Changes

{{Infobox

{{Infobox

|title =  Contributors

|title =  Contributors

|data6 = carakasamhita@gmail.com

|data6 = carakasamhita@gmail.com

|label7 = Date of first publication:

|label7 = Publisher

|data7 = June 26, 2021

|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = DOI

|label8 = Date of first publication:

|data8 = Under process

 

|label9 = DOI

|data9 = 10.47468/CSNE.2021.e01.s09.062

}}

}}

'''Updates on management of cardiac diseases through Ayurveda'''

'''Updates on management of cardiac diseases through Ayurveda'''

 

(This article is based on lecture delivered by Dr. Rohit Sane in Prof.M.S.Baghel Memorial Lecture Series on June 09, 2021.)

This article is based on lecture delivered by Dr. Rohit Sane in Prof.M.S.Baghel Memorial Lecture Series on June 09, 2021. The video lecture can be accessed on the link of [https://fb.watch/8l7PEmmWxC/ facebook page.]

 

The major chronic diseases prevailing in India are cardiovascular disorders (CVD), diabetes, hypertension, obesity and dyslipidemia. Mortality due to cardiovascular disease is increasing substantially. In the year 1990, the mortality rate due to CVD  in India was 15.2, which increased to 28.1 in 2016.<ref>India State-Level Disease Burden Initiative CVD Collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016.Lancet Glob Health 2018; 6: e1339–51 Available from https://www.thelancet.com/action/showPdf?pii=S2214-109X%2818%2930407-8 cited on 23/06/2021 </ref>  Despite the advancements in modern medicine, especially in treating CVD like angioplasty, bypass surgery, etc., the disease burden is increasing. [[Ayurveda]] can play a significant role in treating CVD as a lifestyle disorder and a non-communicable disorder.

The major chronic diseases prevailing in India are cardiovascular disorders (CVD), diabetes, hypertension, obesity and dyslipidemia. Mortality due to cardiovascular disease is increasing substantially. In the year 1990, the mortality rate due to CVD  in India was 15.2, which increased to 28.1 in 2016.<ref>India State-Level Disease Burden Initiative CVD Collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016.Lancet Glob Health 2018; 6: e1339–51 Available from https://www.thelancet.com/action/showPdf?pii=S2214-109X%2818%2930407-8 cited on 23/06/2021 </ref>  Despite the advancements in modern medicine, especially in treating CVD like angioplasty, bypass surgery, etc., the disease burden is increasing. [[Ayurveda]] can play a significant role in treating CVD as a lifestyle disorder and a non-communicable disorder.

 

The risk factors of CVD are diabetes, hypertension, and obesity. The burden of these lifestyle disorders is also high on the rise.  As per the data available, 9.7% of the adult population in India has Diabetes.<ref>Akhtar SN, Dhillon P. Prevalence of diagnosed diabetes and associated risk factors: Evidence from the large-scale surveys in India. J Soc Health Diabetes [serial online] 2017 [cited 2017 Oct 15 ];5:28-36</ref>  Hypertension is present in 25% of urban and 10% of rural subjects in India. Stage I hypertension carries significant cardiovascular risk.<ref>Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004 Feb;18(2):73-8. doi: 10.1038/sj.jhh.1001633. PMID: 14730320.</ref> Therefore, it is essential to treat these comorbid conditions while treating CVD.

The risk factors of CVD are diabetes, hypertension, and obesity. The burden of these lifestyle disorders is also high on the rise.  As per the data available, 9.7% of the adult population in India has Diabetes.<ref>Akhtar SN, Dhillon P. Prevalence of diagnosed diabetes and associated risk factors: Evidence from the large-scale surveys in India. J Soc Health Diabetes [serial online] 2017 [cited 2017 Oct 15 ];5:28-36</ref>  Hypertension is present in 25% of urban and 10% of rural subjects in India. Stage I hypertension carries significant cardiovascular risk.<ref>Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004 Feb;18(2):73-8. doi: 10.1038/sj.jhh.1001633. PMID: 14730320.</ref> Therefore, it is essential to treat these comorbid conditions while treating CVD. </p>

==Importance of animal trials==

==Importance of animal trials==

!  Kalaajaji !! Nigella sativa !! Diuretic

!  Kalaajaji !! Nigella sativa !! Diuretic

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!  Punarnava !! Boerhaviadiffusa !! Diuretic

!  Punarnava !! Boerhavia diffusa !! Diuretic

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Since Bramhi and Shunthi are calcium channel antagonists they can be used for patients with systolic hypertension. Vacha, Bibhitaki and Pippali can be used in diastolic hypertension as they are ACE inhibitors. Kalaajaji and Punarnava are excellent diuretics to be used very effectively in the early phase of hypertension.  

Since Bramhi and Shunthi are calcium channel antagonists they can be used for patients with systolic hypertension. Vacha, Bibhitaki and Pippali can be used in diastolic hypertension as they are ACE inhibitors. Kalaajaji and Punarnava are excellent diuretics to be used very effectively in the early phase of hypertension.

==Anti-diabeti cherbs==

==Anti-diabetic herbs==

Some of the Ayurvedic herbs used in diabetes management and their mechanism of action are shown in Table 2.  

Some of the Ayurvedic herbs used in diabetes management and their mechanism of action are shown in Table 2.  

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*Gudmar also has the capacity to produce a coat over the intestine so that the carbohydrate absorption through the gut gets reduced.

*Gudmar also has the capacity to produce a coat over the intestine so that the carbohydrate absorption through the gut gets reduced.

 

==Herbs for management of coronary artery disease==

==Herbs for management of coronary artery disease==

   

   

The coronary artery disease (CAD) is caused due to atherosclerosis. The deposition of cholesterol and fatty tissue form plaque in the endothelium of coronary arteries. This causes clogging or damage to the artery and hamper blood circulation to myocardium. Ayurvedic herbs are described as hridya (beneficial for heart) in [Charak Samhita [[Sutra Sthana]] 4/10]. Some of the researched herbs used in the management of coronary artery disease (CAD) and their mechanism of action are shown in Table 3.

The coronary artery disease (CAD) is caused due to atherosclerosis. The deposition of cholesterol and fatty tissue form plaque in the endothelium of coronary arteries. This causes clogging or damage to the artery and hamper blood circulation to myocardium. Ayurvedic herbs are described as hridya (beneficial for heart) in [Charak Samhita [[Sutra Sthana]] 4/10]. Some of the researched herbs used in the management of coronary artery disease (CAD) and their mechanism of action are shown in Table 3.

{| class="wikitable"

{| class="wikitable"

! Herb  !! Latin Name !! Mechanism of action

! Herb  !! Latin Name !! Mechanism of action

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! Vrikshamla !! Garcinia indica !! Anti inflammatory, Hypolipidemic

! '''Vrikshamla''' !! '''Garcinia indica''' !! Anti inflammatory, Hypolipidemic

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! Matulunga !! Citrus medica !! Anti inflammatory, Hypolipidemic

! Matulunga !! Citrus medica !! Anti inflammatory, Hypolipidemic

|}

|}

[[File:Image 1.JPG|500px|'''Image 1: Effect of garcinia indica in atherosclerosis '''|thumb]]

[[File:Image 1.JPG|500px|'''Image 1: Effect of garcinia indica in atherosclerosis '''|thumb]]

 

Various experimental studies are conducted to study the effect of herbs in reducing atherosclerosis. The animals were first fed with high fat, high cholesterol diet. As a result, the endothelium of vessels gets deposited with fatty tissues (atherosclerosis), which is considered as the primary cause for blockages. Then the same animals were fed with CAD reversal herbs like Garcinia indica (Vrikshamla) for six weeks. Garcinia treatment protected the endothelium from atherosclerosis. The endothelium becomes intact without any fatty tissue deposition.<ref>Kim, Young-Je & Choi, Myung-Sook & Park, Yong & Kim, Sang & Lee, Mi-Kyung & Jung, Un. (2013). Garcinia Cambogia attenuates diet-induced adiposity but exacerbates hepatic collagen accumulation and inflammation. World journal of gastroenterology : WJG. 19. 4689-701. 10.3748/wjg.v19.i29.4689.</ref>

Various experimental studies are conducted to study the effect of herbs in reducing atherosclerosis. The animals were first fed with high fat, high cholesterol diet. As a result, the endothelium of vessels gets deposited with fatty tissues (atherosclerosis), which is considered as the primary cause for blockages. Then the same animals were fed with CAD reversal herbs like Garcinia indica (Vrikshamla) for six weeks. Garcinia treatment protected the endothelium from atherosclerosis.The endothelium becomes intact without any fatty tissue deposition.<ref>Kim, Young-Je & Choi, Myung-Sook & Park, Yong & Kim, Sang & Lee, Mi-Kyung & Jung, Un. (2013). Garcinia Cambogia attenuates diet-induced adiposity but exacerbates hepatic collagen accumulation and inflammation. World journal of gastroenterology : WJG. 19. 4689-701. 10.3748/wjg.v19.i29.4689.</ref>

==Sampurna Hridaya Shuddhikaran (SHS) therapy==

==Sampurna Hridaya Shuddhikaran (SHS) therapy==

====Improvement in quality of life and VO2 max====

====Improvement in quality of life and VO2 max====

VO2max is the measurement of the volume of oxygen that the body can utilize during physical exertion. In chronic heart failure, the person feels breathless after walking for a certain distance. A total of 692 chronic heart failure patients were recruited in a trial to assess the efficacy of SHS therapy. At the end of this therapy, the patients were assessed for quality of life. It is found that the quality of life improved substantially, and VO2 max was also improved.<ref>Sane R., HanchateM.SampurnaHridayShuddhikaran: An Interventional Health Model to Improve Quality of Life in Chronic Heart Failure. The Lancet. JACC. 1st Asia Pacific Cardiovascular Summit. </ref>

VO2max is the measurement of the volume of oxygen that the body can utilize during physical exertion. In chronic heart failure, the person feels breathless after walking for a certain distance. A total of 692 chronic heart failure patients were recruited in a trial to assess the efficacy of SHS therapy. At the end of this therapy, the patients were assessed for quality of life. It is found that the quality of life improved substantially, and VO2 max was also improved.<ref>Sane R., HanchateM. Sampurna Hriday Shuddhikaran: An Interventional Health Model to Improve Quality of Life in Chronic Heart Failure. The Lancet. JACC. 1st Asia Pacific Cardiovascular Summit. </ref>

====Improvement in exercise tolerance====

====Improvement in exercise tolerance====

====Improvement in ejection fraction====

====Improvement in ejection fraction====

A prospective interventional study on 133 patients was conducted to assess the efficacy of SHS on the ejection fraction. The preintervention ejection fraction (39.43) was significantly increased to 45.98 after 30 days of Sampurna Hridaya Shuddhikaran treatment. SHS showed improvements inejection fraction, myocardial thickness, and exercise tolerance.<ref>Sane R, Hanchate M. Effect of the Sampurna Hriday Shuddhikaran (SHS) Model in Heart Failure Patients in India: A Prospective Study. British Journal of Medicine & Medical Research, 4(1): 564-571, 2014</ref>  

A prospective interventional study on 133 patients was conducted to assess the efficacy of SHS on the ejection fraction. The preintervention ejection fraction (39.43) was significantly increased to 45.98 after 30 days of Sampurna Hridaya Shuddhikaran treatment. SHS showed improvements in ejection fraction, myocardial thickness, and exercise tolerance.<ref>Sane R, Hanchate M. Effect of the Sampurna Hriday Shuddhikaran (SHS) Model in Heart Failure Patients in India: A Prospective Study. British Journal of Medicine & Medical Research, 4(1): 564-571, 2014</ref>  

Effect of SHS with slightly modified protocols is studied in different research programs titled Heart Failure Reversal Therapy (HFRT) and Ischemia reversal program (IRP).  

Effect of SHS with slightly modified protocols is studied in different research programs titled Heart Failure Reversal Therapy (HFRT) and Ischemia reversal program (IRP).  

====HFRT (Heart failure reversal therapy)====

===HFRT (Heart failure reversal therapy)===

[[File:Image 2.JPG|500px|'''Image 2: Heart failure reversal therapy on VO2max'''|thumb]]

[[File:Image 2.JPG|500px|'''Image 2: Heart failure reversal therapy on VO2max'''|thumb]]

In a randomized controlled trial, one group (Arm A) received HFRT (Heart failure reversal therapy) with conventional oral medications for heart failure. The other group (Arm B) received only conventional oral medications. VO2 max in Arm B group was 19.02ml/kg/min initially. After six weeks of conventional treatment, VO2 max increased to 21.9ml/kg/min. After 18 weeks, it again raised to 24.02 ml/kg/min. The initial VO2 max in Arm A patients was 19.65 ml/kg/min, almost equal to that of Arm B.  After six weeks of therapy VO2 max raised to 28.01 ml/kg/min, and after 18 weeks of therapy, it again raised to 29.12 ml/kg/min.<ref>Sane R, Aklujkar A, Patil A, Mandole R. Effect of heart failure reversal treatment as add-on therapy in patients with chronic heart failure: A randomized, open-label study. Indian Heart J. 2017 May-Jun;69(3):299-304. doi: 10.1016/j.ihj.2016.10.012. Epub 2016 Nov 18. PMID: 28648417; PMCID: PMC5485380.</ref>  [Image 2] This shows the significant advantage of HFRT over conventional treatment in heart failure.  

In a randomized controlled trial, one group (Arm A) received HFRT (Heart failure reversal therapy) with conventional oral medications for heart failure. The other group (Arm B) received only conventional oral medications. VO2 max in Arm B group was 19.02ml/kg/min initially. After six weeks of conventional treatment, VO2 max increased to 21.9ml/kg/min. After 18 weeks, it again raised to 24.02 ml/kg/min. The initial VO2 max in Arm A patients was 19.65 ml/kg/min, almost equal to that of Arm B.  After six weeks of therapy VO2 max raised to 28.01 ml/kg/min, and after 18 weeks of therapy, it again raised to 29.12 ml/kg/min.<ref>Sane R, Aklujkar A, Patil A, Mandole R. Effect of heart failure reversal treatment as add-on therapy in patients with chronic heart failure: A randomized, open-label study. Indian Heart J. 2017 May-Jun;69(3):299-304. doi: 10.1016/j.ihj.2016.10.012. Epub 2016 Nov 18. PMID: 28648417; PMCID: PMC5485380.</ref>  [Image 2] This shows the significant advantage of HFRT over conventional treatment in heart failure.  

====Efficacy in ischemic heart disease====

====Efficacy in ischemic heart disease====  

[[File:Image 3.JPG|500px|'''Image 3: Ischemia Reduction on Myocardial Perfusionthrough SPECT MPI'''|thumb]]

[[File:Image 3.JPG|400x400px|'''Image 3: Ischemia Reduction on Myocardial Perfusion through SPECT MPI'''|thumb|alt=]]

Stress Thallium test was applied to assess the reversal of ischemic changes in patients of CHF associated with myocardial ischemia. The radioactive isotope Thallium was injected into the bloodstream of cardiac patients. Gamma scanner was used to assess the circulation of thallium in the myocardium. After three months of ischemia reversal program, 30.33% of the reduction was observed in ischemia on Myocardial Perfusion

Stress Thallium test was applied to assess the reversal of ischemic changes in patients of CHF associated with myocardial ischemia. The radioactive isotope Thallium was injected into the bloodstream of cardiac patients. Gamma scanner was used to assess the circulation of thallium in the myocardium. After three months of ischemia reversal program, 30.33% of the reduction was observed in ischemia on Myocardial Perfusion

through SPECT MPI.<ref>Rohit S, Jagdish H, Chandrakant C, Sujit N, Rahul M (2020) Ischemia Reversal Therapy as an add-on Therapy for Ischemic Heart Disease: A Pilot Study based on SPECT Myocardial Perfusion Imaging. J Cardiovasc Dis Diagn 8: 397.</ref>

through SPECT MPI.<ref>Sane R., Jagdish H, Chandrakant C, Sujit N, Rahul M (2020) Ischemia Reversal Therapy as an add-on Therapy for Ischemic Heart Disease: A Pilot Study based on SPECT Myocardial Perfusion Imaging. J Cardiovasc Dis Diagn 8: 397.</ref>

====Effect on left ventricular distress====

====Effect on left ventricular distress====

Efficacy of Heart Failure Reversal Therapy (HFRT) in reducing left ventricular distress was studied. N-terminal pro-brain natriuretic peptide (NT-proBNP) was used as a marker to assess the effect of therapy in congestive heart failure (CHF)patients.The value of NT-ProBNP increases with an increase in the severity of CHF. The study therapy, HFRT, including SHS protocol, was administered twice daily for seven days. Post-HFRT, decoction prepared with Terminalia arjuna, Acorus calamus, and Boerrhavia diffusa was administered for the next 12 weeks of follow-up. NT-proBNP levels were measured after a follow-up period of 90 days along with some other parameters like BMI, VO2peak (evaluated by cardiac stress test with modified Bruce protocol) and weight. The findings of the investigation revealed a significant reduction in NT-proBNP levels (42.46%, p = 0.009) at the end of the follow-up period. The study also yielded significant improvements in VO2peak (50.96%, p = 0.004). The overall results suggest that HFRT can possibly be explored as add-on therapy or a feasible alternative for the effective management of CHF.<ref>Sane R, Mandole R. To Evaluate the Efficacy of Heart Failure Reversal Therapy Using NT-Probnp Levels in Patients with Chronic Heart Failure. Cardiology and Cardiovascular Research, 2(3): 61-64, 2018. doi: 10.11648/j.ccr.20180203.13</ref>

Efficacy of Heart Failure Reversal Therapy (HFRT) in reducing left ventricular distress was studied. N-terminal pro-brain natriuretic peptide (NT-proBNP) was used as a marker to assess the effect of therapy in congestive heart failure (CHF)patients. The value of NT-Pro BNP increases with an increase in the severity of CHF. The study therapy, HFRT, including SHS protocol, was administered twice daily for seven days. Post-HFRT, decoction prepared with Terminalia arjuna, Acorus calamus, and Boerrhavia diffusa was administered for the next 12 weeks of follow-up. NT-proBNP levels were measured after a follow-up period of 90 days along with some other parameters like BMI, VO2peak (evaluated by cardiac stress test with modified Bruce protocol) and weight. The findings of the investigation revealed a significant reduction in NT-pro BNP levels (42.46%, p = 0.009) at the end of the follow-up period. The study also yielded significant improvements in VO2peak (50.96%, p = 0.004). The overall results suggest that HFRT can possibly be explored as add-on therapy or a feasible alternative for the effective management of CHF.<ref>Sane R, Mandole R. To Evaluate the Efficacy of Heart Failure Reversal Therapy Using NT-Pro bnp Levels in Patients with Chronic Heart Failure. Cardiology and Cardiovascular Research, 2(3): 61-64, 2018. doi: 10.11648/j.ccr.20180203.13</ref>

====Mortality rate and survival====

====Mortality rate and survival====  

[[File:Image 4.JPG|500px|'''Image 4: Survival rate  after cardiac interventions'''|thumb]]

[[File:Image 4.JPG|500px|'''Image 4: Survival rate  after cardiac interventions'''|thumb]]

As per various published data, the survival rate of various cardiac interventions is shown below. [Image 4]

As per various published data, the survival rate of various cardiac interventions is shown below. [Image 4]

==Conclusion==

==Conclusion==

Ayurvedic treatment shows an advantageous effect in treating chronic lifestyle disorders like diabetes, hypertension, and cardiovascular disorders. Ayurvedic treatment is implemented as a first line of therapy in these disorders; then, the mortality burden can be reduced significantly.  

Ayurvedic treatment shows an advantageous effect in treating chronic lifestyle disorders like diabetes, hypertension, and cardiovascular disorders. Ayurvedic treatment is implemented as a first line of therapy in these disorders; then, the mortality burden can be reduced significantly.  

==Interactions==

==Interactive session==

 

'''Q.''' Please share the experience in the development of collateral circulation after Ayurvedic cardiac treatment

'''Q.''' Please share the experience in the development of collateral circulation after Ayurvedic cardiac treatment

'''Ans''': [[Prakriti]] and the involvement of [[dosha]] are very much influencing the development of cardiac disorders. Typical presentations explained for different kinds of hridroga (cardiac disorders) can be seen in patients. For eg. In vataja hridroga the pain will be severe. It may be cutting, stabbing, tearing etc., in nature. In kaphaja hridrog pain will be minimal. The other symptoms like excessive salivation, heaviness in the chest etc., are more predominant. In pittaja hridroga burning in the sternum/epigastric region is the main presenting feature. The classical treatments mentioned for these individual types of cardiac disorders give an excellent result.

'''Ans''': [[Prakriti]] and the involvement of [[dosha]] are very much influencing the development of cardiac disorders. Typical presentations explained for different kinds of hridroga (cardiac disorders) can be seen in patients. For eg. In vataja hridroga the pain will be severe. It may be cutting, stabbing, tearing etc., in nature. In kaphaja hridrog pain will be minimal. The other symptoms like excessive salivation, heaviness in the chest etc., are more predominant. In pittaja hridroga burning in the sternum/epigastric region is the main presenting feature. The classical treatments mentioned for these individual types of cardiac disorders give an excellent result.

   

 

<big>'''Link to video lecture: https://fb.watch/8l7PEmmWxC/'''</big>

 

 

==References==

==References==