suksmela powder 3 .6 gm 3 – 6 gm 24-50 ml 5 – 10 ml 5 – 10 gm Krimi Cardiovascular Disease i. Bala. cumin seeds. Pushkaramula. Punarnavadi Oil 5 – 10 ml Pitta Cardiovascular Disease i. ii. After Vamana. meat. John Vorstermans i. curd and tila to be given for three days after shodhana. Palasa seeds. The diet attracts the worms and helps in releasing the hold of the worms on the gastro intestinal tract (GIT). Rasna. Haritaki and Vaca. Ela and Pippalimula. Page 78 . Ajamoda. ii. powder of Trivrit. Patient should drink oil boiled with Panca Lavana (five salts) iii. Arjuna bark powder Kapha Cardiovascular Disease i. 6. Nimba. Pippalyadi powder iv. Haritaki. ii. Trivrtadi powder iii. Haritaki powder 2 – 6 gm 5 – 10 gm v. Diet of rice.A Study of Cardiovascular Disease in Ayurveda Vata Cardiovascular Disease. and krimigha herbs. Shunti. Shunti. Kharjura. Hrid pousthika powder iii. A decoction made from Puskaramula. Literature Review. Panchakoladi decoction 20 – 40 ml vi. Arjuna milk decoction ii. Vidanga + kustha + gomutra powder John Vorstermans There are numerous herbs that are effective in treatment of Hrdrogas in Ayurveda. Ashwagandha 4. Puskarahvadi 9. Trayamanadi 4. Dhauakadi 4. Navayasa 13. Vidanga powder + gomutra 2 – 4 gms iv. Kustha 9. Some of these are listed below. Narayana 11. Narayanadi 12. Literature Review. Lasuna Ksherapaka 5. Pippalyadi 2. Alkalis (Kasara) 1. Dashamula 2. Powders (Churnas) 1.A Study of Cardiovascular Disease in Ayurveda iii. Hingupancaka 6. Ksara gutika 3. Dadima 5. 1. Hinguvadi 7. Amaladi 2. Yavakshara 3. Kakubhadi 8. Nagaradi 8. Decoctions 1. Pushkaramula 15. Patadi 14. Madha Darvyadi 6. Karoiiradu 10. Dashamula + Saindhava 3. Arjuna 3. Talisadi 17. Triphaladi 6. Satyadi 16. Nagara 7. Yavanyadi 2. Page 79 . Phalasava 8. Arjunarista 3. Bilva kshara 2. Agastya Haritaki 2. Danti Haritaki 4. Vasa 12. Satapaka madhuparni 7. Dadimadi 6. Brhat satavari 5. Souvarcaladi 9. Trayamanadi 10. Fermented products 1. Pippalyadi lehya 6. Punarnavadi 3. Vallabhaka 11.A Study of Cardiovascular Disease in Ayurveda 4. Pippalyadi 8. Yastyadi John Vorstermans 6. Amritaprasa 3. Mulasava 7. Sarkarasava 8. Avalehyas 1. Arjuna 2. Balad 4. Oil (Tailas) 1. Abhayasrista 2. Kanakarista 5. Madhwarista 6. Mahatiktaka 7. Page 80 . Citrakadi lehya 3. Medicated Ghee (Ghritas) 1. Literature Review. Dhatryarista 4. Punarnavadyarista 9. and so less can make its way into the bloodstream. blood levels of LDL-cholesterol are lowered.3. Page 81 . Overall. there is less cholesterol being taken into the body.6. Ezetimibe acts differently to a Statin. and more cholesterol being 'filtered' out of the blood. With both of these drugs working together. Literature Review.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. The first drug. doubling the dose after that will only produce an additional benefit of 6%. the Statin. The second drug. so adding the two together can have a more beneficial effect on cholesterol levels than simply increasing the dose of the Statin. acts by reducing the amount of cholesterol absorbed from the intestines. most of the effect of a Statin occurs at the recommended starting dose.3 Medical Drugs 6. Why use it? Dual inhibition therapy may be useful when one drug alone is not effective in lowering LDL-cholesterol. these drugs seem to be more effective at helping to reduce cholesterol than just one drug alone.1 Dual inhibition Dual inhibition' describes a type of drug therapy that uses both Statins and Ezetimibe to lower cholesterol. For example. reduces the amount of LDL-cholesterol that is made in the liver. How it works. Ezetimibe. 6. Together.6. and also increases the amount of cholesterol that the liver 'clears out' of the blood as it passes through. less cholesterol being made in the liver. This means that less cholesterol is taken into the body. . or rash. Common problems include headache. It may produce some mild side effects.6. This means that dual inhibition therapy may not be safe to use in people who have a liver problem such as liver failure or cirrhosis. Statins have a few important side effects. fenofibrate and clofibrate. A more serious but rare side effect is called rhabdomyolysis.A Study of Cardiovascular Disease in Ayurveda Side-effects. where breakdown of muscle cells occurs. Common examples of fibrates include gemfibrozil. Fibrates lower triglyceride levels by two methods: • • by reducing production of triglycerides in the liver. Another important side effect which may be caused by both ezetimibe and statins is changes in liver function. Page 82 6. John Vorstermans Ezetimibe is a generally safe drug and is well tolerated by most people. resulting in muscle pain and weakness. It rarely interacts with other drugs to cause adverse reactions. Side effects are minimal. and by increasing the rate at which triglycerides are removed from the bloodstream. has been demonstrated in a number of trials to be well tolerated. 6. Literature Review. Dual inhibition therapy.2 Fibrates Fibrates are derivatives of fibric acid which are particularly suited to reducing the triglyceride levels of lipid in the blood.3. nausea and vomiting. where ezetimibe is combined with a statin. diarrhoea. including headache and diarrhoea. almost similar to those of statin treatment alone. They also have the effect of increasing HDL cholesterol ('good cholesterol') in the blood. constipation. 6. and even death.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Fibrates have been shown to reduce triglyceride levels by 35-50 percent in patients with high lipid levels. fibrates will lower LDL-C levels slightly. and particularly in people with a type of hypercholesterolaemia called 'type I hyperlipoproteinaemia'. where breakdown of muscle cells occurs. fibrates may actually raise LDL-C levels slightly. Page 83 . 6. In most people. fibrates (and in particular the drug gemfibrozil) have been shown to increase good HDL cholesterol levels by up to 15-25 percent. The risk of this occurring is greater when kidney function is impaired or when fibrates are combined with statins. abdominal pain or diarrhoea allergic reactions fever or chills generalised body aches and pains One serious but rare side effect of fibrate therapy is called rhabdomyolysis. though. The effect of fibrates on LDL-cholesterol levels is not always the same in every patient. Side effects of fibrates may include: • • • • gastrointestinal symptoms: dyspepsia (indigestion). weakness. In some people.6. with the blood thinning drug warfarin. Potential drug interactions associated with fibrates may include: •Interactions •Interactions with other lipid lowering drugs such as statins. Additionally. Literature Review.3 LDL (Low-Density Lipoprotein) Cholesterol Lowering LDL-cholesterol lowering drugs are commonly prescribed to people with high levels of LDL (low-density lipoprotein) cholesterol.3. resulting in muscle pain. high fibre diet. and there are various 6. Page 84 . More details and help with regards to diet. These include: • Healthy Eating: a low-fat. • Stop Smoking: stopping smoking is vital to cardiac health as well as overall well- being. This can also enhance the effects of medication. However. Why lower LDL-cholesterol? Lowering LDL-cholesterol levels in the blood can have a number of positive effects for health. • Decreasing the risk of developing problems such as heart attack and stroke. Literature Review. there are a number of lifestyle changes that can be made to help lower LDL cholesterol levels. the optimal method of lowering LDL cholesterol as well as the target levels were once unknown until the results of several trials provide some clues. avoid greasy foods and eating more vegetables.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Previous research has demonstrated that lowering LDL cholesterol reduces the progression of Cardiovascular Disease and death rate. Stopping existing plaques from rupturing. • Plant Sterols: These can be found in some margarines and help reduce the absorption of cholesterol. can drastically improve cardiac health. It is strongly encouraged that all patients quit smoking. can be obtained from a general practitioner. How can the level of LDL-cholesterol be lowered? Other than drugs. which can cause problems with formation of blood clots. • Fish Oil and Fish: Consumption of fish twice a week helps to lower cholesterol levels. including: • • Reducing the number and extent of sticky cholesterol plaques on artery walls. cholesterol absorption inhibitors. bile acid sequestrants. These drugs differ in terms of the way they act and the degree and type of cholesterol lowering they can each produce. days. these lifestyle changes are not enough. • Weight Reduction: While this should come from improved diet and exercise. and also improved outcomes over two years among patients with acute Cardiovascular 6. Literature Review. if not all. • Alcohol: Alcohol should be drunk in moderation. so a cholesterol-lowering drug is prescribed to help lower your cholesterol levels. Page 85 . • John Vorstermans Physical Activity: Moderate to intense physical activity of at least 30 minutes should be undertaken on most. Sometimes. Other drugs used include fibric acid derivatives. heart attack. though. The higher dose provided greater protection against death. Some of the results are summarised below: • The Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) trial in Boston compared a high-dose statin treatment to a low-dose statin treatment. especially if there is a high level of triglycerides. What is the evidence for using these treatments to lower LDL-cholesterol? Many trials have been conducted to look at the benefits for patients of taking cholesterol-lowering medications. chest pain requiring hospital admission and stroke.A Study of Cardiovascular Disease in Ayurveda methods for helping with this that can be advised by a GP. • Salt: Reduction in salt intake has been shown to lower hypertension and thus reduce general cardiovascular risk. and nicotinic acid. The most commonly used type of cholesterol-lowering drugs are called 'statins' (sometimes also known as HMG CoA reductase inhibitors). weight reduction plays an important role in the reduction of LDL cholesterol levels. (a) Membrane stabilising agents • • Quinidine and similar agents Lignocain. Beta – Adrenergic Blocking drugs.A Study of Cardiovascular Disease in Ayurveda Disease. Anti-arrhythmic drugs. They also suggest that high-risk patients may benefit from more extensive lowering of LDLcholesterol than was once thought necessary. • The Heart Protection Study in the UK showed that lowering LDL cholesterol from below 3 mmol/L to below 2 mmol/L reduces risk of Cardiovascular Disease by about 25%. • John Vorstermans Another group of researchers from the United States also showed in their trial.3. 6. Page 86 .4 Cardiovascular Drugs Broadly. the Treating of New Targets (TNT) trial. that intensive lipid-lowering treatment provides more significant clinical benefit compared to a lower dose of statin drug. Literature Review. Overall. the drugs for the treatment of Cardiovascular Disease may be classified as follows: 1.6. phenytoin and similar agents (b) Sympathetic agents: beta-blockers ( c) Drugs prolonging action potential: amiodarone (d) Calcium flux antagonists: verapamil 2. the results of these trials suggest that intensive therapy to lower LDL cholesterol levels is beneficial in treatment of both acute and stable Cardiovascular Disease. 3. Digitalis and allied cardiac glycosides 6. Anticoagulants 9. the 'good' cholesterol. By doing this. is also produced. Atorvastatin in particular has a strong effect on LDL-cholesterol. The resulting effect is a reduction of total cholesterol. A small increase in high-density lipoprotein cholesterol (HDL-C). the availability of cholesterol is reduced. Diuretics 8. LDL cholesterol and triglyceride fats.3. and help liver cells take up more LDL cholesterol from the blood as it passes through. Hypotensive agents 6. Statins also increase production of the receptor for 'bad' LDL-cholesterol. which is the enzyme that controls the rate of cholesterol production in the body. Vasodilators and other agents used in Angina Pactoris 7. Statins work by blocking the action of an enzyme called HMG-CoA reductase.and total cholesterol levels in the blood.A Study of Cardiovascular Disease in Ayurveda 4. which helps clear LDL-cholesterol from the circulation. 6.5 Statins Statins are a type of lipid-lowering drug in common use in New Zealand Statins are a type of lipid-lowering drug that are used to lower LDL. Page 87 . Inotropic agents 5. Literature Review.6. How effective are statins? Statins can reduce the level of LDL-cholesterol in the blood by 30 to 63 per cent. Management of hyperlipidmias John Vorstermans 6. Muscle pain and break down of muscle tissue may also occur. constipation. or rash. The strength of this effect increases with the dose of the drugs taken. simvastatin has been reported to be effective in increasing the level. Literature Review. They are well tolerated in the short term. diarrhoea.A Study of Cardiovascular Disease in Ayurveda John Vorstermans In terms of the action on high-density lipoprotein (HDL) cholesterol. Liver problems are dependent on the dose used and mainly occur in the first three months of treatment. Patients at increased risk of developing muscle problem associated with statin therapy are those with kidney failure. There are guidelines currently recommending their use in virtually all patients at high risk of coronary Cardiovascular Disease. Atorvastatin is also effective for the reduction of triglyceride levels. nausea and vomiting. Liver function abnormality may also occur. thyroid problems and liver disease. Are statins safe? Statins are considered one of the safest classes of lipid-lowering drugs. Drugs used in this treatment: • • • • Vytorin (Ezetimibe/ Simvastatin) Lipitor (Atorvastatin calcium) Pravachol (Pravastatin sodium) Zocor (Simvastatin) 6. Common side-effects include headache. Page 88 . Patients started on statins should report muscle ache or weakness that have recently developed. Many studies have confirmed the safety and efficacy of statin therapy in reducing overall mortality from cardiovascular disease. but this is uncommon with statin therapy alone. 7 Correlation between Ayurveda and Modern Medicine Exact correlation between Ayurveda and the modern medical system is not so easy as they both look at cardiovascular disease so differently. Chronic form is characterised by disturbed cardiac rhythm (heart block and 6. However a reasonable comparison can be done as follows: Vata Cardiovascular Disease Valvular Cardiovascular Disease Cardiac arrhythmias Angina pectoris Constrictive pericarditis Aneurysm and dilation of heart and aorta Pitta Cardiovascular Disease Myocardial infarction Endocarditis including valvulitis Myocarditis and pericarditis of all varieties. Page 89 . Literature Review. Kapha Cardiovascular Disease Metabolic disorders like glycogen storage of heart.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. viral or bacterial infections. Krimi Cardiovascular Disease This type of Cardiovascular Disease is due to parasite. tumours of the heart. (ii) Acute infection by trypanosoma cruzi will terminate in myocardial infarction within 20 to 30 days. There are several Cardiovascular Diseases caused by macro and micro-organisms such as: (i) Infective Endocarditis may result from infection by different micro-organisms and by fungi. cruzi. (iv) Hydatid cyst of the heart may be caused by Echinococcus granulosus infestation. This is because of T. (iii) Toxoplasma gondii – its pseudocyst in muscle fibre of the heart will cause Myocarditis. which resides in the heart muscle during its infestation in the body. Literature Review. Page 90 . 6.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Adams syndrome). 1. Kaka nasa 3. pungent and bitter). salty. Ajamoda 2. Kustha 5. Antianginal & hypocholesterolemic 1. Vaca (Azadirachta indica) (Boerhavia diffusa) (Acorus calamus) 3. astringent. Kokilasksa 4. Literature Review.8 Classifying Ayurvedic Herbs on Modern Pathology Ayurveda has its own unique way of classifying herbs. However. Punarnava 3. Antiatherogenic 1.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. Puskaramula 4. Haritaki 3. according to taste (sweet. antihypertensives & diuretics 1. Pasana bhedi (Bacopa monniera) (Asclepia surassavica) (Asterecantha longifolia) (Berginia ligulata) 2. Nimba 2. Guggulu 4. Brahmi 2. Guggulu (Curcuma amada) (Commiphora mukul) (Carum copticum) (Terminalia chebula) (Commiphora mukul) (Saussurea lappa) (Allium sativum) (Inula racemosa) 6. post digestive taste. Lashuna 6. Cardia depressants. Page 91 . Amragandhi Haridra 2. 1. we can also classify them under modern perspectives based on the Ayurvedic understanding of the herbs as below. Cardiac Stimulants. sour. action on the doshas and each herb is also classified with it recognised actions which have been observed over the centuries. Shati 4. Hypolipidemic & hypoglycemic 1. Literature Review. Kasamarda (Cassia oxidentalis) 2. Antihypertensive & antiatherogenic 1. Marica (Mucuna prurience) (Piper nigrum) 7. Apamara 2. (Withania somniferia) (Ailanthus excelsa) (Eclipta alba) (Cynodon dactylon) (Mesua ferrea) (Allium cepa) (Moringa pterigosperma) Page 92 . Antihypertensives 1. Diuretics 1. Haridra (Curcuma longa) John Vorstermans 6. Sahacara (Grewia hirsuta) (Boerhavia diffusa) (Barleria prionitis) (Achyranthis aspera) (Barkerua cristata) 11. Sigru 6. Durva 5. Parusaka 3. Bijaka (Pterocarpus marsupium) 8. Punarnava 4. Kadali 3. Tulasi (Luffa echinata) (Musa paradisciaca) (Hedychium spicatum (Ocimum sanctum) 9. hypoglycemic & antihypertensive 1. Bhringaraja 4. Arula 3. Kapikacchu 2. Antihypertensive.A Study of Cardiovascular Disease in Ayurveda 5. Hypolipidemic. hypoglycaemic & diuretic 1. Sahacara 10. Aswaghanda 2. Jimutaka 2. Antihypertensive & hypoglycaemic 1. Nagakesara 6. Palandu 7. A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. Jan 1986] (2) Essential oil and total oils caused marked fall in BP in cats. 83. (1) Carum copticum is usually added to foods and used in the kitchen.. Page 93 . not because it has not been done but rather that it is not so easy obtain of research done in India outside India without the necessary contacts. In the experimental studies seed powder was feed to normal albino rabbits for four weeks and hypocholesterolemic.2 ml / 100g body weight) caused slight depression followed by stimulation of the rate and force of myocardial contraction of isolated frog's heart and marked vasoconstriction in blood vessels of frog and hind limbs of the rat. hypotriglyceremic and hypophosopholipidemic effects were observed. However below is a summary of some of the research that has been done with some of the more common herbs used in cardiovascular disease.9 Research on Ayurvedic Herbs It is difficult to find valid scientific research on Ayurvedic herbs.2 ml and 0. which of course does not mean that they will have the same effect on humans. Both the extracts showed persistent rise in BP of dogs which could not be altered by any sympathetic drug. Ajamoda (Apium graveolens). Some of these studies are on animals. 1967] Arka (Calotropis procera) (1) The aqueous extract and alcoholic extracts (0. Literature Review. The aqueous extract had a mild diuretic effect in male albino rats [Derasari & Shah 1965] 6. [I JMR. Vol. [Mukharejee et al. The extract did not show any adverse effect on liver and renal function and haematological parameters [Ram A. arjuna) significantly decreased the elevated cholesterol and increased the levels of HDHL. Cairo Univ. “Hypocholesteroaemic effects of Terminal arjuna tree bark” J. 1972] (2) It was observed that Arjuna (T. At the end of the study histopathological evaluation was done which revealed that Arjuna significantly regenerated the cardiac tissue in the infarcted area. 1971. cholesterol. 55 6. 1986] (3) Diet-induced hyperlipidemic rabbits were given 50% ethanolic extract of T. 1962] (3) Calotropin (from C. but its action was not cumulative and was less harmful [Bull.. [Dwivedi S. procera) showed digitalis-like action on the heart. theses. Pharm. Arjuna. Fac. The extract effectively reduced the TCL.. of Ethnopharmacol. It was also noted that the prostaglandin levels which were low have been increased and high levels of catecholamines were brough down by the administration of the drug besides relief from symptoms like pain. “Studies on cardiac muscle regeneration under the influence of certain indigenous drugs” IMS BHU. Page 94 . After carrying out coronary angiographs in dogs treated with Arjuna it was noticed that new coronary vessels developed [Gupta L. P. Ph.A Study of Cardiovascular Disease in Ayurveda John Vorstermans (2) The crude latex of C. 1] Arjuna (Terminalia arjuna) (1) An experimental study was carried out in 50 dogs by ligating coronary artery and Arjuna (Terminalis arjuna) decoction was administered. palpitation etc.D. Literature Review.. 25 dogs were taken as treatment group and 25 dogs were kept as control group. procera and its protein fraction were found to possess high fibrinolytic activity and anti-coagulant activity both in rabbit and human plasma [Srivastava et al.. LDL & TG levels. 10. et al. Varanasi. 500 mg 8 hourly. Literature Review. The test was only done on men and it was also only a short term test. CONCLUSIONS: Terminalia arjuna bark extract. Terminalia arjuna (Roxb.A Study of Cardiovascular Disease in Ayurveda (3): p.3 Several studies here. placebocontrolled.raysahelian. given to patients with stable angina with provocable ischemia on treadmill exercise. 1997] John Vorstermans (4) Efficacy of Terminalia arjuna in chronic stable angina: a double-blind.findarticles. crossover design.D. There were no other tests performed in this case so no clear evidence on what is happening internally. separated by a wash-out period of at least three days in a randomized. Terminalia arjuna reverses impaired endothelial function in chronic smokers. Page 95 . isosorbide mononitrate (40 mg/daily) or a matching placebo for one week each.com/arjuna. They then underwent clinical treadmill tests showing significant decrease in the frequency of angina. crossover study comparing Terminalia arjuna with isosorbide mononitrate.) protects rabbit heart against ischemic-reperfusion injury: role of antioxidant enzymes and heat shock protein. led to improvement in clinical and treadmill exercise parameters as compared to placebo therapy.com/p/articles/mi_m0FDN/is_4_7/ai_91155410#continue http://www.2 Fifty-eight males with chronic stable angina (NYHA class II-III) with evidence of provocable ischemia on treadmill exercise test received Terminalia arjuna (500 mg 8 hourly). 2 3 http://www. (5) ARJUNA by Ray Sahelian.html 6. 265-269. It would have been more interesting to see a longer term test over 3 months to 1 year and then see results. Casuarinin from the Bark of Terminalia arjuna Induces Apoptosis and Cell Cycle Arrest in Human Breast Adenocarcinoma MCF-7 Cells. M. (natural health database). doubleblind. N. While some of the tests were done on humans it would be worth while doing some longer term tests 4 Dravyaguna Vijnana Vol II by Dr J. • Antioxidant and hypocholesterolaemic effects of Terminalia arjuna tree-bark powder: a randomised placebo-controlled trial. liver. Literature Review. Most of the studies were done with extracts of aspects of Arjuna or were compared with other drugs or Vitamines. The result show Arjuna has good results in effecting “T wave changes”. a significant result in regenerating cardiac tissue and development of new coronary vessels. The results look positive in these cases and and verify the Ayurvedic actions of Arjuna.L. Page 96 . as a cardiotonic. Second Edition 2005.L. Page 496 6.N. No side effects or adverse effects on the plasma. It is also shown to decrease elevated cholesterol and increase HDL cholesterol in rats shows antidiabetic activity.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Cardioprotective effect of the alcoholic extract of Terminalia arjuna bark in an in vivo model of myocardial ischemic reperfusion injury. diuretic and hypotensive and anti-acne properties. These results come from a website selling Arjuna so they are likely to pick results that promote their products. None of the tests were long term however there does appear to be postive results in using Arjuna for its hypocholesterolaemic effect. (6) Dravyaguna Vijnana by Dr J. Sastry4 gives references to 12 studies done on the effects of Arjuna mainly on dogs or other animals. Sastry published by Chaukhambha Orientalia. heart or adipose tissue in hyperlipaemic rats. Possible mechanisms of hypotension produced 70% alcoholic extract of Terminalia arjuna in anaesthetized dogs. 1984] (6) Amla juice and pulp (25 mg/kg/day) have prevented developmental atheroma both in aorta and coronary artery. et al. Bordia A. 1994 (4) The anti-atherosclerotic and hypocholesterolarmic effects are also documented [Mand J. officinalis is also reported [Dwivedi S. Literature Review. Haridra (Curcuma longa) (1) Curcumin (7.. 1995]. isolated from ethanolic extract of fruit pulp increased the amplitude of cardiac contraction and heart rate transiently [Khurana et al. Both reduced the serum cholesterol. aortic and hepatic cholesterol significantly in rabbits [Thakur. [Bordia et al. 1991] (8) Hepatoprotective activity – Dry powdered pulp of fruits (1.0g/kg) reduced the levels of serum.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Amalaki (Emblica officinale) (1) The dried powder pulp of Emblica officinalis fruit showed significant reduction in serum cholesterol and atherosclerosis in cholesterol fed rabbits [Thakur and Mandal 1984] (2) Phyllemblin. Page 97 . 1985] (7) Amla fed to rabbits showed hypolipidemic and anti-atherosclerotic activity [Mand et al. c (6 mg/kg) on cholesterolinduced hypercholesterolaemia and atherosclerosis. 1970] (3) The hypertensive activity of E... [Thakur & Mandal. K... 1991.5 mg/kg) caused a sharp but transient fall in BP which was not blocked 6. et al. 1985] (5) Hypo-lipidemic and anti-atherosclerotic activity – Five groups of rabbits were studied for 16 weeks to determine the effect of emblica fruit and vit. 1999] Haritaki (Terminalia chebula) (1) Terminalia chebula fruit powder showed reduction in serum lipid levels without reduction in body weight [CCRIM.. “Effect of turmeric extract on lipid profile (A-22)”. The extracts increased the force of contraction and cardiac output without altering the heart rate 6. TG. Curcumin revealed a depressant effect (Sinha et al. [Deshpande U. brain lipids and produced enhancement of glutathione. [Rajakrishnan et al.i. et al. 2-4 Sept 1966] (3) The alcoholic and ether-soluble extracts showed hypocholesterolemic effect [Pachauri & Mukherjee. HDL and LDL lipoproteoms by administering 1gm b. Literature Review. a non-enzymatic anti-oxidant in ethanol intoxicated rats..R. revealing the anti-oxidative and hypolipidaemic action of curcumin responsible for its protective role against ethanol-induced brain injury. longa (50% ethenol) extract was studied in hyper lipidemic rabbits. 30 and 60 days respectively. [Purohit & Daradka. anti histamines or beta-blockers.d. for 15. 1999] (5) Oral administration of curcumin to rats caused a significant reversal in lipid peroxidation. Similarly. The increased cholesterol levels were brought to normal by administration of C. Int Seminar on Free Radicals Medicated Diseases. Fac of Ayu. Page 98 . 1970] (4) Hypolipdaemic activity of C. IMS. Annual report 74-75] (2) Various extracts prepared from the fruit rind of T-chebula have shown cardiotonic activity when tested on normal as well as hypodynamic isolated frog hearts. BHU.A Study of Cardiovascular Disease in Ayurveda by atropine. longa. 1972) (2) The extract of turmeric has significantly reduced the serum TCL. John Vorstermans On isolated heart from guinea pig.. phospholipids and triglyceride levels were also reduced. Varanasi. . and oleoresin of Commiphora mukul (guggulu) is a ration of 1:1:1 was evaluatied clinically for its efficacy in patients with chronic stable angina. 20 patients of chronic stable angina entered the randomized single blind type trial. serum TG. 1990] John Vorstermans (3) Bala Haritaki is found to be effective in reducing the levels of total lipids.A Study of Cardiovascular Disease in Ayurveda [Reddy et al. Page 99 . Published Journal of International Medical Research. Platelet adhesive index showed 22% and 19% after 30 days in group I and II respectively. Efficacy was assessed using objective end points. Under computerised Tread Mill Test there were statistically significant increases (P<0. and VLDL significantly. UK] (2) Anti-atherosclerotic activity – Effect of gum-guggulu was observed on serum cholesterol. serum cholesterol and serum triglyceride levels were reduced from high and moderate significant levels. 2000] Lashunadi Guggulu (1) Lashunadi guggulu. a combination of 2 medicinal plants. [Dr. there was a marked improvement in precordial pain. On the other hand level HDL is increased significantly [Sood & Sharma. After 2 months treatment with the drug. fibrinolytic activity and platelet adhesive index in healthy individuals (group 1) and in patients of CAD (group II) for a period of 30 days. Serum fibrinolytic activity improved by 22% and 19% at the end of 24 hrs. serum cholesterol. Awasthi A.01) in mean exercise time. Serum cholestrol did not decrease significantly 6. LDL.K. Ten patients completed all phases of study. Inula racemosa (pushkaramula). Haridwar. where as after 30 days it was 40% and 20% in group I & II respectively. West Sussex. The drug was chosen for the study on the basis of textual references in Ayurveda and previous research work carried out during the last 4 decades. dyspnoea and fatigue in all patients. Allium Sativum (lashuna). Literature Review. prothrombin time and fibrinolytic activity. Seminar on Free Radicals Medicated Diseases. Page 100 . “Possible mechanisms underlying the hypolipidemic action of garlic in irradiation (A-25)”.. A. 1996. IMS.. 1979] John Vorstermans (3) Crude guggulu was reported to posses highly encouraging hypolipemic activity in rabbits [Satyavati.ascalonium have shown significant anticoagulant and fibrinolytic activities by virtue of increasing whole blood coagulation time.K. 1967. 1968] Lashuna (Rasona) (Allium sativum) (1) Allium sativum and A. The alcohol insoluble fraction was slightly more potent in this respect than alcohol-soluble fraction as well as crude guggulu [Sastri. 1966] (4) Crude drug as well as its two fractions (alcohol soluble and alcohol insoluble) were found to cause a significant fall in serum cholesterol and serum turbidity with a concomitant increase in the coagulation time and prothrombin time. Reversal of fat-induced decrease in plasma fibrinolytic activity and coagulation time in normal subjects as well as in patients of IHD following garlic therapy [Arocra et. BHU.) (4) Blood cholesterol level was significantly decreased in all human subjects after two 6. 1984] (3) A. No 4] (2) Daily intake of a single piece of Garlic helps to control hypertension and prevents thickening of heart & arteries.ascaonicum also possesses significant hypocholesterolemic properties [JRIM. Literature Review. Int. IX. Fac of Auy. Varansasi 2-4 Sept.. Vol. Tripathi et al. al.A Study of Cardiovascular Disease in Ayurveda [Bordia & Chuttanu. In addition.sativum extract – diallyl disulfide and diallyl propyl disulfide effectively reduces the total cholesterol and triglycerides (Gupta N. Physiol.. 489\ Shankhapuspi (Convolulus pluricaulis) (1) The alcoholic extract of whole plant depressed the amphibian and mammalian myocardium [Boveju & Singla. reduction of body weight. 1966] (2) The alcoholic extract of whole plant depressed amphibian and mammalian myocardium. 1965] (3) The expressed juice of the plant caused a fall in the arterial blood pressure of anaesthetized dogs. improvement in 6. Both showed moderate degree of hypotensive action in anaesthetized dogs [Sharma & Dandiya. J. Pharmaeol. Res. a gradual fall in BP along with relief in the symprom was observed [Chaturvedi et al. 1966] Vaca (Acorus calamus) (1) Cardiac depressant activity was observed both with ascarone and beta-ascarone. dyspnoea on effort. The extract had a spasmolytic activity on the smooth muscle [Barbar & Sharma. In larger doses it produced a transient inhibitory effect on both force and rate of contraction of the heart [Chaturvedi et al. 37. Literature Review.5 ml garlic oil/ml of platelet-rich plasma. thus extract inhibited platelet aggregation [Theanb. 1985.05-0.A Study of Cardiovascular Disease in Ayurveda John Vorstermans months of ingestion of garlic [Ind. 1962] (2) Administration of Vaca (1. 1979] (5) Platelet adhesion to polycarbonate film surface was decreased by 0. 1996] Clinical studies were conducted on 25 cases of arterial hypertension with the decoction of the drug. 23.5 to 3 gms/day in divided doses) for 3 months found effective in chest pain. Page 101 .. 1979. TG.A Study of Cardiovascular Disease in Ayurveda ECG changes etc. Page 102 . Literature Review. John Vorstermans (3) Vaca (acorus calamus) administered in a dose of 1. 6. HDL & LDL.5 to 3gm per day in divided doses for 3 months decreases serum TCL. The roots are numerous. The stem branches are angular or fistular. Ruksha (dry) Usna (heating) Katu (pungent) Apiaceae Apium graveolens Dosha Karma: Actions and Indications: Anulomana (expels downward) 6. sub-orbicular to ellipsoid. Tikta (bitter) Laghu (light). conspicuously jointed. succulent and well developed. It is largely cultivated in Punjab. Pitta Kara Pachana (digests ama) Page 103 Katu (pungent). Principle Constituents: Rasa: Guna: Virya: Vipaka: Prabhava: Parts used: Dosage: Seeds 5-7 gms powder KaphaVata hara. The flowers are white or greenish white and very small. aromatic and slightly bitter. Sanskrit Name: Ajamoda English Name: Celery Botanical Name: Synonyms: Family: Gana: Description: It is native to Europe and now naturalized and occurring wild in the foothills of the northwestern Himalayas and the outlying hills of Punjab. greyish brown to brown with pale ridges. The leaflets are ovate to sub-orbicular and 3-lobed. It is an erect. Himachal Pradesh and Uttar Pradesh.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. annual or biennial herb. The leaves are oblong to obovate. pinnate or trifoliolate. The fruit (commonly called seed) is a schizocarp consisting of two mericarps. Literature Review.10 Details of Ayurvedic Herbs under research. Haryana and Uttar Pradesh. . Sulaghna Indications: Celery seeds are credited with stimulant and carminative properties and are prescribed as nervine. Also benefits heart pain from nervous constriction. intestinal cramps. Ajamododadi churna 6. Temperature: Eyes: Important Yogas: (combinations) Preparations: Ajamodarka. borborygmus.4 As an anti-spasmodic with an affinity for the lower abdomen it can help ease the pain of dysmenorrhea and menstrual cramps. cramps.A Study of Cardiovascular Disease in Ayurveda Deepana (appetizer) John Vorstermans Swasa (relieves asthma) Important Actions: Vidahi.irritation. cystitis etc. The fatty oil from the seeds is used in many medicinal preparations as an antispasmodic and nerve stimulant. cough. Deepana. sinus congestion. Krimijit. It actively helps to dilate the bronchioles by preventing spasm in the airways. tension. Kaphavataji. Respiratory system: Asthma. Literature Review. Usage: External: Internal: Circulatory system: Digestive system: Flatulence. Srotas: Precautions: No adverse effect was reported on use of this plant as medicine in recommended doses. Low agni is stimulated by the pungent volatile oils Nervous System: Spasms. They are prescribed as a decoction or as a liquid extract. Obstructed vata is moved by reducing tension throughout the whole nervous systemthe constriction is eased and a normal flow ensues. The roots are credited with diuretic property. Page 104 . The vegetable 'stalk' heals the urinary system afflicted with problems from heat. Rucikrt. bronchitis. sedative and tonic. Excess kapha is 'digested' Reproductive system: Skin: Urinary system: Specific herb for kidney and bladder discomfort from cold. and is effective in cases of chronic eczema. woody. Roots: Curved. elliptic. and caoutchouc. Katu (pungent). red flowers. Bhaskara. covered with cotton wool.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Arka English Name: Madar Botanical Name: Synonyms: Family: Gana: Calotropis procera Alarka. covered with think bark. Tikshna (sharp) Ushna (hot) Katu (pungent) Description: 6. Arkadi (Sh). thick. Svedopaga (Ch) Adhobhagahara (Sh). Lewin found a neutral principle. Mandara Asclepiadaceae Bhedhaniya (Ch). a crystalline colourless substance. Rasa: Guna: Virya: Vipaka: Pabhava: Parts used: Root bark. It has long been used in India for abortive and suicidal purposes. Principle Constituents: A yellow bitter resin. called Mudarine. Calatripin. an amber coloured viscid substance. Mudar rootbark is very largely used there as a treatment for elephantiasis and leprosy. flowers Dosage: Root bark churna 1-2 gm. buds are ovoid. Varieties: Two types distinguished by the colour of the flower. Vamanopaga (Ch). Leaves: sessile. Calotropis procera – Rakta Arka. white. Madaralbum. Madarfluavil. Page 105 . ravi. Surya pushpaka Kshiraparni. Literature Review. white flowers. Flowers 1-2 gm. and a peculiar principle which gelatinizes on being heated. yellow – white bark. a very active poison of the digitalis type. pedicles longer than the flowers. In India the author's husband experimented with it for paper-making. Tall shrub up to 2-4 metres in height. Tikta (bitter) Laghu (light). The acrid juice hardens into a substace like gutta-percha. Flowers: purplish. dilated at the base. Latex 1/8th – ¼ gm. oblong. light – greyish white yellow. Calotropis gigantea – Shveta Arka. latex. the inner bark yielding a fibre stronger than Russian hemp. Bhanu. clothed beneath and above with cotton. Ruksha (dry). a black acid resin. leaves are heated and bound on the affected area. Not wise to use for internal use and may be not for external. constipation. Respiratory system: Expectorant and anti asthmatic. deafness. purgative. Alkaline extract of flowers is useful in many disorders. Skin: As it is a diphoretic. anthelmintic. It is a strong irritant to skin. heart. cough. Precautions: High toxic properties. Rasavaha. It causes irritation of stomach by stimulating vomiting centre in the brain and thus causes emesis. Majja Organs: Liver. Internal: Circulatory system: Root bark is a cardiac stimulant. Purishavaha Dhatus: Rasa. cholagogue. antidermatotic. Conditions in which there is inflammation and pain. kidney stones. Raktavaha. Brush on teeth for toothache. Rakta. haemorrhoids. cold. Root bark is use in cardiac debility. ear ache. purifies blood and is antiinflammatory. digestive. asthma. autodermatosis. oil made up of the juice is also used for massage. majjavaha. Leaf powder helps wounds heal faster. spleen. Digestive system: It is an emetic. Oil used in otalgia. vranashodana. Pitta hara (red variety). Therefore root bark and flowers are used in kaphavata kasa and asthma. it is used in elephantitis and rheumatoid arthritis. liver and spleen enlargement.A Study of Cardiovascular Disease in Ayurveda Leaves 2-4 gm John Vorstermans Dosha Karma: Vata hara (white variety). Literature Review. boils. . skin disorders. increases appetite. In anorexia. parasitic conditions – worms. Not available in NZ Usage: External: As it is analgesic. Kapha hara (red & white) Actions and Indications: Bhedana-virecanopaga-recana (laxative) Deepana-pacana (stimulates agni) Jvaraghana (anti-pyretic) Hridya (heart tonic) Kaphaghana (kapha pacifying) Kusthaghna (skin conditions) Important Actions: Indications: Gall stones. Srotas: Pranavaha. eczema. Annavaha. antinflammatory. anti microbial. eye disorders. its latex is used. filaria. therefore is used in Page 106 Rakta Pitta Shamaka (pacifies rakta pitta disorders) Raktashodhaka (blood purifier) Vamanopaga-vamaka (emetic) Vedanasthapana (pain killer) Visaghna (anti poison) 6. fever. chancroid ulcers and many other blood diseases. Flowers of red variety is used in haemorrhagic disorders. A Study of Cardiovascular Disease in Ayurveda John Vorstermans dermatosis. Page 107 . also effective in typhoid. Arka Kshara 6. Literature Review. Important Yogas: (combinations) Preparations: Arka Lavana. Temperature: Febrifuge. Arka Taila. It is very potent remedy for scabies. [Vatakara. Kakubha.astringent Udardaprasamana [ch] .. Pittahara and Kapahara. Bark Bark . & A. Nadisarja. cardiac stimulant. Decoction 50 – Actions and Indications: Ashogna (piles) Balya (building) Hridya (heart tonic) Kaphaghana (Kapha pacifying) Jvaraghna (antifever) Medohara (fat reducing) Mutrasangrahaniya (anti-diuretic) Raktaprasadana (good for the blood) Rasayana (tonic) Sandhaniya (joining) Shothahara (swelling) Stambhaka (stopping) Tvacya (skin disorders) Visaghna (anti-poison) Vranaropana (wounds) Important Actions: Cardiac tonic. Combretaceae Kasayaskandha [ch] . virya and vipaka the action of Arjuna has the following effects on doshas: Vatakara. Pittahara and Kapakara] [Vatakara. Rasa: Guna: Laghu (light) Pittakara and Kapahara] Ruksha (dry) Shita (cooling) Katu (pungent) [Vatakara.Powder 1-3 gms. Pārtha. blood disorders. 6.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Arjuna. Pittakara and Kapahara] Virya: Vipaka: Prabjave: Hridya Karma: From the properties of rasa. Pittahara and Kapahara] [Vatakara. Page 108 . Literature Review. 10-30 grains. Juice 10-15 gms. dhavala English Name: Botanical Name: Family: Gana: Arjuna Terminalia arjuna W. guna.relieving rashes Nyagrodhadi [sh] Salasaradi [sh] Kashaya (astringent) Pittahara and Kapahara] [Vatakara. Vīravrksa. Indradru. Dosha Karma: Kapha hara Pitta hara Parts used: Dosage: 100 ml. by reducing urinary discharge and relieving burning and pain during micturition. Respiratory system: Astringent properties useful in purulent and tuberculous cough and in haemoptysis. rakta. Literature Review. Internal: Circulatory system: Cardiac tonic. Urinary system: Useful in diabetes from astringent properties and gonorrhoea. The bark paste can be applied to wounds. Usage: External: It helps in wound healing and joining by astringent property. It increases the peripheral resistance by constricting capillaries which leads to rise in blood pressure. meda. Reproductive system: Prevents early ejaculation of semen. Medavaha Dhatus: rasa. Curna.A Study of Cardiovascular Disease in Ayurveda swelling. Skin: Useful in skin diseases with prurits. Raktavaha. It enhances blood quality. Page 109 . giving strength to cardiac muscles. It is haemostatic. Arjunasrista. Parthadyarista. Arjunatvak. Organs: heart. respiratory John Vorstermans Precautions: Due to it's vatakara quality it could cause constipation so need to be taken with herbs that will prevent this. circulatory. Reduces heartburn and cough. In chronic fever it not only helps as antipyretic but also acts a general tonic. Rasavaha. bleeding. Important Yogas: (combinations) Preparations: Kakubhadhi. anemia. improving cardiac function and rhythm. Srotas: Pranavaha. Prevents accumulation of fluids thereby reduces oedema. Digestive system: Its astringent property reduces motility and being a haemostatic it controls bleeding in dysentery and haemorrhoids. Useful in menorrhagia and leucorrhoea. ulcers and especially used in promoting the union of fractures. Arjunaghrta 6. Temperature: It is febrifuge. It reduces cardiac rate. febrifuge. relieves fevers Praja-sthapana – Promotes reproduction. rejuvenation. flowers in autumn. cure sterility. globose fruit. 6. Principle Constituents: Rich in Vitamin C. unisexual. usually laxative in nature. Vaya-sthapana – Promotes longevity. reduces skin inflammation Virecanopago – Adjunts to purgation. Tree and Bark: small medium sized tree. counters the aging process. Katu (pungent). Page 110 . 8-18 metres in height.stop cough. Kāsahara . Tannic Acid. Rasa: Guna: Virya: Vipaka: Pabhava: Parts used: Dosage: Fruits Powder 3-6 gms daily Pancha (five) Rasa. Tikta (bitter). Gallic Acid. Cellulose and minerals like Calcium.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Amalaki English Name: Emblic myrobalan Botanical Name: Synonyms: Family: Gana: Emblica officinalis Dhatri. very many sub sessile. Shita (cold) Shita (cooling) Madhura (sweet) Description: Dosha Karma: Tridosaghna. Amalaki. Madhura (sweet). anti-trussive Jvarahara . because it nurses the people and protects them against disease. Specifically Pitta pacifying. Euphorbiaceae Triphala Parushakadi Kustaghna . Fruits: Ovary three celled. the nurse.Anti dermatitus. with thin light grey bark that exfoliates in small thin irregular flakes. Flowers: Greenish yellow. fleshy. light green. Literature Review. Leaves: Simple. six striations with seeds. Glucoses. Albumin. Ruksha (dry). pale yellow. Kashaya (astringent) Laghu (light). closely set along the branches. Amla (sour) predominant. pancreas. Page 111 . constipation. haemostatic. general debility and tissue deficiency. antipyretic – refrigerant. gout. Keshavika – hair wash. increases ojas – works on all levels of the dhatus as a rejuvenative. Kushtha. general tonic. cardiac disorders. haemorrhoids. premature greying or hair loss. laxative. lack of libido. anaemia. Organs: Brain. heart. Indications: mental disorders. Raktavaha. aphrodisiac. weakness of the liver or spleen. Ambuvaha. hepatitis. gastritis. asthma. anti-inflammatory. bleeding disorders. fever. diabetes.A Study of Cardiovascular Disease in Ayurveda Actions and Indications: Anulomana (causing downwards movement of apana) Balya (strength tonic) Dahaprashamana ( anti burning) Deepana (kindles digestion) Hridya (heart tonic) Jivaniya (life giving) Jwaraghna (anti pyretic) Kandughna (anti pruritic – anti itching) Keshya ( hair tonic) Kushthaghna (skin conditions) Mutrala (diuretic) Sarvadoshahara (kills all diseases) Stambhana (stopping) Rakta Pitta Shamaka (pacifies rakta pitta disorders) Rakta prasadaka (builds good quality Rakta Stambhaka (to stop bleeding) blood) Rasayana (rejuvenative) Rochana (enhances taste) Sandhaniya (help to heal. eye disorders. leucorrhoea. Majjavaha. inflammation. Literature Review. peptic ulcers. skin diseases. dysentery Usage: External: Netra vikara. wounds etc). Shukrakara (increases sperm) Shula prashamana ( reduces abdominal pain) Tvachya (skin disorders) Vayasthapana (promoting longevity) Vrishya and Vijikara (building good shukra & sexual tonic) John Vorstermans Important Actions: Rejuvenative. Mutravaha Dhatus: Rasa. Shukravaha. bronchitis.Tvakrog – skin 6. Shukra. joining of bones. general weakness. male infertility. liver. Purishavaha. Precautions: Acute diarrhea. Rasavaha. Rakta. Srotas: Annavaha. cardiac tonic. Small doses cause constipation while large doses is laxative. antacid. Dhatriloha.A Study of Cardiovascular Disease in Ayurveda John Vorstermans disorders.strengthens the nervous system. stems from liver disorders. Skin: Useful in skin diseases. Chyavanaprasha. complexion enhancer. Reproductive system: Aphrodisiac tonic and haemostatic Urinary system: Useful in diabetes though it is a diuretic. Arsha – piles Grahi – constipation Yakruti vikara – liver/spleen disorders Aruchi – loss of taste. Indriya daurbalya – weakness of the senses. Prameha – diabetes Pradara – leuccorrhea & menorrhea Mutrakruchra – dysuria Jirna Jvara – chronic fevers Important Yogas: (combinations) Preparations: Triphala. Internal: . refrigerant. anorexia Agnimandya – low digestive fire Amla pitta – gastritis Gulma – tumor in the abdomen Hridroga – heart disorder Pandu – anemia Rakta pitta – bleeding disorders Chardi – vomiting Atisara . Respiratory system: Reduces cough. Brahma Rasayana. Circulatory system: Cardiac tonic.diarrhoea Kasa – cough Svasa – asthma Rajayakshma Kshaya – TB Koch's all tissues affected mainly respiratory tract. biliousness. Digestive system: it improves taste and appetite. Dhatri Avaleha (jam) 6. Temperature: Antipyretic. Page 112 . curative. Manoroga – brain diorders. bone marrow and sense organs. Literature Review. Netra vikara – eye sight problems Udara roga – ascities. HIV. Nisha. Dosa Prabhava: Antibacterial. sesquiterpene hydrocarbons maily zingiberene.conjunctivitis inflammation. hemorrhoids. caproic acid. (oil has no phenols. Ksanada. resin. Ratri. Sitapitta. Pandu (anemia). 6. Principle Constituents: Essential oil. Indications: chronic strep. curcumin--the yellow coloring matter. anemia. Kustha (skin). asthma.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Haridra English Name: Turmeric Botanical Name: Synonyms: Family: Gana: Description: Turmeric is native to India. Page 113 . regulates blood sugar Dosha Karma: VataKaphahara Pittakara Actions and Indications: Krimighna (destroys parasites) Kustaghna (skin conditions) Pramehana (anti-diabetic) Varnya (complextion) Vishaghna (anti-poison) Important Actions: Visavikira.5 to 3 grams Curcuma longa Rajani. The medicinal part of the plant is the dried and cooked rhizome. turmeric oil or turmerol. non healing ulcer. Literature Review. thin blood. an alkaloid. bronchitis. It is found today cultivated in India and other parts of south-east Asia. Twakroga. Prameha (diabetes). aldehydes or ketones). Katu (pungent) Ruksha (dry) Ushna (heating) Katu (pungent) Root 1. cqleric acid. diabetes. Vrana. Fe Rasa: Guna: Virya: Vipaka: Parts used: Dosage: Tikta (bitter). psoriasis. and in pregnancy. skin conditions. and vulnerary. non-healing wounds. and in wound and bruise healing. decoction. sore throat. and circulatory systems. sinus congestion. cat scratches. bronchial asthma. inflammed piles. alterative. It is prepared as an infusion. Usage: Turmeric specifically affects the digestive. lump in breast(not fibrocytic). hoarseness of voice. It is tonic to the skin. Turmeric gives the energy of the Divine Mother and grants prosperity. traumatic arthritis. It not only purifies the blood. It aids in the digestion of protein. It has proven useful in conditions of: indigestion. Externally. therefore. Turmeric promotes proper metabolism in the body. pharyngitis. milk decoction. or by taking it in powder form of 250mg to 1 gram. It is also contraindicated for those with diagnosed gall bladder disease. wounds. It is effective for cleansing the chakras (nadi-shodhana). eczema. Its actions are: carminative. Literature Review. respiratory. anemia bronchitis. stimulant. Srotas: Precautions: Turmeric should not be used during pregnancy due to its reported antifertilty effects. cough. anemia. dermatitis. antibacterial. Turmeric is an excellent natural antibiotic. purifying the channels of the subtle body. Turmeric should be used cautiously in acute jaundice. strains. cold.” Important Yogas: (combinations) Preparations: Haridra Khanda 6. diabetes. while at the same time it strengthens digestion and helps improve intestinal flora. bacterial infection.A Study of Cardiovascular Disease in Ayurveda John Vorstermans fungus. amenorrhea. but also warms it and stimulates formation of new blood tissue. poor circulation. Page 114 . cough. hepatitis. tonsillitis. As such it is a good antibacterial for those chronically weak or ill. for which purposes it can be taken internally as a milk decoction. arthritis. bruises or itching. hemorrhoids. sore muscles. good for the practice of hatha yoga. it can be used with honey for sprains. diabetes. strep throat. It helps stretch the ligaments and is. correcting both excesses and deficiencies. Literature Review. Page 115 . reduces ama) 6. Kusthanghna. Botanical Name: Terminalia chebula Combretaceae [Triphala. Katu (pungent) Laghu (light). siva English Name: Synonyms: Family: Gana: Description: Myrobalans. Kasaghna. Mutrala (mild diuretic action) Pachana (digests ama) Prajastapana (helps in conception) Rasayana (rejuvinitive tonic) Shotahara (anti-inflammatory) Yakrututtejaka (good for liver. Arshoghna A large tree up to 30 meters high with hard and bulky bark. Leaves – 10 – 30cm in length and pointed with 6-8 pairs of veins. an oval shape pulp is obtained.] Prajasthapana. Chebulic myrobalan. white or yellow and strong smell. Madhura (sweet) Dosha Karma: Tridosha Actions and Indications: Anulomana (expels downwards) Balya (strengthens nerves) Deepana (appetizer) Jwaraghna (anti-pyretic) Kaphagna (pacifies kapha.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Haritaki Pathya. abhaya. Parushak. Principle Constituents: Fruit containsup to 30% tannin. Ruksha (dry) Ushna (heating). Fruits – 3-6 cm long green and become yellowish-brown on ripening. Seeds oval and hard and on breaking the shell of the seed. Interior aspects of leaves show two small nodules near its attachment to the stalk. (popular names). Flowers – short stalks. resin etc. amrut. Tikta (bitter). Trivrutt. Amalakyadi. haimavati. chebulinic acid and it also contains gallic acid. Rasa: Guna: Virya: Vipaka: Prabhava: Parts used: Dosage: Fruit Fruit (greater) 3-6gm laxative. Amla (sour). 1gm for alterative. Madhura (sweet). Kasahaya (astringent). Jwaraghna. haritaki khanda. Netravikara. tumors. K less. vomiting. Grandusha and local application on bleeding and ulcerative conditions of the gums. Spring: honey. granthi – excess glands and tumours. Autumn – sugar. Nerves weakness. Smoke / cigarettes of fruit powder for asthma conditions. Shula. thirst. Jwara. Winter: shunti. Fileriasis. arishta. rasayana .A Study of Cardiovascular Disease in Ayurveda Krimighna (destroys parsites – mild) Medya (supports actions of brahmi) Mrudurechana (mild laxative) John Vorstermans hepatitis) Vedanesthapana ( good for pain) Vrishya (removes ama from shukra) Important Actions: A preventative and curative herb. Raktapitta. Chardi. Ajirna – indigestion 3 types = ajirna K type / vidagdha P type/ vistabdha V type. Shotha. ascits. lepa Haritaki rasayana: Anupana: rainy season saindha -salt. stir 10 min on low heat. pathyadi kwatah. eye diseases. Vatarakta. Hikka. Uterine waekness. For Gout – Triphala or Haritaki will drop Uric acid levels. V more. Use as powder. in 6. For Vata Vyadhis. Hrahani. gout. Anaha – gaseous disorders. anemia and bhrama – dizziness. Pitta dosha: sugar. Mukha roga. stambhana effect on GIT. Kustha. Shwasa.rejuvenative medicine and used on number of disorders. Vata vyadhi. Fruit is kept in water over night and this water is used for eye wash as is very cooling. Antioxidant and amapachana Indications: Agnimandya. Mutraghata – obstruction. Krumi. vati. Use Daily. For: vata dosha anupana ghruta. carminative. tonic. urinary calculi. typhoid. Srotas: All srotas Precautions: Important Yogas: (combinations) Preparations: Abhayamodaka. amru haritaki. Page 116 . Jirnajwara – chronic fever. sore throat. pathyadi churna. Pratishyaya – cold. Churna decoction are used in Asthma. leucoderma. Medo roga. Arsha. haritkaydi rasayana. Visarpa. Prameha. bleeding piles. Literature Review. kasa. Gandharva Haritaki 1:1 Castor oil & Haritaki. churna. de-worming. Kapha dosha Lavana. Shweta pradara – leucorrhea. For piles – ½ tsp. Therapeutic Uses: Very commonly used herb. vyaghri haritaki. Amavata. good on paralysis and brain disorders. Fruit is expectorant. Unripe fruit for diarrheoa and dysentry and ripe is purgative. Vishama jwara – typhoid. Rakta vikara. Dysuria. Pharyngitis. Summar guda – jaggery. John Vorstermans 6. Literature Review.A Study of Cardiovascular Disease in Ayurveda capsule or vati. Page 117 . 2 capsules for therapeutic use before going to bed. Mahishaha. Indian Bedellium Commiphora mukul Guggul. Principle Constituents: Contains volatile oil. Varieties – are based on colour and accordingly they are used on humans or for animals. Palankash.5-1. Ovary oblong ovoid attenuated into the style. ovate and serrate. Tikta (bitter) Madhura (sweet) Lagu (light). Gujarat. Mahissraka black in colour used for human body. Flowering and fruiting – after rainy season up to autumn. triangular long as tube. Kumbha. kana and Bhaina Guggul. Rasayana (Rejuvenative) Page 118 . usually ending in sharp spines. Katu (pungent). Mahinila blue in colour for veterinary use. Kumuda and Padme red colour one also for Veterinary use. young parts are glandular.3 mtrs high. Guggul. resinous gum and bitter principle Rasa: Guna: Virya: Vipaka: Parts used: Dosage: Kashaya (astringent). Distribution – Rajasthan. Snigdha (unctuous). branches are knotty and crooked. Kashi. toothed in the upper part. Mysor. Pichilla (sticky). Eladi (Sh) Tree is 1. Kanaka is yellow for human body use. Deodhoop. Tikshna (sharp). Sara (mobile) Ushna (hot) Katu (pungent) Gum resin 1-2 gms Prabhava: Tridoshahara Dosha Karma: Tridoshahara Actions and Indications: Arshoghna (relieves piles) 6. Deveshta Burseraceae Vedanasthapan (Ch). warm regions of India.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Guggulu English Name: Botanical Name: Synonyms: Family: Gana: Description: Gum. Drupes red when ripe. Flowers fascicles 3-5. acute and readily splitting into two. Leaves – 1-3 foliate. In market you get two types. 6-8 mm in diameter. Literature Review. Sukshma (fine). lymphadenitis. Thus useful for loss of appetite. liver diseases. arthritis and skin conditions. It reduces foul smell and wound swelling. Good for ama & vata. Misuse of guggul leads to pathological changes in liver and lungs while excessive dose causes vertigo. cervical lymphadenitis.A Study of Cardiovascular Disease in Ayurveda Ati Lekhana (excessively scraping) Balya (Strengthening tonic) Deepana (Appetizer) Krumighna (destroys parasites) Kustaghna (Skin conditions) Medahara (Fat reducing) John Vorstermans Sandhanakara (promotes fracture healing) Shotahara (anti-inflammatory) Swarya (good for the voice) Vatahara (Vata pacifying) Vranaropana (Wound healing) Important Actions: Hypolipidic. Paste of guggul is locally applied in rheumatoid arthritis. analgesic. Nervous System: Vatashamak. Literature Review. cleaning of wounds and healing due to antibacterial action. Indications: Amavata Arsha Bhahgna (fractures) Gandamala (goitre) Granthi (tumors) Kustha (skin) Medoroga (obesity) Sandhivata ( fractures & connective tissue) Shota (inflamation) Vata vyadhi Srotas: Asthivaha Precautions: It is mentioned that guggul is very useful. constipation. sara and tikshna. Most important for obesity. In stomatitis guggul kept in the mouth helps in wound healing. chronic skin conditions. skin diseases. Its vapours are useful as deodorant and disinfectant in the house. Digestive system: Appetizer by pungent and bitter. dryness of mouth. The dosage should be adequate. Page 119 . piles and worms. Gargling is useful in pyorrhoea and dental disorders. piles etc. laxative by snigdha picchila. It helps in oedema. still one has to be careful about injudicious use of it. Guggul should not be used in patients with the above complaints. Increases haemoglobin and leucocyte count and enhances blood quality. helps in rheumatoid arthritis. hypocholestremia. loss of weight and dryness of skin. nervine tonic. Usage: External: Anti inflammatory. Internal: Circulatory system: Cardiac tonic. impotency. antihaemorrhoidal and anthelminitc by bitter and ushna gunas. liver stimulant. obesity and weight loss. analgesic. so 6. glandular enlargement and filaria when given for a long period. Respiratory system: Expectorant being snigdha and picchila. 6. impotency. Chandraprabhavati – obesity scraping. enhances complexion. anthelmintic. Skin: Effective in dermatoses. Triphala Guggul. Reproductive system: Increases sexual power and acts as an emmenogogue. Page 120 . rheumatoid arthritis. Literature Review. Arogyavardhini. sciatica. leucorrhoea. hemiplegia. and gout. dysmenorrhoea. Great for vata disorders. Deodorant. Useful in chronic cough and chronic asthma.A Study of Cardiovascular Disease in Ayurveda John Vorstermans guggul us useful ineuralgia. Preparation of guggul + pippali + honey + ghee is useful in kapha disorders. and useful in many skin diseases. Important Yogas: (combinations) Preparations: Yogaraj Guggul. It is also useful in oligospermia. Mahayogaraj Guggul. and other gynaecological diseases. facial paralysis. long stalked. Rasa: Guna: Virya: Vipaka: Prabhava: Parts used: Dosage: Roots Powder 1-3 gms Tikta (bitter). inunal isoalloaltolactone and essential oil. Shwetavacha. Kashari. Literature Review. cauline at the base. radical leaves. alantolactone. Page 121 . coriaceous densely hairy beneath. Shoolahara. Shwasari. Sugandhika English Name: Botanical Name: Synonyms: Family: Gana: Description: A stout herb up to 1. top is rough. Tikshna (sharp) Ushna (heating) Katu (pungent) Inula racemosa Padmapatra (leaves similar to lotus leaves) Kashmari Compositae Swasahara. Kashmir. heads involucral with recurved triangular tips. 6. Good for cardiac failure. Kushthabheda. the heart – angina.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Pushkaramula Pushkara. Leaves are feathery. Hikkanigrahana (Ch) Dosha Karma: Kaphahara Vatahara Actions and Indications: Hyridya (heart tonic) Kasahara (relieves coughs) Jwaraghna (anti pyretic) Medohara (good for reducing fat) Mutrajanana (diuretic) Panduhara (anaemia) Parshwashilahara (relieves chest pain) Shotahara (anti-inflammatory) Swasahara (relieves asthma) Vajikarana (aphrodisiac) Important Actions: Good for the respiratory conditions. Katu (pungent) Laghu (light). elliptic-lanceolate. Principle Constituents: Sesquiterpene lactones. isoalantolactone.5 meters tall with grooved stem. Flowers yellow in racemes. Haimavati. Toothed. Swasa. it cures pus formation. Internal: Circulatory system: Digestive system: Used in anorexia indigestion and flatulence. 6. Page 122 . dyspnoea and hiccough. It is effective in chronic cough. Local application of paste is effective in lateral chest pain by which swelling and pain are relieved. Srotas: Annavaha. Anemia. raktavaha Precautions: Usage: External: It is an antifungal. Angina pectoris. hence is useful in cerebral impairment and vata disorders. Nervous System: Stimulates the brain and nervous system. swelling and pain. Pushkaramulasava (all listed indications. Skin: Urinary system: Stimulates the kidneys and increases urine formation Important Yogas: (combinations) Preparations: Pushkaramuladi churna (All listed indications).A Study of Cardiovascular Disease in Ayurveda John Vorstermans Indications: Kasa. hiccups. dyspnoea and pleurisy. In these diseases it alleviates the dosha by killing bacteria and relieves fever and pain. Reproductive system: Useful in amenorrhoea and dysmenorrhoea. Literature Review. Also a good aphrodisiac. Especially in Vata and Kapha predominant jwara. Cardio protective. Hypertension. It's powder is sprinkled over tuberculosis ulcers or its paste if applied. especially in respiratory conditions. It is used in painful swelling. Respiratory system: It clears the airways and alleviates cough. Literature Review. Leaves are flat. Rasayana (rejuvenative) Sandhaniya (promotes fracture healing) Shotahara (anti inflammatory) Shukrala (increases shukra) Sulaprashamana (pacifies abdominal pain) Swedanjana (promotes sweating) Uttejaka (liver stimulant) Vataaghna (reduces vata) Vedanasthapana (removed pain) Vishaghna (anti poison) Page 123 . The single bud variety is used extensively in medical pharmacopoeia. Guru (heavy). It is 30-60 cms in height. thin and long. albumin. whote liquid. Lashuna Liliaceae Botanical Name: Allium Sativum A bulbous variety of plant. Sara (mobile) Ushna (heating) Katu (pungent) Dosha Karma: VataKapha hara Actions and Indications: Anulomana (expels downwards) Artavajamama (amenogouge) Deepana (digestive) Hridya (heart tonic) Kaphagna (reduces kapha) Krimighna (destroys parasites) Kustaghna (skin conditions) Mutrajanana (diuretic) Pachana (digests ama) 6. Kashaya (astringnet) Snigdha (unctuous). Tikta (bitter). Lavana (salty). sugar. Katu (pungent). pinkish with 5 to 12 buds in it. Bulb white. Another (third) variety – garlic with a single bud. The volatile oil which is yellow in colour contains organic sulphur. oil 1-2 drops Madhura (sweet). Inflorescence arises from the centre of the plant and bears flowers right at the top. Cold weather is the season for flowering and fruits. Principle Constituents: Volatile oil.A Study of Cardiovascular Disease in Ayurveda Sanskrit Name: Rasona Lashuna John Vorstermans English Name: Synonyms: Family: Description: Garlic Ugragandha. Picchilla (slimy). jelly like substance. Rasa: Guna: Virya: Vipaka: Prabhava: Parts used: Dosage: Bulb. Tikshna (sharp). Yavunesta. oil Paste 3-6 gms. Varities: Two 1) Rason and 2) Maharason. Its stem is tender. The bulb of Maharason is larger. juice of garlic brings it to normal. Reproductive system: It stimulates the production of semen. The volatile oil kills Mycobacterium tuberculi. pruritus and eczema etc. arthritis. Shula. Skin: As it contains organic sulphur is is very effective in skin diseases. Garlic juice is given internally in diminished vision. Urinary system: Is used in urinary disorders. sciatica and weak memory. Respiratory system: It decreases cough. Page 124 . Rasonpinda. Rasona siddha taila 6. A bud of garlic. worm infestation. Digestive system: In digestion. Hrdroga Heart). Flatulence caused by food like rice can be avoided easily if cooked in garlic water. Garlic paste is used for swelling in rheumatoid arthritis. Krmi (parasite) Precautions: Being tikshna and ushna it is contraindicated in pregnancy and those with pitta prakruti because it aggravates pitta. It is used as a preventative medicine in enteric fever. garlic oil should be used for massage before fever rises. Being a regulator of menstrual function it is useful in dysmenorrhoea. garlic oil is rubbed on the chest. Thus it is of much use in paucity (weakness) of semen. In fevers with rigours. garlic is useful. constipation. low appetite. Garlic juice is used in skin disorders like eczema. a garland of garlic buds is put around the neck. Gulma. Important Yogas: (combinations) Preparations: Rasonvati. Rajayaksma. pain killer and removes toxicity. diphtheria etc. Rasonashtaka. Juice is also used. piles. pain. Vibandha. Lasunadighrita. sciatica. It the uvula is elongated. paralysis. Literature Review. Shota (inflammation). facial palsy and pain in the ribs. In diseases of Vata and Kapha. tuberculosis and hoarseness of voice. Nervous System: Used in paralysis. Healing properties are therapeutic to inflammation patches in lungs. Milk boiled with garlic reduces chronic cough. all diseases of vata and kapha. Usage: External: It is an anti inflammatory. Cough is demulcified by buds of garlic. Swelling due to insect bites almost disappear on rubbing garlic juice or oil of garlic. Internal: Circulatory system: Oedema due to cardiac disorders is decreased by garlic.A Study of Cardiovascular Disease in Ayurveda Raktapittajanana (pacifies rakta pitta disorders) Important Actions: John Vorstermans Yakrituttejaka (Liver regulator) Indications: Vata vyadi. inserted in the ear also relieves pain. In childhood cough. In a persistent cough. Temperature: Useful in fevers. Swasa (asthma). Asthibhagna. Ajirna. a necklace of garlic buds is worn. Kasa (cough). asthma. Tikta (bitter) Snigdha (unctuous) Shita (cooling) Madhur (sweet) Medhya Whole plant Decoction 20 – 30 ml Powder 3-6 gms Cold infusion 12 – 50 ml Tridoshahara Medhya (brain tonic) Mutrala (diuretic) Prajasthapana (infertility treatment) Rakta stambhana (stops bleeding) Rasayana (rejuvenative) Page 125 Convolvulus pluricaulis Kshirpushpi. Varnavilasini Convolvulaceae Dosha Karma: Actions and Indications: Anulomana (expels downward) Hridya (heart tonic) Kapha nissaraka (liquifies kapha) Keshya (hair tonic) Kustaghna (skin conditions) 6. Katu (pungent). Root is like a rope. perennial with many branches. Stem is slightly quadrangular. The fruits are small at the top or near the branches. Kusum. 15-30 cm long. whitish or greenish. Leaves are thin. a finger thickness. long. Smrutihita. Medhya. Shoolaghna.A Study of Cardiovascular Disease in Ayurveda Sanskrit Name: Shankhapushpi John Vorstermans English Name: Botanical Name: Synonyms: Family: Gana: Description: A creeper. without stalk and ciliated. Principle Constituents: Contains sedative ad tranquilliser Rasa: Guna: Virya: Vipaka: Prabhava: Parts used: Dosage: Kashaya (astringent). Literature Review. with three veins. convula. . The flowers are shell shaped. Supushpa. Malavinashini. white. Literature Review. blood impurities. Used in insanity. Digestive system: Improves appetite. Internal: Circulatory system: Cardiotonic. shamaka. digestion and peristalsis. raktapitta. haemopysis. abortions and cervical incompetence. Great for loss of appetite. gulma. Shankhapushpipanaka. hematemesis and hypertension. gonorrhoea. piles. dyspepsia. Page 126 . Shankhapusphi ghrita Important Yogas: (combinations) 6.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Vrsya (improves sperm count) Important Actions: Intellect promoting rasayana. haemostatic. Skin: Good blood purifying action so good for skin conditions. anti stress. it reduces the sensitivity of attacks because of its prabhava. Srotas: Manavaha Precautions: Usage: External: Kusthaghna and hair tonic. heart diseases. loss of gasteric power. Used in defective sperm conditions. In schizophrenia. Reproductive system: Good aphrodisiac. seminal disorders. Useful in heart disease. Respiratory system: An optimum expectorant. kustha. Nervous System: Brain tonic. flatulence. memory promoter. cough. hypertensive. Amrutadi rasayan. Used in mental and psychosomatic diseases. uterine disorders. fever. epilepsy and other mental disorders. Medhya kasaya. sedative and therefore it is used in epilepsy. abdominal diseases. Urinary system: Temperature: Eyes: Preparations: Shankhapushpi syrup. It is used in the form of a paste in skin diseases and siddha oil for hair growth. insomnia and giddiness. Fresh juice 2-4 tolas overcomes schizophrenia by clearing the bowel. flatulence and other Vata conditions of the bowel. Used in cough caused by vatapitta and hoarseness of voice. uterine debility. skin diseases. Indications: Brain tonic. Its peristaltic action helps to eliminate intestinal toxins and constipation. dysuria. insomnia. These roots spread horizontally and can grow to almost 2 metres in length. The plants have long creeping roots that spread out just below the surface of the soil. Fruit – turbinate prismatic. Pippalyadi. Shitaprashamana. Tripthighna. rhizome forming. Rasa: Guna: Virya: Vipaka: Prabhava: Parts used: Katu (pungent). Seeds oblong. Mustadi. albumen fleshy. Vachadi. Urdhvabhagahara (Su) A grass like. Literature Review. embryo axile. This species inhabits perpetually wet areas like the edges of streams and around ponds and lakes. Description: Principle Constituents: Monoterpene hydrocarbons. Native to most Northern Latitude countries around the world. Ugragandha (strong odor). Calamus can often be found growing close to the sites of Indian villages. Shirovirechana (Ch).A Study of Cardiovascular Disease in Ayurveda John Vorstermans Sanskrit Name: Vaca English Name: Botanical Name: Synonyms: Sweet flag Acorus calamus Vacha (helps improve speech). Lekhaniya. and cause a more sedate feeling when ingested. The Asian varieties do contain varying amounts of Beta-asarone. The American variety has consistently tested free of the carcinogenic Beta-asarone. Tikshna (sharp) Ushna (heating) Katu (pungent) Medhya (brain tonic) Roots. (trans or alpha) Asarpne (2. Asthapanopaga. Tikta (bitter) Laghu (light. Arshoghna. Shadgrantha (rhizome having six nodules). top pyramidal. Golomi (like hairy cow) Araceae Family: Gana: Virechana. in ditches and areas of seepage. aromatic. Samjnasthapana. Page 127 .4.5-trimethoxy-1-propenylbenzene). perennial that can grow up to 2 metres high. Rhizome 6. and Beta-asarone (cis-isomer) contained in the roots essential oils. micropyle often fimbricate. sequestrine ketones. The North American variety contains only Asarone.S. It is used in vamana therapy. dried rhizome was listed in the U. Vata hara Actions and Indications: Arshoghna (relieves piles) Kantya (good for the throat) Krimighna (destroys parasites) Kustaghna (skin conditions) Lekaniya (removes excess ama) Medhya (brain tonic) Important Actions: Indications: In large quantities causes vomiting. astivaha. 1 tsp with honey to improve voice. Literature Review. medovaha Precautions: The unpeeled. raktavaha. John Vorstermans Dosha Karma: Kapha hara. FDA studies have shown that only calamus native to India contains the carcinogen Beta-asarone. Medhyarasayana (as Medhya) Sajnasthapana (restores consciousness) Shotahara (anti inflammatory) Swedajanana (promotes sweAting) Vamaka (emetic) Vatahara (pacifies vata conditions) Vedanasthapana (removes pain) 6. Pharmacopoeia until 1916 and in the National Formulary until 1950. Page 128 . for medicinal use in humans.A Study of Cardiovascular Disease in Ayurveda Dosage: Powder 125-500 mg 3 or 4 times daily. useful in diseases of the mouth. Calamus has been banned by the FDA as a food additive within the last few years. Good for throat infections. for improving speech. Important Yogas: (combinations) Preparations: Saraswatha churna (as a Medhya). Massive doses given to lab rats over extended time periods has proven to be carcinogenic. good for health of gums (gargle with water). majjavaha. manovaha. Apasmara (epilepsy) Srotas: annavaha. • Physical reactions to medication. .11. falling.1 Drug to Drug interactions. dementia). There are many physical signs that may be attributed to an adverse drug reaction. such as fatigue.. or weight loss. Adverse drug reactions. There are major drug-drug interactions with almost all drugs. may be mistakenly labelled as "normal" aging. 6. however. Symptoms of a drug reaction are thought to be caused by an existing medical condition or the onset of a new health problem. especially drug to drug interactions and drug to herb interactions.g. including over-thecounter drugs. Literature Review. it paying to check each drug carefully before they are used in combination with any other drug. Drug interactions are something that must be taken into account when treating Cardiovascular Disease.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6.11 Drug Interactions. frequently go unnoticed or are misdiagnosed in older people for the following reasons: • • Drug reactions sometimes mimic signs or symptoms of disease (e. These include: • • • • • • • fatigue constipation or diarrhea confusion incontinence frequent falls depression weakness or tremors Page 129 6. g. Some examples of this type of drug interaction include: • Aspirin can significantly increase the effect of blood thinning drugs (anticoagulants).g.. • Mixing anticoagulants (e. . among them direct-to-consumer advertising and the mind-set that every ailment has a remedy in the form of a pill. there is a higher risk of suffering an adverse drug reaction. Seconal) can result in decreased effectiveness of the anticoagulant medication.g. oral hypoglycemics) and beta blockers (e. • Antacids can cause blood-thinning drugs (anticoagulants) to be absorbed too slowly. When a person is taking several concomitant drugs.. Aldoril. Coumadin. Lanoxin) can result in abnormal heart rhythms..S.A Study of Cardiovascular Disease in Ayurveda • • • John Vorstermans excess drowsiness or dizziness agitation or anxiety decreased sexual behavior Polypharmacy -. Reserpine.. Warfarin) and sleeping pills (e.g. for a variety of reasons. In addition to prescription drugs interacting with each other..which is generally defined as the use of at least three prescription drugs at the same time -. Page 130 . over-the-counter drugs can also interact with prescription drugs. Literature Review. Amytal. • Mixing antihypertensive medication (e.. thus increasing the risk of excessive bleeding. Nembutal. Combipres) and digitalis (e. Some examples of how prescription drugs can interact with each other follow: • Mixing antidiabetic medication (e. Inderal) can result the decreased response of the antidiabetic drug and increased frequency and severity of low blood sugar episodes.is on the rise in the U.g. 6.g. These are just a few of the many interactions that can occur when multiple drugs are taken together. There are 381 other drugs known to interact with simvastatin. can increase the sedative effects of barbiturates. Cardiovascular drugs such as Quinidine have over 80 interactions with other drugs interaction and minor interactions with a over a further 120 drugs..A Study of Cardiovascular Disease in Ayurveda John Vorstermans Antacids can interfere with drug absorption of antibiotics (i. instead of being absorbed into the bloodstream. There are 60 other drugs known to interact with ezetimibe. • Iron supplements taken with antibiotics can reduce or stop the ability of the antibiotics to fight infection. (The chemicals in the supplement and the antibiotic bind together in the stomach.e. over 250 moderate interactions and a similar amount of minor interactions with other drugs. Atorvastatin. around 20 but has excess of 200 moderate interactions. and cardiac arrest. tranquilizers. • Decongestants in cold and cough medications can interact with diuretics or "water" pills to aggravate high blood pressure. This can result in symptoms of nausea. and some prescription pain relievers. Page 131 . 6. muscle cramp diarrhea.) • Salt substitutes can interact with "water" pills or blood pressure medication to increase blood potassium levels. • Antihistamines. Liptor and Zocor each have over 140 major interactions with other drugs. vomiting. Literature Review. thereby reducing the effectiveness of the drug in fighting infection. tetracycline). Accordingly. often used for allergies and colds. Pravachol has less major interactions with other drugs. it is very important that a patient check with their prescribing doctor(s) and dispensing pharmacist(s) to make sure that the combination of drugs prescribed to them does not have the potential to interact so as to cause them to suffer an adverse drug reaction. muscle weakness. May alter NSAIDs Non-nucleoside glucose regulation. reverse transcriptase inhibitors Protease inhibitors Squinavir May be contraindicated in individuals with active bleeding. Guggulu (Commiphora mukul) None known 6. Discontinue use prior to dental or surgical procedures. Adverse effects may include GI upset Anticoagulants Antiplatelet agents Asprin and asprin containing products Cardiac glycosides Chemotherapy agents Cispatin NSAIDs Anticoagulant Antihypertensives Antiplatelet agents Asprin Beta blockers (especially propranolol) Calcium channel blockers (especially ditiazem) NSAIDs Thyroid agents Brahmi monnieria) (Bacopa None known Lashuna . Used in Cyclophosphamide reportedly enhancing these narcotics analgesics.11.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 6. against Cryptococcus neofomans Ginger officinalis) (Zingber May decrease nausea associated with radiation and chemotherapy. Literature Review. Decreases gastric emptying delays associated with cisplatin. amphotercin B. Use with caution in pregnancy and lactation due to thyroid-stimulating properties. Use with caution with history of bleeding or hemostatic disorders. Table 6 Herbal reference chart Herb/plant Ashwaghandha (Withania somnifera) Complementary Effect with Theoretical Cautions / Theoretical Interactive Contraindications / Drug Therapy Drug/Drug category Adverse Effects Acts as a radio sensitizer Contraindicated in pregnancy Benzoidiazepines when administered with and lactation (may be an anxiolytics radiation therapy.garlic (Allium sativam) Reported to increase the fungicidal. May be contraindicated in individuals with a history of bleeding or hemostatic disorders. Discontinue prior to dental or surgical procedures. with heat abortifacient).2 Drug to Herb Interactions Drug to herb interactions are not so common as drug to drug interactions. Use with caution if history of Antihypertensives Antiplatelet agents bleeding or hemostatic Asprin and asprin disorders. Listed in the table below are some possible contraindication and interactions but much of these is theoretical so have not as yet been conclusively proven. Page 132 . containing products Discontinue use prior to Hypoglycemic agents dental or surgical Insulin procedures. Use Narcotic analgesic effects with caution on individuals on benzodiazeppines Use with Caution in None known individuals taking medications for seizure disorders or Alzheimer's disease Amphotericin B May cause GI distress in Anticoagulents sensitive individuals. and the doctor so that the effects can be monitored.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Generally there are no known interaction between Ayurvedic Herbs and Drugs when Ayurvedic herbs are taken in their recommended dosage. Page 133 . It is important to recognise the actions of the herbs used alongside the actions of the drugs. and if ever mixing the two then it must be done with the consent of the patient. 6. Literature Review. In both cases there are changes which can lead to the formation of atheromas and eventual reduced or blocked blood flow to the muscles of the heart. Discussion Page 134 . Apart from an inherent weakness. Modern medicine as outlines under Causative Theory of Cardiovascular Disease is based around atherosclerosis and its development. High levels of cholesterol in the blood injure the artery's lining. according to the World Health Organisation (WHO). however the native Māori rate of death is an average of 94 percent higher that non-Māori in 2002 which is increasing annually.4 percent will die of It is thus clear that this is a major concern through the world. 7. however Ayurveda views the causative factors behind the disorder quite differently due to its perception of the body. In New Zealand the statistics are slightly higher at around 53%. is a major concern with 48. Cardiovascular disease (CVD). Repeated injury to the artery wall may occur through various mechanisms involving the immune system or through direct toxicity. lifestyle. CVD can be caused by changes to blood circulation (rasa and rakta). as can been seen under Cardiovascular Disease Statistics on Page 29-30. This theory postulated that: 1. Ayurveda recognises that cardiovascular disease is a disease associated with hereditary factors. aging. in agreement with modern medical research.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 7. today's lifestyle and diet are the main causes of Cardiovascular Disease.6 percent of death in 2000. Discussion Cardiovascular Disease. causing an inflammation reaction and enabling cholesterol and other fatty materials to accumulate there 2. It is predicted that by 2020 46. Each seems a complex pathology. Ayurveda's understanding of the development of Cardiovascular Disease is also more specific. Majja (Nerves as in irregular heart beat). Both modalities understand similar causative factors relating to lifestyle and diet as has been mentioned throughout the paper.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Ayurvedic medicine recognises the modern medical causative theory as symptomatic of Cardiovascular Disease. and thereby is able understand what the underlying cause is. for example. In the modern medical system. associated with the repair of the artery walls due to damage to the walls. Ayurveda is therefore better placed to give advice and guidance to patients in the early developmental stages of CVD and could work well to complement modern medical practitioners in this area. modern medicine understands that arteriosclerosis is part of the general pathology of Cardiovascular Disease. Rakta (RBC and the liver). Ayurveda classifies Cardiovascular Disease into various types as shown in the Table 2. although Ayurveda is more specific with its approach to different foods and lifestyles affecting the make up of individual Doshas differently. the symptoms. hardening of the arteries. but most importantly the mind and 7. the energy in the body (Ojas in the heart) and the effect these toxins have on the energy in the various Ayurvedic Subdoshas. constriction of arterial pathways or stroke. Discussion Page 135 . which eventually leads to. the state of the dosha. The Ayurveda model associates the various diseases with toxic build-up in the various bodily channels. This includes looking at the tissue (dhatu) involved. as outlined in the Ayurvedic Model and Ayurvedic Samprapti. For example. as shown in the section on Development of Cardiovacular Disease. therefore the causative factors may be somewhat different for individuals with differing Doshas. there has been very good and thorough scientific understanding of the various CVDs under discussion as can be seen in Types of Cardiovascular Disease. Mamsa (muscles). such as in Rasa (plasma and lymph). and lastly. Thus. This differs to the medical approach. 7. at an early stage allows specific Ayurvdic dietary advice and lifestyle changes to be very specific.A Study of Cardiovascular Disease in Ayurveda emotions. An important part of any Ayurveda treatment is to remove the blockages we find within our bodily channels. For Cardiovascular diseases the approach is to: 1. As seen under the Ayurvedic Treatment section. while medical drugs are important in acute cases of CVD. which focuses largely on reducing the cholesterol in the blood stream or its production in the liver through the use of the various drugs as outlined under the section on Treatment. Understanding this. while Ayurvedic medicines have no known side effects or cause damage to the liver. John Vorstermans Thus with hardening of the arteries there is a aggravation of Vata. with inflammation that of Pitta and with arteriosclerosis an increase in Kapha. Ensure lifestyle and diet factors are put into place. in cases which have not yet reached this stage it is clear that Ayurveda de-detoxification and herbal medicines may prove useful as a complimentary therapy and medicine in these cases. This allows the Ayurvedic practitioner to target specifically the tissue and other factors which are the underlying cause. In its treatment principles as outlined under Shamana and Shodana it is clear that the Ayurvedic approach is to remove the toxicity in the dhatu (tissue) or srotas (channel) involved and then to support the cleansing process with herbs and diet appropriate to the condition. Discussion Page 136 . Reduce stress and help patient to process psychological issues. 2. Ayurveda has various methods of helping to reduce the effect of the Doshas and Ama (toxins) within individuals effectively if treated before the pathology becomes acute. Not all drugs work with all people and these drugs do have side effects and may cause damage to the liver. it is able to produce a lifestyle and diet plans which will work to prevent to formation of toxins within the body and thereby prevent the pathology of CVD and if toxins have begun to be formed. especially when there are signs of blockages with the use of angioplasty and stents or by-pass surgery.A Study of Cardiovascular Disease in Ayurveda 3. blood vessels (Rakta) and if necessary support the muscles (mamsa) and the Sub-doshas Prana Vata. 7. Modern medicine tends to take a more invasive approach to treatment. While modern medicine looks for the active constituents in herbs to find its usefulness. Provide rejuvenative support for the weakened tissues and channels. John Vorstermans So in cardiovascular disease we need to clear the toxins from Plasma (Rasa). to be able to help the patient remove the toxins. patient's condition a curative or palliative approach would be used. body therapies and herbal formulas to help clear any blockages before they become acute. 4. and understands the actions of each herb are unique and cannot be isolated through chemical analyses alone. treating the condition through a variety of approaches from Panchakarma. Discussion Page 137 . It is clearly seen in this paper that Ayurveda is in a good position for first line of help in dealing with people with a genetic predisposition to CVD and in early stage if management of the risk factors involved. Sadhaka Pitta. Ayurveda sees the herbs as a whole. Avalambaka Kapha specifically. with its Depending on the detailed understand of diet and lifestyle for each individual persons prakruti. Ayurveda is also in a unique position. Ayurvedic herbs have a well established history of use today. while Ayurveda's approach is non-invasive. Clear channels of toxins (ama). There is a lot of valid scientific research taking place showing the positive actions of these herbs. Vyana Vata. dating back to the Charaka Samhita and other early texts. which details the traditional usage of these herbs according to Ayurvedic texts. Ayurvedic herbs used alone or in combination have few if any side effects and are therefore a viable alternative in many cases. although it is necessary to note that some herbs may have similar effects to some drugs. Modern medical drugs are especially noted for there adverse interaction with other drugs as seen in drug to drug reactions. While more research is needed it is clear that the current research supports some of the traditional usage as shown in the section Research on Ayurvedic Herbs and the following section of Details of Ayurvedic Herbs under research. 7. Drug to herbs reactions are in general minimal however the table 6 does show some theoretical interactions however there seems to be little scientific research to actually prove these. However we are beginning to see scientific research taking place to validate the tradition usage of these herbs. The older we get and the more drugs we take the risk of adverse effects becomes higher. so when taken together the effects do need to be watched or supervised by a doctor. from the long established tradition and usage of the herbs.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Ayurvedic herbs are generally well understood in the industry. Discussion Page 138 . Some of the results of this can be seen in the section under Research on Ayurvedic Herbs. and along with pharmaceuticals it aims to help to prevent its onset. in New Zealand. The main benefit of Ayurveda as a complementary practice is in the early stages of chronic manifestation of cardiovascular disease. While Ayurveda is popular in India and there is some work between Ayurveda practitioners and Medical doctors. Once it goes to the third stage (called Bhedha in Ayurveda) then the best help is by a modern medical practitioner. each have their unique and similar approaches in dealing with Cardiovascular Disease as is clearly presented in this paper. while perhaps not having the mechanisms to treat acute Cardiovascular Disease is well placed to manage those at risk. Modern medicine and Ayurvedic Medicine. Conclusion.A Study of Cardiovascular Disease in Ayurveda John Vorstermans 8. 8. There is scope for working alongside modern medical practitioners and patients. and help in occurrences of chronic Cardiovascular Disease. two health modalities working under differing scientific frameworks. Ayurveda on the other hand. The Ayurveda approach may make a significant difference to any developmental cardiovascular disease. Page 139 . as shown in this paper. before the pathology goes to the third level of manifestation (as shown in Figure 12). With the growth of alternative and complementary medicines in New Zealand it would seem there is good scope to see Ayurveda move to a front line of support for people with early and non-acute health problems. Ayurveda's view of the human body give it the skills to help people bring themselves back into balance. and in the diagnosis of CVD using modern equipment. angiograms. Our modern medical system is well placed to deal with CVD in acute stages with such treatments as angioplasty. and coronary artery bypass grafting. Conclusion. Ayurveda is still in its early days of establishment. Today the Modern Medical framework is used to treat acute Cardiovascular Disease. Conclusion. complementary approach. Page 140 . Ayurveda can act as a good 8. have liver problems or are generally adverse to taking drugs.A Study of Cardiovascular Disease in Ayurveda John Vorstermans especially with those patients who have an adverse reaction to medical drugs. A Study of Cardiovascular Disease in Ayurveda John Vorstermans 9. Page 141 . 9. Recommendation for Further Study. There is a great deal of research done in India on Ayurveda herbs. New Zealand has many of its own plants and herbs which also need proper research in the hope that these plants over time will be able to replace Indian imports. I would recommend that some work is done at making this research available. This paper goes part way in outlining the use of Ayurveda in CVD but further study in these areas. While Ayurvedic herbs are popular in India there are issues in New Zealand with obtaining fresh pure and organic herbs for effective use by patients. Further research is required on drug to herb reaction and also into the use of Ayurvedic minerals along with herbs. in New Zealand would be recommended along with some valid clinical trials to validate the effect of these herbs in comparison with medical drugs. Recommendation for Further Study. There is also further quality research required to satisfy both the public and the scientific community that Ayurvedic herbs are indeed safe and effective as indicated. which is not at present easy to get hold of outside India. 37 P.38 P.72 P.57 P.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Illustrations index Figure 1a Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Prevalence of CVD in Med and Women Formation of atheromas in arteries Coronary artery disease causing heart attack Cardiomyopathy Aneurysms Pericardial effusion Congestive heart failure Blood Pressure Peripheral arterial disease Atherosclerosis Cholesterol Diabetes – glucose build-up Samprapti of Heart Disease Diagrammatic representation of Samprapti of Hrdroga Angioplasty Stent Coronary artery bypass grafting P.72 P.34 P.39 P.41 P.56 P.42 P.29 P.67 P.74 Table index Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 The Human body Ayurveda Heart Diseases Adult risk factors Graph of risk factors of CVF Ayurvedic Aetiology of Heart Disease Herbal reference chart P 28 P 35 P 55 P 58 P 63 P 132 Illustrations index Page 142 .40 P.40 P.46 P.68 P. A Study of Cardiovascular Disease in Ayurveda John Vorstermans Abbreviations BMI CABG CHD CHF CHF CV CVD GIT GP HDL LDL MI NHLBI PVD SCD TNT WHO Body Mass index Coronary Artery Bypass Grafting Coronary Heart Disease Congestive Heart Failure Congestive Heart Failure Cardiovascular Cardiovascular Disease Gastro Intestinal Tract General Practitioner High density Lipoprotein Low density Lipoprotein Myocardial infarction National Heart. Lung. and Blood Institute Peripheral vascular disease Sudden Cardiac Death Treating of New Targets World Trade Organisation Abbreviations Page 143 . Asti. metabolic diseases Digest fire – ability to digest and assimilate food. a decreases the digestive fire or metabolism Functioning of the eyes Toxins created by undigested food Duodenum Rheumatoid arthritis the digestive system Elimination of wastes. bad luck due to bad deeds of previous lives. The seven bodily tissues. Sukra. menstrual cycle carry menstrual fluids supplies nutrients to bones Bone tissue Excess flow Protects the heart. water and earth (Kapha). Kapha. Pitta. emotions. strong muscles. kara increases) Vata. sexual function. air (Vata). Rasa. Action of the Dosha (hara reduced. Composed of the elements of either. Rakta. Mamsa. thoughts. (Pitta). Sannipatika Medicines/Herbs Main excretory products of the body Vitiated Clairified butter Medicated ghee Growth such as tumour Quality Heart Glossary of Sanskrit Terms Page 144 . which is essential for good digestion Healthy glow of the skin Idoipathic. healthy lungs Strength and Stamina Enema Sense of taste.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Glossary of Sanskrit Terms Sanskrit Word Adhyatmika Adibalapracrutta Agni Agnimandhya Alochaka Pitta Ama Amashaya Amavata Anna vaha srothas Apana Vata Artava vaha srotas Asthi vaha srotas Asti Atipravriti Avalambaka Kapha Bala Basti Bhodaka Kapha Bhrajaka Pitta Daivabalakruta Dhatus Dosha Dosha Karma Doshabala pravrutta Dravya Dushyas Dusthi Ghee Ghrita Granthi Guna Hridya Meaning Psychological factors leading to Cardiovascular Disease or hypertension Hereditary Cardiovascular Disease e.g. fire and water. Bodily humors. Majja. Meda. fire. leader of all 15 categories of Vata.ether. Waste products of the body. Muscular system carries nutrients to muscles and wastes from muscle tissue carrying thoughts.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Janmabalapravrutta Jatharagni Kalabalapravrutta Kapha Khaivaigunya Kledaka Kaph Krimi Kshaya Lavana Majja Majja vaha srotas Mala Mamsa Mamsa vaha srotas Mano vaha srotas Meda Meda (medha) vaha srotas Medaroga Mrudu Mutra Mutra vaha srotas Nidana Ojas Pachaka Pitta Pakvashya Pancha Mahabhutas Pitta Prabhava Prakruti prameha prana vaha srotas Prana Vata Purisha Purisha vaha srotas Rajas Rakta Rakta vaha srotas Ranjaka Pitta Congenital Cardiovascular Disease Takes part in the digestion process and separate nutrients from waste products Environmental or seasonal Dosha made of the element water and earth Inherent weakness Moisture of the stomach lining for good digestion Viruses. enthusiasm. water. worms Decreased Salt Nervous system nutrients to bone marrow. creative thinking. toxin-free blood Glossary of Sanskrit Terms Page 145 . and wisdom Bodily fat – adipose tissue supplies fat to adipose tissues Obesity Mild Urine carries urine Incorrect lifestyle and diet Essence relating to vitality and immunity Digestion. parasites. assimilation. metabolism for healthy nutrients and tissues Colon Five elements . air. Diabetes respiratory system The senses. nervous system and the brain. Pitta and Kapha Stool – waste products carries feces Force and ego Red blood cells carries blood – circulatory system Healthy. earth Dosha made of the elements of Fire and Water Special action The individuals constitution as given at birth which should remain the same throughout life. reasoning. mouth. Glossary of Sanskrit Terms Page 146 . movements of thought Infectious diseases e. sense of touch.A Study of Cardiovascular Disease in Ayurveda John Vorstermans Rasa Rasa vaha srotas Rasayana Sadhaka Pitta Samana Vata Samprapti Sanghatabalapravrutta Sattva Shamana Shodana Shukra Sleshaka Kapha Snehana Srotases Stanya vaha srotas sthana Sansharaya Sukra vaha srotas Sveda vaha srotas Swabhavabalakruta Sweda Swedana Taila Tamas Tarpaka Kapha Tri Tridosha Udaka vaha srotas Udana Vata Upasargaja Vamana Vata Vikriti Vipaka Virechana Virya Vruddhi Vyana Vata Blood plasma or fluid. autonomic nervous system. eyes and brain Three All three doshas carry water in the body Quality of voice. spirituality Movement of food through digestive tract Pathogenesis (a) Traumatic. perspiration. drive. decisiveness. minerals.g.g. carries plasma and lymphatic liquid Rejuvenating effect Desire. mental constitution of the The deviation from the normal individual – away from their Prakruti Post digestive taste Purgation Active principle – potency Increased Blood flow. memory. (b) Poisoning Knowledge and Positivism Palliative treatment Curative treatment Reproductive tissue Lubrication of the joints. Endocarditis. ageing. perspiration Fomentation Oil Inertia and negativity Moisture for nose. Myocarditis. soft and supple skin Oliation Bodily channels that transport food. heart rhythm. air and thought through the body carry breast milk Third stage of disease supplies nutrients to sexual organs and carry carries sweat Natural diseases e. water. death Sweat. Pericarditis Emesis Dosha made of ether and air physical. Deepak “Healing the Heart”. Aug 9. John “Healthy Living and Prevention” (ONLINE). India: PSri Satguru Publications. 2003 http://irs. KR “Luminaries of Indian Medicine” Varanasi: Chaukhambha Orientalia. 2006 Chopra. Mayo Foundation for Medical Education and Research. 2007 Rumberger. K “Ayurvedic Management for Heart Diseases” Vasanasi: Glossary of Sanskrit Terms Page 147 . PH “Heartcare in Ayurveda” Delhi. 2004 Http://www. 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