Etiopathology of HRID Rogas WSR to CVDS - Review Article

Cardiovascular disease (CVD) is an umbrella term for a number of linked pathologies, commonly defined as Coronary Heart Disease (CHD), cerebro-vascular disease, peripheral arterial disease, rheumatic and congenital heart diseases and venous thrombo embolism. Globally CVD accounts for 31% of mortality, the majority of this in the form of CHD and cerebro-vascular accident1.As the present scenario has been visualising large number of patients suffering from heart disorders irrespective of age. It has become a major concern for Ayurveda practitioners to cease this increasing morbidity and mortality through the Siddhantas mentioned in Ayurveda. Cardio-vascular diseases can be correlated with Hridrogas mentioned in our classical texts. As the first and foremost purpose of Ayurveda is prevention of Rogas for which Nidan Parivarjan is the first thing adviced to the healthy individuals and also to the diseased ones. The purpose of this article is to highlight the Nidanas of Hridrogas as mentioned in classical texts and to create awareness about few changes in lifestyle that can prevent the Hrid Rogas. During foetal life, the Hridaya originates from the essence of Shonita and Kapha tissues and develops into a muscular organ2. Genetically, in the development of the Hridaya maternal influence dominate3. Hence in an individual with Hridroga, it is particularly important to inquire regarding Hridroga on the maternal side. According to Charak, the heart starts functioning in the third month of foetal life4. Hriday is the seat of Ojas and other important body constitutes like Vyana Vayu, Sadhak Pitta and Avalambaka Kapha. Heart regulates the entire body, because of which it has been included in the ten Pranaytanas as per Acharya Charak5. Any external trauma to this, leads to life threatening symptoms or ultimately to death. Therefore efforts should be done to avoid trauma or pathology induced dysfunction to heart, because after any injury, restoration of heart function to normal is difficult task for clinician as well as for suffering patient. With the increasing trend of modernisation, packed and fatty food, smoking and alcohol consumption increases the incidence of clogged blood vessel, IHD, heart attack, and strokes which have lead Heart Disorders to be common

1. Review of the Nidana Panchak of Hrid Roga in general.

This article is based on a review of Ayurvedic literatures. Materials related to Hrid Rogas and its various Nidanas along with Poorvaroop, Roop, Upshay, Anupshay and Samprapti were collected, compiled, analysed and discussed for a thorough and deep understanding ofHrid Roga.

Classical texts suggest that Hrid Rogas takes place by multiple reasons.

1. Dravya and Guna Under this group, Acharyas mentioned specific Dravyas which might develop particular type of Hridroga considering the specific attributes.Tila sevan, Ati Ksheera Sevan, AtiGudasevan, develops Krimija Hrid Roga. Atimadya Sevan (excessive consumption alcohol)- Madya has exactly opposite properties of Oja, which resides at the heart. Excessive consumption of Madya, vitiates Oja, which indirectly has detrimental effect on heart considering hot, intense attributes of Madya, it contributes in the development of Pittaja Hridroga. Ati Rooksha Sevan-Rooksha means dry food stuffs. Dry foods tend to remain undigested due to lack of essential unctuousness and in the end of digestion; high possibility to form hard stool. This might develop flatulence which indirectly creates pressure on heart to develop symptoms related to heart so as Ati Shukshma Sevana, which needs to be avoided. 2. Ajeerna Bhojan- A stagnant bowel puts an added stress on the heart. 3. Asatmya Bhojana- Lavana Vishyandi-oozing nature excess intake causes Rasavaha Sroto Rodha, oedema, acidity etc. Katu VitatesVata and Pitta. Excess intake cause palpitation, heart burning, cutting pain at heart. Tikta Excess intake causes Vataj Hridroga. Kashaya Excess intake causes Heart pain, Hritstambha. 4. Viruddha Ahar Sevan- The dietary substance which precipitate Dosha but do not expel them out of the body, are called Viruddha Ahar (Incompatible food substance). diseases. Due to Dhatukshaya movement of Prana is hampered which results into the disorders of Prana &Pranavaha Srotas. 1. Sandharan- Vegavarodh i.e. suppression of natural urges disturbances in the normal movement of Vayu. Due to Vegavarodha vitiation of Vata-Avarodhjanya Vata Prakopa takes place vitiation in any type of vata ultimately results in Prana vitilation. 2. Raukshya– Ruksha Guna increases Vata reduces Kapha absorbs Rasa, Meda, Majja and Shukra. It ceases normal lumen of Pranavaha Srotas which leads into the deformity of contraction expansion capacity. 3. Kshudhitasya Vyayamat- Doing exercise in hungry phase creates disturbance in Prana Gati which leads to Pranavaha Srotodushti. 4. Darun Kriya- Darun Kriya done on other Srotas can vitiate Pranavaha 5. Ati-snigdha Sevan- As per modern medicine unctuous food stuffs are the one of the risk factors of heart diseases. In Ayurveda perspective such food aggravates Kapha Doshas which contributes in the development of Kaphaja Hridroga. 6. Ati-Ushna Sevan After application of Dravya possessing Ushna Guna they has innate tendency to generate sweating and increase burning sensation. Excessive consumption of Ushna attribute decreases Kapha Dosha and vitiates Rakta Dhatu. 7. Ati-Sheeta Sevana This attribute is cold to touch. The substance has property to arrest the flow or moment of components of body. It mainly aggravates the Vata Dosha, and can create obstruction in major blood vessels supplying the heart. 8. Ati-Kshar Sevana Ksharhas predominant intense, hot properties; it has irritating action on soft parts of the body. Charak mentioned that excessive consumption of Kshar leads to develop Hridaya related symptoms. 9. Ati-Guru Sevana Brihana is defined as prime function of Guru Attribute. It has specific functions like Sada, Upalepa, Balakrit, Tarpan and Brihana. The excessive consumption of guru attributes lead to increase Kapha Dosha, Rasa and Mamsa. Ati Guru diet will also lower the digestive capacity which tends to develop ‗Ama‘, it vitiates Rasavaha Srotas to manifest Hridaya related symptoms 10. Hridroga and Rasa- Madhur Increases Rasa, Kapha, and Shukra. Excess intake causes obesity, heaviness in the chest excess sleep, oedema, loss of appetite etc. 11. Amla Increases Pitta, Rakta beneficial to Hridaya. Excess intake causes oedema, heart burning, loss of tone of heart muscles. Lavana Vishyandi-oozing nature excess substance)- They also slow down Dhatu metabolism and lead to a host of diseases. Triggered Doshas become antagonists to nourish the body tissues. This kind of diet obstructs normal functions of Dhatu&Dosha continuous deposition of such factors leads towards serious disease. Sometimes it may result into cardiac symptoms. 13. Hrid Viruddha has two fold meaning, anything that is against persons liking, which is in the form of either food or forced behaviour. This is very common thing happens in regular lifestyle of modern era. This kind of repeated lifestyle or consumption of food hampers digestive mechanism, lowers digestive capacity and triggers Dosha to develop disease.  Vihaaraj Hetu(Causes Related To Lifestyle) 1. Ati-Vyayama Excessive physical exercise leads to aggravation of Vata.Physical activity beyond capacity is defined as Shrama. It leads to Dhatukshaya and vitiation of Vata.Bala is mentioned as one of the functions of Udana Vayu. Hence excessive Shrama leads to vitiation of Udan Vayu, manifesting Hridaya related symptoms. 2. At-ivyavay Excessive (coitus) Vyavay leads to Dhatukshaya mainly Shukrakshaya and vitiation of Vata, which further leads to Ojakshaya. This condition manifests palpitation of heart. 3. Avyayam Lack of exercise is the one of causes of the Hridroga. It is accepted and proved by current research in modern medicine. Avyayam tend to aggravate Kapha Dosha. 4. Ati- AtapaSevan. Recurrent exposure to sunlight leads to aggravate of Pitta Dosha, which further may develops Pittaja Hridroga. 5.Rathakshobha Certain professions, hectic business field works force people to travel with exhaustive travelling modes, which tend to aggravate vata. This condition might manifests Hridaya related symptoms like Hridayendriyaparodha. 6. Ati-chankramana- excessive walking leads to aggravation of Vata, which can further develop Hridroga. 7. Divasvapa- (Day sleeping)Divasvapa causes aggravation of Kapha Dosha which results in obstruction of the body channels. This leads to various signs and symptoms like Hridstambha. 8. Vegadharan If the natural urges are forcefully hold, leads to aggravation of Vaata.

Manovaha Srotodushti which causes vitiation of Hridaya leading to Hridroga 2. Achinta- Such causative factors aggravate Kapha, which can further lead to develop Khaphaja Hridroga. 3. Shoka - Vata aggravates due to Shoka and it has immoral effect on mind. This leads to development of Hridroga. 4. Ati-chinta - Excessive stress leads to vitiation of Vata, Pitta indirectly Manovaha Srotas. Heart is seat of Manas. Stress is normal part of today‘s life. If left unmanaged stress can lead to emotional, psychological and even physical problems, including coronary artery disease, high blood pressure, chest pain or even irregular heartbeats. 5. Bhaya-. In Ayurveda heart is believed to be seat and source of emotions. Depression, stress, loneliness and other psychological factors include influence the heart. 6. Ati-krodha-It means anger, continuous anger precipitate pitta, vata which might contribute in development of Pittaja Hridroga. 7. Trasa-It means mental anxiety or physical irritation. Both have atrocious effect on body and mind.

1. Abhighata-Abhighata primarily causes obstruction and later leads to Dhatukshaya. Both of these are responsible for vitiation of Vaata..

If the, Poorvaroopas of Hridrogas are detected and treated at this stage can help to reduce the further probability of getting the disease severe.

resembles with cardio-vascular diseases to a great extent. Hridrogas are of Vata, Pittaj, Kaphaj, Sannipatik and Kramij type having Lakshanas accordingly the Samanya Lakshanashave been summarized here which are-

• Vaivarnya - Discolouration/ Cyanosis

• Murchha - Syncope

• Jwara - Fever

• Kasa - Cough

• Hikka - Hiccups

• Shwas - Dyspnoea

• Asyavairasya - Bad taste of mouth

• Trusha - Thirst

• Pramoha - Stupor

• Chardi - Vomiting

• Kaphotklesh - Nausea

• Aruchi - Anorexia

• Ruja –Pain

• Samprapti (Etiopathogenesis)9- The procedure of manifestation of Hridrogas and their progression needs to be understood in order to do Samprapti Vighatan and planning the relevant treatment of the patient. The Samanya Samprapti of Hrid Rogas is mentioned here.

As Ayurveda is concerned with prevention of diseases, the first and foremost way is Nidana Parivarjan that is avoiding all the causes of Hrid Roga mentioned above. Yoga (Surya Namaskar) and Pranayama is another way of staying away from CVDs as mentioned in Swasth Vritta, it helps in calming mind and balancing Tridoshas. As the resident area of the heart the chest cavity is the Sthana of Vyana Vayu, Prana Vayu, Sadhak Pitta and Avalambaka Kapha. Pranayama is very beneficial in maintaining the equilibrium of all these. Having diet as per the classical texts and keeping in mind Ashtaahar Vidhi Vishesh Aaytan will definitely contribute for custody of healthy heart. Avoiding Ratriagran, Ativyayam, Ativyavay, Atichinta must also be practiced. Rasayana Aushadhis and medicines like Arjuna, , Ashwagandha, Bala, Shunthi, Pippali, Yashtimadhu, Triphala, Dashmool and various herbo-mineral combinations help in keeping heart healthy. To avoid Mansik NidanasPanchkarma therapies like Shirodhara, Nasya have been proved to be highly beneficial.

Hrid Rogas are affecting all the age groups in present scenario. With the advancing time change in lifestyle has been increasing the incidences of cardio-vascular diseases even in youth. The present article compiled the probable causes of cardio-vascular disorders. As the principle of Ayurveda states that ―Swasthasya Swaasth Rakshanam and Aaturasya Vikaar Prashamanam‖ the first and foremost thing is to now the cause of any disease and prevent it. The motive behind the collection of all the Nidaanas of Hrid Rogais to highlight the Aahar and Vihaarasthat can affect the heart health. How these Nidanas leads to creation of the disorder is also mentioned. The prevention of these can decrease the ratio of people suffering from cardio vascular disorders.

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Associate Professor, Dept of Rog Nidan & Vikriti Vigyan, RN Kapoor Memorial Ayurveda Hospital and Medical College, Indore