Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Peripheral vascular disease (PVD) is a disease which affects the blood vessels. Any disorder or disease affecting the circulatory system outside of the brain and heart is called Peripheral Vascular Disease. Sometimes it is used interchangeably with Peripheral Arterial Disease (PAD). But PAD is a part of PVD.
It is the most common disease of the arteries. Primarily PVD is caused by atherosclerosis. Atherosclerosis is a condition wherein there is gradual deposition of fatty material inside the blood vessels. This eventually causes blockages, narrowing or weakening of arteries.
Atherosclerosis is often associated with the arteries of the brain and heart. But it can affect any blood vessel in the body. The legs i.e. the arteries of the legs are most commonly affected.
Related Reading – ‘Peripheral Vascular Diseases’
In this article we will try to understand the Peripheral Vascular Diseases from Ayurveda perspective.
Ayurveda Understanding of Peripheral Vascular Diseases
1. From the perspective of pathogenesis and structural afflictions
Diseases of Sira and Dhamani
Peripheral Vascular Diseases affect the blood vessels in the periphery, other than those in the brain and heart. According to Ayurveda, the disease affects the sira or dhamani. Though sira is compared to veins and dhamani to arteries, these two terms are often used interchangeably. Sira, Dhamani and Srotas are the terms which are synonymous with each other. It is primarily caused by atherosclerosis.
Atherosclerosis is caused by fat deposits in the blood vessels and consequent blockages. These blockages would deprive oxygen and nutrition to the tissues leading to the related symptoms of the disease. The following terms may be used for such pathogenesis –
– Medasavrita Marga – Fat enveloping and blocking inside of any pathway or channel, blood vessels (arteries) in this context. This explains the pathogenesis pathway of atherosclerosis.
– Siragranthi – Though this term is used to explain a growth like cyst or tumour inside or outside the vascular system – arteries or veins, the fat deposits inside the blood vessels can also be considered as granthi-like structures forming inside the blood vessels.
Medo Avarana: Enveloping of structures by fat, fat accumulation causing blocks in multiple channels and passages
The term ‘medasavrita’ has been mentioned in the context of medoroga i.e. diseases caused due to errors of fat metabolism leading to its accumulation in various channels and places of the body.
This will be caused due to excessive foods which bring about abnormal increase of meda – fat and kapha in the body and due to avyayama or inactivity or sedentary life. This will lead to excessive accumulation of fats.
In the context of medoroga it has been said ‘medasavrita margatvat pushyanti anye na dhatavaha…’ i.e. due to the channels being obstructed by the increased fat, no dhatu other than fat is nourished i.e. only the fat tissue is nourished, gets increased, deposited and causes blocks. Since the other tissues are not nourished properly, they undergo deterioration. The increase of meda and consequent dhatu kshaya i.e. depletion of tissues leads to abnormal increase of vata. This vata increase and depletion of tissues is responsible for all the symptoms which are found explained in the context of peripheral vascular disease.
Related Reading – ‘Peripheral Vascular Disease’
Raktapradoshaja Roga
Peripheral Vascular Diseases can also be considered under the umbrella of Raktapradoshaja Rogas i.e. diseases caused by contamination of blood or by contaminated blood.
The vitiated blood, either individually or being contaminated by doshas can cause many diseases. Rakta – blood is considered as the fourth dosha by Master Sushruta. Many symptoms explained in the context of Peripheral Vascular Disease are also mentioned amongst the list of Rakta Pradoshaja Rogas.
From Nidana: Etiological factors & ‘causative diseases’ perspective
Causative Doshas – Seeing the etiological factors, symptoms and complications and risk factors of Peripheral Vascular Diseases it can be said that vata is the primary dosha which afflicts the peripheral circulatory system causing the pathogenesis of PVDs. Pitta can also be involved when there are inflammatory changes in the blood vessels and Kapha when there is clotting of blood.
Medasavrita Marga – Atherosclerosis, as said above is said to be the most important causative factor of Peripheral Vascular Disease. This can be understood on the lines of Medasavrita marga wherein the lumen of the blood vessels is narrowed following the accumulation of fatty substances.
Siraja Granthi, Grathita Rakta, Raktapitta, Rakta Vriddhi – Blood clots which restrict the flow of blood can cause symptoms of PVD. This mechanism can be correlated to Siraja Granthi as mentioned above and also to Grathita Rakta or matted blood (clot) caused due to influence of blood by kapha as explained in the context of Raktapitta – haemorrhagic disorders. Therefore – a clot may be due to meda or kapha influencing rakta or due to hemorrhagic conditions like raktapitta. This can also be caused due to Rakta Vriddhi also.
Rakta Vriddhi – Vatarakta and Raktapitta are mentioned amongst Rakta Vriddhi Lakshanas i.e. symptoms of abnormal increase or vitiation of blood tissue. In vatarakta too there is blockage of passages, mainly hampering the free flow of vata in the blood vessels as caused by ‘enveloping of passages and vata therein by aggravated / increased rakta’. This causes a similar pathogenesis as those of atherosclerosis and blood clot formation in the blood vessels.
Prameha, Medoroga & Santarpanottha Vyadhi Spectrum – Diabetes is yet another chief cause of PVDs. Diabetes Mellitus falls under the big spectrum of Prameha disorders explained in Ayurveda, mainly the Vataja type of Prameha / Madhumeha.
Prameha is a Santarpanottha Vyadhi i.e. disease caused due to excessive nutrition or over-saturation. This is caused due to improper choices of food, mainly fatty foods. Sthoulya – obesity and Medo Roga – fatty disorders also fall into this group of Santarpanottha Rogas. Prameha is also caused by vitiation of Medovaha Srotas and thus is linked to errors of fat metabolism. We can see that most obese people are diabetic and the converse is also true. Sedentary lifestyle choices and over nutritious foods are also said to be the causative factors of Prameha, as they are for Medoroga / Sthoulya.
Shotha – Inflammation of arteries as in vasculitis might cause inflammation and damage to the arteries which in turn causes narrowing or blockage of these blood vessels. Rakta is one of the seats of pitta. When pitta increases above its normal limits, it can burn the blood and cause inflammation of blood vessels, both being hot in nature. Simultaneous increase of rakta and pitta can also cause raktapitta. Both these conditions can cause symptoms similar to those of PVDs. Vasculitis can also be considered as pittaja shotha occurring in the sira and dhamani.
Krimi – Infections cause inflammation, scarring and damage to blood vessels. Though not exactly, the concept of Krimi in Ayurveda has been studied in correlation to the infections. Raktaja Krimis cause Kushta – skin diseases and other similar conditions. These krimis are present in the blood. The skin manifestations, discoloration, gangrene etc of PVDs may be said to be caused by krimis present in the rakta.
Abhighata – Injury is yet another causative factor for causation of PVDs. Abhighata, which means injury or trauma of multiple- origins is one of the causes for vitiation of rakta, for causation of many diseases like vatarakta and shotha, which may in turn cause symptoms mimicking Peripheral Vascular Diseases.
Rakta Kshaya – Rakta shay ai.e. depletion of blood tissue causes Sira Shaitilya i.e. laxity or flabbiness of the blood vessels. This would prevent the blood from returning back to the heart. This in turn causes pooling of blood and damage of blood vessels and causes venous insufficiency. In its chronic run, sira shaitilya can cause symptoms similar to those of PVD.
Grathita Raktapitta – Another cause for PVD, Deep Vein Thrombosis (DVT) wherein there is formation of blood clot in the deep veins of the legs (mainly). This would cause obstruction to flow of blood and also damage the blood vessel walls. This can be correlated with Sira Granthi or Grathita Rakta or Grathita Raktapitta / Kapha pradhana Raktapitta.
Vata Prakopa – Another causative disorder is Raynaud’s Disease. In this condition there occurs constriction of blood vessels in the extremities due to response to extreme stress or cold. This would lead to damage of blood vessels in the long run. This sankocha i.e. constriction is mainly caused by aggravation of vata. Sankocha is one of the symptoms of vata prakopa. Vata gets aggravated both due to stress and also cold.
Shotha – Thrombophlebitis – an inflammation of the vein often caused by blood clot leads to swelling and obstruction to normal blood flow. This is caused due to raktapitta or shotha occurring in the raktavaha srotas / siras or dhamanis.
Sira Shaitilya / Arshas – Varicose Veins is a condition in which the veins get twisted due to the weakening of the valves of the veins. This leads to poor circulation and also structural changes in the blood vessels. This is also a condition which can be correlated to sira shaitilya. The mechanism occurs similarly as in Arshas – haemorrhoids.
From Risk factors perspective
Medoroga – the biggest risk factor – ‘It is better to be thin than be obese’ is what Ayurveda tells. Ayurveda also says that when the increased fat blocks the channels of the body, no tissue will be nurtured and only fat will increase in the system. This is an alarming condition in the long run. Ayurveda further tells that when fat accumulates in excess, the person becomes incapable of doing any activity and would feel tired always. So, excessive fat is a burden and also a risk factor and it is a gateway for many diseases. Medoroga – fat related disorders including being overweight or obese is a risk factor for diseases like PVD.
High Cholesterol, which is also a risk factor too shall be considered under the spectrum of Medoroga.
Avyayama – Sedentary life – Not doing any exercise at all or leading sedentary life is a risk factor and etiological factor for medoroga and prameha according to Ayurveda, the same has been mentioned in modern medicine too. Medoroga and Prameha, when not addressed may lead to manifestation of symptoms similar to those of PVD and hence are the most important risk factors. Prameha is also a disease caused by contamination or vitiation of Medovaha srotas and both are Santarpanottha Rogas.
Hrdroga – Heart Diseases, especially coronary artery diseases are risk factors for PVDs. Here, Hridaya as a marma will be compromised.
Pakshaghata – One who has experienced stroke is also at risk of developing PVDs. Stroke can be correlated to Avarana janya Pakshaghata. ‘Sira Snayu Shosha’ i.e. the dryness of blood vessels and nerves is the main pathogenesis of Pakshaghata.
From the perspective of Symptoms of Peripheral Vascular Diseases
The symptoms of Peripheral Vascular Diseases are scattered amongst the symptoms of the above said conditions explained in Ayurveda but most of the symptoms of PVD appear to fit into the explanation of symptoms of ‘Vatarakta’ or ‘Vatashonita’. Many symptoms are common amongst these two conditions. Symptoms will be in accordance to the condition causing Peripheral Vascular Disease and treatment too shall be in accordance to the same.
Related Reading – ‘Peripheral Vascular Diseases vs Vatarakta’
Ayurveda Treatment Principles for Peripheral Vascular Disease
Peripheral Vascular Disease or Peripheral Artery Disease should be treated after understanding the pathogenesis involved doshas and dhatus from the Ayurveda viewpoint. In the entire length of this article we have discussed many terms and conditions / diseases which have been explained in Ayurveda treatises in a scattered way, which closely resemble PVDs. No single condition can be exactly correlated with PVDs. It is the situational understanding of the pathogenesis of PVDs from Ayurveda perspective and fractional analysis of every component of the disease that will help the physician to plan an Ayurveda protocol to treat these conditions by administering Ayurveda medicines, therapies, dietetic and lifestyle changes.
PVDs shall be treated on the lines of treatment of one or more of the below mentioned conditions as explained in Ayurveda. This shall be done after thorough understanding the disease and its pathogenesis. The conditions which need to be considered here are –
– Vatarakta Chikitsa
– Medoroga Chikitsa
– Shotha Chikitsa
– Rakta Pradoshaja Roga Chikitsa
– Raktapitta Chikitsa
– Prameha Chikitsa
– Santarpanottha Vyadhi Chikitsa (Apatarpana should be given)
– Krimi Chikitsa
– Rakta Kshaya Chikitsa
– Arsha Chikitsa
– Vata Prakopa Chikitsa
– Hridroga Chikitsa
– Pakshaghata Chikitsa
As per the presentation of the disease and as per the rational thinking of the physician in understanding the disease pathogenesis and the components involved therein, treatment principles of one or more of the above said conditions shall be considered in treating PVDs. This includes the implementation of medicines, therapies, dietetic changes and lifestyle changes mentioned in the related conditions considered for treatment.
In short, if PVDs are caused by one of the above said conditions, the treatment principles of the same shall be considered and implemented.
Beneficial Panchakarma Measures to treat PVDs
Since kapha and meda are chiefly involved in the causation of PVDs with atherosclerosis being the main pathogenesis pathway for the manifestation of these conditions, methods and measures to destroy morbid kapha and meda shall be considered mainly among the interventions.
Vamana followed by Virechana is ideal for these conditions. Udwarthana shall be considered in the treatment lineup and shall be plugged in during Abhyanga and Swedana days following Snehapana. Guggulutiktaka Ghrita and Varanadi Ghrita shall be used in combination for snehapana. I have seen very good results when these Ghritas are used for snehapana, followed by Abhyanga – Udwarthana – Swedana – Vamana, Virechana or both in that order.
If Vatarakta, Pakshaghat or Vata Prakopa / Vata Roga are causal of PVDs, along with disease specific treatments, Vasti – medicated enemas – decoction and oil enemas should be considered, followed by a course of Virechana or otherwise. Varanadi Ghrta, Guggulutiktaka Ghrta, Dashamula Kashaya or Ksheera Kashaya, Erandamuladi Kashaya or Ksheera Kashaya, Medohara Vasti and Mustadi Yapana Kashaya are used for Vasti.
Useful Ayurveda formulations in PVDs
– Varanadi Kashayam / Varanadi Ghrta
– Guggulutiktakam Kashayam / Guggulutiktakam Ghritam
– Guluchyadi Kashayam
– Dashamula Kashayam
– Mahamanjishtadi Kashayam
– Nishakatakadi Kashayam
– Nayopayam Kashayam
– Dushparshakadi Kashayam
– Varadi Kashayam
– Kaishora Guggulu
– Panchatikta Ghrta Guggulu
– Amritadi Guggulu
– Navaka Guggulu- Medohara Vidangadi Lauha
