WDS 96: General consideration of heart diseases in Ayurveda by Prof. Satyendra Narayan Ojha Sir & Others

A HEARTFELT TRIBUTE TO PROF. SATYENDRA NARAYAN OJHA SIR WHO WAS A GREAT SCHOLAR OF KAYACHIKITSA.

Prof. Surendra A. Soni

[9/29, 9:21 AM] Vaidyaraj Subhash Sharma Sir Delhi: 

एक बहुत अच्छा सूत्र 'दश मूलसिरा ह्रतस्थास्ता: सर्वं सर्वतो वपु:, 

रसात्मकं वहन्त्योजस्तन्निबद्धं हि चेष्टितम्।' 

अ ह शा 3/18

 शरीर में प्रमुख दश शिरायें हैं ये ह्रदय प्रदेश में स्थित रहती हैं तथा शरीर में सभी और रस रूप ओजो धातु का वहन करती हैं और और इन्ही पर वाणी, शरीर तथा मन का नियन्त्रण है।

*clinic पर जब रोगियों को देखते है तो इस सूत्र में ही अधिकतर रोगियों का हेतु मिल जाता है, आवेश में आ कर किसी को कुछ कह दिया फिर भीतर चिन्तन कर कर के लोग रोगी बन रहे है, बाद में पश्चाताप या बदले की भावना पाल कर रोगी बन रहे हैं ये 'वाणी' है।*

*आयुर्वेद के ज्ञान को सभी काल में सभी स्थलों पर apply करिये , सत्य पायेंगे। ऐसा आप्त ज्ञान हमें मिला है जो दुर्लभ है।*

[9/29, 9:33 AM] Dr. Pavan mali sir, Delhi: 

Important hetu of hridrog sirji👌🏻🙏🏻 charak has also opined same....

👇🏻

तेन मूलेन महता महामूला मता दश| 

ओजोवहाः शरीरेऽस्मिन् विधम्यन्ते समन्ततः||८|

येनौजसा वर्तयन्ति प्रीणिताः सर्वदेहिनः |

 यदृते सर्वभूतानां जीवितं नावतिष्ठते||९||

यत् सारमादौ गर्भस्य यत्तद्गर्भरसाद्रसः |

 संवर्तमानं हृदयं समाविशति यत् पुरा ||१०||

यस्य नाशात्तु नाशोऽस्ति धारि यद्धृदयाश्रितम् | 

यच्छरीररसस्नेहः प्राणा यत्र प्रतिष्ठिताः||११||

[9/29, 9:36 AM] Dr. Pavan mali sir, Delhi: 

Important aspect of chikitsa also mentioned....👇🏻

||१३||

हृद्यं यत् स्याद्यदौजस्यं स्रोतसां यत् प्रसादनम्|

 तत्तत् सेव्यं प्रयत्नेन प्रशमो ज्ञानमेव च||१४||

[9/29, 9:56 AM] Dr.Bhadresh Naik Gujarat: 

? Coronary artery disease is

Rasvah strosh rog

Or

Hrudgat disease

To whom to deal frist

Kindly guide sirji

[9/29, 10:00 AM] Prof.Satyendra Narayan Ojha Sir।: 

Dr.pavan ji

*भूयश्च हृद्युपसृष्टे हिङ्गुचूर्णं लवणानामन्यतमचूर्णसंयुक्तं मातुलुङ्गस्य रसेनान्येन वाऽम्लेन हृद्येन वा पाययेत्, स्थिरादिपञ्चमूलीरस: सशर्कर: पानार्थं, बिल्वादिपञ्चमूलरससिद्धा च यवागू: ,

 हृद्रोगविहितं च कर्म.

च.सि.९/८*

[9/29, 10:11 AM] Dr. Pavan mali Sir, Delhi: 

🙏🏻🙏🏻👌🏻❤️ pranaam sirjee

[9/29, 10:12 AM] Prof.Satyendra Narayan Ojha Sir।: 

प्रणाम पवन भाई

[9/29, 10:14 AM] Dr. Pavan mali Sir, Delhi:

 🙏🏻🙏🏻 we would love to learn  special case of heart diseases from you today sir..

[9/29, 10:16 AM] Prof.Satyendra Narayan Ojha Sir: 

*Yes.. in evening , we will talk on ischaemic heart diseases*

*वातिक हृदय रोग*

 Or Cardiomyopathies ?

What is your choice ?

[9/29, 10:17 AM] Dr. Pavan mali Sir, Delhi: 

I have already typed for cardiomyopathy....sir

[9/29, 10:18 AM] Prof.Satyendra Narayan Ojha Sir: 

Great..

 final.. when will you be available for discussion on Cardiomyopathies in evening ?

[9/29, 10:18 AM] Dr. Pavan mali Sir, Delhi: 

This is one of the area where patients seeks our help as modern medicine has not way out....

[9/29, 10:18 AM] Prof.Satyendra Narayan Ojha Sir: 

Yes..

[9/29, 10:23 AM] Prof.Satyendra Narayan Ojha Sir।: 

Dr.Bhadresh ji

रसवह स्रोतस् मूल होने से हृदय को रसवह स्रोतस् से सम्पूर्णत: भिन्न नहीं देखा जा सकता. 

सु.उ. ४२ (गुल्म प्रकरण ) में वर्णित हृच्छूल‌ एवं ४३ (हृदय रोग प्रकरण) में वर्णित हृदय रोग की सामान्य सम्प्राप्ति अवलोकनीय‌ है

[9/29, 10:39 AM] Prof.Satyendra Narayan Ojha Sir: 

Disparity between supply and demand is cause of ischaemia.

Decreased coronary blood supply ⬅️ coronary artery atherosclerosis.

Increased demand ⬅️ increased heart rate as in exercise, fever, anxiety, hyperthyroidism, etc.. 

Diastolic dysfunction ➡️Decreased diastolic time ➡️ decreased coronary artery filling time ➡️ inadequate blood ➡️ decreased supply ➡️ ischaemia..

[9/29, 11:04 AM] Vd.Divyesh Desai Surat: 

दूषयित्वा रसं दोषा,

विगुणाह हृदयं गताः

हृदि बाधा प्रकुर्वन्ति

हॄदरोग तं प्रचक्षते।। 

रस धातु की दृष्टि होना या फिर रसवह स्त्रोत की दृष्टि होना दोनों में हृदरोग की उत्पत्ति होती है,

रस धातु की दृष्टि होने के पश्चात उसका स्थानसंश्रय कहाँ होता है, किस दोष के कौन से गुण से दृष्टि होतीं है

स्थानसंश्रय कोरोनरी arteries में है, वाल्व में है, मायोकार्डियम, पेरीकार्डियम, जैसे कौन से muscular लेयर में है

SA NODE या AV नोड में है,

अगर वात वर्धक निदान है तो प्राण और व्यान वायु की, पित वर्धक निदान से साधक पित की एवं कफ वर्धक निदानों से अवलम्बक कफ की ओर आमोत्पत्ति है तो सभी दोषों की दृष्टि होकर अगर मन मे विषाद है तो भी सारे दोषों की दृष्टि हो सकती है तो शायद हृदरोग की ये सम्प्राप्ति में ज्यादातर मॉडर्न HEART DISEASES का समावेश हो सकता है, आज हम आदरणीय OJHA SIR से काफी सारी हृदरोग की जानकारी एवं चिकित्सा सूत्र की माहिती प्राप्त होगी,आदरणीय सुभाष सर से चिकित्सा सूत्र कहाँ ओर कब APPLY करना है वो ज्ञान की प्राप्ति होगी,गिरिराज सर से ANATOMICAL डिटेल्स मिलेगी एवं बाकी सारे गुरुजनों से उनका अनुभवों की प्राप्ति होगी इस लिए 7 बजे का इंतजार रहेगा🙏🏻🙏🏻🙏🏻जय आयुर्वेद,

जय धन्वंतरि👏🏻👏🏻

[9/29, 7:00 PM] Dr. Pavan mali Sir, Delhi: 

Good evening to all senior vaidya....

Resp sir...

divyeshaji has raised few queries ..we can start discussion from here..🙏🏻🙏🏻🙏🏻

[9/29, 7:14 PM] Prof.Satyendra Narayan Ojha Sir।: 

We will talk on Cardiomyopathies..

Issue is name mentioned is allopathic name..

[9/29, 7:17 PM] Dr. Pavan mali Sir, Delhi: 

Yes sir..

there are many diseases which we have to treat where patient came with allopathy diagnosis and seeks our help...as khandel sir has mentioned ...

we have to understand all this in ayurvedic view ..then only we can proceed....

subhash sir has presented so many cases and guided us

[9/29, 7:23 PM] Prof.Satyendra Narayan Ojha Sir:

 Sira as discussed previously contribute to Mansadhara and Raktadhara kala. They give aadhar to rakta dhatu and perform the action of mansadhara kala whereas by sarana nature i.e. to enter the avayava it helps in providing nutrition by entering deep into the organ thereby performing the action of Raktadhara kala. 

Sira are formed from the mridu paka of sneha ansha of meda in the intrauterine life. This is the explanation of vasculogenesis by Acharya Sushrut. Further there is a reference that Sira are upadhatu of Rakta dhatu. It means Sira poshak rakta sara bhag is acted upon by the upadhatvagni leading to sira utpatti and poshan. This is the explanation of Angiogenesis as per Acharya Sushruta. Thus for the utpatti and poshan of Sira alongwith bija bhag obtained from pitruj bhag, sneha ansha of medha, Sira poshak rakta sara bhag, upadhatvagni, raktadhara kala and mansadhara kala all contribute together. Further, just after explanation of Sira Snayu Acharya Sushrut explains the utpatti of Ashaya. Vata takes ashraya in ashaya and by abhyas form the Ashaya. The ashaya mentioned prior explains the space within whereas the later explains the organ. Thus vata by its function of akrutikaranam indulges itself to form various organs by taking ashraya in some space (ashaya). 

Modern too explains that Heart development (also known as cardiogenesis) refers to the prenatal development of the human heart. This begins with the formation of two endocardial tubes which merge to form the tubular heart, also called the primitive heart tube, that loops and septates into the four chambers and paired arterial trunks that form the adult heart. In the splanchnopleuric mesenchyme on either side of the neural plate, a horseshoe-shaped area develops (AASHAYA as mentioned by Acharya Sushruta) as the cardiogenic region. This has formed from cardiac myoblasts (mansadhara kala) and blood islands as forerunners of blood cells and vessels (Raktadhara kala). By day 19, an endocardial tube begins to develop in each side of this region. These two tubes grow (Aashaya abhyasayogena vayu sthiti kurvati as expalained by Acharya Dalhan) and by the third week have converged towards each other to merge, using programmed cell death to form a single tube, the tubular heart. The tubular heart quickly differentiates into the truncus arteriosus, bulbus cordis, primitive ventricle, primitive atrium, and the sinus venosus. The truncus arteriosus splits into the ascending aorta and pulmonary artery. The bulbus cordis forms part of the ventricles. The sinus venosus connects to the fetal circulation. https://en.wikipedia.org/wiki/Heart_development

The heart tube elongates on the right side, looping and becoming the first visual sign of left-right asymmetry of the body. Septa form within the atria and ventricles to separate the left and right sides of the heart. The heart derives from embryonic mesodermal germ-layer cells that differentiate after gastrulation into mesothelium, endothelium, and myocardium. Mesothelial pericardium forms the outer lining of the heart. The inner lining of the heart, lymphatic and blood vessels, develop from endothelium. https://en.wikipedia.org/wiki/Heart_development

Thus the endothelium of blood vessel continues to form the inner lining of the cavity of heart and myocardium forms the muscle. Therefore from above it may be concluded that Hridaya are similar to Sira i.e. it is part of mansadhara kala (myocardium) and raktadhra kala (inner cavity of chamber). It may be noted that it is endothelium which is affected in RHD which is continued with mitral valve which is also an endothelial tissue.

In context of Granthi Acharya Sushrut mentions Sira Granthi which may occur in Marma and it is asadhya. Vitiated Vata dosha takes ashraya in Sira and form pratan sira. Acharya Dalhan mentions Pratana means vistara. Thus if vistara of sira is possible then vistara of Hridaya is also possible. Similarly Acharya Caraka in context of Siragata vata has mention that the vitiated vata takes ashraya in sira and can lead to 2 condition Tanu Sira or narrowing of vessel and Mahantyo va sira i.e. Dilatation of sira or aneurysm. The dilatation of sira may occur in Hridaya too. 

Aayama is another word used for vistara by Acharya Caraka (आयामः विस्तरणम्)  

(Ca. Ci.29/25). 

Aayama means stretching, extending, expansion. Acharya Dalhan has mentioned Aayam as 

आयामनं सङ्कुचिताङ्गदेशस्यदीर्घीकरणमिव (Su. Su.22/11 dalhan).

Acharya Caraka has mentioned Sira Ayama in context of vatarakta adhyaya. Therefore vitiating hetus of vata rakta, alone vata, sira dushtikar hetu and rakta dustikar hetu contribute to Sira ayama and in this context Hridaya ayama. We shall discuss the hetus in context of hridaya ayama. Rakta dusthi hetu have been mentioned in Vidhishonitiya adhyaya, raktapitta nidan adhyaya, vatashonita adhyaya. The hetus which are explained in Raktapitta adhyaya are firstly viruddha type and secondly increased ushnata of pitta followed by increased swedan of dhatu contributing to increased drava guna contributing to Raktapitta. Hence they are deal in other context. In the following table Urustambha hetu have been compared with raktadushti as Sira dushti is observed in this disease. Some hetus are common in each of this adhyaya which we can understand from the following table.

Hetu

Vidhi-shonitiya

Vatashonita

Uru-stambha

praduṣṭa bahu tīkṣṇōṣṇair madya

+

piṣṭa vyāpanna madya 

a'tilavaṇakṣārairamlaiḥ kaṭubhi

+

+

Kulattha māṣa niṣpāva tilataila  

+

Kulattha māṣa niṣpāva 

piṇḍālu mūlakādīnāṁ haritānāṁ ca sarvaśaḥ

+

piṇyākamūlakaiḥ , śākādipalalēkṣubhiḥ

Jalajānūpa bailānāṁ prasahānāṁ

+

klinna śuṣkāmbujānūpamāṁsa

grāmy ānūpa udakāmiṣaiḥ

Dadhyamla mastu suktānāṁ 

Surā sauvīrakasya

+

Dadhy āranāla sauvīra śukta takra surāsavaiḥ

dadhi kṣīra

Viruddhānām upaklinna pūtīnāṁ 

bhakṣaṇēna 

+

viruddh

snigdhōṣṇalaghuśītāni

bhuktvā ca drava snigdha gurūṇi ca divā prasvapatāṁ 

+

divāsvapna

Drava śuṣka 

Ātidivāsvapna

atyādānaṁ / ajīrṇādhyaśanai

+

ādhyaśana

adhyaśana

jīrṇājīrṇē samaśnataḥ

krōdhaṁ

+

krōdha

bhaya

bhajatāṁ cātapānalau/ santāpai

+

Chardivēgapratīghātāt

+

vēgavidhāraṇaiḥ

kālē cānavasēcanāt

+

aśuddhyā

Śrama 

+

āyāsa

Abhighāta

+

Abhighātād 

prajāgaraiḥ

+

prajāgaraiḥ

prāyaśaḥ sukumārāṇāṁ miṣṭānnasukhabhōjinām [1] 

acaṅkramaṇaśīlānāṁ

+

Śarat kāla svabhāvācca

+

snigdhōṣṇājīrṇabhōjanaiḥ

+

jīrṇājīrṇē samaśnataḥ

laṅghana / alpa /abhōjanāt

+

+

kaṣāya kaṭu tikta 

+

rūkṣāhārād

+

hayōṣṭrayānayānāmbukrīḍāplavana cātyadhvavaiṣamyādvyavāyād 

+

If we compare the above hetus we find some common hetu in all the three columns. This common hetus contribute to the rakta dushti in specific manner whereas the other hetu also contribute to Rakta dushti with different specific samprapti. As by Ashraya Ashrayi siddhant if ashraya gets dushit the ashrita also gets dushit and the vice versa is also true. In this case once the rakta gets dushit invariably the ashraya Sira and Hridaya will also get dushit. 

As understood in vatarakta adhyaya if specific hetu of vatavriddhi are associated with raktadushti and if the vata gets abhyasa (repeated) in the specific ashaya it will lead to dilatation. In this case we need to understand the same in case of hridaya ayama.

If we study the above table we can understand that considering urustambha as a base the hetu in all 3 column present with similar samprapti. snēhāccāmaṁ citaṁ kōṣṭhē vātādīn mēdasā  saha (Ca. Ci. 27/10). Chakrapani commentary is important in this case “āmaṁ citamiti rasaśēṣarūpaṁ, kōṣṭhōpalēpanāpyāmaṁ sañcitaṁ, mēdasā sahēti mēdaḥsahitamāmaṁ vātādīnāṁ rōdhakaṁ jñēyam.” The detail explanation about how the above pathophysiology leads to atherosclerosis in understood in dhamanipratichaya now this particular process will cause poshana alpata leading to ischemia. Repeated ischemia leads to vata prakopa. One among the symptoms of Vata prakopa is VYAS. Chakrapani commenting on the word Vyas has mentioned it to be vistara. In the same shlok Chakrapani mentions that sransa etc are avayava vishesha i.e. specific for the organs. In this case the vata prakopa leads to Hridaya Ayama or Ischemic Cardiomyopathy as understood below.

Ischemic cardiomyopathy (ICM) is a term that refers to the heart's decreased ability to pump blood properly, due to myocardial damage brought upon by ischemia. When discussing the term ICM, coronary artery disease (CAD) has to be addressed. CAD is a condition characterized by the formation of plaques in the coronary blood vessels, decreasing their capacity to supply nutrients and oxygen to the contractile heart muscle. ICM has a spectrum of clinical changes which eventually leads to congestive heart failure (CHF). Initially, there is a reversible loss of cardiac contractile function because of decreased oxygen supply to the heart muscle; however, when there is ischemia for a prolonged period, there is irreversible cardiac muscle damage resulting in cardiac remodeling. In ischemic cardiomyopathy, there is a significant impairment of the left ventricular systolic function, with a left ventricular ejection fraction (LVEF) less than 40%. Remodeling is primarily achieved by myocardial fibrosis which results in decreased cardiac function, arrhythmia, and possible cardiac conduction system impairment. https://www.ncbi.nlm.nih.gov/books/NBK537301/

Signs and symptoms may vary between patients and their degree of physiological compensation. Some patient may be asymptomatic or present with mild anginal chest pain and dyspnea on exertion whereas some patients may present with overt heart failure symptoms which include dyspnea, orthopnea, poor exercise tolerance, and increased fatigability alongwith swelling of the legs and feet (edema). Angina (chest pain or pressure that occurs with exercise or physical activity and can also occur with rest or after meals) is a less common symptom. Weight gain, cough and congestion related to fluid retention, Palpitations or fluttering in the chest due to abnormal heart rhythms (arrhythmia), Dizziness or lightheadedness, Fainting (caused by irregular heart rhythms, abnormal responses of the blood vessels during exercise, without apparent cause) https://my.clevelandclinic.org/health/diseases/17145-ischemic-cardiomyopathy Physical evaluation can reveal bibasilar crackles, S3 gallop (found when the left ventricle is dilated), displaced PMI, carotid bruits, JVD, hepato-jugular reflex and bilateral lower extremity edema. 

There is a wide spectrum of complications from ischemic cardiomyopathy. The most common complication is the development of clinical congestive heart failure which is often the most common form of presentation for ICM; as the cardiac chambers dilate, innate conduction system of the heart changes leading to abnormal heart rhythms which could be life-threatening.

https://www.ncbi.nlm.nih.gov/books/NBK537301/

Madya or alcohol consumption is again a common hetu in all the above 3 columns. Suras, Sauvira, sukta are all fermented products which naturally contain alcohol percentage. Caraka has mentioned bahu madyapana to be a hetu. Bahu means in excess, normal quantity of madyapana is helpful for body as explained in Madatyaya chapter. Modern too explains that the individual amount of alcohol consumed acutely or chronically decides on harm or benefit to a person’s health. Available data suggest that one to two drinks in men and one drink in women will benefit the cardiovascular system over time, one drink being 17.6 ml 100 % alcohol. Moderate drinking can reduce the incidence and mortality of coronary artery disease, heart failure, diabetes, ischemic and hemorrhagic stroke. More than this amount can lead to alcoholic cardiomyopathy, which is defined as alcohol toxicity to the heart muscle itself by ethanol and its metabolites.  Chronic heavy alcohol abuse will also increase blood pressure and cause a downregulation of the immune system that could lead to increased susceptibility to infections, which in turn could add to the development of heart failure. Myocardial tissue analysis resembles idiopathic cardiomyopathy or chronic myocarditis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013142/

The madya with its ten qualities affects heart by counteracting the oja and its ten qualities. Laghu, ūṣṇa, tīkṣṇa, sūkṣma amla, vyavāyyi, āśu, rūkṣa, vikāśi, viśadaṁ are the ten qualities. Each of these qualities hampers the 10 qualities of oja and leads to hridaya vikriti. We shall discuss only the one contributing to cardiomyopathy. The slakshna guna is pervaded by the vikasi guna of madya. “ślakṣṇatāmapi Vikāsibhāvāt”. Slakshna guna helps in poshana and improves pinnatva whereas vikasi like tikshna breaks the normal bonding between the dosha and dhatu and weakens the sandhi bandhan. Thereby reducing the contractibility of heart but the body tendency for vikar vighata bhava (remodelling) is started which leads to increase in size leading to Hridaya Ayama.

The asu guna reduces the prasada guna of hridaya leading to chalatva which may be the cause for rhythm changes. Acute effects of alcohol can result in rhythm disturbances. Since this happens often on weekends and holidays, Ettinger and Regan coined the term ”holiday heart syndrome“,

Alcoholic cardiomyopathy is a disease in which the chronic long-term abuse of alcohol (i.e., ethanol) leads to heart failure. Alcoholic cardiomyopathy is a type of dilated cardiomyopathy. 

The toxicity of alcohol damages and weakens the heart muscle over time. This makes it difficult for heart to pump blood efficiently. When it can’t pump out enough blood, the heart starts to expand to hold the extra blood. This causes the heart to become thinned and enlarged. Eventually, the heart muscle and blood vessels may stop functioning properly due to the damage and strain. https://www.healthline.com/health/alcoholism/cardiomyopathy#causes

Alcohol is still suspected to be the major cause or contributory factor of secondary nonischemic dilated cardiomyopathy being involved in up to one third of all cases of dilated cardiomyopathy. In alcoholic cardiomyopathy, dilation and impaired contraction of the left or both ventricles is observed. Left ventricular end-diastolic diameters are increased compared to age- and weight-matched controls, the left ventricular mass index is increased, and the left ventricular ejection fraction is well below normal (<45 %). Thus, the diagnosis of alcoholic cardiomyopathy is still based on the coincidence of heavy alcohol consumption and a global myocardial dysfunction, which cannot be explained by any other underlying myocardial disease.

Further evidence suggests that not only ethanol but also the first metabolite acetaldehyde may directly interfere with cardiac and skeletal muscle homeostasis. In vitro studies have further elucidated the direct effect of ethanol on electromechanical coupling, indicating a decrease in myofilament–calcium sensitivity during alcohol consumption, changes in the transmembrane action potential, the amplitude of the cytosolic calcium transients, and the shortening of the action potential duration. Isolated cardiomyocytes of alcohol-fed rats did not maintain ATP levels upon energy demand due to an inadequate increase in mitochondrial ATP-synthase activity, which led altogether to further myocyte loss. Ultrastructural disarray of the contractile apparatus is associated with a depressed myofibrillar and sarcoplasmic protein synthesis in cardiac muscle after ethanol exposure. This reduces contractile cardiac filaments with subsequent negative inotropic effects on heart contractility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013142/

Signs and symptoms presented by the occurrence of alcoholic cardiomyopathy are the result of the heart failing and usually occur after the disease has progressed to an advanced stage. Therefore, the symptoms have a lot in common with other forms of cardiomyopathy. These symptoms can include the following: Ankle, feet, and leg swelling (edema), Overall swelling, Loss of appetite, Shortness of breath (dyspnea), especially with activity, Breathing difficulty while lying down, Fatigue, weakness, faintness, Decreased alertness or concentration, Cough containing mucus, or pink, frothy material, Decreased urine output (oliguria), nocturia, Heart palpitations (irregular heart beat), tachycardia. 

Abnormal heart sounds, murmurs, ECG abnormalities, and enlarged heart on chest x-ray may lead to the diagnosis. Echocardiogram abnormalities and cardiac catheterization or angiogram to rule out coronary artery blockages, along with a history of alcohol abuse can confirm the diagnosis.

https://en.wikipedia.org/wiki/Alcoholic_cardiomyopathy

Beriberi heart disease

If madyapana is continued followed by low nutritional diet as discussed in the table like Kulattha māṣa niṣpāva tilataila  piṇḍālu mūlakādīnāṁ haritānāṁ ca sarvaśaḥ laṅghana / alpa /abhōjanāt rūkṣāhārād kaṣāya kaṭu tikta, Viruddhānām upaklinna pūtīnāṁ bhakṣaṇēna. It will lead to vata prakopa and if vikashi guna is increased it will lead to vistar or Hridaya Ayama.

Thiamine deficiency is common feature in a malnourished and/or alcoholic population. Thus, the concept of beriberi heart disease dominated thinking about alcohol and the heart for decades and caused many to doubt that alcohol was actually cardiotoxic. But vitamin B1 (thiamine) deficiency is accompanied by an elevated cardiac output and diminished peripheral vascular resistance. According to its central hemodynamics, it can be classified as hyperdynamic cardiomyopathy or high output failure with a cardiac output >8 l/min or a cardiac index >3.9 l/min/m2. In contrast, alcoholic cardiomyopathy is characterized by a low cardiac output, associated with systemic vasoconstriction. However, the high output state can lead to cardiac dilation, thus, representing a characteristic subentity of cardiomyopathy different from low output dilated cardiomyopathy. Therefore, thiamine deficiency per se is just a historical nutritional anomaly in the history of alcoholic cardiomyopathy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013142/

Restrictive Cardiomyopathy

There are some other hetus which are common in above mentioned table viz. Jalaja, ānūpa bailānāṁ prasahānāṁ, klinna śuṣka, ambuj, ānūpa māṁsa and grāmy ānūpa udakāmiṣaiḥ. These are hetu in which an individual is indulged in eating Santarpanotha Aahar. Ādhyaśana, divāsvapna especially after eating drava snigdha gurūṇi. Further sukumar patient if eats miṣṭānna and is sukhabhōjinām and lastly acaṅkramaṇaśīlānāṁ (sedentary) lifestyle. This Santarpanotha hetus which are pre-dominant in Parthiv components results in Vaigunyat Pavakasya i.e. difference in functioning of Agni leading to Utpatti of Apachit Ahar-rasa which is predominant in impaired Parthiv ansa. As explained in Grahani dosha chikitsa adhyaya such a rasa dhatu when propagated by Vyana vayu will cause disease once it finds Kha-vaigunnya. The abnormal Parthiv ansa built up in the Heart tissue if beeja bhaga avayava dushti is present. The parthiv ansa here are similar to kapha dharma and or similar to proteins and Iron which further affects the functions of vata.

The prakopita kapha depending on the avayava shows symptoms like gaurav, sthairya, Supti, kleda and upadeha . The significance of kleda, upadeha has been dealt in dhamanipratichaya whereas gaurav, sthairya and supti is understood in relation to Restrictive Cardiomyopathy. Restrictive cardiomyopathy is a disease of heart muscles characterised by restricted filling of ventricles. Heart muscles become stiff and are poorly compliant which makes it difficult for ventricles to fill the blood normally. As the filling phase of the heart is abnormal it further affects the blood supply to the organs. The Parthiv ansa such as proteins and Iron further affects the functions of vata. The extra iron (Parthiv ansa) cause fentoin reaction that is affects the Bhootagni and increases the concentration of free radicals (Ama) leading to cellular damage and later tissue fibrosis. It may be noted that this kathinyata is not due to ruksha guna of vata instead due to increase parthiv ansa. The tissue fibrosis in the Heart muscles causes cardio-myopathy and also arrhythmia (impaired vata gati). Whereas the abnormal proteins which have reached heart tissue bound together and get abnormally folded and form rigid insoluble sheet this is to be understood as sthirata and deposit in extra cellular space leading to stiff cardiac muscle causing the restrictive cardio-myopathy. The gauravta and sthairyata leads to Supti. Chakrapani mentions supti means niskriyata. The hallmark of the restrictive cardiomyopathies (RCMs) is abnormal diastolic function; the ventricular walls are excessively rigid and impede ventricular filling. In late stages systolic function is also impaired. The restrictive cardio-myopathy may further complicate as congestive cardiac failure which may results into death.

Clinical Features include Decreased exercise tolerance, Fatigue, Peripheral edema, and ascites. Jugular venous distention,  Arrhythmias and conduction blocks are common, Biatrial enlargement, Thickened LV walls (with normal chamber size), Thickened RV free wall (with normal chamber size), Elevated right atrial pressure (>12mmHg), Moderate pulmonary hypertension, Normal systolic function, Poor diastolic function, typically Grade III - IV Diastolic heart failure.

CARDIAC AMYLOIDOSIS

Involvement of the heart is the most frequent cause of death in primary amyloidosis (AL) and hereditary amyloidosis, with deposition of amyloid in the cardiac interstitium. Proteins with abnormal shape which are like Starch (Increased parthiv ansha) in absence of  vikar vighat bhava deposit in the tissues. In case of Cardiomyopathy they are the heart tissues where kha vaigunya is made available. Proteins are abnormally folded which can’t break and are rigid insoluble sheet (β sheet) which deposit in extracellular space of heart muscles.

On gross pathologic examination, the heart is firm, rubbery, and noncompliant and has a waxy appearance. The picture resembles the kapha vridhi leading to guruta and sthirata in hridaya.

Clinically significant cardiac involvement is uncommon in the secondary form. Focal deposits of amyloid in the hearts of elderly persons (senile cardiac amyloidosis), although common, are usually clinically insignificant.

Four clinical presentations (alone or in combination) are seen: (1) diastolic dysfunction, (2) systolic dysfunction, (3) arrhythmias and conduction disturbances, and (4) orthostatic hypotension. 

However, the overall prognosis is poor, especially in the primary form with advanced cardiac involvement. (Harrisons Internal Medicine 17th Edition Page 1488)

OTHER RESTRICTIVE CARDIOMYOPATHIES

Iron-overload cardiomyopathy (hemochromatosis) is often the result of multiple transfusions or a hemoglobinopathy, most frequently β-thalassemia; the familial (autosomal recessive) form should be suspected if cardiomyopathy occurs in the presence of diabetes mellitus, hepatic cirrhosis, and increased skin pigmentation.    (Harrisons Internal Medicine 17th Edition Page 1488)

The extra iron is nothing but the increased abnormal Parthiv Ansa. The impaired bhutagni (Fenton Reaction) leads to Aam Utpatti (Free Radicals) which contribute to Cellular Damage and Tissue Fibrosis. If Kha vaigunya takes place in hridaya (Cardiac Cells) it leads to Restrictive Cardiomyopathy

[9/29, 7:25 PM] Dr. Pavan mali Sir, Delhi: 

Request all members to discuss their views and participate so that we can have fruitful learning process...

[9/29, 7:27 PM] Prof.Satyendra Narayan Ojha Sir।: 

Right , we should come with questions answers session

[9/29, 7:27 PM] Prof.Satyendra Narayan Ojha Sir।: 

I posted my view need to read by all participants

[9/29, 7:29 PM] Dr. Pavan mali Sir, Delhi: 

You have given detail elaboration..

it will take time for all to go through so that everyone can understand concept and discuss the queries..thanks for providing basic platform reg same

[9/29, 8:35 PM] Prof.Satyendra Narayan Ojha Sir।: 

पांच प्रकार के हृदय रोग मे ही हमें सभी हृदय रोगो को समाविष्ट करना है और फिर चिकित्सा व्यवस्था शुरु करनी होती है..

[9/29, 8:37 PM] Prof.Satyendra Narayan Ojha Sir।: 

*द्वंदज हृदय रोग भी देखने को मिलते है , उनका भी समावेश अभिष्ट है*

[9/29, 8:39 PM] Dr.Bhadresh Naik Gujarat: 

Acute early morning chest pain can concider as a vatic hrugrog?

[9/29, 8:40 PM] Dr.Dinesh Chand Katoch Sir: 

And Hritshool, Hritgat Vaat

[9/29, 8:40 PM] Prof.Satyendra Narayan Ojha Sir।:

 *हृदय रोग प्राणावृत उदान और समानावृत अपान मे वर्णित है तथा  आवरण के उपद्रव स्वरुप भी , इन सभी पर चर्चा अपेक्षित है*

[9/29, 8:41 PM] Prof.Satyendra Narayan Ojha Sir।: 

जी हृच्छूल , हृदय गत वात पर भी विचार विनिमय किया जाना युक्तियुक्त है

[9/29, 8:43 PM] Prof.Satyendra Narayan Ojha Sir।:

 गुल्म , ग्रहणी, अर्श , उदावर्त आदि रोगो में भी हृदय गद/रोग का उल्लेख है , इनका भी विश्लेषण अपेक्षित है

[9/29, 8:45 PM] Prof.Satyendra Narayan Ojha Sir।: 

कोष्ठगत वात में हृदय रोग , पुरीषावृत वात में हृदय की अस्वस्थता क्या है ? इसकी भी समझ बनानी है

[9/29, 8:46 PM] Dr.Dinesh Chand Katoch Sir:

 In sab mein hridye a lakshan hotein hain, hridrog nahi.

[9/29, 9:02 PM] Prof.Satyendra Narayan Ojha Sir: 

ऐसा नहीं है , हृदय गद शब्द को लक्षण नहीं कह सकते , पाण्डु में वर्णित हृदय स्पन्दन लक्षण स्वरुप है

[9/29, 9:02 PM] Dr.Dinesh Chand Katoch Sir: 

Ye bhi hridlakshan matra hain

[9/29, 9:04 PM] Prof.Satyendra Narayan Ojha Sir: 

फिर भी , किस प्रकार का लक्षण है, इसपर स्पष्टीकरण जरुरी है

[9/29, 9:04 PM] Dr.Dinesh Chand Katoch Sir: 

Phir to anxiety situation mein hone wali precordial discomfort is Hridyagad.

[9/29, 9:07 PM] Prof.Satyendra Narayan Ojha Sir: 

Chest pain in Anxiety neurosis is defined as neurocirculatory ashtenia or D' Costa syndrome.. इसी तरह से एक समझ बनानी पडेगी.

[9/29, 9:08 PM] वैद्य नरेश गर्ग: 

प्रणाम सर ।

वातिक हृदय रोग में वैवर्ण्य मूर्च्छा और मोह को कैसे समझ सकते हैं

[9/29, 9:08 PM] Dr. Pavan mali Sir, Delhi: 

🙏🏻🙏🏻🙏🏻Thank you so much for providing in detail and marvelous presentation on such a important topic. You have covered all aspect of samrapti and hetu . You keep little space for queries...

Siragat vaat is the important aspect you have mentioned in samprapti..

What is role of avalambak kapha here...as it is one of the important factor as vikaar vighat bhav and in the treatment how to preserve this bhav so that samprapti will not enhance further and we can prevent disease process...

Shonit kapha prasadajam hridayam is the important aspect here as both these factors are again vikaar vighata bhaav here..🙏🏻

[9/29, 9:09 PM] Prof.Satyendra Narayan Ojha Sir।:

वैद्य नरेश गर्ग

 सामान्य लक्षण है , सभी हृदय रोगी में मिलना सम्भाव्य नहीं है

[9/29, 9:14 PM] Prof.Satyendra Narayan Ojha Sir।: 

अवलम्बक कफ  हृदय को स्वस्थान में प्रतिस्थापित करता है, तथा बाह्य दबाव और समिपस्थ अवयवो से हृदय को सुरक्षित रखता है. इसकी वृद्धि से हृदय को अतिरिक्त कार्य करना पडता है

[9/29, 9:17 PM] वैद्य नरेश गर्ग:

 क्या यहां वैवर्ण्य को हम पांडू ले सकते हैं क्या

[9/29, 9:17 PM] Prof.Satyendra Narayan Ojha Sir।: 

अवलम्बक कफ का कार्य हृदय अन्तर्गत आवश्यक घटको के निर्मिती में भी है , यथा intraventricular septum.. इसके वैषम्य से VSD जैसे सहज विकार होते हैं

[9/29, 9:17 PM] Dr.Ranvijay Singh Delhi: 

हृदद्रव ---

वातजनानात्मज 

रसक्षय

मिथ्याव्यवाय

वतिकहृद्रोग 

पाण्डु

वातिक अर्श 

अपस्मार पूर्वरूप  इत्यादि में ये लक्षण मिलता है 

रोगी इनमे से कई रोगों को एक साथ होते है ये समझ पाना मेरे लिए मुश्किल हो जाता है कि इसका क्या कारण है और क्या औषधि योजना करनी है।

[9/29, 9:17 PM] Dr. Pavan mali Sir, Delhi: 

Shonita prasad,shonit phen,shonit kitta,shonit saar these are various terminolgies used while mentioning organogenesis by acharya sushruta...how to interpret these terminologies in various organ development.

[9/29, 9:18 PM] Prof.Satyendra Narayan Ojha Sir।: 

वैद्य नरेश गर्ग

पाण्डु् वर्ण , श्याव वर्ण , पीत वर्णादि सभी ले सकते हैं

[9/29, 9:19 PM] Prof.Satyendra Narayan Ojha Sir।: 

अभी हम हृदय पर चर्चा करेगें

[9/29, 9:21 PM] Prof.Satyendra Narayan Ojha Sir: 

गर्भिणी के द्वारा मद्यादि सेवन से भी इस प्रकार के सहज रोग देखे जाते हैं

[9/29, 9:23 PM] Prof.Satyendra Narayan Ojha Sir:

 म्लान , दीन , आदि लक्षण भी मिलते हैं

[9/29, 9:24 PM] वैद्य नरेश गर्ग: 

सर मैं वैवर्ण्य के बारे में मत रखना चाहता हूं। जितने भी हृदय रोगी होते हैं उनका चेहरे पर तेज नहीं रहता है उनका चेहरा म्लान लगता है  और ह्रदय रोगियों में पादशोथ और अन्य लक्षण मिलते हैं क्या इन सब को भी वैवर्ण्य से लिया जा सकता है क्या

[9/29, 9:24 PM] Prof.Satyendra Narayan Ojha Sir: 

इन रोगो के प्रत्यात्म लक्षण से ही इनका व्यवच्छेद निदान होगा

[9/29, 9:24 PM] Prof.Satyendra Narayan Ojha Sir।: 

वैद्य नरेश गर्ग

नहीं..

[9/29, 9:26 PM] Prof.Satyendra Narayan Ojha Sir: 

पादशोथ में रक्तवर्ण का होना ग्रथित रक्त जन्य सिरा विकार की तरफ संकेत मिलता है

[9/29, 9:31 PM] Prof.Satyendra Narayan Ojha Sir।:

 Cardiac arrest is due to (1) ventricular fibrillation ⬅️ वात प्रकोप

(२) Asystole ⬅️निष्क्रित्व ⬅️ कफ प्रकोफ

(३) electromechanical dissociation ⬅️ वात प्रकोप..

In Wolf Parkinson white syndrome , extraconduction or preventricular excitation is present can be considered as वात प्रकोप.

Ischaemia is one cause of cunduction disorder should be considered as वात प्रकोप

[9/29, 9:32 PM] Prof.Satyendra Narayan Ojha Sir।: 

‌what is thinning of heart muscle ? In which disease it is present ?

[9/29, 9:32 PM] Dr.Ashwani Kumar Sood Ambala: 

Not necessarily in CAD unless some comorbidity has not developed this symptom is not present , पदशोथ developed after FAILURE sets in otherwise not

[9/29, 9:34 PM] Prof.Satyendra Narayan Ojha Sir।:

 How much coagulopathy contribute to MI ?

[9/29, 9:35 PM] Prof.Satyendra Narayan Ojha Sir।: 

Thrombosis in presence of atherosclerosis should be dealt which is common cause of MI

[9/29, 9:35 PM] Dr.Ashwani Kumar Sood Ambala:

 In certain blood dyscrasia coagulopathy can cause MI

[9/29, 9:36 PM] Prof.Satyendra Narayan Ojha Sir।:

 Yes , but not common cause

[9/29, 9:36 PM] Dr.Ashwani Kumar Sood Ambala: 

Certainly remote

[9/29, 9:37 PM] Prof.Satyendra Narayan Ojha Sir।: 

We need to talk on common causes initially

[9/29, 9:38 PM] Prof.Satyendra Narayan Ojha Sir।: 

Carditis is cause of 1st degree heart block in rheumatic fever , here , tridosha are involved

[9/29, 9:39 PM] Prof.Satyendra Narayan Ojha Sir।:

 I appreciate understanding of underlying pathology that is dosha dooshya sammoorchchhana

[9/29, 9:42 PM] Prof.Satyendra Narayan Ojha Sir।: 

धमनी प्रतिचय ⬅️कफ नानात्मज विकार➡️ कफानुबन्ध रक्त सपित्त ➡️ग्रथित रक्त ➡️आवरण ➡️वातिक हृदय रोग ➡️ कटु द्रव्य, क्षार प्रयोग

[9/29, 9:43 PM] Vd. Atul J. Kale M.D. (K.C.) G.A.U.:

 Here vata involvement is secondary.

[9/29, 9:44 PM] Dr.Ranvijay Singh Delhi: 

दूषयित्वा रसं। दोषा विगुणा ह्रदय गताः।

हृदि बाधां प्रकुर्वन्ति हृद्रोग तं प्रचक्षते

[9/29, 9:44 PM] Prof.Satyendra Narayan Ojha Sir।: 

Cardiomyopathies में बल्य , वातघ्न , कफघ्न ,हृद्य द्रव्य प्रयोग उपयोगी है.. गति नियंत्रण के लिये चतुष्पर्णी.

ग्रथित रक्त बनने से रोकने के लिये पंचकोल क्षारादि

[9/29, 9:45 PM] Dr. Pavan mali Sir, Delhi: 

Vd. Atul

Chikitsa of avaran is first

[9/29, 9:46 PM] Prof.Satyendra Narayan Ojha Sir।:

 No , if there is aavarana , aavaraka and aavarya both have equal importance , therefore vasodilator like pushkaramoola devadaaru rasna chitraka  are used

[9/29, 9:47 PM] Prof.Satyendra Narayan Ojha Sir।: 

In combination , Acharya Charak mentions punarnavaa haritaki shunthi amrita amalaki rasna pushkaramoola etc

[9/29, 9:48 PM] Prof.Satyendra Narayan Ojha Sir।: Given the importance of all involved factors

[9/29, 9:48 PM] Vd. Atul J. Kale M.D. (K.C.) G.A.U.: 

Here Tikta rasa will not work.

[9/29, 9:49 PM] Prof.Satyendra Narayan Ojha Sir।: 

Guduchi work because of its ushna veerya

[9/29, 9:50 PM] Prof.Satyendra Narayan Ojha Sir: 

Tikta is good to maintain patency of vessels (अप्रतिघात)

[9/29, 9:50 PM] Vd. Atul J. Kale M.D. (K.C.) G.A.U.: 

Yes sir, while treating kaphavaran vata shouldn't be increased.

[9/29, 9:51 PM] Dr. Pavan mali Sir, Delhi: 

👍🏻👌🏻Due to vayu and aakash combination....

[9/29, 9:52 PM] Vd.Divyesh Desai Surat: 

सर, क्या कार्डियोमायोपैथी भी 1 तरह की pseudomuscular Hypertrophy है? क्योंकि आप ने हेतु के हिसाब से सम्प्राप्ति बताई तो व्यास, स्वाप, शौषिर्य आदि वायु से ही होते है .... इस लिए ये मैन में ये प्रश्न आया🙏🏻🙏🏻

[9/29, 9:52 PM] Prof.Satyendra Narayan Ojha Sir।:

 Most of dravya mentioned in kaphaj hridroga are also indicated in vaatika hridroga shows the involvement of kapha as aavaraka , simply atherosclerosis

[9/29, 9:52 PM] Prof.Satyendra Narayan Ojha Sir।: 

Dr. Pavan

Yes.

[9/29, 9:53 PM] Prof.Satyendra Narayan Ojha Sir।: 

No , it's hypertrophy or dilated or restrictive type not dystrophy type

[9/29, 9:55 PM] Prof.Satyendra Narayan Ojha Sir।:

 Reason to use panchakola in vaatika hridroga is to clear aavarana

[9/29, 9:55 PM] Prof.Satyendra Narayan Ojha Sir।: 

To dissolute thrombus

[9/29, 9:56 PM] Prof.Satyendra Narayan Ojha Sir।: 

Lavan increase rakta , so , help in increased blood supply

[9/29, 9:57 PM] Prof.Satyendra Narayan Ojha Sir: 

We need to work on each and every dravya used in charakokta hridroga

[9/29, 9:58 PM] Prof.Satyendra Narayan Ojha Sir:

 In kaphaj hridroga , kashaya rasaatmaka dravya are used but with trikatu or trivrita , reason is to prevent side effects of kashaya rasa; हृदयं पीडयति..

[9/29, 9:58 PM] Dr. Pavan mali Sir, Delhi: 

Avaran is continues process..we have to watch for lakshan samprapti in every case ...because avaraka vayu always try to get rid of avaran and may leads to vaat prakopa in later stage..in the initial phase since avarak dosha is in predominant..symptoms of same occurs and in the treatment also avaraka has to keep in mind along with aavarya dosha...

[9/29, 10:00 PM] Prof.Satyendra Narayan Ojha Sir।:

 Definitely , therefore , katu , tikta , amla , lavana , kshaara , taila , Ghrita are used in vaatika hridroga

[9/29, 10:01 PM] Prof.Satyendra Narayan Ojha Sir।: 

See the contents of triyushanaadi ghrit

[9/29, 10:01 PM] Dr. Pavan mali Sir, Delhi: 

Jee sir🙏🏻

[9/29, 10:02 PM] Prof.Satyendra Narayan Ojha Sir।: 

Cardiomyopathies , our approach to deal vaata and kapha both

[9/29, 10:02 PM] Vd.Divyesh Desai Surat: 

सर, अष्ट बिंदु ओज को हृदरोग के संदर्भ में कैसे Co-relate कर सकते है?

[9/29, 10:02 PM] Prof.Satyendra Narayan Ojha Sir।: 

If Arjun for kapha , then shatavari for vaata

[9/29, 10:03 PM] Prof.Satyendra Narayan Ojha Sir।: 

 Vd.Divyesh

आज नहीं

[9/29, 10:04 PM] Vd.Divyesh Desai Surat: 

🙏🏻🙏🏻जी सर, आपकी अनुकूलता पर..👏🏻👏🏻

[9/29, 10:04 PM] Prof.Satyendra Narayan Ojha Sir।:

 Why dashamoola in Cardiomyopathies ? 

To prevent heart failure since it's shothaghna 

Marmopaghata is one reason of shotha

[9/29, 10:06 PM] Prof.Satyendra Narayan Ojha Sir।: 

वातिक हृदय रोग मे पुनर्नवा ?

[9/29, 10:07 PM] Prof.Satyendra Narayan Ojha Sir।: 

इन सभी का यदि उत्तर है , तभी चिकित्सा व्यवस्था फलदायी होती है

[9/29, 10:08 PM] Vd. Atul J. Kale M.D. (K.C.) G.A.U.: 

Excessive ekantik Tikta Rasa is not indicated.

[9/29, 10:09 PM] Prof.Satyendra Narayan Ojha Sir।: 

Yes , but see whole thing will surprise you

[9/29, 10:09 PM] Prof.Satyendra Narayan Ojha Sir।: 

Ch.chi.26⬆️

[9/29, 10:09 PM] Dr. Pavan mali Sir, Delhi: 

Why kaphaghna treatment is needed in dilated cardiomyopathy...or it is for other type of cardiomyopathy....

[9/29, 10:10 PM] Prof.Satyendra Narayan Ojha Sir।: 

Not in dilated , but in other types

[9/29, 10:10 PM] Dr. Pavan mali Sir, Delhi: 

Ok sir🙏🏻

[9/29, 10:11 PM] Prof.Satyendra Narayan Ojha Sir।: 

Dilated Cardiomyopathy needs vaataghna including sneha

[9/29, 10:12 PM] Dr. Pavan mali Sir, Delhi: 

What is goal of our treatment in cardiomyopathy condition...we have to watch for ejection fraction or any other factors along with this

[9/29, 10:13 PM] Dr. Abhijeet Patil:

 What will be role of hrudbasti in such conditions🙏🏼

[9/29, 10:14 PM] Prof.Satyendra Narayan Ojha Sir।:

Dr.pavan

 Good strength of myocardial contractility.

Systolic and diastolic functioning.

Ejection fraction.

Prevent Thromboembolism.

Prevent Arrythmia.

Prevent heart failure.

Care of tridosha , rasa , rakta and maansa dhatu

[9/29, 10:14 PM] Dr. Pavan mali Sir, Delhi: 

Dashmula and punarnava is providing good result in dilated cardiomyopathy ..as mentioned by you...

[9/29, 10:15 PM] Prof.Satyendra Narayan Ojha Sir।: 

Dr. Abhijeet Patil- role of hrudbasti

To increase coronary circulation, to increase myocardial perfusion

[9/29, 10:15 PM] Prof.Satyendra Narayan Ojha Sir।:

 Yes dr.pavan , my choice of dravya but in combination

[9/29, 10:16 PM] Prof.Satyendra Narayan Ojha Sir।: 

Dashamoola churna or kvaatha

[9/29, 10:20 PM] Dr. Pavan mali Sir, Delhi: 

Hriday basti is local bahya snehan and swedan ...will be effective enough to increase myocardial perfusion sir

[9/29, 10:21 PM] Dr. Pavan mali Sir, Delhi: 

These are important points to be observed ....will keep in mind while follow up of cases

[9/29, 10:26 PM] Prof.Satyendra Narayan Ojha Sir।:

 त्र्यूषणादि घृत में ➡️ त्र्यूषण (त्रिकटच) , द्वे त्रिफले है अर्थात् हरितकी आमलकी विभितक द्राक्षा गम्भारी फालसा ,पाठा कंटकारी ,गोक्षुर , बला , अतिबला आदि २२ द्रव्य है ,एक ऐसा योग जो‌ all types of Cardiomyopathies में उपयोगी है.

च.चि.२६/८७,८८,८९

Dr Pawan Mali , please analyse the role of each and every content of combination with reference to vaatika hridroga

[9/29, 10:28 PM] Prof.Satyendra Narayan Ojha Sir।: 

Yes , but we also give internal medicine.

I have seen in too many cases of IHD , result is much better if hridaya basti is administered.

Hriday basti is found best option in conduction disorders especially in complete AV nodal block

[9/29, 10:30 PM] Prof.Satyendra Narayan Ojha Sir।:

 After adding hridaya basti in treatment plan , result is accelerated

[9/29, 10:30 PM] Prof.Satyendra Narayan Ojha Sir।:

 Nowadays I am using agurvaadyam tailam mixed with coconut oil in complete AV nodal block

[9/29, 10:32 PM] Dr. Pavan mali Sir, Delhi: 

As mentioned by you sir त्र्यूषणादि घृत 

 ..this will take care of vata,kapha,rakta and balya too...will go in details of each individual drugs for understanding of karya.kaaran bhav.🙏🏻

[9/29, 10:34 PM] Dr.Bhadresh Naik Gujarat:

To increased mand and shtirgungun of kuf ?

[9/29, 10:35 PM] Dr. Pavan mali Sir, Delhi: 

Traditional healers are using pippal patra kwath in hridrog  cases....what is your opinion sir.....charak has mentioned its use in vaat rakta treatment..

[9/29, 10:36 PM] Prof.Satyendra Narayan Ojha Sir।: 

You will be surprised to note karya - karan bhava

[9/29, 10:37 PM] Prof.Satyendra Narayan Ojha Sir।: 

Dr.Bhadresh ji

कफ ➡️ हृदय निष्क्रियत्व ⬅️ अगुर्वाद्यं तैलं ➡️ हृदयस्थ क्रियत्वत

[9/29, 10:38 PM] Vd Raghuram Shastri ,Banguluru: *To add up to the wonderful discussions going on in relation to cardiomyopathy*

*Already Guruji, Ojha sir has already detailed about this condition* and modes of intervention. Very important is to address the issue by looking at morbid vata, kapha or vatakapha in their *tara Tama manifestation*. 

👉 *Dilated Cardiomyopathy* - *Vata pradhana*, treat on lines of vataja Hridroga

👉 *Hypertrophic Cardiomyopathy* - *Kapha Pradhana Vatanubandha condition*, Kaphaja Hridroga chikitsa while taking care of vata, that vata doesn't eventually aggravate while addressing kapha morbidity

👉 *Restrictive Cardiomyopathy* - *Vata Pradhana Kaphanubandha condition*, treat to address rigidity and improve elasticity by Sneha pradhana chikitsa while taking care of kapha

*Also*

Seeing the symptoms of Cardiomyopathy in general we can think of incorporating lines of treatment of - 

👉 *Shotha*

👉 *Shwasa*

💐💐💐💐💐💐💐

*A lateral thinking???*

*Can we think of hrid-mamsagata vata here?* *And treat it on the lines of mamsagata vata??*

🙏🙏🙏

[9/29, 10:38 PM] Dr. Pavan mali Sir, Delhi: 

It's your deep thinking of charak samhita which brings out gems  regarding treatment principles and kalpa 🙏🏻

[9/29, 10:39 PM] Prof.Satyendra Narayan Ojha Sir।: 

Traditional healers are using pippal patra 

It's mentioned in kaphaj hridroga too but always with trikatu or trivrita

[9/29, 10:40 PM] Prof.Satyendra Narayan Ojha Sir।: 

कषाय रसात्मक द्रव्यो का प्रयोग प्रशस्त नहीं है, इसलिए त्रिकटु सदृश द्रव्य मिलाए..

[9/29, 10:40 PM] Prof.Satyendra Narayan Ojha Sir।: 

Thanks

[9/29, 10:42 PM] Prof.Satyendra Narayan Ojha Sir।: 

One more condition - hypertrophic obstructive Cardiomyopathy in which vaata and kapha both are involved..

[9/29, 10:43 PM] Prof.Satyendra Narayan Ojha Sir।: 

Better to think about hridaya gata vaata in place of Maansa gata vaata ..

[9/29, 10:44 PM] Vd Raghuram Shastri ,Banguluru: 

Noted sir.

I hv mentioned that in my post🙏

Correct me if I am wrong.

[9/29, 10:45 PM] Prof.Satyendra Narayan Ojha Sir।:

 Maansamedogata vaata is very close to musculoskeletal disorders , myopathies

[9/29, 10:46 PM] Dr. Pavan mali Sir, Delhi: 

Great summary 👌🏻👍🏻 you always present crux of discussion and master stroke also....All cardiomyopathy patients eventually land up in failure where we have to apply shotha and shvas chikitsa principles....🙏🏻

[9/29, 10:48 PM] Vd Raghuram Shastri ,Banguluru:

 But since we were speaking about myopathy of heart I thought if we can have another window to consider this option sir. As we hv Vasti, virechana and shamana in MamsaMedogata vata treatment principles. 

A stupid curiosity!!

Your guidelines sincerely noted sir🙏🙏

[9/29, 10:48 PM] Prof.Satyendra Narayan Ojha Sir।: 

श्रमितं अति अर्थम् may be due to Decreased cardiac output , but  the presence of गुर्वङ्गादि features refer श्रमितं अति अर्थम् as undue fatigue as in myeshenia gravis

[9/29, 10:49 PM] Vd Raghuram Shastri ,Banguluru: 

🙏🙏🙏

Understood sir

[9/29, 10:49 PM] Prof.Satyendra Narayan Ojha Sir।: 

Associate features are important to note

[9/29, 10:50 PM] Dr. Abhijeet Patil: 

Beautiful explanation sir

[9/29, 10:50 PM] Vd Raghuram Shastri ,Banguluru:

 Yes sir, if everything matches up we can consider.

[9/29, 10:51 PM] Prof.Satyendra Narayan Ojha Sir।:

 Suptam is followed by stimita indicates the presence of heart failure

[9/29, 10:51 PM] Prof.Satyendra Narayan Ojha Sir।:

 Right dear

[9/29, 10:51 PM] Vd Raghuram Shastri ,Banguluru: 

Thanks Pavan sir🙏

[9/29, 10:51 PM] Prof.Satyendra Narayan Ojha Sir।:

 Thanks Dr Abhijit Patil my young cardiologist

[9/29, 10:51 PM] Vd Raghuram Shastri ,Banguluru: 

Wow... Great interpretation sir🙏

[9/29, 10:52 PM] Prof.Satyendra Narayan Ojha Sir।:

 Sequential presentation of features help in understanding of underlying pathology

[9/29, 10:54 PM] Prof.Satyendra Narayan Ojha Sir।: 

Calcified pericardium (seen in echocardiogram study ) ⬅️अश्मावृत ➡️ कफज हृदय रोग

[9/29, 10:54 PM] Dr. Abhijeet Patil: What 

about collateral channels sir 🙏🏼

[9/29, 10:55 PM] Vd Raghuram Shastri ,Banguluru: 

And we are learning these things from your guidance sir🙏🙏

We often miss the sequence and chronology. This makes us to read each symptom in a complex or syndrome explained in Ayurveda separately. This is the samprapti of wrong understanding and misinterpretation.

[9/29, 10:56 PM] Prof.Satyendra Narayan Ojha Sir।: य

दि हम ५०-१०० बार चरक संहिता पढते हैं और ५०-१०० बार Harrison' internal medicine , बात बनेगी , फिर जो बोलेगें , वही करेगें भी..

[9/29, 10:57 PM] Prof.Satyendra Narayan Ojha Sir।:

about collateral channels sir 🙏🏼

 फिर कभी , प्रिय शिष्य.

[9/29, 10:58 PM] Dr. Abhijeet Patil: Ok sir 🙏🏼

[9/29, 11:00 PM] Prof.Satyendra Narayan Ojha Sir।:

 जब मैं अन्तिम वर्ष में था (BAMS) ८ बार Davidson's medicine पढी थी और‌  १२ बार चरक संहिता..

[9/29, 11:03 PM] Dr.Santanu Das: 

Sir bradycardia ....mein vyan  vayu ki  manda gati samjhe...where ECG / TG / cholesterol normal/ BP normal but bradycardia......which drug to be choose here🙏

[9/29, 11:07 PM] Dr. Pavan mali Sir, Delhi: 

💐💐💐👏🏻👏🏻❤️❤️ Tussi great ho sirji......very few persons are having command on both ...you have elaborated concept very nicely today...moreover you have typed and collected a marvelous presentation of seventeen pages on such a important but neglected topic by ayurveda fraternity...thanks  a lot for providing inputs regarding various queries by kaay sampraday members..now you should take rest sir...you are continuously working very hard on various front...Dhanwantari aapako lambi aur swasth ayu pradaan kare....taaki aanewale Naye generation ko aapke anubhav milate rahe...🙏🏻🙏🏻🙏🏻

[9/29, 11:08 PM] Prof.Satyendra Narayan Ojha Sir।: 

Goodman Gilman pharmacology & भावप्रकाश  निघण्टु , आचार्य प्रियव्रत शर्मा की द्रव्यगुण विज्ञान और Lauren's pharmacology भी..

[9/29, 11:08 PM] Prof.Satyendra Narayan Ojha Sir।:

 रास्ना अगुरु कुष्ठ पुष्करमूल चित्रक वचा प्रभृत द्रव्य

[9/29, 11:09 PM] Prof.Satyendra Narayan Ojha Sir।:

 Reason of bradycardia is mandatory in selecting drugs

[9/29, 11:09 PM] Prof.Satyendra Narayan Ojha Sir।: 

Athletes have bradycardia normally

[9/29, 11:11 PM] Prof.Satyendra Narayan Ojha Sir।: 

*धन्यवाद सांगलीकर*

*शुभ रात्रि पवन भाई, वैद्यराज सुभाष शर्मा जी एवं आचार्य गण*

[9/29, 11:11 PM] Dr. Abhijeet Patil:

 Good night sir 💐💐

[9/29, 11:11 PM] Prof.Satyendra Narayan Ojha Sir।: 

शुभ रात्रि पाटील सरकार

[9/29, 11:11 PM] Dr.Santanu Das:

Yes true sir ... normally I found more in Athletes......I used to prescribe Rasna kwatha

[9/29, 11:12 PM] Prof.Satyendra Narayan Ojha Sir।: 

Ok.

[9/29, 11:13 PM] Prof.Satyendra Narayan Ojha Sir।: 

In my life , you know , the importance of teaching and importance of my students..

[9/29, 11:13 PM] Vd. Atul J. Kale M.D. (K.C.) G.A.U.:

 Sir you are really great. Its not such a easy task to give the answers of questions without breath. You arrrreee so genius. 🌹🌹👏🏻👏🏻🙏🏻🙏🏻🙏🏻

[9/29, 11:14 PM] Prof.Satyendra Narayan Ojha Sir।: 

I love you all ❤️

[9/29, 11:14 PM] Dr.Ashwani Kumar Sood Ambala: 

बहुत ही ज्ञावर्धक बातें कही आपने

[9/29, 11:15 PM] वैध आशीष कुमार: 

गुरुदेव आपके कठिन परिश्रम द्वारा प्राप्त अनुभव को आप हम सबको पुनः इतनी मेहनत करके हम सबके लिये पहुँचा रहे हो,आपको कोटि कोटि वंदन,चरण स्पर्श🙏🏻💓🕉🙂🙏🏻

[9/29, 11:15 PM] Prof.Satyendra Narayan Ojha Sir।:

 Dr.Ashwani ji

आपकी सहृदयता है.. 🙏🙏

[9/29, 11:16 PM] Vaidyaraj Subhash Sharma Sir Delhi:

 *आज तो ओझा सर को पढ़कर मन कर रहा है बस पढ़ते ही रहे 🙏💐🌺🌹🙏*

[9/29, 11:16 PM] Dr. Pavan mali Sir, Delhi: 

I am lucky to  have a experience of teaching under your dept at ganga college in 2005..and still learning through sampraday now and ayurvedpeeth before🙏🏻🙏🏻

[9/29, 11:17 PM] Prof.Satyendra Narayan Ojha Sir।: 

आप सभी हमारे प्रिय है. 

वैद्यराज सुभाष शर्मा जी से मैं सहमत हूं की हम सभी को अपनी अपनी जिम्मेदारी निभानी चाहिए

[9/29, 11:17 PM] Prof.Satyendra Narayan Ojha Sir।: 

🙏🙏

[9/29, 11:17 PM] Dr.Amol Kamble : 

Aprox 42 days continue lecture on ECG in final year by Dear Ojha sir are always special in my life...

Will never forget ...

Always love n respect sir...!!!

🙌🏻🙌🏻🙌🏻

[9/29, 11:18 PM] Prof.Satyendra Narayan Ojha Sir।: 

We both are lucky..☺️☺️

[9/29, 11:18 PM] Prof.Satyendra Narayan Ojha Sir।: 

Amol , you are precious boy . Love you dear..

[9/29, 11:19 PM] Prof.Satyendra Narayan Ojha Sir।: 

2007..

[9/29, 11:19 PM] Vd. Atul J. Kale M.D. (K.C.) G.A.U.: 

सर आपकी सोच ही सर्वसमावेशक है। आप कृतकृत्य है  और रहेंगे भी।

[9/29, 11:19 PM] Prof.Satyendra Narayan Ojha Sir।: 

🌹🌹☺️☺️

[9/29, 11:20 PM] Prof.Satyendra Narayan Ojha Sir।: 

That time , we had a discussion on विकार विघात भाव / अभाव ..

[9/29, 11:22 PM] Dr. Pavan mali Sir, Delhi: 

Pranaam gurudev..you have uplifted kaay sampraday to such a level that...everyone has started to find applied and clinical view...and boosted confidence through various case presentation which is unique speciality....Ashvino dvaya of kaaysampraday.... oza sir and subhash sir...dandavat pranaam 🙏🏻🙏🏻🙏🏻🙏🏻

[9/29, 11:24 PM] Prof.Satyendra Narayan Ojha Sir।:

 Okay , thanks Dr Pawan Mali ( PM) for initiating the discussion on hridaya roga.. you are genius.. keep it up..

Good night to all of you. 

Tomorrow , I have to go to Sindhudurg in morning.. bye for now..

[9/29, 11:24 PM] Prof.Satyendra Narayan Ojha Sir।: 

God bless you all my dearest..

[9/29, 11:26 PM] Dr. Pavan mali Sir, Delhi: Good night sir.

.🙏🏻🙏🏻

[9/29, 11:39 PM] Vaidyaraj Subhash Sharma Sir Delhi:

 *नमस्कार डॉ पवन माली जी, ये आप सब का स्नेह है जो ओझा सर और मुझे निस्वार्थ भाव से काय सम्प्रदाय में अपना योगदान देने के लिये प्रेरित करता है।*

             🙏🌺💐🌹

[9/29, 11:44 PM] Dr. Pavan mali Sir, Delhi: 

🙏🏻🙏🏻 Aap dono aaj ke generation ke liye Aaapt hai...jo niswarha bhaav se ..sab dyaan apane logo ko dete hai..Shubh raatri💐💐

[9/29, 11:47 PM] Vaidyaraj Subhash Sharma Sir Delhi:

 *शुभ रात्रि ओझा सर एवं सभी विद्वानों को।* 💐🌹🌺🙏

***************************************************************************************

Above discussion held on 'Kaysampraday" a Famous WhatsApp -discussion-group  of  well known Vaidyas from all over the India. 

******************************************************************************

Compiled & Uploaded by

Vd. Rituraj Verma

B. A. M. S.

ShrDadaji Ayurveda & Panchakarma Center,

Khandawa, M.P., India.

Mobile No.:-

 +91 9669793990,

+91 9617617746

Edited by

Dr.Surendra A. Soni

M.D.,PhD (KC) 

Professor & Head

P.G. DEPT. OF KAYACHIKITSA

Govt. Akhandanand Ayurveda College

Ahmedabad, GUJARAT, India.

Email: surendraasoni@gmail.com

Mobile No. +91 9408441150