Critical review on Hrudaya (Heart) and Hrudroga (Cardiovascular disorders) and its Nidana (Causative factors)

Deeksha Rana; Sushree Susmita; A.C. Kar

Critical review on Hrudaya (Heart) and Hrudroga (Cardiovascular disorders) and its Nidana (Causative factors)

Rana D.^1*, Susmita S.², Kar A.³

DOI:

^1* Deeksha Rana, Final Year Post Graduate Scholar, Department of Vikriti Vigyan, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India.

² Sushree Susmita, First Year Post Graduate Scholar, Department of Vikriti Vigyan, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India.

³ A.C. Kar, Professor, Department of Vikriti Vigyan, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India.

Introduction: The Ayurvedic word Hrudya can be corelated with Heart in modern science on the basis of its vital functions, Also, according to some Acharyas, Ayurvedic Hrudya is a broader term which comprises functions of both heart and brain. Various terms like Hridyata, Hridroga, Hridayamaya and Hridaya Sula are mentioned in Ayurveda in accordance to Cardiovascular Disease. Discussion: Ayurvedic concept of Hridroga is quite primitive as compared to that of western system of medicine and it does not extend beyond ischemic heart disease and to some extent congestive Heart Failure. Five type of Hridrogas have been described in Ayurveda, out of which the description of Vatika Hridroga is clearly in accordance with that of Ischemic Heart Disease, combined with symptomatology of Vatika Sotha and Swasa give a vague picture of congestive Heart Failure. Conclusion: Agnimandya, Vata Prakopa (vitiation of Vata Dosha) and Dhatu Kshaya are the three mechanism involved in Samprapti of all the Hrudya Rogas.

Keywords: Cardiovascular Diseases, Hrudya, Hridroga, Nidana

Corresponding Author	How to Cite this Article	To Browse
Deeksha Rana, Final Year Post Graduate Scholar, Department of Vikriti Vigyan, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India. Email:	Deeksha Rana, Sushree Susmita, A.C. Kar, Critical review on Hrudaya (Heart) and Hrudroga (Cardiovascular disorders) and its Nidana (Causative factors). J Ayu Int Med Sci. 2022;7(5):91-95. Available From https://jaims.in/jaims/article/view/1842

Introduction

The word ‘Hrudaya’ in Ayurveda is a synonym for Heart in Modern medicine. The name ‘Hrudaya’ itself explains its vital function where ‘Hru’ means, one which draws fluid or blood from the body forcibly and ‘Da’ which means to donate.^[1] According to Ayurvedic texts, the heart originates from the essence of Rakta and Kapha, predominantly from maternal side, and develops into a muscular organ.^[2] Movement of the heart is controlled by Vyanavayu and so is the case of valvular disorders. It can be assumed that the pericardium is developed from Meda, myocardium from Mamasa Dhatu and endocardium from Rasa and Rakta Dhatu.

Five type of Hridrogas viz. Vataja, Pittaja, Kaphaja, Sannipataka and Krimija have been described by Charaka^[3]and Vagbhata. Susruta has omitted Tridoshaja variety.^[4] While referring to 5 types of heart diseases - Vataja Hrudaroga have vitiated or aggravated involvement of Vata Dosha, Pittaja Hrudaroga have Samanya Laksana of Hruda Roga and Vishesa Laksana are gastric symptoms. In Kaphaja Hrudaroga pain seems to be dull in nature with subacute symptoms, Sannipataja Hrudaroga shows severity in pain and stated as difficult to cure, while in Krimija Hrudaroga acute pain in various intensities which may threaten the life of patients has been described and this disease stated as Sighrakari, so it seems acute painful cardiac disease.

Aim and Objectives

The aim of study was to understand the concept of Hrudaya, Hrudyaroga and its Nidana (factors which are responsible for various pathologies in the Hrudya) so that it may help the Ayurvedic Physicians to take appropriate preventive measure against Hridyaroga. It is necessary to throw some light on text to visualize the concept of Hridayroga Nidana from modern view.

Materials and Methods

In our current manuscript we have studied reviewed texts books of Charak, Sushrut, Vagbhat and Sharangdhar Samhita. Research articles available on internet, Google Scholar, Pubmed, Science direct were also used to support the Ayurvedic concept of Hruday which is quite similar to ancient text.

Nidana of Hrudyaroga

The terms Hrudyata, Hrudroga, Hrudayamaya and Hrudaya Sula have been used in Vedas for Cardiovascular Disorders.

The Etiological factors of Hridroga, according to Ayurveda can be categorized into three groups:

1. Aharaj Nidana: Ati Usna, Guru, Kasaya, Tikta Sevana, Adhyashana.

2. Viharaj Nidana: Srama, Vegadharana, Abhigata, Ativerechana.

3. Mansik Nidana: Chinta, Bhaya, Trasa, Mada.^[5]

Ati Usna: Foods which are Ushna (warm in potency), when consumed in excessive amount are responsible for various cardiovascular disorders. E.g., Excessive use of Spices like green and red chilli sauces, Chilli flakes over pizzas, vinegar and spicy pickles. Excessive use of dry nuts like kaju, walnut, peanuts, chicken (Anupa Desha Prani).

Ati Guru Ahara: Foods which are Guru Guna Pradhana i.e., heavy to digest and metabolise are also a leading cause for cardiovascular disorders. E.g., Deep fried foods, fatty foods, processed foods like chips, Yellow of eggs, Red Meat.

Carb-Dense Foods is the leading cause of Cardiovascular disorders. It can lead to long-term health damage as it causes an increase in inflammation and transforms the gut flora and heart too.

Foods containing excessive Kashaya Rasa

When Kashaya Rasa Darvyas are consumed in excess they causes the contraction or shrinkage of tissues and dry up the secretions. These foods are responsible for desiccation of Cardiomyocytes. Kashaya Rasa Darvyas (Astringents) are usually classified into three groups according to their mode of action: (1) those that decrease the blood supply by narrowing the small blood vessels (e.g., epinephrine and cocaine), (2) those that abstract water from the tissue (e.g., glycerol and alcohol) and (3) those that coagulate the superficial tissue layers into a crust (e.g., metallic astringents, such as calamine or alum). According to Ayurvedic concept excessive use of Kashaya Rasa Darvyas are responsible for contraction, Shoshana and Sthambhana Karma. These are responsible for Vata Vriddhi E.g. of Kshaya Rasa Darvyas are Chestnut (Myrica rubra), food containing Tannic acids.^[6]

Foods containing excessive Tikta Rasa

When Tikta Rasa Dravyas are consumed in excess they are responsible for exsiccation of all the Dhatus of body like Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Shukra. It develops dryness in different channels of body and heart. It causes the Dhatu Kshaya and ultimately vitiation of Vata Dosha.

Adhyashana: (Eating before digestion of previous food) Adhyashana causes Agnimaandya and Aama. Agni is said to be Bala of the body. Decrease in Agni causes decrease in pure Rasa Dhatu, which leads to lack of Prinana (nutrition) of the Deha. This decreases Dehabala too. Thus, due to decreased Agnibala and Dehabala, diseases become difficult to treat.

Srama: In a healthy practice exercise in moderate quantity is beneficial for the body while Sternous exercise for long duration results in exhaustion and production of free radicals, which are responsible for many cardiovascular disorders. All these activities results in vitiation of Vata Dosha. According to Ayurvedic texts Ativyayam is responsible for many ailments like dyspnoea, Coagulopathies which are similar to cardiovascular disorders.

Vegadharana: when a person supress the natural urges like Shwas, Kasa, Kshavathu they are responsible for vitiation of Vata Dosha and brought the pressure changes in the circulation. Results in different Hrudya Roga.

Abhigata: Direct injury to the thoracic cavity or indirect injury through the blood vessels in the form of high blood pressure or thrombus or embolism or any inflammatory process in the cardiac muscles results in severe cardiovascular pathologies.

Ativirechana: Virechana is a common term for both Vamana and Virechana. When performed in excess are responsible for severe dehydration and hypovolemia. This causes Kshaya of Apa Dhatu and vitiation of Vata Dosha, ultimately results in Hrudya Roga.

Ati Chinta: Excessive stressful activities are also a leading cause for heart diseases. Chinta results in Rasakshaya and causes Shoshana of Apa Dhatu. High levels of cortisol from long-term stress can increase blood cholesterol, triglycerides, blood sugar, and blood pressure. These are common risk factors for heart disease. This stress can

also cause changes that promote the build-up of plaque deposits in the arteries.

Other factors;

Medo Roga and Prameha: Adiposity and diabetes are two important risk factors of Ischemic Heart Diseases. Adiposity or Medo Roga may be Sahaja or it may be cause by over nutrition, sedentary life style, bad sleeping habits like excessive day sleep and due to other psychosocial factors. A large number of diseases have been classified in Ayurveda to be caused by over nutrition (Santarpanajanya). Ayurveda has emphasized the conversion of excessive sweet Amarasa into Meda Dhatu due to it’s Sneha property and these substances also induced to Prameha .^[7]

Vitiated Rakta Dhatu: Blood may be vitiated by taking excessive Viruddha, Snigdha, Guru, food and by day sleep, which may give rise to Agnimandya.^[8] Vitiation of Raktadhatu directly results in Hridyaroga as its seat for origin of Hrudya.

Hrudya as a seat of Sadhaka Pitta, Avalambaka Kapha and Vyana Vayu

This ‘Hrudaya’ is the special seat of Sadhaka Pitta, Avalambaka Kapha and Vyana Vayu. Concept of Sadhaka Pitta appears to be psychophysiological as it enables to achieve one’s Manoartha like Dharma, Artha, Kama and Moksa, by dispelling the Kapha and Tamas of Hrdaya and thus, enables Hrdaya to perceive things clearly. This may be cytochrome C, a type of haemoprotein which takes part in tissue respiration. A reduction of this substance in heart may lead to anoxia and in consequence the weakening and deterioration of this organ. Avalambaka Kapha seems to be the protein content of intracellular and extracellular fluid system of the body, which attributed to support Hrudaya when it mixed with Anna Rasa. Vyan Vayu have similarity with hydrostatic pressure produced by contraction of heart, with the force of Vyan Vayu Rasa circulates to entire body (Rasasamvahanodyatah).^[7]

Hrudya Roga Lakshana

General symptomatology of Hridrogas has been mentioned only by Caraka. In the 26th chapter of Cikitsa he observes

Vaivarnya Murcha Jwara Kasa Hikka Swasasya Vairasya Trisha Pramohah

Chardhih Kaphotklesha Rujo Arucisca Hridrogajah Syuh Vividhah Thathonye^[9]

Vaivarnaya (discolouration; e.g., pallor, cyanosis and flushing)
Moorcha (syncope)
Jwara (increase body temperature)
Kasa (cough), Shwasa (difficulty in breathing) and Hikka (Hiccoughs), Vairasya (distaste), Trushna (thirst) and Pramoha (drowsiness)
Vaman (vomiting), Utklesh (nausea) and Aruchi (loss of Appetite)

Commenting on this verse Cakrapani has made an interesting observation. The usage ‘Hridrogaja’ according to him refers to the signs and symptoms that appear in a person who has already been afflicted by the disease. Hence, he considers them as complications of Hridroga.

Discussion

In Ayurveda, Hrudaya is considered under Trimarma and Dasha Prana Ayatana which duly signifies the importance of this organ in causation of grave diseases.^[10] As per Satpathbrahman and Brihadaranyak “Hridaya” is derived from three verbs. “Hrun” which means to abduct, “Dad” which means ‘to donate’ and “in gatou” self-generated rhythmicity for contraction and relaxation.

Among the five types of Hridroga described, in Vatika variety Ayurveda seems to have conceived the disease entity that comes under Ischemic Heart Disease. None of the other Cardiac afflictions seem to have been described under Hridroga. It seems that a few of the presenting features based on this Acute/important/predominant nature have been described Vatika Sotha and Swasa. It looks as though pain dominating heart disease is conceived as Hridroga. When oedema is found to be the main presenting feature it is kept under Vatika Sotha and when Dyspnoea is the main symptom it is described as Swasa.^[11]

Regarding Samprapti of disease all the above mentioned Nidana causes Mandagni, Mandagni results in formation of Ama (undigested toxic material). This vitiated Rasa when mixes with Vayu it causes Ruja (Pain) and when it mixes with Pitta and Kapha it causes Srotorodha thus, obstruction of Prana Vayu and Hrda Badha (Ischemia).

Regarding pathogenesis only few sentences are on record in the available Ayurvedic literature and two types of pathogenesis of Cardiac diseases is

found. One deals with derangement of Rasa thus causing disturbance in the nutrition of Hrdaya and then manifestation of different types of pain in the precordial region. Second type describes any organic change in the cardiac structure with the formation of nodules, distortion of normal structure, formation of a space with accumulation of fluids (Kleda). This all causes growth of organisms in this area and thus severe pain and complications in the cardiac function.

Conclusion

Vatika variety Ayurveda seems to have conceived the disease entity that comes under ischemic heart disease. All the Aharaj (Ati Usna, Guru, Kasaya, Tikta sevana, Adhyashana) Viharaj (Srama, Vegadharana, Abhigata, Ativerechana) and Mansik Nidana (Cinta, (Bhava, Trasa, Mada) are responsible for 3 type of mechanism by which Hrudyarogas are developed, these are Agnimandya, Vata Prakopa (vitiation of Vata Dosha) and Dhatu Kshaya.

Reference

1. Athavale V.B. 1st ed. Chaukhamba Sanskrit Pratishthan; 1999. Cardiology in ayurveda. [Google Scholar]

2. Sastry J.L.N., Nisteswar K. 1st ed. Chaukhamba Sanskrit Pratishthan; 2014. Ayurvedic management for heart diseases. [Google Scholar]

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4. Sushruta Samhitha, Uttara Tantra, Hrudyaroga pratishedham, 43/05. Available from: http://niimh.nic.in/ebooks/esushruta.

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6. Available at https://niimh.nic.in/ebooks/madhavnidana

7. Britannica, The Editors of Encyclopaedia. "astringent". Encyclopedia Britannica, 2 Apr. 2020, https://www.britannica.com/science/astringent. Accessed 25 November 2021

8. Mamgain P, Singh RH. A critical study of the concept of iaschaemic heart disease in ayurveda. Anc Sci Life. 1993 Jul;13(1-2):102-10. PMID: 22556635; PMCID: PMC3336546

9. Caraka Samhita Sutra Sthana, Vidhishonitiya adhyaym24/8,13. Available on https://niimh.nic.in/ ebooks/ecaraka

10. Caraka Samhita Chikitsa Sthana, Trimarmiyam Chikitsa adhyaym 26/78. Available on https://niimh.nic.in/ ebooks/ecaraka

11. Das Tripti, Chakraborty Swapan Kumar, Analytical Study of Heart in Ayurveda, https://www.ijrrjournal.com/ IJRR_Vol.5_Issue.11_Nov2018/Abstract_IJRR001.html

12. Murthy, A.R.V. & Singh, RH. (1993). Ayurvedic concept of hridroga its present relevance. Ancient science of life. 12. 403-13.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-05-02	2022-05-03	2022-05-10	2022-05-17	2022-05-24
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	16%

Review Article

Nidana

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