TITLE: MEDOROGA AND DYSLIPIDEMIA
AUTHOR: 1. DR.SALUNKHE SNEHALATA SAGAR
B.A.M.S. MD (Kayachikitsa) PhD (Scholar)
ASSISTANT PROFESSOR,
DEPARTMENT OF KAYACHIKITSA.
B.V.D.U.C.O.A. PUNE-411043
Mobile No. 9860066325
CO- AUTHOR: DR.
KADLASKAR BHARAT BANSI
MD, Ph.D.
(Kayachikitsa) PGDHA
PROFESSOR,
DEPARTMENT OF KAYACHIKITSA.
B.V.D.U.C.O.A. PUNE-411043
Mobile
No. 9422330084
Email address :
drkadlaskar@gmail.com
CO-
AUTHOR: 2. DR. SALUNKHE SAGAR NANASAHEB
M.B.B.S.MD (Biochemistry)
ASSOCIATE PROFESSOR,
DEPARTMENT OF BIOCHEMISTRY
B.V.D.U
MEDICAL COLLEGE. PUNE-411043
Mobile No. 9850073525
Total
number of pages: 11
Word
count of abstract:156
Word
count of the text: 2469
MEDOROGA AND DYSLIPIDEMIA
ABSTRACT:
Dyslipidemia involves abnormally elevated levels of
any or all lipids and/or lipoproteins in the blood.It can be included under Santarpanjanya vyadhias “Medoroga”.In our body, there are many
tissues whichare rich in lipids such asMedodhatu,
Vasa andMajjadhatu.Among the
above lipids;medodathu is very
important, as it has significant role in developing many metabolic disorders.Thepathology-
it is a condition caused by derangement ofagni,
leads to aamarasa, aama causesMedodhatwagnimandya;
which leads to excess homologues PoshakaMedodhatu
in circulation, which can be referred to the conditions such as Dyslipidemia.
Hyperlipidemia a
broad term, also called
hyperlipoproteinemia, is a
common disorder in
developed countries and
is the major
cause of coronary
heart disease and stroke.
Dyslipidemia in general
has no apparent
symptoms and can diagnosed during
routine examination. The high costs and side effects of hyperlipidemia
medications have led many people to search for alternate treatments. Therefore
there is need to evaluate herbal formulations for the treatment of
dyslipidemia.
Key
Words: Dyslipidemia, Santarpanjanya,Medoroga
INTRODUCTION:
Ayurveda
is being increasingly accepted by world for its relevance and adaptability to
modern times. An important concept of ayurveda is that each individual is
genetically different; this gives him a very specific constitution and also a
very individual way of interacting with the environment. To promotehealth each individual must modify his
lifestyle tooptimize bodily functions.
In
modern era every person is running after life’s goal, hence does not have time
to think, act for healthy life and not able to follow properDincharya, Ritucharya,
Dietetic Rules and Regulations. The industrialization,stress, lack of exercise
and various varieties of food in daily diet e.g.Fast food,frizzedfruits,soft drinks and beverages,canned foods may results
into clinical entity which we can say as Medoroga.
Due to Medodhatudushti
-- Sthoulya, Prameha, Kushthaetcmay
develop whose prevalence has
increased drastically over a past few decades.
In Ayurveda, there is no direct reference of a
single disease entity that can be directly correlated with the Dyslipidemia.
Moreover different scholars have different opinions about the nearest possible
disease. Most of them have considered hyperlipidemia under the heading of Medoroga or Medodosha. Few of them have considered as Rasagata-Snehavriddhi,
Raktagata-Snehavriddhi or Rasa Raktagata-Snehavriddhi, whereas some are
consideringhyperlipidemia under the broad umbrella of Aama.
Dyslipidemia is major
risk factor for Cardio Vascular Diseases (CVD), Cerebro –Vascular-Episode
(CVE),Peripheral-Vascular-Disorders,etc. Over the last two decades there has
been an increasing emphasis placed on screening for high cholesterol and
adopting interventions to reduce cholesterol levels in order to reduce the risk
of above diseases.
Cholesterol lowering drugs available in the market without
stabilizing the artery wall aggravates the problem because cholesterol lowering
drugs decrease the body repair factors, without stabilizing the vascular wall.[1]Most of the drugs
(statins) available today are inhibitors of 3-hydroxy-3-methylgluatarylcoenzyme
a reductase, which is involved in cholesterol biosynthesis in the liver. The
mechanism precisely known is that they inhibit the key enzyme of cholesterol
synthesis, HMG Co-A reductase but have severe deadly side effects. [2] This has led to a
search for more natural methods to control cholesterol levels.
CONCEPTUAL REVIEW
1.0 LIPIDS
Lipids are essential to life, but an excess of certain lipids
can increase the risk for cardiovascular disease.
Cholesterol is a lipid that is present in cell membranes and is
the precursor for steroid hormones and bile acids. Cholesterol is found in the
blood in distinctparticles containing both lipids and proteins, and the
particles are called lipoproteins. Lipoproteins found in humans are divided
into classes according to their flotation constants or densities. Three major
classes are found:
Low- Density Lipoproteins (LDL),
High- Density Lipoproteins (HDL), and
Very-Low- Density Lipoproteins (VLDL).
LDL
cholesterol contains cholesterol and a single protein or
apolipotrotein, apoB-100. LDL constitutes about 60% to 70% of total serum
cholesterol.LDL is the major atherogenic lipoprotein, and is the primary target
for cholesterol lowering therapy.
HDL
contains cholesterol and apo AI and apo AII apolipoproteins. HDL constitutes,
about 20% to 30% of total serum cholesterol. HDL is thought to protect against
the development of atherosclerosis.
Triglycerides
are transported in the blood as chylo-microns following absorption from the
small intestine, or as a component of VLDL if synthesized by the liver.
In dyslipidemia,
the level of one or more of these lipids is abnormal (either too high or too
low).
According to Adult
Treatment Panel III (2001)[3]
|
|
|
Desirable
|
Borderline
|
High Risk
|
|
1.
|
Total cholesterol
|
< 200 mg/Dl
|
200-239 mg/dL
|
>240mg/dL
|
|
2.
|
LDL-C
|
≥130 mg/Dl
|
130-159 mg/dL
|
160-189mg/dL
|
|
3.
|
HDL-C- Males
Females
|
<
40 mg/dL
<50
mg/Dl
|
35-
45 mg/dL
|
|
|
4.
|
Triglycerides
|
>150
mg/ dL
|
150-
199 mg/dL
|
200-499
mg/dL
|
|
5.
|
Blood
Pressure
|
≥140/≥90 mmHg
|
|
|
|
6.
|
Waist Males
|
>102 cm
|
|
|
|
7.
|
Circumference
Females
|
> 88 cm
|
|
|
|
8.
|
Fasting Plasma
Glucose
|
>110
mg/dL
|
|
|
Overweight:
- BMI>85th% and <95 th%
for age and gender.
1.1 DYSLIPIDEMIA[4]
Dyslipidemia
is abnormal levels of lipids (cholesterol, triglycerides, or both) carried by
lipoproteins in the blood. This term includes hyperlipoproteinemia
(hyperlipidemia), which refers to abnormally high levels of total cholesterol, LDL—the bad—cholesterol, or triglycerides, as
well as an abnormally low level of HDL—the good—cholesterol.
1.1.1Prevalence
of Dyslipidemia[5]
·
The prevalence of dyslipidemia is
observed to be higher in males than in females.
·
Total Cholesterol concentration ≥ 200mg/dl, 38.7%
are males and 23.3% are females.
·
HDL-C is abnormally low in 64.2% males and 33.8% in
females.
·
The increase of prevalence of
hypercholesterolemia and
hypertriglyceridemia is more prominent in 31-40 age group than in ≤30 age
group.
1.1.2Primary
causes:[4]
Primary
causes are single or multiple genetic mutations that result in either
overproduction or defective clearance of TG and LDL cholesterol or in
underproduction or excessive clearance ofHDL. Primary lipid disorders are
suspected when a patient has physical signs of dyslipidemia, onset of premature
atherosclerotic disease (< 60 yrs), a family history of atherosclerotic
disease, or serum cholesterol > 240 mg/ dl.
1.1.3Secondary
causes:[4]
Secondary causes
contribute to many cases of dyslipidemia in adults. The most important
secondary cause in developed countries is a sedentary lifestyle with excessive
dietary intake of saturated fat, cholesterol, and trans fats. Trans fats are
polyunsaturated or monounsaturated fatty acids to which hydrogen atoms have
been added; they are commonly used in many processed foods and are as
atherogenic as saturated fat.
Other common
secondary causes include diabetes mellitus, alcohol overuse, chronic kidney
disease, hypothyroidism, primary biliary cirrhosis and other cholestatic liver
diseases, and drugs, such as thiazides, β-blockers, retinoids, highly active
antiretroviral agents, cyclosporine, tacrolimus, estrogen and progestins, and
glucocorticoids.
Secondary causes
of low levels of HDL cholesterol include cigarette smoking, anabolic steroids,
HIV infection, andnephritic syndrome.
1.1.4Symptoms and Sign:[4]
Dyslipidemia
itself usually causes no symptoms but can lead to symptomatic vascular disease,
including coronary artery disease (CAD), stroke, and peripheral arterial
disease.
·
High
levels of TGs (> 1000 mg/dL ) can cause acute pancreatitis.
·
High
levels of LDL can cause arcuscorneae and tendinousxanthomas at the Achilles,
elbow, and knee tendons and over metacarpophalangeal joints.
·
Patients
with the homozygous form of familial hypercholesterolemia may have the above
findings plus planar or tuberous xanthomas.
·
Patients
with severe elevations of TGs can have eruptive xanthomas over the trunk, back,
elbows, buttocks, knees, hands, and feet.
·
Severe
hypertriglyceridemia (> 2000 mg/dL)
can give retinal arteries and veins a creamy white appearance
(lipemiaretinalis).
·
Extremely
high lipid levels also give a lactescent (milky) appearance to blood plasma. Symptomscan
include paresthesias, dypsnea, and confusion.
1.1.5Treatment
·
Eat well
balanced diet: include
decreasing intake of
saturated fats and
cholesterol;
Increasing the proportion of
dietary fiber, and complex
carbohydrates, e.g. Whole grains,
fruits, vegetables, etc.
·
Weight Management
·
Exercise Regularly : Exercise for
at least 30
minutes every day, i.e. walking,
yoga, dancing .
·
Quit smoking: to
reduce the risk
of heart disease
and stroke.
·
Medicines /
Drug Treatment :
The National Cholesterol
Education Program (NCEP) Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel
III)reinforced LDL as the primary target of cholesterol-lowering therapy with
the optimal goal of its level below 100 mg/dL.[4]
‘Statins’
are usually recommended as they reduceLDL cholesterol by up
to 60 % and produce
small increase in
HDL and modest
decrease in TGs. .
Bile acid sequestrates (cholestyramine; colestipol [Colestid]), nicotinic acid
(crystalline, timed-release preparations, extendedrelease nicotinic acid
[Niaspan]), and fabric acid derivatives (gemfibrozil [Loped]); fenofibrate
(TRICOR) are alternative therapies. [4]
2.0 CONCEPTOFLIPIDS IN AYURVEDA
In
our body, there are many tissues which are rich in lipids. All these structures have Sneha (oiliness) as common feature. They areMedoDhatu, VasaandMajjaDhatu. All these three haveSnehatwaas common feature but all the three differ in their site
and function.[6]
But
importance is given to MedoDhatuwhich
is having significant role in developing many metabolic disorders like Medoroga, Pramehaetc.
There are two
types of MedoDhatu. One isPoshaka(Nutrients)and second isPoshya(Nourish). Among these, PoshakaMedoDhatu isGatiyukta (mobile in nature) which
is circulatedin the whole body along with theRasa-RaktaDhatu, to give
nutrition to PoshyaMedoDhatu. Through
different imaging techniques it can be visualized that lipids along with the
cholesterol are being circulated with the blood.
Second, PoshyaMedoDhatu
isGativivarjita(immobile in nature),
which is stored in Medodharakala. The
site of Medodharakala is Udara, Anuasthi, Sphika, Stana and
Gala.
2.1 Concept of Cholesterol in Ayurveda
Ayurveda emphasizes
the importance of metabolic processes in health promotion as well as disease
management. “Agni” is the term used
in Ayurveda for defining collectively all the bodily metabolic actions.
The
vitiation of Agni has serious impact
on health at various levels depending on type of Agni involved.
Ayurveda classifies agni into several varieties:
JATHARAAGNI – located in the alimentary
tract and performing major metabolic processes, DHATUAGNI – situated at tissue levels and capable of processing
metabolic requirements of individual tissues, andBHOOTAAGNI – subtle metabolic processes that happen at the cellular
level.[7]
Metabolic processes maintain the normal quantity, quality and function
of the dosha and dhatu. When in abnormal states due to various causative factors relating to
body and the mind; metabolites that are not assimilated by the body tissues
will be produced. The resultant product of such metabolic action is calledaama.
Aamais the primary cause of all
metabolic disorders in Ayurveda.
The accumulation ofAama
could be compared with the accumulation of lipofusin, amyloid bodies, modified
proteins and lipids, which are not suitable for further metabolism, by the
normal cellular pathway.
There is no precise term for dyslipidemia in the
Ayurvedic classics. Study of dyslipidemia reveals its similarity to AsthayiMedoDhatuVriddhi (abnormal
increase in circulating lipids) with regard to the patho-physiology. This
excessively increased circulating lipid isaamain
nature, resulting in further complications.[8]
2.2 Pathology
of Dyslipidemia According to Ayurveda:
Atisnigdha , madhur , adhyashan, atimatra ahara
Avyayama, achinta, Diwaswapna
Beeja swabhavaj
Jatharagni mandya, Medo
Dhatwagni mandya + Bhootagni vyapar
Aama Ati pramana
medavridhhi
Vyanvayu spreads toxic bioproducts
in
sarvasharir with rasadhatu
Medovaha srotas vaigunya
Accumulation of abnormal poshakmedodhatu
in rasa
2.3Ayurvedic Treatment Principles for Managing
dyslipidemia:
The Ayurvedic approach
to dyslipidemia involves methods to increase the power of agni to digest the aama, regulating
assimilation, elimination and controlling the causative factors.[9]Several individual herbs
and combinations of herbs are used in Ayurveda for themanagement of MedoDhatuVriddhi (increased lipids), aama
and metabolic disorders.[10]
·
NidanParivarjana
All the
nidan (etiological factors) mentioned
should be avoided .
·
Samshodhan
Therapy
Basti : Ruksha, Ushna,
Tikshna basti are
suggested for santarpanjanya roga
chikitsa.
Lekhan basti
is considered as
the best therapy
for medovriddhi.
Vaman-
Yashtimadhu phanta, etc
Virechan- Haritaki,
Katuki, Trivritta etc.
Raktamokshan
Nasya- Tripaladi
Taila,
etc.
·
Samshaman
Therapy
Langhana : All ten
types of
langhana can
use as per
conditions.
Drugs having deepan, pachan, rookshan, chedan, lekhan, teekshana, Ushna properties to
produce srotovishodhan, ampachan
are useful. Especially Shilajatu,
Guggulu, Gomutra, Triphala, Loha
Raj, Rasanjan, Madhu.
3.0Similarities betweenmedoroga& lipid disorders:
·
Etiological
factors
|
According to
Modern
|
According to
Ayurved
|
|
Intake
of high fat diet
|
Medyanna -
Atisevana
|
|
Lack
of exercise
|
Avyayama
|
|
Sedentary
life style
|
Divaswapna-
Achintana
|
|
Genetic
predisposition
|
Bijaswabhava
|
·
Clinical
Features
|
According to
Modern
|
According to
Ayurved
|
|
Excessive
deposition of fat in
abdomen, waist, buttock etc
|
Sphik, udara,
parshva, sthanapradeshi
Ati
medavriddhi
|
|
Excessive
appetite
|
Ksudaatimatra
|
|
Exertional
dyspnea
|
Kshudrashwasa
|
|
Excessive perspiration
|
Atisweda
|
|
Generalweakness
|
Dourbalya
|
·
Complications
|
According to
Modern
|
According to
Ayurved
|
|
Decreased
life expectancy
|
Ayusho-Hrahsa
|
|
Mechanical
disabilities
|
Javaprodha
|
|
Loss of immunity
|
Alpaprana
|
|
Cardiovascular
and cerebrovascular manifestations
|
Vata-vikara
|
DISCUSSION
After studying the above comparison of the
facts, it seems that dyslipidemia can be considered asMedoroga. No separate disease in the name ofMedoroga is described in CharakaSamhita,
but Atisthaulya is mentioned underAshtauninditiya, which is actually Medoroga.[11]
InMadhavaNidan,
the term Medoroga is used while
describing its etiology. Abnormal accumulation ofMedaDhatuin body is known asMedodushti. Medodushti includes several numbers of otherMedovikaras, which are collectively known asMedoroga.
This idea is supported by Madhukoshakara[12] and Bhavmishra[13] by describing separate
chapter ofMedoroga.
Madhavakarahas described
the disease under heading ofMedorogain
34thchapter and has usedMedasvina[14], Atisthula[15 ]and
sthula[16] words as synonyms.
CONCLUSION
Dyslipidemia
involves abnormally elevated levels of any or all lipids and/or lipoproteins in
the blood.
In our body,
there are many tissues which are rich in lipids such asMedoDhatu, Vasa and MajjaDhatu.
Among the above
lipids,vitiatedmedodathuhas
significant role in developing many metabolic disorders.
Etiological
factors and signs and symptoms mentioned formedorogaare
almost similar to dyslipidemia.
Agni is responsible for all metabolic
activities of the body.
The pathology – Medhodhatwagnimandyaleads to excess
homologuesPoshaka MedoDhatu in
circulation,which can be referred to the conditions such as dyslipidemia.
Treatment
options depends on the specific lipid abnormality.
Ayurvedic
medicine has been used for thousands of years for the treatment of various
metabolic disorders. However, few studies have been conducted to evaluate the
effectiveness of Ayurveda herbal medicine formulae on hypercholesterolemia.
Higher quality studies, such as randomized clinical trials, are lacking.
Thus
dyslipidemia may
be correlated with Medoroga
which are the conditions of santarpanjanya vikaras
as explained in Ayurvedic classics.
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