ROLE OF INDIAN MEDICINE IN MANAGEMENT OF HYPERTENSION

www.wjpr.net Vol 9, Issue 4, 2020.

Pandey. World Journal of Pharmaceutical Research

1103

ROLE OF INDIAN MEDICINE IN MANAGEMENT OF

HYPERTENSION

*Prof. (Dr.) Punita Pandey

Kayachikitsa Department Gurukul Parisar, Haridwar UAU, Harrawala, Dehradun (U.K.)

ABSTRACT

In present day scenario hypertension is a major public health problem

and has taken the form of pandemic. It is often called a silent killer as

in most of the cases it goes unnoticed despite continuous detrimental

changes in arterial system and vital organs of the body. As a result it

often turns in lethal complications viz. myocardial infarction, stroke,

renal failure, aneurysm etc. Previously considered a disease of old age

is now prevalent in younger generation worldwide. Modern medicine

divides hypertension in two groups viz. primary and secondary. 90-

95% of cases of hypertension comesunder primary or essential

hypertension in which no cause is detected and only 5-10% case have

some cause and are termed as secondary hypertension. Treatment of hypertension through

modern medicine though brings the blood pressure down but in most of the cases patients

have to bear the side effects of these chemical originated drugs. Indian medicine has holistic

acumen and envisages diet, lifestyle and psyche responsible for maintenance of health and

disease manifestation. From the perspective of Indian medicine unhealthy diet and lifestyle,

chronic stress and anxiety, chronic hostility, anger, unresolved psychological issues

contribute in overt manifestation of hypertension particularly essential hypertension.

Principles and practices of Indian medicine when applied judiciously have the capability to

address all aforementioned factors. Keeping this point of view in mind present study was

planned and beside drug management non drug management in the form of Asana, Pranayam

and Dhyan were also incorporated.

KEYWORDS: Stress, Lifestyle, Holistic.

World Journal of Pharmaceutical Research SJIF Impact Factor 8.084

Volume 9, Issue 4, 1103-1122. Research Article ISSN 2277– 7105

Article Received on

04 Feb. 2020,

Revised on 24 Feb. 2020,

Accepted on 14 March 2020,

DOI: 10.20959/wjpr20204-17094

*Corresponding Author

Prof. (Dr.) Punita Pandey

Kayachikitsa Department

Gurukul Parisar, Haridwar

UAU, Harrawala, Dehradun

(U.K.)



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INTRODUCTION

Hypertension is a state of persistent rise in arterial blood pressure above the accepted limit.

The blood flows through the body with certain pressure, but if the pressure is higher than the

normal range then it is a disease, which is called High Blood Pressure or hypertension.[1]

Hypertension remains the most common, readily identifiable and reversible risk factor for

myocardial infarction, stroke, heart failure, atrial fibrillation, aortic stenosis and peripheral

arterial disease.[2]

Blood pressure is characteristics of each individual like height, and weight with marked inter-

individual variation, and has a continuous (bell shaped) distribution.[3]

All definition of

hypertension are arbitrary including those issued by JNC 7, WHO and ISH.[4]

At present

hypertension is defined as a usual blood pressure of 140/90 mm Hg or higher.[5]

The

prevalence of hypertension rises with age-rising exponentially after 30 years of age. Before

50 years of age, women have a somewhat lower prevalence of hypertension than men. After

menopause, the prevalence of hypertension increases rapidly in women and surpasses that in

men. The global burden of hypertension is raising owing to escalating obesity an population

ageing, and the condition is projected to affect 1.5 billion persons i.e. one third of the world‟s

population by 2025.[6]

A study conducted on global burden of hypertension related disease revealed that about 54%

of stroke and 47% of ischemic heart disease worldwide were attributable to high blood

pressure. Worldwide, 7·6 million premature deaths (about 13·5% of the global total) and 92

million (6·0% of the global total) DALYs(disability adjusted life years) were attributed to

high blood pressure.[7]

The World Hypertension League (WHL), an umbrella organization of 85 national

hypertension societies and leagues, recognized that more than 50% of the hypertensive

population worldwide are unaware of their condition. To address this problem, the WHL

initiated a global awareness campaign on hypertension in 2005 and dedicated May 17 of each

year as World Hypertension Day (WHD).[8]

As far as management of hypertension is concern wide range of drugs are available today.

These drugs are synthetic and chemical in nature. Hypertensive patients need medication for

long duration often lifelong and suffer not only due to ravages of hypertension but many

untoward effect of these drugs make their condition even more pathetic. On the other hand

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

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

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

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



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drugs used in Indian medicine are herbal or herbo-mineral and are congenial to human and

thus produce no side effect if used judiciously. Literature of Indian medicine has vast range

of non drug measures which aid in eliminating the dreaded disease hypertension from its

roots. Measures such as asana, pranayam, mantra chanting and dhyan work at the psyche

level and eliminate untoward effect of stress and strain and restore harmony and balance in

internal milieu as well as with external environment. Hence these measures when applied in

conjunction with appropriate drugs provide an effective management of hypertension. With

this perspective present study was planned and holistic therapeutic intervention was taken in

the present study.

REVIEW OF LITERATURE

Hypertension is multifactorial in origin; many different forms of mechanisms partake in

precipitation of hypertension. The condition of hypertension is only detectable with the help

of an instrument named sphygmomanometer and is coined only before few decades ago and

certainly the term hypertension could not be uncovered in literature of Ayurveda. Many

contemporary scholars of today are of opinion that there is no description of such condition in

Ayurveda but literary evidences contradict this view. In Ayurvedicclassics we find an

elaborate and scientific description of blood circulation[9]

as well as clinical entities which are

considered as complications of hypertension nowadays viz. bhram[10]

, murccha[11]

,

sanyas[12]

, ardit[13]

, pakshaghat[14]

, shoth[1]

, bahumutrata.[16]

Hence it should be inferred that

great scholars of yesteryears were very well aware of condition like hypertension.

The arbitrary borderline accepted by most the doctors as being the point to consider drug

therapy, is taken at 140/90 mm Hg. It is considered that many factors participate in

manifestation of hypertension. Below is a brief mention of such factors:

Age and Sex- Almost all surveys show that blood pressure rises with age in both men and

women. In adult women, BP is lower than in men of comparable age, but the rise is more

steep thereafter and around middle age blood pressure is about the same, in later life it is

higher in women.

Genetic factors-Blood pressure tends to run in families and children of hypertensive parents

tend to have higher blood pressure than age matched children of people with normal blood

pressure.



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Foetal factors-Low birth weight is associated with subsequent high blood pressure.

Environmental factors

Among the several environmental factors that have been proposed, the following seems to be

of most significance-

● Obesity- Fat people have higher blood pressure than thin people.

● Alcohol intake- Most studies have shown a close relationship between the consumption

of alcohol and blood pressure level.

● Sodium intake- A high sodium intake has been suggested to be a major determinant of

blood pressure differences between and within population around the world. Population

with higher sodium intake have higher average blood pressure than those with lower

sodium intake.

● Migration- Migration from a rural to an urban environment is associated with an increase

in blood pressure that is in part related to the amount of salt diet.

● Weight gain-Increased weight appears to be a major controllable risk factor. The

Framingham study showed approximately 1 mm Hg rise of SBP for every 1.25 kg of

weight gain. Abdominal obesity as evidenced by waist circumference of 80 cm in women

and 90 cm in men has also been found to be associated with risk for hypertension.

● Physical activity-Sedentary individuals have a 20% to 50% increased risk of developing

hypertension.

● Smoking-Tobacco smoking has been reported to cause acute rise of BP, whether

prolonged smoking leads to sustained hypertension has not been established.

Clinical Feature of Hypertension[17]

1.General

● Headache

● Dizziness

● Palpitation

● Easy fatigability

2.Symptoms referable to systemic vascular disease

● Epistaxis

● Blurring of vision

● Angina pectoris

● Hematuria

● Transient ischemic episodes leading to weakness or paralysis

● Dyspnoea due to left heart failure

3.Symptomsrelated to underlying disease in secondary hypertension

● Polyurea, polydipsia, weakness due to primary aldosteronism(Conn‟s syndrome)

● Weight gain, emotional liability, truncal obesity due to Cushing syndrome

● Episodic headache, palpitation, diaphoresis and postural dizziness due to pheochromocytoma



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Complications of hypertension

A. Central nervous system complications

● Transient ischemic attacks

● Cerebrovascular accidents (strokes) due to cerebral thrombosis or haemorrhage

● Subarachnoid haemorrhage

● Hypertensive encephalopathy is characterised by very high blood pressure, neurological

manifestations including transient disturbances in speech and vision, paraesthesia,

seizures, disorientation, loss of consciousness and papilloedema. The neurological deficit

is usually reversible with control of blood pressure.

B. Ophthalmic complications

Hypertensive retinopathy is characterised by thickening of the walls of the retinal arterioles,

diffuse or segmental narrowing of blood columns, varying width of the light reflex from

vessel walls, arterio-venous nipping, retinal haemorrhages, soft and hard exudates and

papilloedema. Severe retinopathy can cause visual field defects and blindness.

C. Cardiovascular complications

● Coronary artery disease (angina and myocardial infarction)

● Left ventricular failure

● Aortic aneurysm

● Aortic dissection

D. Renal complications

● Proteinuria

● Progressive renal failure

MATERIAL AND METHODS

Aim and Objective

The present study has been undertaken with following aim and objectives.

● To study the aetiopathogenesis of hypertension.

● To find an effective safe treatment modality for hypertension.

● To evaluate the efficacy of Tab Pressocalm and Arjun ksheer pak.

● To establish the relevance of non-drug approach in management of hypertension.

● To establish the efficacy of holistic approach of Indian medicine for management of

hypertension.



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Plan of Study

Duration of Study: 90 Days

Selection of Patients

Present study was conducted at Rishikul Govt. P.G. Ayurvedic College and Hospital,

Haridwar. Patients of hypertension were selected from OPD/IPD of P.G. dept. of

Kayachikitsa. Patients of hypertension referred by other doctors were also incorporated in

this study. The criteria for selection of patients for present clinical study were as follows:

Diagnostic Criteria

Objective and subjective parameters were utilized for diagnostic purpose.

Objective parameter

The main criterion for selection was the measured blood pressure reading of the patients. For

diagnostic purpose blood pressure of the patients was measured three times over a period of

at least 3 minutes and the lowest reading recorded. Patients having blood pressure of 140/90

mm of Hg or above were diagnosed as hypertensive and were selected for study.

Subjective parameter

1. Insomnia

2. Headache

3. Anger

4. Excessive perspiration

5. Body ache

6. Vertigo

7. Chest Pain

8. Polyurea

9. Palpitation

10. Breathlessness

Inclusion Criteria

Patients of 20-80 age group having blood pressure 140/90 mm of Hg or more were included

for present study.

Exclusion Criteria

1. Patients of age less than 20 and more than 80 years.

2. Blood pressure below 140/90 mm of Hg.



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3. Malignancy.

4. C.H.D

5. Coarctation of aorta

6. Endocrine diseases

7. Pregnancy.

8. Patients having serious complications of renal, cardiovascular, and cerebral vascular

system were excluded from this study.

Criteria for Withdrawal

● Personal matters.

● Inter-current illness.

● Aggravation of complaints.

● Any other difficulty.

● Left against medical advice.

Selection of Drug

● Psychological and somatic disturbances both have role in manifestation of hypertension.

Hence for present study drugs were selected which could balance tridosha, normalise

agni, ward away obstruction, reduce anxiety, calm down nervous system and provide

serenity.

● Ashwagandha, Sarapgandha, Jatamansi, Mandukaprni, Guggulu, Haritaki, Vibhitki,

Aamalaki, and Arjun were selected for present study. Arjun was used to make ksheer pak

while rest other drugs were used to make tablet. On the basis of their pharmacodynamics

actions it was inferred that they will tranquil the mind and will bring down the blood

pressure to normal limit. Hence the tablet made by selected drugs was named as

Pressocalm. Total 50 patients of hypertension were selected for clinical trial. patients

were treated with Tab Pressocalm along with Arjun ksheer pak.Tab. Pressocalm and

Arjun ksheer pak was administered. The dose of the tablet was 2 B.D. (1gm) with plain

water for 12 weeks. Patients were also advised to take salt restricted and low fat diet.

They were also encouraged to eat satvic diet having ample amount of fresh fruits,

vegetables. Patients were also advised to inculcate some yogic practices in their daily

routine. In this regard they were advised to practice some Asanas viz. Tadasan,

Triyakatadadan, Katichakrasana, Shashankasana, Dhanurasana, and Nadishodhan

pranayam as well as Gyatri manyra chanting.



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Investigations

● Blood examination-TLC, Hb%, ESR

● Biochemical investigations: Estimations of B. Sugar, B. Urea, S. Creatinine, S.

Cholesterol, TG, LDL, HDL, and VLDL

● Urine analysis: Physical, chemical and microscopic examinations were done and

presences of albumin, sugar, acetone, R.B.C., pus cell, cast

● Stool examination: Routine and microscopic examination of stool

● Other investigation: Chest x-ray and E.C.G.

Follow up Study

After completion of therapy all patients were advised to report in the OPD once a week for at

least 15 days.

Assessment criteria for Overall Effect of Therapy

Presentation of Data

The collected data were analysed and depicted in the following sequence:

(1) General observations viz. age, sex, religion etc.

(2) Result of therapy was evaluated on the basis of reduction in blood pressure reading as

well as improvement in ten selected symptoms.

Percentage of overall improvement

Percentage of overall improvement of each patient was calculated by the following formula:

Statistical Analysis

The obtained information were analysed statistically in terms of Mean Score (x), Standard

Deviation (S.D.) and Standard Error (S.E.). Wilcoxon sign rank test and Paired„t‟ test was

carried out at the level of 0.05, 0.02, 0.01, and 0.001 of P levels. The results were interpreted

as:

● P<0.05 & P<0.02 - improvement

● P<0.01 -Significant improvement

● P<0.001- Highly significant improvement



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Criteria for Assessment of Result

No Improvement-Patients having 0-20% improvement were kept under no improvement

group.

Mild Improvement-Patients having 20-40% improvement were kept under mild

improvement group.

Moderate Improvement-Patients having 40-60% improvement were kept under moderate

improvement group.

Marked Improvement-Patients having 60-80% improvement were kept under marked

improvement group.

Excellent Improvement-Patients having 80-100% improvement were kept under excellent

improvement group.

OBSERVATIONS AND RESULTS

● In present series of patients out of 50 patients 48% were male and 52% were female. And

maximum patients (62%) were in age group of 30-60.

● Maximum patients of this study were Hindu (84%) and were married (96%). More

patients (64%) were from urban area.

● Maximum patients (52%) were from middle class family.

● Majority of patients (64%) were leading sedentary lifestyle.

● Fifty percent of the patients of this series were known hypertensive among them 18% and

10% were having hypertension for 1-5 year and 5-10 year respectively and 6% were

having for ≥ 15 years.

● Appetite was found normal in maximum patients (52%). Twenty five percent of patients

were vegetarian. Among non-vegetarian 36% were regularly taking non vegetarian diet

while 14% were consuming non vegetarian diet occasionally.

● Dietary habits were also observed and it was found that maximum numbers of patients

were not following rules of eating. Adhyashan, samashan and vishamashanwas observed

in 60%, 78%, and 64% of patients respectively.

● Maximum patients were having Krur koshth and constipation was found in 54% of

patients. And hard consistency of stool was observed in 44% of patients. Normal

urination was observed in 58% patients.

● Hypertension is a psychosomatic disease. Hence emotional make up of the patient has

great impact in its manifestation. Regarding emotional status irritability was observed in



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46%, anxiety in 26%, and depression in 28%. Disturbed sleep was observed in 40% of

patients.

● Regarding status of agni it was noticed that maximum patients were having either

mandagni (46%) or vishamagni (40%).

● Worry (76%), anger (88%) and jealousy (60%) were major mental aetiological factors

observed in the present series of patients.

● Inactivity (58%), holding of urges (70%) and awakening in night (74%) were observed as

major lifestyle related aetiological factors

● Observation made on dashavida parikshya bhav revealed that maximum patients were of

madhyama sar (58%), sanhanan (72%), satmya (52%), and having madhyam

abhyavaharan (46%), jaran (40%) and vyayamshakti (62%). Whereas maximum numbers

of patients (62%) were of Avarsatva.

● Maximum patients were of vata-pittajaprakrati (46%) followed by kapha-pittajaprakrati

(30%). Regarding manasprakrati 78% were of predominant rajasika prakrati.

Effect of Therapy

A. Effect of therapy on blood pressure

● Effect of Therapy on blood pressure

Table No. 1: Depicting Statistical Computation Made on SBP.

Mean

% Relief SD SE T p BT AT BT-AT

1.809 0.000 1.809 100 0.741 0.108 16.726 ˂0.001

Table No. 2: Depicting Statistical Computation Made on DBP.

Mean

% Relief SD SE T p BT AT BT-AT

1.638 0.0213 1.617 98.70 1.012 0.148 10.955 ˂0.001

B. Effect of Therapy on Symptoms

Insomnia

Table No. 3: Effect of Therapy on insomnia.

Mean % Relief SD SE Z Value P- Value

BT AT BT-AT

1.64 0.170 1.47 89.61 0.8302 0.1211 -5.672 <0.001



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Headache

Table No. 4: Effect of Therapy on Headache.

MEAN % RELIEF SD SE Z- Value P Value

BT AT BT-AT

1.47 0.02 1.45 98.55 1.1943 0.1742 -5.009 <0.001

Anger

Table No. 5: Effect of Therapy on Anger.

Mean % Relief SD SE Z-Value P- Value

BT AT BT-AT

1.45 0.298 1.149 79.412 0.9320 0.1359 -5.066 <0.001

Body ache

Table No. 6: Effect of Therapy on Body ache.

Mean % Relief SD SE Z- Value P-Value

BT AT BT-AT

0.55 0.02 0.47 84.62 0.8559 0.1248 -3.473 <0.001

Giddiness

Table No. 7: Effect of Therapy on Giddiness.

Mean % Relief SD SE Z Value

P-

Value BT AT BT-AT

0.55 0 0.55 100 0.9512 0.1387 -4.335 <0.001

Chest Pain

Table No. 8: Effect of Therapy on Chest Pain.

Mean % Relief SD SE Z- Value P-Value

BT AT BT-AT

0.32 0.043 0.28 86.67 0.6494 0.0947 -2.598 <0.008

Breathlessness

Table No. 9: Effect of Therapy on Breathlessness.


BT AT BT-AT

0.45 0.04 0.41 90.48 0.8511 0.1231 -2.850 0.002

Excessive Sweating

Table No. 10: Effect of Therapy on Excessive Sweating.

Mean % Relief SD SE Z-Value P- Value

BT AT BT-AT

0.55 0.09 0.47 84.62 0.7178 0.1047 -3.640 <0.001



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Palpitation

Table No. 11: Effect of Therapy on Palpitation.

Mean % Relief SD SE Z-Value p- Value

BT AT BT-AT

0.38 0.02 0.36 94.44 0.7640 0.1114 -2.859 0.002

Polyurea

Table No. 12: Effect of Therapy on Polyurea.


BT AT BT-AT

0.59 0.08 0.51 86.44 1.006 0.1547 -3.023 0.001

❖ Effect of therapy on Laboratory investigations

TLC Count

Table No. 13: Before and After Treatment Mean ± SD of TLC.

Mean SD SE t- Value p- Value

BT AT BT-AT

8051.06 7157.45 893.62 3094.76 451.42 1.980 0.054

HB%

Table No. 14: Before and After Treatment Mean ± SD of Hb%.

Mean SD SE t- Value p- alue

BT AT BT-AT

11.93 12.92 -0.636 1.753 0.256 -2.488 0.017

ESR

Table No. 15: Before and After Treatment Mean ± SD of ESR.


BT AT BT-AT

24.79 19.94 4.86 15.989 2.332 2.080 0.043

B. Urea

Table No. 16: Before and After Treatment Mean ± SD of B. Urea.


BT AT BT-AT

28.732 24.519 4.213 11.430 1.616 2.6063 0.012

FBS

Table No.17: Before and After Treatment Mean ± SD of FBS.


BT AT BT-AT

88.13 83.51 4.62 29.793 4.346 1.062 0.294



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S. Cholesterol

Table No. 18: Before and After Treatment Mean ± SD of S. Cholesterol.


BT AT BT-AT

209.06 165.34 42.72 59.136 8.626 5.068 0.001

S. TG

Table No. 19: Before and After Treatment Mean ± SD of S. TG.


BT AT BT-AT

151.65 133.70 17.95 39.202 5.718 3.139 0.003

HDL

Table No. 20: Before and After Treatment Mean ± SD of HDL.


BT AT BT-AT

35.52 42.04 -6.52 17.069 2.490 -2.618 0.012

LDL

Table No. 21: Before and After Treatment Mean ± SD of LDL.


BT AT BT-AT

117.59 90.12 27.48 77.273 11.273 2.438 0.019

VLDL

Table No. 22: Before and After Treatment Mean ± SD of VLDL.


BT AT BT-AT

34.06 25.59 8.469 22.756 3.319 2.522 0.014

Overall improvement

Table No. 23: Depicting After Treatment Improvement.

S. No. Chief Complaints % of Improvement

1. Elevated SBP 100

2 Elevated DBP 98.70

3. Insomnia 89.61

4. Headache 98.55

5. Anger 79.42

6. Excessive Sweating 84.62

7. Body Ache 84.62

8. Vertigo 100

9. Chest Pain 86.67

10 Polyurea 86.44

11. Palpitation 94.44

12. Breathlessness 90.48



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DISCUSSION

In present day scenario prevalence of hypertension is increasing day by day. Previously

considered a disease of old age is now becoming prevalent in younger age group. The root

cause of such presentation is observance of unhealthy lifestyle, unwholesome food, mental

conflicts, emotional disturbances, ever declining moral and ethical values of the individual as

well as society and stress.

Hypertension is a psychosomatic disease and certainly needs yogic intervention. Yoga creates

balance and harmony in mind body complex and thus protect from ravages of stress and

strain of fast pacing modern city life. Yogic practices when practiced daily and its principles

such as yama, niyam, sadachar, sadvratta are followed regularly in daily life leaves no room

for ill-health. It is quoted in Charaka Samhita that one who has a happy combination of his

thought, speech, action, who has his mind under control, who has his intellect clear and also

possesses the knowledge of soul and who is devoted to austerities and yoga, never suffers

from any disease.[19]

Asana

The mind and body act as a unit. The gross form of mind is the body and the subtle form of

the body is the mind. The practice of Asana integrates and harmonizes the two. Both the body

and the mind harbour tensions or knots. Every mental knot has a corresponding physical,

muscular knot and vice versa. The aim of Asana is to release these knots. Asana release

mental tensions by dealing them on the physical level, acting somato-physically, through the

body to the mind. For example, emotional tensions and suppression can tighten up and block

the smooth functioning of the lungs, diaphragm and breathing process, contributing to

debilitating illness in the form of respiratory disorders.[20]

Asanas aid in development of good

health by stretching, massaging, and stimulating the pranic channels and internal organs.

In addition, Asanas are designed to have specific effects on the glands and internal organs,

and to alter electrochemical activity in the nervous system.[21]

These Asanas are intended to

gently massage the internal organs, glands, and muscles as well as to relax the nerves

throughout the body. They are especially concerned with bringing tranquillity to the mind and

preparing the practitioner for the higher practices of yoga, such as meditation. Yogic Sukshma

Vyayama, Tadasana, Katichakra Asan, Kona Asana, Uttanapada Asana, Pavanmukta Asana,

Shashanka Asana, Dhanura Asana, Vakra Asana, Bhujanga Asana, Gomukha Asana,

Ardhamatsyendra Asana, Shava Asana are beneficial in hypertension.[22]



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Pranayam

The breath is the most vital process of the body. It influences the activities of each and every

cell and, most importantly, is intimately linked with the performance of the brain.[23]

A slow

breathing rate keeps the heart stronger and better nourished and contributes to a longer life.

Deep breathing also increases the absorption of energy by Pranamayakosha, enhancing

dynamism, vitality, and general well being.[24]

Pranayam establishes regular breathing patterns, instil vitality and are effective tool for

attainment of longevity. Pranayamutilizes breathing to influence the flow of Prana in the

nadi or energy channels to the pranamayakosha or energy body.[25]

Pranayam is a vital

technique and bridge between body and mind. It brings tranquility and restrict interfence

from the thoughtprocess. It stills the disturbances of the mind and tune one to its inner core of

being.[26]

Lifestyle has a profound impact on the pranamayakosha and its Prana. Physical activities

such as exercise, work, sleep, intake of food and sexual relations all affect the distribution

and flow of Prana in the body. Faculties of the mind such as emotion, thought, and

imagination affect the pranic body even more. Irregularities in lifestyle, dietary indiscretions,

and stress deplete and obstruct the pranic flow. The techniques of Pranayam reverse this

process, energizing and balancing the different Prana within pranamayakosha.[27]

Pranayam reduces the need of oxygen, so also the production of carbon dioxide. So the

respiration rate reduces. Bhramari, Ujjayi and Nadishodhanpranauam are useful in

hypertension. Ujjayi Pranayam balances the Pranic flow of energy in the body. Ujjayi also

affects carotid sinus, which help reduce BP. Nadishodhan Pranayam controls the Pranic

flow. But people suffering from BP should not practice Kumbhaka (retention of breath) but

should only do inhalation and exhalation.[28]

Mantra Chanting

The mind, as an organic entity, requires the right conditioning, just as the body does. The

body requires a specific regimen, with proper timing and manner of eating and exercise, and

sleep. The mind also requires a regimen of taking in impression, mental exercise, and rest.

Mantra means “the instrument of mind” or what protect the mind. It is direct method for

dealing with the mind.[29]

Mantra purifies the mind; destroys pain, sin, and ignorance; brings

liberation; and bestows health, beauty, strength, vitality, power, intelligence, and magnetic



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aura.[30]

When we repeat a mantra for a long period of time, this creates an energy that

neutralizes the scar left from our distracted mental activity and creates a more powerful

memory to override them.

Meditation

Meditation has been considered an effective tool in Indian medicine. The Bhagavada Geeta

in sixth chapter[31]

elaborately described philosophical and practical aspect of meditation.

Bhagwan Buddha has given his instructions for meditation in a simple form known as

Vipassana Meditation. Maharshi Patanjali through Rajayoga explicitly emphasizes the

relevance of meditation and put forward meditation as a tool for conquering the mind.

Meditation is a state of intense, pure awareness; it works profound changes in the psyche.

During meditation there is generally a tremendous acceleration of energy to the individual

cells. Just as negative thought can pollute them, positive thoughts rejuvenate them and retard

decay. Penetrating all the cells, its vibrations can prevent and cure diseases. The soothing

waves that arise also exercise a favourable effect on mind and nerves, resulting in a

prolonged, positive state of mind. Thus interior world takes direction from the mind and

promotes physical health, mental acuity, and tranquillity and thus aid in eradicating

hypertension.

The probable mechanisms through which blood pressure come under control could be as

follows[32]

:

● Blood pressure increases by sustained activation of Flight and Fight response of the body.

Yoga effectively switches off the response and brings adrenaline levels down, thus

reducing blood pressure.

● The chronic stress induced sustained muscular contraction reduces lumen diameter of

blood vessels in the muscles. It in turn increases blood pressure. Stretching of muscles

and relaxing the same as done in yogic exercises reverse this effect.

● Sustained muscular contraction sends signals to the brain, thereby it provokes the

secretion of stress hormones, and neurotransmitters associated with stress and high B.P.

the regular practices of yoga may reverse this.

● Regular yoga may reduce stress hormone „aldosterone‟ which is a potent vasoconstrictor.

● Regular yoga may reduce the release of „vasopressin‟-another stress hormone secreted by

pituitary gland in the brain. Vasopressin increases B.P. by vascular contraction.



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● The medulla oblongata in the brain has both the respiratory center and the vasomotor

center side by side. Fast breathing in stressful situations tends to overspill the electric

signals over vasomotor centre thus increasing B.P. Pranayam regulates breathing and

therefore may reduce the signal overspill from respiratory center, thus reducing B.P.

● Certain posture in yoga do offer controlled pressure on kidneys and adrenal thereby

possibly regulating blood supply to these vital organs, which mainly regulate B.P.

through secretion of renin, angiotensin, and adrenalin.

CONCLUSION

i. Hypertension is a psychosomatic illness. Disturbance at psyche level plays an important

role in its manifestation.

ii. Genetic predisposition is also important factor in precipitation of hypertension.

iii. Hypertension is multifactorial in origin. Dietetic and lifestyle indiscretion, type A

personality, negative emotions, unresolved conflicts and negative outlook towards life all

are potential factors for manifestation of hypertension.

iv. All the three doṣa participate in pathogenesis of hypertension. Hypertension is a vata-

pitta pradhantridoshajvyadhi.

v. Formation of ama is an important event in avaran induced hypertension.

vi. Srotasa which are involved primarily are rasavaha, raktavaha, and manovaha srotasa.

vii. Vata aggravation, vitiation of rakta and avaran of vata; these three events are crucial in

manifestation of hypertension.

viii. Hypertension is outcome of wrong dietary and lifestyle choices hence, correction of

lifestyle is necessary.

ix. Sarpagandha is a potent blood pressure lowering drug and effectively decreases blood

pressure. The drugs like Ashwagandha, Jatamansi, Mandukaparni, are knownmedhya

drugs. Many recent studies support the view that these drugs decrease stress hormone in

body. These drugs helped in relieving stress and induced a sense of well-being in patients

of hypertension. Drugs like Haritaki, Arjuna, and Guggulu worked through their

srotośodhaka and lipid lowering properties. Amalaki, Haritaki, and Vibhitak are mild

laxative and are good for heart health too. Pharmacodynamics characteristics of these

drugs also correct the metabolism and it seems that they helped in checking the ama

formation, condition of dyslipidemia and process of atherogenesis.

x. The regulation of sattva (mind) by yogic exercises is highly beneficial in the treatment of

hypertension caused by stress and hard life. Yogic practices facilitate the free flow of



1120

energy, correct the psycho-neuro-endocrine axis, and thus relieve the stress. Certain

asana, pranayam, mantra chanting and meditation are some of the yogic practices which

certainly benefit hypertensive patients.

xi. Yogic measures adopted in this study worked synergistically. It seems that the combined

effect of selected drugs and yogic interventions helped in lessening the peripheral

vascular resistance, stress hormone level and thus effectively checked the on-going

offending mechanism and break the process of pathogenesis. As a result blood pressure

came down and patients felt great relief in other symptoms also. Hence it may be

concluded that practices such as yogic exercises, pranayam, mantra chanting, prayer,

surrender to God, and meditation are definitely beneficial when applied with drugs.

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