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A Comparative Study of Sarpagandha Vati and Vaachadi Yoga in the Management of Essential Hypertension

Research Article ºÚÁÏÍø
Nishant Shukla Anil*
North Gujarat University, Gujarat, India
*Corresponding authors: Dr. Nishant Shukla Anil
North Gujarat University
Gujarat, India
Tel: 9426984260
Email: nishantvd@rediffmail.com
 
Received April 09, 2012; Published August 28, 2012
 
Citation: Anil NS (2012) A Comparative Study of Sarpagandha Vati and Vaachadi Yoga in the Management of Essential Hypertension. 1:285. doi:10.4172/scientificreports.285
 
Copyright: © 2012 Anil NS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 
Introduction
 
Hypertension is one of the disastrous diseases resulting of various physiological and psychological causes. It is major risk factor for cardio-vascular, cerebro-vascular, reno-vascular, etc problems as the disease is remaining in silent form and presented with the unalterable complications. Though knowledge of the disease is widespread but incidence and prevalence of the disease is increasing at an alarming rate. Science acquired the knowledge of this disastrous disease, various medicaments are known to mankind but has very limited role and effect and thus after extensive researches in this field, neither the science is in the position to stop or decrease incidence nor it can prevent complications, though with the help of drugs one important sign of the disease i.e. blood pressure remains in control. Controlling BP to the level of 140/90 mmHg doesn’t ensure the occurrence of the complications of Hypertension. Looking to changing scenario, of mere controlling blood pressure doesn’t ensure presentation of hypertensive complications even with the use of drugs, it is required to come with the possible remedy that not only treats hypertension, controls blood pressure but also prevents complications & risks. Ayurveda with its holistic approach can offer a comprehensive solution to a burning health problem. Hypertension though not found as such in the any of Ayurvedic texts, scholars of the twenty and twenty-first century tried to explain the problem naming them differently like Vaata- Rakta, Rakta-Vaata, Raktaghata Vaata, Raktaavrita Vaata, Pranavrita Vyana, Vyanavrita Prana, Shleshmavrita Vyana etc. but fails to explain the disease ayurvedically. Charaka whilst describing Raktapradosha Vikaras described certain symptoms that closely resemble to the symptoms of Hypertension. Hence the work is taken up to come-up for explaining the disease on the tristhuna concept of Ayurvedic with naidaanik (diagnostic) and chikitsaatmak (therapeutic) approach strictly according to Ayurveda.
 
Disease review
 
Hypertension is defined as a Chronic elevation in Blood Pressure (BP) >140/90 mmHg with no definable cause. With every rise 20 mmHg in SBP and 10mmHg rise in DBP increases the risk for the target organ injury, and cardio-vascular risk. Elevated blood pressure is one of the major risks for micro & macro vascular injury which results to increased risks of heart attack, heart failure, stroke, and kidney diseases. Essential Hypertension usually remains silent and diagnosed accidentally in routine clinical examination or after the target organ involvement, and hence considered to a major risk factor to human health. Hypertension as defined is the state of increased Blood pressure; first it is required to study the factors that control Blood pressure with both modern and Ayurvedic concepts. Blood pressure is defined as the latertal pressure exerted by blood on the walls of blood vessels by the circulating blood. Factors that influnce and controls blood pressure includes: 1) cardiac output 2) stroke volume, 3) Perpheral resistance and 4) status of Arterial wall. Moreover endogenous regularisation of blood pressure as understood till date is controlled by these phenomenons viz. 1) Baroreceptor reflex, 2) Renin-angiotensin system and 3) Aldosterone release. Hypertension is classified as, 1) primary hyertension, 2) secondary hypertension, 3) essential hypertension, 4) maglinant hypertension, 5) labile hypertesnion, 6) Accelerated Hypertension etc. usually Hypertension is classified into two board groups on the basis of the cause i.e. 1) Primary Hypertension, 2) Secondary Hypertension, 3) Malignant hypertension.
 
Etiological Factors Primary Hypertension as the name suggests it is a primary disease, usually caused by derangement of the factors responsible for controlling blood pressure. Etiology of Primary Hypertension or Essential Hypertension is not clear and usually results due to some indefinite cause, but the factors that influence or precipitate blood pressure includes obesity, life style changes, status of arterial wall, and use of drugs, psychological stress and life style. Over use of salt is also considered to be the one of the major factor affecting blood pressure. Secondary Hypertension results from the various causes, and as soon as the cause is removed hypertension is treated. These causes includes 1) Chronic kidney disease, 2) Renovascular hypertension, 3) Primary aldosteronism, 4) Mineralocorticoid excess states like Cushing’s syndrome 5) glucocorticoid excess states, 6) Drug-induced, i) NSAIDs, cyclooxygenase 2 inhibitors, ii) Cocaine, amphetamines, other illicit drugs iii) Sympathomimetics (decongestants, anorectics), iv) Oral contraceptive hormones v) Adrenal steroid hormones vi) Cyclosporine and tacrolimus vii) Erythropoietin viii) Licorice ix) Selected over-thecounter dietary supplements and medicines (e.g., ephedra, ma huang, bitter orange) 7) Pheochromocytoma, 8) Coarctation of the aorta 9) Sleep apnea 10) Hyperparathyroidism 11) Hyperthyroidism Essential hypertension within mild to moderate usually remains asymptomatic only, when accelerated presented with the symptoms viz. headache, somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy), Retinal hemorrhages, or papilledema epitasis, etc. AS discussed earlier disease is not described in any of the ayurvedic classics, so the disease is understood on the basis of similarity of etiopathology and symptomatology. Clinical presentation of essential presentation is comparable with that of the Rakta Pradosha Vikaras, thus it provides the guidelines to analyze and correlate disease ayurvedically. Diagnosis of Hypertension is not only on the symptoms but on the blood pressure. According to Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classification of Hypertension is as under Ayurvedic approach to Blood Pressure.
 
Hypertension is as such not found in any of the Ayurvedic classics. Blood Pressure is also not described in any of the Ayurvedic classics. Blood Pressure is an important phenomenon for the normal functioning of blood circulation, and Physiology related to blood circulation is described by Ayurvedic Scholars. Factors that influence blood circulation include Vyan Vayu, Saadhaka Pitta, Avalambak Kapha, Rasa and Rakta. According to Acharya Ranjit Rai Deasi, vitiation of Vata, Pitta and Kapha, Asthi Medas etc affects blood pressure. Kapha Vitiation (Avalambak Kapha) increases cardiac strength but due to sluggishness of Kapha, decreases Kapha and on the other hand Pitta (Sadhaka Pitta) and Vayu (Vyan Vayu) vitiation increases Blood Pressure. Here one thing must be clarified that according to Ayurveda the term for blood circulation is not the Rakta Samvahana but Rasanudhaavana. Ayurveda believes that Rasa is the circulating medium and not the Rakta, so various terms laid down by the Ayurvedic scholars of the twentieth century needs reconsideration.
 
Plan of study
 
Patients presenting with classical symptoms of Hypertension, asymptomatic patients examined for blood pressure fulfilling diagnostic criteria according "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” will be under taken for the clinical trial for one month. Patients fulfilling diagnostic criteria intreasted for clinical trial were taken for the study with duly filled written conscent of the patient. A special proforma is made and filled to incorporate all the classical symptoms, history & clinical progress. Research is undertaken with the following aims and objective.
 
Aims and Objects
 
Research study is taken up with the following Aims and Objectives
 
1. To study the etiopathogenesis, symptomatology of essential hypertension on the basis of Ayurvedic principles.
 
2. To find out the pathophysiological changes responsible for the elevated blood pressure ayurvedically.
 
3. To study the efficacy of Vaachadi Yoga and comparative effect of Vaachadi Yoga over Sarpagandha Vati
 
Materials and Methods
 
Selection criteria of the patients:
 
Inclusion Criteria: Patients presenting with classical symptoms of Hypertension, asymptomatic patients examined for blood pressure fulfilling diagnostic criteria according "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” will be under taken for the clinical trial for one month. Patients fulfilling diagnostic criteria intreasted for clinical trial were taken for the study with duly filled written conscent of the patient. A special proforma is made and filled to incorporate all the classical symptoms, history & clinical progress. Research is undertaken with the following aims and objective. Patients having the age between 20-70 years were included irrespective of sex, religion and caste discrimination.
 
Table 1: Table showing symptoms observed in patients of both the groups.
 
Table 2: Table showing the effect of sarpagandha Vati Group.
 
Exclusion Criteria:
 
1. I.H.D., C.H.D., C.A.D., coarctation of aorta
 
2. Renal failure
 
3. Endocrine diseases
 
4. Hypertension with cerebral complications e.g. hypertensive encephalopathy, cerebral haemorrhage, convulsive seizure.
 
5. Malignant hypertension etc.
 
Investigations done for the Study:
 
1. Routine haematological investigation such as Hb%, ESR, DC.
 
2. Biochemical tests like blood urea, serum creatinine, serum cholesterol, and blood sugar fasting and PP.
 
3. Microscopic examination of urine.
 
4. They were also subjected for ECG and X-ray chest wherever required.
 
5. These investigations were conducted to exclude any other underlying pathology.
 
Table 3: Table Showing effect of Sarpagandha Vati group on biochemical values.
 
Table 4: Table showing the effect of Vaachadi Yoga Vati treated group on symptoms
 
Selection of the drugs for the study:
 
Two drugs viz. Sarpagandha Vati containing sarpagandha root (roots of Latin name) powder of 400mg with required amount of binding agent for making the tablet and the other drug i.e. Vaachadi Yoga Vati containing Vaacha (LN), Guduchi (LN), Brhami (LN), Kustha (LN), Shankhapushpi (LN), Yastimadhu (LN) and Shatavari (LN) were powdered and equal amount of the powder of these drugs is made in to Tablet of 500 mg (adding adequate amount of binding agent).
 
Table 5: Ayurvedic Apporach to Blood Pressure.
 
Table 6: Table showing the effect of Vaachadi Yoga Vati on Biochemical parameters.
 
Grouping and Duration
 
Selected patients were randomly divided into two groups viz Group A (Sarpagandha Vati group) and Group B (Vaachadi Yoga Vati Group).
 
Group A: Patients treated with Sarpagandha Vati (400 mg) twice a day with luke warm water for a period of one month.
 
Group B: Patients treated with Vaachadi Yoga Vati (500 mg) three times a day with luke warm water and Sarpagandha Vati (400 mg) twice a day with luke warm water for a period of one month.
 
 
Patients of both the groups were advised to restrict salt intake (salt intake is not completely stopped but limited use is advised), oily, fried, red chilli powder, onion, garlic and cold beverages. Patients were also advised to restrict diet quantity.
 
Chart 1: showing the comparative effect of both the therapy are separately kept at the end of paper.
 
Observations
 
Data analysis on the basis of the patient record and Performa revealed following information. The details regarding the results and analysis are discussed in the summery.
 
It is observed that the patients treated by Sarpagandha Vati showed the marked improvement in Blood pressure it is statically significant. Other symptoms also showed marked improvement and stand significant on statical grounds Santapa, Krodhaprachurata, Feeling of tension Bhrama Vertigo Shirahashula Chronic Headache Klama, Arati Fatigue - general tiredness Anidra Tandra Drowsiness Buddhi Sanmoha.
 
It is observed that the patients treated by Sarpagandha Vati showed the marked improvement in Blood pressure it is statically significant. Other symptoms also showed marked improvement and stand significant on statical grounds in all the symptoms excepting a strong need to urinate often.
 
Summery
 
Here it may be summarised
 
1. Blood Pressure is due to the effect of Vyan Vayu and is controlled by the proper functioning of the Vayu.
 
2. Rasa is the circulating material medium; factors that control the movement of the Rasa are Vyan Vayu, Saadhaka Pitta and Avalambak Kapha.
 
3. Kapha (Avalambak Kapha) vitiation increases bala of hridya, but due to sluggishness and heaviness decreases blood pressure and nourishes myocardium.
 
4. Pitta and Vyan Vikriti are responsible for increase of blood pressure, thus measures are to be taken that pacifies Vata and Pitta.
 
5. Therapeutic principles lied down by Charaka for Vata i.e. Tridha Vyan Samaacharet is to be employed.
 
6. Hridya Bala is to be increased.
 
7. Hridya is also the seat of Mano Vaha Srotas and thus emotions effects blood pressure, if any tranquilizing technique employed with the drugs can help in decreasing blood pressure.
 
8. Life style modification, stress management is essential for maintenance of normal homeostasis and also blood pressure.
 
9. Mitaashiyaata is a golden rule of diet for hypertensive patients.
 
10. It is found in both the sexes in equal proportions, most of the patients registered presented with non specific symptoms or headache or giddiness, which are the symptoms of Pitta vitiation.
 
11. Sarpagandha is described by susruta Anagatbaadha pratishedhaniya.
 
12. It is observed that though Sarpagandha Vati was used in both the groups, none of the patients complained of depression or bredycardia, but they the sleep duration was slightly increased. This effect may be due the use of crude Sarpagandha. It is usually observed in the OPD that if Sarpagandha Ghan Vati is used patients blood pressure falls down and also bredycardia is also observed. Adverse drug reactions found is reserpin is not found as Sarpagandha is used in crude form.
 
13. Marked improvement is observed in Vaachadi Yoga Vati. Vaachadi Yoga Vati is the combination of Medhya Rasayana mentioned by Charaka. The formulation is described in Charak Chikitsa 1 in Medhya Rasayana and the other in Charaka Chikitsa 10. Medhya Rasayana controls emotions and improves mental health. It increases positive emotions, thus increased Kapha decreases Pitta and Vata, increases bala of Hridya that helps in decreasing blood pressure.
 
14. Patients with negative family history, with short duration of ailment, acclimatised with the changing scenario and performing any tranquilizing techniques like meditation responded better and the effect of the treatment was also sustained and their blood pressure was under normal range even after the discontinuation of therapy.
 
15. Life Style modification, Meditation, Restricted salt intake, Diet regularisation, exercise, proper sleep and awakening schedules may ensure positive cardiac health and can prevent form disease like hypertension, ischemia, angina etc.
 
Conclusion
 
1. Here it may be concluded that both the drugs are helping in treating hypertension.
 
2. Vaachadi Yoga Vati a mental health promoting drugs is having synergic effect to the Sarpagandha Vati i.e. it increases the efficacy of Sarpagandha Vati in controlling blood pressure. Vaachadi Yoga Vati is a mental health promoter helps in controlling effects of emotions over Body and thus controls blood pressure.
 
3. None of the drug should any toxic or adverse reaction for the period of one month or during follow up.
 
4. Medication and meditation if done collectively ensures positive cardiac health.
 
5. Life style modification with the use of mental health promoters provides a comprehensive management to cardiac problems esp. Hypertension.
 
6. Same project is to be undertaken with prolong duration and at various places, carry out double blind trials, cross over study, to come up with large volume of Data so that affectivity of the Ayurvedic management can be established in scientific world and inclusion of Ayurvedic in national system of Medicine in preventive cardiology.
 
 
References