E-ISSN:2456-3110

Research Article

Ucharaktachap

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

Management of Essential Hypertension (Ucharaktachap) - A Pilot Study

Solanki S1*, Dash B2
DOI:10.21760/jaims.9.4.5

1* Sonika Solanki, Post Graduate Scholar, Dept of Panchakarma, Pandit Khushilal Sharma Govt Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.

2 Babita Dash, Lecturer, Dept of Panchakarma, Pandit Khushilal Sharma Govt Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.

Hypertension is the most common lifestyle disorder today. Hypertension may be a chronic and sometimes asymptomatic medical condition during which systemic blood pressure is elevated beyond normal. Fewer than half of those with hypertension are conscious of their condition and lots of others are Modern treatment modalities are effective for the management of hypertension but pose human beings to their unwanted complications on their long-term use. The conventional antihypertensive drugs have many adverse effects & are not well tolerated which led to non-compliance, switching & discontinuation of treatment. There is no direct description of HTN in Ayurveda but based on its clinical presentation and similarity between pathogenesis factors for hypertension can be correlated with Raktadhatugata Vata (Vatpradhan) and it is considered as Tridoshaja Vyadhi. Treatment for hypertension in Ayurveda on the idea of Balancing all three Doshas. So Nidan Parivarajan, proper dietary habits, Yoga, Meditation along with Ayurvedic herbs can be beneficial for balancing the state of mind, maintaining as well as reducing blood pressure. Ayurveda has various classical formulations and single herbs having Hridya, Kaphahara, Vatahara, Balya, Raktaprasadana, etc. properties which are safe and cost-effective too. In present study Nitya Virechana Karma has been selected as Shodhana measure, to trump over offending Tridosas, as Virechana has also been equally effective in Rakta vitiation. In the present study Shamana remedy (Amritanagaradi Kashayam) has been selected taking in to view the aspect of the preventive, curative and also Dosha Pratyanic effect of Shamana Yoga drugs.

Keywords: High Blood Pressure, Lifestyle disorder, Nitya Virechan, Shodan, Shaman

Corresponding Author How to Cite this Article To Browse
Sonika Solanki, Post Graduate Scholar, Dept of Panchakarma, Pandit Khushilal Sharma Govt Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India.
Email: 		Solanki S, Dash B, Management of Essential Hypertension (Ucharaktachap) - A Pilot Study. J Ayu Int Med Sci. 2024;9(4):33-39.
Available From
https://jaims.in/jaims/article/view/3272

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-11 2024-02-21 2024-03-02 2024-03-09 2024-03-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 22.27

© 2024by Solanki S, Dash Band 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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Sonika Solanki et al. Management of Essential Hypertension (Ucharaktachap) - A Pilot Study

Introduction

Hypertension (HTN) is a lifestyle disorder occurs due to faulty lifestyle and stressful psychological conditions with a low estimate of remission and recovery. The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure guidelines recommended some striking changes in the diagnosis and management of hypertension.[1] Diagnostic criteria of HTN are systolic blood pressure above 130 mm Hg and diastolic above 80 mm Hg.[1] Hypertension is called as a silent killer because majority patients (85%) are asymptomatic[2] and cause adverse effect to brain, kidney, heart and peripheral arteries over a period.[3] Hypertension is precisely responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD) deaths in India.[4] About 26.4% of the world adult population in 2000 had hypertension and 29.2% were predicted to have this disorder by 2025.[5] In 95% cases of the hypertension, the primary etiological factors are still unknown[6] but are presumed to be due to genetic and environmental factors.[7] Although antihypertensive therapy certainly reduces the risk of cardiovascular and renal disease, but lifelong usage of antihypertensive drugs is associated with detrimental effects.[8] Hence to attain and maintain good health, hypertensive patients are looking towards Ayurveda.

In Ayurveda, the regulation of blood pressure is governed by the Tridoshas viz Vata (Prana and Vyana), Pitta (Sadhaka) and Kapha (Avalambaka), Dushya like Rasa, Rakta and Meda, with the proper functioning of Mana (mind) and Oja which are situated in heart and helps in circulation of blood. On the basis of strong resemblances between etiological factors,[10] symptoms,[11] involvement of Doshas and Dushya in the etiopathology and complication,[12] it is believed Vata Dosha to be the main culprit. Hence, Essential Hypertension can be correlated with Vata Pradhana Tridoshaja Vyadhi.

Acharya Charaka has mentioned that if there is Bahudosha Avastha, then morbid toxins should be eliminated by the purificatory process.[13] Virechana is mainly indicated in Pitta and Shonita predominant Vyadhi.[14] As Pitta Dosha is having Asharaya-Ashrayi Sambandha (mutual interdependence) with Rakta Dhatu, so Virechana is significantly beneficial in Rakta Dushtijanya Vyadhi.[15]

In Vatapradhana Vyadhi, Mridu Sanshodhana is the choice of treatment.[16] Nitya Virechana is a type of Mridu Sanshodhana. There are many Virechana drugs described in Samhita. Among them, Aargvadh is considered as Mriduvirechnanam.[17] So in this study, Aargvadh Churna was selected for Nitya Virechana and Amritanagaradi Kashayam was selected as a Shaman drug in the management of Essential Hypertension.

Aim and Objectives

To evaluate the effect of Nitya Virechan (Argvdhadi kashayam) and Amritanagaradi kashayam in the management of essential hypertention (Uchcharaktachap).

Materials and Methods

Source of patient

The patients suffering from hypertension (Uchchraktachap) attending the OPD of Pt. Khushilal Sharma Govt. Ayurvedic Hospital, Bhopal. Overall, 8 patients were included in the study fulfilling the diagnostic, inclusion and exclusion criteria. A detailed history taking and physical examination were carried out in these patients. The clinical data along with the elaborated assessment of the condition were recorded in specially designed case proforma. Among 9 patients, 7 completed the treatment, 2 patients did not complete the whole treatment due to unknown cause.

Diagnostic criteria

Subjective criteria

  • Swedhadhikya (Excessive sweating)
  • Klama (fatigue)
  • Bhrama (giddiness)
  • Shirhashool (headache)
  • Anidra (insomnia)

Objective criteria

Table 2: Diagnostic criteria of Hypertension (ACC / AHA blood pressure guidelines)

Category of HTNSystolic blood pressureDiastolic blood pressure
Normal< 120mmhg< 80
Pre HTN120 -129 mmhg<80 mmhg
Stage 1HTN130-139 mmhg80- 89 mmhg
Stage 2 HTN≥ 140 mm≥ 90 mm Hg

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Sonika Solanki et al. Management of Essential Hypertension (Ucharaktachap) - A Pilot Study

Inclusion criteria

1. Patients of essential hypertension without taking any hypertensive medicine.
2. Patients with systolic blood pressure 120-140 mmHg & Diastolic blood pressure 80-90 mmHg.
3. Patients between the age group 20 to 50 years.
4. Patients fit for Virechan Karma.

Exclusion criteria

1. Patients below 20 yr and above 50 years of age.
2. Patients with systolic blood pressure > 120mmHg & Diastolic blood pressure >90mmHg.
3. Patients receiving antihypertensive drug.
4. Complicated hypertensive cases eg. congestive cardiac failure, neuropathy
5. Diabetic patients.
6. Secondary hypertension.
7. Pregnant women.
8. Patients taking oral contraceptive pills and steroids etc.

Assessment criteria

Grading of subjective criteria

Swedhadhikya

1Able to do both routine special activities without discomfort0
2Mild sweating by heavy work1
3Sweating with moderate work relieves soon2
4Sever sweating with mild work but no disturbance to the routine3
5Sever sweating with mild work disturb the routine4

Anindra (Disturbed sleep/ Insomnia)

1Sound sleep0
2Disturbed sleep wakes up 1-2 times a night1
3Difficult to onset remains disturbed in night2
4Very less sleep in small intervals and makes patient irritable3
5Unable to sleep without medicine4

Bhrama (Giddiness)

1Nil0
2Rarely Bhrama for some movement during change of posture1
3Often for some movement during change of posture2
4Often for each movement even in lying condition also3
5Patient unable to hold himself without any support4

Klama (Fatigue)

1Nil0
2Rarely feeling of tiredness without any exertion1
3Rarely feeling of tiredness without any exertion with any inability in concentration2
4Frequency feeling of tiredness without any exertion with inability in concentration3
5Continuous feeling of tiredness without any exertion with inability in concentration4

Shirhshool (Headache)

1Nil0
2Rarely headache relieve without medicine1
3Frequent headache relives by rest does not disturb daily activity2
4Frequently severe headache disturbs daily activities requires medicine3
5Continues severe headache disturbs sleep and daily activities not manage by medicine4

Objective criteria

Systolic and diastolic blood pressure

Treatment regimen

SNTherapyDrugDays
1.Nitya VirechanaAragvadh Kashaya30
2.Kashaya PanAmritanagaradi Kashaya30

Ingredients of Amrita Nagaradi Kashayam (for Pana)

SNDrugLatin NameFamily
1.Guduchi (Amrita)Tinospora cordifoliaMenispermaceae
2.Nagar (Shunthi)Zingiber officinalisZingiberaceae
3.DhanyakCoriandrum sativamUmbelliferae

Ingredients of Argvadh Kashayam (for Virechana)

SNDrugLatin nameFamily
1.AragvadhaCassia fistulaLeguminoceae

Result

The values of data were expressed as a percentage of relief and mean-standard error of the mean. The data were analysed by Student's‘t’ test for comparing before and after treatment obtained scores. The level of significance is expressed asP> 0.05 as insignificant,P< 0.05 and 0.01 as significant,P< 0.001 as highly significant.

SNSymptomsMeanMDSDSE% Relieft-testp-valueResult
BTAT
1.Swedhadhikya2.710.861.850.690.2668%3.7520.0028VS
2.Klama2.290.431.860.530.2081%5.3070.0002ES
3.Anindra2.1411.140.580.2253%3.3600.0057S
4Bhrama2.291.141.150.690.2650%2.5730.0244S
5.Shirahshool1.140.710.430.490.1837%1.3410.2046NS

VS - Very significant, ES - Extremely Significant, S - Significant, NS - Not significant

  • Swedhadhikya - the mean score of Swedhadhikya in this study, before treatment was 2.71 and after treatment it was

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  • reduced to 0.86. So, the mean difference was 1.85, with percentage relief of 68% which was statistically very significant (P=0.0028).
  • Klama - the mean score of Klama in this study, before treatment was 2.29 and after treatment it was reduced to 0.43. So, the mean difference was 1.86, with percentage relief of 81% which was statistically extremely significant (P=0.0002)
  • Anindra - the mean score of Anidra in this study, before treatment was 2.14 and after treatment it was reduced to 1. So, the mean difference was 1.14, with percentage relief of 53% which was statistically significant (P=0.0057).
  • Bhrama - the mean score of Bhrama in this study, before treatment was 2.29 and after treatment it was reduced to 1.14. So, the mean difference was 1.15, with percentage relief of 50% which was statistically significant (P=0.0244).
  • Shirahshool - the mean score of Shirahshool in this study, before treatment was 1.14 and after treatment it was reduced to 0.71. So, the mean difference was 0.43, with percentage relief of 37% which was not significant (P=0.2046).

Discussion

Essential Hypertension is a psychosomatic haemodynamic disease with a multi-factorial pathology and origin of several dietary, environmental and genetic factors. Modern medical science has already invented so many medicines, to keep the blood pressure in its normal ranges. But all these Drugs have a long list of adverse effect with them. The Ayurvedic medicine gives side benefits instead of side effects. Therefore, the Ayurvedic therapeutics, have attracted considerable glamour for providing safe and effective remedies. Numerous researches have been done time and again to reprove the worth of these time-tested medicaments. Yet, there is a necessity for pursuing further research to find out some safe and effective therapy i.e. Shoddhan Chikitsa with no adverse effects and which also retracts the life threating complications of the Hypertension and save the Hypertensive population. In Ayurveda, there is no direct references regarding hypertension and as per Ayurvedic principles, in case of

unknown disease, the physician should try to interpret the features of the disease through the involvement of Dosha, Dushya and its etiological factors involved in the pathogenesis of the disease and treat accordingly.[18] Blood Pressure is the outcome of many physiological activities which is regulated by the Tridoshas viz Vata (Prana and Vyana), Pitta (Sadhaka), and Kapha (Avalambaka) Doshas, Dushyas like Rasa, Rakta and Meda, with the proper functioning of Mana and Oja which are situated in heart and helps in pumping of blood.[19] On the basis of involvement of these factors, hypertension is said to be Vata Pradhana Tridoshaja Vyadhi. Further after understanding the EHT on the basis of Ayurvedic fundamentals, the treatment has been selected in compliance with the principles propounded. Among Shodhana karmas, Virechana was selected for present study due to its acceptability, less complications and popularity.

Aragvadha Kashaya

Aragvadha has Madhur and Tikta Ras, Guru, Shit and Madhur in Vipaka. It is useful to reduce various diseases like Fever (Jwara), Skin Diseases (Kushta), Rheumatic Diseases (Amavaata), Cervical Lyrnphadenitis (Gandamaala), Cardiac Diseases (Hrudroga), Worm Infestations (Krimi), Abdominal Pain (Shoola), Abdominal Disorders (Udararoga), Polyuria (Prameha), Dysuria (Mootrakrucha), Bloating of Abdomen (Gulma) etc. It also reduces all the three Dosha. It acts as laxative (Mrudurechaka). The fruit of it is said to be Laxative (Sramsanam), increases taste perception (Ruchya), reduces skin disorders (Kushta), Pitta and Kapha. This is said to be the best drug for laxation and it is also said to be the best for the elimination of Doshas of the gastrointestinal tract (Kostashuddikaram Param). The fruit Majja of Aragvadha is having major chemical constituents like rhein dianthraquinone glucosides, Sennoside A, Sennoside B and fistulic acid. Purgative activity: The aqueous extract of the fruit pulp had significant purgative action; the activity is due to the presence of anthraquinones present. Aragvadha exhibit analgesic, carminative, anti-inflammatory, antioxidant, hepato protective, immunomodulatory and hydragogue activities.[23] When administered as laxative helps in alleviating the symptoms of hypertension by initiating the excretion of sodium and reducing vascular resistance.

Mridu Sanshodhana has been mentioned as


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Sonika Solanki et al. Management of Essential Hypertension (Ucharaktachap) - A Pilot Study

the line of treatment of Vata Vyadhi. Nitya Virechana is a type of Mridu Sanshodhana. The probable mode of action of Nitya Virechana with Argavadh Churna can be understood by the dominant pharmacodynamics which helps in removing obstruction (Margavarodha) and eliminates the excess morbid toxic materials (Kledamsha) through Adhobhaga by the predominance of Jala and Prithvi Mahabhutas. Thereby it helps in pacifying Kapha and Pitta Doshas which altogether has its effect on Rakta due to Ashraya-Ashrayi Sambandha and regulates Vata Dosha by its Anulomana action and ultimately balances the Tridosha. Thus, Nitya Virechana acts either by hyper osmotic action or by reducing fluid electrolyte retention in the blood helps in expulsion of morbid Doshas from the body in less quantity and thereby reduces the total volume of Rasa and Rakta and maintaining the electrolyte balance and ultimately decreased blood pressure. Hence, we can conclude that Nitya Virechana with Aragvadh Churna acts by Pittakaphahara, Sukhavirechaka, Anulomana and Raktashodhaka properties, which helps in maintaining osmotic pressure, thereby regularize Tridosha and reduces hypertension.

Amritanagaradi Kashayam

Kashayam contains Ardraka (Zingiber officinale), Amrit (Tinospora cordifolia), and Dhanyak (Coriandrum sativam) as its active ingredients.

Ayurvedic properties and action of composition -

1. Guduchi (Tinospora cordifolia) - Rasa - Tikta and Kashay, Guna - Guru and Snigdha, Virya Ushna, Vipaka - Madhura and Effect on Tridosha - Tridoshahar.

2. Shunthi - Rasa - Katu, Guna - Ruksha and Teekshan, Virya - Ushna, Vipak Madhur and Effect on Dosha - Kaphahara.

3. Dhaynaka - Rasa - Kashay and Tikta, Guna - Laghu Snigdha, Vipak - Madhur, Veerya - Ushan, Effect on Doshas - Tridoshahar.

Conclusion

Hypertension is a common disorder of present era. Essential Hypertension is a psychosomatic hemodynamic disorder which is well explained in modern. Hypertension can be correlated with Vata Pradhana Tridoshaja

Vyadhi in Ayurveda based on the similarities in etiological factors, clinical features, complications etc. Statistically significant reduction in clinical symptomatology of hypertension and significant improvement was found in Systolic and Diastolic blood pressure. From the outcomes, we can conclude that Nitya Virechana with Argvadh Kashay is effective to reduce Systolic and Diastolic blood pressure in Essential Hypertension. In this study none of the patients had developed any adverse effects during the course of treatment. The sample size was small and the study duration was too short to draw exact conclusion, thus the study with large sample and optimum duration should provide more improvement.

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