by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
Throughout the developed world, coronary artery disease is the foremost cause of morbidity and mortality, causing over half a million deaths a year in the US alone. To a great extent, the disease is lifestyle-related, and results from a kapha-provoking sedentary lifestyle, coupled with excess consumption of fatty foods, especially trans-fats, and insufficient intake of fruits and vegetables. Pitta factors such as stress and overwork are also known to play a major role. "Metabolic syndrome", as it is currently described, is the precursor to heat disease. Consisting of abdominal obesity, elevated serum cholesterol and triglycerides, elevated blood pressure, insulin resistance and a prothrombotic state (sticky blood that clots too easily), metabolic syndrome could more accurately be called kapha syndrome.
Modern, reductionist physiology has tended to see the heart's importance mainly in terms of its action as a circulatory pump. However, contemporary research shows that the heart is also an endocrine gland, producing neurotransmitters in response to emotional stimuli. The heart produces adrenaline and dopamine as well as oxytocin, the "love hormone."(1, 2).
These findings only serve to validate the perspective of the Ayurvedic classics, which describe the heart as the seat of consciousness, known as hridaya, from which our word "heart" originates, as well as mahat--the great.
"The body with six divisions, sense organs, five sense objects, atma (self) together with qualities, mind along with its objects are located in the heart." (3)
Like the central girder of a house, the heart holds the aspects of the body together. "It is also the seat of the excellent ojas and reservoir of consciousness (chitta)." (4)
Because of this emphasis on the heart as the seat of consciousness, the Ayurvedic classics emphasise that "One who wants to protect the heart...should avoid particularly the causes of affliction of the mind."(5)
Contemporary studies underscore the close relationship between heart disease and negative emotions. "Negative emotions are associated with increased CHD (chronic heart disease) incidence among otherwise healthy men even when results are controlled for the presence of components of the metabolic syndrome or markers of sympathetic nervous system activity." (6) According to the American Psychiatric association, "Hostility is a better predictor of coronary heart disease (CHD) in older men than a variety of other sociodemographic and physiological risk factors, including smoking, drinking, high caloric intake and high levels of LDL cholesterol, according to a new study published in Health Psychology (Vol. 21, No. 6)". Another study published in the Archives of Internal Medicine, demonstrated that marital dissatisfaction tripled a woman's chances of having metabolic syndrome. A study by Prof. Tim Smith at the University of Utah recently indicated that hostility during marital disputes could increase hardening of the arteries in women's hearts, while controlling behaviour during marital disputes did the same for men's hearts. Warm, intimate and supportive relationships are as important for heart health as a good diet.
Changes in complexion, breathlessness, confusion and lack of appetite are symptoms that may indicate hrid rog or heart disease. Vata symptoms of heart disease include palpitations and arrhythmia, pitta symptoms are angina-- a pain often confused with heartburn-- and a yellowish colouration caused when the liver is congested by heart failure. Indications of kapha heart disease include drowsiness, cough and a heavy sensation in the heart. (7)
Ayurvedic chikitsa for CHD and metabolic syndrome involves a multi-faceted approach. After determining the main dosha(s) involved by history taking and pulse diagnosis, the practitioner will need to address ama and agni, pacify the involved doshas, initiate appropriate diet and lifestyle changes, address emotional issues and recommend specific herbs for heart health.
Simple methods such as ginger tea in the morning will be helpful for burning ama and increasing agni--fresh ginger is best for vata and pitta and dry ginger for kapha. The Ayurvedic spice cinnamon has been shown to enhance the activity of insulin (8, 9), improve blood lipids, (10) and provide valuable anti-oxidants to help prevent CHD. (11) Thus for the individual with kapha syndrome, a morning tea of dry ginger and organic cinnamon is ideal.
For vata provoked individual with hypertension and CHD, Ashwagandha and Dashamoola are good choices to pacify vata, alleviate stress and lower blood pressure, while Brahmi will regulate heart rate. Amlaki is ideal to pacify pitta, since it is an excellent antioxidant and has been shown to lower cholesterol and reverse arterial plaque formation. (12) As long as the blood sugar is not significantly elevated, one can also use Chyavanprash, which has all the benefits of Amlaki and additionally improves lung function in situations where breathlessness is a symptom, as well as enhancing metabolism. Punarnava is the best choice to pacify kapha and eliminate retained fluid in mild heart failure. It is also an important heart tonic. In addition, for metabolic syndrome, Neem and Turmeric will both lower blood glucose and reverse the prothrombotic state. Sweet Ease is a combination well tailored to the need of individuals with metabolic syndrome. For raised cholesterol, Triphala or Triphala Guggulu are ideal kapha pacifying choices.
Diet and lifestyle changes are essential in the management of CHD. Diet should be appropriate for the doshic involvement, with emphasis on reducing intake of fried food, eliminating trans-fats, lowering salt intake and increasing the consumption of legumes, vegetables and doshically appropriate berries and fruits. Food combining will be highly beneficial in improving agni and preventing further ama build up. A good exercise plan is essential. While regular exercise is extremely beneficial for CHD and metabolic syndrome; irregular excessive exercise can precipitate a heart attack. As a junior doctor on the wards, I admitted several pitta men under forty who had a heart attack at the eighteenth hole while golfing after a sedentary week. Cigarette smoking of course should be eliminated as it is a well known cause of heart and arterial disease. A hard-driving, overworked, pittagenic lifestyle must be modified by the use of yoga, shivasana and meditation to introduce an emphasis on being rather than doing. The business lunch-- still worse, the business dinner-- is a significant culprit in precipitating heart attacks because of the combination of excess consumption of heavy food with stressful negotiations. Selecting restaurants with lighter choices such as salads or stir-fried vegetables could add years to the susceptible businessman or businesswoman's life.
A holistic approach to CHD requires that we address the issue of negative emotions, helping clients find skilful means to foster positive emotions and healthy relationships and change habitual patterns of dwelling on negative emotions such as hostility. Practices for cultivating loving kindness are particularly beneficial in this regard. In addition to these practices, Brahmi, Bacopa and Tulsi are useful in reducing ingrained patterns of stress and anxiety and helping build the capacity for sattvic, positive states of mind.
Heart-specific herbs are a most valuable addition to the individual's programme. Of these the most outstanding is Arjun (terminalia arjuna). Arjuna is possessed of astringent and bitter rasa, cooling virya and pungent vipak. It is especially beneficial for pitta and kapha. A number of active components have been identified in Arjun, including Tannins, Triterpenoid saponins (arjunic acid, arjunolic acid, arjungenin, arjunglycosides), Flavonoids (arjunone, arjunolone, luteolin), Gallic acid, Oligomeric proanthocyanidins (OPCs)and Phytosterols (b-sitosterol). Arjuna is cardioprotective (13), strengthens heart muscle and has been shown to lower cholesterol significantly.
"To evaluate the antioxidant and hypocholesterolaemic effects of Terminalia arjuna tree bark (a popular cardiotonic substance in Indian pharmacopoeia) and to compare it with a known antioxidant, vitamin E, we performed a randomized controlled trial. Terminalia arjuna tree bark powder had significant antioxidant action that is comparable to vitamin E. In addition, it also has a significant hypocholesterolaemic effect."(14)
Arjun is more effective in angina than nitroglycerin, the standard medicine (15). In addition, Arjuna has diuretic properties that help reduce hypertension and are beneficial in congestive cardiac failure. Arjuna even has antibiotic capabilities valuable in Subacute Bacterial Endocarditis. Named for Shri Krishna's best friend, Arjuna is a mighty and well armed warrior able to combat all aspects of hrid rog. Arjuna is best used in combination with supportive herbs that supply additional effectiveness in lowering cholesterol, strengthening heart muscle and reducing blood stickiness. For example, Heart Formula combines Arjuna, Punarnava, Amlaki, Triphala, Guggulu and other valuable herbs for heart health.
Arjuna the mighty warrior and his companion herbs provide great help in incipient and chronic heart disease. Genuine well being requires the combination of proper diet, exercise and lifestyle regimens along with these powerful herbs, for Ayurveda is never simply as matter of pill popping. With the help of herbal allies such as Arjuna, it may be possible to avoid reliance on toxic medications to control cholesterol, blood pressure and angina.
- Lacey, J. I. and B. C. Lacey (1978). Two-way communication between the heart and the brain: Significance of time within the cardiac cycle. American Psychologist (February): 99-113.
- LeDoux, J. (1996). The Emotional Brain: The Mysterious Underpinnings of Emotional Life. New York, Simon and Schuster.
- Charak samhita, Sutrasthan ,Ch XXX v3-4, tr. PV Sharma, Chaukhamba Orentalia.
- Ibid v 6-7
- Ibid v 13.
- Todaro JF, et al. Effect of negative emotions on frequency of coronary heart disease (the Normative Aging Study). Am J Cardiol October 15, 2003;92:901-6.
- Charak Samhita, Chikitsasthanam, Ch XXVI v 70-73.
- J Agric Food Chem. 2004 Jan 14;52(1):65-709)
- Diabetes Res Clin Pract. 2003 Dec;62(3):139-48
- Kham A et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diab Care 2003, 26:3215-18.
- American Chemical Society May 19 2004 web Journal
- Antony B, Merina B, Sheeba V, Mukkadan J. Effect of standardized Amla extract on atherosclerosis and dyslipidemia. Indian J Pharm Sci 2006;68:437-441
- Cardioprotective effect of the alcoholic extract of Terminalia arjuna bark in an in vivo model of myocardial ischemic reperfusion injury. Life Sci. 2003 Oct 10;73(21):2727-39.
- Gupta R. Singal S. Goyle A. Sharma VN. J Assoc Physicians India. 2001 Feb;49:231-5.
- Efficacy of Terminalia arjuna in chronic stable angina: a double-blind, placebo-controlled, crossover study comparing Terminalia arjuna with isosorbide mononitrate. Indian Heart J. 2002 Mar-Apr;54(2):170-5.
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Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at 303-786-7437 or by email at: firstname.lastname@example.org.