Lecture Note: Rationality of Ayurvedic Prescriptions & Hridroga (Part-4)

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Rationality of Ayurvedic Prescriptions & Hridroga
Part-4

Dr. Muralidhara Sharma

based on the lecture available at- Rationality of Ayurvedic Prescriptions & Hridroga

Draksharishta:

It can be indicated as a Bruhan Dravya when the patient mainly exhibits Vataja or Pittaja Lakshanas. This could include conditions such as anemia, emaciating disorders, chronic bronchitis, and neuritis.

Pipplyasava:

This is a well-known remedy often used for bronchitis, but my prescriptions are not limited to bronchitis alone. It can be administered to patients with Agnimandya, particularly when accompanied by heaviness in the abdomen, which is typical of Mandagni lakshanas. The patient may also have a tendency for nausea and a feeling of vomiting without actually vomiting. In such cases, Pipplyasava can be useful. A single dose is often sufficient to provide relief. Another common indication is when the patient experiences a vague but specific symptom of Romaharsha or Romasantap. While modern diagnosis may not pinpoint the exact cause, you may come across patients with these symptoms. Regardless of the diagnosis, the use of Pipplyasava can significantly relieve the patient.

In cases where a patient experiences a sweet taste in the mouth, Pippalyasava is a very specific remedy. It is not limited to a specific disease but can be administered to patients who exhibit these symptoms, which can often be explained by the concepts of Dosha and Dushya. Contemporary diagnosis may provide vague terms like gastrointestinal tract anomaly and gastritis, but when you have a specific understanding of these dosha-dushya combinations, you can prescribe effectively.

Why this exercise:

Although I have not included all of my prescriptions, there are a few more that I have not mentioned. I initially thought that the information I provided would suffice. It’s not necessary to use the exact drugs I mentioned; you can select any Ayurvedic prescriptions for your practice. The key is to analyze your prescriptions using the lens of Dosha and Dushya lakshanas, which will enable you to prescribe efficiently with observable results. This aligns with the teachings of our Samhita, where you have a choice based on the availability of medicines. Once you have narrowed down your list of drugs and have a clear understanding of how they match the Dosha-Dushya indications, you can administer them in various forms. Vagbhat limited it to Kalka, Kwath, Sneha, Lehya, or Rasaaushadhi is in addition to Vagbhata’s view; the drugs can be administered in any form such as Paniya, Nasya, Anuvasan, etc. Ultimately, it comes down to identifying the Dosha-Dushya combination and the indications of the Dravya based on Rasa, Veerya, Guna, and Vipak. While Roga Pareeksha (patient examination) is advised, our situation often requires us to choose Aushadhies (medicines) that are readily available and then select patients who are suitable for these medicines. The facilities for preparing Aushadhies after examining the patient are rarely available and almost difficult to come by. Therefore, we need to adapt to a situation where we have medicines readily available, and we must choose patients who are suitable for those medicines. This statement might seem confusing, but there’s no need to be confused. With a clear understanding of the potential of the drugs you have, you can use them for any patient.Naturally, questions arise about whether Roga Pareeksha is more important or Aushadha Pareeksha is more important. The answer provided by Charak is very significant.

रोगमादौ परीक्षेत ततोऽनन्तरमौषधम्|
ततः कर्म भिषक् पश्चाज्ज्ञानपूर्वं समाचरेत्||२०||

यस्तु रोगमविज्ञाय कर्माण्यारभते भिषक्|
अप्यौषधविधानज्ञस्तस्य सिद्धिर्यदृच्छया||२१||

यस्तु रोगविशेषज्ञः सर्वभैषज्यकोविदः|
देशकालप्रमाणज्ञस्तस्य [१] सिद्धिरसंशयम्||
Ch. Su .20/20.21.22

If you have a perfect knowledge of Aushadhi, occasionally or accidentally, you may get some results. But when you have a perfect background of Roga as well, you can have a perfect assessment of the Vyadhi. Simultaneously, you have a perfect assessment of Aushadhi, and when they are matched together. Also, those who know about Desha, Kaal, Pramana, like the availability of the drug, the current season, and the dosage of the drug, including the contemporary mode of drug, for example, two tablets, one Kashaya, and so on. So, there is a general perception about Ayurvedic prescription in patients that we somewhat meet. Not necessarily are these the essential aspects of the practice, but somehow you can meet the expectations of the patient with that. This is what has been said, and what I have pursued in my practice is also the same.

Hrudroga:
The area of Hrudroga is a quite varying issue. So, to cover all the areas would be difficult. So I have tried to concentrate on this with the limited scope of what we can do in Ayurvedic practice. But I can do it in my practice again; I would limit it to that based upon my clinical practice because there is one area where we have certain serious limitations, severe limitations in the area of cardiac pathology. Most of the time, in the majority of the conditions, it’s the responsibility of the identification of the disease rather than the management. So, the right time of identification, the right opportunity for the identification of the disease becomes more critical than whether we can manage it or not. So, certain such issues would be the point of discussion among them. Again, I would try to cover up this area, though it’s a very broad area; I would cover it under these heads: congenital heart disease, ischemic diseases, cardiac failure, cardiac myopathy, and inflammatory disorders as such.

Congenital heart diseases:

Jinga M. et al. (2018) Essential in Genetic Etiology of Congenital Heart Diseases. In: Dumitrescu S., Ţintoiu I., Underwood M. (eds) Right Heart Pathology. Springer, Chamhttps://doi.org/10.1007/978-3-319-73764-5_13

I will not go into detail as this is not a cardiology class. The causes of congenital heart disease are many, but primarily there are two causes: genetic factors and environmental factors, both of which are preventable. So, wherever there is a possibility and scope, prevention of a congenital abnormality is better than the other way. So, when it comes to certain issues, many times, patients come to us for premarital genetic assessment, wondering if it’s necessary or not. If a patient asked me that question, I would definitely say, ‘Yes, it is necessary.’ Known established factors like consanguinity before marriage should be avoided wherever possible within our limited scope. So, even though we may not take up the responsibility of preventing that, environmental factors like the pathology of rubella should be considered. Another common question is whether patients with rubella pathology have to take immunosuppressant drugs or antiviral drugs that can produce fatal abnormalities. Of course, they do, and we don’t have any definite method of preventing that, as far as I know. In such conditions, it’s better to adopt the available facilities. So, my Ayurvedic perspective shouldn’t hinder the prevention of these possible complications. That’s my policy, and I would not interfere with these facts.

  The incidence and prevalence of congenital heart diseases:

Prevalence in different geographic regions 1970–2017. (A) The prevalence of overall CHD in six geographic zones

It is quite common. So, whenever pediatric cases are examined, we have a responsibility for the identification of these pathologies. Congenital heart diseases are quite frequent in Asia. The longest line is about the regional; the second line is in Asia, where there is a significant number of congenital heart diseases. A simple auscultation can help identify many of these congenital heart diseases. So, I take up the responsibility of identifying the heart condition. It may not be possible to manage many of them. I don’t claim that we have very effective management for all congenital heart diseases. But if we can identify them, and I take credit for many unidentified congenital heart diseases being identified when a patient has been brought to me for some other condition, and then recommending the patient to go for evaluation. Whatever effective management is available can help the patient. In the majority of congenital heart diseases, there is virtually no medical treatment. It’s only either a surgical treatment or, at times, it could be palliative treatment as a choice. But in the majority of the conditions, surgical intervention is indicated, especially in South India.

Congenital heart disease incidence and surgical intervention before 1 year of age

 Congenital Heart Disease in India: A Status Report Anita Saxena from the Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India.

 This is about the statistics from different sources. In South India, people are more aware of surgical treatments, and the third column pertains to South India compared to North India. In Northern India, surgical treatment for identified congenital heart diseases is less common. Many children are carried into adulthood with existing congenital heart diseases. Now, I will not delve into other issues like how effective this would be or not. However, when there is no other definite treatment available, I would always suggest that the child has a surgical consultation. Wherever there is an option, surgical treatment should be preferred, even for mild and insignificant congenital heart diseases. Once it is proven that it’s an insignificant heart disease based on echocardiography findings, there is virtually no need for any other specific treatment. The only concern is trying to prevent respiratory infections. Therefore, advice about diet, exercise, and, most of the time, palliative treatment can be administered without specific medications.

What can general physicians do?

I believe that’s what I have summarized. Let me express my point of view: I acknowledge that there are significant limitations from a treatment perspective when it comes to heart disease. However, we can certainly make a valuable contribution by early disease identification. When a congenital heart disease is identified in adulthood, that presents a different challenge. But we can still make a difference.

Congenital heart disease in adulthood:

If a patient has survived with congenital heart disease for 50 years, I would assure them that there is no need for surgery. This might contradict the advice given by other cardiologists. The logic behind this is quite simple. If a person has lived with that pathology for 50 years, they can likely live with it for another 25 years. So, there is no need to be overly concerned about it. This is the approach I have taken with my patients, and I have witnessed many individuals who were diagnosed with congenital heart disease at a later age opting for surgery and experiencing more severe or fatal complications as a result. The outcome of surgery in adulthood for congenital heart disease is consistently poor, as reported by major sources like the World Health Organization (WHO).

“The outcome becomes progressively poorer as the number of surgeries increases. The graph’s downward trend clearly indicates that the cumulative survival period is consistently lower with a higher number of surgeries, including second, third surgeries, and so forth. This reduction in success rates is irrespective of the specificity and applies to most critical conditions. Critical congenital heart disease conditions typically do not allow a person to live into adulthood. However, if a person has reached adulthood with a congenital heart disease, there is some scope for management.The management in such cases is primarily aimed at preventing the possibility of a stroke. In congenital heart disease, one potential complication is the development of a stroke due to embolism or cardiac myopathy resulting from the heart’s pumping failure. Both of these can be managed, as we will discuss in the other category of diseases, including other coronary cardiovascular disorders beyond congenital conditions

Percentage of heart diseases

They primarily consist of ischemic heart disease, which constitutes the major group of cardiac pathologies. Hypertensive heart disease is one group, while rheumatic heart disease is a relatively minor group. Inflammation diseases are comparatively lesser in number.A cardiac pathology resulting in cerebrovascular complications is another group of the condition, where a stroke can develop due to cardiac pathology, leading to the production of an embolism. In this condition, anticoagulants and platelet aggregation inhibitors of any category, such as Ecosprin or Clopitab, are usually used. Most patients would have been prescribed these drugs, and I would not stop those prescriptions. As far as I know, there is no definite method of prevention for this.

So, if a patient already has a tendency for cardiac pathology and is on such treatment, I would not avoid that treatment. I would recommend continuing the treatment, and depending on the patient’s condition, I would manage the patient with my prescriptions. This is the only way to prevent it; there is no other method of prevention.

Of course, diet and exercise are universal practices to prevent any cardiovascular pathology. In such patients who have a predisposition to these cardiac pathologies, the risk of cerebrovascular complications is a concern. The only means of prevention are either platelet aggregation inhibitors or, occasionally, anticoagulants (rarely). So that’s the choice. I won’t delve into the complex issue of selecting these drugs here, but if necessary, we may address it.

Now, the question arises regarding Hridroga as described from our Ayurvedic point of view.

वातेन शूल्यतेऽत्यर्थं युद्यते स्फुटतीव च ||
भिद्यते शुष्यति स्तब्धं हृदयं शून्यता द्रवः |
अकस्माद्दीनता शोको भयं शब्दासहिष्णुता | |
वेपथुर्वेष्टनं मोहः श्वासरोधोऽल्पनिद्रता ||
A. H Ni 5/39,40,41

The mention of Vataja Hridroga is obviously referring to ischemic disorders where the patient experiences acute pain in the substernal area. This is a typical feature of ischemic disorders and is exactly what Vataja Hridroga represents. It can even lead to complications like Moha, Shwasrodha, and may result in respiratory failure. So, the entire range of possible complications associated with ischemic disorders is described as Vataja Hridroga.

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