LITERARY REVIEW

It comprises of

1. Preview

2. Veda literature

3 . .Ayurveda literature

4. Modem medical literature

1. Preview:

Previous research word regarding 'Soura-SUkta' is not

available. H0wever, .Ayurvedic research work regarding Hypertension is

enlisted here:

1. Anjaneya S. - A Preliminary clinical study of the effect of

Vacha on hypertension - Dr. B.K.R.R. Government

Ayurvedic college, AP University, Vijayawada, 1979

2. Rao J.V. - A study of Jotishmati and Punamava III

hypertension Dr. B.K.R.R. Government Ayurvedic

college, AP University, Vijayawada, 1985

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3. Bhushan K. - Effect of Sarpagandhadi Yoga on

hypertension - Dr. B.K.R.R. Government Ayurvedic

college, AP University, Vijayawada, 1989

4. Madhava Rao G. - The effect of Takra-Dhara on

hypertension - Dr. B.K.R.R. Government Ayurvedic

college, AP University, Vijayawada, 1993

5. Shrinivas K. - A clinical study of effect of the Nartia

compound in hypertension - Dr. B.K.R.R. Government

Ayurvedic college, AP University, Vijayawada, 1999

6. Sastri B.S.R.L.N. - A comparative study on the effect of

Arjuna Kshirapaka and Rasona Kshirapaka on management

of hypertension - Dr. B.K.R.R. Government Ayurvedic

college, AP University, Vijayawada, 2003

7. Ravani A.T. Hypertension - Raktachapa, Institute for post

graduate teaching and research in Ayurveda, Gujrat

Ayurveda University, Jamnagar, 1967

8. Pathania Sunilkumar k - Role of Takra-Dhara and

Sarpagandha Ghana-Vati In the management of Uccha­

Rakta-Chapa (essential hypertension) Institute for post

graduate teaching and research in Ayurveda, Gujrat

Ayurveda University, Jamnagar, 2001

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9. Bhayal Ramesh B - Role of Virechana Karma and Shamana

Chikitsa in the management of Uccha-Rakta-Chapa

(essential hypertension) Institute for post graduate teaching

and research in Ayurveda, Gujrat Ayurveda University,

Jamnagar, 2003

10.Shah (Mrs) J. R. Appraisal of Dosha in Hypertension -

Govt. Akhandananda Ayurvedic College, Gujrat Ayurveda

University, Jamnagar, 1985

l1.Vasistha A. G. - A clinical study of role ofBasti chikitsa in

the management of essential hypertension - Govt.

Akhandananda Ayurvedic College, Gujrat Ayurveda

University, Jamnagar, 1994

12.Deshbandhu R. C. - A clinical and comparative study of

Shodhana (Virechana) - Poorvakarma Shamana and

Shamana chikitsa in the management of essential

hypertension - Govt. Akhandananda Ayurvedic College,

Gujrat Ayurveda University, Jamnagar, 1998

13.Rani Yogita B. - Avasthiki Shodhana-Poorvaka Shamana

chikitsa and Shamana chikitsa in the management of

hypertension - Govt. Akhandananda Ayurvedic College,

Gujrat Ayurveda University, Jamnagar, 2001

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14.Chaure P.S. - An experimental and clinical study on the

effect of an indigenous drug Bhringaraja (Ec1ipta alba) in

the management of arterial hypertension Faculty of

Ayurveda Institute of Medical Sciences Banaras Hindu

University 1968

IS.Pandey D. P. - A study on arterial hypertension and role of

Japapushpa (H Rosasinensis) in the management Faculty of

Ayurveda Institute of Medical Sciences Banaras Hindu

University 1977

16.Raut A. A. - Studies on the etiopathogenesis of

hypertension in Ayurveda Faculty of Ayurveda Institute of

Medical Sciences Banaras Hindu University 1986

17.Bhupendra Pai - A c1inico-pathological study of Raktagata

Vata (hypertension) and its management by Jatamansi

Chooma Faculty of Ayurveda Institute of Medical Sciences

Banaras Hindu University 1994

18.Shrivasava P. S. - Therapuetic trial of Coleus amboinicus in

systemic hypertension State Ayurvedic College,

University of Lucknow, 1979

19.Dwivedi Patanjali - Effect of Sarpagandhadi Yoga and

Shavasana in hypertension State Ayurvedic College,

University of Lucknow, 1982

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20.Shrivastava v. S. - Effect of Jatamansadi Yoga in essential

hypertension. A clinical study - State Ayurvedic College,

University of Lucknow, 1985

21.Sharma P. C. - Further observation on the effect of

alcoholic extracts of Coleus forshcollie Brims (Chhangala

Jadi) in case of hypertension - State Ayurvedic College,

University of Lucknow, 1990

22.Kumar Rajiv - Further observation of effect of alcoholic

extract of Coleus forshcolli root in cases of hypertension -

State Ayurvedic College, University of Lucknow, 1991

23.Agarwal Satish - A clinical study on the effect of

Madhupamyadi-hypothetical-Yoga In management of

hypertension M. M. M. Govt Ayurvedic College, Rajasthan

University, Jaipur, 2003

24.Asha K. K. - Clinical study to evaluate the efficacy of an

Ayurvedic coumpound w. s. r. to its action on hypertension

Govt Ayurvedic College, Kerala University,

Thruvananthapuram, 2001

2. Veda literature:

The meaning of the word 'Veda' is knowledge, true or sacred

knowledge. In fact ~gveda is the only original work. There are two

groups deciding the time of origination of ~gveda. One group considers the

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time of~gveda 4000 to 2500 B.C. after the settlement of Aryans. The other

group believes it be 1400 to 1000 B.C. after settlement of Aryans.

Each Veda has two distinct parts. Mantra or the words of

prayer and adoration often addressed to Deities like Agni, Indra, Maruta,

etc. The prayers are for health, wealth, long life, cattle offspring, victory and

even forgiveness for the sins. Another part is Brahmana consisting of

rituals (Vidhi), which are the directions for the details of ceremonies at

which the Mantras were to be used, and explanations of the legends

connected with the Mantras. Both these portions are termed as Sruti. The

revelation orally communicated by the Deity and heard but not composed by

men. Although it is certain that both Mantras and Brahmanas were

compositions spread over a considerable period, much of the later being

comparatively modem. As Manu is his law book says Vedas are actually

three.

three forms.

~ iffiIT 'f1~It1~st I ..... Sij~Rl

As the Vedaas are properly three so the Mantras are properly of

1. ~gveda, which collection of verses in context to praise

of deities and are intended for loud rec1.tation.

2. Yajurvedaa is in prose and is intended for the recitation

in the lower tone of sacrifices.

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3. Samavedaa, which is intended for chanting at Soma or

Moon-plant ceremonies

Yajur and Sarna Veda, in spite of presenting their own Mantra;

happen to borrow Mantra from Rugveda. Atharvaveda is collection of

original hymns like Rugveda; borrowing little from Rugveda. The hymns of

Atharvaveda are mixed up with incantations, having no direct relation with

sacrifices, but supposed by mere relation to produce long life, to cure

diseases, to affect the ruins of enemies.

Each of four Vedas seem to have passed through numerous

Suktas or schools giving rise to various recensions of text though Rugveda

is only preserved in the Shakala recensions, while a second recension that of

Bhashkalas is only known by name. A tradition makes Vyas the compiler

and arranger of Vedas in their present form. They each have an index or

Anukramani. Out of the Brahmana portion of the Veda grew two other

departments of sometimes included under the general name Veda viz. the

strings of aphorism rules called Sutras and mystical treatises on the nature

of God. The relation of soul and matter were Upani~adas, which were

appended to Aranyakas, which became the real Veda of thinking Hindus,

leading to Darsanas or systems of philosophy.

Rugveda is most ancient First Veda available today.

The word '?/i.~G' is a conjugated term of'~' and 'ctG',

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About '?f[q)' ,

The meaning of the word '~' is composition of rhyme made

in a typical way called 'gC;:·fiFll'.

Etymological aspect of '~' is as follows:

The definitions of the word ~ is as follows:

Means the verses where holy moieties are praised. (Sha. Ka.)

Means the mantra which follows the rules of 'Vrtta' and

contain 'Carana' and 'Ardhi'. (Jai. Nya. 2.1.12)

Means verses where the composition of the 'Carana' is based

on Anu~tupadi Chanda.

Many 'I}cha' together comprise one 'Siikta'. Siiktas in I}gveda

are mainly the prayers of holy moieties like Indra, Agni, Vauma, Marut.

Besides these prayers these verses express about the society in

those days, culture in those days, philosophy in that time, and environment

in those days and many other things.

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Entire ~gveda-Samhita is basically composed in two ways:

1. A~taka-racana.

2. Mandala- racana.

A~taka- racana:

~gveda is divided into 64 chapters (adhyaya). Eight chapters

together comprise one A~taka. B.-gveda contains such eight A~taka. The

remaining sector of each chapter is called 'Varga'. Number of verses in one

'Varga' is five. Some of the vargas nevertheless are comprised of nine

verses also. This irregularity in the composition cannot be logically

explained. Total number of 'Varga' in ~gveda is 2006. This must be for the

sake of simplicity for the learners.

Mandal-racana:

~gveda is divided into 10 mandals. Each 'MandaI' comprises

many 'Suktas' and each 'Siikta' contains many 'ruchas'.

These mandals are again divided into:

1. Gotra-mandal.

2. Mishra-mandal.

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GOTRA-MANDAL

MandaI from second to eighth are called 'Gotra-madal' because

they are composed to describe the genetic tree of Rushi, their genetic

configuration 'gotra' and their heirs etc. the names of the Gotra-rushis from

second to seventh mandals respectively are Gutsamada, Vishwamitra,

Vamadeo, Atri, Bharadwaj and Vasishtha. The names of the rushis of the

eighth mandaI are Kanva and Angirasa.

Mandals from second to eighth are the core of Rugveda. The

composition of these verses is ancient most. Other Siiktas are composed in

the further era.

Suktas from the ninth mandal are prayers of single moiety

Soma. The synonym of Soma is Pawamana. So this mandaI is also called

Pawamana- mandaI. It is guessed that after the composition of second to the

eighth mandaI simple compilation of Soma-Suktas through them made the

ninth mandaI.

First and tenth mandals contain 191 Suktas each and it is

guessed that they are inserted in ~gveda afterwards. The relatively modem

language of the tenth mandaI with newly proposed holy moieties and latest

philosophical approach in those days prove that this mandaI was from

further era.

Katyayana produced the numerical data of ~gveda

composition. It is as follows:

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1. Mandals 10

2. Suktas 1017

3. Ruchas 10580.25

4. Shabdas 1,53,826

5. Aksharas 4,32,000

Beside abovementioned numerical values ~gveda-Samhita

contains 11 Suktas in eighth mandaI ranging from 49th to 59th number. These

Suktas are called Balakhilya Suktas. The number of Mantras included in

them is 80.

Due to such systematic and wonderful studies of the scholars in

those days, ~gveda-Samhita is available today as it was composed, in

unaltered form and unadulterated way.

The traditional notion is that the entire ~gveda-Samhia is

compiled and edited by a single person. About all ~~I in ten mandals,

Katyayan, in his Sarvanukramanee states as follows:

~1(1R;l""1 am1 4106cl~ 1tl~~cm4151~cml ~ ~: I

It means that the ~~Is composing hundred Ruchas from the first

mandaI are called composers of hundred ruchas. The ~Is composing the

last mandaI are named Ksudra-sukte and Maha-sukte. The ~~Is composing

middles mandaI are called Madhyama.

Commentator Shadgu~~Ishya of above-mentioned

Sarvanukramanee, composed by Katyayana stated that composer of the first

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mandaI Madhuchhanda, son of Vishwamitra wrote more than hundred

Ruchas so he is named as 'Shatarchin'. This is the reason all ~~Is by the rule

of 'Chatri-nyaya' acquired the same, i.e. 'Shatarchin' name. Similarly

Siiktas in tenth mandaI before Nasadiya Siikta are called Maha-Siikta and

Siiktas after Nasadiya Siikta are called Kshudra-Siikta. Mandals from

second to ninth are in the central portion of ~gveda-Samhita and the ~~Is

composing them are therefore called 'Madhyama'.

About '<fG'

Jf;::llillS06 0llfJiCb) ~ <fG: I

In the beginning the Veda was written in a hotchpotch way.

Vyasa~~I divided Veda into four parts and each part descended to one

student (Shishya) through him. He was crowned due to this as \~ FclClJI'('f

~ ~GClJI'('f'. It means the person who divided Vedaa. The learner of

~gveda was a student named Paila.

Paila divided the learnt ~gveda into again two parts and taught

one part to Bashkala and the other to Indrapramati. Bhagwata purana and

Bramhanda purana refer to the further descend of Indrapramati Samhita to

Mandukeya. From Mandukeya it was taught to Satyashrava, Satyahita and

Satyashriya.

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In such way various versions of ~veda were available in those

days. Patanjali in his 'Vyakarana-mahabhashya paspashanhika' refers to

twenty-one different editions of ~gveda. Amongst them Shakala, Bashkala,

Ashwalayana, Shankhayana and Mandukayana are most popular editions.

Shakala gave following editions, which are not available today.

1. Mudgala shakha.

2. Galava shakha.

3. Shaliya shakha.

4. Vatsya shakha.

5. Shoushiri shakha

The root samhita was named Shakalya or Shakalaka or

Shakaleyaka. It is very highly respected

Bashkala gave following editions, which are also not available

today.

1. Boudhya shakha.

2. Agnimathar shakha.

3. Parashara shakha.

4. Jatukamya shakha.

Eight additional Siiktas were written in Bashkalashkha.

Ashwalayana shakha avails Gruhya and Shroutasutras. No

other material is available today.

Shankhayana shakha avails the Brahmana, Aranyaka and

Kalpasutra.

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Mandukayana shakha in any form is not available today.

General grouping of the Siiktas in ~gveda are under the

headings as follows:

1. Devata-sukte.

2. Dhrupada-sukte.

3. Katha-sukte.

4. Samvada-sukte.

5. Danastuti -sukte.

6. Tatvadnyana-sukte.

7. Samskar-sukte.

8. Mantrik -sukte.

9. Laukik-sukte.

10. Apri-sukte.

~gveda contains 10,414 mantras. The division of Chandas in

~gveda is as follows:

1. Gayatri.

2. Ushnik.

3. Anushtubh.

4. Bruhati.

5. Trishtubh.

6. Pankti.

7. Jagati.

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8. Atijagati.

9. Shakvari.

10. Atishkwari.

11. Ashti.

12. Atyashti.

13. Dhruti.

14. Atidhruti.

15. Ekapadachhanda.

16. Dwipdachhanda.

17. Pragayabarhata.

18. Kakubh.

19. Mahabarhat.

It is taken that the creation of ~gveda IS not by ordinary

human. It is supposed to be created by God himself.

3i4''6~lIJt "fIffr ~ ~~)~ollq ~: ~ ~ I ~G~lftl

q'<~:tq,<~ffldJt"1 4~'6~1I("Cflq I W~ElIR~'6~~ffld("CfI'I1IGln'6~lI("Cf~Rl ~ I

'fI6t?1 ~~: I

?Jr.~.10.90.1

This dispute ultimately was dissolved to agree that the

composition is not sheer inhuman.

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The language in ~gveda is very difficult. It is suggested that

Veda should be read after acquiring command on six tools to understand

Vedic language.

~ ~Gt'Qltd4"fqE()~ ftrefICfH:) q~""RI !'I qct1 IP! I

t ~ ~~d&Q ~ ~ ~ "lfC\ ~S15~G) qGRi "W ~qlqi(1 T.f I

d?llqi(1 ?Ii"~G) ~clG: t114"f~G)S~: ftan ~ &IICfji(uj P!'6ctti

~ GdlRlq~RlII

3T~ "W "lf~ ~~ II

j\SCf»)qp!qG 1.1.4-5

These six tools are capable of explaining the verses properly.

It is not desirable here in this dissertation to elaborate the

details of the six entities, yet the definitions of them are given below:

• q uh:<NIq:gi5iUi(UI!'ICf)lx) ~?ilqf4~d ~ ftan I

• ct>C'4ttl 3f1~q~ICIt~lqX"d~I~~I~~?I11

• ClIICf)xUI4"f~!'ICIlRI !'I~~Iq:gq4~~ ~ 'tCIXiiq ~- P!lSCI4Iqg\Jild I

• 3T~ ~amm q G\JIld ~?il (fei d P-i'6crei I

• ",,~:;fl \3lSDft"lj~iii!6<ftqRct8!~M"I<ft~dI4'l 'Htff 9GiRi I

• GiI~Rlqt'Q !'IlI)\JI;:J ~ I

'Soura-Siikta' is part and parcel of ~gveda. It is a collection of

hymns about God Sun. it is refered in 14 verses at various places in ~gveda.

Out of these 14 verses 11 verses are meant for praising God Sun, its names

29

in various contexts, time division by Sun in Samvatsara etc, its velocity,

eclipse, months, importance in science of astronomy (2.27.1; 10.72.8;

l.35.11; l.50.8; 2.36.2; l.123.8; l.164.11,12; l.117.4,5; l.16.48; 1.155.6;

5.40.5,6,7,8,9; 7.66.11; 10.156.4; 10.189.1,2,3; 1.84.15)

Since these references are not necessary for this particular

experimental project, they are only mentioned here, no given in details.

Important ~ca around which entire project is whirling is as

follows:

Two more verses related to health care together with the 11 th is

called 'Rogaghna Upani~ada' and they all together are as follows:

Si £1.5 £I flt?l Si g 3f I '() ~"jct1 if ~ I

?FL1f.1 3fjql~ 9 ~ 50 ?ft-C.IT 11

~ "4 gBSiIU} '()~O"q>I'tl ~ I

30

~J.II~R~ll) f<t~ ~ WI

ftCl;:Q ~.~ ~~~~I

?Ir:J:f.1 3i jClI <ft 9 ~ 50 ?It'f.IT 13

Experiment of this research project is designed with first out of

three 'Rogaghna Upani~ada', which is explained before.

Atharvaveda also claims that for cure of any disease medicine

is necessary and that is through God Sun without whom there could be no

herb.

at4R.!a: J:r "tffiO ~ CltidRCI I

~: &long ~ iF~SfI q)q)STSg

3T~ (6.83.1)

The speed with which the Eagle flies away from its residential

place, to eliminate diseases like indigestion and others, let God Sun prepare

medicine and destroy diseases.

This description emphasizes the need of Sunlight without

which it is impossible for any plant to prepare food. Only plants are source

of food. Human can not prepare his food, nor can he prepare medicines

without Sun.

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Rays of Sun were given utmost importance. Atharvaveda does

not fail to mention 'Varna-Cikitsa' or 'Chromotherapy' for heard diseases

and for anemia.

&J 'ti4jGlJcti iJ'tEl)ffi ~ :q tf I

III "<)~ct'fll ~ ~ ~ ~I

~ 1.22 qof~Fchffil

Yellow color of yours (may be due to anemia or jaundice) and

the heart diseases you are suffering from; should vanish with red rays of

Sun, which wrap you and keep healthy

everyone.

llft CQT "<)~~cfoicft~fg(cllll ~ I

<:r~ III 41 't4 I ~ 315 Rct) 1jCfC{ I

3T~ qof~Fchffil

Red shining Sun rays and milk of red cows bestow health on

In that ancient era also authors of compendia were aware of the

color therapy

Various allied branches of medicine are cropping up now like

'Naturopathy', 'Electrotherapy', 'Magneto-therapy', 'Hydrotherapy', and

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many others. Veda is a real treasure of knowledge as all these references are

found in four Veda. One more very interesting reference is as follows:

\iEFTJI~~: rsp'i"11 ~ Pl;!h11 ~~: I

~ 3Rf: @>J1 \Q~ l"Jfct I

3J~ 2.32.1

Rising Sun by his rays kills organisms and so does rays of

setting Sun. both types of Sun rays are capable to kill insects on Earth.

fcr~ ~ ~ ttl~'IJ1~"1't I

-'q°IIRl~ tt~'<fCl 'lJl..~ 1I~'<: I

3J~ 2.32.2

And insects and worms with morphology like those having

various colors and white color, with four eyes, and so on are killed by rays

of Sun. Sun rays are able to kill the worms by breaking their vertebral

column and by severing their neck.

Mode of action of mantra:

Mantra is an invocation or a mystical formula, which aids the

person to release the self and attain bliss and ultimate fulfillment. The

sounds involved in a Mantra are themselves significant for they generate in

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the individual an unusual mystic power. Mantra produces a set of vibration

in the surrounding atmosphere & its force depends on the attitude of the

person as well as the intensity of concentration.

Mantras are performed through faith, the results of which

cannot be analyzed measured, weighed, seen but are felt. The force of

Mantra can be only felt. It should be performed with due faith and all

rituals, and then it is fruitful. One must have complete faith in Mantra he is

reciting and must know its meaning. Prescribed methods should be

followed. The performer does experience sensation and vibrations during or

at the end of Japa, this is a sufficient proof to believe. Mantra requires faith,

Japa, hard work ad per laid dictums to realize the desired objects and

vibrations. Each Mantra has a different use, The vibrations of sound create

desired reactions within the body too.

Recitation of Mantras with a prescribed number of times at different timings

to give desired results. There are three ways to perform Mantra

UPANSU JAPA: It is the method where Japa is done very slowly so that

nobody can hear it. Only lip movement should be there.

MANSIC JAPA : The Japa carried out only in the heart without any sound

or lip movements.

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V ACHNIK JAP A : In this method you can recite the mantra in a low,

medium or high tone of sound.

Sanskrit Mantras are sound formulas that echo the language of

Creation, ranging from single-syllable "seed sounds" to more extensive,

lengthy compilations of sounds designed to have specific effects. We have

been told that "In the beginning there was The Word ... " and the scriptures

from many world religions testify that sound was the originating

manifestation of the Universe as we know it. y world religions testify that

sound was the originating manifestation of the Universe as we know it. This

"Word" can be understood as Sanskrit, and delving into Sanskrit mantra is

ultimately a process of understanding Creation itself. However, the less

subtle layers of this sacred language can also serve those of us with more

practical concerns.

The word "mantra" can be translated as "that which sets free

from the ordinary mind." The regular use of Sanskrit mantra helps us to

transcend the ordinary faculty of the mind and its limited scope, helping us

access illumined intellect, the storehouse of our soul's wisdom and powerful

creative energy, and eventually awaken enlightened consciousness.

Because Sanskrit mantra is an energy-based language of light,

it works whether you fully understand it or not. Many mantras are

untranslatable, and the translations that do exist are subjectively drawn

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sketches of a deeper meaning that supersedes our ability to convey it with

the English language.

The best way to understand a mantra is to work with it. Each

mantra has a direct, specific effect on the chakra system. (In fact, the 50

seed sounds of the Sanskrit alphabet correspond with the 50 petals of our

chakra system.) As the mantra formulae are intoned, the petals on the

chakras vibrate in sympathetic response and the bridge to healing, from the

gross physical level to the eternal cosmic consciousness, is awakened. More

simply put, the mantra creates a forcefield of such positive energy that you

cannot help but be affected positively.

There are powerful mantras that address every possible area of

personal growth, and every possible dilemma of the human condition. The

"seers" of these mantras were sages with profound understanding of human

evolution, and they set out the mantras like a trail of stars for us to follow

Home.

Each issue that humans face, whether physical, mental,

emotional, or spiritual, brings attention to something that they do not yet

understand. The learning process (aka "healing") can take days, months,

years, or lifetimes, depending on the depth of the lesson. Working with the

Sanskrit mantra for a particular issue links the awareness to its root in

cosmic consciousness, ultimately transcending space and time to access the

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pure knowing that is inherent to our own higher nature. Through this

knowledge, we are empowered to unravel our personal knots and unleash

the dormant creative power that had been trapped inside.

Working with a personal mantra for practical or spiritual

intentions is like releasing an arrow straight to the core of the matter. It puts

the destiny of soul evolution within reach, and ones empowerment only as

far away as the tip of his tongue.

It's generally advised that one should learn mantras directly

from a teacher, rather than from a book. Since there are millions of mantras,

it's also important to choose proper mantras wisely depending on the result

one is expecting. If the mantra is desired purely for spiritual growth; one of

the great liberation mantras such as the Gayatri, "Om Mani Padme Hum," or

"Om Namah Shivaya," could resonate with you. If mantra is for practical or

medical intention, one of many more focused formulae could be better.

The science teaching the method of pronunciation of vowels,

alphabets, etc. is shiksha. Famous holy texts on this science are written by

Sages Panini, Yadnyavalkya and Vasishtha. 'The Shatpath Brahman states

that every metrical composition of Vedic mantras or every alphabet of a

word possesses some kind of strength and explains the secret of every

alphabet. The Mandukya Upanishad believes that even uttering of alphabets

from a mantra is powerful and hence describes the greatness of the alphabet

37

Om. Since the Vedas were considered to be divine in origin the order of

every word from their mantras had to be maintained while chanting, as per

the established rules. In this regard authors of the Nirukta say, Pillt1lj'{OQf

Pillt1QI'Cl)9;Ck1;: meaning a word, the order of alphabets in it and its method of

pronunciation is definite; hence the meaning of the Vedas also does not

change".' To be able to chant Vedic mantras appropriately one should know

the correct pronunciation of vowels (svar). Vowels mean sound. If

pronounced correctly the sound generated by a word makes it efficacious.

Hence if Vedic mantras are chanted correctly then the mantras become

efficacious.

Faulty pronunciation of even one word changes the entire

meamng; hence vowels decide the meaning of words. In this regard the

Panini Shiksha (52) says -

The mantra without proper pronunciation of vowels (svar) and

consonants (varna), that is the utterance of a mantra in a faulty manner

makes it faulty and does not convey the intended meaning. Instead it gets

converted into a verbal thunderbolt and harms the one chanting it, as had

occurred in the case of the word Indrashatru with faulty pronunciation of

vowels.

The compound word Indrashatru could have two meanings,

one being "Indra's enemy" (the slayer of Lord Indra) from Tatpurush Samas

38

and "the one whose enemy is Lord Indra" (the one who will be slain by

Lord Indra) from Bahuvrihi Samas. Since the first meaning was intended for

Tvashta he had to utter the note of the last letter of the entire word in a lofty

tone. He however, uttered the last letter of the first word in the Samas in a

lofty tone. Consequently, instead of a son being born to slay Lord Indra, a

son, Vrutra who would be killed by Lord Indra was born (Taittiriya Sanhita

2.5.1-2); hence in the Vedas importance is endowed to the pronunciation of

vowels.'

A. Distortion in the Vedas: 'The ancient Aryans thought of another idea to

preserve Vedic mantras in appropriate metrical compositions and hence

created distortion in the Vedas. For that poetic compositions of the Sanhitas,

which appeared in different branches of the Vedas in the mantra form, were

created. Sages Shakalya, Gargya and Atreya created poetic compositions of

the Rugveda, Samaveda and Taittiriya Sanhita respectively. Based on these

compositions distortions such as Kram, Jata, Ghan, etc. were written. These

variations were useful to chant Vedic mantras in reverse order and thus to

realise the variations of notes occurring in them.'

B. Pratishakhya: After several branches of the Vedas came into being each

branch began to chant the mantras in their own way. To bring uniformity

among them the Pratishakhya was created.

39

A couplet in the Bhagwad Gita, one of the most ancient of

Indian scriptures, clearly describes the virtues of healthy lifestyle in

prevention of infirmity and ill-health. The couplet states that those who

combine a balanced diet, regular physical activity, regular hours, maintain

equanimity, and are balanced in thoughts and action, are away from

infirmity. This couplet matches the current recommendations for CHD

prevention propounded by the World Health Organization and various

international societies. These recommendations include a balanced diet,

regular physical activity, smoking cessation and stress management.

According to Brhadaranyaka and Chhandyoga Upanishads the

ultimate aim of pranayama and yogic techniques is to control life (Prana).

This target is difficult to achieve, but mental peace and relaxation thus

achieved could be used as a therapeutic tool. Studies of yoga, transcendental

meditation and prayers have shown that it causes a decrease in blood

pressure and pulse rate. This effect is seen in normal volunteers and in

patients with hypertension. Patel and others in Britain have shown that

meditation and prayer techniques lower blood pressure on a short term and

long term basis. This factor may be important in primary prevention of

coronary atherosclerosis. On metabolic level it causes a decrease in various

biochemical inducers and aggravators of atherogenesis. Among the effects

seen are on pulse rate, respiration, blood pressure, lean body mass, basal

40

metabolic rate and biochemical parameters like glucose intolerance, lipids,

norepinephrine and epinephrine.

Bernardi et al reported the effect of prayer and yoga mantras on

autonomic cardiovascular rhythms in Italy. 23 healthy participants were

asked to recite the Ave Maria (in Latin) or a mantra. Both prayer and mantra

caused striking, powerful and synchronous Increases In existing

cardiovascular rhythms when recited six times a minute. This recitation

slowed respiration and enhanced heart rate variability and baroreflex

sensitivity and was considered a useful health practice.

Among the African Americans (blacks) that regularly pray in

church there is a significantly lower prevalence of multiple coronary risk

factors including hypertension. Oexmann et al reported results on a church­

based intervention in cardiovascular risk reduction in Christian communities

in North and South Carolina in USA. Among the 381 participants in this

one-year long trial there was a significant short term reduction in weight and

systolic blood pressure which were sustained throughout the year.

Significant decline In cardiovascular risk factors- hypertension,

dyslipidemias and obesity have been reported by Patel et al in Britain using

group meditation techniques, and in India by Mahajan et al in Delhi and

Damodaran et al in Mumbai.

41

3. Ayurveda literature:

Ayurveda accepts Mantra as a supportive treatment in many

health problems. For example, as one of the means of measure on edema

C~otha)

Tf.~ 18.5

For good measure of 'life-span-increment-technique', Caraka-

Samhita has advised to follow the rules and regulations dictated through

four Vedaas.

Caraka-Samhita has advised Mantra as one of the tools to

check psychological disorders. In chapter for diagnosis for Unmada, a

psychological disorder it mentions:

am: *,1~'1IP1

Tf.~. 7.16

42

Even III treatment of poisoning, Mantra acts as supportive

measure.

T:f.~. 23.223

The vibration of sound waves of Mantra must be executing

impact on the fluid on which they fall.

~) ~ I ~ I ~\J1 ~C'!!"Rft 'N'I41 """ fa ~ II '< c!1 I

~.~34-7

Not only physician but a surgeon was no exception in having

faith in power of Mantra.

3lRtlCl41ftl 414~iI ~l/Iri'f"",,Cf)~faG:: I

"ffi g ~ fa~~ffiCf)~ 11ffi11

~.q;. 5.8

This Mantra management is not taken lightly by Ayurveda

physicians, even in emergencies execution of this treatment seems to be

authentic.

g\JilIct1~ ~ Wi ~ 41;:::i1d;:::ilfaq I

3T.la.\'f. 3.58

For babies this hannless yet strongly effective treatment was in

practice.

43

All these references point towards acceptance of Mantra as a

supportive measure in various diseases and disorders.

Blood pressure as a disease is not considered III Ayurveda

compendia yet Cardiac diseases were known. The tenns then differed from

present tenns hence all collaborations are difficult to present in the review.

Nevertheless references show that ancient Hindu physicians were executing

such treatment in era of compendia.

Kriya - Sarira of Hrdaya and circulation

Intra-uterine differentiation:

~:m. 4

_ ~: ~ClICft1~ 11Cffff I

~:m. 3

Heart is differentiated in/orth month 0/ intra-uterine life.

Beating a/heart is indication a/living baby in mother's uterus.

Modem embryology cites exact time of development of heart.

It is most logical that in ancient era it was accepted that heart beating of

viable fetus is indicative of differentiation of heart in fourth month of intra­

uterine life of fetus.

44

Origin of heart:

~M{)ldCJ)4?!JItlIG\ji ~GlI't I

~:m. 4.31

Constituting tissues of heart are: 'Prasada' portion of blood

and Kapha.

In intra-uterine life all nutriments are provided to fetus by

maternal placenta. Hence tissues organized in fetus are in their purest

possible form.

Ayurveda considers non-accepted part of extra cellular

nourishing fluid or products of metabolism as 'mala' for that particular

tissue. Since Ayurveda assumes that maternal blood does not contain such

mixture of acceptable and non-acceptable portions, provision to fetus IS

pure. Therefore it is 'prasada' in nature. Ayurveda assumes heart IS

originated from such pure body entities, namely blood and Kapha.

These originating constituents are important for treatment of

cardiac diseases. Drugs acting of such constituents are seen to offer fantastic

results.

Heart as a vital organ:

Ayurveda accepts 'Marma' as body entity, which is vital for

living body. Heart is one of such vital organs.

RI x I Ii ihi Cf> Ii C'I!!Cfi C'li Cf> I ~ ~ iI g~!!cl 'tf Elh'll RI "q I

45

Heart is four anguli in measurement, appears like lotus with

face downwards principally constitutes of (Sira' and if hurt or injured, IS

responsible for immediate death.

Location of Hrdaya:

~-,

3l.{a'.W. 4

Location of Hrdaya is between midlevel of chest, breast and

'Ko~tha'.

~.W. 6

Location of heart is in the chest cavity between breasts just

above stomach, abiding satva, raja and tama.

Relation of Hrdaya:

~.W. 4.31

46

Anatomical relations of heart are; inferiorly and laterally on

right side is liver and 'Kloma', inferiorly and laterally on left side spleen

and part of lungs.

Aru~adatta mentions only right relations of heart as 'Kloma',

liver and lungs.

Hrdaya abides:

1. Oja:

T.f.~ 30

Hrdaya abides matter known as 'Oja' in Ayurveda.

2. Touch sensors:

T.f.~ 30

Whatever is necessary mechanism for sensory reception of touch IS

supported by heart.

It must be noted here that circulation is essential for sensations. If

circulation is arrested for a long time, touch sensors do not work.

47

3. Caitanya or Cetana tatva:

"q.~ 30

Hrdaya abides Cetana tatva.

4. Orientation of body organs:

All stimulations from all organs of body are reached to heart.

This is again dependent on circulatory efficiency. Experts in Caraka era

must have noticed that extreme degree of circulatory inefficiency is

responsible for non-perception of any kind of perception.

5. Functional output of sense organs:

Functions of five types of sense organs reach heart.

Any organ functions properly if oxygen and nutriment is reached to

organs and metabolic products are drained. In other words circulation is

vital for sense organs.

6. Soul:

48

Soul abides in heart.

7. Mind with its attributes:

T.f.~ 30

Mind with its three attributes namely satva, raja, tama abide in heart.

Shape and appearance of heart:

Heart has shape of a red lotus facing downwards.

Ii I~ q:tftillft XCtt1 q ,,+1 I Cf) IX+1ti'j{SlSO(I

3l~OIGct1, 3T.@.~. 3.15

~~f1c8°1 ~ ~ ~IGti~j{SlSO(I

\J11;!H1«1mCf)~R1 ~Jl..T.f Pl4")61R1II

~.~. 4.32

Heart looks like red lotus and it faces down. While sleeping

this lotus like heart appears as if it has closed petals and while activities it

appears as if it has opened all its petals.

Due to lotus shape of heart, vessels through this muscular

organ provide entire body even in particular sitting posture meant for

meditation.

49

Chief organ of two systems:

It is chief organ of two systems namely respiratory and

circulatory .

"'Cf.fct 5

Heart is chief organ for system of Rasa.

Heart is chief organ for system of Prii1}a.

Do~a-dhatu·-mala of heart:

A list of these entities is provided here. detail references are

read in chapter for 'lfrdayastha Do~a' .

a. Do~a:

Vatado~a - Udana, Vyana, PdiQ.a.

Pittado~a - Sadhaka.

Kaphado~a - A valambaka.

b. Dhatu:

Rasadhatu.

Raktadhatu.

Mamsadhatu.

Cetanadhatu.

Oja.

50

Functions of heart:

Enumeration of functions of heart is as follows:

1. To support vessels those convey Pral)a (acrr~ f6

2. Important organ of Rasavaha srotas ('{'{1Q61"1i '¢t'Id'tii

~ I 'Cf.fct 5).

3. Important organ for Pral)avaha srotas (SOIl oIQ61"1i '¢t~d'tii

~ I 'Cf.fcr. 5).

4. To support Vyanavayu (C1IT"1l ~ ~: I 3T.t2.~ 12).

5. To support Rasa (~I 'Cf.).

7. To realize sensation of touch ((IT{ ~~HiI~l;:j I 'Cf.~ 30).

8. To circulate Rasa (CZlI~"1 ~ ·Fcnil4~RldCf)4ol1 I 'Cf.

"RI". 15).

9. To express happy or unhappy condition of mind

IO.To repeatedly contract and to relax (~: "Tf: "Tf:

. 'fil . 'ffl ~ ~ '(1 Cf) I 'iI Cf) I '(11.R.'Cf Cf) '< I I "111 ~ I ) .

1 1. To abide Cetana tatva (-ad;x:j'ti~6: I 'Cf.~ 30).

1 2. Maintenance of alertness of sensory organs

51

13. Information about body condition

14. Lodgment of soul (3T"RiIT 'q ~A.~ I 'q.~ 30).

I5.All mental reactions (lFRf: ~ I 3l.ta.~ 12).

1 6. Cleaning of Rasa (W 'lJ: t<:IiUdi "lJm: "fl d~qlqRltidd I

3l'{i°IGct1, 3l.ta.~ 12).

ttl fF1 ~ ~i.J i{) ~ '<'t1 iff q ~F1) El d: I

~:~. 1.17,18

Vyana occupies entire living body. it induces circulation of

Rasa. It is responsible for sweating, various secretions, and five types of

motions like relaxations, contractions etc. it this Vata type gets vitiated, it

becomes responsible for diseases related to any location of whole body.

Compendium A~tanga-Samgraha adds more functions to Vyana

than previous references. In addition to five types of motions, movements of

eyelids he refers to yawning, enjoying flavor of food, penetrating all intra

and inter cellular spaces, sweating, bleeding, deposition of semen in vagina

after coitus. He does not stop short of saying that separation of absorbable

and not absorbable part of digested food is in jurisdiction of Vyana.

52

Chronological nourishment of Dhatavah is included in specific functions of

Vyana.

One of the chief functions of hrdaya is to circulate Rasa in

body in cyclical order.

heart.

Rasa is circulated through out the body, which is pumped by

*1ct~1 qRCIRct~ 't'Hf)qq II

'q.ftr. 15

qRCIRct~ fcllfiq Olt1i:;,<OIl~q)1 (tTcm)

t2GlIlq ~:lffqut ~ m=r ~ I ~ ~ mr mr tl5,<01SO( I

Reference from Bhelasamhita reads that Rasa is expelled

through heart and from there it is circulated everywhere in entire body.

For this expulsion, reference from Caraka-Samhitii provides

two important adjectives. One is continuous (tlctflll) and other is cyclical

Commentator explains meaning of word (qRCIRtO as (fcllfiqoD

and (*1'5'<01). Further he explains meanings of~) as process of Rasa

thrown out of heart and (*15,<01) as process of Rasa coming towards heart.

53

In this, Vyanavayu is chief executor of this function:

ClII;i"1 ~ Fcla)q1~(1ct>4ulIl

9}14q tl4dlS\iffi ~ ~ ~II

"q.~. 15

Vyana, chief amongst five types of Vatado~a, circulates

Rasadhatu. This Rasa is circulated in entire body (rrcfa) at a time (9J1Qro,

ceaselessly (rrcrT) without taking a single seconds rest ( 3lfJIWj.

Commentator wants to impress that a physician should not take

only Rasa into consideration while reading this verse. Blood and all other

fluids should be considered while reading about circulation of Rasa.

Commentator further describes the meanings of different words in the verse.

These are mentioned while reading meaning of verse. They are as follows:

Entity, which executes function of pushing and pumping in

appropriate manner, is known as 'viksepoCitakarmii '. This is function of

Vyiina. This circulation is accomplished in entire body, simultaneously

flown ceaselessly, all the time all the way.

54

This is systemic as well as pulmonary circulation. It is

described in short below. Susrta-Samhita has given examples to describe the

fashion of circulation.

~.~ 14.16

3flTIT Rt~)~OI ~lfJ1gq;l~ol I ~lqRl 't1iNRII O?r ~16G't1tll..,qt\

~t"lt;H Rl4~l~ll~tii ~ \iCft111 31"ftf: 't1t11..,qt\ ~t"lt~'" ~~II~tii,

\l1CW1t1dHqt\ ~t"lt~'" 3ThIl~II~eq~RlI ~~t\ 3RJ@U dll\@lOIl..,lIPd

~16GIR~tel""tl?l~OI dlau(+'1&1s:j(n~.fHi \l1CW1't1t11..,Qri"jG 1~4)"'I~RlI

This circulation is reached to micro capillaries. The

circulatory process is compared with sound to indicate that sound reaches

to any depth in any direction. It is compared with flames to indicate upward

direction. It is compared with water to indicate downfall means downward

direction. Different kind of velocity is also indicated here. Sound is faster

than flames and flames are faster than waterfall. Hence circulation is in all

directions in body and is maintained in different velocities.

55

This verse III this way indicates microcirculation of body,

different velocities of blood at different places and pumping in all

directions.

4. Modern medical literature:

Blood pressure in modern physiology

Definition: Blood pressure is lateral pressure exerted by blood on vessel

wall while flowing through it.

Four terms are read in this context:

A] Systolic pressure (S.P.) - maximum pressure during systole.

B] Diastolic pressure (D.P.) - minimum pressure during

diastole.

C] Pulse pressure (P.P.) - difference between systolic and

diastolic pressure.

D] Mean pressure (M.P.) - it is roughly arithmetic mean of

diastolic and systolic pressure. Approximate mean pressure may be obtained

by adding diastolic pressure with one-third of pulse pressure. In true sense it

is level of the line halving area between pulse wave contour and the

diastolic pressure level.

56

In adults relation between three pressures is as follows:

S.P. / D.P. / P.P. =3 / 2 / 1, viz., if systolic pressure is 120,

diastolic pressure should be 80 and pulse pressure should be 40 mm of Hg.

in normal conditions.

Basal blood pressure: When an individual is with the least possible amount

of strain or stress basal blood pressure is generally considered. It may be

regarded, as the lower pressure necessary in maintaining blood flow

sufficient for needs of body. When a subject is in reclining state, 5-6 hours

after last meal, in a comfortably warm room, after resting for at least 30-40

minutes and with a mind at possible ease, basal pressure is obtained.

Although it is constant in a given individual, different individuals show

variations depending on following factors:

Significance of blood pressure:

Systolic pressure undergoes considerable fluctuations.

Excitement, exercises, meals etc., increase it while sleep rest, etc.

diminishes it.

The height of systolic pressure indicates:

1. The extent of work done by heart.

2. The force with which the heart is working.

3. The degree of pressure, which the arterial walls have to

withstand.

57

Diastolic pressure undergoes much less fluctuations in health

and remains within a limited range. Increase of diastolic pressure indicates

that heart is approaching towards its failure. Variations of diastolic pressure

are of greater prognostic importance than those of systolic. Diastolic

pressure is the measure of peripheral resistance. It indicates the constant

load against which heart has to work. Pulse pressure directly varies as stroke

volume.

Function of blood pressure:

1. To maintain a sufficient pressure head to keep the blood

flowing.

2. To provide for motive force of filtration at the capillary bed,

thus assuring nutrition to the tissue cells, formation of urine

etc.

Factors controlling arterial blood pressure:

1. Pumping action of heart and Cardiac output: Effectual contraction of

heart is the main factor for controlling cardiac output, blood pressure and

flow within blood vessel. In each effectual contraction of the ventricle,

certain amount of blood is ejected out into aorta. Driving force of blood is

mainly created by the pumping action of heart. The efficiency of heart is

considered upon how much amount of blood is driven out by heart into aorta

in each beat.

58

Alteration of cardiac output will alter blood pressure. Cardiac

output depends upon venous return, force and frequency of heartbeat. Blood

volume affects blood pressure directly, by mainly modifying the cardiac

output.

2. Peripheral resistance: It is resistance which blood has to overcome while

passing through periphery. Chief seat of peripheral resistance is arterioles

and to a smaller extent the capillaries.

Muscular vascular bed offers maximum resistance due to high

extra vascular compression by skeletal muscles and skin vessels cutaneous

vascular resistance is due to sympathetic constrictor tone.

3. Elasticity of vessel wall: Decrease in elasticity increases systolic blood

pressure. Since there is an increase in peripheral resistance along with a loss

of elasticity due to involvement of peripheral vessels, diastolic blood

pressure either rises or does not change. So, in old age force, which distends

walls, now drives blood increasing blood pressure.

4. Viscosity of blood: This denotes thickness of fluid in blood. Blood is 4.5

times viscous than water. So naturally more pressure is required to push

blood in circulation. It affects both systolic and diastolic blood pressure.

Viscosity is affected by:

1. Cell count.

11. Plasma proteins.

111. Temperature.

59

IV. Chemical composition like C02, 02 etc.

v. Drugs like general anesthetics.

5. Circulating blood volume: Arterial with venous system is closed system

with elastic tubes. Any fluid in such a system can exert significant pressure

only if fluid fills the system to its capacity or more than its capacity. Normal

blood volume fills system and blood pressure is normal and maintained.

Hemorrhage - decreases blood volume - decreases blood pressure

Polycythemia - increases blood volume - increases blood pressure.

Cushing syndrome - increases blood volume - increases blood pressure.

Factors affecting peripheral resistance:

1. Velocity: A rapid flowing steam will have more frictional

effect than a slower one. Hence, pressure is high in aorta, low in capillaries.

2. Viscosity: Other factors remaining constant, a more viscid

blood will have a higher friction than a lesser one. It is for this reason that

plasma transfusion proves to be more effective to maintain blood pressure

than ordinary saline. Alteration in blood viscosity will affect the diastolic

pressure by its effect on peripheral resistance. Intermolecular friction is

greater when viscosity is high.

3. Elasticity: Due to elastic properties, arteries can dilate and

accommodate considerable amount of blood with relatively less rise of

blood pressure. In old age, arterial walls become stiff. Hence, blood pressure

60

rIses. In systolic pressure arterial wall are stretched due to presence of

elastic tissues in their walls. Blood gets accumulated while flowing through

vessels. In diastole walls of arteries recoil and maintain diastolic pressure

when no blood is actually pumped through left ventricle into systemic

circulation. Distention of aorta minimizes rise in systolic B.P. recoil acts

like an accelerator pump to heart and this facilitates diastolic blood pressure.

In arteriosclerosis where arteries undergo a narrowing of lumen and the

wall becomes relatively hard, elasticity is lost. This is usually seen in old

age.

4. Lumen of vessel: Peripheral resistance IS inversely

proportional to lumen of vessels. Smaller the vessel, higher will be the

resistance. One should expect therefore that the capillaries, having smallest

lumen, should have highest pressure. Contrary to this, due to lowest velocity

of blood in capillaries, functional effect is low. Seat of resistance is found in

arterioles mainly, where velocity is fairly high and lumen is narrow.

5. Length of vessel: Greater the length of vessel more IS

resistance.

6. Volume of blood: Increase in blood volume will raise both

systolic and diastolic bloo<;l pressures due to increased quantity of blood in

the arterial system and greater stretching of the arterial walls.

7. Extra vascular compression: this factor is responsible for

increasing peripheral resistance.

61

Physiological variations in arterial blood pressure:

1. Diurnal: This could by idiosyncratic. It varies per person. A person may

show highest blood pressure in morning, another may show highest blood

pressure in evening. These fluctuations are rhythmic and are called circadian

chythm.

2. Age: At birth systolic BP is 40 - 60 mm Hg.

15 th day systolic BP is around 70 mm Hg.

I i h year systolic BP is around 105 mm Hg.

I t h year systolic BP is around 120 mm Hg.

60th year systolic BP is around 160 mm Hg.

3. Sex: Females have around 5 mm Hg less than males of same age. This is

due to sex hormones. After menopause values are same for both sexes.

4. Surface area: blood pressure is proportional to surface area. Hence, in

obese person blood pressure is more.

5. Digestion: Intake of food and digestion increase systolic blood pressure

by about 10 mm Hg. This is due to cardiac output, which in tum is due to a

sympathetic stimulation. Diastolic blood pressure falls slightly due to

vasodilatation in gastro-intestinal tract.

6. Sleep: During sound sleep, systolic blood pressure may fall by about 20

mm Hg. this is due to -low metabolic rate. However in disturbed sleep, blood

pressure may rise. This is due to cortical stimulation of vasomotor center.

62

7. Posture: blood pressure is variable with posture. In standing posture

systolic blood pressure is low and diastolic blood pressure is more. In lying

posture it is reverse.

When an individual stands up from a sitting posture earth's

gravitational forces start acting in long axis of body trying to minimize

venous return. This results in a fall of cardiac output and hence blood

pressure faJls. Fall in blood pressure triggers sino-aortic mechanism.

Vasomotor center is activated increasing sympathetic discharge. This

increases peripheral resistance and heart rate. Diastolic blood pressure

increases, systolic blood pressure remains low because venous return

remains low.

Thus, in standing posture systolic blood pressure is low and

diastolic blood pressure increases. In prolonged standing both systolic blood

pressure and diastolic blood pressure fall enough to cause a decreased blood

flow to brain. Subject may faint. When a person lies down from a sitting

posture, earth's gravitational forces no longer act along long axis. This is the

reason why venous return and cardiac output, increase. Sino-aortic

mechanism is inactivated. Vaso-dilation takes place causing a fall in

peripheral resistance. This results in a fall m diastolic blood pressure.

However, systolic blood pressure remams high as venous return is

increased. H~nce in lying down position systolic blood pressure is more and

diastolic blood pressure is less.

63

8. Effect of gravity: If heart is imagined at zero point, blood pressure

increases towards feet and decrease towards head. Below heart, earth's

gravitational force, acting in same direction, augments blood pressure. For

every 1 cm, rise or fall in blood pressure is by 0.77 mm Hg.

9. Emotions: Excitement, anger etc. increase blood pressure as cerebral

cortex especially limbic system through hypothalamus stimulates vasomotor

center and thereby increase activity of sympathetic nervous system.

10 Respiration: In major part of inspiration blood pressure falls and during

entire expiration it increases.

During inspiration increased negativity of intra-thoracic

pressure sucks more blood into right side. At the same time blood going to

left side of heart decreases as most of blood is trapped in lungs. Therefore

left ventricular output decreases during earlier part of inspiration causing a

fall in blood pressure. However, pulmonary circulation soon compensates

output, raising blood pressure.

11. Exercise: In strenuous exercise systolic pressure rises and might reach

even up to 180 mm of Hg. in moderate exercise there is slight rise of

systolic pressure.

Regulation of arterial blood pressure:

Whenever any fluctuation in blood pressure takes place various

short-term acting and long term acting mechanisms come into play. Putting

them in concise form:

64

a) Neural.

1. Baro receptor reflexes - Carotid SInUS reflex,

aortic arch reflex.

11. Chemoreceptor reflexes - Hypoxia, hypercapnoea,

acidosis.

111. Cushing reflex.

b) Hormonal.

1. Catecholamines - Epinephrine, nor-epinephrine.

11. Glucocorticosteroids - Cortisol, corticosterone.

111. Mineralocorticosteroids - Aldosterone, deoxy

cortico sterone.

IV. Thyroid hormone.

v. Angio tensin II

VI. Vasopressin.

VB. Histamine.

V111. Serotonin.

IX. Nitric acid

c) Chemical.

d) Renal - Renin angiotensin system, prostaglandins and

bradykinin, renal body fluid mechanism.

e) Stress relaxation phenomenon.

f) Capillary fluid shift mechanism.

65

Clinical significance:

Davidson's 'Principles and Practice of Medicine', 19th edition,

on page number 388 and onwards quotes following passages about

Hypertension.

High blood pressure is a trait as oppose d to a specific disease

and represents a quantitative rather than a qualitative deviation from the

norm. Any definition of Hypertension is therefore arbitrary. Systemic blood

pressure rises with age, and the incidence of cardiovascular disease

(particularly stroke and coronary artery disease) is closely related to average

blood pressure at all ages, even when blood pressure readings are within the

so-called 'normal range'. Moreover, a series of randomized control trials

have demonstrated that antihypertensive therapy can reduce the incidence of

stroke and to a lesser extent, coronary artery disease (EBM panel, page

393).

The cardiovascular risks associated with a given blood pressure

are dependent upon the combination of risk factors in the specific

individual. These include age, gender, weight, physical activity, smoking,

family history, blood cholesterol, diabetes mellitus, and pre-existing

vascular diseases. Effective management of Hypertension therefore requires

a holistic approach that is based on the identification of those at higher

66

cardiovascular risk and the adoption of multi factor intervention, targeting

not only at blood pressure but all modifiable cardiovascular risk factors. In

light of these observations a useful and practical definition of Hypertension

is 'the level of blood pressure at which the benefits of treatment overweigh

the costs and hazards' .

The relation between blood pressure (BP) and the risk of

cardiovascular disease is direct, graded, and continuous over a wide range,

apparently beginning at 115 mm Hg systolic and 75 mm Hg diastolic.

Despite such a continuous relation, some working definitions, or subtypes,

of Hypertension have gained wide clinical acceptance. Experimental and

clinical data support the notion that the Hypertension subtypes defined by

isolated or combined elevations of systolic and diastolic BP reflect distinct

patho-physiological mechanisms, have different prognostic implications,

and may require a different therapeutic approach.

There are two broad categories of Hypertension - Primary (or

Essential) and Secondary Hypertension. Approximately 90-95% of

patients diagnosed with Hypertension have primary Hypertension. Unlike

secondary Hypertension, there is no known cause of primary

Hypertension. Therefore, the diagnosis of primary Hypertension is made

after excluding known causes that comprise what is called secondary

Hypertension.

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Despite many years of active research, there is no unifying

hypothesis to account for the pathogenesis of primary Hypertension. There

is a natural progression of this disease that suggests early elevations in

blood volume and cardiac output might initiate subsequent changes in the

systemic vasculature (increased resistance). This has suggested to some

researchers that a basic underlying defect in many hypertensive patients is

an inability of the kidneys to adequately handle sodium. Increased sodium

retention could then account for the increase in blood volume. In chronic,

long-standing Hypertension, blood volume and cardiac output are often

normal; therefore the Hypertension is sustained by an elevation in

systemic vascular resistance rather than by an increase in cardiac output.

This increased resistance is caused by a thickening of the walls of

resistance vessels and by a reduction in lumen diameters. There is also

evidence for increased vascular tone. This could be mediated by enhanced

sympathetic activity or by increased circulating levels of angiotensin II. In

recent years, considerable evidence has suggested that changes in vascular

endothelial function may cause the increase in vascular tone. For

example, in hypertensive patients, the vascular endothelium produces less

nitric oxide and the vascular smooth muscle is less sensitive to the actions

of this powerful vasodilator. There is also an increase in endothelin

production, which can enhance vasoconstrictor tone. There is compelling

evidence that hyper insulinemia and hyperglycemia in type 2 diabetes

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(non-insulin dependent diabetes) causes endothelial dysfunction by

enhanced oxygen free radical mediated damage and decreased nitric oxide

bioavailability.

Many mechanisms may operate to initiate and sustain

Hypertension. Treatment of patients with primary Hypertension is in

reality a pharmacologic intervention to modify factors (e.g., angiotensin II,

sympathetic activity, calcium entry into cells) in a way that leads to a

reduction in arterial pressure. However, these treatments do not target the

cause(s) of the underlying disease. Nevertheless, treatment of

Hypertension with antihypertensive drugs is vitally important because

Hypertension increases the risk for coronary artery disease, stroke, renal

disease and other disorders. The three broad classes of drugs used to treat

primary Hypertension are diuretics (to reduce blood volume), vasodilators

(to decrease systemic vascular resistance), and cardioinhibitory drugs (to

decrease cardiac output).

Secondary Hypertension accounts for approximately 5-10%

of all cases of Hypertension, remaining being primary Hypertension.

Secondary Hypertension has an identifiable cause whereas primary

Hypertension has no known cause (i.e., idiopathic).

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There are many known conditions that can cause secondary

Hypertension. Regardless of the cause, arterial pressure becomes elevated

either due to an increase in cardiac output, an increase in systemic

vascular resistance, or both. When cardiac output is elevated, it is

generally due to either increased neurohumoral activation of the heart or

increased blood volume.

Patients with secondary Hypertension are best treated by

controlling or removing the underlying disease or pathology, although

they may still require antihypertensive drugs.

Target organ damage:

The adverse effects of Hypertension principally involve the

blood vessels, the central nervous system, the retina, the heart and the

kidneys and can often be detected by simple clinical means.

Blood vessels

In target arteries (over 1 mm in diameter) the internal elastic

lamina is thickened, smooth muscle is hypertrophied and fibrous tissue is

deposited. The vessels dilate and become tortuous and their walls become

less compliant. In smaller arteries (less than 1 mm in diameter) hyaline

arteriosclerosis occurs in the wall, the lumen narrows and aneurysms may

develop. Widespread atheroma develops and may lead to coronary and/or

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cerebro-vascular disease, particularly if other risk factors (e.g. smoking,

hyper-lipidaemia, diabetes) are present.

These structural changes in the vasculature often perpetuate

and aggregate Hypertension by increasing peripheral vascular resistance and

reducing renal function.

Hypertension is also implicated in the pathogenesis of aortic

aneurysm and aortic dissection.

Central nervous system

Stroke is common complication of Hypertension and may be

due to cerebral hemorrhage or due to cerebral infarction. Carotid atheroma

and transient cerebral ischemic attacks are more common in Hypertensive

patient. Subarachnoid hemorrhage is also associated with Hypertension.

Hypertensive encephalopathy is a rare condition characterized

by high blood pressure and neurological symptoms, including transient

disturbance of speech or vision, parasthesia, disorientation, fits, dizziness

and loss of consciousness. Papilloedema is common. A CT scan of the brain

often shows hemorrhage in and around the basal ganglia; however the

neurological deficit is usually reversible if the Hypertension is properly

managed.

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Retina

The optic fundi reveal a gradation of changes linked to the

severity of Hypertension. Fundoscopy can therefore provide an indication of

the arteriolar damage occurring elsewhere.

Heart

The excess cardiac mortality and morbidity associated with

Hypertension is largely due to higher incidence of coronary artery disease.

High blood pressure places a pressure load on the heart and

may lead to left ventricular hypertrophy with a forceful apex beat and fourth

heart sound. ECG or echocardiography evidence of left ventricular

hypertrophy is highly predictive of cardiovascular complications and these

tests are therefore particularly useful in risk assessment.

Atrial fibrillation is common and may be due to diastolic

dysfunction caused by left ventricular hypertrophy or the effects of coronary

artery disease.

Severe Hypertension can cause left ventricuIar failure in the

absence of coronary artery disease, particularly when renal function and

therefore sodium retention is impaired.

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Kidneys

Long standing Hypertension may cause proteinuria and

progressive renal failure by damaging the renal vasculature.

Malignant or (accelerated' phase Hypertension

This rare condition may complicate Hypertension of any

etiology and is characterized by accelerated micro vascular damage with

necrosis in the walls of the small arteries and arterioles and intravascular

thrombosis. The diagnosis is based on evidence of high blood pressure and

rapidly progressive end organ damage such as retinopathy of grade three or

four, renal dysfunction, hypertensive encephalopathy. Left ventricular

failure may occur and if this is untreated, death occurs within months.

Approach to newly diagnosed Hypertension:

Hypertension occasionally causes headache but, provided there

are no complications, most patients remain asymptomatic. Accordingly, the

diagnosis is usually made at routine examination or when a complication

arises. A blood pressure check is adisable every 5 years in adults.

The objectives of the initial evaluation of a patient with high

blood pressure readings are:

• To obtain accurate and non representative measurements

of blood pressure

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• To identify contributory factors and any underlying

cause (Secondary Hypertension)

• To assess other risk factors and quantify cardiovascular

risks

• To direct any complications regarding target organs that

are already present

• To identify co-morbidity that may influence the choice

of Antihypertensive therapy

These goals can be usually attained by a careful history,

clinical examination and some simple investigations.

Clinical assessment and investigations:

History

Family history, lifestyle (exercises, diet, smoking habits) and

other risk factors should be recorded. A careful history will also identify

these patients with drugs or alcohol induced Hypertension and may elicit

symptoms of other causes of Hypertension such as pheochromocytoma

(paroxysmal headaches, palpitation and sweating) and/or complications

such as coronary artery disease (e.g. angina, breathlessness).

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Examinatil'n

Radio-femoral delay (coarctation of aorta), enlarged kidneys

(polycystic kidney disease), abdominal bruits (renal artery stenosis), and the

characteristic facies and habitus of Cushing's syndrome are all examples of

physical signs that may help to identifY one of the causes of Secondary

Hypertension. Examination may also reveal features of important risk

factors such as central obesity, hyperlipidemia. Nevertheless the majority of

abn~rmal signs are due to the complications of Hypertension.

Non-specific findings may include left ventricular hypertrophy

(apical heave), accentuation of aortic component of the second heart sound,

and a fourth heart sound. The optic fundi are often abnormal and there may

be the evidence of generalized atheroma or specific complications such as

aortic aneUlysm or peripheral vascular disease.

Investigations

All hypertensive patients should undergo a limited number of

investigations. Additional investigations are appropriate in selected patients,

the list is given below.

Hypertension - investigations for all patients

• Urinanalysis for blood, proteins and glucose

• Blood urea, electrolytes and creatinine

• Blood sugar

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• Serum total and high density lipoproteins, cholesterol

• 12 lead ECG

Hypertension - investigations for specific patients

• Chest X-Ray (for detection of cardiomegaly, heart

failure, coarctation of aorta)

• Ambulatory BP recording to assess borderline or 'white­

coat' Hypertension

• Electrocardiogram to detect or quantify left ventricular

hypertrophy

• Renal ultrasound to detect possible renal disease

• Urinary catecholamine to detect possible

pheochromocytoma

• Urinary cortisol and dexamethasone suppression test to

detect Cushing's syndrome

• Plasma rennin activity and aldosterone to detect possible

primary aldosteronism

High Blood Pressure Symptoms:

High blood pressure usually causes no symptoms.

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Even if high blood pressure does cause symptoms, the

symptoms are usually mild and nonspecific (vague or suggesting many

different disorders).

Thus, high blood pressure often is labeled "the silent killer."

People who have high blood pressure typically don't know it

until their blood pressure is measured.

Sometimes people with high blood pressure have the following

symptoms:

• Headache

• Dizziness

• Blurred vision

• Nausea

People often do not seek medical care until they have

symptoms arising from the organ damage caused by chronic (ongoing, long­

term) high blood pressure. The following types of organ damage are

commonly seen in chronic high blood pressure:

• Heart attack

• Heart failure

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• Stroke or "mini stroke" (transient ischemic attack,

TIA)

• Kidney failure

• Eye damage with loss of vision

• Peripheral arterial disease

• aneurysms

About 1 % of people with high blood pressure do not seek

medical care until the high blood pressure is very severe, a condition known

as malignant Hypertension.

• In malignant Hypertension, the diastolic blood pressure (the

lower number) often exceeds 140 mm Hg.

• Malignant Hypertension may be associated with headache,

light-headedness, or nausea.

• This degree of high blood pressure reqUIres emergency

hospitalization and lowering of blood pressure to prevent

brain hemorrhage or stroke.

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It is of utmost importance to realize that high blood pressure

can be unrecognized for years, causing no symptoms but causmg

progressive damage to the heart, other organs, and blood vessels.

Factors that can't be changed:

Age: The older one gets, the greater is the likelihood of developing high

blood pressure, especially systolic, as your arteries get stiffer. This is largely

due to arteriosclerosis, or "hardening of the arteries."

Race: African Americans have high blood pressure more often than whites.

They develop high blood pressure at a younger age and develop more severe

complications sooner.

Socioeconomic status: High blood pressure is also more common among

the less educated and lower socioeconomic groups. Residents of the

southeastern United States, both whites and blacks, are more likely to have

high blood pressure than Americans from other regions.

Family history (heredity): The tendency to have high blood pressure

appears to run in families.

Gender: Generally men have a greater likelihood of developing high blood

pressure than women. This likelihood varies according to age and among

various ethnic groups.

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Factors that can be changed :Overweight (obesity): Obesity is defined

as having a body mass index (BMI) greater than 30 kg/m2. It is very closely

related to high blood pressure. Medical professionals strongly recommend

that all obese people with high blood pressure lose weight until they are

within 15% of their healthy body weight. Your health care provider can help

you calculate your BMI and healthy range of body weight.

Sodium (salt) sensitivity: Some people have high sensitivity to sodium

(salt), and their blood pressure goes up if they use salt. Reducing sodium

intake tends to lower their blood pressure. Americans consume 10-15 times

more sodium than they need. Fast foods and processed foods contain

particularly high amounts of sodium. Many over-the-counter medicines,

such as painkillers, also contain large amounts of sodium. Read labels to

find out how much sodium is contained in food items. Avoid those with

high sodium levels.

Alcohol use: Drinking more than one to two drinks of alcohol per day tends

to raise blood pressure in those who are sensitive to alcohol.

Birth control pills (oral contraceptive use): Some women who take birth

control pills develop high blood pressure.

Lack of exercise (physical inactivity): A sedentary lifestyle contributes to

the development of obesity and high blood pressure.

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Drugs: Certain drugs, such as amphetamines (stimulants), diet pills, and

some pills used for cold and allergy symptoms, tend to raise blood pressure.

When to Seek Medical Care :

One should call for health care provider if a routine blood

pressure measurement (during health screening) reveals systolic blood

pressure higher than 140 mm Hg, diastolic blood pressure higher than 90

mm Hg, or both.

Also care should be taken III case of any of the following

symptoms:

• Unexplained severe headache

• Sudden or gradual changes in vision

• Light-headedness or dizziness

• Nausea associated with severe headache

• Chest pain or shortness of breath upon exertion

It is needed to tell the health care provider if any family

member has or has had high blood pressure, heart attack, stroke, or kidney

failure.

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It is needed to go to a hospital emergency department if your

blood pressure is high when measured (for example, if your diastolic

pressure is greater than 100 mm Hg).

It is also needed to go to a hospital emergency department if

you have any of the following symptoms:

• Severe headache

• Unexplained dizziness of faintness

• Unexplained blurred vision or loss of vision (partial or

complete)

• Chest pain or breathlessness that is severe or occurs at

rest

• Unexplained sudden weakness or other symptoms of

stroke

Medical Treatment:

In about half of people with high blood pressure, limiting

sodium intake by eliminating table salt, cooking salt, and salty and

processed foods can reduce blood pressure by 5 mm Hg. Losing weight and

doing regular physical activity can reduce the blood pressure further.

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If these lifestyle changes and choices don't work, medications

should be added. The medications have been proven to reduce the risk of

stroke, heart disease, and kidney problems. Do not stop taking your

medications without talking to your health care provider.

Medications :

Medications most often prescribed for high blood pressure

include the following:

Water pills (diuretics):

Diuretics are used very widely to control mildly high blood

pressure, and are often used in combination with other medications.

They increase sodium excretion and urine output and decrease

blood volume. The sensitivity to the effect of other hormones in your body

is decreased.

Example - Hydrochlorothiazide (HydroDIURIL)

Beta-blockers:

Beta-blockers reduce heart rate and decrease the force of heart

contraction, thereby reducing the pressure generated by the heart.

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They are preferred for people who have associated coronary

heart disease, angina, or history of a heart attack, since they also prevent

recurrent heart attacks and sudden death.

Examples - Carvedailol (Coreg), metoprolol (Lopressor),

atenolol (Tenormin)

Side effects - Fatigue, depression, impotence, nightmares

Calcium channel blockers :

Calcium channel blocking agents work by relaxing the muscle

in the walls of the arteries.

They also reduce the force of contraction of the heart.

Examples - Nifedipine (Procardia), diltiazem (Cardizem),

. verapamil (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc),

felodipine (Plendil)

Side effects - Ankle swelling, fatigue, headache, constipation,

flushing

Angiotensin-converting enzyme (ACE) inhibitors:

ACE inhibitors stop the production of a chemical called

angiotensin II, a very potent chemical that causes blood vessels to contract,

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a cause of high blood pressure. Blockage of this chemical causes the blood

vessels to relax.

Examples - Captopril (Capoten), enalapril (Vasotec), lisinopril

(Zestril, Prinivil), quinapril (Accupril), fosinopril (Monopril)

Side effects are infrequent but sometimes they can worsen

kidney function and raise blood potassium levels, especially in patients with

damaged kidneys. ACE inhibitors sometimes cause dry cough and rarely

angioedema (severe swelling around the trachea/windpipe).

Angiotensin receptor blockers or ARBs :

ARBs work on receptors in tissues all over the body to prevent

uptake of angiotensin II, and therefore inhibit the vasoconstrictor effect of

angiotensin II.

Examples - Losartan (Cozaar), valsartan (Diovan), candesartan

(Atacand), and irbesartan (Avapro)

Side effects tend to be less with ARBs than ACEls with much

less cough.

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Alpha-blockers :

Alpha-blockers relax blood vessels by blocking messages from

the nervous system that cause muscular contraction.

Examples - Terazosin (Hytrin), doxazosin (Cardura)

Since publication of a study known as the ALLHA T

(Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack

Trial) in 42,000 patients, and premature termination of the alpha-blocker

arm (discontinuation of treatment in the group receiving alpha-blockers)

because of excessive incidence of congestive heart failure, alpha-blockers

are no longer frequently prescribed and are primarily used in men with

associated prostatism (benign prostatic hyperplasia, or enlargement of the

prostate) symptoms.

Blockers of central sympathetic (autonomic nervous) system:

These agents block messages out of the brain from the

autonomic nervous system that contract blood vessels. The autonomic

nervous system is the part of the nervous system that is automatic and

controls heart rate, breathing rate, and other basic functions.

The effect of these drugs is to relax blood vessels, thus

lowering blood pressure. These agents are not as popular because of

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exceSSIve side effects, and no randomized trials demonstrate their

effectiveness in lowering heart attacks, strokes, etc.

Example - Clonidine (Catapres)

Direct vasodilators:

Direct vasodilators dilate the blood vessels to allow blood to

flow under lower pressure.

These medications are often given through an IV line in an

emergency (that is, in malignant Hypertension).

Examples - Nitroprusside (Nitropress), diazoxide (Hyperstat).

Oral medications are hydralazine and minoxidil.

Surgery :

Rarely, surgery is needed to remove benign, hormone­

producing tumors of the adrenal gland. If a narrowing of a renal artery is

discovered, sometimes a balloon dilatation, followed by placement of a

metal stent, is done in the invasive vascular laboratory.

Other Therapy:

Alternative therapies may be helpful to people trying to control

their blood pressure.

87

Acupuncture and biofeedback are well-accepted alternative

techniques that may help some people with high blood pressure.

Techniques that induce relaxation and reduce stress are

recommended. These include meditation, yoga, and relaxation training.

These techniques alone will not keep the blood pressure in the

healthy range for many people. They are not used as a substitute for medical

therapy.

Dietary supplements and alternative medications and therapies

are sometimes recommended for high blood pressure.

Examples are vitamins, garlic, fish oil, L-arginine, soy,

coenzyme QI0, herbs, phytosterols~ and chelation therapy.

While these substances may be beneficial, the exact nature of

their benefits is not known.

Scientific studies have produced no evidence that these

therapies lower blood pressure or prevent the complications of high blood

pressure.

Most of these substances are harmless if taken in moderate

doses. Most people can take them without problems.

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Apparatus:

1. Cuff - it consists of an empty rubber bag, rectangle in shape, measuring

about 18 x 12 cm. It beats two tubes. It is wrapped in silk or linen covering

bag.

2. Tubes of cuff - one of the tubes is connected to mercury manometer and

other to hand pump.

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3. Mercury manometer - it is U-shaped glass tube with one long calibrated

arm and other short well-shaped thick arm filled with mercury. One tube

from cuff is connected to calibrated arm of mercury manometer so pressure

of inflation of rubber bag is recorded directly on manometer.

4. Hand pump - it bears valve for pushing air when desired. It is directly

connected to cuff. Hence pushed air enters bag and inflates it pressing

brachial artery around which it is wound.

Methods:

1. Palpatory method.

2. Auscultatory method.

J. Oscillatory method.

1. Palpatory method:

1. Cuff ofB.P. apparatus is wound around brachial artery four fingers above

cubital crease so as to expose cubital fossa.

2. Cuff is connected to mercury manometer of shygmomanometer.

3. Radial pulse of same upper extremity to which cuff is tied is palpated

with three fingers.

4. With the help of hand pump, closing valve of pump, air is pushed into

cuff inflating it against brachial artery. B.P. cuff is inflated to around 200

mm Hg. While deflating the cuff, mercury manometer is constantly

observed.

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5. Pressure at which radial pulse IS no more palpable IS recorded as

'approximate systolic pressure' .

Diastolic pressure is not measured by this method. This is

because once radial pulse is re-established at systole and continues being

palpable throughout deflation.

1. Auscultatory method:

1. Cuff is inflated to 20 mm Hg. above approximate systolic pressure

decided by palpatory method.

2. Chest piece of stethoscope is kept on brachial artery and valve of

hand pump is released.

3. While cuff is deflated, sounds over brachial artery are heard carefully.

First sound heard is clear tap sound of systolic pressure. This IS

because of gush of forcing blood, hitting wall of empty vessel.

4. Due to occlusion in flow of blood, Eddie currents produce sounds

like murmur, which last for sometime while deflation is continued,

get muffled, and stop. These are called Korotcoff s sounds. Pressure

at which these stop is diastolic pressure. This is because normal

laminar flow of blood is established in artery, which is soundless.

5. In patients where systolic pressure is high sometimes while

deflating the cuff, the blood hits walls of empty vessel and gives first

systolic tap, as usual. A few sounds may be heard following this tap,

which are not strong. At lower pressure than the first systolic tap,

91

strong sounds start becoming audible through stethoscope. For a

beginner, this lower tap is many times approximate systolic pressue.

The gap between real systolic tap and reappearance of strong sounds

is called 'auscultatory gap'.

ntlatabltl-·~"~' cuff

How to overcome 'auscultatory gap'?

No sQunds (artery is closed)

sound$, are ooafd with $t~osoopt\

Palpation of radial artery after deflation of cuff helps in

estimating real systolic blood pressure. Whenever one feels auscultatory

gap, one should go for palpation of radial artery to overcome misjudgment

of systolic blood pressure.

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2. Oscillatory method:

Cuff of apparatus is wound over brachial artery on upper arm.

Cuff is inflated to around 200 mm Hg. then it is deflated slowly. Mercury

column of manometer is observed while this deflation takes place. At a

certain pressure, oscillations are noticed to appear, in the mercury column.

This pressure is recorded as systolic pressure. After sometime, these

oscillations disappear. At this time, pressure recorded is diastolic pressure.

93