With some supporting Ayurvedic evidences we can draw some clarification of the disease hypertension. The disease hypertension is an abnormality of Rakta Dhatu (blood) and is popularly known as Shonita Dusti. It includes multitude of illness ranging from stubborn skin disorder to abnormality of blood coagulation. It also includes clinical manifestation that is analogous to hypertension. The illness Shonita Mada simulates the symptom of malignant hypertension. To clear the concept vitiation of Raktadhatu may cause different group of illness pertaining to different Srotas. On the basis of abnormal coloration of the body is manifestation of Shonita Dusti and are seen diseases like Pandu, Kamala etc. Morbidity of the Shonita Dusti leads to cause skin lesions that are collectively called as Kusta. Bleeding tendency disorders like RaktaPitta (abnormal bleeding from different roots of the body), Raktapradara (excessive vaginal bleeding), Rakta meha (Hematuria) etc. are also the morbidity of Rakta Dhatu (Blood), group of vascular disorders explained in Vatarakata and some of mucosal inflammation as Mukhapaka (Oral Ulcers), Akshiraga (Redness of Eyes), Upakusha are also regarded as maladies of Shonita Dusti.
A unique category of clinical presentations comprising Shiroruka (Headache), Klama(Nausea, Vomiting), Anidra (Sleeplessness), Bhrama, Buddi Sammoha, Kampa etc. do not fall under any of the above said class. Also it is interesting to note that all these symptoms are akin to manifestations of hypertension. More to add Mada, Moorcha and Sanyasa the different diseases caused by Shonita Dushti are described also as progressive manifestation of increasing Shonita Dushti. So also, such a sequel is equally true in relation to malignant Hypertension. All these deliberation corroborates parlance of the Shonitadusti and its different clinical manifestations of Mada, Murcha and Sanyasa to the essential Hypertension as well as Malignant Hypertension.
Etiology of Shonita Dusti (Hypertension)
Alcohol intake (Madya)
Alcohol has direct effect on the excitability as well as contractibility of the heart muscles. Intoxication doses of alcohol raise cardiac rate, cardiac output and hence increasing the systolic as well as pulse pressure.
Salt intake (Lavana)
Salt (Lavana), one of the major cause to increase the blood pressure due to its hygroscopic quality. Sodium salt (Lavana) has an ability to hold water in the blood and consequently increase its volume; volume of the blood is directly proportional to the blood pressure hence for the Shonita Dusti, Lavana is one of the leading causes.
Hypertension is a one of the leading lifestyle disorder. The one who sits ideally; who leads stressful life may have every possibility to have such diseases. Nutritious food habit with sedentary behavior leads abnormal increase in the lipids in the blood this in turn predisposes to atherosclerosis. Atherosclerosis increases the peripheral resistance and thus contributes to increased risk of Hypertension.
Mental stress (Chinta)
When a person is calm, heart rate is regular, pulse is even, blood pressure is relatively low, visceral organs are well supplied with blood. Contrary to this with stress vessels of the visceral organs constrict, blood flows in larger quantities to the muscles, the heart beats faster and the blood pressure rises. Due to chronic emotional stress the hypertension becomes inevitable.
Physical strain (Shrama)
Isotonic exercises like jogging and swimming that does not causes any physical strain helps in lowering the body weight. Isometric exercise like weight lifting increases the blood pressure.
The person who suffers from various vascular diseases like scleroderma, peripheral vascular disorder etc. they have tendency to increase the symptoms in the cold season may be due to constriction of blood vessels. Low environmental temperature tend to constrict the blood vessel to prevent heat loss, here volume of the blood remains same, but vascular compartment reduced due to constriction, disparity in blood volume and vascular compartment leads to elevation of blood pressure.
Symptoms Of Shonita Dusti and Hypertension
Symptoms of Shonita Dusti like Headache (Shiroruk), Tiredness (Klama), Dizziness (Shirobrhama), Vomiting (Chardi), Altered state of consciousness (Sammoha, Mada, Tandra, Nidra), Delirium, Seizures (Akshepa), different neurological deficits. These symptoms does not descend on any of the disease category, these symptoms are akin to the clinical manifestation of Hypertension (Shonita Dusti).
The illness is asymptomatic in most of the hypertensive, about 40% of the patients suffering from the hypertension (Malignant type) develops headache.
Undue exhaustion is a symptom of hypertension and the exact path physiology of this system is not clear.
Disturbance of emotion is not uncommon in hypertension.
Raised body temperature(Taap)
Reason is unknown.
Occasional dizzy spell is seen in some patients suffering from hypertension.
Patients suffering from malignant hypertension are likely to present with vomiting along with other symptoms.
Altered consciousness (Tamsaatidarshan)
In malignant hypertension the cerebral edema is sequel, this cerebral edema presents with altered state of consciousness. Patients suffering from malignant hypertension develop this altered state of consciousness, this may range from the simple confused state to stupor and coma.
Patients of malignant hypertension suffer from convulsion and usually generalized one.
Urinary system (Raktameha)
Oliguria, Proteinuria, Hematuria and decline in the renal functions are the manifestation of the malignant Hypertension. Balancing etiology and symptomatology of Shonita Dusti with hypertension some Nidana (causative factor) of Shonita Dusti can predispose to hypertension, many clinical manifestation of the Shonita Dusti can be explained by pathophysiology of hypertension.
Different causes of mada
Patient of Shonita Mada may not give the history of alcohol intake or poisoning, spontaneous onset for no apparent reason, variable course and spontaneous remission is characteristics of Rudhiraja Mada. If left untreated leads to Murcha and Sanyasa as in hypertension leading to stupor and coma.
In case of no availability of treatment or poor response Hypertensive encephalopathy progressive from delirium to cloudiness of consciousness, stupor and coma also Rudhiraja Mada progress to Murcha and Manyasa.
There is multiple diseases may lead to develop with Shonita Dusti from Mukhapaka (Mouth Ulcer), Kamala (Jaundice), Pandu (Anemia ), Rakta Pitta (Bleeding Disorders ) etc. There is separate set of clinical manifestation like Shiroruk, Bhrama, Tamastidarshana, Krodhaprachurata, Klama. These symptoms are similar to manifestations of asymptomatic essential hypertension (Shonita Dusti). Several etiological factors of Rakat Dusti like Lavana (excessive intake of salt), Madya (excess alcohol intake), Krodha (mental stress), excessive nutrition with sedentary habit, physical strain, are also best mimicking the etiological factors of essential hypertension. Shonitadusti, Shonita Mada, Moorcha and Sanyasa are the different progressive condition of the hypertension based on the criteria naming the disease by their leading symptoms the Rudhiraja Mada is related to the symptomatic phase of malignant hypertension. Asymptomatic hypertension can very well be considered as Avyakta stage of the illness or may be simply referred to Shonita Dusti. Involvement of variety of factors contributing in pathology the complexity of disease goes on increasing and putouts an obstacle in the line of treatment. Since there is involvement of TriDosha with Shonita, as Shonitadushti may further progress to Mada, Moorcha, Sanyasa, and hence dynamic planning of treatment is essential. As there is involvement of Madyama Rogamarga phrased as Yapya Vyadhi. So depending upon the Dosha, Dushya involved, and treatment is planned and consequently Shodhana, Shamana, Rasayana line should be adopted in patients.
The line of treatment in the disease of Shonitadushti consists of Nidana parivarjana, Shodhana in the form of Virecana (gut purification), Shirovirecana (purification through nasal root), Raktamokshana (Bloodletting), Murdhni Taila (special technique to keep oil and massage), Shamana medications (different oral medication) and Rasayana Chikitsa. According to the dominance of Dosha and the Avastha of disease, the planning of treatment goes on differing.
Various Ayurvedic authors have their own view on the disease hypertension but if we look closely in relation with causes and symptoms of the disease in Ayurveda hypertension can be considered as Shonita Dusti. Most of the causative factors like Lavana, Madya etc. have direct relation with Shonita Dusti and almost all symptoms of mimicking with different stages of hypertension so one can consider this disease as Shonita Dusti rather than considering other.