Prof. Dr. S.K. Mishra (IND)

Ayurveda believes that whole physical creations are made of the five basic elements that is Panch MAHABHUTA this implies that the body, the prakriti of the human beings, the components of samprapti and treatment be it drug, diet or any other directly depend upon the PANCH MAHABHUTA.

charak says -
SARVAM DRAVYAM PANCH BHAUTIKAM i.e. all matter is PANCH MAHABHAUTIK

Here we have to be conscious that doshas, dhatus, garbhavakrnti in (i.e. Embryology), rasas (SHARASAS), all are affected by these. Most important BHUTAGNIS take a very important role in healing.
So, without considering the PANCH MAHABHUTA its impossible to diagnose, treat or manage or plan the drug treatment in Ayurveda as KAYAGNESHCHIKITSA KAYACHIKITSA that is the treatment of 13 agnis is the whole treatment.

Psychophysiological aspects
Susruta says -
tatra sattavam bahulam akasham (akash is sattva predominant)
sattva rajobahulam agni (agni is sattva & raja predominant)
sattva tamobahulo apah (water is sattva & tam predominant)
tamobahulo priwiriti (earth is tam predominant)

(Su.Sa.1-25)

So while considering the manas & manas prakriti of the pesent we have to be aware and conscious of these components in relating the samprapati as well as planning the management & diet.

If it is not assessed and related properly, the whole management being perfect, the result may not be positive. It is very subtle level of healing and a fine tuning at this level goes a long way in proper healing.

Tridosha and PANCH MAHABHUTA
The awareness and consideration of PANCH MAHABHUTA and its relationship with the doshas is imperative as tridosha are actually further abbreviation of this only.

- VATA - VAYU AND AKASH
- PITTA - AGNI AND JAL
- KAPHA - PRITHVI AND JAL

So the awareness of this and applications of the qualities of these while managing the healing, facilitates the success and ensures healing.

PROPERTIES OF PANCH MAHABHUTA
KHARDRAV CHALO SHNATWAM
BHU JAL ANIL TEJASAM AKASHYAPRTIGHATAM
DRISHTLINGAM YATHA KRAMAM (Ca.Sa. 1.29)

- Prithvi (earth) - kharattva (roughness)
- Jal (water) - dravattva (fluidity)
- Teja (fire) - ushnatwan (heat)
- Vayu (air) - chalattwa (mobility)
- Akash (space) - apratighat (intouchable/unbreakable)

The applicability of these qualities has to be decided by the physician as per the requirement of the situation in the healing processes.

- Akash (sound) has the quality of shabda (sound)
- Vayu (air) - sparsha (touch) and sound
- Agni (fire) - Rupa (form) - shape and sparsh (touch) and sound
- Jal (water) - rasa (taste) - and shabd sound, touch, shape and form
- Prithvi (earth) - Gandha (smell) - and sound, touch, form and taste

The importance of PANCH MAHABHUTA in management of pregnancy
These Bhutas govern the development of the fetus after zygote formation Air (vayu) is responsible for cell division, TEJA (fire) is taking care of maturity. The fluidity or moisture as aspect is by water (jal) mahabhuta. Samhanana or the compactness depends upon - earth element. Prithvi MAHABHUTA. the development per se (vivardhan) depends upon AKASH (space).

So in antenatal care proper nurturing of these individual elements is crucial in healthy development of fetus in the embryonic stage.

Shadrasas and MAHABHUTA

- Madhur (sweet) - Prithvi (earth) Jal (water)
- Amla (sour) - prithvi (earth), agni (fire)
- Lavana (salty) - jal (water), agni (fire)
- Tikta (bitter) - Vayu (air), Akash (space)
- Katu (punjent) - vayu (air), agni (fire)
- Kashaya (astrigent) - vayu (air), prithvi (earth)

So planning the diet and medication in each situation. Consciousness goes a long way in the healing process.

Bhutanis
Panch mahabhutagnis or the final level of digestive process. The diet we take is acted upon by the jatharagnis first which is most important. Then further fine action is completed by dhatwagnis, the last stage of digestion is completed by the bhutagnis. If proper bhutagnis is not there then the actual utilizable form of the dietary components is not prepared so proper nutrition will not reach the body tissues, hence will suffer from some deficiencies which hamper physiological function as well as the healing process in a diseased person.

Treatment and mahabhuta
As the treatment in Ayurveda has been conceptualized as management of KAYAGNIS the knowledge of mahabhuta is crucial to decide the drugs as ras, guna, veerya all will depend upon mahabhuta.
The diet as well cannot be properly planned without considering the mahabhuta.

To summarise panch mahabhuta after “panch panchikaran” take the physical form which are the basic elements of the body and then their qualities have been considered and relation with embryology,brasas and bhutagnis were discussedbin nutshell.
All this has to be done of course in relation to the planning of comprehensive diagnostic and dietary and drug treatment. Incidentally psychophysiological aspects of the individual in the healing process.

MANA HI MANYSHANAM KARAN BANDHAN MOKSHAYOH

Ayurveda believes that mana (spirit) is the main cause of attachments and detachments or proclamation and renunciation.
We know that mana is the bridge between body and soul.

Dincharya is our daily schedule for a lifestyle according to Ayurveda. It is obvious that Dincharya is the basis of this lifestyle, which depends entirely on our Chitta Vrittis, i.e. on our likes and dislikes. These in turn are determined by our status as Satva, Rajas and Tamas, i.e. our Manas Prakriti.

Another important point is the tripod of life: Ahar, Nidra and Brahmacharya.

The daily routine should be planned and carried out by both our Sharir and Manas Prakriti in such a way that it runs effortlessly, which in turn determines our mental stability and the mental stability of the proper implementation of the schedule. They are interdependent.

The mechanism of interaction between Dincharya, mind and soul will be the purpose of the lecture.

The components of Dincharya are dependent on the belief in comprehensive health, not just physical. Mental health, spiritual health, social health and other aspects that make us a radiantly happy, healthy individual must be considered.

Mental stability depends on the balance between the three Eshanas (desires) in the life according to Ayurveda.
1. praneshana
2.Dhaneshana
3.parlokeshana

The first is the desire to live a healthy, fruitful life, the second is the desire to have resources in abundance, and last but not least the renunciation or liberation, so to speak, the improvement of life beyond life, just as Ayurveda believes in rebirth. Moksha or liberation means to have freedom from the cycle of birth and death.

These concepts are briefly discussed as they depend on and are influenced by Dincharya or lifestyle in simple terms. Achar Rasayana of Ayurveda is nothing more than a perfect way of life, for which Dincharya is a rock in the surf.

Comparative clinical trial of Nagarjunabhra ras in Vataj Hridroga
Prof. Dr. S.K. Mishra
We have had enough experience of treating "Vataj Hridrog" since 80's of last century. We initiated this trial as we got some positive results in our clinical practice. That was in a combination but looking to the requirements of scientific enquiry we opted for are ingredients of our formulation for the study. Our objective was to evaluate any ayurvedic formulation for its efficacy in selected cases of Vataj Hridroga.

Materials and methods
Criteria of Selection of cases were
- Features of stable angina (chest pain an emotion/Exertion relieved after rest)
- Chest pain referred to left shoulder or finger and arm without perspiration, to Jaw epigastrium
- Veshthana (Oppression in chest)
- Stambha (Spasmodic Pain in chest)
- Dara (tachycardia)
- Pramoha (Stuper Syncope)
- Dainya (depression-weakness)
- Shoka (Sorrow-grief)
- Sabda Ashahishnuta (Intolerance for noise)
- Jeerntyarth Vedana (exaggeration of pain after digestion of food) relieved after rest
- History of being treated on IHD lines with relief.
- Enzymology suggestive of myochordial Ischaemila
- Electrocardiogram not suggestive of established myocordial infarction
The patients who has signs of Ischamia in chest leads of ECG were directly diagnosed as Vataj Hridrog, those who did not have were put to stress test. We used MASTER's.

criteria of assessment
- Detailed Clinical Profile for Kshaya and Vriddhi of Dosa, Dhatu and Mala
- Blood Examination TLC/DLC/ESR
- Urine and Stool examination routine and microscopic.
- Blood sugar estimation fasting-PP
- serum cholesterol
- Blood Urea
- serum creatinine
- S.G.O.T., LDL and CPK
- X-ray chest AP for size and configuration of heart
- 3 months follow up and weekly progress was recorded.
A cross over customized design was done for each group.

trial drug
Nagarjunabhra Ras contents 1000 Puti Abhrak Bhasma (Mica) with 7 days trituration (Bhavana) with terminalia arjuna bark decoction

control drug
- Abana 650mg (Himalaya) two tablets twice daily
- Angised (GTN) 0.5 ml twice or thrice SOS sublingual

Observation and results
The data have been reported as + SD coefficient of correlation between two variables (r) with regression coefficient analysis of variance has been done by chi square (x²) has T-test also has been done for two categorical variables for significance p-value <0.01 has been considered significant

Discussion
In our studies we are in disagreement with the common belief that it is more prevalent in males. We found a clear dominance of the female sex. 40-50 age group was found to be more susceptible for Vataj Hridroga. It required further confirmation.

Vata Vridhi was found to the tune of 58.33 percent and Rasakshaya to the tune of 81.8 percent Rakshkshay to the tune of 45.5 percent. Hence we can safely conclude that Vatavridhi Rasakshaya, Rasvridhi and No Raktavridhi at all may be roughly regarded as an indication for Vataj Hridrog.

Not only this significant Purish Vridhi (67.7 percent) again indicates towards apparent metabolic activities going on in the body by way of accumulation of metabolites which is responsible for Purish Vriddhi. If could be interpreted as an ayurvedic indication to understand the current concept of rise in the value of enzymes like SGOT CPK, LDH and the like.

As stress test in our studies we used masters so to generate more authentic data it would be worth while to use TREADMILL test (TMT) in future studies.

The features encountered in our studies from amongst textual description were Veshthan, Vepathu Hrichhula, Shunyata, Nidralpata, Shwas, Shabd Ashisnuta, Dainya Shoka and Bhaya. By and large we propose that feature must be short listed after a larger study. In our studies these of Nidralpata, Dainya Shabda Asashisnuta Hrichhula and Hridshunyata.

Our studies and interpretation based on our data is in agreement with Chaturvedi G.N. (1973) Upadhyay B.N. (1980), Gupta O.P. (1988), Sharma S.D. (1984) our Ranasingha S.G. (1989) that I.H.D. particularly angina pectoris should be interpreted as "Vataj Hridrog". However we do not agree with the proposition that the total arena of I.H.D. should be regarded as "Sannipataj Hridrog (Chaudhari K, et. al. 1989)" we have generated sufficient data supported by statistical evaluation for interpretation of angina pectoris as "Vataj Hridroga". Nidralpata (Lack of Sleep) and Shunyata (feeling of void) are two features which are significantly affected by Nagarjunabhra and not affected by control (Abana) puts an additional benefit to Nagarjunabhra use as against Abana.

The number of attacks was not significantly affected by trial drug (p<0.05) whereas the control drug reduced it significantly (p<0.001) this was because of the synergistic action of additional ingredients in Abana the control drug.

The duration of chest pain has been significantly affected by trial drug (p<0.001) as compared to control drug (p<0.01). This is a more utilitarian observation from the patients point of view because it is pain in chest which emotionally disturbs the patients which is not only a matter of immediate concern to the patient but also forms a complex in his mind end perpetuates the process of attacks of angina.
Since we were encouraged in our statistical analysis on the score of pain we further evaluated the severity of chest pain by grading its in both the groups. Here also the trial drug was significantly superior (p<0.001) as against control (p<0.01)

The effect of both trial as well as control drug was highly significant in lowering the blood cholesterol of the patients (p<0.001). There was no significant effect on pulse rate (p<0.01).
However a positive role of the trial drug was observed in lowering the systolic blood pressure (p<0.001) which was superior to control drug (p<0.05) though it is promoted as a treatment for hypertension since the diastolic blood pressure was not significantly by either trial or control drug this needs further evaluation.
We are in full agreement with the published work regarding positive effect of Terminalia arjuna in I.H.D. (Chaturvedi G.N., Dwivedi S. and Udupa K.N.) since arjuna is main ingredient of nagarjunabhra the efficacy of trial drug might have been significantly affected by Abhrak Bhasm in strongly recommended for Hridroga both conventionally and current practice.

Conclusion
1. vataj hridroga in corporate angina pectoris
2 The efficacy of Nagarjunabhra Ras is no way inferior to Abana-the control drug which contains 36 ingredients.
3 If can be safely concluded that Nagarjunabhra Ras can easily replace Abana which will avoid unnecessary burden of extra drugs to the patients.
4. it should be further evaluated for its role on lipid profile and preventive role in avoiding precipitation of heart attack.

Acknowledgement
The assistance provided by Dr. Sanjay Kumar Sharma in executing the studies and Himalaya Drug Co. and Unjha pharmacies for their supply of drugs in gratefully acknowledged.