Special Section : Cardiovascular diseases :
Surekha Pai
PERSPECTIVE
Cardiovascular disorders Ayurveda perspective
Surekha Pai
Department of Kaya Chikitsa, Ahalia Ayurveda Medical College, Palakkad, Kerala, India
Correspondence to: drsurpai@gmail.com
Rivers flow freely when uninterrupted so
does blood in the blood vessels of human
body. Just as any obstruction causes
impediment to the flow of water in the river
such as dams, blockade in its path, so does
blocks in the blood vessels of cardiovascular
system. The blood vessels carry blood to and
fro from the heart. It is the pump that
circulates the blood in the whole body.
Diseases of Cardiovascular system include
disease of heart.
Cardiovascular disorders (CVD) are the
number one cause of death globally: more
people die annually from CVDs than from
any other cause. An estimated 17.3 million
people died from CVDs in 2008,
representing 30% of all global deaths. Of
these deaths, an estimated 7.3 million were
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Ayurveda perspective
due to coronary heart disease and 6.2
million were due to stroke. Low- and
middle-income countries are
disproportionally affected: over 80% of
CVD deaths take place in low- and middle-
income countries and occur almost equally
in men and women. By 2030, almost 23.6
million people will die from CVDs, mainly
from heart disease and stroke. These are
projected to remain the single leading causes
of death. Tobacco consumption and
smoking remains the largest risk factor for
cardiovascular diseases worldwide. It raises
the risk of strokes as well.
Disorders of blood vessel and heart
constitute cardiovascular diseases (CVDs).
1. Diseases of blood vessels include:

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Coronary heart disease disease of
the blood vessels supplying the heart
muscle;
Cerebrovascular disease - disease of
the blood vessels supplying the
brain;
Peripheral arterial disease disease
of blood vessels supplying the arms
and legs;
Deep vein thrombosis and
pulmonary embolism blood clots
in the leg veins, which can dislodge
and move to the heart and lungs.
Heart attacks and strokes are usually acute
events and are mainly caused by a blockage
that prevents blood from flowing to the
heart or brain. The most common reason
for this is a build-up of fatty deposits,
calcium and macrophages on the inner walls
of the blood vessels that supply the heart or
brain. Strokes can also be caused by bleeding
from a blood vessel in the brain or from
blood clots. Survivors of a heart attack or
stroke are at high risk of recurrences and at
high risk of dying from them. Peripheral
vascular disease refers to any disease or
disorder of the circulatory system outside of
the brain and heart.
2. Diseases of heart include:
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Congestive heart failure - This is
caused when the heart muscles
become progressively unable to
pump blood into the blood vessels.
Rheumatic heart disease damage to
the heart muscle and heart valves
from rheumatic fever, caused by
streptococcal bacteria;
Congenital heart disease -
malformations of heart structure
existing at birth
Diseases of heart are the result of disease of
structures of the heart such as muscle, valves
etc.
Often, there are no symptoms of the
underlying disease of the blood vessels. A
heart attack or stroke may be the first
warning of underlying disease.
Coronary heart disease is due to disease or
narrowing of the coronary blood vessels
supplying the heart muscle.
Atherosclerosis is the most common cause
and is caused due to hardening and
narrowing of coronary arteries of heart by
formation of plaques and plugs. Coronary
heart disease can be caused due to risk
factors like high blood pressure, high blood
cholesterol, tobacco use, obesity, unhealthy
diet, physical inactivity, diabetes, advancing
age, and inherited disposition.

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Symptoms of a heart attack include pain or
discomfort in the centre of the chest; pain or
discomfort in the arms, the left shoulder,
elbows, jaw, or back. In addition the person
may experience difficulty in breathing or
shortness of breath; feeling sick or vomiting;
feeling light-headed or faint; breaking into a
cold sweat; and becoming pale. Women are
more likely to have shortness of breath,
nausea, vomiting, and back or jaw pain.
Stroke or Cerebrovascular accident is caused
when the blood supply to part of the brain is
hampered. This may result from either
blockage or rupture of a blood vessel in the
brain. Those at risk include those with high
blood pressure, heart rhythm disorders, high
blood cholesterol, tobacco use, diabetes and
advancing age.
The most common symptom of a stroke is
sudden weakness of the face, arm, or leg,
most often on one side of the body. Other
symptoms include sudden onset of:
numbness of the face, arm, or leg, especially
on one side of the body; confusion,
difficulty speaking or understanding speech;
difficulty seeing with one or both eyes;
difficulty walking, dizziness, loss of balance
or coordination; severe headache with no
known cause; and fainting or
unconsciousness.
Peripheral arterial disease or peripheral
vascular disease or peripheral artery occlusive
disease (PAOD) refers to any disease or
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disorder of the circulatory system outside of
the brain and heart. It is caused by build-up
of fatty material, calcium and macrophages
within the vessels, called atherosclerosis.
Another name for this condition is
arteriosclerosis, or hardening of the arteries.
PVD can result
from atherosclerosis, inflammatory processes
leading to stenosis, an embolism,
or thrombus formation. It causes
either acute or chronic ischemia (lack of
blood supply). Often PVD is a term used to
refer to atherosclerotic blockages found in
the extremity.
This can cause various symptoms depending
on, which organ or system is affected. These
symptoms usually appear during walking or
exercise and go away after several minutes of
rest. The symptoms range from pain, cold
feet, and bluish discoloration to stroke or
gangrene; if it is not reversed, the body part
affected is injured and eventually starts to
die. It is important to detect the narrowed
artery before irreversible damage occurs. The
pulses in the arm or leg are decreased or
absent, indicating a lack or decreased arterial
blood flow.
Deep venous thrombosis (DVT) and
pulmonary embolism: In DVT, blood
clots form in the leg veins giving rise to
severe pain and disability. These clots can
dislodge and move to the heart and lungs
leading to life threatening complications.
Risk factors include long surgery, trauma,

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obesity, cancers, recent childbirth, use of
oral contraceptive and hormone replacement
therapy etc.
Congestive heart failure is caused when the
heart muscles become progressively unable
to pump blood into the blood vessels. Those
at risk include persons with high blood
pressure, heart rhythm disorders, heart
attacks, obesity etc. The appearance of
symptoms of CHF can be delayed for
years. This is because the heart tries to
compensate when it is not pumping
efficiently. It includes breathing difficulties
during the night or when lying down,
coughing and wheezing, fatigue and
weakness, shortness of breath, swollen ankles
Rheumatic heart disease is caused by damage
to the heart valves and heart muscle from
the inflammation and scarring caused by
rheumatic fever. Rheumatic fever is caused
by streptococcal bacteria, which usually
begins as a sore throat or tonsillitis in
children.
Symptoms of rheumatic fever include: fever,
pain and swelling of the joints, nausea,
stomach cramps and vomiting.
Congenital heart disease is a category of heart
disease that includes abnormalities in
cardiovascular structures that occur before
birth. Congenital heart defects may produce
symptoms at birth, during childhood, or not
until adulthood. Other congenital defects
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may cause no symptoms. Defects such as
coarctation of the aorta may not cause
problems for many years. Other problems,
such as a small ventricular septal defect
(VSD), may never cause any problems.
Some people with a VSD have a normal
activity level and lifespan. In adults, if
symptoms are present, they may include:
Shortness of breath, Limited ability to
exercise.
Ayurvedic perspective
Rasavaha srotas is constituted by srotas
(Dasha Dhamani), Mula- Hrudaya(heart)
and the dhatu within i.e. Rasa(fluid
component of blood). The srotases, many in
number, spread all over the body from its
mula- Hrudaya. They are of various sizes big
and small including microscopic. Hrudaya is
one of the trimarma, where in prana is
located. It is the mulasthana of Pranavaha
srotas as well. As the central girder supports
wood frame of thatch so the heart represents
the substratum of shadanga, pancha
indriyartha, aatma and its gunas and manas
its gunas. The dhamanis carry rasa and ojas.
The hrudaya upaghata leads to
murcha(alteration in the consciousness) and
bheda leads to marana (death). According to
susrutacharya, the rasa sthana is also
Hrudaya and the Rasa gets circulated
throughout the body through the dhamanis
(form of srotas). Rasa is constantly moving
throughout the body hence the name Rasa
(aharahar gachati ityato rasaha |su su 14/14).

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Acharya bhela explains that from hrudaya,
Rasa spreads all over body and reaches back
hrudaya through the siras. Acharya charaka
explains the rasa dhatu reaches all over by
the action of vyana vayu.
Diseases of the Rasavahasrotas can manifest
as Rasavaha srotodusti, Rasa dhatu
pradoshaja vikara (vititation) and/or vyadhi
of hrudaya (srotomula vyadhi). The sroto
dusti occur basically due to the etiological
factors; aharaja (food) and viharaja
(lifestyle). Rasavahasrotas is vitiated by guru,
sheeta, atisnigdha, atimatra and atichintana.
This leads to Dosha vriddhi and Dhatu
vigunata (that which causes dhatu vitiation).
The dosha vriddhi leads to vitiation of the
srotases. Whenever the sroto dushti takes
place the dhatu it carries also get dushta
(vitiated), hence the laxanas of dhatu dushti
and respective dhamani/sroto dushti are
same. For ex Srotorodha, one of the
Rasapradosha vyadhi is also the laxana of
Rasavaha sroto dushti. In addition to the
above, the srotas themselves have exclusive
laxanas that are common to all srotases viz
atipravritti (increase in the mobility of rasa
etc.), sanga (decrease in the mobility/
formation of the rasaadi dhatus),
Vimargagamana (deviation from its original
path ex appearance of mala from the mutra
marga) and siragranthi (alteration in the
structure of sira such as granthi).
In cerebrovascular accident, alteration in the
sensorium and weakness is the main
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presentation, If the rasa, rakta and
samjnavaha srotas are obstructed by kupita
mala along with raja and tamas it leads to
murcha. Now, how can we relate to the
rasavahasroto dusti and Pakshaghat, a
Vatavyadhi. The samprapti of vatavyadhi is
occupation of kupita vata in the rikta srotas
of body. Acharya Chakrapani comments
that rikta means that which has lost its
snehadiguna which we can understand
hardened or loss of function of the srotas
(blood vessel).One of the hetus explained in
vatavyadhi that is relevant in the present
context is Ama. Ama is the product of
improper pachana of ahara rasa due to
agnimandya. The atherosclerotic plaque can
be understood as one of the forms of ama.
Vata gets vitiated either due to Margavarana
or dhatu ksaya. This leads to either sarvanga
(affecting whole body) or ekanga Roga
(affecting one or more parts of the body).
Various Vatavyadhi manifests based on the
sthana( part afflicted) and the hetu (like
avarana or kevala vata). (Hetu sthana
visheshaat cha bhavet roga visheshakrut). If
the sthana is sira and snayu, then
Pakshaghata (loss of function in one half of
the body), Ekanga roga (any one part of the
body such as upper limb) and sarvanga roga
(all the angas such as loss of function in all
four limbs) are some of the manifestations.
Vatavyadhis are one of the mahagadas which
are difficult to cure.
In peripheral vascular disease and deep
venous thrombosis, the pathology remains

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the same however the place is in other than
heart and brain, hence the manifestations
are also different. The part distal to the
obstruction is injured that causes pain and
may result in tissue death. If the hetu and
srotas remain the same as above but sthana
is different, such as shakha, the margavarana
and the resultant vata prakopa causes shula
and other symptoms in the shakha and will
eventually result in dhatu kshaya of the part
distal to obstruction
In coronary artery disease, partial or
complete obstruction in the coronary
arteries is the pathology. The manifestations
are pain in different areas in and around
chest and general symptoms of altered
sensorium which may become fatal. The
hrudaya is the mula of Pranavaha and of
rasavaha srotas; sthana of rasa and astabindu
ojas. Murcha and marana are the
manifestation of hrudaya Upaghata and
marana respectively. In hrudroga, different
types of shula are mentioned depending on
the dosha vitiated. Avarana of raktamarga
due to kapha and medas is mentioned in
vatarakta samprapti and murcha may be
resulted when the obstruction includes rasa
and samjnavaha srotas. The dhatu distal to
the obstruction gets affected and results in
dhatu kshaya.
Diseases of heart are the result of disease of
structures of the heart such as muscle, valves
etc. Vyadhi of Hrudaya may be produced
one or more reasons such as rasavaha sroto
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dusti or pranavaha sroto dusti or oja ksaya,
sahaja or jataja hetu etc. leading to
abnormalities in structure and function of
hrudaya. Eventually that may lead to either
murcha or marana.
Chikitsa
Samprapti vighatana is the chikitsa.
However restoration of consciousness is
essential and should be first line of
treatment. Vyadhi vikalpa is asadhya if the
samjna is not restored and the patient goes
into sanyasa. Once the samjna is restored,
next vyadhi chikitsa should be initiated.
Rasapradoshaja vikara and rasavaha srotas
dusti should be treated initially by
Langhana. Of the ten options, best suitable
langhana chikitsa can be selected as per the
roga, its avastha and rogi bala.The samanya
chikitsa of vata is based on whether the
avastha is sopasthambha means vata is
associated with other doshas i.e kapha and
pitta or the opposite - nirupastambha vata.
If there is sopasthambha then shodhana (one
of the langhana) is the chikitsa. In case of
pakshaghata virechana is the line of
treatment. However, shodhana should be
mrudu and snehayukta in a vatavyadhi.
Taila is best sneha for vata dosha.
Erandataila is the best oushadha. If the Vata
dosha is kupita (aggravated) due the marga
samrodha (sirayana and raktamarga) be it in
hrudaya or shaka by kapha and medo then
snehana should not be the first line of
treatment instead clearance of

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margasamrodha i.e. kaphamedohara
chikitsa.(Kupite maargasamrodhat medaso
va kaphasya va ativruddhe anile naadou
shastam snehana bruhmanam). If the
rasavaha srotas is obstructed in hrudaya or in
shaka, then even if vatakupita lakshanas are
present, vatadosha chikitsa is done only after
marga shodhana chikitsa that clears the
kapha and medas. Shodhana such as
virechana and niruha basti, oushadha such
as guggulu, shilajitu, abhaya, makshika,
mutra, seedhu, arishta, sura and asava, ahara
like takra, purana yava and godhuma have
all been explained in Charaka Samhita vata
rakta prakaran. After shodhana, chikitsa of
vata dosha should be initiated.
In case of vyadhi of hrudaya, the vyadhi
vikalpa is mostly asadhya as it is a marma. If
pranavaha srotas is affected then shwasa
chikitsa should be done, depending upon
type of shwasa. If rasavaha srotomula is
affected then langhana is the line of
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treatment. If oja kshaya is present then
ojovriddhi is the chikitsa. If sahaja and jataja
is the hetu then again it is mostly asadhya.
Nidana parivarjan
Nidana parivarjana is the best treatment.
Rasa is responsible for sthoulya and karshya.
Rasa pradosha is basically produced because
of aharaja hetu. Hence Hita ahara is the best
pathya. Hrudaya being the mula of rasavaha
srotas, pranavaha srotas, ojo sthana and rasa
sthana, it requires special care. To preserve
ojas, maintain hrudaya and the dhamanis
attached to it one should avoid manaso
dukha hetu (mental worries), and indulge in
aahara and vihara conducive to all the three.
For the margarodha, vyayama and ruksha
ahara is best; however vata dosha should be
pacified by snigdha, ushna ahara and vihara,
once margashuddhi is done.