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Evaluation of the efficacy of Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to Essential Hypertension, By SANJEEV KUMAR, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103TRANSCRIPT
“Evaluation of the efficacy of Shilajatu Guggulu
Rasayana in Pittavruta Udana w.s.r. to
Essential Hypertension” By
SANJEEV KUMAR
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial f
Ayurved
KUnd
Dr. RagM.D. (Ayu), As
DepartmPost Graduate
D.G. MELMALAGI AY
ulfillment of the degree of
a Vachaspati M.D. In
ayachikitsa er the Guidance of havendra V. Shettar st. Professor in Kayachikitsa
ent of Kayachikitsa Studies & Research Center URVEDIC MEDICAL COLLEGE,
GADAG 2006-2009
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER
GADAG, 582 103
This is to certify that the dissertation “Evaluation of the efficacy of Shilajatu
Guggulu Rasayana in Pittavruta Udana w.s.r. to Essential Hypertension”
is a bonafide research work done by Sanjeev Kumar in partial fulfillment of the
requirement for the post graduation degree of “Ayurveda Vachaspati M.D.
(Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences, Bangalore,
Karnataka.
Date:
Place: Gadag.
Guide
Dr. Raghavendra V. Shettar, M.D. (Ayu),
Asst. Professor. Dept. of Kayachikitsa DGMAMC,
PGS&RC, Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTER
GADAG, 582 103
Endorsement by the H.O.D, principal/head of the institution
This is to certify that the dissertation entitled “Evaluation of the efficacy of
Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to Essential
Hypertension” is a bonafide research work done by Sanjeev Kumar under the
guidance of Dr. Raghavendra V. Shettar, M.D. (Ayu), Asst. Professor, Dept. of
Kayachikitsa in partial fulfillment of the requirement for the post graduation degree of
“Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of
Health Sciences, Bangalore, Karnataka.
.
D
Dat
Pla
(Dr. G. B. Patil) Principal,
DGM Ayurvedic Medical College, Gadag
Date:
.
Professor & HOD ept. of Kayachikitsa
PGS&RC e:
ce: Gadag
Place:GadagDeclaration by the candidate
I here by declare that this dissertation / thesis entitled “Evaluation of the
efficacy of Shilajatu Guggulu Rasayana in Pittavruta Udana w.s.r. to Essential
Hypertension” is a bonafide and genuine research work carried out by me under the
guidance of Dr. Raghavendra V. Shettar, M.D. (Ayu), Asst. Professor, Dept. of
Kayachikitsa, DGMAMC, PGS&RC, Gadag.
Date:
Place:
Sanjeev Kumar
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this dissertation/
thesis in print or electronic format for the academic / research purpose.
Date:
Place:
Sanjeev Kumar
© Rajiv Gandhi University of Health Sciences, Karnataka
Acknowledgement
Acknowledgement
First of all I would like to pay grateful thanks to my lord i.e. my parents Shri
Raghubir Singh Choudhary and Smt. Raj Kumari, who made me mentally strong and
capable to face and solve the problems in the life without any tension and fear and
made me able to fulfill my duties. I am enormously happy to articulate my deepest sense of gratefulness to my
dearly loved and respected guide Dr. Raghvendra V. Shettar, Ass.Prof. (M.D.Ayu).
He has been very kind to guide me in the preparation of compilation and for whose
extraordinary efforts, tremendous encouragement and most valuable thoughts
provoking advice made me to complete this work.
I would like to thank specially to my Grand parents with whose blessings, I was
able to do this work successfully.
I have no words to express my feelings towards my brother: Er. Gaurav Kumar
Choudhary and sisters: Er. Vendana, who always provided me great support in all the
situations. I am thankful to my relatives who always gave me support and
encouragement.
I express my gratitude to Dr. V. V. Varadacharyulu (Professor & H.O.D.) for
his good suggestions and encouragement in every step of this work.
I pay my humble respects to Honorable Principal Dr. G. B. Patil for providing
all the essential facilities to make this study success.
I extend my gratefulness to my Co-guide Dr. Shankar Gouda for his guidance
and untiring effort for this work.
I am extremely thankful to Prof. Dr. K. Shiva Rama Prasad M.D., C.O.P.
(German), M.A., [Ph.D.] and Dr. B.M. Mulkipatil M.D. for his encouragement and
co-operation throughout my study period.
I
Acknowledgement
I extend my gratitude to Dr. G. Purushottamacharyulu, Dr. Mulgund, Dr. P.
Shivaramudu, Dr. M. C. Patil, Dr. G. S. Hiremath, Dr. B.G .Swami, Dr. Purad,
Dr. G.N. Danappagoudar, Dr. S. N. Belawadi, Dr. Nedugundi, Dr. Kuber sankh,
Dr. J. G. Mitti. Dr. Mulki Patil. Dr. Yasmin A.P, Dr. Samudri, for their kind help.
I express my enormous thanks to my statistician Mr. P.M. Nandakumar, Mr.
Tippanagoudar (Lab), Sri. V.M. Mundinamani (librarian), Shyavi and Kerur for
facilitating me in collection and production of my thesis.
I take this moment to express my thanks Dr Ashok M.G. Dr. Kamalaxi,
Dr.Ratna, Dr. Shivaleela, Dr. Sulochana, Dr. Shekhar Sharma, for their constant help
during the study.
“Faithful friends are the medicine of life” Dr.Prassan V.Joshi, Dr.Neeraj Kumar,
Dr.Vijayalakshmi, Dr. Veena. Jigalur, Dr. Anupama, Dr.Ishawar, Dr. Bodake, Dr.
Praveen, Dr. V S Kanti, Dr Trupti, Dr. Adarsha, Dr. Nataraja, Dr. Udaya, Dr Shaileja,
Dr. Ravi, Dr. Shivakumar, Dr. Sanat, Dr. Shabareesh, Dr. Rajesh, Dr.Deepak, Dr.
Jaishankar, Mr. Shakti, Dr. Joshi, Dr. Bhagyesh, Dr. Aneesh, Dr. Baba, Dr. Dash, Dr.
Vinod, Dr. Patil, Dr. Vijay, Dr. Surej, Dr. Kavitha. Dr. Sarvamangala, Dr Savitha,
Dr. Bhopesh, Dr. Gorpade, Dr. Deepa and Dr. Asha, deserves special thanks to their
affection and constant help throughout my study.
I would like to thank all my patients without whose co-operation this work
could not have been completed.
Last but not least I express my deepest thankfulness whose names are not
taken here but helped me a lot along with my kit and kins to my family members
Dr. Sanjeev Kumar Choudhary
II
Abstract
Abstract
“Evaluation of the efficacy of “Shilajatu Guggulu Rasayana in
Pittavruta Udana w.s.r. to Essential Hypertension”
Key words: Pittavruta udana, Essential hypertenshion, Shilajatu Guggulu Rasayana.
Avarana is the obstruction to movement of Vata, Avaraka is the cause for it. In
this regard Hypertension is compared to that of Pittavruta udana, which is having
symptoms Bharama, Kalama, Moorcha and Daha by Acharya Shusruta and others
whereas Acharya Charka add Ojobharamsha and Avasada in the above symptoms. As
this symptomatology manifest later stages of Hypertension hence taken for
comparison.
Although hypertension is usually asymptomatic for the first 10-20 yrs, it
slowly but surely strains the heart and damages the arteries. For this reason
hypertension is often called as silent killer.
The pathogenesis of essential hypertension is not clearly understood. Thus the
present study was undertaken to evaluate the efficacy of Shilajatu Guggulu Rasayana
in the management of Pittavruta udana with respect to Essential hypertension.
The symptoms, which are expressed in Essential hypertension, are very nearer
to the symptoms of Pittavruta udana. Pittavruta udana is explained as disease in
Ayurvedic classics. So the sign and symptoms of Pittavruta udana are simulate to that
of essential hypertension at the present context.
In this regard Shilajatu Guggulu Rasayana is best for the treatment of
Avarana. Guggulu is having its effect over atherosclerosis, obesity and is proven anti-
inflammatory drug. Shilajatu is presumed to posses the unique drug for the Dhatu
poshana and Tridosha prashamana. Hence this medicine if used wisely will account
for samprapti vightana, nullifies avarana pathology and generates healthy tissues.
III
Abstract
The subjective parameter Bhrama and Daha showed 100% response, where as
Shirah shoola shown 91% result and Klama shown 86% result. The objective
parameters like Systolic blood pressure shown 92% result where as Diastolic blood
pressure shown 83% result in this study. The present study revealed that the mean
difference of Serum cholesterol was found 36.86 i.e. lower than the before treatment
mean, mean difference of Serum triglycerides was found 29.94 i.e. lower than the
before treatment mean, mean difference of Low density lipoprotein was found 26.72
i.e. lower than the before treatment mean whereas mean difference of Very low
density lipoprotein was found 06.00 i.e. also lower than the before treatment mean.
Net mean results of the therapies (All subjective and objective in to the consideration)
= 92% i.e. Good response.
Totally Shilajatu Guggulu Rasayana has shown good response in Pittavruta
udana w.s.r. to Essential hypertension in the present study.
IV
Contents
Contents
Sl. No. Contents Page no.
01. Introduction 1 - 5
02. Objectives 6 – 8
03. Literary review 9 – 102
04. Materials and methods 103 - 107
05. Observations and results 108 – 134
06. Discussion 135 – 162
07. Conclusion 163 – 165
08. Summary 166 – 167
09. Bibliography I - XXVIII
10. Annexure i - vi
V
List of Tables Table No.
Content Page No.
01. Showing the opinion of Acharyas regarding Sira, Dhamani & Srotas 27 02. Showing samanya prakopaka karanas 48 03. Showing possible reason for manifestation of disease 48 04. Showing the Lakshana and Dosha involvement 60 05. Showing the Vyavachedaka nidana of Pittavruta udana 65 06. Showing the Vyavachedaka nidana of Hypertension 66 07. Showing the classification of blood pressure 74 08. Showing the classification of secondary hypertension 76 09. Showing the Korotkoff Sounds 83 10. Showing the classification of Chikitsa 86 11. Showing the efficacy of Non-Pharmacological management 90 12. Showing the treatment of Hypertension 92 13. Showing the Pathyapathya in Pittavruta udana 93 14. Showing the properties of Ingredients 102 15. Showing the composition of Shilajatu Guggulu Rasayana 103 16. Showing Age wise distribution of total 30 patients 108 17. Showing Sex wise distribution of total 30 patients 109 18. Showing Religion wise distribution of total 30 patients 109 19. Showing Occupation wise distribution of total 30 patients 110 20. Showing Economical Status wise distribution of total 30 patients 110 21. Showing Marital Status wise distribution of 30 patients 111 22. Showing Intake Rasa predominance wise distribution of 30 patients 111 23. Showing Nidra wise distribution of total 30 patients 112 24. Showing Malapraviti wise distribution of 30 patients 112 25. Showing Addiction wise distribution of 30 patients 113 26. Showing Ahara wise distribution of total 30 patients 113 27. Showing Manasika Prakriti wise distribution of total 30 patients 114 28. Showing Shareera Prakriti wise distribution of total 30 patients 114 29. Showing Sara wise distribution of total 30 patients 115 30. Showing Samhanana wise distribution of total 30 patients 115 31. Showing Satmya wise distribution of total 30 patients 116 32. Showing Satwa wise distribution of total 30 patients 116 33. Showing Vyayama Shakti wise distribution of total 30 patients 117 34. Showing Vaya wise distribution of total 30 patients 117 35. Showing Pramana wise distribution of total 30 patients 118
36-A. Showing Abhyvarana (AS) wise distribution of total 30 patients 118 36-B. Showing Jarana (AS) wise distribution of 30 patients 119 37. Showing Jatharagni Bala wise distribution of total 30 patients 119 38. Showing Koshta wise distribution of total 30 patients 120 39. Showing Family History wise distribution of total 30 patients 120 40. Showing Chronicity wise distribution of 26 patients (Previously
diagnosed) 121
41. Showing Onset History wise distribution of 30 patients 121 42. Showing Intensity wise distribution of total 30 patients 122 43. Showing Relieving Factors wise distribution of total 30 patients 122
VI
Table No.
Content Page No.
44. Showing Aggravating Factors wise distribution of total 30 patients 123 45. Showing Drug History wise distribution of total 30 patients 123 46. Showing Symptoms wise distribution of total 30 patients 124 47. Showing Associated complaints wise distribution of total 30 patients 124 48. Showing Systolic Blood Pressure (Average) of 30 patients 125 49. Showing Diastolic Blood Pressure (Average) of 30 patients 125 50. Showing the effect of therapy on Bhrama 127 51. Showing the effect of therapy on Klama 127 52. Showing the effect of therapy on Shirah shoola 127 53. Showing the effect of therapy on Daha 128 54. Showing the effect of therapy on Systolic hypertension 128 55. Showing the effect of therapy on Diastolic hypertension 128 56. Showing the over all response on Subjective and Objective parameters 129 57. Showing the effect of therapy on Biochemical Parameters 129 58. Showing the effect of therapy on Bhrama 130 59. Showing the effect of therapy on Klama 130 60. Showing the effect of therapy on Shirah shoola 130 61. Showing the effect of therapy on Daha 131 62. Showing the effect of therapy on Moorcha 131 63. Showing the effect of therapy on Systolic hypertension 131 64. Showing the effect of therapy on Diastolic hypertension 132 65. Showing the effect of therapy on Serum Cholesterol 132 66. Showing the effect of therapy on Serum triglycerides 132 67. Showing the effect of therapy on High density lipoprotein 133 68. Showing the effect of therapy on Low density lipoprotein 133 69. Showing the effect of therapy on Very Low density lipoprotein 133 70. Showing overall result of the therapy 156 71. Showing the effect of therapy on Pittavruta udana (Essential
hypertension) 160
72. Showing Demographic Data i 73. Showing Subjective parameters Before and After treatment ii 74. Showing Objective parameters Before and After treatment iii 75. Showing Lipid Profile values Before and After treatment iv 76. Showing Scoring Before and After the Treatment of all the parameters v 77. Showing Net Response of the Treatment (all the parameters) vi
VII
List of Figure & Photo Figure No.
Content Page No.
01. Showing the Blood Pressure Regulation 33 02. Showing the role of Renin-Angiotensin System 36 03. Showing the diagramatic presentation of concept of Avarana 41 04. Showing the Environmental factors and Cardiovascular events 52 05. Showing Obesity and Sodium sensitivity in Hypertension 53 06. Showing Samprapti chart of Pittavruta udana 62 07. Photo showing the Shilajatu Guggulu Rasayana 103 08. Showing Age wise distribution of total 30 patients 108 09. Showing Sex wise distribution of total 30 patients 109 10. Showing Religion wise distribution of total 30 patients 109 11. Showing Occupation wise distribution of total 30 patients 110 12. Showing Economical Status wise distribution of total 30 patients 110 13. Showing Marital Status wise distribution of 30 patients 111 14. Showing intake Rasa Predominance wise distribution of 30 patients 111 15. Showing Nidra wise distribution of total 30 patients 112 16. Showing Malapraviti wise distribution of 30 patients 112 17. Showing Addiction wise distribution of 30 patients 113 18. Showing Ahara wise distribution of total 30 patients 113 19. Showing Manasika Prakruti wise distribution of total 30 patients 114 20. Showing Shareera Prakriti wise distribution of total 30 patients 114 21. Showing Sara wise distribution of total 30 patients 115 22. Showing Samhanana wise distribution of total 30 patients 115 23. Showing Satmya wise distribution of total 30 patients 116 24. Showing Satwa wise distribution of total 30 patients 116 25. Showing Vyayama Shakti wise distribution of total 30 patients 117 26. Showing Vaya wise distribution of total 30 patients 117 27. Showing Pramana wise distribution of total 30 patients 118 28-A. Showing Abhyvarana (AS) wise distribution of total 30 patients 118 28-B. Showing Jarana (AS) wise distribution of 30 patients 119 29. Showing Jatharagni Bala wise distribution of total 30 patients 119 30. Showing Koshta wise distribution of total 30 patients 120 31. Showing Family History wise distribution of total 30 patients 120 32. Showing Chronicity wise distribution of 26 patients (Previously
diagnosed) 121
33. Showing Onset History wise distribution of total 30 patients 121 34. Showing Intensity wise distribution of total 30 patients 122 35. Showing Relieving Factors wise distribution of total 30 patients 122 36. Showing Aggravating Factors wise distribution of total 30 patients 123 37. Showing Drug History wise distribution of total 30 patients 123 38. Showing Symptoms wise distribution of total 30 patients 124 39. Showing Associated Complaints wise distribution of 30 patients 124 40. Showing Systolic Blood Pressure (Average) of 30 patients 125 41. Showing Diastolic Blood Pressure (Average) of 30 patients 126 42. Showing overall result of the therapy 157
VIII
Introduction
Introduction
Research is a process of finding out the old hidden facts from the old theories
and concepts as well as discovery of new facts. The chief goal of any medical
research will be clinical application. Ayurveda, the science of life is an amicable
dictum of life principles, which benefits health, happiness and harmony to the
humanity.
The aim of Ayurveda is “to maintain the health in the healthy person and to
alleviate the disorders in the diseased”1. This supports the fact that any research taking
place in the world of Ayurveda must be having its impact or role in the clinical field.
Blood pressure is the pressure exerted by the blood on the walls of blood
vessels. Persistent high arterial blood pressure without a known cause is essential
hypertension when the elevation of systolic blood pressure is more than 140 mm of
Hg and diastolic blood pressure is above 90 mm of Hg2.
Our Acharyas have described the various kinds of ailments in Ayurveda i.e.
more than thousands of diseases, Ayurveda, an ancient medical science has a rich
literature regarding a plenty of disorders. Hypertension in Ayurveda may fall under
Pittavruta udana3, Raktagata vata4, Pittavruta vata5, Raktavruta vata6, Pranavruta
udana7, Rakta vega vridhi, Rasa bhara, Rakta Samvardhana, Vyanabala,
Uccharaktachapa, Siragata vata8, Bhrama9,10,11, Raktamada12, Moorcha13,14,
Sanyasa15,16 and Dhamanipratichaya17 etc.
As Ayurveda is a technical science, yukthi pramana is a pre-requisite in
pragmatic practice, to achieve the talent a vaidya should process unbeatable
knowledge of the scriptures and discriminating skill in handling the patients therefore,
Ayurveda emphasizes on efficiency and discrete knowledge of the physician.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
1
Introduction
In this competitive world, time becomes more precious for human being. The
20th century described as the age of anxiety and stress. People don’t have time to think
about themselves, so they are becoming less concerned regarding health and are
taking more stress and strain. Therefore, these irregularities regarding health and
mental stress leads to many physical and mental disorders, out of these hypertension
is one of the alarming diseases.
The great physiologist of modern science, Dr. Chaudhury18 has told
hypertension is an ancient disease. More then 2500 years ago Acharya Charka, the
Father of Hindu system of medicine describes the condition admirably. Essential
hypertension cannot be permanently cured but the level of blood pressure in such
patients can substantially reduce by drugs and measures. A large number of
hypertensives in the early stages have no symptoms often with high blood pressure is
detected on a routine check up and physical examination 19, 20.
Until now, the cause of majority of types of hypertension is unknown. All the
anti hypertensive drugs reduce the blood pressure without correcting the cause.
Hypertension is an established risk factor for all clinical manifestations of
atherosclerosis. It is a common and powerful independent predisposing factor for
development of coronary heart disease (C.H.D.), stroke, peripheral arterial disease
and heart failure. The high prevalence of hypertension, its powerful impact on the
incidence of cardiovascular disease (C.V.D.) and the potential impact on control
justify high priority efforts to detect and treat elevated blood pressure (BP) 21.
Nearly 15% of the world population is labeled hypertensive, either knowing or
unknowingly by doctors. In India approximately 14% of people suffer from
hypertension and majority of them had essential hypertension, which is indicated its
significance and prevalence. In the recent survey in Mumbai, diagnosis of
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
2
Introduction
hypertension (SBP >140 mm of hg & DBP > 90 mm of Hg) 22 was based on the
average of three readings a confirmed on two subsequent occasions.
Indian council of medical researches (ICMR) All India institute of medical
science (AIIMS) study declared India as a nation of hypertension. 40-45 million
Indians are believed to be suffering for the disease that are a key risk factor for
coronary artery disease, diabetes and renal failure.
Thus considering the prevalence and significance of the problem it should be
of academic interest to Ayurvedic clinician to diagnose and treat it through Ayurveda.
So the concept of hypertension, when clearly understood can be used as an effective
tool for various purposes.
The modern life style, stress, smoking, etc. that interferes with homeostatic
mechanism and circadian rhythmic patterns, thus manifests its ill effects.
The ill effects of faulty regimens of Triupastambha23, Asatmendriyanrtha
sanyoga, Pragnyaparadha and Parinama24 etc. influence the Rajodosha in Manas, thus
directly bring out the dosha vitiation so as it cause the ailment.
The faulty regimens i.e. deviating from dinacharya, ritucharya an extreme
competitive life thus directly predisposes hypertension.
The symptoms, which are expressed in essential hypertension, are very nearer
to the symptoms of Pittavruta udana. Pittavruta udana is explained as disease in
Ayurvedic classics. So the sign and symptoms of Pittavruta udana are in resemble to
that of hypertension at the present context.
Although hypertension is usually asymptomatic for the first 10-20 yrs, it
slowly but surely strains the heart and damages the arteries. For this reason
hypertension is often called as silent killer 25.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
3
Introduction
The adverse effects of hypertension principally involve the blood vessels, the
CNS, the retina, the heart and the kidneys 26, ending in organ damage.
The pathogenesis of essential hypertension is not clearly understood in
Ayurveda. Thus, the present study was undertaken to evaluate the efficacy of
Shilajatu Guggulu Rasayana in the management of Pittavruta udana with respect to
Essential hypertension.
Explanation of Hypertension is not at all found in Ayurvedic literature.
Acharya Charaka has mentioned that due to the time and geographical change disease
would occur and the physician of that era should diagnose and treat disease according
to dosha, dushya vichara 27. Therefore, Ayurveda provides three-fold approach to
manage any disease i.e. Hetu, Linga and Aushadha28.
Avarana is the obstruction to movement of Vata, Avaraka is the cause for it 29.
Hypertension is compared to that of Pittavruta udana, which is having symptoms like
Bhrama, Klama, Moorcha and Daha, which resembles sign and symptoms of
Hypertansion. Acharaya Sushruta30 and others 31, 32, 33 opines the same while Acharya
Charaka34 added Ojobharamsha and Avasada to the above symptoms. As these
symptomatology manifests later stages of Hypertension, for this reason taken for
assessment.
In general for all the Avarana, Rasayana is the best treatment as it pacify the
vitiated doshas and conducive to the dhatus35, 36.
In this regard, Shilajatu Guggulu Rasayana is best for the treatment of
Avarana37. Guggula38 is having its effect over atherosclerosis, obesity and is proven
anti-inflammatory drug. Shilajatu39, 40 is presumed to posses the unique drug for the
dhatu poshana and tridosha prashamana. Hence, this medicine if used wisely will
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
4
Introduction
account for samprapti vighatana, nullifies avarana pathology and generates healthier
tissues.
Apart from this, the medicine proposed for this study is cost effective and
easily available hence present clinical study; “Evaluation of the efficacy of
Shilajatu Guggulu Rasayana in Pittavruta udana” with special reference to
Essential hypertension” was undertaken.
Study hypothesis:
Diseases always takes new form from their original existing diseases may not
be there in olden days vis-à-vis olden day’s diseases may not exist now.
In this regard Acharya Charaka has told, one should diagnose the diseases on
the basis of dosha dushya vivechana. Many of recent researchers have made attempt
to correlate Hypertension with many conditions told in Ayurveda.
In the present study an attempt was made to correlate the Essential
hypertention with Pittavruta udana.
Vata is responsible factor for the gati, the blood flow. So dosha dushya
vivechana in Essential hypertension fit for Vata dosha vikriti. In Vidhishoniteeya
Adhyaya of Charaka, we get plenty of refferences regarding Raktadusti, which are
simulates to the probable etiological factors for Essential hypertension. On the basis
of Ashrayaashrayi sambandha, vitiation of Rakta is mainly because of Pitta. Pitta
vikruti thus assumed in Essential hypertension. This hypothesis built in the present
study and justified. The clinical symptoms of Pittavruta udana are mimic the Essential
hypertension at one or the other stages of Hypertension.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
5
Objectives
Objectives of the study
Essential hypertension with special reference to Pittavruta udana is a very
significant as its symptoms are not explained separately in our classics, so we can
compare it with the other symptomatically diseases. Then why this problem has been
taken for Research work. There are so many positive reasons behind the selection of
this topic because every one wants to do something different and get success.
Therefore, it becomes necessary that each and everyone should have some
extra qualities, which make his or her personality special to others. Success is depends
upon hard work. Thus to achieve the goals it is very important to develop some
different characteristics and personality.
Objectives of the study:
1. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in the management of
Pittavruta udana.
2. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in the management of
Essential hypertension.
3. To evaluate the anti hypertensive effect of Shilajatu Guggulu Rasayana.
4. To evaluate the efficacy of Rasayana effect of Shilajatu and Guggulu.
1. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in the
management of Pittavruta udana:
Avarana is the obstruction to movement of Vata, avaraka is the reason for it.
The symptoms of Pittavaruta udana are Bhrama, Klama, Moorcha and Daha,
according to Acharaya Sushruta and others, while Acharya Charaka further adds
Ojobhramsha and Avasada to it. As this symptomatology manifest later stages of
Hypertension, hence taken for comparison.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 6
Objectives
In general for all the Avarana, Rasayana is the best treatment as it pacify the
vitiated doshas and conducive to the dhatu’s. In this view, Shilajatu Guggulu
Rasayana is the best treatment for Avarana.
2. To evaluate the efficacy of the Shilajatu Guggulu Rasayana in the
management of essential hypertension:
High Blood Pressure is not a disease in itself. It is only; at best, a risk factor
for future vascular accidents in the various target organs like the heart, brain, kidney,
eyes, etc. It carries the same significance as other risk factors for vascular diseases.
Hypertension is a symptomatic but is having a direct relation to that of vasculature.
Atherosclerosis and arteriosclerosis are the phenomena, which affects the individuals
if neglected accounts for morbidity and mortality, which needs an effective of careful
approach.
Now it is the time to highlight the Ayurveda in the world of hypertension with
its unique aspects. The adverse reactions of modern antihypertensive and higher cost
of therapy are also one of the causes to look towards Ayurveda for its humeral
approach.
The pathogenesis of essential hypertension is difficult to understand. Thus, the
present study was conduct to evaluate the efficacy of Shilajatu Guggulu Rasayana in
the management of Essential hypertension.
3. To evaluate the anti hypertensive effect of Shilajatu Guggulu Rasayana:
A multiplicity of treatment modalities exist and newer ones are continuously
being introduced to undertake the hypertensive problems in modern era. Until now,
the cause of majority of types of Hypertension is unknown. All the anti hypertensive
drugs reduce the blood pressure without correcting the cause.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 7
Objectives
Guggulu is having its effect over atherosclerosis, obesity and is established
anti-inflammatory drug. Shilajatu is presumed to posses the unique drug for the Dhatu
poshana and Tridosha prashamana. Hence, this medicine if used wisely will account
for samprapti vightana, nullifies Avarana pathology and generates healthier tissues.
4. To evaluate the efficacy of Rasayana effect of Shilajatu and Guggulu:
The modern life style, stress, smoking, alcohol etc. interfere with homeostatic
mechanism and circadian rhythmic patterns, thus manifests its ill effects.
The ill effects of faulty regimens of Triupastambha, Asatmendriyanrtha samyoga,
Pragnyaparadha, Parinama etc. influence the Rajodosha in Manas, thus directly brings
out the dosha vitiation so as it cause the ailment.
Acharya Charka has laid down the code of good conduct by which one can
remains healthy and long life. The Charka Samhita shows the path by which we can
avoid the ailment and enjoy the normal life span.
Rasayana gives the strength to all the dhatus of the body and refreshes the vital
organs of the humankind. Rasayana gives longevity, intelligence, good memory,
health, good complexion, luster and strength to the body.
Rasayana chikitsa maintains equilibrium of doshas and dhatus. Makes strong and
healthy dhatus of the body and prevents the diseases.
Apart from this, the medicine proposed for this study is cost effective and
easily available hence present clinical study; to evaluate the efficacy of Rasayana
effect of Shilajatu Guggulu.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 8
Literary review
Historical Review
History says that past paves the way for future & knowing about past events,
aids in a having a better present. Thus, history study is important to know about the
systematic growth and improvement of the subject to decide plans for further
establishment and research designing. Here are some Historical facts regarding
Hypertension.
The division of Historical aspect is:
A) Vedic Kala B) Pre-samhita Kala C) Samhita Kala.
A) Vedic Kala:
In Vedas, the references are in a scattered manner. Some of the references
regarding Heart and blood flow are found which are as follows:
In Rigveda:
Hridaya as a organ described & also give description about Hridroga in
Mantras form.
In Yajurveda:
In human being Hridaya - Heart is considered to be seat of Shubha - Ashubha
Sankalpa.
In Athervaveda:
The flow of Rasa in body has been stimulated to the rivers flowing towards the
sea. The direction of flow of this Ragayukta fluid (red colored) has been described in
terms of Urdhwa Dhaminis or Lohini.
These vessels carrying Lohitas are stated as ‘HIRA’. These are hollow organs
i.e. having lumen.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 9
Literary review
B) Pre-Samhitas Kala:
Brahmanas & Upanishads
In Brihad - Aranyaka Upanishad:
Here ‘Hridaya’ is formed by three words - Hri-da-ya. Hri is to take (Aharana),
Da is to give (pana), Ya is to control or move constantly (yachhati).
It means that the Hridaya receives Rasa and Rakta from whole body &
supplies the Suddh Rasa, Rakta, gives nutrition and controls the circulation by its
specific action of Sanckocha and Vikasa. Hridaya is the origin of five Indriyas i.e.
Shabda, Sparsha, Rupa, Rasa and Gandha. Hridaya is situated in the middle of the
chest wall and connect with various Nadies.
In Chhandogya Upnishada:
One hundred and one nadies emerge from Heart & towards whole body.
In Mandakopnishad:
Hridaya collect Rasa and circulate the Rasa in all over body.
Hridaya is stated to be seat of kapha.
In Vayu Purana:
Hridaya situated in mid body and it is considers as the seat of Manas (mind) &
Panchbhutas- seat of Pran & Agni are discussed in new perspective.
In Skanda Purana:
Hridaya is the seat of Sadhaka Agni.
C) Samhita kala:
The description of Heart, Blood Circulation, Dhamanis, Shiras etc. are found
in Samhita Kala.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 10
Literary review
Charaka Samhita:
Hridaya is the Adhistana and root of the Pranavaha, Rasavaha41, Manovaha,
Sangnyavaha srotas. Hridaya is said as the seat of Ojas42.
Hridaya is root cause for the maintenance of six organs Mana, Atma, Vigyana,
Indriya, Pancha-artha and Trigunas including it various Vishaya43 and also explains
the Hridaya roga prakarana separately44.
Sushruta Samhita:
Hridaya is the Adhistana and root of the Pranavaha and Rasavaha srotas45.
Hridaya is said to be seat of Chetana46 and is to be found adhomukha just like lotus
flower47.
Astanga Samgraha & Astanga Hridaya:
Here more description about Hridaya, Dhamani, Siras, Srotas etc. are found.
Hridaya is said to be place of Chetana, shleshma rakta prasadat and is to be found
adhomukha just like lotus flower48. Hridaya is the sthana of ojus and the origin of
dashamoola shiras49.
Kashyapa Samhita:
Hridaya is said to be the seat of Shonitha and it motivates the Mana and
Indriyas50.
Sharangdhar Samhita:
Sharangadhar visualize the significance of Oxygen is extensively distributed
through the body from Heart and give description about rasa, rakta, blood circulation
with Hridaya51. He was the first Physician to incorporate Nadi pariksha into orthodox
medicines, mentioned different types of pulses on the bases of Doshas and certain
physiological condition52.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 11
Literary review
Historical milestone in blood pressure:
In modern medicines normal Blood Circulation & Pulse tension is known
since very early period. But the name of Hypertension & specifically Essential
hypertension is given a little more then one century.
First time Blood circulation was described by Galen. He also established the
Autonomous movements without the control of Nervous system.
1559: Calsalpino (ITALY) introduced term circulation with reference to movement of
blood in Arteries & Veins.
1628: The inventor of blood circulation “William Harvey” was the first to learn the
whole structure.
1731: Blood circulation described by Galen first time. He also established the
autonomous movement without the control of nervous system.
1789: The English clinician Richard Bright (1789-1858) made an important
contribution to the understanding of the link between Hypertension and renal disease,
based on his observations of patients. In a paper published in 1836, Bright noted that
pathological changes in the kidney are often accompanied by hypertrophy of the left
ventricle of the heart, although he did not link the two conditions to Hypertension.
However, he did speculate that the presence of small vessels disease in the
tissues might require a greater cardiac force to overcome the increased resistance to
blood flow.
The condition that Bright described where nephritis and albuminuria were
usually accompanied by edema and elevated blood pressure became known as
Bright’s disease. Bright’s work led others to realize the significance of Hypertension
as a cause of some of the pathological changes in the kidneys and other organs and
hence, to recognize Hypertension as disease.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 12
Literary review
1836: Richard Bright (England) established association of blood pressure in Kidney
diseases.
1852: Charles Brown-Sequard (1817-1894) outlined the effects of sympathetic
innervations on the vasculature. He demonstrated that cutting of the sympathetic
nerve leads to vasodilatation, whereas stimulating the peripheral sympathetic nerve
endings causes vasoconstriction.
1855: Introduction of the Sphygmograph by Kari Vicrodt.
1874: Frederick Mohamed (1849-1884) - was the first to notice “high tension in the
arterial system” occurs “previous to the commencement of any kidney change, or to
the appearance of albumin in the urine.
1876: Sir William Richard Gower’s (1845-1915) - a neurologist and one of the
pioneers of the ophthalmoscope, noted the presence of vascular changes in the retina
in patients with Bright’s disease. He published a paper in which he demonstrated a
close correlation between constrictions of retinal arterioles and raised arterial
pressure.
1880: Introduction of the Sphygmograph by Vas Basch.
1896: Albutt introduced the term ‘Hyperplesia’ in to distinguish patients with
elevated blood pressure alone from those with Bright’s disease. The disease was later
renamed ‘Essential Hypertension’.
1897: Hill & Barnard developed an arm occluding sphygmomanometer.
1904: Theodore Janewaydrew attention to the striking response to stresses such as
surgery, tobacco and anxiety.
1911: Frank first gave the name Essential Hypertension.
1920: McLeod (1876-1935) - produced his acclaimed text on physiology, in which he
outlined the major factors controlling blood pressure. Later, in 1934, Goldblatt and
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 13
Literary review
colleagues demonstrated that Hypertension could be induced in dogs by clamping the
renal artery.
1939: Keith and colleagues published a paper in which they showed a correlation
between retinal abnormalities and prognosis in Hypertension. The relation between
Hypertension and arteriosclerosis was appreciated in 1948, although its nature was not
fully understood at that time.
1940: Anyuman & Gold shine established that Blood Pressure measured at home was
lower then in clinic.
1944: Smirk assessed blood pressure behavior in the individual by measuring based
blood pressure.
1955: Pereira described the natural history of Hypertension and its frequent
progression to end-organ complications, largely resulting from acceleration of the
processes of arteriosclerosis. He was one of the first to question the existence of
benign form of Hypertension.
1964: George Pickering showed for first time profound fall Blood Pressure record
during sleep.
1970: Physiology & pharmacology of B.Adrenergic Receptor by Black for which he
got noble prize in 1998.
1994: Smik assessed Blood Pressure Behavior in the individual by measure basal
Blood Pressure.
Review of previous research work:
Ahamedabad:
Shah J.R. - Studied appraisal of dosha in H.T.N. (1984)
Solanki P.V.-An effect of Virechana & Shaman on Essential Hypertension. (1987)
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 14
Literary review
Vashishta A.G. - A clinical study on the role of Basti-Chikitsa in the management
of E.H.T.(1994)
Bhupendra Pal- A clinicopathological study of Raktagata Vata (H.T.N.) &
management by Jatamansi Churna. (1994)
Banaras Hindu University (B.H.U.):
S.P.Pande- Study of Arterial H.T.N. and role of Japapushpa (Hibiscus Rosa
sine sis) in its management. (1977)
Ram Singh- A Clinical & experimental evolution of certain indigenous dugs
and its significance in the management of E.H.T. (1993)
G.J.Sayakarars- Study of Avritta in the light of H.T.N. (1993)
Murti Krishana.P.- A clinical study in Ayurvedic management of H.T.N. with
specific reference to some non-pharmacological measures. (1993)
Ph.D. Thesis:
H.C.Gupta- A new care treatment of H.T.N.(Shleshmavrita Vayana). (1990).
Ritu Bhardwaj- A clinical & competitive study Shodhana (Virechana) purvaka
shaman & shamana chikitsa in the management of E.H.T. (1998)
Hyderabad Govt. Ayurvedic collage:
Anjanedya.S- A clinical study of the effect of Vacha on H.T.N. (1985).
J.V. Rao- A study on the effect of Jyothishmati & Punarnava in H.T.N. (1985)
K.Bhushan- Effect of Sarpagandhadi yoga on H.T.N. (1989)
I.P.G.T & R.A. Jamnager:
G.B.Pandey- Avarut Vata Vigyana. (1960)
O.C.Birla- Abhivridha Raktachapa par Sirodhara. (1973)
P.D.Joshi- Role of Dosha-Dushya in H.T.N. (1979)
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 15
Literary review
Maheshwar Shukla- Effect of Shirodhara by Takra in patients suffering from
H.T.N. (1983)
A.R.Dev (MRS)- A comparative study on the Rasayana drug & Jaladhara in
the management of Uccharaktachapa. (1988)
Jay Krishana Jani- A study on the Etiopathogenesis of E.H.T. and its
management with certain Ayurvedic drugs. (2000)
Mahopty K.- Critical study of Srotovijananam in Brihatrayi w.s.r. to
Raktavaha Srotodusti & its management B.P. (2000)
Sumit Pathania- Role of Takradhara & Sarpangandha Ghanvati in the
management of Uccharaktachapa. (2000)
Dhananjay Patel- The role of Mansikbhavas in the Etiopathologenesis of
Uchharaktachapa & its management with Medhya-rasayan & shirodhara. (2003)
Ramesh Bhayala- The role of Virechana & Shaman Chikitsa in the
management of E.H.T. (2003)
Govt. College of Indian Medecine Mysore:
R.Mohammed - A study of H.T.N. on Ayurvedic apporach. (1987)
Titlak Ayurved Mahavidhayalaya Pune:
P.P.Patil - Efficiency of Rasgandha vati in H.T.N. (1995)
H.D.Datkhile - Study of H.T.N. according to Ayurveda. (1994-95)
Ahiv Rao B.G.- Relation of B.P.(Raktabhar) & Prakrati. (1984-85)
Gopa Bandhu Ayurvada Mahavidhyalaya Puri:
Chandra B. - Management of H.T.N. with Jatanmansi. (1993)
G.C.D.Sharma - Study on the effect of Sarpagandha churna with Jatamansi
kwatha on Benign Arterial H.T.N. (1989)
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 16
Literary review
Govt. Ayurvedic College-Raipur (P.T. Ravishankar University):
Tamrakar B.C.- Comparative therapeutic evolution of shirodhara
(Panchakarma therapy) in H.T.N. (1987)
N.Mishara - Ayurvedic drishtikon se Uccharaktachap ka nidanik evam
vaignyanik adhyayana. (1985)
Anil Singhai-A clinical study of Ayurvedic compound in arterial H.T.N. (1987)
Govt. Ayurveda College (Kerala University) Trivendram:
Ravindranath M. N. - Management of H.T.N. (1984)
P.N.Jaya Singh - Management of H.T.N. with Shodashanga kashaya. (1993)
N.I.A. Jaipur:
J.P.Pathak - Raktachap evam Bramhi Rasayana-uccha raktachap ka nidan
chikitsatamak adhyayana. (1983)
S. Malik - Avrit Vyan udan vayu (Uccharaktachapa) per Rasona Guggulu ka
chikitsatmak adhyayana. (1996)
Views of ayurvedic scholars
Vidya Ranjit Rai Desai:
In his book Nidana Chikitsa Hasthamalaka, he has opined that the disease
hypertension is a raktaja Vyadhi. Langhana, virechana and Raktamokshana etc,
samanya chikitsa sutras of raktajavyadhi can give fruitful results in the management
of Hypertension. He has clearly stated that the hypertension is due to Raktavruta
Vyana vata.
Vaidya Shri.Sudarshan Shastri, Shri.Yadunanda Upadhyaya:
They have opined that hypertension is due to Raktagata vata and is to be taken
as pravruddha raktachapa.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 17
Literary review
Vaidya Shri.Gananath Sen:
He has opined that high blood pressure is Raktagata vata or Raktavruta vata.
Here vitiated vata will become Raktagata or Raktavruta and manifests the disease.
Here the symptoms are not only due to the Hridaya but also due to the vikriti of
vrukka also.
Vaidya Shri.V.V.Shastry:
In his paper, he has considered raktapeedanadhikya as hypertension and
dhamanipratichaya to be one of the major causes for causing the high blood pressure.
He has given the following causes, which cause the dhamani pratichaya:
As this is a shlaishmika disease, a shlaishmika and snigdha substance may be
smear or added to the vessel wall, consequently producing a growth and increase in
the thickness of the vessel wall. This may finally lead to the obstruction of srotas
(srotorodha).
The dhamani which loose the elasticity due to the increase in the thickness of
the vessel wall, also loose the quality of dhamana, thereby necessitating an increased
force in the contraction of the hridaya to maintain the preenana and jeevana kriyas. As
a consequence there is rakta peedanadhikyata.
Vaidya Shri. M.Mahadevashastry:
He has suggested the following treatment during the management of rakta
samurdam (hypertension).
Shodhana and shamana as in vatashonita and medasavrita Vata, Anavarana
vata, Sudation and cleansing, use of purana guggulu with tila taila, internal use of
unsaturated seed oils, Ksheerabalataila, shilajatu, guduchi, in atheroma and
atherosclerosis. Brihat Vatachintamani, Agatsya hareetaki etc. strengthen hridaya,
brain, arterioles and renal vessels.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 18
Literary review
Vaidya Shr. D.T.Giri and Vaidya Smt. Jayashree.R.Shah:
In the Aug. 85 issue of Ayu magazine, Dr.Giri and Dr.Jayashree have
considered hypertension as uchcha raktachapa. They have classified hypertension into
three categories, namely, i) Vataja, ii) Pittaja, iii) Kaphaja, according to do dosha on
the basis of dosha vriddhi lakshana.
As per their opinion Chinta, Bhaya, Shoka, Vegadharanadi, Vatavriddhi
karanas are the nidanas for vataja uchcharaktachapa, Krodha, Shoka, Mamsa sevana,
Katurasa sevana, Dhumra pana etc, are said to be the nidana for pittaja uchcha
raktachapa, And Diwaswapna, Alasya, Amlarasa, Lavanarasa, Guruahara sevana,
Madhura rasa sevana, Masha etc, are the nidanas for Kaphaja Uchcha Rakta Chapa.
In Vataja uchcharaktachapa- dhamani kathinyata and rakta vahi sankocha is
the main pathogenesis. In paithika uchcharaktachapa rajoguna vriddhi are due to
ushna teekshna gunas of pitta. Then vata vriddhi and paithika uchcharaktachapa is
manifested.
They have stated that shodhana chikitsa in uchcharaktachapa should be
according to doshas involved.
In vatapradhana uchcharaktachapa, basti karma is indicated. In pitta pradhana
uchcharaktachapa, virechana is indicated and in Kapha pradhana raktachapa, vamana
is indicated. They have told that this shodhana karma in uchcharaktachapa is only an
upashaya, which gives the knowledge of predominant dosha in the patients suffering
from uchcharaktachapa.
Hypertension in Ancient Period:
Ayurveda an ancient medical science has a rich literature regarding a plenty of
disorders but it is difficult to find a clear-cut correlation to that of hypertension in our
science. However, looking to the description of hridaya, the diseases like Hridroga,
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 19
Literary review
Pakshaghata that can be taken as the complications of hypertension. We can think that
hypertension might be present in those days.
Diseases considered under the heading Hypertension by 20th Century Authors is as
follows –
1) Pittavruta udana vata, 2) Pittavruta prana vata, 3) Pittavruta vata, 4)
Dhamani pratichaya, 5) Mada, 6) Moorcha, 7) Bhrama, 8) Sanyasa, 9) Rakta gata
vata, 10) Raktachapadhikyata, 11) Raktapradoshaja vikara, 12) Raktavruta vata, 13)
Roudhiryamada, 14) Siragata vata, 15) Ucharakta bhara, 16) Ucha rakta chapa,
17) Pranavruta udana vata, 18) Raktamada, 19) Vyanabala, 20) Raktasamvardhana,
21 )Raktavega vridhi, 22) Rasabhara.
Pittavruta udana vata
The Pittavruta udanavata lakshana are - Murcha, Daha, Bhrama, Klama,
Avasada, daha in the nabhi and urah region and Ojobhransha53.
Pittavrutha prana vayu
The lakshanas are- Murcha, Daha, Bhrama, Shoola, Vidaha, Chardi and
Sheeta kamatwa54.
Pittavruta vata
In Pittavruta vata, the following symptoms are- Daha, Trishna, Shoola,
Bhrama, Tama, aggravation of daha by the use of Katu, Amala, Lavana, Ushana and
Sheetakamita55.
Raktavruta vata
Acharya Charaka has described the disease Raktavruta Vata36 under the
context of Vatavyadhi but no other Acharyas have mentioned regarding this disease.
In Raktavruta vata, the symptoms are - Daha in between twak, Mamsa, Raga,
Mandalas and Kshavathu56.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 20
Literary review
Raktapradoshaja vikaras
Raktapradoshaja vikaras are explained under the vidhishonita adhyaya. In
charaka samhita totally 43 diseases are mentioned in vidhishonita adhyaya all these
diseases come under the rakta pradoshaja vikaras. In this group mada, raktapitta etc.,
diseases are considered57.
Raktagatavata
The lakshanas of Raktagatavata, according to Acharya Charaka- Teevraruja,
Santapa, Vaivarnya, Krishata, Aruchi and Stambhata soon after having food58.
Acharya Vagbhata also explained almost all the symptoms, which are explained by
Acharya Charaka, in addition with – Swapam, Raga and Bhrama59.
Sri Sudarshan Shastri and Sri Yandunandanopadhya conferred opinion, as
Raktagata Vata is nothing but hypertension.
Siragata Vata
The Lakshanas of siragata vata are- Mandaruja, shopha, Shushyati, Spandyate,
Suptasatanvyo in siras60.
Bhrama:
It is one of the symptoms of Pittavruta udana. It is one of the vataja nanatmaja
vyadhi61. The shareerika doshas vata, pitta and manasika dosha rajas are considered as
the causative factors for the Bhrama. Bhrama means Giddiness or rotation, a person
feels the fast rotation in the shirah62.
Dhamani Pratichaya
It is one of the kaphaja nanatmaja vikara63. Due to adhika poshana especially
Rasa and Rakta dhatus the dhamanis in which these dhatu circulates get dilated.
Because of these, the gati becomes manda and guru. The Dhamani will not be guru,
manda and mrudu as seen in Atipoornata but it will be Katina and Teekshna due to
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 21
Literary review
vitiation of Vata. It will sometimes be Teekshana, Manda, Poorna and Ksheena due to
the vitiation of Vata.
Roudhira Mada
Mada is one of the rakta dushti vikaras. In the seven type of mada the
Roudhira mada is considered as hypertension and stated that the dushya involved in
this disease is Rakta whereas Vata, Pitta, and Kapha plays an important role in the
formation of Roudhira Mada64.
Raktachapadhikyata
Raktachapadhikyata is created by three words - Rakta, Chapa and Adhikyata.
Rakta’ refers to – Vishesha dhatu among all dhatus and rakta indicates life.
‘Chapa’- refers to pressure or squeezing.
‘Adhikyata’-refers to, high or increased.
Raktachapadhikyata” means high blood pressure65.
Moorcha
Madhava Nidana66, 67 has explained the moorcha in detail. It is due to vitiated
Vatadidosha, rakta dusti and tama dosha. It can be considered as syncope. Lose of
consciousness induced by a temporarily insufficient flow of blood to the brain.
Acharya Vagbhata68 mentioned the mada, moorcha and sanyasa. Acharya
Charka and Acharya Sushruta explained the types of moorcha.
Sanyasa
It is the disease of rakta dushti and samjnya vaha srotas. It is due to the
vitiated doshas. If moorcha is not treated properly, it leads to Sanyasa. According to
contemporary science coma is a state of unnatural heavy deep and prolonged sleep
often accompanied by slow irregular breathing and consequently ending in to death69.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 22
Shareera
Shareera Vivechana
Anatomy-Physiology of the heart and blood vessels with physiology of blood
circulation is very much indispensable in Pittavruta udana w.s.r.t. Essential
hypertension before going to discussion part.
Hridaya
The word ‘Hridaya’ in Ayurveda is a synonym for the word Heart. Hridaya is
derived from two verbs. ‘Hri’ which means to bring back forcibly and ‘Da’ which
means to donate. According to Shatapatabrahmana the word hridaya is made up of
three dhatu’s, Hri, Da, and Ya. These dhatus by the combination of the pratyaya and
adesha, forms Hrit, Dana and Ayana.
The dhatu Hrit gives the meaning of Hanane, Apatirite i.e., to take or to
receive. The dhatu Dana gives the meaning of Tyage, Palane, Chedane i.e. to give or
to eject or to nourish. The dhatu Ayana having the paribhasha of Kayam, gives the
meaning of Gati, Chalana, or Movement.
The word hridaya has been attributed to mainly two organs, namely Mastishka
or Shirohridaya and Hridaya i.e. Urohridaya. Generally, yogis attribute the word
hridaya to Mastishka- and the physicians or Vaidyas denote the word hridaya to
Urohridaya or Muscular heart.
The anatomy and physiology of Hridaya is not explained under one heading or
at one place in classics, we get lot of quotes and descriptions based on which we
should appreciate the anatomy and physiology of heart.
Hridaya is considered as one of the kostanga. It is situated in vaksha pradesha
in between the two stanas. It is formed by shleshma and rakta, having the shape of
inverted lotus and according to Arunadatta it is made up of mamsapeshi and rakta. It
measures two angula according to Chakrapani and four angula according to Sushruta.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 23
Shareera
Hridaya is the moola of pranavaha and rasavaha Srotas70. It is the seat of
manas and para-apara ojus71. Hridaya is the sthana of dashadhamani’s which spreads
all over the body and which carries rasa, ojas and does tarpana karma72, 73. Hridaya
continues to work whether the person is in jagrutavasta or swapatavasta74.
The particular function of hridaya is conceded out by particular dosha. These
functions are discussed below:-
Doshas related to Hridaya
The three doshas are related with Hridaya i.e. among vata, the Udana vata,
Prana vata and Vyana vata75related to Hridaya. Among pitta, the Sadhaka pitta76, and
among kapha, the Avalambaka kapha is related to Hridaya77.
Udanavata with Hridaya
Acharya Charaka and Vagbhata have mentioned the uras as the sthana of
Udana vata78, 79, 80 and is related to hridaya. The functions of Udana vata are prayatna
(Endeavour or effort), urja (enthusiasm) and bala (strength)81, with respect to hridaya,
we can think of the conductive system of the heart, i.e. Udana vata by the functions
like prayatna and bala initiates and helps in the conduction of the cardiac impulses in
the heart. It is the coordinator of speech, memory, strength etc82, 83.
Pranavata with Hridaya
Acharya Charaka and Vagbhata have mentioned the Shiras84, 85 are the sthana
of Pranavata and acc. to Acharya Sharangadhara, Prana is situated in hridaya86.
Acharya Vagbhata states that Prana vata maintains the activities of hridaya and does
dharana of dhamanis87. Thus, Prana vata is situated in murdha and sends impulses to
hridaya, there by overriding the sympathetic and parasympathetic actions or functions.
Prana is central controller of all the motor activities of body88.
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Vyanavata with Hridaya
Acharya Vagbhata stated that Vyana vata is situated in hridaya89,90 and it
moves quickly all over the body91,92. Vyana vata is responsible for circulation of Rasa
(Rasadhatu) all through the body93, 94. Acharya Sushruta has also mentioned asruk
sravana to be one of the functions of Vyana vata95. Acharya Vagbhata summarizing
all functions of Vyana vata by the statement that Vyana vata96 conducts all the actions
or movements of the body.
Even Acharya Charaka has mentioned that Vyana vata is responsible for the
continuous flow of rasadhatu to all parts of the body throughout the life by using the
words like ajasram and sada97 and controls the circulation of Rasa, Rakta and Sweda
in the body98.
Sadhakapitta with Hridaya
Acharya Sushruta and Vagbhata stated that Sadhaka pitta is situated in
hridaya99, 100, 101 and is responsible for attainment of buddhi, medha, abhimana, utsaha
and abhipretartha.
Therefore, it is connected with some of the higher mental faculties and
emotional states. Hence, Sadhaka pitta related with psycho-physiological actions.
Avalambaka Kapha with Hridaya
Acharya Vagbhata and Sushruta stated that Avalambaka kapha is situated in
uras102, 103, 104. It does avalambana of hridaya i.e. with the help of rasa it gives bala to
hridaya. It also does tarpana and kledana of Hridaya.
Manas with Hridaya
Acharya Charka and Acharya Sushruta stated that hridaya is the adhistana of
Manas105, 106. Acharya Charaka while mentioning measures to protect hridaya and oja
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say to avoid the thing that produces dukha to the Manas. Even in Unmada chikitsa
adhyaya also Acharya Charaka mentions about manovaha srotas.
Ojas with Hridaya
Ojas has been classified in to two types, i.e. para ojus and apara ojus. Para
ojus is located in hridaya107 and pramana is ashta bindu. It is said to be uttama
pranayatana even, if a very little is destroyed the body cannot exist. Apara ojus is
located in hridaya and dhamani, and circulates all over the body. It is ardhanjali in
pramana and the deficiency of this ojus does not cause death.
Rasa Rakta Paribhramana
Hridaya is the srotomula of rasavaha and pranavaha srotas108 and responsible
for rasa samvahana in the shareera. Samanavata brings the ahara rasa that is fashioned
to hridaya, and in hridaya it is called as rasa dhatu. At the present with the help of
Udana vata and Vyana vata the sankocha and vikasa i.e. the praspandana of hridaya
starts. Praspandana of hridaya can be correlated to the conductive system of the heart.
Now sankocha can be .considered as systole and vikasa can be considered as diastole.
Prana vata maintains the actions of hridaya and does dharana of dhamanies. This
indicates that it governs the vasomotor functions. Once the sankocha takes place the
rasa moves in to dashadhamani, and proceeds further109.
As per kedarakulyanyaya, the rasa moves to all parts of the body and
nourishes the whole body. This function is conceded constantly all over the life
Afterwards this rasa is brought back to the hridaya by Vyana vata, Samana
vata and Hridaya vikasana takes place, followed by sankocha and rasa moving
towards sarva shareera. This cycle continues and Acharya Charaka uses the word
ajasra to denote the continuous function of hridaya in circulation of rasa110.
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Blood Vessels and Shareera
The concept of blood vessels in Ayurveda has not been cleared till today.
Different Acharyas have different opines regarding this. The three terms i.e. Sira,
Dhamani and Srotas are used with different meanings depending on the context at
different places. Dalhana in Dhamaneevyakarana adhyaya has described regarding
sira, dhamani and srotas, elaborately. He has differentiated these three based on four
pramanas, i.e. lakshana, moola, karma and agama. Dalhana giving the reason for
these three being read together says, though they are differentiated, however has
similarity in vahana karma.
Table-01: Showing the opinion of Acharyas regarding Sira, Dhamani and Srotas
Sira Dhamani Srotas Definition:
“Saranat Siraha”111
Chakrapani, Gangadhara,
Gananathsen’s opinion goes in
favour of vein.
Ashuddha raktavahini’s are
considered as sira and can be
referred as vein (Atharvaveda).
Pandit Hariprapannaji considers
sira to be vein. Pittavaha siras
can be considered as vein.
The word sira has been used
with the meaning of kandara.
The word sira has been used
with the meaning of dhamani.
The word sira denotes vein,
artery and lymphatics.
Definition:
“Dhmand Dhamanyaha” 112
Chakrapani, Gangadhara,
Gananathsen’s opinion goes in
favour of artery. Shuddha
raktavahini’s are considered as
dhamani and can be referred as
artery (Atharvaveda). The word
dhamani has been used with the
meaning of Jnyanatantu.
At parishad shabdartha it was
concluded that dhamani can be
considered as artery, nerve or
vein, or any vessel in the body.
The word dhamani has been
used with the meaning of
rasavahini.
The word dhamani has been
used with the meaning of sira.
Definition:
“Sravanat Srotamsi” 113
Chakrapani, Gangadhara,
Gananathsen’s opinion goes in
favour of capillaries.
It has paryayas like sira,
dhamani, rasayanya, nadi,
pantha, marga etc.
Therefore, by the above, it is very difficult to come in a conclusion that
whether sira is considered as artery or dhamani is considered as artery.
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Acharya Charaka is more of the opinion of considering dhamani to be as
artery, while Acharya Sushruta considers rohini sira or asrugvaha sira as the artery.
Even the parishad that was conducted on shabdartha could not conclude on this
controversy. Therefore, now based on pulsatile feature, dhamani is taken as artery in
this study. Acharya Sushruta has used the word sira pratana to describe the plexus of
arteries or veins.
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The Heart (Anatomy)
Greek name is cardia from which we have the adjective cardiac, Latin name
is cor from which we have the adjective coronary.
The heart is a conical, hollow muscular organ, situated in the middle
mediastinum. It is enclosed within the Pericardium. It pumps the blood to various
parts of the body. The heart is placed obliquely behind the body of the sternum and
adjoining parts of the costal cartilages, so that 1/3rd of it lies to the right, 2/3rd to the
left of the median plane. The direction of blood flow, from atria to the ventricles, is
downwards, forwards and to the left. The heart measures about 12×9 cm (5×3 or 3 ½
inches) and weighs about 300 gms in males, 250 gms in females114.
External features
The human heart has four chambers. These are right and left atria and the right
and left ventricles. The atria lie above and behind the ventricles. On the surface of the
heart, they are separated from the ventricles by an atrioventricular groove. The atria
are separated from each other by an interatrial groove. The Ventricles are separated
from each other by inter-ventricular groove, which is subdivided into anterior and
posterior parts. The upper part of each atrium has an appendage called the auricle.
The heart has an apex directed downwards, forwards and to the left; a base (or
posterior surface) directed backwards; and anterior, inferior and left surfaces. The
surfaces are demarcated by upper, lower, right and left borders115.
Arteries and veins of the heart
The heart is supplied by two coronary arteries, arising from the ascending
aorta. Both arteries run in the coronary sulcus116.
The venous blood is drained by great cardiac vein, the middle cardiac vein, the
small cardiac vein, the posterior vein of the left ventricle, the oblique vein of the left
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atrium, the right marginal vein, the anterior cardiac veins, and the venae cordis
minimae. All these except last two drain into the coronary sinus which opens into the
right atrium. The anterior cardiac veins and the venae cordis minimae open directly
into the right atrium117.
Lymphatic and the nerve supply of the heart
Lymphatic of the heart accompany the coronary arteries and from two trunks.
The right trunk ends in the brachiocephalic nodes, and the left trunk ends in the
tracheobronchial lymph nodes at the bifurcation of the trachea.
Parasympathetic nerves reach the heart via the vagus. These are cardio
inhibitory; on stimulation they slow down the heart rate. Sympathetic nerves are
derived from the upper 3-5 thoracic segments of the spinal cord. These are
cardioaccelaratory, and on stimulation they increase the heart rate, and also dilate the
coronary arteries. Both parasympathetic and sympathetic nerves form the superficial
and deep cardiac plexuses, the branches of which run along the coronary arteries to
reach the Myocardium118.
Anatomy of Artery and Arterioles
The whole circulatory system from the finest capillaries up to and including
the heart is lined by a smooth, continuous single layered endothelium. The walls of all
vessels except capillaries and sinusoids are formed by three analogous zones (coats)
i.e., from inside outwards the tunica intimae, tunica media, and tunica adventitia.
These coats confer on the vessels a number of important properties, including an
endothelial lining low in friction and connective tissue components able to withstand
longitudinal and circumferential stress due to prevailing blood pressure.
The smallest arteries terminate in muscular arterioles 100-50 µm in diameter,
which branch into terminal arterioles less than 50 µm in diameter. Metarterioles are
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branches of terminal arterioles, 10-15 µm in diameter at their origin and decreasing
over 5-100 µm to as little as 5 µm, where they open in to the capillary bed. They are
surrounded by a strong circular layer of non striated myocytes forming precapillary
sphincters, which affect the final control of blood flow through the capillaries. Pre
capillary sphincters have been seen to open and close periodically with a cycle of 2-8
seconds.
Physiology of Blood Circulation
The activity of the organs of the circulatory system, that is, of the heart and
blood vessels, ensures a constant flow of blood in the organism. Because of its
movement, the blood can perform numerous transport functions, in particular,
supplying oxygen and nutrients to the tissues, and removing substances formed as the
result of metabolism.
The movement of blood in the organism follows a complicated course known
as the systemic or greater circulation, and the pulmonary or lesser. The systemic
circulation starts at the left ventricle of the heart, passes to the aorta, to the arteries,
originating from it and to all their branches, then to the arterioles, capillaries, and the
veins of the whole body, and finally to the two venacavae which enter the right
atrium. The pulmonary circulation begins from the right ventricle, continues along the
pulmonary artery and all its branches, then along the pulmonary arterioles, capillaries,
and veins and terminates in the pulmonary veins, which empty into the left atrium.
The flow of blood in the vessels is due to the work of the heart. Contraction of
the ventricular myocardium ejects blood under pressure from the heart into the aorta
and pulmonary arteries. The movement of the blood further along the vessels, and its
return to the heart, is conditioned by its pressure in the large arteries being higher than
in the small arteries, the pressure in the latter being higher than in the capillaries, and
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the pressure in the capillaries being higher in turn than in the veins and atria. In this
way, there is difference in pressure all along the blood stream that determines its
circulation in the vascular system, blood flowing from the vessels with higher
pressure to those with lower. The gradual drop in the pressure along the blood stream
(from the arteries to the capillaries and veins) is brought about by the fact that the
energy imparted by the heart is utilized to overcome the resistance of the vessels to
the movement of the fluid arising from friction between the fluid particles and the
vascular wall and between the particles themselves.
The function of the heart is rhythmic pumping of blood that it receives from
the veins in to the arteries. It is performed by alternate rhythmic contraction and
relaxation of the muscular fibers that forms the walls of the atria and ventricles.
Contraction of the myocardium of these chambers is known as their systole, and
relaxation as their diastole.
In normal physiological conditions systole and diastole occur in a definite co-
ordination and constitute the cardiac cycle. Each cycle is considered to start with the
atrial systole. The contraction begins as a wave in that part of the right atrium where
the orifices of the venacava are, and then involves both atria, which have a common
musculature with a cardiac rhythm of 75 contractions per minute; an atrial (auricular)
systole lasts 0.1 second. As it ends, the ventricular systole begins, the atria then being
in a state of diastole which lasts 0.7 second. The contraction of the two ventricles
occurs simultaneously, and their systole persists for about 0.3 second. After that,
ventricular diastole begins and lasts about 0.5 second. One-tenth second before the
end of the ventricular diastole a new atrial systole occurs, and a new cycle of cardiac
activity begins.
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Regulation of Blood Pressure
Physiologically the magnitude of the arterial pressure depends on two
fundamental homodynamic variables; cardiac out put and total peripheral resistance.
In other words, the arterial blood pressure is a product of cardiac out put and
peripheral vascular resistance.
Figure-1: Showing the Blood Pressure Regulation
HUMORAL FACTORS
Constrictors Dilators
BLOOD VOLUME -Angiotensin II -Prostaglandins
-Sodium -Catecholamines -Kinins
-Mineralocorticoids -Thromboxane -NO/EDRF*
-Atriopeptin -Leukotrienes
-Endothelin
BP = CARDIAC X PERIPHERAL LOCAL FACTORS
OUTPUT RESISTANCE -Autoregulation
-Ionic (pH, hypoxia)
CARDIAC FACTORS NEURAL FACTORS
-Heart rate Constrictors Dilators
-Contractility -α-adrenergic -β-adrenergic
* Nitric oxide / endothelium - derived relaxing factor
The Blood Pressure can be raised by increased peripheral resistance and by
increased cardiac output.
The cardiac output depends upon the heart rate, its contractibility and the
blood volume. The blood pressure can be raised by an increase in the volume of fluid
absorption of water and water retaining sodium from the intestine in to the vascular
system or an increased production of the adrenocortical hormonal aldesterone, which
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blocks the excretion of sodium and water into the urine.
It appears that most patients with established hypertension have abnormal
cardiac output and blood pressure is mainly sustained by increased peripheral vascular
resistance.
The peripheral vascular resistance is determined by the arteriolar lumen,
which may expand or contract depending on the state of muscular cells in the vessel
wall. This is known as local vascular tone. Normal vascular tone depends on the
competition between vasoconstricting influences and vasodilators. Peripheral
resistance depends on the size of the lumen of some vessels. A decrease in the inner
(lumen) diameter will raise the Blood Pressure. The decrease in the lumen could be
brought about by an anatomical thickening of vessel walls (eg., intimal thickening of
arteries), by their mechanical compression from outside or most commonly by their
active muscular contraction which can be induced by a variety of vasoconstrictor
mediators. The common vasoconstricting mediators are epinephrine, norepinephrine
and renin- activated angiotensin II. The other recently described vasoconstrictors
include endothelin I, thromboxane and leucotrienes. Resistance vessels also exhibit
auto regulation, a process by which increased blood flow to such vessels induces
vasoconstriction, an adaptive mechanism that protects against hyperperfusion of
tissues. The vasodilators include kinins, prostaglandins and nitric oxide. Certain
metabolic products such as lactic acid, hydrogen ions, adenosine and hypoxia can also
function as local vasodilators.
Recently it has been discovered that haemoglobin plays an important role in
regulation of blood pressure. In the body tissues, haemoglobin releases oxygen and
super nitric oxide (SNO) and picks up carbon dioxide. The released SNO causes
vasodilatation. At the tissue level haemoglobin also picks up excess nitric oxide (NO),
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which tends to cause vasoconstriction. Thus haemoglobin helps in regulating the
blood pressure by adjusting the amounts of SNO and NO to which blood vessels are
exposed. This newly appreciated role of haemoglobin may influence development of
drugs to treat hypertension.
Further the arteriolar smooth muscle contraction can be increased by increased
sympathetic tone and also by increased sodium load and extra cellular fluid load.
The kidneys play an important role in the blood pressure regulation, and there
is considerable evidence that renal dysfunction is essential for the development and
maintenance of both essential and secondary hypertension.
The kidney influences both peripheral resistance and sodium homeostasis, and
the renin-angiotensin system appears central to these influences. Renin elaborated by
the juxtaglomerular cells of the kidney transforms plasma angiotensinogen to
angiotensin I, and the latter is converted to angiotensin II by angiotensin converting
enzyme (ACE). Angiotensin II alters blood pressure by increasing both peripheral
resistance and blood volume. The former effect is achieved largely by it’s ability to
cause vasoconstriction through direct action on vascular smooth muscle, the latter by
stimulation of aldosterone secretion, which increases distal tubular reabsorption of
sodium and thus of water.
The renin-angiotensin system
The renin-angiotensin system has been extensively studied since the
introduction of practicable essay methods for plasma renin and angiotensin patients
with essential hypertension have been subdivided into subgroups with low, normal
and high plasma renin on the grounds of the elevated pressure. The different
mechanisms and in particular those patients with low plasma renin might have excess,
mineralocorticoid activity. Plasma renin and angiotensin ii values are continuously
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distributed in the hypertensive population. Further peripheral levels of plasma renin
and angiotensin –II is found in relation inversely to age in essential hypertension.
Peripheral levels of anti diuretic hormone have been reported as being slightly
suppressed in uncomplicated essential hypertension.
Figure-2: Showing the role of Renin-Angiotensin System
Renin Renin Substrate
Angiotensin I
Converting Enzyme
Angiotensin II
Vasoconstriction Increased Aldosterone Synthesis
Sodium retention
Increased Blood Pressure
The kidney produces a variety of vasodepresser or antihypertensive substances
that presumably counter balance the vasopressin effects of angiotensin. These
include the prostaglandins, a urinary kallikrein-kinin system, platelet-activating
factor, and nitric oxide.
When blood volume is reduced, the glomerular filtertation rate(GFR) falls, this, in
turn, leads to increased reabsorption of sodium by proximal tubules in an attempt
to conserve sodium and expand blood volume.
GFR- independent natriuretic factors, including atrial natriuretic factor (ANF), a
peptide secreted by heart atria in response to volume expansion, inhibit sodium
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reabsorption in distal tubules and cause vasodilation. Abnormalities in these renal
mechanisms are implicated in the pathogenesis of secondary hypertension in a
variety of renal diseases, but they also play an important role in essential
hypertension.
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Disease Review
Importance of Avruta vata
Vata is most significant and commanding among three doshas in many ways, for
example Pitta, Kapha and Dhatus are pangu without Vata consequently Vata regulates
their functions, another one is its ashukaritwa.
Gati is the unique feature of vata, whenever its gati is disturbed due to Avarana or
other cause then its vitiation occurs. According to chakrapani, because of avarana, the
speed of the moment of vata gets arrested which leads to its aggravation.
Vata gets vitiates in to two ways i.e. by marga Avaranas or by the dhatu kshaya,
whereas Pitta have single rout of its vitiation. Before going to the Avarana aspect of vata,
first its various pathological conditions are being discussed.
Pathological Conditions of Vata:
Acharya Sushruta had point out the three pathological condition of Vata i.e.
Kevala vata
Dosha-Yukta Vata &
Avruta Vata119
Kevala Vata Disordrders:
Kevala Vata indicate Shudha Vata. The word kevala refers to Dosha-Asamsrista
i.e pathological state of Vata without association of other Dosha120.
Due to the nidanas of Vata, the body tissues under goes destruction resulting in
increase of Akasha i.e.Vaccum and to fill this vaccum, by marga Avaranas Vata leads to
its prakopa. The treatment can be given to Vata only. However, certain care has taken for
this disorder. Here it may produce both Nanatmaja and samanyaja types of Vata
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disorders. The nanatmaja disorders are produced only by vata not by other dosha. On the
other hand, its samanyaja disorders are produced by the the dosha, which may be of vata
type only or may be due to samasarga and sannipata with other Dosha.
Doshayukta Vata i.e. Samsarga and sannipata:
Doshayukta vata indicate the association of other Doshas, which is different from
Avarana121. It is a pathological state of Vata due to the association of Pitta or Kapha or
both, which may be caused by the mutual hetus. Clinical manifestations of Vata as well
as of the associated Dosha as Anubandha may be there. In that case, generally the
primary Dosha i.e Vata dominates in all the sphere of hetu, symptoms and treatment.
Usually, with the treatment of primary Dosha, the secondary Dosha or
complications is also relieved provided a care is taken because the treatment is not
opposed to associated Dosha.
The Samsarga or Sannipata may occur in the simple way of prakriti sama
samaveta i.e like physical mixture of Dosha, where the mixed symptoms of both the
involved Dosha are manifested. On the other hand, when the combination of Dosha is in
the form of Vikriti Vishama Samaveta then there may be some peculiar symptoms, which
may not be belonging to either of the Dosha.
Gata Vata: The word GATA has 2 meanings-
• Related with movement
• Related to Destination / Site /Adhishthana122
Initially Vata is vitiated by its own nidanas, afterward, following the specific
path of its pathogenesis, when involves some specific site i.e Dhatu, Upadhatu or Ashaya,
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then such condition is termed by adding adjective of that site (Dhatu or Ashaya e.g
Pakvashaya Gata Vata or Rakta Gata vata and so on123.
The symptoms developed according to the severity, site of participation etc. Pain
is the common and chief complaint in all the conditions of Gatavata. On the other hand,
character of the pain varies according to the site of localization. For example, unbearable
pain associated with burning sensation is the symptom of Rakta Gata Vata, deep-seated
aching pain is the typical feature of Mamsa Gata Vata124.
Avruta Vata:
Like Ama, the Avarana is also a unique concept of disease pathogenesis,
especially of Vata vyadhis. Term Avarana means; achhadana, avarodha, obstruction,
occlusion, to cover or to mask. Gati is unique feature of Vata, whenever the gati of vata
gets arrested which leads to its aggravation125. Avarana of vata is a characteristic
pathological condition, where obstruction to its Gati occurs due to the nidanas other then
its own, leading to its Prakopa resulting into various Avaranas. The Dosha, Dhatu, Mala,
Anna, Ama & sub type of Vata can cause the Avarana.
Synonyms of Avaranas:
Avintah
Samyuktah126.
Meaning of term used in Avarana:
The three terms are used to understand the Avarana i.e. Avarana, Avarka and
Avruta described below:-
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Avarana:
Avarana denotes the obstruction of vata movements. This obstruction can be due
to Pitta, Kapha, Rasadi dhatus, Malas or even by panchavidha vata.
Avaraka:
The factor, which causes obstruction of vata, is called Avaraka. For example if
Pitta cause obstruction of Vata, then Pitta is called Avaraka.
Avruta:
The gati of Vata, which is affected by the Avaraka is known as Avruta.
The substance, which obstructs the pathway of Vata, is termed as Avaraka while Vata
whose avarana occurs is termed as Avarita.127.
Figure 3: Showing the diagramatic presentation of concept of Avarana
VATA PITTA PITTA (Avaraka) (Avaraka) (Avruta)
This concept of Avarana is particularly stated for Vata.
According to Chakrapani, the excessively strong Avaraka suppresses the normal
dealings of Vata. The excessively increased Avaraka manifests its actions. Avarana of
Vata leading to its prakopa, thus the symptoms is also manifested depending upon its site
involvement128.
In the initial stage of the situation, as the Avaraka is strong and Vata is nearly in
the normal status, there will be decrease in the functions of Vata, in the beginning with
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increase in the function of Avaraka. When the obstruction is complete, it leads to Prakopa
of Vata resulting in its disorder129.
Hence, it is clear that Vata is initially in its normal state, but development of
Avaraka occurs. The Vata Prakopa occurs after the obstruction is completed. Hence the
Vata disorders are produced without indulging of its own nidana.
How to know Avruta-Avraka:
Charak samhita describes certain guidelines to identify the affected Avruta, and
Avaraka, the causative factor of Avarana in 28th chapter cikitsa sthana.
i) If Avaraka is stronger than Avruta, i.e. Avruta dosha looses its functions and
there is increase in the activity of the Avaraka factor (it may be vata, kapha or pitta etc.).
ii) However, if the Avruta dosa (Vata) is stronger due to sanchaya, prakopa etc.
than the Avaraka, then there is increase in the functions of Avruta and decrease in the
functions of Avaraka.
iii) According to some scholars, the decrease of the functions of the Avruta,
increase in the functions of the Avaraka130.
By observing these lakshanas in a particular case of Avarana one has to analyze
them to identify Avruta-Avraka etc.
Indicator composite in Avruta Vata:
Repeatedly the symptoms manifested are comprised of disturbed function of the
obstructing factor as well as the obstructed Vata. The symptoms produced are based on
the principles of Karma Hani (Rupahani), Karma Vriddhi (Rupa Vriddhi) and Anya
Karma (Rupantara)131.
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These are depending upon the intensity of the obstruction i.e. partial or complete,
functional or organic, acute or chronic, transient or persistent, etc. For example, the less
strong obstruction of Vata will lead to its aggravation, where as the very powerful
obstruction may make it weak and like wise.
The symptomatology of the Avarana depends up on the place where the Dosha-
Dushya Sammurchana has takes place. For instance, the symptom of Shoola of Avruta
Vata may occur in the different parts like head, ears, abdomen, back, depending upon the
organ involved in the process of Avarana.
Avarana Bhedas:
Avarana may be innumerable132. However, 42 types of Avarana of Vata have
been described in the texts; these are categorized under the following hading.
Murta Avarana133,134:
Pitta & Kapha Dosha, Dhatus, Mala and Anna are the Murta substances, which
obstruct the gati of Vata and this state is called as Murta Avarana. These are 22 in
numbers i.e.
Doshavruta Panchabedha of Vata
Pittaavruta Udana-1,
Pittaavruta Apana -1,
Pittaavruta Samana-1,
Pittaavruta Vyana-1,
Pittaavruta Prana-1,
Kaphavruta Udana-1,
Kaphavruta Prana-1,
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 43
Disease Review
Kaphavruta Apana-1,
Kaphavruta Samana-1,
Kaphavruta Vyana-1 &
Pitta avruta Vata-1,
Kapha avruta vata-1.
Dhatavarita Vata
Rakta avruta Vata-1,
Mamsa avruta Vata-1,
Meda avruta Vata-1,
Asthi avruta Vata-1,
Majja avruta Vata-1,
Shukra avruta Vata-1,
Sarva Dhatvarita Vata -1 &
Malavruta Vata -1,
Mutravruta Vata -1,
Anna vrita Vata -1.
Amurta Avarana135,136:
When sub-type of Vata obstruct the function of each other, is called Amurta or
Anyonya Avarana. It is of 20 in number i.e.
Vyana avruta Udana-1,
Vyana avruta Prana-1,
Vyana avruta Samana-1,
Vyana avruta Apana-1,
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 44
Disease Review
Udana avruta Prana-1,
Udana avruta Apana-1,
Udana avruta Samana-1,
Udana avruta Vyana-1,
Samana avruta Prana-1,
Samana avruta Apana-1,
Samana avruta Udana-1,
Samana avruta Vyana-1,
Apana avruta Prana-1,
Apana avruta Samana-1,
Apana avruta Udana-1,
Apana avruta Vyana-1,
Prana avruta Samana-1,
Prana avruta Apana-1,
Prana avruta Udana-1 &
Prana avruta Vyana-1.
Mishra Avarana:
In this, two or more factors are involved in the pathogenesis of Avarana, here
variation and combinations of Pitta and Kapha and sub-type of Vata resulting in
innumerable numbers of Pathologies of Avarana137,138.
Avarana and Sama Dosha:
Sama state of Dosha and Dushya is very important to produce Margavarana in the
srotas and avayava. The sama Dosha or Mala is capable of producing srotosanga, which
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 45
Disease Review
in turn obstruct the Gati of Vata. In this way, Ama may also help in producing the
Avarana of Dosha and Dushya etc. indirectly.
Avarana-As atypical Clinical presentation:
The symptom complex produced by Avarana is always an analytic challenge. To
identify the accurate cause and pathogenesis of Avarana requires a special diagnostic
skills and expertise. Some time it misleads the physician because of its complex atypical
presentation.
Acharya Charaka alarms about its atypical presentation by mentioning that vata
obstructed by Meda and Kapha produced pain (shula), Numbness (supti) and Oedema
(shvayathu)
The Physician ignorant of the condition of Avarana, thinking that vata prakopa is
there, may prescribe unctuous enema, which may further decline the conditions139. All
these references indicate towards its atypical presentation, which may lead to diagnostic
error resulting in mismanagement too.
Diagnostic Method of pathologies of Vata:
Kshaya, Vriddhi and Gatatva condition of Vata can be diagnosed easily with the
help of symptomatology’s mentioned in the text.
The Avarana requires a special diagnosis between the conditions of Kevala Vata,
Samsarga Vata and Avruta Vata. The diagnosis can be made based on their symptoms
and by applying reasoning.
Some times it may not be possible to diagnose the Avarana and Anyonya-Avarana
straightforwardly and in that case it can be diagnosed with the help of the exclusion
methods with proper reasoning on the basis of its altered physiology 140.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 46
Disease Review
Diagnosis of Avarana
Some times it is very hard to analyze that condition of Avarana so it requires
repeated clinical examination and frequent administration of Upashaya before getting to
proper clinical diagnosis141.
For example madhumeha is described in two types in Charaka Samhita. Among
which one type is due to Vata avaruta by Kapha, Pitta, Medas and Mamsa142. and another
type is due to Dhatukshaya or Shuddha Vata143.
The etiological factors described in the sutra sthana are of Avaraka i.e of Kapha,
Pitta etc. and in the nidana sthana is due to dhatu kshayajanya. The descriptions of
etiological factors of both these varieties are:
A) Etiological factors of Madhumeha due to Avarana:
By taking excess heavy, unctuous, sour, and salty articles; by using new cereals
and drinks, by over indulgence in sleep, sedentary habits, by not undergoing seasonal
purification, the Kapha, Pitta, Meda and Mamsa increases excessively leading to
Madhumeha144.
B) Etiological factors of Madhumeha due to Kevala Vata:
The habitual use of astringent, pungent, bitter, dry, light and cold articles; over
indulgence in sexual act, exercise, emesis, purgation, enema and errhines; suppression of
natural urges, fasting, trauma, sun-heat, worry, grief, depletion of blood, waking in the
night and unwholesome postures of the body, lead to immediate provocation of vata145.
Finally, the Madhumeha is same but fashioned by different nidanas.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 47
Nidana
Nidana
Nidana (etiological factor) is defined as a cause of the disease. Lacking of
nidana, disease can not be manifested. In Ayurvedic as well as Modern texts, the
exact cause for Pittavruta udana w.s.r.t. ETH is not explained. The samanya
prakopaka karana are given below:
Table2: Showing samanya prakopaka karanas Factors Vata Pitta Rakta
Rasa Katu, Tikta and
Kashaya146.
Katu, Amla, and
Lavana147.
Lavana, Amala,
Katu and Kshara148.
Guna Ruksha, Laghu, Sheeta,
Khara, Sukshma, Daruna
and Chala149.
Ushna, Teekshna,
Laghu, Vidahi, and
Kshara150.
Drava, Snigdha &
Guru161.
Aharaja Pulses like Uddalaka,
Masha, Adaki, Kalaya,
Nishpava and Harenu.
Dried leafy vegetables,
Vallura, millets like
Varaka, Koradusha,
Syamaka and Neevara.
Peenyaka, Atasi,
Kulatha, Sarshapa,
Greenleafy vegetables
like Harenuka, the
flesh of Godha, fish or
goat, curds, whey,
buttermilk and sura.
Dushita, adhika,
atiteekshna,
atiushna, Madira
sevana, Kulatha,
Masha, Nishpava,
Pindalu, Moolaka,
Dadhi, Kanji, Sura,
Mastu, Saktu and
Souveera.
Table3: Showing possible reason for the manifestation of disease
Nidana Possible reasons
Excess amala rasa Pittakarka, agni vardhaka and rakta dushtikara. Produces daha,
shotha and other Pitta vikaras152.
Excess lavana rasa Causes Pitta prakopa, Rakta dushti, Vidaha, moorcha, santapa,
trishanakarka, indriya glani, vivarnta and other Pittaja &
Raktaja vikaras153.
Excess katu rasa It is vata and agni guna bahulya and pittakaraka. Produces
avasada, moorcha, bhrama, tama, santapa, trishana, daha, bala
kshaya, kampa, toda, bhedavat vedana and vata vikaras154.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 48
Nidana
Nidana Possible reasons
Excess tikta rasa It produces shira shoola, bhrama, toda, bheda, moha, vata
vikaras and causes bala kshaya155.
Excess kashaya rasa Causes hrudaya vedana, rasavahi srotas avarodha, trishna,
stambhata, akunchana, akshepaka, tingling sensation,
convulsions and is khara, vishada, rooksha guna pradhana156.
Excess Teekshna
guna ahara
It is agni mahaboota pradhanya and pittakara, it produces daha,
paka, etc. and it results in bala ksheenata157.
Excess Ushana guna
ahara
It is pitta vardhaka, agni guna pradhana and sweda pravartaka.
It produces daha, paka, moorcha, trishana etc158.
Excess Laghu ahara It is vata vardhaka and agni vardhaka159.
Excess Drava ahara It is pitta vardhaka160.
Excess Rooksha
guna ahara
It is vata vardhaka and agni vardhaka. It produces moorcha,
bhrama etc161.
Excess Snehayukta
ahara
It is pitta and kapha vardhaka162.
Atimatrahara Leads to ama dosha163, causes durvipaka.
Viruddha ahara This ahara cause tejo, bala, smruti, indriyan, chitta nasha and
causes mrityu just like visha164. According to Acharya Charka,
it acts like “visha” and can cause moorcha, napunsakata etc.
Such ahara could cause mrityu165.
Tila sevana The properties of tila taila are Ushna veerya, Madhura, Tikta,
Kashaya, Katu rasa. It is Raktapitta karaka, vata kapha hara.
With excessive intake, Pitta vardhana166.
Kshara Kshara possesses the following qualities: ushana,
teekshana,laghu and pitta vardhaka167.
Mamsa Hamsa, Kukkuta, Mahisha Tittira, mamsa and matsaya are
Ushna and Kaphapittakaraka. Shushka mamsa is Kashaya,
Amla rasa Katu vipaka, Ruksha, Sheeta168.
Sarshapa Guru, Ushna, Sarvadoshakrit, Baddha vinmootram169.
Madya pana Madya is Amla Rasa, Katu in vipaka, has Teekshna, Vidahi
guna and Ushna virya170.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 49
Nidana
The some expected nidanas are:
Adhyashana, Ajeerna, Anashana, Kulatha, Vidahi ahara, Vishma ahara, Vega
dharana, Krodha, Chinta, Bhaya, Samprahara, Udvega, Kshobha, Deenata, Ati
maithuna, Shoka, Ati vyayama, Kriya atiyoga, Atapasevana etc.
Dosha prakopa Karana:
Pitta prakopka nidana: Katu, teekshana, ushana, Krodha and vidahi anna171.
Udanavata Prakopa Karanas: Kshavathu, udgara, chardi, nidra vegadharana, guru
ahara, bhara vahana, ati rodana, ati hasya172 etc.
Srotodusti Karanas:
Rasa vaha Srotodusti Karanas: Guru, sheeta, atisnigdha, atimatra bhojana, adhika
chinta173 etc.
Rakta vaha Srotodusti Karanas: Vidahiannapanani, ushna, snigdha, drava ahara,
adhika atapa and vata sevana174 etc.
Manovaha Srotodusti Karanas: Krodha, shoka, bhaya, harsha, kama, lobha, moha,
chinta, ayasa, udvega and aghata175 etc.
Margavarodha:
The site or sthana of margavarodha176 could be anywhere in the body. For
instance, stenosis of one or both of the renal arteries can cause hypertension and so
also the coarctation of the aorta. Examples of margavarodha are many; including, the
pheochromocytoma (the chromaffin tissue tumours of the adrenal medulla),
atherosclerosis, other endocrine tumours, Glomerulonephritis, pylonephritis etc., Any
kind of obstruction anywhere in the body affecting the flow of nutrients (Rasavaha
srotas) results in "Hypertension" as one of the manifestations.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 50
Nidana
Etiology:
In 90–95% of hypertension cases, the etiological factors that are responsible
for the blood pressure increase remain unknown177i.e. the cause of disease is not
known; however in recent years, experimental, epidemiological and therapeutic
evidence seems to indicate that essential hypertension is due to one or combination of
etiological factors. The probable factors which are responsible for the development of
essential hypertension are:-
1) Genetic Factors:
The role of heredity in the etiology of essential hypertension has long been
suspected. The evidences in support are the familial aggregation, occurrence of
hypertension in twins, epidemiologic data, experimental animal studies and
identification of susceptibility gene (angiotensinogen gene).
Acharya Charaka while describing the genetic influence in disease says, at the
time of conception, if the beeja (shukra or ovum), beeja bhaga (chromosome) or beeja
bhaga avayava (genes) get vitiated, It is likely to travel in subsequent generations178.
Dalhana has also commented that beeja dushti does not mean whole dushti, but
there may be a dushti of a part of beeja, that is the organ developing from that
particular part are also defective or abnormal179.
Acharya Sushruta, while classifying the diseases, has mentioned adibala pravrutta
vyadhi and is said to originate due to deformity of raja or veerya of the parents at the
time of conception180.
2) Racial and Environmental Factors:
Surveys in the US have revealed higher incidence of essential hypertension in
blacks than in whites. But in rural Africa hypertension is relatively rare, suggesting
that the high prevalence in the US is not because of the genetic tendency, rather, it
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 51
Nidana
might be due to adaptation of western life style by American blacks181. There is a lot
of controversy in the environmental factors. One of the evidence showing that, the
environment in which a person lives affects his blood pressure.
Figure-4: Showing the Environmental factors and Cardiovascular events182
3) Salt Intake:
For a long time salt is suspected, to have an etiological influence on the blood
pressure. It is also known that only an increased salt content of diet intake alone will
not lead to high blood pressure. Invariably there are some predisposing factors like
heredity or renal diseases. In such patients alone increased intake of salt more then 10
grams per day leads to renal retention of salt and water, which in turn increases the
plasma and extravascular fluid volume.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 52
Nidana
Ultimately peripheral resistance increases, which leads to increase blood
pressure. Excessive use of Lavana causes rakta dushti and leads to shonitaja roga183.
since rakta dhatu is one of the important dushya in the etiopathogenesis of
hypertension, it is given more importance. Therefore salt should not be consumed in
excess and for longer duration184. When excessively used, it produces fatigue and
weakness of the body185, which are the symptoms usually found in patients of
hypertension.
4) Obesity:
There is a strong link between excess body fat, blood pressure levels and
prevalence of hypertension. As obesity contributes to blood lipid abnormalities and
impaired glucose tolerance. Acharya Sushruta has mentioned medoroga leads to vata
vikara186.
Figure-5: Showing Obesity and Sodium sensitivity in Hypertension187
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 53
Nidana
5) Stress:
The stressful stimuli certainly raise blood pressure and may be more
argumentative in subjects who have familial hypertension. Sustained or repeated
emotional stress (anger, frustration, envy, hatred, fear and worry) causes arteriolar
contraction through an outpouring of nor-epinephrine from the sympathetic
vasomotor nerve endings and epinephrine from the adrenal medulla. In some persons,
the blood pressure increases due to the presence of a doctor (white coat hypertension).
This is possibly due to the temporary emotional stress.
Raja and tama are the doshas pertaining to the mind and the types of morbidity
caused by them are kama, krodha, lobha, mada, bhaya etc188. Acharya Charaka has
advised to suppress these factors189, because they tend to elevate raja and tama gunas
which cause manodusti resulting in manovikara with involvement of samjnavaha or
manovaha srotas190.
Further, Chakrapani commenting on srotomula says, hridaya and
dashadhamani are the manovaha srotomula191. In this way the arteries of the heart
may get afflicted by these manovikara and therefore they also afflict oja which is also
ashirta of hridaya192,and vitiation of Vata193 and Pitta also takes place.
Hence it may be concluded that all the psychological factors directly provoke
Vata and Pitta which can produce hypertensive state.
6) Meals:
After meals the blood pressure is little higher.
7) Emotion:
Anger and fear raise the blood pressure. However, there may be fainting
attacks.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 54
Nidana
8) Sleep:
Sleep causes a fall of blood pressure. However, sleep associated with
frightening dreams may cause rise of blood pressure.
9) Exposure to cold:
It causes rise of blood pressure. This is due to hypothalamic stimulation.
There is cutaneous vasoconstriction leading to increased resistance to the blood flow
and elevation of blood pressure (cutaneous vasoconstriction causes conservation of
heat within the body).
10) Geographic factors:
Several studies have shown that high altitude residents have lower blood
pressure. Possible constituting factors include -
Lower peripheral resistance due to increased capillarisation of tissues.
Hypoxia causing reduced thyroid activity and
Primitive conditions.
11) Physical activity:
Several population studies have suggested that individuals who undertake
regular physical exercise have lower blood pressures.
Regarding exercises, dynamic exercise raises blood pressure and isometric
exercise raises it a lot more. Despite this, there is good evidence that people who take
regular exercises are healthier and have lower blood pressures than those who take
none.In Ayurveda idle sitting is told to be one of the astamaha doshakarabhava194.
12) Other Trace Metals:
More hypertension has been seen in association with long-term exposure to
arsenic and carbon disulfide. Long-term exposure to even low levels of lead may lead
to hypertension, perhaps by increased production of reactive oxygen species beyond
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 55
Nidana
the probability that increased intracellular calcium is involved in the pathogenesis of
hypertension195. The following findings usually are noted in uncomplicated, untreated
primary hypertension:
Lower dietary intake of calcium
Increased urinary calcium excretion, which is likely the reason for an
increased incidence of kidney stones.
Lower plasma ionized calcium levels.
Increased levels of parathyroid hormone in some, likely related to reduced
intake of calcium. Parathyroid hormone levels are even higher in Blacks than
Whites and are potentially able to raise BP.
Intake of more sodium leads directly to an increase in calcium excretion.
13) Socio-economic status:
A very large study in Mumbai found no difference between high and low
socio-economic groups. So higher or lower socio-economic status does not have
significant effect on blood pressure.
14) Age:
Older people tend to have higher blood pressure than young people. Almost
all surveys show that blood pressure rises with age in both men and women. Due to
the thickening of vessel wall, an increase in sub-endothelial layer and the media,
which increase collagen content and elastic fragmentation. In Vriddhavasta vata is
predominant and in Youvana avastha Pitta is predominant196.
15) Sex:
Though Hypertension affected both sexes, the incidence is slightly lower in
the female up to 40 years. However after that females are more prone to
Hypertension.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 56
Nidana
16) Smoking:
The nicotine in cigarette smoke acutely raises blood pressure(BP), even in
addicted smokers. No tolerance develops, so the BP remains high as long as the
patient continues to smoke. However, the effect of each cigarette is transient and is
over within 30 minutes; if the BP is taken in a smoke-free environment, as in most
physicians' offices and clinics, the pressure effect may be missed. Cigars, if inhaled,
and smokeless tobacco also raise BP, but nicotine replacement therapies do not appear
to do so. Cross-sectional data on smokers and nonsmokers are not consistent: Some
studies find smokers to have a higher BP, whereas others find smokers to have a
lower BP. Regardless, all who smoke should be strongly advised to quit. Smoking is
associated with insulin resistance and an attenuation of endothelium-dependent
relaxation. These multiple adverse effects obviously add to the major cardiovascular
damage induced by smoking197.
17) Caffeine:
Acutely, consumption of the caffeine contained in 3 cups of coffee will raise
BP an average of 4/3 mm Hg. Some develop tolerance to this effect and only an
average 2.4/1.2 mm Hg higher pressure has been noted in those who drink 5 cups or
more of coffee per day compared to nondrinkers. In contrast, increasing caffeine
intake, ascertained by multiple careful dietary recalls, was associated with lower BP
among the participants in the Multiple Risk Factor Intervention Trial. Three cups of
black tea raised the BP even more than seen with 3 cups of coffee, but the pressure
effect was prevented when the tea was accompanied with food198.
18) Alcohol:
The possible role of alcohol, in amounts consumed by a large part of the
overall population, needs special emphasis. In contrast to its immediate vasodepressor
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 57
Nidana
effect, chronic consumption, even of only moderate quantities, may raise the BP; in
larger quantities, alcohol may be responsible for a significant amount of
hypertension199.
In madatyaya chapter, Acharya Charaka has explained that, when madya is
taken in large quantity, it shall affect channels of rasa (rasavaha srotas) and by
entering hridaya it affect the dhatus situated in hridaya (rasa, oja, rakta). The gunas of
alcohol like ushna, teekshna, sukshma, vyavayi etc. are exactly opposite to the gunas
of oja200, which also provoke vata-pitta dosha.
Acharya Charaka has also described pradusta, bahu (excessive), ushna,
teekshna madyapana and surapana as causative factors of shonita dusti201. Further, it
is the shelter to moha, krodha, shoka and mrityu202.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 58
Poorvaroopa
Poorvaroopa
The Purvaroopa manifests in the Sthana Samshraya stage of Shatkriya kala.
Charaka has quoted that avyakta lakshanas of vata vyadhi are to be taken as its
Poorvaroopa203.
Commentator Vijayarakshita explains the term Avyakta as the symptoms
which are not manifested clearly204.
Hence Mild exhibition of actual features of the disease Pittavruta udana prior
to the manifestation of Pittavruta udana may be taken as purvaroopa.
According to most of the 20th century authors and with the available references
we can compare essential hypertension to that of Avruta Vata. Since the poorvarupa
of Vata vyadhi are avyakta, the poorvarupa of Hypertension are also avyakta. In
modern science also prodromal symptoms have not been explained.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
59
Roopa
Roopa
A disease is produced on the completion of dosha dushya sammurchana.
Signs and symptoms of the fully manifested disease indicating the specific
characteristics of the disease (in the vyaktavastha) are called roopa. These become
evident in the fifth stage of kriyakala i.e. vyaktavastha.
Pittavruta udana:
The Pittavaruta udana having symptoms Bhrama, Klama, Moorcha, Daha.
Acharya Sushruta205 and others206, 207, 208 opine the same while Acharya Charaka209
added ojobhramsha and avasada to the above symptoms. Shira shoola added to above
according to contemporary texts.
Table-4: Showing the lakshana and Dosha involvement
Lakshana Dosha involvements
Acc. to Acharya Susruta, Bhavaprakasha, Gadanigraha and Madhava Nidana
Klama Fatigueness, languor, it is due to Rakta210, 211.
Daha Burning, conflagration. It is due to Pitta and Rakta212, 213, 214.
Bhrama Confuse, perplex, giddiness. It is due to Vata and Pitta215, 216, 217.
Moorcha Fainting, delusion, swooning. It is due to Pitta218, 219.
Acharya Charka some more added in the above symptoms
Daha in nabhi
and uras
Burning sensation in nabhi and uras. It is due to Pitta220, 221, 222.
Avasada Fainting, exhaustion. It is due to Vata223, 224.
Ojobharamsha Bhramsha means decline, losing, falling down225.
According to contemporary text books explanation with Ayurveda
Shiroshoola. Headache. It is due to Vata and Rakta226, 227, 228, 229.
According to contemporary texts:
A large number of hypertensives in the early stages have no symptom i.e., why
it is called as the silent killer230. Most patients with hypertension have specific
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 60
Roopa
symptoms referable to their blood pressure elevation and are identified only in the
course of a physical examination231.
Mild to moderate essential hypertension is usually associated with normal
health and well being for many years. So essential hypertension may be-
• Asymptomatic or
• Symptomatic.
The first and foremost symptom of essential hypertension is headache later the
other symptoms like dizziness, easy fatigability, insomnia, chest pain, and palpitation
can be seen232, 233.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 61
Samprapti
Samprapti
The whole sequence of manifestation of disease starting from the causative
factors, dosha dushti till the appearance of lakshanas is known as Samprapti234.
Direct reference regarding the samprapti of Pittavruta udana is not
available in the classics. Hence to understand the samprapti of Pittavruta Udana,
the general samprapti of avarana can be considered.
By observing the lakshanas of Pittavruta udana, the doshas and dooshyas
involved in the samprapti to cause this condition can be assessed as follows.
Figure-6: Showing Samprapti chart of Pittavruta udana
Pitta prakopaka Nidana
Pitta prakopa
Vata prakopaka Nidana
Vata Prakopa
Vata Avarana
Avarodha of UdanaVata by Pitta
Nidana Nidana
Pittavruta udana
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
62
Samprapti
Samprapti:
The Pittavruta udana comes under Vata vyadhi chapter. If Pitta Vitiated
and then obstruct the Udana vata comes under samanyaja vyadhi. Hence in the
samprapti of Pittavruta udana, Vata and Pitta vitiates by their own nidanas and
then vitiated Vata comes in contact with vitiated Pitta which causes more Pitta
vikruti, resulting in the obstruction of Udana vata leading to the Pittavruta udana.
Samprapti-Ghatakas:-
Doshas: Vata (Udana) – Shirashoola and bhrama235,236.
Pitta (anubandi) – Daha, bhrama and moorcha237, 238, 239.
Dushyas: Rakta – daha, klama and Shira shoola240.
Agni: Jatharagni.
Srotas: Rasavaha, Raktavaha & Manovaha.
Srotodushti-Prakara: Sanga type of srotodusti.
UdbhavaSthana: Pakvashaya-Amashaya Samudbhava.
Avayava: Hridaya, Dhamani.
Adhisthana: Manodaihika (Psychosomatic, Sira, Dhamani, Srotas).
Sanchara-sthana: Sarva Sharira.
Rogamarga: Madhyama Rogamarga.
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Upshaya and Anupshaya
Upshaya and Anupshaya
For Vata dosha:
Upashaya of Avruta Vata is not at hand; on the contrary, Upshaya of Avaraka
is present.
For Example in Pittavruta vata, the patient gets Vidaha from the Upshaya of
Vata i.e, Amla, Lavana and Ushna. In Kaphavruta Vata there is Upashaya from Katu
etc and patient shows desire for Fast, Exercise, Ruksha etc. things which are Upshaya
for Kapha and Anupshaya for Vata241.
For Pitta dosha:
In Pittavruta vata, patient feels Daha, Trishana, Shoola, Bhrama, Tama and
gets Vidaha from Amla, Lavana, Katu and Ushna veerya dravyas. On the other hand,
the patient shows the desire for cold (sheeta) things, which is Upashaya for Pitta242.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
64
Vyavachedaka Nidana
Vyavachedaka Nidana
Vyavachedhaka Nidana or differential diagnosis plays a prime role in arriving
at an exact decision between diseases presenting a similar clinical feature. While
making the diagnosis of Pittavruta vata the following disorders that are having similar
features has to be excluded.
Table-5: Showing the Vyavachedaka nidana of Pittavruta Udana
Sl.
No
Laxanas Pittavruta
Udana243
Pittavruta
Vyana244
Pittavruta
Prana245
Pittavruta
Samana246
1. Klama + + - -
2. Bhrama + - + -
3. Daha + + + +
4. Moorcha + - + +
5. Avasada + - - -
6. Ojobhramsha + - - -
5. Gatravikshepana - + - -
6. Santapa - + - -
7. Vedana - + + -
8. Vidaha - - + -
9. Chardana - - + -
10. Aruchi - - - +
11. Atisweda - - - +
12. Agni upaghata - - - +
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
65
Vyavachedaka Nidana
In modern science essential hypertension should be differentiated from
secondary hypertension given below:
Table-6: Showing the Vyavachedaka nidana of Hypertension Factors Essential Hypertension Secondary Hypertension Incidence 95% 5% Etiology Unknown etiology Known etiology Pathology Pathogenesis is not clearly
understood. Pathogenesis depends on the disease that has caused hypertension.
Blood Pressure Recording
A rise in diastolic pressure when the patient goes from the supine to the standing position is most compatible with essential hypertension.
A fall in the absence of antihypertensive medication with the treatment of the cause, suggest secondary forms of hypertension.
Symptoms Symptomatic or asymptomatic. If symptomatic, vague symptoms like headache, dizziness, easy fatigability etc., will be present.
Symptoms will be present with the underlying disease.
Investigations Sr. creatinine, Blood urea, Lipid profile, fasting blood sugar, ECG and chest X-ray. ECG and chest X-ray will be normal.
Depending on the basic disease, the values of these laboratory investigations, ECG and chest X-ray varies. Some other investigations are needed to rule out the secondary hypertension.
Prognosis It is controllable with proper treatment. It requires life long monitoring and treatment may require periodic adjustments.
It is curable. When cause is treated, the elevated blood pressure comes down to normal.
Treatment Treatment comprises of Drug and Non Drug therapy
Treatment depends on the cause and requires drug therapy during severe condition.
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Sadhyasadhyata
Prognosis of Avarana
In Dosha Avarana, the Avarana of Prana and Udana by Pitta and Kapha
are more severe and difficult to treat (Gurutaram) because of their vital function in
the body physiology i.e. to provide life (Jivana-Ayu) and strength (Bala).
Among the Dhatu avarana conditions, Medavruta Vata is comparatively
more difficult to treat due to its complications and poor therapeutic
response247,248,249,250.
In Anyonya Avarana conditions Udanavruta prana, the condition of
occlusion of Prana by Udana leads to loss of all sensory and motor functions
(Karma Kshaya), loss of vital essence (Oja Kshaya), loss of strength (Bala,
kshaya) and complexion, and it may result even in death of the patient251. So
depending on the type of Avarana and Avaraka prognosis of the Avarana
pathology varies.
Similarly if the condition persists for one year, its management is delayed
or improper, then it may land up in difficult to cure or incurable state. So early
diagnosis and timely management make the prognosis good252.
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Upadrava
Upadrava
Improper diagnosis and delayed treatment of different Avarana conditions or
of one year chronicity lead to complications like Hridroga (heart disease) due to
Pranavruta udana vata, udavarta, Gulma (Localized enlargement of abdomen) due to
Vyanavruta apana253. There are many conditions like Sthaulya, Prameha, Urustambha,
which occur through the pathogenesis of Avarana. Additionally, Dalhana mentions
that in sthaulya and many other types of Vata vikara may occur as complications due
to avarana type of pathology. For example, Medavruta vata in which meda obstructs
the Gati of Vata leads to the vitiation of Vata resulting in different Vata disorders254.
In this way, it can be stated that Avarana may occur as independent disease as
well as part of the pathogenesis of certain diseases. It may also help in understanding
the pathogenesis of many conditions described in modern medicine as well as to
decide their management on Ayurvedic lines. Further it has been mentioned that there
may be innumerable Avarana disorders255. It means the few conditions of Avarana
mentioned in the texts are just for example and by involving different sites other
specific condition of Vata may be produced. For instance, the Pittavruta and
Kaphavruta incident occurs in different organs like stomach, head, heart256 etc.
resulting in the symptomatology pertaining to that particular organ. In this way by
considering the findings of the modern medicine the diseases like cerebral thrombosis
and embolism leading to hemiplegia, coronary thrombosis and embolism leading to
myocardial infraction etc can be interpreted by the Avarana pathology of Ayurveda
and accordingly their management may also be evolved purely based on Ayurvedic
principles. Acharya Charaka has mentioned the use of Rasayana drugs particularly
Shilajatu and Guggulu in the management of Avarana257. So the globe of indications
of these drugs may be widened to treat such conditions.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 68
Hypertension
Essential hypertension
A large number of hypertensive in the early stages have no symptoms often
with high blood pressure is detected on a routine check up and physical
examination258, 259.
Hypertension is a major risk factor for the development of cardiovascular
disease260.
Definition of Essential Hypertension
Varieties of factors are responsible for Blood Pressure261. These factors are
interconnected with each other and difficult to find out the particular causes for
hypertension. Thus, when a specific cause of Hypertension can not be identified, then
the hypertension is called as essential hypertension262.
In more than 95% of cases, a specific underlying cause of hypertension cannot
be found such patients are said to have essential hypertension263. Hypertension is said
to be an essential when the cause is unknown264.
Blood pressure is the pressure exerted by the blood on the walls of blood
vessels. Persistent high arterial blood pressure without a known cause is essential
hypertension, when the elevation of systolic blood pressure is more than 140 mm Hg
and diastolic blood pressure is above 90 mm Hg upon repeated
sphygmomanometric265, 266.
Till now the cause of majority of types of hypertension is not known. All the
anti hypertensive drugs reduce the blood pressure without correcting the cause.
Unfortunately there was no clinical or laboratory tests which can give an
affirmative diagnosis of essential hypertension. However, essential hypertension is a
clinical entity in itself, though its pathogenesis is not known.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
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Hypertension
Even though hypertension is usually asymptomatic for the first 10-20 yrs, it
slowly but surely strains the heart and damages the arteries. For this reason
hypertension is often called as silent killer267.
The difficulty in studying a disease process such as hypertension begins with
the fact that the etiology of hypertension is heterogeneous. Hypertension can be
primary or secondary to a defined process, such as renal artery stenosis268.
According to 7th Report of the Joint National Committee, the “normal” or
“high normal” blood pressure is called as “prehypertension which differs from
European Society of Hypertension/European Society of Cardiology. The definitions
of hypertension proposed by the 2003 European Guidelines and the 7th Report of the
Joint National Committee incorporate aspects of disease characterization that are not
previously defined. One is the classification of patients into different categories at
blood pressure values, 140/90 mmHg, which is based on the continuous relationship
to cardiovascular risk in the normotensive range269.
Classification
The sign and symptoms of Essential Hypertension are not explained separately
in our classics. But According to modern medicine Hypertension can be classified in
number of ways i.e.
A. Systolic and Diastolic Hypertension.
B. Essential or Primary and Secondary Hypertension.
C. Accelerated and Malignant Hypertension.
D. On the basis of Severity.
A. Systolic and Diastolic Hypertension
Since the mid-1920s, a relationship has been known to exist between diastolic
and systolic blood pressures and life expectancy. Highly elevated blood pressure was
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
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Hypertension
called malignant hypertension because 79% of affected individuals died within 1 year
of this diagnosis. From the 1920s until the 1980s, the risks of coronary heart disease
and stroke have been attributed predominantly to elevated diastolic blood pressure.
Diastolic blood pressure would be a better predictor of cardiovascular risk270.
Systolic hypertension
a) Increased cardiac output
• Aortic valvular insufficiency
• Atrioventricular fistula, patent ductus arteriosus
• Thyrotoxicosis
• Paget’s disease of bone
• Beriberi
• Hyperkinetic circulation
b) Rigidity of aorta or small arteries271.
B. Essential and Secondary Hypertension
Essential Hypertension is said in which the cause of increases in blood
pressure is unknown272.
Secondary Hypertension is said in which the increase in blood pressure is
caused by disease of the kidney, endocrine gland, central nervous system, aorta or
some other organs273.
A. Primary, essential or idiopathic:
B. Secondary:-
Renal :
a) Renal parenchymal disease:
• Acute glomerulonephritis
• Chronic nephritis
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
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Hypertension
• Polycystic disease
• Diabetic nephropathy
• Hydronephrosis
b) Renovascular
• Renal artery stenosis
• Intrarenal vasculitis
c) Renin-producing tumors
d) Renoprival
e) Primary sodium retention (Liddle’s syndrome, Gordon’s syndrome)
Endocrine :
a) Acromegaly
b) Hypothyroidism
c) Hyperthyroidism
d) Hypercalcemia (hyperparathyroidism)
e) Adrenal
i. Cortical
Cushing’s syndrome
Primary aldosteronism
Congenital adrenal hyperplasia
Apparent mineralocorticoid excess (licorice)
ii. Medullary pheochromocytoma
f ) Extra-adrenal chromaffin tumors
g) Carcinoid
h) Exogenous hormones
Estrogen
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Hypertension
Glucocorticoids
Mineralocorticoids
Sympathomimetics
Tyramine-containing foods and monoamine oxidase inhibitors
Coarctation of the aorta
Pregnancy-induced hypertension
Sleep apnea
Neurologic disorders
a) Increased intracranial pressure
Brain tumor
Encephalitis
Respiratory acidosis
b) Quadriplegia
c) Acute porphyria
d) Familial dysautonomia
e) Lead poisoning
f) Guillain–Barre´ syndrome
Acute stress, including surgery
a) Psychogenic hyperventilation
b) Hypoglycemia
c) Burns
d) Pancreatitis
e) Alcohol withdrawal
f) Sickle cell crisis
g) Postresuscitation
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Hypertension
h) Postoperative
Increased intravascular volume
Alcohol274
Drug use eg. Oral contraceptives containing oestrogens, anabolic steroids,
carbenoxolone, corticosteroids, sympathomimetic agents, NSAIDs275 etc.
C. Accelerated and Malignant Hypertension
These forms of Hypertension have become less common with the widespread use
of antihypertensive therapy. It represents a sudden acceleration in the vascular disease
associated with essential hypertension276.
D. Based on Severity
A commonly accepted classification would be the one adopted from “The Sixth
Report of the Joint National Committee on Detection, Evaluation, and the Treatment
of High Blood Pressure (JNC-VI)” Archives of Internal Medicine 1572413-2446,
1997.
Table-7: Showing the classification of blood pressure277
Classification Systolic (mm Hg) Diastolic (mm Hg)
Optimal* <120 <80
Normal <130 <85
High normal 130-139 85-89
HYPERTENSION**
Stage I. HTN (Mild) 140-159 90-99
Stage II. HTN (Moderate) 160-179 100-109
Stage III. HTN (Severe) ≥180 ≥ 110
Stage IV. HTN (Very Severe) >210 >120
JNC of WHO/International society of HTN (ISH).
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Hypertension
*Optimal BP with respect cardiovascular risk is <120/80 mm of Hg. However,
unusually low reading should be evaluated for clinical significance.
**Based on the average of > 2 readings taken at each of two or more visits
after an initial screening.
Hypertension in some other forms:
Borderline Hypertension:
If the SBP is more than 140 mm of Hg and DBP is above 90 mm of hg278.
Isolated Systolic Hypertension:
The systolic B.P is 160mm Hg and above, and fluctuates from time to time, high
in the morning and low at night279.
Benign Hypertension:
Is moderate elevation of B.P, and the rise is slow over the years280.
Malignant Hypertension:
The marked and rapid increase of blood pressure to 200/140 mm of Hg or
more, the complications like papilledema, retinal exudates, haemorrhage281 are seen.
White coat Hypertension:
White coat hypertension is the most commonly used term to describe patients
whose blood pressure is high only in a medical setting. The concept of White coat
hypertension has been widely adopted in the lay press as well as professional
publications. White coat hypertension should be distinguished from the white coat
effect, which is a measure of the pressure response to the clinic visit and is generally
defined as the difference between the average clinic blood pressure and the daytime
ambulatory blood pressure. The white coat effect is present to a greater or lesser
degree in most hypertensive patients and is greatest in patients with the highest clinic
pressures282. The causes of Secondary hypertension are as follows:-
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
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Hypertension
Table-8: Showing the classification of secondary hypertension
Renal endocrinal Cardiovascular Miscellaneous
Glomerulonephritis
Pyelonephritis
Pregnancy
gs: Dru
Polycystic kidney Oral
Contraceptives
Diabetic Nephropathy Liquorice
Rini Produceing
Tumour
Cortico Steroids
Renal Artery Stenosis
Adrenal Cortex
Cushing Syndrome
Hyper Aldosteronism
ADERNAL
MEDULLA
Pheorochromocytoma
Coarctation of
Aorta
Amphetamines
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Blood Pressure Measurement
Blood pressure measurement
The blood pressure should be taken lying, sitting and standing positions and
can be recorded directly or indirectly. There are three common devices used for the
indirect recording of blood pressure –
Sphygmomanometers, either mercury column or aneroid
Electronic devices
Automated ambulatory blood pressure devices
On the other hand, mercury Sphygmomanometer remains the gold standard for
recording
Indirect Blood Pressure Measurement:
Indirect blood pressure measurement is safe, painless, and provides reliable
information when performed accurately. These guidelines based on BP’s, obtained by
American Heart Association (AHA) standardized indirect measurement method.
Health professionals base crucial clinical decisions on these measurements;
therefore, the proven benefits of treating high BP can be completed only when BP
measurement is taken accurately. The accurate BP measurement requires the ability to
hear, interpret, record Korotkoff sounds and operate the equipment properly.
Selecting the Blood Pressure Measurement Equipment:
The manometer is mercury or an aneroid instrument calibrated to the nearest 2
mm Hg. The mercury manometer’s reading is at the top edge (the meniscus) of the
mercury column. It is the most accurate measurement device available.
The aneroid manometer consists of a metal bellows that expands as the
pressure in the cuff increases and its reading is at the point indicated by a needle on its
dial. The accuracy of the mercury manometer is assessed by noting whether the
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 77
Blood Pressure Measurement
mercury meniscus rests at zero. Users cannot be certain that it is accurate even when
the needle is positioned at zero.
The use of automated devices is discouraged in most clinical settings because
they are often difficult to calibrate, fail to give accurate readings on many individuals,
and do not eliminate human error.
Steps Needed to Obtain Accurate and Reliable Readings283:
Step 1: Environment:
The setting should be private and quiet, with a comfortable room temperature.
To get the best estimate of the patient's usual BP, environmental factors that may
cause BP variation or interfere with hearing Korotkoff sounds must be controlled.
The manometer must be positioned so the observer can view it at eye level.
Viewing the manometer above or below the observer's eye, level results in inaccurate
readings. The room should have a straight-backed chair to seat the patient next to a
table or desk with feet flat on the floor.
A seat for the BP observer should be provided along with an adjustable
surface to support the arm at heart level during standing measurements. The height of
the table should be such that the midpoint of the cuff is in place on the patient's right
arm (or the arm that is known to produce the higher BP reading) and is supported at
heart level.
It is important to avoid errors induced by differences in hydrostatic pressure
between the point of artery compression by the cuff and the heart.
If the center of the cuff on the arm or leg is above the heart level, the reading
will be falsely low by 0.8 mm Hg for each 1 cm above the heart level. If below heart
level, it will be falsely high by a similar amount. Supporting the back in the seated
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 78
Blood Pressure Measurement
position and the arm in any position avoids increases in BP due to isometric muscle
contraction.
Step 2: Preparation and rest period:
Inquire about biologic factors that may affect the reading at this time,
including the time and dose of medications. If not wearing short, loose sleeves,
patients should nude their arm.
To get the best estimate of the patient's usual BP, biologic factors that may
cause BP variation such as pain, stress, full urinary bladder, and recent meal should be
minimized. Recent ingestion of prescription, over-the-counter or street drugs,
caffeine, and nicotine can affect BP readings. Clothing interferes with cuff placement,
pressure, and sound transmission. Proper preparation avoids elevated readings due to
anxiety about the procedure. Repeated readings increase accuracy.
Instruct patients to sit up straight with legs uncrossed, back resting against the
chair, and feet flat on the floor, and to remain silent until after BP readings.
Allow a 5-minute rest period before the first reading. The lack of back and
foot support, such as occurs when the patient is seated on an examination table, causes
BP elevation averaging 5 mm Hg diastolic. Talking or active listening during
measurement causes BP elevation.
Step 3: Proper cuff (bladder) size:
To get an accurate reading, the width of the cuff bladder should encircle at
least 40% of the arm circumference; the length of the cuff bladder should encircle at
least 80% of the arm circumference.
At the first visit, measure circumference at the midpoint of the upper arm,
between the olecranon and acromion processes. Chart the arm circumference for
future reference. Arms >53 cm in circumference should have the BP measured with a
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 79
Blood Pressure Measurement
cuff of the appropriate size on the forearm. When arm circumference measurement is
not practical, as during screening situations, it is acceptable to estimate the proper cuff
size by comparing the bladder width and length to arm circumference.
When BP is not measured in both arms, the reading should be taken in the
right arm unless it is known that BP in the left arm is higher.
Note the appropriate cuff and bladder size on each chart. Using a bladder that
is too narrow or short for the limb is a common error that is serious because it yields
false high readings.
Step 4: Cuff placement:
Locate the patient's brachial artery at the midpoint of the upper arm by
palpating between the biceps and triceps muscles on its inner surface. Wrap the cuff
smoothly and snugly around the arm with its bladder center directly over the palpated
artery and the lower edge of the cuff 2.5 cm above the antecubital fossa.
This technique avoids false high readings that occur when cuff pressure is not
equally distributed over the artery and avoids errors that result from extra sounds
when the stethoscope is exposed to the cuff or tubing.
Step 5: Determine the maximum inflation level:
Before listening for the BP, determine the inflation level necessary to obtain
an accurate systolic reading, the maximum inflation level. To do this, locate the radial
pulse and note the heart rate and rhythm. When the heart rate is irregular, systolic BP
may vary beat to beat, and additional readings are needed to get the best estimate of
the systolic BP.
Continue feeling the pulse and rapidly inflate the cuff to 60 mm Hg, and then
by 10-mm increments until the pulse is no longer palpable. This is the first estimate of
the palpated pressure. Stop inflating the cuff.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 80
Blood Pressure Measurement
Begin deflation at 2 mm Hg per second. Note the pressure at which the pulse
reappears. This is the palpated systolic pressure and is usually within 10 mm Hg of
the level at which the pulse disappeared.
Immediately release all pressure. Add 30 mm Hg to the palpated systolic
reading to determine the maximum inflation level. This maneuver determines the
minimum pressure needed to get an accurate systolic BP on a patient, decreases
patient discomfort, and avoids errors that result from failure to inflate above systolic
BP reading, including an inaccurately low systolic BP reading, which occurs when the
observer begins listening during an auscultatory gap.
Step 6: Stethoscope placement284:
Position the stethoscope earpieces pointing forward in your ears. Sound is not
transmitted well when the ear tips fail to point into the ear canal. Find the point at
which the brachial artery pulse is the strongest, usually just above the antecubital
fossa on the inner aspect of the arm.
Using light pressure, position the chest piece over this point with all edges
gently touching the skin surface. The stethoscope bell or a low-frequency detector is
recommended. The loudest sounds can be heard over this pulse and errors owing to
difficulty hearing and interpreting Korotkoff sounds are minimized along with errors
from too much stethoscope pressure that may cause artery occlusion and distortion of
BP sounds.
Do not allow the stethoscope head to touch the cuff or tubing because
extraneous sounds mask and confuse Korotkoff sounds.
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Blood Pressure Measurement
Step 7: Inflation and Deflation:
Rapidly inflate the cuff to the maximum inflation level. If sounds are heard
immediately, completely release all pressure and repeat step five to repeat the
palpated pressure.
Rapid inflation to the correct maximum inflation level ensures listening above
systolic BP. Slow inflation traps venous blood in the arm and may result in pain and
diminished or distorted sounds. Release the air from the cuff so that the mercury falls
at a rate of 2 mm Hg per second until Korotkoff sounds are heard.
Continue deflation at the rate of 2 mm Hg per beat. If unable to hear sounds
clearly, quickly release all pressure and check position of ear tips and stethoscope.
Repeat the procedure. Slow deflation is necessary to allow the observer to hear the
systolic and diastolic pressures at the point of onset. A reading can be no more
accurate than the rate of deflation (i.e., a deflation rate of 10 mm Hg/second results in
a pressure accurate to only 10 mm Hg, and if 1 beat, is missed, to only 20 mm Hg).
Step 8: Systolic blood pressure:
Read to the nearest 2 mm Hg mark. Remember the systolic pressure at the
onset of Korotkoff phase 1. Forgetting the reading is a very common source of errors
of 8 to 10 mm Hg, especially in the presence of a wide pulse pressure (difference
between the systolic and diastolic pressures).
Concentrate and remember the reading by silently repeating the systolic
number with every heartbeat until you confirm disappearance. Observers must learn
to rule out sound artifacts. Single sounds inconsistent with heart rate are insignificant
artifacts unless the pulse was irregular during palpation. In the case of arrhythmia,
additional readings are needed to get the best estimate of the systolic BP.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 82
Blood Pressure Measurement
Table-9: Showing the Korotkoff Sounds The Korotkoff Sounds are classified under five phases*
Phase 1 The pressure level at which the first faint, consistent tapping sounds are
heard. The sounds gradually increase in intensity as the cuff is deflated.
The first of at least 2 of these sounds is defined as the systolic pressure.
Phase 2 Times during cuff deflation when a murmur of swishing sounds are heard.
Phase 3 The period during which sounds are crisper and increase in intensity.
Phase 4 The time when a distinct, abrupt muffling of a sound (usually of a soft
blowing quality) is heard. This is defined as the diastolic pressure in anyone
in whom sounds continue to zero.
Phase 5 The pressure level when the last regular blood pressure sound is heard and
after which all sound disappears. This is defined as the diastolic pressure
unless sounds are heard to zero.
*To avoid error, the observer must be prepared to recognize two normal Korotkoff
sound variations associated with BP readings.
The auscultatory gap is a period of silence occurring during Korotkoff phases
1 and 2. This disappearance of sound is temporary and is usually short, but the gap
can occur over a period of 40 mm Hg. It seems to be associated with higher BP
readings. An absent Korotkoff phase 5 occurs when sounds are heard to zero. When
this is the case, phase 4 should be recorded along with phase 5. In this case, phase 4 is
the best reference for diastolic pressure.
Step 9: Diastolic blood pressure:
Remember the point at which the last regular Korotkoff sound is heard.
Korotkoff sounds are designated as K1 through K5. When the sounds continue to very
low diastolic levels or zero, remember the reading at the onset of K4, the point at
which sounds begin to muffle, as well as the last sound heard.
The onset of K5 is more reliably interpreted when observers listen for the last
sound heard. The absence of K5 occurs often in children, during pregnancy, and in
other high-cardiac-output states. In these cases, the onset of K4 is the most accurate
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 83
Blood Pressure Measurement
diastolic indicator. If the diastolic BP is heard above 90 mm Hg, listen for an
additional 40 mm Hg. Otherwise, listen for 10 to 20 mm Hg below the last sound to
confirm disappearance to avoid inaccurately high diastolic BP owing to failure to
listen until sounds reappear after a period of silence (auscultatory gap).
Step 10: Recording:
Immediately record the reading, the arm used, the position of the patient, and
the cuff size used to avoid recall artifact. Record the reading as K1/K5. If K4 is
recorded, write the three numbers as K1/K4/K5.
If sounds do not cease, record K5 as zero. Standardized recording methods are
necessary to correctly interpret and compare readings by different observers. When
phase 5 is absent, Korotkoff phase 4 is the best indication of diastolic pressure.
Step 11: Repeat the reading:
Make certain all air is out of the cuff and wait 1 to 2 minutes, then repeat steps
6 through 10. BP normally changes from minute to minute, especially during clinical
measurements. The average of two or more BP readings in a single arm is more
reliable and a better indicator of usual readings than is a single reading or one reading
in each arm.
Step 12: Repeat the process285:
Repeat the measurements in the other arm during initial workup and standing
or supine as dictated by the patient's situation. Postural changes in BP are measured
after 1 and 3 minutes of standing. Note the arm with the higher reading for future
comparisons. BP can differ by >10 mm Hg between arms. The higher pressure more
accurately reflects intra-arterial pressure.
Special Techniques and Populations286:
Absence of Korotkoff phase 5: When cardiac output is high, as in some children,
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 84
Blood Pressure Measurement
in thyrotoxicosis, during fever, and in pregnant women, K5 is often absent. In this
event, Korotkoff sounds are heard until the mercury column falls to zero. BP should
be recorded as three numbers (K5/K4/0).
Blood pressure measurement in children287:
The principles of measurement are the same in newborns, infants, and
children. A most important consideration is the selection of a cuff that is appropriate
for the arm circumference, as described above.
Blood pressure measurement in the elderly288:
In the elderly, the brachial arteries occasionally become very thickened and
stiff. When this happens, the indirect cuff pressure may overestimate intra-arterial
pressure, because higher cuff pressure is required to compress such a rigid vessel.
The presence of a radial artery that is still palpable after the cuff is inflated
above the systolic BP should be a warning of this error. If the artery feels excessively
thick when rolled back and forth under the finger, the BP reading measured with
indirect techniques may be falsely high. Recheck the pressure by palpation in the
forearm. If the palpated systolic pressure differs by >15 mm Hg, then a direct arterial
puncture may be needed to be certain of the true pressure, although this is rare.
Very large, cone-shaped, and muscular arms289:
If the patient's arm is >41 cm in circumference or if it is shaped so that a cuff
does not fit on it well, then accurate pressure measurement may be impossible. In this
case, palpated and auscultator readings should be attempted, with a cuff of the
appropriate size, in the upper arm and forearm. If these differ by greater than 15 mm
Hg, then a better estimate of true pressure is the palpated systolic pressure with the
cuff on the forearm.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 85
Chikitsa
Chikitsa
The aim of chikitsa is not only to remove of the causative factors of the disease,
but also the restoration of doshik equilibrium. The prime importance of chikitsa is to
breakup the samprapti ghatakas290. Here the specific chikitsa as well as chikitsa sutra of
Pittavruta udana has not been mentioned in classics. Therefore our Acharyas have
mentioned towards the new diseases i.e. understanding the prakruti, adhistana of doshas,
immediately the chikitsa should be started291, 292.
Because of the above explanation, the chikitsa can be planed under following headings:
Table-10: Showing the classification of chikitsa
Chikitsa
Dravyabhoota chikitsa Adravyabhoota chikitsa
Vyadhi pratyaneeka chikitsa
Dosha pratyaneeka chikitsa
Nidana parivarjana
Satvavajaya chikitsa
Yoga and other practices
Adravyabhoota chikitsa:
i) Nidana parivarjana:
Nidana parivarjana refers to abstaining from samanya karanas responsible for the
vitiation of vatadi dosha293 etc. and other risk factors like excess salt intake, over weight,
smoking, alcohol etc. These are highlighted in the later part.
ii) Satwavajaya chikitsa:
The manasika karanas also play a important role. Raja and tama along with
tridoshas vitiates hridaya and raktavaha dhamani’s. So Achara rasayana is advised to
prevent mana getting indulged in ahita arthas.
iii) Yoga and other practices:
The most important cause is stress, strain, anxiety, tensions etc. So Yoga helps to
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 86
Chikitsa
elevate the capacity of mind and removes the stress and strain. Some of the important
yogas like Bhujangasana, Shalabhasana, Vajrasana, Pranayama, Shavasana, Yoganidra,
and sudarshana kriya, etc., have shown hopeful results in recent times.
Dravyabhoota Chikitsa:
i) Dosha Pratyanika Chikitsa
In Pittavruta udana, main importance is to be given for the treatment of Pitta and
Vata. Some of the shodhana chikitsa can be adopted, these are basti and virechana. Basti
corrects the vata where as virechana corrects the pitta. Following are the general
shodhana measures that can be used:
a) Virechana:
Virechana is a special treatment for pitta294. It can also be given in pitta pradhana
dosha295. Virechana is advised in rakta pradoshaja vikaras296.
b) Basti:
Basti is the pradhana chikitsa for vata297. It is also useful in pitta, kapha, rakta,
samsarga dosha and sannipata dosha298. The tailas which are used in basti suppress the
ruksha, laghu and khara gunas of vata and helps in reducing the katinyata and produces
mardavata of blood vessels
c) Raktamokshana:
Sushruta recommends raktamokshana for vatavyadhi299. Charaka explains
raktamokshana chikitsa for rakta pradoshaja vikara300.
ii) Vyadhi Pratyaneeka Chikitsa
Following are the dravyas and yogas that can be preferred.
Dravyas: Shilajatu, Guggulu, Gomutra, Brahmi, Jatamamsi, Shatavari, Hareetaki etc.
Yogas: Shilajatuguggulu rasayana, Brahmi vati, Brahma rasayana, Pravala pisti, Brihat
vata chintamani rasa, Chandrakala rasa etc.
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Chikitsa
Apart from these, certain hridya and rasayana dravyas and yogas can be used.
Shirodhara is used to reduce high blood pressure.
General Management for Avarana:
The principles of avarana chikitsa are as follows-
In avruta vata301 first avaraka is to be treated. When both kapha and pitta are
avaraka, first pitta is to be treated then kapha and care should be taken not to
provoke the avaruta.
General principles of Vatopakrama can be adopted302.
The oushadha and ahara which are not Pitta prakopa and does vatanulomana
should be used303.
The Avarana should be treated by measures, which are Anabhishyandi (Non-
obstructive), Snigdha (unctuous) and sroto-Shudhi Karaka (depuration of body
channels)304.
In case, Vata is obstructed at all the places (Sarva Sthana Avarita), prompt (Ashu)
measures, which are regulative of Vata and at the same time not antagonistic to
Pitta and Kapha are beneficial305.
A vitiated Dosha attains great strength in its natural seats, hence it should be first
subdued by suitable medications such as emesis, purgation, enema and
sudation306.
Madhura anuvasana basti with yapana basti can be given or depending on the bala
of rogi, mridu virechana can be given307.
In Avarana the drugs that are snigdha and srotoshuddhikaraka are to be used and
at the same time these should not increase kapha308.
In condition of Pittavruta Vata, the treatment of Pitta, which is not antagonistic to
vata, should be prescribed. In the condition of Kaphavruta Vata, the treatment of
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 88
Chikitsa
Kapha, which is anulomana to Vata, should be prescribed309.
In case of Raktagata vata according to therapeutic response towards blood letting,
one has to decide the associated Avarana Pathology and should be continued
accordingly310.
Rasayana therapy: All the palliative and preventive Rasayana drugs are useful for
the prevention and treatment of avrita induced disorders. Especially Shilajitu,
Guggulu, Chyavanaprasha and Bramha Rasayana are indicated after proper
Shodhana311.
According to specific pathologies of Doshavarana, Dushyavarana, and
Mishravarana treatment modalities varies. For example, alternative administration
of cold and hot therapeutics in case of Pittavruta Vata312.
Anyonya Avarana
When one type of Vata obstructs the function of other types of Vata is called
Anyonya Avarana e.g. Prana avruta vyana313.
They should be treated by means of massage, unctuous potion, enema and all
other similar therapies and by cold and hot measures alternatively314.
Generally Udana should be regulated upward and the Apana downwards. The
Samana should be pacified and the Vyana should be treated by all these three measures.
Prana should be maintained with due care in comparison to other types of Vata, because
life depends on the proper maintenance of it. Thus the various types of Vata that are
occluded or misdirected (Vimargamana) should be established in their normal habitat315.
Treatment:
The aim of treatment is to prevent the morbidity and mortality of hypertension.
The benefits of treatment have to be considering against side effects and inconvenience
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Chikitsa
Treatment of blood pressure includes non-pharmacological and pharmacological
measures. Non-pharmacological involvement through life style modification is promoter
as preliminary therapy for essential hypertension.
Non-Pharmacological Management Includes:
Relief of emotional and environmental stress.
Sodium intake: Elderly people are more sensitive to sodium intake. So advised to
reduce the sodium intake i.e. 6 gms per day is suggested.
Weight reduction: Weight reduction is most beneficial in patients who are more
than 10% over weight. However even a 5% reduction in weight will result in
significant lowering of blood pressure.
Avoidance of excessive alcohol intake.
Avoidance of excessive smoking.
Reduction of cholesterol and saturated fat intake
Regular physical exercise.
Table-11: Showing the efficacy of Non-Pharmacological management316
Modification Recommendation
Recommendation
Approximate reduction (range)
Weight reduction
Maintain normal body weight (body mass index 18.5–24.9 kg/m2)
5–20 mmHg/10 kg
Adopt eating plan Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat
8–14 mmHg (74)
Dietary sodium reduction
Reduce dietary sodium intake to no .100 mmol/day (2.4 g sodium or 6 g sodium chloride)
2–8 mmHg (74)
Physical activity
Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week)
4–9 mmHg
Moderation of alcohol consumption
Limit consumption to no more than two drinks; (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day, in most men and to no more than one drink per day, in women and lighter weight persons.
2–4 mmHg
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Pharmacological Management:-
General Management:
1. Start with a low dose of an agent and, if blood pressure is not controlled, increase slowly
with diet control therapy.
2. Start with an agent that may also treat and/or not harm a coexisting condition.
3. Add a second agent from a different, complementary class, if blood pressure is not
controlled with a moderate dose of the first agent.
4. Start with an agent that the patient is likely to tolerate best; long term compliance is
related to tolerability and efficacy of the first agent used.
5. Use a diuretic when two agents are used, in nearly all cases.
If the blood pressure is controlled, then a slowly reduce the dose and withdrawal
of some of the agents with regular observation. In general, there are six classes of
drugs; diuretics, anti adrenergic agents, vasodilators, calcium entry blockers, angiotensin
converting enzyme (ACE) inhibitors and angiotensin receptor antagonists.
Fish Oil317:
From a physiologic viewpoint, it is attractive to propose that fish oil lowers BP.
Fish oil has highly unsaturated fatty acids that stimulate the synthesis of vasodilating
prostaglandins, inhibit platelet aggregation, and limit the release of vasoconstrictors. Fish
oil is often prescribed as capsules that contain 1 ml of purified oil or as crude cod liver
oil. Large doses of fish oil (e.g., 30 to 45 ml daily) clearly lower BP levels in
hypertensive patients. A smaller dose (e.g., 6 capsules daily) had no effect in hypertensive
and normotensive persons. The unpleasant taste of the fish oil and belching interfere with
compliance. Therefore, fish oil is not considered a practical therapy for hypertension.
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Table-12: Showing the treatment of Hypertension
Class of Drug
Compelling Indications
Possible Indications
Compelling Contra Indications
Possible Contra Indications
Diuretics Heart failure, Elderly patients, Systolic hypertension
Diabetes Gout Dyslipidemia, Sexually active malaes
Blockers Angina, After myocardial infarct, Tachy arrhythmias
Heart failure, Pregnancy, Diabetes
Asthma & COPD, Heart block
Dyslipidemia, Athletes & Physically active patients, Peripheral vascular disease
ACE –Inhibitors
Heart failure, Left ventricular dysfunction, After myocardial infarct, Diabetic nephropathy
Pregnancy, Hyperkalaemia, Bilateral renal artery stenosis
Calcium Antagonists
Angina, Elderly patients, Systolic hypertension
Peripheral vascular disease
Heart block Congestive heart failure
Blockers Prostatic hypertrophy
Glucose intolerance, Dyslipidemia
Orthostatic hypotension
Angiotensin IIAntagonists
ACE-inhibitor cough
Heart failure Pregnancy, Bilateral renal artery stenosis, Hyperkalaemia
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 92
Pathya-Apathya
Pathya- Apathya
That which is not against the srotas and priya to manas318. Srotas is always an
important integral part of samprapti of a disease, which needs to be corrected by the
means of chikitsa. Pathya sevana along with the proper Aushada will always reduce
the recovery phase of a disease. Acharya Lolimbaraja who was known as the best poet
physician was the first to explain the significance of pathya in his work Vaidhya
Chintamani. He feels that if a person knows all about pathya then there is no necessity
of taking the oushadha for the disease319.
The specific Pathya-Apathya is not mentioned for Pittavruta udana, but the
general Pathya-Apathya mentioned for Pittavruta vata and Vatavyadhis are good for
Pittavruta udana. In the treatment of diseases, diet and other habits are given equal
importance with drugs and therapeutic measures.
The pathyapathya that can be suggested are as follows,
Table-13: Showing the Pathyapathya320 in Pittavruta udana
Pathya Apathya
Ahara Mamsa of jangla pradesha
animals and birds, Yava,
Shalee.
Other than Jangala mamsa, Dadhi,
Tobacco, Tea, Coffee, Salt, Fatty
substances, Alcohol, Amala, Lavana,
Katu rasa, stored food etc.
Vihara Samyak vishrama, Upavasa,
Shavasana, Samyak vyayama,
Sadvritta palana, Nitya
abhyanga, Krodha-Irsha-
Bhaya-Chinta-Shokadi
dharaneeya vega dharana, etc.
Divaswapna, Ativyayama, Avyayama,
Vegadharana,Adhyashana,
Atichintana, Atikrodha, Atishrama,
Atisukhasana, Ratri jagarana, etc.
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Drug Review
Shilajatu:
Shilajatu is an exudation from rock during hot sunny days. Though it may be
occurring in many parts of the world but India was the first to highlight its wonderful
therapeutic value for many centuries. Ayurveda mentions it as wonderful medicine. It
describes that shodhita Shilajatu can cure even the assadhya diseases. Acharya
Charaka says “there are hardly any curable diseases which can not be controlled or
cured with the help of Shilajatu321”.
Names according to Language322:
Sanskrit: Shilajatu, Hindi: Shilajita, Nepali: Kalo Shilajita, Arabic: Hajar–ul–Musa,
Bengali: Shilajita, English: Black Bitumen or Mineral Pitch, Gujarati: Shilajita,
Marathi: Shilajita Latin: Asphaltum punjabinum, Malayalam: Kanmadam, Unani:
Momiye and Shilajita, Parsi : Momiya Phacyral Yahud.
Synonyms of Shilajatu323, 324,325:
Adrija, Adreyam, Ashmaja, Ashmotham, Girija, Gaireya, Shaila, Shilodbhava,
Jatu, Adrijatu, Ashmajatuka, Girijatu, Shilajatu, Shilaniryasa, Shilasveda, Shilamaye,
Shiladhatu, Shaildhatuja, Shaileya, Shilaya, Shilaj, Ashamlaksha, Atithi, Shilaha,
Shail, Ashamsara, Dhatuja, Ashamajatu, Ashamj-jatu, etc.
Test: The testing techniques for Shilajatu are as follows:
i. Shilajatu put on fire it erects perpendicularly and burn with out smoke.
ii. If pure Shilajatu put in water, through the tip of a thin erect glass it will come down
slowly after spreading like fibre326.
Properties:
Rasa, Guna, Virya, Vipaka, Karma can be considered as the properties of the
drug.
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The texts like Rasa Ratna Samucchaya believed that Shilajatu possess all the
properties of rasa, uparasa, parada, ratna and lauha together in itself327.
Rasa328: Tikta, Katu
Guna: The samanya guna of Shilajatu is considered to be sheeta by Rasa Paddhati,
where as Acharya Charaka mentions it to be of natiushna-sheeta329 whereas another
place Acharya Charka mentioned the types of shilajatu as sheeta Veerya330.
Virya: Ushna virya331.
Vipaka: Katu vipaka332
Karma: Mutrala, Yogavahi, Rasayana333, Chedana, Tridosha hara334 etc.
Uses:
According to Charaka Samhita there is no curable disease on earth which
Shilajatu can not perforce subdue. When administered at right time, well prepared and
in the right manner, it will secure for the healthy subject the optimum measure of
vitality. It removes old age and disease, gives great firmness of the body, increases
intelligence and memory and promotes prosperity335.
Pathya–Apathya:
While taking a course of Shilajatu care should be taken to see that, irritating
and heavy articles are excluded form the dietary. Exercise, sun light, direct air and
chittsantapa should be avoided. During the administration of Shilajatu the following
materials are contraindicated:
1. Vidahi 2. Guru 3. Kulatha 4. Kapota mamsa.
Kulatha is kashaya rasa, ushna virya, kapota mamsa is alo ushana veerya.
Shilajatu is katu, kashaya, Tikta rasa and ushna virya. So the above properties cause
untoward effect in the body. Therefore should be avoided double the days of
administration336.
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Chemical Composition337:
Analyzed by Hooper it yielded:
Water = 09.5%, Organic matter = 36.20%, Mineral matter = 34.65%, Nitrogen =
01.3%, Lime = 07.80%, Potash = 09.07%, Phosphoric acid = 00.16%, Silica =
01.35%.
Guggulu:
Guggulu gum is used to produce standardized or purified extracts called
guggulipids or guggulsterones. Heart drugs based on Guggulu extracts are sold in
India, where almost all of the research on Guggulu has been done in the past thirty
years338.
Vernacular name:
Sanskrit: In Sanskrit, Guggulu means “that which protects against diseases”. Another
traditional Sanskrit name for Guggulu is palnkash- pal means flesh and kash means to
reduce. It is one of the best herb for obesity339.
Latin: Commiphora Mukul.
Family: Burseracae340.
English: Indian bedellium
Common Name: Bdellium Gum, Guggulipid, Gum Gugal, Gumgu Ggulu, Salaitree,
Commiphora mukul, Balasmodendron mukul341.
Hindi: Gugal, Guggal. Kanada: Kanthagana, Gugggula, Gugulugida, Guggulu.
Telugu: Guggipannu. Assam: Guggulu. Malayalam: Guggulu. Marathi: Guggul.
Urdu: Muqil (Shihappu). Gujarati: Gugal. Oriya: Guggulu. Punjabi: Guggal.
Kashmiri: Kanth Gan342.
Synonyms: Devdhoop, Jatayu, Koushik, Pur, Kumbholookhlak, Mahishaksh,
Kalaniryas, Natankchar, Shiv and Durg, Palnkash343,344.
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Habitat Sindh, Rajasthan, Eastern Bengal, Assam, Mysore, Northeast Africa,
Afghanistan, Bihar, Bellary etc345.
Characteristics:
Guggulu is obtained from a tree, which exudes a resinous sap out of incisions,
that are remade on its bark. This resin has been used for centuries. The fresh the oleo-
gum resin is moist, viscid, fragrant and of a golden color. It burns in fire, melts in the
sun, & forms a milky emulsion with hot water346.
Gunakarma:
Rasa: Tikta, Katu, Kasaya, Virya: Usna, Vipaka: Katu, Prabhava: Tridosahara
Guna: Laghu, Ruksha, Tikshna, Vishada, Sukshma, Sara347.
Part used: Resin / Gum348.
Phytoconstituents349:
Guggulu an extract of the exudate (gum guggulu) of Mukul myrrh tree
contains phytosterols named guggulsterones, organic acids, aromatic acids,
diterpenes, lignans, sterols, steroids, esters and fatty acid alcohols. Guggulu is
preferred to crude gum guggulu because it is safer and more effective. 0.37% volatile
oil consisting chiefly myrcene, dimyrcene, gum resin & bitter principle.
Actions:
Analgesic, highly potent anti inflammatory, rejuvenator, aphrodisiac,
diaphoretic, diuretic, astringent, hypocholesterolaemic / hypolipidaemic, demulcent,
alterative, carminative, appetizer, antispasmodic, emmenagogue, antirheumatic,
antiarthritic, antisuppurative, antiseptic, hypercholestremia, enhances phagocytosis,
immunostimulant, thyroid stimulant, uterine stimulant350,351.
The pharmacological action of the oleo resin resembles in many ways with the
actions of copaiba cubebs. Its active components, Z-guggulsterone and E-
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guggulsterone, have an ability to lower both cholesterol and triglyceride levels.
Specifically, gugulipid lowers VLDL and LDL cholesterol and triglycerides while
simultaneously raising HDL cholesterol. This indicates Guggulu primary use for
providing a protective effective against atherosclerosis. These effects are due to
Guggulu action on the liver and thyroid.
The thyroid is stimulated to increase the body's metabolic rate, and the liver is
stimulated to metabolize LDL cholesterol, effectively lowering the amount in the
bloodstream352.
Theraputic uses:
Obesity, nervous diseases, arthritis, diabetes, hemiplegia, leprosy, leucorrhea,
marasmus, muscle spasms, neuralgia, neurasthenia, ophthalmia, pertussis, pneumonia,
pyelitis, pyorrhea, rheumatism, scrofula, skin disorders, sore throat, spongy gums,
ulcerative pharyngitis, hypertension, ischemia, heart diseases, urinary disorders, skin
diseases, applied locally in hemorrhoids, abscesses, bad ulcers. A number of studies
have supported the claims that Guggulu extracts can help to reduce heart disease risk
factors, with reductions in both blood fats and total cholesterol of 15-30 percent over
three months.
Guggulu extracts have been shown to lower overall blood fats, reduce "bad"
LDL cholesterol, and raise "good" HDL cholesterol. If it is also true, as some studies
suggest, that guggulu extracts can reduce platelet stickiness, this herb would rank
among the most important since few substances have a positive impact on both blood
fats and platelets353.
Triphala354:
This includes three drugs: (a) Haritaki (b) Vibhitaki (c) Amalaki.
Synonyms355: Phalatrika, Vara.
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Rasa: Kshaya Pradhana.
Vipaka: Madhura.
Veerya: Anushna.
Properties : Tridoshahara, Chakshushya, Dipana, Vrishya, Sara.
1) Haritaki356:
Latin name - Terminalia chebula Retz.
Family - Combretaceae
Paryaya357:
Sanskrit - Abhaya, Pathya, Shiva, Girija, Pramthya, Amrita.
Hindi – Harad, Kannada – Anilekayi, Gujarati – Harde, Marathi – Harda.
English – Chebulic myrobalan.
Fruit: Drupe, glabrous, pendulous 1-2 inch long, ellipsoid ovoid from a broad base,
more or less five ribbed.
Test of genuine Haritaki: It should be fresh, smooth, dense, heavy and round in
shape, when put into water it should sink.
Chemistry: Fruits contain about 24.6-32.5% of tennin and also contains chebulagic
acid, glucose, corilagin, amino etc.
Guna Karma:
Rasa - Kashaya pradhana Tikta, Katu, Madhura, Amla, Virya – Ushna, Guna -
Laghu, Ruksha, Vipaka - Madhura, Prabhava - Tridoshahara.
Action and uses: Medhya, Rasayana, Brimhana, Anulomana, Ayushya, Chakshushya,
Mootrala etc. and used in Prameha, Sopha, Hridroga, Eye diseases, Tvakroga etc.
Part used – Fruit
2) Vibhitaki358:
Latin name – Terminalia bellirica Roxb.
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Family – Combretaceae
Paryaya359:
Samskrita- Kalidruma, Kasaghna, Aksha, Karshaphala, Kalpavriksha
Hindi – Baheda, Gujarati – Beheda, Kannada – Tarekayi, Marathi – Behda
English – Belliric myrobalan.
Fruit: 10-25 mm in diameter, ovoid, grey suddenly narrowed into a very, short stalk,
velvety, obscurely 5 angled when dried.
Chemistry – Fruits contain about 21.4% B-sitosterol, gallic acid, ellagic acid,
chebulagic acid, galloyl, glucose, Mannitol, galactose, ethyl gallate, fructose,
rhamnose, a new cardiac glycoside, belliricanin, and kernels yielded yellow fatty oil.
Guna Karma:
Rasa – Kashaya. Guna – Ruksha, Laghu
Virya – Ushna, Vipaka – Madhura, Doshaghnata – Tridosha, mainly Kaphahara.
Action and uses: Dipana, Anulomana, Grahi, Chakshushya, Kanthya, Swasakasahara,
Raktashodhana. It is used in Kasa, Swasa, Swarabheda, Vatavyadhi, Arsha etc.
Part used – Fruit
3) Amalaki360:
Latin name – Emblica officinalis Gaertn.
Family – Euphorbiaceae
Paryaya361:
Samskrita – Dhatri, Vayastha, Amruta phala etc.
Hindi – Amla, Anvla, Kannada – Nellikayi, Gujarati – Anvla, Marathi – Awle,
English – Emblic myrobalan.
Gana: Virechnopag, Vayahsthapana etc.
Distribution: This tree is common in the mixed deciduouis forests of India
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Fruit: 1.3-1.6 cm in diameter, fleshy, globosely, with 6 obscure vertical furrows. The
fruit is green, changing to light yellow when mature; it is sour and astringent in taste.
Chemistry: Fruit contains mineral matter (0.7%), fiber (3.4%), Protein (0.5%)
carbohydrate (14.1%), fat (0.1%) calcium (0.05%), phosperous (0.02%), ferrous (1.2
mg), vit.C, nicotinic acid (0.2mg/100gm), tenic acid, gelic acid etc.
Guna Karma:
Rasa – Amla (Pradhana), Kashya, Tikta, Katu, Madhura., Guna – Guru, Ruksha,
Sheeta, Vipaka – Madhura, Virya – Sheeta, Doshaghnata –Tridoshaghna
Action and uses – Rasayana, Vrishya, Shonita and Garbha sthapana, Mootrala etc.
Part used – Fruit (without seed)
Gomutra:
Gana, Guna and Karmadi of Gomutra:
Gana : Acharya Charaka has described Gomutra in Katuskanda362. Sushruta in
shirovirechana gana363.
Guna Karmadi364, 265:
Rasa – Katu, Tikta, Kashaya, Madhura, Lavana, Guna – Tikshna, Laghu, Virya –
Ushna.
Karma366,367 – Kaphavata shamaka, Pitta janaka, Agni pradeepaka, Medhya.
Other properties:
According to Bhava Prakasha, the simple mutra is taken as Gomutra. Different
types of mutras are used in the treatment of different diseases but Gomutra is highly
effective in all the mutras368. Acharya Sushruta has advised to use Shilajatu, Guggulu,
Gomutra and Triphala in the treatment of Sthaulya369.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
101
Table-14: Showing the properties of Ingredients
Sl no
Drug Latin name Paryoga RasaAnga
Guna Veerya Vipaka Doshaghnata Karmukata
1 Shilajatu Asphaltumpunjabinum
Ishat- Amla MriduKashaya
Sama-Sheetoshna
Katu Balya, Yogavahi, Vrishya, Rasayana, Medhohara, Hritshoolanashaka
2 Guggulu Commiphora Niryasa mukul
Tikta, Katu Laghu ,Ruksha, Teekshna,Vishada Sukshma,
Ushana Katu Vata Kapha Shamaka
Hridya,Rakta prasadana, Mutrala,Shothahara, Medohara,
3 Hareetaki Terminaliachebula
Phala Lavanavarjita- Pancharasa Kashaya
Laghu ,Ruksha
Ushana Madhura Tridosha hara Hridya,Shonitasthapana, Mutrala Shotha hara,
4 Vibhitaki Terminaliabellarica
Phala Kashaya Laghu , Ruksha
Ushana Madhura Tridosha hara Rakta stambhana, (Kapha hara) Sleshama hara
5 Amalaki Emblicaofficinalis
Phala PpancharasaLavanavarjita Amla
Guru , Ruksha Sheeta
Sheeta Madhura Tridosha hara Hridya, Shonita sthapana, Pittashamaka Rasayana, Mutrala
6 Gomutra Katu, Tikta,Kashaya, Madhura, Lavana (anurasa)
Tikshna, Ushna, Laghu
Ushna Katu Kaphavatashamaka, Pitta prakopaka
Deepana, Pachana, Anulomana, Amapachana, Malashodhana, used in Shula, Vataroga, Shopha etc.
102
Material & Methods
Materials and Methods
Source of data
Patients:
Patients suffering from Essential hypertension were selected from department
of Kayachikitsa Post graduation studies and research O.P.D. of Shri D.G.M
Ayurvedic medical college and hospital by preset inclusion and exclusion criteria.
Literary:
Literary aspects of study were collected from classical Ayurvedic and Modern
texts, updated with recent journals.
Composition of Trial Drug:
Table-14: Showing the composition of Shilajatu Guggulu Rasayana
Sl.No Sanskrit Name Botanical Name Proportion
1 Shilajatu Black bitumen 1 Part
2 Guggulu Commiphora mukul 1 Part
Preparation of yoga:
All the drugs were identified and collected from local area, Good
manufacturing practice was followed for the preparation.
Method of collection of data
Study design:
Present study is prospective clinical study. The patients with Pittavruta udana
w.s.r. to Essential Hypertension within the age group of 35 yrs to 70 yrs. were
selected randomly from O.P.D of D.G.M. A M.C.,H.& Research Center after
fulfilling the inclusion and exclusion criteria irrespective of their sex, occupation and
socio-economic status.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 103
Material & Methods
Sample size:
A minimum of 30 patients was taken excluding the dropouts. The present
study is a single group study where as patients were assigned in one group. It is a
Simple random sampling technique clinical trial.
Exclusion criteria: -
Following were the criteria to exclude the patients from the study: -
Essential hypertension with diabetes.
Essential hypertension with ischaemic heart diseases.
Secondary hypertension.
Left ventricular hypertrophy.
Left ventricular failure.
Renal hypertension.
Patient with malignant hypertension.
Lactating and pregnant females.
Hypertension secondary to malignancy.
Inclusion Criteria
The selection of the patient for clinical study was done with following criteria:
Patients were selected between the age group of 35 to 70 years.
Patients of both sexes were selected indiscriminately.
Patients with following conditions were considered for the clinical trial:
• Freshly detected and untreated case of essential hypertension.
• Established and treated case of essential hypertension and who had
discontinued the treatment before the clinical trial was taken for the
study.
• Asymptomatic and symptomatic cases were taken for the study.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 104
Material & Methods
• Both mild and moderate cases.
• Racial of environmental factors.
• No discriminations of chronicity and severity of disease.
• Other than the exclusive criteria mentioned above.
Criteria of Diagnosis
The symptomatology of Pittvaruta udana mentioned in Ayurvedic text were
the basic diagnostic criteria.
The symptomatology of essential hypertension explained in modern text were
the basic diagnostic criteria.
Estimation of high blood pressure according to American Heart association
(A.H.A) diagnostic criteria.
Diagnosis is made on the basis of measurements of sphygmomanometer.
Posology
Abhyantara 6 gms per day/24 hrs, in three divided doses. Sadhyo virechana
has been carried out with 30 ml of Gandharvahastadi castrol prior to the initiation of
the treatment.
Study Duration
Study: 30 days.
Follow-up: The duration of follow up was 30 days.
Assessment of Result
The subjective and objective parameters of base line data to pre and post
medication were compared for assessment of the results. All the result were analyzed
statistically for “p” value using student‘t’ test, Paired t- test.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 105
Material & Methods
Subjective parameters
The symptoms of Pittavruta udana mentioned in classical text as Daha,
Moorcha, Bhrama, Klama, and symptoms of hypertension mentioned in contemporary
text were the subjective parameters.
Objective Parameters
Blood pressure:-
Standing
Sitting
Laying down posture
These have been recorded regularly during study duration.
Investigations
Diagnostic and exclusion:-
Lipid profile:
• Very low density lipoprotein cholesterol (VLDL)
• Low-density lipoprotein cholesterol (LDL)
• High-density lipoprotein cholesterol (HDL)
• Serum cholesterol
• Serum triglycerides
Chest X-Ray
Electro cardiogram (E.C.G)
Fasting blood sugar (F.B.S)
Blood urea
Serum creatinine
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 106
Material & Methods
Preparation of medicine:
1. Shilajatu shodana370:
The Shilajatu which was exuded from the stones was collected, powdered and
kept immersed in hot water for three hours. Later it was vigorously squeezed and
filtered through cloth and collected in a clean mud plate and exposed to bright sun.
The scum that collects at the top is separated and dried in the sun till it becomes a
hard mass in about two months of time. This is fit to be used as medicine. The sign of
good Shilajatu when put on fire assumes the shape of a linga(round mass) and does
not emit smoke. The water which remains underneath in the earthen plate might also
yield some Shilajatu if kept in sun light for a number of days.
2. Guggulu Shodhana371:
i) Guggulu
ii) Triphala
iii) Gomutra
Guggulu must be bundled in a strong cloth and boiled in dolayantra containing 4
parts of Triphala kashaya prepared with Gomuthra. When all the guggulu dissolves in
Triphala kashaya, pottali is removed and the liquid is evaporated to collect purified
Guggulu.
Guggulu and Shilajatu are powdered and mixed properly. Then 90 gms of yoga is
stored airtight container.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 107
Observations
Observations
In this study total 33 patients were registered, out of which 3 patients left the
study before completion and 30 no. of patients have completed their course of
treatment with Shamana Oushdha (Shilajatu Guggulu Rasayana).
Table-16: Showing Age wise distribution of total 30 patients with percentage Male patients Female patients Total patients Age
Number % Number % Number % 36-42 01 3.33% 01 3.33% 02 6.66% 43-49 04 13.33% 03 10% 07 23.33% 50-56 07 23.33% 03 10% 10 33.33% 57-63 02 6.66% 04 13.33& 06 20.00% 64-70 04 13.33% 01 3.33% 05 16.66% Total 18 12 30
Age wise distribution of all thirty patients shows that maximum patients were
from 50-56 years age group i.e. 10 (33.33%) patients, where 07 (23.33%) were male
and 03 (10%) were female. In age group of 43-49 years 07 (23.33%) patients were
reported, in these patients 04 (13.33%) were male and 03 (10%) were female, in age
group of 57-63 years 06 (20%) patients had undergone the treatment, here 02 (6.66%)
were male and 04 (13.33%) were female and in age group of 64-70 years 05
(16.67%) patient were approached, in these patients 04 (13.33%) were male and 01
(3.33%) were female and in the age group of 36-42 years total 02 (6.67%) i.e. 01
(3.33%) were male and 01 (3.33%) were female patients had completed the treatment.
Figure-08: Showing Age wise distribution of total 30 patients
1
4
7
2
4
1
3 3
4
1
2
7
10
6
5
0
1
2
3
4
5
6
7
8
9
10
MALE FEMALE TO TAL
36-42 Years43-49 Years50-56 Years57-63 Years64-70 Years
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 108
Observations
Table-17: Showing Sex wise distribution of total 30 patients with percentage Sex Total no. of Patients % age
Male 18 60.00% Female 12 40.00% Total 30
In the present study 18 (60%) of the patients were male and 12 (40%) were
female.
Figure-09: Showing Sex wise distribution of total 30 patients
18
12
0
2
4
6
8
10
12
14
16
18
MaleFemale
Table-18: Showing Religion wise distribution of total 30 patients with percentage Religion Total no. of Patients % age
Hindu 26 86.67% Muslim 04 13.33% Christian 00 00 Others 00 00 Total 30
In this study 26 (86.67%) of the patients belongs to Hindu category and 04
(13.33%) belongs to Muslim.
Figure-10: Showing Religion wise distribution of total 30 patients
26
4
0 0
0
5
10
15
20
25
30
HinduMuslimChristianOthers
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 109
Observations
Table-19: Showing Occupation wise distribution of total 30 patients Male patients Female patients Total patients Occupation
Number % Number % Number % Sedentary 08 26.66% 12 40.00% 20 66.67% Active 06 20.00% 00 - 06 20.00% Labour 04 13.33% 00 - 04 13.33% Total 18 - 12 - 30 -
In the occupation wise distribution 20 (66.67%) of the patients had sedentary
life style where 08 (26.66%) male and 12 (405) were female, 06 (20%) were male
patients had active occupation and 04 (13.33%) were male patients are of labour class.
Figure-11: Showing Occupation wise distribution of total 30 patients
86
4
12
0 0
20
64
2
0
4
6
8
10
12
14
16
18
20
MALE FEMALE TO TAL
SedentaryActiveLabour
Table-20: Showing Economical status wise distribution of 30 patients Economical status Total no. of Patients % age
Poor 04 13.33% Middle 24 80.00% Higher class 02 6.67% Total 30
Here, 04 (13.33%) of the patients comes from Poor Class, 02 (6.67%) of the
patients come from Higher Class and 24 (80.00%) of the patients comes from Middle
Class.
Figure-12: Showing Economical status wise distribution of total 30 patients
4
24
2
0
5
10
15
20
25
PoorMiddleHigher class
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 110
Observations
Table-21: Showing Marital status wise distribution of 30 patients with percentage Marital Status Total no. of Patients % age
Unmarried 00 00 Married 30 100% Total 30
All the 30 patients i.e. 100% approached are married.
Figure-13: Showing Marital status wise distribution of total 30 patients 30
0
5
0
10
15
2 0
2 5
3 0
MarriedUnmarried
Table-22: Showing Intake Rasa predominance wise distribution of 30 patients Rasa predominance Total no. of Patients % age
Madhura 20 66.67% Amala 08 26.67% Lavana 17 56.67% Katu 30 100.00% Tikta 00 00 Kashaya 00 00
In this study maximum 30 (100%) patients have taken Katu Rasa
predominantly in their diet, followed by 20 (66.67%) Madhura Rasa, 17 (56.67%)
Lavana Rasa and 08 (26.67%) Amala Rasa. Excessive use of Katu, Lavana and Amala
Rasa may be the etiological factors of this disease.
Figure-14: Showing Intake Rasa predominance wise distribution of 30 patients
20
8
17
30
0 0
0
5
10
15
20
25
30
MadhuraAmalaLavanaKatuTiktaKashaya
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 111
Observations
Table-23: Showing Nidra wise distribution of total 30 patients with percentage Nidra Total no. of Patients % age
Sound sleep 12 40.00% Disturbed sleep 18 60.00% Total 30
The present study shows that maximum 18 (60%) of the patients had disturbed
sleep and 12 (40%) of the patients had sound sleep.
Figure-15: Showing Nidra wise distribution of total 30 patients
12
18
0
2
4
6
8
10
12
14
16
18
Sound sleepDisturbed sleep
Table-24: Showing Malapraviti wise distribution of 30 patients with percentage Malapraviti Total no. of Patients % age
Prakruta 22 73.33% Constipated 08 26.67% Total 30
In this study 08 (26.67%) of the patients had constipated stool where as 22
(73.33%) of the patients had normal stool.
Figure-16: Showing Malapraviti wise distribution of total 30 patients
22
8
0
5
10
15
20
25
PrakrutaConstipated
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 112
Observations
Table-25: Showing Addiction wise distribution of 30 patients with percentage Addiction Total no. of Patients % age
Tea 20 66.67% Coffee 22 73.33% Smoking 06 20.00% Alcohol 10 33.33% Tobacco Chewing 06 20.00%
The present study shows 22 (73.33%) of the patients had addiction to Coffee,
20 (66.67%) of the patients to Tea, 06 (20%) of the patients to Tobacco, 10 (33.33%)
of the patients to Alcohol and 06 (20%) patients had Smoking addiction.
Figure-17: Showing Addiction wise distribution of total 30 patients
Table-26: Showing Ahara wise distribution of total 30 patients with percentage
Ahara Total no. of Patients % age Vegetarian 14 46.66% Mixed 16 53.33% Oil 17 56.66% Ghee 11 36.66% Stored Food 16 53.33%
In the present study 14 (46.66%) of the patients had vegetarian diet, 16
(53.33%) of the patients had mixed diet where as 17 (56.66%) of the patients had
more oily diet, 11 (36.66%) of the patients had used ghee and 16 (53.33%) of the
patients had used stored food.
Figure-18: Showing Ahara wise distribution of total 30 patients
2022
6
10
6
0
5
10
15
2 0
2 5
TeaCoffeeSmokingAlcoholTobacco Chewing
1416 17
11
16
0
2
4
6
8
10
12
14
16
18
VegetarianMixedOilGheeStored Food
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 113
Observations
Table-27: Showing Manasika Prakruti wise distribution of total 30 patients Manasika Prakruti Total no. of Patients % age
Bhaya 09 30.00% Kopa 17 56.67% Deenata 19 63.33% Udvega 08 26.67% Kshobha 20 66.67% Samprahara 09 30.00% Mada 06 20.00%
In this study 20 (66.67%) of the patients had Kshobha, 19 (63.33%) of the
patients had Deenata, 17 (56.67%) of the patients had Kopa, 09 (30%) of the patients
had Bhaya, 09 (30%) of the patients had Samprahara, 08 (26.67%) patients had
Udvega and 06 (20%) of the patients had Mada.
Figure-19: Showing Manasika Prakruti wise distribution of total 30 patients
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 114
9
1719
8 9
6
20
Table-28: Showing Shareera Prakriti wise distribution of total 30 patients
0
Shareera Prakriti Total no. of Patients % age VP 18 60.00% VK 10 33.33% PK 02 06.66% Total 30
The above table shows 18 (60%) of the patients had vatapitta prakriti, 10
(33.33%) of the patients had vatakapha prakriti and 02 (6.66%) of the patients had
pittakapha prakriti.
Figure-20: Showing Shareera Prakriti wise distribution of total 30 patients
2
4
6
8
10
12
14
16
18
2 0BhayaKopaDeenataUdvegaKshobhaSampraharaMada
18
10
2
0
2
4
6
8
10
12
14
16
18
VPVKPK
Observations
Table-29: Showing Sara wise distribution of total 30 patients with percentage Sara Total no. of Patients % age
Twak 02 06.66% Rakta 10 33.33% Mamsa 12 40.00% Meda 05 16.66% Asthi 01 03.33% Majja 00 00 Shukra 00 00 Satwa 00 00 Total 30
The above table shows 12 (40%) of the patients had Mamsa Sara, 10 (33.33%)
of the patients had Rakta Sara, 05 (16.66%) of the patients had Medha Sara, 02
(6.66%) of the patients had Twak Sara and 01 (3.33%) of the patients had Asthi Sara.
Figure-21: Showing Sara wise distribution of total 30 patients
2
1012
5
10 0 0
0
2
4
6
8
10
12 TwakRaktaMamsaMedaAsthiMajjaShukraSatwa
Table-30: Showing Samhanana wise distribution of total 30 patients Samhanana Total no. of Patients % age
Susamhita 25 83.33% Madhyama samhita 05 16.66% Heena samhita 00 00 Total 30
The above table shows 25 (83.33%) of the patients had Susamhita and 05
(16.66%) of the patients had Madhyama Samhanana. Even single patient also has not
had Heena Samhanana.
Figure-22: Showing Samhanana wise distribution of total 30 patients
25
5
0
0
5
10
15
2 0
2 5
Susamhita
Madhyama samhitaHeena samhita
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 115
Observations
Table-31: Showing Satmya wise distribution of total 30 patients with percentage Satmya Total no. of Patients % age
Pravara 05 16.66% Madhyama 20 66.66% Avara 05 16.66% Total 30
The above table shows 20 (66.66%) of the patients were having Madhyama
Satmya and 05 (16.66%) of the patients were having Pravara Satmya and 05 (16.66%)
of the patients were having Avara Satmya.
Figure-23: Showing Satmya wise distribution of total 30 patients
5
20
5
0
2
4
6
8
10
12
14
16
18
20
PravaraMadhyamaAvara
Table-32: Showing Satwa wise distribution of total 30 patients with percentage Satwa Total no. of Patients % age
Pravara 04 13.33% Madhyama 19 63.33% Avara 07 23.33% Total 30
The above table shows 19 (63.33%) of the patients had Madhyama Satva and
07 (23.33%) of the patients had Avara Satva and 04 (13.33%) of the patients were
having Pravara Satva.
Figure-24: Showing Satwa wise distribution of total 30 patients
4
19
7
0
2
4
6
8
10
12
14
16
18
20
PravaraMadhyamaAvara
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 116
Observations
Table-33: Showing Vyayama Shakti wise distribution of total 30 patients Vyayama shakti Total no. of Patients % age
Pravara 04 13.33% Madhyama 06 20.00% Avara 20 66.66% Total 30
The above table shows 06 (20.00%) of the patients had Madhyam
Vyayamashakti, 20 (66.66%) of the patients had Avara Vayamashakti and 04
(13.33%) of the patients had Pravara Vyayamashakti.
Figure-25: Showing Vyayama Shakti wise distribution of total 30 patients
4
6
20
02
4
6
8
10
12
14
16
18
20
PravaraMadhyamaAvara
Table-34: Showing Vaya wise distribution of total 30 patients with percentage
Vaya Total no. of Patients % age Balya 00 00 Madhya 23 76.66% Vruddha 07 23.33% Total 30
The above table shows 23 (76.66%) of the patients had Madhyama Vaya and
07 (23.33%) of the patient’s had Vruddha Vaya.
Figure-26: Showing Vaya wise distribution of total 30 patients
0
23
7
0
5
10
15
20
25
BalyaMadhyaVruddha
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 117
Observations
Table-35: Showing Pramana wise distribution of total 30 patients Pramana Total no. of Patients % age
Supramanita 28 93.33% Adhika 01 03.33% Heena 01 03.33% Total 30
The above table shows 28 (93.33%) of the patients Supramanita, 01 (3.33%)
of the patients had Adhika Pramana and 01 (3.33%) of the patients had Heena
Pramana.
Figure-27: Showing Pramana wise distribution of total 30 patients
28
1 1
0
5
10
15
2 0
2 5
3 0
SupramanitaAdhikaHeena
Table showing Ahara Shakti (AS) wise distribution:- Table-36-A: Showing Abhyvarana (AS) wise distribution of total 30 patients
A) Abhyvarana Total no. of Patients % age Pravara 00 00 Madhyama 30 100.00% Avara 00 00 Total 30
The above table shows 30 (100%) patients had Madhyama Abhyvarana Shakti
and no patients were seen in Pravara and Avara kind of Ahara Shakti.
Figure-28-A: Showing Abhyvarana (AS) wise distribution of 30 patients
0
30
0
0
5
10
15
20
25
30
PravaraMadhyamaAvara
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 118
Observations
Table-36-B: Showing Jarana (AS) wise distribution of 30 patients B) Jarana Total no. of Patients % age
Pravara 00 00 Madhyama 30 100.00% Avara 00 00 Total 30
The above table shows 30 (100%) patients had Madhyama Jarana Shakti and
no patients were seen in Pravara and Avara kind of Ahara Shakti
Figure-28-B: Showing Jarana (AS) wise distribution of 30 patients
0
30
0
0
5
10
15
20
25
30
PravaraMadhyamaAvara
Table-37: Showing Jatharagni Bala wise distribution of total 30 patients
Jatharagni bala Total no. of Patients % age Manda 19 63.33% Teekshna 02 6.66% Vishama 09 30.00% Sama 00 - Total 30 -
The above table shows 19 (63.33%) of the patients had Manda Agni, 09 (30%)
of the patients had Vishama Agni and 02 (6.66%) of the patient had Teekshana Agni
Not even the single patint Sama Agni.
Figure-29: Showing Jatharagni Bala wise distribution of total 30 patients
19
2
9
0
0
2
4
6
8
10
12
14
16
18
20
MandaTeekshnaVishamaSama
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 119
Observations
Table-38: Showing Koshta wise distribution of total 30 patients with percentage Koshta Total no. of Patients % age
Krura 09 30.00% Madhyama 19 63.33% Mrudu 02 6.66% Total 30 -
The above table shows 02 (6.66%) of the patients had Mrudu Koshta, 19
(63.33%) of the patients had Madhyama Koshta and 09 (30%) of the patients had
Krura Koshta.
Figure-30: Showing Koshta wise distribution of total 30 patients
9
19
2
0
2
4
6
8
10
12
14
16
18
20
KruraMadhyamaMrudu
Table-39: Showing Family History wise distribution of total 30 patients
Family history HTN Total no. of Patients % age Yes 13 43.33% No 17 56.67% Total 30
In this study 13 (43.33%) of the patients had family history of
Hypertension and 17 (56.67%) of the patients’ family were devoid of Hypertension.
Figure-31: Showing Family History wise distribution of total 30 patients
13
17
0
2
4
6
8
10
12
14
16
18
YesNo
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 120
Observations
Table-40: Showing Chronicity wise distribution of 26 patients (Previously diagnosed) with percentage
Chronicity Total no. of Patients % age Up to 6 Month 06 20.00% Up to1 Years 12 40.00% Up to2 Years 06 20.00% Up to3 Years 02 6.66% Total 26 -
In this study 06 (20%) of the patients had minimum of 6 months Chronicity,
12 (40.00%) of the patients had 6 months to 1 year Chronicity, 06 (20.00%) of the
patients had 1 to 2 years Chronicity, and 02 (6.67%) of the patients had 2 to 3 years
Chronicity.
Figure-32: Showing Chronicity wise distribution of total 30 patients
6
12
6
2
0
2
4
6
8
10
12
Up to 6 MonthUp to1 YearsUp to2 YearsUp to3 Years
Table-41: Showing Onset history wise distribution of total 30 patients Onset history Total no. of Patients % age
Acute 04 13.33% Chronic 26 86.67% Total 30
The study shows that 26 (86.67%) of the patients had Chronic Onset and 04
(13.33%) of the patients had Acute Onset of history.
Figure-33: Showing Onset history wise distribution of total 30 patients
4
26
0
5
10
15
2 0
2 5
3 0
AcuteChronic
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 121
Observations
Table-42: Showing Intensity wise distribution of total 30 patients Intensity Total no. of Patients % age
Mild 02 6.66% Moderate 14 46.66% Severe 14 46.66% Total 30 -
Here in this study 14 (46.66%) of the patients had Moderate Intensity of
Hypertension, 14 (46.66%) of the patients had Severe Intensity of Hypertension and
02 (6.66%) of the patients had Mild Intensity of Hypertension.
Figure-34: Showing Intensity wise distribution of total 30 patients
2
14 14
14
12
4
10MildModerateSevere
8
6
2
0 Table-43: Showing Relieving Factors wise distribution of total 30 patients
Relieving factors Total no. of Patients % age Rest 23 76.67% Sleep 28 93.33% Tranquillizer 01 3.33% Anti Depressants 06 20.00%
In the present study, Relieving factors of 28 (93.33%) of the patients had
Sleep, 23 (76.67%) of the patients had Rest, 06 (20%) of the patients had Anti
Depressants and 01 (3.33%) of the patients had Tranquillizers.
Figure-35: Showing Relieving Factors wise distribution of total 30 patients
23
28
1
6
0
5
10
15
20
25
30
RestSleep TranquillizerAnti Depressants
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 122
Observations
Table-44: Showing Aggravating Factors wise distribution of total 30 patients Aggravating factors Total no. of Patients % age
Traveling 02 6.67% Anxiety 07 23.33% Emotion 15 50.00% Stress 28 93.33% Physical stress 14 46.67%
In the present study, Aggravating factors of 28 (93.33%) of the patients had
Stress, 14 (46.67%) of the patients had Physical Stress, 15 (50%) of the patients had
Emotions, 07 (23.33%) of the patients had Anxiety and 02 (6.67%) of the patients had
Travelling.
Figure-36: Showing Aggravating Factors wise distribution of total 30 patients
2
7
15
28
14
0
5
10
15
20
25
30
TravelingAnxietyEmotionStressPhysical stress
Table-45: Showing Drug History wise distribution of total 30 patients Drug history Total no. of Patients % age
Allopathic Medicine 19 63.33% Ayurvedic Medicine 00 - Discontinued Medicine 07 23.33% Others 00 -
In this study 19 (63.33%) of the patients had Allopathic Medicine where as 07
(23.33%) patients had discontinued the medicine.
Figure-37: Showing Drug History wise distribution of total 30 patients
19
0
7
0
0
2
4
6
8
10
12
14
16
18
20
Allopathic MedicineAyurvedic MedicineDiscontinued MedicineOthers
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 123
Observations
Table-46: Showing Symptoms wise distribution of total 30 patients Symptoms Total no. of Patients % age
Shirah shoola 25 83.33% Klama 27 90.00% Bhrama 24 80.00% Daha 05 16.67% Moorcha 00 00
The present study revealed that maximum 27 (90%) of the patients had
Klama following 25 (83.33%) of the patients had Shirah Shoola, 24 (80%) of the
patients had Bhrama and 05 (16.67%) of the patients had Daha but Moorcha was not
seen in any patient.
Figure-38: Showing Symptoms wise distribution of total 30 patients
2527
24
5
0
0
5
10
15
20
25
30
Shirah shoolaKlamaBhramaDahaMoorcha
Table-47: Showing Associated Complaints wise distribution of total 30 patients Associated complaints Total no. of Patients % age
Avsada 04 13.33% Dourbalya 19 63.33% Ati-sweda 00 - Daha in nabhi and uras 00 - Others 00 -
In this study, the associated complaints of 19 (63.33%) of the patients had
Dourbalya and 04 (13.33%) of the patients had Avsada. The rest of the complaints
were not seen in any patient.
Figure-39: Showing Associated Complaints wise distribution of total 30 patients
4
19
0 0 0
0
2
4
6
8
10
12
14
16
18
20
AvsadaDourbalyaAti-swedaDaha in nabhi and urasOthers
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 124
Observations
Table-48: Showing Systolic Blood Pressure (Average) of 30 patients Systolic blood pressure Total no. of Patients % age
Normal 00 - Stage I (140-159) 02 6.67% Stage II (160-179) 14 46.67% Stage III (180-209) 14 46.67% Stage IV >210 00 00 Total 30
The above table revealed that maximum 14 (46.67%) of the patients were
recorded Stage II and Stage III Average Systolic Blood Pressure followed by 02
(6.67%) of the patients were suffer from Stage I Average Systolic Blood Pressure. No
patients were recorded of Stage IV.
Figure-40: Showing Systolic Blood Pressure (Average) of 30 patients
0
2
14 14
0
0
2
4
6
8
10
12
14
NormalStage I (140-159)Stage II (160-179)Stage III (180-209)Stage IV >210
Table-49: Showing Diastolic Blood Pressure (Average) of 30 patients Diastolic blood pressure Total no. of Patients % age Normal 08 26.67% Stage I (90-99) 15 50.00% Stage II (100-109) 07 23.33% Stage III (110-119) 00 - Stage IV >120 00 - Total 30
The above table revealed that maximum 15 (50%) of the patients were
recorded Stage I Average Diastolic Blood Pressure followed by 07 (23.33%) of the
patients were suffering from Stage II Average Diastolic Blood Pressure and 08
(26.67%) of the patients were in Normal Stage. No patients were recorded of Stage III
and IV Average Diastolic Blood Pressure.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 125
Observations
Figure-41: Showing Diastolic Blood Pressure (Average) of total 30 patients
8
15
7
0 0
8 6
4
2
0
10
12
14
16
Normal
Stage I (90-99)
Stage II (100-109)
Stage III (110-119)
Stage IV >120
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 126
Results
Results
Results of any research work are like always a new outcome in the medical
field. The results are obtained by the different observations which are collected during
the clinical trial. All these findings are tabulated in different headings.
Table-50: Showing the effect of therapy on Bhrama
Parameter Score Percentage Net result (BT - AT)
Response
Total scoring (Bhrama) BT
36 100%
Total scoring (Bhrama) AT
00 00%
100%
Good response.
The present study revealed that 36 score was found before the treatment
whereas 00 score was found after the treatment. This study illustrated that the effect
of Shilajatu Guggulu Rasayana on Bhrama gives 100% result i.e. Good response.
Table-51: Showing the effect of therapy on Klama
Parameter Score Percentage Net result (BT - AT)
Response
Total scoring (Klama) BT
42 100%
Total scoring (Klama) AT
06 14%
86%
Good response.
The present study shows that 42 score was found before the treatment whereas
06 score was found after the treatment. This study demonstrated that the effect of
Shilajatu Guggulu Rasayana on Klama gives 86% result i.e. it also comes under Good
response.
Table-52: Showing the effect of therapy on Shirah shoola
Parameter Score Percentage Net result (BT - AT)
Response
Total scoring (Shirah shoola) BT
45 100%
Total scoring (Shirah shoola) AT
04 09%
91%
Good response.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 127
Results
The present study revealed that 45 score was found before the treatment
whereas 04 score was found after the treatment. This study illustrated that the effect
of Shilajatu Guggulu Rasayana on Shirah shoola gives 91% result i.e. Good response.
Table-53: Showing the effect of therapy on Daha
Parameter Score Percentage Net result (BT - AT)
Response
Total scoring (Daha) BT
06 100%
Total scoring (Daha) AT
00 00%
100%
Good response.
The present study shows that 06 score was found before the treatment whereas
00 score was found after the treatment. This study demonstrated that the effect of
Shilajatu Guggulu Rasayana on Daha gives 100% result i.e. it also comes under Good
response. As the symptom Daha was found only in 5 patients.
Table-54: Showing the effect of therapy on Systolic hypertension
Parameter Score Percentage Net result (BT - AT)
Response
Total scoring (SBP) BT
72 100%
Total scoring (SBP) AT
06 8%
92%
Good response.
The present study revealed that the highest 72 score was found before the
treatment whereas 06 score was found after the treatment. This study illustrated that
the effect of Shilajatu Guggulu Rasayana on Systolic blood pressure gives 92% result
i.e. the result comes under Good response.
Table-55: Showing the effect of therapy on Diastolic hypertension
Parameter Score Percentage Net result (BT - AT)
Response
Total scoring (DBP) BT
29 100%
Total scoring (DBP) AT
05 17%
83%
Good response.
The present study revealed that 29 scores was found before the treatment
whereas 05 score was found after the treatment. This study demonstrated that the
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 128
Results
effect of Shilajatu Guggulu Rasayana on Diastolic blood pressure gives 83% result i.e.
it shows Good response.
Table-56: Showing the over all response on Subjective and Objective parameters
Net Result Percentage Net results of all therapies (X/N)
Response
Systolic B.P. 92% Diastolic B.P. 83% Shirah shoola 91%
Klama 86% Bhrama 100%
Daha 100% N = 6 X = 552
92%
Good response.
Net mean results of the therapy on all parameters (all subjective and objective
in to the consideration) showed 92%. This study demonstrated that the effect of
Shilajatu Guggulu Rasayana on all parameters showed Good response.
Table-57: Showing the effect of therapy on Biochemical Parameters
Mean score Biochemical Parameters
BT AT
Mean difference Net Relief
Serum cholesterol 193.81 156.95 36.86
Serum triglycerides 172.94 143.00 29.94
High density lipoprotein 47.63 43.39 4.24
Low density lipoprotein 111.69 84.97 26.72
Very low density lipoprotein 34.54 28.54 06.00
The present study revealed that the mean difference of Serum cholesterol was
found 36.86 i.e. lower than the before treatment mean, mean difference of Serum
triglycerides was found 29.94 i.e. lower than the before treatment mean, mean
difference of High density lipoprotein was found 4.24 i.e. lower than the before
treatment mean, mean difference of Low density lipoprotein was found 26.72 i.e.
lower than the before treatment mean whereas mean difference of Very low density
lipoprotein was found 06.00 i.e. also lower than the before treatment mean, hence
this shows that the effect of Shilajatu Guggulu Rasayana on Lipid Profile.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 129
Results
Statistical Analysis
Table-58: Showing the effect of therapy on Bhrama
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 1.2 0.80 - - Bhrama
AT 0.0 0.0 1.2 0.805
0.147 29 8.163 <0.001 HS
In order to assess the Parameter the patients were examined according to the
clinical findings and the results were analysed from the statistical analysis.
In parameter Bhrama Mean ±SD before was 1.2 ±0.8 and after the treatment it
is reduced to 0.0 ±0.0 with Mean difference 1.2 and standard of mean 0.147 and test
shows more highly significant before and after the treatment as P<0.001.
Table-59: Showing the effect of therapy on Klama
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 1.44 0.77 - - Klama
AT 0.2 0.40 1.2 0.664
0.121 29 9.917 <0.001 HS
In parameter Klama Mean ±SD before was 1.44 ±0.77 and after the treatment
it is reduced to 0.2 ±0.40 with Mean difference 1.2 and standard of mean 0.121 and
test shows more highly significant before and after the treatment as P<0.001.
Table-60: Showing the effect of therapy on Shirah shoola
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 1.5 0.86 - - Shirah
shoola AT 0.13 0.34 1.366 0.764
0.139 29 9.827 <0.001 HS
In parameter Shira shoola Mean ±SD before was 1.5 ±0.86 and after the
treatment it is reduced to 0.13±0.34 with Mean difference 1.366 and standard of mean
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 130
Results
0.139 and test shows more highly significant before and after the treatment as
P<0.001.
Table-61: Showing the effect of therapy on Daha
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 0.2 0.48 - - Daha
AT 0.0 0.0 0.2 0.484
0.0884 29 5.475 <0.001 HS
In parameter Daha Mean ±SD before was 0.2 ±0.48 and after the treatment it
is reduced to 0.0 ±0.0 with Mean difference 0.2 and standard of mean 0.0884 and test
shows more highly significant before and after the treatment as P<0.001.
Table-62: Showing the effect of therapy on Moorcha
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 0.0 0.0 - - Moorcha
AT 0.0 0.0 0.0 0.0
0.0 29 - - -
In parameter Moorcha before and after the treatment is not seen.
Table-63: Showing the effect of therapy on Systolic hypertension
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 2.4 0.62 - - Systolic
B.P. AT 0.2 0.55 2.2 0.664
0.121 29 18.18 <0.001 HS
In parameter Systolic B.P. Mean ±SD before was 2.4 ±0.62 and after the
treatment it is reduced to 0.2 ±0.55 with Mean difference 2.2 and standard of mean
0.121 and test shows more highly significant before and after the treatment as
P<0.001.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 131
Results
Table-64: Showing the effect of therapy on Diastolic hypertension
Para
Meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 0.96 0.71 - - Diastolic
B.P. AT 0.16 0.37 0.8 0.55
0.1 29 8.00 <0.001 HS
In parameter Diastolic B.P, Mean ±SD before was 0.96 ±0.71 and after the
treatment it is reduced to 0.16 ±0.37 with Mean difference 0.8 and standard of mean
0.55 and test shows more highly significant before and after the treatment as P<0.001.
Effect of therapy on Biochemical Parameters:
Table-65: Showing the effect of therapy on Serum Cholesterol
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE D
F
T-
Value
P-
Value
Rem
arks
BT 193.81 29.22 - - Choleste
rol AT 156.95 29.7 37.63 18.29
3.34
1
29 11.26 <0.001 HS
In parameter Cholesterol Mean ±SD before was 193.81 ±29.22 and after the
treatment it is reduced to 1560.95 ±29.70 with Mean difference 37.63 and standard of
mean 18.298 and test shows more highly significant before and after the treatment as
P<0.001.
Table-66: Showing the effect of therapy on Serum Triglycerides
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 0.96 0.71 - - Trigly
ceride AT 0.16 0.37 0.8 0.55
4.72 29 8.73 <0.001 HS
In parameter Triglyceride Mean ±SD before was 172.94 ±60.41 and after the
treatment it is reduced to 143.0 ±57.43 with Mean difference 41.206 and standard of
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 132
Results
mean 4.72 and test shows more highly significant before and after the treatment as
P<0.001.
Table-67: Showing the effect of therapy on High Density Lipoprotein
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 47.63 10.03 H.D.L.
AT 43.39 8.03 4.813 3.619
0.66 29 7.29 <0.001 HS
In parameter H.D.L Mean ±SD before was 47.63 ±10.03 and after the
treatment it is reduced to 43.39 ±8.03 with Mean difference 4.813 and standard of
mean 0.66 and test shows more highly significant before and after the treatment as
P<0.001.
Table-68: Showing the effect of therapy on Low Density Lipoprotein
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Valu
e
Rem
arks
BT 111.69 30.13 - - L.D.L
AT 84.97 24.64 29.09 16.29
2.974 29 9.781 <0.0
01
HS
In parameter L.D.L. Mean ±SD before was 111.69 ±30.13 and after the
treatment it is reduced to 84.97 ±24.64 with Mean difference 29.09 and standard of
mean 2.974 and test shows more highly significant before and after the treatment as
P<0.001.
Table-69: Showing the effect of therapy on Very Low Density Lipoprotein
Para
meter
Dura
tion
Mean
± SD
Mean
differ
ence
SD of
Differ
ence
SE DF T-
Value
P-
Value
Rem
arks
BT 34.54 12.10 - - V.L.D.L
AT 28.54 11.46 8.694 5.201
0.949 29 9.16 <0.001 HS
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 133
Results
In parameter V.L.D.L. Mean ±SD before was 34.54 ±12.10 and after the
treatment it is reduced to 28.54 ±11.46 with Mean difference 8.694 and standard of
mean 0.949 and test shows more highly significant before and after the treatment as
P<0.001.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 134
Discussion
Discussion Discussion is the most important part of any research where the observations
are discussed and given reasons by the researcher. Here researcher conveys the
practical experience with special reference to textual explanations. The significant
results and insignificant results will be discussed in the same section with reasons.
Hence it becomes important to discuss the clinical study in detail.
Discussions on this study are made under the following headings:
1) Discussion on Disease Review
2) Discussion on Drug Review
3) Discussion on Clinical study.
4) Discussion on Results
1) Discussion on Disease Review:
Pittavruta udana is explained as disease in Ayurvedic classics. The symptoms,
which are expressed in essential hypertension, are similar to the symptoms of
Pittavruta udana. As Ayurveda explains, Pitta pangu, Kapha pangu without vata, so
vata plays an important role in the formation of diseases. Vata is a unique Dosha as it
differs from other Doshas in many ways, for example Vata regulates the functions of
Pitta and Kapha. In the pathological state also it has double path of its vitiation i.e its
vitiation may occur by the depletion of dhatus or by the obstruction, while Pitta and
Kapha have a single route of vitiation. Most of the hypertensive patients show
minimal cause in vascular integrity. Acharya Vagbhata clearly states that vascular
integrity is maintained by Vata (Prana). In one word he says “Dhamani dharana” is a
function of Prana Vata.
Nearly 15% of the world population is labelled hypertensive, either knowing
or unknowingly by doctors. In India approximately 14% of peoples suffer from
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 135
Discussion
hypertension and majority of them had essential hypertension which indicates its
significance and prevalence. At present, Indian Council of Medical Research (ICMR)
and All India Institute of Medical Sciences (AIIMS) also have declared India as a
nation of hypertension. Although hypertension is usually asymptomatic for the first
10-20 yrs, it slowly but surely strains the heart and damages the arteries. For this
reason hypertension is often called as silent killer5 because mild to moderate levels
usually ignored by patient until serious damage has been done.
Epidemiological studies revealed that it is the most important single factor
responsible for death from cardiovascular and cerebro-vascular disease. Therefore its
epidemiology has drawn the attention of W.H.O in 1978 and declared that year as
“Hypertension Year”.
So far hypertension in various systems of medicines likes Ayurveda, Unani,
homeopathy and allopathic-claim success in preventing, controlling hypertension. But
the fundamental factor that blood pressure is not a disease but a reaction, is
manifested by the cardiovascular system against unnatural behaviours in relation to
one’s Ahara and Vihara (mithya hara vihara). Among these systems of medicines
Ayurveda adopts the treatment for the benefit of life and life is nothing but the feeling
of self or self-consciousness. Ayurveda is eternal and ever lasting principle.
Ayurvedic drugs have shown re-constructive or rejuvenate effect.
So many Allopathic medications like beta-blockers, calcium channel blockers,
ACE inhibitors etc. are invented, to keep the blood pressure in normal ranges. But all
these medicines have big adverse effects, where as Ayurvedic medicines cure the
disease without producing the adverse effects and give side benefits as a substitute of
side effects. Therefore, the Ayurvedic therapeutics has attracted considerable glamour
for providing safe and effective remedies. Several researches have been done to tell
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 136
Discussion
off the significance of medication. However, it is necessary to conduct the further
research to find out some safe and effective therapy with no adverse effects and
protect the hypertensive population. In Ayurvedic literature, the disease essential
hypertension is not described by its name. But, from compilation of scattered
references it is concluded that Essential hypertension is a condition that simulates the
Pittavruta udana vyadhi. After understanding essential hypertension on the basis of
Ayurvedic fundamentals, the treatment selected was more effective and also cost
effective. The clinical trial was conducted in a randomized sample of 30 patients. The
drugs and doses have already been described in the clinical study. The results were
assessed individually on various parameters, monitored carefully; subjected to bio
statistical analysis.
Nidana Panchaka
I. Nidana:
In the classics there are no direct references regarding nidanas of Pittavruta
udana. Vriddhi of avaraka along with avaruta dosha is essential to cause avarana. So
the nidanas which causes mainly Pittavriddhi along with vatavriddhi to some extent
be considered as the hetus for Pittavruta udana. Many of Raktadustikara Nidanas
contribute to the Pitta vruddhi, intern’s manifestation the Avarana to Vata producing
clinical manifestation. While discussing about Nidana of Vata prakopa, Acharya
clearly mentioned that viruddha/vishama ahara leads to margavrodha. This can be
understood as obstructive pathology, the prime factor of Essential hypertension.
In the present study majority of patients have irregular and incompatible food
style. Tea/Coffee may contribute to agni vaishamya interns Pitta and Vata prakopa
takes place. Particularly Pitta makes the margavarana to Vata leads to Hypertension.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 137
Discussion
II. Poorvaroopa:
The Poorva roopa for this condition is not described in the classics. Charaka
has quoted that avyakta lakshanas of vata vyadhi are to be taken as its Poorvaroopa.
III. Roopa:
Shirah shoola: is due to the Vata, shiro daha is due to Vata and Pitta. Here
Vata as well as Pitta vitiation occurs.
Klama: is due to vitiation of Rakta
Daha: is due to the vitiation of Pitta
Bhrama: is due to vitiation of Vata and Pitta
Moorcha: is due to the vitiation of Pitta
IV. Upashaya and Anupshaya
For Vata: Upashaya of Avruta Vata is not at hand; on the contrary, Upashaya
of Avaraka is present. For Example in Pittavruta vata, the patient gets Vidaha from
the Upashaya of Vata i.e, Amla, Lavana and Ushna. In Kaphavaruta Vata there is
Upashaya from Katu etc and patient shows desire for Fast, Exercise, Ruksha etc.
things which are Upashaya for Kapha and Anupashaya for Vata.
For Pitta: In Pittavruta vata, patient feels Daha, Trishana, Shoola, Bhrama,
Tama and gets Vidaha from Amla, Lavana, Katu and Ushna veerya dravyas. On the
other hand, the patient shows the desire for cold (sheeta) things, which is Upashaya
for Pitta.
V. Samprapti:
The whole sequence of manifestation of disease starting from the causative
factors, dosha dushti till the appearance of lakshanas is known as Samprapti. The
samprapti ghatakas i.e. dosha, dushya, srotas, agni etc. having great significance in
this process, whereas Acharya Sushruta’s describes the stages of the development of a
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 138
Discussion
disease. The shatkriyakala’s are chaya, prakopa, prasara, sthanasanshraya, vyakti and
bheda avasthas372. To understand the samprapti of Pittavruta udana (Essential
hypertension), it is necessary to know about the nidana factors of the disease because
the three chief events of the healthy human being towards the disease happen only
from the fractions of nidana factors. These chief events are
a). Dosha Prakopa
b). Kha Vaigunya
c). Dhatu Shaithilya
In this perspective, it is necessary to take note of the involved factors i.e.
samprapti ghatakas viz ; dosha, dushya, srotas, agni, ama etc. Direct reference
regarding the samprapti of Pittavruta udana is not available in the classics. Hence to
understand the samprapti of Pittavruta udana, the general samprapti of avarana can be
considered.
Like ama, the Avarana is also unique concept of disease pathogenesis,
especially of Vata vyadhis. Vata dosha is the chief among Tridoshas373, because of its
asukaritwa & its ability to carry on the all life process in association with Pitta,
Kapha, Saptadhatus & Trividha mala. It is composed of “Rajo guna bahulya374”
which is the “Pravartaka-sarvabhavanam” and other two doshas are of turn described
as Pangu without the involvement of Vata dosha375. Such dynamic factor Vata,
naturally causes more number of diseases in the body than the other doshas. One of
the reasons behind causation of the 80 diseases by Vata376 is because it is provoked
by two principle factores:
1. Dhatus kshaya (Emaciation of body tissues)
2. Margasya Avarana (by the occlusion of its channel of circulation)
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 139
Discussion
Acharya Chakrapani377 mentions that Vata get aggravated in two different
ways. Because of second type of cause Avarana, the speed (vega) of Vata gets
arrested which leads to its aggravation. However, when Vata is obstructed in the
same way, it is specifically called Avarana.
Explanation of the word Avarana:
The words Avarana means– Achhadana i.e covering or avarodha i.e
obstruction. The three terms are used to understand the Avarana i.e. Avarana, Avarka
and Avrutah.
i. Avarana: Avarana denotes the obstruction of vata movements. This obstruction
can be due to Pitta, Kapha, Rasadi dhatus, Malas or by the panchavidha vata.
ii. Avaraka: The factor, which causes obstruction of vata, is called Avaraka or the
main sources which cause the obstruction is Avaraka. For example if Pitta cause
obstruction of Vata, then Pitta is called Avaraka.
iii. Avruta: The gati of Vata, which is affected by the Avaraka is known as Avruta or
which is arrested by other dosha is known as Avruta. The substance, which obstructs
the pathway of Vata, is termed as Avaraka while Vata whose avarana occurs is termed
as Avruta.
To understand the samprapti of Pittavruta udana, it is necessary to know about
the nidana i.e. karanas of the disease because the disease Pittavruta udana comes
under Vata vyadhi chapter. If Pitta Vitiated and then obstruct the Udana vata comes
under samanyaja vyadhi. Hence in the samprapti of Pittavruta udana, Vata and Pitta
vitiates by there own nidanas and then vitiated Vata comes in contact with vitiated
Pitta causes more Pitta vikruti and results the obstruction of Udana vata. So by seeing
this samprapti Avarana comes under Vata vyadhi chapter (nanatmaja vikara).
By observing the lakshanas of Pittavruta udana, the doshas and dooshyas involved in
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 140
Discussion
the samprapti to cause this condition can be assessed as follows:
Samprapti-Ghatakas:-
Doshas: Vata (Udana) – Shirashoola and bhrama.
Pitta anubandi– Daha, bhrama and moorcha
Dushyas: Rakta – daha, klama and Shira shoola
Agni: Jatharagni
Srotas: Rasavaha, Raktavaha & Manovaha
Srotodushti-Prakara: Sanga type of srotodusti
UdbhavaSthana: Pakvashaya-Amashaya Samudbhava
Avayava: Hridaya, Dhamani
Adhisthana: Manodaihika (Psychosomatic, Sira, Dhamani, Srotas)
Sanchara-sthana: Sarva Sharira
Rogamarga: Madhyama Rogamarga.
Prognosis:
In dosha avarana, the Avarana of Prana and Udana by Pitta and Kapha are
more severe and difficult to treat because of their vital function in the body
physiology i.e. to provide life and strength. Therefore Pittavruta udana is difficult to
treat.
If the condition continues for one year, its management is delayed or improper
and then it may difficult to treat or is incurable. So early diagnosis and timely
management make the prognosis good.
Modern concept of Essential Hypertension:
Blood pressure is the pressure exerted by the blood on the walls of blood
vessels. Persistent high arterial blood pressure without a known cause is essential
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 141
Discussion
hypertension when the elevation of systolic blood pressure is more than 140 mm Hg
and diastolic blood pressure is above 90 mm Hg.
Arterial pressure depends on the cardiac out put and total peripheral resistance.
The Blood Pressure can be raised by increased cardiac output and increased peripheral
resistance. The cardiac output depends upon the heart rate, its contractibility and the
blood volume. The blood pressure can be raised by an increase in the volume of fluid
absorption of water and water retaining sodium from the intestine in to the vascular
system or an increased production of the adrenocortical hormone aldesterone, which
blocks the excretion of sodium and water into the urine.
It appears that most patients with established hypertension have abnormal
cardiac output and blood pressure is mainly sustained by increased peripheral vascular
resistance.
The peripheral vascular resistance is determined by the arteriolar lumen,
which may expand or contract depending on the state of muscular cells in the vessel
wall. This is known as local vascular tone. Normal vascular tone depends on the
competition between vasoconstriction influences and vasodilators. Peripheral
resistance depends on the size of the lumen of some vessels. A decrease in the inner
(lumen) diameter will raise the Blood Pressure. The decrease in the lumen could be
brought about by an anatomical thickening of vessel walls (e.g. intimal thickening of
arteries), by their mechanical compression from outside or most commonly by their
active muscular contraction which can be induced by a variety of vasoconstrictor
mediators. The common vasoconstricting mediators are epinephrine, norepinephrine
and renin- activated angiotensin II. The other recently described vasoconstrictors
include endothelin I, thromboxane and leucotrienes. Resistance vessels also exhibit
auto regulation, a process by which increased blood flow to such vessels induces
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 142
Discussion
vasoconstriction, an adaptive mechanism that protects against hyper perfusion of
tissues. The vasodilators include kinins, prostaglandins and nitric oxide. Certain
metabolic products such as lactic acid, hydrogen ions, adenosine and hypoxia can also
function as local vasodilators.
Recently it has been discovered that haemoglobin plays an important role in
regulation of blood pressure. In the body tissues, haemoglobin releases oxygen and
super nitric oxide(SNO) and picks up carbon dioxide. The released SNO causes
vasodilatation. At the tissue level haemoglobin also picks up excess nitric oxide (NO),
which tends to cause vasoconstriction. Thus haemoglobin helps in regulating the
blood pressure by adjusting the amounts of SNO and NO to which blood vessels are
exposed. This newly appreciated role of haemoglobin may influence development of
drugs to treat hypertension.
Further the arteriolar smooth muscle contraction can be increased by increased
sympathetic tone and also by increased sodium load and extra cellular fluid load.
The kidneys play an important role in the blood pressure regulation, and there
is considerable evidence that renal dysfunction is essential for the development and
maintenance of both essential and secondary hypertension.
The kidney influences both peripheral resistance and sodium homeostasis, and
the renin-angiotensin system appears central to these influences. Renin elaborated
by the juxtaglomerular cells of the kidney transforms plasma angiotensinogen to
angiotensin I, and the latter is converted to angiotensin II by angiotensin
converting enzyme(ACE). Angiotensin II alters blood pressure by increasing both
peripheral resistance and blood volume. The former effect is achieved largely by
it’s ability to cause vasoconstriction through direct action on vascular smooth
muscle, the latter by stimulation of aldosterone secretion, which increases distal
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 143
Discussion
tubular reabsorption of sodium and thus of water. The kidney produces a variety
of vasodepresser or antihypertensive substances that presumably counter balance
the vasopressin effects of angiotensin. These include the prostaglandins, a urinary
kallikrein-kinin system, platelet-activating factor, and nitric oxide.
When blood volume is reduced, the glomerular filtertation rate (GFR) falls,
this, in turn, leads to increased re-absorption of sodium by proximal tubules in an
attempt to conserve sodium and expand blood volume.
GFR- independent natriuretic factors, including atrial natriuretic factor
(ANF), a peptide secreted by heart atria in response to volume expansion, inhibit
sodium re-absorption in distal tubules and cause vasodilatation. Abnormalities in
these renal mechanisms are implicated in the pathogenesis of secondary
hypertension in a variety of renal diseases, but they also play an important role in
essential hypertension.
Chikitsa:
In classics several treatment modalities are explained for Pittavruta vata. The
dravyas which are not abhishyandi but having snigdha and srotoshodhaka gunas
should be used. The oushadhi drayas which are not virudha to Pitta, which causes
Vatanulomana and Vatashamana are to be administered. In Vata enclosed by Pitta,
alternative application of cold and hot things is desirable. Jeevaneeya sarpi, meat of
wild animals, barely, shali rice, sustaining milk enema, purgation, intake of milk
boiled with panchamoola and bala are employed. Then sprinkling with madhu yasti
taila, bala taila, ghee, ksheera panchamoola decoction or cold water are useful.
Recent studies’ shows significant improvement of Essential hypertension by
chikitsa like Virechana, Shirodhara, Rasayana. If we look in to the chikitsa principles
of Avarana, Virechana is the best shodhana chikitsa. Pitta and Vata both are regulised
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 144
Discussion
by Virechana. Shirodhara also had beneficial role in management of Essential
hypertension.
In all encircled conditions, the regular use of Rasayana such as Shilajathu
Guggulu with milk would be beneficial or use of chyavana prasha should be
employed with milk diet. In Pithavrutha panchavata the measures to be adopted are
Pittaghna remedies which never derange Vata.
Treatment of Vata is not effective whereas the treatment of Avaraka is
effective. When Vata is occluded by Pitta, it leads to Vata Prakopa manifested by the
symptom of Shula. It may be the main symptom disturbing the patient very much. In
addition other symptoms of Pitta like burning, thirst, giddiness and darkness before
eyes may be there. Here to relive dominant symptom of Vata i.e Shula, Pitta
alleviating treatment should be undertaken as the basic pathology is due to the
increased Pitta. Hence the administration of Vata alleviating treatment such as use of
hot, sour and salt substances, which are antagonist to Pitta, may deteriorate the
condition. If Kapha occludes Vata, it leads to Vata prakopa manifested by the
symptom of Shoola. It may be the main symptom disturbing the patient very much. In
addition other symptoms of kapha such as cold, heaviness, pronounced desire to
pungent and similar other articles and carving for fasting, exertion, dry and hot things.
Here to relive dominant symptom of Vata i.e Shoola, Kapha alleviating treatment
such as katu, kashaya etc. articles should be used, as the basic pathology is due to the
increased Kapha though this therapy is antagonist to Vata.
2. Discussion on Drug Review:
Shilajatu:
By its tikta rasa and naatiushna gunas, acts on Pitta dosha and by ushna verya
act on Vata dosha. Because of tikta rasa, it removes avarana of Vata dosha and their
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 145
Discussion
by Vata anulomana occurs. As it is having rasayana property, hence does Vata
shamana.
Shilajatu is one of the best mootrala dravya. Its diuretic property is
established. Because of its mootrala properties, it reduces the blood volume
automatically blood pressure reduced. In Essential hypertension diuretic property is
very beneficial. By its virtue of diuretic property Shilajatu showed significant best
result in the present study.
Guggulu:
By its tikta and kashaya rasas it makes Pitta shamana, by its tikta rasa, ushna
and teekshna gunas it removes the Avarana of Vata. Because of Ushna veerya and
Rasayana properties it is Vatashamaka.
The Guggulu shodhana was done with the Triphala kwatha, which is prepared
with Gomutra. Consequently it is necessary to consider the effects of these dravyas on
Pittavruta udana. A number of studies have supported the claims that Guggulu
extracts can help to reduce heart disease risk factors, with reductions in both blood
fats and total cholesterol of 15-30 percent over three months. Guggulu extracts have
been shown to lower overall blood fats, reduce "bad" LDL cholesterol and also
normalizing the weight. It also reduces blood triglycerides which are known to
contribute to atherosclerosis and heart attack. As some studies suggest, that Guggulu
extracts can reduce platelet stickiness, this herb would rank among the most important
since few substances have a positive impact on both blood fats and platelets. These
effects are due to Guggulu action on the liver and thyroid. The thyroid is stimulated to
increase the body's metabolic rate, and the liver is stimulated to metabolize LDL
cholesterol, effectively lowering the amount in the bloodstream and is
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 146
Discussion
antihypertensive. Due to its diuretic action it reduces the blood pressure. Although the
use of Guggulu is appears to be safe and non-toxic.
Triphala is mainly Pitta shamaka and Vatanulomaka. Hareetaki and Vibhitaki
by their Kashaya, Tikta and Madhura rasa and by Madhura vipaka it acts on Pitta
dosha. Amalaki, by its Kashaya and Madhura rasa, Madhura vipaka and Sheeta
veerya, does Pitta shamana. Hareetaki and Vibhitaki by their Madhura rasa and
vipaka, Ushna veerya and anulomana properties it acts on Vata dosha. Amlaki by its
Amla, Madhura rasa and vipaka and Rasayana properties it pacifies Vatadosha.
Gomutra has srotoshodhaka property. We have made Guggulu shodhana by
Gomutra siddha Triphala kwatha. Because of Gomutra shodhita Guggulu, it may act
as Vatanulomaka and srotoshodhaka although Gomutra is Pitta prakopaka but because
of the Triphala, it may not aggravate Pitta. By its Ushna guna and veerya, Lavana and
Madhura rasa it dose Vata shamana.
By summarising all these factors, this yoga is effective in Pittavruta udana
because of sroto shodhaka, Vata and Pitta shamaka, Vatanulomaka and Rasayana
properties.
3) Discussion on Clinical study:
In this study total 33 patients were registered, out of which 3 patients left the
study before completion and 30 no. of patients have completed their course of
treatment with Shamana Oushadha (Shilajatu Guggulu Rasayana). All 30 patients are
screened for hypertension before and after the clinical trial. Before to initiation of the
treatment, all patients are screened for cardiac abnormalities, renal abnormalities,
metabolic abnormalities like diabetes, hypo/hyper thyroidism etc. Patient’s blood
lipids are assessed before and after the treatment. For the safety purpose X-ray and
ECG are taken before to include in the trial. Once he/she found with normal findings
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 147
Discussion
of X-ray, ECG then included in the study. Throughout the clinical trial, all patients are
closely observed for any adverse changes. Telephonic communication was kept
through the clinical trial. After the clinical trial, patients are put on control drug i.e.
Sarpagandha Ghana vati 1 TID for further management, with consent of the
Physician. Some patients are referred to concerned Physician for further management.
Observations:
Age:
Age wise distribution of all thirty patients shows that maximum patients were
from 50-56 years age group i.e. 10 (33.33%) patients where 07 (23.33%) were male
and 03 (10%) were female. In age group of 43-49 years 07 (23.33%) patients were
reported, in these patients 04 (13.33%) were male and 03 (10%) were female, in age
group of 57-63 years 06 (20%) patients were undergone the treatment, here 02
(6.66%) were male and 04 (13.33%) were female and in age group of 64-70 years 05
(16.67%) patient were approached, in these patients 04 (13.33%) were male and 01
(3.33%) were female and in the age group of 36-42 years total 02 (6.67%) i.e. 01
(3.33%) were male and 01 (3.33%) were female patients had completed the treatment.
The age is the important factor in the manifestation of the disease because
hypertension is establish mostly in middle and senile age group. In Ayurveda, the
Vaya has been significant factor in the manifestation and prognosis of the disease.
Seeing that the hypertension normally occurs in middle and senile age, hence it can
mainly related to Pitta and Vata pradhana378 because of the dosha pradhanyata
according to the age. Essential hypertension is more prevalent in the middle and old
age. According to Acharya Vagbhata, the dosha pradhanyata according to age makes
difficult to treat379.
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Discussion
Sex:
The present study showed that 18 (60%) of the patients were male and 12
(40%) were comes under female category. In female, occurrence is mainly due to age,
hormonal changes and increase in blood pressure take place due to menopause also.
Thus in the present study the percentage of females is less than that of males.
Religion:
In this study 26 (86.67%) of the patients belongs to Hindu category and 04
(13.33%) belongs to Muslim. It may be due to Hindu dominant population. As the
sample size is too small, it is difficult to rule out the exact difference in their life style
concern to etiology of hypertension as both communities had taken lavana, katu,
amala etc. rasa yukta ahara.
Occupation:
In the occupation wise distribution 20 (66.67%) of the patients had sedentary
life style where 08 (26.66%) male and 12 (405) were female, 06 (20%) were male
patients had active occupation where as 04 (13.33%) were male patients are of labour
class. In the sedentary life style patients have taken heavy diet, excessive fat meal,
excessive salty diet and having more tension. The active occupation related strain and
stressful work where as in the labour occupation also having the stressful work. Even
though physical exercise is beneficial to Essential hypertension but dynamic exercise
raises blood pressure and isometric exercise raises it a lot more. These are the
important cause for increase in blood pressure.
Marital Status:
The present study showed that all the 30 patients i.e. 100% approached are
married. Stress and tension was the most common factor observed in married life.
Oppositions of opinion between the partners, the worry for their children and family
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 149
Discussion
etc. after marriage these could be the reason for the high blood pressure.
Economical Status:
Here, 04 (13.33%) of the patients comes from Poor Class, 02 (6.67%) of the
patients come from Higher Class and 24 (80.00%) of the patients comes from Middle
Class. The middle class peoples suffer with more anxiety. Stress may because of
financial insecurity or work tension and the negligence to proper Ahara and Vihara
may be the cause of hypertension.
Ahara:
In the present study 14 (46.66%) of the patients had vegetarian diet, 16
(53.33%) of the patients had mixed diet where as 17 (56.66%) of the patients had
more oily diet, 11 (36.66%) of the patients had used ghee and 16 (53.33%) of the
patients had used stored food. The geographical population takes more oily food, salt,
chillies, stored food, mixed food, ghee etc., therefore it can be concluded that patients
were taken the ahara which have been the nidana of hypertension so leads to
hypertension.
Intake of dominant Rasas:
In this study maximum 30 (100%) patients have taken Katu Rasa
predominantly in their diet, followed by 20 (66.67%) Madhura Rasa, 17 (56.67%)
Lavana Rasa and 08 (26.67%) Amala Rasa. The more use of Katu, Lavana and Amla
Rasa may be the nidana of this disease and these provokes the Pitta also, where as
Madhura rasa was used for the taste or after food. To make diet tastier Katu, Lavana
and Amla are used and they have taken spicy food.
Addictions:
The present study shows 22 (73.33%) of the patients had addiction to Coffee,
20 (66.67%) of the patients to Tea, 06 (20%) of the patients to Tobacco, 10 (33.33%)
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 150
Discussion
of the patients to Alcohol and 06 (20%) patients had addiction with Smoking. Coffee
and tea becomes a most commonly used in this era, so it should not be considered as
addiction. On the other hand in liable persons nicotine and caffeine in higher
concentration may work as nidanas. Tobacco is toxic thing and having Vyavayi,
Vikasi, Ushna and Tikshna gunas, can vitiate Rakta Dhatu. Alcohol also vitiates the
Rakta and Pitta.
Family History:
In this study 13 (43.33%) of the patients had family history of Hypertension.
This was important factor in the formation of disease because of involvement of
genetic factors in this disease.
Prakriti
Sharirika:
The study shows 18 (60%) of the patients had vatapitta prakriti, 10 (33.33%)
of the patients had vatakapha prakriti and 02 (6.66%) of the patients had pittakapha
prakriti. This shows that Vata and Pitta plays more important role in the formation of
disease. The Samprapti of hypertension is having the route of Avarana. The Vata
always gets vitiated by Avarana Pitta and Pitta Prakriti persons are more susceptible
Pittaja Vikaras. So in Pitta prakruti person the Vata get aggravating themselves. If the
Dosha matches with Prakriti and other factors like Dushya, Desha, Kala, Bala etc.
then the curability of disease becomes very difficult380.
Manasika:
In this study 20 (66.67%) of the patients had Kshobha, 19 (63.33%) of the
patients had Deenata, 17 (56.67%) of the patients had Kopa, 09 (30%) of the patients
had Bhaya, 09 (30%) of the patients had Samprahara, 08 (26.67%) patients had
Udvega and 06 (20%) of the patients had Mada. The stressful stimuli certainly raise
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 151
Discussion
blood pressure. Mada, Bhaya, Kama, Krodha, Lobha etc. elevate raja and tama gunas
which cause manodusti results in manovikara with involvement of samjnavaha or
manovaha srotas381. These factors are responsible for the disease formation because
stress, strain like nidanas are plays majour role in Hypertension. Hence it may be
concluded that all the psychological factors directly provoke Vata and Pitta which can
produce hypertensive state.
Satva:
The study shows 19 (63.33%) of the patients had Madhyam Satva and 07
(23.33%) of the patients had Avara Satva and 04 (13.33%) of the patients were having
Pravara Satva. Hypertension is stated as psychosomatic disease. Acharya Charka has
toled that satva is nothing but mana382. The Pravara Sattva patients have less attention
to exposing the disease because tension plays a major role in the formation of disease.
The stress and strain contribute highly in Essential hypertension. So Pravara satva
when reduces, the person will be victim for stress and strain hence Madhyama and
Avara Satva patients have more chances to get the disease.
Satmya:
The study shows 20 (66.66%) of the patients were having Madhya Satmya and
05 (16.66%) of the patients were having Pravara Satmya and 05 (16.66%) of the
patients were having Avara Satmya. Sarva Rasa intake is designate to accomplish
equipoise state of Dhatus383, but further Chakrapani has make clear that it does not
mean to take all Rasas in equal quantity. For example Vata Prakriti persons may
require more diet of Madhura, Amla and Lavana Rasa. Thus the part of Rasa requires
according to the bodily constitution, season, and dietetic properties384. So it is difficult
to look for the effect of Satmyata of Rasa in the manifestation of disease.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 152
Discussion
Agni:
The present study shows 19 (63.33%) of the patients had Manda Agni, 09
(30%) of the patients had Vishama Agni and 02 (6.66%) of the patient had Teekshana
Agni not even a single patient had Sama Agni. Manda Agni385 is major cause for all
disorders. Dooshya Rasa and Rakta which are involved in Essential hypertension
depend on Agni. Mandagni always responsible for srotoavarodha and is the
predominant factor in manifestation of Pittavruta Udana.
Koshtha:
The present study shows 02 (6.66%) of the patients had Mrudu Koshta, 19
(63.33%) of the patients had Madhyama Koshta and 09 (30%) of the patients had
Krura Koshta. Koshatha is also related to Agni hence also plays an important role in
the formation of disease.
Onset history:
The study shows that 26 (86.67%) of the patients are known hypertensive
among them 19 are on medication, 7 are discontinued. Before to the initiation of the
treatment, all were advised to taper down the previous medications. Data was
collected after the withdrawal of medication and found hypertensive and 04 (13.33%)
of the patients are newly diagnosed. After observation of the patients and monitoring
of the blood pressure, they were found hypertensive and were included in the clinical
trial with pre requisite inclusion criteria.
Intensity:
Here in this study 14 (46.66%) of the patients had Moderate Intensity of
Hypertension, 14 (46.66%) of the patients had Severe Intensity of Hypertension and
02 (6.66%) of the patients had Mild Intensity of Hypertension. The present clinical
trial was mainly aimed on antihypertensive effect of the trial drug. Majority of
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 153
Discussion
patients approached are known cases. As we discussed earlier all patients who are
taking medications for hypertension advised to stop the pervious medication. Because
of that majority of patients comes under the category of moderate and severe
intensity.
Vaya
In this study 23 (76.66%) of the patients had Madhya Vaya and 07 (23.33%)
of the patient’s had Vruddha Vaya. The Vaya is also plays an important role in the
manifestation of disease because hypertension is mostly found in Madhya and
Vruddha Vaya. In Ayurveda, the Vaya has been significant factor in the manifestation
and prognosis of the disease. In Madhya Vaya Pitta pradhanta and in Vruddha Vaya
Vata pradhanta occures. Essential hypertension is more prevalent in the Madhya and
Vruddha Vaya.
Vyayama shakti
The above table shows 06 (20.00%) of the patients had Madhyam
Vyayamashakti, 20 (66.66%) of the patients had Avara Vyamashakti and 04 (13.33%)
of the patients had Pravara Vyayamashakti. In observation, table no 33, showed that
66.67% patients are of sedentary life style. Global survey of the hypertension confine
that, sedentary life style may contribute to hypertension.
Nidra:
The present study shows that maximum 18 (60%) of the patients had disturbed
sleep and 12 (40%) of the patients had sound sleep. Majority of the patients with
disturbed sleep showed imbalanced condition of mind due to some psychological
conditions like anxiety, stress etc.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 154
Discussion
Aggravating & Relieving factors:
In the present study, emotional and physical stress was observed as
aggravating factor. Aggravating factors of 28 (93.33%) patients had Stress, 14
(46.67%) patients had Physical Stress, 15 (50%) of the patients had Emotions, 07
(23.33%) of the patients had Anxiety and 02 (6.67%) of the patients had Travelling.
Whereas sleep and rest was observed as a relieving factor in the patients. Relieving
factor of 28 (93.33%) patients had Sleep, 23 (76.67%) of the patients had Rest, 06
(20%) of the patients had Anti Depressants and 01 (3.33%) of the patients had
Tranquillizers. Therefore stress i.e. manovikaras plays a major role in Essential
hypertension.
Symptomatology:
The present study revealed that 27 (90%) of the patients had Klama following
25 (83.33%) of the patients had Shirah Shoola, 24 (80%) of the patients had Bhrama
and 05 (16.67%) of the patients had Daha but Moorcha was not seen in any patient.
As klama and shirashoola are raktapradoshaja vikaras which were observed in 90%
and 83.33% patients respectively and Daha in 16.67%, indicates predominance of
Pitta. The presence of Bhrama in 80% of patients indicates vataprakopa in present
condition. As shirashoola is the laxana of both Raktadusti and Vataprakopa, it
indicates involvement of both Vata and Pittadosha in Pittavruta vata.
Associated complaints:
Regarding the associated complaints of 19 (63.33%) of the patients had
Dourbalya and 04 (13.33%) of the patients had Avsada. The rest of the complaints
were not seen in any patient.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 155
Discussion
Systolic Blood Pressure:
The study revealed that maximum 14 (46.67%) of the patients were recorded
Stage II and Stage III average Systolic Blood Pressure followed by 02 (6.67%) of the
patients were of Stage I average Systolic Blood Pressure. No patients were recorded
of Stage IV. As the Allopathic medicine were withdrawn from the patients who had
undergone the Allopathic treatment. This may be the reason that maximum patients
were having stage II and stage III systolic hypertension.
Diastolic Blood Pressure:
Table no 49 revealed that maximum 15 (50%) of the patients were recorded
Stage I average Diastolic Blood Pressure followed by 07 (23.33%) of the patients
were suffering from Stage II average Diastolic Blood Pressure and 08 (26.67%) of the
patients were in Normal Stage. No patients were recorded of Stage III and IV average
Diastolic Blood Pressure. Here also by the same reason patients having stage I and
stage II diastolic hypertension.
4) Discussion on Results:
Results are drawn on cumulative effects of therapy on subjective and objective
parameters. In the present study 25 patients showed good response and 5 responded
moderately.
Table-70: Showing Overall Result of the therapy
Result No of patients Percentage
Good response 25 83.33%
Moderate response 05 16.66%
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 156
Discussion
Figure-42: Showing Overall Result of the therapy
83%
17%
goodresponsemoderateresponse
Effect of Therapy on Bhrama:
The present study illustrated that the effect of Shilajatu Guggulu Rasayana on
Bhrama gives 100% result. As Bhrama is due to Vata and Pitta dosha, the Shilajatu
and Guggulu having the rasayana properties hence act on the Vata dosha whereas
Guggulu having kashaya rasa act on Pitta dosha., the drug Triphala having the
properties of Pitta hara and madhura rasa hence act on Vata and Pitta. Gomutra
having the properties of anulomana with madhura and hence give the effect to
Shilajatu and Guggulu to act on Vata dosha. Like this Shilajatu and Guggulu
Rasayana, helps in regulating Bhrama.
In parameter Bhrama Mean ±SD before was 1.2 ±0.8 and after the treatment it
is reduced to 0.0 ±0.0 with Mean difference 1.2 and standard of mean 0.147 and test
shows more highly significant before and after the treatment as P<0.001.
Effect of Therapy on Klama:
The present study demonstrated that the effect of Shilajatu Guggulu Rasayana
on Klama gives 86% result. As Klama is due to Rakta dushti, the drug Triphala
having the properties of Pitta hara and madhura rasa hence acts on Pitta. The Shilajatu
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 157
Discussion
having sheeta guna and Guggulu having kashaya rasa hence acts on Pitta dosha. By
these properties Shilajatu and Guggulu Rasayana, helps in reducing Klama.
In parameter Klama Mean ±SD before was 1.44 ±0.77 and after the treatment
it is reduced to 0.2 ±0.40 with Mean difference 1.2 and standard of mean 0.121 and
test shows more highly significant before and after the treatment as P<0.001.
Effect of Therapy on Shirah shoola:
The present study revealed that the effect of Shilajatu Guggulu Rasayana on
Shirah shoola gives 91% result. As Shirah shoola is due to Vata dosha and Rakta
dushti, , the Shilajatu and Guggulu having the rasayana properties hence act on the
Vata dosha whereas Guggulu having kashaya rasa and Shilajatu having sheeta guna
act on Pitta dosha. Triphala having the properties of Pitta hara and madhura rasa
hence act on Vata and Pitta. Gomutra having the properties of anulomana with
madhura hence give the effect to Shilajatu and Guggulu to act on Vata. By these
properties Shilajatu and Guggulu Rasayana helps in subsiding Shirah shoola
In parameter Shira shoola Mean ±SD before was 1.5 ±0.86 and after the
treatment it is reduced to 0.13±0.34 with Mean difference 1.366 and standard of mean
0.139 and test shows more highly significant before and after the treatment as
P<0.001.
Effect of Therapy on Daha:
The present study shows that the effect of Shilajatu Guggulu Rasayana on
Daha gives 100% result. As Daha is due to Pitta dosha, the drug Triphala having the
properties of Pitta hara and madhura rasa whereas Shilajatu having sheeta guna and
Guggulu having kashaya rasa hence acts on Pitta dosha. Therefore Shilajatu and
Guggulu Rasayana, regulates Daha.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 158
Discussion
In parameter Daha Mean ±SD before was 0.2 ±0.48 and after the treatment it
is reduced to 0.0 ±0.0 with Mean difference 0.2 and standard of mean 0.0884 and test
shows more highly significant before and after the treatment as P<0.001.
Discussion on Moorcha:
In the present study none of the patient gives the history of moorcha. It
develops in the later stage of the hypertension and mostly observed during malignant
hypertension, where reduction in blood supply to the brain was established.
Effect of Therapy on Systolic hypertension:
The present study revealed that the effect of Shilajatu Guggulu Rasayana on
Systolic blood pressure gives 92% result. As Shilajatu and Guggulu having the
mutrala properties hence reduces the blood pressure.
In parameter Systolic B.P. Mean ±SD before was 2.4 ±0.62 and after the
treatment it is reduced to 0.2 ±0.55 with Mean difference 2.2 and standard of mean
0.121 and test shows more highly significant before and after the treatment as
P<0.001.
Effect of Therapy on Diastolic hypertension:
The present study revealed that the effect of Shilajatu Guggulu Rasayana on
Diastolic blood pressure gives 83% result. As Shilajatu and Guggulu having the
mutrala properties hence reduces the blood pressure.
In parameter Diastolic B.P, Mean ±SD before was 0.96 ±0.71 and after the
treatment it is reduced to 0.16 ±0.37 with Mean difference 0.8 and standard of mean
0.55 and test shows more highly significant before and after the treatment as P<0.001.
Over all response on Subjective and Objective parameters:
Net mean results of the therapy on all parameters (all subjective and objective
in to the consideration) showed 92%. This study demonstrated that the effect of
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 159
Discussion
Shilajatu Guggulu Rasayana on all the parameters. The drug Shilajatu and Guggulu
having the Rasayana affects hence Vata shamka, whereas Guggulu having kashaya
rasa and Shilajatu having sheeta guna hence Pitta shamka. Triphala having Pittahara
properties with madhura rasa hence act on Vata and Pitta dosha. Gomutra having the
properties of anulomana with madhura and hence give the effect to Shilajatu and
Guggulu to act on Vata dosha. Therefore by these properties Shilajatu and Guggulu
Rasayana, act on all parameters.
Table71: Showing the effect of therapy on Pittavruta udana (Essential
hypertension)
Net Result Percentage Net results of all therapies (X/N)
Response
Systolic B.P. 92% Diastolic B.P. 83% Shirah shoola 91%
Klama 86% Bhrama 100%
Daha 100% N = 6 X = 552
92%
Good response.
Effect of therapy on Biochemical Parameters:
Effect of Therapy on Serum Cholesterol:
In parameter Cholesterol Mean ±SD before was 193.81 ±29.22 and after the
treatment it is reduced to 1560.95 ±29.70 with Mean difference 37.63 and standard of
mean 18.298 and test shows more highly significant before and after the treatment as
P<0.001.
Effect of Therapy on Serum Triglycerides:
In parameter Triglyceride Mean ±SD before was 172.94 ±60.41 and after the
treatment it is reduced to 143.0 ±57.43 with Mean difference 41.206 and standard of
mean 4.72 and test shows more highly significant before and after the treatment as
P<0.001.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 160
Discussion
Effect of Therapy on High Density Lipoprotein:
In parameter H.D.L Mean ±SD before was 47.63 ±10.03 and after the
treatment it is reduced to 43.39 ±8.03 with Mean difference 4.813 and standard of
mean 0.66 and test shows more highly significant before and after the treatment as
P<0.001. Although HDL is highly significant in statistical analysis but clinically it is
insignificant.
Effect of Therapy on Low Density Lipoprotein:
In parameter L.D.L. Mean ±SD before was 111.69 ±30.13 and after the
treatment it is reduced to 84.97 ±24.64 with Mean difference 29.09 and standard of
mean 2.974 and test shows more highly significant before and after the treatment as
P<0.001.
Effect of Therapy on Very Low Density Lipoprotein:
In parameter V.L.D.L. Mean ±SD before was 34.54 ±12.10 and after the
treatment it is reduced to 28.54 ±11.46 with Mean difference 8.694 and standard of
mean 0.949 and test shows more highly significant before and after the treatment as
P<0.001.
Over all effect of therapy on Biochemical Parameters:
The present study revealed that the mean difference of Serum cholesterol was
found 36.86 i.e. lower than the before treatment mean, mean difference of Serum
triglycerides was found 29.94 i.e. lower than the before treatment mean, mean
difference of High density lipoprotein was found 4.24 i.e. lower than the before
treatment mean, mean difference of Low density lipoprotein was found 26.72 i.e.
lower than the before treatment mean whereas mean difference of Very low density
lipoprotein was found 06.00 i.e. also lower than the before treatment mean. As
Guggulu is the best drug to act on Serum cholesterol and Serum triglycerides where as
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 161
Discussion
Guggulu promotes the High density lipoprotein but in this study High density
lipoprotein mean difference was found 4.24, lower than the before treatment, this may
be due to the other cause. Even though it is highly significant in statistical analysis but
clinically it is insignificant. The Low density lipoprotein and Very low density
lipoprotein are the calculation of the rest of lipid profile. Hence the action of Shilajatu
Guggulu Rasayana on Lipid Profile has been seen.
OVER ALL RESPONSE:
Overall in almost all parameter the drug shows highly significant except HDL
cholesterol before and after the treatment. Majority of patients showed significant
control in the blood pressure. Except HDL, Serum Cholesterol, Serum Triglyceride,
LDL and VLDL are significantly reduced.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 162
Conclusion
Conclusion
Following conclusion can be drawn from the present study:
The symptoms of Pittavruta udana is correlated to certain extent with essential
hypertension.
Avarana means the obstruction to movement of Vata, avaraka is the cause for
it. In this regard hypertension is compared to that of Pittavruta udana, which is
having symptoms Bhrama, klama, moorcha daha opined by Acharaya Sushruta
and others Acharya Charaka added ojobhramsha and avasada to the above
symptoms.
Mainly in more than 95% of cases a specific underlying cause of hypertension
cannot be found such patients are said to have essential hypertension.
Hypertension usually asymptomatic for the first 10-20 yrs, slowly but surely
strains the heart and damages the arteries often called as silent killer.
Hypertension is asymptomatic but is having a direct relation to that of
vasculature. Atherosclerosis and arteriosclerosis are the phenomena, which
affects the individuals if neglected accounts for morbidity and mortality, which
needs an effective of careful approach.
Dr. Chaudhury great physiologist has mentioned hypertension is an ancient
disease, even Acharya Charaka; the Father of Hindu system of medicine
described the condition admirably more than 2500 years ago.
In the present study most of the patients had symptoms like bhrama, klama and
shirashoola.
Among the patients of present study only five had daha as one of the symptom.
Moorcha one of the symptom of Pittavruta udana, not observed in any of the
patients.
Shilajatu Guggulu Rasayana in Pittavruta Udana (Essential Hypertension) 163
Conclusion
In the present study 13 patients had the family history of hypertension it
suggests that there is strong involvement of genetic factors.
Among the 30 patients 4 patients newly diagnosed and rest 26 patients were
previously suffering with the hypertension.
Life style also have significant role in the manifestation of hypertension as 20
patients of the present study had sedentary life style.
A minimum of 2 months to maximum of three years chronic was noticed in the
present study.
14 patients had moderate to severe intensity of hypertension.
6 patients had the habit of smoking followed by 10 patients had alcohol
consumption as habit which are the triggering factors of hypertension.
Even 22 and 20 patients respectively had frequent intake of coffee and tea as
they contain certain triggering factors.
In the present study all patients were taking katu rasa pradhana ahara followed
by 17 patients were consuming lavana rasa pradhana ahara as which are the
pitta, vata and rakta prakopaka rasas.
As all patients had involvement of manovaha sroto vikruti as stress and strain is
the strong etiology behind the screen.
Shilajatu Guggulu Rasayana is best for the treatment of Avarana.
Guggulu is having its effect over atherosclerosis, obesity and is proven anti-
inflammatory drug.
Guggulu is the best drug to act on Serum cholesterol and Serum triglycerides
where as Shilajatu is presumed to posses the unique drug for the Dhatu poshana
and Tridosha prashamana.
Shilajatu Guggulu Rasayana in Pittavruta Udana (Essential Hypertension) 164
Conclusion
Both Shilajatu and Guggulu having the property of mootrala hence act as
diuretics as per modern system of medicine. Diuretic is the first aid in some
cases of hypertension.
The subjective parameter bhrama and daha shown 100% response, where as
shirah shoola shown 91% result and klama shown 86% result.
The objective parameters like systolic blood pressure shown 92% result where
as diastolic blood pressure shown 83% result in this study.
The present study revealed that the mean difference of Serum cholesterol was
found 36.86 i.e. lower than the before treatment mean, mean difference of
Serum triglycerides was found 29.94 i.e. lower than the before treatment mean,
mean difference of Low density lipoprotein was found 26.72 i.e. lower than the
before treatment mean whereas mean difference of Very low density
lipoprotein was found 06.00 i.e. also lower than the before treatment mean.
Overall in almost all parameter the drug shows highly significant before and
after the treatment i.e., good response.
Net mean results of the therapies (All subjective and objective in to the
consideration) = 92% i.e. Good response
Totally Shilajatu Guggulu rasayana has shown good response in Pittavruta
udana (essential hypertension) in the present study.
Suggestion for future study:
Present study showed encouraging results. The same study if done with large
sample more data can be obtained.
Present study showed good response on lipid profile. Further research may
show hopeful out come in hyperlipidaemia.
Shilajatu Guggulu Rasayana in Pittavruta Udana (Essential Hypertension) 165
Summary
Summary
The thesis entitled “Evaluation of the efficacy of “Shilajatu Guggulu
Rasayana in Pittavruta udana” with special reference to Essential hypertension”
comprises following parts.
1. Introduction
2. Objectives of the study
3. Review of literature
4. Methodology
5. Observation and results
6. Discussion
7. Conclusion
1. Introduction:
This part includes importance of the disease entity Pittavruta udana
comparison with Essential hypertension with its prevalence and about the importance
of Shilajatu Guggulu Rasayana in all type of Avarana with its individual effects.
2. Objectives of the study:
It includes importance of Avarana and our acharyas opinion on Pittavruta
udana, effect of Shilajatu Guggulu Rasayana on Avarana with its anti hypertensive
effects, effects of Essential Hypertension in modern life style, objectives of the study,
and reasons behind the selection of drug for this disease.
3. Review of literature:
This part includes historical review, description of Hridaya in ancient time,
review of previous research works, views of Ayurvedic scholars; Review of Pittavruta
udana includes disease etymology description of Avarana with classifications,
Description regarding nidana, lakshanas, nidana, poorvaroopa, roopa, samprapti,
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 166
Summary
upashaya-anupashaya, pathya-apathya etc., Description regarding the Hypertension
and its classification and different types of treatments. In the drug review description
concerning about the properties and preparation of Yoga.
4. Methodology:
This includes the selection criteria, study design, plan of the study, subjective
and objective parameters, posology, preparation of yoga, sample size, literary aspect,
criteria of diagnosis, inclusion and exclusion criteria and preparation of drug.
5. Observation and result:
It includes observation on all demographic data with their percentage and
graphical representation, regarding the observation nidanas, poorvaroopas, lakshanas
and results of individual symptoms followed overall response of the treatment.
6. Discussion:
Shilajatu Guggulu Rasayana vis-à-vis of Essential Hypertension, Discussion
on disease review, Discussion on drug review, Discussion on clinical study,
Discussion on results, Discussion on the patients of Pittavruta udana (Essential
Hypertension) who underwent the trial, Mode of Action of Shilajatu Guggulu
Rasayana.
7. Conclusion:
This is the last part of the present study. This section comprises of the
Conclusion on the whole study.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension) 167
Bibilography
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I
Bibilography
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Bibilography
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36) Ibid, Chapter-1/1/7-8, pp-5.
37) Ibid, Chapter-28/241-242, pp-981.
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III
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47) Ibid, Chapter-4/32, pp-358
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54) Ibid, Chapter-28/221-222, pp-626.
55) Ibid, Chapter-28/61-62, pp-619.
56) Ibid, Chapter-28/63-64, pp-619.
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Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
IV
Bibilography
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Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/11, Published by
Chaukhambha Sanskrit Santhan, Varanasi, pp- 113.
62) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit
commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary
by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha
Sanskrit Santhan, Varanasi, pp- 346.
63) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-
Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/17, Published by
Chaukhambha Sanskrit Santhan, Varanasi, pp- 115.
64) Ibid, Chapter-24/15,34, pp-124,126.
65) Arun.K.Tiwari, details on Hypertension, Heritage healing, Professional publications pvt. Ltd,
Madhurai, May 2002, pp-14.
66) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit
commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary
by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1-3, Published by
Chaukhambha Sanskrit Santhan, Varanasi, pp- 333.
67) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-
Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24, Published by
Chaukhambha Sanskrit Santhan, Varanasi, pp- 124.
68) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-6, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-485.
69) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-
Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/42-44, Published by
Chaukhambha Sanskrit Santhan, Varanasi, pp- 126.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
V
Bibilography
70) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-5/8, Published
by Chaukhambha Sanskrit Santhan,Varanasi, pp- 250.
71) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-
Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/7, Published by
Chaukhambha Sanskrit Santhan,Varanasi, pp- 184.
72) Ibid, Chapter-30/3-4, pp-183.
73) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Shareera Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-3/13-15, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-388.
74) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Shareera Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-4/32, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 358.
75) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/5-9,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.
76) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-21/10,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 101.
77) Ibid, Chapter-21/14, pp-102.
78) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/5, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.
79) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-20/6, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-156.
80) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-
Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/7, Published by
Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.
81) Ibid
82) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/5, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
VI
Bibilography
83) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/14, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.
84) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/6,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.
85) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/4, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.
86) Pandit Parashurama Shastri and Vidyasagar edited Sharangadhara Samhita, Poorvakhanda,
Anonymous Adhamalla Dipika Sanskrit commentary, Edition 3rd 1983, Chapter-5/27-28,
Published by Chaukhambha Orientalia,Varanasi-01, pp-50
87) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/4, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.
88) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the Ayurveda-
Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/6, Published by
Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.
89) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/6, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.
90) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-20/6, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-156.
91) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/9,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.
92) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/17, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.
93) Ibid, Chapter-1/17-18, pp-260.
94) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/9,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 616.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
VII
Bibilography
95) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/17, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.
96) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/7, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-193.
97) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-15/36,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 516.
98) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/17-18,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 260.
99) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/13, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-194.
100) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-20/7, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-157.
101) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-21/10,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 101.
102) Ibid, Chapter-21/14, pp-102.
103) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/15-16, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-
194.
104) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-20/8, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-157.
105) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/4,13,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 183,185.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
VIII
Bibilography
106) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Shareera Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-4/31, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 358.
107) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/7
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 184.
108) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-5/8, Published
by Chaukhambha Sanskrit Santhan,Varanasi, pp- 250.
109) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/8,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 185.
110) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-15/36,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 516.
111) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-30/12,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 185.
112) Ibid.
113) Ibid.
114) B.D. Chaurasia edited Human Anatomy Regional and Applied, Section-2 Chapter-18,
Vol-1, 3rd edition, Fourth Reprint 1999, published by: CBS Publishers and Distributors, New
Delhi pp-216.
115) Ibid.
116) Ibid, pp-226.
117) Ibid, pp-228.
118) Ibid, pp-229.
119) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-5/29, Published
by Chaukhamba Surbharati Prakashan, Varanasi, pp- 429.
120) Ibid
121) Ibid
122) Raja Radhakanta Deva edited Shabda-Kalpadrum, Part-2, 3rd edition 1967, Published by
Chaukhamba Sanskrit Series Office, Varanasi-1, pp- 298.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
IX
Bibilography
123) Brahmanand Tripathi edited Charaka samhita, Chikitsa Sthana, Charaka chandrika Hindi
commentary, Reprint 2002, Chapter-28/24-37, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-939.
124) Ibid, Chapter-28/31-32, pp-942.
125) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/59,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.
126) Dr. S. Suresh Babu edited The Principles and Practice of Kaya Chikitsa (Ayurveda’s
Internal Medicine), Vol-1, Edition:1st 2003,Jaikrishnadas Ayurveda Series No. 116, Chapter-
14, Published by Chaukhambha Orientalia,Varanasi-1, pp- 141.
127) Ibid, pp-142.
128) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/216,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 626.
129) Ibid, Chapter-28/215, pp-626.
130) Ibid, Chapter-28/215-216, pp-626.
131) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-16/47, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-420.
132) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-16/30, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-538.
133) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/61-71,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.
134) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-16/43, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-420.
135) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/199-216,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 625.
136) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-16/44, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-420.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
X
Bibilography
137) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/233,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 626.
138) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-16/48, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-421.
139) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sidhi Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/57,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 686.
140) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-5/29, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 429.
141) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-16/55, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-540.
142) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-17/78-81,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 103.
143) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-4/36-37,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 215.
144) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-17/78-79,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 103.
145) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-4/36,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 215.
146) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-1/66-67, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-36.
147) Ibid.
148) Ibid Chapter-24/5, pp-429.
149) Ibid Chapter-1/59, pp-32.
150) Ibid Chapter-1/60, pp-32.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XI
Bibilography
151) Ibid Chapter-24/8, pp-430.
152) Ibid Chapter-26/42-2, pp-482.
153) Ibid Chapter-26/42-3, pp-483.
154) Ibid Chapter-26/42-4, pp-483.
155) Ibid Chapter-26/42-5, pp-484.
156) Ibid Chapter-26/43, pp-484
157) Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol-1, 2nd part, Chapter-2, Reprint 2001,
Published by: Chaukhambha Bharati Academy Varansi, pp-142.
158) Ibid , pp-139.
159) Ibid , pp-138.
160) Ibid , pp-147.
161) Ibid, pp-140.
162) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-1/11-12, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-9-
10.
163) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-25/40, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-454.
164) Dr. Ravidutt Tripathi edited Astanga Samgrah, Sutra sthana, Saroja Hindi Vyakhya Sahit,
Reprint 2001, Chapter-9/29, Published by: Chaukhambha Sanskrit Pratishthan Delhi, pp-193.
165) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-26/102-103, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-498.
166) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Poorvardham, Tailaverga, Shaloka-2-6, 5th edition 1969, Published by Chaukhambha Sanskrit
Series office Varanasi-1, pp-779.
167) Brahmanand Tripathi edited Charaka samhita, Vimana sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-1/17, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-660.
168) Brahmanand Tripathi edited Charaka samhita, Sutra sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-27/66-86, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-509-511.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XII
Bibilography
169) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-6/101, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-107.
170) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Poorvardham, Sandhanaverga, Shaloka-19-20, 5th edition 1969, Published by Chaukhambha
Sanskrit Series office Varanasi-1, pp-785.
171) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-1/16, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-445.
172) Ibid Chapter-16/21, pp-537.
173) Brahmanand Tripathi edited Charaka samhita, Vimana sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-5/13, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-699.
174) Ibid Chapter-5/14, pp-699.
175) Brahmanand Tripathi edited Charaka samhita, Nidana sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-7/4, Published by: Chaukhambha Surbharati Prakashana
Varansi, pp-639.
176) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-13/23-24, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-
216.
177) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles
and Practice, Published in 2005, Chapter-2, Published by Taylor & Francis Group, new York,
pp-16.
178) Brahmanand Tripathi edited Charaka samhita, Shareera sthana, Charaka chandrika Hindi
commentary, Reprint 2003, Chapter-3/17, Published by: Chaukhambha Surbharati
Prakashana Varansi, pp-872.
179) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-24/5, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 114.
180) Ibid.
181) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003,
Published by: The Association of Physicians of India, pp-452.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XIII
Bibilography
182) Norman M. Kaplan edited Kaplan's Clinical Hypertension, 9th copyright 2006, Chapter-3,
Printer: Quebecor World –Taunton, pp-173.
183) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/5,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 124.
184) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/15,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 234.
185) Ibid, Chapter-1/18, pp-234.
186) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/32,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 73.
187) Norman M. Kaplan edited Kaplan's Clinical Hypertension, 9th copyright 2006, Chapter-3,
Printer: Quebecor World –Taunton, pp-176.
188) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-6/5, Published
by Chaukhambha Sanskrit Santhan,Varanasi, pp- 254.
189) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-7/27,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 50.
190) Ibid, Chapter-24/25, pp-125.
191) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Indriya Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-6/41,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 363.
192) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/23,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 72.
193) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/16-17,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 617.
194) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Siddi Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-12/11,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 730.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XIV
Bibilography
195) Norman M. Kaplan edited Kaplan's Clinical Hypertension, 9th copyright 2006, Chapter-3,
Printer: Quebecor World –Taunton, pp-182.
196) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-1/12, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-5.
197) Norman M. Kaplan edited Kaplan's Clinical Hypertension, 9th copyright 2006, Chapter-
3, Printer: Quebecor World –Taunton, pp-183.
198) Ibid, pp-183.
199) Ibid, pp-183.
200) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/30-31,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 583.
201) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/5,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 124.
202) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/56,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 585.
203) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/19-20,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 617.
204) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit
commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary
by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-22/5, Published by Chaukhambha
Sanskrit Santhan, Varanasi, pp- 410.
205) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 4th edition 1980, Chapter-1/35,
Published by Chaukhambha orientalia Varanasi, pp- 263.
206) Sri Harihar prasad pandeyen edited Bhavaprakasha, Udradhah, Udradhah, Vidhyotani
namikya bhasha teekya samvrita, 5th edition, Chapter-24/222, Published by: Choukhambha
Sanskrit Sansthan Varanasi. pp-260.
207) Ganga Sahaya Pandeya edited Gadanigraha, Vydyotini hindi commentary, 1st edition
1969, Chapter-21/26, Published by Chaukhambha Sanskrit Series, Varanasi-1, pp-474/475
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XV
Bibilography
208) Yadunandana Upadhyaya edited Madhava Nidana-I, with Madhukosha Sanskrit
commentary by Shri Vijayaraksita and Srikanthadatta, with the Vidyotin hindi commentary
by Shri Sudarsana Sastri, 15th edition 1985, Chapter-22/23, Published by: Choukhamba
Sanskrit Sansthan Varanasi, pp-419.
209) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-28/223,224,
Published by Chaukhambha Sanskrit Sthana Varanasi, pp- 626.
210) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16,
Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.
211) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published
by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-169.
212) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16,
Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.
213) Ibid. Chapter-20/14, pp-114.
214) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published
by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-250.
215) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/11, Published
by Chaukhambha Sanskrit stahan Varanasi, pp-113.
216) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit
commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary
by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha
Sanskrit Santhan, Varanasi, pp- 346.
217) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published
by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-414.
218) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 4th edition 1980, Chapter-
15/13, Published by Chaukhambha orientalia Varanasi, pp- 70.
219) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published
by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-444.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XVI
Bibilography
220) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16,
Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.
221) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/14, Published
by Chaukhambha Sanskrit stahan Varanasi, pp-114.
222) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published
by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-250.
223) Ibid, pp-62.
224) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/12, Published
by Chaukhambha Sanskrit stahan Varanasi, pp-114.
225) Vaman Shivram edited The Student Sanskrit-English Dictionary, reprint 1976, Published
by Motilal Banarsidass, Delhi, Printed at Shri Jainendra press, Delhi-7, pp-414.
226) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-24/11-16,
Published by Chaukhambha Sanskrit stahan Varanasi, pp-124.
227) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Aurveda dipiaka commentary of Chakrapanidatta, reprinted 2004, Chapter-20/11, Published
by Chaukhambha Sanskrit stahan Varanasi, pp-113.
228) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited,
Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by:
Churchill Livingstone Elsavier, pp-551.
229) Anthony S. Fauci, Joseph B. Martin, Eugene Braunwald, Kurt J. Isselbacher, Jean D.
Wilson, Dan L. Longo, Stephen L. Hauser, Dennis L. Kasper edited Harrison’s Principles of
internal medicine-I, 14th edition 1998, Part 8th section 4-246, Published by: McGraw- Hill
Health Professions Division New York. pp-203.
230) Daryl Fox edited Elaine N. Marieb Human anatomy and physiology, 4th edition 1998,
Unit-IV, Chapter-20, Published by Benjamin/Cummings science California pp-. 709.
231) Anthony S. Fauci, Joseph B. Martin, Eugene Braunwald, Kurt J. Isselbacher, Jean D.
Wilson, Dan L. Longo, Stephen L. Hauser, Dennis L. Kasper edited Harrison’s Principles of
internal medicine-I, 14th edition 1998, Part 8th section 4-246, Published by: McGraw- Hill
Health Professions Division New York. pp-203.
232) Ibid.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XVII
Bibilography
233) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited,
Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by:
Churchill Livingstone Elsavier, pp-551.
234) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-1/8, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-443.
235) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/11,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 113.
236) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit
commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary
by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha
Sanskrit Santhan, Varanasi, pp- 346.
237) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/14,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 114.
238) Prof. Yadunandana Upadhyaya edited Madhava Nidana, with Madhukosha Sanskrit
commentary by Sri Vijayaraksita and Srikantha Datta with the Vidyotini hindi commentary
by Sri Sudarsana Sastri, Part-1, 30th edition 2000, Chapter-17/1, Published by Chaukhambha
Sanskrit Santhan, Varanasi, pp- 346.
239) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/13,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 70.
240) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/11-16,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 124.
241) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/61-62,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.
242) Ibid, Chapter-28/61, pp-619.
243) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/223-224,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 626.
244) Ibid, Chapter-28/227-228, pp-626.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XVIII
Bibilography
245) Ibid, Chapter-28/222-223, pp-626.
246) Ibid, Chapter-28/221-222, pp-626.
247) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/233-235,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 626.
248) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-5/29, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 429.
249) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-16/56-57, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-
206.
250) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-16/50, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-421.
251) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/208-209,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 625.
252) Ibid, Chapter-28/235,236, pp-626.
253) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/206-
207,211-212, Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 625.
254) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/32,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 73.
255) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-16/31, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-538.
256) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/61-62,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 619.
257) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/241-242,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 627.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XIX
Bibilography
258) Anthony S. Fauci, Joseph B. Martin, Eugene Braunwald, Kurt J. Isselbacher, Jean D.
Wilson, Dan L. Longo, Stephen L. Hauser, Dennis L. Kasper edited Harrison’s Principles of
internal medicine-I, 14th edition 1998, Part 8th section 4-246, Published by: McGraw- Hill
Health Professions Division New York. pp-203.
259) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited
Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by:
Churchill Livingstone Elsavier, pp-551.
260) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003,
Published by: The Association of Physicians of India, pp-452.
261) Harsh Mohan edited Textbook of pathology, 5th edition 2005, Chapter-20, Published by:
Jaypee brother’s medical publishers (P) Ltd. New Delhi, pp-708.
262) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited
Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by:
Churchill Livingstone Elsavier, pp-608.
263) Ibid.
264) Harsh Mohan edited Textbook of pathology, 5th edition 2005, Chapter-20, Published by:
Jaypee brother’s medical publishers (P) Ltd. New Delhi, pp-708.
265) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003,
Published by: The Association of Physicians of India, pp-453.
266) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles
and Practice, Chapter-2, Published in 2005, Published by Taylor and Francis Group, New
york, pp-16.
267) Daryl Fox edited Elaine N. Marieb Human anatomy and physiology, 4th edition 1998,
Unit-IV, Chapter-20, Published by Benjamin/Cummings science California pp-. 709.
268) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder,
Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited
Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter A41,
Published by Lippincott Williams & Wilkins, New York, pp-120.
269) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles
and Practice, Chapter-2, Published in 2005, Published by Taylor and Francis Group, New
York, pp-16-17.
270) Ibid.Chapter-3, pp-37.
271) Ibid.Chapter-14, pp-217.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XX
Bibilography
272) Harsh Mohan, Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee
brother’s medical publishers (P) Ltd. New Delhi, pp-709.
273) Ibid.
274) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles
and Practice, Chapter-14, Published in 2005, Published by Taylor and Francis Group, New
York, pp-217.
275) Nicholas A. Boon, Nicki R. Colledge, Brain R. Walker, & John A.A. Hunter edited
Davidson’s Principles & practice of medicine, 20th edition 2006, Chapter-18, Published by:
Churchill Livingstone Elsavier, pp-609.
276) Robert C. Schlant, R. Wayne Alexander edited The Heart, 8th international edition,
Copyright 1994, Vol.-2, Chapter-75, Published by McGraw-Hill,Inc Health Professions
Division, New York, pp-1397.
277) Harsh Mohan, Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee
brother’s medical publishers (P) Ltd. New Delhi, pp-709.
278) Ibid, pp-708-709.
279) Siddharath N. Shah edited API Text book of medicine, Chapter-X-20, 7th edition 2003,
Published by: The Association of Physicians of India, pp-453.
280) Harsh Mohan, Textbook of pathology, 5th edition 2005, Chapter-20, Published by: Jaypee
brother’s medical publishers (P) Ltd. New Delhi, pp-709.
281) Ibid.
282) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder,
Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited
Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter
B101, Published by Lippincott Williams & Wilkins, New York, pp-296.
283) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder,
Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited
Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter
C109, Published by Lippincott Williams & Wilkins, New York, pp-322.
284) Ibid, pp-323.
285) Ibid, pp-324.
286) Ibid.
287) Ibid.
288) Ibid.
289) Ibid.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
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Bibilography
290) Dr. Shivprasad Sharma edited Astanga Samgraha, Nidana Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-2/4, Published by: Chaukhamba Sanskrit Series
Office, Varansi, pp-358.
291) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/66, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-206.
292) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/103-104,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 621.
293) Sri Satyapala Bhisagacharya edited Kasyapa Samhita, Garbhakrantishareera adhyaya,
The Vidyotini Hindi Commentary and with Sanskrit Introduction, 3rd edition, Chapter-16/42,
Published by: Chaukhamba Sanskrit Sansthan, Varansi, pp-338.
294) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/16,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 115.
295) Dr. Shivprasad Sharma edited Astanga Samgraha, Sutra Sthana, Sasilekha Sanskrit
Commentary by Indu, Reprint 2006, Chapter-27/4, Published by: Chaukhamba Sanskrit
Series Office, Varansi, pp-203.
296) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/18,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 125.
297) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/13,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 114.
298) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-35/6, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 525.
299) Ibid, Chapter-4/7, pp-420.
300) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/18,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 125.
301) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/245,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 627.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XXII
Bibilography
302) Ibid, Chapter-28/75,183, pp-620,624.
303) Ibid, Chapter-28/239, pp-627.
304) Ibid.
305) Ibid.
306) Ibid, Chapter-28/198, pp-625.
307) Ibid, Chapter-28/240, pp-627.
308) Ibid, Chapter-28/239, pp-627.
309) Ibid, Chapter-28/245, pp-627.
310) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Chikitsa Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-4/7, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 420.
311) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/241-243,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 627.
312) Ibid, Chapter-28/183-184, pp-624.
313) Ibid, Chapter-28/200-202, pp-625.
314) Ibid, Chapter-28/218, pp-626.
315) Ibid, Chapter-28/219,221, pp-626.
316) Edouard J. Battegay, Gregory Y. H. Lip, George L. Bakris edited Hypertension Principles
and Practice, Chapter-23, Published in 2005, Published by Taylor and Francis Group, New
york, pp-361.
317) Izzo, Joseph L.; Black, Henry R.; Goodfriend, Theodore L.; Sowers, James R.; Weder,
Alan B.; Appel, Lawrence J.; Sheps, Sheldon G.; Sica, Domenic A.; Vidt, Donald G. edited
Hypertension Primer: The Essentials of High Blood Pressure, 3rd Edition 2003, Chapter B95,
Published by Lippincott Williams & Wilkins, New York, pp-276.
318) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-25/45,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 133.
319) Dr. In Dradeva Tripathi edited Lolimbaraja, Vaidhyajeevanam, prathama vilasa, 10th
shloka, 3rd edition 2005, Chawkhambha Orientalia Varanasi, pp-4.
320) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/185,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 624.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XXIII
Bibilography
321) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/65,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp-59.
322) Dr. Chanderbhooshan jha edited Ayurved Rasashastra, , reprint 2003, Chapter-6,
Published by Chaukhambha Surbharti Prakashan Varanasi, pp- 225.
323) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-73, First edition
1982, Published by Chaukhambha Orientalia Varanasi, pp-117.
324) Pandit Kashinath Shastri edited Rasatrangini,11th edition 1979, Chapter-22/60-61,
Published by Motilal Banarsidas Varanasi, pp-582.
325) Dr. Chanderbhooshan jha edited Ayurved Rasashastra, , reprint 2003, Chapter-6,
Published by Chaukhambha Surbharti Prakashan Varanasi, pp- 225.
326) Dr. Indra Dev Tripathi edited Rasaratna Samuchchaya, with Rasaprabha hindi
commentary, 2nd edition 2003, Chapter-2/207, Published by Chaukhambha Sanskrit
Bhawan,Varanasi, pp- 20.
327) Ibid, Chapter-2/208-209, pp-20.
328) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-73, First edition
1982, Published by Chaukhambha Orientalia Varanasi, pp-117.
329) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/48-49,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 54.
330) Ibid, Chapter-1/3/58-59, pp-57.
331) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-73, First edition
1982, Published by Chaukhambha Orientalia Varanasi, pp-117.
332) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/48-49,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 54.
333) Pandit Kashinath Shastri edited Rasatrangini,11th edition 1979, Chapter-22/84, Published
by Motilal Banarsidas Varanasi, pp-588.
334) Pandit Shiva Sharma edited Ayurveda Prakasha, with the Arthavidyotini and
Arthaprakasini Sanskrit and Hindi commentaries, reprinted 1999, Chapter-4/100-104,
Published by Chaukhambha Bharati Academy Varanasi, pp- 428.
335) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/3/65,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp-59.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XXIV
Bibilography
336) Pandit Shiva Sharma edited Ayurveda Prakasha, with the Arthavidyotini and
Arthaprakasini Sanskrit and Hindi commentaries, reprinted 1999, Chapter-4/126-127-104,
Published by Chaukhambha Bharati Academy Varanasi, pp- 433.
337) Pandit Kashinath Shastri edited Rasatrangini,11th edition 1979, Chapter-22, Published by
Motilal Banarsidas Varanasi, pp-582.
338) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm.
339) Ibid.
340) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Vedanasthapana-
20, Chapter-1, Published by Chaukhambha Bharati Academy Varanasi, pp-54.
341) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm.
342) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Karpooradiverga-25, 5th edition 1969, Published by Chaukhambha Sanskrit Series office
Varanasi-1, pp-205.
343) Ibid, pp-204.
344) Prof. Priyavrat Sharma edited Dhanvantari Nighantuh, Tritya verga-59, First edition
1982, Published by Chaukhambha Orientalia Varanasi, pp-112.
345) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Karpooradiverga-25, 5th edition 1969, Published by Chaukhambha Sanskrit Series office
Varanasi-1, pp-205.
346) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Vedanasthapana-
20, Chapter-1, Published by Chaukhambha Bharati Academy Varanasi, pp-54.
347) Ibid, pp-55.
348) Ibid, pp-57.
349) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm.
350) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Vedanasthapana-
20, Chapter-1, Published by Chaukhambha Bharati Academy Varanasi, pp-54.
351) file:///F|/tmp/Ayuherbal/Guggulu -Medicinal Plant of India.htm
352) Ibid.
353) Ibid.
354) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-1, Pratham Khanda, reprint: 2001,
Chapter-9, Published by Chaukhambha Bharati Academy Varanasi, pp-99-100.
355) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Haritkyadiverda, 5th edition 1969, Shaloka-43, Published by Chaukhambha Sanskrit Series
office Varanasi-1, pp-12.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XXV
Bibilography
356) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005,
Jawaraghanadiverga-340, Chapter-9, Published by Chaukhambha Bharati Academy Varanasi,
pp-753.
357) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Haritkyadiverda, 5th edition 1969, Published by Chaukhambha Sanskrit Series office
Varanasi-1, pp-7.
358) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005, Chenadiverga-93,
Chapter-4, Published by Chaukhambha Bharati Academy Varanasi, pp-239.
359) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Haritkyadiverda, 5th edition 1969, Published by Chaukhambha Sanskrit Series office
Varanasi-1, pp-9.
360) Prof. P.V.Sharma edited Dravya Guna Vijnana, Vol.-2, reprint: 2005,
Jawaraghanadiverga-340, Chapter-9, Published by Chaukhambha Bharati Academy Varanasi,
pp-758.
361) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh,
Haritkyadiverda, 5th edition 1969, Shaloka-43, Published by Chaukhambha Sanskrit Series
office Varanasi-1, pp-10.
362) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/142,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 284.
363) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-39/6, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 171.
364) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, 5th
edition 1969, Mootraverga, shaloka-1-6, Published by Chaukhambha Sanskrit Series office
Varanasi-1, pp-778.
365) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-1/94,101,
Published by Chaukhambha Sanskrit Santhan,Varanasi, pp- 21.
366) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-45/220-221,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 213.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XXVI
Bibilography
367) Sri Brahmasankara Misra and Sri Roop lal ji edited Bhava Prakasha Nighantuh, 5th
edition 1969, Mootraverga, shaloka-1-6, Published by Chaukhambha Sanskrit Series office
Varanasi-1, pp-778.
368) Ibid.
369) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-15/32,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 73.
370) Pandit Parasurama Sastri, Vidyasagar edited Sarngadhara Samhita, Madhyama Khanda,
with the commentary of Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, 6th edition
2005, Chapter-11/94-98, Published by Chaukhambha Orientalia Varanasi, pp-255.
371) The Ayurvedic formulary of India, Part-1, 1st edition 1978, Govt.of India, Ministry of
Health and Family Planning Department of Health, Delhi, pp-55.
372) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, `Sutra Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-21/36,
Published by Chaukhamba Surbharati Prakashan,Varanasi, pp- 106.
373) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-17/118,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 105.
374) Vaidya Jadavji Trikamji Acharya edited Susruta Samhita, Nidana Sthana, with the
nibandhasangraha commentary of Sri Dalhnacharya, reprinted 2008, Chapter-1/8, Published
by Chaukhamba Surbharati Prakashan,Varanasi, pp- 257.
375) Pandit Parasurama Sastri, Vidyasagar edited Sarngadhara Samhita, Prathma Khanda, with
the commentary of Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika, 6th edition 2005,
Chapter-5/25, Published by Chaukhambha Orientalia Varanasi, pp-50.
376) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-20/11,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 113.
377) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-28/59,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 619.
378) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/122,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 280.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XXVII
Bibilography
379) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-1/31, Published by: Chaukhambha Surbharati Prakashana Varansi, pp-18.
380) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/101,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 278.
381) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-24/25,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 125.
382) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-8/119,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 279.
383) Vaidya Jadavji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, with the
Ayurveda-Dipika commentary of Sri Chakrapanidatta, reprinted 2004, Chapter-7/41,
Published by Chaukhambha Sanskrit Santhan, Varanasi, pp- 52.
384) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Sutra Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-3/57, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-50.
385) Pt. Hari Sadasiva Sastri Paradakara Bhisagacarya edited Astanga Hrdaya, Nidana Sthana,
Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri Commentaries, Reprint
2007, Chapter-12/1, Published by: Chaukhambha Surbharati Prakashana Varanasi, pp-513.
Shilajatu Guggulu Rasayana in Pittavruta Udana ( Essential Hypertension)
XXVIII
i
Table72: Showing Demographic Data
Sex: M- Male, F- Female, Religion: H-Hindu, M-Muslim, FS-Fiscal Status: P-Poor, M- Middle, H- Higher class, Occ-Occupation: S- Sedentary, A-Active, L-Labor, MS-Marital Status: M-Married, OS-Onset: C-Chronic, A-Acute, Intensity: S-Severe, Mo-Moderate, Mi-Mild, Diagnosis: P-Previously diagnosed, N-Newly diagnosed, FH- Family History of HTN: Y-Yes, N-No, Nidra: S-Sound, D-Disturbed, MV-Mansika Vritanta: B-Bhaya, K-Kopa, D-Deenta,, U-Udvega, Ks-Kshobha, Sa-Samprahara, M-Mada, Diet: V-Vegetarian, M-Mixed, Vyasana: T-Tea, C-Coffee, S-Smoking, A-Alcohal, Prakruti: VP-Vatapitta, VK-Vatakapha, PK-Pittakapha, Re-Remarks: GR-Good Response, MR-Moderate Response.
Sl OPD Age Sex Religion F.S. M.S. Occ. O.S. Int Diagnosis F.H. Nidra M.V. Diet Vyasana Prkruti. Re. 01. 5276 70 M H M M S C S P N D KDKs M T VP GR 02. 5285 70 M H M M S C S P N D KDKs M T VP GR 03. 5719 58 F H M M S C Mo P N D BD V C VK GR 04. 5774 55 M H M M S C S P Y S BKKsSa V TCA VP GR 05. 5735 48 M H M M S C Mo P Y D DKs V CA VK GR 06. 5892 45 M H P M L C S P N S KDSa M TA VP MR 07. 6342 50 M H M M S C Mo P Y D KKsSa M C VK GR 08. 6341 40 F M M M S C Mi P N S KKsSa M C VP GR 09. 6457 56 M H M M S C Mo P Y D KDKs V TC VP GR 10. 6529 66 M H M M S C S P Y S KKsSa M TCSA VK MR 11. 6530 58 F H M M S C Mo P Y S DUKs M C VK MR 12. 1225 38 M H H M A C Mo P N D BKKs V C VP GR 13. 4905 46 F H M M S C Mo P Y S BD M C VK MR 14. 5899 55 F M M M S C S P Y S KKsSa M TC VK GR 15. 345 55 M H P M L C Mo P Y D BDKs V TSA VP GR 16. 347 58 F H M M S C S P N S DU V T PK GR 17. 349 65 F H M M S C S P Y D DKsM V TC VP GR 18. 494 68 M H M M A C S P N S KKsSaM V T VP GR 19. 459 49 M H M M A C S P N D KDUKsSa V C VP GR 20. 496 45 M H M M S C S P N D KSaM M TSA VK GR 21. 527 57 F M M M S C Mo P N D KUKs M TC VP GR 22. 531 44 F H M M S A Mi N Y S BDKs V TC VP GR 23. 1219 53 F H M M S C Mo P N D DU V TC VP GR 24. 1218 52 M H M M A A S N N S KKsM M CSA VP GR 25. 1217 58 M H P M L C Mo P N D BDUM V TSA VK GR 26. 1445 48 F H H M S A Mo N N D BKDUM V TC VP GR 27. 1435 50 F M M M S C S P N S BDU M C VK GR 28. 1442 55 M H P M L C S P N D DKs M TSA PK MR 29. 1446 50 M H M M A A Mo N Y D D M TC VP GR 30. 1444 60 M H M M A C Mo P Y D KKs M TCA VP GR
ii
Table73: Showing Subjective parameters Before and After treatment
Bhrama Klama Shirah shoola Daha Moorcha Sl. No.
OPD NO BT AT % BT AT % BT AT % BT AT % BT AT %
01. 5276 3 0 100 3 0 100 2 0 100 0 0 - 0 0 - 02. 5285 1 0 100 2 0 100 1 0 100 0 0 - 0 0 - 03. 5719 2 0 100 2 1 50 1 0 100 1 0 - 0 0 - 04. 5774 1 0 100 2 0 100 1 0 100 0 0 - 0 0 - 05. 5735 2 0 100 0 0 - 2 0 100 0 0 - 0 0 - 06. 5892 1 0 100 2 1 100 3 1 67 0 0 - 0 0 - 07. 6342 2 0 100 1 0 100 1 0 100 0 0 - 0 0 - 08. 6341 0 0 - 2 0 100 2 0 100 0 0 - 0 0 - 09. 6457 1 0 100 2 0 100 0 0 100 0 0 - 0 0 - 10. 6529 2 0 100 3 1 67 0 0 - 0 0 - 0 0 - 11. 6530 2 0 100 2 1 50 2 1 50 0 0 - 0 0 - 12. 1225 1 0 100 1 0 100 2 0 100 0 0 - 0 0 - 13. 4905 0 0 - 2 1 50 3 1 67 0 0 - 0 0 - 14. 5899 2 0 100 1 0 100 2 0 100 0 0 - 0 0 - 15. 345 2 0 100 1 0 100 1 0 100 0 0 - 0 0 - 16. 347 2 0 100 1 0 100 2 0 100 0 0 - 0 0 - 17. 349 2 0 100 1 0 100 1 0 100 0 0 - 0 0 - 18. 494 0 0 - 1 0 100 2 0 100 0 0 - 0 0 - 19. 459 1 0 100 1 0 100 2 0 100 1 0 100 0 0 - 20. 496 1 0 100 2 1 50 2 0 100 0 0 - 0 0 - 21. 527 1 0 100 2 0 100 2 0 100 1 0 100 0 0 - 22. 531 1 0 100 1 0 100 1 0 100 0 0 - 0 0 - 23. 1219 2 0 100 1 0 100 0 0 - 0 0 - 0 0 - 24. 1218 0 0 - 1 0 100 2 0 100 0 0 - 0 0 - 25. 1217 1 0 100 1 0 100 2 0 100 0 0 - 0 0 - 26. 1445 0 0 - 0 0 - 2 0 100 2 0 100 0 0 - 27. 1435 1 0 100 1 0 100 0 0 - 0 0 - 0 0 - 28. 1442 1 0 100 0 0 - 2 1 50 0 0 - 0 0 - 29. 1446 0 0 100 1 0 100 2 0 100 0 0 - 0 0 - 30. 1444 1 0 100 2 0 100 0 0 - 1 0 100 0 0 - BT- before treatment, AT- after treatment, Total- total number of patients, % - percentage
iii
Table74: Showing Objective parameters Before and After treatment
Blood Pressure Systolic B.P.(S.B.P) Diastolic B.P.(D.B.P)
SL No.
OPD No.
BT AT % BT AT % 01. 5276 3 0 100 % 0 0 - 02. 5285 3 0 100 % 0 0 - 03. 5719 2 0 100 % 2 1 50 % 04. 5774 3 0 100 % 1 0 100 % 05. 5735 2 0 100 % 0 0 - 06. 5892 3 2 33 % 2 1 50 % 07. 6342 2 0 100 % 1 0 100 % 08. 6341 1 0 100 % 0 0 - 09. 6457 2 0 100 % 2 0 100 % 10. 6529 3 2 33 % 2 1 50 % 11. 6530 2 0 100 % 2 1 50 % 12. 1225 2 0 100 % 1 0 100 % 13. 4905 2 0 100 % 2 1 50 % 14. 5899 3 0 100 % 1 0 100 % 15. 345 2 0 100 % 0 0 - 16. 347 3 0 100 % 1 0 100 % 17. 349 3 0 100 % 1 0 100 % 18. 494 3 0 100 % 1 0 100 % 19. 459 3 0 100 % 1 0 100 % 20. 496 3 1 67 % 1 0 100 % 21. 527 2 0 100 % 0 0 - 22. 531 1 0 100 % 1 0 100 % 23. 1219 2 0 100 % 1 0 100 % 24. 1218 3 0 100 % 1 0 100 % 25. 1217 2 0 100 % 0 0 - 26. 1445 2 0 100 % 1 0 100 % 27. 1435 3 0 100 % 0 0 - 28. 1442 3 1 67 % 1 0 100 % 29. 1446 2 0 100 % 1 0 100 % 30. 1444 2 0 100 % 2 0 100 %
BT- before treatment, AT- after treatment, Total- total number of patients, % - percentage, SBP- Systolic blood pressure, DBP- Diastolic blood pressure, GR- Good Response, MR- Moderate Responce
iv
Table75: Showing Lipid Profile values Before and After treatment
LIPID PROFILE Cholesterol Triglyceride H.D.L. L.D.L. V.L.D.L. Sl.
No. OPD. No. BT AT BT AT BT AT BT AT BT AT
1. 5276 256.5 215.7 154.4 92.9 58.3 50.0 167.4 147.2 30.8 18.52. 5285 165.5 140.9 100.4 118.2 31.8 39.7 113.7 77.6 20.0 23.63. 5719 197.3 201.8 103.5 169.8 57.2 42.8 119.4 125.1 20.7 33.94. 5774 154.6 136.2 123.6 117.1 59.7 55.7 70.2 57.8 24.7 23.45. 5735 177.4 145.3 298.7 190.1 67.5 53.5 50.2 53.8 59.7 38.06. 5892 203.0 147.5 197.9 154.2 59.2 47.8 104.3 68.9 39.5 30.87. 6342 189.1 163.6 194.5 152.8 37.9 35.4 112.3 97.6 38.9 30.58. 6341 172.2 128.1 134.0 101.2 35.4 34.0 110.0 73.9 26.8 20.29. 6457 186.2 133.1 102.6 86.2 37.2 34.0 128.4 81.8 20.5 17.210. 6529 196.0 148.2 196.1 138.1 50.5 48.2 106.3 72.3 39.2 27.611. 6530 146.5 132.1 145.6 86.1 41.9 38.2 75.5 76.6 29.1 17.212. 1225 159.0 132.2 155.0 130.0 50.0 49.4 52.0 57.0 31.0 26.013. 4905 207.5 143.2 118.1 92.1 48.6 45.1 135.3 79.7 23.6 18.414. 5899 218.4 168.2 140.2 122.4 53.7 50.0 136.7 93.7 28.0 24.415. 345 198.7 163.7 192.1 165.2 39.2 35.0 121.0 95.6 38.4 33.016. 347 183.1 148.2 163.6 137.5 32.1 30.0 118.2 90.7 32.7 27.517. 349 210.2 165.1 180.1 132.7 53.7 49.5 120.4 89.0 36.0 26.518. 494 232.0 172.9 192.2 148.2 55.0 52.1 138.5 91.1 38.4 29.619. 459 225.0 232.0 308.0 382.0 35.7 30.3 157.0 125.3 61.6 76.420. 496 223.0 220.0 334.0 218.0 39.3 40.0 116.9 137.0 66.8 43.021. 527 214.1 178.9 221.7 184.2 37.4 35.2 132.4 106.8 44.3 36.822. 531 216.5 159.4 126.0 170.2 55.6 49.3 135.7 76.1 25.2 34.023. 1219 173.2 113.9 168.1 107.2 39.0 32.9 100.5 59.6 33.6 21.424. 1218 192.3 142.7 128.7 92.5 43.5 37.0 123.0 87.2 25.14 18.525. 1217 184.3 130.7 118.7 92.4 40.0 37.2 120.5 75.0 23.7 18.426. 1445 250.1 184.2 248.6 192.1 59.2 55.9 141.2 89.9 49.7 38.427. 1435 185.7 157.2 140.3 137.1 47.4 47.0 110.3 81.9 28.0 27.428. 1442 200.3 153.1 130.9 92.9 55.7 48.2 118.4 86.3 26.18 18.529. 1446 168.5 132.3 201.1 150.9 62.3 55.2 65.9 46.9 40.2 30.130. 1444 128.3 118.2 169.7 135.9 45.0 43.2 49.3 47.8 33.9 27.1 BT- before treatment, AT- after treatment, H.D.L- High density lipoprotein L.D.L. - Low density lipoprotein, V.L.D.L. - Very low density lipoprotein, Cholesterol- Total serum cholesterol, Triglyceride- Serum triglycerides
v
Table76: Showing Scoring Before and After the Treatment of all the parameters Scoring Before Treatment (all the parameters) Scoring After Treatment (all the parameters) Sl.
No OPD. No. Bhrama Klama Shirah
shoola Daha Systolic
B.P. Diastolic B.P
Total Bhrama Klama Shirah shoola
Daha Systolic B.P.
Diastolic B.P
Total
1. 5276 3 3 2 0 3 0 11 0 0 0 0 0 0 0 2. 5285 1 2 1 0 3 0 7 0 0 0 0 0 0 0 3. 5719 2 2 1 1 2 2 10 0 1 0 0 0 1 2 4. 5774 1 2 1 0 3 1 8 0 0 0 0 0 0 0 5. 5735 2 0 2 0 2 0 6 0 0 0 0 0 0 0 6. 5892 1 2 3 0 3 2 11 0 1 1 0 2 1 5 7. 6342 2 1 1 0 2 1 7 0 0 0 0 0 0 0 8. 6341 0 2 2 0 1 0 5 0 0 0 0 0 0 0 9. 6457 1 2 0 0 2 2 7 0 0 0 0 0 0 0 10. 6529 2 3 0 0 3 2 10 0 1 0 0 2 1 4 11. 6530 2 2 2 0 2 2 10 0 1 1 0 0 1 3 12. 1225 1 1 2 0 2 1 7 0 0 0 0 0 0 0 13. 4905 0 2 3 0 2 2 9 0 1 1 0 0 1 3 14. 5899 2 1 2 0 3 1 9 0 0 0 0 0 0 0 15. 345 2 1 1 0 2 0 6 0 0 0 0 0 0 0 16. 347 2 1 2 0 3 1 9 0 0 0 0 0 0 0 17. 349 2 1 1 0 3 1 8 0 0 0 0 0 0 0 18. 494 0 1 2 0 3 1 7 0 0 0 0 0 0 0 19. 459 1 1 2 1 3 1 9 0 0 0 0 0 0 0 20. 496 1 2 2 0 3 1 9 0 1 0 0 1 0 2 21. 527 1 2 2 1 2 0 8 0 0 0 0 0 0 0 22. 531 1 1 1 0 1 1 5 0 0 0 0 0 0 0 23. 1219 2 1 0 0 2 1 6 0 0 0 0 0 0 0 24. 1218 0 1 2 0 3 1 7 0 0 0 0 0 0 0 25. 1217 1 1 2 0 2 0 6 0 0 0 0 0 0 0 26. 1445 0 0 2 2 2 1 7 0 0 0 0 0 0 0 27. 1435 1 1 0 0 3 0 5 0 0 0 0 0 0 0 28. 1442 1 0 2 0 3 1 7 0 0 1 0 1 0 2 29. 1446 0 1 2 0 2 1 6 0 0 0 0 0 0 0 30. 1444 1 2 0 1 2 2 8 0 0 0 0 0 0 0 B.P.- Blood Pressure
vi
Table77: Showing Net Response of the Treatment (all the parameters)
GR- Good Response, MR- Moderate Response, MdR- Mild Response, NR– No Response.
TOTAL RESPONSE :
GOOD RESPONSE - 25
MODERATE RESPONSE - 05
MILD RESPONSE - 00
NO RESPONSE - 00
Sl. No.
OPD No.
BT (SCORE)
AT (SCORE)
BT (%)
AT (%)
NET RESPONSE (%)
REMARKS
01. 5276 11 0 100 000 100 GR 02. 5285 7 0 100 000 100 GR 03. 5719 10 2 100 20 80 GR 04. 5774 8 0 100 000 100 GR 05. 5735 6 0 100 000 100 GR 06. 5892 11 5 100 45 55 MR 07. 6342 7 0 100 000 100 GR 08. 6341 5 0 100 000 100 GR 09. 6457 7 0 100 000 100 GR 10. 6529 10 4 100 40 60 MR 11. 6530 10 3 100 30 70 MR 12. 1225 7 0 100 000 100 GR 13. 4905 9 3 100 33 67 MR 14. 5899 9 0 100 000 100 GR 15. 345 6 0 100 000 100 GR 16. 347 9 0 100 000 100 GR 17. 349 8 0 100 000 100 GR 18. 494 7 0 100 000 100 GR 19. 459 9 0 100 000 100 GR 20. 496 9 2 100 22 78 GR 21. 527 8 0 100 000 100 GR 22. 531 5 0 100 000 100 GR 23. 1219 6 0 100 000 100 GR 24. 1218 7 0 100 000 100 GR 25. 1217 6 0 100 000 100 GR 26. 1445 7 0 100 000 100 GR 27. 1435 5 0 100 000 100 GR 28. 1442 7 2 100 29 71 MR 29. 1446 6 0 100 000 100 GR 30. 1444 8 0 100 000 100 GR
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
I
Department of Post Graduate Studies in Kayachikitsa
D.G.M. Ayurvedic Medical College & Hospital GADAG Special case sheet for evaluation of
Shilajatu Guggulu Rasayana in Pittavaruta udana w.s.r.to Essential Hypertension Guide: Dr. R.V. Shettar, M.D (Ayu), Scholar: Sanjeev Kumar (Asst. Professor, P.G. Dept of Kayachikitsa.) 1) Name of the Patient
2) Father’s / husband’s name Sl.No
3) Sex Male Female OPD No
4) Age (in years) Birth place IPD No
5) Religion Hindu Muslim Christian Other
6) Occupation Sedentary Active Labor
7) Marital status Married Unmarried
8) Economical status Poor Middle Higher middle Higher class
9) Address
Contact No: Pin
10) Selection Included Excluded
11) Schedule Initiation Date Completion Date
Well responded Moderately responded 12) Result
Mild responded Poor responded Discontinued
13) INFORMED CONSENT I Son/Daughter/Wife of am
exercising my free will, to participate in above study as a subject. I have been informed to my satisfaction, by
the attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am also
aware of my right to opt out of the treatment schedule, at any time during the course of the treatment.
EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw ___________________________________________________
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gÉÆÃVAiÀÄ gÀÄdÄ/Patient’s Signature
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
II
14) Pradhana vedana: Duration Sl.no. Complaints Present / Absent
Fresh < 1 Yrs < 5 Yrs > 5 Yrs 1 Bhrama 2 Klma 3 Shirah shoola 4 Daha 5 Moorcha
15) Anubandha vedana:
Duration Sl.no
Complaints Present/Absent Fresh <1Yrs < 5Yrs > 5Yrs
1 Daha in nabhi and uras 2 Avsada 3 Ati sweda 4 Others
16) Adhyatana vyadhi vrittanta:
Mode of onset [Atanka samutpatti]
Acute Chronic
Course of the disease [Vedana samucchaya]
Yrs / Month
Intensity Mild Moderate Severe Traveling Anxiety Emotion Aggravating
[Anupashaya] Stress Physical stress If any other Rest Tranquilizers
Fac
tors
Relieving [Upashaya] Sleep Anti depressant’s
Others 17) Poorva vyadhi vrittanta: 18) Kula vrittanta: (Write relationship)
Heart Disease Cancer Hypertension Thyroid disorders Obesity Hemiplegic Diabetes Any other
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
III
19) Chikitsa vrittanta:
Newly Diagnosed Previously Diagnosed Previous Medication Ayurvedic Allopathic Discontinued
1. 2. Drug used Dose Duration Dose Duration Response Controlled Not controlled Oral contraceptives
Yes No Duration Dose
Anti depressant Yes No Duration Dose 20) Vyasna:
21) Vyaktika vrittanta:
Night sleep Hrs. Day sleep Hrs. Nature of sleep Sound Disturbed
Nidra
Dreams Yes No Vegetarian Madhura Amala Mixed food Lavana Katu Oil/Ghee Tikta Kshaya
Ahara
Stored food
Rasa predominance
Kostha Krura Madhyama Mrudu Jatharagni bala Manda Teekshna Vishama Sama Occupational history Sedentary Active Labour Work involving any mental stress Yes No If yes Mild Moderate Severe Whether symptoms produced during working hours Yes No Weather symptoms relieved by change of place Yes No
22) Rutuchakra vrittanta: (For women)
Menopause attained Yes No If yes the age of attainment No.of days of flow Regular Irregular Duration of flow Normal Excessive Scanty Nature of flow Dysmenorrhoea Leucorrhoea
Duration Cigarette/Beedi Daily Beedi
Smoking
Frequency of smoking Chain smoker Duration Hot drinks / Beer Daily Quantity
Alcohol
Occasionally Tea /coffee Tobacco Chewing Duration Quentity
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
IV
23) Mansika vrittanta:
Sl. BT AT SI BT AT 1 Bhaya (Fear) 5 Deenata (Depression) 2 Kopa (Anger) 6 Samprahara (Aggressiveness) 3 Mada (Delirium) 7 Kshobha (Irritability) 4 Udvega (Anxiety) 24) Samanya Pareeksha: Pulse /min Temp °F Respiration rate /min
Weight /kgs Height Heart rate /min
25) Vishesha pariksha: Fundus of Eye Peripheral pulses Neck vein BMI
Pitting Non pitting Oedema Pedal Face Back
26) Aturabala pareeksha: Ashta vidha pareeksha :- 1.Nadi Rate Type 4. Jihwa
Varna Times/day 5. Shabda 2.Mala Consistency 6. Sparsha Varna 7. Druk 3.Mootra Times/day 8. Akruti
Dashavidha pareeksha:- Prakruti Shareerika V P K VP VK PK Sama
Sara Twak Rakta Mamsa Meda Asthi Shukra Majja Satwa
Samhanana Susamhita Madhyama samhita Heena samhita
Satmya Pravara Madhyama Avara
Satwa Pravara Madhyama Avara
Vyama shakti Pravara Madhyama Avara
Vaya Balya Madhya Vruddha
Pramana Supramanita Adhika Heena
Ahara shakti Abhyvarana Jarana
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
V
27) Systemic examination:- Cardiovascular system A) JVP Pressure B) Pulse Rhythm Volume Character C) Blood pressure - Standing Sitting Supine In mm/hg Systolic Diastolic Systolic Diastolic Systolic Diastolic Lt. Upper Rt. Upper
1) Shape of Chest wall 2) Other pulsation Para sternal Epigastric Supra sternal In the neck Second Left space On the right side
Ins
pect
ion
3) Dilated veins 4) Scars Sinuses 6) Others
1) Apex beat 2) Left Parasternal heave 3) Thrills
Palp
atio
n
4) Other pulsation
1) Left second & Intercostal space dullness 2) Upper border 3) Right border 4) Left border
Perc
ussi
on
5) Lower sternal resonance S1 S2 1) Heart sounds S3 S4
2) Murmur Systolic Diastolic Continuous 3) Rate 4) Rhythm
Aus
culta
tion
5) Other sounds Respiratory System: Inspection Palpation Percussion Auscultation
Abdomen: Inspection
Liver Palpation Spleen Percussion Auscultation
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
VI
Other systems (If any): 28) Laboratory investigations:
Before After Changes observed Serum Cholesterol Serum Triglycerides High Density Lipoprotein Low Density Lipoprotein Very Low DensityLipoprotein Serum Creatinine Fasting Blood Sugar Blood Urea
Other Investigations: Before After Changes observed
E.C.G.
Chest X -Ray
29) Chikitsa: Yoga: Shilajatu Guggulu Rasayana. Posology: 6 gms per day in three divided doses. Anupana: Warm Milk Medicine distributions/advises record: Day Date Systolic Diastolic Complaints if any advise
0
7
14
21
30
45
60
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
VII
Assessment Sheet Clinical Parameters During treatment schedule Follow up
F1 F2 a) Subjective 1 day 7 days 14 days 21 days 30 days 45 days 60 days
1. Bhrama 2. Klama 3. Shirah shoola 4. Moorcha 5. Daha
b) Objective Blood Pressure 1. Supine
2. Sitting
3. Standing
Average Systolic (SBP)
Average Diastolic (DBP)
Blood Pressure Grading Systolic (SBP)
Diastolic (DBP)
c) Lab Investigations BT AT Serum Cholesterol
Serum Triglycerides
High Density Lipoprotein
Low Density Lipoprotein
V.L.D.L.
Blood Urea
Serum Creatinine
Fasting Blood Glucose
E.C.G.
Chest X-Ray
Investigators note :- Signature of Guide: (Dr.R.V. Shettar)
Signature of Scholar: (Dr. Sanjeev Kumar)
Special Case sheet
Shilajatu Guggulu Rasayana in Pittavruta udana (Essential Hypertension)
VIII
Note:-
CLASSIFICATION SYSTOLIC (mm Hg) DIASTOLIC (mm Hg) Optimal <120 <80 Normal <130 <85 High normal 130-139 85-89 HYPERTENSION Stage I. HTN (Mild) 140-159 90-99 Stage II. HTN (Moderate) 160-179 100-109 Stage III. HTN (Severe) 180-209 110-119 Stage IV. HTN (Very Severe) >210 >120 Malignant HTN >200 >140
Joint National Committee of WHO/International society of HTN (ISH)
SUBJECTIVE PARAMETERS Criteria Score Particulars
0 No pain. 1 Pain tolerable. 2 Not disturb the normal work 3 Disturb the normal work
1) Shirah shoola
4 Intolerable. 0 No brama. 1 1-2 episodes in 24 hrs. 2 On physical work. 3 Continuous.
2) Bharama
4 Even at rest. 0 No klama. 1 Wishes to stand while walking. 2 Wishes to sit while standing. 3 Wishes to lie down while sitting.
3) Klama
4 Wishes to sleep while lying down. 0 Nil. 1 Mild. 2 Moderate. 3 Severe.
4) Daha
4 Extensive. 0 Nil. 1 Transient attack. 2 Unconscious not more than 2 to 3 second. 3 Unconscious less than 30 second.
5) Moorcha
4 Unconscious less than 1 minute. OBJECTIVE PARAMETERS
0 Normal. 1 Stage I (Mild). 2 Stage II (Moderate). 3 Stage III (Severe).
Blood Pressure
4 Stage IV (Very severe).