E-ISSN:2456-3110

Case Report

Ayurveda medications

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August
Publisherwww.maharshicharaka.in

A successful management of Raktagatavata (Essential hypertension) through Ayurveda medications Rasayana Vati and Kakubhadi Churna: A Case Series

Jamadari N1*, Jain N2
DOI: DOI:10.21760/jaims.8.8.34

1* Nikita Jamadari, Post Graduate, Kayachikitsa, Govt Auto Dhanwantari Ayurvedic College Hospital, Ujjain, Madhya Pradesh, India.

2 Naresh Jain, Associate Professor, Department of Kayachikitsa, Govt Auto Dhanwantari Ayurvedic College Hospital, Ujjain, Madhya Pradesh, India.

Hypertension is a primary risk factor for cardiovascular disease, including heart attack, heart failure, stroke and aneurysm. Keeping blood pressure under control is vital for preserving health and reducing the risk of these dangerous conditions. Hypertension can be considered as a Raktaj Roga, where the Vata is the related (Anubandha) Dosha. Consequently, the term Raktagatavata is more suitable to the condition rather than other term. In hypertension we can see signs and indications of unsettling influence of Vata Dosha that for the most part of Vyana Vayu. The treatment is additionally on the premise to remedy of the equilibrium of Rakta and Vata Dosha. Essential Hypertension is the most frequent kind of hypertension and also known as primary or idiopathic hypertension, affecting 95% of hypertension patients. Many works have been carried out on hypertension to evaluate the perfect diagnosis and mode of treatment on the basis of Ayurvedic principles but a widely acceptable theory is still not available. Different opinions of various disease as parallel to hypertension e.g., Raktagatavata, Raktaavritvata, Pranavritvata, Vyanbalavishamaya, Siragatavata etc. Ayurveda treatment for hypertension aims at balancing these Dosha, Dushya and Lakshanas along with proper dietary habits, regular exercises, yoga, medications that can prove beneficial to balance the state of mind and stress and maintain the blood pressure. This study was conducted to see the effect of Rasayana Vati and Kakubhadi Churna in different cases on the symptoms of Raktagatavata, blood pressure, S. Cholesterol, S. Triglycerdies.

Keywords: Raktagatavata, Rasayana Vati, Kakubhadi Churna, Essential Hypertension, Blood Pressure, Cholesterol, Case Series.

Corresponding Author How to Cite this Article To Browse
Nikita Jamadari, Post Graduate, Kayachikitsa, Govt Auto Dhanwantari Ayurvedic College Hospital, Ujjain, Madhya Pradesh, India.
Email: 		Jamadari N, Jain N, A successful management of Raktagatavata (Essential hypertension) through Ayurveda medications Rasayana Vati and Kakubhadi Churna: A Case Series. J Ayu Int Med Sci. 2023;8(8):222-229.
Available From
https://jaims.in/jaims/article/view/2707

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-13 2023-06-19 2023-06-26 2023-07-03 2023-07-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 23.54%

© 2023by Jamadari N, Jain Nand 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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Nikita Jamadari et al. A successful management of Raktagatavata (Essential hypertension)

Introduction

In Ayurveda there is no description of such a single disease which can be similar to Hypertension. However, as Acharya Charaka has mentioned, it is not necessary that every manifestation be named but, the problem can be measured according to their specific features itself,[1] but it can be understood on the basis of some Ayurvedic concepts like Raktagatavata, Pachaka Pitta, Prana Vayu, Apana Vayu, Sadhaka Pitta and with  respect to pathological state of Avalambaka Kapha Bhava. The involvement of Mansika Doshas like Raja and Tama Doshas also contributes towards the conditions.

Raktagatavata means involvement of Rakta by vitiated Vayu. According to Ayurveda, the main function of Rakta is Jivanam (life). hence, it is has been mentioned as Jiva. When Rasa-Rakta Dhatu remains in their normalcy, mainly Sira, Dhamani and Hridaya stay put standard and perform their functions as a rule. Any abnormality of Rasa Rakta Dhatu affects the normal circulation of Rasa Rakta and ultimately results in the abnormality of the blood pressure or by increasing the blood pressure. Rasa Rakta Samvahana occurs simultaneously in the body.[2] Manas Bhavas is crucial factors in the development of various diseases. Manas Bhavas such as Krodha, Shoka, Bhaya, Lobha, Chinta etc. described in Ayurveda are responsible for the development of different Vikara.

Hypertension or high blood pressure is a circulatory state, arise from any cause in which the pressure of the blood in the arteries becomes elevated beyond normal limits. Hypertension in adults age 18 years and older is defined as systolic blood pressure of 140 mm Hg or more and/ or diastolic blood pressure of 90 mm Hg or more or any level of blood pressure taking antihypertensive medication.[3]

Classification of BP in adults as per JNC VII criteria[4]

BP classification SBP mmHgDBP mmHg
Normal<120and <80
Pre hypertension120-139or 80-89
Stage 1 hypertension140-159or 90-99
Stage 2 hypertension>160or >100

Patients with arterial hypertension and no definable cause are said to have primary, essential, or idiopathic hypertension. Primary hypertension tends to be familiar and is likely to be the consequences of an interaction between environmental and genetic factors. The prevalence of primary hypertension increases with age, and individual with relatively

high blood pressure at younger ages are at increased risk for the subsequent development of hypertension. It is likely that primary hypertension represents a spectrum of disorders with different underlying pathophysiology’s. In the maximum no. of patients with established hypertension, peripheral resistance is increased and cardiac output is normal or decreased however in younger patients with mild or labile hypertension, cardiac output may be increased and peripheral resistance may be normal. In contrast, individuals in whom generalized or functional abnormalities may be the cause of hypertension, even if the abnormalities are discrete, are defined as having essential hypertension.[5]

Aims and Objectives

1. To evaluate the efficacy of Rasayana Vati in the management of Essential Hypertension.
2. To evaluate the efficacy of Kakubhadi Churna in the management of Essential Hypertension.
3. To compare the efficacy of Rasayana Vati & Kakubhadi Churna in the management of Essential Hypertension.

Materials and Methods

Literary Review

Detailed literary review of Raktagatavata, Essential hypertension and Drugs under trial was done by using appropriate and authentic sources.

Clinical Study

3 patients of Raktagatavata indicating each group of Ayurvedic medicine was taken. Clinical trial was initiated after getting approval from Ethical Committee and patients were also registered in Dhanwantari Hospital and informed written consent was taken from all subjects to include in clinical trial.

All the selected patients after the registration and attending Kayachikitsa OPD and giving history related to the Raktagatavata which cannot be resolved with the other medications. All the selected patients were properly informed regarding the nature of disease process, potential complications and alternative treatments. Written informed consent was signed by patients. Diagnostic medical history was taken according to both Ayurveda and Modern clinical methods. CBC, Lipid profile, ECG and blood sugar, X-ray of chest (As per need) before and after treatment were done.


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Detailed proforma was prepared which used to record the progress and status of the patients under trial.

Methodology / Treatment given

Medicine has been prepared at Pharmacy of Govt. (Auto) Dhanwantari Ayurveda College, Ujjain. All cases have been treated at O.P.D. of Kayachikitsa of Dhanwantari Ayurveda hospital, Ujjain and also taken consent of the patients before the clinical research trial. During the treatment follow up have been done in every 7th day for 2 months.

Type of study - Case Study

Drug administration

Medicine given Rasayana VatiKakubhadi Churna  Both (Rasayana Vati and Kakubhadi Churna)
Dose 2-tab (each 250 mg) BD3gm BDRasayana Vati – 2 tab (each 250 mg) BDKakubhadi Churna - 3gm BD
Route of administration OralOralOral
Anupana Lukewarm waterLukewarm waterLukewarm water
Follow up Every 7th & 15th dayEvery 7th & 15th dayEvery 7th & 15th day
Duration 2 months2 months2 months
Case name Case 01Case 02Case 03

Rasayana Vati – composition of Vati

DrugLatin name Family Part UsedMode of action Quantity
BramhiCentella AsciaticaUmbelliferae Panchang (Whole Plant)Unmada, Apasmara, Yosapasmara, Balaroga, Smritivikara, Dourbalya, Pandu, Kamala, Kandu, Pliharoga Vriddhi, Sotha, Prameha1 Part
JatamansiNordostachy jatamansiValerianaceaeMool (Root)Bhutaghna, Balya, Sangyaasthapana, Deepan, Pachana, Anuloma, Varnya1 Part
TagarValerianaceaeValerianaceaeMool (Root)Vedanasthapaka, Vrana Ropaka, Balya, Medhya, Vishaghna1 Part
BhringrajEclipta alpbaCompositaePanchang (Whole Plant)Kesharanjana, Deepana, Pachana, Keshvardhan, Amapachana, Rasayan, Balya1 Part
AmalakiCucurma longaZingiberacaePhala (Fruit)Daha-Prashamana, Shonita Sthapana, Rasayana, Medhya1 Part
HaridraTribulus terrestrisZygophyllaceaeKand (Stem)Shothahara, Vedanasthapana, Varnya, Vranashodhana, Vranaropana, Lekhana1 Part
GokshuraEmblica officinalisEuphorbiaceaePhala (Fruit)Vedanasthapaka, Shothahara, Rakta-Pitta Shamaka, Mutrala1 Part
GuduchiTinosporacordifoliaMenispermaceae Kand (Stem)Kushthaghna, Vedanasthapana, Raktashodhaka1 Part

Mode of action of Rasayana Vati

It is combination of 8 drugs that is given above, these all drugs have Rasayana Guna property. Brahmi works in hearts disease, inflammation and also increase memory power. Jatamansi is used as Samjyasthapana and also maintain blood pressure. Tagar is used as Vednasthapana and having Akshephara property. Brahmi, Tagar, Jatamansi all are Medhya drugs.

Bhringraj and Haridra both are blood purifier and reduce inflammation. Gokshura is Rakta-Pitta Shamaka and is diuretic.

Kakubhadi Churna - Composition of Churna

DrugLatin name Family Part UsedMode of action Quantity
ArjunaTerminalia ArjunaCombretaceaeTwak (Bark)Hridya-Raktaprasadana, Stambhaka, Sothahara, Kaphaghna, Vranaropana1 Part
VachaAcorus CalamusAraceaeMool (Root)Swedjanana, Traptighna, Chintahara, Manodoshhara, Medhya Shamaka1 Part
RasanaPluchea LanceolataCompositaeMool (Root)Shothahara, VedanasthapanaRaktashodhaka, Vishghna, Raktashodhaka1 Part
BalaSida CordifoliaMalvaceaeMool (Root)VedanasthapakaShothahara, Mutrala, Raktapitta Shamaka, Garbha Poshaka, Nadibalya Vatahara, Balya Brihana1 Part
NaagbalaGrewia HirsutaTiliaceaeMool (Root)Rasayana, Nadibalya, Medhya, Hrdya-Raktapittasamaka, Mutrala, Dahaprasamana1 Part
AbhayaTerminaliaCombretaceae Phala (Fruit Pulp)Shotha-Hara, Vedana-Sthapana, Shonita-Sthapana1 Part
ShatiHedychium SpicatiumZingiberaceaeMool (Root)Raktasodhaka, Rocana-Dipana, Sulaprasamana, Savasahara1 Part
PippaliPiper LongumPiperaceaePhala (Fruit)Shirovirechana, Medhya, Deepaneeya, Triptighna, Vatanulomana, Krimighna, Rakta Vardhaka, Rakta Shodhaka, Kushthaghna, Rasayana, Balya1 Part
PushkarmoolInula RacemosaAsteraceaeMoo l(Root)Hridya, Svasahara, MastiskasamakaMedohara, Mutrajanana1 Part
ShunthiZingiberOfficinaleZingiberaceaeKanda (Tuber)Sheetaprashamana, Shotha-Hara, Vedana-Sthapana, Triptighna, Rochana, Deepana, Pachana, Vatanulomana, Shoola-Prashamana, Arshoghna, Shwasa-Hara, Vrushya, Jwaraghna.1 Part

Mode of action of Kakubhadi Churna

Kakubhadi Churna is mentioned in Bhaishaya Ratnawali under Hridrogadhikar. It is a combination of ten drugs like Arjun, Vacha, Shunthi, Haritaki, Rasna, Shati, Pippali, Pushkarmool, Bala & Nagabala; which has Rasayan Guna and due to Its Rasa, Veerya, Vipaka has Tridoshnashak action especially Vatashamak. This Churna has Katu-Tikta as main Rasa which acts on Rakta and is Hridya (Arjuna). So, this drug is very effective in HTN.

Case History

Case 01 presentation - A 65 years old female patient presented on 10/01/2023 at O.P.D. of Kayachikitsa department of Dhanwantari Ayurveda Hospital, Ujjain (M.P) with chief complaint of numbness in right hand, eyes straining, headache, palpitation. She also has a history of hypertension and also taking allopathy medicine in the past 10 years. Blood pressure examination done on visited date was 130/80 mm of Hg.


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Case 02 presentation - A 45 years old female patient presented on 13/03/2023 at O.P.D. of Kayachikitsa department of Dhanwantari Ayurveda Hospital, Ujjain (M.P) with chief complaint of heaviness in the body, dizziness, uneasiness, palpitation in the heart. No past history of hypertension but she was taking allopathy medicine Asomax tablet in the last 10 days. Blood pressure examination done on visited date was 140/90 mm of Hg.

Case 03 Presentation - A 40 years old male patient presented on 03/03/2023 at O.P.D. of Kayachikitsa department of Dhanwantari Ayurveda Hospital, Ujjain (M.P) with chief complaint of giddiness, Body ache, headache, sweating. Blood pressure examination done on visited date was 150/90 mm of Hg.

Demographic data of presented cases

Data Case 01Case 02Case 03
Namexxxyyyzzz
O.P.D.7036602130
DOA10/01/202313/03/202303/01/2023
Age65 Y45Y40Y
SexFFM
Marital statusMarriedMarriedUnmarried
OccupationHouse wifeHouse wifeService
Diet and habitsVegetarianVegetarianVegetarian
AddictionTeaNoneTea
Kostha Mrudu Krura Mrudu
Bala Madhyam Madhyam Avara
Emotional statusAnxiousSentimentalSentimental
SleepModerateDisturbedModerate
Family historyAbsentFather -PresentMother -Present
Treatment historyTaking allopathy in the last 10 yearsTaking allopathy in the past 10 daysFresh case

 General examination

Data Case 01Case 02Case 03
BuiltMediumMediumLean
Height5.5 inches5.3 inches5.7 inches
Weight60 kg75 kg55 kg
Body temperatureAfebrileAfebrileAfebrile
Blood pressure130/80 mmHg140/90 mmHg150/90 mmHg
Pulse rate72/min60/min76/min
PallorAbsentAbsentAbsent
IcterusAbsentAbsentAbsent
ClubbingAbsentAbsentAbsent
CyanosisAbsentAbsentAbsent
EdemaAbsentAbsentAbsent
LymphadenopathyAbsentAbsentAbsent
Mutra NormalNormalPrabhut Mutrata
Mala Niram Saam Niraam
Jiwha Coated -whiteUncoatedUncoated
Prakruti VPVPVP

Given Treatment

Case NameCase 01Case 02Case 03
Name of medicinesRasayana Vati Kakubhadi Churna Rasayana Vati and Kakubhadi Churna both
Dose2 BD (250 mg each tab)After meal3gm BDAfter mealRasayana Vati - 2 BDKakubhadi Churna - 3gm BDAfter meal
AnupanaLukewarm waterLukewarm waterLukewarm water
Duration2 months2 months2 months

Subjective parameters for Raktagatavata

Symptoms Scoring is done (0-3) on the basis of severity Before treatment After treatment % of relief
Shirashoola (headache)Nil - 0Mild headache - 1Headache in the morning hours, throbbing and usually frontal - 2Continuous and severe headache - 3Case 01 = 1 Case 02 = 0 Case 03 = 1Case 01 = 0 Case 02 = 0 Case 03 = 0Case 01 = 100% Case 02 = 0 Case 03 = 100%
Bhrama (dizziness)Nil - 0Rarely for some moment during change of posture - 1Feeling slightly off balance - 2Feels unsteady, off balance and need supports - 3Case 01 = 0Case 02 = 1Case 03 = 0Case 01 = 0Case 02 = 0Case 03 = 0Case 01 = 0Case 02 = 100%Case 03 = 0
Spandana (palpitation)Nil - 0Rapid palpitations - 1Rapid palpitations with irregular beating of heart - 2Slipped beat, rapid flutterings, flip-floppin and pounding sensations - 3Case 01 = 1Case 02 = 1Case 03 = 1Case 01 = 0Case 02 = 0Case 03 = 0Case 01 = 100%Case 02 = 100%Case 03 = 100%
Swedaadhikyata (sweating)Absent - 0Mild sweating - 1Sweating with moderate work - 2Severe sweating with mild work - 3Case 01 = 1Case 02 = 0Case 03 = 1Case 01 = 0Case 02 = 0Case 03 = 0Case 01 = 100%Case 02 = 0Case 03 = 100%
Systolic BPNormal (110-119) - 0Pre-HTN (120-139) - 1Stage 1 HTN (140-159) - 2Stage 2 HTN – (160-180) - 3Case 01 = 1Case 02 = 2Case 03 = 2Case 01 = 1Case 02 = 1Case 03 = 1Case 01 = 0%Case 02 = 50%Case 03 = 50%
Diastolic BPNormal (70-79) - 0Pre-HTN (80-89) - 1Stage 1 HTN (90-99) - 2Stage 2 HTN (100-110) - 3Case 01 = 1Case 02 = 2Case 03 = 2Case 01 = 0Case 02 = 1Case 03 = 2Case 01 = 100%Case 02 = 50%Case 03 = 0%

Objective parameters - Before and after the Treatment

Case  Case 01 Case 02 Case 03
Blood pressure (mm Hg)BT130/80140/90148/90
AT120/70120/80138/90
HGB(g/l)BT11.112.512.9
AT10.412.712.4
Total lipidBT823523438
AT450513448
S. CholesterolBT268169162
AT164161161
S. TriglyceridesBT286191116
AT122185101
ECG -Normal ECGInferior T wave abnormalityNormal ECG

Result

Both Rasayana Vati and Kakubhadi Churna are very effective in Raktagatavata. Both pacified and normalized the level of systolic and diastolic and all other subjective parameters given above. About 70-85% of symptoms subsides in all cases. Also, adverse drug reaction was not found in both medicines. By this case study we found that more valuable result in subjective parameters were given by Case 01 in which Rasayana Vati is given. After that Case 03 in which both the drugs were given and at last case 02 Kakubhadi Churna. There were more severe symptoms was present in Case 03 than in Case 02 and then in Case 01, % of relief was more in Case01> Case03>Case 02. All the cases got relief in chief complaint as shown above.


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Nikita Jamadari et al. A successful management of Raktagatavata (Essential hypertension)

Discussion

Prominent Rasa of both Rasayana Vati is Tikta. So, it should act up to Rasa, Rakta Dhatu along with their Srotas. It reduces the Aama in the Rasa Rakta and there by viscosity of Rasa Rakta. This in turn reduces the pressure on the heart muscle and Rasa Vikshepana is ease too though.

Laghu and Ruksha Guna of both Rasayana Vati initially help Mandagni factor with Ushna Virya of the Rasayana. The Guna and Virya of Rasayana should collectively correct the Mandagni, and reduce the Dhamani Upalepa and Virya pacify the Vayu. This combines effect of Rasa and Virya seems to play a major role in breaking the Dosha Dushya Samurchhana of EHT.

In addition, major Vipaka of combination of Rasayana Vati is Madhur. This Madhur Vipaka should help disturbed Vata, Oja, Hridaya and cooling effect (Shamana or Aapyaayana) on the Dhatus and Srotas. Collective mode of action of Vipaka should have Urajaskara and nourishing effect on disturbed Mana, as Madhur is the only nutrition to mind [Shadhindriyaprasadana]. The combination has Tridoshahara effect so, the action of the Rasayana will be general Shanshamana, Samadoshakara and they’re by Manaprasadkara. EHT is Vatapradhan, Tridoshajvyadhi with Raja and Tama Dosha. Vata acts as the major Dosha in Hypertension. Pitta and Kapha also plays secondary role in producing the symptoms in Hypertension i.e., dizziness and headache.

Kakubhadi Churna contains Arjun, Vacha, Shunti, Haritaki, Rasna etc. which has Rasayan Guna and due to its Rasa, Veerya, Vipak has Tridoshnashak action especially Vatashamak. Katu-Tikta as main Rasa will act on Rakta and is Hridya (Arjun). So, this drug is very effective in HTN. Kakubhadi Churna acts on lipids and lowers cholesterol (triglycerides, LDL) and increases HDL level.

Conclusion

Since this disease involves persistent elevation of blood pressure. The Blood pressure depends on the force of contraction of Hridaya and Dhamanis at primary level. Vata Doshas is main cause of this conditions. Apart from general Nidana for Vata Kopa, the incidence of Rasa Rakta Dushti also is to be taken into account as Rasa & Rakta are Dushyas.

Role of Mandagni is the principal source at the back of every disease told by Acharyas, which causes Utpatti of Aama. Aama in the Rasa Rakta Dhatu increases the viscosity and also pressure to combat this. Dhamani Uplepa is one of the main incidences in Hypertension and is stated in Kapha Nanatmaja Vyadhi. Hence, the Hypertension (EHT) can be assigned as Tridoshaja Vyadhi with predominance of Vata. According to Ayurveda all diseases are caused by Doshas only and primary hypertension is no exception to this. All diseases are to be understand thoroughly in terms of Nidana [etiology], Purvarupa [prodromal signs], Rupa [signs and symptoms], Upashyas [therapeutics] and Samprapti [pathogenesis] for planning of correct line of treatment. In the present trial Rasayana Vati better results in pacifying the entire range of Symptomatology. It is suggested that Rasayana drugs which have Hridaya and Medhya properties are also used. Kakubhadi Churna is significant in the control of Hypertension. It can be concluded that Kakubhadi Churna possess cardio-protective properties. It is Balya, Aampachak, Rasayana, Tridoshnaashak and increases Dhatwagni which strengthens all the Dhatus, improves blood circulation and brings blood pressure to normal level. No any adverse effect was noted in this study.

References

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2. Dwivedi BK, Goswami P. Charak Samhita, Chikitsa Sthana 3/114. 1st ed. Varanasi; Chaukhambha Krishna Das Academy; 2013

3. Golwallas medicine, Aspi F Golwalla, Sharukh A Golwalla, edited by Milind Y Nadkar, Jaypee Brothers medical publishers (P) Ltd, New Delhi, 25th Edition: 2017.Chapter, P.No.-298

4. Golwallas medicine, Aspi F Golwalla, Sharukh A Golwalla, edited by Milind Y Nadkar, Jaypee Brothers medical publishers (P) Ltd, New Delhi, 25th Edition: 2017.Chapter, P.No.-299

5. Harrison’s Principles of internal medicine, Loscalzo, Fauci, Kasper, Hauser, Longo and Jameson, 21st edition publishers Mc Graw Hill reprinted 20 volume.


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