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ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 3  |  Page : 193-202

A randomized, parallel-group study to evaluate the effect of Nidana parivarjana to augment effectiveness of ayurvedic formulation in Vyanbala vaishamya with special reference to primary hypertension


1 Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University (De- Novo), Jaipur, India
2 Ayurvedic Medical Officer, Dwarapur, Alwar, Rajasthan, India

Date of Submission04-Jul-2021
Date of Decision21-May-2022
Date of Acceptance08-Jun-2022
Date of Web Publication28-Sep-2022

Correspondence Address:
Kusum Verma
Ayurvedic Medical Officer, Dwarapur, Alwar, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_201_21

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  Abstract 


Introduction: It is estimated that hypertension (HTN) increases the risk at least twofold for cardiovascular diseases including coronary artery diseases, congestive heart failure/stroke (ischemic and hemorrhagic), renal failure, and peripheral arterial disease. In wide consensus, HTN is considered Vyanabala Vaishamya by recent Ayurvedic scholars. The aim of the study was to evaluate the effect of an Ayurvedic formulation and Nidana Parivarjana in the management of Vyanabala Vaishamya with special reference to Stage 1 primary HTN as per 8th JNC criteria. Methods: The present study was a randomized, interventional, two-arm, open-level, 30-day clinical trial on Vyanabala Vaishamya (primary HTN). Twenty-five patients in Group A were administered Ayurvedic formulation and 25 patients in Group B were administered Ayurvedic formulation along with Nidana Parivarjana (avoidance of causative factors) decided as per Ayurveda principles. Results: Ayurvedic formulation alone lowered systolic blood pressure (BP) mean from 150.087 (standard deviation [SD] ± 6.331) to 142.478 (SD ± 6.842) and diastolic BP mean from 93.609 (SD ± 3.539) to 89.522 (SD ± 3.566), while Ayurvedic formulation with Nidana Parivarjana lowered systolic BP mean from 151.000 (SD ± 5.800) to 136.174 (SD ± 5.449) and diastolic BP mean from 93.652 (SD ± 3.406) to 85.435 (SD ± 3.678). Although the reductions in BPs of both the groups were statistically highly significantly (P < 0.001), Ayurvedic formulation with Nidana Parivarjana was more effective in lowering the BPs than Ayurvedic formulation alone as found on intergroup comparison (P < 0.001). Conclusion: Ayurvedic formulation with Nidana Parivarjana was more effective in primary HTN than Ayurvedic formulation alone. It also proved that Nidana Parivarjana has a significant role in the management of Vyanabala Vaishamya, i.e., primary HTN.

Keywords: Ayurvedic formulation, Nidana parivarjana, primary hypertension, Vyanabala vaishamya


How to cite this article:
Saroj UR, Verma K, Bhakuni H. A randomized, parallel-group study to evaluate the effect of Nidana parivarjana to augment effectiveness of ayurvedic formulation in Vyanbala vaishamya with special reference to primary hypertension. J Ayurveda 2022;16:193-202

How to cite this URL:
Saroj UR, Verma K, Bhakuni H. A randomized, parallel-group study to evaluate the effect of Nidana parivarjana to augment effectiveness of ayurvedic formulation in Vyanbala vaishamya with special reference to primary hypertension. J Ayurveda [serial online] 2022 [cited 2022 Dec 4];16:193-202. Available from: http://www.journayu.in/text.asp?2022/16/3/193/357295




  Introduction Top


Hypertension (HTN), commonly known as high BP or arterial HTN, is a long-term medical disorder, in which blood pressure (BP) in the arteries remains consistently high.[1] HTN usually does not cause symptoms initially, but sustained HTN over time is a major risk factor for hypertensive heart disease and coronary artery disease. There is no particular underlying cause of HTN in more than 95% of cases, and these patients are considered having primary HTN. In ~5% of cases, HTN results from a specific underlying disorder (secondary HTN).[2] The Indian Council of Research and All India Institute of Medical Sciences have declared India as a nation of HTN.[3] HTN will affect almost one-third of adults over the age of 20 years, or 1.56 billion individuals, by the end of 2025.[4]

HTN is an instrumental diagnosis, which is the recent diagnostic invention of modern science. Hence, there is no direct reference of HTN in Ayurvedic classics by name as well as by its pathophysiological views. Many studies have been carried out on HTN to evaluate the perfect diagnosis and mode of treatment on the basis of Ayurvedic principles. There are different opinions regarding Ayurvedic nomenclature for HTN such as Vyanabala Vaishamya, Raktagatavata, Dhamanipurnata, Siragatavata, and Dhamanipratichaya, but widely, it is considered Vyanabala Vaishamya by recent Ayurvedic scholars.

BP is the pressure of blood on the wall of arteries as the heart pumps it around the body and this pressure also comes under the purview of Vyana vata (one among 5 types of Vata). BP is correlated with bala (force) of Vyana circulating all over the body as described in Ayurveda. The condition of Vaishamya (abnormality) can be either Vriddhi (increase) or Kshaya (decrease). HTN comes under Vriddhi type of Vaishamya of Vyanabala; hence, it is called as Vyanabala Vaishamya,[5] rather it should be called as Vyanabala Vriddhi.

Although there is no direct reference of HTN in Ayurvedic classics, it can be managed as per the principles of treatment of Anukta-vyadhi (unmentioned diseases). Acharya Charaka suggested that if a disease is not mentioned in text even, it can be treated without knowing its name.[6] Basic principle of treatment of such a disease is that the treatment should be having the properties opposite to the dosha, dushya, and hetu (etiological factor) involved in the pathogenesis.[7] Keeping these points in mind, a compound Ayurvedic formulation was prepared by adding the drugs which have been proved to be effective in HTN either individually or in combination and the drugs that have protecting and/or calming effect on heart.

There are various potent pharmacological agents available in conventional therapy for HTN, but they are not free from side effects. Hypertensive patients are always seeking an alternate therapy that is free from major side effects and are regularly asking to Ayurveda fraternity for the same. Few Ayurveda drugs have gain popularity as antihypertensive medicines such as Sarpagandha and Arjuna, but they have a limited role and are not very effective in variety of cases on a larger scale. Hence, in this trial, an attempt has been made to develop and validate a formulation that would be a potent Ayurvedic antihypertensive drug without major side effects. As per Ayurveda, Nidana (etiological factor) plays a major role in the causation of a disease as well as its maintenance. Hence, in the present study, an effort has also been made for the identification of various etiological factors present in the patients, and after proper identification, patients were advised to avoid such Nidana as much as possible.

Objectives

The objective of the present study was to evaluate the effect of an Ayurvedic formulation with and without Nidana Parivarjana in Vyanabala Vaishamya with special reference to primary HTN.


  Subjects and Methods Top


The study was conducted on 50 clinically diagnosed patients of Vyanabala Vaishamya (primary HTN) selected from the OPD of (name of department and institute). These patients were divided into two groups: Group A and B, having 25 patients in each. After initial registration and group allotment, each and every patient was thoroughly examined and detailed history taking was done as per the CRF prepared for the purpose. Patients were also examined for the indulgence in any Nidana as described in Ayurveda texts. These Nidana were noted down and the patients were advised to refrain from these Nidana as much as possible. This study was a randomized, open-label, single-centered, and interventional clinical trial for 30 days on 50 patients of primary HTN.

Registration: The Institutional Ethical Committee (IEC) had approved the study protocol vide letter No. IEC/ACA/2019/1-25; on date 28.05.2019.

Inclusion criteria

  • Patients willing to sign the consent form for the clinical trial
  • Patients belonging to either sex between the age group of 18–59 years
  • Patients having no known complication of disease (HTN)
  • Diagnosed case of Stage 1 primary HTN as per 8th JNC (systolic BP = 140-159 and diastolic BP = 90-99 mm of Hg).


Exclusion criteria

  • Patients having secondary HTN
  • Patents having systemic/serious complications of cardiovascular/cerebrovascular/renal system
  • Pregnant patients
  • Patients on oral contraceptive pills
  • History of liver disease in the recent past
  • Hypertensive retinopathy
  • Patients who have completed participation in any other clinical trial drugs or their ingredients within 1 month period
  • Patients who have received any antihypertensive medication (modern drug) within the last 2 weeks.


Criteria for withdrawal

  • The treatment would have been stopped if there was either any increase in the HTN or no any response of trial medicine on HTN even after 15 days. Treatment also would have been discontinued on the development of any serious complication due to disease or drug that required urgent treatment.


Instrumental estimation of blood pressure

BP was measured by the use of an aneroid sphygmomanometer. The cuff was wrapped around the arm about 8 cm above the elbow, which was quite free to move, so that the bell of the stethoscope could be placed in the cubital fossa. The arm cuff contained a rubber bag which was blown up until the brachial artery occluded. At this point, the radial pulse disappeared. The systolic and diastolic BPs were measured by auscultatory method.

The following precaution had been taken care for the correct measurement of BP:

  • Subjects were asked to refrain from smoking and drinking tea and coffee for at least 30 min before measuring the BP
  • At the initial visit, an average of the reading was taken at an interval of 2–3 min
  • The patients were allowed to sit to relax at least for 5 min before measuring BP
  • Measurement was done preferably in supine position. Arm was placed and fully supported at the level of the heart.


Materials

Administration of drug

After the complete examination and investigation, all the patients were divided randomly into two equal groups with the help of computer-generated randomization chart and were administered the therapy as following [Chart 1]:



  • Group A: 25 well-diagnosed patients of Vyanabala Vaishamya (primary HTN) were administered Ayurvedic formulation 2 capsules (500 mg each) twice a day with lukewarm water before meal for 30 days.
  • Group B: 25 well-diagnosed patients of Vyanabala Vaishamya (primary HTN) were administered Ayurvedic formulation 2 capsules (500 mg each) twice a day with lukewarm water before meal and were instructed to follow Nidana Parivarjana for 30 days.


Nidana Parivarjana

Nidana factors such as Atikashayarasa Sevana (overuse of astringent food), Adhyasana (eating during digestion of previous meal), Atilavanasevana (excessive use of salt), Ati-ambupana (excessive use of water), Atigurubjojana (excessive use of heavy to digest food articles), Atividahibhojana (excessive use of inflammation/burn causing food), Atimadyapana (excessive use of alcohol), Avyayama (lack of exercise), Diwasvapana (daytime sleeping), Atidhoomrapana (excessive use of medicated smoking), Ratrijagarana (night awakening), Chinta (anxiety), and Krodha (anger) were mainly observed in patients, and patients were advised to avoid indulging into these.

Trial drugs

The drug of the present clinical trial was a self-formulated Ayurvedic formulation [Table 1].
Table 1: Ingredients of Ayurvedic formulation (capsule 500 mg each)

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Methods of preparation

Contents number 1 and 2 of trial drug were taken separately and coarse powder was made and then 16 parts of water was added and boiled till 8 parts of water remained as Kwatha (decoction). Then, the decoction was again boiled for Rasakriya (drying of decoction), until it became Ghana (solid/semisolid) and dried out. Then, Niryasa Yukta Sunthi-Jala (water processed with ginger) was prepared and it was used as Bhawana Dravya (disintegrating agent) to triturate the dried water extract of contents number 1 and 2. Then, after drying all the moistures, this product was added with separately prepared by classical methods contents number 4–6 in the above said ratio and was mixed well. Finally, 500 mg capsules were filled and stored in air-tight packaging.

Routine examination and assessment

The full details of history and physical examination of patients were recorded as per the pro forma. Clinical assessment was done on 1st day, 15th day, and 30th day.

Criteria of assessment

  1. Qualitative variables:[4],[8] Headache (Shiroshoola), burning sensation (Vidaha), giddiness (Bhrama), fatigue (Klama), palpitation (Hrritspandana), tinnitus (Karnanada), insomnia (Anidra), excessive sweating (Swedadhikyata), and breathlessness (Swasakrichhrata)
  2. Quantitative variables: Systolic and diastolic BPs were analyzed before treatment, 7th day, 15th day, and after the completion of treatment. Renal function test (RFT) (blood urea and serum creatinine), liver function tests (LFT) (serum glutamic-oxaloacetic transaminase (SGOT), Serum glutamic pyruvic transaminase (SGPT)), lipid profile, erythrocyte sedimentation rate (ESR), and urine analysis (routine and microscopic) were analyzed before and after the completion of the treatment. ECG and fasting blood sugar were done before treatment only for exclusion purpose
  3. Symptom rating scale:[9] Subjective symptoms were assessed using 9-point symptom rating scale developed for the purpose [Table 2].
Table 2: Subjective symptoms were assessed using following symptom rating scale

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Statistical analysis

Sigma stat 4.0 software (Systat Software from San Jose, California, United States) was used for the analysis of data. For intragroup comparison in nonparametric variables, Wilcoxon signed-rank test and for intergroup comparison Mann–Whitney U test were used to check the result of intervention on subjective criteria. For intragroup comparison in parametric variables, Student's paired t-test and one-way repeated measured analysis of variance test (for systolic and diastolic BP) were used. For intergroup comparison for parametric variables, unpaired t- test was used. Results were calculated in terms of mean, median, standard deviation (SD) of mean or median, standard error of mean, and confidence interval of mean, as per the types of data.

Demographic observation

Among a total of 50 cases of Vyanabala Vaishamya (primary HTN), a maximum of 18 (36%) patients were aged between 41 and 50 years, followed by 12 (24%) patients aged between 31 and 40 years and 28 patients (56%) were male. 31 (62%) patients belonged to urban areas, 19 patients (38%) were servicemen and household workers each. 35 patients had chronicity of disease for <1 years, 19 patients (38%) had positive family history of primary HTN, while 31 patients (62%) had negative family history. Among them, 24 patients had Vishamagni, 23 patients had Kroora Koshtha, 21 patients had Vata-Pitta dominant Prakriti, 39 patients had Rajsika Manas Prakriti, and 25 patients were having Avara Vyayama Shakti. In the present trial, maximum 16 patients (32%) were found to be addicted to tea and 13 patients (26%) were addicted to smoking.

In the present clinical trial, maximum, i.e., 23 patients (46%), presented with the symptom of fatigue, 20 patients (40%) presented with headache, 18 patients (36%) presented with palpitation, 18 patients (36%) presented with breathlessness, 14 patients (28%) presented with excessive sweating, and 13 patients (26%) presented with giddiness. Among those, 16 patients (32%) were suffering from insomnia, 5 patients (10%) were suffering from burning sensation, and 2 patients (4%) were suffering from tinnitus.


  Results Top


Both the groups have exhibited highly significant (P < 0.001) decline in systolic and diastolic BPs even from the first follow-up, i.e., 7 days [Table 3]. Although the effect of therapy on systolic and diastolic BPs of both the groups was highly significant, on the intergroup comparison, there was a significant difference between the groups. On further examination, it was found that the effect of therapy on BPs in Group B was more than that of Group A [Table 4].
Table 3: Effect of interventions on blood pressures in Group A and B (by one-way repeated measured analysis of variance

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Table 4: Intergroup comparison of effect of interventions on blood pressures in both groups (unpaired t-test)

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Group B proved a statistically significant (P < 0.05) in reducing symptoms such as headache, fatigue, palpitation, and insomnia and Group A had also similar results on these variables except palpitation on which it was not significant (P > 0.05). On other subjective variables such as burning sensation, giddiness, tinnitus, excessive sweating, and breathlessness, both the groups have shown statistically nonsignificant changes or improvement (P > 0.05) [Table 5].
Table 5: Effect of interventions on both the groups in subjective parameters (Wilcoxon matched paired signed ranks test)

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Both the groups have not shown any significant changes in other quantitative variables used in the study like RFT (blood urea and serum creatinine), LFT (SGOT and SGPT), lipid profile, ESR, and urine analysis (routine and microscopic) except in serum cholesterol by Group A that provided statistically significant (P < 0.05) improvement of 10.53% by lowering its mean from 201.93 (SD ± 44.542) to 191.39 (SD ± 38.794) mg/dl.


  Discussion Top


BP is the lateral pressure produced by the flow of blood on the artery walls. As per Ayurveda, Vata Dosha particularly Vyana Vata is located in the heart and is the in-charge of blood circulation.[10] Vyana Vata is responsible for the movement of Rasa-Rakta Dhatu in the body and deranged Vyana Vata causes alteration in the circulation of Rasa and Rakta Dhatu. Hridaya (heart) has been considered Moola (root) of Rasa and Rakta Vaha Srotas and Moolasthana (place of origin) of Vyana Vata also. Vyana Vata moves throughout the body from Hridaya and is also responsible for each and every function of the body.[11] Acharya Vagbhat mentioned that blood is constantly forced out of the heart and distributed in whole body by Vyana Vata.[12] Thus, it makes clear that circulation of Rasa-Rakta takes place with the help of Vyanavayu.[10] Vyana performs the function of Rasa Samvahana (circulation) and it is not confined to any particular region but are found affecting the whole organism.[13] As a result, the systolic and diastolic BPs obtained during cardiac cycle are controlled by Vyana Vata.

The condition of Dhamani/sira (blood vessels) is also a contributing factor for BP. Stiffness occurring into blood vessels particularly in arteries is also responsible for HTN. This is called Dhamani/sira Kathinya (stiffness of blood vessels) and can be attributed to the Daruna (causing Hardness) Guna (property) of increased Vata in elderly that makes it Kathina (hard/stiff) by Shoshana (drying) of Sneha (unctuousness) present in it.[14] In younger population, Dhamani/sira Kathinya (stiffness of blood vessels) is mainly due to increased Kapha, leading to deposition of Vasa (fat/lipids) in and around its wall and making it Kathina (less elastic).[15] Dhamani Sankocha (vascular constriction) can occur in any age due to Vata vitiating conditions such as Chinta (anxiety), Bhaya (fear), Shoka (grief), and Krodha (anger)[16] that can be correlated with increased sympathetic activity in the body, leading to HTN.[17] Thus, BP is affected by the vitiation of Vata, Pitta, and Kapha caused by various etiological factors. Vitiation of Kapha (especially Avalambaka Kapha) increases or decreases cardiac strength, but due to sluggishness of Kapha, it usually decreases the BP, whereas vitiation of Pitta (Sadhaka) and Vata (Vyana) increases BP. BP's management in Ayurveda is explained by the control of functions of Prana Vayu, Vyana Vayu, Sadhaka Pitta, Avalambaka Kapha, Rasa, and Rakta Dhatu; all located in Hridaya.

The present study was conducted on a self-formulated Ayurvedic preparation containing those medicines as contents that are popularly used as a single or in composition for the management of HTN by Ayurveda physicians. This Ayurvedic formulation contained water extract of Sarpagandha and Arjuna along with Shunthi, Akika Pishti, Pravala Pishti, and Swarnamakshika Bhasma [Table 1]. Sarpagandha has Hridaya-Avsadaka (cardiac sedative) property[18] and is widely used in HTN. Arjuna has also antihypertensive property along with its Hridya-Prabhava (cardioprotective effect).[19] Shunthi possess Hridroga-Nashana (heart ailments removing) property.[20] Akika Pisthi[21] and Pravala Pisthi[22] are indicated in heart disease as a cardiotonic and calming agents. Swarnamakshika bhasma[23] is also Hridya and has Raktaprashadana (blood purifying) property.

Most of the contents of the trial drug (Ayurvedic formulation) were having Tikta (bitter taste), Madhura (sweet), Kashaya Rasa (astringent), Madhura and Katu (pungent), vipaka (biotransformed Rasa), Sheeta (cold), Virya (potency), and Tridoshahara properties. Tikta Rasa has Deepana (appetizer), Pachana (digestive), and Lekhana (scraping) properties. It absorbs excess Kleda (water), Meda (fat), Ama (improperly diseted), Kapha, and Pitta from the body[24] and thus might helped in reducing blood volume. Tikta Rasa also promotes digestion in healthy and helps in body purification and Kapha depletion that can obstruct channels of Vyana Vata. It removes the obstructions from Srotas and also causes Srotoprasarana (dilatation of channels). Kashaya Rasa is also having Samshamana (pacifying), Sheetala (cold), Shoshana (drying), Shleshma (Kapha), Rakta (blood), and Pitta Prashamana (pacification) properties and absorbs Kleda from the body.[24] Madhura Rasa enriches all the seven Dhatu (tissues) along with Oja;[24] thus, it protects heart. Hence, these drugs acted as Amanashaka (Ama removing) by Agnivardhana (enhancing Agni) and Kledashoshana (reducing water contents).

The trial drug acted as a Kaphahara (Kapha reducing) due to its Ruksha (rough), Laghu (lightness) Guna and also cleared the obstruction of Srotas (channels) being a Amashoshaka (Ama drying drug). Most of the drugs of formulation were having Sheeta Virya that alleviated Pitta and Rakta Dosha. The drug was having Katu Vipaka property, which helped alleviate obstruction in the Srotas caused by Ama by its digestion and thereby resulting in Srotosodhana (channels' purification) and Vatanulomana (proper physiological flow of Vata/proper defecation and urination). As a result, the medicine might be beneficial in cases where the disease is caused by obstruction, such as vitiation of Vata due to Margavarodha (obstruction of path/channels). Majority of drugs of formulation had Madhura Vipaka that is Vata–Pitta Shamaka (pacifying). According to Acharya Charaka, Madhura Vipaka is diuretic in nature. Majority of drugs of trial drug had Hridya and Raktaprashadana Prabhava (blood purifying effect) which acted on heart and improved its function; thus, it might have beneficial effect in the management of primary HTN.

Sarpagandha has Tikta Rasa that possesses Deepana, Pachana, and Lekhana properties and it absorbs excess Kleda, Meda, Ama, Kapha, Pitta from the body[18] and thus might be reducing blood volume. Sarpagandga is also having properties like Kapha-Vatahara, Hridya avasadaka, Shoola-Jwara-Krimihara, Anidra-Unmaada-Apasmara-Bhrama nashaka, and Agnimandya-Visha-Rakta-Vatadhikya Shamaka.[18] Hence, it is used in essential HTN, sinus tachycardia, anxiety, tension, and psychomotor irritation. It has hypotensive, tranquilizer, sedative, and antiarrhythmic activity due to reserpine, ajmaline, and deserpidine alkaloids. Reserpine helps lower BP by binding to the catecholamine in nerve cells. It has antiarrhythmic activity also. It leads to general vasodilation and lowers BP by acting on the vasomotor center and it also acts as a depressant on the cerebral centers, calming the nervous system.[25]

Arjuna has many therapeutic effects such as inotropic (modifying the force of contraction of muscles/myocardium), anti-ischemic, antioxidant, BP lowering, antiplatelet, hypolipidemic, antiatherogenic, and antihypertrophic property.[26] Arjuna is commonly used to treat cardiovascular disorders, including heart disease and its associated chest pain, high BP, and high cholesterol. It is an anti-ischemic drug and a powerful antioxidant that protects the heart from LDL, reperfusion ischemic injury, and has the ability to lower atherogenic lipid levels.[27] The aqueous extract of Arjuna enhances the force of cardiac muscle contraction, increases coronary flow, and causes bradycardia, according to an experimental study.[28]

According to Ayurveda, Shunthi has Anulomana, Dipana, Pachana, Hridya, Vatakaphapaha, and Amadosahara properties.[20] It has hypocholesterolemic, circulatory stimulant action and increases bioavailability of prescription drugs. It has sedative, hepatoprotective, hypotensive, and cardiotonic effect because of gingerol and shogaols.[29] Ginger enhances the amount of NO (Nitric oxide), a well-known vasodilator molecule, while decreasing the activities of angiotensin-1 converting enzyme (ACE) and arginase. A study on hypertensive rats showed that BP decreased due to use of ginger. It also protects against HTN-derived complication by preventing platelet aggregation.[30] According to Ayurveda, Akika has Kashaya, Madhura Rasa, and Sheeta Virya with Hridya Prabhava and Pittashamaka properties. It is used in Hriddaha (burning sensation in heart region), Pitta Roga (diseases due to Pitta Dosha), Vataroga (diseases due to Vata Dosha), Kasa (cough), Hridroga (heart disease), Kshaya (phthisis), and shiroroga (diseases of head).[21]

Pravala Pishti has Madhura Rasa, Sheeta Virya with Tridoshashamak, mainly Kapha-Vatahara Karma.[31] It used in Pitta Roga (disease due to Pitta Dosha), Manodaurbalya (mental weakness), Ojokshaya (loss of body strength or immunity), and Hridroga (heart disease).[22] It also has Deepana, Pachana, Balya, Drishtiroga-Raktapitta-Atiswedanashaka, Ratriswedahara, Vishaghna, and Veerya-Varna Vardhana properties.[31]

According to Ayurveda, Swarnamakshika Bhasma has Madhura, Tikta Rasa, Sheeta Virya, Agnideepaka, Laghu, Snigdha Guna, and Kapha-Pittahara properties. Swarnamakshika's Hridya effect is attributable to lysyl oxidase, a copper-dependent metalloenzyme that helps repair and maintain heart tissue by crosslinking arterial collagen and elastin.[32] SOD (Super oxide dismutase), an antioxidant that promotes cardiovascular health, is also found in heart tissue. By binding with porphyrin, iron helps in the synthesis of hemoglobin, which oxygenates the entire body. Copper has been shown to lower plasminogen activator inhibitor type 1, a risk factor for atherosclerosis.[33] In studies on anxiety and stress, both Fe and Cu consumption suppress GABA receptors that lowers the risk of depression.[34]

From the above description, it is evident that the contents of Ayurvedic formulation were capable of lowering BP individually as well as holistically as a compound drug. As a compound drug, it might have acted like Deepana, Pachana, Amadosahara, Srotosodhana, Lekhana, Kapha-Vatahara, Pittashamaka, Vatanulomana, Hridya, Ojovardhaka, Anidranashaka, Manodoshahara etc.

In modern pharmacology's terminology, it would have acted as hypotensive agent by its virtue like vasodilator, tranquilizer, sedative, antidepressant, antioxidant, antiplatelet, hypolipidemic, diuretic, anti-atherogenic, and antihypertrophic properties along with heart rate reducing action.

Nidana (etiological) factors like Atikashayarasa Sevana, Adhyasana, Atilavanasevana, Ati-ambupana, Atigurubjojana, Atividahibhojana, Atimadhyapana, Avyayama, Diwasvapana, Atidhoomrapana, Ratrijagarana, Chinta, and Krodha were mainly found in patients. These etiological factors deranged the Dosha, diminished the Jatharagni, and produced Ama at different level that caused Srotorodha perticularily in Raktavahasrotas in this case and led to Vyanabala Vaishamya (primary HTN). As per Ayurveda, any Nidana present in patients should be discontinued to check the progress of disease and also for the effective management of the disease. Hence, in the present study, patients were advised to avoid indulging into these etiological factors at the possible extent. Discontinuing the Nidana factors helped in breaking the pathogenesis by Ayurvedic formulation and its additive effect was evident in the form of better improvement in respective group.


  Conclusion Top


It is concluded that Ayurvedic formulation used as a trial drug in this study with and without Nidana Parivarjana was effective in lowering the systolic and diastolic BPs in the cases of Vyanabala Vaishamya, i.e., primary HTN. It also reduced significantly the major symptoms of Vyanabala Vaishamya (primary HTN) such as headache (Shirashoola), fatigue (Klama), insomnia (Anidra), and palpitation (Hritspandana). However, the effect of Ayurvedic formulation along with Nidana Parivarjana was more on systolic and diastolic BPs than that of Ayurvedic formulation alone. Thus, it also proves that Nidana Parivarjana has a significant role in the management of Vyanabala Vaishamya, i.e., primary HTN.

Financial support and sponsorship

The study was financially funded as PG Thesis Research work by the Institute (National Institute of Ayurveda, Jaipur).

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
James PA, Oparil S, Carter BL, Cushman WC, Dennisin-Himmelfarb C, Handler J, et al. 2014 evidence- based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eight Joint National Committee (JNC 8). JAMA 2014;311:507-20.  Back to cited text no. 1
    
2.
Newby DE, Grubb NR, Bradbury A. Cardiovacular diseases. In: Colledge NR, Walker BR, Ralston SH, editors. Davidson's Principles and Practice of Medicine. 21st ed. Edinburgh: Churchill Livingstone Elsevier; 2010. p. 521-640.  Back to cited text no. 2
    
3.
Bhansali A, Dhandania VK, Deepa M, Anjana RM, Joshi SR, Joshi PP, et al. Prevalence of and risk factors for hypertension in urban and rural India: The ICMR-INDIAB study. J Hum Hypertens 2015;29:204-9.  Back to cited text no. 3
    
4.
Kamath SA. Hypertension and its management. In: Munjal YP, editor. API Textbook of Medicine. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2015. p. 916-29.  Back to cited text no. 4
    
5.
Vyanabala Vaishamya (Hypertension). National Health Portal: MoHFW Govt. of India; February 12, 2016. Available from: https://www.nhp.gov.in/Vyanabala-vaishamya-(Hypertension)_ mtl. [Last accessed on 2022 Apr 09].  Back to cited text no. 5
    
6.
Charaka Samhita, Sutrasthana, Trishothiyadhyaya, 18/44-46. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2022 Apr 27].  Back to cited text no. 6
    
7.
Charaka Samhita, Chikitsasthana, Yonivyapad Chikitsa, 30/292. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2022 Apr 27].  Back to cited text no. 7
    
8.
Hypertension (High Blood Pressure) National Health Portal: MoHFW Govt. of India; December 30, 2015. Available from: https://www.nhp.gov.in/disease/cardio-vascular/hypertensionhigh-blood-pressure. [Last accessed on 2022 Apr 09].  Back to cited text no. 8
    
9.
Baghel MS, Rajagopala S. Developing Guidelines for Clinical Research Methodology in Ayurveda. Institute for Post Graduate Teaching and Research in Ayurveda Gujarat Ayurveda University Jamnagar India. 2011.  Back to cited text no. 9
    
10.
Charaka Samhita, Chikitsasthana, Grahanichikitsadhyaya, 15/36. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2022 Apr 27].  Back to cited text no. 10
    
11.
Vagbhat, Ashtang Hridayam, Sutra Sthana, Doshabhediya Adhyaya, 12/6, Vidyotini Commentary by Kaviraja Atrideva Gupta, Reprint edition. Varanasi: Chaukhambha Prakashan; 2016. p. 121.  Back to cited text no. 11
    
12.
Srimad Vrddhavagbhata, Astang Samgraha, Sutrasthana, Doshabhedeeyadhyaya, 20/4, Saroj Hindi Commentary by Dr. Ravi Dutt Tripathi. Delhi: Chaukhambha Sanskrit Pratishthan; 2001. p. 385.  Back to cited text no. 12
    
13.
Susruta Samhita, Nidansthana, Vatavyadhinidana, 1/17-18. Available from: https://niimh.nic.in/ebooks/esushruta. [Last accessed on 2022 Apr 27].  Back to cited text no. 13
    
14.
Chakrapani on Charak Samhita, Sutrasthana, Vatakalakaliyaaddhyaya, 12/4. Available from: https://niimh.nic.in/ebooks/ecaraka/?mod=read. [Last accessed on 2022 May 01].  Back to cited text no. 14
    
15.
Charaka Samhita, Sutrasthana, Maharogaddhyaya, 20/18. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2022 May 13].  Back to cited text no. 15
    
16.
Charaka Samhita, Sutrasthana, Maharogaddhyaya, 20/12. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2022 May 13].  Back to cited text no. 16
    
17.
Yoshihara K, Tanabe HC, Kawamichi H, Koike T, Yamazaki M, Sudo N, et al. Neural correlates of fear-induced sympathetic response associated with the peripheral temperature change rate. Neuroimage 2016;134:522-31.  Back to cited text no. 17
    
18.
Sharma PV. Dravyaguna Vijnana. Vol. 2. Varanasi: Chaukhambha Bharti Academy; 2001. p. 39.  Back to cited text no. 18
    
19.
Sribhava Mishra. Bhavaprakasa, Vatadivarga, Vidyotini Hindi Commentary by Sri Brahmasankara Misra and Sri Rupalalaji Vaisya. Part 1., 12th ed. Varanasi: Chaukhambha Sanskrit Bhawan; 2016. p. 681.  Back to cited text no. 19
    
20.
Sribhava Misra. Bhavaprakasa, Haritakyadivarga, Vidyotini Hindi Commentary by Sri Brahmasankara Misra and Sri Rupalalaji Vaisya. Part 1.,12th ed. Varanasi: Chaukhambha Sanskrit Bhawan; 2016. p. 216.  Back to cited text no. 20
    
21.
AFI 2000: Ayurvedic Formulary of India. Part II., 1st ed. Government of India. Ministry of Health and Family Welfare, Department of Indian Systems of Medicine and Homoeopathy; 2000. p. 200.  Back to cited text no. 21
    
22.
API 2003: The Ayurvedic Pharmacopoeia of India. Part 1, 2nd ed. Government of India. Ministry of Health and Family Welfare, Department of Indian Systems of Medicine and Homoeopathy; 2003. p. 584-5.  Back to cited text no. 22
    
23.
Acharya Sri Madhava. Ayurveda Prakasha, Upadhatunirupana Adhyaya, 4/9, Arthavidyotini & Arthaprakasini Sanskrit Hindi Commentaries by Shri Gulrajsharma Mishra and Pandit Shiva Sharma. Reprint edition. Varanasi: Chaukhambha Bharti Academy; 2014. p. 410.  Back to cited text no. 23
    
24.
Charaka Samhita, Sutrasthana, Atreyabhadrakapiyadhyaya, 26/43. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2022 Apr 27].  Back to cited text no. 24
    
25.
Bunney WE Jr., Davis JM. Norepinephrine in depressive reactions. A review. Arch Gen Psychiatry 1965;13:483-94.  Back to cited text no. 25
    
26.
Maulik SK, Talwar KK. Therapeutic potential of Terminalia arjuna in cardiovascular disorders. Am J Cardiovasc Drugs 2012;2:97-101.  Back to cited text no. 26
    
27.
Amalraj A, Gopi S. Medicinal properties of Terminalia arjuna (Roxb.) Wight & Arn.: A review. J Tradit Complement Med 2017;7:65-78.  Back to cited text no. 27
    
28.
Verma P, Muneesh RS, Bhutani G. Experimental evaluation of Terminalia arjuna (Aqueous Extract) on cardiovascular system in comparison to digoxin. J Dent Med Sci 2013;7:48-51.  Back to cited text no. 28
    
29.
Khare CP. Indian Medicinal Plants (An Illustrated Dictionary). New Delhi: Springer-Verlag Berlin/Heidelberg; 2007. p. 734.  Back to cited text no. 29
    
30.
Akinyemi AJ, Thome GR, Morsch VM, Stefanello N, Goularte JF, Belló-Klein A, et al. Effect of dietary supplementation of ginger and turmeric rhizomes on angiotensin-1 converting enzyme (ACE) and arginase activities in L-NAME induced hypertensive rats. J Funct Foods 2015;17:792-801.  Back to cited text no. 30
    
31.
Shri Sadananada Sharma. Rasatarangini, Ratnavigyaniya, 23/139-141, edited by Prof. Kashinath Shastri. Reprint edition. Varanasi: Motilal Banarasi Das; 1973. p. 629.  Back to cited text no. 31
    
32.
Klevay LM. Cardiovascular disease from copper deficiency – A history. J Nutr 2000;130 2S Suppl: 489S-92S.  Back to cited text no. 32
    
33.
Vaughan DE. PAI-1 and atherothrombosis. Thromb Haemost 2005;3:1879-83.  Back to cited text no. 33
    
34.
Li Z, Li B, Song X, Zhang D. Dietary zinc and iron intake and risk of depression: A meta analysis. Psychiatry Res 2017;251:41-7.  Back to cited text no. 34
    



 
 
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