E-ISSN:2456-3110

Review Article

Hridroga

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 2 February
Publisherwww.maharshicharaka.in

A conceptual study of Hridroga in context of modern era

Parveen T.1*, Jadhav G.2, Sharma R.3, K. Sevatkar B.4
DOI:

1* Tabassum Parveen, Second Year Post Graduate Scholar, Department of Roga Nidana evam Vikriti Vigyan, National Institute of Ayurveda, Jaipur, Rajasthan, India.

2 Gauri Jadhav, Second Year Post Graduate Scholar, Department of Roga Nidana evam Vikriti Vigyan, National Institute of Ayurveda, Jaipur, Rajasthan, India.

3 Reetu Sharma, Associate Professor, Department of Roga Nidana evam Vikriti Vigyan, National Institute of Ayurveda, Jaipur, Rajasthan, India.

4 B. K. Sevatkar, Professor, Department of Roga Nidana evam Vikriti Vigyan, National Institute of Ayurveda, Jaipur, Rajasthan, India.

The word ‘Hridaya’ in Ayurveda is a synonym for heart in Modern medicine. The name itself indicates the function of this vital organ. Hridroga embodies a significant part of cardiovascular disease. Cardiovascular disease is one which is tremendously increasing in this era. Life style modifications like high caloric intake, alcohol consumption, smoking and stress are the risk factors for cardiovascular disease. Nidana plays important role in manifestation of disease hence Nidanaparivarjana is the first line of treatment for any disease. Hridaya being Moola of Rasavaha and Pranavaha Srotas, Dusthi of those also lead to Hridroga. As there are different sets of Nidanas being explained in classics there is a need for critical understanding hence the present write up is aimed to provide an insight into the concept of Nidanas based on classical references and allied modern literature.

Keywords: Hridroga, Cardiovascular disease (CVD), Hridya

Corresponding Author How to Cite this Article To Browse
Tabassum Parveen, Second Year Post Graduate Scholar, Department of Roga Nidana evam Vikriti Vigyan, National Institute of Ayurveda, Jaipur, Rajasthan, India.
Email: 		Tabassum Parveen, Gauri Jadhav, Reetu Sharma, B. K. Sevatkar, A conceptual study of Hridroga in context of modern era. J Ayu Int Med Sci. 2023;8(2):120-125.
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https://jaims.in/jaims/article/view/2243

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-12-31 2023-01-02 2023-01-09 2023-01-16 2023-01-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Tabassum Parveen, Gauri Jadhav, Reetu Sharma, B. K. Sevatkarand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Hridroga is a disease of Marma (vital organ), which controls many vital activities. Hridroga are now a days observed in very young age also. Due to change in concept of diet and life style, the incidence of cardiovascular disease is increasing at a high rate. In the 22nd century diet pattern and life style of populations across the world have been changed dramatically. Change in life style & diet pattern, lack of physical exercise, increase mental stress, environmental changes have increased the incidence of this disease. Hridroga is one the disease mentioned in Ayurveda where the description is quite brief and in the Ayurvedic point of view it needs clarification in view of the increasing evidence of cardiac disorder in the present time this aspect assumes added importance. Definition of Hridaya Roga (heart disease) Nidana (aetiology), Samprapti (pathogenesis) and Chikitsa (management) has been described in Charak Samhita.[1,2] According to Sushruta any condition which produces disturbances in the heart is called as Hridroga.[3] Hritshoola has been described separately in the 42nd chapter of Sushruta Uttara Tantra entitled Gulma Pratisheda Adhyaya. Hridaya is the one of the places for Gulma also[4] similarly the disease /syndrome marked by severe pain appear to have been described under Hritshula.

Hridaya is Mool of Rasvaha and Pranvaha Srotas which play significant role in maintaining body homeostasis. Hridaya is seat of all the three types of Dosha like Vyana Vata, Sadhaka Pitta, and Avalambaka Kapha. Hridaya is mentioned on Pranayatana as vital point. Embryologic Hridaya is produced from Shonita and Kapha (Shonita Kapha Prasadja).[6] So, Nidanatmak study of Hridroga is being very important to avoid, diagnose, treatment and prevention of the disease.

Materials and Methods

This article is based on Ayurvedic literature, various modern textbooks and useful websites.

Concept of Hridroga

Classification

According to Charak, Madhavkar and Ashtanga Hridaya describes five types of Hridroga.[5]

Sushurta describes four types of Hridroga, and has not explained about Sannipataj Hridroga.

1. Vataj Hridroga

2. Pittaj Hridroga

3. Kaphaja Hridroga

4. Tridoshaj Hridroga

5. Krimij Hridroga

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include:

  • Coronary heart disease – a disease of the blood vessels supplying the heart muscle;
  • Cerebrovascular disease – a disease of the blood vessels supplying the brain;
  • Peripheral arterial disease – a disease of blood vessels supplying the arms and legs;
  • Rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;
  • Congenital heart disease – birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth; and
  • Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can be caused by bleeding from a blood vessel in the brain or from blood clots.[6]

Causes of Hridroga

According to Charak

1. Excessive physical exertion,

2. Drastic and excessive administration of purgation and enema therapies

3. Excessive anxiety/worry, fear, stress; and faulty management of diseases,

4. Suppression of vomiting and Ama (products improperly digested),


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5. Emaciation and trauma (physical and mental).

According to Madhukosh

1. Continuous eating of excessively hot and excessive Guru[7]

2. Consumption of astringent and saying substances, labor, injury, study, Ati-Chinta (excessive contemplation) and holding of Adharniuya Vegas, five type of heart disease occurs. Vagbhata says that the etiological factors of Hridroga are similar to Gulma.

According to contemporary science, over the course of lifetime starting from early childhood to the adulthood, due to one’s bad food habits like eating junk, fatty foods, fried and spicy food materials.

Classification and Symptoms

Bheda-Lakshana: Five type of Hridroga viz. Vataja, Pittaja, Kaphaja, Sannipataja and Krimija have been described by Charak and Vagbhata. Susurta has described Tridoshaja variety.

Samanya Lakshana

वैवर्ण्यमूर्च्छाज्वरकासहिक्काश्वासास्यवैरस्यतृषाप्रमोहाः |

छर्दिःकफोत्क्लेशरुजोऽरुचिश्चहृद्रोगजाःस्युर्विविधास्तथाऽन्ये ||(Ch.Chi.26/78)

Discoloration in skin complexion, fainting, fever, cough, hiccup, dyspnea, unpleasant taste in mouth, excess thirst, confusion/unconsciousness, vomiting, nausea and distress / pain, anorexia and such other various symptoms manifest in patient suffering from heart disease

1. Vataja Hridroga: The symptoms of Vata dominant disease of heart are:[8]

a. Vepathu (fibrillation/ extra systole),

b. Vestanam (cardiac cramps),

c. Stambhah (pauses in cardiac beats),

d. Promoh (stupor),

e. Shunyata (sensation of emptiness in the cardiac region),

f. Darah (murmur). The patient suffers from severe chest pain at the time of completion of digestion of the meal

2. Pittaja Hridroga: The symptoms of pitta dominant disease of heart are:[9]

a. Hriddaha (burning sensation in the pericardial region),

b. Tiktata (bitter taste in the mouth),

c. Tiktamlodgiranam (sour eructation),

d. Klamah (exhaustion),

e. Trishna (thirst),

f. Murccha (fainting),

g. Bhrama (gliddiness), and

h. Sweda (perspiration).

3. Kaphaja Hridroga: The symptoms of Kapha dominant disease of heart are:[10]

a. Suptam (numbness),

b. Stimita (stiffness),

c. Bharikam (heaviness in the pericardial area ),

d. Tandra (drowsiness),

e. Aruchi (anorexia),

f. Asmaavartam (a stony sensation in the heart region),

4. Tridoshaj Hridroga: In Tridoshaja Hridroga, the etiological factors and symptoms of all the three Dosha dominant types of heart diseases are present.

5. Krimija Hridroga: The symptoms of Krimija dominant disease of heart are:[11]

a. Tudyaman (pricking pain),

b. Suchibhiriv (piercing pain),

c. Chidyamanam Yatha Sastrairjatak (cut open by weapons).

d. The patient of Krimija Hridroga feels severe pain in the pericardial region. Krimija Hridroga is a very grave heart condition and may lead to immediate death.

e. In case of decreased Vata, if increased Kapha obstructs the normal Pitta then it cause Hrudaya Roga.

Samprapti (Pathogenesis)[12]

Dushayita Rasam Doshah Viguna Hridayamgatah Hridibadam |

Prakurvanti Hridorganga Pracakshate || Su.Ut.43/4


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In the presence of the etiological factors the Doshas get vitiated and take refuge in Hridaya. Create Hridroga by vitiating Rasa, which is housed in Hridaya. There is some debate about whether the Rasa becomes vitiated once the Doshas invade Hridaya or before. Given that Hridaya is the seat of Rasa, it makes sense to agree that Rasa becomes vitiated once the vitiated Doshas get to Hridaya. It is also feasible to translate the text as "Viguna Kupita Doshah Rasam Dushayitva Hridayam Gatah".[6] It appears that many Ayurvedic academics hold this opinion. However, given the current situation, where we Ayurvedists are unable to fully utilise the pathological basis (as described in Ayurvedic classics) in the management.

The Presence of the Etiological factors

↓

Doshas get vitiated and take refuge in Hridya

↓

Then vitiated Ras Dhatu, Hridaya being the seat of Rasa

↓

Produce Hridaya Roga

Samprapti Ghatak

  • Dosha - Vatadi tridosha,
  • Dushya - Rasa dhatu, Meda dhatu
  • Srotas - Rasvaha, Pranvaha
  • Adhishthan - Hardiya
  • Srotodushthi - Sang
  • Swabhav - Chirkaari
  • Agnidushthi - Agnimaandhya
  • Sadhya-Asadhya - Yapya

Prevention of Hridroga

सङ्क्षेपतः क्रियायोगो निदानपरिवर्जनम् |[13]

Prevention is better than cure - principle of Ayurveda

So, preventive aspect is more important than Chikitsa of Hridroga.

1. Nidan Parivarjana (Diet & life style modification)

2. Avoidance of Manas Hetu

3. Rasayana therapy for Hridroga - Brahm Rasayana, Amalaki Rasayana, Shilajeet Rasayana, Agastaya Haritaki, Chayavanprasha Rasayana.[14]

4. Samshodhan therapy (Mridu Vaman – Vataj and Kaphaj Hridroga, Mridu Virechan – Pittaj Hridroga and Krimija Hridroga)

Shaman Chikitsa

Hrudya Mahakashaya: Amra, Amarataka, Lakucha, Karmarda, Vrikshamla, Amlavetas, Kuvala, Badra, Dadima, & Matulunga.[15]

Vataja[16]

1. Oil, Sauviraka, Mastu (curd water / whey), buttermilk, along with salt to be consumed in lukewarm form.

2. Decoction prepared out of Punarnava, Devdaru, Panchmula (Bilva, Syonaka, Gambhari, Patala, Ganikarika), barley grains, Bilva, Kulattha, Kola, Medicated oil is prepared with above mentioned decoction and used for internally as well as externally (for massage) helps in Vataja type of

3. Medicated ghee prepared with paste of Haritaki, Shunthi, Pushkarmoola, Guduchi, Amalaki, and Hingu is useful in Gulma (lump like feeling in abdomen), chest pain and pain in flanks caused due to aggravated Vata.

4. Beneficial drugs: Trikatu (Shunti, Maricha, Pippali), Triphala. (Haritaki, Bibhitaki, Amalaki), Draksa, Kasmarya, Kharjura, Parusaka, Patha, Kantakari, Goksura, Bala, Mahabala, Truti (smaller Cardamom), Tamalaki, Kapikacchu, Meda, Mahameda, Madhuka, Salaparni, Satavari, Jivaka, Prsniparni.

Pittaja[17]

1. Cold anointings, affusion and purgation therapy is indicated. After purgation the patient is advised, Pitta - alleviating diet combined with Draksha, sugar, honey and Parusaka.

2. Beneficial drugs: Kaseruka, Saivala, Sringavera (Sunthi), Prapaundarika, Madhuka, tuber of Lotus Stem, Draksha, Bala, Sreyasi (Rasna), Kharjura, Vira, Rishabhaka and

Kaphaja[18]

1. Decoction (three part) of Udumbara, Asvattha, Vata, Arjuna, Palasa, Rohitaka, Khadira and


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powder of Trivrita, Trikatu (Shunti, Maricha, Pippali) and made into a linctus (Lehya). Taken with warm water cures Kaphaja Hridroga.

2. Beneficial drugs: Katphala, Sunthi, Daruharidra, Haritaki, Ativisha, Pippali, Sati, Puskaramula, Rasna, Vacha, Haritaki, Sunthi

Sannipataja[19]

1. Firstly Langhana (fasting therapy)

2. Diet which alleviates all the three Dosha to be advised.

3. Treatment of the three Dosha should be done after determining their relative degree

Table 1: Pathya / Apathya Vihara[20]

Pathya Vihar Apathya Vihar
Swedana, Vamana, Basti, Virechana, Vishrama, Laghna etc. Tarishna, Vamana, Mutra, Adhovayu, Kash, Ashru Vega Dhaaran Karna, Daatun Karan.

Table 2: Pathya / Apathya Ahara

Pathya Aahar Apathya Aahar
 Puraanraktshali, Jaangal Pshupakshiyo Ka Maasrasa, Munga, Kultha Ka Yush, Khandayush, Aama, Anaar, Amal- Taash, Nayi Muli, Shunti, Kelaa, Aakesh Ka Jla, Parwal etc. Bheda Ka Dudh, Nadi Ka Jal, Usna, Tikshna, Gurupakee, Kashaya Aahar Ka Sevan, Mahuaa etc.

Discussion

Samanya Lakshan of Hridroga is also found in various diseases of the heart - (1) Discolouration - This includes pallor, cyanosis and malar flush on the body. Paleness is an indicator of anemia caused by malformation of the various valves of the heart. Blackheads are caused by a lack of hemoglobin and are especially noticeable in areas like the lips, tip of the nose and nails, where the capillaries are superficial. This is caused by venous stasis. The cause of forehead redness is mitral stenosis. (2) Fainting This is a special symptom of cardiac asthma. (3) Fever - This symptom is predominant in rheumatic or septic endocarditis. (4) Cough, hiccups and wheezing are called pressure symptoms. They are found in mitral regurgitation and especially in mitral stenosis. Bilateral congestion also involves vomiting of blood. Coronary thrombosis is characterized by vomiting, anorexia and shortness of breath. In these diseases, knowledge of the special symptoms of 'Vatadi' mentioned by Madhava can also be used to facilitate treatment. They should not be considered a separate disease.

1. Vataja Hridroga: Due to excessive exercise, sad mood, fasting, Rooksha, Shushka, Alpa Aahar aggravates Vata and produce pain in heart region. Common symptom of Vata is Shoola. Severe pain is present in Angina. So, we can correlate Vataja Hruday Roga with angina. Due to Laghu and Ruksha Guna Vata aggravates and cause hardness and calcification of arterial wall.

2. Pittaja Hridroga: Due to excessive use of Amla, Lavan, Katu, Kshar, Ushna and excessive use of alcohol aggravates Pitta Dosha and produce burning in heart region, sweating, thirst and fainting in the body. As per modern view we can correlates with pericarditis and inflammatory disease of heart.

3. Kaphaja Hridroga: Due to excessive use of Snigdha Guru food and lack of exercise aggravates Kapha Dosha and produce heaviness and numbness in cardiac region. It can be correlate with myocardial infarction because of heaviness feels in MI.

4. Sannipataj Hridroga: Due to Vata, Pitta, Kapha, all symptoms are present in Sannipataj Hridroga. It can be corelated with acute chest pain.

5. Krimija Hridroga: Krimija Hridroga occurs by Rasa Dhatu Dushti due to over eating of Tila, Guda, leads to Granthi Utpati. Granthi Krimi arrives and spread in all region of heart and produces itching and pain etc. It leads in death and Krimija Hridroga can be corelated infectious cardiac disease Due to severe pain occur and required urgent management to Krimija Hridroga.

Due to faulty diet pattern & life style increase incidence of the heart disease in all over the world. Role of Ayurveda in the prevention and cure of the cardio-vascular disease is very systematic and good manner because of Ayurvedic text have described Ahara, Vihara, Ritucharya, Dincharya, Yoga, Rasayan which have good role in prevention & cure of the cardiovascular disease. It can be helpful in the decrease the incidence of cardiovascular disease.

As a result, the heart is an important crossroads among pathways through the subtle body (Nadis), and it is intimately connected to the heart Chakra as well. So, we should protect our heart by simply following healthy lifestyle, avoiding stress, eating right and practicing Yoga daily.



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Conclusion

Heart disease or Hridaroga is a term covering any disorder of the heart. Everyone should have brief knowledge about this. So, this article is explaining the heart disease in a very scientific way by covering its Ayurvedic view as well as modern explanation.

Reference

1. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthna, Kiyantshirsiya Adhyaya, 17/30-40, edited by Acharya Vidhyadhar Shukla 1st edition, Chaukhamba Prakashan, Varanasi. pp.259 (2002)

2. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Trimarmiya Chikista Adhyaya, 26/77-104, Chaukhamba Prakashan, Varanasi.

3. Sushruta, Dalhana, Charaka Samhita, Sutra Sthana, Astodariyam Adhyaya,19/4, pp285., uttara Tantra, Hridrog pratishedh Adhyaya,43/4, edited by P. G. Aathavale 2nd edition, Godavari publishers and book promoters , Nagpur, pp543, (2008)

4. Sushruta Samhita, Uttar sthana, Gulma pratishedh Adhyaya, 42/5, pp530

5. Charaka Samhita, Sutra Sthana, Astodariyam Adhyaya,19/4, pp285.

6. Cardiovascular diseases (CVDs) (who.int)

7. Madhav nidana, Madhukosh Tika Hridroga Nidana Adhyay 29/1

8. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthna, Kiyantshirsiya Adhyaya, 17/31

9. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthna, Kiyantshirsiya Adhyaya, 17/33

10. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthna, Kiyantshirsiya Adhyaya, 17/35

11. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthna, Kiyantshirsiya Adhyaya, 17/39-40

12. Sushruta Samhita, Uttar Sthana, Hridroga Pratished Adhyaya, 43/4

13. Madhava Nidana 29/1 (Tika-Alanka Dorpana)

14. Sushruta Samhita, Uttar Sthana, Aupadravika Adhyay 1/25

15. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsasthna, Rasayana Adhyaya, 2.1/13,14,15

16. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutrasthna Shadvirechanshatashatriya adhyaya 4/10

17. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthan, Trimarmiya Adhyay 26/81-89

18. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthan, Trimarmiya Adhyay 26/90-95

19. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthan, Trimarmiya Adhyay 26/96-99

20. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthan, Trimarmiya Adhyay 26/96-100

21. Kayachikitsa, part 2, Prof Ajay Kumar Sharma, Chaukhamba Publication, Varanasi, edition 2013;136


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