RK Joshi With Issn

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CLINICAL EVALUATION OF THE EFFICACY OF ‘VACHADI COMPOUND

(KALPITA YOGA)’ AND ‘SHIRODHARA BY KSHEERA’ IN THE MANAGEMENT OF

RAKTAGATA VATA W.S.R.TO HYPERTENSION

Dr. Deshmukh Rohini Dr. Kute Arun Dr. Buddhi Prasad Dr. Rathod Motilal

Dr. Joshi Ram Kishor

Department of Kayachikitsa, NIA, Jaipur

ABSTRACTIt has been estimated that hypertension accounts for 6% of deaths worldwide. The burden

of hypertension increases with age, and among individuals aged ≥60, hypertension prevalence is65.4%. Essential hypertension is high blood pressure with unknown aetiology. Out of total

hypertensive patients, 95% patients are having essential hypertension.On the basis of involved and Lakshana it can be said that that it is a Vata vyadhi along withinvolvement of kapha, pitta dosha and rakta dhatu. In the present study out of total 34 patients,

30 patients completed clinical trial 15 subjects in group-I, treated with oral drug Vachadi

Compound and rest 15 subjects treated with ksheerdhara in group-II. Both groups were foundeffective in reducing the systolic and diastolic blood pressure and also alleviate the symptoms of

essential hypertension. Group – II showed better results than Group – I in subjective and

objective parameters.

Keywords: Raktagata vata, shirodhara, Hypertension, vachadi compound INTRODUCTION

Cardiovascular disease is the leading

cause of death and disability in developing

nations and increasing rapidly in the

developing world. By the year 2020, it is

estimated that cardiovascular diseases will

surpass infectious diseases as the world’s

leading cause of death and disability1. It has

been estimated that hypertension accounts

for 6% of deaths worldwide2. The burden of

hypertension increases with age, and amongindividuals aged ≥60, hypertension

prevalence is 65.4%.2. It is likely that

hypertension represents a polygenic disorder

in which a single gene or combination of

genes act in concert with environmental

exposures to contribute only a modest effect

on blood pressure. It has long been

suspected that chronic stress may be a risk

factor for hypertension.3

Essential

hypertension is psychosomatic disease with

unknown aetiology, accounting for 95% of

total hypertensive patients.

There are so many references in

Ayurveda classics supporting the

presumption that, the disease hypertension

was present in the ancestral society, but in a

dormant fashion, hence the descriptions arescattered here and there; like Pakshavadha,

Shirahshula, Shotha, Mutra kriccha etc. in

classics. Perhaps the disease was not

obtained very often in the population of

ancient era and due to lack of a

sphygmomanometer it could not come to

ISSN-23205091 International Ayurvedic Medical Journal Research Article



Joshi Et Al; Effica cy Of ‘Vachadi Compound (Kalpita Yoga)’ And ‘Shirodhara By Ksheera’ In The Management Of Raktagata Vata W.S.R.To Hypertension

2IAMJ: Volume 1; Issue 1; Jan – Feb 2013 www.iamj.in

human knowledge as noticeable as now

days. The descriptions of related organs like

Hridaya, Dhamani and Sira etc. can be

traced back in our epics.

AIMS AND OBJECTIVES

Present research study was conducted with

following aims and objectives.

1. Conceptual and clinical study on essential

hypertension vis-à-vis Raktagata Vata.

2. To evaluate the clinical efficacy of

Vachadi Compound in the management of

essential hypertension.

3. To evaluate the clinical efficacy of

Ksheeradhara (Shirodhara) in themanagement of essential hypertension.

4. To compare the efficacy of Vachadi

Compound and Ksheeradhara in the

management of essential hypertension.

MATERIALS AND METHODS

Selection of the Patients

The 34 clinically diagnosed patients of

essential hypertension were selected

randomly from OPD/IPD of Arogyashala, NIA, Jaipur. Out of these 30 patients have

completed the trial and 4 patients were

dropped out.

INCLUSION CRITERIA

a) Patients between the age group of 25 to

70 years in either sex presenting with

cardinal symptoms of hypertension.

b) Patients having elevated blood pressure

i.e. above 140/90 mm of Hg.

c) Patients willing to sign the consent form.

EXCLUSION CRITERIA

a) Patients with age below 25years and

above 70 years.

b) Patients having secondary hypertension,

malignant hypertension i.e. blood

pressure above 200/140 mm of Hg,

Pregnancy induced hypertension and

hypertensive lactating mothers.

c) Patients having any other serious illness

like coronary artery disease,

cerebrovascular disease, renal function

impairment.

d) Patients having complications of the

hypertension like hypertensive

retinopathy.

CLINICAL TRIAL

30 diagnosed patients had undergone for clinical

examination and drug therapy along with

necessary dietary advice.

DETAILS OF CLINICAL TRIAL

a) Experimental Groups:

34 clinically diagnosed and confirmed

patients of Hypertension were randomly

divided into two groups. Out of 34

patients, 2 in each group were dropped

out.

GROUP 1- 15 registered patients of

Hypertension was administered Vachadi

Compound -2 Capsules TDS for a period

of 1 ½ Months.

GROUP 2- 15 registered patients of

Hypertension was administered Shirodhara

for a period of 1 Month.

CRITERIA FOR ASSESSMENT

Subjective Parameters-Symptoms of the

patients viz. Shirshula, Hriddravata, Klama,

Anidra etc.were assessed before and after

trial.

A) Objective Parameters

It includes Blood Pressure measurement of

the patients.





C) Laboratory Parameters

Laboratory investigations of patients’ viz.

Hb%, TLC, ESR, Blood sugar, Lipid

Profile, Blood urea, Serum creatinine were

done before and after the treatment.

D) Hamilton Anxiety Scale - This scale

was used to assess psychological

involvement of the patients.

Table 1: Showing contents of trial drug

Sr.no Sanskrit name Botanical name Part used Ratio

1. Vacha Acorus calamus Root ½

2. Tagara Valeriana wallichi Root 1/2

3. Shankhpushpi Convolvulus

pluricaulis

Panchanga 1

4. Punarnava Boerhavia diffusa Root 1

Table 2: Showing observations in the Clinical study

Observations Group %

Age 46-55 yrs 35.29%

Sex Female 55.88%

Religion Hindu 70.59%

Occupation Housewives 44.12%

Marital Status Married 82.35%

Socio-economic status Middle 61.76%

Diet Mixed 52.94%

Nature of Work Sedentary 73.52%

Nidra Alpa Nidra 58.82%

Malapravritti Grathita and Prakrita each 47.05%Addiction Tea, Smoking and Alcohol each 97.06%, 23.52%

Sharira Prakriti Vata-Pitta Prakriti 58.82%

Manasika Prakriti Rajasika Prakriti 70.59%

Sara Madhyama Sara 44.12%

Samhanana Madhyama Samhanana 61.76%

Satva Madhyama Satva 67.65%

Abhyavaharana Shakti Madhyama 61.76%

Vyayama Shakti Avara 47.05%

Agni Mandagni and Vishamagni 26.47% Koshtha Krura 50%

Chronicity 1-2 yrs 35.29%

Onset Insidious 73.52%

Family History Present 52.94%

Treatment History Allopathic 50%





BMI Obese 38.23%

Table 3: Showing improvement in Objective parameters after treatment

Objective

Parameters

Group BT±SD Mean

AT±SD

Mean

Diff

SEM %

change

t p S

Systolic BP

Group I155.20±9.2

5

149.60±

9.045.60

1.03 3.69 5.40 <0.001 HS

Group II 156±6.71143.73±

15.22 12.26 3.05 7.86 4.01 <0.001 HS

Diastolic BP

Group I 95.86±5.7393.60±

6.37 2.26 0.70 2.36 3.23 <0.001 HS

Group II 97.33±7.5091.46±

9.89 5.86 1.59 6.02 3.68 <0.001 HS

Pulse

Pressure

Group I 55.06±17.551.60±

16.65 3.46 0.83 6.28 4.13 <0.01 S

Group II 53.86±15.947.60±

15.75 6.26 2.83 11.23 2.21 <0.001 HS

Table 4: Showing improvement in symptoms of patients in trial

SYMPTOMS Group – I Group – II

n %

change

P Result N % change p Result

Shirashula(Headache) 14 53.33% <0.01 S 13 08(53.33%) <0.001 HS

Hriddravata( Palpitations) 11 (60%) >0.05 NS 09 06(40%) <0.01 S

Klama(Fatigue) 14 (73.33%) >0.05 NS 14 08(53.33%) <0.001 HS

Anidra(Insomnia/Disturbed

sleep)

11 (33.33%) <0.01 S 14 09(60%) <0.001 HS

Shvasakricchata(Breathlessness) 08 (46.66%) >0.05 NS 07 02(13.33%) >0.05 NS

Hritshula(Chest pain) 03 (13.33%) >0.05 NS 05 02(13.33%) >0.05 NS

Chinta(Anxiety) 11 (33.33%) <0.01 S 10 07(46.66%) <0.01 S

Bhrama(Dizziness) 08 (33.33%) >0.05 NS 06 04(26.66%) >0.05 NS

Sammoha(Confusion) 03 (13.33%) >0.05 NS 04 01(6.66%) >0.05 NS





Swedapravartana(Sweating) 12 (53.33) >0.05 NS 10 05(33.33%) >0.05 NS

Krodha(Irritability) 11 (60%) >0.05 NS 12 06(40%) <0.01 S

Table 5: Showing Overall effect on Systolic and Diastolic Blood Pressure

Blood Pressure

Group – I Group – II

% improvement

- Systolic BP

% improvement-

Diastolic BP

% improvement-

Systolic BP

% improvement-

Diastolic BP

Controlled 20.00% 33.33% 26.66% 33.33%

Marked (>75%) 13.33% 13.33% 20.00% 13.33%

Moderate (50-75%) 20.00% 06.66% 20.00% 13.33%

Mild (25-50%) 13.33% 06.66% 13.33% 13.33%

No Relief (<25%) 33.33% 40.00% 20.00% 26.66%

No any significant results were found in lab parameters which mainly relate to the disease.

DISCUSSION

Probable mode of action of drug

Constituents of the drug in the present study

may have different pharmacodynamic

properties due to which, multiple

mechanism of actions taken place at

different sites which may be responsible for

disruption of pathogenesis of disease.

Maximum ingredients of drug of Vachadi

Compound have ushna virya predominantly.

It mainly acts on vitiated vata dosha and

thereby helps to alleviate the samprapti of disease. The drug having tikta rasa mainly

along with deepana, pachana 5(Vacha,

Punarnava) properties helps to alleviate

obstruction in the strotasa due to ama by its

digestion and thereby resulting into

strotoshodhana and vatanulomana.

The drug posseses tridoshahara6 (Tagara,

Shankhpushpi) property by which

etiopathogenesis of the disease may be

broken at the level of tridosha, as in

essential hypertension there is involvement

of tridosha. Drugs may have destroyed

strotorodha due to lekhana, medohara 7(Vacha), deepana, anulomana

8

( Punarnava) properties and normalize the

route of the vata in the strotasa.along with

mutrala8 ( Punarnava) property and

mutravishodhana8

(Vacha) property, thereby

removing kleda in the body and also reduces

cardiac volume. The significant result

produced by Vachadi Compound may be

due to its rasayana, medhya effect thereby

producing anxiolytic, antistress, CNS

depressant effect by inhibiting noradrenergic

sympathetic nerves supplying to the heart.Through its deepana, pachana, lekhana,

mutrala, vatanulomana properties it relieved

strotorodha and digestion of ama and also

decreased blood volume. Thus it may have

contributed to decrease in blood pressure.

The drug reduces vata-pitta dosha by its

madhura vipaka and produces rasayana,

medhya, nidrajanana effects. It probably

induced sleep through its sedative,

anxiolytic and depressant action on CNS.

Drug alleviates raja dosha, by their

manasdoshahara guna (Tagara,

Shankhpushpi)9. The relief in shirshula may

be due to raktadoshahara and

hirshadoshahara properties10

. Drug





contribute for the reduction of psychological

factors like anxiety, stress etc. They also act

as nervine tonic through their medhya ,

rasayana property.

Probable mode of action of Shirodhara

In shirodhara tactile impulses from the

forehead by stimulating ophthalmic nerve

may cause a somato-autonomic reflex and

changes in levels of various neuro-

transmitters including serotonin, TRH,

catecholamine resulting in sympathetic

suppression and physioimmunologic

changes of peripheral circulation and NK

cell activityexhibits symptomatic effect.

Kshiradhara by increasing tarpaka kapha,reduces vata-pitta and thereby relieves

hriddravata through its anxiolytic, sedative

and altered sense of consciousness inducing

effects on brain. Shirodhara also improves

circulation to hypothalamus and thereby

improves function of Autonomic Nervous

System. So that significant results were

obtained in symptoms like klama and ati

swedapravartana. Shirodhara increases

tarpaka kapha, it acts as sedative and hassoothing effect on brain and it induces sleep.

That is reason to reduce anidra significantly

in hypertensive patients.

Ksheeradhara exerts its pacifying effects on

sadhaka pitta and regulates function of

hridaya. Thus it helps to alleviate irritability

of mind. It can be said that shirodhara by

acting on the hypothalamus regulates

emotions and behavioural pattern resulting

in decrease of most of the psychic and

somatic disorders.

Shirodhara facilitates function of kapha and

thereby stablilzes the mana. Agnya Chakra

is stimulated by shirodhara which improves

function of mind, vitiated in stress and

anxiety. Shirodhara acts on structures like

Pituitary gland, pineal body, sub cortical

structure of mid-brain which are related with

mental functions like memory, anger, grief,

pain, fear and other higher intellectual

functions and corrects their functions. In this

way shirodhara is responsible for

improvement in anxiety at significant levels.

CONCLUSION

Vachadi Compound and Ksheerdhara were

found effective in reducing blood pressure

of mild and mild plus moderate grade

respectively and also alleviate the symptoms

of essential hypertension without any

adverse effects.

Ksheerdhara reduced both systolic and

diastolic pressure in a more pronounced

way. Though maximum duration of

Shirodhara is 21 days as per described in

texts no any untoward side effect had been

observed after its administration for 1

month. During the follow up study, it was

found that there was rise in systolic anddiastolic pressure suggesting the palliative

nature of the treatment.The plus point

observed in case of Ayurvedic management

is absence of and hazardous effect, which is

really a great benefit to the patient and is of

vital importance in view of the global

acceptance of Ayurveda. Further extensive

study is needed to authenticate the results of

the present study, with larger samples and

more precise diagnostic and assessmentcriteria.





REFERENCES

1. Daniel G et al, Clinical Cardiology.

2. Harrison's Principles of Internal Medicine

17th edition published by Tata Mc.Graw Ltd,

New Delhi .page no.

3. Oxford Textbook of Medicine, David

Weatherall; Oxford University Press 2003.4th

Ed. Page no.

4. Charaka Samhita Chikitsasthana 28/19,

CHARAKA SAMHITA with “Vidyotini”

Hindi commentary by Pt. Kashinath Shastry

and Dr. Gorakhnath Chaturvedi, Part 1 and 2,

Chaukhambha Bharati Academy, 1996.

5. Dhanvantari Nighantu by Z. Ojha, Adarsh

Vidya Niketan Prakashan, 1985.

6. Bhavaprakash Nighantu of Shri Bhavamishra

commentary by Dr. K.C. Chunekar,

Chaukhambha Bharati Academy, 2002.

7. Ashtanga Hridaya of Vagbhata with the

Nirmala Hindi commentary by Dr.

Bramhanand Tripathi, Chaukhambha Sanskrit

Prakashana, Delhi, Sutrasthana16/36 VachadiGana, reprint edition 2007.

8. Dravyagunavigyana Vol.II by Priyavrata

Sharma, Chaukhamhba Bharati

Academy,Varanasi, 2005

9. Priya Nighantu with Padmakhya Hindi

commentary by Priyavrata Sharma,

Chaukamba Surbharati Prakashana, Varanasi,

1983

10. Kaiydev Nighantu by Priyavrata Sharma,

Chaukhambha Orientalia, Varanasi, 1979.

Corresponding Author:Dr. Joshi Ram Kishor Professor and Head,

PG Dept. of Kayachikitsa, NIA,

Jaipur-Rajasthan

Source of support: Nil, Conflict of interest:

None Declared

RK Joshi With Issn

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