Recurrent coronary blockages following PTCA present a significant clinical challenge, often signalling that the root metabolic and doshic imbalance remains unaddressed by conventional intervention alone. This case report documents a 67-year-old male patient who developed recurrent blockages within eight months of PTCA, presenting with chest pain, burping, and impaired lipid parameters despite ongoing allopathic medication. Through an integrative Ayurvedic protocol combining Kalamegha (Andrographis paniculata) with supportive herbal formulations and weekly Panchakarma over three months, the patient achieved complete symptomatic resolution, significant improvement in exercise tolerance and echocardiographic parameters, and successful withdrawal of all allopathic medications — offering a compelling glimpse into the cardioprotective potential of classical Ayurvedic therapeutics.
Introduction
Cardiovascular diseases (CVDs) remain among the leading causes of morbidity and mortality globally. Despite significant advances in conventional cardiology, recurrence of coronary blockages following interventional procedures such as PTCA continues to challenge clinicians. In Ayurveda, disorders of the heart are collectively referred to as Hridroga, a broad category of conditions arising from the vitiation of doshas affecting the Hridaya (heart), which is considered the seat of Prana (life force), Ojas (vital essence), and the mind.
Classical Ayurvedic texts including the Charaka Samhita describe Hridroga as arising primarily from the disturbance of Kapha dosha and the accumulation of Ama within the cardiac channels (Hridaya srotas), manifesting as heaviness, chest discomfort, and impaired cardiac function. The involvement of Vata and Pitta doshas further complicates the clinical picture, contributing to irregular circulation, inflammation, and tissue damage.
Kalamegha (Andrographis paniculata), classified in classical pharmacology texts such as the Bhava Prakasha Nighantu, is described as Tikta (bitter) in Rasa (taste), Laghu (light) and Ruksha (dry) in Guna (qualities), Ushna in Virya (hot potency), and Katu in Vipaka (post-digestive effect). These properties make it a potent Kapha-Pitta shamaka (pacifier of Kapha and Pitta doshas) and a powerful Deepana-Pachana herb, capable of enhancing Agni (digestive fire) and reducing Ama. Its bioactive compound andrographolide has demonstrated anti-inflammatory, antioxidant, and lipid-lowering effects in experimental studies, supporting its potential role in cardiovascular protection.
This case report documents the clinical management of a patient with recurrent coronary blockages using an integrative Ayurvedic approach centered on Kalamegha, supplementary herbal formulations, and Panchakarma procedures.
Patient Background and Presentation
Demographics and Chief Complaints
A 67-year-old male patient presented to the clinic with the following complaints of 15 days’ duration:
- Chest pain
- Heaviness in the chest
- Burping (Vata anulomana / Udgara)
- Elevated cholesterol levels
History of Present Illness
The patient had no prior history of Diabetes Mellitus (DM) or Hypertension (HTN). Approximately one year before presentation, he had undergone PTCA following a diagnosis of Coronary Artery Disease (CAD). Despite being on continuous allopathic medication post-procedure, he developed recurrent coronary blockages within seven to eight months, accompanied by persistent chest pain and burping. Repeat lipid profiling revealed impairment in LDL levels. The patient sought Ayurvedic consultation to address the root cause of his condition.
Past History
Known case of Coronary Artery Disease (CAD); post-PTCA status.
Personal History
- Bowel habits: Regular
- Appetite: Good
- Micturition: 4–5 times per day
- Sleep: Sound
Clinical Assessment
General Examination
| Parameter | Finding |
|---|---|
| Weight | 56.1 kg |
| BMI | 18.7 |
| Pallor | Absent |
| Icterus | Absent |
| Cyanosis | Absent |
| Clubbing | Absent |
| Lymphedema | Absent |
| Oedema | Absent |
Vital Signs
| Parameter | Finding |
|---|---|
| Blood Pressure | 108/68 mmHg |
| Pulse Rate | 68 bpm |
| SpO2 | 98% |
| Abdominal Girth | 85 cm |
| CVS | Mild bradycardia |
| Respiratory System | No abnormality detected |
| CNS | No abnormality detected |
| Per Abdomen | Tenderness in epigastric region |
Ayurvedic Assessment
The symptom complex of chest pain (Hridruja), heaviness (Gaurava), burping (Udgara), epigastric tenderness, and impaired lipid metabolism indicated:
- Dosha involvement: Tridosha dushti (vitiation of Vata, Pitta, and Kapha), with Kapha-Ama predominance in the Hridaya srotas
- Dushya (tissue affected): Rasa and Rakta dhatu (plasma and blood tissues)
- Srotas involved: Hridaya srotas and Rasavaha srotas
- Agni status: Mandagni (diminished digestive fire) with Ama formation
The recurrence of blockages despite allopathic medication and the presence of epigastric tenderness and burping strongly suggested an Ama-dominant Samprapti (pathogenesis) requiring both Shodhana and Shamana interventions.
Pre-Treatment Investigations
6-Minute Walk Test (6MWT):
| Parameter | Value |
|---|---|
| Distance covered | 319 metres |
| VO2 Max | 13.58 mL/kg/min |
| MET value | 3.9 |
Lipid Profile:
| Parameter | Value |
|---|---|
| Total Cholesterol (TC) | 115 mg/dL |
| Triglycerides (TG) | 72 mg/dL |
| HDL | 42 mg/dL |
| LDL | 58.6 mg/dL |
| HsCRP | 0.41 mg/L |
| D-Dimer | 0.1 mg/L |
2D Echocardiography:
- Ejection Fraction (EF): 55%
- Aortic valve sclerosis noted
- Mid-distal anterior wall hypokinesia
- Trivial Mitral Regurgitation (MR) and Tricuspid Regurgitation (TR)
- No Pulmonary Arterial Hypertension (PAH)
- IVC collapse present
Treatment Protocol
Concurrent Allopathic Medication (at time of presentation)
| Medication | Dosage |
|---|---|
| Rosuvas 10 mg | 0-0-1 |
| Brilinta 90 mg | 1-0-1 |
| Ecosprin | 0-1-0 |
Ayurvedic Shamana (Palliative) Medications
| Formulation | Dose and Timing | Rationale |
|---|---|---|
| Kalamegha + Shallaki combination vati | 1-0-1 | Kapha-Pitta shamana, cardioprotective, lipid-modulating; Shallaki for lekhana (channel-scraping) action |
| Avipattikara Churna | 1-0-0 | Deepana-Pachana (digestive stimulant), Ama reduction, Anulomana |
| Chyavanprasha | 1-0-0 | Rasayana (rejuvenation), Ojas enhancement, antioxidant |
| Arjuna vati | 1-0-1 | Hridya (cardiac tonic), reduces myocardial oxidative stress |
| Arjuna + Punarnava + Vacha Kashaya | 20 ml twice daily after meals | Hridya, diuretic, reduces fluid retention, improves circulation |
| Amalaki + Haridra + Guduchi combination vati | As directed | Tridosha shamana, immunomodulatory, anti-inflammatory |
Kalamegha was additionally administered as a single-drug preparation for one month during the recovery phase to assess its individual cardioprotective contribution.
Panchakarma (Shodhana) Procedures
Panchakarma was administered once weekly for three months alongside the Shamana medications.
Snehana (Oleation): External application of Tila taila (sesame oil) combined with lavender essential oil, 100 ml, for 15 minutes. Tila taila, being Vata-shamaka, promotes tissue nourishment and facilitates mobilization of Ama from the channels.
Swedana (Sudation): Steam therapy using Dashamoola Kashaya (decoction of ten roots), 15 ml extract, for 15 minutes. Dashamoola Swedana promotes Sroto-shodhana (channel purification) and reduces Kapha-Ama accumulation.
Kashaya Basti (Medicated Enema): Rectal administration of 100 ml Kashaya prepared from Gokshura, Haridra, and Amalaki. Basti is considered the most effective Panchakarma procedure for Vata regulation and systemic detoxification, directly addressing the root imbalance in Apana Vata which governs lower bodily functions and indirectly supports Prana Vata and cardiac function.
Allopathic medications were progressively tapered based on the patient’s clinical improvement throughout the treatment period.
Outcomes and Follow-Up
Post-Treatment 6-Minute Walk Test
| Parameter | Pre-Treatment | Post-Treatment | Change |
|---|---|---|---|
| Distance covered | 319 m | 511 m | +192 m |
| VO2 Max | 13.58 mL/kg/min | 19.58 mL/kg/min | +6.0 |
| MET value | 3.9 | 5.6 | +1.7 |
The post-treatment 6MWT demonstrated a substantial improvement in cardiorespiratory exercise tolerance, reflecting meaningful functional recovery.
Post-Treatment 2D Echocardiography
Post-treatment echocardiographic evaluation revealed complete normalization of all cardiac chambers, improvement in Ejection Fraction, resolution of anterior wall hypokinesia, and normalization of D-Dimer levels. The patient was entirely asymptomatic at follow-up.
Allopathic Medication Status
All allopathic medications were successfully tapered and discontinued. The patient remains under follow-up on Ayurvedic maintenance therapy alone.
Discussion
This case presents a clinically significant instance of recurrent coronary blockages despite standard post-PTCA pharmacotherapy, managed successfully through an integrative Ayurvedic protocol. The recurrence of blockages within less than a year of intervention, accompanied by Ama-mediated symptoms including burping, epigastric tenderness, and dyslipidaemia, strongly indicates that the root pathology had not been addressed at the level of metabolic and doshic imbalance.
From an Ayurvedic standpoint, the pathogenesis of Hridroga involving Ama and Kapha excess correlates well with the modern understanding of atherosclerosis driven by oxidative stress, endothelial dysfunction, and chronic low-grade inflammation. The therapeutic strategy therefore appropriately combined Shodhana to eliminate accumulated Ama with Shamana to restore doshic equilibrium.
Kalamegha’s role in this protocol was multifaceted. Its Tikta rasa and Ushna virya make it a potent Kapha-Pitta shamaka, and its ability to enhance Agni addresses the root cause of Ama formation. Experimentally, andrographolide — the principal bioactive constituent of Andrographis paniculata — has been shown to inhibit NF-kB-mediated inflammatory pathways, reduce lipid peroxidation, and improve endothelial nitric oxide bioavailability, mechanisms directly relevant to atherosclerotic disease. The combination with Shallaki (Boswellia serrata), which offers potent lekhana (channel-scraping and lipid-clearing) and anti-inflammatory properties, produced a synergistic effect supporting arterial patency and cholesterol metabolism.
Arjuna (Terminalia arjuna), widely recognised as the premier Hridya (cardiac tonic) herb in Ayurveda, was included both as a vati and in decoction form combined with Punarnava (Boerhavia diffusa) and Vacha (Acorus calamus). Arjuna’s bark is rich in glycosides, flavonoids, and tannins that have demonstrated antioxidant, hypolipidaemic, and positive inotropic effects in published clinical studies. Punarnava, a Kapha-Vata shamaka with diuretic properties, supports cardiac unloading, while Vacha contributes to neurological support and Vata regulation. The Rasayana preparation Chyavanprasha provided systemic rejuvenation and antioxidant support throughout the recovery.
The Panchakarma protocol was designed to progressively mobilise and eliminate Ama through external oleation, sudation, and rectal Basti. Kashaya Basti using Gokshura, Haridra, and Amalaki is particularly relevant for cardiac management: Gokshura supports renal and cardiac function, Haridra (turmeric) provides curcumin-mediated anti-inflammatory action, and Amalaki offers powerful antioxidant support via its vitamin C and tannin content. Weekly administration over three months allowed for sustained, gradual detoxification without taxing the patient’s already compromised cardiac reserve, as evidenced by the initially low MET value of 3.9.
The improvement in the 6MWT distance from 319 metres to 511 metres represents a clinically meaningful gain, exceeding the established minimum clinically important difference of approximately 30 metres for cardiac patients. This parallels the echocardiographic improvement and supports the conclusion that the combined protocol produced genuine functional and structural cardiac recovery.
A limitation of this report is its single-case design, which precludes generalisation. Controlled trials evaluating Kalamegha-based Ayurvedic protocols in post-PTCA patients are warranted to establish reproducibility and safety parameters.
Conclusion
This case report demonstrates that an integrative Ayurvedic approach combining Kalamegha (Andrographis paniculata) with complementary herbal formulations and Panchakarma procedures can yield significant clinical improvement in a patient with recurrent coronary artery disease following PTCA. By addressing the root pathology of Tridosha imbalance and Ama accumulation — factors that contemporary pharmacotherapy does not directly target — this protocol achieved outcomes including complete symptomatic resolution, improved exercise tolerance, normalised echocardiographic parameters, and successful withdrawal of allopathic medications.
The convergence of Kalamegha’s classical pharmacological properties as a Kapha-Pitta shamaka and Deepana-Pachana herb with its modern evidence base as an anti-inflammatory, antioxidant, and lipid-modulating agent makes it a compelling candidate for integration into evidence-based cardiac management protocols. Further research through well-designed clinical trials is recommended to validate these findings at a larger scale.
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This article on recurrent coronary blockages and Kalamegha (Andrographis paniculata) has been carefully revised to present a well-balanced integration of classical Ayurvedic principles and contemporary cardiovascular research. Foundational references from the Charaka Samhita, Bhava Prakasha Nighantu, and Ashtanga Hridayam have been incorporated to preserve traditional authenticity and accurately represent Kalamegha's classical indications, as well as the Ayurvedic understanding of Hridroga in the context of Tridosha imbalance and Ama accumulation.
Recent research on Andrographis paniculata's phytochemical profile, particularly its principal bioactive compound andrographolide, along with its anti-inflammatory, antioxidant, and lipid-modulating findings, has been critically reviewed to validate its relevance in managing coronary artery disease and post-interventional recurrence.
These updates aim to offer readers a reliable, holistic, and evidence-informed resource — bridging classical Ayurvedic therapeutics with modern cardiology — to support a deeper understanding of Kalamegha's role in the integrative management of Hridroga alongside Panchakarma and supportive herbal formulations.
Disclaimer:
The information shared in this article about Kalamegha (Andrographis paniculata) and its role in the management of Hridroga (heart diseases) is based on classical Ayurvedic literature, a single clinical case report, and current scientific research. This content is intended solely for educational purposes and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified cardiologist, physician, or Ayurvedic practitioner before starting any herbal treatment, particularly if you have a diagnosed cardiovascular condition, have undergone cardiac interventions, or are currently taking prescribed medications such as anticoagulants, antiplatelets, or statins. Do not alter, taper, or discontinue any allopathic medication without the direct supervision of your treating physician. Individual responses to herbal and Panchakarma therapies may vary, and the use of Kalamegha or any associated formulation does not guarantee cure, prevention, or improvement of any specific cardiac condition. Personalised clinical assessment and guidance are essential for safe and effective integrative care.
Disclosure:
The author declares no conflict of interest. Patient information has been fully anonymised in accordance with ethical standards for clinical case reporting. This article does not constitute medical advice. All treatment decisions should be made in consultation with a qualified healthcare professional.
Copyright:
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I’m a BAMS student, and this article helped me understand how to apply Tridosha theory in modern cardiac cases. The mention of NF-kB inhibition by andrographolide makes the link between Ayurveda and evidence-based medicine so clear. Thank you!
Very encouraging. I run a small Ayurveda clinic in rural Maharashtra. Many patients with heart disease cannot afford repeated angioplasty. This protocol using Kalamegha + Shallaki + Arjuna is affordable and seems effective. Will try under strict supervision.
Excellent case report, Dr. Vijayalaxmi. The way you’ve correlated Ama accumulation with recurrent post-PTCA blockages is very insightful. Kalamegha’s role as a Deepana-Pachana herb is often underutilized in cardiology. The improvement in 6MWT from 319 to 511 metres is truly remarkable. Would love to see a larger study.