Review-article: “EVALUATION OF TRIPHALA KWATH BHAVITA AMALAKI CHURNA/RASAYAN IN THE MANAGEMENT OF HYPERTENSION : A CLINICAL STUDY "
“EVALUATION OF TRIPHALA-KWATH-BHAVITA AMALAKI-CHURNA/RASAYAN IN THE MANAGEMENT OF HYPERTENSION: A CLINICAL STUDY"
*Dr. Nishita R. Limbachia
**Prof. Surendra A. Soni
---------------------------------------------------------------------------------------------------------------
ABSTRACT
Hypertension,
a pervasive lifestyle disorder, remains a significant public health challenge
globally, particularly in rural India, due to low awareness and management.
This study explores the Ayurvedic perspective of hypertension as a
manifestation of Tridosha imbalance, specifically focusing on Pitta
and Rakta. It investigates the efficacy of Triphalakwath Bhavit
Amalaki Churna, a Rasayana (rejuvenative therapy), in managing
hypertension. Conducted as an open-label randomized comparative clinical trial,
the study involved 60 patients divided into two groups: Group A, treated with
the Ayurvedic formulation, and Group B, receiving standard modern
antihypertensive protocols.Results revealed that both groups experienced
significant reductions in systolic and diastolic blood pressure, with Group A
showing superior improvements in related symptoms such as headache, insomnia,
and chest discomfort. Additionally, Group A demonstrated enhanced metabolic
health and overall well-being, emphasizing the holistic benefits of the
Ayurvedic approach. These findings suggest that Triphalakwath Bhavit Amalaki
Churna is a safe, economical, and effective alternative to conventional
antihypertensive therapies, aligning with Ayurvedic principles of treating root
causes and promoting systemic balance. Further research is warranted to expand
its clinical applications and elucidate its mechanisms.
Keywords:
Hypertension,
Ayurveda, Rasayana, Triphalakwath Bhavit Amalaki Churna, Pitta dosha,
Raktadhatu, lifestyle disorders, holistic management, alternative medicine,
blood pressure control, clinical trial.
---------------------------------------------------------------------------------------------------------------
INTRODUCTION:
Ayurveda, one of the
oldest systems of medicine, provides a holistic approach to health and disease
management by focusing on the balance of body, mind, and spirit. It aims to
maintain the health of a healthy individual and cure diseases in the afflicted.
In the modern world, lifestyle disorders like hypertension have become a
significant health concern due to rapid industrialization, fast-paced living,
and unhealthy habits. Hypertension, often termed the "silent killer,"
is a chronic condition affecting about 29.8% of the Indian population. Despite
its prevalence, awareness and effective management remain low, particularly in
rural areas. It is a major risk factor for severe complications such as
cardiovascular diseases, stroke, and renal failure.
Ayurveda does not have a
direct reference to hypertension, but the disease can be understood through its
principles and treated based on the concept of Tridoshas—Vata, Pitta, and
Kapha. Hypertension can be correlated with conditions like Raktapradoshaja
Vyadhi, where the imbalance of Pitta and vitiation of Rakta play a
central role in its pathogenesis. The symptoms described in Vidhishonitiya
Adhyaya,[i]
such as headache (Shirahshoola), giddiness (Bhrama), palpitation
(Hriddravatva), and insomnia (Anidra), align with the clinical
features of hypertension.
Modern treatments for
hypertension often involve lifelong medication, which may lead to side effects
and financial burden. This calls for alternative approaches that are effective,
safe, and affordable. Ayurveda offers Rasayana therapies that rejuvenate
the body and prevent aging while addressing disease at its root. This study
focuses on the use of Triphalakwath bhavit Amalaki Churna, a combination
of two powerful Rasayanas, to manage hypertension by pacifying
aggravated Pitta, purifying the blood, and promoting overall well-being. By
aligning with classical Ayurvedic principles, this research aims to offer a
holistic, side-effect-free solution for hypertension management.
UNDERSTANDING THE
PATHOGENESIS OF HYPERTENSION AS PER AYURVEDA :
Hypertension, though not
directly described in Ayurvedic texts, can be understood through the principles
of Tridosha (Vata, Pitta, Kapha) and their impact on Raktadhatu
(blood). Different etiological factors contribute to the pathogenesis,
categorized as follows:
1.
RAKTADUSTIJANYA
HYPERTENSION:
Excessive intake of Ushna
(hot), Tikshna (sharp), and Vidahi (irritant) foods
aggravates Pitta, which vitiates Rakta, increasing blood volume and
pressure. This can lead to vascular overload, fluid retention, and activation
of the renin-angiotensin-aldosterone system (RAAS), resembling hypertension
symptoms and complications like edema and vascular resistance.
2.
SANTARPANJANYA
HYPERTENSION:
Over-nourishment from
calorie-dense, lipid-rich foods combined with sedentary habits leads to Meda
(fat) accumulation and Rasavaha Srotas (circulatory channels)
obstruction. This mirrors modern conditions like atherosclerosis, causing
hypertension due to excessive cardiac workload.
3.
APATARPANJANYA
HYPERTENSION:
Under-nourishment from Ruksha
(dry) and Laghu (light) diets, coupled with excessive physical or mental
strain, causes Vata aggravation. This results in hardening and narrowing
of blood vessels (similar to arteriosclerosis), increasing vascular resistance
and blood pressure.
4.
STRESS-INDUCED HYPERTENSION:
Emotional stress leads to hormonal changes, triggering Vyanavata imbalance,
which disrupts heart function. Stress-related Vata vitiation and
suppression of natural urges (Udavarta) contribute to hypertension's
onset and complications.
5.
UDAVARTA-JANYA
HYPERTENSION:
Excessive
intake of Ruksha (dry), Kashaya (astringent), Katu (pungent), and
Tikta (bitter) foods, along with suppression of natural urges (Vegadharana)
and fasting (Upavasa), leads to the aggravation of Apana Vata in
the Pakwashaya (lower abdomen). This results in obstruction of Adhovaha
Srotasa (downward channels), disrupting the flow of Vata, Mutra
(urine), and Purisha (stool). This obstruction causes periluminal
congestion, particularly in the portal and splenic systems, leading to reduced
renal blood flow (renal ischemia). This activates the
renin-angiotensin-aldosterone system (RAAS), which increases vasoconstriction,
sodium retention, and blood volume. These factors collectively result in
hypertension.
6.
VARDHAKYA JANITA HYPERTENSION:
Aging causes
physiological Vata aggravation, leading to arterial rigidity and reduced
elasticity. Poor Dhatu nourishment narrows arterial lumens, increasing vascular
resistance and blood pressure, aligning with modern aging-related hypertension
theories.
These Ayurvedic
perspectives offer insights into hypertension's multifactorial etiology,
guiding holistic management strategies. This study focuses on addressing Raktadusti
using Triphalakwath bhavit Amalaki Churna, a Rasayana remedy, for safe
and effective blood pressure control.
AIM & OBJECTIVES:
·
To
evaluate the role of Triphalakwath bhavit Amalaki Churna (Rasayana) in
the management of hypertension.
·
To
analyze hypertension in the context of Ayurveda, interpreting the disease based
on Ayurvedic principles and terminology.
·
To
identify and establish an economical, safe, and effective Ayurvedic remedy for
hypertension, contributing to clinical research and addressing a significant
societal health concern.
MATERIAL
AND METHODS:
STUDY DESIGN: An open Label Randomized Comparative -
Clinical Trial
CLINICAL MATERIALS: A comprehensive research proforma was
developed to evaluate the therapeutic outcomes using an appropriate grading
system. Patients were selected from the OPD and IPD of Govt. Akhandanand
Ayurveda Hospital, Ahmedabad; Smt. Maniben Amrutlal Hargovandas Sarkari
Ayurvedic Hospital, Asarva, Ahmedabad; and the Department of Medicine OPD,
Civil Hospital, Ahmedabad.
INTERVENTION IN BOTH
GROUP:
GROUP – A:
In this group ‘Triphlakwath
bhavit Amlaki Churna (Amalaki churna processed in Triphala kwath 7
times) was given in increasing and decreasing dose (Aarohi-Avarohi krama). Dose was started from 2gm twice a day. The
total course was completed in 40 days followed by 3 weeks of follow up.
GROUP – B:
30 registered patients
undergoing treatment according to the standard modern protocol were observed.
ASSESSMENT CRITERIA:
1. OBJECTIVE CRITERIA:
The results were assessed based on the monitoring of blood pressure
before and after treatment. O.P.D. patients were reviewed each week and
instructed to record their blood pressure every day throughout the treatment
period. The assessment criteria available in full article.
INCLUSION CRITERIA:
The study included male and female patients aged between 18 and 70 years,
presenting with elevated blood pressure and associated clinical symptoms as
described in Ayurveda and modern medical science. Patients were categorized
based on their blood pressure levels: pre-hypertensive (systolic 120-140 mmHg,
diastolic 80-90 mmHg), stage 1 hypertension (systolic 140-160 mmHg, diastolic
90-100 mmHg), stage 2 hypertension (systolic >160 mmHg, diastolic >100
mmHg), and stage 3 hypertension (systolic >180 mmHg, diastolic >110
mmHg). This comprehensive inclusion criterion ensured the systematic evaluation
of hypertension across different severity levels.
EXCLUSION CRITERIA:
Patients below 18 years and above 70 years were excluded from the study, along
with those presenting with inflammatory conditions or systemic disorders such
as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
Individuals with Apatarpana (severe emaciation) or Atikarshan
conditions, chronic alcoholics, and chronic smokers were also excluded.
Additionally, patients suffering from severe systemic illnesses such as
leukemia, chronic kidney disease, cirrhosis of the liver, myocardial
infarction, or malignancies were not considered. Cases of severe hypertension,
with systolic blood pressure exceeding 200 mmHg or diastolic pressure above 120
mmHg, were similarly excluded from the study.
Approval
by Institutional Ethical Committee:
The
study was conducted following ethical approval from the Institutional Ethical
Committee of Government Akhandanand Ayurveda College and Hospital, Ahmedabad,
under certificate number 179, dated 16/01/2023, and was registered with the
Clinical Trials Registry of India (CTRI) under registration number
CTRI/2023/06/054546.
OBSERVATION
& RESULTS:
In
this study, the effectiveness of two treatments was assessed using various
statistical analyses. The Wilcoxon Rank Sum Test was applied to analyze
subjective parameters within a group, while the Student’s Paired ‘t’ Test was
used for objective parameters. The study included 60 patients, divided into two
groups (A and B) of 30 each. Both groups showed significant reductions in
systolic and diastolic blood pressure after treatment, with Group A showing a
slightly higher percentage of relief in diastolic pressure. Regarding symptom
severity, Group A consistently demonstrated greater improvements across various
symptoms compared to Group B, with statistical significance in many cases (p
< 0.001 or p < 0.01). Notably, Group A showed complete relief in symptoms
like Hridadravata and Daurbalya, while Group B exhibited more
modest improvements. Comparative analyses using the Mann Whitney U Test showed
significant differences in certain symptoms, such as Shirahshoola and Anidra,
between the two treatments. However, no significant differences were found for Bhrama,
Hridadravata, and Krodhaprachurya. In terms of overall therapeutic
responses, 70% of patients in Group A were successfully treated, while only
6.66% in Group B achieved similar outcomes, indicating a higher efficacy of the
treatment in Group A. However, no significant differences were observed in the
impact on blood pressure between the two groups, suggesting that both
treatments have similar effects on this parameter.
EFFECT OF GROUP A ON BLOOD PRESSURE
OF 30 PATIENTS (PAIRED T TEST)
|
VERIABLE |
No. OF
PATIENTS
|
MEAN |
SD |
SE |
% |
“t” |
P |
S |
||
|
BT |
AT |
DIFF |
||||||||
|
SYSTOLOIC BP |
30 |
1.43 |
0.36 |
1.07 |
0.58 |
0.10 |
74.42 |
10 |
<0.001 |
HS |
|
DIASTOLIC BP |
30 |
1.73 |
0.6 |
1.13 |
0.77 |
0.14 |
65.38 |
7.99 |
<0.001 |
HS |
EFFECT OF GROUP B ON BLOOD PRESSURE
OF 30 PATIENTS (PAIRED T TEST)
|
VERIABLE |
NO. OF PATIENTS
|
MEAN |
SD |
SE |
% |
“t” |
P |
S |
||
|
BT |
AT |
DIFF |
||||||||
|
SYSTOLOIC
BP |
30 |
1.56 |
0.4 |
1.16 |
0.59 |
0.108 |
74.46 |
10.8 |
<0.001 |
HS |
|
DIASTOLIC
BP |
30 |
1.76 |
0.66 |
1.1 |
0.75 |
0.139 |
62.26 |
7.93 |
<0.001 |
HS |
SHOWING EFFECT OF
THERAPY ON INTER GROUP COMPARISON OF
BLOOD PRESSURE (UNPAIRED T TEST)
|
VARIABLE |
GROUP |
MEAN
DIFF. |
% OF RELIEF |
SD± |
SE± |
T |
P |
S |
|
SYSTOLIC BP |
A |
1.07 |
74.41 |
0.583 |
0.106 |
0.659 |
>0.05 |
NS |
|
B
|
1.16 |
74.46 |
0.592 |
0.108 |
||||
|
DIASTOLIC BP |
A
|
1.13 |
65.38 |
0.776 |
0.141 |
0.168 |
>0.05 |
NS |
|
B
|
1.1 |
62.26 |
0.758 |
0.138 |
SHOWING EFFECT OF
THERAPY ON INTER GROUP COMPARISON OF
SUBJECTIVE PARAMETERS (MANN WHITNEY U TEST)
|
VARIABLE |
GROUP |
MEAN DIFF. |
% OF RELIEF |
SD± |
SE± |
U |
P |
S |
|
SHIRASHOOLA
|
A |
1.43 |
79.62 |
0.858 |
0.156 |
309 |
<0.05 |
S |
|
B |
0.97 |
50 |
0.718 |
0.131 |
||||
|
BHRAMA |
A |
0.46 |
93.33 |
0.681 |
0.124 |
406 |
>0.05 |
NS |
|
B |
0.3 |
47.36 |
0.466 |
0.085 |
||||
|
HRIDADRAVATA |
A |
0.66 |
100 |
0.844 |
0.154 |
340 |
>0.05 |
NS |
|
B |
0.26 |
47.05 |
0.449 |
0.082 |
||||
|
ANIDRA |
A |
1.13 |
94.44 |
1.136 |
0.207 |
274 |
<0.01 |
VS |
|
B |
0.4 |
40 |
0.563 |
0.102 |
||||
|
AYASJANYA
SWASKASTATA |
A |
0.6 |
85 |
0.723 |
0.132 |
305 |
<0.05 |
S |
|
B |
0.16 |
31.25 |
0.379 |
0.069 |
||||
|
KRODHA
PRACHURYA |
A |
0.67 |
90.9 |
0.994 |
0.181 |
374 |
>0.05 |
NS |
|
B |
0.3 |
37.5 |
0.534 |
0.097 |
||||
|
DAURBALYA |
A |
1.13 |
94.44 |
0.922 |
0.168 |
173 |
<0.001 |
HS |
|
B |
0.13 |
10.5 |
0.345 |
0.063 |
||||
|
KLAMA
|
A |
0.97 |
93.54 |
0.964 |
0.176 |
211 |
<0.001 |
HS |
|
B
|
0.13 |
14.8 |
0.345 |
0.063 |
DISCUSSION:
The
study highlights the relationship between Ayurvedic principles and
hypertension, with a significant prevalence of Vishamagni (46.66%),
indicating digestive imbalances linked to stress and poor dietary habits. Most
hypertensive patients exhibited Krura Kostha (40%), suggesting dominance
of Vata dosha affecting digestion, while Pitta dosha was notably
prominent in individuals with Pitta-Kapha Prakriti (38.33%) and Rakta
Sara (46.67%), both contributing to hypertension through factors like excessive
heat sensitivity and an active circulatory system. Additionally, psychological
stress and unhealthy behaviors were linked to elevated blood pressure, with 65%
of patients exhibiting Rajasika Manasaprakriti and 35% showing Tamasika
tendencies. Poor physical activity (61.67%) and unbalanced diets, including
excessive salty, sour, and oily foods, were significant lifestyle contributors.
Raktavaha and Rasavaha srotodusti (85% and 83.33%) further
reflected disruptions in blood and circulation, and symptoms like Shirahshoola
(78.33%) and Daurbalya (71.67%) correlated with Pitta and Rakta
imbalance. The study also revealed that 50% of patients had stage 1 and 2
hypertension, underscoring the need for a holistic management approach
addressing lifestyle and dosha imbalances.
Moreover,
the study compared the effects of Ayurvedic herbal therapy (Group A) and
conventional allopathic treatment (Group B) on hypertension and related
clinical features. Both groups showed significant reductions in systolic and
diastolic blood pressure, but Group A demonstrated superior outcomes. Patients
in Group A achieved higher relief rates for symptoms like Shirahshool
(headache), Hridadravata (chest pain), and Anidra (insomnia),
with notable improvements in hemoglobin levels, serum cholesterol, blood sugar,
and body weight. Group A's treatment, enhanced by the Rasayana effects
of Triphala and Amalaki, promoted overall well-being, improved
metabolism, and offered rejuvenating benefits. In contrast, Group B, which
received a combination of antihypertensive drugs, showed modest improvement,
particularly in blood pressure, but lacked the broader health benefits observed
in Group A. The overall success rate was higher in Group A (70%) compared to
Group B (6.66%), indicating the superior efficacy of the Ayurvedic approach in
not only managing hypertension but also improving patients' general health.
PROBABLE
MODE OF ACTION OF DRUG:
As
per the principle of Ayurveda selected herbal formulation enriched with ‘आमलकं वयःस्थापनानां’[ii]; ‘हरीतकीपथ्यानाम्’[iii]; ‘त्रिफलात्रिदोषशमनानाम्’; acted collectively on
“Srotomaypurush”(entire human body) by expelling the causative Doshas
(Pitta and Kleda), thereby restoring balance and establishing the
purity of Raktadhatu. This aligns with the fundamental principles of
Ayurveda, which emphasize holistic health, balance, and the interconnectedness
of bodily systems.
Upon
deeper analysis, it becomes evident that the ‘Shad Upakramas’[iv]
primarily represent physiological states. This concept is distinct from the ‘Dashavidha
Atura Pariksha’ which evaluates the patient through subjective parameters.
The Shad-Upakramas are therapeutic applications systematically derived
from the insights gained through Dashavidha Atura Pariksha. They do not
merely reflect physiological conditions but also serve as targeted
interventions for restoring homeostasis. These Upakramas are divided
into two opposing categories: Santarpana (Nourishing therapies) and Aptarpana
(Depleting therapies), with three interventions in each group, designed to
counterbalance each other and maintain the body's equilibrium.[v]
Based
on the above concepts, all diseases can be classified into Santarpaniya
(over-nourishment) and Aptarpaniya (under-nourishment) categories.
Similarly, hypertension can also be divided into these two types. The Santarpaniya
type is associated with Brimhana (excessive nourishment) and Ati-Swedana
(excessive sweating). The recommended therapeutic interventions for this
condition are Langhana and Stambhana.
In
the current clinical trial, most patients were categorized under the Santarpaniya
type of hypertension, indicating a need for therapies that reduce excess
nourishment and stabilize bodily functions. The trial drug exhibited
predominant Langhana and Stambhana effects, helping to regulate
blood pressure by promoting Langhana and Stambhana effect with an
additional advantage of ‘Sara Guna’ of Amalaki who exserted the
purgation effect.
This
dual action of trial drug Langhana and Stambhana demonstrated a
comprehensive approach to managing hypertension, aligning with Ayurvedic
principles of treating both the root cause and symptoms effectively.
Dashvidh-atur-pariksha
|
|
|
Shadupakram
|
|
Sharirik-sthiti-----------------------Chikitsopakram
(Physiological-condition) (Therapeutic-interventions)
Kayachikitsa (internal medicine) is
regarded as the most important and supreme branch of Ayurveda. It emphasizes
the pivotal role of the Mahasrotas (gastrointestinal tract) in the
pathogenesis of all diseases. The word 'Kaya' signifies Agni,
specifically Kayagni or the digestive fire, which governs metabolic
processes and physiological functions throughout the body.
All
key regulatory systems of the human body—such as the
Renin-Angiotensin-Aldosterone System (RAAS), the autonomic nervous system,
vascular endothelial function, and volume regulation—are intricately linked to
the Mahasrotas and influenced by the quality and quantity of the food
consumed. The state of health is largely dependent on the proper functioning of
the digestive system and the nourishment it provides. Ignoring this fundamental
principle while focusing on selective pharmacological interventions may offer
quick symptomatic relief but fails to address the root cause of the disease.
The
Shad Upakramas (six therapeutic principles) described in Ayurveda
reflect the specific conditions of the GIT and appropriate dietary practices.
Therefore, the Ayurvedic approach is both holistic and selective by targeting
the patient’s unique constitution and disease status. This is achieved through
a personalized treatment strategy based on the principles of Dashavidha
Atura Pariksha and Shad Upakramas ensuring a sustainable resolution
of imbalances and restoration of health.
In
line with traditional Ayurvedic concepts, our study suggests that similar to
how Prameha is categorized into two types, Hypertension can also be
classified into two primary categories:
1.
Santarpaniya (over-nourishment)
2.
Aptarpaniya (under-nourishment)
Our
clinical study focused on hypertension, with findings indicating that the drug
demonstrates significant efficacy in patients with Santarpaniya
hypertension particularly in individuals who are overweight, exhibit pitta
dominancy, and possess Raktasarata. In contrast, the drug was found to
be ineffective for patients with Aptarpaniya hypertension, who tend to
be lean and present with Vata prakriti. Since Vata dominant
patients often require therapies aimed at replenishment and nourishment, this
formulation may not be suitable for their constitution or pathology. The
formulation not only regulates blood pressure but also addresses underlying
imbalances of Doshas, particularly those involving Pitta Dosha
associated with excess weight. Moreover, it improves metabolic parameters,
contributing to enhanced overall health and better quality of life. These
findings highlight the importance of conducting further research to deepen our
understanding of the drug’s mechanisms and explore its potential for broader
clinical applications.
The
results of this study indicate that the proposed formulation (Triphlakwath
Bhavit Amalaki Churna) demonstrates superior efficacy compared to standard
modern antihypertensive medications. This is evidenced by its ability not only
to reduce blood pressure but also to improve patient’s overall quality of life.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Above article has been published in 'Journal of emerging technologies & innovative research(JETIR)www.jetir.org
Article Link-
https://www.jetir.org/papers/JETIR2502006.pdf
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Presented by
Dr. Nishita R. Limbachia
3RD YEAR PG SCHOLAR,
P. G. KAYACHIKITSA DEPARTMENT ,
GOVERNMENT AKHANDANAND AYURVED COLLEGE & HOSPITAL ,
BHADRA, AHMEDABAD, GUJARAT 380001
Email: nishulimbachiya33@gmail.com
Guided by
Prof. Surendra A. Soni
H.O.D.,
P. G. DEPARTMENT OF KAYACHIKITSA,
GOVERNMENT AKHANDANAND AYURVEDA COLLEGE & HOSPITAL,
BHADRA, AHMEDABAD, GUJARAT 380001
Email: kayachikitsagau@gmail.com
Comments
Post a Comment