INTERNATIONAL

AYURVEDIC
MEDICAL JOURNAL
Research Article ISSN: 2320 5091 Impact Factor: 4.018

EVALUATORY STUDY OF ESSENTIAL HYPERTENSION WITH SPECIAL

REFERENCE TO SANTARPAN AND APATARPAN HETU

Swati P. Sarnaik1, Ranjit A. Deshmukh2

1
Assitant. Professor, Dept. of Rognidan & Vikritivigyan, MUP’S Ayurved college, Hospital & Research Centre
Degaon, Risod, Washim. 7028020647
2
Associate Professor & HOD, Dept. of Rachana Sharir, Dr. Rajendra Gode Ayurved College, Hospital and
Research Centre, Amravati. 7028020648

Email: drswararanjitd@gmail.com

ABSTRACT
Ayurveda symbolizes holistic approach towards treating disease and better prevention than cure as its one of the
main motto. Hypertension is silent or hidden killer of mankind. An elevated arterial pressure is probably most
important public health problem in developed countries. Hypertension is major risk factor for cardiovascular dis- di
ease, stroke and kidney disease leading to high mortality. It is one among the various life style disorder, this result
is form a no. of reason
eason like stress, obesity, genetic disorder, excessive alcohol, salt intake, smoking, sedentary life
style , so Classification of hetu in the category of santarpan & apatarpan can help to diagnose the cause of es- e
sential hypertension in ayurvedic perspect
perspective & thus can help to treat the condition also. This study also reflects
that nidanpariwarjan is the best remedy for the hypertension. The present study reveals the causes of hyperten-
hyperte
sion in Ayurvedic aspect. Hypertension is primarily diagnosed on basis ooff systolic and diastolic blood pressure
while lipid profile is advocated to study the risk level. The effect of santarpan and apatarpan hetu was observed
on systolic
tolic and diastolic blood pressure and lipid level to execute severity among them, so outcome of the study is
to know the exact cause of hypertension.

Keywords: Hypertension, Ayurvedic pathogenesis, Santarpan- Apatarpan hetu,, Blood pressure, Lipid profile.

INTRODUCTION
Human life has been considered as a valuable oppo oppor- er, during ensuing century, there have been tremen-
treme
tunity to achieve the prime goal of life vizviz. dharma, dous changes in lifestyle. Therefore today’s meta- met
artha, kama, moksha. To achieve this, one needs a physical society is facing unsteady, weaken, hard &
healthy & calm life. Whole ancient culture tried to everyday changing
hanging lifestyle. The miserable gift of
achieve all four prime goals of life, so that they had stressful, hectic lifestyle, diet habit, an environmen-
environme
a smooth, sound, safe, steady & healthy life style. tal changes that man has become victim of many
On other hand, today mankind kind is trying to gain good disease like obesity, hypertension, diabetes, AIDS
financial status to fulfill all physical desire. Howe
Howev- etc. Among which most potent gift is hypertension.
Swati P. Sarnaik & Ranjit A. Deshmukh: Evaluatory Study Of Essential Hypertension With Special Reference To Santarpan And Apatarpan
Hetu

Hypertension is silent or hidden killer of mankind. gy of hypertension all 3 doshas are involved &
An elevated arterial pressure is probably the most which turns affect the rasa & rakta dhatu to cause
important public health problem in developed coun- this condition. Due to these samprapti, vitiation of
tries. Most sufferers are asymptomatic & as per psychological factor viz. raja & tama is also present.
available report, in more than 95% cases of hyper- This vitiated doshas leads to vitiation of rasavaha,
tension underlying cause is not found, such patients raktavaha & manovaha srotas.
are said to have essential hypertension. Essential In the context of “vyadhi hetu”, Aacharya charaka
hypertension is common asymptomatic, readily de- explained santarpaniyam adhyaya which focus the
tectable, usually easily treatable & of uncured them cause of different disease in context of santarpan &
often leads to lethal complications. If it is untreated apatarpan. Therefore detail literary review can be
in the long run, it chiefly affects heart, brain & reti- observed that vata, pitta, kapha, rasa, rakta
na. Thus now days it has become a life threatening dushtihetu can be classified in two categories i.e.
disease. 1) Santarpan aahar vihar janya hetu
Though, Ayurvedic texts provides no straight refer- 2) Apatarpan aahar vihar janya hetu
ence to essential hypertension, here is an effort made
to understand the possible pathogenesis in terms of ETIOLOGY OF HYPRETENSION-
involved factors like dosha, dushya etc. According  Santarpan hetu responsible for Hypertension-
to Aacharya Agnivesh naming of a disease is not 1) Ati madhur bhojan-Madhur rasa is constituted
essential, removal of disease is more important. with prithvi & jala mahabhuta , therefore it has
Aacharya charaka recommended that if a physician guru manda shit, mrudu property. It produce
is unable to diagnose the disease, he should treat the ama & apakva meda & ultimetly causes
disease considering rog prakriti, rog adhishthan, rog medovriddhi.these property lead to produce ob-
samutthan. Chakrapanidatta in his commentary in- struction in rasavaha srotas.
cludes vyadhi hetu, vitiation of dosha due to these 2) Ati amla bhojan-Amla rasa is prithvi & agni
hetu, vyadhi udbhavsthana vyadhi adhishthana & mahabhuta pradhana, it can cause the pitta &
vyadhi vyaktisthana to diagnose & treat the disease. rakta dushti .
Understanding Essential Hypertension in the light 3) Ati lavan bhojan-Lavan rasa is jala & agni
of Tridoshas principle of ayurveda it is found that it mahabhuta pradhan, it can cause pitta, rakta
is “vata pitta pradhan tridoshas & raktashrit dushta. Visyandan property of lavan rasa may
vyadhi”. In vata prakopak samprapti, Vata being be pointing toward change in osmolarity, which
ruksha (dry) & sheeta (cold) in nature may cause could be factor in pathogenesis of essential hy-
stiffness of vessels which increases peripheral vascu- pertension.
lar resistance & leads to hypertension, due to pitta 4) Ati guru bhojan-Overconsumption of guru
prakopit hetu , ushna tikshna & drava guna of rakta aahara causes strotouplepa, it results in narrow-
increases which results in increased blood volume & ing of lumen of artery.
which exert the pressure on the wall of blood vessel 5) Ati snigdha bhojan-Overconsumption of ati
& leads to hypertension, Third mechanism due to snigdha aahara causes, rasavaha & medovaha
kapha prakopit hetu, which cause defect in the vas- strotas dushti. Snigdha guna has kledan proper-
cular smooth muscle (atherosclerotic changes caused ty which causes retention of jala & other con-
by factors like hyperlipidemia ) where the blood ves- stituents whitch leads to increase Hypertension.
sel lose their normal tone & thus increase 6) Ati vidahi bhojan-It can cause rakta dushti, viti-
pheripheral resistance causing hypertension. Based ated raktavaha srotas causes shonitaj roga.
on these points it can be deduced that in the patholo-

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Swati P. Sarnaik & Ranjit A. Deshmukh: Evaluatory Study Of Essential Hypertension With Special Reference To Santarpan And Apatarpan
Hetu

7) Samashana –Samashana means taking 2) Ati tikta rasa sevan-According to vagbhata it

pathyakara & apathyakara aahara at a time, can causes dhatukshaya & vatavyadhi.
due to this agnimandya occur and ama is formed 3) Ati kashay rasa sevan-Charaka explained that it
which produce obstruction in rasavaha srotas & can cause strotorodha & sushruta mention that
dhamni pratichaya formed. it can cause hrudayapida.
8) Adhyashana-Adhyashana means taking food 4) Alpabhojan-Due to this dimination of bala,
before the previously taken meal is digested, it is pushti & oja cause vataprakopa & sankoch of
also one of the causes of shonitaj roga, and due sira occure.
to obstruction of vyan vatagets vitiated which 5) Shushka bhojan-It can cause vataprakop, loses
leads to forceful viksepana karma which exerts its snigdhata resulting in sira, dhamani
excessive pressure on rasa-raktavahini. sankocha & kathinya.
9) Ati abhishyandi bhojan-It can cause 6) Ruksha bhojan-Vata prakopa occurred.
kaphaprakop which leads to uplep in sira, 7) Ati kshar sevan- It exterts pressure over sira &
dhamani, srotas. dhamni raising BP.
10) Ati mansa sevan- It can cause mansa, meda 8) Ati langhan- Vagbhata explains that atilanghana
vriddhi & rakta dushti. causes hrudshula.
11) Madyapana-Madya has tikta, kashay rasa, 9) Ati vyayam- Due to this vata pitta prakopa &
ushna, tikshna, sukshama, vishada, ruksha, raktadushti occer.
ashukari, vyavayi properties. It can cause rakta 10) Ati jagaran- According to sushruta, ignoring
dushti along with vata pitta dushti, kashay rasa normal sleep at night aggravates vata-pitta
constricts vessels. dosha & affects physical, psychological health.
12) Ati nidra-Due to ati nidra kapha & pitta get vi- 11) Visham upchara- Due to this damage of vital
tiated & elevation of tamoguna causes organ occur & contributes in production of tox-
manodushti. ins, causes vata prakopa .
13) Divaswapa-It can cause jathragnimandya, 12) Vegvidharana- Vata prakopa occur which cause
medodhatvagni mandya, due to this ama & of sira sankocha.
apakva meda produced causes medovridhhi. 13) Plavana- Due to this vata prakopa occur.
Hridpradeshi pralepvat bhavana in divaswapa . 14) Ati atap sevan- It can cause pitta prakop & rakta
14) Avyayama-It can cause kaphaprakopa & dushti .
medovriddhi leading to obstruction in rasavaha 15) Shramadhikya- Rakta & mansa kshaya occur,
srotas. due to which vata, pitta get vitiated.
15) Acheshta- It can cause kaphaprakopa & 16) Abhighat- In Abhighat vitiated vata mixed with
medovridhhi. rakta.
16) Achinta- It is important cause of medoroga, ex- 17) Chinta- Chinta causes ojakshay & rasavaha
cess apakva meda leads to accumulation of srotas dushti which affect the rasa rakta
dhamni pratichaya. samvahan.
17) Atiharsha-It can causes kaphaprakopa & 18) Bhaya- It can cause vataprakopa &
medovridhhi. sirasankocha.
18) Vishaditva-Vishaditva is a tamas manoguna, it 19) Shoka- It is manas vikara affect hriday by in-
affects mana & hridaya kriya. creasing cardiac output resulting in Hyperten-
 Apatarpan hetu responsible for Hypertension- sion & vataprakopa, sirasankoch occurred.
1) Ati katu rasa sevan-Vagbhata explained that 20) Krodha- It can cause vata & pitta prakopa
katu rasa causes sira sankoch. which leads to vitiation of rakta dhatu.

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Swati P. Sarnaik & Ranjit A. Deshmukh: Evaluatory Study Of Essential Hypertension With Special Reference To Santarpan And Apatarpan
Hetu

SAMPRAPTI GHATAK OF HYPERTENSION- Material & Method:-

1) Nidana- Vataprakopak, pittaprakopak, 1] Material-
kaphaprakopak, rasa dushti, rakta dushti, 100 patients attending OPD/IPD of kayachikitsa de-
vataraktadushti, manas dosha dushti nidana are partment of SAM, SANGAMNER are selected ran-
involved. domly according to inclusion & exclusion criteria
2) Dosha- for the study irrespective of sex, religion.
Vata- vyan, prana, apana, samana 1. Inclusion criteria-
Pitta- pachaka, sadhaka a) Patient between age 30 to 50 yrs irrespective of
Kapha- avalambaka gender & occupation.
Manasa- raja, tama b) Diagnosed patient hypertension ( having hyper-
3) Srotas- Rasavaha, raktavaha, manovaha tension more than 1 year)
4) Srotodushti prakara-Atipravrutti, sanga 2. Exclusion criteria-
5) Agni-Jatharagnimandya, dhatvagnimandya a) Patients below age 30 & above 50 yrs.
6) Ama-rasagata b) ANC women & lactating mother.
7) Udhabhava sthana-Pakvashaya- amashaya c) Patient suffering from- malignancy, TB, renal
8) Avayava-Hrudaya, dhamani, sira failure, hepatitis, D.M.
9) Adhishthana-Sharir & manasa 2] Methodology
10) Sancharasthana-Sarva sharira a. Screening of the patients was done.
11) Rogamarga- madhyama b. GROUP A- 50 patients having hypertension due
12) Svabhava- chirkalina to santarpan hetu were screened & selected.
Aim & Objectives: c. GROUP B- 50 patients having hypertension due
Aim- to apatarpan hetu were screened & selected.
To evaluate essential hypertension in terms of d. Systolic & diastolic blood pressure level in both
santarpan & apatarpan hetu observing its effect on groups was recorded.
systolic & diastolic blood pressure & lipid profile to e. Serum triglyceride & serum cholesterol level in
execute severity among them. both groups was recorded.
Objectives- f. Average values of blood pressure level & lipid
1. To study santarpan & apatarpan hetu of essen- levels in both groups were compared.
tial hypertension & to execute severity among g. Assessment of all the selected cases was done
them. according to the following assessment criteria.
2. To compare the level of systolic & diastolic BP A. Assessment of patients according to hetu
& lipid level in the patient of essential hyperten-
sion due to santarpan & apatarpan hetu.

1. Santarpan hetu-
S.N HETU
1 Ati madhur bhojan
2 Ati amla bhojan
3 Ati lavan bhojan
4 Ati guru bhojan
5 Ati snigdha bhojan
6 Ati vidahi bhojan
7 Samashan (Combine intake of hit, ahit bhojan)
8 Adhyashana (excessive consumption of food)

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Swati P. Sarnaik & Ranjit A. Deshmukh: Evaluatory Study Of Essential Hypertension With Special Reference To Santarpan And Apatarpan
Hetu

9 Ati abhishyandi bhojan

10 Ati mansa sevan
11 Madyapan
12 Ati nidra
13 Diwaswap
14 Avyayam
15 Acheshta
16 Achinta
17 Atiharsha
18 Vishaditwa (mudhata)

2. Apatarpan hetu-
SN HETU
1 Ati katu rasa sevan
2 Ati tikta rasa sevan
3 Ati kashay rasa sevan
4 Alpa bhojan
5 Ruksha bhojan
6 Shushka bhojan
7 Ati kshar sevan
8 Ativyayama
9 Atijagran
10 Visham upachar (wrong treatment)
11 Vegvidharan
12 Plavana (swimming)
13 Aatap sevan
14 Langhan
15 Shramadhikya
16 Abhighata
17 Chinta
18 Bhaya
19 Shoka (dukhabhahulya)
20 Krodha

B. Assessment of blood pressure levels trend to describe this disorder by literally translating
1. Systolic blood pressure the term by making some prefix to the term rakta. In
2. Diastolic blood pressure literal translation of hypertension, rakta is used as
C. Assessment of lipid profile levels common prefix & different suffix as to denote the
1. Serum Triglyceride pressure like ‘bhara, daba, chapa, sampida’ etc. The
2. Serum Cholesterol process of nourishment of various dhatu (body tis-
3. HDL Cholesterol sue) & excretion of metabolic waste product of
4. LDL Cholesterol dhatu are going on continuously within human body.
5. VLDL cholesterol The mechanism is carried out by the
rasaraktasamvahana[13]. The main organ of this
OBSERVATION & DISCUSSION system is hrudaya. The circulation of rasa rakta is
As such the direct description of hypertension is not achieved & regulated by various mechanisms. The
available in ayurvedic classical text but there is a rasa rakta is circulated through the sira, dhamani.

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Swati P. Sarnaik & Ranjit A. Deshmukh: Evaluatory Study Of Essential Hypertension With Special Reference To Santarpan And Apatarpan
Hetu

For proper circulation certain amount of pressure is & study of all these hetu it is observed that these
needed. This pressure is generated by pumping ac- cause either create vriddhi or kshaya & then leads to
tion of hrudaya, the state of wall of sira, size of lu- etiopathogenesis in two way. Vriddhikar hetu leads
men & volume of blood[3]. For proper supply of to santarpan of dosha dushya, jatharagnimandya,
nutrients & excretion of waste as per requirements srotouplep, avarodhajanya samprapti and kshayakar
during variations in external & internal environ- hetu leads to apatarpan of dosha dushya, agnidushti,
ments, the pressure within the sira & dhamani needs strotovaigunya, shaithilya of dhamni & sira. There-
to be change accordingly. This changes of pressure fore these dosha, dushya, srotas, agni vitiating hetu
is regulated by the complex interaction of tridosha can be classified into 2 main categories that is
as all the functions of the body are regulated by santarpan aahar vihar janya hetu & apatarpan
tridosha[2]. The various dosha involved in this regu- aahar vihar janya hetu considering pathogenesis of
lation process are pran, saman, vyan, apan vata, hypertension. Santarpan hetu nourishes the rasadi
pachaka & sadhaka pitta, avalambak kapha [4][5]. dhatu in excessive quantity due to which rasa, rakta,
Medovaha srotas[6] is closely related to the lipid mansa, meda dhatu increases in abnormal quantity.
metabolism & manovaha strotas [7] is also involved Lipids are group of naturally occurring molecules
in manifestation of Hypertension by psychogenic that include fats, waxes, sterol. These lipids resem-
stress. ble to excessive & vitiated meda dhatu. In this way
The present study is mainly related to the essential maximum consumption of santarpan hetu & less
hypertension & its etiological factors (hetu) in metabolism of lipids increases its level in blood.
ayurved perspectives. It is related to the elaboration Therefore lipid level are higher in santarpanoth pa-
of possible causes of essential hypertension available tients, continuous sevan of santarpan dhatu also
in ayurved literature and correlates their cause & causes kaphaprakopa & jatharagnimandya which
effect relationship. Ayurved literature does not pro- result in formation of aama & causes obstruction in
vide straight reference of essential hypertension. It is srotas, thus excessively produced rasadi dhatu,
in scattered & clue form. aama & vikrut medodhatu obstruct sira ,dhamni &
As literary review concludes that essential hyperten- srotas producing atherosclerosis which result in hy-
sion is a disease condition mainly realated to hriday pertension. In apatarpan hetu vataprakopa associated
& its components that is vata dosha, pitta dosha, with pittadushti is the most important factors for higher
kapha dosha, rasa-rakta dhatu & its srotas. Consid- blood pressure levels. It can causes dhatukshay & vitiate
ering above factors it can be concluded that essential rakta, mansa & meda dhatu & vitiated pitta increases
hypertension is vata pitta pradhan tridoshaj & volume of vitiated blood. Rakta, mansa, meda dhatu is
related with sira, dhamni & rasaraktasamvahan kriya,
raktashrit vyadhi. Vitiation of these components re-
vitiation of rakta dhatu due to vataprakop causes
sult into raised blood pressure which is the cardinal
kharatva, shaithilya, sankoch of sira & dhamni. Sankoch
sign of hypertension. Therefore the cause (hetu ) of of sira causes narrowing of lumen, shaithily of sira causes
vitiation of these components are ultimate causes of loosening in texture. Thus increases volume of vitiated
hypertension but these cause are not listed categori- blood when passes through sankuchit, shitil, thickened,
cally in ayurveda text, so it is very essential to narrow sira & dhamni, it get obstructed producing
catagorised these causes to provide scientific basis & arterioscletosis which result in hypertension.
easy access of the listed hetu, so after detail review

Statistical Analysis-
The present study is observational in between two groups with independent variables, so unpaired t- test applied
to test significance of observation.

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Swati P. Sarnaik & Ranjit A. Deshmukh: Evaluatory Study Of Essential Hypertension With Special Reference To Santarpan And Apatarpan
Hetu

S Systolic BP Diastolic BP Sr. triglyceride Sr.cholesterol HDL LDL VLDL

N A B A B A B A B A B A B A B
1 Average 152.64 157.52 94.44 95.64 179.26 158.48 215.96 197.76 41.96 43.54 105.92 97.40 29.43 27.61
2 Mean 76.32 78.76 47.22 47.82 89.63 79.24 108.0 98.88 20.98 21.77 52.96 48.70 14.72 13.81
3 Median 76.32 78.76 47.22 47.82 89.63 79.24 108.0 98.88 20.98 21.77 52.96 48.70 14.72 13.81
4 SD 107.9 111.4 66.78 67.63 126.8 112.1 152.7 139.8 29.67 30.79 74.90 68.87 20.81 19.52
5 P-value 0.9843 0.9937 0.9387 0.9561 0.9815 0.9582 0.9681

CONCLUSION
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Swati P. Sarnaik & Ranjit A. Deshmukh: Evaluatory Study Of Essential Hypertension With Special Reference To Santarpan And Apatarpan
Hetu

Varanasi , Chaukhamba Sanskrit Pratishthan, 2003,

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Sutrasthana 24/5-10, p. 289.

Source of Support: Nil

Conflict Of Interest: None Declared
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Deshmukh: Evaluatory Study Of Essential Hypertension
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