In this modern era of specialties and super-specialties in medical care, Ayurveda stands out by its holistic approach towards the body as one single entity. The body with all its parts co-existing with interdependence and mutual interaction makes it difficult to comprehend when approached separately. In recent times, humanity has begun to realize this holistic approach to health with the multidimensional aspects of body, mind and soul preached by Ayurveda ages ago.
In the present times, life has been made easy for man with modernization every step of the way, but he has also paid for it by becoming prey to many lifestyle diseases. The diseases occur due to his faulty life style and stressful psychological conditions. These factors affect one’s mind and homeostasis of the body by several psychosomatic mechanisms and lead to many lifestyle diseases such as diabetes and hypertension. As per World Health Organization report, about 40% of people aged more than 25 years had hypertension in 2008. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD) deaths in India. It is the most potent risk factor for diseases of the brain, kidney, heart and peripheral arteries which may prove fatal if not managed effectively. Hypertension is a silent killer because most sufferers (85%) are asymptomatic. In 95% of the cases of hypertension, the exact underlying causes are still unknown but is believed to be due to genetic and environmental factors.
Hypertension cannot be considered as a Vyadhi (disease) as per Ayurveda but it can be understood by assessing the involved Doshas, Dooshyas (entity which is affected by morbid Dosha), Srotas etc. Many Ayurvedic scholars have proposed different theories about how hypertension can be understood in Ayurveda, but there is no standardized and widely accepted view about the Ayurvedic pathogenesis of this condition. There are still many controversies related to this disease in Ayurveda. Thus, this is an attempt to thoroughly understand hypertension and interpret it in terms of Ayurvedic principles, considering all the existing views.
Previous theories – Ayurvedic view
Various Ayurvedic scholars have coined different names for hypertension such as:Raktagata Vata,Siragata Vata,Avrita Vata,Dhamani Prapurana,Rakta Vikshepa,Vyana Prakopa,Raktamada,Uchharaktachapa,Vyana Atibalaetc.[8]. In each of these terms, different points of view have been adopted, but no one has denied the fact that in hypertension, the main pathogenesis occurs inRaktaalong with the blood vessels. This being the only factor in common, many previous authors have given separate views on theAyurvedicpathogenesis of this condition. As modern science is well advanced in understanding hypertension, we must understand all that is known about this disease and suitably correlate it toAyurvedicprinciples for better understanding.
Hypertension cannot be considered as a Vyadhi (disease) as per Ayurveda but it can be understood by assessing the involved Doshas, Dooshyas (entity which is affected by morbid Dosha), Srotas etc. Many Ayurvedic scholars have proposed different theories about how hypertension can be understood in Ayurveda, but there is no standardized and widely accepted view about the Ayurvedic pathogenesis of this condition. There are still many controversies related to this disease in Ayurveda. Thus, this is an attempt to thoroughly understand hypertension and interpret it in terms of Ayurvedic principles, considering all the existing views.
Blood pressure regulation and the role of Tridosha
Blood Pressure in the body is regulated by multiple mechanisms. Short-term Neural mechanisms and Long-term Renal, Hormonal and Local vascular mechanisms.
Short term mechanisms include the Nervous mechanism controlled by the vasomotor center of the brain via autonomic stimulation through Baro-receptor and feedback of Chemoreceptors. This CNS regulation of Blood pressure can be understood mainly as a Vata function, typically Prana Vata (taking the help of Kapha in case of Baro-receptors and Pitta in case of Chemo-receptors).
Long term regulation of blood pressure is by:
- Pressure Diuresis and Pressure Natriuresis – Kidneys excrete water and sodium through urine (Kleda nirvahanam) [Asthanga Samgraha, Sutra Sthana, 19/20] to bring down the blood volume to regulate the blood pressure. This mechanism can be attributed to elimination of Kapha in the form of Kleda by the function of Apana Vata [Asthanga Samgraha, Sutra Sthana, 20/2]
- Renin-Angiotensin Mechanism – The Kidneys secrete Renin in response to low blood pressure as a result of which Angiotensin II is secreted to bring about vasoconstriction along with defective sodium and water homeostasis and thereby increasing blood pressure. This can be attributed to the function of Pitta.
- Hormonal regulation of Blood pressure – There are about 15 different hormones secreted which can create variations in the blood pressure. They are Adrenalin, Nor-Adrenalin, Thyroxin, Aldosterone, Vasopressin, Angiotensins, Serotonin, Bradykinin, Prostaglandins, Histamine, Acetylcholine, Atrial Natriuretic Peptide etc. All these being chemical substances causing regulation of blood pressure, may come under the perview of Pitta Dosha.
- Local mechanism of BP regulation at the blood vessel level– There are local vasocontrictors like endothelins and local vasodilators like CO2, H+ ions, Lactate, Adenosine and Nitric oxide which cause change in peripheral resistance thus influencing the BP. This again can be understood as a function of Pitta.
Thus, the role played by the Tridoshas in regulation of blood pressure has been discussed.
Principles of management
Ayurveda gives more emphasis to the prevention and promotion of the health. Avoiding etiological factors of disease is considered as the first line of management [Sushruta Samhita of Sushruta, Uttara Tantra, 1/25]. In the management of hypertension, non-pharmacological methods such as correction of lifestyle, diet etc. is proven to reduce the risk of Coronary heart disease (CHD) which is leading cause of morbidity and mortality worldwide. The role of Ayurveda is more pertinent here, many of the chapters in classical texts such asDinacharya Adhyaya,Ritucharya Adhyaya,Matrashiteeya,Navegannadharniya Adhyayaetc. are particularly dedicated to healthy lifestyle. These include the harmonious living pattern by a deeper understanding of human life and its interaction with nature.
Adopting Ayurveda guidelines may be helpful to reduce the increasing incidence and management of lifestyle disorders which include hypertension. This will also reduce the risks which are associated with the drug therapy. Long-term drug treatment can be expensive and side-effects can threaten patients’ adherence to the medicines. In general, reducing body weight, stopping smoking, healthy diet and increasing physical exercise are routinely recommended by most of the physicians. While treating this conditionPrasara Avasthaof all theTridoshaandRasa,Rakta and Meda Dushtishould be taken in to consideration and along with lifestyle modifications, appropriateVata Anulomana(maintaining normal course ofVata)Tridoshahara(normalizing allTridosha), andRasa,Rakta Prasadakar(blood purifying),Medohara(reducing excess fat)Chikitsamay be adopted.