HRIDROGA and CARDIAC DISEASES

HRIDROGA and CARDIAC DISEASES

Prof.Dr.Dattatraya L.Shinde MD; PhD

Department Of Kayachikitsa ,Bharati Vidyapeeth University,College Of Ayurved , Katraj-Dhanakwadi , Pune -43 (MS),Cell No. -9890111954, Email- dshinde249@gmail.com

            Hridaya (Heart) is the organ constituted with Mansapeshi (Mansadhatu). During foetal development it is formed by the  end products (prasadbhav) of Rakta and Kapha dosha. Hridaya is like a downward held Lotus ( adhomukhakamal) located in the Ura (Thoracic cavity) in between the two breasts (stana) slightly towards left side near the opening of the stomach( Aamashaya). Rasa, Rakta, Ojas are the elements (dhatus) which give nutrition and  nourish the  whole body are circulated  and supplied by the Hridaya. Satwa, Raja, Tama these manasik bhava, Chaitnya, vishaygrahan samarthya are associated with Hridaya and it is the basic controlling center of the whole body.

            Rasa, Rakta are circulated by Vyan vayu which is located in the hridaya. It does the contractions and relaxation of the cardiac muscles and hence the rasa,rakta are circulated throughout the body. By the closure of Atrioventricular and semilunar valves different kinds of heart –sounds are heard. The  final end product of digestion and rakta that keeps the life alive to give nutrition and nourishment is circulated throughout the body. This rasa and rakta for the purpose mentioned earlier through blood vessels goes to the whole body and again returns back to the heart  and again the circle continues. Ayurved has described this kind of function and  activity as “Parivruttistu Chakravat”.

Hridayasta Bhavvishesha (Important and Influencing Constituent factors associated with the HRIDAYA)

            Along with anatomical features and physiology of the Heart and Cardiovascular System different important and influencing constituent factors are necessary and important in the study of Hridrogas (cardiac diseases).

            Hridaya constitutes of Mansadhatu, Rasadhatu which  nourishes the whole body. Rakta which is circulating along with Rasadhatu, Ashtabindu  Oja which is very essential and vital for life. Shuddha, prakrita, kapha swarup Ardhanjali Oja which gives complexion, varna, kanti, bala and Utsah, karyakshamata, Avalambak kapha, sadhak pitta, Prana Vyan Udan vayu are associated with Hridaya. Along with it, Hridaya is moolsthana of rasavaha and pranavaha strotas. Hence these are to be considered in association with cardiac diseases.

A) Ojas

The most important part of all dhatus. It is located in the hridaya and also present all over the body. It is viscus, clear and slight reddish yellow in colour. By its presence, life is survived and by its loss it results in loss of life.

            Oja decreases in quantity by anger, hunger, worries, grief, over exertion etc. With it person becomes discontented, debilitated, worries frequently irrespective of the reasons, feels discomfort in the sense organs, bad complexion & dryness.

            Ojas is the refined end product of digestion, metabolism, absorption and assimilation. The substance that connects the mind to the body and consciousness, it is a wholesome biochemical substance that nourishes all body tissues and has a direct influence on the nature and quality of physical, mental and emotional life which is snigdha, sheeta, shuddha  in nature, raktapitta varna and  when in deficient of oja  results in weakness, fatigue and  leading to pathogenesis of diseases and ultimately death.

Oja is responsible for the longevity of life, nourishing mana and other dhatus,  normal physiological functions, clarity and purity of thoughts,happiness, well being of mind and for higher states of consciousness, intelligence, normal functions of sensory organs and motor functions.

            There are different aetiological factors responsible in the pathogenesis of oja

1) Aghat- sharirik,mansik

2) Dhatukshaya

3) Krodha –anger

4) Santaap – doshaprakop- vitiation of doshas

5) Shoka

6) Chinta-stress

7) Shrama- overexertion

8) Langhan- excess fast

9) Apatrpan- malnutrition

This pathogenesis with the oja is of three types.

Ojovikriti

1)  OjoVisransa – oja distorts from its own place.

2) Ojo Vyapat- in associating with vitiated doshas becomes vitiated itself

3) Ojakshaya-  deficient in quantity

OjoVisransa -  laxity in the joints,fatigue ,dosha distorts from its own places, weakness, difficulilty in doing day to day activities and physiological functions are lessened.

Ojo Vyapat-  stiffness in the body and different organs of the body,numbness, slowness in the activities,discoloration,edema,fatigue, laziness and  excess sleep.

Ojakshaya- somnolence, stupor, emaciation, disturbed mental functions and behavioral disorders , altered sensorium.

            Along with this the symptoms and signs mentioned in OjoVisransa and Ojo Vyapat are seen in Ojakshaya and finally results in the death.

             

B) Avlambak Kapha

            Avlambak  kapha is located in chest and trika (the meeting  place of shoulder, neck and back) by its own power and by the power of the rasa (the essence of food) present in the hridaya. It gives strength to the seats of other kapha, hence called avalambak kapha.

            Whatever the qualities of Oja are mentioned are nothing but they are of  avlambak kapha.The energy ,virya, bala of  avlambak kapha is nothing but it is Oja Bala. As agni protects the body by pachak pitta likely Oja (soma) along with and by avlambak kapha protects the body.

C) Sadhaka Pitta

            It is located in the pakvasaya and amasaya. Though it  is composed of panchamahabhutas having predominant qualities of teja bhuta, it is lacking  liquidity ,sita  and other properties of aap mahabhuta. The pitta located in the hridaya is known as sadhaka  because it serves the mental functions such as buddhi, medha, abhimaan  thereby helping the purposes of life.

D) Vyan vayu

            Vyana is located in the heart, moves all over the body, does the functions such as walking, bringing the body parts downwards, lifting the body parts upward, opening and closing of the eyes, walking & all musculoskeletal activities. Any pathogenesis occurring with the vyan vayu results in different kinds of diseases.

Definition of Hrudroga

There are many kinds of pathological changes in the organ hridaya and then symptoms of hridroga are seen. Hence, the disease is called hridroga. Hrudaya as being a marma is very difficult to treat.

Hridroga are of 5 types viz.

Vataj, Pittaj, Kaphaj, Sannipatik, Krumij

Hetu

1.      Vyayam

2.      Vega vidharan

3.      Shodan lekhan   

4.      Aghaat

5.      Tikshna basti, tikshna virechana (excessive panchakarma therapy)

6.      Ati guru, ati snigha, kashaya tikta rasa pradhan ati ruksha anna sevan

7.      Virudha asatmya ajirna anna sevan

8.      Bhaya

9.      Kalji

10.  Shoka

11.  Tras

12.  Manasa vikara

Samprapti

Hetu sevan à dosha prakop  à dushta dosha hrudaya sthani sthanshavhaya à Hrudroga.

Lakshana

Vataj hrudroga –

Hetu – shoka, upvasa (fast) ,vyayam (exercise),ruksha (dry), alpa (low quantity food) ,shita (cold food) anna sevana

Samprapti  -

Hetu sevan àvata dosha prakop  à vata dosha hrudaya sthani sthanshavhaya à vataj Hrudroga.

Lakshana –

Shunnyata,Shuskata,Shoka,Bhaya,Shabdasahishnuta,Moha,swasawrodha,Alpanidrata,Hrudayspandan, Hrudaygati, vaishyamaya, Veparthuven

Pittaja hrudroga –

Hetu-

Ushna, Amla, kshar, Katu, Ajirna bhojan, Madyapana, Krodha, Atap sevan

Samprapti-

Hetu sevan à pitta dosha prakop  à pitta dosha hrudaya sthani sthanshavhaya à pittaj Hrudroga.

Lakshana –

Trushna, Murcha, Bhrama, Sweda, hrudaya daha, jwara, pittavabhas, tamapravesh, nakha netra pitata

Kaphaj hrudroga –

Hetu –

guru, snigdha, achinta, acheshta, atinidra,

Samprapti –

Hetu sevan à kaphaj dosha prakop  à kaphaj dosha hrudaya sthani sthanshavhaya à kaphaj Hrudroga.

Lakshana –

Tandra , aruchi , stabdha guru gatrata, kasa , mukha madhurya , mardava ,jalalupta mukha

Sannipatik hrudroga –

Hetu – tridosha prakopak

Samprapti –

Tridosha prakopak Hetu sevan à tridosha prakop  à dushta dosha hrudaya sthani sthanshavhaya à sannipatik Hrudroga.

Lakshana –

Swasa, shool, jwara, shotha, hruddhwani vikruti, Tandra, murcha, moha etc.

Krumija hrudroga –

Hetu-

Tridoshaja hrudrogi tila, dudha, gud sevan

Samprapti -

Tridoshaja hrudrogi tila, dudha, gud sevan à hrudayasthani granthi uttapati à hrudaya vikruti à kleda nirmiti à krumi uttapati à krumij hrudaroga.

Lakshana -

Hrudaya suchibhiriv, chidyamana tatha shashtrarjata vedana, kandu, maharaja, tama pravesh, swasa, aruchi, sarvanga shotha.

Chikitsa

Avoid all these thing those hurts mind they are chinta, shoka, bhaya, krodha, utkantha, matsar, lobha etc. adhyayana and tatvadnyana is the best for calm the mind. After food and medication take the ojovardhak, good for srotasa and hrudya ahar vihar.

Vataja Hridroga

In the beginning  by doing snehan & swedan mild vaman is given in Vataj Hridroga.

Pittaja Hridroga

Local application of sheeta dravya or sheeta parisheka & cardiotonic virechan is given in Pittaja Hridroga.

Kaphaja Hridroga

In Kaphaj Hridroga swedan ,vaman & langhan chikitsa along with kaphaghna dravya  are very useful.

Tridoshaj Hridroga

In tridoshaja hrudaroga langhana along with laghu santarpana ahara with the examination of balabal pariksana.

Krumija Hridroga

In krumija hrudroga main thing is vayu rudha gati so virechana is done for amashaya shudhi then langhana, pachan along with krumighna dravya.

Dravya and kalpa –

Arjuna , shaliparni, draksha, dadim, harmal, kuchala, kanhermula, pimpalmula, karpur, shrunga, kasturi, muktik, abraka, suvarna, vanga, laksmi vilas, trailokya chintamani,hemegarbha,arjunaarishta,drakshasava.

Anna –

Drava, laghu, santarpana dravya, Tandul and rava khir, phalara (draksha,dadim etc)

Hridyashool   

Pushkarmoola choorna with madhu Lakshmivilasrasa,Tribhuvankirti,Nagguti,

Trailokyachintamani,Vatvidhansa,Dashmoolarishta,Shankavati,Amapachanvat

Hrudabasti etc.

Hrudroga – dravyas & kalpas

1)      Haritaki, vacha, rasna, pippali, Shunthi, shati, pushkarmool, Arjun, Vanshalochana, shrungabhasma

2)      Suvarnabhasma, Abhrakbhasma, Rajat bhasma, Rasasindoor, Hirak bhasma, Vaikrantbhasma, vangabhasma

3)      Ratnakar rasa,Kalyansundar rasa,Chintamani rasa,Prabhakar vati

4)      Pathyapathya

5)      Arjun,Shaliparni,draksha,dadim,kuchala,Pimplimoola

6)      Shrunga,kasturi Mautika  

7)      Abhraka,Suvarna,Vanga

8)      Lakshmivilasrasa, Trailokyachintamani, Hemagarbha, Arjunarishtra, drakshasava

Pathya

Shali, yava, jangal mamsa, patol, karvellaka etc hrudyamaya ahar sevana.

Apathya

Taila, amla, takra kashaya rasatmaka ,atapa, sex indulgens, chinta va bhashya etc. which bad for hrudaya.

Aahar and Vihar

1)      Drava, laghu, santarpan kind of food

2)      Shali, Shastik, rava etc.

3)      draksha, dadima juices

4)      Vishranti

5)      Yoga, Pranayam

6)      Ojovardhak chikitsa, Rasayan chikitsa

Functional Classification of Heart Disease

            In the management of patients with heart disease, it is important to quantify and monitor the severity of symptoms. A commonly used classification system is that of the New York Heart Association (NYHA) shown below. However, in monitoring individual patients, it is better to document specific activities that produce symptoms, such as walking a distance; or performing activities of daily living, such as using a vacuum sweeper or going grocery shopping.

Class I : No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea or anginal pain.

Class II : Slight limitation of physical activity. Ordinary physical activity results in symptoms.

Class III : Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms.

Class IV : Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.

            Other classifications have been proposed, but these are universally accepted, and clinically can be applied to both heart failure and angina symptoms. Some experts use the category of Class V to describe symptoms that are atypical and can occur either at rest or with exertion.                                                                                                           

Cardiac diseases are as follows

1.      Congenital Heart Disease

·         Pulmonary Stenosis

·         Coarctation of Aorta

·         Atrial Septal Defect & Patent Foramen Ovale

·         Ventricular Septal Defect

·         Tetralogy of Fallot

·         Patent Ductus Arteriosus

2.      Valvular Heart Disease

·         Mitral Stenosis

·         Mitral regurgitation (Mitral insufficiency)

·         Mitral Valve Prolapse

·         Aortic Stenosis

·         Aortic Regurgitation

·         Tricuspid Stenosis

·         Tricuspid regurgitation

·         Pulmonary regurgitation

3.      Coronary Heart Disease (Atherosclerotic CAD, Ischaemic Heart Disease)

·         Chronic Stable Angina Pectoris

·         Coronary vasospasms & angina with normal coronary arteriograms

·         Acute coronary syndromes without ST segment elevation

·         Acute myocardial infarction with ST segment elevation.

4.      Disorders of Rate & Rhythm

·         Sinus arrhythmia, bradycardia & tachycardia

·         Atrial premature beats (Atrial extrasystoles)

·         Paroxysmal supraventricular tachycardia

·         Supraventricular tachycardias due to accessory AV pathways (Preexcitation syndromes)

·         Atrial fibrillation

·         Atrial flutter

·         Multifocal atrial tachycardia

·         AV Junctional rhythm

·         Ventricular premature beats (Ventricular extrasystoles)

·         Ventricular tachycardia

·         Ventricular fibrillation & death

·         Accelerated idioventricular rhythm

·         Long QT syndrome

·         Sick sinus syndrome

·         Syncope

5.      Bradycardias & Conduction Disturbances

6.      Congestive Heart Failure

7.      Myocarditis & Cardiomyopathies

8.      Rheumatic Fever

9.      Diseases of the Pericardium

10.   Pulmonary Hypertension & Pulmonary Heart Disease

11.   Neoplastic Diseases of the Heart

12.   Cardiac Involvement in Miscellaneous Systemic Diseases

13.   Traumatic Heart Disease

In present scenario, number of cardiac diseases are treated on modern aspects. But it is very interesting to see that ayurveda has elaborated cardiac diseases in detail. Its therapeutic approaches and preventive measures have found to be very helpful in the treatment of cardiac diseases. Some of the ayurvedic diseases and principles that can be co-related with concepts of modern physiology and medicine are mentioned below. Eg:

1)       Hrudayabhighaat (~ Acute Myocaridal Infarction)

            A disease named Hrudayabhighaat is found to be mentioned in Charak Siddhistana. It is difficult to state it as an indepandant disease or just a symptom. Cough, dyspneoa, generalized weakness, drying of throat, epigastric pain, falling of tongue, dryness of mouth and palate, altered mental sensorium with epileptic symptoms.

Acute Myocardial Infarction :

            It results from an occlusive coronary thrombus at the site of a pre existing (though not necessarily severe) atherosclerotic plaque. Infarction may result from prolonged vasospasm, inadequate myocardial flow (eg. hypotension), or excessive metabolic demand. Cocaine is a cause of infarction, which should be considered in young individuals without risk factors. A condition that may mimic STEMI is stress cardiomyopthy (also referred to as Tako-Tsubo or stress cardiomyopathy or apical ballooning syndrome). ST elevation connotes an acute coronary occlusion and thus warrants immediate reperfusion therapy.

SIGNS: Patients may appear anxious and sometimes are sweating profusely. The heart rate may range from marked Bradycardia (most commonly in inferior infarction) to tachycardia, low cardiac output, or arrhythmia. Respiratory distress usually indicates heart failure. Fever, usually low grade, may appear after 12 hours and persist for several days.

2)         Hrudaya Vruddhi (~ Congestive Heart failure)

When cardiac disease is advanced  symptoms like dyspnoea, edema, cough, fever, somnolence and stupor, sleepiness, pain, excessive thirst, palpitation, abnormalities in heart sounds and pallor are increased.

During development of heart and lungs it comes into relation with liver and spleen. Hence any abnormality in the heart ultimately also leads to abnormality in the liver.

Hrudroga is considered to be an incurable disease. It is not necessary that as soon as this disease develops it turns out to be fatal, but it surely does not get cured completely. Hence, abnormal heart sounds, palpitations and cardiac effusion does not go away permanently. The symptoms that remain permanently are dyspnoea, cough, fatigue, pain, oedema and palpitations. Patient has to follow some particular advices to remain healthy and free from the above symptoms. If not followed can result in increasing in severity of symptoms.

           

Congestive Heart Failure:

LV failure : Exertional dyspnea, cough, fatigue, orthopnea, paroxysmal nocturnal dyspnea, cardiac enlargement, rales, gallop rhythm, and pulmonary venous congestion.

RV failure : Elevated venous pressure, Hepatomegaly, dependant edema; usually due to LV failure.

3) Upadrava (~ Ischaemic Heart disease, Acute Coronary Syndrome)

Vataja, pittaja, kaphaja and sannipatak types results in dizziness, fatigue, bodyache and atrophy. Krimija hrudroga leads to salivation, rhinitis, headache, vomiting and oedema. General symptoms of hrudroga like cough, dyspnoea, oedema, fever and discoloration of skin can present as severe symptoms.

Ischaemic heart disease includes precordial chest pain, often occurring at rest during stress or without known precipitant. Ischaemia may be silent or result in angina pectoris. Prinzmetal (variant) angina is a clinical syndrome in which chest pain occurs without the usual precipitating factors and is associated with ST-segment elevation rather than depression. 

Acute Coronary Syndrome generally consists of signs and symptoms of myocardial ischaemia either at rest or with minimal exertion. Symptoms consisting of substernal chest pain, dyspnea, nausea, syncope.

Also symptoms can be seen as described in classification by New York Heart Association from Class I to Class IV.

4) Urograha (~ Constrictive Pericarditis )

High grade fever, heaviness of chest, dryness of chest, fullness of abdomen, difficulty in urination and flatus, loss of taste of mouth, pain in chest and abdomen, tenderness in cardiac region and oedema at cardiac region.

Constructive Pericarditis : Evidence of right heart failure with an elevated JVP, edema, hepatomegaly and ascites. The principal symptoms are slowly progressive dyspnea, fatigue and weakness. Chronic edema, hepatic congestion and ascites are usually present.

5) Parivruttistu Chakravat (~ Systemic Circulation)

Rasa ,Rakta are circulated by the Vyan vayu which is located in the Hridaya. By the Vyan vayu there are contractions and relaxation of the cardiac muscles and hence the rasa,rakta are circulated throughout the body. By these contractions and relaxation and no doubt by the closure of Atrioventricular and semilunar valves different kinds of heart –sounds are heard. The  final end product of digestion (prasadrup poshak-aaharrasa) and the rakta which keeps the life alive to give nutrition and nourishment is circulated throughout the body. These rasa and rakta for the purpose mentioned earlier through blood vessels goes to the whole body and again returns back th the heart  and agin this cicle continues.Ayurved has described this kind of function and  activity as “Parivruttistu Chakravat”.

            According to modern it is otherwise known as greater circulation. The blood pumped from left ventricle passes through a series of blood vessels of arterial tree or arterial system and reaches the tissues. The blood vessels of the arterial system are the aorta, larger arteries, smaller arteries and arterioles. The arterioles branch into the capillaries. The capillaries are responsible for exchange of various substances between blood and the tissues. It is because the wall of the capillaries is permeable to various substances. After exchange of materials at the capillaries, the blood enters the venous system and returns to right atrium of the heart. The blood vessels of the venous system are the venules, smaller veins, larger veins and vena cava. From right atrium, blood enters the right ventricle. Thus, through the systemic circulation, the oxygenated blood or arterial blood is supplied from heart to the tissues and the venous blood returns to the heart from the tissues.

6) Parshvashool  (~ Pleural effusion due to Congestive Heart failure)

Vayu is filled with kapha which results into fullness of abdomen. During respiration, due to the dry property of vayu, an undistinguished sound is heard in the lungs on the posterior side. Pricking sensation is developed in the back which increases during respiration. Respiration is constrained. Dislikeness over food due to pain is seen. Patient becomes restless and insomniac. If there is Pitta anubandh then symptom of high grade fever is seen. Due to vitiation of doshas constriction of the lungs takes place which leads to severe dyspnoea. Rasa and kapha get klinna and become nichita resulting into heaviness and stillness of the lungs. This condition is termed as WET or WATERY phase of the lungs.

Congestive Heart Failure leading to Pleural Effusion: Evidence of pulmonary venous hypertension includes relative dilation of the upper lobe veins, perivascular edema (haziness of vessel outlines), interstitial edema and alveolar fluid. In acute heart failure, these findings correlate moderately well with pulmonary venous pressure. Patients with chronic heart failure may show relatively normal pulmonary vasculature despite markedly elevated pressures. Pleural effusions are common and tend to be bilateral or right sided.

7) Hrutshool (~ Angina Pectoris)

Sushruta has mentioned hrutshool as an independent disease but different from hrudroga. But this disease can develop independently. It develops as a purvaroop of heart diseases. Rasavahinis that nourish the heart get blocked due to kapha and pitta resulting into vitiation of vayu that causes severe pain. Thus causing difficulty in expiration. Due to severity of symptoms perspiration, fear, irregular heart rhythm, tremors, discoloration of skin, dyspnoea, fatigue, giddiness, syncope, etc. are seen alongwith. In case of pitta anubandh fever is seen.

            This disease is acute and severe.

Angina Pectoris : Occurs most commonly during activity and is relieved by resting. Patients often do not refer to angina as “pain” but as a sensation of tightness, squeezing, burning, pressing, choking, aching, bursting or an ill-characterized discomfort.

References

1)                   

WarmaamaaSayasya ca sa%vaaidQaama )dyaM stnaaOr: kaoYzmaQyagama²  ..

)dyaM naama yanmama- tdip saVaoGnama .tccaamaaSayasya WarMmauKma² .to na ih WaroNaannapanamaamaaSayao p`ivaSait                   .tcca sa%vaaidnaaM )id baaQaa p`kuva-int  )daogaM tM p`caxato .

Narendranath shastri (edi 5^th 2005)Madhavnidanam hrudrog chapter ,Motilal Banarasidas Varanasi

2)                

)damaya: pMcaivaQa : p`idYT : .

Narendranath shastri (edi 5^th 2005)Madhavnidanam hrudrog chapter ,Motilal Banarasidas Varanasi

3´

A%yauYNagauva-nnakYaayait>EamaaiBaGaataQyaSanap`sa=gaO : .

saMicantnaOvaogaivaQaarNaOSca )damaya: pncaivaQa : p`idYT : ..

Narendranath shastri (edi 5^th 2005)Madhavnidanam hrudrog chapter ,Motilal Banarasidas Varanasi

4)

vyaayaamatIxNaaitivarokbaist – icantaBaya~asagadaitcaara : .

CVa-masaMQaarNakSa-naaina )d`aogaktR-iNa tqaaAiBaGaat: ..

Pandye G.S Editor,(6^thedi.)Charak samhita chikitsa sthana chapter  26-77,chaukhamba publications Varanasi

vaogaaGaataoYNa$xaannaOritmaa~aopsaoivatO : .

iva$QdaQyaSanaajaINaO-rsaa%myaOScaaip ( it) BaaojanaO : ..

Dr.Ambikadatta shastri ,Editor,(14^th edi)Susruta samhita sutra sthana chapter 43-3 chaukhamba publications Varanasi.

5´

dUYaiya%vaa rsaM daoYaa ivagauNaa )dyaM gata : .

kuva-int )dyao baaQaaM )d`aogaM tM p`caxato ..

 Dr.Ambikadatta shastri ,Editor,(14^th edi)Susruta samhita sutra sthana chapter 43-4 chaukhamba publications Varanasi.

6´

vaOvaNya-maUcCa-jvarkasaih@ka SvaasaasyavaOrsyatRYaap`maaoha: .

Cid- : kfao%@koSa$jaaoA$icaSca )d`aogajaa:syauiva-QaastqaaAnyao  ..

Pandye G.S Editor,(6^thedi.)Charak samhita chikitsa sthana chapter  26-78,chaukhamba publications Varanasi

7)                

Saaokaopvaasavyaayaama$xaSauYkalpBaaojanaO : .

vaayauraivaSya )dyaM janaya%yau<amaaM $jama  ..

vaopqauvao-YTnaM stmBa: p`maaoh: SaUnyata dr: .

)id vaataturo $pM jaINao- caa%yaqa-vaodnaa ..

   Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  17-30-31,chaukhamba publications Varanasi

8´

]YNaamlalavaNaxaarkTukajaINa-BaaojanaO : .

maVk`aoQaatpOScaaSau )id ip<aM p`kuPyait ..

)_ahist>ta va@~o it>amlaaoigdrNaM Ea (@la) ma: .

tRYNaa maUcCa- Ba`ma: svaod : ip<a)d`aogalaxaNama ..

Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  17,32-33,chaukhamba publications Varanasi

9)

A%yaadanaM gau$isnagQamaicantnamacaoYTnama .

inad`asauKM caaByaaiQakM kf)d`aogakarNama ..

)dyaM kf)d`aogao sauPtistimatBaairkma .

tnd`a$icaprItsya Bava%yaSmaavaRtM yaqaa ..

Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  17,34-35,chaukhamba publications Varanasi

10)

hotulaxaNasaMsagaa-ducyato saainnapaitk: .

ivaVati~daoYaM %vaip sava-ila=gama\ .

Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  17,36,chaukhamba publications Varanasi

11)

i~daoYajao tu )d`aogao yaao dura%maa inaYaovato  ..

itlaxaIrgauDaidina ga`inqastsyaaopjaayato .

mamaO-kdoSao saM@kodM rsaScaasyaaopgacCait ..

saM@koda%a\ ik`mayaScaasya Bavan%yauphta%mana: .

mamaO-kdoSao saMjaata: sap-ntao Baxayaint ca ..

tuVmaanaM sa )dyaM saUcaIiBairva manyato .

iCVmaanaM yaqaa Sas~Ojaa-tkNDUM maha$jama\

)d`aogaM ik`imajaM  %vaotOila--=gaObau-d\Qvaa sauda$Nama\  .

%varot jaotuM tM ivavdainvakarM SaIGa`kairNama\  ..

Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter  17, verse 36-40,chaukhamba publications Varanasi

12)

tnmahta mahamaUlaastccaaOja: pirrxata .

pirhayaa- ivaSaoYaoNa manasaao du:Khotva: .

)dyaM ya%syaaVdaOjasyaM s~aotsaaM ya%p`saadnama\ .

t<a%saovyaM p`ya%naona p`Samaao &anamaova caoit ..

 Pandye G.S Editor,(6^thedi.)Charak samhita sutra sthana chapter 30, verse 13/14,chaukhamba publications Varanasi

                            

13)

vaataopsaRYTo )dyao vaamayaot isnagQamaaturma\ a .

Dr.Ambikadatta shastri , Editor,(14^th edi)Susruta samhita nidan sthana chapter 6/3 chaukhamba publications Varanasi.

14)

SaItap`doha pirsaocanaaina tqaa ivarokao )id ip<aduYTo . 

 Pandye G.S Editor,(6^thedi.)Charak samhita chikitsa sthana chapter 26/90,chaukhamba publications Varanasi

15) isvannasya vaatsya ivalaMiGatsya .

ik`yaa kfGnaI kfmama-raogao ..

Pandye G.S Editor,(6^thedi.)Charak samhita chikitsa sthana chapter 26/96,chaukhamba publications Varanasi

                       

16)

i~daoYajao la=Ganamaaidt: syaadnnaM  ca savao-Yau ihtM ivaQaoyama\ .

ihnaaitmaQya%vamavaoxya caOnaM kaya-M ~yaaNaamaip kma- Sastma .

Pandye G.S Editor,(6^thedi.)Charak samhita chikitsa sthana chapter 26/100,chaukhamba publications Varanasi

                                                 

17)

p`ayaao|inalaao $wgait: p`kuPya%yaamaaSayao SaaoQanamaova tsmaat\ .

kaya-M tqaa la=GanapacanaM ca sava-M kRimaGnaM kRima)gddo ca ..

 Pandye G.S Editor,(6^thedi.)Charak samhita chikitsa sthana chapter 26/103,chaukhamba publications Varanasi

                                 

18)

Saailama-ugda yavaa maaMsaM jaa=galaM maaircaainvatma\  .

pTaolaM karvaollaM ca pqyaM p`ao>M    )damayao ..

DrTripathi (Edi 1998)Yogratnakar Hrudroga Chapter Caukhamba publication, Varanasi.

19)

tOlaamlatk`gauva-nnakYaayaEamamaatpma\ .

raoYaM s~Inama- icanta vaa BaaYyaM )d`aogavaaMs%yajaot ..

 Dr.Tripathi (Edi 1998)Yogratnakar Hrudroga Chapter Caukhamba publication, Varanasi.

20)

VÌ öÚ{^h²Vo H$mgûdmg~bj¶H§$R>emofëH$mo‘mH$f©U

[Oìhm{ZJ©‘‘wIVmbwemofmnñ‘mamoÝ‘mXàbmn{MËVZmemX¶…ñ¶w… ; &

 Pandye G.S Editor,(6^thedi.)Charak samhita sidhi sthana chapter9-6 ,chaukhamba publications Varanasi

21)

emo{UVmV² öX¶§ Vñ¶ Om¶Vo öX¶mV² ¶H¥$V² &

¶H¥$Vmo Om¶Vo iPlahm iPlahm ’w$ß’w$g‘wÀ¶Vo &

nañna {Z~ÜXm{Z gdm©Ê¶oVm{Z ^mJ©d &&

Kashyapa Samhita

22)

^«‘@la‘m¡ gmXemofmo ko¶mñVofm‘wnÐdm… &

dmVm{XOmZm§ H¥${‘hrZmZm§ öÐmo{JUm‘wnÐdmZmh²-^«‘oë¶m{X

^«‘… MH«$méT>ñ¶od ^«‘U§, @la‘… AZm¶mg… l‘… & gmX²

A…“gmX²… & emofmo‘wIñ¶ YmVyZm§ M & ¶Ú{n ^«‘mX¶mo

dmV{nËVmË‘H$mñVWm@{n ì¶m{Yñd^mÀN>¡pî‘Ho$@{n ^dpÝV &

 Dr.Ambikadatta shastri ,Editor,(14^th edi)Susruta samhita uttar stana chapter 43-10; chaukhamba publications Varanasi.

23)

H¥${‘Oo H¥${‘OgVrZm§ ûc¡pî‘H$mUm§ M ¶o ‘Vm… &&

H¥${‘Oñ¶monÐdmZmh - H$¥{‘Oo H¥${‘OmVrZm{‘˶m{X &

ûc¡pî‘H$mUm{‘{V H¥${‘OmVrZm{‘˶ñ¶ {deofUm‘² & VoZ

ûc¡pî‘Um§ H¥${‘OmVrZm§ ¶ Ed CnÐdmñV Ed H¥${‘Oo

öÐmoJo ‘Vm B˶W©… &

Dr.Ambikadatta shastri ,Editor,(14^th edi)Susruta samhita uttar stanachapter 43-10; chaukhamba publications Varanasi.

24)

eamoöÐmoJd‘Wwà{Ví¶m¶H$amü Vo &&

Vonm§ gd}fm‘od H$‘m©Ê¶mh- {eamoöÐmoJo˶m{X & amoJeãX…

{eamoöX²ä¶m§ g§~ܶVo, VoZ {eamoamoJmo öÐmoJü, d‘Ww…N>{X© 

MH$mamV² AݶmZ{n H$’$Oì¶mYrZ² Hw$d©pÝV Vo H$’$Om… H¥$‘¶… &

 Dr.Ambikadatta shastri ,Editor,(14^th edi)Susruta samhita uttar stanachapter 54-14; chaukhamba publications Varanasi

25)

gñVå^§ géO§ Kmoa§ ñnem©gh§ Jw鑲 &&

AmÜ‘mZHw$[úmöÀN>moÏdmV{dÊ‘yÌamoYVm

VÝÐmamoMH$eybm{Z VÌ {b“m{Z {Z{X©eoV² &&

VANGASEN Urograha

26)

ì¶mZoZ agYmVw{hª {djonmo{MVH$‘©Um &

¶wJnËgd©Vmo@Oņ̃ Xoho {d{j߶Vo gXm &&

Pandye G.S Editor,(6^thedi.)Charak samhita chikitsa sthana chapter 15-36  ,chaukhamba

publications Varanasi

27)K sembulingam, 5^th edition, essentials of medical physiology, jaypee brothers,medical publishers, new delhi.

28)Dr. sujit k. chaudhari, 2^nd  edition, quintessence of medical pharmacology, new central book agency,Calcutta

29)Stephen j. McPhee, 51^st edition 2012 current medical diagnosis & treatment,  cenveo publisher services.

30)Principles and practice of medicine; 16th edition. Davidson

31)Anthony S. Fancietal, 17th edition Harrison Principles of Medicines, edited by, McGraw Hill, Health Professions Division.