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== Definition of hridaya ==

== Definition of hridaya ==

<p style="text-align:justify;">The term "Hridaya" carries multifaceted meanings within the Ayurvedic context. In its essence, hridaya signifies more than a physical organ; it is a dynamic force governing the body, mind, and senses. [Cha. Sa. Sutra Sthana.30/4] Critical analysis of Ayurvedic literature reveals that Ayurveda includes the heart and the brain under the umbrella term 'Hridaya.'</p>

<p style="text-align:justify;">The term "Hridaya" carries multifaceted meanings within the Ayurvedic context. In its essence, hridaya signifies more than a physical organ; it is a dynamic force governing the body, mind, and senses. [Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 30/4] Critical analysis of Ayurvedic literature reveals that Ayurveda includes the heart and the brain under the umbrella term 'Hridaya.'</p>

== Structure of hridaya ==

== Structure of hridaya ==

<p style="text-align:justify;">Understanding the structure of the hridaya is pivotal in comprehending its diverse functions. From a physiological perspective, the hridaya is commonly associated with the heart, a muscular organ situated in the chest. The heart is like a lotus in an inverted position. It is open while awakening and contracted during sleep. [Su. Sa. Sutra Sthana 4/32]</p>

<p style="text-align:justify;">Understanding the structure of the hridaya is pivotal in comprehending its diverse functions. From a physiological perspective, the hridaya is commonly associated with the heart, a muscular organ situated in the chest. The heart is like a lotus in an inverted position. It is open while awakening and contracted during sleep. [Su. Sa. [[Sutra Sthana|Sutra Sthana]] 4/32]</p>

== Origin/ utpatti ==

== Origin/ utpatti ==

<p style="text-align:justify;">The heart is formed from the sara[essence] of shonita and kapha [Su. Sa. Sutra sthana 4/31]. It is the supporter of the pranavaha dhamanis. Below the heart on the left side are the pleeha(spleen) and the phupphusa(lung), and on its right and below are the yakruta (liver) and kloma (pancreas). When this is covered by tamas (delusion,ignorance), all living beings sleep. [Su. Sa. Sutra sthana 4/31].</p>

<p style="text-align:justify;">The heart is formed from the sara[essence] of shonita and kapha [Su. Sa. [[Sutra Sthana|Sutra sthana]] 4/31]. It is the supporter of the pranavaha dhamanis. Below the heart on the left side are the pleeha(spleen) and the phupphusa(lung), and on its right and below are the yakruta (liver) and kloma (pancreas). When this is covered by tamas (delusion,ignorance), all living beings sleep. [Su. Sa. [[Sutra Sthana|Sutra sthana]] 4/31].</p>

== Size ==

== Size ==

The pramana of hrudya is two angula. [Cha. Sa.Vimana sthana 8/117]

The pramana of hrudya is two angula. [Cha. Sa. [[Vimana Sthana|Vimana sthana]] 8/117]

== Importance of hridaya ==

== Importance of hridaya ==

== Hridaya in different contexts ==

== Hridaya in different contexts ==

=== Hridaya as koshthanga and pratyanga ===

=== Hridaya as koshthanga and pratyanga ===

<p style="text-align:justify;">Hridaya is mentioned as one of the organs of koshthanga. According to Charak, fifteen koshthangas have been mentioned. These include nabhi [umbilicus], hridaya [heart], kloma [oesophagus], yakrit [liver], pliha [spleen], vrikka[kidney], basti [urinary bladder], purishadhara [colon], amashaya [stomach], pakvashaya [intestine], uttaraguda [rectum], adhara guda [anus], kshudrandra [small intestine], sthulantra [large intestine] and vapavahanam [omentum]. [Cha. Sa. Sharira Sthana 7/10] [A.Hr. Sharira Sthana 4/1,12] </p>

<p style="text-align:justify;">Hridaya is mentioned as one of the organs of koshthanga. According to Charak, fifteen koshthangas have been mentioned. These include nabhi [umbilicus], hridaya [heart], kloma [oesophagus], yakrit [liver], pliha [spleen], vrikka[kidney], [[Basti|basti]] [urinary bladder], purishadhara [colon], [[Amashaya|amashaya]] [stomach], pakvashaya [intestine], uttaraguda [rectum], adhara [[Guda|guda]] [anus], kshudrandra [small intestine], sthulantra [large intestine] and vapavahanam [omentum]. [Cha. Sa. Sharira Sthana 7/10] [A.Hr. Sharira Sthana 4/1,12] </p>

=== Pranayatana ===

=== Pranayatana ===

<p style="text-align:justify;">Hridaya is one of the organs of pranayatanam. Pranayatanam is also called as jivitadhamam. "Ayatanam" means resting place, and "dhamam" means residence. These are the resorts of life. There are ten pranayatana or jivitadhama situated in our body. These are murdha [head], kantha [throat], hridaya [heart], nabhi [umbilicus], gudam [anus], basti [bladder], ojas, shukram [reproductive elements], shonitam [blood] and mansa [muscle]. Out of these, the first six organs are said to be "Marma”. [Cha. Sa. Sharira Sthana 7/9] </p>

<p style="text-align:justify;">Hridaya is one of the organs of pranayatanam. Pranayatanam is also called as jivitadhamam. "Ayatanam" means resting place, and "dhamam" means residence. These are the resorts of life. There are ten pranayatana or jivitadhama situated in our body. These are murdha [head], kantha [throat], hridaya [heart], nabhi [umbilicus], [[Guda|gudam [anus]]], [[Basti|basti]] [bladder], [[Ojas|ojas]], shukram [reproductive elements], shonitam [blood] and mansa [muscle]. Out of these, the first six organs are said to be "Marma”. [Cha. Sa. Sharira Sthana 7/9] </p>

=== Roga marga ===

=== Roga marga ===

<p style="text-align:justify;">There are three roga margas (pathways to diseases) shakha, marmasthisandhi and koshtha. Madhyama roga marga includes diseases involving marmas  (vital organs i.e. basti (bladder), hrudya (heart), murdha (head) etc.) Hridaya is one of the madhyama roga marga.[ Cha. Sa. Sutra sthana 11/48] The disease of madhyama rogamarga will be krichhrasadhya.<ref name="ref2">Sengupta N, Sengupta B; Gangadhara commentary on Charaka Samhita Sutrasthana Tistraishaniya Adhyaya, 11/30; 3rd edition, Chaukhamba publishers, Varanasi; 2009.</ref></p>

<p style="text-align:justify;">There are three roga margas (pathways to diseases) shakha, marmasthisandhi and koshtha. Madhyama roga marga includes diseases involving marmas  (vital organs i.e. [[Basti|basti (bladder)]], hrudya (heart), murdha (head) etc.) Hridaya is one of the madhyama roga marga.[ Cha. Sa. [[Sutra Sthana|Sutra sthana]] 11/48] The disease of madhyama rogamarga will be krichhrasadhya.<ref name="ref2">Sengupta N, Sengupta B; Gangadhara commentary on Charaka Samhita Sutrasthana Tistraishaniya Adhyaya, 11/30; 3rd edition, Chaukhamba publishers, Varanasi; 2009.</ref></p>

=== As a site of different physiological entities ===

=== As a site of different physiological entities ===

<p style="text-align:justify;">The heart is the seat of chetna (consciousness) [Su. Sa. Sharira Sthana 4/34], sadhaka pitta i.e. known to help in the achievement of the desired objects [Su. Sa. Sutra Sthana 21/10], vyana vayu[ash.hru. Su.12/6] i.e. responsible for causing circulation of rasa dhatu all over the body simultaneously and continuously; and para oja as well, [Sh. Sa. Pu. 5/49]. Hridaya is said to be chaitanaya sangraha by acharya charaka. [Cha. Sa. Sutra sthana 30/7] In hridaya, are situated the ten dhamani (ten great vessels arising from the heart), prana, apana, manas (mind), buddhi (intellect), chetna (life) mahabhutas (five fundamental elements) just like spokes of the axle in the centre of a wheel.[Cha. Sa. Siddhi Sthana 9/4] Shadanga (six divisions of the body, i.e. four limbs, head, and torso), consciousness, sensory organs, five objects of sensory perceptions and the soul, mind and objects of the mind are all located in the heart (i.e. are dependent on the functioning of the heart).[Cha. Sa. Sutra Sthana 30/4]</p>

<p style="text-align:justify;">The heart is the seat of chetna (consciousness) [Su. Sa. [[Sharira Sthana|Sharira Sthana]] 4/34], sadhaka pitta i.e. known to help in the achievement of the desired objects [Su. Sa. [[Sutra Sthana|Sutra Sthana]] 21/10], vyana vayu[ash.hru. Su.12/6] i.e. responsible for causing circulation of rasa dhatu all over the body simultaneously and continuously; and para oja as well, [Sh. Sa. Pu. 5/49]. Hridaya is said to be chaitanaya sangraha by acharya charaka. [Cha. Sa. [[Sutra Sthana|Sutra sthana]] 30/7] In hridaya, are situated the ten dhamani (ten great vessels arising from the heart), prana, apana, [[Manas|manas (mind)]], [[Buddhi|buddhi (intellect)]], chetna (life), [[Pancha mahabhuta|mahabhutas (five fundamental elements)]] just like spokes of the axle in the centre of a wheel.[Cha. Sa. Siddhi Sthana 9/4] Shadanga (six divisions of the body, i.e. four limbs, head, and torso), consciousness, sensory organs, five objects of sensory perceptions and the soul, mind and objects of the mind are all located in the heart (i.e. are dependent on the functioning of the heart).[Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 30/4]</p>

=== As one among the three vital organs ====

=== As one among the three vital organs ====

<p style="text-align:justify;">Basti [urinary bladder and urinary system], hridaya [heart and cardiovascular system] and shira [head & brain] are three vital organs (trimarma). [ Cha. Sa. Chikitsa Sthana 26/3]</p>

<p style="text-align:justify;"> [[Basti|Basti]] [urinary bladder and urinary system], hridaya [heart and cardiovascular system] and shira [head & brain] are three vital organs (trimarma). [ Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 26/3]</p>

=== As a matruja bhava ===

=== As a matruja bhava ===

<p style="text-align:justify;">Matruja means maternal. bhava means existence or innate property. The mridu [soft] parts like mamsa [muscle], shonita [blood], medas [fat], majja [bone-marrow], hridaya [heart], nabhi [umbilicus], yakrit [liver], pliha [spleen], antra [intestine], guda [anus] etc. are matruja bhava [origin of maternal innate property]. [Cha. Sa. Sharira Sthana 3/6]</p>

<p style="text-align:justify;">Matruja means maternal. bhava means existence or innate property. The mridu [soft] parts like [[Mamsa dhatu|mamsa]] [muscle], shonita [blood], [[Meda dhatu|medas]] [fat], [[Majja dhatu|majja]] [bone-marrow], hridaya [heart], nabhi [umbilicus], yakrit [liver], pliha [spleen], antra [intestine], [[Guda|guda [anus]]] etc. are matruja bhava [origin of maternal innate property]. [Cha. Sa. [[Sharira Sthana|Sharira Sthana]] 3/6]</p>

=== As srotas mula ===

=== As srotas mula ===

<p style="text-align:justify;">The pranavaha srotas and rasa vaha srotas have their origin in hridaya. [Cha. Sa. Vimana Sthana 5/8]</p>

<p style="text-align:justify;">The pranavaha srotas and rasa vaha srotas have their origin in hridaya. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 5/8]</p>

== Embryology ==

== Embryology ==

<p style="text-align:justify;">Acharya Charaka mentioned Kankayan’s view that hridaya is the first foetal organ to develop. [Cha. Sa. Sharira Sthana 6/21] Acharya Sushruta quoted Kartavirya's view that hridaya develops prior to other organs of the embryo itself being the site of buddhi [mental faculty] and manas [mind]. [Su. Sa. Sharira Sthana 3/32] Acharya Charak considered that the fetal heart starts pulsating in the third month. While Sushruta considered that the fetal heart starts functioning from the fourth month onwards [Su. Sa. Sharira Sthana 3/4]</p>

<p style="text-align:justify;">Acharya Charaka mentioned Kankayan’s view that hridaya is the first foetal organ to develop. [Cha. Sa. [[Sharira Sthana|Sharira Sthana]] 6/21] Acharya Sushruta quoted Kartavirya's view that hridaya develops prior to other organs of the embryo itself being the site of [[Buddhi|buddhi]] [mental faculty] and [[Manas|manas [mind]]]. [Su. Sa. [[Sharira Sthana|Sharira Sthana]] 3/32] Acharya Charak considered that the fetal heart starts pulsating in the third month. While Sushruta considered that the fetal heart starts functioning from the fourth month onwards [Su. Sa. [[Sharira Sthana|Sharira Sthana]] 3/4]</p>

== Diversities in hridya dravyas ==

== Diversities in hridya dravyas ==

<p style="text-align:justify;">The term "hridya" is used in diverse contexts. The concept of "hridya mahakashaya," drugs that evoke pleasure and are considered suitable for the body. [Cha. Sa. Sutra Sthana 4/10] These substances, ranging from food articles to fragrances, act as stimuli that impart pleasurable sensations and are identified as hridya dravyas in classical Ayurvedic texts. While portraying the concept of hridya, it is essential to consider the motor, sensory, and psychological components. Any stimuli that impart a sense of pleasure to the respective sense organ and, consequently, to the hridaya are regarded as hridaya. This holistic approach recognizes the interconnectedness of physical and mental well-being.</p>

<p style="text-align:justify;">The term "hridya" is used in diverse contexts. The concept of "hridya mahakashaya," drugs that evoke pleasure and are considered suitable for the body. [Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 4/10] These substances, ranging from food articles to fragrances, act as stimuli that impart pleasurable sensations and are identified as hridya dravyas in classical Ayurvedic texts. While portraying the concept of hridya, it is essential to consider the motor, sensory, and psychological components. Any stimuli that impart a sense of pleasure to the respective sense organ and, consequently, to the hridaya are regarded as hridaya. This holistic approach recognizes the interconnectedness of physical and mental well-being.</p>

== General causative factors of diseases of heart ==

== General causative factors of diseases of heart ==

<p style="text-align:justify;">Hrudroga is caused by the following factors:<br/>

<p style="text-align:justify;">Hrudroga is caused by the following factors:<br/>

Excessive exercise, excessive use of articles having tikshna guna, administration of purgation and emetic therapies and enema in excess; excessive worry, fear, and stress, improper treatment of disease; emesis, ama, and suppression of natural urges; emaciation and trauma. [Cha. Sa.Chikitsa Sthana 26/77]</p>

Excessive exercise, excessive use of articles having tikshna guna, administration of purgation and emetic therapies and enema in excess; excessive worry, fear, and stress, improper treatment of disease; emesis, ama, and suppression of natural urges; emaciation and trauma. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 26/77]</p>

=== Classification of diseases in heart ===

=== Classification of diseases in heart ===

Heart-related diseases are broadly classified into five types: Vatika, paittika, kaphaja, sannipatika, and krimija [Cha. Sa. Sutra Sthana 17/6].   

Heart-related diseases are broadly classified into five types: Vatika, paittika, kaphaja, sannipatika, and krimija [Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 17/6].   

=== Other diseases and conditions with clinical features pertaining to heart ===

=== Other diseases and conditions with clinical features pertaining to heart ===

<ol style="text-align:justify;"><li>Vaataj Murchha–(syncope): Cardiac pain [Cha. Sa. Sutra Sthana 24/36] </li>

<ol style="text-align:justify;"><li>Vaataj Murchha–(syncope): Cardiac pain [Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 24/36] </li>

<li>Baddha guda udara (ascites due to obstruction)- Cardiac pain [Cha. Sa.Chikitsa Sthana 13/41]</li>

<li>Baddha guda udara (ascites due to obstruction)- Cardiac pain [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 13/41]</li>

<li>Rasa kshaya (depletion of rasa dhatu)- Palpitation on little exertion - [Cha. Sa. Sutra Sthana 17/64] </li>

<li>Rasa kshaya (depletion of rasa dhatu)- Palpitation on little exertion - [Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 17/64] </li>

<li>Vaataj jwara (vata dominant jwara) - Stiffness in precordial or cardiac region [Cha. Sa.Nidana Sthana 1/21]</li>

<li>Vaataj jwara (vata dominant jwara) - Stiffness in precordial or cardiac region [Cha. Sa. [[Nidana Sthana|Nidana Sthana]] 1/21]</li>

<li>Aam jwara (jwara due to ama dominance)- Feeling of fullness of the heart [Cha. Sa.Chikitsa Sthana 3/133]</li>

<li>Aam jwara (jwara due to ama dominance)- Feeling of fullness of the heart [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 3/133]</li>

<li>Purvarupa (premonitory sign of shwasa roga (respiratory disorders) [Cha. Sa.Chikitsa Sthana 17/20]</li>

<li>Purvarupa (premonitory sign of shwasa roga (respiratory disorders) [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 17/20]</li>

<li>Kaphaja grahani – Feels as if cardiac region or heart is distended [Cha. Sa.Chikitsa Sthana 15/69]</li>

<li>Kaphaja grahani – Feels as if cardiac region or heart is distended [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/69]</li>

<li>Pandu (premonitory symptom of anemia)- Palpitation of heart [Cha. Sa.Chikitsa Sthana 23/43]</li>

<li>Pandu (premonitory symptom of anemia)- Palpitation of heart [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 23/43]</li>

<li>Kshayaja kasa (cough due to depletion) - Feels as if heart is displaced from its site due to coughing. [Cha. Sa.Chikitsa Sthana 18/26]</li>

<li>Kshayaja kasa (cough due to depletion) - Feels as if heart is displaced from its site due to coughing. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 18/26]</li>

<li>Madaatyaya (excess alcoholism) – Feeling of discomfort in cardiac region [Cha. Sa. Chikitsa Sthana 24/101]</li>

<li>Madaatyaya (excess alcoholism) – Feeling of discomfort in cardiac region [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 24/101]</li>

<li>Excessive consumption of amla rasa results in burning sensation in cardiac region - [Cha. Sa. Sutra Sthana 26/43], [Su. Sa. Sutra Sthana 42/10]</li></ol>

<li>Excessive consumption of amla rasa results in burning sensation in cardiac region - [Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 26/43], [Su. Sa. [[Sutra Sthana|Sutra Sthana]] 42/10]</li></ol>

== Diagnostic tools and investigations ==

== Diagnostic tools and investigations ==

== Preventive measures ==

== Preventive measures ==

<p style="text-align:justify;">To protect heart, great vessels and ojas one has to avoid causes of mental suffering especially. Diet, drugs/medicines, and behaviour that are beneficial for the heart, for the formation of ojas and for keeping the vessels clear should be adopted, along with the pursuit of mental peace and wisdom. [Cha. Sa. Sutra Sthana 30/13]</p>

<p style="text-align:justify;">To protect heart, great vessels and [[Ojas|ojas]] one has to avoid causes of mental suffering especially. Diet, drugs/medicines, and behaviour that are beneficial for the heart, for the formation of [[Ojas|ojas]] and for keeping the vessels clear should be adopted, along with the pursuit of mental peace and wisdom. [Cha. Sa. [[Sutra Sthana|Sutra Sthana]] 30/13]</p>

== Contemporary approach ==

== Contemporary approach ==

=== Insight from these research works: ===

=== Insight from these research works: ===

<p style="text-align:justify;">In a case report treatment of valvular heart disease was done through ayuvedic interventions. The concept of ojas, avalambak kapha and Sadhak pitta gives special indication about the metabolism of the heart and modern experimental approach of the neurohumoral chemical and electrical turnover in the heart tissue during its arduous work. While portraying the concept Hridya, the motor, sensory and psychological components should be considered. One of the studies on Heart rate variability emphasizes the critical role of Prakriti-based phenotyping in stratifying the differential responses of cardiac autonomic modulation in various postures among healthy individuals across different populations. </p>

<p style="text-align:justify;">In a case report treatment of valvular heart disease was done through ayuvedic interventions. The concept of [[Ojas|ojas]], [[Avalambaka|avalambak kapha]] and Sadhak pitta gives special indication about the metabolism of the heart and modern experimental approach of the neurohumoral chemical and electrical turnover in the heart tissue during its arduous work. While portraying the concept Hridya, the motor, sensory and psychological components should be considered. One of the studies on Heart rate variability emphasizes the critical role of Prakriti-based phenotyping in stratifying the differential responses of cardiac autonomic modulation in various postures among healthy individuals across different populations. </p>

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