Hrudaya (हृदयम्)

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In Ayurveda we often find multiple attributes to a single term, in relation with ayurvedic shareera (शारीरम्) or anatomy, hruday or Hrday (हृदयम्) is corelated with Heart. At fundamental level hrday is a sadyopranahara marma (मर्म । a vital point which if injured leads to sudden death). During foetal development, hrday starts to develop along with other ashayas (organs) in the fourth month. Hrday is considered as a matraja bhava (मातृजभावः । precisely maternal factor) which is among shad garbhakara bhavas (षड गर्भकर भावाः) which precisely is a process of embryogenesis according to Ayurveda shastras. Acharya charaka in sutrasthana states “artha” as its synonym and it being the abode of six organs (five sensory organs, its objects, atma, and mind). Precisely hriday is a complex structure with

Etymology

The word hrday in Samskrit is derived from three words

1. hrun – which means to abduct
2. dad – which means to donate
3. in gatau –verb which means rythmic movement

thus, hruday is an organ which draws fluid along with blood from all parts of the body and supplies to every part of the body.

Anatomy of the Hruday

 Anatomy of Hrudaya in Ayurveda and that in western medicine is different because the entire perspective of looking at this particular body organ is different in both the sciences which includes its structure, function and associated factors, diseases and treatment. Here the anatomy of structure of Hrudaya as per Ayurveda treatises is discussed.

            पुण्डरीकेण सदृशं हृदयं स्यादधोमुखम् |(Sush.sam.shar.4.32)

Acharya sushruta describes the shape of the heart is like the shape of inverted lotus flower. The specific variety of lotus named as 'Pundarika' is selected as an analogy to describe the hrudayam. At the same place Acharya Sushruta explains that, it is the adhisthan (seat) of Chetana (life energy) which is also known as consciousness. The contraction of hrday happens during sleep and dilatation when awake.

Hriday also is known to be the originating point of the ten important vessels in the body known as dashamahamoola.

The heart houses the internal organs, consciousness, motor and sensory organs, five objects of sensory perceptions, and the soul(life energy), mind and objects of the mind. This is explained with the simile, as the central shaft supports the framework of the roof, these organ entities are supported by hrday.

Location

According to Acharya Sushruta, Hriday is situated in between two breasts in the thoracic region. (sush.shar.6.34)

Pleeha and phuppusa (organ entities which can be corelated with spleen and lungs respectively and precisely) are located on the left side of the hriday and yakrut and kloma(these are organ entities which are precisely corelated with liver and gallbladder) are situated below the right side of the hriday.(sush.shar.4.31)

Functional aspect

यद्धि तत् स्पर्शविज्ञानं धारि तत्तत्र संश्रितम्||६||तत् परस्यौजसः स्थानं तत्र चैतन्यसङ्ग्रहः| हृदयं महदर्थश्च तस्मादुक्तं चिकित्सकैः ||७||

While describing the functional aspects, Hriday has the property of sparsha vidnyana which means tactile perception or touch perception.

Shuddha rakta or blood is circulated with the help of vyana vata(a type of vata dosha) from hriday throughout the whole shareera.(shar samh purv 1/76-78)

Doshas and Hruday

A type of pitta dosha, Sadhak pitta, is situated in hriday. (vagh.sutr.12.13-14)

Its karma or action is primarily related with mental attributes (knowledge, intelligence etc)

Vyana vata which is a type of vata dosha, moves all over the shareera, is sited in Hriday (vagh.sutr.12.6)

Its karma or action is to blood circulation, flexion and extension, opening and closing of eyelids etc.

   

हृदयस्यावलम्बनं करोति| (vagh.sutr.12.15,16) (sarvangasundari vyakha)

Avalambaka kapha situated in the thoracic region acts as avalamban in hriday(binding)

The karya or the action is nourishment, lubricating and influences functioning of other types of kapha dosha as well.

Concept of dauhridini.

In fourth month of the pregnancy demarcation of the organs start becoming prominent and so does hriday, and the women is stated as “dauhridini” which means the women is now possessing two hearts. Concept of developing desires in pregnancy is uniquely stated in Ayurveda samhitas in relation with development of foetal heart. This explains the presence of consciousness in the hriday of the foetus (seat of knowledge, intellect and mind). (sush.shar.3.15-28)

General preventive measures for Heart diseases

तन्महत् ता महामूलास्तच्चोजः परिरक्षता| परिहार्या विशेषेण मनसो दुःखहेतवः||१३||

हृद्यं यत् स्याद्यदौजस्यं स्रोतसां यत् प्रसादनम्| तत्तत् सेव्यं प्रयत्नेन प्रशमो ज्ञानमेव च||१४|| (char.sutr.30.13-14)

Mental suffering, stress should be avoided as a primary method of prevention.

Diet modifications, appropriate dravya medications, behaviour modifications are certain general care methods for preservation of hriday, ojas and ten great vessels originating from hriday.

Ojas and Hruday

तेन मूलेन महता महामूला मता दश| ओजोवहाः शरीरेऽस्मिन् विधम्यन्ते समन्ततः||८|| (char.sut.30. 8-12)

Ojas is the concept unique to ayurveda and is the essence part of the dhatus or the bodily tissues.

The ten vessels or the dashamahamoola that arise from the hriday are the carriers of the ojas(precisely..).

It is situated in the heart and preenana or the nourishment of the shareera is the key functionality.ojas helps keeps the human beings jeeveta or alive. It enters the hriday during cardiogenesis and its deficiency causes degeneration of the body.

While describing the effects of madya(intoxication) on oja, Acharya charaka describes hriday as the site for the channels of Rasa dhatu, vata etc and ojas as well.(char.chik.24.36)

General Symptoms of Hrudroga (Heart diseases)

वैवर्ण्यमूर्च्छाज्वरकासहिक्काश्वासास्यवैरस्यतृषाप्रमोहाः|

छर्दिःकफोत्क्लेशरुजोऽरुचिश्चहृद्रोगजाःस्युर्विविधास्तथाऽन्ये||७८||

Causes (char.chik trimarm 77)	Symptoms (char.chik trimarm 78)
Excessive exercise	Skin discolouration
Strong purgation and basti therapy	Dizziness
Excess anxiety	Fever
Stress	Cough
Suppression of urges	Hiccups
Ill treatment protocols	Unpleasant taste in mouth
Injury/trauma	Shortness of breath
	certain types of diabetes
	Vomiting
	Loss of appetite
	Chest pain
	Different types of heart diseases

(char.chik.trimarm.78-80)

General Classification of Hrudrogas

Hridrogas are fundamentally classified as,

1.      Vataja hridroga

2.      Pittaja hridroga

3.      Kaphaja hridroga

4.      Sannipataja hridroga

5.      Krimija hridroga

Vataja Hridroga

Symptoms- feeling of emptiness in the cardiac region, pricking pain, palpitations, cardiac muscke atrophy, mental confusion, obstructed movements

Treatment – application of medicated oils, administration of various herbal decoctions (for e.g.; punarnava, devdaru etc), administration of medicated ghrita (clarified butter/ghee)

Pittaja Hridroga

Symptoms – dizziness, fever, burning sensation etc

Treatment – virechana or purgation therapy, administration of medicated ghee, intake of sugarcane juice etc.

Kaphaja hridroga

Symptoms – heaviness of the heart, fever, excess salivation, drowsiness etc

Treatment – intake of barley, various herbal decoctions, rasayana therapy (administration of chyavanprash, agastyaharitiki(herbal formulations))

Sannipataja hridroga

Symptoms – the symptoms of the three doshas are manifested together.

Treatment – langhana, appropriate diet administration, etc

Krimija Hridroga

Symptoms – acute pain, itching, discomfort

Treatment – anti helminthic measures.

Other disorders with involvement of the hruday

Manifestation of jwara

सन्तापः सारुचिस्तृष्णा साङ्गमर्दो हृदि व्यथा|(char.chik.3.26)

Hridhivyatha or pain in the hriday region is one of the manifestations of jwara or fever.

Sannipataja jwara

शिरसो लोठनं तृष्णा निद्रानाशो हृदि व्यथा||१०६||(char.chik.3.106)

In Sannipataja jwara which is a type of fever where all the three doshas(vata,pitta,kapha) are dominant, hridvyatha or pain in the heart region is a symptom.

Clinical feat of amaja jwara

हृदयस्याविशुद्धिश्च तन्द्रा चालस्यमेव च|

Improper vamana in jwara

हृद्रोगं श्वासमानाहं मोहं च जनयेद्भृशम्|

Hridroga or disorders of heart is one of the sign of improper vamana therapy.

Five sites of gulma

बस्तौ च ना भ्यां हृदि पार्श्वयोर्वा स्थानानि गुल्मस्य भवन्ति पञ्च| (char chik.5.8)

Gulma is an isolated disorder in Ayurveda which is often corelated with tumours of different kind and hriday is one of the five primary sites of its pathological manifestation.

In Clinical features of unmada

अबद्धवाक्त्वं हृदयं च शून्यं सामान्यमुन्मादगदस्य लिङ्गम्||६|| (char.chik. .6)

Feeling of emptiness in the hriday is one of the clinical feature in unmada roga(disorder related with psychiatric disorder)

In Attatvabhinivesha

A mahagada(grave disorder) and isolated disease mentioned in ayurveda, its clinical feature includes affliction of doshas in hriday.

Symptoms of Arsha(haemorrhoids)

Stiffness in chest and cardiac region is one of the general symptoms mentioned in Arsha roga.