By Dr. Ram Adhar Yadav, M.D. (Shalya)
Lecturer- Department of Shalya tatha Shalakya
Ayurveda Campus and Teaching Hospital, IOM, TU
Introduction:
Dyslipidemia is a common problem in common population due to change of life style and food habits. This people suffer from most vulnerable diseases due to atherosclerosis changes which could be many more fatal or sudden. The most common disease is coronary artery disease. Data shows that about 25 % of population in Nepal, diagnosed and undiagnosed, suffers from this disease. So the management and prevention of this condition is a big task.
Aim of Study:
To study the effects of Ayurvedic Remedies in Hyperlipidemia disorder.
Objectives:
1. To study the effect of (Arogyavardhani vati + Prabhakar vati) in Hyperlipidemia.
2. To study the effect of drug Hyperlipidemia arised disorder
Literature Review:
Circulating lipids are of four types, namely:
1. Free cholesterol
2. Cholesterol ester
3. Triglycerides
4. Phospholipids
When they are transported in blood, they remain as rounded macromolecular complexes which are called lipoproteins. The inner core contains triglycerides and cholesterol ester whereas the outer membrane contains various proteins along with free cholesterol and phospholipids.
Classification:
According to ultra-centrifugal density they are classified into:
1. Chylomicrons- mostly triglycerides
2. Low Density Lipoprotein (LDL)- mostly cholesterol. It has direction with CAD.
3. Very Low Density Lipoprotein (VLDL)- mostly triglycerides
4. High Density Lipoprotein (HDL)- mainly phospholipids. It has inverse relationship with CAD.
According to their electrophoretic mobility they are classified into:
1. Beta lipoprotein (LDL)
2. Pre-beta lipoprotein (VLDL)
3. Alpha lipoprotein (HDL)
There are several genetic disorders which may be associated with dyspipidemia. In familial hypercholesterolemia all surface receptors for LDL molecules are absent or defective. This results in high LDL level and thereby high cholesterol level. So they present premature atherosclerosis with CAD in their 30-40 yrs period. In other condition called familial hyperchylomicronemia there is abnormality in lipoprotein lipase. This enzyme helps the peripheral cells, e.g. muscle or adipose cells to take up triglycerides from chylomicrons and VLDL proteins. This results in hypertriglyceridemia which may give rise to hepatosplenomegaly and recurrent pancreatitis in children.
Lipid and Atherogenesis:
The relationship of lipid disorder to atherogenesis and CAD is very much certain. In atherosclerosis the atheromatous plaque on the vascular wall contains huge amount of cholesterol. Major amount of cholesterol in serum is LDL cholesterol. It has been found that the higher level of LDL cholesterol greater is the risk of CAD on the other hand there is an inverse relationship between CAD and HDL cholesterol. In presence of high cholesterol level the risk of CAD is more and vice versa. In each 10 mg/dl increase of cholesterol may increase in HDL by about 10% and each 5mg/dl increase in HDL cholesterol reduce the risk of CAD particles help in formation or HDL particles helping prevention of plaque formation is not clearly understood. Resent research indicates that LDL particles which become oxidized are more atherogenic. The receptors on the surface of macrophage cells of plaque bind up and ultimately accumulate oxidized LDL. Antibodies to these oxidized LDL particles also help in plaque formation. There is also great role of antioxidant in preventing atherosclerosis and estrogen may have similar function. However the relationship between VLDL cholesterol and atherosclerosis is less clear. It might be possible to have a role in size and number of VLDL particles.
Other than formation of atherosclerotic plaques lipids may have role in thrombogenesis. Persons who consume fat containing omega-3 fatty acids may have less platelet aggregation. Several trials have established that middle aged individuals without CAD will have less risk for development of CAD and in the CAD group there will be definite reduction MI, new development of angina or requirement for bypass after reduction of cholesterol level. However, cholesterol lowering effect of diet is unclear.
The requirement of screening programme:
Screening for development is required in the following conditions:
1. Familial hyperglycemia
2. Family history of presence of CAD
3. Obesity
4. Diabetesmellitus
5. History of pancreatitis
6. Hypertension
7. Nodular xanthoma
8. Presence of arcus senilis or Xanthiulasma before the age of 40 yrs.
Treatment:
Diet: It should contain less fat so as to become less than 30 % of total calories. Again the saturated fat (animal origin) should be reduced by 10% of total calories. The amount of cholesterol should be reduced to 300 mg per day substitution of polyunsaturated fat for unsaturated fat will have no beneficial effect and hence not recommended nowadays.
Ayurvedic Remedies:
Arogya-vardhini Vati (composition):
1. Purified Parad (Mercury): 1 tola
2. Purified Gandak (Sulphur): 1 tola
3. Loha Bhasma 1 tola
4. Abhrak Bhasma 1 tola
5. Tamra Bhasma 1 tola
6. Haritaki 2 tola
7. Bibhitaki 2 tola
8. Aamalaki 2 tola
9. Suddha Shilajeet 3 tola
10. Suddha Guggulu 4 tola
11. Chitrak moola 4 tola
12. Kutaki 22 tola
Prabhakar Vati
1. Swarnamakshik 1 part
2. Loha Bhasma 1 part
3. Abhrak bhasma 1 part
4. Vanshalochan 1 part
Proceed in Arjun chhal kwath.
Observation Results:
Thirty two patients registered for trial obtaining their consent, 22 of them was put in trial (group A) with Arogya vardhini vati + prabhakar vati and 10 patients were placed (group B) patients were advised for dietary restriction.
After 30 days continuous therapy patients were examined and the result showed that they got significant reduction in lipid profile which was raised before the treatment. Whereas patients were on placebo therapy did not get reduction of lipid profile.
Conclusion:
1. The effect of Arogyavardhini + Prabhakar vati showed highly significant reduction to lipid level. It clearly indicates that Haridra reduced harmful lipids and significant increase in HLD.
2. The patients were having a typical chest pain got significant relief in pain.
3. It was also noted that three patient were obese with dyslipidemia, got significant reduction in wt.
4. The combination therapy which was introduced in the management of dyslipidemias based upon the properties of each drugs which contain it which directly combat the ehupathogenesis and prevent the CAD in future.
5. The drugs have no untoward side effects and are very nicely tolerated by trial patients.
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