See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/271236274

Etiopathogenesis of hypertension in Ayurveda

Article in International Journal of Research in Ayurveda and Pharmacy · December 2012

DOI: 10.7897/2277-4343.03618

CITATIONS READS

3 1,855

2 authors, including:

Sreelakshmi.c. Reddy
Prasanna College of Ayurveda
11 PUBLICATIONS 31 CITATIONS

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Nasya fitness form View project

All content following this page was uploaded by Sreelakshmi.c. Reddy on 21 May 2015.

The user has requested enhancement of the downloaded file.

 Rajashekhar V. Sanapeti et al / IJRAP 3(6), Nov – Dec 2012

Review Article
www.ijrap.net

ETIOPATHOGENESIS OF HYPERTENSION IN AYURVEDA

Rajashekhar V. Sanapeti*, Sreelakshmi Chaganti
Dept of PG studies in Panchakarma, KLEU’s BMK Ayurveda Mahavidyalaya & Hospital, Belgaum, Karnataka, India

Received on: 10/08/12 Revised on: 14/10/12 Accepted on: 09/11/12

*Corresponding author
E-mail: [email protected]
DOI: 10.7897/2277-4343.03618
Published by Moksha Publishing House. Website www.mokshaph.com
All rights reserved.

ABSTRACT
Hypertension is prevalent disorder with 33.5%, accounting for 6% of deaths worldwide. Various scattered references are present in Ayurvedic
literature depicting Hypertension disease. Shonita dushti can be correlated with this particular disease. The detailed explanation of its nidana panchaka
has been elaborated in terms of Hypertension. Here is an effort made to establish the etiopathogenesis of Hypertension in Ayurveda.
Key words: Hypertension, Shonita dushti, Blood Pressure

INTRODUCTION stimulation of Cardio-vascular centre in the medulla

Hypertension (High blood pressure) is an elevated arterial oblongata that controls the functions of the heart. CV
pressure measured with the help of an instrument centre regulates heart rate, contractility of ventricles and
‘‘Sphygmomanometer’’ when the levels are > 140/90 mm blood vessel diameter through which it regulates the
of Hg. It is a major risk factor for stroke, myocardial blood pressure5. Hridaya dharana function specifies
infarction, heart failure and peripheral arterial disease. influence of Prana vayu on heart functions via vyana vayu
Prevalence of Hypertension is 33.5% and risk increases that regulates normal myocardial activities. This
with age above 60 years. It has been estimated that mechanism can be considered as neural regulation of
hypertension accounts for 6% of deaths worldwide. Both blood pressure.
environmental and genetic factors may contribute to Vyana vayu: Vyana vayu situated in hridaya6 performs
regional and racial variations of blood pressure. Obesity the functions like-Rasadi samvahana, Prasarana,
and weight gain are strong, independent risk factors for Akunchana, Gati, Asrik sravana7. Nyaya chandrika
Hypertension. Among populations, hypertension commentary explains rasadi samvahana as rasa-rakta
prevalence is related to dietary NaCl intake. Additional samvahana. Prasarana, Akunchana could be viewed with
environmental factors that may contribute to hypertension respect to contraction and relaxation of heart. Gati as the
include alcohol consumption, psychological stress and force of blood flow. Hence Vyana vayu in its normal state
low levels of physical activity. Even though Hypertension performs contraction and relaxation of the heart and
is diagnosed instrumentally, symptoms will also manifest propels the blood from the heart to the body tissues and
in sustained Hypertension which include headache, the blood pressure remains in normal limits.
giddiness, palpitation and fatigability1. In Ayurveda, Sadhaka pitta: Sadhaka pitta situated in Hridaya
while explaining Shonita dushti in Vidhishonitiya responsible for Buddhi, Medha, Utsaha8 and helps to keep
adhdhyaya many causative factors are elicited among away Tama and raja guna which hampers normal
those ati lavana sevana, madya, sura pana, ati snigdha functions of Manas. As Hridaya is the seat of manas, in
bhojana and ati chinta, shoka etc. manasika bhavas which good status of mental health the Cardiac functions are
are similar to the etiological factors of Hypertension. optimum and blood pressure will be in normal limits. Any
Shonita dushti will give rise to many manifestations psychological disturbance hampers the normal functions
which include shirashoola, bhrama, klama2 etc resemble of Sadhaka pitta w.r.t increase in raja guna that aggrevates
Hypertension symptoms. the vyana vata resulting in variations of Cardio-vascular
functions which ensues in exaggerated contractility of
Regulation of Blood Pressure in Ayurveda heart that increases forceful expulsion of blood resulting
The regulation of Blood pressure is carried by Myocardial into high blood pressure.
contractility that pump the heart continuously and ejects Avalambaka kapha: Avalambaka kapha situated in urah
the blood from ventricles into vessels. Normal heart rate sthana performs Avalambana of hridaya. Hemadri
and volume of blood helps in maintaining normal Blood commenting on avalmabhana said as ‘Hridaya samarthya
pressure. In Ayurveda regulation of Blood pressure can be Karoti’. Avalambaka kapha gives strength to the cardiac
understood by functions of Prana vayu, Vyana Vayu, muscle tissue for proper pumping action which results in
Sadhaka Pitta, Avalambaka Kapha, and Rakta Dhatu ejecting blood to body tissues through vessels. Hence
which are situated in Hridaya. samyavastha of Avalambaka kapha helps in maintaining
Prana vayu: Prana vayu situated in murdha3 performs normal blood pressure.
the functions like hridaya dharana, buddhi, indriya
dharana4. Here hridaya dharana could be viewed as neural

786
 Rajashekhar V. Sanapeti et al / IJRAP 3(6), Nov – Dec 2012

Etiological Factors (Nidana) blood. Also the saturated fats are broken down in the
Essential hypertension is idiopathic where exact etiology body, the liver uses some of the break down products to
of the rise in blood pressure is not yet clear, although few produce cholesterol. High blood cholesterol promotes the
pre–disposing factors have the strongest association with growth of fatty plaques that build up in the wall of
blood pressure. Excessive salt intake, excessive alcohol arteries. As the plaque enlarges the passageway for blood
intake, fatty diet, psychological stress is elicited as the flow narrows and results in increased vascular resistance
causative factors of Hypertension9. In parallel ati lavana leads to increased arterial blood pressure15.
sevana, madya, sura pana, ati snigdha bhojana and chinta, In etiopathogenesis of Shonita dusti, excessive intake of
shoka, bhaya are nidanas of Shonita dusti10 which could snigdha, guru ahara with day sleep is explained. Ati
be viewed w.r.t. Hypertension. Snigdha, Guru Ahara causes Jatharagni Vaigunya and
Excessive Salt intake (Ati lavana sevana): Excessive Medodhatvagni mandhya leads to production of Ama
intake of salt for a longer duration is suspected to have an (apakwa rasadhatu) and Apakva Medovriddhi. This
etiological influence on the blood pressure. Salt more than Apakva meda and rasa when deposits in Rasavaha Srotas
10gms/day leads to renal retention of salt and water which may leads to Dhamani Pratichaya16 (Atherosclerosis),
in turn increases the plasma and extravascular fluid which may be a responsible factor of High Blood
volume that keeps the circulatory volume higher than it pressure.
should be, exerting excess fluid pressure on blood vessel Stress (manovighata): There is a clear relation between
walls. These walls react to this stress by thickening and emotional stress and temporary rise in blood pressure.
narrowing, leaving less space for the fluid raising The mechanism by which mind affects arterial pressure
“resistance” and requiring higher pressure to move blood could be either by a central influence on sympathetic
to the organs. The heart has to pump against this high efferent neurons which ultimately leads to increased
pressure system that leads to High blood pressure11. arterial blood pressure17
Vagbhatta has described the qualities of lavana rasa as In Ayurveda ati chinta, shoka, bhaya are said to be
vishyandi, tikshana and ushna. When ati lavana is causitive factors of shonita dusti. These Manasika Bhavas
consumed in diet it leads to pitta and shonita vitiation Vitiate Manas via Raja and Tama. As a result, prana vayu
along with increase in the quantity of rakta12. Lavana rasa gets prakopa and vitiates hridaya which is the seat of
is formed with Jala and Agni Mahabhuta and one of the manas, resulting into Hrid-drava, an increased cardiac
function described as kledana which can be compared output ultimately manifesting in increased blood pressure.
with retention of sodium ions in the tissues and increased Age: Older age people tend to have higher blood pressure
quantity of rakta can be correlated with the excessive than young people. Studies have demonstrated that blood
blood volume which may lead to increase in the blood pressure rise with advancing age. The mechanism is, the
pressure. decline of plasma renin and catacholamines with age. It
Excessive Alcohol Intake (Ati madyapana): Excessive is also secondary to structural thickening and
intake of Alcohol for the longer period damages cardiac degenerative changes in arteries and arterioles. Due to the
muscle tissue. As a result cardiac pump action becomes thickening of vessel wall as arteriosclerosis leads to
less active, more blood remains in ventricles at the end of decrease in elasticity results increased resistance that
each cardiac cycle and gradually the end diastolic volume tends to cause increase in blood pressure18.
(preload) increases. Initially this increased preload may Acharya Sushruta has mentioned that the nutrient
promote increased force of contraction for compensation. materials can not nourish the body which has under gone
This increased force of contraction results into increased changes due to age19. Old age is Vatadosha pradhana
blood pressure13. vaya. Physiological aggravation of Vata with its Ruksha,
Ushana, tikshna, sukshma, vishada, ruksha, ashukari, Khara, Daruna, Sheeta Gunas may cause Sankocha and
vyavayi, vikashi are ten qualities of madya which are Kathinya of the vessels. Poor nourishment of dhamanis
exactly opposite to the qualities of Oja14. Ushana, tikshna results in reduction of the lumen of the arteries that raise
guna provoke pitta dosha and shonita dusti. Laghu guna the blood pressure.
of madhya aggravate vata dosha. Ultimately Oja kshaya
occur and Hridaya gets involved being the seat of Oja. Pathogenesis of Blood Pressure in Ayurveda
Hridayashrita Vyana vayu, Sadhaka pitta, Avalambaka Ati lavana sevana, madyapana, snigdha bhojana with diva
kapha are also get affected. Among the causes of sonita shayana and mano vigatha leads to vitiation of Shonita.
dushti Surapana is also described. This shonita dusti in- But Shonita being dhatu is not capable of vitiating doshas
turn vitiates avalambaka kapha w.r.t kapha kshaya that independently. The doshas present in the Shonita which
weakens the function of upachaya of Hridaya are involved indirectly in the manifestation of high blood
mamsapeshi, resulting weak pumping action of heart pressure.
which results in increase end diastolic volume. Also The over use of salt, alcohol vitiates the Sadhaka pitta and
vitiates the vyana vayu w.r.t vridhdhi resulting aggravated Shonita. Sedentary habits vitiate the Avalambaka kapha
contractility of heart to compensate the extra volume and psychological stress induces vitiation of Prana vayu.
which ultimately leads into increased arterial blood Initially Prana vayu gets prakopa. Since Prana vayu has
pressure. influence on hirdaya, vitiates Hridaya and its residing
Fatty Diet (Snigdha bhojana): There is positive co- components like Vyana vayu, Sadhaka pitta, Avalambaka
relation between fatty food habits and arterial blood kapha. Shonita is also involved as it is located in hridaya.
pressure. The high intake of dietary fats stimulates Prakupita Avalambaka kapha induces exaggerated
reabsorption of cholesterol containing bile back into contractility of the heart, while aggrevted Vyana vayu

787
 Rajashekhar V. Sanapeti et al / IJRAP 3(6), Nov – Dec 2012

leads increased gati, the force of ejection of blood from REFERENCES

1. Harrison, Principles of Internal Medicine, Naomi DL. Fisher,
Hridaya. These events result into forceful expulsion of
Gordon H. Williams, 16th edition, p.1463-1464
blood through dhamanis, ultimately leading into increased 2. Agnivesha, Charaka samhita, Dipika commentary of
resistance in vessels ensuing High blood pressure. Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, 5th
Samprapti Ghatakas edition, Varanasi Chaukhamba publications, 2001, p 124
3. Agnivesha, Charaka samhita, Dipika commentary of
Doshas : Prana, Vyana vayu, Sadhaka Pitta, Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, 5th
Avalambaka Kapha edition, Varanasi Chaukhamba publications, 2001, p.616
Dushyas : Rakta, rasa, meda 4. Vagbhata, Astanga Hridayam, commentaries of Arunadatta and
Agni : Jatharagni-Dhatwagnimandya Hemadri, edited by Bhishagacharya Harishastri Paradakara vaidya ,
Aama : Rasagata 9th edition, Chaukhamba publications 2002, p.193
5. Tortora, Principles of Anatomy and Physiology, Gerald J Tortora
Srotas : Raktavaha, Rasavaha & Manovaha and Sandra Reynolds Grabowski, 10th edition, p.709
Srotodushti-Prakara : Sanga type of srotorodha 6. Vagbhata, Astanga Hridayam, commentaries of Arunadatta and
UdbhavaSthana : Hridaya, Dhamani Hemadri, edited by Bhishagacharya Harishastri Paradakara vaidya ,
9th edition, Chaukhamba publications 2002, p.193
Adhisthana : Mano-daihika (Sira, Dhamani,
7. Susruta, Nibandha sangraha commentary by Dalhana, edited by
Srotas) Vaidya Jadavaji Trikamaji Acharya, 7th edition, Chaukhamba
Sanchara-sthana : Sarva Sharir publications 2002, p.260
Rogamarga : Madhyama Rogamarga 8. Vagbhata, Astanga Hridayam, commentaries of Arunadatta and
Hemadri, edited by Bhishagacharya Harishastri Paradakara vaidya ,
Lakshanas 9th edition, Varanasi Chaukhamba publications 2002, p.194
Hypertension is asymptomatic in most cases. But the 9. Harrison, Principles of Internal Medicine. Naomi D.L. Fisher,
symptoms can be seen in accelerated hypertension or Gordon H. Williams, 16th edition, p.1463-1464
sustained hypertension like - Headache, Dizziness, 10. Agnivesha, Charaka samhita, Dipika commentary of
Palpitation and Fatigability. Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, 5th
edition, Varanasi Chaukhamba publications 2001, p 124
Headache: Headache usually in the early morning hours 11. Cushman WC. The burden of uncontrolled hypertension: morbidity
is one of the symptoms of hypertension. It is located in and mortality associated with disease progression. J Clin Hypertens
the occipital region that subsides in the later hours of the (Greenwich) 2003;5:14- 22 http://dx.doi.org/10.1111/j.1524-
6175.2003.02464.x
day. Shiroruk is one of the lakshanas of shonita dusti
12. Agnivesha, Charaka samhita Dipika commentary of
explained in vidhisonitiya adhya20 Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, 5th
Dizziness: Dizziness transient or persistent is presentation edition, Varanasi Chaukhamba publications 2001, p.144
of hypertension. Parallel to this, Bhrama is the feature of 13. ABC of Hypertension, edited by Eoin O’ Brien; D. Gareth; Beevers;
shonita dusti. Here the dosha involved are Pitta, Vata, and Hpward. J. Marshall, BMJ Publication, 1995, 3rd edition, p. 58
14. Susruta, Nibandha sangraha commentary by Dalhana, edited by
Rajas21. The chala guna of vayu becomes more dominant Vaidya Jadavaji Trikamaji Acharya, 7th edition , Chaukhamba
due to vitiated raja dosha and along with pitta results into publications 2002, p741
bhrama. 15. Tortora, Principles of Anatomy and Physiology, Gerald J Tortora
Palpitation: Tachycardia representing the palpitation is and Sandra Reynolds Grabowski, 10th edition, p.708
16. Agnivesha, Charaka samhita, Dipika commentary of
the symptom of Hypertension. Acharya Gangadhara has Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, 5th
clearly mentioned Hrid-drava means increased Gati of edition, Varanasi Chaukhamba publications 2001, p.116
Hridaya. So while describing the symptoms of Rasa 17. Price, Text Book of Medicine, by Sir Ronald Bodley Scott; Oxford
Publication, 12th edition, p.813
kshaya, Acharya Charaka mentioned “Hridayam
18. Price, Text Book of Medicine, by Sir Ronald Bodley Scott; Oxford
Tamyati”22 the exaggerated contractility of heart. Here, Publication, 12th edition, p.814
Vyana vayu is aggravated with its Chala Guna resulting in 19. Susruta, Nibandha sangraha commentary by Dalhana, edited by
Hridadravata. Vaidya Jadavaji Trikamaji Acharya, 7th edition , Chaukhamba
Fatigability: Easy fatigability is one of the feature of publications, 2002, p.64
20. Agnivesha, Charaka samhita, Dipika commentary of
Hypertension. Without any physical or mental work the Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, 5th
feeling of tiredness of the body and mind is called edition, Varanasi Chaukhamba publications 2001, p.124
Klama23. Charaka has mentioned Klama under Shonitaja 21. Susruta, Nibandha sangraha commentary by Dalhana, edited by
Dusti. Vaidya Jadavaji Trikamaji Acharya, 7th edition , Chaukhamba
publications, 2002, p.360
22. Agnivesha, Charaka samhita Dipika commentary of
CONCLUSION Chakrapanidatta, edited by Vaidya Jadavaji Trikamaji Acharya, 5th
Normal regulation of blood pressure, etiological factors edition, Varanasi Chaukhamba publications 2001, p.103
23. Susruta, Nibandha sangraha commentary by Dalhana, edited by
and patho-physiology of Hypertension resembles with Vaidya Jadavaji Trikamaji Acharya, 7th edition, Chaukhamba
Shonita dushti nidana, samprapti and lakshanas along publications, 2002, p.360
with the involvement of Prana vayu, vyana vayu, sadhaka
pitta and avalambaka kapha. Hence Shonita dushti can be Cite this article as:
correlated with Hypertension Rajashekhar V. Sanapeti, Sreelakshmi Chaganti. Etiopathogenesis of
hypertension in Ayurveda. Int. J. Res. Ayur. Pharm. 2012; 3(6):786-788

Source of support: Nil, Conflict of interest: None Declared

788

View publication stats