In many countries last century's developments have led to life style alterations characterized by increased caloric and fat intake and reduction in physical activities along with a dramatic increase in metabolic syndrome related diseases such as Diabetes, Hyperlipidaemia, Hypertension and obesity etc. Hyperlipidaemia alone curretly affects approximately 10% of the global population.
Definition: Hyperlipidaemia is an elevation of lipids, in the "Bad" low density liporotein (LDL) cholesterol and the triglycerides concentrations and a decrease in the "Good" high density lipoprotein (HDL) cholesterol concentration in the blood.
Causes of Hyperlipidaemia: These can be classified in two groups:
Primary causes: This group includes various genetic causes of hyperlipidaemias.
Secondary causes: This group includes following factors:
• Sedentary life style
• Excessive dietary intake of saturated fats, cholesterol and trans fatty acids (Processed food)
• Diabetes mellitus.
• Alcohol overuse
• Chronic renal insufficiency /Failure.
• Primary biliary cirrhosis and other cholestatic liver diseases.
• Drug-Thiazides, B-blockers, Retinoids, Estrogen Progestins, Glucocorticoids.
Role of Lipids in Atherosclerosis: Atherosclerosis beings when a fatty streak develops on the arterial wall in response to lipoprotein oxidation. when monocytes leave the blood stream and migrate to the intima, they become macrophages. Macrophages then phagocytize oxidized LDL cholesterol and die, thereby contributing to the lipid component of the fatty streak. Fibroblasts, smooth muscle cells and collagen in another principal contributor to atherosclerotic plaque formation.
In response to increased plaque volume, arterial remodeling occurs, which results in an outward expansion of the coronary arteries. The arteries expand in an effort to overcome the effects of the blockage allowing blood to flow through the stenosed vessel segment. Progressive arterial stenosis eventually leads to ischaemic vascular disease and the rupture of a plaque can cause a myocardial infarction.
Signs and Symptoms of Hyperlipidaemia: Following are the common manifestations of Hyperlipidaemia-
• Heaviness in body.
• Breathlessness on mild exertion.
• Excessive sweating.
• Excessive sleep
• Cramps in legs.
• Cramps in legs.
• Eyelid xanthelasma (yellow-brown patches on eyelids)
• Tendinous xanthomata:
— Achilles tendon.
— Elbow tendon.
— Knee tendon
— Meta carpophalangeal joint
Ayurvedic concepts: In Ayurvedic classics a clinical condition termed as medo Dhatu Dusti is described which closely resembles with the hyperlipidaemic condition. Due to excessive indulgence in Slesma Vardhaka Ahara-Vihara Agnimandya is produced. Due to Agnimandya Ama dosa is formed resulting in Ama Annarasa. This Samarasa circulates in the body and vitiates Dosa, Dhatus, Srotasa, Bhutagni and Dhatwagni. There is excessive vitiation of Medodhatwagni. Thus due to Medodhatwagnimandya excessive production of Sama medasa occurs. This Sama meda circulates and accumulates in whole of the body. Thus both Posaka and Posya Dhatus become Sama and ultimately Medo Dhatu Dusti results.
In Charaka Samhita Sutrasthana chapter 20/17 Acharya Charaka has clearly mentioned a term "Dhamanipraticaya in twenty Kaphaja Nanatmaya Vikaras. On the basis of their clinical manifestations Dhamanipraticaya (Dhamniupalepa, Dhamanipustata Dhamniatipoorana) can be correlated with the term atherosclerosis/Arteriosclerosis.
As discussed earlier this Posaka Sama Medo Dhatu circulates all over the body and deposited in Dhamanies resulting in decreased diameter and elasticity of Dhamanis. Thus it results in Sangatmaka vikriti of Srotasa and ultimately disturbances in normal physiology of the Srotasa takes place.
Constituents of Samprapti: Probable constituents of Samprapti of Hyperlipidaemia are described below:
Dosa: Kapha predominant Tridosa.
Dusya: Meda, Rasa, Rakta.
Srotasa: Rasavaha, Raktavaha, Medovaha srotasa.
Srotodustilaksana: Sangatmaka dusti.
Adhisthana: Sarva Shariragata Dhamani.
Agni: Medo Dhatwagnimandhyata
Management of Hyperlipidaemia : Hyperlipidaemia can be managed effectively on following Ayurvedic principles of treatment:
• Nidana Privarjana.
• Langhana, Upavasa.
• Vyayama & Pranayama.
• Kapha Meda Nasaka Chikitsa.
• Administration of Dipana, Pacana and Lekhana drugs.
• Shodhana Therapy.
Nidana Privarjana: It includes following factors.
• Stop smoking/Tobacco chewing.
• Avoid excessive intake of Alcohol
• Avoid saturated fats and trans fatty acids (processed food).
• Avoid kapha medovardhaka Ahara-Vihara.
Langhana/ Upavasa: It is considered as Ama Pacaka, Srotosodhaka and corrects Agnimandya.
Dipana Pachana: These drugs help in improving the status of Agni and thereby checking Amadosha formation and also, Ama pacana is performed at various levels.
Lekhana Drugs: These drugs are capable of removing deposited and accumulated fat like substances from the srotasas and Dhatus (microcirculatory channels) which ultimately help in checking the onset of Dhamanipraticaya (Atherosclerosis).
Shodhana: Hyperlipidaemia is a Kapha meda bahula condition, so Snehana is contraindicated Shodhana of the patients should be done with Ruksa dravyas. Vamana karma with drugs having properties of Pitta Virecana, Yakritauttejaka, (Choleretics and Cholagogue) Lekhana Guna (Katuki) are helpful. Niruha Basti can be administered with Lakhaniya dravyas.
Compound Drug Formulations: Following drug formulations may be used successfully in managing a patient of Hyperlipidaemia.
Dose : 125-250 mg. B.D.
Anupana: Honey Luke warm water. Medoharavidangadi lauha, Shilajatvadi Lauha, Vadvagni rasa, Hardyarnava rasa, Trimurti rasa, Vyosadhya lauha, etc.
Dose : 125-250 mg. B.D.
Anupana: Luke warm water.
Arogyavardhani Vati, Navaka Guggulu, Amrtadhya guggulu, Medohara guggulu, Kutaki vati.
Dose: 3-6 gm. B.D.
Anupana: Luke warm water.
Pippaliyadi Churan, Haritakyadi Churna, Vidangadi Churna, Pathadhya Churna.
Dose: 20-30 ml. B.D.
Anupana: Simple water.
Phalatrikadi Kwatha, Mustadi Kwatha, Dashmoola Kwatha.
Note: For the best results drugs should be given empty stomach before meals.
Pathya: Moonga, Yava, Madhu, Parvala, Anara, Takra, Shunthi, Ardraka, Lahasuna, Amalki, Haritaki, Ushna Jala, Vyayama, Sharama, Langhana and Upavasa etc. are beneficial.
Apathya: Adhyashana, Atibhojana, Vishamabhojana, Virudhasana, Atyambupana, Madhura-Snigdha-Pistanna Sevana, Dadhi, Vegadharana, Divasayana and Abhyanga etc. should be avoided.
Conclusion: Formulations comprising of drugs possessing pharmacological properties like depana, Pachana, Anulomana, Yakrituttejaka, Pittaveirechana, Lekhana, Chedana, Snehakledameda Shoshana and srotosodhaka are likely to influence and correct the lipid metabolism which in turn may check/reverse the pathogenesis of Hyperlipidaemia.