Achar Rasayana in Cardiac Health
Dr. Vikas Chothe
PG Scholar, Department of Swasthavritta (PSM), College of Ayurveda and Research Centre, Akurdi, Pune.
Email:vchothe@gmail.com

Abstract:
Coronary heart disease (CHD) is the leading cause of death in India .This article attempts to study the efficacy of Achara Rasayana and Art therapy in the modification of cardiovascular risk factors. Stress , , alcohol , , and smoking , are important determinants of coronary heart disease and diabetes. Ayurveda considers the functions of heart and mind inter-linked. By adoption of ethical elements mentioned in 'Achara Rasayana' like following a sattvik diet and life style, speaking the truth, practicing non-violence, living in harmony with the nature, following social ethics, conducts and incorporating nonconventional form of psychotherapies such as Art therapy into the comprehensive cardiac rehabilitation program definitely would enhance efficacy and add value.
Keywords: Coronary heart disease (CHD), Stress, Achara Rasayana, Art therapy


Introduction
The branch of rasayana or rejuvenation is one of the eight specialized branches of Ayurveda. The literal meaning of rasayana is “augmentation of rasa”, the vital fluid produced by the digestion of food. A type of rasayana is described for psychological and spiritual health called as “Achara rasayana”, where Achara” literally means “discipline”. Art therapy for the reduction of stress and mood elevation was used in Ayurveda, now has also been proven to be positive and highly influential . Hence compared to western medicine Ayurveda is a holistic science with equal focus on the body, mind, and soul and fuller link between health and broader social and family well-being.
India has one of the highest burdens from CVD in the world and the number of deaths attributed to CVD is expected to increase from approximately 2.3 million in 1990 to more than double this number by 2020. In an age where there is increasing dependency on pharmacotherapy, which is expensive and not always without side effects, for the management of congestive heart disease and diabetes, introduction or integration of Achar Rasayana (Ayurvedic lifestyle interventions) and art therapy may be of tremendous benefit. The American Heart Assosiation also states that there is a great need to optimize dietary and lifestyle factors in high-risk persons and in cardiac patients.

Causes of heart disease in Ayurveda
Vayaam tikshna ati virechak vasti chinta bhay trasgada atichaara
Chardaam sandharan karsonani haidogkartani thataabhigath
[Charak chikitshasthan xxvi/70 ]

Physical exertion, drastic & excessive purgation & enema, anxiety, fear, terror, and suppression of vomiting & ama are some of the important causes of heart diseases according to Ayurveda.
Modifiable Cardiovascular risk factors
World Heart Federation (2011) has associated many risk factors with coronary heart disease and stroke. The major risk factors, tobacco use, alcohol use, hypertension, high cholesterol, obesity, physical inactivity, unhealthy diets are modifiable. A chronically stressful life, social isolation, anxiety and depression increase the risk of heart disease and stroke.
Tobacco
Heavy smoking is responsible for CHD in a good number of cases. An estimated 34.7% of all deaths resulting from cigarette smoking are related to CHD. Prospective cohort studies have showed a strong, graded relationship between cigarette smoking and coronary heart disease. Passive smoking is also a risk factor for cardiovascular disease. Stopping tobacco use can reduce risk of cardiovascular disease significantly . For those who have a myocardial infarction, the risk of fatal recurrence may be halved after cessation of smoking .
Alcohol
Rimm et al observed that the relation between alcohol consumption and risk of CHD was causal, and alcohol abuse increases the risk for diabetes too.
Stress
Interestingly, stress has long been suspected as having important effects on the development of CHD.
The Concept of Stress
Selye has defined stress as “the nonspecific response of the body to any demand,” with the body going through three universal stages of dealing with the alarm phase (Cannon’s fight-or-flight), the resistance phase (in which resistance to the stress is built), and the exhaustion phase (when the duration of stress is sufficiently long), together encompassing the “general adaptation syndrome.”
Stress, Anxiety and risk of CHD
Napoleon's favorite physician, Corvisart, wrote that heart disease was due to "the passions of the mind", among which he included anger, madness, fear, jealousy, terror, love, despair, joy, avarice, stupidity, and ambition. The Menningers suggested that coronary heart patients tended to be very aggressive. Wolf characterized people who were coronary prone as constantly striving against real but often self-imposed challenges, and even if successful, not being able to relax or enjoy the satisfaction of achievement. Such individuals exhibited certain characteristic activity patterns, including, a sense of guilt while on vacation or relaxing, a competitive attitude that often creates challenges even when none exist, hyperactive responsiveness, unsatisfactory interpersonal relationships, self-centered and poor listening behavior. It was also noted that coronary prone patients tend to be in a hurry and consequently eat, talk, walk and do most other activities at a more rapid pace.
Also Studies of Rod et al. showed that participants who had reported high levels of stress compared to those with low levels of stress were less likely to quit smoking and less likely to stop drinking during follow-up.
Depression and the Risk of CHD
According to researchers at Washington University School of Medicine in St. Louis, depression increases the risk of heart disease more than genetics or the environment.
Work Stress and the Risk of CHD
Numerous surveys confirm that occupational pressures are far and away the leading source of stress and that job stress has escalated progressively over the past four decades. The clear link between job stress and cardiovascular disease is scientifically demonstrated by Karasek and Theorell too .
Distressed Sleep and the Risk of CHD
Poor sleep can be an important indicator of emotional stress. Cappuccio et al. (2010) tested whether habitual sleep disturbances were associated with a higher incidence of type 2 diabetes and heart diseases.
Intervention Program according to Ayurveda
Achar Rasayana (Disciplined lifestyle)
Ayurveda has two main aims – one is to maintain health and the second is to cure disease. Risk factors for diabetes and CVD are similar, and most can be effectively decreased by lifestyle modification. Rasayana is defined as any herb, food, or activity which confers youthfulness and cures diseases. If taken in a proper way, the rasayana prevents early aging and keep people young and active both physically and mentally, thus preventing CVD and diabetes.
The Aim Of Rasayana:
Stress can cause accelerated atherosclerosis and coronary occlusion. Stress-related sympathetic nervous system drive and catecholamine secretion are the major culprits in coronary heart disease . Different emotions have powerful influences on the heart and the mind-heart connection in ayurveda is hardly new. Hence the heart rather than the brain (limbic system) was the seat of the mind and soul according to Ayurvedic texts and ancient Hindu scriptures.
Rasayana therapy enriches nutritional quality of Rasa, enhances digestion and metabolism by normalizing agni or body fire, and promoting the competence of channels. It is very essential for a person who wishes to undergo rasayana therapy to undergo samshodhana (detoxification) as a preparatory procedure. A detoxified body and mind is a like a clean cloth which readily absorbs the color in which it has been dipped unlike a soiled cloth which looks soiled even after coloring with best colors. But when a person is not eligible for samshodhana or is not able to get samshodhana then he can also consume rasayana preparations which still boost the qualities of rasa in his body.
Benefits of Rasayana:
The main purpose of Rasayana therapy is to retard the aging process and to delay the degenerative process (atherosclerosis?) in the body. With enriched excellent Rasa, one attains longevity, memory, intelligence, freedom from disorder, youthfulness and excellence of luster, complexion & voice, optimum development of physique and sense organs, mastery over phonetics, respectability and brilliance. Hence by following Achara Rasayana one can be more Satwic (pure) and surge ahead in the spiritual field. Chastity, integrity, sympathy towards all objects around us – both living and non living and obligation to society are some other rules to be followed in Achar Rasayana which will help in stress management.
Hence an Ayurvedic healthy lifestyle is defined as no smoking, no consumption of excess alcohol or any other drug abuse, following the rules relating to eating, sleeping, and celibacy. In addition, following a sattvik diet and life style, speaking the truth, practicing non-violence, living in harmony with the nature, following social ethics and conducts, are all included under the category of Achara rasayana (healthy lifestyle). Following these principles leads to formation of high quality dhatus (tissues) and increases the quantity and quality of ojas, a vital factor for health and immunity. Hence, lifestyle modification as prescribed by Ayurveda, is effective in the improvement of many cardiovas¬cular risk factors.


Art Therapy
Art therapy is a mind-body interaction, which offers an opportunity to explore intense or painful thoughts, dreams, and feelings in a supportive environment. Ranging from ancient rock cave paintings at Bimbetaka and mandalas to new aged clinical therapy, art has been used for stress reduction in Ayurveda. Chitra sutra from Vishnudharmottara Purana states that a painting cleanses and curbs anxiety, augments future good, causes pure delight and banishes the evils of bad dreams. The art therapy involves almost every form of art, from painting to collage making, and drawings with a main objective of reaching and comprehending some of the inner thoughts.
One of the main benefits of art therapy is that it can help to reduce stress levels through symbolizing the cause of stress, processing it therapeutically, sublimating and discharging unhealthy unwanted feelings which could otherwise be harmful. Art therapy allows for new ways to explore creativity, and lead to managing stress. Art Therapy can benefit people by providing a bridge between their inner thoughts and feelings and communication with others. The art work helps to open up communication and increase self awareness. Researchers confirm that art therapy can indeed play a role in reducing symptoms of anxiety and fear because creative play provides a form of distraction that takes patients away from their suffering, by getting them to focus on something positive, unrelated to their health, yet somehow benefiting their health in the long run. A 2007 study found that Anthroposophy art therapy intervention leads to substantial improvement in depression, anxiety or fatigue during chemotherapy . It is a great resource for getting out those feelings which can often be harmful when not expressed. With alternative medicine becoming a preferred way to dealing with CHD, art therapy is shown to be an excellent add-on non-pharmacological intervention, beneficial for reducing stress-related behaviors.
Many a times it has happened that a frustrated, depressed or stressed person seeks refuge in drug and alcohol, in the course of overcoming a failure of life. The primary goal of art therapy is to break down the clients’ resistance to substance abuse treatment during art therapy sessions. .Forrest (1975) spoke of art therapy within substance abuse treatment as an ideal mode of emotional self-expression. Art Therapy gives them an aperture to interact with fellow people. Diane Waller(Waller, Pleven, & Groterath, 1999) reported that art therapy had increased participants creativity through art interactions during art sessions. Springham stated that the ideal treatment goal for the art therapist is to try to help the patient conceive of both good and bad aspects of the substance, which will make patient, realize the harm caused by substance abuse. Reduction of smoking and alcohol through art therapy thus leads to the improvement of many cardiovas¬cular and diabetes risk factors.
Result and Discussion
Emotional stress was found to be associated with unhealthy lifestyle behaviors, i.e., inadequate eating behaviors in terms of quality and quantity of food, low exercise levels, smoking and alcohol abuse increasing the risk for diabetes and cardiovascular diseases. All therapies in Ayurveda aim to provide complete health – physical, mental, and spiritual - so that people can engage in achieving the real goal of self-realization. The rasayana therapy makes it easily possible with its remarkable benefits on health, immunity, and longevity. The results of large comprehensive controlled trials in high-risk persons and secondary prevention trials in cardiac patients both have showed that substantial reductions in the risk for coronary heart disease can be obtained by dietary and lifestyle changes as mentioned in Achar Rasayana; aerobic exercise; stress management through art therapy; smoking cessation and group social support. , ,
Art therapy is an established therapeutic modality used by many mental health practitioners today, specifically aimed to reduce anxiety and elevate mood. Art therapy provides stress relief, works to ameliorate depression, affords patients a sense of control in an otherwise overbearing and chaotic medical environment, and allows fun through manipulation of art mediums.

Conclusion
In general, the research findings described in this review support the notion that different forms of emotional stress, smoking and alcohol are associated with an increased risk for the development of cardiovascular diseases. Ayurveda is not just a system of medicine for treating diseases but also a science designed to increase our well-being and happiness in all aspects. Good social conduct, morality, good manners and good character are some other factors which are necessary to stay away from diseases. Art therapy and following principles of Achar rasayana (Ayurvedic Lifestyle modification) have been effective in the improvement of many cardio¬vascular risk factors and perhaps are the best choice in preventing cardiovascular diseases. Further evaluation of the Achar Rasayana and Art therapy for cardiac health is needed to shed more light on this important question.

Acknowledgement
First and foremost, my utmost gratitude to Dr. Atul Rakshe who has been my inspiration as I hurdle all the obstacles in the completion of this research work. Thanks for all my teachers and colleagues of CARC, Akurdi who helped me in organizing the data and proof reading my manuscript.