Comprehensive Ayurvedic Clinical Management of Essential Hypertension (Vyana Bala Vaishamya): A Case Series

Hypertension represents a profound global cardiovascular risk factor. While contemporary allopathic medicine relies on targeted pharmacotherapy, classical Ayurveda conceptualizes it as Vyana Bala Vaishamya — the dysregulation of Vyana Vata.¹ Vyana Vata constantly forces the Rasa Dhatu out of the Hridaya (heart), governing systemic circulation.²Thus, deviations in cardiac output and peripheral resistance inherently map to physiological disturbances in Vata, Pitta, and Kapha.³ This case series documents the clinical trajectory of five hypertensive patients meticulously managed demonstrating the remarkable efficacy of individualized Samprapti vighatana chikitsa (therapies) in removing obstructions (Avarodha) and restoring hemodynamic equilibrium.

Clinical Case Reports

Case 1

A 54-year-old male information technology (IT) professional presented to the OPD (OP-366000) with elevated blood pressure (150/90 mm of Hg), Stage 2 Hypertension and severe Amlapitta (Gastritis). The Samprapti involved occupational stress vitiating Prana Vata and Sadhaka Pitta, alongside Amlapitta functioning as a Nidanarthakara Roga (secondary causal disease) where Apana vata, Samana vata and Pachaka Pitta were vitiated. Here, Apana Vata caused Avarana (occlusion) of Vyana Vata, Prana Vata resulted into vasoconstriction and Sadhaka pitta & Pachaka pitta leading to volume overload. Therapeutic management focused on Shamana (pacification) measures. He was prescribed Avipattikara Churna for Anulomana (downward regulation of Apana Vata), Cardimap (Medhya to calm Prana Vata and Sadhaka pitta), and Amlapitta Mishrana (a Pittahara formulation containing Guduchi and Vasa) to regularise the Pachaka pitta.⁴ Following an 8-day regimen, his blood pressure decreased significantly to Stage 1 (130/80 mm of Hg), showcasing a rapid hemodynamic transition and substantial subjective relief from Amlapitta.

Case 2

A 63-year-old male (IP-087497) was admitted with Stage 1 Hypertension (130/90 mm of Hg) Vatakantaka (bilateral plantar fasciitis) and Amlapitta (Gastritis). Primarily the pathogenesis was driven by intense musculoskeletal pain acting as a physiological stressor, triggering Vyana Vata (hyperactivity/Atipravrutti of circulatory Vata) and increased heart rate. Secondary Amlapitta as a Nidanarthakara Roga (secondary disease) where Apana vata and Pachaka Pitta were vitiated. Pachaka Pitta vitiation contributed to Rakta Dushti (blood vitiation), further causing volume overload⁵ and Apana vata caused Avarana to Vyana. Management utilized a dual Shamana and Panchakarma approach.  Dhanwantara Vati provided necessary Pachana and Vatanulomana, while Kamduga Mukta pacified Pitta. Procedural interventions included Sarvanga Abhyanga (full-body oleation) with Parisheka Taila followed by Dashamoola Kwatha Parisheka to pacify Vyana Vata, alongside Anuvasana Basti (medicated oil enema) with Yashtimadhu Taila to target the Apana Vata (enteric nervous system). Within 48 hours of monitoring, his blood pressure stabilized to normotension (110/80 mm of Hg).

Case 3

A 68-year-old female (IP-088031) with chronic hypertension, diabetes mellitus, and Katishoola (lower back pain) presented with severe hypertension (200/90 mm of Hg). Her chronic pain induced severe Anidra (insomnia), profoundly vitiating Prana Vata and Vyana Vata leading to increased Heart rate and vasoconstriction. Concurrently, Pramehajanya Kleda (pathological moisture) and Meda (lipids) caused a physical Avarana understood as Dhamani Pratichaya (vascular coating)⁶causing increased peripheral resistance. Low back pain also led to Vyana Prakopa in the Apana Pradesha (pelvic region), causing Vyana Vata Atipravrutti contributing to increased heart rate. Aushadhi dravyas were administered according to Samprapti, as Samprapti vighatana chikitsa, such as Maharasnadi Kashaya (vatahara), Haritaki Tab(anulomana), Prasarini capsule (vatahara and balya), and Cardimap (Medhya to calm Prana Vata).  Sarvanga Udwartana (powder massage) followed by Dashamoola Kwatha Parisheka was administered for its Lekhana (scraping) effect to actively mobilize the obstructive Kapha and Meda, followed by Abhyanga and Anuvasana Basti with Prasarini Taila for Vatahara action. Over five days, this treatment protocol reduced her systolic pressure from 200 mm of Hg to 140 mm of Hg.

Case 4

A 76-year-old female (IP-088196) diabetic presented with Stage 2 Hypertension (160/70 mm of Hg), debilitating giddiness, and prominent bilateral pedal edema. The probable Samprapti highlighted Kapha dusti and Abaddha medas, kleda due to Prameha and pedal edema establishing Avarana of Vyana Vata by Kapha and Medas can be understood as Dhamani Pratichaya (vascular coating)⁶, causing increased peripheral resistance. Kleda causing increased cardiac output. Personal stress caused Prana Vata vitiation led to vasoconstriction and increased heart rate. Aushadhis including Sootshekhara Rasa (bhramahara), Punarnavashtaka Kashaya (Shothahara), Nuro XT capsules (containing Ekangaveera Rasa specific for neuropathy ⁷), and Cardimap (Medhya to calm Prana Vata). Localized Dashanga Lepa was applied for edema reduction, alongside Dashamoola Kwatha Parisheka for removing avarana of Vyana Vata by kapha,pitta, Anuvasana Basti with Dadimadya ghrita for Vyana Vata regulation, and Shiropichu for Prana Vata regulation. Within four days, targeted Shothahara therapy effectively reduced pedal edema and drained the peripheral resistance, dropping her blood pressure to Stage 1 hypertension (130/70 mm of Hg).

Case 5

A 66-year-old bedridden male (IP-087487) with a history of left-sided Pakshaghata (stroke) presented with Stage 2 Hypertension (170/100 mm of Hg). Prolonged immobility since1 year caused massive, Kapha dusti occluding Vyana Vata — manifestation of Kaphavrita Vyana.⁸ Consequently, Prana Dushti occurred due to stress (related to stroke), while Vyana Vata Atipravrutti due to old age elevated both systolic and diastolic pressures against the peripheral resistance. Treatment included Srotoshodhana. He received Arogyavardhini vati (kaphamedohara), Dashmoola capsule (shothhara and tridoshhara), Kamaduga Mukta (pittahara), Makardhwaja (vrushya to prevention pratiloma dhatu kshaya). Procedures like Pradhamana Nasya (Trikatu Churna) (kaphahara), Mustadi Yapana Basti (containing Madhu/honey, Ashwagandha Ghrita)⁹, was administered to provide Sadyo-Bala (quick strength) and as Avaranahara Chikitsa¹⁰. This neuro-restorative intervention successfully reduced his systolic pressure from 170 mm of Hg to 140 mm of Hg within a 48-hour window.