AIAPGET Points
– Ajirna Ahara-Adhyashana, Asatmya Bhojana, Viruddha Ashana and Ushna Ruksha Anna – are the important Nidanas of Hrdroga according to Acharya Sushruta. (Su.Ut.43/3-4)
– Nirmathyate, Diryate, Sphotyate, Patyate – are the types of pains in VATAJA HRDROGA (Su.Ut.43/6)
– Hridaya Klama is a symptom of Pittaja Hrdroga (Su.Ut.43/7)
– Tamaha and Shyava Netrata are symptoms of Krimija Hrdroga (Su.Ut.43/9)
– Snehana and Vamana are indicated by Sushruta in Vataja Hrdroga (Su.Ut.43/11)
– Decoctions which are beneficial for and mentioned in the context of Pittaja Jwara (fevers caused due to predominant aggravation of pitta) should be administered in Pittaja Hrdroga also. (Su.Ut.43/15)
– Sneha Vasti using Madhuka Taila mixed with honey is administered in Pittaja Hrdroga (Su.Ut.43/16)
– Bala Taila Basti is indicated in Kaphaja Hrdroga (Su.Ut.43/19)
– Pippalyadi Churna is administered following Vamana in both Vataja and Kaphaja Hrdroga (Su.Ut.43)
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The 43rd chapter of Uttaratantra of Sushruta Samhita is named as Hrdroga Pratiṣedha Adhyaya. This chapter deals with the Treatment of Heart Diseases.
अथातो हृद्रोगप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Hrdroga pratiședha – treatment of diseases of the
heart; as revealed by the venerable Dhañvañtari.
Nidāna-samprāpti – causes and pathogenesis
वेगाघातोष्णरूक्षान्नैरतिमात्रोपसेवितैः |
विरुद्धाध्यशनाजीर्णैरसात्म्यैश्चापि(ति) भोजनैः ||३||
दूषयित्वा रसं दोषा विगुणा हृदयं गताः |
कुर्वन्ति हृदये बाधां हृद्रोगं तं प्रचक्षते ||४||
Causes –
– Vegaghata – Suppression of the urges,
– Ushna ruksha anna – excessive consumption of food which is hot in potency and dry in quality
– Viruddha ashana – excessive use of mutually opposite and incompatible foods,
– Adhyashana – consumption of food in more quantity than what is needed,
– Ajirna ahara – excessive consumption of uncooked or unprocessed foods or taking foods when one has indigestion,
– Asatmya bhojana – excessive consumption of foods which are unaccustomed,
Pathogenesis –
Due to the above said etiological causes, the doshas get aggravated. These aggravated doshas vitiate the rasa present in the heart. Due to this, the person experiences pain in the heart. This condition is known as Hrdroga.
Symptoms –
Due to the vitiation of rasa present in the heart, the person experiences pain in the heart.
Types of Hrdroga
चतुर्विधः स दोषैः स्यात् कृमिभिश्च पृथक् पृथक् |
लक्षणं तस्य वक्ष्यामि चिकित्सितमनन्तरम् ||५||
There are four types of Hrdroga.
Among them, three types of Hrdroga are caused by the vitiated doshas, one from each dosha separately. They are also named after these doshas i.e. Vataja Hrdroga, Pittaja Hrdroga and Kaphaja Hrdroga.
The fourth type is caused by krimi – worms.
Now, the features and treatment of these Hrdrogas will be described.
Vātaja Hrdroga
आयम्यते मारुतजे हृदयं तुद्यते [१] तथा |
निर्मथ्यते दीर्यते च स्फोट्यते पाट्यतेऽपि च ||६||
In the Hrdroga caused by aggravated vata, the person feels the below mentioned kinds of pain in the heart / cardiac region –
– Ayama – expanding / stretching type of pain
– Toda – pricking pain
– Mathanavat – twisting / churning type of pain
– Deerana – tearing type of pain
– Sphotana – blasting or exploding type of pain
– Patyate – splitting type of pain
Pittaja Hrdroga
तृष्णोषादाहचोषाः स्युः पैत्तिके हृदयक्लमः |
धूमायनं मूर्च्छा च स्वेदः शोषो मुखस्य च ||७||
In the Hrdroga caused by aggravated pitta, the person experiences the below mentioned symptoms –
– Trshna – thirst
– Daha – burning sensation
– Chosha – sucking pain
– Hrdaya klama – exhaustion or debility of the heart,
– Dhumayana – feeling as if hot fumes are coming out of the region of the heart / chest
– Murcha – fainting
– Sweda – excessive sweating
– Mukha Sosha – dryness of the mouth
Kaphaja Hrdroga
गौरवं कफसंस्रावोऽरुचिः स्तम्भोऽग्निमार्दवम् |
माधुर्यमपि चाऽऽस्यस्य बलासावतते हृदि ||८||
In the Hrdroga caused by aggravated Kapha, the below mentioned symptoms are found –
– Gaurava – heaviness of the body or heaviness in the chest / region of the heart,
– Kapha samsrava – excessive flow of kapha from the mouth and nose
– Aruchi – tastelessness, anorexia,
– Stambha – stiffness of the body parts,
– Agni mardavam – sluggish digestive fire / weak digestion capacity,
– Madhurya – manifestation of sweet taste in the mouth
Krimija Hrdroga
उत्क्लेशः ष्ठीवनं तोदः शूलो हृल्लासकस्तमः |
अरुचिः श्यावनेत्रत्वं शोषश्च कृमिजे भवेत् ||९||
In the Hrdroga caused by Krimi, the below mentioned symptoms can be seen –
– Utklesha – excessive watering in the mouth,
– Shteevana – excessive spitting
– Toda – picking pain
– Shula – pain or oppression in the region of heart / chest
– Hrllasa – nausea, vomiting sensation
– Tama – appearance of darkness in front of eyes / excessive drowsiness or tendency to sleep
– Aruchi – tastelessness, anorexia
– Shyava netrata – bluish black colouration in the eyes
– Shosha – emaciation
Upadrava – complications
भ्रमक्लमौ सादशोषौ ज्ञेयास्तेषामुपद्रवाः |
कृमिजे कृमिजातीनां श्लैष्मिकाणां च ये मताः ||१०||
Below mentioned are the complications of Hrdroga –
– Bhrama – giddiness
– Klama – exhaustion
– Sada – debility
– Shosha – emaciation
The complications mentioned under Shlesmika Krimi – worms produced due to kapha will also be present in Krimija Hrdroga.
Cikitsā – treatment
Treatment principles of Vataja Hrdroga –
वातोपसृष्टे हृदये वामयेत् स्निग्धमातुरम् |
द्विपञ्चमूलक्वाथेन सस्नेहलवणेन तु ||११||
पिप्पल्येलावचाहिङ्गुयवभस्मानि सैन्धवम् |
सौवर्चलमथो शुण्ठीमजमोदां च चूर्णितम् ||१२||
फलधान्याम्लकौलत्थदधिमद्यासवादिभिः |
पाययेत विशुद्धं च स्नेहेनान्यतमेन वा ||१३||
Snehana – Firstly, snehana – oleation therapy should be administered.
Vamana – Next, the patient should be administered Vamana – vomiting. For inducing vamana, decoction prepared with both Mahat Pancamula and Laghu Pancamula (i.e. Dasamula) should be given after adding fats and salts, for drinking.
Pippalyadi Churna – After proper cleansing i.e. after confirming that the emesis has taken place properly, the powder of the below mentioned herbs should be given –
– Pippali
– Ela
– Vacha
– Hingu
– Yava Bhasma / yava kshara
– Saindhava
– Sauvarchala
– Sunthi and
– Ajamoda
The above-mentioned powder should be consumed with one among the juice of sour fruits, dhanyamla – fermented liquid, horse-gram soup, curds, Madhvasava etc. It can also be given mixed with any one of the fats i.e. oil, ghee, fat or bone-marrow.
भोजयेज्जीर्णशाल्यन्नं जाङ्गलैः सघृतै रसैः |
वातघ्नसिद्धं तैलं च दद्याद्बस्तिं प्रमाणतः ||१४||
Bhojana – food prepared from old rice is ideal for these patients. It should be served along with soup of meat of animals and birds living in desert-like / arid regions after adding ghee to it.
Vasti – Enema shall be administered with oil prepared from Vataghna dravyas – vata mitigating drugs.
Treatment Principles for Pittaja Hrdroga
श्रीपर्णीमधुकक्षौद्रसितोत्पलजलैर्वमेत् |
पित्तोपसृष्टे हृदये सेवेत मधुरैः शृतम् ||१५||
घृतं कषायांश्चोद्दिष्टान् पित्तज्वरविनाशनान् |१६|
Vamana – Firstly, vamana – emesis should be given to the patient suffering from Pittaja Hrdroga. Emesis should be given by administering water boiled with the below mentioned herbs –
– Sriparni
– Madhuka
– Kshaudra – honey
– Sita – sugar and
– Utpala
Ghrta / Kashaya – After Vamana, the patient should be given ghee or decoction prepared with herbs belonging to Madhura gana – herbs having sweet taste. Decoctions which are beneficial for and mentioned in the context of Pittaja Jwara (fevers caused due to predominant aggravation of pitta) should be administered in Pittaja Hrdroga also.
तृप्तस्य च रसैर्मुख्यैर्मधुरैः सघृतैर्भिषक् ||१६||
सक्षौद्रं वितरेद्बस्तौ तैलं मधुकसाधितम् |१७|
Bhojana – The physician should give meat soup for drinking and ask the patient to drink it to the level of contention. The meat soup should be added with sweet substances like sugar, honey etc and also ghee.
Vasti – Then, the patient is administered an unctuous enema using Madhuka Taila mixed with honey.
Treatment Principles for Kaphaja Hrdroga
वचानिम्बकषायाभ्यां वान्तं हृदि कफात्मके ||१७||
चूर्णं तु पाययेतोक्तं वातजे भोजयेच्च तम् |
फलादिमथ मुस्तादिं त्रिफलां वा पिबेन्नरः ||१८||
श्यामात्रिवृत्कल्कयुतं घृतं वाऽपि विरेचनम् |
बलातैलैर्विदध्याच्च बस्तिं बस्तिविशारदः ||१९||
Vamana – Vamana should be administered to the patient suffering from Kaphaja Hrdroga. For this, the decoction of Nimba and Vaca should be used.
Pippalyadi Churna – After vamana has been conducted properly, the patient should be given with Pippalyadi Churna which has been explained in the context of treatment of Vataja Hrdroga.
Virechana – Next, the patient should be given purgation therapy. Below mentioned recipes shall be used for conducting Virecana –
– Decoction of herbs of Madanaphaladi Gana
– Decoction of herbs of Mustadi Gana
– Decoction of Triphala or
– Ghee boiled with Shyama and Trivrit
Vasti – The physician who is specialized in administering enema therapy should give enema with Bala Taila.
For krimija hrdroga
कृमिहृद्रोगिणं स्निग्धं भोजयेत् पिशितौदनम् |
दध्ना च पललोपेतं त्र्यहं, पश्चाद्विरेचयेत् ||२०||
सुगन्धिभिः सलवणैर्योगैः साजाजिशर्करैः |
विडङ्गगाढं धान्याम्लं पाययेताप्यनन्तरम् ||२१||
हृदयस्थाः पतन्त्येवमधस्तात् क्रिमयो नृणाम् |
यवान्नं वितरेच्चास्य सविडङ्गमतः परम् ||२२||
Snehana – Oleation should be first administered to the patient suffering from Krimija Hrdroga.
Bhojana – After snehana, the patient should be given food with meat along with curds and fried sesame seeds for three days.
Virecana – Next, the patient should be administered purgatives added with sugandhi dravyas i.e. sweet-smelling drugs, salt, ajaji and sugar.
Dhanyamla – Once the virechana has been conducted in a proper way, the patient should be given dhanyamla – fermented liquid / gruel added with a good quantity of Vidanga.
With these therapies and medicines, the krimis present in the heart (region of the heart) are eliminated through a downward route (anus). After this, the patient should be given food prepared with Yava, mixed with Vidanga.
इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे हृद्रोग प्रतिषेधो नाम (पञ्चमोऽध्यायः, आदितः) त्रिचत्वारिंशोऽध्यायः।।४३।।
Thus ends the forty third chapter by name Hydroga pratiṣedha in Uttara Sthana of Suśrutasamhita.
