It was a Clinical Trial performed at National Institute of Ayurveda, Jaipur, Rajasthan, India. The results of the trial were very encouraging and many patients are being treated on similar lines today and getting significant improvemnt.

1. C.A.D. - Hridroga 1

2. Presented by :
Amit Kumar Sharma
M.D. (Kayachikitsa), Ph.d. Scholar
PG Department of Kayachikitsa,
NIA , Jaipur.
Email : amit_jaipur84@hotmail.com
Mobile : 9414822823
Supervisor Co-Supervisor
Dr. R. K. Joshi Dr. S.M. Sharma
Asso. Prof. M.D. (Ay.), Ph.D (Ay.) M.D.(Med) D.N.B. (Cardiology)
P.G.Deptt. of Kayachikitsa Prof. Of Cardiology
RMO, Arogyashala, NIA Hospital Head, Unit-II of Cardiology
National Institute of Ayurveda S.M.S. Bangar Hospital
Jaipur Jaipur
C.A.D. - Hridroga 2

3. 1. Conceptual and clinical studies on Hridroga vis-a-vis
Coronary Artery Disease on various scientific
parameters.
2. Clinical evaluation of the role of proposed
formulations Prabhakara Vati & Lekhana Basti
treatment in the management of Coronary Artery
Disease.
3. To put forward a hypothesis in the form of effective
strategies as Ayurvedic approaches for prevention of
CAD.
C.A.D. - Hridroga 3

4.  It was randomized, comparative, open ended, pre and
post design, clinical trial.
 Selection Of Patients:
The study was conducted on 30 clinically diagnosed &
confirmed cases of Hridroga i.e. C.A.D., from OPD & IPD
units of P.G. Department of Kayachikitsa, National
Institute of Ayurveda Jaipur & Cardiology Unit of S.M.S.
Bangar Memorial Hospital, Jaipur.
C.A.D. - Hridroga 4

5.  Exclusion Criteria adopted for the current clinical
trial :
• Acute Myocardial Ischaemia
• Myocardial Infarction
• Congenital Anomalies
• Valvular Heart Diseases
• Hypertrophic Cardiomyopathies
• Severe Hypertension (Stage 2; ≥160 mm Hg Sys. And ≥ 100 mm Hg Dias.)
• Congestive Heart Failure
C.A.D. - Hridroga 5

6. Out of 50 cases registered, 30 clinically diagnosed and confirmed
patients of C.A.D. (Hridroga), matching our criterias of selection
were selected for the present trial and randomly divided into
following three groups -
 Group I : 10 patients of C.A.D. were recommended Tab. Dilzem
30 mg TDS as Allopathic therapy for 30 days with simple water.
 Group II : 10 patients of C.A.D. were recommended Prabhakara
Vati 500mg (2 Tabs) BD with lukewarm water for 30 days as
Ayurvedic therapy.
 Group III : 10 patients of C.A.D. were recommended
Prabhakara Vati 500mg (2 Tabs) BD for 30 days with lukewarm
water and simultaneously administered Lekhana Basti
treatment (Kala Basti krama i.e. 16 Bastis).
C.A.D. - Hridroga 6

7.  It was developed by Prof. A.K. Sharma et. al. for the assessment
of clinical improvement, the incidence of presenting features and
severity of the symptoms of Hridroga (C.A.D.)
S. No. GRADE PERCENTAGE NUMBER ACCORDING TO
GRADE
1. Nil 0% 0 0
2. Mild 25% 1 +
3. Moderate 50% 2 ++
4. Severe 75% 3 +++
5. Agonizing 100% 4 ++++
C.A.D. - Hridroga 7

8. Symptoms Mean Mean Mean Mean S.D. ± S.E. ± t P Result
BT AT Diff. %
Veshthana 1.2 0.5 0.7 58.33 0.67 0.21 3.27 <0.01 S
(Cardiac Cramps)
Hriddrava (Palpitation) 1.6 0.9 0.7 43.75 0.48 0.15 4.58 <0.01 S
Vedana (Pain-Chest) 1.3 0.7 0.6 46.15 0.51 0.16 3.67 <0.01 S
Hriddah (Burning 1.1 0.6 0.5 45.45 0.84 0.26 1.86 <0.05 NS
sensation -Retrosternal)
Hrit Klama (Fatigue of 2.3 1.6 0.7 30.43 0.48 0.15 4.58 <0.01 S
Cardiac Muscles)
Stambhita Hridya (Feeling 1.7 0.9 0.8 47.05 0.63 0.2 4.0 <0.01 S
of Tightness)
Aruchi (Anorexia) 0.9 0.6 0.3 33.33 0.48 0.15 1.96 <0.05 NS
Ashmavat Hridaya 1.8 1.1 0.7 38.88 0.67 0.21 3.27 <0.01 S
(Heaviness in chest)
aa
8
C.A.D. - Hridroga

9. Symptoms Mean Mean Mean Mean S.D. ± S.E. ± t P Result
BT AT Diff. %
Veshthana (Cardiac 1.9 0.8 1.1 57.89 0.56 0.17 6.12 <0.001 HS
Cramps)
Hriddrava (Palpitation) 2.5 0.9 1.6 64 0.96 0.30 5.23 <0.001 HS
Vedana (Pain-Chest) 1.1 0.4 0.7 63.63 0.67 0.21 3.27 <0.01 S
Hriddah (Burning 1.5 0.7 0.8 53.33 0.63 0.2 4 <0.01 S
sensation-Retrosternal)
Hrit Klama (Fatigue of 2.6 1.5 1.1 42.30 0.73 0.23 4.71 <0.01 S
Cardiac Muscles)
Stambhita Hridya (Feeling 8 0.6 1.2 66.66 0.91 0.29 4.12 <0.01 S
of Tightness)
Aruchi (Anorexia) 1.2 0.6 0.6 50 0.69 0.22 2.71 <0.05 NS
Ashmavat Hridaya 2.5 0.8 1.7 68 0.94 0.3 5.66 <0.001 HS
(Heaviness in chest)
aa
9
C.A.D. - Hridroga

10. Symptoms Mean Mean Mean Mean S.D. ± S.E. ± t P Result
BT AT Diff. %
Veshthana (Cardiac 1.7 0.6 1.1 64.70 0.73 0.23 4.71 <0.01 S
Cramps)
Hriddrava (Palpitation) 2.5 0.7 1.8 72 0.91 0.29 6.19 <0.001 HS
Vedana (Pain-Chest) 1.9 0.5 1.4 73.68 0.96 0.30 4.58 <0.01 S
Hriddah (Burning 1.7 0.5 1.2 70.58 0.78 0.24 4.81 <0.001 HS
sensation-Retrosternal)
Hrit Klama (Fatigue of 2.9 1.2 1.7 58.62 0.94 0.3 5.66 <0.001 HS
Cardiac Muscles)
Stambhita Hridya (Feeling 2.4 0.7 1.7 70.83 0.94 0.3 5.66 <0.001 HS
of Tightness)
Aruchi (Anorexia) 1.6 0.7 0.9 56.25 0.56 0.17 5.01 <0.001 HS
Ashmavat Hridaya 2.2 0.6 1.6 72.72 0.84 0.26 6 <0.001 HS
(Heaviness in chest)
10
C.A.D. - Hridroga

11. Group I Mean Mean Mean Mean S.D. ± S.E. ± t p Result
BT AT Diff. %
Systolic BP in mm. of 144.30 137.50 6.80 5.11 3.43 1.08 6.28 <0.001 HS
Hg.
Diastolic BP in mm. of 87.84 83.04 4.80 5.84 2.86 0.90 5.31 <0.001 HS
Hg.
Pulse rate/ minute 76.93 72.53 4.40 5.80 13.2 4.18 1.05 <0.1 NS
Body wt. in Kgs. 64.9 64.7 0.20 0.32 0.35 0.11 1.83 <0.05 NS
c
11
C.A.D. - Hridroga

12. Group II Mean Mean Mean Mean S.D. ± S.E. ± t p Result
BT AT Diff. %
Systolic BP in mm. 138.70 135.90 2.80 2.07 3.16 1.00 2.81 <0.02 NS
of Hg.
Diastolic BP in mm. 84.50 83.10 1.40 1.66 2.32 0.73 1.91 <0.05 NS
of Hg.
Pulse rate/ minute 74.30 73.90 0.40 0.54 0.84 0.27 1.50 <0.1 NS
Body wt. in Kgs. 64.10 62.20 1.90 2.93 1.91 0.60 3.14 <0.01 S
12
C.A.D. - Hridroga

13. Group III Mean Mean Mean Mean S.D. ± S.E. ± t p Result
BT AT Diff. %
Systolic BP in mm. 138.70 134.70 4.00 3.03 2.67 0.84 4.74 <0.01 S
of Hg.
Diastolic BP in mm. 86.59 82.79 3.80 4.53 3.71 1.17 3.24 <0.01 S
of Hg.
Pulse rate/ minute 74.30 73.80 0.50 0.67 0.85 0.27 0.86 <0.1 NS
Body wt. in Kgs. 68.40 65.60 2.80 4.10 2.33 0.74 3.80 <0.01 S
13
C.A.D. - Hridroga

14. Lipid Profile Mean Mean AT Mean Mean t p Result
BT Diff. %
S.D. ± S.E. ±
S.Cholesterol 188.45 179.09 9.36 4.96 12.67 4.00 2.33 <0.1 NS
S.Triglyceride 130.04 118.84 11.2 8.6 21.78 6.88 1.62 <0.1 NS
V.L.D.L. 22.87 20.83 2.54 11.1 3.95 1.25 2.02 <0.1 NS
L.D.L. 68.23 65.23 3.0 4.36 19.16 6.06 0.49 <0.1 NS
H.D.L 48.95 48.84 0.11 0.22 5.88 1.84 0.05 <0.1 NS
14
C.A.D. - Hridroga

15. Lipid Profile Mean BT Mean AT Mean Mean S.D. ± S.E. ± t p Result
Diff. %
S.Cholesterol 224.78 186 38.78 17.25 27.26 8.62 4.49 <0.01 S
S.Triglyceride 201.6 120.3 81.3 40.32 53.78 17.0 4.77 <0.01 S
V.L.D.L. 46.92 25.11 21.81 46.48 16.26 5.14 4.2 <0.01 S
L.D.L. 134.25 98.7 35.55 26.48 25.34 8.01 4.43 <0.01 S
H.D.L 50.3 52.4 - 2.1 -4.17 5.38 1.70 -1.23 < 0.1 NS
C.A.D. - Hridroga 15

16. Lipid Profile Mean Mean Mean Mean % S.D. ± S.E. ± t P Result
BT AT Diff.
S.Cholesterol 207.8 160.6 47.2 22.71 24.23 7.62 6.15 <0.001 HS
S.Triglyceride 167.7 114.3 53.4 31.84 28.84 9.12 5.85 <0.001 HS
V.L.D.L. 40.4 24.59 15.8 39.13 7.67 2.42 6.51 <0.001 HS
L.D.L. 133.9 79.06 54.89 40.97 34.69 10.9 5.00 <0.001 HS
H.D.L 53.5 56.8 -3.3 -6.16 4.83 1.52 -2.16 <0.05 NS
16
C.A.D. - Hridroga

17. TMT Mean Mean Mean Mean % S.D. ± S.E. ± t p Result
BT AT Diff.
Changes
Exercise 6.38 7.73 1.35 21.22 1.02 0.32 4.16 <0.01 S
Time in
Minutes
Max. ST -3.63 -2.42 1.21 33.33 0.83 0.26 4.60 <0.01 S
Changes in
mm.
17
C.A.D. - Hridroga

18. TMT Mean BT Mean Mean Mean % S.D.± S.E. ± t p Result
AT Diff.
Changes
Exercise 6.21 7.91 1.7 27.34 1.12 0.35 4.76 <0.01 S
Time in
Minutes
Max. ST -3.2 -1.91 -1.29 40.31 1.12 0.35 3.61 <0.01 S
Changes in
mm.
C.A.D. - Hridroga 18

19. TMT Mean Mean Mean Mean S.D.± S.E. ± t p Result
Changes BT AT Diff. %
Exercise 5.76 7.65 1.88 32.76 1.25 0.39 4.74 <0.01 S
Time in
Minutes
Max. ST -2.87 -1.59 -1.28 44.59 0.88 0.27 4.59 <0.01 S
Changes
in mm.
C.A.D. - Hridroga 19

20. GRAPH SHOWING IMPROVEMENT PERCENTAGE
IN TMT CHANGES IN ALL GROUPS
45
40
% improvement 35
30
25
20
15
10
5
0
Gp Gp Gp
1 2 3
Change in Exercise Time
21.72 27.34 32.76
in min.
Max. ST changes in mm. 33.33 40.31 44.59
C.A.D. - Hridroga 20

21. DISCUSSIONS

22. Avlambaka
Sadhaka Kapha
Para Oja
Pitta
Vyana Pranavaha
Vayu Srotasa
Prana Rasavaha
Vayu
HRIDAYA Srotasa
CHETANA, PRANAYATANA, MARMA
C.A.D. - Hridroga 22

23. Katu
MEDA
PRABHAKARA RASA PRABHAVA
KAPHA
VATI Tikta
KLEDA
Kashaya
Kashaya Rasa Sharira Kledopshoshana property (Ch.Su.26)
(4) Rukhsa (Depletion), Lekhana (Scrapping off)
Sangrahi, Stambhaka
Tikta Rasa Kleda-Meda-Kapha-Shoshana , Lekhana,
(3) Pachana
Katu Rasa Sroto-Shodhaka, Mansa Vilekhana, helps in
(1) Pachana
Abaddha Baddha Lekhana
Meda Meda
C.A.D. - Hridroga Pachana 23

24. Katu Vipaka (3) Ashukari
Jatharagni,
Prabhava
PRABHAKARA Rasadhatvagni &
VATI Laghu(2),
Medodhatvagni.
Teekshna(2),
Sara (2) Gunas
Sheeta Veerya
(4)
PRABHAKARA
VATI
Madhura Vipaka
(1)
HOLISTIC MANNER Tend to increase
C.A.D. - Hridroga 24

25.  Due to the presence of properties like
Lekhana (hypolipidemic),
Karshana,
Srotoshodhaka,
Pachana,
Medohara,
Ashukari and
Kapha-Vatahara
Prabhakara Vati and Lekhana Basti have worked out to be
Cardio-tonic &
Cardio-protective in nature.
C.A.D. - Hridroga 25

26.  Antianginal (Prevents or alleviates Angina).
 Coronary Vasodilator (Results in dilation of coronary
blood flow)
 Thrombolytic & Antiplatelet agent (Prevents thrombus
formation).
 Vasoprotective (Protective effects on blood vessels).
 Hypotensive (Controls & regulates raised Blood
pressure).
 Hypolipidaemic (Reduces blood lipids concentrations).
 Antioxidant (Reduces oxidative stress).
 Antiinflammatory (Counteracts inflammation).
 Immunomodulator (Immune status enhancer).
 Cardioprotective/Anabolic agent.
26
C.A.D. - Hridroga

27. 1. Limited Description in Ayurvedic classics.
But on the basis of their clinical manifestations Vata-Kaphaja
type of Hridroga ~ Coronary Artery Disease.
OBJECTIVE 1
2. Prabhakara Vati & Lekhana Basti when used separately and /
or together act not only on a single modifiable risk factor but
on a variety of these factors.
3. By decreasing Total Cholesterol, Serum Triglyceride, Serum
L.D.L., Serum V.L.D.L. and partially increasing Serum H.D.L.
level, thus these preparations control and correct
dyslipidemias leading to arrest of the pathogenesis of
formation of atheromatous plaque and ultimately delaying
the pathogenesis of C.A.D. (Hridroga).
C.A.D. - Hridroga 27

28. 3. Improvement of ischaemic changes, increase exercise
time along with correction of ST changes On parameters
like ECG and C.T.M.T, respectively along with
improvement in chest pain, dyspnoea on effort and
palpitation provide potent antianginal and coronary
vasodilating effects.
4. Prabhakara Vati and Lekhana Basti have very limited role to
play in acute episodes of C.A.D.
But these can be used effectively separately or in
combination together as an adjuvant therapy along with
modern coronary vasodilators or independently to prevent
or slow down or reverse the pathogenesis of
Atherosclerosis - an essential precursor of C.A.D.
C.A.D. - Hridroga 28

29. 5. Trial Drugs Prabhakara Vati and Lekhana Basti are safe herbo-
mineral formulations which have shown encouraging results in
the prevention / management of C.A.D. (Hridroga) on various
scientific parameters. No Toxic / Side effects were reported in
any of the patients during or after completion of the trial.
OBJECTIVE 2
6. A new hypothesis can be put forward, “The administration of
Prabhakara Vati and / or Lekhana Basti separately or in
combination together may prove to be an effective strategy as
Ayurvedic approach for the prevention of C.A.D. (Hridroga).”
7. Dietary and Lifestyle modifications, besides proposed Ayurvedic
strategies are essential factors to be strictly adhered to by the
patient for effective control / prevention of C.A.D. (Hridroga)
OBJECTIVE 3
C.A.D. - Hridroga 29

30. Therefore, it can be concluded that
Prabhakara Vati and Lekhana Basti can be
used separately or in combination
together effectively in the management
of C.A.D. / to prevent / delay / reverse the
progress of Atherosclerosis leading to
Coronary Artery Disease (Hridroga).
C.A.D. - Hridroga 30

31. PREVENTION IS BETTER THAN CURE
NIDANA
PARIVARJANA
PREVENTIVE
CARDIOLOGY
C.A.D. - Hridroga 31

32. C.A.D. - Hridroga 32