E-ISSN:2456-3110

Research Article

Essential Hypertension

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

Efficacy of Virechana Karma in the management of Uccha Rakta Chapa (Essential Hypertension) - A Clinical Study

Patel RK1*, Patel A2
DOI:10.21760/jaims.9.10.1

1* R K Patel, Phd Scholar, Dept of Panchakarma, Pt Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

2 Abhilasha Patel, Medical Officer, Dept of Panchakarma, Pt Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

The management of various systemic disorders and found to effectively detoxify the body by elimination of vitiated Dosha. Various clinical studies have shown that therapeutic modalities of Shodhana followed by Shamana have better clinical response than just Shamana (Palliative treatment plan). It has also changed the approach of the researchers towards palliative role of various form of modalities in the diseases which are considered to be newly emerging and do not find place in the classical treaties. Essential Hypertension is a form of Hypertension that by definition has no identifiable causes and is the most common type of Hypertension affecting 90% of Hypertensive patients and accounts to approx. 6% of deaths world-wide. The involvement of Pitta and Kapha is undisputed in the pathogenesis of Hypertension along with Vikriti of Vyan Vayu because it is Vyanavayu that facilitates Rasa, Rakta Samvahana. Keeping above view into consideration, it was thought desirable to consider Virechana as an appropriate. Virechana is considered to remove the Margavarodha, eliminates the morbid Doshas and regulate movement of Vata by its Anulomana action. Thus, it corrects the Rasa-Rakta Samvahan and helps to regulate the activity of heart and helps to reduce blood pressure.

Keywords: Uccha Raktachap, HTN, EHTN, Virechana Karma

Corresponding Author How to Cite this Article To Browse
R K Patel, Phd Scholar, Dept of Panchakarma, Pt Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Patel RK, Patel A, Efficacy of Virechana Karma in the management of Uccha Rakta Chapa (Essential Hypertension) - A Clinical Study. J Ayu Int Med Sci. 2024;9(10):1-8.
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https://jaims.in/jaims/article/view/3921

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-13 2024-09-23 2024-10-03 2024-10-12 2024-10-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.32

© 2024by Patel RK, Patel Aand 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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Patel et al. Efficacy of Virechana Karma in the management of Uccha Rakta Chapa

Introduction

The Panchkarma therapeutics are widely used in the management of various systemic disorders and found to effectively detoxify the body by elimination of vitiated Dosha. Various clinical studies have shown that therapeutic modalities of Shodhana followed by Shamana have better clinical response than just Shamana (Palliative treatment plan). It has also changed the approach of the researchers towards palliative role of various form of modalities in the diseases which are considered to be newly emerging and do not find place in the classical treaties. In Ayurveda although there is no identical clinical entity available in classics however there are certain pathological condition which can be considered to manifest some of the features comparable to that of Hypertension. Like - Pittavrita Vata, Pittavrita Udana, Pittavrita Vyana, Pranavrita Udana, Vyanavrita Prana and Siragata Vata.[1]

Hypertension is one of such diseases that is not described in Ayurveda as such, the reasons implicated that it has no clear classical symptoms but is rather a machine diagnosed disease. Essential Hypertension is a form of Hypertension that by definition has no identifiable causes and is the most common type of Hypertension affecting 90% of Hypertensive patients and accounts to approx.6 % of deaths world wide.[2]

Hypertension is the cause of 50% coronary heart diseases, stroke and heart failure. Overall incidence of Hypertension has been reported to be 32.5%.[3] The urban population is more likely to suffer from Hypertension (incidence rate 25%) than the rural (10%).[4] Increased urbanization and industrialization also significantly contribute to increasing incidences. Hypertension is defined as a sustained increase in systolic BP of 140 mmHg or more and / or diastolic BP of 90 mmHg or more by the usual criteria of average, Hypertension is considered as one of the leading non communicable diseases, as acknowledged by WHO.

Classification of blood pressure (Joint National Committee 7 guide lines)[5]

CategorySystolic BP (mmHg)Diastolic BP (mmHg)
Normal<120<80
Pre-hypertensive120-13980-89
Stage 1140-15990-99
Stage 2≥ 160≥ 100

Treatment plan advocates the use of Beta- Blockers, Ca++ channel blockers, CNS depressants, diuretics, ACE inhibitors etc. On the same line Ayurvedic drugs have also been used from time to time and have shown exhilarating response. Nomenclature of various diseases as mentioned in contemporary medicine has not been found by name as such in Ayurvedic classics. Acharyas however have emphasized on the importance of understanding the possible pathogenesis of a particular condition in terms of involved factors like Dosha, Dushya, Prakriti, Adhisthan, Samutthan etc. for management purpose rather than naming them. (Ch.Su.18/44-46)

It is important to note that the involvement of Pitta and Kapha is undisputed in the pathogenesis of Hypertension along with Vikriti of Vyan Vayu because it is Vyanavayu that facilitates Rasa, Rakta Samvahana. Hence it is obvious that a treatment modality that can impart appropriate action on Pitta and Kapha as well as channelization of Gati of Vayu could prove to be effective in the management of Hypertension.

Keeping above view into consideration, it was thought desirable to consider Virechana as an appropriate. The present clinical study was planned to evaluate their respective role in the management of essential hypertension because the available modern treatment plans are empirical, have lifelong dependency and are full of hazardous side effects.

Aim and Objectives

The present clinical study was planned under following aims and objectives: To evaluate the efficacy of Virechana Karma along with Arjuna and Gokshura Churna in the management of essential Hypertension.

Materials and Methods

For this study 30 patients of Essential Hypertension fulfilling the criteria were selected from OPD and IPD of Pt. Khushilal Sharma Govt. Autonomous Ayurveda College and Institute, Bhopal (M.P.) 30 patients were subjected to Virechana therapy (Charaka Kalpsthana 7/23). & Oral medication – AG Powder containing Arjuna and Gokshura (in equal quantity) in the dose of 10 gm. twice a day for 15 days with luke warm water.


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Patel et al. Efficacy of Virechana Karma in the management of Uccha Rakta Chapa

Table 1: Treatment Regimen

SNProcedurePreparationQuantityDuration
1.Deepana-PachanaTrikatu Churna2-5 gm.Till Niram Dosha Lakshana appear.
2.Snehana
a) Abhyantar
b) Snehapana		Murchhit Go GhritaAccording to Agni and KosthaTill Samyaka Snigdha Lakshana appear.
c) Bahya
Abhyanga		Til Taila25-30 min.
3.SwedanaNiragni Sweda -Grupravrana.Till Samyaka Swedana Lakshana appear.
4.Pradhana KarmaShyamatrivrut Sharkara.According to Kostha
Shamana ChikitsaArjuna and Gokshura Churna10 gm. (Equal quantity in each powder)15 days

Follow-up study:

After completion of treatment all the patients were advised to report in the O.P.D. after 15 days, for follow up study, after 15 minute of rest the status of other symptoms and sign was also recorded.

Preparation of Trivruta Avleha for Virechana

Trivruta: 1part
Sharkra: 4part
Ghee: 2part.
Water: 4part

Trivruta Avleha was prepared as mentioned in classics (Sha.M.khanda 8/2). In Quath of Trivruta it is added to Truvruta powder and Sharkra, heated to semisolid consistency. When appropriate Paka was achieved, it was taken away from Agni and allowed to cool down. After that it is added with ghee. No any preservatives were used for preparation of Avaleha.

Inclusion Criteria:

1. Patients of essential Hypertension without taking any Hypertensive medication.
2. Patients with Systolic blood pressure <160 mmHg and ≥ 140 mmHg, Diastolic blood pressure <100 mmHg and ≥90 mmHg
3. Patients between the age group of 20 years to 50 years.
4. Patients fit for Virechana

Exclusion Criteria:

1. Patients below 20 years and above 50 years of age.

2. Patients with Systolic blood pressure ≥160 mmHg, < 140 mmHg, Diastolic blood pressure ≥100 mmHg and < 90 mmHg
3. Patients receiving Antihypertensive drugs.
4. Complicated Hypertensive case e.g., Congestive heart failure, Nephropathy.
5. Diabetic patients.
6. Secondary Hypertension.
7. Pregnant woman.
8. Patients taking oral contraceptive pills or steroids etc.

Investigations

All the patients registered under this study were subjected for following investigation.

Fasting blood sugar and post prandial blood sugar/ random blood sugar, Lipid profile, and ECG.

Assessment Criteria:

Subjective Criteria

1. Shirashoola (Headache)
2. Swedadhikyata (Excessive sweating)
3. Anidra (Insomnia)
4. Bhrama (Giddiness)
5. Klama (Fatigue).

All above symptoms were graded by giving score in the basis of severity as below-

Scoring Pattern

Table 2: The scoring of Shirshoola

ParametersScores
Nil0
Rarely headache relieves without medication.1
Frequently headache relieves by rest doesn’t disturb daily activities.2
Frequently severe headache disturbs daily activities requires medicine.3
Continuous / severe headache disturbs sleep and daily activities and also not manages by the medicine.4

Table 3: The scoring of Swedadhikyata

ParametersScores
Able to do both routine special activities without discomfort.0
Mild sweating by heavy work.1
Sweating with moderate work relieves soon.2
Severe sweating with mild work but no disturbance to the routine.3
Severe sweating with mild work disturbs the routine.4

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Table 4: The scoring of Anidra

ParametersScores
Sound sleep0
Disturbed sleep wake-up 1-2 times a night.1
Difficult to onset sleep remains disturbed in night.2
Very less Sleep-in small interval makes patient irritable3
Not getting Sleep without medicine4

Table 5: The scoring of Bhrama

ParametersScores
Nil0
Rarely Bhrama for some moment during charge of posture.1
Often for some moments during charge of posture.2
Often for each moment even in lying condition.3
Patients unable to hold himself without any support.4

Table 6: The scoring of Klama

ParametersScores
Nil0
Rarely feeling of tiredness without any exertion.1
Rarely feeling of tiredness without any exertion with inability in concentration.2
Frequently feeling of tiredness without any exertion with inability in concentration3
Feeling of tiredness without any exertion with inability in concentration.4

Objective Criteria

Assessment of change in both systolic and diastolic blood pressure level in supine position, was recorded.

Table 7: The JNC (7 guide lines) and WHO criteria for Diagnosis of Hypertension was also adopted.

Category of HTNSystolic BP (mmhg)Diastolic BP (mmhg)
Normal<120<80
Pre-Hypertension120-13980-89
Stage 1 Hypertension140-15990-99
Stage 2 Hypertension≥160≥100
Isolated systolic Hypertension>140<90

The symptoms and signs including the blood pressure were recorded at the interval of 7, 15, 22, 30 and 45th day.

Table 8: To make cumulative assessment for final outcome the HTN was also graded as below.

Diastolic blood pressureScore
≤800
81-851
86-912
91-953
96-1004

Observations and Results

The information gathered on the basis of observations were subjected to statistical analysis in terms of mean (x), standard deviation (S.D.) and standard error (S.E.). Wilcoxon test and Mann-whitney is a Non-parametric test which were applied for paired and unpaired data respectively. The obtained results were interpreted as

  • Not significant p >0.05
  • Significant p <0.01-0.05
  • Highly significant p <0.001
  • Extremely significant p <0.0001

Total 30 patients were registered in Group A, 28 patients had completed the treatment and follow up and 2 patients discontinued before the completion of treatment course.

Duration of SnehapanaNo. of patientPercentage
3 Days725
4 Days517.85
5 Days1035.71
7 Days621.42

In the present study maximum 35.71% of patients have developed Samyaka Snehana Lakshana on 5thday, 25% on 3rdday, 21.42% of patients on 7th day, and 17.85% on 4th day.

Graph 1: Distribution of 28 patients of Group A, according to SamyakaSnehana.
jaims_3921_01.JPG


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Table 9: VagikiSuddh wise distribution of 28 patient of Virechana group

No. of VegaNo. of PatientPercentage
Uttam828.57
Madhyam1760.71
Heena310.71

In the present study maximum no. of patients (60.71%) had seen Madhyam Shudhi followed by 28.57% patients Uttam Shudhi While 10.71% patients were Heena Shudhi in Virechana.

Graph 2: VagikiSuddh wise distribution of 28 patient of Virechana group.
jaims_3921_02.JPG

Effect of treatment on clinical profile

Table 10: Effects of therapies on Blood pressure on 28 patients of EHT.

B.P.MeanX% ReliefS.D.S.ETP
B.T.A.T.
Group-A
S.B.P.145.79126.5019.2813.227.221.3614.12<0.0001
D.B.P.94.5781.716.406.766.401.2110.62<0.0001

28 patients of Uccharaktachapa were treated in this group. The initial mean systolic blood pressure value of the 28 patients of this group before treatment was 145.79 mm of Hg, the decline to 126.50 mm of Hg after treatment with “t” value of 14.12 The statistical analysis shows extremely significant result at p<0.0001.

Before treatment the mean D.B.P. of the 28 patients of this group was 94.57 mm of Hg and that after treatment was 81.71 mm of Hg. The “t” value was found to be 10.62 the statistical analysis shows extremely significant at p<0.0001.

Result- In this 30 out of 28 patients after the completion of treatment only (7.14%) patients got Mark improvement, (25%) patients got Moderate improvement, (67.85%) patients got mild improvement. There was No complete remission of disease.

Discussion

Hypertension is called a silent killer because it rarely causes symptoms before it damages the heart, kidneys or brain. The disease Essential Hypertension (EHT) is neither denoted in Samhita nor in any Samgraha Granthas, as it is stated that every disease cannot be given nomenclature.

Acharya Charak says that when Kapha is in aggravated position, Pitta in normal states and Vata is decreased in the body then symptoms appear like Shirahshoola (Headache), Hrida Roga (cardiac diseases), Nidra (sleepiness), Tandra (Drowsiness), Gaurav (Heaviness in the body), Pralap (Delirium), Mandagni (Diminished appetite) etc. (Ch.Su.17/51). These symptoms are many times reported by hypertensive patients. After going through the literature both modern and the Ayurveda, it is concluded that hypertension is a Tridoshaja Vyadhi.

On clinical symptoms

Although there are no specific symptoms attributed to HTN, however Shirahshoola, Swedadhikya, Anidra, Bhrama, Klama are to be commonly observed. However, 30 patients of EHT, Shirahshoola was by far the most common manifestation in the patients registered in this series, as we have already discussed that role of Pitta and Vata, along with Raktadhatu is important, which leads to Paittic pattern of Shirahshoola.

The main symptoms like Shirahshoola (Headache) in 76.36%, Swedadhikya (Sweating) in 30.90%, Anidra (Insomnia) in 58.18%, Bhrama (Giddiness) in 65.45%, Klama (Fatigue) in 41.81% were observed in patients.

Effect of therapy on clinical sign (Virechana + Shamana Chikitsa group)

28 patients of Uccharaktachapa were treated in this group. The initial mean systolic blood pressure value of the 28 patients of this group before treatment was 145.79 mm of Hg, that declined to 126.50 mm of Hg after treatment with “t” value 14.12 showing extremely significant result at p<0.0001.


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Before treatment the mean D.B.P. of the 28 patients of this group was 94.57 mm of Hg and that after treatment was 81.71 mm of Hg. The “t” value was found to be 10.62 which was statistically extremely significant at the level of p<0.0001 (Table No. 10)

On effect of individual drugs on EHT

Arjuna

Rationale behind selection:

Doshaghna: Arjuna has Kasaya Rasa, Ruksa Guna, Sita Virya and Katu Vipaka. Kaphanasak by Kashaya, Ruksha, Laghu property and Pittanasak by Sheeta property, it is used in diseases induced by Kapha and Pitta. It's Kashaya & Ruksha Guna help to reduce swelling & Meda (due to Kaphanashaka Guna), and also reduce Fatigue & Daha.[6]

Gokshura

Rationale behind selection:

Gokshura is having Madhura Rasa and Madhura Vipaka in addition with Rasayana and Balya Prabhav seem to alleviate all signs & symptoms. Its Mutravirechaiya Prabhav and Basti Shodhak Karma causes elimination of Kleda from the body, by their it might have helped to reduce the raised blood pressure. It's Madhura Rasa and Vipaka, Snigdha, Guru Guna may reduce hyperactivity of Vata and thus probably reduced Sankocha and Kathinya of Srotas, Along with its diuretic properties the reduction in inflammation might have resulted.[7]

Probable mode of action of Karma

Virechana

Charaka has indicated Virechana in Raktapradosha (Ch.Su.24), Pitta dominated Vyadhis, in Santarpanottha Vyadhis (Ch.Su.23/8), in Langhaniya Vyadhis (Ch.Su.22/19) and in Viruddha Ahara induced Vyadhis (Ch.Su.26/105) and in the complex Avarana of Kapha, Pitta, Rakta and Meda.(Ch.Chi.26)

Symptoms of Doshas pre-dominancy


  • Vata Dosha: When Vata is predominant, then blood pressure will increase after worry, strain, overwork, anxiety or insomnia. It is often associated with nervous system disorders. Anxiety, worry, stress, and strain, are usually the main factors.
  • Pitta Dosha: When the Pitta dominant, anger, Irritability, nose bleed, Violent headaches and Sensitivity to light contribute to high blood pressure.
  • Kapha Dosha: When Kapha is dominant, there may be dull headache, edema, and lethargy with obesity and Blood pressure remains continually high.[8]

The Virechana Karma eliminate the morbid Doshas. Pitta effect on Rakta Dhatu, regulate activity and movement of Vata by its Anulomana action. Thus, it corrects the Rasa-Rakta Samvahan and helps to regulate the activity of heart and helps to reduce systolic and diastolic blood pressure. Virechana means inducing purgation helps to decrease fluid volume which may help to reduce cardiac overload and consequently reduces blood pressure. Virechana is also considered to remove the Margavarodha (obstruction), eliminates the morbid Doshas and regulate movement of Vata which is found to be in Avarana state. It is also implicit that the Shodhana effect of Virechanakarma, might have improved the functioning of Heart, and was found to be effective in Bhrama, Klama, Shirashoola, Swedadhikyata and Anidra.[9]

Rasa-Rakta Dushya are main culprits and Raja-Tama are also involved. Various etiological factors produce Dosha Dushti, Srotodusti, Khavaigunya and Agnimandhya which all leads to EHT. For EHT Virechana Karma was selected. As such Samprapti Vightan is said to be treatment. Aamashaya and Pakwashaya is Udbhava Sthana of EHT. Virechana Karma helps to eradication of Dosha from not only Aamashaya and Pakwashaya but also from whole body. Virechana also potentiates and reduces Agnimandhya. Virechana Dravyas by its Ushna, Tikshna properties spread in whole body and lead to remove Srotosanga and Srotoupalepa. Virechana is believed to expel the excessive Dravatva from whole body. It also establishes the functional integrity between these three subtypes of Dosha through its process, which ultimately help to pacify Tridosha. It is also capable of mitigating of Vata Dosha besides Pitta[10,11] eliminates Kapha Dosha either associated with Pitta Dosha or situated in Pitta Sthana. Virechana Karma has been also advised in all Dhatu-Dushti Janya Vikara viz. Rasaja, Raktaja Vikara.[12] Aacharya Sushruta and Vagbhata state that, it helps to improve intellectual and mental status.


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It is also provides strength to the body by increasing strength of Indriyas and stabilizing seven Dhatus,[13] thus Virechana stands as prime therapeutic Shodhana to help in normalizing the Blood pressure.

Hypothesis: Virechana process can be remove excess of sodium ions and potassium through G.I.T. Watery stool cause depletion of bicarbonate, thus Virechana can eliminate bicarbonate. It can maintain Acid-Base balance too. By the process of Virechana, we may say that Virechana may give positive effects on Angiotensin-II enzyme, which helps to reduce retention of salt and water, and which decrease extracellular fluid from the body, and thereby decreased blood pressure.

Conclusion

The provoked Kapha normal Pitta and decreased Vata (Ch. Su.17) are the probable factors embraced in the Samprapti of EHT. Provoked Kapha may causes the structural abnormalities in Dhamanies (Dhamanipratichaya and Dhamani Sankocha) which leads to the increased peripheral resistance and thus the hypertension. After going through the literature (both modern and the Ayurveda) It can be concluded that hypertension is a Tridoshaja Vyadhi. Virechana is considered to remove the Margavarodha, eliminates the morbid Doshas and regulate movement of Vata by its Anulomana action. Thus, it corrects the Rasa-Rakta Samvahan and helps to regulate the activity of heart and helps to reduce blood pressure.

References

1. An Ayurvedic management of Essential Hypertension –a clinical study, Dr. Vijay Sheel Upadhyay Post. Graduate institute of Ayurveda- Chitarakoota Satna (MP) Aug-1997
2. Kasper DL, Fauci AA, Hauser S,et al, editors. Harrisons principles of internal medicine, 17th (monograph on the internet) New york; the McGraw-Hill Companies.
3. World Health Organization.
4. Journal of Hypertension by Wolter and Kluwer health june 2014 vol 32.
5. Seventh report of Joint National Committee on Prevention, Detection, Evaluation & treatment of High blood pressure the JNC complete report Hypertension 2003 :42 :1206 1252 published online.

6. Vishnu Gogate, Ayurvedic pharmacology, Dravyaguna Vidnyana, First edition oct2000 ,Vaidha Bhartiya vidhya , Prakashna, Mumbai page no. 299 .
7. Vishnu Gogate, Ayurvedic pharmacology, Dravyaguna Vidnyana, First edition oct2000 ,Vaidha Bhartiya vidhya , Prakashna, Mumbai page no. 361 .
8. Vedpathak Amruta A Prevention and management of hypertension w.s.r. to Ayurveda PG Scholar, Dept. of Kriya Sharir, Govt. Ayurved College, Osmanabad, Maharashtra, India International Journal of Ayurveda and Pharma Research.
9. Ujwala Samadhan Hivale, A randomized clinical study on the effect of triphaladi virechana karma with arjuna punarnavadi ghanavati in the management of essential hypertension. Research Article International Ayurvedic Medical Journal ISSN:2320 5091.
10. Charaka Samhita of Agnivesha revised by Charaka and Dridhabala with ‘Ayurveda Deepika’ commentary by Chakrapanidatta, edited by VdJadavaji Trikamaji Acharya, Chaukhambha Surabharati Publications, Varanasi, reprint 2008. VimanaSthan6/16, pg no. 256.
11. Ashtanga hrdaya of Vagbhata with Arunadatta tika and Hemadri tika, edited by Hari Sadasiva Sastri, Chaukhambha Sabskrit Sansthan, Varanasi, reprint, 2012. Sutrasthan 13/1. Pg no. 211
12. Charaka Samhita of Agnivesha revised by Charaka and Dridhabala with ‘Ayurveda Deepika’ commentary by Chakrapanidatta, edited by Vd Jadavaji Trikamaji Acharya, Chaukhambha Surabharati Publications, Varanasi, reprint 2013. Sutrasthan 24/18 pg no. 125
13. Sushruta samhita of Susruta with Dalhanacharya Tika, edited by Jadvji Trikamji Acharya, Chaukhambha Sanskrit Sansthan, Varanasi, reprint, 2013, Chikitsasthan 33/27 Pg. No. 419


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