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2 REVIEW ARTICLE Scientific Journal Impact Factor (2015) by InnoSpace Sci. Res., Morocco AN AYURVEDIC UNDERSTANDING OF HYPERLIPIDEMIA Santhosh Avangapur 1*, Vasudev Chate 2, Shreevathsa 3 1. PG Scholar, Dept. of PG studies in Ayurveda Samhitha and Siddhanta, Government Ayurveda Medical College, Mysore, Karnataka state, India, Contact No.: , - skavangapur@gmail.com 2. Lecturer, Dept. of PG studies in Ayurveda Samhitha and Siddhanta, Government Ayurveda Medical College, Mysore, Karnataka state, India, Contact No.: , vachate37@gmail.com 3. Professor (I/C) and HOD, Dept. of PG studies in Ayurveda Samhitha and Siddhanta, Government Ayurveda Medical College, Mysore, Karnataka state, India, Contact No.: , - dr.shreevathsa@rediffmail.com Article Received on - 28 th Jan 2016 Article Revised on - 27 th Feb 2016 Article Accepted on - 29 th Feb 2016 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non commercial purpose (see copyright notice below). (Full Text Page IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 REVIEW ARTICLE AN AYURVEDIC UNDERSTANDING OF HYPERLIPIDEMIA *Corresponding Author Santhosh Avangapur PG Scholar, Dept. of PG studies in Ayurveda Samhitha and Siddhanta, Government Ayurveda Medical College, Mysore, Karnataka, India, Contact No.: , - skavangapur@gmail.com QR Code IJAAM ABSTRACT: The term Hyperlipidemia is used to denote raised serum levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides or both total cholesterol and triglyceride. Hyperlipidemia does not bear a precise reference in Ayurvedic classics, though the study of Ayurvedic literature conveys through some implicit references, which might be due to the fact that it is a metabolic disorder. Liver plays an important role in metabolism of low density lipids (cholesterols) and also protein and fat metabolism. The study of Ayurvedic texts bears certain ambiguous concepts or references pertaining to an increase in the amount of rasaraktagata sneha (circulating body lipids), yet the literal meaning of Hyperlipidemia is not found to be distinctly stated anywhere. With the proper exploration of literary sources and applying the basic concepts of Ayurveda, one can establish the possible abnormal conditions mentioned in Ayurveda with the existing modern concepts. In this paper, an attempt is made to explore the nearest possible conditions of hyperlipidemia and its chikithsasiddhanta as per the Ayurvedic classics. DIDS: Key Words: Hyperlipidemia, Medo-roga, Liver, Medo-dhatu INTRODUCTION: Acharya Charaka claims that; "A physician should never get ashamed or embarrassed if he is unable to name a given diseased condition, as each and every disease cannot be named". [1] This quotation is rightly quoted and best fit for today s era where the arrays of newer diseases have come into present scenario. Evolution of many newer diseases due to modernization, sedentary lifestyle and other reasons, made man to tremble and physician to handle such condition cautiously in his clinical practice. This is mainly due to the dealings of various lifestyles, genetic and environmental factors which have altered over the years. Whatever in Ayurveda is found everywhere and whatever is not here is not found anywhere else [2] So, No disease is newer or unknown to the Ayurveda. With the proper exploration of literary sources, understanding and applying the basic concepts of Ayurveda, one can make the possible equivalence of Ayurvedic concepts with the existing modern concepts. Hyperlipidemia is one such condition where there is no exact narration in any of the Ayurvedic classical texts. The concept of Hyperlipidemia can be elaborated according to the Ayurvedic classics through indirect relevant references and concepts. Critical review of the Ayurvedic classics will reveal that the impairment of vitiated medo-dhatu vis-avis lipids might results in hyperlipidemia. HYPERLIPIDEMIA Hyperlipidemia is a metabolic disorder in which the levels of Lipoproteins, Cholesterol, Triglycerides or both are raised in plasma, wherein there is a deposition of lipids mainly in form of esterifies cholesterol in the wall of arteries. Lipids have been considered as fats in the bloodstream, which is commonly divided into cholesterol and triglycerides. However, the cholesterol circulates in the bloodstream which is involved in the structure and functions of cells, whereas, the triglycerides are either used immediately or stored in the fat cells. It causes narrowing and blockage of the arteries and produces mainly heart disease while other diseases include CVD (Cerebrovascular Disease), Renal disease, Liver disease, Peripheral Vascular disease. Hyperlipidemia is not a single disease but a range of disorder with a variety of metabolic disorder, life style disorders and even environmental as well as genetic factors. It can be caused or influenced by a wide range of other disorders also. Its presence can affect many different organs and systems at the time. Hyperlipidemia is generally divided into2 subtypes as primary and secondary hyperlipidemia. Primary hyperlipidemia is usually due to genetic causes (such as a mutation in a receptor protein), while secondary hyperlipidemia arises due to other underlying cause, such as diabetes, thyroid disease, renal disorders, liver disorders, and Cushing s syndrome, as well as obesity, alcohol consumption, Page2

4 estrogen administration and other drug-associated changes in lipid metabolism. Role of Liver in Hyperlipidemia: [3] LIVER: Absorption of Lipids from small intestine is converted into Triglycerides which converts into Fatty acids and Glucose SYSTEMIC CIRCULATION: Flow of Triglycerides and glucose into ciculation FAT DEPOSIT: Triglycerides BODY TISSUE: Utilized by body tissues Figure 1: Schematic diagram showing the lipid metabolism Few aspects of Lipid metabolism are unique to the liver. Liver is the major site for converting excess carbohydrates and proteins into fatty acids and triglyceride which are then exported and stored in adipose tissue. The liver is extremely active in oxidizing triglycerides to produce energy. The liver breaks down many more fatty acids that the hepatocytes need and exports into blood. The liver synthesizes large quantities of lipoproteins, phospholipids, amino-acids and cholesterol. Hepatocytes are responsible for synthesis of most of the plasma protein (albumin) and also clotting factors. Hyperlipidemia is a known risk factor for fatty infiltration of the liver, a condition that can progress to cirrhosis and liver failure. Low LPL(lipoprotein lipase) activity further causes high synthesis of LDL cholesterol by the liver, ultimately leads to hyperlipidemia. The pathophysiology of hyperlipidemia involves the defect in lipid metabolism. Cholesterol, triglycerides and phospholipids are transported in the bloodstream as a complex of lipids and proteins known as lipoproteins. Due to the impaired lipid metabolism, lipoproteins circulating in the blood stream start adhering to the walls of blood vessels and thereby causing the deposition over the blood vessels. Gradually, the Elevated total and low-density lipoprotein (LDL) cholesterol and reduced highdensity lipoprotein (HDL) cholesterol are associated with the development of Coronary Heart Disease (CHD). Hyperlipidemia An Ayurvedic Perspective In Ayurveda, Hyperlipidemia does not bear a precise reference in any Ayurvedic classical treatises, though the study of Ayurvedic literature bears some implicit references. Hyperlipidemia is characterized by an increased amount of lipids present in the bloodstream. The lipids which are elevatedcan be correlated to Sneha, Medo-dhatu, Saama-rasa, due to the similarity in their properties. Attempts were made by various scholars of Ayurveda to correlate clinically it to Rasagata Sneha Vriddhi, Raktagata Sneha Vriddhi, Rasaraktagata Sneha Vriddhi, Medoroga and Sthaulya. Hyperlipidemia can be included in Santarpanjanyavyadhi. Hyperlipidemia is also a Dhatu-pradoshajaVikara in which Medodhatu is being dominant, thus it can be correlated it with Medodosha (Amaposhakamedo-dhatu Vruddhi) comes under the broad umbrella of Ama. Hence, the conditionof Hyperlipidemiacan be considered under the Medo-Dosha as well as SantarpanjanyaVyadhi. Nidana: Most of the Acharyas have stressed upon the role of an imbalanced diet with sedentary habits as an important cause, the etiological factors of medoroga or santarpanajanyavyadhi s can be classified as follows: Aharaja-Dietary factors: it includes atisampurana of ahara (overeating), Adhyashana (repeated eating), Madhura-gurusheetadravya ahara (sweet, heavy and cold food items), shleshmadravyaahara, vishishtaahara, ati medaahara sevana (fatty food), ati-madya sevana (excess alcohol consumption), etc. [4] In short, santarpana, kaphakara and amakaraka Page3

5 ahara s are the main etiological factors responsible for medo-dushti. Viharaja-Behavioral factors: some of the behavioral factors held responsible for medoroga are: Divaswapna(day sleep), Avayayama(lack of exercise), Achintana (lack of thinking), Harshanityatva (exhilaration) and sedentary habits. [4] Beejadosha- Genetic or Hereditary factors: in addition to the above etiology factors, genetic or hereditary factors will also play an important factor in the development of medoroga. [4] Primary hyperlipidemia is due to Genetic cause. Anya nidanas - Other causes: Unintentional andinjudicious use of some of the therapeutic measures i.e. Santarpana etc. may give rise to medoroga (sthaulya). In Prameha (Santarpanajanya vyadhi), similar causative factors will be contributing which leads to drastic metabolic changes in the body are as follows; According to Charaka, excess intake of meat of domestic, marshy and aquatic animals, vegetables,new rice, new fresh wine sesame oil, Paayasa (a type of milk preparation), gruel prepared out of Tila (Sesamuindicum), rice (Oryza sativa) and black gram (Vigna mungo), preparations of sugarcane, milk, unformed curd, avoidance of dry massage and physical exercise, indulgence in sleep, rest, sedentary habits, etc. [5] According to Sushrutha,excess intake of cold, unctuous, sweet, fatty, liquid food habits, daysleep, lack of physical exercise, etc. [6] So, the same etiological factors will be responsible for raised levels of lipids, cholesterol and for the deposition of circulating lipids over blood vessels due to altered lipid metabolism by liver. Use of specific dietary factors like too much sweet, unctuous foods itemsand lifestyle factors like absence of physical exercise, day sleep, etc leads to diminished digestive capacity. This further leads to the formation of undigested food i.e. - Ama anna rasa and subsequent rasa dhatu. The Ama rasa dhatu leads to medodhatvagnimandya. The above equation due to their affinity for medo-dhatu causes direct increase in the asthayimedo-dhatu. Then medodhatvagnimandya results in the increase of amaasthayimedo-dhatu or amasthayimedo-dhatu(excessive adipose tissue) or both, which is known as Hyperlipidemia. Samprapti Ghataka: Dosha -KledakaKapha; Pachaka Pitta; Samana and VyanaVata Dushya - Rasa and MedoDhatu Agni Parthiva and Aap Bhutagni s; Rasa and Medo-dhatvagni Srotas Medovaha Srotas Srotodusti Sanga and Margavarodha Adhisthana - Whole Body Udbhavasthana -Amashaya Prasarasthana Rasayani Vyaktasthana - Sarvanga Ama - Jatharagni mandhyajanita ama; Dhatvagnimandhyajanita ama Roga-marga -Bahya Poorvaroopa (Premonitory symptoms): The poorvaroopa s are in alpa-vyakta state, which could be understood by the occurrence of the minimal features of hyperlipidemia. Samprapti (Pathogenesis): Hyperlipidemiacan be narrated as a dushya dominant disorder.medo-vriddhi is a complex process. Regarding the samprapti of Medodusti, both Acharya Charaka and Susrutha have different views. Acharya Charaka has accepted Ahara as a most common pathogenic factor, whereas Susrutha has accepted as ama (rasa) as the main factor for medotpatti. [6] Fig 2: Flow-chart showing the formation of amamedovruddhi: Clinical Features: In Hyperlipidemia,the drastic changes in the levels of lipids, triglycerides and cholesterols were found due to hampered lipid metabolism by the liver. Page4

6 Chikitsa Siddhanta: Ayurveda with its own holistic approach in treating the different diseases adopts the various treatment modalities to treat at the disease s root level. [7] So firstly the etiological factors responsible for the causation of diseases in terms of food and activities should be avoided. So, the use of specific diet and activities producing ama (indigestion of food) and vitiating the medo-dhatu should be avoided. Samanya Chikitsa: Vriddhaasthayi medo dhatu (increased circulating lipids) is a santarpanajanya condition as stated earlier. Hence the Samanya chikitsa comprises of apatarpanajanya upakrama. Apatarpana (making body lean) measures like ullekhana, raktamokshana (bloodletting), vyayama(physical exercise), upavasa (fasting), dhuma (medicated smoking), swedana (sudation), sakshaudraahara (food mixed with honey), abhayaprasha (oral intake of amalakichoorna), rukshannasevana (dry food items), different types of choornas (powders) and pradehas. [8] Hyperlipidemia can also be treated with some drugs, habits and diet style which can reduce the vitiated body constituents as well as to control the obesity and its associated problems. Vishesha Chikitsa: Hyperlipidemia can be a santarpanajanya vyadhi where the medo-dhatuis the main factor vitiated in the pathogenesis of Hyperlipidemia. So, the wise physician should aim to reduce excessive Medo Dhatu, these can also be considered as the line of treatment for the vruddhaasthayi medodhatu. Shodhana (Purificatory therapies) should be done in order to remove the vitiated doshas and malas forcefully, which includes the Virechana, Rakta- Mokshana, Swedana, Udwarthana, etc.are said to be effective in any santarpanajanya vyadhis. All these therapies does the sroto-shodhana (clears the obstruction in the channels), removes the adherent, deep seated vitiated doshas, kaphamedovilayana (diminution of fat), etc. For Shamana(Palliative measures), use of the medicines performing the role of Rookshana (to reduce the snehamsha), lekhana and kaphamedohara action can be administered in the form of vati, kashaya, udhwarthana, basti, ahara,etc. Formulations like Kanchanara Guggulu, Triphala Guggulu, Arogyavardhini Vati, Mustadi Ghana Vati, Yavamalakadi Choorna, etc are proven to be very effective in Hyperlipidemia. DISCUSSION: There is no direct reference of a single disease entity that can be directly correlated with the hyperlipidemia. Moreover different scholars have different opinions about the nearest possible disease for hyperlipidemia. Most of them have considered hyperlipidemia under the heading of medoroga or medodosha. Few of them have considered asrasagata-snehavriddhi, raktagatasnehavriddhi or rasa raktagata-snehavriddhi, and even some authors are considering hyperlipidemia under the broad umbrella of Ama. Hyperlipidemia involves abnormally elevated levels of any or all lipids or lipoproteins in the blood. In body, there are many tissues which are rich in lipids such as medo-dhatu, vasa and majjadhatu. Among the above lipids medo-dathu is very important, as it has significant role in developing many metabolic diseases. Agni is responsible for all metabolic activities of the body. The pathology of medo-dhatwagnimandhya leads to excess homologous poshakamedo-dhatu in circulation,which can be referred to the conditions such as hyperlipidemia. There are two types of medodhatu(lipids);poshya and Poshakamedodhatu. The Poshakamedo-dhatuis mobile in nature, (gatiyukta) which is circulated all over the body along with the rasa-raktadhatu, to give nutrition to poshyamedo-dhatu. The vitiation of Agni has serious impact on health at various levels depending on type of Agni involved. When Agni is decreased, it will lead to various metabolic disorders at various levels and produces ama. If agnimandya is present at the level of dhatwagni (one or more), then the particular dhatus cannot assimilate nutrients present in the circulating ahara rasa or circulating poshakadhatu. So, such poshakadhatus will be accumulated in ahara rasa in abnormal quantities and they may further get accumulated at abnormal sites. This sort of process can be called leenatwa(deep seated) of ama in dhatus. Such leenatwa can cause a number of disorders. When medodhatwagni is diminisheddue to various etiological factors, then the homologous nutrients present in poshakamedodhatu will be excess in circulation, which leads to excess accumulation of abnormal quantities of poshakamedodathu in rasa.this condition can be referred as Hyperlipidemia. This is because the poshakamedodhatu cannot be assimilated into sthayimedodhatu by medodhatwagni, causing excess poshaka medodhatu in circulation. The consequence of such increase in poshaka medodhatu leads to disorders such as dhamanipratichaya, etc. The Etiological factors, signs and symptoms mentioned for Page5

7 medoroga or any santarpanottavyadhi s are almost similar to hyperlipidemia. Thus the condition which is characterized by hyperlipidemia can be considered under the concept of medoroga or a santarpanajanya vyadhi. CONCLUSION: Hyperlipidemia is a metabolic disorder in which the levels of Lipoproteins, Cholesterol, Triglycerides or both are raised in plasma, where there is a deposition of lipids (esterified cholesterol) in the wall of arteries. In Ayurveda, Hyperlipidemia does not bear a precise reference in any Ayurvedic classical treatises, though the study of Ayurvedic literature bears some implicit references. With the proper exploration of literary sources and applying the basic concepts of Ayurveda, one can make the possible equivalence of concept of medo-vruddhi with the hyperlipidemia. The pathology of medodhatwagnimandhya leading to excess homologous poshakamedo-dhatu in circulation can be referred to hyperlipidemia. The Etiological factors, signs and symptoms mentioned for medoroga or any santarpanottavyadhi s are almost similar to hyperlipidemia. Thus the condition which is characterized by hyperlipidemia in the body can be considered under the concept of medo-roga or santarpanajanya vyadhi. REFERENCES: 1. Yadavji Trikamji, Editor, Charaka Samhita. Varanasi, Chaukhamba Orientalia; 2011.p Yadavji Trikamji, Editor, Charaka Samhita. Varanasi, Chaukhamba Orientalia; 2011.p K Sembulingam, Prema Sembulingam, Editors. Essentials of Medical Physiology, New Delhi, Jaypee Brothers Medical Publishers; 2006.p Yadavji Trikamji, Editor, Charaka Samhita. Varanasi, Chaukhamba Orientalia; 2011.p Yadavji Trikamji, Editor, Charaka Samhita. Varanasi, Chaukhamba Orientalia; 2011.p Yadavji Trikamji, Editor, Charaka Samhita. Varanasi, Chaukhamba Orientalia; 2011.p Yadavji Trikamji, Editor, Charaka Samhita. Varanasi, Chaukhamba Orientalia; 2011.p Yadavji Trikamji, Editor, Charaka Samhita. Varanasi, Chaukhamba Orientalia; 2011.p.122 CITE THIS ARTICLE AS Source of Support Nil Conflict of Interest None Declared Page6

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