|
Analysis of Pathological Factors of
Hypertension
&
Concept of Management
DR.K.P.YADUNANDANAN MD (AYU)
MEDICAL OFFICER
GAD, CHERUVANNOOR – NALLALAM
KOZHIKODE
Hypertension
Hypertension is one of
the most common worldwide diseases afflicting humans.
Because of the
associated morbidity and mortality and the cost to society,
hypertension is an important public health challenge.
Hypertension is the
most important modifiable risk factor for
Ø
Coronary heart disease
Ø
Stroke
Ø
Congestive heart failure
Ø
End-stage renal disease
Ø
Peripheral vascular disease
Normal
Systolic lower than
120, diastolic lower than 80
Prehypertension
Systolic 120-139,
diastolic 80-99
Stage 1
Systolic 140-159 or
diastolic 90-99
Stage 2
Systolic equal to or
more than 160 or diastolic equal to or more than 100
Based on the
average of 2 or more readings taken at each of 2 or more visits
after
initial screening
Normal blood pressure
with respect to cardiovascular risk is less than 120/80 mm Hg
Arterial blood pressure
Arterial blood
pressure is a product of
Ø
Cardiac output and
Ø
Systemic vascular resistance
Determinants of blood
pressure include factors that affect both
Ø
cardiac output and
Ø
arteriolar vascular physiology
Cardiac output
The factors affecting
cardiac output include –
Ø
Sodium intake
Ø
Renal function
Ø
Mineralocorticoids- the inotropic effects occur via
extracellular fluid volume augmentation and an increase in heart rate
and contractility
Peripheral vascular
resistance
Peripheral vascular
resistance is dependent upon
Ø
sympathetic nervous system - vasoconstrictor
alpha effect or the vaso
dilator beta effect
Ø
humoral factors - vasoconstrictors (angiotensin
and catecholamines) or vasodilators (prostaglandins and kinins)
Ø
local autoregulation - intravascular volume
contraction and expansion & by transfer of transcapillary fluid
The pathogenesis of
essential hypertension is multifactorial and highly complex.
Multiple
factors modulate the blood pressure for adequate tissue perfusion and
include -
Ø
humoral mediators
Ø
vascular reactivity
Ø
circulating blood volume
Ø
vascular caliber
Ø
blood viscosity
Ø
cardiac output
Ø
blood vessel elasticity and
Ø
neural stimulation
The natural history of
essential hypertension evolves from occasional to established
hypertension. After a long invariable asymptomatic period, persistent
hypertension
develops into complicated hypertension. Organs get
damaged due to persistent
hypertension include -
Target organ damage to
the
Ø
Aorta and small arteries
Ø
Heart
Ø
Kidneys
Ø
Retina and
Ø
Central nervous system
Pre - Hypertension
The early stage of
hypertension has been described as high-output
hypertension.
High-output hypertension results from decreased
peripheral vascular resistance and concomitant cardiac stimulation by
adrenergic hyperactivity and altered calcium
homeostasis
Chronic -
Hypertension
The chronic phase of
essential hypertension characteristically has normal or reduced
cardiac output and elevated systemic vascular resistance.
Vascular
Endothelium
Ø
The vascular endothelium is presently considered a vital
organ, where
synthesis of various vasodilating and constricting
mediators occurs.
Ø
The interaction of autocrine and paracrine factors takes
place in the vascular endothelium, leading to growth and remodeling of
the vessel wall and to the hemodynamic regulation of blood pressure.
Target organ damage
CVS
Cardiac involvement in
hypertension manifests as
Ø
LVH
Ø
Left atrial enlargement
Ø
Aortic root dilatation
Ø
Atrial and ventricular arrhythmias
Ø
Systolic and diastolic heart failure and
Ø
Ischemic heart disease
LVH is associated with
an increased risk of premature death and morbidity
The central nervous
system
Long-standing
hypertension may manifest as -
Ø
hemorrhagic &
Ø
atheroembolic stroke
Kidneys
Nephrosclerosis is one
of the possible complications of long-standing hypertension
Courtesy
emedicine.com
Hypertension & Ayurveda
In Ayurveda all about
hypertension is often
Rx
“SARPAGANDHA”
Texts in Ayurveda
didn’t explain HT.
Ø
HT is a modern disease and is not explained as it
is in Ayurveda
Ø
To understand a modern disease in Ayurvedic perspective
we have to follow
these steps
Identify Factors
(pathological)
First by studying the
symptoms and progression of the disease, identify the functional
and
structural factors that get imbalanced in the disease like -
Ø
Agni Vaishamya
Ø
Vayu Vaigunya
Ø
Ama, Kleda
Ø
Srotorodha Etc.
Correlation
Ø
Second correlate these factors with disease processes
already explained in Ayurveda like Jwara, Sopha, Pandu etc
Ø
This helps us apply the treatment & medicines of above
diseases in a new unexplained condition
Analysis of Factors in HT
Prana Vaigunya
Ø
Prana seated in Siras (head) initiates breathing and
sustains Hridaya
(heart), Budhi (intelligence) and Manas (mind).
Ø
Prana stimulates functions of brain and heart
In HT imbalance of
Prana is often responsible for life threatening conditions like stroke
& cardiac arrest
Vyana Vaigunya
Ø
Vyana seated in Hridaya (heart) is responsible for
circulation and functional integrity of Sira (vessels)
Ø
Functions of Vyana depends on quality of the Rasa &
Raktha that it circulates all over the body
Vyana Vaigunaya
results from
Ø
Srotorodha &
Ø
Apana Vaigunya
Srotorodha due to Ama,
Kapha Vridhi & Medo Vridhi imbalances Vyana Vayu. Imbalanced Apana
Vayu in diseases like Arsas and Gulma also causes Vyana Vaigunaya.
Imabalace of Vyana affects normal functioning of Hridaya and Sira.
Rasa & Raktha
Dushti
Ø
Rasa and Raktha flowing through the Sira (vessels)
maintain structural integrity of vessels.
Ø
Sudhi (purity) of Rasa & Raktha is maintained by Agni
Impurity (Dushti) of
Rasa & Raktha has important role in imbalancing Vyana Vayu and also
affects structural contsitution of Sira (vessels)
Medo Dushti &
Srotorodha
Ø
Resulting from Dhatawgni Agni Vaishamya, Medo Dushti
imbalances Vayu by producing Avarana (block)
Medo Dushti leads to
Vatha Vyadhi by producing Avarana of Srotases & could be fatal when
vital Sira, Dhamani & Srotas are involved
Ojakshaya & Rajo
Guna Vridhi
Ø
Rajo Guna destabilizes mind and throws it into an
extreme emotional
state resulting in Ojaksaya and stress
Mental Stress is an
important factor causing HT
Correlation with Diseases
Prana & Vyana
Vaigunya
Disease condition with
this imbalance -
Ø
Vata Vyadhi
Often HT is an
indicator of Vata Vyadhi and Vata Kopa signs can be noted in HT
patients. Here Vata Vyadhi is caused in majority by Avarana and less
frequently - Dhathukshaya.
Vyana Vaigunya &
Rasa Dushti
Disease condition with
this imbalance -
Ø
Hridroga
Hridroga, its causes
similar to Gulma, is a disease with Srotorodha and Vayu Kopa. Symptoms
of Hridroga like Swasarodha (dyspnoea), Brama (dizziness), Moha
(syncope) etc can be noted in HT patients also.
Vyana Vaigunya &
Raktha Dushti
Disease condition with
this imbalance -
Ø
Rakthapitha
Ø
Sopha
Raktha is Anushna
(balance of heat & cold) & Asamhatham (balance of fluidity &
density). VathaPitha increases fluidity and causes RakthaPitha while
KaphaPitha
increases density and causes Sopha.
Internal bleeding and
swelling, especially of extremities are symptoms of HT.
Medo Dushti
Disease condition with
this imbalance -
Ø
Medo Roga
Ø
Prameha
Increase of Medas
causes Srotorodha and results in Vayu Kopa.
Silent stage of HT is
mostly caused by Medo Vridhi
Ojakshaya & Rajo
Guna Vridhi
Disease conditions
with this imbalance are –
Manasa
Rogas
Ø
Moorcha
Ø
Mada
Rajo Guna increases
Vatha & Pitha causing dizziness, altered consciousness & loss of
consciousness.
Diagnosis of HT in Ayurvedic
Perspective
Rogee Pareeksha
Using Darsana,
Sparsana & Prasna closely examine the patient – physical, mental &
emotional aspects and diagnose HT as any of the following conditions -
Ø
Vatha Vyadhi
Ø
Hridroga
Ø
Rakthapitha
Ø
Sopha
Ø
Medo Roga
Ø
Manasa Roga – Mada & Moorcha
Management of HT
Management of HT has
two Phases -
Ø
Emergency treatment &
Ø
Long Term treatment
Emergency
treatment
Ø
Prana Anulomana & Srotosodhana
Ø
Pitha Samana, Ojo Prasadana, & Mana Prasadana
Prana Anulomana &
Srotosodhana
Nasya
Sirodhara
Rookshasweda
Medicines with
Prabhava – Eg.
Dasamoolarishtam
Dhanwnthara Gulika
Nayopayam
Kashayam
Rasonadi
Kashayam
Kasthooryadi Gulika
Pitha Samana Pitha
Samana, Ojo Prasadana, & Mana Prasadana
Ksheeradhara
Nasya
Thalam
Virechana
Medicines – Eg.
Drakshadi
Kashayam
Aswagandharishtam
Gorochanadi Gulika
Suvarnamukthadi Gulika
Manasamitram
Long Term
Management
Vatha Vyadhi
Chikitsa
Vatha Vyadhi
associated with HT is usually caused by Avarana. Treatment should be
Amapachana, Srotosodhana & Anulomana
Eg. Shaddharanam,
Ashthavargam Dhanadanayanadi etc
This should be
followed by Snehana, Swedana & Sodhana (Vasthi)
Hridroga Chikitsa
Hridroga Chikitsa
involves -
Ø
Correction of Rasa Dushti
Ama Pachana medicines
like Dasamoolam, Vaiswanaram, Hinguvachadi etc
Ø
Vyana Anulomana & Hridya
Medicines like
Rasonadi, Partharishtam, Hridayarnava Rasa, Sthira Sidham paya,
Silajathu Rasayana etc
Raktha pitha
Chikitsa
Ø
Virechanam
Ø
Kashaya pana
Drakshadi
Shathavaryadi
Guloochyadi etc
Sopha Chikitsa
Ø
Mootrala
Ø
Raktha Sodhana
Ø
Virechanam
Ø
Kashaya pana
Punarnavadi
Punarnavasam
Dasamoolahareethaki etc
Medo Roga Chikitsa
Ø
Ama Pachana
Ø
Medohara
Ø
Rookshana
Ø
Vyayama
Ø
Udwarthana
Guggulu
Silajathu
Loha Prayoga
Mano Roga Chikitsa
Ø
Sodhana – Vamana, Virechana, Vasthi
Ø
Manaprasadhana – Sirodhara, Sirolepa
Ø
Oja Vardhana - Rasayana
Ø
Yoga
Ø
Meditation
Ø
Medicines
Mridweekadi
Kalyanakam
Manasamitravatakam etc
Thrimarma
In HT all three Maha
Marmas Siras, Hridaya & Vasthi are affected. Marmas are
the seats of Prana vayu. So balancing Vayu is the most important step in managing
HT. This imbalance of Vayu is caused by Avarana in most cases. The
Avaraka factors that
produce Srotorodha are –
Ø
Ama
Ø
Kapha & Medas
Ø
Raktha
Agitation of mind and
body also results in Vayu Kopa. This also involves
Oja Kshaya and
imbalance of Pitha.
So after properly
managing these Avaraka factors balancing Vayu should be done.
Vasthi
is the best treatment for balancing Vayu. Rasayana therapy also
balances
functions of Vayu. For example Vathanulomyam is explained as
an effect of Chyavanaprasa. Importance of Rasayanas also should be
acertained in maintaining
normal blood pressure.
MORE JOB INFORMATIONS ( click on the
following headings to get more job infornations )
|
