The human body is revered as a temple by the Vedas & other Indian literatures. Sanctity is to be maintained with utmost care & regular cleansing. A major part of the daily routine is excretion. This article talks about the role of proper expulsion of wastes in keeping the Hrudaya healthy.

“Sharirachintamnirvartya krutashouchavidhistataha…”1

After waking at Brahmi Muhurtha, one is directed to empty bowel & bladder, and clean oneself thoroughly.

Chinta (worries) broadly refers to anything that causes disturbance in the body& is usually used with reference to emotions  / Manas. In this context, Sharirachinta refers to the Mala (waste products) generated during various physiological processes occurring in the body. With continuous anabolism & catabolism, our body strives to get rid of wastes continuously at both macro & micro levels. It can be solid (Shakrut – stool, ear wax etc), liquid (Mutra – urine & Sweda – sweat) or gas (Adhovayu – flatus, respiratory by-products etc). Regular (daily) bowel movement is an indicator of proper digestion, segregation & absorption. A Swastha2 or optimally healthy individual is expected to have a naturally occurring urge to excrete soon after waking up & without any difficulty or straining.

Factors influencing excretion : Agni, Koshta, Vaya, Kala, Ahara, Vihara, Dosha, Dhatu etc.

  1. Agni, Pachaka pitta, Samanavata – proper digestion leads to proper segregation of nutrients & waste. For this to occur, the Agni & Pachaka pitta must actively disintegrate & digest the food particles. Samanavata plays a major role in separating the necessary nutrients & pushing wastes forward for expulsion.
  2. Koshta – is of 3 types : Krura, Madhyama & Mrudu. If by nature it is krura, the person is prone to constipation. If mrudu, the person is prone to increased frequency or loose stools.
  3. Vaya / Age – Vata naturally dominates in the elderly. They are prone to Vatavikruthi (imbalance in Vata) very easily & experience symptoms like constipation, reduced appetite etc.
  4. Food : you are what (& how) you eat. Items like bread, biscuit, idli; over eating, extreme fasting etc pose a burden on digestion & in turn hamper excretion.
  5. Activities & posture : Sedentary living, sleeping during the day especially after food, untimely & improper exercises, stress etc contribute to unwanted changes in digestion & expulsion. Another important point is that squatting posture. It is the ideal position for defecation / evacuation as it stimulates defecation mechanism by avoiding probable mechanical obstruction between rectum, anal canal and sphincters.

Hrudaya & Mala visarjana 3

Acharya Vagbhata lists the causes of Hrudroga & related symptoms as forcefully controlling the natural urges of Adhovata (flatus), Shakrut (stools), Mutra (urine), Udgara (belching), Trushna (thirst), Kasa (cough), Shramashwasa (exertion breathing), Bhashpa (tears) etc.
Note : These may not cause disease overnight or after fewer in frequent episodes.

  1. Adhovatarodha : Flatus is produced during digestion. If the digestion is complete, the gas is relatively odour less, less frequent & not troublesome. Ajirna or indigestion results in foul smelling, frequent, painful & troublesome passage of gas. With holding a by-product of digestion meant to be expelled, may lead to absorption of unwanted materials back into the circulation. This, along with Ajirna or indigestion can affect the Hrudaya.
  2. Shakrutrodha : Usually solid, this is produced after all possible nutrients are absorbed post digestion. It also includes several hormones, pigments & other wastes. Controlling stools will lead to re-absorption, hardening etc. Constipation can induce atherosclerosis, blood pressure rise, and cardiovascular events14. Straining causes blood pressure rise, which can trigger cardiovascular events such as congestive heart failure, arrhythmia, acute coronary disease, and aortic dissection.
  3. Mutrarodha : Urine is a liquid containing wastes filtered from the blood, by the kidneys. Withstanding the urge chronically can damage the kidneys, hampering blood purification & in turn, cardiac issues. Basti (bladder or urinary system in general) is a Marma (vital point) similar to the Hrudaya. If affected, it leads to immediate death or retrograde increase in pressure effects Hrudaya15.
  4. Kasarodha : Coughing depicts irritation in the respiratory system. If forceful expulsion of kasa is with held, it can lead to further increase in bouts of cough, other respiratory illnesses, digestive issues, Hrudroga etc. Chronic cough can weaken the lungs, paving way for further infections. Over time, the symptoms persist & Heart failure is often diagnosed16.
  5. Shwasarodha : after strenuous activities, the rate of breathing increases naturally. This is due to increased demand for oxygen by the tissues, especially muscles. If such panting is controlled forcefully, the tissues receive less oxygen than required & the circulatory system is disturbed. Further, heart has to pump more, leading to increased heart rate to meet the oxygen demand.
  6. Bashparodha : State of Manas is determined by emotions. Tears represent overwhelming grief or happiness. If such is controlled, one may have experienced a constricting feeling in throat, heaviness in the head & chest region. Stress (mental) induced Hrudroga may occur.

In first 3 points, Apanavata is the main force. Being the regulator of expulsion of Shukra (semen, ejaculation), Artava (menstruation), Shakrut, Mutra & Garbha (delivery), any change attributes to increased risk of developing ailments of heart, kidney, lungs, liver or any other organ as such!

Kasa, Shwasa & Bhashpa involve Prana & Udanavata principally. Pranavata travels from the head to thorax, controlling the respiration, deglutition (swallowing food) etc; while providing innate support to Hrudaya, Chitta (mind), Buddhi etc. Udanavata travels from nose to Nabhi (umbilicus), regulates speech, strength (innate immunity), Urja (energy) etc.
Manasikavega (psychological urges / overwhelming emotions) such as chinta (stress), bhaya (fear), trasa (anxiety / terrified) are directly mentioned as causative factors of Hrudroga. Chronic obstruction to natural movement of Vata acts as a foundation to Hrudroga4.

The Heart & Excretion : Western perspective
Excretion is a delicately balanced process. The cardiovascular system operates tirelessly in close relations with the respiratory, digestive & excretory systems. The wastes are broadly classified as Non-metabolic & Metabolic5. Non-metabolic wastes are either materials indigestible by human digestive system or materials already in the body & not required. Metabolic wastes may be divided into gases, liquids, solids, and heat. Heat, though usually not classified as a waste product, should be considered as it is a by-product of metabolic activity and must be eliminated to avoid harmful elevation of body temperatures.

Heart & respiratory system : The heart is located centrally in the thorax in between the lungs. The respiratory wastes principally include the gaseous carbon dioxide and ammonia. The required oxygen as well as wastes are regulated & transported by the circulatory system. Respiratory diseases can cause heart conditions and is called Corpulmonale6.

Heart & urinary system : Kidneys are the filtration units of the body which regulate the levels of water, salts, and organic materials. Wastes excreted include ammonia, urea, uric acid, creatinine, amino acids etc. These wastes are usually released into the blood & the circulatory system gets rid of them through filtration in the kidneys. Renal disorders often pose the risk of developing cardiovascular diseases7.

Heart & digestive system : The solid waste is usually a by-product of digestion of food, along with bile pigments, residual haemoglobin processed by the liver etc. It begins from the mouth & involves major organs like liver, gall bladder, pancreas, intestines. Several studies have shown connection between the Gut & the Coronary artery disease8. Heart failure & involvement of liver, intestines is seen to increase morbidity & mortality9.

Psychological factor & excretion : People have often experienced bouts of diarrhoea when scared & anxious. Depression can lead to slower peristalsis (movement of intestines) resulting in constipation10. Increased urination is usually seen in case of stress & anxiety11. Directly or indirectly, psychological factors influence excretion & in turn, cardiovascular system.

Excretion ensures internal cleansing. However, once excreted, it is as important to clean externally as internal purification. While discussing various personal laws of cleanliness, Manu Smruti mentions the use of water to wash after attending the nature’s call12. This reference is also seen in Ayurveda treaties. Ashtanga Sangraha specifically states that hands must be cleaned as well with water, ash & other disinfectants to get rid of Mala & odour. Another important aspect is the posture during excretion. Squatting helps in relieving urges without having to strain. It also strengthens the muscles in the lower abdomen.

Western thoughts : Use of toilet papers to wipe rather than washing with water is the norm in most of the developed countries. Along with threats of deforestation, increasing carbon footprints etc, these pose a risk of developing rectal / colon cancer, vaginal irritation etc13. This is because the “tissue” is chlorinated or bleached & even contains formaldehyde! The posture too is sitting on a commode which neither contributes in easing the abdominal muscle nor aids peristalsis. A very bad habit which is rampant is the use of phones in the toilet. This is not only unhygienic but also diverts the mind from the natural urge which is prohibited in Ayurveda.

Just like cleaning the home is mandatory in keeping it hygienic, so is excreting & cleansing every day. Hrudroga occurs due to improper expulsion & other symptoms that occur due to the latter. The heart is closely linked to all vital physiological processes especially respiratory, digestive & urinary systems. Therefore, it is imperative to maintain a balanced daily routine involving getting rid of wastes to avoid the risk of cardiovascular diseases.

For more information on Mala visarjana, constipation & Cancer read:
1. AshtangaHrudaya Sutrasthana chapter 2
2. Sushrutha Samhita Sutrasthana chapter 15
3. AshtangaHrudaya Sutrasthana chapter 4
4. Charaka Samhita Chikitsasthana chapter 26