Understanding cardiovascular health
The cardiovascular system consists of the heart and the blood vessels. Whenever there is an anomaly in these structures and their functioning, it leads to cardiovascular diseases. Cardiovascular disease is an umbrella term referring to coronary heart disease (CHD, disease of the blood vessels supplying heart tissues), cardiomyopathies (diseases of the heart muscle), peripheral arterial disease, cerebrovascular disease (diseases of blood vessels supplying the brain), rheumatic heart diseases, venous thromboembolism (blockages in the veins) and congenital heart diseases (1). Because every cell in the body requires a reliable flow of oxygen-rich blood to function well, cardiovascular diseases can severely impact systemic health and wellbeing.
In the tradition of Ayurveda, cardiovascular diseases are referred to as ‘hridaroga.’ In this term, hridya means ‘heart’ and roga means ‘diseases’. Therefore, hridyaroga in Ayurveda are the diseases or conditions related to the heart (7).
The term hridya is also made of two words: ‘hru’ means something which draws blood or fluid from the body and ‘da’ means to donate. In simple words, the blood and the body fluids are circulated throughout the body by the heart. Therefore, it is named hridya. According to Ayurvedic thought, the heart originates predominantly from the maternal component, with rakta (blood) and kapha building a muscular structure. The movement of the heart is governed by the vyana type of vata (vyanavayu). It is assumed the endocardium is made up of rasa (body fluid) and rakta (blood), the myocardium is made from mamsa (muscles) and the pericardium from meda (fat).
Globally, cardiovascular diseases (CVD) are the leading cause of death, resulting in 17.9 million deaths per year. Of these, heart attack and stroke are the cause for more than 4 in 5. One third of these deaths happen prematurely under the age of 70 (2). An estimate has been reported that by 2030 the above number will rise to 24 million people globally (3). In England, 6.8 million people live with a cardiovascular condition. The NHS is under considerable financial burden as these conditions cost £7.4 billion per year (4).
How does cardiovascular disease work?
While many processes contribute to this wide range of conditions, atherosclerosis is a key disease process underlying CVD. In atherosclerosis, the arteries become narrow and less pliable, putting pressure on blood flow and reducing nutrient delivery to the affected tissues (5). Common risk factors for atherosclerosis are hypertension, hypercholesterolemia, consuming a diet rich in processed foods, and cigarette smoking. These risk factors collectively contribute to the development of CVD by causing inflammation and oxidation of the blood vessel walls, leading to fatty-fibrous lesions called atherosclerotic plaques. Further inflammation or physical trauma to the lesion may release chunks of plaque into the circulation which can lead to a stroke or heart attack.
Heart failure (HF), a serious cardiovascular disease outcome, is frequently caused by coronary atherosclerosis (atherosclerosis of the blood vessels supplying heart muscle with nutrients and oxygen). Heart failure happens when the body’s demand for circulation outstrips the heart’s ability to function, resulting in circulatory stagnation and systemic oedema.
Understanding the root of cardiovascular health in Ayurveda
Ayurvedic thought offers numerous causative factors of CVD. They are as follows (8):
- Excessive exercise
- Trauma (physical and mental)
- Excessive consumption of hot, heavy, difficult-to-digest food
- Suppression of natural urges that should not be suppressed
- Excessive consumption of pungent and astringent food
- Excessive consumption of items that are sharp (tikshna) in nature
- Excessive stress, worry or fear
- Excessive use of purifying therapies and procedures like emetic, enema and purgation therapy
- Production of ama (toxic undigested waste), which is formed because of a compromised digestion and metabolism
It is also believed that metabolic disorders like obesity and diabetes contribute to issues in the heart. When a person consumes a diet high in calories and saturated fats and has a sedentary lifestyle, digestive power (mandagni) is reduced. A low digestive capacity causes depletion in rasa (body fluid) and rakta (blood), leading to sama rasa (hyperlipidemia). This sama rasa then combines with kapha, pitta, rakta and meda (body fat) and gives rise to dhamniprachitya (atherosclerosis), causing obstruction of the arteries (strotorodha). When vata is aggravated, a person feels uro ruja (chest pain). All these events together contribute to the onset of hridroga (CVD). This mechanism is classed as a functional derangement (9).
The classical textbooks of Ayurveda mention krimija hridroga. Conditions like cardiomyopathy, pericarditis, mediastinal swelling etc. have some similarities to this type of hridroga. They fall under the category of organic changes. These conditions are serious and require medical attention. Ayurveda also mentions vidrathi (abscess) and gulma (tumour) in the cardiac region (10).
Ayurveda categorises CVD into five types (8):
- Vataj hridroga:
When there is an excess of exercise, fasting, inadequate quantity of food, or oily, dry food and grief, then vata becomes aggravated. This results in trembling, excruciating pain, cramps, unconsciousness, stiffness, sensation of emptiness, and severe pain during digestion. One may feel twisting, splitting, pressure or a pricking sensation in the chest.
- Pittaj hridroga:
In this type, a person suffers from both local and whole-body burning sensations, excessive thirst, sucking pain and the heart feels exhausted with exertion, fainting, dryness in the mouth alongside perspiration and heat.
- Kaphaj hridroga:
In this type, a person feels timidity and heaviness of the heart, excessive salivation, bradycardia, cough, fever and drowsiness.
- Tridoshaj hriroga:
This one is caused by the equal aggravation of all three doshas and therefore presents with a combination of symptoms from the other types.
- Krumija hridroga:
Spitting, nausea, pricking pain, drowsiness, pressure in the chest, anorexia and emaciation of the body are the signs for this type.
Signs and symptoms of cardiovascular disease
The signs and symptoms according to Ayurveda are as follows:
- Ruja (Pain)
- Urshula (Pain in chest)
- Aruchi (Anorexia)
- Shwas (Dyspnoea)
- Kasa (Cough)
- Aasyavairasya (Bad taste)
- Trishna (Thirst)
- Vaivarnya (Discolouration)
- Murcha (Syncope)
- Hikka (Hiccough)
- Kaphautklesha (Nausea)
- Jwara (Fever)
- Pramoh (Stupour)
Herbal solutions to improve cardiovascular health
Charak Samhita, the classical textbook of Ayurveda, mentions a group of ten herbs beneficial for the heart named as ‘hridya mahakashaya’ (8).
The herbs are as follows:
Amra (Mangifera indica):
It is commonly known as mango and is a native to tropical Asia. The sour fruit of mango is beneficial for the heart and the ripened fruit is considered nourishing.
The chemical constituents include mangiferolic acid, mangiferin, and indicenol (11). Mangiferin is a potent antioxidant, immunomodulator, hypotensive, cardiotonic, anti-lipid peroxidator andantidiabetic as well as wound healer (12).
Amaratak (Spondias mangifera):
It is commonly known as wild mango and is distributed throughout South East Asian countries, Sri Lanka and India.
In Nepal, a study was conducted on 15 fruits and the study concluded that in comparison to Vitamin C, amaratak reported more free radical scavenging activity (13). The fruit of this plant also possesses a significant thrombolytic activity (14).
Lakucha (Artocarpus lakoocha):
It is known as monkey jack in English and badhal in Hindi. It possesses various pharmacological properties including anti-inflammatory, anticancer, antivirus etc. The chemical constituents include alkaloids, phenols, flavonoids, tannins, lignins and glycosides (15) which are cardioprotective.
Karmarda (Carissa carandas):
It is frequently used as spices or condiments in pickles. It alleviates excess vata and pitta. Many studies have reported its antioxidant (nitric oxide, peroxide radicals and DPPH scavenging activity), anti-inflammatory, anti-rheumatic as well as cardiotonic activities(16).
Vrikshamla (Garcinia indica):
It is also known as kokum and its berries are lemon sized and usually pink to deep purple in colour. The chemical constituents include hydroxycitric acid, garcinol and anthocyanin. All these contribute to its anti-inflammatory, antioxidant, anticancer, cardioprotective and hepatoprotective properties (17). In Ayurveda, it is widely used in cardiac diseases, abdominal disorders, piles, sprue (a form of chronic malabsorption) etc.
Amlavetas (Garcinia pedunculata):
This plant is very versatile with respect to its pharmacological activities. The chief constituents are phenolic acid, benzophenones, flavonoids and xanthones. Because of these, it is used for a wide variety of health conditions, from indigestion and colic to cardiac diseases (18).
Kola (Ziziphus jujuba):
It consists of seedless dried fruit pulp. The fruit is rich in minerals, vitamin C and sugar. It is a good digestive and appetizer. It has an antimicrobial, anti-inflammatory, antioxidant and anticancer effect. It contains vitamin A, vitamin B, P and C, flavonoids, tannins, saponins, phosphate, iron and calcium. The fruit contains pectin-A as well (19). Many of these constituents have cardioprotective properties.
Badar (Ziziphus sativa):
The fruits from this plant can either be used fresh or as dried ripe fruits. Numerous studies have suggested its immunomodulatory, antioxidant, anti-inflammatory, antiulcer, anti-allergic, and wound-healing properties. The fruit also has digestive, tonic, laxative, and aphrodisiac actions and has been used to manage tuberculosis and blood-related diseases (20).
Dadim (Punica granate):
This fruit is commonly known as pomegranate. Its flesh reduces the risk of cardiovascular diseases. The chemical constituents include flavonoids, alkaloids, glycosides, tannins, lignin, etc. This fruit is thought to strengthen the heart and purify the rakta dhatu.
Matulunga (Citrus medica):
The common name is citron and it contains flavonoids, ascorbic acid, pectin and phenolic compounds. The fruit and seeds are tonic to the heart. The extract from the fruit contains umbelliferone and the seeds contain limonol and limonin which have reported antioxidant activity (21).
Mechanism of hridya mahakshaya:
According to Ayurveda, it is believed that amla rasa nourishes the heart (8). The fruits of all the aforementioned plants have an amla rasa.
In cardiovascular diseases, the causative factors can lead to the formation of ama which contaminates the rasa and aggravates the doshas, mainly vata. Amla rasa is known to balance the excess vata. It also pacifies ama.
Furthermore, arjuna, garlic, gokshura, amalaki and guggulu are also known to prevent or manage chronic heart conditions.
Holistic solutions
Wholesome diet for cardiovascular health
- Puran ashali (old rice)
- Patola (snake guard)
- Mudga (green gram)
- Kulatha (horse gram)
- Karavellaka (bitter gourd)
- Yava (barley)
- Abhaya (chebulic myrobalan)
- Dadima (pomegranate)
- Purana kushmanda (old ash guard)
- Eranda taila (castor oil)
- Draksha (grapes)
- Shunti (ginger)
- Takram (buttermilk)
- Lashuna (garlic)
- Kushta (coccus)
- Chandana (santalum)
Unwholesome diet and lifestyle
- Tailam (saturated fats)
- Overconsumption of kashaya rasa dravya (astringent foods) guru ahara (heavy to digest)
- Ati atapa sevana (over-exposing body to sun light),
- Krodha (anger)
- Parisrama (over-exertion)
- Adhika maithunam (excessive sexual intercourse)
- Adhika sambhashanam (excessive talking)
- Chinta (excessive thinking)
Natural urges should not be suppressed.
Other useful holistic solutions to improve your cardiovascular health
- Opt for an early, light dinner
- Eat 70% of your appetite
- Mild to moderate exercises for 45 mins a day 5 times per week
- Marma therapy suggests stimulating specific vital points to improve heart health
- Body massage should be performed 45 minutes before bathing to improve circulation
- Personalised yoga is very beneficial for the heart
- Personalised breathing exercises are also advised for heart conditions
In terms of yoga or breathing exercises, there is no one-size-fits-all. It is always beneficial to seek guidance from an expert about which yoga or breathing exercise will suit you and your health condition.
References
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- World Health Organization. (n.d.). Cardiovascular diseases. World Health Organization. https://www.who.int/health-topics/cardiovascular-diseases/
- Health matters: Preventing cardiovascular disease. GOV.UK. (n.d.). https://www.gov.uk/government/publications/health-matters-preventing-cardiovascular-disease/health-matters-preventing-cardiovascular-disease
- Libby, P., Ridker, P. M., & Hansson, G. K. (2011). Progress and challenges in translating the biology of atherosclerosis. Nature, 473(7347), 317-325.
- NHS. (n.d.-a). NHS choices. https://www.nhs.uk/conditions/coronary-heart-disease/
- Scott J. (2004). Pathophysiology and biochemistry of cardiovascular disease. Current opinion in genetics & development, 14(3), 271–279. https://doi.org/10.1016/j.gde.2004.04.012
- Athavale, V. B. (1999). Cardiology in Ayurdeva (Hrud-Vijnyana). Chaukhamba Sanskrit Pratisthan.
- Charak Samhita. (2023b, March 6). Kiyanta Shiraseeya Adhyaya. Charak Samhita. https://www.carakasamhitaonline.com/index.php?title=Kiyanta_Shiraseeya_Adhyaya
- Asthana, A. K., Asthana, M., & Sharma, P. (2018). PREVENTION OF CARDIOVASCULAR DISEASE THROUGH AYURVEDA. Asian Journal of Pharmaceutical Research and Development, 6(4), 97-100.
- Madhavan, J. (2018). Redefining the Scope of Ayurveda in Cardiology. Asian Journal of Pharmaceutical Research and Development, 6(5), 56-59.
- Sharma, S., Rath, S. & Kotecha, M. (2017) Role of Hridya Mahakashay in Management of Stress. World Journal of Pharmacy and Pharmaceutical Sciences, 6(6) 562-571
- Hasan, N. M., Al Sorkhy, M. A., & Al Battah, F. F. (2014). Ziziphus jujube (ennab) of the middle east, food and medicine. Unique J Ayurvedic Herb Med, 2(6), 7-14.
- Chalise, J. P., Acharya, K., Gurung, N., Bhusal, R. P., Gurung, R., Skalko-Basnet, N., & Basnet, P. (2010). Antioxidant activity and polyphenol content in edible wild fruits from Nepal. International Journal of Food Sciences and Nutrition, 61(4), 425-432.
- Bora, N. S., Kakoti, B. B., Gogoi, B., & Goswami, A. K. (2014). Ethno-medicinal claims, phytochemistry and pharmacology of Spondias pinnata: A review. International Journal of Pharmaceutical Sciences and Research, 5(4), 1138.
- Krishnamurthy, S. R., & Sarala, P. (2013). Phytochemical studies of Artocarpus gomezianus Wall. ex Trecul. var. lakoocha Roxb. fruits collected from various altitudes of Central Western Ghats.
- Arif, M., Kamal, M., Jawaid, T., Khalid, M., Saini, K. S., Kumar, A., & Ahmad, M. (2016). Carissa carandas Linn.(Karonda): An exotic minor plant fruit with immense value in nutraceutical and pharmaceutical industries. Asian J. Biomed. Pharm. Sci, 6(58), 14-19.
- Swami, S. B., Thakor, N. J., & Patil, S. C. (2014). Kokum (Garcinia indica) and its many functional components as related to the human health: a review. Journal of food research and technology, 2(4), 130-142.
- Sarma, R., Kumari, S., Elancheran, R., Deori, M., & Devi, R. (2016). Polyphenol rich extract of Garcinia pedunculata fruit attenuates the hyperlipidemia induced by high fat diet. Frontiers in Pharmacology, 7, 294.
- Hasan, N. M., Al Sorkhy, M. A., & Al Battah, F. F. (2014). Ziziphus jujube (ennab) of the middle east, food and medicine. Unique J Ayurvedic Herb Med, 2(6), 7-14.
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- Nagaraju, B., Anand, S. C., Ahmed, N., Chandra, J. N. S., Ahmed, F., & Padmavathi, G. V. (2012). Antiulcer activity of aqueous extract of Citrus medica Linn. fruit against ethanol induced ulcer in rats. Advances in Biological Research, 6(1), 24-29.
