Hypercholesterolemia: Ayurvedic Perspective And Pathophysiology

Article by Dr Raghuram Y.S. MD (Ay)
We don’t get any medical condition explained in Ayurveda which can be directly compared to Hyper-cholesterolemia. But investigating deep into the treatises we can grab some conditions to the surface which mimic similar condition. Now let me try to give a brief account on understanding Hypercholesterolemia with an Ayurveda perspective.

Causes

Causes of hypercholesterolemia –
Meda or fat belongs to kapha varga (group of elements related to kapha). They also have ashraya ashrayi bhava (abode and tenant relationship) wherein kapha is located in meda. Thus they can mutually guard or vitiate each other. In normal proportions (quality and quantity), both are protective and constructive in nature.

The statement ‘Prakrutastu balam shleshma vikruto balam uchyate’ means ‘kapha in the state of its normalcy is considered to be bala or strength to the body and when it gets vitiated it gets the status of mala (waste, toxin, morbid element)’ is also applicable to meda.

The causes of hypercholesterolemia includes the –
Causes of Kapha vitiation (increase)
Causes of meda vitiation
Causes of ama formation – agnimandhya (low digestion fire or gut metabolism) and ajeerna (indigestion) are the main causes of formation of ama. Ama means the intermediate products of digestion or immature essence of food formed after digestion of food. This ama keeps circulating in the blood. Being sticky in nature (cholesterol is also said to be a sticky substance) it clogs all the channels of transportation. It also causes multiple blocks at various tissues and impairs their smooth functioning. When associated with doshas, dhatus (tissues) and malas (excreta), ama vitiates them and impairs their functions.

Ayurvedic correlation

Hypercholesterolemia, Ayurvedic correlation –
Since hypercholesterolemia is accumulation of bad fats in the blood vessels leading to wide array of diseases, it strictly falls under the category of MedoRoga. Though circulating bad cholesterol can be a part of medo vriddhi or sthoulya they might not initiate a disease process or might not be severe enough to cause multiple organ damage. They are just giving signs of fat accumulation and that it can cause serious damages in future. Thus Medo vriddhi and sthoulya can be considered as the premonitory conditions of Medo Roga vis-à-vis hypercholesterolemia.

Hypercholesterolemia causes serious damage to heart and brain causing heart attack and stroke respectively. This is due to the atherosclerosis occurring in the blood vessels caused by cholesterol accumulation and subsequent formation of plaques.

Similar conditions have been explained in the context of Medoroga, the proof of which is enumerated below –

The chapters Medoroga Prakarana (chapter covering Medoroga or disease manifested due to errors of fat metabolism) of Madhava Nidana text (Chapter 34) and Ashtounindhita Adhyaya (chapter explaining 8 types of socially unfit people) of Charaka Samhita (Sutra Sthana Chapter 21) give us some terminologies which directly or indirectly point out to one or the other complication occurring as effects or errors of fat metabolism or obesity. Let us try to understand them in terms of complications caused due to accumulation of high quantities of lipid or bad cholesterol (hyperlipidemia or hypercholesterolemia) as explained by the modern science (already explained at the beginning of this article). Anumana or knowledge through inference comes to our help in understanding these terms.

मेदसा आवृत मार्गत्वात् पुष्यन्ति अन्ये न धतवह।
मेदस्तु चीयते तस्मात् अशक्तः सर्व कर्मसु॥
क्षुद्र श्वास तृषा मोह स्वप्न क्रथन सादनैः।
युक्तः क्षुत् स्वेद दौर्गन्ध्यैः अल्प प्राणो अल्प मैथुनः॥(मा.नि.३४/२,३)
मेदस्यतीव संवृद्दे सहसा एव अनिलादयः।
विकारान् दारुणान् कृत्वा नाशयत्याशु जीवितम्॥(मा.नि.३४/८)

Medasaa aavruta maargatvaat pushyanti anye na dhaatavaha
Medastu cheeyate tasmaat ashaktaha sarva karmasu
Kshudra shvaasa trushaa moha svapna krathana saadanaihi
Yuktaha kshut sveda daurgandhyaihi alpa praano alpa maithunaha (Ref – Madhava Nidanam 34/2,3)

Meaning – When the pathways and channels in the body get blocked by morbid fat, the other tissues of the body get deprived of the nutrition. When this fat increases over a period of time and accumulates in all the passages leading to depletion of all other tissues (as the fat tissue takes away the bulk of nutrition), the person becomes incapable of doing any kind of work. He suffers from short of breath, thirst, unconsciousness, sleep, intermittent dyspnoea, laxity and weakness of the body parts, excessive hunger, excessive sweating, foul smell from the body, decreased life expectancy and lowered sexual drive.

Medasya ateeva savrudde sahasaa eva anilaadayaha
Vikaaraan daarunaan krutvaa naashayati aashu jeevitam (Ref – Madhava Nidanam – 34/8)

Meaning – When the morbid fat blocks all the pathways of the body, the dosha’s immediately get aggravated. The vitiated doshas cause severe life threatening complications and take away the life in quick time.

In the above said context, the terms Ayukshaya (decrease in life span), Ashaktaha-sarvakarmasu (inefficiency in doing all kinds of works), Alpaprana (deterioration of life), Nashayatyashu-Jeevitham (quickly takes away the life), Kshudra-Shwasa (dyspnoea or short of breath), Pushyanti Anye Na Dhatavaha (lack of nourishment of other tissues) etc. point out towards anatomical damage and failure of heart as a pump (physiological breakdown). This can be understood as occurring due to the effect of stress created over the heart by increased fat, due to errors of fat metabolism and obesity and due to the atherosclerosis caused by accumulation of bad fats in the blood vessels supplying the heart (coronary vessels).

Medasavrita Margatvat –
Medasa – fat, Avrita – masked or enveloped or blocked, Marga – passages, channels

Thus the term Medasavrita Margatvat means ‘the passages or routes or channels blocked by the morbid fat’. This point towards the process of atheroscelrosis caused due to hypercholesterolemia. This may lead to coronary artery diseases (CAD)

Pushyanti Anye Na Dhaatavaha (Under Nourishment of other Dhatus) –
Pushyanti – get nourished, Anye – other, Na – not, Dhatavaha – tissues

Thus Pushyanti anye na dhatavaha means ‘the other tissues are not nourished or are under-nourished’. This is also a consequence of blocks caused by medas or morbid fat as occurs in hypercholesterolemia. This leads to multiple organ damage and depletion of other tissues due to deficient supply of nutrients and other requirements to the other dhatus. In these conditions the fat takes away the bulk of nutrition and causes depletion of other tissues. This in turn causes functional overload on heart. This leads to enlargement of heart (hypertrophy and dilatation), hypertension and heart failure.

Medastu Cheeyate –
Medastu – The fat, Cheeyate – accumulates

Thus Medastu cheeyate means ‘the fat accumulates’. It indicates and explains the mechanism of accumulation of morbid and unwanted fat tissue in undesired places like passages and channels of circulation in the body. It indicates the impending atherosclerosis and plaques in the blood vessels which form a risk factor for the CVD’s. Atherosclerosis in coronary vessels may cause IHD (Ischemic Heart Disease)

Ashaktaha Sarva Karmasu (Inability to do any work), Dourbalya (Extreme weakness, Loss of strength) & Javoparodha (Breathlessness) –
All these symptoms point out towards the compromised heart as a result of burden imparted on it by excessive unwanted and morbid fat in the body and in circulation.

Kshudra Shwasa –
Kshudra – short, Shwasa – breath, Thus Kshudra Shwasa means shortness of breath (Dyspnoea, Difficulty in breathing). Dyspnoea (difficult or laboured breathing) on mild exertion may also be due to functional over load over the heart and lungs produced by excessive fat, as the hyper-functioning heart may cause pulmonary congestion.

Alpaprana (Decreased Life expectancy and Hypoxia)
Aplaprana = Alpa – less or decreased, Prana – life, Thus Alpaprana means a decreased life expectancy which also reflects a condition called Hypoxia (less amount of oxygen reaching the tissues). This is an effect of hypercholesterolemia, hyperlipidemia, atherosclerosis etc caused by excess fat accumulation leading to functional overload on the heart.

Here, the hypoxia caused due to multiple blocks caused by morbid fat exerting a functional burden on heart and lungs in the process will cause decreased life expectancy as a whole as well as that of each and every cell.

Vikaaraan Daarunaan Kritva Naashayatyaashu Jeevitham
Vikaaraan – diseases or disorders, Daarunaan (complicated or troublesome), Kritva (does), Naashayati (destroys) aashu (quickly), Jeevitam (life)

Thus ‘Vikaaraan daarunaan kritva naashayati aashu jeevitam’ means ‘it causes complicated disorders quickly leading to loss of life i.e. death’. This explains that the meda (fat) is responsible for manifestation of life threatening disorders in the body.

Accumulation of excessive morbid fat in the body passages leads to imbalanced supply of nutrients and building elements to the tissues. Deprivation of nutrition leads to cell damage consequentially leading to tissue depletion. Amidst all these pathological background, the dosha’s – Vata, Pitta and Kapha get aggravated and start destructive activities in the body. The immunity starts deteriorating. The overall effect leads to the manifestation of life threatening disorders which can ultimately end up in death.

These life threatening disorders are hypertensive cardiac diseases, Ischaemic Cardiac Disease (IHD), Myocardial Infarction (MI), Stroke, hyperinsulinaemia, Non Insulin Dependent Diabetes Mellitus (NIDDM) or Type2 Diabetes, hypo-ventilation syndrome, Arrhythmias, Congestive Cardiac Failure (CCF) and Heart Failure, Aneurysm, polycythaemia etc

Atherosclerotic plaques Ayurvedic concept

Ayurvedic concept of atherosclerotic plaques:
Meda or fat is a kapha varga dravya i.e. belongs to the group of kapha. Thus basically Meda is made up (like kapha) by prithvi (earth element) and jala (water element) mahabhuta in its makeup. The combination of prithvi and jala always forms a cement like substance and tendency to adhere and stick to the places. Like Kapha, morbid meda afflicted by doshas in medo roga too will have a tendency to stick to the walls of the cells, channels and organs and block them.

Meda tends to accumulate in both larger and smaller spaces. Udara or belly or tummy is said to be one of the important places wherein meda or normal fat is seen to be present. This is seen in all of us. But when meda increases abnormally, it shows its first sign of abnormal accumulation around the abdomen. Even according to modern science, Belly fat is said to be an alarming condition which needs to be addressed immediately to protect the vital organs and functions. Therefore ‘udaragata meda’ or abnormal fat around the belly is the first indication that the fat metabolism in the body is going weird. The next important places of accumulation as already discussed are spik i.e. butts and stana i.e. breasts.

Meda also tends to accumulate in the small spaces. Ayurveda has mentioned meda or fat to be naturally present in anu-asthi or small bones. This meda is called ‘sarakta meda’ fat with blood, probably suggests the precursors of bone marrow or bone matrix. This also justifies the formation of bone tissue from fat as explained by Ayurveda.

‘Bahu abaddha meda’ or ‘abundance of free fat in circulation’ is a condition explained in Prameha prakarana (context of describing the group of diseases which correlates to urinary disorders and diabetes mellitus). This suggests that Ayurveda had the earliest evidence of unbound free fats circulating in the blood stream and when they could not be expelled from the blood stream, they tend to accumulate in the blood vessels. This probably was the first explanation of formation of plaques in the blood vessels and thus be correlated with the pathogenesis of hypercholesterolemia and hyperlipidaemia.

‘Medasavrita margatvaat pushyanti anye na dhatavaha’ that means to tell that ‘when the channels of the body are blocked by the morbid fat, the other tissues and organs are depleted of nutrition’. This leads to many disorders, complications and organ damages.

In the later stages of the pathogenesis, the excessively accumulated meda blocks all the pathways of vayu or vata, the driving force of all the activities in the body. This condition is called ‘Medasavrita vayu’ or ‘vayu enveloped, blocked or clouded by morbid meda’. The consequence is life threatening disorders (vikaaraan daarunaan kritva naashayati aashu jeevitam).

The advanced stages are very difficult to treat because the medicines given to reduce fat or bad cholesterol are antagonistic to Vayu and the treatments and medicines given to reduce vayu are antagonistic to meda and kapha, the pathological elements of medoroga. The tricky amalgamation of meda and vayu comes in the way of easy treatment. Therefore obesity and related conditions like hypercholesterolemia, hyperlipidaemia etc are difficult to handle in later stages.

Therefore the keys of handling medoroga will be –
Effective management of morbid ama (deepana, pachana, shodhana as explained above)
Effective management of morbid meda
Effective management of vitiated kapha
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