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C.A.D. - Hridroga   1
Presented by :
                            Amit Kumar Sharma
                     M.D. (Kayachikitsa), Ph.d. Scholar
     ...
1.   Conceptual and clinical studies on Hridroga vis-a-vis
     Coronary Artery Disease on various scientific
     paramet...
   It was randomized, comparative, open ended, pre and
    post design, clinical trial.

   Selection Of Patients:
    T...
   Exclusion Criteria adopted for the current clinical
    trial :
    • Acute Myocardial Ischaemia
    • Myocardial Infa...
Out of 50 cases registered, 30 clinically diagnosed and confirmed
  patients of C.A.D. (Hridroga), matching our criterias ...
   It was developed by Prof. A.K. Sharma et. al. for the assessment
    of clinical improvement, the incidence of present...
Symptoms             Mean   Mean   Mean    Mean    S.D.   ±   S.E.   ±      t        P     Result
                        ...
Symptoms             Mean   Mean   Mean    Mean    S.D.   ±   S.E.   ±    t        P       Result
                        ...
Symptoms             Mean   Mean   Mean    Mean    S.D.   ±   S.E.   ±    t           P      Result
                      ...
Group I                  Mean      Mean      Mean    Mean    S.D. ± S.E. ± t       p           Result
                    ...
Group II              Mean     Mean     Mean    Mean   S.D. ± S.E. ± t       p           Result
                      BT  ...
Group III          Mean     Mean     Mean    Mean   S.D.   ±   S.E.   ±   t      p         Result
                   BT   ...
Lipid Profile   Mean     Mean AT   Mean    Mean                           t      p     Result
                   BT       ...
Lipid Profile    Mean BT Mean AT   Mean     Mean       S.D.   ±   S.E.   ±   t       p       Result
                      ...
Lipid Profile   Mean    Mean    Mean      Mean %      S.D. ±   S.E. ±     t       P      Result
                   BT     ...
TMT          Mean    Mean    Mean    Mean %   S.D. ±   S.E. ±     t          p         Result
                 BT      AT ...
TMT          Mean BT   Mean    Mean    Mean %         S.D.±   S.E. ±     t      p     Result
                           AT...
TMT         Mean    Mean    Mean     Mean        S.D.±   S.E. ±    t       p     Result
Changes        BT      AT     Diff...
GRAPH SHOWING IMPROVEMENT PERCENTAGE
                      IN TMT CHANGES IN ALL GROUPS

                           45

  ...
DISCUSSIONS
Avlambaka
           Sadhaka       Kapha
                                         Para Oja
            Pitta


   Vyana   ...
Katu
                                                                 MEDA
PRABHAKARA         RASA                        ...
Katu Vipaka (3)                Ashukari
                                                                Jatharagni,
      ...
 Due to the presence of properties like
     Lekhana (hypolipidemic),
     Karshana,
     Srotoshodhaka,
     Pachana,
  ...
   Antianginal (Prevents or alleviates Angina).
   Coronary Vasodilator (Results in dilation of coronary
               ...
1.   Limited Description in Ayurvedic classics.
     But on the basis of their clinical manifestations Vata-Kaphaja
     t...
3.   Improvement of ischaemic changes, increase exercise
     time along with correction of ST changes On parameters
     ...
5.   Trial Drugs Prabhakara Vati and Lekhana Basti are safe herbo-
     mineral formulations which have shown encouraging ...
Therefore, it can be concluded that
Prabhakara Vati and Lekhana Basti can be
    used separately or in combination
togethe...
PREVENTION IS BETTER THAN CURE




          NIDANA
        PARIVARJANA


      PREVENTIVE
      CARDIOLOGY
       C.A.D. ...
C.A.D. - Hridroga   32
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Cardiology and ayurveda

It was a Clinical Trial performed at National Institute of Ayurveda, Jaipur, Rajasthan, India. The results of the trial were very encouraging and many patients are being treated on similar lines today and getting significant improvemnt.

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Cardiology and ayurveda

  1. 1. C.A.D. - Hridroga 1
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  21. 21. DISCUSSIONS
  22. 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. 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. 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. 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. 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. 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. 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. 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. 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. 31. PREVENTION IS BETTER THAN CURE NIDANA PARIVARJANA PREVENTIVE CARDIOLOGY C.A.D. - Hridroga 31
  32. 32. C.A.D. - Hridroga 32
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It was a Clinical Trial performed at National Institute of Ayurveda, Jaipur, Rajasthan, India. The results of the trial were very encouraging and many patients are being treated on similar lines today and getting significant improvemnt.

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