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C.A.D. - Hridroga   1
Presented by :
                            Amit Kumar Sharma
                     M.D. (Kayachikitsa), Ph.d. Scholar
                      PG Department of Kayachikitsa,
                                NIA , Jaipur.
                    Email : amit_jaipur84@hotmail.com
                             Mobile : 9414822823

        Supervisor                                       Co-Supervisor
        Dr. R. K. Joshi                                  Dr. S.M. Sharma
Asso. Prof. M.D. (Ay.), Ph.D (Ay.)                  M.D.(Med) D.N.B. (Cardiology)
   P.G.Deptt. of Kayachikitsa                            Prof. Of Cardiology
RMO, Arogyashala, NIA Hospital                       Head, Unit-II of Cardiology
 National Institute of Ayurveda                        S.M.S. Bangar Hospital
             Jaipur                                             Jaipur
                                C.A.D. - Hridroga                                   2
1.   Conceptual and clinical studies on Hridroga vis-a-vis
     Coronary Artery Disease on various scientific
     parameters.
2.   Clinical   evaluation      of          the   role   of   proposed
     formulations Prabhakara Vati & Lekhana Basti
     treatment in the management of Coronary Artery
     Disease.
3.   To put forward a hypothesis in the form of effective
     strategies as Ayurvedic approaches for prevention of
     CAD.
                        C.A.D. - Hridroga                                3
   It was randomized, comparative, open ended, pre and
    post design, clinical trial.

   Selection Of Patients:
    The study was conducted on 30 clinically diagnosed &
    confirmed cases of Hridroga i.e. C.A.D., from OPD & IPD
    units of P.G. Department of Kayachikitsa, National
    Institute of Ayurveda Jaipur & Cardiology Unit of S.M.S.
    Bangar Memorial Hospital, Jaipur.




                        C.A.D. - Hridroga                  4
   Exclusion Criteria adopted for the current clinical
    trial :
    • Acute Myocardial Ischaemia
    • Myocardial Infarction
    • Congenital Anomalies
    • Valvular Heart Diseases
    • Hypertrophic Cardiomyopathies
    • Severe Hypertension (Stage 2; ≥160 mm Hg Sys. And ≥ 100 mm Hg Dias.)
    • Congestive Heart Failure




                                C.A.D. - Hridroga                            5
Out of 50 cases registered, 30 clinically diagnosed and confirmed
  patients of C.A.D. (Hridroga), matching our criterias of selection
  were selected for the present trial and randomly divided into
  following three groups -
   Group I : 10 patients of C.A.D. were recommended Tab. Dilzem
    30 mg TDS as Allopathic therapy for 30 days with simple water.
   Group II : 10 patients of C.A.D. were recommended Prabhakara
    Vati 500mg (2 Tabs) BD with lukewarm water for 30 days as
    Ayurvedic therapy.
   Group III : 10 patients of C.A.D. were recommended
    Prabhakara Vati 500mg (2 Tabs) BD for 30 days with lukewarm
    water and simultaneously administered Lekhana Basti
    treatment (Kala Basti krama i.e. 16 Bastis).
                            C.A.D. - Hridroga                        6
   It was developed by Prof. A.K. Sharma et. al. for the assessment
    of clinical improvement, the incidence of presenting features and
    severity of the symptoms of Hridroga (C.A.D.)


    S. No.   GRADE       PERCENTAGE             NUMBER   ACCORDING TO
                                                            GRADE
      1.        Nil          0%                   0           0

      2.       Mild         25%                   1           +

      3.     Moderate       50%                   2           ++

      4.      Severe        75%                   3          +++

      5.     Agonizing      100%                  4          ++++




                            C.A.D. - Hridroga                           7
Symptoms             Mean   Mean   Mean    Mean    S.D.   ±   S.E.   ±      t        P     Result
                             BT     AT    Diff.     %
        Veshthana            1.2    0.5    0.7    58.33   0.67       0.21        3.27     <0.01     S
     (Cardiac Cramps)
  Hriddrava (Palpitation)   1.6    0.9     0.7    43.75   0.48       0.15        4.58     <0.01    S
   Vedana (Pain-Chest)      1.3    0.7     0.6    46.15   0.51       0.16        3.67     <0.01    S
     Hriddah (Burning       1.1    0.6     0.5    45.45   0.84       0.26        1.86     <0.05    NS
 sensation -Retrosternal)
  Hrit Klama (Fatigue of    2.3    1.6     0.7    30.43   0.48       0.15        4.58     <0.01     S
     Cardiac Muscles)
Stambhita Hridya (Feeling   1.7    0.9     0.8    47.05   0.63        0.2         4.0     <0.01     S
       of Tightness)
     Aruchi (Anorexia)      0.9    0.6     0.3    33.33   0.48       0.15        1.96     <0.05    NS
    Ashmavat Hridaya        1.8    1.1     0.7    38.88   0.67       0.21        3.27     <0.01    S
   (Heaviness in chest)

               aa




                                                                                                           8
                                                                            C.A.D. - Hridroga
Symptoms             Mean   Mean   Mean    Mean    S.D.   ±   S.E.   ±    t        P       Result
                             BT     AT    Diff.     %
   Veshthana (Cardiac        1.9    0.8    1.1    57.89   0.56       0.17       6.12   <0.001         HS
          Cramps)
  Hriddrava (Palpitation)   2.5    0.9     1.6     64     0.96       0.30       5.23   <0.001         HS
   Vedana (Pain-Chest)      1.1    0.4     0.7    63.63   0.67       0.21       3.27    <0.01          S
     Hriddah (Burning       1.5    0.7     0.8    53.33   0.63        0.2        4      <0.01          S
 sensation-Retrosternal)
  Hrit Klama (Fatigue of    2.6    1.5     1.1    42.30   0.73       0.23       4.71    <0.01         S
     Cardiac Muscles)
Stambhita Hridya (Feeling    8     0.6     1.2    66.66   0.91       0.29       4.12    <0.01         S
       of Tightness)
     Aruchi (Anorexia)      1.2    0.6     0.6     50     0.69       0.22       2.71    <0.05         NS
   Ashmavat Hridaya         2.5    0.8     1.7     68     0.94        0.3       5.66   <0.001         HS
   (Heaviness in chest)

                   aa




                                                                                                           9
                                                                                  C.A.D. - Hridroga
Symptoms             Mean   Mean   Mean    Mean    S.D.   ±   S.E.   ±    t           P      Result
                             BT     AT    Diff.     %
   Veshthana (Cardiac        1.7    0.6    1.1    64.70   0.73       0.23       4.71      <0.01        S
          Cramps)
  Hriddrava (Palpitation)   2.5    0.7     1.8     72     0.91       0.29       6.19      <0.001      HS
   Vedana (Pain-Chest)      1.9    0.5     1.4    73.68   0.96       0.30       4.58       <0.01      S
     Hriddah (Burning       1.7    0.5     1.2    70.58   0.78       0.24       4.81      <0.001      HS
 sensation-Retrosternal)
  Hrit Klama (Fatigue of    2.9    1.2     1.7    58.62   0.94        0.3       5.66      <0.001      HS
     Cardiac Muscles)
Stambhita Hridya (Feeling   2.4    0.7     1.7    70.83   0.94        0.3       5.66      <0.001      HS
       of Tightness)
     Aruchi (Anorexia)      1.6    0.7     0.9    56.25   0.56       0.17       5.01      <0.001      HS
   Ashmavat Hridaya         2.2    0.6     1.6    72.72   0.84       0.26        6        <0.001      HS
   (Heaviness in chest)




                                                                                                             10
                                                                                       C.A.D. - Hridroga
Group I                  Mean      Mean      Mean    Mean    S.D. ± S.E. ± t       p           Result
                         BT        AT        Diff.   %
Systolic BP in mm. of     144.30    137.50    6.80    5.11   3.43   1.08   6.28    <0.001          HS
Hg.
Diastolic BP in mm. of    87.84     83.04     4.80    5.84   2.86   0.90   5.31    <0.001          HS
Hg.
Pulse rate/ minute        76.93     72.53     4.40    5.80   13.2   4.18   1.05        <0.1        NS
Body wt. in Kgs.          64.9      64.7      0.20    0.32   0.35   0.11   1.83        <0.05       NS




                            c




                                                                                                        11
                                                                               C.A.D. - Hridroga
Group II              Mean     Mean     Mean    Mean   S.D. ± S.E. ± t       p           Result
                      BT       AT       Diff.   %
Systolic BP in mm.    138.70   135.90   2.80    2.07   3.16   1.00   2.81    <0.02         NS
of Hg.
Diastolic BP in mm.   84.50    83.10    1.40    1.66   2.32   0.73   1.91    <0.05         NS
of Hg.
Pulse rate/ minute    74.30    73.90    0.40    0.54   0.84   0.27   1.50    <0.1          NS
Body wt. in Kgs.      64.10    62.20    1.90    2.93   1.91   0.60   3.14    <0.01         S




                                                                                                  12
                                                                     C.A.D. - Hridroga
Group III          Mean     Mean     Mean    Mean   S.D.   ±   S.E.   ±   t      p         Result
                   BT       AT       Diff.   %
Systolic BP in mm. 138.70   134.70   4.00    3.03   2.67       0.84       4.74   <0.01     S
of Hg.
Diastolic BP in mm. 86.59   82.79    3.80    4.53   3.71       1.17       3.24   <0.01     S
of Hg.
Pulse rate/ minute 74.30    73.80    0.50    0.67   0.85       0.27       0.86   <0.1      NS

Body wt. in Kgs.   68.40    65.60    2.80    4.10   2.33       0.74       3.80   <0.01     S




                                                                                                         13
                                                                                     C.A.D. - Hridroga
Lipid Profile   Mean     Mean AT   Mean    Mean                           t      p     Result
                   BT                Diff.    %
                                                     S.D.   ±     S.E. ±

S.Cholesterol     188.45   179.09    9.36    4.96    12.67        4.00     2.33   <0.1    NS
S.Triglyceride    130.04   118.84    11.2    8.6     21.78        6.88     1.62   <0.1    NS
V.L.D.L.          22.87     20.83    2.54    11.1     3.95        1.25     2.02   <0.1    NS
L.D.L.            68.23     65.23     3.0    4.36    19.16        6.06     0.49   <0.1    NS
H.D.L             48.95     48.84    0.11    0.22     5.88        1.84     0.05   <0.1    NS




                                                                                               14
                                              C.A.D. - Hridroga
Lipid Profile    Mean BT Mean AT   Mean     Mean       S.D.   ±   S.E.   ±   t       p       Result
                                   Diff.    %
S.Cholesterol    224.78   186      38.78    17.25      27.26      8.62       4.49    <0.01     S
S.Triglyceride   201.6    120.3    81.3     40.32      53.78      17.0       4.77    <0.01     S
V.L.D.L.         46.92    25.11    21.81    46.48      16.26      5.14       4.2     <0.01     S
L.D.L.           134.25   98.7     35.55    26.48      25.34      8.01       4.43    <0.01     S
H.D.L            50.3     52.4     - 2.1    -4.17      5.38       1.70       -1.23   < 0.1    NS




                                   C.A.D. - Hridroga                                                  15
Lipid Profile   Mean    Mean    Mean      Mean %      S.D. ±   S.E. ±     t       P      Result
                   BT      AT     Diff.
S.Cholesterol     207.8   160.6   47.2       22.71      24.23    7.62     6.15    <0.001    HS
S.Triglyceride    167.7   114.3   53.4       31.84      28.84    9.12     5.85    <0.001    HS
V.L.D.L.          40.4    24.59   15.8       39.13      7.67     2.42     6.51    <0.001    HS
L.D.L.            133.9   79.06   54.89      40.97      34.69    10.9     5.00    <0.001    HS
H.D.L             53.5    56.8    -3.3       -6.16      4.83     1.52     -2.16   <0.05     NS




                                                                                                    16
                                          C.A.D. - Hridroga
TMT          Mean    Mean    Mean    Mean %   S.D. ±   S.E. ±     t          p         Result
                 BT      AT     Diff.
 Changes
Exercise        6.38    7.73    1.35    21.22    1.02     0.32     4.16      <0.01            S
Time       in
Minutes
Max.       ST   -3.63   -2.42   1.21    33.33    0.83     0.26     4.60      <0.01            S
Changes in
mm.




                                                                                                   17
                                                                          C.A.D. - Hridroga
TMT          Mean BT   Mean    Mean    Mean %         S.D.±   S.E. ±     t      p     Result
                           AT     Diff.
 Changes
Exercise         6.21     7.91    1.7     27.34          1.12    0.35     4.76   <0.01     S
Time       in
Minutes
Max.       ST    -3.2     -1.91   -1.29    40.31         1.12    0.35     3.61   <0.01     S
Changes in
mm.




                                     C.A.D. - Hridroga                                         18
TMT         Mean    Mean    Mean     Mean        S.D.±   S.E. ±    t       p     Result
Changes        BT      AT     Diff.       %
Exercise      5.76    7.65    1.88     32.76       1.25    0.39     4.74   <0.01     S
Time     in
Minutes
Max.     ST   -2.87   -1.59   -1.28    44.59       0.88    0.27     4.59   <0.01     S
Changes
in mm.




                               C.A.D. - Hridroga                                         19
GRAPH SHOWING IMPROVEMENT PERCENTAGE
                      IN TMT CHANGES IN ALL GROUPS

                           45

                           40

           % improvement   35

                           30

                           25

                           20

                           15

                           10

                            5

                           0
                                 Gp               Gp      Gp
                                  1                2       3
Change in Exercise Time
                                21.72            27.34   32.76
        in min.
Max. ST changes in mm.          33.33            40.31   44.59



                                  C.A.D. - Hridroga              20
DISCUSSIONS
Avlambaka
           Sadhaka       Kapha
                                         Para Oja
            Pitta


   Vyana                                            Pranavaha
   Vayu                                              Srotasa



Prana                                                  Rasavaha
Vayu
                     HRIDAYA                            Srotasa




        CHETANA, PRANAYATANA, MARMA
                     C.A.D. - Hridroga                            22
Katu
                                                                 MEDA
PRABHAKARA         RASA                           PRABHAVA
                                                                 KAPHA
   VATI                     Tikta
                                                                 KLEDA
                                      Kashaya




             Kashaya Rasa    Sharira Kledopshoshana property (Ch.Su.26)
                  (4)        Rukhsa (Depletion), Lekhana (Scrapping off)
                             Sangrahi, Stambhaka
             Tikta Rasa      Kleda-Meda-Kapha-Shoshana , Lekhana,
                   (3)       Pachana
             Katu Rasa       Sroto-Shodhaka, Mansa Vilekhana, helps in
                   (1)       Pachana




     Abaddha                Baddha                Lekhana
      Meda                   Meda
                              C.A.D. - Hridroga   Pachana                  23
Katu Vipaka (3)                Ashukari
                                                                Jatharagni,
                                               Prabhava
PRABHAKARA                                                    Rasadhatvagni &
   VATI          Laghu(2),
                                                              Medodhatvagni.
                 Teekshna(2),
                 Sara (2) Gunas




                Sheeta Veerya
                     (4)
PRABHAKARA
   VATI
                 Madhura Vipaka
                      (1)


             HOLISTIC MANNER               Tend to increase




                       C.A.D. - Hridroga                                   24
 Due to the presence of properties like
     Lekhana (hypolipidemic),
     Karshana,
     Srotoshodhaka,
     Pachana,
     Medohara,
     Ashukari and
     Kapha-Vatahara
Prabhakara Vati and Lekhana Basti have worked out to be
                     Cardio-tonic &
                     Cardio-protective in nature.
                    C.A.D. - Hridroga                 25
   Antianginal (Prevents or alleviates Angina).
   Coronary Vasodilator (Results in dilation of coronary
                             blood flow)
   Thrombolytic & Antiplatelet agent (Prevents thrombus
                                         formation).
   Vasoprotective (Protective effects on blood vessels).
   Hypotensive (Controls & regulates raised Blood
                  pressure).
   Hypolipidaemic (Reduces blood lipids concentrations).
   Antioxidant (Reduces oxidative stress).
   Antiinflammatory (Counteracts inflammation).
   Immunomodulator (Immune status enhancer).
   Cardioprotective/Anabolic agent.
                                                              26
                                          C.A.D. - Hridroga
1.   Limited Description in Ayurvedic classics.
     But on the basis of their clinical manifestations Vata-Kaphaja
     type of Hridroga ~ Coronary Artery Disease.
                                                  OBJECTIVE 1
2.   Prabhakara Vati & Lekhana Basti when used separately and /
     or together act not only on a single modifiable risk factor but
     on a variety of these factors.

3.   By decreasing Total Cholesterol, Serum Triglyceride, Serum
     L.D.L., Serum V.L.D.L. and partially increasing Serum H.D.L.
     level, thus these preparations control and correct
     dyslipidemias leading to     arrest of the pathogenesis of
     formation of atheromatous plaque and ultimately delaying
     the pathogenesis of C.A.D. (Hridroga).



                           C.A.D. - Hridroga                      27
3.   Improvement of ischaemic changes, increase exercise
     time along with correction of ST changes On parameters
     like ECG and C.T.M.T,            respectively along with
     improvement in chest pain, dyspnoea on effort and
     palpitation provide potent antianginal and coronary
     vasodilating effects.
4.   Prabhakara Vati and Lekhana Basti have very limited role to
     play in acute episodes of C.A.D.
     But these can be used effectively separately or in
     combination together as an adjuvant therapy along with
     modern coronary vasodilators or independently to prevent
     or slow down or reverse the pathogenesis of
     Atherosclerosis - an essential precursor of C.A.D.

                        C.A.D. - Hridroga                     28
5.   Trial Drugs Prabhakara Vati and Lekhana Basti are safe herbo-
     mineral formulations which have shown encouraging results in
     the prevention / management of C.A.D. (Hridroga) on various
     scientific parameters. No Toxic / Side effects were reported in
     any of the patients during or after completion of the trial.
                                                   OBJECTIVE 2

6.   A new hypothesis can be put forward, “The administration of
     Prabhakara Vati and / or Lekhana Basti separately or in
     combination together may prove to be an effective strategy as
     Ayurvedic approach for the prevention of C.A.D. (Hridroga).”

7.   Dietary and Lifestyle modifications, besides proposed Ayurvedic
     strategies are essential factors to be strictly adhered to by the
     patient for effective control / prevention of C.A.D. (Hridroga)
                                                   OBJECTIVE 3
                          C.A.D. - Hridroga                         29
Therefore, it can be concluded that
Prabhakara Vati and Lekhana Basti can be
    used separately or in combination
together effectively in the management
of C.A.D. / to prevent / delay / reverse the
  progress of Atherosclerosis leading to
   Coronary Artery Disease (Hridroga).



               C.A.D. - Hridroga           30
PREVENTION IS BETTER THAN CURE




          NIDANA
        PARIVARJANA


      PREVENTIVE
      CARDIOLOGY
       C.A.D. - Hridroga         31
C.A.D. - Hridroga   32

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Cardiology and ayurveda

  • 2. Presented by : Amit Kumar Sharma M.D. (Kayachikitsa), Ph.d. Scholar PG Department of Kayachikitsa, NIA , Jaipur. Email : amit_jaipur84@hotmail.com Mobile : 9414822823 Supervisor Co-Supervisor Dr. R. K. Joshi Dr. S.M. Sharma Asso. Prof. M.D. (Ay.), Ph.D (Ay.) M.D.(Med) D.N.B. (Cardiology) P.G.Deptt. of Kayachikitsa Prof. Of Cardiology RMO, Arogyashala, NIA Hospital Head, Unit-II of Cardiology National Institute of Ayurveda S.M.S. Bangar Hospital Jaipur Jaipur C.A.D. - Hridroga 2
  • 3. 1. Conceptual and clinical studies on Hridroga vis-a-vis Coronary Artery Disease on various scientific parameters. 2. Clinical evaluation of the role of proposed formulations Prabhakara Vati & Lekhana Basti treatment in the management of Coronary Artery Disease. 3. To put forward a hypothesis in the form of effective strategies as Ayurvedic approaches for prevention of CAD. C.A.D. - Hridroga 3
  • 4. It was randomized, comparative, open ended, pre and post design, clinical trial.  Selection Of Patients: The study was conducted on 30 clinically diagnosed & confirmed cases of Hridroga i.e. C.A.D., from OPD & IPD units of P.G. Department of Kayachikitsa, National Institute of Ayurveda Jaipur & Cardiology Unit of S.M.S. Bangar Memorial Hospital, Jaipur. C.A.D. - Hridroga 4
  • 5. Exclusion Criteria adopted for the current clinical trial : • Acute Myocardial Ischaemia • Myocardial Infarction • Congenital Anomalies • Valvular Heart Diseases • Hypertrophic Cardiomyopathies • Severe Hypertension (Stage 2; ≥160 mm Hg Sys. And ≥ 100 mm Hg Dias.) • Congestive Heart Failure C.A.D. - Hridroga 5
  • 6. Out of 50 cases registered, 30 clinically diagnosed and confirmed patients of C.A.D. (Hridroga), matching our criterias of selection were selected for the present trial and randomly divided into following three groups -  Group I : 10 patients of C.A.D. were recommended Tab. Dilzem 30 mg TDS as Allopathic therapy for 30 days with simple water.  Group II : 10 patients of C.A.D. were recommended Prabhakara Vati 500mg (2 Tabs) BD with lukewarm water for 30 days as Ayurvedic therapy.  Group III : 10 patients of C.A.D. were recommended Prabhakara Vati 500mg (2 Tabs) BD for 30 days with lukewarm water and simultaneously administered Lekhana Basti treatment (Kala Basti krama i.e. 16 Bastis). C.A.D. - Hridroga 6
  • 7. It was developed by Prof. A.K. Sharma et. al. for the assessment of clinical improvement, the incidence of presenting features and severity of the symptoms of Hridroga (C.A.D.) S. No. GRADE PERCENTAGE NUMBER ACCORDING TO GRADE 1. Nil 0% 0 0 2. Mild 25% 1 + 3. Moderate 50% 2 ++ 4. Severe 75% 3 +++ 5. Agonizing 100% 4 ++++ C.A.D. - Hridroga 7
  • 8. Symptoms Mean Mean Mean Mean S.D. ± S.E. ± t P Result BT AT Diff. % Veshthana 1.2 0.5 0.7 58.33 0.67 0.21 3.27 <0.01 S (Cardiac Cramps) Hriddrava (Palpitation) 1.6 0.9 0.7 43.75 0.48 0.15 4.58 <0.01 S Vedana (Pain-Chest) 1.3 0.7 0.6 46.15 0.51 0.16 3.67 <0.01 S Hriddah (Burning 1.1 0.6 0.5 45.45 0.84 0.26 1.86 <0.05 NS sensation -Retrosternal) Hrit Klama (Fatigue of 2.3 1.6 0.7 30.43 0.48 0.15 4.58 <0.01 S Cardiac Muscles) Stambhita Hridya (Feeling 1.7 0.9 0.8 47.05 0.63 0.2 4.0 <0.01 S of Tightness) Aruchi (Anorexia) 0.9 0.6 0.3 33.33 0.48 0.15 1.96 <0.05 NS Ashmavat Hridaya 1.8 1.1 0.7 38.88 0.67 0.21 3.27 <0.01 S (Heaviness in chest) aa 8 C.A.D. - Hridroga
  • 9. Symptoms Mean Mean Mean Mean S.D. ± S.E. ± t P Result BT AT Diff. % Veshthana (Cardiac 1.9 0.8 1.1 57.89 0.56 0.17 6.12 <0.001 HS Cramps) Hriddrava (Palpitation) 2.5 0.9 1.6 64 0.96 0.30 5.23 <0.001 HS Vedana (Pain-Chest) 1.1 0.4 0.7 63.63 0.67 0.21 3.27 <0.01 S Hriddah (Burning 1.5 0.7 0.8 53.33 0.63 0.2 4 <0.01 S sensation-Retrosternal) Hrit Klama (Fatigue of 2.6 1.5 1.1 42.30 0.73 0.23 4.71 <0.01 S Cardiac Muscles) Stambhita Hridya (Feeling 8 0.6 1.2 66.66 0.91 0.29 4.12 <0.01 S of Tightness) Aruchi (Anorexia) 1.2 0.6 0.6 50 0.69 0.22 2.71 <0.05 NS Ashmavat Hridaya 2.5 0.8 1.7 68 0.94 0.3 5.66 <0.001 HS (Heaviness in chest) aa 9 C.A.D. - Hridroga
  • 10. Symptoms Mean Mean Mean Mean S.D. ± S.E. ± t P Result BT AT Diff. % Veshthana (Cardiac 1.7 0.6 1.1 64.70 0.73 0.23 4.71 <0.01 S Cramps) Hriddrava (Palpitation) 2.5 0.7 1.8 72 0.91 0.29 6.19 <0.001 HS Vedana (Pain-Chest) 1.9 0.5 1.4 73.68 0.96 0.30 4.58 <0.01 S Hriddah (Burning 1.7 0.5 1.2 70.58 0.78 0.24 4.81 <0.001 HS sensation-Retrosternal) Hrit Klama (Fatigue of 2.9 1.2 1.7 58.62 0.94 0.3 5.66 <0.001 HS Cardiac Muscles) Stambhita Hridya (Feeling 2.4 0.7 1.7 70.83 0.94 0.3 5.66 <0.001 HS of Tightness) Aruchi (Anorexia) 1.6 0.7 0.9 56.25 0.56 0.17 5.01 <0.001 HS Ashmavat Hridaya 2.2 0.6 1.6 72.72 0.84 0.26 6 <0.001 HS (Heaviness in chest) 10 C.A.D. - Hridroga
  • 11. Group I Mean Mean Mean Mean S.D. ± S.E. ± t p Result BT AT Diff. % Systolic BP in mm. of 144.30 137.50 6.80 5.11 3.43 1.08 6.28 <0.001 HS Hg. Diastolic BP in mm. of 87.84 83.04 4.80 5.84 2.86 0.90 5.31 <0.001 HS Hg. Pulse rate/ minute 76.93 72.53 4.40 5.80 13.2 4.18 1.05 <0.1 NS Body wt. in Kgs. 64.9 64.7 0.20 0.32 0.35 0.11 1.83 <0.05 NS c 11 C.A.D. - Hridroga
  • 12. Group II Mean Mean Mean Mean S.D. ± S.E. ± t p Result BT AT Diff. % Systolic BP in mm. 138.70 135.90 2.80 2.07 3.16 1.00 2.81 <0.02 NS of Hg. Diastolic BP in mm. 84.50 83.10 1.40 1.66 2.32 0.73 1.91 <0.05 NS of Hg. Pulse rate/ minute 74.30 73.90 0.40 0.54 0.84 0.27 1.50 <0.1 NS Body wt. in Kgs. 64.10 62.20 1.90 2.93 1.91 0.60 3.14 <0.01 S 12 C.A.D. - Hridroga
  • 13. Group III Mean Mean Mean Mean S.D. ± S.E. ± t p Result BT AT Diff. % Systolic BP in mm. 138.70 134.70 4.00 3.03 2.67 0.84 4.74 <0.01 S of Hg. Diastolic BP in mm. 86.59 82.79 3.80 4.53 3.71 1.17 3.24 <0.01 S of Hg. Pulse rate/ minute 74.30 73.80 0.50 0.67 0.85 0.27 0.86 <0.1 NS Body wt. in Kgs. 68.40 65.60 2.80 4.10 2.33 0.74 3.80 <0.01 S 13 C.A.D. - Hridroga
  • 14. Lipid Profile Mean Mean AT Mean Mean t p Result BT Diff. % S.D. ± S.E. ± S.Cholesterol 188.45 179.09 9.36 4.96 12.67 4.00 2.33 <0.1 NS S.Triglyceride 130.04 118.84 11.2 8.6 21.78 6.88 1.62 <0.1 NS V.L.D.L. 22.87 20.83 2.54 11.1 3.95 1.25 2.02 <0.1 NS L.D.L. 68.23 65.23 3.0 4.36 19.16 6.06 0.49 <0.1 NS H.D.L 48.95 48.84 0.11 0.22 5.88 1.84 0.05 <0.1 NS 14 C.A.D. - Hridroga
  • 15. Lipid Profile Mean BT Mean AT Mean Mean S.D. ± S.E. ± t p Result Diff. % S.Cholesterol 224.78 186 38.78 17.25 27.26 8.62 4.49 <0.01 S S.Triglyceride 201.6 120.3 81.3 40.32 53.78 17.0 4.77 <0.01 S V.L.D.L. 46.92 25.11 21.81 46.48 16.26 5.14 4.2 <0.01 S L.D.L. 134.25 98.7 35.55 26.48 25.34 8.01 4.43 <0.01 S H.D.L 50.3 52.4 - 2.1 -4.17 5.38 1.70 -1.23 < 0.1 NS C.A.D. - Hridroga 15
  • 16. Lipid Profile Mean Mean Mean Mean % S.D. ± S.E. ± t P Result BT AT Diff. S.Cholesterol 207.8 160.6 47.2 22.71 24.23 7.62 6.15 <0.001 HS S.Triglyceride 167.7 114.3 53.4 31.84 28.84 9.12 5.85 <0.001 HS V.L.D.L. 40.4 24.59 15.8 39.13 7.67 2.42 6.51 <0.001 HS L.D.L. 133.9 79.06 54.89 40.97 34.69 10.9 5.00 <0.001 HS H.D.L 53.5 56.8 -3.3 -6.16 4.83 1.52 -2.16 <0.05 NS 16 C.A.D. - Hridroga
  • 17. TMT Mean Mean Mean Mean % S.D. ± S.E. ± t p Result BT AT Diff. Changes Exercise 6.38 7.73 1.35 21.22 1.02 0.32 4.16 <0.01 S Time in Minutes Max. ST -3.63 -2.42 1.21 33.33 0.83 0.26 4.60 <0.01 S Changes in mm. 17 C.A.D. - Hridroga
  • 18. TMT Mean BT Mean Mean Mean % S.D.± S.E. ± t p Result AT Diff. Changes Exercise 6.21 7.91 1.7 27.34 1.12 0.35 4.76 <0.01 S Time in Minutes Max. ST -3.2 -1.91 -1.29 40.31 1.12 0.35 3.61 <0.01 S Changes in mm. C.A.D. - Hridroga 18
  • 19. TMT Mean Mean Mean Mean S.D.± S.E. ± t p Result Changes BT AT Diff. % Exercise 5.76 7.65 1.88 32.76 1.25 0.39 4.74 <0.01 S Time in Minutes Max. ST -2.87 -1.59 -1.28 44.59 0.88 0.27 4.59 <0.01 S Changes in mm. C.A.D. - Hridroga 19
  • 20. GRAPH SHOWING IMPROVEMENT PERCENTAGE IN TMT CHANGES IN ALL GROUPS 45 40 % improvement 35 30 25 20 15 10 5 0 Gp Gp Gp 1 2 3 Change in Exercise Time 21.72 27.34 32.76 in min. Max. ST changes in mm. 33.33 40.31 44.59 C.A.D. - Hridroga 20
  • 22. Avlambaka Sadhaka Kapha Para Oja Pitta Vyana Pranavaha Vayu Srotasa Prana Rasavaha Vayu HRIDAYA Srotasa CHETANA, PRANAYATANA, MARMA C.A.D. - Hridroga 22
  • 23. Katu MEDA PRABHAKARA RASA PRABHAVA KAPHA VATI Tikta KLEDA Kashaya Kashaya Rasa Sharira Kledopshoshana property (Ch.Su.26) (4) Rukhsa (Depletion), Lekhana (Scrapping off) Sangrahi, Stambhaka Tikta Rasa Kleda-Meda-Kapha-Shoshana , Lekhana, (3) Pachana Katu Rasa Sroto-Shodhaka, Mansa Vilekhana, helps in (1) Pachana Abaddha Baddha Lekhana Meda Meda C.A.D. - Hridroga Pachana 23
  • 24. Katu Vipaka (3) Ashukari Jatharagni, Prabhava PRABHAKARA Rasadhatvagni & VATI Laghu(2), Medodhatvagni. Teekshna(2), Sara (2) Gunas Sheeta Veerya (4) PRABHAKARA VATI Madhura Vipaka (1) HOLISTIC MANNER Tend to increase C.A.D. - Hridroga 24
  • 25.  Due to the presence of properties like Lekhana (hypolipidemic), Karshana, Srotoshodhaka, Pachana, Medohara, Ashukari and Kapha-Vatahara Prabhakara Vati and Lekhana Basti have worked out to be Cardio-tonic & Cardio-protective in nature. C.A.D. - Hridroga 25
  • 26. Antianginal (Prevents or alleviates Angina).  Coronary Vasodilator (Results in dilation of coronary blood flow)  Thrombolytic & Antiplatelet agent (Prevents thrombus formation).  Vasoprotective (Protective effects on blood vessels).  Hypotensive (Controls & regulates raised Blood pressure).  Hypolipidaemic (Reduces blood lipids concentrations).  Antioxidant (Reduces oxidative stress).  Antiinflammatory (Counteracts inflammation).  Immunomodulator (Immune status enhancer).  Cardioprotective/Anabolic agent. 26 C.A.D. - Hridroga
  • 27. 1. Limited Description in Ayurvedic classics. But on the basis of their clinical manifestations Vata-Kaphaja type of Hridroga ~ Coronary Artery Disease. OBJECTIVE 1 2. Prabhakara Vati & Lekhana Basti when used separately and / or together act not only on a single modifiable risk factor but on a variety of these factors. 3. By decreasing Total Cholesterol, Serum Triglyceride, Serum L.D.L., Serum V.L.D.L. and partially increasing Serum H.D.L. level, thus these preparations control and correct dyslipidemias leading to arrest of the pathogenesis of formation of atheromatous plaque and ultimately delaying the pathogenesis of C.A.D. (Hridroga). C.A.D. - Hridroga 27
  • 28. 3. Improvement of ischaemic changes, increase exercise time along with correction of ST changes On parameters like ECG and C.T.M.T, respectively along with improvement in chest pain, dyspnoea on effort and palpitation provide potent antianginal and coronary vasodilating effects. 4. Prabhakara Vati and Lekhana Basti have very limited role to play in acute episodes of C.A.D. But these can be used effectively separately or in combination together as an adjuvant therapy along with modern coronary vasodilators or independently to prevent or slow down or reverse the pathogenesis of Atherosclerosis - an essential precursor of C.A.D. C.A.D. - Hridroga 28
  • 29. 5. Trial Drugs Prabhakara Vati and Lekhana Basti are safe herbo- mineral formulations which have shown encouraging results in the prevention / management of C.A.D. (Hridroga) on various scientific parameters. No Toxic / Side effects were reported in any of the patients during or after completion of the trial. OBJECTIVE 2 6. A new hypothesis can be put forward, “The administration of Prabhakara Vati and / or Lekhana Basti separately or in combination together may prove to be an effective strategy as Ayurvedic approach for the prevention of C.A.D. (Hridroga).” 7. Dietary and Lifestyle modifications, besides proposed Ayurvedic strategies are essential factors to be strictly adhered to by the patient for effective control / prevention of C.A.D. (Hridroga) OBJECTIVE 3 C.A.D. - Hridroga 29
  • 30. Therefore, it can be concluded that Prabhakara Vati and Lekhana Basti can be used separately or in combination together effectively in the management of C.A.D. / to prevent / delay / reverse the progress of Atherosclerosis leading to Coronary Artery Disease (Hridroga). C.A.D. - Hridroga 30
  • 31. PREVENTION IS BETTER THAN CURE NIDANA PARIVARJANA PREVENTIVE CARDIOLOGY C.A.D. - Hridroga 31