Hypertension is one of the most common diseases of modern times prevalent all over the world.’ The incidence of this disease is notably rising in Indian population too. Although the exact etiology of hypertension is not clearly known, the observations reveal that it is a multifactor disease involving both ecological, biological as well as genetic factors. Although hypertension may not carry a characteristic set of symptoms and signs but it is characteristically followed by a set of complications involving vital organs like heart, brain, kidneys and eyes. Diagnosis of hypertension is essentially instrumental and is not much clinical and hence is often missed and is many times detected at the time of complications.
In view of the growing incidence of hypertension and increasing risk of complications and risk to life extended efforts have been made to study the nature of this disease and its management. Powerful antihypertensive drugs like Beta Blockers, Calcium Channel Blockers and ACE inhibitors are now available to treat hypertension As such, control of hypertension has not remained a problem in modern medicine. But cure is still a remote possibility. In majority of cases a patient needs life long treatment which many a times becomes difficult because of distressing side effects of these drugs besides their high cost.
Considering the above limitations, in recent years more and more attention has been paid to preventive measures and search for cost effective and soft holistic medications of herbal origin. However till date the real potential of Ayurvedic Medicine in the care or Hypertension remains undocumented and the efficacy and safety of these medications remains to be evaluated. There is a need to launch extended studies on the subject. For searching the treatment of hypertension, it is absolutely essential to understand the likely disease entity of hypertension in Ayurveda. A number of conceptual studies have been conducted to develop the correlates of hypertension in Ayurveda. Certain scholars have attempted to correlate hypertension with “Raktagat Vãta” disease as described in Ayurvedic classics while others compare it with Vyapa Bala Vikti. Attempt has also been made to compare the Ayurvedic Patho-terms Dhamani Praticaya and Dhamani Kathinya with atherosclerosis and arteriosclerosis which are the known pathological associates of hypertension. Thus the Saxnprapti of this disease encompasses, on one hand, the dominent role of Vãta while on the other, the pathological contributions of Kapha, Ama and Meda in causing Dhamani Praticaya and Dhamani Kathinya.
In view of the above path physiology, the logical treatment of hypertension is to utilize on one hand the Vãta Stabilizing and Medhya drugs while on the other hand the measures to reduce Kapha, Ama and Meda. We at Banaras. Hindu University have been following this approach with good results and possible ‘Cure Potential’.
The Monograph in hand “Ayurvedic Management of Hypertension” authored by Dr. K. Nishteshwar is a good peice of work on this important topic. I have reviewed this work with great pleasure and find it very useful reading material for researchers and professionals at all levels. The able author has dealt with the subject both from Ayurvedjc and conventional modern perspective making it a complete book.
I have known Dr. K. Nishteshwar for last few decades as a brilliant Ayurvedic scholar with due scientific temper. I wish all the best for this new publication.
In certain selected Indian population, the incidence of Hypertension has been found to be about 10%. It is known to the layman as the Blood Pressure disease. Though the word blood pressure and hypertension are used almost like synonyms the former referred as a physiological phenomenon while the latter referred to pathological one. In classical literature of Ayurveda we do not come across the word like Raktasammaradanam, Raktabala or the descriptions reflecting the raise of blood pressure. But certain conditions involving rakta as well as the channels of circulation have been described. Therefore an attempt is made to identify’ blood pressure — a physiological phenomenon and the hypertension a pathological one from the point of view to understand these conditions in terms of Ayurvedic concepts and to prescribe rational therapy of both Samana and Sodhana measures.
Any treatment undertaken without the correct knowledge of the disease meets with success only accidentally.’ The knowledge of the disease is to be obtained through the study of nidãna, pragrupa, laksana, upasaya and samprdpti. The descriptions of Niddna etc., of a few diseases in the text is not exhaustive. They explain only the fundamental approach to be adopted. Whatever is not stated explicitly is to be inferred by the intelligent physician. Sastra aided with one’s intelligence makes a physician successful in the art of healing.2 Many diseases mentioned in the texts are not at all come across now a days. Many a diseases are come across which have not been described or mentioned in the texts. As Dr. Gananath Sen says the old diseases disappear giving room to newer ones. stala which is common now-a-days is disposed off in half a line by caraka and in o lines by suruta and vãgbhata but described in detail later works. Moderii medical authorities whose opinion coun admit that eradication of communicable diseases is not met with more serious problem of spread of constitutional diseases. Therefore the early Acaryas who have envisaged such contingencies have advised the method to be adopted dealing with new disease entities. Suruta advises to treat even disease not described by him on the basis of the linga or signs dosa as there is no disease Without the involvement of dosas.3 araka recornjneids to understai-id the vikãras inside the patient’s body through the knowledge of the signs. The involvement of doa and dusyas the site and the mode of onset are the three important things to be taken into account to plan rational therapy. Though in understanding a disease the five aspects of nidãna, Ptiroarupa, lak.sana, uPasaya and samprapti are important the last one is most important as the treatment is only to negativat or destroy Samprapti. The assessment of Samprapti depends on the assessment of certain important pathological factors like agni dusti, ama, srotodusti etc.
The review of contemporaiy Ayurvedic scholai’s view in understanding this disease hypertension in terms of Ayurveclic principles reveals that there is so much divergence of views of equating with Rakta Bhãra Rasabhara, Vyãnabala Dhanjaijj ftratichaya, Rakta itta etc. Such conditions are identifier with hypertension. However a critical and careful study of the Ayurvedic classics confirms that hypertension is merely a collective concept for a number of conditions having in common the positive characteristics of arterial hypertenso like Rakia vãta or Raktagatavata Siravata, Rakta vruta vdta, Pitta z’rutavdla and Kapha vruta vyãna etc.
Vãta seems to be important dosa in all the above conditions. From the point of view of dusyas involved in J?asa and Rakta or Rasa Rakta complex as well as possibility of avarna of vatadifferently, care is to be taken to evolve a rational therapy according to Ayurvedá. According to one of the modern classifications hypertension may be described to be of degenerative, inflammatory and atherosclerotic type which corresponds to conditions of vãta, pitta and kapha dominance respectively. Hypertension which pertains to Sakhãs (tissues) is a bãhya rogamãrga disease. But it may involve the madhyama roga marga also comprising the three vital organs or marms like basti, .iras and hrdaya. Therefore the complications like cerebral, cardiac and renal disturbances only indicate the serious types of hypertensive vascular diseases.
A few potent anti hypertensive drugs have been found out recently. Evaluation of Sarpagandha as anti hypertensive drug is a great contribution by Ayuroeda to medical profession as a whole. ankhapuspi, Japakusum, Signs, Jaamansi also are found to possess anti hypertensive property. Sarpagandha which shares a common name nãkuli with Rdsnd is somewhat akin to Rasna in rasa, guna, veera, vipaka etc., such being the case why Rasna was given important place among vãtahara drugs as Rasana vãta haranam. Rãsnä is extensively used in a number of vãta diseases including Rakta vãta, Raktavruta vãta, Sirãvdta and other avruta vatas. It is also commonly used in the conditions like pzkãghãta, ardita etc., which are precipitated by hypertension. Compared with Sarpagandha, Rãsnd is a safer drug free from any side effects and is conducive to any cardiac conditions. Though the odhana measures to be prescribed in the treatment of hypertension are more cumbursome and laborious in comparison with vyädhi pratyaneeka cikitsd of the same condition with drugs like sarpagandha etc., still they have unique role to play in the treatment of hypertensive vascular diseases and in finding a cure for hypertension itself.
The recent recognition of the role of neurogenic and neuropsychic factors in the genesis of hypertensive vascular diseases confirms Ayurvedic view that pragydparadha is at the root of initiation of all diseases including the constitutional disorders like hypertension. To avoid or minimize the impact of excessive stress so characteristic of modern society it wiil be highly beneficial to follow the principles of dcãya rasayana, sadvrtha, general rasäyana measures and satwavajaya including important physical and mental exercises prescribed by yoga.
An attempt is made in the following pages to describe the above pertaining to understanding and treatment of hypertension from Ayurvedic points of view in detail.
I gratefully acknowledge Prof. R. H. Singh, Head of the department of Kayacikitsa, Faculty of Ayurveda, Institute of Medical Science, Banaras Hindu University, Varanasi for his blessing conveyed through his foreword. I am greatly between to my beloved teacher Dr. S. Venkatraghawan, Assistant Director, ALURIM (CCRAS), Madras for his ablest guidance in the preperation of this monograph. I thankfully acknowledge Messers. Krishnadas Academy, Varanasi for publishing this work.
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