Hridaya

The Sanskrit term 'hridaya' literally means heart. The Ayurvedic tradition, based on ancient wisdom, places significant emphasis on the heart. According to both Charak and Chakrapani, the heart is not just a mechanical pump, but is also intricately linked to both physical and psychological well-being. They believe that the soul, the source of all knowledge and the upholder of the system, resides in the heart. In this exploration, we will delve into the Ayurvedic understanding of the hridaya, covering its definition, structure, origin, and importance in maintaining holistic health.

Contributors

Section/Chapter/topic	Concepts/Sharira/Marma/Hridaya
Authors	Bhojani M. K. 1 Garg Nisha 1
Reviewers & Editors	Basisht G.2 Deole Y.S.3
Affiliations	1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2 Rheumatologist, Orlando, Florida, U.S.A. 3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	meera.samhita@aiia.gov.in, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India & Symbiohealth Foundation, India
Date of publication:	May 04, 2024
DOI	10.47468/CSNE.2024.e01.s09.163

Etymological derivation

The term "hridaya" is derived from the Sanskrit language, and its etymology can be broken down to understand its meaning: The core of the word "Hridaya" comes from the Sanskrit word "Hṛd [हृद्]" which denotes the heart or the centre. ‘Hru’ means one which draws fluid or blood from the body forcibly, and ‘Da’ means to give. This term is fundamental to the concept, capturing the essence of the organ's centrality in both a physiological and metaphorical sense.

Definition of hridaya

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.'

Structure of hridaya

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]

Origin/ utpatti

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].

Size

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

Importance of hridaya

The hridaya is a vital organ, intricately linked to the trimarams and dasha pranaayatana, encompassing the three doshas and ten pranas. All these factors govern physiological processes. Any harm to the hridaya is believed to result in severe diseases, complications, or even death. The ayurvedic texts highlight that the hridaya serves as more than a pump for blood circulation. It is depicted as the central regulator of prana, orchestrating its flow rhythmically. Moreover, the hridaya governs the body, mind, and senses, acting as the seat of intelligence and vitality.

Hridaya in different contexts

Hridaya as koshthanga and pratyanga

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]

Pranayatana

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 ma nsa [muscle]. Out of these, the first six organs are said to be "Marma”. [Cha. Sa. Sharira Sthana 7/9]

Roga marga

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.

As a site of different physiological entities

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]

As one among the three vital organs

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]

As a matruja bhava

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]

As srotas mula

The pranavaha srotas and rasa vaha srotas have their origin in hridaya. [Cha. Sa. Vimana Sthana 5/8]

Embryology

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]

Diversities in hridya dravyas

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.

General causative factors of diseases of heart

Hrudroga is caused by the following factors:
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]

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].

Other diseases and conditions with clinical features pertaining to heart

1. Vaataj Murchha–(syncope): Cardiac pain [Cha. Sa. Sutra Sthana 24/36]
2. Baddha guda udara (ascites due to obstruction)- Cardiac pain [Cha. Sa. Chikitsa Sthana 13/41]
3. Rasa kshaya (depletion of rasa dhatu)- Palpitation on little exertion - [Cha. Sa. Sutra Sthana 17/64]
4. Vaataj jwara (vata dominant jwara) - Stiffness in precordial or cardiac region [Cha. Sa. Nidana Sthana 1/21]
5. Aam jwara (jwara due to ama dominance)- Feeling of fullness of the heart [Cha. Sa. Chikitsa Sthana 3/133]
6. Purvarupa (premonitory sign of shwasa roga (respiratory disorders) [Cha. Sa. Chikitsa Sthana 17/20]
7. Kaphaja grahani – Feels as if cardiac region or heart is distended [Cha. Sa. Chikitsa Sthana 15/69]
8. Pandu (premonitory symptom of anemia)- Palpitation of heart [Cha. Sa. Chikitsa Sthana 23/43]
9. Kshayaja kasa (cough due to depletion) - Feels as if heart is displaced from its site due to coughing. [Cha. Sa. Chikitsa Sthana 18/26]
10. Madaatyaya (excess alcoholism) – Feeling of discomfort in cardiac region [Cha. Sa. Chikitsa Sthana 24/101]
11. Excessive consumption of amla rasa results in burning sensation in cardiac region - [Cha. Sa. Sutra Sthana 26/43], [Su. Sa. Sutra Sthana 42/10]

Diagnostic tools and investigations

The following investigations can be done for the diagnosis of different diseases of heart region:

1. Chest X-ray
2. Electrocardiogram (ECG or EKG).
3. Holter monitoring.
4. Echocardiogram.
5. Exercise tests or stress tests.
6. Cardiac catheterization.
7. Cardiac MRI
8. CT Angiogram
9. TROP T

Preventive measures

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]

Contemporary approach

Anatomical aspects in contemporary science:

The heart is a muscular organ in the centre of the chest behind the sternum. It consists of four chambers: the two upper chambers are called the right and left atria, and the two lower chambers are called the right and left ventricles. The right atrium and ventricle are often called the right heart, and the left atrium and left ventricle functionally form the left heart.

Physiological aspects in contemporary science:

The heart, a vital muscular organ, pumps blood throughout the body. It functions via an electrical conduction system coordinated by the sinoatrial node (SA node), which initiates the heartbeat. The atrioventricular node (AV node) controls the signal's passage to the ventricles. Cardiac muscles contract synchronously, propelling blood through the circulatory system. Governed by pacemaker cells, the heart's rhythmic contractions propel oxygenated blood to the body and return deoxygenated blood to the lungs. The heart, asymmetrically positioned on the left, beats at about 72 beats per minute at rest.

Psychology and heart

Research in psychophysiology has shown connections between the heart and the brain through the autonomic nervous system, particularly the vagus nerve, which plays a crucial role in regulating emotions and social engagement. The vagus nerve influences both heart rate variability and emotional regulation. This theory highlights the intricate connection between physiological processes, emotions, and social behavior. Moreover, advancements in neuroimaging techniques, such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG), have allowed researchers to investigate the neural correlates of emotion and the role of the heart-brain connection in emotional processing.

Conclusion

The Ayurvedic understanding of the hridaya, encompassing its structure, origin, and significance, reflects a holistic approach to health. Rooted in ancient wisdom, ayurveda recognizes the heart as more than a mere organ but as a dynamic force integral to physical, mental, and emotional well-being. The term "Hridaya" transcends its anatomical confines to symbolize the centre of consciousness and vitality. Emphasizing the role in regulating physiological processes and governing the body, mind, and senses, ayurveda underscores the importance of maintaining the hridaya's health for overall wellness. Furthermore, exploring the diverse contexts in which the hridaya is referenced reveals its multifaceted significance in ayurvedic philosophy. As contemporary science continues to uncover the complexities of heart-brain interactions, Ayurveda's holistic perspective on the hridaya offers valuable insights into the interconnectedness of mind, body, and spirit for optimal health and vitality.

Research works

1. M P Mithra. Ayurvedic approach to treat Hridroga (valvular heart disease): A case report; J Ayurveda Integr Med 2020 Jan-Mar;11(1):78-81.
2. Thakar V. J. (1983). Heart - its structure metabolism and cardiac tonics - as described in ayurveda. Ancient science of life, 2(4), 181–186.
3. Indu S et al. A Review on the concept of Hridaya in Ayurveda: Looking beyond Cardio tonics. Int. J. Res. Ayurveda Pharm. 2021;12(3):88-94.
4. Ram Manohar, P., Sorokin, O., Chacko, J., & Nampoothiri, V. (2018). An exploratory clinical study to determine the utility of heart rate variability analysis in the assessment of dosha imbalance. Journal of Ayurveda and integrative medicine, 9(2), 126–130.
5. Rani, R., Rengarajan, P., Sethi, T., Khuntia, B. K., Kumar, A., Punera, D. S., Singh, D., Girase, B., Shrivastava, A., Juvekar, S. K., Pesala, B., Mukerji, M., Deepak, K. K., & Prasher, B. (2022). Heart rate variability during head-up tilt shows inter-individual differences among healthy individuals of extreme Prakriti types. Physiological reports, 10(17), e15435.

Insight from these research works:

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.

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