Este é um resumo da conferência de abertura da World Conference on AYU realizada em Pune, de 04 a 08 de Janeiro de 2012, com a presença de mais de 1000 médicos e mais de 20 países representados. Vou publicar os slides brevemente pelo Youtube. 

PREVENTIVE CARDIOLOGY

“Either you open your heart or your cardiologist will do it for you”

In my professional life I have worked with acute and chronic heart diseases. In the last 38 years I’ve been studying the causes of these problems with all my dedication through the practice of the Vedic tradition which explains in an unique way the causes of human suffering and how to transcend it.

Emotions and the heart

The person desiring to be protected from the adverse effects upon his heart, coronary blood vessels, and the contents thereof should particularly avoid all that causes mental affliction.

Charaka Sutra, 30/13

The heart is one of the most sensitive Marmas of our body, and the one that most expresses the consequence of our emotions, lifestyle, diet and environment.

Heart disease is by far the main cause of death.

That is, the of interruption of the possibility  our souls continue their journey of learning and evolution in the world

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My personal experience:

I finished my degree in Medicine in 1981. At that time, our experience with treating Acute Myocardial Infarction at the Hospital was extremely distressing. Our statistics at the time:

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• The AMI is the largest killer in the world.
• 30% of people with AMI die before reaching hospital
• 30% of the infarcted die in hospital or post-hospital period until one year after the episode of AMI or remain with disabling squeals.

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At the time, our treatment options were restricted to sedation, cardiac monitoring and continuous infusion of lidocaine. These treatments were administered in order to avoid the most severe complication of AMI, ventricular fibrillation, which is almost always fatal.

In 1985 I finished my postgraduate work in intensive care and spent the next 15 years treating critically ill patients arriving at hospital with acute complications of myocardial infarction and cerebrovascular diseases.

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Since that time, there has been progress in our understanding of the pathophysiology of the formation of coronary thrombi. We began administering thrombolytic drugs such as aspirin, heparin and in some cases streptokinase to patients who arrived at the hospital within the first 3 hours of an AMI.

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Acute Myocardial studies have been conducted by a Large Multicenter worldwide having those mentioned drugs and hospital stay patients tested.

I had the opportunity to be part of those experiments, as well as RISC, GUSTO, and GISSI with our intense care service unit.

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The 90′s spectacular technology advance changed the statics as they follow:

• Acute Myocardial Infarction continues to be the largest killer in the world with cerebrovascular disease following.
• 30% of people with AMI still die before reaching hospital.
• Acute Myocardial Infarction disease increased.
• . With these technological advances in-hospital mortality and post-hospital reduced to around 15%, half of the previous one
• Although the number has improved, the side effects from the use of thrombolytic agent may cause death or complicated results because of severe bleeding.
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In the first decade of the third millennium a new method called Primary Percutaneous Angioplasty was created. The patient who has gotten to the hospital before completing three hours from suffering a heart attack goes to a quick invasive procedure that places one or more stents in their coronary arteries.

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Obviously, the high cost of the procedure was another cause for the aggravation post hospital heart attack!
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This was again reduced by half (7.5%) the death of patients who were in hospital and post-hospital mortality. However, the incidence of pre-hospital death remains with the same index, 30%. According to World Health Organization in 2002 16.7 million people died worldwide, of which 7.2 million were caused by AMI that equals13 deaths per minute!!
Esteem, though, the WHO in 2020, we will get 35 to 40 million deaths from AMI in the world.
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Analyzing the whole data, we can see that technological advance has brought a great reduction in mortality in hospital stay, and also post-hospital one of the main causes of death worldwide. However, it is clear that our preventive methods to avoid AMI onset have failed completely, and AMI has been transformed into a terrifying global epidemic with increasing incidence in developing countries.

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Even within the vision of modern medicine, four diseases that are collectively called metabolic syndrome, strongly contribute to the onset of AMI:
• Diabetes mellitus
• Hypertension
• Dyslipidemia
• Obesity

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WHO acknowledges an epidemic of these four diseases focusing around the world, but with more marked increase in developing countries, mainly because a huge population has left the band misery and adopted a “modern” lifestyle, eating artificial foods and refined, increasing meat consumption, increasing greed for wealth, stress, abandonment of the values of a life based on religious practice, etc..
On the basis of many epidemiological surveys have been identified ten risks factors for IHD, divided in two groups:

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A. Major factors:
1. Elevated serum lipid levels
2. Habitual diet high in calories, total fats, saturated fats, cholesterol, refined carbohydrates and salts.
3. Hypertension
4. Cigarette smoking
5. Carbohydrate intolerance
6. Obesity

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B. Other factors:
1. Oral contraceptives
2. Sedentariness
3. Personality type
4. Psycho-social tension
And all the trials conducted to date show that only three factors are decisive for the reduction of our killers:

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• Eating right
• Exercise
• positive mental state
And, in this context the Vedic tradition through Yoga and Ayurveda can help our modern world to reverse this self-destructive tendency of our society.
So let’s see a quick overview of the teachings of the classical texts of Ayurveda to this problem.

CLASSIC CONCEPT OF HRDAYA

It derives from three verbal roots: Hr, Da and Ya, having the sense of receiving, giving and moving respectively according to Haláyuddha Kosha.

The term Hrdaya has been used in different connotations. The meaning has to be related to the context, but all the concepts refer to the intimate relationship between the heart and mind:

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1. According to Amarakosa the term Hridaya is a synonym of mind (Chittam).
2. Charak has also accepted the heart to be the seat of consciousness that is primarily a function of the brain. Sutra sthana 30/7.
3. In Nadi Vignana has been described to be a muscular organ beating frequently. It has been observed to be the seat of consciousness.
4.  Hemadri, the commentator of Ashtanga Hrdaya described Hridaya to be the seat of mind

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1. Maharishi Sushruta states that organ is a Sira Marma and it is one in number and the base of Pranavaha Dhamanyah.

6. Hrdaya is classified as Sadya Pranahara causiing immediate death when injured
7. Heart has been compared with the red lotus having it’s apex downwards. Sushruta – sharira 4/31 Ashtanga Hirdaaya Sutra 4
8. Heart as a vital organ:
1. Mararishi Charak included Heart among Pranayatana – seat of Prana and is considered among 3 main Marma. Sutra 20/3
2. The site of Ojas in the heart. Sutra 17/35

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9. Tridosha related with heart:

3. Sadhaka Pitta: “That it enables us to achieve one’s Manorahta viz. Dharma, Artha, Kama and Moksha. This is done by dispelling the Kapha and Tamas of Hridaya and thus enables Hridaya to perceive thing clearly. Dalhana on Susruta Sutra 21/10.

It is probably related to cerebral oxygenation and the presence of cytochrome c, a type of haemoprotein which takes part in the tissue respiraton.

4. Avalambaka Kapha: associated with Rasa dathu and related to lubrication of pericardium and pleura and probably related with affection – Kapha Sthana.
5. Vyana Vayu

Related to the dynamics of complex cardiac and circulatory physiology, heart rate, hydrodynamics, conduction system of the heart (sino-atrial node, atrio-ventricular bundle of Hiss) and peripheral circulation.

“If Vyana Vayu gets vitiated (Kruddha) then disease of intire body begins. Sushruta Nidana 1/17.

For this reason Vata imbalances are so important in the  heart’s pathogenesis.
The classical texts of Ayurveda clearly classify the causes of heart disease:

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1. Violation of diet’s principle:

If we review the pathogenesis, we may find two factors that are vitiation of Vata and Rasa considered to be predominantly involved on heart diseases. Some factors among these vitiate Vata and some vitiate the Rasa in the diet.

2. Violation of exercise’s principle:

Excessive exercise is described to develop cardiorespiratory diseases in Ashtanga Hrdaya Sutra 2/11-14 and the importance of exercises as a way to prevent in Charak Sutra 17/30

3. Violation of treatment’s principle:

It is described how excessive or powerful virechana and basti may also cause heart disease. Charaka chikitsa 26/77

4. Psychic factors:

Anger, anxiety, fear, worry, terrorization Charaka Sutra 17/32 26/77

5. As complication due to other diseases:

In Madhava Nidana is described to complicate Jvara, Atisara, Vataja Grahani,Swasa, Gulma, Amavata, Raktapitta, etc.

It is obvious from this review that whatever has been described in etiology of cardiac disease by Ancient Ayurvedic Sages has absolute relevance in our modern medicine.

Observing all the factors mentioned above, we will see throughout the day, several approaches for the Ayurvedic treatment and prevention of these serious diseases.

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We have applied a preventive program, as well as a medical and educational treatment program in our Kalayasa Clinics and Suddha Sabba Ashram, those for people suffering from diabetes mellitus, hypertension, hypercholesterolemia, obesity, and a specific program for cardiac patients.

Probably the themes concerning dietary and medicinal herbs will be expose by other speakers, I would like to highlight deeply that we have adopted a program which involves Yoga and Ayurveda  for the psychophysical factors with emphasis on:

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1. Sequence of movements to release Prana in the joints, known as Pavanamuktasana. It is very suitable for everyone, with an average duration of 30 minutes daily.
2. Suryanamaskar according to individual constitution and in terms of speed to complete the sequence of asanas. On average the person takes to perform the 12 positions 1 minute, according to their capacity, and cardiorespiratory capacity 5-12 sequences.
3. Our emphasis are given to Pranayama which is considered by most researchers as the most fast and effective way to alter the activities of the autonomic nervous system. We adopted, in general, the sequence of eight traditional pranayama recommended by Patanjali Yog Peetha where investigations were including: Bhastrika, Kapalabhati Bahya with traya Bandha, Ujjayi, Anuloma Viloma, Brhamari, Udghita and Pranava Pranayamas, obviously adapted to the ayurvedic constitution’s knwoledge, age, Bala, Agni, etc..
4. Meditation with three levels of methods:
a. Stabilizer: keep your mind focused on one point – ekagrata – as vipasana associated with Bija Mantras, according to ayurvedic concepts.
b. Reflexive: Self research in the process of vichara with the aim to achieve non attachment related to thoughts and emotions, and also the pursuit of real Self.
c. Contemplative: The ultimate method is to connect with the Divine in its various expressions as Saguna Brahm, Nirguna Brahm  and Suddha Brahma or the Absolute, according to the nature of each person.
According to my spiritual tradition or Guruparampara that I follow almost for the last 40 years, the constant meditation on Antaryami Atma which is the One that permeates everything, but covered in Akasha’s Heart, shining like a million suns that emanates from Grace and Mercy is the Parama Dharma and Sanatana Dharma delivering us from the root of existential human suffering, which is Avidya, ignorance of our true nature.

Undoubtedly, there is no better prevention for heart problems than to open our hearts to the Divine in us and all other beings.

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Yuktáhára vihárasya yuktacestasya karmasu

Yuktasvapna vabodhasya yogo bhavati duhkhahá.

“If a person eats properly and conducts his life properly, has a set routine for his worldly activities, has a fixed time to go to bed and to get up, only such a person can practice yoga, and by the practicing of yoga he destroys his miseries.”

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Namaste

Dr. José Ruguê Ribeiro Júnior