An Introduction of the Drugs of Hridya Mahakashya (Group of Cardio Tonics Drugs) and its Mode of Action

Ayurveda defines health as a state of physical, men tal, i tellectual and spiritual well-being. Nowaday s, life has become so erratic that everybody is in hur ry and is stressed. This life style has a direct im pact on the health especially on the heart. Thus cardiovasc ul r diseases pose an alarming threat to global hea lth. Large number of herbs are mentioned in Ayurveda as Hrida i.e. beneficial for heart. In this study I have discussed about the herbs that are mentioned in Hridya Mahakashya (Group of cardio tonics drugs). Acharya charaka has mentioned the Hridya Mahakashaya in his classification .This is a group of ten drugs i. e. beneficial for heart. All ten drugs are Amla Rasa Pradhana (sour in taste) and rich source of vitamin c. Vitamin c is proved to be a potent antio xidant as well as a good stress buster. The aim of this article is putting forward the brief accounts and p robable mode of action of these drugs mentioned in Hridya Mahakashaya.

Cardiovascular diseases pose an alarming threat to global health. Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India. A quarter of all mortality is attributable to CVD. Ischemic heart disease and stroke are the predominant causes and are responsible for >80% of CVD deaths. The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100 000 population in India is higher than the global average of 235 per 100 000 population (Prabhakaran et al., 2016).

Ayurvedic aspect of Hridya (Heart)
The word Hriday is composed of three syllables, i.e. hri+da+ya=hriday. The first syllable denotes the suction activity of Hriday (Hridayam i.e. venous return), second points out the pumping activity of Hriday (Samvardhanam i.e. supply of oxygenated blood) and lastly the third syllable means control of these above two functions (Yama). According to Ayurveda, Hriday is the best place of chetnayata (consciousness) and oja. Charak has stated that heart is the seat of consciousness which is primarily a function of the brain (Charak Su. 30/7). Hriday is the place of origin of two equally important Srotasas i.e. Pranavaha srotas and Rasavaha srotas . Rasavaha srotas is responsible for converting the Aahar Rasa to Rasa Dhatu and providing nourishment to all other body constituents and Pranvaha srotas is responsible for uninterrupted supply of the Ambarapeeyush (oxygen) through breathing. Rasa Dhatu is the first tissue emerging out of the nutritive fluid Aahar Rasa. Rakta circulates with Rasa all over the body and is responsible for Jeevan Karma, sustaining the life processes by supplying Pran to all body constituents. Rasarakta complex is essential for the continuation of life. The human body is nourished by Shuddha rakta circulated by Hriday with the help of Vyanavayu (Arif al el., 2018).
In Ayurvedic text word "Hridya" is generally used for the drug which is beneficial for the heart "Hridya Hitam Hridyam". (Charak Su. 4/10). Thus Hridya means Cardiac tonic, the drugs which are helpful in maintaining the cardiac health are called as Hridya. Acharya Charak classified the drugs based on their pharmacological action in fifty Mahakashaya (class). One of them is Hridya mahakashaya the group of ten drugs which are beneficial for heart.

Objective of the study
To review the literature of Hridya Mahakashay and Hridya Karma.

MATERIALS AND METHODS
Systematic review has been made from possible texts of Ayurveda and other authenticated texts to gather information regarding Hridya Mahakashay and Hridya Karma.

Literary review of the drugs of Hridya Mahakashaya:
Amra (Mangifera indica Linn): Mangifera indica is commonly known as mango belongs to anacardiaceae family. Normally height of the tree is about 20 m. It is native to tropical Asia and has been cultivated in the Indian subcontinent for over 4000 years. The seed and bark are mainly used in the Ayurvedic text. Sour fruits are considered to be Hridya and ripen fruits are brimhana (nourishing) in nature. Its leaves are mentioned under 'Pancha Pallavas' (Sastry, 2012). Its Major chemical constituents are Mangiferin, Mangiferolic acid, indicenol (Sharma et al., 2017). Mangiferin, being a polyphenolic antioxidant and a glucosyl xanthone, it is a strong antioxidant, anti lipid peroxidator, immunomodulator, cardiotonic, hypotensive, wound healer, and antidiabetic. The fruit pulp contains vitamin A and C, β-carotene and xanthophylls. Thus Fruits of mangoes are good source of antioxidants in human diet and are beneficial for heart (Hasan et al., 2014).

Aamratak (Spondias mangifera (Linn. F. Kurz.)
Spondias mangifera is also known as wild mango or Ambara. It belongs to Anacardiaceae family. It is an evergreen as well as deciduous tree which is distributed throughout India, Sri Lanka and South-East Asian countries. The tree has a strong, stout trunk having a smooth ash-coloured bark; having 27 meters of height. The Flowers are bisexual and fruits are yellow in colour; with fleshy pulp which is finely flavoured and edible. The seeds bear ridges and have hard and fibrous surface. S. pinnata is the species which grows well in light abundant areas. The fruits when unripe are often used for making pickles. Almost all parts of the plant like young leaves, flowers and fruits are edible.
In Ayurveda, it has been used as a potent medicine in case of haemorrhagic diseases. The unripe fruits were used as an aphrodisiac. The fruit juice is useful antiscorbutic. The fruit pulp cures rheumatism and is used in bilious dyspepsia. The fruit is a valuable source of vitamin C, vitamin A and Iodine. The fruit contains sucrose, glucose, and fructose. The fruit is found to contain betaamyrin, oleanolic acid and amino acids-glycine, cystine, serine, alanine leucine; and polysaccharides (Bora et al., 2014).
In a study conducted on fifteen edible fruits found in Nepal; it was found that S. pinnata showed a more potent free radical scavenging activity than Vitamin C. The extracts of S. pinnata showed a 16% radical scavenging activity at 5µg/mL whereas Vitamin C only showed 5% radical scavenging activity at 5µg/mL (Chalise et al., 2010;Hazara et al., 2008). The exocarp of the fruit of S. pinnata also produced significant thrombolytic activity (Bora et al., 2014).

Lakucha (Artocarpus lakoocha)
It belongs to Moraceae family and commonly known as barhala. It is called Monkey Jack in English and in Ayurveda it is called Lakuch, Kshudra Panas, Granthiphala and Pitanaasha. It is a medium to large deciduous tree dropping its leaves for a short time at the beginning of the dry season. Fruit is a syncarp (the entire female inflorescence forms a fruit), irregularly rounded, green when young, turning yellow at the time of maturity, later brown. The size of fruits differ with the diameter of 5-10 cm and their weight varies between 200-350 g. The number of seeds per fruit varies between 10-30 . In most places Ripe fruits are collected at the end of June to early August. It is found on the western coast of Konkan Kerala and Tamil Nadu.

Karamarda (Carissa carandas Linn.)
It is a common herb of Apocynaceae family found throughout India mainly in the semi-arid regions. It is commonly used as a condiment or additive in Indian pickles and spices. Traditionally the plant has been used in the treatment of scabies, intermittent fever, anemia etc. In Ayurveda text it is described as pita-samirjit (allivate vata and pitta dosha) and it is used in the treatment of toxicity and liver disorders children (Pandey, 2012,p.81-82). Recently many other biological activities are reported such as analgesic, anti inflammatory, anti pyretic, cardiotonic and histamine releasing. Additionally it has shown wide range of evidences for its, hepato-protective, free radical scavenging, anti-rheumatic, antibacterial, antiviral and anticonvulsant activity. The results of many studies suggest that C. carandas fruit extract was the most potent antioxidant as it exhibit exceptional reducing power, scavenging activity against nitric oxide, DPPH and peroxide radicals (Arif et.al. 2016).

Vrikshamla (Garcinia indica)
It is commonly known as kokum and it belongs to guttifereae family. It is a beautiful evergreen tree mainly found along the western coast of the Konkan, Goa, and Kerla. It is cultivated commercially. The tree blooms between November to February and the fruits ripe in April-May. The berries are usually deep purple to pink in colour and occasionally whitish. These are of lemon size. The fleshy rind of the fruit is juicy and acidic.
It contains the important chemical constituents viz, Garcinol, Hydroxycitric acid and Anthocyanin pigment. Anthocyanins are well known for their antioxidant, anti-inflamatory, and anti-carcinogenic activities (Shrikant et al., 2014). In Ayurveda, it is used for treating piles, sprue, abdominal disorders, and cardiac disease, etc. According to Acharya charak it is beneficial for vata-shleshmic disorders (Sharma, 2003). Deore.et al. reported the antioxidant and hepatoprotective effect of aqueous and ethanolic extract of G. indica fruit rind (Elumalai & Eswaraiha, 2011).

Amlavetas (Garcinia pedunculata Roxb.)
Garcinia pedunculata is a plant found in northeast region of India and belongs to Guttiferae family. It is considered to have versatile therapeutic properties. It is used by the people of this region as a medicinal plant for healing different gastrointestinal disease. G. pedenculata is a rich source of Flavonoids, Xanthones, Benzophenones and phenolic acids. It has been revealed that G. pedenculata have beneficial antioxidant properties (Sharma et al., 2016).
It is mentioned under Phala varga by Charaka. According to him it is mild purgative, and alleviates vata and kapha dosha. It is indicated in colic, stone, indigestion (Sastry, 2012, p.657) Kola Ziziphus jujuba Kola consists of dried fruit pulp (devoid of seed) of Zizyphus mauritiana Lam. Syn. Z. jujuba Lam. (Fam. Rhamnaceae); is a small, evergreen subdeciduous tree, wild and also extensively cultivated throughout the country and is found in Himalayan region upto about 1370 m. The plant Ziziphus jujuba is also known as Desi Ber. Fruits of kola contain vitamin C, sugar and minerals. It is sweet, sour and astringent in taste. It is a good appetizer and digestive. It alleviates Vata dosha. (API, 2006, Part-1, Vol.3, p.94-95) It is used in traditional medicines as laxative and blood purifier. Several research papers have shown various activities of fruit Ziziphus jujube such as antioxidant, antimicrobial, anti inflammatory, and anticancer. Chemically, Ziziphus jujube contains Flavonoids, Saponins, tannins, Vitamin A, Vitamin B, sugars, mucilage, calcium, phosphate & iron. Ziziphus jujube fruits are very rich in vitamins C, B1 and B2. It is also known to have high vitamin P content, which enhances the action of vitamin C. Presence of Pectin-A in Ziziphus jujube fruit is also reported (Hasan et al., 2014).

Badar (Ziziphus sativa Gaertn)
Ziziphus sativa known as Unnab in Unani medicine belongs to the family Rhamnaceae and is widely used in traditional system of medicine as fresh and dried riped fruit. It is a shrub or small deciduous tree, up to 12m in height, sometimes a large bush, found both cultivated and wild. Unnab or Ber is used as edible fruit and also used medicinally in Ayurvedic system. Medicinally, it is used as an expectorant, stomachic, digestive, laxative, blood purifier and anti pruritus. Its phytochemical constituents are Vitamin C, alkaloids, glycosides, flavonoids, terpenoids, phenolics and polysaccharides. Research studies showed its pharmacological activities like antioxidant, immunomodulatory, antiinflammatory, antiulcer, antiallergic, antifungal, antidiarrhoeal, antidiabetic and wound healing etc. The fruit is cooling, digestible, tonic, aphrodisiac, laxative and removes biliousness, burning sensations, thirst, vomiting etc. and is also good in treating tuberculosis and blood diseases. The fruit is employed as an antidote to aconite poisoning (Talib et al., 2017).

Dadim (Punica granatum Linn.)
It is commonly known as Pomegranate belonging to the family Lytheraceae. It is native from the Himalayas in northern India to Iran nowadays it has been cultivated all over India. The Pomegranate tree typically grows 12 to 16 feet high, and has many spiny branches. According to Ayurveda it is Balya (providing strength), Medhya (brain tonic), Shukralam (having aphrodisiac effect), and Hridya (cardiac tonic) and it is indicated in Atisara (diarrhea), jwar(fever),Aamvat (arthritis),Kasa (cough), Raktpitta (bleeding disorder) etc (API, Part-1, Vol.4).
The fruit contains many seeds separated by white, membranous pericarp and each surrounded by small amounts of tart, red juice. Fruits are believed to be a potential source of natural phenolics that has been associated with reducing the risk of cardiovascular diseases. Phytochemical analysis of Punica granatum indicated the presence of alkaloids, flavonoids, cardiac glycosides, phenolic compounds, tannins, lignins, etc. Pomegranate juice is rich in Vitamin C, flavonoids like Punicalgin, tannins, possesses anti-atherosclerotic action, and has an anti-aging effects and potent anti-oxidant properties. These compounds are responsible for antioxidant and free radical scavenging effect of plant material (Arif et al., 2018).

Matulunga (Citrus medica Linn.)
It is commonly known as Citron and Bara nimbu, belongs to family Rutacae. It is an evergreen shrub/small tree about 3.6 m high with short, thick and thorny branches cultivated throughout warm moist regions in India. It contains secondary metabolites including the ascorbic acid, flavonoids, phenolics and pectin etc. The fruits and seeds are cardiac tonic. Fruit extracts have also shown good umbelliferone, while seeds contain limonin, limonol and antioxidant activity (Nagaraju et al., 2012). In ancient medicine, it is very commonly used in the management of Agnimandy (Poor digestion), Raktapitta(Bleeding disorder), Vibandha (constipation), Shawas (Asthma), Kasa(cough), Aruchi (anorexia) (API, 2006, Part-1, Vol.3, p.).

Hridya karma (cardio tonic action)
We have observed that all plants mentioned in Hridya mahakashya are amla rasa pradhan (mainly sour in taste) as well as contain a large amount of vitamin C and Flavonoids.

Hridya action (cardio tonic action) of Amla rasa
Acording to Achrya Charak renounced physician of Ayurveda, Amla rasa nourishes the heart (Charak su. 26/42-2) as well as as it is the best among Hridya. (Charak su. 25/) This view is further sustained with the description of group of ten plants which are good for heart i.e. 'Hridya Mahakashaya' Under this group, only the plants possessing sour taste fruits are quoted.
Drugs of Hridya Mahakashaya' breakdown the Samprapti (pathophysiology) of Hridroga by means of its virtues as described above. As Amla rasa is composed of Agni and Prithvi Mahabhutas, it is Agneya in origin (Ashtang Sangrah, Su.18/4) allied with Snigdha (unctuous), Laghu (light) Gunas (Ashtang Sangrah, Su.18/9) and Ushna virya (hot potency) (Ashtang Sangrah, Su.17/9) By virtue of above mentioned properties Amla rasa performs the function of Agni deepan (stimulating Agni) and Anuloman and thus Amla rasa makes the channels potent to carry on the nutrients to subsequent Dhatus as per the chronological order mentioned in Ayurveda. In this way it encourages the organic metabolism and improves structural & functional form of tissues. Amla Rasa and Rakta dhutu (blood) comes under the similar category i.e., both have the domination of Agni Mahabhuta. So Amla Rasa aggravates blood and it is useful in Rakta Kshaya (anaemia). In Ayurveda, Amla Preeti (desire for sour taste) is described as a specific symptom of Rakta Kshaya (anemia).
In Hridyaroga the predisposing factors causes generation of Aam, contamination of Rasa and vitiation in Doshas creating obstruction in Rasavaha srotasa leading to provocation of Vata. This also results in diminished supply of Pranvayu and nutrition to Hriday. Amla ras, brings Vata in its normal state and proper channel due to its specific Karma (action) i.e. Vatanulomana as well as Amla rasa helps in the opening of channels by its ushna veerya (hot potency).
The clear channels facilitate Dhatu Poshana (Tissue nourishment) as well as production of Ojas (a factor which increase immunity). Amla rasa works as oxidative as it helps to bring the vitiated Vayu in its healthy states and pacifies Ama and thus Drugs of Hridya Mahakashay being amla ras pradhan, play a major role in maintaining healthy heart.

Modern Aspect of Hridya karma (cardio tonic action)
Most of the degenerative diseases are caused by free radicals. Antioxidants are the agents responsible for scavenging free radicals. Antioxidants are specific phytochemicals, vitamins and other nutrients that protect our cells from damage caused by free radicals. The evidence of vitamin C's beneficial effects on the heart proved an association between high blood levels of vitamin and a healthy cholesterol profile. Vitamin C is found to increase HDL and decrease LDL to considerable level (Sharma, 2003). Vitamin C has potent antioxidant property. It reduces free radicals by directly binding to oxidizing chemicals and converting them to less harmful molecules. Vitamin C is proved to be a potent antioxidant in addition it is also a good stress buster. Role of vitamin C in improving the cardiac structure and functions is very clear from various studies (Akolkar et al., 2017). Drugs of Hridya Mahakashaya are Amla Rasa Pradhana (dominating) and rich source of vitamin C. Therefore the drugs of Hridya mahakashaya act as Hridya (cardiotonic).

CONCLUSION
Today the mortality and morbidity rate due to cardiovascular diseases is a worldwide issue. Ayurveda offers satisfactory management strategies for CVD through preventive and curative approaches. Researches on organ targeting and low toxic effects drugs are the need of time. All drugs of Hridya mahakashya are the cheapest and easily available dietary fruits which contain rich Vitamin C and flavonoids and have potent anti-oxidant properties. By means of Amla rasa all these ten drugs perform the function of Agneesandhukshana and Dhatwagnideepana (improves digestion and metabolism). It brings the vitiated Vayu in its healthy state and pacifies Ama and thus helps in breakdown of the pathophysiology of Hridyarog. From this exhaustive literature review it is concluded that drugs mentioned in Hridya Mahakashaya are all Amla rasa predominant and rich in vitamin C and flavanoids and thus these are beneficial for heart.