According to Ayurveda “HRIDAYA” is most important marma and pranayatana. It is also moolsthana of Ras and Rakta vaha srotasa. Modern science says Heart is cardinal organ of respiratory and circulatory system. It is very essential to know Ayurvedic anatomy, physiology of hridaya in modern terms, to know pathology of heart diseases and then we will be able to give ayurvedic solution to modern heart diseases.

ANATOMY:

Heart is made up of specialised tissue called myocardium. With four chamber and valves in between them and working in rhythmic manner continuously. According to Ayurveda myocardium can be correlated with mamsa dhatu. And those rhythmic contractions are due to vayu.

“HRU”- means Harati (to receive from).
“DA”- means Dadati (to give).
“YA”- means Yagati (to control).

All these functions are due to Vayu, Specially Prana and Vyana vayu. Prakrut vata dosha is responsible for, well directed gati, due to chal guna of vata. Also hridaya is sthana of sadhak pitta, avalambak kapha, and oja and man.

PHYSIOLOGY:

Blood is drained in Right atrium by both vena cava and then to right ventricles. From it, is ejected towards lung for gaseous exchange and then again return back to heart in left atrium then to left ventricle. From it is ejected to periphery. Ayurveda also described in same way, that saman vayu brings aahar ras to hridaya and then vyan vayu circulate it to all over body and bring back. According to Sharangdhar acharya, pran vayu brings amberpiyush means oxygen inside the body by every inspiration udana vayu gives bala, energy to cardiac muscle.

Sadhak pitta is responsible for normal functioning of “Buddhi”, medha, and pranagni. Kapha plays role of dharan and avalambana, holding, lubricating and Shock absorbing property. According to ayurveda utpatti of hridaya is Prasadansha of Rakta and Kapha and hence considered as “sira marma” because sira are rakta updhatu.

PATHOLOGY:

Hriday utpatti is very much important by the point of view of pathology and treatment.

All kinds of coronary artery diseases come under sira dushti that is Raktavikruti because sira and kandara are raktaupdhatu.
When Raktavikruti is due to pitta, permeability of sira increases due to laghu and ushna, visra guna, and haemorrhagic disorders occurs.

When Raktavikruti is due to kapha, coagubility of blood increases, and atherosclerotic diseases occurs due to guru, sthira and manda guna of kapha.

If Raktavikruti is due to vata, it mainly affect the rhythm of heart .So cardiac arrhythmia may develop or impulse conduction disorders like BBB, heart block seems.

Congenital heart diseases are also due to vata dosha like ASD, VSD, PDA or Tetralogy of fallot, Coarctation of Aorta because vibhajana is karma of vata and defective vibhajana while organogenesis in gestational age leads to congenital anomalies etc.

According to pathology there are five types of Hridroga: Vataj, Pittaj, Kaphaj, Sannipataj and Krimij hridroga.

1) Vataj hridroga:
Acharya charka said that, vataprakopaka means rookshya, laghu, shushka and dhatukshayajanan or alpasatwa aahar i.e. malnutrition or long term fasting and heavy work called as ati vyayam.

Mental stress that is anxiety, sorrow, hyper excitability is also equally responsible for vataj hridroga. Vataprakop due to ruksha and laghu guna causes hardness means calcification of arterial walls i.e. Arteriosclerosis which leads to arterosclerotic cardiovascular heart diseases like angina, HTN -which is known as “silent killer “. Ayurveda says old age is the dhatukhsyakarak and vataprakopak awastha of life hence vaatpradhan rog mainly occurs in old age. Modern sciences say arteriosclerosis generally occurs in old age. Hence we can say that all arteriosclerotic diseases should be treated as vataj hridroga by Ayurveda. Calcification of cardiac valves also comes under vataj hridroga.

If chala guna of vata increases due to strains work or heavy exercises then heart rate increases. If this continues for long periods then due to heavy work load cardiac muscles got hypertrophied and arrhythmia. If it again continued then heart muscle got fatigue leads to dilated cardiomyopathy. It leads to congestive heart failure. Ayurveda named it as Hridravata and Hridavyasa in vataj hridroga.

2) Pittaj hridroga:

Acharya charaka described as due to ushna, tikshana, vidahi, kshara, amla and lavana ras, alcohol beverages ,oily and spicy food, pitta dosha prakopa occurs, which ultimately does raktadushti . Fever, perspiration, excessive thrust, heart burn, giddiness, syncope, burning sensation all over body.

According to modern we can correlate it with infective endocarditis, pericarditis, pericardial effusion or all inflammatory disorders of heart.

3) Kaphaj hridroga:

Acharya charaka mentioned that guru and sthira gunatmak kaph deposits at inner lining of dhamanies called as ‘Dhamni pratichaya’-a kaphaj naanatmaj vyadhi. Modern sciences called it as atherosclerosis, a one of the leading cause of coronary heart disease, MI, and stroke in young peoples.

Symptoms of kaphaj hridroga are guru bharikam uram ashmavruttam means chest heaviness like a stone is on chest, as seems in angina or MI.

4) Sannipataj hridroga:

It is described with all above symptoms, but in high intensity, along with giddiness, syncope, nausea and acute chest pain. It is an emergency condition in which quick active management is essential.

5) Krimij hridroga:

Ayurveda says that ‘Hridayad krimi’ - a special type of parasites also cause heart disease. The patients suffering from sannipataj hridroga, if take kledajanya aahara i.e. Til, Gud means jiggery, milk. Kledajanya rasadushti leads to granthi uttpati in which krimi arises. These krimi go into hridaya with ras dhatu and make erosions and granthi on in dhamanies of hridaya. Symptoms of krimij hridroga are “suchivat tudyate” means stabbing, cutting severe chest pain, itching, nausea, chest discomfort. And advised to treat as emergency otherwise it leads to death.

All these symptoms are suggestive of, thrombo-embolic event of coronary artery leading to acute M.I.

‘CHAGAS’ disease is by far most important parasitic infection of heart in America caused by ‘Trypanosoma cruzi’ protozoa .Heart and lungs are the thoracic organ most frequently affected by parasites.

TREATMENT:

Ayurveda stated that “pariharya visheshen manaso dukkha hetava”.

As hridya is the sthana of oja, prana, buddhi and man. Hence anxiety, stress, depression or mental stress should be avoided preferably .Shirodhara Shiropichu, Hridbasti, Pranayam, Yoga, these are very effective for stress management. Follow the lifestyle stated by ayurveda.

As par doshadushti lakshana seems, shodhana treatment should be done with panchakarma. Then we should do shaman therapy for remaining dosha with different herbal preparations.

It is the sthanvaigunya which gives base to invade dosha. Sthanvaigunya means perticularly dhatuvikruti. To repair the dhatuvikruti dhatu paushtik aahara dravyas should be used. Hence after shodana and shamana, give rasayan and hridbalya therapy for rejuvenation and revitalization. That will avoid the recurrence of the disease.

Finally I will remind the sutra mentioned in Charak Samhita, the entire misery (diseases) related to both Mind and Body depends upon lack of knowledge or ignorance, and the entire happiness or healthy state reside in pure knowledge. Pure knowledge with thoughtful implementation of Modern perspective will definitely help in globalization the Ayurveda.