Prof. Dr. S. N. Ojha M.D Ph.D
Padmashree Dr. D.Y. Patil College of Ayurved and Research Centre Pune
Understanding Of Charakokta Gramyadosh And Related Diseases With Special Reference To Hridrog (CVD) And Hypertension
It is composed of cultural and behavioural patterns and lifelong personal habits that have developed through process of socialization. Health requires the promotion of healthy lifestyle.
Our acharyas had accumulated a considerable body of evidence which indicate association between health and lifestyle of individuals.
Charak in Rasayan Adhyaya Ayurved-samuthaniya pada has elaborated that gramya aahar chosen by the society was not successful in making inroads in community health.
Sedentary lifestyle was responsible for less physical activity which became the cause of preventable diseases.
A sedentary lifestyle and lack of physical activity can contribute to or be a risk factor for
2) Cardiovascular disease
3) Deep Vein thrombosis
8 ) Osteoporosis
9) Lipid disorders
10) Kidney stone
11) Mortality in elderly men by 30% and double risk in elderly woman.
What does gramya aahar include?
Charak in Rasayan adhyaya has describe gramya aahar to be consist of –
– Amla, lavana, katu, kshar pradhan aahar
– Shuska shaka, shuska mansa, teel-tail & kalka and ruksha content which have a very low nutritional value
– Klinna, guru, pishtanna, adhyasana, avyayam and abhisyandi aahar which are source of extra calories.
– Virudha, asatmya, visham aahar, and paryushit anna which have an impact on our immune system.
– Day sleeping, Indulging in excessive exercise and sex, Alcohol intake, which increases oxidation process and release oxidants and free radicals.
– Pshycological factors such as bhaya, krodha, lobha, shoka, moha which are cause for the neuro-hormonal imbalance, for example excess adrenaline secretion and inturn over sympathetic activity.
Pathophysiology due to gramya aahar
Due to intake of gramya aahar following changes occur in the sharir.
A) Mansani shithilibhavanti – Lack of exercise causes muscle atrophy ( abhadha, anibhida mansa)
Shrinking and weakening of the muscles causes increasing susceptibility to physical injury.
B) Vimuchyante sandhaya – Joints are vitiated so does the physic reducing the body activity.
C) Vidahyate raktam – Due to nutritional deficiency shudha rakta utpatti does not takes place. One can easily compare the hetus explain in vidhishonitiya adhyaya, pandu roga and gramya aahar.
Formed rakta dhatu is unable to carryout proper jeevan karma, poshan karma and unable to increase bala.
D) Vishyandate cha-analpam meda – Due to samanya between klinna, guru, pishtamay aahar with meda dhatu, drava guna vridhi takes place and that is the reason why syandan word has been used to explain vridha medha dhatu.
The hetus are similar to sthaulya and prameha hetu as explained in sutrasthan 17th chapter.
E) Na – Sandhiyate ashtishu – Majja – Majja dhatu is unable to reside in ashtidhatu. Due to nutritional deficiency bone marrow does not get properly stimulated and is unable to form normal erythrocytes, leucocytes and platelets leading to pancytopenia.
F) Shukram na pravartate – Due to nutritional deficiency sarvottam dhatu is unable to be formed completely does leading to shukra apravartan.
In context of sthaulya too Charak has explained shukra bahutwat and due to aavaran by meda dhatu person feels impairment in ejaculation of semen.
G) Oja kshaya – Essential nutrients are not made available in required quantity does leading to symptoms of oja kshaya or depressed immune system.
Physical fitness is correlated with immune system function, a reduction in physical fitness is generally accompanied by a weakening of the immune system.
Lakshana produced by gramya dosha:
– Sidati (depression)
– Tandra (Drowsiness)
– Aalasya (Lassitude)
– Nirutsaha (Loss of interest)
– Swashiti (Dyspnoea on simple exertion)
– Asamartha chesta sharir manasinam – Reduced physical & mental activity.
– Nasta smriti, budhi – loss of memory & reduced intellect
– Nasta chaya – Loss of lusture
– Roganam adhistanabhutam – Cause for various preventable diseases.
Contribution in pathogenesis of Heart diseases
– 1.5 million people die of CVD every year.
– 2.4 million people suffer from IHD
– Indiasuffers the highest loss in potentially productive years of life [ 35-64 years ]
– By 2030, the loss is expected to rise to 17.9 million / year.
– Prevalence of CVD is reported 2-3 times higher in urban area than rural population.
A] Beej swabhavat – ‘sthula matapitrujanya bhavat’. Atherosclerotic vascular disease often runs in families. This may be due to a combination of shared genetic, environmental and lifestyle factors. This has been explained by Charak in astoninditiya adhyaya by using the words ‘tasya hi ittyadi’
Chakrapani coments as ‘Samprati sthulasya sadarana api aaharat medojan aaha’ ie in a person with family history a normal diet also has a tendency for increasing meda dhatu.
The most common inherited risk chracteristics (hypertension, hyperlipidaemia, diabetes) are polygenic.
B] Previous exposure to behavioural risk factors such as
i) Avyayam (Insufficient physical activity)
Physical inactivity roughly doubles the risk of coronary heart disease. Regular exercise (brisk walking, cycling, swimming for 20 minutes) appears to have a protective effect which may be related to increase HDL cholesterol, lower blood pressure, reduced blood clotting and collateral vessel development.
Sedentary activities include sitting, reading watching television and computer use for much of the day with little or no vigorous exercise.
Nature reviews Cardiology suggest that enforced rest during illness or injury has physiologically become linked to life preserving metabolic and stress related responses such as inflammation that aid recovery during illness and injury but which due to being NON-ADAPTIVE during health now lead to chronic disease.
ii) Inappropriate nutrition
Diet deficient in fresh fruit, vegetables and polyunsaturated fatty acids are associated with an increased risk of vascular disease.
Charak has explained the role of shuska shaka, shuska phala, teel, teelpalala, kshar katu anna to be cause of gramya dosha and so hridroga.
Low levels of vitamin C, vitamin E and other antioxidants may enhance the production of oxidized LDL.
Charak explains intake of nitya pathya in which he includes aamalaki, rich source of vitamin C and wheat a good source of vitamin E.
Vrukshamla, dadima, matulunga are good source of vitamin C and are so classified under Hrudya gana.
Homocysteine is derived from methionine and is metabolized through pathways associated with folic acid, with vitamin B and vitamin B12 as cofactors.
Elevated Homocysteine level confers an independent and incremented risk for vascular disease.
Direct endothelial toxicity, failure of nitric oxide release, smooth muscle cell proliferation, LDL proliferation, platelet abnormalities, abnormal factor V, VII, vWF have been implicated.
Folate supplementation helps to reduce homocysteine levels. Over cooking [vidagda aahar] destroys folic acid from leafy vegetables a good source of folic acid.
Leafy vegetables, liver, meat, milk fruit cereals are good source of folic acid but overcooking destroys it. Vidagda aahar causes rakta dusti has been referred by our acharyas.
Alcohol (Madhya sevan) is antagonist to folic acid. It is the cause explained in Raktapitta, Pandu, Medodustikarak and a gramyadoshkar bhava.
Heavy drinking is associated with hypertension and excess cardiac events. Alcohol beverages are rich in calories and so included under santarpanottha aahar by Charak (C.Su. 23/3)
Essential fatty acids are those that cannot be synthesized by humans they can be derived by food only. Research has shown that diet rich in EFA reduces serum cholesterol and LDL. Coconut oil, Palm oil are low source of EFA while Safflower oil, Sunflower Oil, Soyabean Oil, Sesame Oil are relatively very good source of linoleic acid, a important EFA.
Atisampurna aahar, guru, madhur snighda, pichchhil, paistik, anup mansa, varija mansa are all high calori diet. They are the rich source of fats. Fat consumption induces very little energy expenditure as most is stored. ‘Meda eva upacheyate na tathe tare dhatawa.’
The above hetu are responsible for dyslipidaemia.
Cholesterol is found in all foods of animal origin.
LDL has been shown to function in delivery of cholesterol to body cells. Excessive level of LDL thus leads to the accumulation of cholesterol particularly smooth muscles cell of the vascular system (Vishyandate cha analpam meda)
Butter, Coconut oil, Palm oil are rich source of saturated fatty acids which increase plasma cholesterol.
Trans fatty acids render the plasma lipid profile even more atherogenic than saturated fatty acids, by not only elevating LDL cholesterol but also by decreasing HDL cholesterol.
Secondly it takes years for trans fatty acids to be flushed oil from the body-
Trans fatty acids are high is concentration in
– Deep fried fast food
– Cake mixes
– Cereal and Energy bars
– Chips, Crackers and Whipped toppings
– Packed Cookies and Candy
– Packed doughnuts
– Pies and Cakes.
Excessive Salt intake increase the incidence of hypertension.
Upakledan, dosha sanchyanubanda, and its action to bring shaithilyata to mansa and shonita forms an important cause for Hridroga.
Diabetes Mellitus is an important cause for atherosclerosis and hence cardiovascular disease. Angiopathy is a common complication of diabetes mellitus. Insulin resistance is associated with obesity and physical inactivity as potent risk factor for CAD.
Hetus explained in concept of prameha in sutrasthan 17th chapter hold the concept of meda vridhi in madhumeha leading to hridroga.
Haemostatic factors :– Platelet activation and high levels of fibrinogen and factor VII are associated with an increased risk of myocardial infarction (coronary thrombosis)
Animal fat (anup varija mansa) are low source of Essential fatty acids. EFA decreases platelet adhesiveness thus due to low source of EFA platelet aggregation helps in coronary thrombosis.
Faulty dietary habits, exposure to carcinogen, sunlight, certain toxic drugs, cigarette smoking over exercise all increase free radicals. These free radicals are short of electron while in circulation through blood. These free radicals snatch electron from other tissue molecules and cause damage. This is one of the cause of I.H.D.
Antioxidant like vitamin A,C,E, neutralize free radicals by donating their electron. Hence diet low in vit. A,C,E and other antioxidant are the cause of CVD.